The London Medical Gazette E-Book

Various

• Herausgeber: Science & Technology Publishing
• Kategorie: Wissenschaft und neue Technologien
• Sprache: Englisch

Seitenzahl: 103

Veröffentlichungsjahr: 2025

Beschreibung

The London Medical Gazette, December 27, 1828, stands as a significant historical publication, offering a comprehensive weekly journal dedicated to medicine and the collateral sciences during the early 19th century. This particular issue provides a fascinating window into the medical knowledge, practices, and debates of its time, capturing the dynamic evolution of healthcare and scientific inquiry in London and beyond. Within its pages, readers will find a rich array of articles, case studies, and reports that reflect the concerns and advancements of contemporary practitioners. The journal covers a broad spectrum of topics, including clinical observations, surgical techniques, pharmacological developments, and public health issues, as well as reviews of new medical literature and proceedings from leading medical societies. The December 27, 1828, edition features detailed accounts of medical cases, offering insights into diagnostic methods and therapeutic approaches that shaped the era. It also includes correspondence and essays from prominent physicians and surgeons, providing a platform for the exchange of ideas and the dissemination of new discoveries. The Gazette not only documents the progress of medical science but also addresses the ethical, social, and institutional challenges faced by the profession. Its content reflects the interplay between traditional practices and emerging scientific methods, highlighting the transition toward modern medicine. In addition to its clinical and scientific content, the journal offers commentary on medical education, hospital administration, and legislative matters affecting the health sector. It serves as a valuable resource for historians, medical professionals, and anyone interested in the development of medical science. The London Medical Gazette, December 27, 1828, is more than a periodical; it is a testament to the intellectual rigor and curiosity that propelled medicine forward during a pivotal period in history.

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TRANSCRIBER'S NOTE

The 'Apothecary System' of measurement was used in the original text. The etext uses the following Unicode symbols:℞  Prescription symbolʒ  Dram℥  OunceℳScruple Roman numerals, and 'ss.' for 'half', are retained, so for example '℥iss.' indicates 'one and a half ounces'.

The 'Apothecary System' of measurement was used in the original text. The etext uses the following glyphs taken from the text images:Prescription symbolDramOunceScruple Roman numerals, and 'ss.' for 'half', are retained, so for example 'iss.' indicates 'one and a half ounces'.

Obvious typographical errors and punctuation errors have been corrected after careful comparison with other occurrences within the text and consultation of external sources.

More detail can be found at the end of the book.

THELONDON MEDICAL GAZETTE,

BEING AWEEKLY JOURNALOFMedicine and the Collateral Sciences.

SATURDAY, DECEMBER 27, 1828.

PATHOLOGICAL ESSAYSON SOMEDISEASES OF THE HEART;

Being the Substance of Lectures delivered before the College of Physicians,

By P. Mere Latham, M.D.

Physician to St. Bartholomew's Hospital.

[Continued from p. 7.]

ESSAY II.

Morbid Anatomy of the Internal Lining Membrane of the Heart.

The membrane which lines the cavities of the heart is very liable to disease, but not equally so in every part. Where it is thin and transparent, and admits the colour and character of the muscular structure upon which it is spread to be seen through it, it is seldom found diseased; but where it is of a denser texture, either in itself or from an admixture of other structures, whether cellular or fibrous, with its own, it is frequently, and often exclusively diseased. This latter character of a denser texture belongs to it where it forms the tough white circles which surround the apertures of communication between the auricles and ventricles; also where it is reflected upon itself, and forms the loose duplicatures of membrane, which are given off, as it were, from the internal surface of the heart, either at the fibrous circles intermediate between the auricles and ventricles, constituting the tricuspid and the mitral valves, or at the commencement of the pulmonary artery and aorta, constituting the semilunar valves.

It is remarkable how curiously disease is apt to limit itself to the spaces just pointed out. Of the fibrous circle between the auricle and ventricle, of the valves which originate from it, and of the tendinous cords which connect the valves with the carneæ columnæ, there will not be the smallest space free from disease; but the disease will abruptly stop where the tendinous cords cease and the carneæ columnæ begin[1].

The membrane, however, where it covers the fleshy columns of the heart, is not exempt from the possibility of disease: but when disease actually affects it, it has seldom originated there, but has generally spread from other parts of the same membrane, although (as we have just remarked) it is apt to stop short before it reaches this.

Of the two sides of the heart, the membrane which lines the left is unquestionably the more liable to disease. But my own observation would never have led me to conclude that the membrane of the right side was so far exempt as it is commonly thought to be. Speaking from the best recollection I have of the specimens which have fallen under my examination, I should say that, in one-third of the cases where disease has been found on the left side, it has existed on the right side also, and been essentially of the same character. But there has been a remarkable difference in the extent to which it has proceeded on each side respectively: while on the left it has gone so far as to be the undoubted cause of death, on the right, although essentially of the same character, it has been only just beginning.

It very seldom happens that disease appertains to the lining of the right cavities of the heart exclusively; and, where it affects both, the disease in the right cavities is very seldom found in advance of that in the left.

It should seem, indeed, according to the ordinary course of things, that disease does not begin in the lining of the right cavities of the heart, until it has already advanced to an extreme degree in the left.

The internal lining of the heart, as well as of the arteries, is often found to have become of a red colour. This redness, so well known to all who are accustomed to examine dead bodies, used to be regarded as a mere stain imparted to it by the colouring matter of the blood after death. Yet a due consideration of various circumstances connected with it will hardly warrant this conclusion.

It has been found whether the heart or artery be full or empty of blood; and if blood be present it has been found, whether it is liquid or clotted; and if it be clotted, whether it does or does not retain its colouring matter. External temperature, and length of time between the death of the patient and the dissection of his body, have not made any difference in the frequency with which this peculiar appearance occurs. Lastly, no artificial methods, such as washing of any kind, can get rid of it; nor will inclosing blood within an artery for any period produce it[2]. This simple redness is sometimes seen universally in both sides of the heart and throughout the whole arterial system, and sometimes in patches only, of greater or less extent, whether in the arteries or in the heart.

Now, when all these circumstances are considered, although in some instances it may be a mere stain imparted by the colouring matter of the blood after death, it is plainly impossible that it should be of that nature in any large proportion of the numerous instances in which it is found.

But if the appearance in question implies (as I believe it generally does) a morbid condition, of what kind is that condition? There are the same objections to considering mere redness as equivalent to inflammation here as in the pericardium, or in any other part of the body: here, as elsewhere, in one case it may be the condition out of which inflammation is to spring; while in another it may not be destined to give origin to any change in the structure of the part beyond itself, and may itself constitute the whole disease.

It appears to me, that this mere redness of the internal lining of the heart and arteries has become a matter of undue perplexity to pathologists, because they have laboured to infer from it more than the simple fact itself will authorize. All I wish to establish concerning it is, first, that it is not always (probably very seldom) a mere stain imparted by the colouring matter of the blood after death; secondly, that it alone does not constitute inflammation.

It may not be improper to mention the circumstances under which it has occurred to myself to find it. I have met with it most frequently, and to the largest extent, in subjects whose previous disease has produced a constant and habitual impediment to the transmission of blood through the heart and through the lungs, and that impediment has gone on increasing to the hour of their death; also in those, whatever might have been the nature of their disease, whose dissolution (I mean the actual process of dying) has been tardy and agonizing, and marked by great labour of respiration; in the apoplectic, for example, in whom, after sense and consciousness were extinct, life had been protracted, with stertorous breathing, for many days.

In such subjects the countenance, the lips, and the whole skin, give evidence during life of blood pushed beyond the natural sphere of the circulation, and detained in the extreme blood-vessels. Hence it is obvious that the causes which have loaded and distended the capillaries in every part of the body have had a like influence upon the vasa vasorum.

I do not mean to say that I never met with this peculiar condition of the heart and arteries under other circumstances, or that other causes may not produce it; but that I am not acquainted with it under any other with which, from frequent coincidence, it has seemed to have a natural connexion, or which have afforded a reasonable explanation of the phenomenon.

This condition of the heart and arteries, considered as inflammation, has been assigned by some as the cause of fevers of the more malignant kind. The frequency with which it has been found in some particular epidemic, must have led to the conclusion. But, however this may be, from my own observation, not restricting myself to the fever of any particular season, but taking into account all complaints called febrile, and belonging to all seasons, also from the result of inquiry among medical men who have had large acquaintance with morbid dissections, and from the experience of those who have made this particular point a subject of investigation (Laënnec and Andral) I venture to conclude that it has no essential connexion with fevers of any kind, either as cause or as effect.

On some occasions the internal membrane of the heart and arteries, wherever it exhibits the appearance described, will allow itself to be peeled off from the subjacent structure with the least possible force; this facility of separation ceasing entirely beyond the boundary of the red tinge.

Here unquestionably is further evidence of a diseased condition: but of what nature? Most pathologists would consider this to be of the nature of inflammation—and I believe justly.

There is indeed much difficulty in pronouncing upon the nature of minuter changes of structure detected in the internal parts of the body after death. We are obliged to arrive at conclusions by help of analogies drawn from morbid processes, which we have watched in their progress during life, upon the external surfaces; for during life we have the functions and sensibilities of the part to aid us in forming a right judgment concerning its disease. When, during life, one tissue is separated from another, as the periosteum from the bone, or the cuticle from the skin, or the mutual cohesion between different tissues is sensibly weakened, we find it to be owing to the intervention of serous fluid which does not belong to their healthy state; and this, together with increased vascularity, or redness and heat, and pain, is enough to bespeak the presence of inflammation. All these conditions cannot remain after death. Hence, if we desire to form positive opinions concerning much which is unfolded by dissection, we must supply the defect by analogy. Thus, whenever, in any part of the heart or arteries, the cohesion between the internal membrane and the subjacent structure is manifestly lessened, and the membrane is unusually red at that part, we may regard these appearances as the vestiges of inflammation, without thinking that we go too far in so regarding them.

The internal lining of the heart and arteries is often found red solely in the neighbourhood of ulcerated spaces, when there can be no doubt concerning the existence of inflammatory action.

But the internal lining of the heart and arteries gives the most unequivocal evidence of its inflammation when it is found of a deep red colour, with coagulable lymph adhering to its surface. This condition is represented, as it was found in the aorta, in one of the beautiful plates, illustrative of the diseases of arteries, by Mr. Hodgson[3]. And the same condition, in the heart, I have seen in a preparation of Dr. Farre's, where lymph is deposited, upon the circular zone, which forms the aperture of communication between the left auricle and ventricle. These appearances denote the most acute inflammation: they are, I suspect, very rarely met with. In the few instances in which I have heard of them, they have been found where death has taken place after short and severe suffering, and with symptoms which characterize inflammation.

But the specimens of disease most frequently met with in the internal lining of the heart, consist in an entire change of its natural structure, and in the formation of new products upon it or within it. Many of these, from the analogy of morbid actions in other parts of the body, must be considered to result from chronic inflammation.

In any of those situations which have been stated as especially liable to disease, the membrane will become thick, tough, inelastic, puckered and shrivelled; and cartilage or gristle, and bone, will enter into its structure; excrescences will sprout out from it, resembling warts and fungus; and it will become ruptured and ulcerated.

Cartilaginous depositions are often found beneath the membrane where it is single; or between its folds where it is double, in the situation of the valves; and thus they seem rather to belong to some structure contiguous to the membrane than to the membrane itself. Such depositions will proceed to a considerable extent, while the membrane still remains free from disease. From a valve, which has been thick, opaque, and cartilaginous, I have seen the membrane separated on both sides, and transparent; the opaque and cartilaginous matter being left behind. Where, in cartilaginous depositions, the lining of the heart has become puckered and uneven on its surface, and the valves shortened and altered in their shape, the membrane itself participates in the disease, and is generally incapable of being separated from the subjacent structure. But great thickening may take place in the situation of the valves, from deposition of cartilage, without any unevenness of their surface or alteration of their shape; and under these circumstances the membrane itself you may expect to find hitherto exempt from disease[4].