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THE 

SEATS  and  CAUSES 

v  <•;•  t 

O  F 

DISEASES 

INVESTIGATED  BY  ANATOMY; 

IN  FIVE  BOOKS, 


CONTAINING 

A  Great  Variety  of  DISSECTIONS,  with  Remarks. 

\ 

TO  WHICH  ARE  ADDED 

Very  Accurate  and  Copious  INDEXES  of  the 
Principal  Things  and  Names  therein  contained. 


Translated  from  the  Latin  of 


„,-A 


JOHN  BAPTIST  MORGAGNI, 

Chief  ProfefTor  of  Anatomy,  and  Prefidentof  the  Univerfity  at  Padua, 


By  BENJAMIN  ALEXANDER,  M.  D. 

IN  THREE  VOLUMES. 

-• 


VOL.  I. 


LONDON, 

Printed  for  A.  Millar;  and  T.  Cadell,  his  Succeflor,  in  the  Strand; 
and  Johnson  and  Payne,  in  Pater-nofter  Row. 

MDCCLXIX. 


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Dr.  F  O  T  H  E  R  G  I  L  L. 

■  ..%  -  y  W 

SIR, 

r  I  AHE  great  excellence,  and  ufefulnefs,  of  the  work, 
which  I  have  attempted  to  tranflate,  claims  a  patron¬ 
age  from  the  moll  eminent  phyficians.  And  could  I  flatter 
myfelf  that  the  tranflation  bears  any  tolerable  proportion 
to  the  merit  of  its  original,  perhaps  the  patronage  of  this  pro¬ 
duction  might  not  feem  altogether  unworthy  of  the  moft 
reipeCtable  characters. 

In  the  prefent  cafe,  however,  I  cannot  but  acknowledge  ; 
the  humanity  and  condefcenfion  of  Dr.  Fothergill,  in  per¬ 
mitting  his  name  to  ftand  prefix’d  to  this  performance. 
The  countenance  of  a  phyfician  fo  defervedly  at  the  head 
of  his  profeflion  —  fo  univerfally  efteem’d  through  thefe 
kingdoms  and  their  dependant  colonies  —  mud  not  only 
do  honour  to  the  tranflator,  but  generally  extend  the  uti¬ 
lity  of  the  work. 

You  will  fee,  Sir,  that,  in  this  undertaking  I  have  aimed 
at  nothing  but,  the  praife  of  a. faithful  tranflation.  And 
my  great  ambition  will  be  to  have  been  ufeful  to  the  pub¬ 
lic  without  being  a  difcredit  to  my  patron. 

There  are  but  very  few  perfons  who  have  abilities  for 
original  writings,  and  very  few  indeed  who  have  refolution  > 

fufficient . 


DEDICATION. 

fufficient  to  cultivate  thofe  abilities  by  long  courfes  of  la¬ 
bour  and  application.  Both  thefe  happy  requilites,  how¬ 
ever,  we  fee  united  in  Dr.  Fothergill.  And  from  the  proofs 
he  has  already  given  of  his  talents  for  medical  compofition, 
we  cannot  help  wifhing  to  fee  his  refearches  carried  on  to  a 
greater  extent.  That  almoft  immenfe  experience  in  dif- 
eafes,  that  ingenious  turn  for  obfervation  and  inquiry,  joined 
to  a  great  capacity,  and  clearnefs  of  conception,  could  not 
fail  to  be  of  importance  to  phylicians,  and  of  advantage  to 
the  public. 

Yet  while  you,  Sir,  are  thus  continually  harafs’d  by  the 
folicitations  of  that  public  —  while  you  are  thus  unremit¬ 
tingly,  and  unavoidably,  employ’d  in  alleviating  their  dif- 
trefles  —  how  can  we  hope  to  have  the  full  advantage  of 
your  admonitions  ?  Neverthelefs  I  hope  the  time  will 
come,  when  the  public  will  be  favour’d  with  more  of 
them  —  That  for  this  purpofe,  or  as  well  as  the  many  other 
purpofes  of  fo  valuable  a  life,  you  may  be  long  favoured 
with  health,  and  every  plealing  capacity  of  ufefulnefs,  is 
the  fincere  delire  of 


Your  greatly  obliged  friend, 

April  ^tb,  1768* 

and  very  refpedtful  humble  fervant, 


BENJ.  ALEXANDER. 


f 


CONTE  NTS 

O  F  T  H  E 

FIRST  VOLUME. 

BOOK  I.  Of  Disorders  of  the  Head* 

Letter 

L  Q  F  Pain  in  the  Head . 

II.  Of  the  Apoplexy  in  general,  and  particularly  of  the  fanguineous  Apoplexy „ 

III.  Of  the  fame  fanguineous  Apoplexy. 

•  S  .  i 

IV.  Of  the  ferous  Apoplexy. 

V.  Of  the  Apoplexy  which  is  neither  fanguineous  nor  ferous. 

VI.  Of  the  remaining  foporific  Ajfefiions . 

Vi  I.  Of  the  Phrenitis,  Paraphrenitis,  and  Delirium, 

VIII.  Of  Madnefs,  Melancholy,  and  Hydrophobia. 

IX.  Of  Epilepfy. 

X.  Of  Ccnvulfwns  and  ccnvulfive  Motions, 

XI.  Of  Paralyfis . 

XII.  Of  the  Hydrocephalus,  and  Hydrorachitis. 

XIII.  Of  the  Catarrh-,  and  of  Affe Elions  of  the  Eyes. 

XIV.  Of  Affections  of  the  Ears,  and  Nofrrils  and  of  Stammering » 

Vo l.  I.  a 


BOOK 


CONTENTS. 


BOOK  II.  Of  Disorders  of  the  Thorax. 

Letter 

XV.  Of  Refpir  a  tion  being  injur'd ,  particularly  from  Caufes  that  lie  on  the  Out- 
fide  of  the  Thorax ;  and  alfo  from  fuch  as  lie  within  the  Lungs  ;  and 
efpecially  from  Calculi. 

XVI.  Of  Refpir  a  tion  being  injur'd  from  a  Drop fy  of  the  Thorax,  or  Pericar¬ 
dium. 

XVII.  Of  Refpir  at  ion  being  injur'd  from  Aneurifms  of  the  Heart ,  or  Aorta , 
within  the  Thorax. 

XVIII.  Of  the  fame.  • 

XIX.  Of  Suffocation and  of  Cough. 

XX.  Of  Pain  in  the  Breajt,  Sides,  and  Back. 

XXI.  Of  the  fame. 

XXII.  Of  the  Spitting  of  Blood ;  and  of  purulent  Spittings,  the  Empyema  and 
,  Pkthifs. 

XXIII.  Of  Palpitation ,  and  Pain  of  the  Heart . 

XXIV.  Of  Preternatural  Pulfes. 

XXV.  Of  Lypothymia ;  and  Syncope. 

XXVI.  Of  fudden  Death,  particularly  from  a  Dif order  of  the  Blood-veJJels  in  the 
Thorax. 

XXVII.  Of  the  fame  from  a  Diforder  of  the  Heart. 


THE 


TRANSLATOR’S 


iHE  buiinefs  of  a  Translator  is  to  convey,  with  faith» 
fulnefs,  the  ideas  of  his  author.  The  greater  precision 
and  clearnefs  he  Shall  give  to  thefe  ideas,  the  more  will 
his  merit  in  translation  encreafe.  And  if  to  thefe  qualities  of  faith- 
fulnefs,  precifion,  and  clearnefs,  he  could  add  eafe  and  elegance  of 
di&ion,  the  work  would  certainly  attain  to  the  higheSt  degree  of 
perfection  of  which  its  nature  is  capable.  For  it  is  not  with 
translation,  as  it  is  with  original  writings,  and  works  of  genius, 
where  the  invention  and  fancy  have  a  principal  Share  and  merit  in 
the  production. 


There  are,  however,  fome  works  of  fcience,  and  abftrufe  lite¬ 
rature,  wherein  a  great  freedom  of  Style,  and  an  elegance  of  lan¬ 
guage,  can  neither  be  requir’d,  nor  admitted.  To  attempt  the 
one,  or  the  other,  would  be  to  interrupt  the  bufinefs  of  technical 
narration,  and  to  render  thofe  ideas  which  ought  always  to  be 
precile,  and  well-defin’d,  loofe,  diffipated*  and  obfcure, 

i  '  .  •*  » 

Whoever,  therefore,  may  attempt,  in  works  of  a  fcientific  or 
abStrufe  nature,  to  heighten  the  merit  of  his  productions  by  the 
addition  of  claSftcal  ornaments,  in  whatever  language  he  may  write,, 
Vol.  I.  b  will 


r 


•£ 


THE  TRANSLATOR’S  .PREFACE, 

r 

will  be  fo  far  from  improving,  though  he  may  fomewhat  amufe, 
his  reader,  that  even  the  attentive  mind  mud;,  of  courfe,  be  left 
vacant  and  uninform’d.  And  it  is  always  fhrewdly  to  be  argued, 
that  fuch  writers  are  incapable  of  communicating  precife  ideas,  or, 
at  lead:,  that  they  chufe  to  affed  the  praife  of  elegant  fcholarfhip, 
and  polite  learning,  in  preference  to  that  of  more  ufeful  fcience, 
jjind  more  fevere  erudition. 

This  affedation,  however,  has  feldom  been  imputed  to  phy- 
licians.  And,  indeed,  it  is  feldom  that  the  nature  of  medical 
fcience  will  allow  of  the  attempt.  For  if  we  except  mathematical 
learning,  and  abftrufe  philofophy,  there  is,  perhaps,  no  fcience  in 
nature  wherein  a  precife,  definite,  and  technical  language  is  more 
dtridly  and  abfolutely  requir’d.  It  is  not  at  all  furprizing,  there¬ 
fore,  that,  by  readers  of  the  more  exalted  and  elegant  clafs,  me¬ 
dical  writings  have  been  look’d  upon,  in  general,  as  clumfy  and 
unpleafing  compofitions. 

Yet  this,  we  fee,  is  not  to  be  confider’d  as  a  reproach  to  phy- 
dcians,  but  as  arifing  from  the  neceffity  of  the  fubjeds  on  which 
they  are  employ’d.  For  men  who  have  devoted  themfelves  to  the 
ftudy  of  phydc  have,  for  the  mod:  part,  neither  been  wanting  in 
capacity,  nor  in  learning.  Nor  have  they  fail’d  to  acquit  them¬ 
felves  with  manlinefs  and  elegance,  whenever  they  have  had  oc- 
cafion  to  exert  their  abilities  in  the  more  pleafiftg  departments  of 

erudition  and  philology. 

*■  _  \ 

It  is  very  certain,  that  many  of  the  more  improving  fciences 
become  the  naturaf  produds,  if  I  may  be  allow’d  to  fpeak  thus, 
of  that  province  which  it  is  their  bufinefs  to  cultivate.  And  an 
enlarg’d  proportion  of  knowledge  in  the  languages,  and  in  other 
parts  of  claflical  attainment,  are  indifpenfable  to  the  theoretical, 
if  not  to  the  practical,  phyfician.  Yet  what  medical  writer,  that 
has  utility  and  inftrudion  in  view,  would  wifh  to  quit  the  path  of 
iimple  and  technical  narration,  in  order  to  coiled:  together  the 
flowers  of  elegance,  and  the  refinements  of  language  ?  To  what 
purpofe  would  be  the  pomp  of  rhetorical  fiourifh  !  the  diffufe  and 
figurative  didion  !  the  pathos  or  the  energy  of  ftyle  !  To  what  pur- 

pofe 


xi 


THE  TRANSLATOR’S  PREFACE. 

pofe  all  the  labour’d,  yet  nicely-conceal’d,  arts  of  declamation,  but 
to  throw  a  dazzling  luftre  upon  his  ideas,  and  render  his  thoughts 
indiftindfc  and  confus’d  ?  And,  in  a  word,  what  would  it  be  lefs 
than  an  infult  on  human  nature,  to  degrade  the  fcience,  whofe  na¬ 
tural  objects  are  the  prefervation  of  life  and  of  health,  into  the 
mere  romance  and  amufement  of  an  hour  ? 

This  difquifition,  however,  I  did  not  enter  into  with  a  view  of  \ 
accufing  others,  but  of  exculpating  myfelf.  For  whoever  fhall  read 
the  work  before  us,  in  its  prefent  Englifh  drefs,  will  find  that  the 
tranflator  has  no-where  ftudied  a  diffufenefs,  a  pomp,  or  an  ele¬ 
gance  of  language ;  but  that  clearnefs  and  precifion  of  ideas  were 
the  foie  objects  of  his  attention. 

Inftrudtion,  not  amufement,  was  his  aim.  And  indeed,  that 
this  only  ought  to  be,  and  could  be,  the  objedt  of  his  views,  muff 
be  evident  to  every-one  who  reads  the  original  with  accuracy  and 
penetration.  For  the  excellent  author  himfelf,  though  perfe&ly 
ikill’d  in  polite  literature,  as  is  well-known  to  the  learned  world, 
has  been  under  a  neceflity,  from  the  nature  of  his  fubjedl,  of  con¬ 
fining  himfelf  to  technical  ideas.  And  fuch  are  the  enquiries  upon 
which  his  difcourfes  turn,  as,  for  the  mod  part,  to  exclude  alii 
attempts  after  claflical  elegance,  or  embellifhments  of  language. 

And  from  hence  it  may,  perhaps,  principally  arife,  that  his  dyle 
has,  to  many,  feem’d  intricate  and  perplex’d  $  bccaufe  the  work 
being  loaded,  in  every  part,  with  fcience,  and  his  intention  being 
always  to  dwell  as  little  as  poffible  upon  prolix  narration,  he  has 
necedarily  fallen  into  the  mode  of  frequent  parenthefis,  whereby 
his  periods  are  drawn  out  to  a  confiderable  extent.  For  though  it 
might  feem,  that  this  inconvenience  could  have  been  obviated,  by. 
annotations  in  the  margin,  yet  thefe  our  author  confider’d  as  dill 
more  inconvenient  to  the  reader,  by  withdrawing  his  attention  from 
the  thread  of  the  narration,  and  breaking,  as  it  were,  the  very 
energy  of  the  difcourfe. 

I  cannot,  indeed,  but  be  fo  far  of  his  opinion,  as  to  think,  that, 
in  the  prefent  work,  any  method  befide  that  which  he  has  chofen,. 

b  2  would: 


xli  THE  TRANSLATOR’S  PREFACE. 

would  have  been  liable  to  more  important  objections.  For  fuch  is 
the  nature  of  the  fubjeCts  whereon  he  treats,  as  to  make  it  necelfary, 
even  for  the  learned  reader,  to  employ  every  intellectual  power,  and 
maintain  every  faculty  of  the  mind  in  full,  confiant,  and  vigorous 
exertion,  in  order  to  comprife  the  whole  compafs  and  competition  of 
ideas.  ’  '  >  ■ 

If  inch,  then,  be  the  nature  of  the  work,  and  there  be  fo  great 
a  difficulty  in  the  comprehenfion  of  its  views,  it  is  not  furprizing 
that  the  difficulty  of  tranflation  has  been  fo  much  infilled  upon. 
For  where  it  is  not  eafy  to  conceive  of  an  idea,  it  mull  of  courfe 
not  be  eafy  to  reprefent  and  convey  it  properly  to  others. 

\ 

Indeed,  this  difficulty  of  tranflation  has  been  univerfally  acknow¬ 
ledg’d  by  all  perfons  well-acquainted  with  the  nature  of  the  work 
in  queflion.  And  fo  far  has  the  conviction  been  carried,  by  a  gen¬ 
tleman  eminent  for  his  learning  and  abilities,  as  fro  make  him  alfert 
that  it  could  not  be  tranllated  by  any-one  whatever  :  which  aflertion 
I  do  not  here  take  upon  me  to  difprove,  as  it  might,  in  this  cafe, 
be  very  Ihrewdly  replied,  that  the  work  is  as  yet  untranllated. 

However,  I  lhall  elteem  myfelf  happy,  if  this  tranflation,  when 
in  the  hands  of  the  learned,  fhall  be  found  erroneous  in  fuch  points 
only  as  do  not  materially  affeCl  the  fentiments  of  its  author.  A 
merit  beyond  this  I  neither  plead  nor  attempt.  And  this  I  am  in 
fome  meafure  embolden’d  to  hope,  by  the  candid  approbation  which 
the  work  has  met  with  from  gentlemen  whofe  names  are  arnongll 
the  moll  eminent  in  phyfic.  An  approbation  of  fo  much  impor¬ 
tance,  as  already  to  have  remov’d,  in  fome  degree,  the  fears  and 
tremors  of  one  who  is  about  to  be  an  adventurer  in  the  lottery  of 
publick  reputation.  Nor  will  the  weight  of  fuch  opinions  be 
doubted,  if,  befides  others  whom  I  might  mention,  the  refpeClable 
characters  of  thole  gentlemen  be  confider’d,  who  have  done  me  the 
honour  of  permitting  their  names  to  Rand  at  the  head  of  thefe 
volumes. 

And  here  let  me  acknowledge  my  obligations  to  my  friend  and 
neighbour  Dr.  Way  man.  This  gentleman’s  condefcenfion  in  reading 

the 


THE  TRANSLATOR’S  PREFACE.  xiii 


the  written  tranflation  to  me,  during  my  correction  of  the  proof- 
fheet,  has  greatly  expedited  the  work.  Nor  has  the  afiiftance  re¬ 
ceiv’d  from  him  been  that  of  an  Anagnoftes  merely.  His  knowledge 
of  the  fubjeCt  in  queftion,  and  of  the  language  from  whence  the 
tranflation  had  been  made,  render’d  him  very  proper  to  recur  to 
on  any  occafion  of  doubt.  This  afliftance  in  correction,  therefore, 
when  time  would  allow  it,  might  be  conflder’d  as  a  farther  revifal 
of  the  work.  And  to  the  Doctor’s  candid  obfervations  this  per¬ 
formance,  in  many  parts,  Hands  indebted. 

After  all,  the  merits  of  this  tranflation,  fuch  as  they  are,  muft 
be  fubmitted  to  the  deciflon  of  the  publie.  And  I  would  with  to 
engage  the  candour  of  my  reader,  by  reminding  him  that  it  was 
ufefulnefs  alone  which  I  had  regard  to  in  the  execution  of  the  work. 
And  I  would  have  him,  at  the  fame  time,  be  inform’d,  that 
when  I  firfl  was  defir’d  to  engage  in  it,  I  did  it  with  a  view  of 
inftru&ing  myfelf,  as  well  as  others.  Nor  was  I  difpleas’d  with  an 
opportunity  of  filling  up,  to  the  greatefl:  advantage,  that  leifure 
which  I  had  then  no  profped:  of  feeing  fo  fpeedily  broken  in  upon, 
by  the  addition  of  public  and  private  avocations. 


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A  U  T  H  O  R's 


P  R  E  FACE. 


^■"'gs  ^HERE  are  two  fayings  of  C.  Lucilius,  as  you  have  it 
in  Cicero  (*z) ;  I  mean,  “  That  he  neither  wifh’d  to  have 
“  his  writings  fall  into  the  hands  of  the  moft  unlearned, 
“  nor  of  the  moft  learned  readers j”  which  I  fhould  equally 
make  ufe  of  on  the  prefent  occafion,  if  it  were  not  my  defire  to  be 
ufeful  to  the  unlearned,  as  well  as  to  be  afiifted  by  the  learned, 
reader.  For  I  have  had  two  views  in  publifhing  thefe  writings ;  the 
firft,  that  I  might  aflift  the  ftudies  of  fuch  as  are  intended  for  the 
practice  of  medicine  ;  the  fecond,  and  this  the  principal  view,  that 
1  might  be  univerfally  ufeful,  though  this  cannot  happen  without 
the  concurrence  and  affiftance  of  the  learned  in  every  quarter.  In 
what  manner  I  have  endeavour’d  to  execute  thefe  intentions  will  ap¬ 
pear  from  this  preface. 

2.  Theophilus  Bonetus  was  a  man  who  deferv’d  the  efteem  of  the 
faculty  of  medicine  in  particular,  and  of  mankind  in  general,  in  an 
equal  degree  with  any  other,  on  account  of  his  publifhing  thofe 
books  which  are  entitled  the  Sepulchretum.  For  by  collecting,  in  as 
great  a  number  as  pofiible,  and  digefting  into  order,  the  directions 
of  bodies,  which  had  been  carried  off*  by  difeafes,  he  form’d  them 
into  one  compact  body  ;  and  thereby  caus’d  thofe  obfervations,  which, 
when  fcatter’d  up  and  down  through  the  writings  of  almoft  innu¬ 
merable  authors,  were  but  of  little  advantage,  to  become  extremely 
ufeful,  when  collected  together  and  methodically  difpos’d. 

( a )  L.  2.  Orat. 

& 


As 


V  XVI 


THE  AUTHOR’S  PREFACE. 


As  the  publication  of  this  work  gave  pleafure  to  every-one,  which 
it  was  natural  to  exped,  the  fame  was  re-publifh’d  in  the  year  1700, 
under  the  infpedion  and  revifal  of  Jo.  Jacobus  Mangetus,  but  at 
the  fame  time  with  additions  which  made  up  a  third  part  of  the 
work.  Of  this,  therefore,  as  of  a  fuller  edition,  I  would  always 
be  underhood  to  fpeak. 

3.  And  fir  ft,  if  there  are  any  perfons  who  think  that  the  intention, 
and  labour,  of  both  thefe  editors  are  greatly  to  be  commended, 
I  readily  concur  in  opinion  with  them,  and  fhall  always  concur. 
Rut  when  I  read  in  the  writings  of  authors,  in  other  refpeds  very 
excellent,  that  the  Sepulchretum  is  a  work  compil’d  <c  with  incom- 
“  parable  diligence,  by  colleding  the  choiceft  obfervations  from 
“  every  author,  and  reducing  them  under  proper  heads,”  and  other 
affertions  of  a  fimilar  nature,  I  wifh  it  were  in  my  power  to 
alien  t  to  thefe  like  wife. 

Why  I  think  it  is  not  in  my  power  to  agree,  I  will  prefently  de¬ 
clare  :  yet  I  (hall  always  be  mindful  of  what  I  juft  now  readily 
granted j  and,  befides  this,  fhall  confider,  that  two  men  alone, 
though  never  fo  induftrious,  could  not  poffibly  be  equal  to  an  under¬ 
taking  which  was  not  only  new  in  itfelf,  but  almoft  inconceivably 
vaft  and  laborious  :  for,  as  you  have  it  in  the  fourth  book  of  the 
Iliad,  if  I  rightly  remember,  “  The  gods  have  not  put  every  thing 
“  in  the  power  of  men  5”  and,  in  the  twelfth  book,  “  The  work 
“  of  many  is  moft  perfed.” 

4.  All  thefe  things,  then,  I  readily  advance  and  acknowledge  : 
yet  if  a  work  fo  ufeful  is  to  be  render’d  more  ufeful  for  the  future, 
it  ought  not  to  be  conceal’d,  that  there  are  obfervations  ftill  re¬ 
maining,  not  only  in  ancient,  but  even  in  modern  authors,  whofe 
works  were  extant  before  the  fecond  edition  of  the  Sepulchretum, 
which  ought  by  no  means  to  have  been  omitted  :  thefe  obfervations 
are  far  from  being  few,  and  do  not  merely  belong  to  writers  whofe 
names  are  never  mention’d  in  that  work,  but  even  to  fuch  as  are 
mention’d  therein. 

On  the  other  hand,  it  may  be  obferv’d,  that  fuch  obfervations  as, 
through  negligence,  are  repeated  in  one  and  the  fame  fedion,  and 
fometimes  even  in  one  and  the  fame  page,  after  having  been  given 
before,  ought  to  have  been  omitted  in  the  fecond  place  ;  and  not 
only  thefe,  but  fuch  as,  being  fo  metamorphos’d  by  a  certain  crafty 
writer,  that,  if  you  confider  the  names  of  the  patients,  their  con¬ 
ditions,  and  places  of  abode,  appear  to  be  entirely  new ;  yet,  if 
you  confider  the  things  themfelves,  and  the  dodrines  refulting  there¬ 
from,  you  immediately  perceive  to  be  the  fame  as  we  read  above 
fiom  their  true  authors. 


To 


THE  AUTHOR’S  PREFACE,  xvii 

To  thefe  add  the  obfervations  wherein  you  have  natural  appearances 
propos’d  as  morbid  ones,  or  thofe  things  which  relate  to  fome  pe¬ 
culiar  fpecies  of  injury,  as  appearances  of  a  far  different  nature,  when 
an  aneurifm,  for  inftance,  is  reprefented  as  an  abfcefs :  for  fuch  ob¬ 
fervations,  certainly,  ought  not  to  have  been  admitted,  or  at  leaf; 
not  without  fome  ftridtures,  and  reafons  for  doubting  being  fubjoin’d ; 
fmce  any  one  who  is  but  (lightly  practis’d  in  the  diffedtion  of  found 
and  morbid  bodies,  would  at  once  difcover  their  fallacy. 

I  omit  fuch  as  are  not  difpos’d  under  the  heads  whereto  they  pro¬ 
perly  belong,  fuch  as  are  falfly  copied  from  their  authors,  fuch  as 
are  taken  from  you  know  not  what  author,  or  fuch  as  you  would 
fuppofe  to  be  from  authors  in  whofe  writings  they  do  not  exift  :  and 
led  I  (hould  be  too  prolix,  I  willingly  omit,  befides  thefe,  whatever 
you  might  rather  chufe  to  afcribe  to  the  careleffnefs,  or  ignorance, 
of  the  printers ;  notwithftanding  thefe  overfights,  if  not  corredted, 
may  lead  readers  into  the  mod  grievous  miftakes,  and  therefore  di¬ 
minish  the  ufefulnefs  of  the  work.  And  this  ufefulnefs  is  greatly 
diminiftfd  by  two  other  circumftances,  of  which  I  (hall  immediately 
fpeak  y  but  in  the  mean  while  I  will  take  upon  me  to  affirm,  that 
whoever  (hall  perufe  thefe  books  of  mine,  will  be  fully  fatisfied,  that 
none  of  the  affertions  which  I  have  now  made,  were  haftily  or 
rafhly  advanc’d. 

5.  As  there  are  very  few  difeafes,  efpecially  if  of  any  long  con¬ 
tinuance,  to  which  fome  other  diforder  is  not  join’d,  or  to  which 
many  different  fymptoms  are  not  added  j  for  this  reafon  every  obfer- 
vation  of  fuch  a  difeafe,  after  having  been  given  at  large  under  the 
head  whereto  it  particularly  belongs,  ought,  without  doubt,  to  be 
made  mention  of  under  other  heads  to  which  it  likewife  relates  in 
fome  meafure  :  this,  however,  (hould  be  done  in  a  few  words  only, 
fo  as  juft  to  refer  to  the  place  where  the  reader,  who  ought  to  con- 
iider  the  whole  of  the  oblervation,  and  not  take  it  piece-meal,  may 
immediately  find  it  complete. 

Nor  is  it  fufficient,  as  is  done  in  the  Sepulch return,  to  refer  to 
the  fedtion,  which  frequently  contains  a  great  number  of  obfervations, 
as  at  that  obfervation  of  Jo.  Petrus  Lotichius,  for  inftance ;  to  produce 
one  example,  at  leaft,  from  among  others  almoft  innumerable ;  which, 
befides  that  it  is  not  made  mention  of  under  all  the  heads  it  ought 
to  be,  is,  in  four  of  the  fedtions  wherein  we  find  it  referr’d  to,  I 
mean  thofe  De  Dolor?  Capitis,  obf.  10.  De  Infonmiis  &  Incubo,  obf.  2. 
De  Vertigine,  obf.  7.  &  De  Convuljione ,  obf.  13,  always  referr’d  to 
in  the  fedtion  De  Melancholia. 

The  reader,  therefore,  is  under  a  neceflity  of  turning  over  the 
whole  of  this  fedtion,  or,  in  other  words,  the  fifty  obfervations  of 

Vol,  I.  c  which 


xviii  THE  AUTHOR’S  PREFACE. 

* 

which  it  confifts,  in  order  to  find,  with  difficulty,  that  which  is  there 
mark’d  thirty-one.  And  I  fay  with  difficulty,  becaufe  in  all  thofe 
four  places  the  patient  is  fpoken  of  as  a  young  man  only,  in  the 
beginning  of  the  obfervation,  but  as  the  fervant  of  a  tradefman  in 
this. 

Yet  even  when  he  has  read  it  over,  and  has  found  it  to  be  that 
to  which  he  was  referr’d,  do  you  think  he  then  fees  the  whole  of 
it  ?  Certainly  not.  For  the  external  caufe  of  the  diforder  is 
wanting,  I  mean  the  philtre  which  had  been  given  :  and  other  cir- 
cumftances  are  alfo  deficient,  where  the  reader  would  not  fo  much 
as  fufpedt  it,  unlefs  he  fhould  happen  to  ftumble  on  that  place  in 
the  fedtion  De  Dolore  Capitis ,  or,  what  would  be  dill  more  to  his 
purpofc,  fhould  read  it  in  the  work  of  the  author. 

But  to  attend  folely  to  the  afiertion  with  which  we  fet  out;  I 
mean,  that  a  great  deal  of  time  is  neceffarily  confum’d  in  looking 
for  any  article  to  which  we  are  referr’d  ;  you  undoubtedly  fee  that 
the  work  would  have  been  much  more  ufeful,  if  the  whole  of  the 
obfervation,  having  been  fully  propos’d,  on  the  mod:  convenient  op¬ 
portunity,  and  mark’d  out  by  a  certain  number,  were  always  to  be 
made  mention  of,  wherever  it  was  necefiary,  as  under  that  number, 
and  not  merely  by  faying  in  what  fedtion  it  had  been  given. 

6.  But  two  very  accurate  indexes,  added  to  the  work,  would,  at 
lead,  have  been  of  far  greater  advantage.  I  remember  that  when 
the  Sepulchretum,  which  had  been  lately  printed,  was  jud  imported 
to  Bologna,  where  I  then  refided,  I  was  prodigioufly  pleas’d  to  find 
thefe  words  in  the  title-page,  With  the  neceffary  indexes. 

But  my  joy  laded  no  longer  than  till,  looking  for  thefe  indexes, 
I  found  that  there  was  only  one,  and  that  this  contain’d  nothing  more 
than  the  titles  prefix’d  to  the  obfervations :  and  as  a  great  number 
even  of  thefe  titles  are  either  undefignedly  imperfedf,  or  confefiedly 
fo,  and  without  any  difguife,  and  all  of  them  are  difpos’d  exactly  in 
the  fame  order  as  the  obfervations  themfelves ;  it  is  impofiible  to  fay, 
how  many  fymptoms,  or  how  many  morbid  conditutions  of  parts 
in  like  manner,  are  defcrib’d  in  the  obfervations  indeed,  but  not 
taken  notice  of  in  the  index  ;  not  to  fay  that  each  of  thefe  fymptoms, 
or  morbid  appearances,  are  not  exhibited,  at  one  view,  together  with 
the  others  which  are  fimilar  thereto. 

For  from  this  defedt  the  great  and  primary  advantage  of  the  work 
is  totally  cut  off ;  as  this  advantage  could  only  have  arifen  from 
having  a  great  number  of  fimilar  fymptoms  at  hand,  fo  that  you 
might  readily  compare  them  with  many  morbid  appearances;  which 
were  either  fimilar,  or  not  fimilar,  to  each  other ;  and  by  this  means 
be  able  at  once  to  conceive,  which  of  thofe  fymptoms  are  mod  fre¬ 
quently. 


THE  'AUTHOR’S  PREFACE.  *ix~ 

quently,  mod  rarely,  or  never,  join’d  with  any  particular  fpecies  of 
internal  morbid  conditution. 

I  remember,  likewife,  that,  as  young  men  are  generally  pre~ 
fumptuous  enough  to  entertain  thoughts  of  the  mod  difficult  and 
laborious  undertakings,  I  did  not  even  then  defpair,  but  if  I  fhould 
have  fufficient  leifure  in  future  time,  I  fhould  not  only  be  able  to 
fupply  the  deficiences  that  I  have  pointed  out  in  the  Sepulchretum, 
and  others  befides  thefe,  but  alfo  that  I  fhould  be  able  to  reform  the 
indexes  ;  and  I  even  thought  of  a  plan  whereby  this  might  be  done, 
and  communicated  my  plan  to  that  refpedtable  fociety,  which  is 
now  call’d  the  Academy  of  Sciences. 

7.  As  to  the  remaining  inconfidencies  of  the  Sepulchretum,  which 
I  jud  now  hinted  at,  they  chiefly  relate  to  the  fcholia.  And  though 
I  did  not  doubt,  but  many  of  thefe  were  longer  than  was  needful, 

I  neverthelefs  found  that  they  feem’d  to  be  fo  much  the  longer,  by 
advancing,  in  the  place  of  ufeful  remarks,  either  fuch  as  were  but 
of  little  ufe,  or  fuch  as  could  fcarcely  be  admitted  j  and  even  fome- 
times  by  repeating  thefe  things  over  again. 

It  would  not  have  been  proper,  however,  to  repeat  even  good 
things,  but  only  when  a  remark  has  been  once  given,  to  fay  in  a  Angle 
word,  whenever  there  was  occaflon  to  refer  to  it,  in  what  place  it 
was  to  be  found  :  and  it  would  have  been  proper  conveniently  to 
fubjoin  to  fome  places  of  obfervations  the  doubts  of  the  compiler, 
and  at  other  places  to  obferve  how  far  they  agree  with  other  obfer¬ 
vations,  to  fhew  what  confequences  might  be  drawn  therefrom,  in 
order  to  illudrate  the  theory,  but  particularly  to  illuflrate  the  practice 
of  medicine  j  and  this  not  by  doctrines  which  are,  at  prefent,  either 
quite  given  up,  or  call’d  into  quedion,  by  mod  peifons,  but  by  the 
more  probable,  eafy,  and  even,  as  far  as  could  be,  the  mod  common 
modes  of  explication. 

I  do  not,  indeed,  deny  that  fome  of  thefe  cautions  are  here  and 
there  attended  to,  in  the  fcholia  of  the  Sepulchretum  ;  nor  am  I 
ignorant  what  dodtrines  were  in  vogue  in  the  time  of  Bonetus.  But 
the  quedion  is  not  here  of  refuting  him  ;  but  of  rendering  bis  work 
more  ufeful,  and  more  confldent  with  the  fuperior  dodtrines  of  the 
prefent  times. 

8.  As,  therefore,  I  had  not  fail’d  to  revolve  in  my  mind,  more 
than  once  afterwards,  all  thefe  circumdances  which  I  have  hinted  at 
in  regard  to  the  Sepulchretum  ;  and  had  even  begun  to  contribute, 
as  much  as  my  poor  abilities  would  allow,  in  order  to  encreafe  its 
utility  ;  I  was  exceedingly  encourag’d  in  the  profecution  of  my  de- 
fign  by  the  remarks  that  I  read,  from  time  to  time,  in  new  publica- 

c  2  tions 


XX  THE  AUTHOR’S  PREFACE. 

tions  of  learned  men  :  for  inftance,  “  That  fcarcely  any-thing  was 
“  more  ufeful  than  that  work  nor  was  there  any  work  which 
“  better  deferv’d  to  have  a  fupplement  added  to  it,  and  be  brought 
(l  down  to  the  prefent  times  and,  in  like  manner,  that  “  It  is 
“  furprifing  how  much  it  might  be  encreas’d,  and  with  how  much 
“  a  better  index  it  might  be  furnifh’d,  in  order  to  make  it  advan- 
“  tageous  to  ftudents  but,  to  omit  other  things,  “  That  the  work 
“  of  Bonetus  would,  however,  have  deferv’d  greater  praife,  and  more 
u  efteem,  in  part,  if  he  had  been  lomewhat  more  accurate  in  fe- 
“  leding  the  oblervations,  and  referring  them  to  particular  difeafes, 
Ci  as  to  their  refpedive  heads  and  in  part,  if  he  had  admonifh’d  us 
“  in  the  fcholia  and  annotations,  what  things  were  here  and  there 
“  uncertain,  or  altogether  falfe,  or  what  were  not  properly  explain’d 
“  by  their  authors.” 

Now,  then;  in  an  affair  wherein  every  one  is  concerned,  and  not 
only  in  the  prefent,  but  in  future  ages ;  in  order  to  judge  more  eafily 
what  may  be  expeded  from  me  alone,  and  how  far  it  is  juft  to  ex- 
ped  it,  I  muft  by  no  means  conceal  the  circumftance  which  firft  gave 
occafion  to  my  writing  thefe  books. 

9.  The  anatomical  writings  of  Valfalva  being  already  publifh’d, 
and  my  epiftles  upon  them,  it  accidentally  happen’d,  that,  being  retir’d 
from  Padua,  as  in  thofe  early  years  I  was  wont  frequently  to  do  in 
the  fummer-time,  I  fell  into  company  with  a  young  gentleman,  of 
ftrid  morals  and  an  excellent  difpofition,  who  was  much  given  to 
the  ftudy  of  the  fciences,  and  particularly  to  that  of  medicine.  This 
young  gentleman,  having  read  thofe  writings,  and  thofe  letters  like- 
wife,  every-now-and-then  engag’d  me  in  a  difccurfe,  than  which 
nothing  could  be  more  agreeable  to  me  ;  I  mean,  a  difeourfe  in  re- 
fped  to  my  preceptors,  and  in  particular  Valfalva  and  Albertini,  whofe 
methods  in  the  art  of  healing,  even  the  inoft  trifling,  he  was  defirous- 
to  know:  and  he  even  fometimes  enquir’d  after  my  own  oblervations. 
and  thoughts  as  well  as  after  theirs. 

And  having  among  other  things,  as  frequently  happens  in  con- 
verfations,  open’d  my  thoughts  in  regard  to  the  Sepulchretum,  he 
never  ceas’d  to  entreat  me,  by  every  kind  of  folicitation,  that  I  would 
apply  to  this  fubjedt  in  particular ;  and,  as  I  had  promis’d  in  my  little 
Memoir  upon  the  Life  of  Valfalva,  to  endeavour  that  a  great  number 
of  his  obfervations,  which  were  made  with  the  fame  view,  fhould  be 
brought  to  public  light,  he  begg’d  that  I  would  join  mine  together 
with  them,  and  would  fhew  in  both  his  and  mine,  by  example  as  it 
were,  what  I  fhould  think  wanting  to  compleat  a  new  edition  of  the 
Sepulchretum,  which  he,  perhaps,  if  he  could  engage  his  friends  to 

affift 


THE  AUTHOR’S 


PREFACE. 


xsi 


aflifl  him,  would,  at  Tome  time  or  other,  undertake.  He  alfo  defir’d 
that  I  would  write  in  as  familiar  a  manner  as  I  would  wifh;  and  by 
this  means  throw  in,  at  any  time,  what  I  had  faid  in  conversion,  or 
medical  conferences,  or  any  thing  of  that  kind,  which,  though  never, 
fo  minute,  would  always  be  very  grateful  to  him. 

You  afk  me  what  was  the  effedt  of  his  entreaties  ?  I  fuffer’d  my- 
felf  to  be  prevail'd  upon.  For  you  fee  what  he  requir’d  of  me  was 
partly  what  I  had  promis’d  in  that  Memoir,  and  partly  what  I  hop’d 
would  be  of  ufe,  if  it  fhould  turn  out  agreeably  to  my  defig  n,;.  as  by 
being  afterwards  revis’d  and  publifh’d,  it  might,  feme  time  or  other, 
excite  perfons,  far  more  capable  than  myfelf,  to  undertake  the  fame 
kind  of  labour. 

With  this  view,  then,  I  began,  upon  returning  to  Padua,  to  make 
a  trial  of  that  nature,  by  fending  fome  letters  to  my  friend.  And 
that  he  was  pleas’d  with  them  appears  from  two  circumflances ;  the 
firft,  that  he  was  continually  folliciting  me  to  fend  him  more  and 
more  after  that,  till  he  drew  me  on  fo  far  as  to  the  feventieth  ;  the 
fecond,  that  when  I  begg’d  them  of  him,  in  order  to  revife  their  con¬ 
tents,  he  did  not  return  them,  till  he  had  made  me  folemnly  promife, 
that  I  would  not  abridge  any  part  thereof. 

io.  You  fee  then,  candid  reader,  why  I  faid  in  the  beginning, 
that  I  would  not  have  thefe  writings  of  mine  be  read  by  the  mofl 
unlearned ;  and  fhould  alfo  have  faid,  nor  yet  by  the  mofl;  learned, 
if  they  had  only  contain’d  thofe  things  which  he  infilled  upon  being 
retain’d  ;  I  mean,  fuch  as  might  be  ufeful  to  ffudents. 

But  I  am  not  at  liberty  here  to  make  ufe  of  that  expreffion  of  Lu¬ 
cilius  (<£),  Perjium  non  curo  legere  hcec :  Lcelium  Decimum  volo:  “  I 
“  do  not  chufe  Perfius  fhould  read  thefe  things ;  but  would  wifh 
t(  Laelius  Decimus  to  read  them  nay,  I  even  wifh  the  Perfii ,  that 
is  the  mofl  learned  men,  to  read  them,  and,  leaving  the  other  parts 
to  the  Decimi  Lcelii,  that  is  to  youths  of  learning  and  genius,  to 
confider  only  my  intention  and  defire  ;  and  if  thefe  are  not  difagree- 
able  to  them,  to  affifl  by  their  affent,  or,  if  they  think  it  will  anfwer 
a  better  purpofe,  by  their  admonitions  and  examples,  in  making  the 
Sepulchretum  of  the  mofl  utility  it  can  poffibly  be.  And  that  they 
may  do  either  the  one  or  the  other  the  more  eafily,  I  will  tell  you 
what  I  have  done  with  this  intention,  in  the  fubfequent  letters ;  and 
that  in  as  few  words  as  it  is.  poffible  on  a  fubjed  which  is  fo  complex,, 
and  requires  to  be  related  fo  clearly. 

(6)  Ciceron.  L  cit. 

31.  The 


r 


XXli 


THE  AUTHOR’S  PREFACE. 


ii.  The  obfervations,  (for  I  will  begin  with  them  in  order  to 
preferve  nearly  the  fame  method  which  I  made  ufe  of  above)  the 
obfervations,  I  fay  ;  I  mean  thofe  which  I  have  obferv’d  to  have  been 
omitted  in  the  Sepulchretum,  from  the  ancient  or  more  modern  au- 
>rs,  though  they  might  have  been  included  ;  and  thofe  moreover 
it  have  been  made  public  fince  the  fecond  edition  of  this  work  ; 
liave  pointed  out  each  under  their  proper  heads,  in  as  great  a 
number  as  occurr’d  to  me  when  writing. 

And  this  I  fay,  that  every-one  may  know  a  great  number  to  be 
Rill  remaining,  which  might  be  added ;  for  out  of  the  books  that 
I  have  read,  1  did  not  call  to  mind  all  the  contain’d  obfervations,  and 
from  thofe  which  I  had  not  read,  it  is  certain  none  could  occur  to 
my  mind  :  and  there  are  many  which  I  have  never  feen,  either  be- 
caufe  they  have  never  been  imported  hither  during  the  prefent  ca¬ 
lamities  in  which  Europe  is  involv’d,  or  becaufe  I  am  not  very  well 
{kill'd  in  the  languages  wherein  they  are  written ;  and  I  do  not  chufe 
to  put  great  confidence  in  any  interpreters,  efpecially  in  affairs  of 
this  kind. 

♦  In  each  fedlion  of  the  Sepulchretum  alfo,  if  you  except  a  few  of 
the  former  ones,  I  have  not  negledled  to  take  notice,  as  far  as  it  was 

•  in  my  power  to  obferve,  what  obfervations  are  given  more  than 
once,  either  from  the  effedt  of  carelefinefs,  or  in  confequence  of  the 
impofitions  of  a  crafty  metamorphofer ;  nor  yet  in  which  of  them 
either  natural  appearances  are  deferib’d  a9  morbid,  one  difeafe  is  re- 
prefented  as  another,  or  the  printers  have  been  fo  carelefs,  as  to  fub- 
vert  the  very  intention  of  the  obfervers  by  their  prepofterous  blun¬ 
ders  j  fo  that  by  fuch  ftri&ures,  I  think  1  cannot  fail  being  of  great 
afliftance  to  any  perfons,  who  fhall  hereafter  uudertake  to  give  a  new 
edition  of  the  Sepulchretum  :  for  though  fome  of  thefe  animadver- 
fions  are  minute,  yet  they  are  by  no  means  of  little  importance. 

I  wifh  I  could  have  been  of  equal  afiiftance,  either  when  the  readers 
are  referr’d  to  fome  other  place,  where  they  may  find  this  or  that 
obfervation  more  fully  deferib’d,  and  yet  the  number  of  the  obfer- 
vation  is  not  exprefsly  pointed  out;  or  when  they  are  overwhelm’d 
with  ftupendoufiy-long  fcholia,  and  yet  fuch  as  do  not  contain  the 
more  ufeful  remarks,  but  at  one  time  fuperfluous  things,  at  another 
time  repetitions,  and  fometimes  fuch  as  are  falfe,  or,  at  lead:,  very 
doubtful.  Of  thefe  things,  indeed,  I  have  fometimes  admonifh’d 
my  readers  :  but  always  to  do  it  would  have  been  endlefs. 

There  is  no  occafion,  however,  to  tell  thofe  who  know  any  thing 
of  the  matter,  that  I  had  not  leifure  to  compofe  the  indexes  which 
are  fo  neceffary,  and  would  require  fo  long  and  fo  arduous  a  labour. 

7  I  hope 


.THE  AUTHOR’S  PREFACE.  acriii 

I  hope  it  will  be  thought  quite  fufficient,  by  any  reafonable  perfons, 
that  at  my  time  of  life,  and  without  any  one  to  affift  me,  even  a 
pupil,  or  an  amanuenfis,  I  have  at  leaft,  not  only  in  thefe  laft-men- 
tion’d  inftances,  but  alfo  in  others  whereof  I  have  fpoken,  all  of 
which  (hall  now  be  recapitulated  in  their  order,  fhown  by  my  own 
example,  fuch  as  it  is,  in  what  manner  *it  appears  to  me,  that  the 
Sepulchretum  may  be  much  enlarg’d,  and  at  the  fame  time  render’d 
much  more  ufeful  and  correct. 

12.  I  therefore  produce  obfervations  which  have  never  been  pub- 
lifh’d  before,  a  great  number  of  which  are  Valfalva’s,  not  a  few  of 
my  friends,  but  the  greater  part  mine.  To  the  firft,  on  account  of 
the  author’s  merit,  and  the  refpedt  which  I  owe  him,  I  give  the  firfi: 
place  under  each  head.  And  thefe,  which  have  been  colledted  with 
the  fame  care  that  other  things  were  formerly,  as  has  been  faid  in 
his  life,  and  where  they  were  written  in  Italian  tranflated  into  Latin,, 
and  all  of  them  copied  over  again  in  the  manner  that  I  knew  he  had 
been  accuftom’d  to  wifh,  I  give  with  fuch  a  fcrupulous  exadhnefs, 
that,  as  I  have  fometimes  doubted  whether  I  rightly  conceiv’d  of 
them  or  not,  I  have  chofen  rather  to  produce  his  own  words,  with¬ 
out  taking  away  or  adding  any  thing,  except  what  I  had  receiv’d, 
from  his  own  mouth  :  for  this  happen’d  in  regard  to  a  few  obfer¬ 
vations  which  he  had  given  an  accurate  relation  of  to  me,  and  had 
not  committed  to  writing.  And  the  other  obfervations  I  took  from 
his  papers,  which  were  fome  of  them  connected  together,  and  fome 
loofe. 

And  although  thefe  papers,  after  having  taken  out  from  them,  in 
every  refpedt  that  was  necefiary,  the  obfervations,  experiments,  and 
other  things  that  are  given  in  thefe  Letters,  I  return’d,  number’d  and 
feal’d  up,  in  the  fame  manner  as  before,  to  his  fon-in-law  Lewis 
Montefani,  that  celebrated  man,  who  is  librarian  to  the  Academy  of 
Sciences  at  Bologna ;  yet  if  any-one  fhould  chufe  to  compare  a  par¬ 
ticular  paper  with  thefe  my  deferiptiens,  and  (hould  afk  me  by  what 
mark  he  might  find  it,  in  fo  great  a  number  of  papers,  I  (hall  have 
no  objection  to  telling  him,  nor  yet  to  (hew  any  letter,  whereby  my 
friends  have  communicated  to  me  their  obfervations  which  1  make 
ufe  of  in  thefe  books,  as  they  are  all  of  them  men  of  well-known 
integrity,  (kill,  and  accuracy. 

For,  finally,  in  refpedt  to  my  own  obfervations,  I  have  particularly, 
related  in  each,  the  year,  month,  and  place  in  which  they  were  made, 
and  who  aflifted  me,  or  were  prefent,  at  the  time,  unlefs  I  had  fuf- 
ficiently  done  it  before.  And  I  have  not  only  remark’d  the  age  and 
lex  of  the  patient,  but  other  things  alfo  that  Peyerus  (c)  requires,  as 

(c)  Meth.  Hill.  Anat,  Medic,  c.  2,  Si  3. 


far 


XXIV 


THE  AUTHO  R  ’  s  PREFACE. 


far  as  it  was  in  my  power  to  learn,  and  amongft  thefe  fuch  as  relate 
to  the  method  of  cure  which  had  been  applied  :  though  it  may  b® 
neceftary  to  admonfth  my  readers,  that  they  are  not,  bv  any  means, 
to  impute  a  particular  method  of  treatment  to  me  or  to  Valfalva, 
unlefs  we  fay  it  was  prefcrib’d  by  us,  any  more  than  they  would  the 
external  caufes  and  the  fymptoms  of  the  difeafes  ;  for  we  relate  thefe 
juft  in  the  fame  manner  as  we  do  the  method  of  treatment. 

And  in  defcribing  the  difiedtions  themfelves,  I  thought  it  particu¬ 
larly  behov'd  me  to  take  care,  that  I  did  not  admit,  what  I  fo  greatly 
difapprov’d,  in  fome  certain  defcriptions  of  other  authors ;  I  mean, 
that  I  fhould  not  confider  as  morbid  appearances,  either  thofe  which 
are  agreeable  to  the  ufual  order  of  nature,  or  not  far  different  there¬ 
from,  fuch  as  fome  varieties,  for  inftance,  are. 

I  have  endeavour’d  alfo  that  the  hiftories  fhould  not  be  divided, 
but  fhould  be  exhibited  at  one  view :  or  if  it  did,  at  any  time,  happen 
(though  this  was  but  rarely)  to  feem  more  advantageous  to  divide 
them,  or,  what  happen’d  very  often,  to  take  notice  of  them,  I  have 
taken  care  to  point  out  that  very  place,  in  which  either  the  remaining 
part,  or  the  whole,  of  the  hiftory  might  be  found  :  and  I  have  been 
equally  cautious  of  repeating  even  anything  that  might  have  been 
formerly  treated  of  fully  in  fome  of  my  writings ;  inafmuch  as  it  is 
odious  to  me ,  in  the  fame  manner  as  it  was  to  the  Ulyffes  of 
Homer  (d),  to  relate  over  again  any- thing  that  has  been  fully  related . 
For  by  thefe  means  the  hiftories  really  become  too  long;  but  not 
when  all  the  circumftances  which  relate  to  the  foregoing  caufes  of 
the  difeafe,  and  to  the  fymptoms,  (all  which  I  wifh  could  be  equally 
and  fully  known  at  all  times)  or  to  the  injuries  of  parts  obferv’d  in 
the  bodies,  are  accurately  defcrib’d.  And  indeed  they  often  give  us 
occafion  to  obferve,  as  I  have  done,  not  only  what,  in  each  of  thefe 
claftes,  were  prefent,  but  what  were  abfent  likewife. 

1 3.  But  what  fhall  I  fay  of  the  prolixity  of  the  fcholia  ?  I  was 
not  ignorant  indeed,  that  this  was  not  very  agreeable  to  mod  readers, 
and  totally  difapprov’d  by  fome  ;  although  I  fee  that  Peyerus,  who 
is  one  of  the  laft-mention’d  clafs  (<?),  has  adjoin’d,  to  his  hiftory  (f)^ 
a  fcholium  that  is  longer  than  itfelf  by  feven  pages,  in  the  firft 
place,  however,  I  fay  that  all  the  matter,  befides  hiftories,  which  is 
contain’d  in  thefe  letters  of  mine,  is  not  fcholia.  And  in  the  fecond 
place  I  fay,  that  if  I  was  fo  fupply,  in  my  fcholia,  the  many  circum¬ 
ftances  which  I  have  faid  are  wanting  in  the  fcholia  of  the  Sepulchre- 
tum  (g),  I  could  not  avoid  detaining  my  reader  confiderably. 

(d)  OdyiT.  1.  12  in  fin.  (e)  Meth.  Cit.  c.5.  in  fin.  (/)  Ibid.  c.  6.  (^)  Supra,  n.7. 

And 


XXV 


THE  AUTHOR’S  PREFACE, 

And  what  will  you  fay  to  this  ?  that  almoft  innumerable  obfer- 
vations  were  to  be  pointed  out,  at  the  fame  time,  to  be  added  to  it ; 
and  that  it  was  likewife  my  bufinefs  to  fhow  what  errors  had  been 
frequently  committed,  in  feleCting,  copying,  difpofing,  and  marking 
out,  either  on  account  of  the  great  quantity  of  matter,  or  by  the 
careleffnefs  of  the  printers,  thofe  obfervations  of  which  the  work 
already  confifted. 

Here  you  will  perhaps  enquire,  whether  I  do  not  fuppofe  that  I 
have  alfo  been  very  often  faulty,  I  do  not  now  fay  in  correcting  the 
blunders  of  the  printers,  from  whom  I  was  certainly  at  a  great 
diftance ;  but  I  fay  in  that  very  point  upon  which  I  fo  much  dis¬ 
approv’d  thofe  fcholia;  I  mean,  in  the  choice  of  theories  and  opi¬ 
nions,  whereby  to  explain  the  obfervations  that  were  the  mod  eafy, 
probable,  and  common,  or  fuch  as  the  greater  part  of  phyficians  had 
not  called  into  queftion  ? 

I,  however,  am  a  perfon  who  think  that  there  is  nothing  human 
which  may  not  fall  to  my  lot ;  and  that  not  only  in  this  cafe,  but  in 
any  other.  Yet  in  this  cafe,  confidering  to  whom  I  was  writing, 
I  took  all  the  pains  I  could  to  avoid  abftrufe,  difficult,  and  fingular 
modes  of  explication,  and  ftudied  to  make  ufe  of  fuch  as  were  ob¬ 
vious,  plain,  and  almoft  common  j  I  mean,  almoft  common  at  the 
time  wherein  I  began  to  write. 

For  I  had  already  made  a  confiderable  progrefs  in  writing,  when 
certain  controverfies  began  to  be  fuddenly  agitated ;  but  as  it  would 
have  been  too  laborious  an  undertaking  to  alter  what  was  written  on 
this  account,  I  thought  it  would  be  fufficient,  if,  in  what  remain’d 
to  be  written,  I  fhould  be  fo  cautious  as  to  give  no-one  a  juft  oc- 
cafion  of  complaint ;  and  the  more  fo,  as  I  left  every-one  at  his  li¬ 
berty,  both  then  and  before,  to  ufe  any  mode  of  explication  he  fhould 
prefer,  if  he  happen’d  to  difapprove  what  he  might  find  in  my  letters. 
For  this  was  not  what  I  had  principally  in  view  :  nor  do  I  furnifh 
any-thing,  to  fpeak  ftriClly,  befides  the  obfervations  j  fince,  in  regard 
to  the  other  parts,  I  give  free  leave  to  every  reader  to  approve  or  dif¬ 
approve,  juft  as  if  they  were  not  mine  :  and  this  I  do  becaufe  I 
(hould,  otherwife,  be  afraid,  left,  when  fpeaking  from  opinion  only, 
notwithftanding  I  make  probability  my  guide,  fome-body  fhould  ne¬ 
ver  thelefs  rife  up  and  retort  upon  me,  agreeable  to  what  Homer  fays(Z’), 
Dixit  mendacia  mult  a ,  dicem  veris  Jimilia :  “  In  faying  things  that 
“  were  probable,  he  utter’d  many  falfities.” 

Wherefore,  I  have  not  dwelt  long  upon  explications,  and  have 


Vo L.  I. 


( h )  Odyff.  1.  19. 

d 


taken 


XXVI 


THE  AUTHOR’S  PREFACE. 

/ 

taken  care  to  interfperfe  other  remarks  relative  to  the  practice  of  me¬ 
dicine,  fome  of  which  relate  to  the  hiftory  thereof,  and  fome  to  the 
hiftory  of  anatomy,  and,  finally,  many  things  which  relate  to  other 
ftudies  and  purfuits  of  the  young  gentleman  to  whom  I  addrefs’d  the 
letters  •,  and  this  with  an  intention  to  withdraw  his  imagination,  for 
a  while,  from  the  horrid  and  perpetual  idea  of  difeafes  and  dead 
bodies.  Now,  then,  if  you  duly  confider  all  thefe  parts  of  the  pub¬ 
lication,  and  disjoin  them  from  the  fcholia,  you  will  plainly  perceive, 
that  the  proportion  of  thefe  fcholia,  when  taken  feparately  and  in 
a  ftri<ft  fenfe,  is  not  very  confiderable  :  or,  if  you  fhould  think  it 
confiderable  neverthelefs,  be  fo  kind  as  to  leave  them,  without  regret 
or  grudging,  to  my  L  cel  ins ;  and  confider,  at  the  fame  time,  that 
thofe  things,  and  othets  with  which  you  are  difpleas’d,  may  be 
equally  difpleafing  to  me  at  prefent :  yet  thefe  are  the  very  parts 
which  he  made  me  fo  folemnly  promife  not  to  withdraw. 

14.  Do  not  expedt,  that,  before  I  fpeak  of  the  indexes  which  are 
added,  I  fhould  here  repeat  what  I  have  faid  in  my  preface  to  the 
Anatomical  Epiftles.  For  in  that  preface  (/)  I  have  faid  enough  to 
inform  every-one,  why  I  have  been  fo  long  taken  up  in  writing 
this  work  alfo,  which  is  in  many  refpe&s  fimilar  to  that,  and  why 
I  wrote  it  in  the  form  of  letters.  Or,  if  what  is  there  faid  is  not 
fufficient,  add  to  other  caufes  of  delay  this  very  reafonable  one,  that, 
from  the  time  of  publifhing  thofe  epiftles  to  the  prefent  time,  I  am 
fo  far  advanc’d  in  life,  that  all  thefe  parts  of  the  work,  after  being 
revis’d  with  the  utmoft  diligence  1  was  capable  of,  at  length  came 
abroad  into  the  world  almoft  in  the  eightieth  year  from  the  time  in 
which  I  was  born. 

But  there  is  much  lefs  reafon  to  wonder,  at  prefent,  why  I  pre- 
ferr’d  the  epiftolary  manner,  not  fo  much  in  conformity  to  the 
example  of  modern  and  ancient  phyficians,  (amongft  whom  Ma- 
nardus  (£)  recounts  Archigenes  and  Themifon  ;  the  former  of  which 
authors,  according  to  the  teftimony  of  Galen,  wrote  eleven  books 
of  medicinal  epiftles ;  and  the  latter,  according  to  the  teftimony  of 
Paulus,  ten)  as  in  conformity  to  that  of  the  greateft  anatomifts 
mention’d  in  the  preface  already  fpoken  of  (/),  who  have  written 
much  longer  epiftles  than  I,  as  I  fhew’d  above  (*»),  from  whence 
the  occafion  of  writing  thefe  letters  arofe,  and  as  the  letters  them- 
felves  plainly  and  jointly  demonftrate,  on  proper  occafions,  with 

whom  I  had  to  do  for  by  thefe  means  it  became  me,  in  writing 

-  -  (  •  •  •  •  •  '  -  ...• 
\  \  '  4*  .  .  *  .  -  *•  ‘ 

\ _ _ 

(0  N.  1.  &  feqq.  (£)  L.  1.  Epift.  Medic.  1.  (/)  N.  3.  ( m )  N.  9. 


to 


THE  AUTHOR’S  PREFACE.  xxvii 

to  a  young  gentleman  who  was  my  friend,  to  fay  fuch  things  every- 
now-and-then  as  would  have  been  ufeful  to  the  ftudents  who  attend 
my  ledtures.  And  although  the  younger  Pliny  («)  concludes  his 
letters  to  Tacitus  in  thefe  words,  It  is  one  thing  to  write  to  a  friend, 
and  another  thing  to  write  to  the  public  in  general ;  yet  he,  never- 
thelefs,  publifh’d  thofe  very  letters  with  the  others,  as  he  did  not 
doubt  but  every-one,  who  fhould  read  them,  would  fee  that  they 
were  not  written  with  an  intention  for  public  infpedtion. 

Nor  would  I  have  you  fuppofe,  that  I  think  differently  of  thefe 
letters  from  what  I  thought  of  my  Anatomical  Epiftles  ( o ),  becaufe 
you  fee  that  I  have  divided  them  into  books. '  For  1  (till  continue  in 
the  fame  opinion  ;  and  I  think  this  fufficiently  appears  from  the 
feries  of  numbers,  by  which  they  are  particularly  mark’d  out,  not 
being  interrupted  by  fuch  a  divifion  :  and  I,  moreover,  not  only 
think  this  order  more  convenient  for  the  completion  of  the  indexes, 
but  alfo  for  referring  the  reader,  as  is  often  neceffary,  to  this  or  that 
letter;  and,  in  all  probability,  it  will  be  found  more  ready  and  con¬ 
venient  for  others  as  well  as  for  myfelf.  As  to  the  title  of  the 
books,  however,  and  that  particular  divifion  of  them,  they  had  their 
origin  from  far  different  caufes.  For  they  were  not  only  defied  by 
the  bookfellers,  but  were  requir’d  in  conformity  to  the  order  of  the 
Sepulchrctum,  which  was  the  plan  I  had  laid  down  to  myfelf,  and 
is  diftributed  in  this  manner  :  and,  finally,  this  diftribution  exactly 
correfponded  to  a  certain  very  juft  thought  of  mine,  which  I  will 
immediately  declare. 

15.  That  is  to  fay,  as,  when  a  young  man,  I  had  not  omitted  to 
teftify  publicly,  to  the  firft  academy  of  fciences  which  had  admitted 
me,  the  feelings  of  a  grateful  mind  on  that  occafion,  and  had  feen 
that  teftimony  receiv’d  by  them  with  the  fame  degree  of  conde- 
fcenfion,  wherewith  they  had  formerly  conferr’d  fo  many  benefits, 
as  are  mention’d  by  that  very  celebrated  man  Francefco  Maria  Za- 
notti  (/>),  who  is  one  of  the  committee  to  that  body,  and  to  the  In- 
ftitution  of  Sciences  at  Bologna ;  why  fhould  I  now,  that  I  am  grown 
old,  fuffer  myfelf  to  die  under  the  influence  of  ingratitude  to  five 
other  of  the  moft  noble  academies  of  fciences  in  all  Europe,  which 
had,  afterwards,  very  condefcendingly  and  very  honourably,  chofen 
me  into  the  number  of  their  fellows  ?  Therefore,  as  I  had  nothing, 
nor  could  hope  to  have  any-thing,  whereby  I  might  fhew  myfelf  to 
have  a  grateful  fenfe  of  their  favours,  in  the  beft  manner  I  was 

(«)  L.  6.  Epift.  16.  (0)  Praefat.  indicar.  n.  3. 

(p)  Commentar,  de  Bonon.  Sc.  Inft.  Tom.  1.  ubi  dc  ejus  Academia,  c.  1,  &  feqq. 

d  2  able, 


xxviii  THE  AUTHOR’S  PREFACE. 

able,  unlefs  I  (hould  depute  perfons  to  wait  upon  each  of  them, 
to  afifure  them  of  my  gratitude  and  duty  towards  them,  and,  at  the 
fame  time,  prefent  them  with  a  copy  of  this  work,  and  requeft 
that  they  would  each  of  them  accept  it,  fuch  as  it  was,  with  their 
well-known  condefcenfion,  and  confider  the  intention  rather  than 
the  thing ;  I  did  not  think  that  I  ought  to  lofe  fuch  an  oppor¬ 
tunity. 

And  that  this  might  be  known  to  all  of  them,  it  very  conve¬ 
niently  happen’d,  that  the  number  of  books,  into  which  thefe  letters 
were  naturally,  and  of  themfelves,  divided,  exactly  correfponded  to 
the  number  of  academies  ;  fo  that  I  could  prefix  to  each  of  the 
books  that  very  letter,  wherein  1  fhould  fignify  what  I  would  wifh 
to  have  faid,  to  each  of  thofe  refpedtable  bodies,  in  my  name.  Thefe 
letters  I  have  prefix’d  without  obferving  any  other  order,  than  that 
of  the  time  in  which  I  was  chofen  into  their  celebrated  focieties : 
and  that  they  might  be  the  more  read  by  every-one,  I  added  feveral 
other  things  to  the  teftimonies  of  a  grateful  and  refpedtful  mind, 
and  of  thofe  five  letters  made  fo  many  prefaces,  as  it  were,  in  which 
I  might  demonftrate  how  great  an  advantage  there  is  arifing  from 
the  difiedfions  of  dead  bodies. 

In  the  firft,  therefore,  having  argued  againft  fome  perfons,  who 
have  been  prefumptuous  enough  to  call  this  utility  into  queflion,  I 
have  fhewn  in  what  manner  the  deceptions,  which  have  been  made 
ufe  of  as  objections  to  the  pra&ice,  may  be  avoided  by  thofe  who 
difiedt  bodies,  and  who  prove  both  the  feat  and  the  caufe  of  the 
difeafe,  which  are,  for  the  moft  part,  eafily  demonftrated  from  the 
dififedtion.  In  the  fecond  I  have  confirm’d  the  fame  utility,  by  the 
full  and  ample  confent  of  almoft  all  phyficians,  particularly  thofe 
who  have  flourifh’d  amongft  the  moft  polite  and  cultivated  nations, 
from  the  moft  ancient  times,  fpeaking  of  the  merits  of  each  nation 
in  regard  to  this  queftion,  and  mentioning  the  name  of  moft  of  the 
phyficians  in  order  ;  and  efpecially  of  thofe  who,  from  their  own 
observations,  or  even  the  obfervations  of  others,  wifh’d  to  have 
compil’d  a  Sepulchretum  before  the  time  of  Bonetus.  In  the  third 
an  anfwer  is  particularly  given  to  thofe,  who,  becaufe  dififedtions  are 
of  no  ufe  in  order  to  detedl  the  firft  and  moft  hidden  caufes  of 
difeafes,  and  fuch  as  are  entirely  inacceftible  to  the  fenfes,  think 
that  it  is,  therefore,  quite  needlefs  to  profecute  the  pradtice,  as  if 
they  did  not  thereby  detedt  any  evident  internal  caufes,  or  the 
knowledge  of  thefe  caufes  were  of  no  advantage,  becaufe,  even 
where  they  are  known,  a  great  number  of  diforders  are,  neverthelefs, 
ilill  uncur’d. 

In 


THE  AUTHOR'S  PREFACE. 


XXIX 


In  the  fourth  I  make  this  enquiry,  whether  it  is  more  ufeful  to 
difledt  the  bodies  of  thofe  who  died  of  the  more  rare,  (for  fome  of 
thefe  alfo  I  have  differed)  or  of  the  more  common  difeafes. 

In  the  fifth,  finally,  it  is  (hewn,  that,  although  the  anatomy  both 
of  found  bodies,  and  of  thofe  that  are  carried  off  by  difeafe,  is  ufe¬ 
ful,  the  latter  is,  neverthelefs,  by  far  the  more  ufeful. 

And  as  all  thefe  circumftances  ought,  fome  for  one  reafon,  and 
fome  for  another,  not  to  be  pafs’d  by ;  fo  if  they  had  been  all 
thrown  together  into  this  preface,  they  would  have  made  that 
difcourfe,  which  is  already  long,  in  confequence  of  the  many  things 
that  were  neceflarily  to  be  fpoken  of,  extremely  long  and  prolix. 

1 6.  It  now  remains,  at  length,  to  fpeak  of  the  indexes.  I  have 
given  four  :  the  fird  of  which  is  the  fhorteft,  the  lad  the  longed. 
For  the  fird  contains  nothing  but  the  arguments  of  the  feveral  letters 
and  their  order.  And  this  order  I  was  under  the  neceflity  of  pur- 
fuing  without  deliberation,  as  I  was  oblig’d  to  follow  Bonetus.  And 
this  author,  as  the  cudom  was  then  with  mod  phyficians,  follow’d 
Alexander  Trallianus  in  general  ;  who,  as  Freind  ( q )  has  obferv’d, 
notwithdanding  “  others  had  digeded  diforders  in  a  very  confus’d 
“  manner,  difpos’d  them,  neverthelefs,  in  fuch  order,  as  to  begin 
**  with  the  head,  and  go  on  to  the  feet.” 

And  from  hence  you  have  the  reafon  why,  although  I  (hould  have 
rather  chofen  to  begin  with  the  apoplexy,  as  of  a  difeafe  in  refpedt 
to  which  I  have  more  obfervations,  and  could  remark  many  and 
various  things,  from  whence  it  might  more  certainly  and  more  eafily 
be  known  what  is  given  in  thele  books;  I,  neverthelefs,  began  with 
the  pain  of  the  head. 

As  to  the  lad  index,  it  is  very  copious  for  this  reafon,  that  it 
points  out  particularly  every  thing  which  may  feem  to  be  more 
worthy  of  remark,  whether  you  have  an  eye  to  the  date  of  the 
parts  as  natural  or  morbid,  or  the  hidory  of  anatomy,  and  fome 
certain  controverfies,  whether  the  varieties,  and  other  lefs  frequent 
appearances,  or  the  medical  admonitions  and  obfervations,  are  con- 
fider’d  ;  or,  finally,  it  is  faid  by  whom  the  diffedtions,  that  are  not 
now  fird  given  by  us,  have  been  given. 

For  I  have  dili  purfu’d  my  method  of  exprefsly  afcribing  to 
every-one  his  own,  and,  in  like  manner,  of  commending  the  greater 
part  of  the  mod  famous  modern  authors,  (and  I  wifli  they  were  all 
dill  living)  who  have  deferved  well  of  our  faculty,  or  of  me ;  and 

(q)  Hift.  Medic,  ad  A.  500. 


of 


XXX 


THE  AUTHOR'S  PREFACE. 


of  particularly  pointing  out  fome  faults  of  the  ancient  authors  only, 
or,  at  lead,  of  thofe  who  are  no  longer  living,  that  younger  phy- 
ficians  rfiight  not  be  mifled  by  their  authority.  And  amongd  other 
things,  as  having  a  reference  to  our  chief  view,  thofe  padages  are 
pointed  out,  where  I  did  not  think  it  became  me  to  conceal  what 
feem’d  tc  be  wanting  in  the  Sepulchretum,  what  might  be  corrected, 
or  what  taken  away,  and  in  particular  what  it  feem’d  proper  to  add 
thereto. 

17.  To  the  fame  purpofe  the  two  remaining  indexes,  the  fecond 
and  third,  mod;  undoubtedly  confpire :  which  we  have  compil’d, 
not  fo  much  on  account  of  the  obfervations  contain’d  in  thefe  letters, 
as  that  (which  we  hope  will  not  be  difagreeable  to  men  of  learning) 
all  the  obfervations  already  extant  in  the  Sepulchretum,  or  which 
diall  be  added  to  it,  with  every-thing  deferving  notice  contain’d 
therein,  may  more  readily  be  found ;  and  thereby  the  whole  render’d 
confiderably  more  ufeful. 

The  fird  of  thefe  indexes,  therefore,  fhews  what  has  been  obferv’d 
in  living  bodies,  the  other  what  in  the  bodies  after  death  ;  fo  that 
if  any  phyfician  obferve  a  fingular,  or  any  other  fymptom  in  a  patient, 
and  defire  to  know  what  internal  injury  is  wont  to  correfpond  to 
that  fymptom  ;  or  if  any  anatomid  find  any  particular  morbid  ap¬ 
pearance  in  the  dide&ion  of  a  body,  and  fhould  wifh  to  know  what 
fymptom  has  preceded  an  injury  of  this  kind  in  other  bodies;  the 
phyfician,  by  infpe&ing  the  firft  of  thefe  indexes,  the  anatomid:  by 
infpe&ing  the  fecond,  will  immediately  find  the  obfervation  which 
contains  both  (if  both  have  been  obferv’d  by  us)  j  and  this  fo  much 
the  more  eafily,  becaufe  where  it  was  neceffary  to  point  out  more 
circumdances  in  regard  to  any  fymptom,  or  the  morbid  date  of  any 
part,  each  of  them  are  pointed  out  in  a  certain  order. 

Nor  will  the  fird  of  thefe  two  indexes  only  point  out  the  fymptoms 
and  the  difeafes,  but  other  things  alfo  which  I  thought  might  be  very 
ufefully  added ;  fuch  as  the  previous  external  caufes  of  difeafe,  the 
mode  of  diet,  the  condition  in  life,  as  that  of  a  widow  or  a  virgin, 
the  date  of  childhood,  or  decrepid  age,  and  finally  the  trade  or  em¬ 
ployment  in  life  ;  fo  that,  again,  if  any-one  fhould  intend  to  treat 
of  the  diforders  of  any  particular  clafs  of  people,  fuch  as  of  virgins, 
children,  or  old  men,  or,  defiring  to  imitate  our  Rammazzini,  or 
make  additions  to  his  book,  fhould  wifh  to  write  of  the  diforders  of 
artificers,  he  will  not  only  have  an  opportunity  of  informing  himfelf, 
to  what  diforders  thofe  feveral  clades,  and  they  as  artificers,  or  any 
other  fet  of  artificers,  are  liable,  but  alfo  what  morbid  appearances 
are  wont  to  be  found  in  their  bodies. 


Nor 


THE  AUTHOR’S'  PREFACE.  xxxi 

Nor  have  we  omitted,  in  the  fecond  of  thefe  indexes,  to  remark, 
as  occafion  offer’d,  any-thing  that  relates  to  the  quantity,  or  (fate,  of 
the  blood,  or  other  humours.  And  as  Valfalva  has  frequently  and 
accurately  told  us,  what  he  faw  in  the  lymph  ted  u<fts,  and  what  ex¬ 
periments  he  made  upon  the  water  extravafated  into  the  various  ca¬ 
vities  of  the  body,  we  have  not  even  omitted  to  mention  thefe  in 
the  fourth  index  at  leaff. 

1 8.  But  as  all  our  obfervations  are  but  few,  if  compar’d  with 
thofe  contain’d  in  the  Sepulchretum,  fo  thefe  latter  will  be  much 
more  fitted  to  produce  the  advantages  I  have  mention’d,  if  indexes 
are  compil’d  from  them  by  any  diligent  man,  and  from  thofe  which 
others  may  publifh  hereafter  by  their  own  authors,  almoft  in  this 
manner.  Nor  was  it  extremely  difficult,  but  rather  eafy,  for  me  to 
collect  all  thefe  indexes  of  mine.  For  when  I  had  written  an  ob- 
fervation,  a  fcholium,  or  an  animadverfion,  each  under  its  prefix’d 
and  immutable  number,  I  immediately  put  down  every-thing,  while 
it  was  yet  prefent  in  my  mind,  in  its  proper  index. 

In  a  long  work  therefore,  and,  of  confequence,  one  which  the 
better  deferves  to  be  excus’d,  if  any  things  have  crept  in  differently 
from  my  intention,  (and  that  many  errors  have  crept  in  it  is  natural 
to  fuppofe)  being  admonifh’d  by  the  indexes  themfelves,  I  eafily 
avoided  repeating  any-thing :  and  by  the  fame  pains  the  very  trouble- 
fome  labour  of  compiling  thefe  indexes  after  the  completion  of  the 
work,  was  provided  againff,  at  the  fame  time  that  care  was  taken*, 
that,  if  the  work  ever  happen’d  to  be  reprinted  in  any  other  form 
whatever,  the  indexes  fhould  not  become  ufelefs,  but  fhould  ffill 
continue  to  have  the  fame  reference  or  effect,  as  appears  from  the 
fecond  edition  of  my  Anatomical  Epiflles. 

There  is  one  inconvenience  which  may  happen,  and  has  fometimes 
happen’d  to  me;  I  mean,  the  greater  prolixity  than  I  would  with  of 
fome  articles.  For  as  I  found  it  neceffary  to  add  other  things  to 
them, "-and  that  more  than  once,  and  yet  without  diffurbing  or 
changing  the  order  of  the  numbers,  which  was  by  no  means  to  be 
attempted ;  and  as,  from  the  time  that,  having  publifh’d  the  firfl  cf 
my  Adverfaria,  and  on  the  one  hand  obferv’d  the  perpetual  and  ex¬ 
cellent  cuffoms  of  our  anceffors,  and  on  the  other  how  much  it  is 
prejudicial  both  to  readers  and  authors,  and  to  both  equally,  to  have 
their  attention  call’d- from  the  thread  and  energy  of  the  difccurfe,  by 
notes  which  are  fubjoin’d  ;  this  method,  which  is  now  alrnoff  uni- 
verfal,  did  not  fufficiently  pleafe  me  ;  I  chofe  rather  to  be  a  little, 
prolix  now  and  then,  and  tedious  to  my  readers,  than  frequently  to 
call  away  their  intention  from  the  tenour  of  the  difcourfe. 

2.  Rut 


t  f  ,  •  • 

xxxii  THE  AUTHOR’S  PREFACE. 

But  be  this  as  it  will,  (for  I  do  not  altogether  difapprove  that 
cuftom,  and  even  confefs  of  how  great  an  advantage  it  has  been  to 
writers,  who  have  experienc’d,  as  well  as  I,  according  to  what  I  have 
formerly  faid  (r)  with  the  younger  Pliny,  how  laborious  it  is  to  in¬ 
corporate  new  members ,  as  it  were ,  with  a  body  which  is  already  com¬ 
plete ,  and  yet  not  dijlurb  or  change  the  order  of  the  former)  it  certainly 
cannot  happen  to  obfervations,  that,  when  we  have  once  put  down 
with  accuracy  what  has  been  obferv’d  in  the  patient  while  living, 
and  found  in  his  body  after  death,  there  can  ftill  remain  circum- 
ifances  to  be  added  which  may  require  a  great  number  of  words. 

And  thofe  two  indexes  relate  only  to  obfervations,  or  to  that 
method  of  compiling  them  which  I  have  mention’d,  or  to  a  better 
which  learned  men  will  point  out.  And  this  I  earneflly  beg  and 
intreat  them  to  do,  for  the  fake  of  the  public  in  general :  nor  do  I 
lefs  carneftly  beg  and  in  treat  of  them,  that,  if  they  Ihould  happen 
to  find  any-thing  which  may  not  feem  fo  much  to  deferve  their  dif- 
appi*obation  in  thefe  books,  or  in  this  example  of  an  old  man  fuch 

I  am,  they  will  not  fail  to  confirm  it  by  their  own  very  great  au¬ 
thority,  and  thereby  add  weight  to  the  work,  fo  as  to  preferve  it 
from  opprefiion  and  difgrace.  For  a  difcourfe ,  as  Euripides  fays  (r), 
which  comes  from  men  who  are  not  celebrated ,  and  from  thofe  who  are 

fo,  has  by  no  means  the  fame  effedl. 

'  / 

College  at  Padua ,  Augujl  30,  1760. 

(r)  Praefat.  ad  Epift.  Anat.  n.  8.  (x)  In  Hecuba. 


T  H  E 


T  H  E 


SEATS  and  CAUSES 

O  F 

DISEASE 

INVESTIGATED  BY  ANATOMY. 


BOOK  the  FIRST 

Which  treats  of  Disorders  of  the  Head. 


«*• 

Vgl.  I.  B 


. 


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If  I 

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t  '  . 

. 


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. 


. 


LETTER  the  FIRST. 


Of  PAIN  in  the  H  E  A  D. 


i.  V  N  order  to  perform  what  I  promifed  you,  I  will  begin  with  the  pain 
I  of  the  head  ;  but  do  not  expeit,  that  1  lhall  include  in  this  letter,  all 

A.  the  caufes  of  that  pain,  which  have  occurr’d  to  Vallalva,  or  myfelf 
in  diffe&ions.  Moft  of  them  will  be  recounted  hereafter,  on  other  occa- 
fions.  For  this  pain,  not  only  attends  dilorders  of  the  head  itfelf,  but  is 
frequently  join’d,  to  thofe  of  the  other  parts  of  the  body.  And  indeed,  of  itfelf 
alone,  it  is  perhaps  never  mortal :  for  which  reaibn,  I  have  but  few  hi  (lories 
thereof  to  introduce  here,  and  thefe  only  treat  of  it  as  preceding  other  dis¬ 
orders,  or  as  a  threatening  fymptom  which  attended  them.  I  will  firfl  give 
you  an  indance  of  each  kind  from  Yalfalva. 

2.  A  boy  of  thirteen  years  of  age,  of  a  ready  wit,  whofe  brother  and 
fider  had  died  of  a  confumption,  having  himfelf  labour’d  under  an  inflam¬ 
mation  of  the  left  lobe  of  the  lungs  the  year  before,  was  feiz’d  with  a  pain 
in  his  head  over  his  eyes :  his  eyes  were  alfo  painful,  and  troubled  with  a 
vifcid  defluxion.  The  day  following  he  became  delirious  ;  his  eyes  were 
fix’d  on  thofe  about  him  ;  and  he  threw  up  a  little  tough  phlegm.  Then 
on  a  fudden,  he  Was  feiz’d  with  convulfions  ;  after  which  he  fell  into  a  kind 
of  lethargy :  yet  was  frequently  rous’d  by  convulfions,  attended  with  dif¬ 
ficult  refpiration.  At  length  he  died.  Vvhen  the  abdomen  was  open’d,  the 
vifcera  were  all  found  to  be  in  a  found  (late:  but  the  (lomach,  contain’d  a 
kind  of  aeruginous  humour,  the  bladder  was  turgid  with  urine,  and  the 
gall-bladder  with  bile.  In  the  cheft,  the  right  lobe  of  the  lungs  did  not 
adhere  to  the  pleura;  but  in  the  upper  part  toward  the  clavicle  contain’d  a 
tubercle  almod  as  big  as  a  walnut,  in  which  were  little  cavities  full  of  matter, 
that  in  colour  and  confidence  refembled  the  medullary  fubdance  of  the 
brain.  And  this  perhaps  would  have  given  rife  to  a  diforder,  had  the  youth 
liv’d  longer,  fimilar  to  thofe  which  took  off  his  brother  and  fider.  But  the 
left  lobe  of  the  lungs,  which  as  I  faid  above,  had  been  inflam’d  the  year 
before,  was  on  the  back  part  connected  with  the  pleura.  The  pericardium 
contain’d  two  ounces  of  ferum,  and  was  confequently  enlarg’d  ;  and  the  right 
ventricle  of  the  heart,  had  in  it  a  little  polypous  concretion :  yet  the  red  of 
the  blood  was  not  in  the  lead  concreted,  although  he  had  been  dead  feven- 

B  2  "  teen 


4  Book  I.  Of  Difeafes  of  the  Head. 

teen  hours.  Having  faw’d  open  the  ikull,  the  dura  mater  was  found  ting’d 
with  a  cineritious  colour,  along  the  fides  of  the  blood-veflels.  And  when 
the  dura  mater  was  torn  away  from  the  crifta  galli,  a  little  fanious  ferum 
burft  forth  :  and  about  an  ounce  of  limpid  ferum,  came  from  the  origin  of 
the  optic  nerves.  But  the  whole  brain  appeared  found  -,  and  we  could  not 
help  taking  notice  of  the  unufual  magnitude  of  the  pineal  gland. 

3,  This  laft  article,  which  refpeds  the  ingenuity  of  the  youth,  you  will 
underftand  was  written  when  the  pineal  gland  was  believ’d  to  be  the  feat 
of  the  foul.  As  to  the  difeafe,  it  began  with  the  pain  of  the  head  and 
eyes  ;  the  delirium,  the  vomitings,  the  convulfions,  brought  it  to  its  acme, 
and  the  fame  convulfions,  it  would  feem,  by  bringing  on  death  put  an  end 
to  it.  Nay,  perhaps  this  convulfion  though  occult,  was  the  beginning  of 
it.  Since  pain,  delirium,  and  vomiting,  might  be  the  effects  of  flight  con¬ 
vulfions  :  as  the  turgid  ft  ate  of  both  bladders,  might  be  the  effed  of  the 
delirium.  For  it  is  ufual  with  delirious  perfons  not  to  attend  to  the  ftimulus 
of  the  urine  and  to  refufe  food,  which  by  comprefling  the  cyft  would 
fqueeze  out  the  bile.  Yet  fome  part  of  this  may  have  been  forced  into  the 
ftomach  by  the  draining  to  vomit,  and  have  given  the  aeruginous  colour  to 
the  ejeded  humour.  The  fame  convulfion  alfo  left  a  fleepinefs  behind  it, 
the  brain  being  comprels’d  round  about;  which  fleepinefs  was  frequently 
interrupted  by  the  returning  twitches  of  the  convulfion.  But  was  the  ferum, 
found  at  the  anterior  bafis  of  the  cerebrum,  the  caufe,  or  the  effed  of  the 
convulfion?  ’Tis  no  matter  which  you  believe;  for  whether  we  fuppofe  that 
the  latent  caufe  of  the  convulfion,  by  conftringing  the  veflels  and  giving  a 
remora  to  the  blood,  was  alfo  the  caufe  of  the  ferum  being  effus’d  ;  or  that 
the  ferum  being  firft  extravafated,  by  irritating  the  meninges  which  lie  at 
the  lower  part  of  the  forehead  and  round  the  optic  nerves,  originally  created 
flight  convulfions  and  pains ;  the  cafe  will  be  diffidently  intelligible,  which¬ 
ever  mode  of  explication  we  choofe.  For  it  is  not  neceflary  we  fhould 
believe,  that  becaufe  the  ferum  was  limpid  it  was  confequently  harmlefs; 
fince  it  is  certain  that  falts  which  are  the  moft  capable  of  erofion,  by  no 
means  affed  the  pellucidity  of  water,  when  diffolv’d.  Though,  in  fad  the 
ferum  was  not  altogether  limpid,  but  in  part  fanious.  But  how  that  fanies 
is  to  be  accounted  for,  we  fhall  enquire  in  other  hiftories  of  a  fimilar  nature; 
whether  it  was  a  true  fanies,  or  rather  an  appearance  of  it  only  ( a ).  I  fhall 
now  give  you  the  other  hiftory  from  Valfalva. 

4.  A  man  about  forty  years  of  age,  had  been  liable  many  years  to  a  pain 
in  the  right  hypochondrium,  which  return’d  periodically,  often  attended 
with  vomitings,  and  fometimes  degenerating  into  the  iliac  paffion,  with 
delirium.  He  was  alfo  troubled  with  violent  pains  in  his  head,  which  were 
almoft  conftant,  and  join’d  with  a  defluxion  of  ferum  upom  his  eyes.  This 
man  having  drunk  too  freely  of  wine,  was  foon  after  attack’d  with  his  ufual 
pain  and  vomitings.  However,  he  got  rid  of  both  thefe  complaints  by  an 
undion  which  an  empiric  had  order’d  to  be  applied  to  his  belly.  But  he 
was  immediately  feiz’d  with  a  vehement  heat  in  his  head,  both  internally 
and  externally :  and  the  fame  undion  being  applied  to  his  head,  it  was  atr 

(«)  Infra  numb,  13.  &  epift.  5.  n.  5  &  13. 

tack’d 


Letter  I.  Articles  5,  6.  5* 

tack’d  with  the  moft  violent  pain  ;  and  this  pain  was  accompanied  with  a 
delirium  and  convulfive  motions :  which  cealing  about  an  hour  before  death, 
or  at  leaft  not  being  obfervable,  he  became  apoplectic,  with  a  difficult 
relpiration,  a  foaming  at  his  mouth,  and  a  ftrong  full  pulfe ;  and  in  this 
manner  he  died.  The  face  of  the  carcafe  was  pale,  and  the  limbs  con¬ 
tracted  ;  but  whether  this  happened  from  the  great  coldnefs  of  the  external 
air,  or  from  the  foregoing  convulfion,s  is  uncertain.  The  pericranium  about 
the  finciput,  was  found  much  thickened  by  ftagnating  juices,  which  were 
concreted  into  the  form  of  a  jelly.  There  was  lome  ferum  betwixt  the  pia 
mater  and  brain,  and  fome  alfo  in  the  ventricles  of  the  brain.  Having 
open’d  the  abdomen,  nothing  appear’d  that  was  worthy  of  notice,  except  a  little 
quantity  of  ftagnant  ferum,  and  a  hard  liver. 

5.  Thefe  things  which  come  laft  in  the  difleCtion,  anfwer  to  thofe  that 
went  firft  in  the  hiftory.  The  hardnefs  of  the  liver  fhews  that  the  periodical 
pain  in  the  right  hypochondrium,  depended  on  the  (late  of  the  vifcus ;  for 
in  fuch  a  ftate  it  muft  neceffarily  fecrete  a  vitiated  bile,  which  when  collected 
in  its  cyft,  would  be  plentifully  pour’d  out  into  the  duodenum,  and  give  rife 
to  thofe  pains  in  that  inteftine  and  the  parts  about  it :  and  thefe  pains  by  in¬ 
verting  more  or  lefs  the  mufcular  contraction  of  the  ftomach  and  inteftines, 
often  brought  on  vomitings,  and  fometimes  the  iliac  pafhon  itfelf.  But  when 
the  pain  and  vomitings,  which  had  become  the  more  urgent  as  they  were 
the  more  neceflary  to  carry  off  the  caules  of  the  diforder,  when  encreas’cl  by 
his  late  drunkennefs,  were  fuddenly  fupprefs’d,  part  of  thefe  caufes  ealily 
feiz’d  upon  the  head  which  was  already  weakened  by  its  pains ;  and  this  part 
might  poffibly  have  been  fomewhat  diflipated  by  the  heat,  had  it  not  been 
imprudently  repelled  by  the  unCtion  :  for  by  this  means,  the  morbid  caufe 
became  inherent  in  the  neareft  membrane  without  the  cranium,  in  the  form 
of  a  jelly,  and  violently  diftended  it;  and  within  the  cranium,  by  breaking 
in  upon  the  parts  mention’d,  and  by  irritating  the  pia  mater  where  it  invefts 
the  brain  and  ventricles,  firft  brought  on  thofe  levere  pains,  then  delirium 
and  convulfive  motions,  and  at  length  apoplexy  itfelf.  But  if  you  choole  to 
confider  that  ferum  as  an  effeCt  rather  than  a  caule,  I  fhgll  not  conteft  your 
opinion., 

6.  To  thefe  two  hiftories  give  me  leave  to  add  a  third,  which,  though  it 
does  not  relate  to  a  man,  but  a  fheep,  is  far  from  being  unworthy  of  our  no^ 
tice.  Efpecially  as  Bonetus  in  order  more  fully  to  afcertain  the  feats  of  pain, 
has  given  us  hiftories  of  fheep,  and  other  animals  in^his  Sepulchretum  (*)• 
This  fheep  avoided  herding  with  the  flock,  and  every  day  by  intervals  roll’d 
himfelf  upon  the  earth,  nor  would  fuffer  his  head  to  be  touch’d,  but  avoided 
it  by  all  poflible  endeavours.  Valfalva  obferving  this,  and  being  defirous  to 
know  the  origin  of  the  pain,  purchas’d  and  difleCted  the  fheep;  nor  did  he 
find  any  thing  morbid  elfewhere  than  in  the  brain  :  for  when  he  firft  took  it 
out  from  the  cranium,  a  little  acidulated  water  fell  from  that  part,  where  the 
mamillary  procefs  approach’d  to  the  os  ethmoides.  But  a  greater  quantity 
of  water  was  effus’d,  when  it  was  pull’d  away  from  the  pituitary  gland,  Then 
in  difieCting  the  brain,  when  he  came  to  the  lateral  ventricles,  a  follicle  ap¬ 


pear’d 


{&)  Lib.  1.  fed.  xi.  obf.  8.  &  feft.  9. 


6  Book  I.  Of  Difeafes  of  the  Head. 

pear’d  Therein,  containing  a  good  quantity  of  water,  being  made  of  a  mem¬ 
brane,  which  leem’d  to  be  a  production  of  the  pia  mater,  except  that  fomc 
very  fmall  corpufcles  were  fcatter’d  through  it,  refembling  the  medullary 
fu  bit  an  ce  of  the  brain.  -The  roots  of  the  follicle  came  out  from  the  bottom 
of  the  right  ventricle  :  and  wherefoever  they  were,  below  this  ventricle,  there 
the  fubftance  of  the  brain,  both  in  its  medullary,  and  cortical  part,  was  cor¬ 
rupted  all  round  to  a  confiderable  extent.  In  fnort,  the  whole  brain  was  ex¬ 
tremely  flaccid  ;  neverthelefs  the  difpofition  of  the  nerves  was  as  ufual. 
The  examination  being  carried  on,  that  part  of  the  os  ethmoides  which  lies 
under  the  mamillary  proceffes,  was  found  to  be  fo  much  eroded  by  the  conti¬ 
nual  dripping  of  water  from  the  brain,  as  to  afford  a  free  paffige  from  the 
cranium  to  the  noftriis. 

7.  An  obfervation  nearly  of  this  kind  you  will  find  in  Bonetus’s  Sepul- 
chretum(c),  or  rather  in  the  firft  century  of  the  medico  phyfical  Inftories  of 
Petrus  Borellus,  not  the  thirty-feventh,  but  the  thirty-eighth  obfervation  :  in 
this  I  lay  rather,  becaule  Bonetus  has  omitted  many  things  in  his  copy,  nor 
has  the  other  editor  replac’d  them,  contrary  to  the  admonitions  of  ( d )  Peyerus  ; 
fo  that  by  reafon  of  omifiions  of  this  kind  which  I  have  obferv’d,  not  only 
in  one  place,  but  in  many,  it  were  to  be  wifh’d,  that  we  had  a  new  edition 
of  the  Sepulchretum,  under  the  infpeCtion  of  1'ome  diligent  man,  who  would 
be  at  the  pains  of  comparing  the  ieveral  articles,  with  the  books  from  whence 
they  were  taken.  A  girl  had  been  long  troubled  with  a  violent  pain  in  the 
crown  of  her  head,  in  whom  Borellus  law  an  ablcefs  full  of  the  moll  limpid 
water,  to  the  quantity  of  two  pints,  lying  upon  the  nates  cerebri  and  infun¬ 
dibulum.  From  fo  deep  and  fo  hidden  a  place,  where  the  ablcefs  could 
fcarcely  be  found,  did  this  pain  reach  principally  to  the  crown  of  the  head  ; 
and  thus  in  fome  meaiure  confirm’d  what  we  have  elfewhere  obferv’d  from 
IVlalpighi  (^),  but  render’d  doubtful  what  Archangelus  Piccolhominus  (/) 
has  advanc’d,  that  pains  vyhich  are  felt  at  the  upper,  or  lower  part  of  the 
cerebrum,  are  leated  in  the  pia  mater,  which  invefts  the  lateral  ventricles  of 
the  brain  ;  for  though  this  may  fometimes  be  true,  yet  we  muft  attend  to  what 
was  juft  now  hinted,  that  the  other  parts  which  lie  deeper  than  the  ventricles, 
and  the  bafis  cerebri,  are  invefted  with  the  fame  membrane  alfo,  and  even 
under  that ;  not  to  mention  other  things,  that  the  tranfverfe  procefs  of  the 
dura  mater  is  produc’d  on  both  fides,  quite  to  the  borders  of  the  fella  equina  ; 
and  that  in  fo  tenle  a  ftate,  that  even  on  this  account,  it  might  be  fubjedl  to 
the  fharpelt  pains,  either  from  the  irritating  nature  of  an  extravafated  hu¬ 
mour,  or  only  from  a  quantity  of  the  fame  preternaturally  overloading  and 
diflending  it.  And  that  orher  parts  of  the  meninges,  may  be  opprefs’d  by 
congefted  humours,  obfervations,  which  may  be  added  to  this  firft  fedtion  of 
,  the  Sepulchretum,  will  alfo  fhow,  as  for  inftance,  thofe  made  by  Behrenfius^), 
and  by  Preuffius  (A).  For  it  happen’d  to  both  thefe  gentlemen,  that  fcarcely 
had  the  knife  reach’d  to  the  lateral  ventricles  of  the  brain,  but  the  included 
humour  rufn’d  upwards  with  a  confiderable  impetus  ;  fo  great  was  its  quan¬ 
tity,  and  fo  great  the  force  with  which  it  urg’d  the  fides  of  the  ventricles  and 

(A  L.  2.  f.  1.  obf.  46.  (/)  L.  5.  anat.  praelett.  3. 

(d)  MethoJ.  hift.  anat.  rr.ed,  c.  1  &  fe<j.  (g)  A&.  nat.  cur.  t.  2.  obf.  31. 

it)  Epift.  anat.  13.  n.  7.  (A)  Eph.  n.  c.  cent.  3.  obf.  14.  n.  3. 


the 


Letter  I.  Article  8.  7 

the  membrane  that  inverted  them?  It  is  therefore  not  to  be  wonder’d  at,  if 
the  pains  of  the  head  were  vehement  to  fuch  a  degree,  that  one  of  the  pa¬ 
tients  ran  almoft  mad  with  miferable  howlings ;  and  that  the  other,  though 
a  woman,  was  feiz’d  with  a  fury,  and  threw  herfelf  headlong  into  a  well. 
And  Preuflius  has  fhown,  not  only  in  this,  but  in  two  other  obfervations  (*), 
that  where  the  pain  was  altogether  on  one  fide  of  the  head,  there  the  ventricle 
of  that  fide  only  was  diftended :  and  where  it  affedted  one  fide  chiefly,  and 
the  other  in  part,  there  the  ventricle  of  the  one  fide  was  much  more  diftended 
with  water  than  the  other;  and  though  the  water  was  extremely  limpid,  it 
was  not  the  lefs  noxious  than  if  it  had  been  yellowilh.  For  even  the  moft  lim¬ 
pid  may  contain  an  occult  ftimulus,  as  I  faid  above  (£),  and  as  the  hiftory  of 
Cohauienius  (/)  alfo  proves,  in  which  the  right  fide  of  the  cerebrum  *,  and  this 
it  was  that  fuffer’d  the  moft  vehement  pains ;  fcem’d  as  it  were  to  fwirn  in  a 
great  quantity  “  of  acrid,  fait,  and  perfectly  limpid  ferum.”  Which,  in  other 
obfervations,  as  for  inftance  that  of  Jo.  Francus  (; m ),  whether  it  was  limpid 
or  not,  feems  to  have  been  deftitute  of  ftimulating  particles,  and  to  have 
injur’d  by  preflure  only  :  for  although,  upon  opening  thefkull,  water  was. 
univerfally  found,  yet  the  head  had  been  aftedted  only  with  a  dull  and  heavy 
pain.  But  to  return  to  the  fheep  :  it  is  probable  that  the  pia  mater  which 
cover’d  the  fundus  of  the  right  ventricle,  had  been  pull’d  away  from  the  fub- 
ftance  of  the  brain,  by  the  gradual  congeftion  of  the  water,  and  form’d  into, 
a  follicle  :  and  that  fome  particles  of  the  brain,  which  were  torn  away  with 
it,  gave  that  corpufcular  appearance  I  have  fpoken  of.  As  to  the  water, 
which  was  found  to  be  fomewhat  acid  on  tafting  it,  this  doubtlefs  confirms 
what  has  been  already  advanc’d,  that  water  effus’d  within  the  cranium,  may 
even  fometimes  act  by  vellicating,  fo  as  to  give  rife  to  diforders  of  the  head. 
But  in  regard  to  the  corruption  of  a  part  of  the  brain,  and  the  great  laxity  of 
the  whole,  notwithftanding  that  the  animal  liv’d  and  mov’d  at  the  fame  time,, 
I  fhall  have  a  more  proper  occaflon  of  di  feu  fling  this  iubjedl  hereafter  ( n ).. 
Laft  of  all,  the  erofion  of  the  os  ethmoides  muft  not  be  pafs’d  over  without 
fome  animadverfion. 

8.  As  a  palfage  was  open’d  in  this  manner  from  the  cranium  to  the  noftrils, 
and  conlequently  from  the  noftrils  to  the  cranium,  fo  if  it  ftiould  have  hap¬ 
pen’d  that  any  animalcule  had  been  feen  in  the  brain  of  that  fheep,  our  won¬ 
der  would  certainly  have  been  lels,  than  when  we  read  fo  many  hiftories  col- 
ledted  in  the  Sepulchretum  (0),  fpeaking  of  '(earth-worms  and  other  worms,, 
flies,  and  with  God’s  leave,  even  fcorpions,  having  in  every  refpedt  their  na¬ 
tural  appearances,  as  being  found  within  human  fkulls,  and  thence  account¬ 
ing  for  the  pains  of  the  head.  But  fome  are  without  teftimonies,  fome  want 
a.  more  diligent  examination,  wh;£h  was  certainly  needful ;  and  others,  if  they 
are  compar’d  with  the  books  from  whence  they  were  taken,  will  be  found 
to  have  a.  different  meaning,  as  that  which  is  produced  from  Fernelius  (p). 
For  if  you  turn  to  his  defeription,  you  will  wonder  that  Bonetus  has  been 
filent  upon  fome  things  which  ought  not  to  be  omitted,  eipecially  as  the 

(/)  Eph.  n.  c.  cent.  3.  obf.  14.  n.  1  &  2.  flz)  Vid  epife.  9.  n.  15.  16.  19. 

.(/')  n.  3.  (0)  Seft.  hac  1.  obf.  116  &  feqq. 

(/)  Aft.,  cir.  t.  7.  obf.  74.  (y>)  Paihol.  1.  5.  c.  7. 

f»0  Eqh.  n.  c.  dec  3.  a.  3,  obf.  72, 

deferiptiom 


£  Book  I.  Of  Difeafes  of  the  Head. 

defeription  is  ffiort  ;  and,  if  you  well  weigh  in  the  medical  fcale,  the  fenfe  of 
thole  things  which  immediately  precede,  you  will  readily  acknowledge  that 
thole  two  worms  were  found  without  the  cranium,  in  the  cavities  of  the  noi'e. 
And  it  is  probable  that  of  the  worms,  fpoken  of  in  the  fcholia  which  are 
added  to  thefe  hiftories,  as  difcharg’d  from  the  nofe,  fome  had  liv’d  in  its 
cavities  •,  but  that  others  had  crept  from  the  ftomach  into  the  noftrils,  while 
the  patient  was  sfleep.  Nor  is  it  uncommon  for  worms  to  grow  in  the  frontal 
finufles,  elpecially  in  fheep,  by  the  irritation  of  which  they  are  much  agitated: 
fo  that  any  one  before  diflection,  might  have  fuppos’d  this  had  been  the  cafe 
with  the  fheep  above  mentioned,  fince  he  roll’d  himfelf  in  fuch  agonies  on 
the  ground.  Nay,  and  that  it  fometimes  happens  to  men,  to  have  worms 
form  a  nidus  in  fimilar  places,  and  bring  on  pains  of  the  head,  even  the 
Arabians  formerly,  after  the  opinion  of  the  Indian  phyficians,  deliver’d  down 
in  their  writings,  among  whom  was  Avicenna  (j),  who  gives  the  fymptoms 
and  the  cure  of  the  diforder.  And  thefe  things  are  even  taken  notice  of  in 
thofe  fcholia  ;  and  moreover,  we  are  refcrr’d  to  iEgineta,  book  the  fourth, 
chapter  the  57th,  as  if  he  there  “  granted  that  pains  were  indeed  excited 
“  by  worms,  but  denied  that  they  were  generated  in  the  brain.”  Yet  they 
do  not  for  this  reafon  rejedt  thefe  incredible  hiftories  ;  but  rather  feek  to  con¬ 
firm  them  from  thence  (r),  becaufe,  as  it  appear’d  that  worms  might  be  ge¬ 
nerated  from  putrid  matter  in  the  nofe,  io  they  did  not  doubt  but  the  fame 
might  happen  from  an  abfcefs  within  the  fkull ;  being  led  on  by  an  error 
ealily  pardonable  in  thofe  times,  when  the  ingenious  obfervations  of  our 
Vallifneri  (s)  had  not  yet  demonftrated  that  worms  found  in  the  nofe  of  a  fheep 
were  depofited  by  a  fly*,  nor  the  celebrated  Reaumur,  in  his  incomparable 
hiftory  of  inledls  (/),  had  confirm’d  it.  Since  then  it  is  certain,  that  thefe 
worms  are  carried  from  without  into  the  noftrils  of  fheep,  and  other  animals 
of  that  kind  ;  and  fince  they  are  fo  frequently  found  in  the  noftrils  of  thefe 
creatures,  but  never  in  their  brain,  why  fhould  we  on  the  contrary  believe, 
that  although  they  fo  feldom  are  found  to  exift  in  the  noftrils  of  men,  they 
are  neverthelefs  often  found  to  exift  in  the  human  brain  ?  For  there  is  not  a 
paflfage  from  the  nofe  into  the  brain  of  a  living  perfon,  as  there  is  from  the 
nofe  to  the  frontal  finufles  *,  but  it  is  entirely  Hopp’d  up  with  nervous  fibres, 
and  vefiels  and  membranes,  fo  that  not  even  the  fmoke  of  tobacco,  when 
drawn  up,  much  lei's  the  lmalleft  particle  of  its  fineft  powder,  or  the  fmalleft 
new-born  infect  that  exifts,  can  pal's  through.  And  indeed  there  was  for¬ 
merly  a  time,  when  it  was  affirm’d  from  diffe6tions,  that  the  powder  of  to¬ 
bacco,  and  much  more  the  fmoke  of  it,  had  enter’d  the  brain  *,  and  thefe  ob¬ 
fervations  you  will  in  like  manner  read  in  the  Sepulchretum  (#).  Yet  even 
there  you  will  fee  that  one  is  rejected  as  falfe,  that  others  are  differently  ex¬ 
plain’d,  and  that  ail  are  immediately  invalidated  by  a  greater  number  of  dif- 
fedtions  of  a  contrary  tendency,  that  are  immediately  put  in  contrail  with 
•them  ;  and,  if  it  were  needful,  many  others  of  the  fame  nature  might  alfo  be 
added  to  thefe,  and  particularly  from  the  books  of  the  Csefarean  academy  (x)'. 

(7)  Canon.  ].  3.  F.  1.  tr.  2.  c.  3.  7.  31.  (/)  Tom.  4.  mem.  12. 

(r)  Ad  obf.  117.  (a)  Seft.  ead.  j.  obf.  82.  &  1.  4.  S.  ult. 

P)  Vid.  preefertim  oper.  in  fol.  tom.  2.  p,  4.  obf.  j. 
epiit.  ad  Gimmam.  (*)  Cefaresenat.  cur.  acad.cent.  10.  obf.  89. 

9.  What 


Letter  I.  Article  9.  9 

9.  What  then  ?  yon  will  fay*,  fhall  we  believe  that  no  little  animal,  no 
foot,  no  fnuff,  was  ever  found  within  the  cavity  of  the  fkull  ?  Indeed,  I  fuf- 
pe<5t,  that  whoever  afierts  in  his  writings  his  having  really  feen  fuch  things, 
was  certainly  impos’d  upon,  either  by  the  tricks  of  fome  juggler,  by  chance, 
or  by  his  own  incautioufnefs.  For  you  know  how  deceitful  the  hands  of 
jugglers  are ;  fo  that  a  perfon  who  was  before  aware  of  their  defigns,  cannot 
with  all  his  attention  perceive,  when  they  infinuate  any  thing  into  a  place, 
which  they  pretend  not  to  infinuate:  how  ealily  then  may  a  perfon  be  de¬ 
ceived,  who  is  not  only  not  forewarn’d,  but  intent  on  another  thing  ?  Nor 
is  it  altogether  unlikely  that  we  may  be  impos’d  upon  by  accident  itfelf:  as 
little  infers  may  perhaps  adhere  to  the  fponge,  which  is  generally  us’d  to 
wipe  away  the  blood,  upon  opening  the  fkull,  or  to  dry  up  any  extravafated 
humour;  and  thefe  infedls,  by  the  frequent  application  of  the  fponge,  may 
be  left  behind  in  the  brain.  But  incautioufnefs  would  more  frequently  give 
rife  to  fuch  afifertions :  for  inflance,  when  a  llender  polypous  concretion,  which 
is  white  and  round,  is  taken  for  a  worm  ;  for  it  is  very  rare,  and  very  difficult, 
for  a  true  and  living  worm  to  creep  fo  far  as  into  the  longitudinal  finus,  by 
the  way  which  I  fhall  mention  hereafter;  yet  in  this  finus  du  Verney  (y)  af- 
ferts,  that  a  worm  was  found  (2),  whether  he  really  faw  it  himfelf  or  not.  Or 
the  incautious  obferver  may  have  been  deceiv’d  by  very  fmall  and  crumbly 
concretions  of  matter,  fuch  as  we  often  meet  with  in  the  male  urethra  at  the 
orifices  of  the  proflate  gland,  and  even,  as  I  have  more  than  once  feen,  within 
the  (a)  proflate  itfelf ;  for  thefe  particles  of  matter  exaftly  refemble  the  moifl 
granules  of  tobacco,  both  in  colour  and  form.  Or  it  is  eafy  to  conceive,  that 
a  particle  of  fnuff,  which  was  lodg’d  in  the  frontal  finus,  may  have  been  drawn 
into  the  cavity  of  the  fkull,  by  the  faw  or  knife  of  the  anatomift :  for  it  is 
very  certain,  that  the  fmallefl  dufl  of  tobacco  may  get  into  the  frontal  finus ; 
perhaps  may  fly  in  by  chance ;  or  drop  into  it  if  the  head  were  inverted  ; 
but  may  molt  furely  be  driven  thither  by  the  force  of  expiration.  Or  finally 
a  narrow,  winding,  and  for  that  reafon  let's  obfervable  pafiage,  might  happen  to 
reach  from  an  external  ulcer,  into  the  cavity  of  this  finus  :  and  by  that  means, 
either  in  the  dead  or  the  living  body,  animalcules  might  be  tranfmitted.  Other 
things  I  defignedly  pafs  over;  nor  indeed  is  it  neceffary  to  bring  more  argu¬ 
ments,  efpecially  on  your  account,  as  you  are  fkill’d  in  the  hiflory  of  inledts, 
and  can  very  well  determine  from  thence,  whether  weevils,  gnats,  flies,  fcor- 
,  pions,  and  other  animals,  can  live  and  thrive,  notwithflanding  they  are  flint 
up  in  a  flreight  place,  altogether  depriv’d  of  air,  and  without  proper  nourifh- 
ment  to  fubfifl  on.  And  it  is  certain,  that  from  the  time  in  which  natural 
hiflory  began  to  be  much  fludied,  and  the  feveral  articles  of  it  to  be  fcru- 
puloufly  enquir’d  into,  no  more  obfervations  of  that  kind  came  abroad ;  or 
at  lead  very  few  only,  and  thofe  believ’d  by  as  few  perfons.  Nor  did  any 
difcovery  of  this  kind  ever  happen  to  V alfalva  or  myfelf,  though  former  phy- 
flcians  afiert  it  to  have  happen’d  fo  often  to  them  :  and  yet  the  number  of 
heads  which  Yalfalva  has  examin’d,  is  very  confiderable ;  and  the  number  I 
have  examin’d  myfelf,  is  perhaps  not  much  inferior  to  his.  So  that,  if  I 
ffiould  allow  any  one  of  thefe  gentlemen  to  have  really  feen  fuch  appearances, 

( y)  Hifl.  de  l’acad.  R.  des  Sc.  an.  170c.  (A  Vid.  epifh  Z4.  n,  23.  (*)  Epift.  44.  n.  20. 

Vol.  I.  C  without 


i  o  Book  I.  Of  Difeafes  of  tlie  Head. 

./ 

without  fraud  or  error ;  you  mull  take  it  for  granted  that  I  do  it  rather  from 
a  reverence  for  their  names,  than  from  any  convi&ion  of  my  own  mind. 
Nor  need  it  furprife  you,  that  after  the  molt  fevcre  pains  of  the  head,  no¬ 
thing  elfe  be  faid  to  appear  but  a  worm,  or  animalcule  found  within  the 
cranium,  or  feen  to  come  out  therefrom.  For  there  are  many  caufes  of  pain 
in  the  head,  which  either  lie  on  the  outfide  of  the  cranium  *,  or  if  they  do  exift 
within,  do  not  ealily,  or  perhaps  at  all,  fall  under  the  notice  of  the  fenl'es. 
What  if  they  are  not  fought  after  ?  for  inflance,  when  a  worm  coming  out 
from  the  nofe  of  a  dying  woman,  is  believ’d  to  have  come  from  the  brain ; 
as  if  it  were  really  impoffible,  that  it  fhould  have  crepe  up  there  from  the 
inteftines.  What  if  other  caufes  are  fought  after,  when  they  have  been  al¬ 
ready  found  in  the  brain  ?  and  yet  the  little  worms  which  are  obferv’d  a  day 
after  in  the  water,  where  a  portion  of  the  brain  had  been  macerated,  are 
accus’d  as  the  caufes  of  the  diforder.  Vehement  alfo  were  thofe  pains  which 
two  worms  of  the  caterpillar  kind  created,  before  they  were  thrown  out 
from  the  nofe  j  yet  thofe  learned  men  Littre  (£),  and  Maloer  (r),  who  faw 
them,  did  not  at  all  fufpedt,  that  they  came  from  the  brain  ;  but  accounted 
for  them,  by  fuppofmg  that  they  came  from  the  frontal  finus,  into  which 
the  very  minute  egg  of  the  infeft  had  been  carried  by  the  force  of  refpiration. 
In  like  manner  the  learned  Henckelius  ( d ),  when  he  faw  two  little  worms  like 
weevils  coming  forth  by  the  fame  way,  and  freeing  the  patient  from  the  mod 
violent  tortures  of  the  head,  judg’d  that  they  had  been  perhaps  drawn  up 
into  the  cavities  of  the  nofe,  by  incautioufly  lmelling  to  flowers :  for  the 
young  of  thefe  animals  are  frequently  harbour’d  there,  and  it  is  not  uncom¬ 
mon  for  us,  to  apply  them  clofe  to  our  noftrils,  while  we  make  a  full  and 
ftreng  inspiration.  And  before  him  Gahrliepius  (h),  w’hen  he  faw  worms  dis¬ 
charg’d  from  the  nofe  with  the  fame  good  effe<ft,  becaufe  he  perceiv’d  they 
were  like  thofe  which  are  generated  by  flies,  made  no  doubt  of  aferibing  this 
offspring  to  a  fly.  And  they  were  all  in  the  right,  becaufe  it  was  their  opi¬ 
nion,  that  thefe  animals  did  not  come  from  any  putrefeent  matter,  nor  were 
generated  in  the  cavity  of  the  fkull,  but  proceeded  from  the  fmall  eggs  or 
rudiments  of  animalcules,  carried  from  without,  into  the  receffes  of  the  nofe. 
It  is  rot  fufficiently  agreed  betwixt  the  two  celebrated  men  whom  I  firft 
quoted,  what  kind  of  remedies  are  to  be  applied,  or  in  what  manner,  in  order 
to  bring  out  thefe  worms  from  the  noftrils.  And  this  controverfy  it  is  the 
more  difficult  perhaps  abfolutely  to  decide  upon,  becaufe  the  worms  arc  of 
different  kinds  in  different  cafes  ;  fo  that  it  does  not  feem  pofiible  they  fhould 
always  be  allur’d,  or  put  to  flight  by  the  fame  things.  But  however  this  may 
be,  it  will  certainly  be  cf  advantage  to  know  from  medical  hiftories,  by  what 
methods  they  have  for  the  moft  part  been  drawn  out  •,  to  which  hiftories  you 
will  add  thofe  things  that  are  extant  in  the  A<fts  of  theCsefarean  academy  (/), 
already  commended,  and  thofe  in  the  Commercium  Laterarium  Norimber- 
genfe(o-),  but  efpecially  what  we  read  in  the  le&ures  of  the  great  Boerhaave 
on  his  inftitutiones  Rei  Medicae  {b)t  where  he  mentions  a  girl  cured  by  him, 

( b }  Hift.  de  l’acad.  R.  des  Sc.  an.  1708.  (f)  T.  4.  obf.  30. 

(<•)  Et  an.  1733.  (g)  A.  1739,  Hcbd*  21.  II.  n.  3. 

ftO  Aft.  nat.  cur.  d.  3.  obf.  no.  (/?)  Ad.  §.  792. 

(e)  Eph.  nat.  cur.  dec.  3.  A.  8-.  obf.  141. 


whofe 


Letter  I.  Article  10.  -  11 

whofe  pituitary  finuffes  were  all  full  of  worms.  But  as  they  chiefly  inhabit 
the  frontal  finuffes,  which  is  indicated  by  the  pain  beginning,  and  being  the 
moft  troublefome,  in  the  region  of  either  finus,  efpecially  when  join’d  with  a 
fenfe  of  motion  and  gnawing ;  Littre  therefore  judg’d  it  proper,  that  if  all 
other  afiiftances  fail’d,  the  aid  of  furgery  fhould  be  call’d  in,  as  an  operation 
on  the  frontal  bone  was  neither  difficult  nor  dangerous.  And  I  do  not  doubt 
but  he  meant  to  recommend  the  fame  operation  which  Caefar  Magatus  formerly 
us’d,  as  I  have  heard  from  Vallifneri  ;  that  is,  to  trepan  the  bone  quite  into 
the  finus,  and  to  take  out  the  worm,  which  he  had  predicted  was  contained 
there,  to  the  great  admiration  of  the  fpedlators  ;  and  thus  he  happily  rid  the 
patient  of  the  pain,  againft  which  all  other  applications  had  been  of  no  ef¬ 
fect.  And  if  Vallifneri  had  publifhed  the  account  of  this  cure  from  the 
manufcript  of  the  author,  as  1  hop’d  in  my  Adverfaria  (*'),  I  fliould  perhaps 
have  learn’d  among  other  things,  not  unworthy  to  be  known,  whether  the 
fame  fuccefs  attended  the  clofing  up  of  the  expos’d  finus,  that  had  attended 
the  trepanning  of  the  bone;  for  how  much  difficulty  there  is  to  bring  that 
about,  Cornelius  Celfus  has  already  obferved  (i) ;  and  after  him  the  furgeons 
commended  by  Palfin  (/)  and  Palfin  himfelf  has  alfo  obferved  the  caufes 
of  this  difficulty,  and  the  great  mifchiefs  that  arife  from  this  finus  not  being 
clos’d  up  ;  and  in  like  manner  that  excellent  archiater  Nicolaus  Rofenius  (*»), 
whom  I  faw  while  I  was  revifing  this  letter;  and  from  him  you  may  feledt 
many  things  to  be  compar’d  with  Verheyen  (w),  who  feems  to  fpeak  of  the 
fame  ftage-quack  as  Palfin ;  and  to  be  added  to  what  1  have  already  given 
out  (o),  upon  that  obfervation  of  Celfus.  But  if  you  would  have  further  ex¬ 
amples  of  worms  found,  as  they  fay,  within  the  fkull,  or  thrown  out  from 
the  cavities  of  the  nofe,  you  will  meet  with  both  kinds  of  them,  among 
thofe  things  which  Daniel  Le  Clerc(y>)  has  related,  and  intermix’d  with  re¬ 
marks  for  the  moft  part:  of  the  fecond  kind  you  will  find  many  among  the 
inftances  taken  notice  of,  or  propofed  by  John  Saltzman  (q),  who  has  neg¬ 
lected  neither  to  mention  the  fymptoms  of  them,  nor  the  methods  by  which 
they  were  difcharg’d. 

io.  But  I  will  now  give  you  three  obfervations  of  my  own,  which  are 
taken  from  patients,  with  whom  pain  in  the  head  was  either  the  firft  fymptom, 
or  at  leaft,  the  moft  troublefome  one  among  others.  A  beggar  man  was  re¬ 
ceiv’d  into  the  hofpital,  who  certainly  had  long  before  had  a  diforder  in  his 
head ;  he  had  always  been  filly,  but  of  late  fo  deftitute  of  fenfe,  that  he 
threw  away  even  the  bread  which  he  had  begg’d.  It  appear’d  he  had  been 
much  liable  to  pains  of  the  head,  and  at  that  very  time  labour’d  under  ob- 
ftrudtions  of  the  belly.  He  dying  of  a  kind  of  fever  which  came  upon  him, 
his  body  was  brought  into  this  anatomical  theatre,  in  the  year  1728,  much 
emaciated,  yet  not  difcovering  any  figns  of  diforder  in  the  belly  or  cheft,  if 
you  except  an  obftruftion  of  the  fpleen  ;  but  when  the  fkull  was  fawed 
through,  and  the  upper  part  taken  off,  it  was  obferv’d  that  the  dura  mater 


(/)  VI.  animad.  90. 

(^)  De  medicina,  ].  8.  c.  4. 

(/)  Anat.  du  corps  hum.  1.  2.  tr.  4.  ch.  15. 
(m)  Diflert.  de  off.  Calvar,  p.  1.  n.  28. 

(«)  Anat.  du  corps  hum.  1.  1.  tr.  4.  ch.  16. 

.  c 


(0)  Epift.  in  Celf.  4. 

Ip)  Hift.  Jator.  lumbric.  c.  13. 

(^)  Diflert.  de  verme  paribus  excuflo  §  4. 
.6.  1 1.  &  feqq. 


was 


i  2  Book  I.  Of  Difeafcs  of  the  Head. 

was  firmly  attach’d  to  it  on  the  left  fide  of  the  forehead ;  and  there  for 
fome  fpace  this  meninx  was  not  membranous,  but  had  degenerated  into  a 
middle  date  betwixt  a  bone  and  a  ligament,  and  form’d  the  figure  of  an 
ellipfe.  Though  the  cerebellum  was  loft  and  flaccid,  and  the  medulla  ob¬ 
longata  not  very  firm  ;  yet  the  cerebrum  I  found  to  be  hard,  as  is  frequently 
the  cafe  in  idiots :  notwithftanding  there  was  a  little  limpid  water  in  the  late¬ 
ral  ventricles,  with  colourlefs  plexufles,  on  the  pofterior  part  of  which  a  few 
vehicles  appear’d,  fill'd  with  the  fame  limpid  water.  Finally,  fomething  yel¬ 
low  adher’d  to  the  anterior  part  of  the  pineal  gland,  which  when  comprefs’d 
betwixt  my  fingers,  1  perceiv’d  to  have  a  kind  of  fand  intermix’d  with  it. 

i  r.  Thefe  appearances  relate  to  different  affedlions,  as  I  (hall  fliew  in  the 
courfe  of  thefe  letters  (r) :  and  that  only,  to  the  pain  of  the  head,'  which  v/as 
found  in  the  dura  mater.  For  whatfoever  the  caufe  might  be,  whether  in¬ 
ternal  or  external,  of  the  dura  mater  being  indurated,  almoft  to  the  con¬ 
fidence  of  a  bone,  though  no  traces  of  this  caufe  were  obvious  to  me;  yet 
it  is  eafy  to  imagine,  that  as  often  as  the  blood,  either  by  its  plenty,  or  by 
its  turgefcency,  or  by  its  motion  being  accelerated  through  the  head,  put  a 
force  upon  the  veflels  going  to  this  part,  it  nmft  necefiariiy  be  obflructed  by 
that  impediment  to  its  courfe,  and  diftend  the  fibres  which  furround  the 
veflels  of  the  dura  mater.  And  you  will  fee  it  is  aferib’d  to  this  caufe  in  the 
Sepulchretum  (/),  that  thofe  perfons  were  tc  fubjedl  to  the  moft  miferable 
“  head-aches,  in  whom  the  two  meninges  for  fome  fpace,  often  two  fingers 
“  breadth,  had  coalefc’d  in  fuch  a  manner  with  each  other,  that  the  mouths 
“  of  the  veflels  were  entirely  lock’d  up.”  And  it  is  probable  that  obftacles  of 
this  kind,  as  far  as  they  oppofe  the  circulation  of  the  blood,  or  other  juices, 
through  the  meninges,  may  fometimes  give  occafion  to  pains  which  return 
periodically;  as  often,  for  inftance,  as  a  fufficient  portion  of  juices  is  ob- 
ilrudled,  to  caufe  a  diftenfion  by  its  weight;  and  this  cbltruflion  will  conti¬ 
nue,  till  the  fluids  being  vitiated  thereby,  fhall  irritate  the  meninges,  and 
confequently  bring  on  a  contradlion  of  their  fibres  ;  yet  no  fooner  is  the  firfl: 
portion  of  thefe  obitrufted  juices  thruft  on  by  this  new-excited  force,  into  the 
narrow,  and  lateral  canals,  but  a  new  portion  fucceeds,  and  is  in  the  fame 
manner  delay’d,  and  expell’d;  to  this  others  alfo  fucceed  ;  nor  is  there  an  end 
of  the  diforder,  till  the  lateral  canals  are  by  thefe  repeated  impulfes,  fo  far 
dilated,  that  they  no  more  refill  the  circulation  of  the  juices.  But  pains  of  this 
kind  are  generally  either  the  forerunners  of  a  fatal  event  (/),  or  rarely,  and  with 
difficulty,  admit  of  a  cure ;  and  the  more  fo,  as  they  more  conftantly  recur 
at  the  fame  hour ;  perhaps  becaufe  by  this  regular  return  it  is  prov’d,  that 
the  lateral  canals  more  ftrongly  refill  the  dilating  impulfe.  I  remember  when 
I  was  a  young  man,  I  had  a  patient  among  my  companions,  in  the  place  of 
my  birth,  by  name  Lawrence  Bagattrini,  who  had  been  feiz’d  not  long  be¬ 
fore  with  an  external,  but  very  violent  hemicrania,  which  return’d  every  day 
at  the  eleventh  hour,  according  to  the  method  of  reckoning  the  hours  among 
the  Italians.  Whatever  I  did,  had  either  no  effedl  at  all,  or  at  leall  only 
that  of  fhortening  and  alleviating  the  pain,  for  it  Hill  return’d  at  the  fame 

(0  Vid.  Eph.  n.  c.  cent.  3.  obf.  14.  n.  1. 
Sc  3.  &Dec.  3.  a.  7.  append,  pag.  74.  obf. 75. 

hour  i. 


(r)  V15.  viii.  n.  13. 

(/)  Sedfl  hac  1  obf.  12. 


Letter  I.  Articles  12,  13.  1  3 

hour*,  and  if  any  little  error,  or  irregularity,  was  committed,  it  return’d  with: 
its  former  vehemence.  Having  for  many  days  us’d  all  ether  remedies  in- 
vain,  I  at  length  got  the  better  of  the  diforder,  by  means  of  a  flight  decoc¬ 
tion  of  the  woods-,  which  gently  agitating  and  impelling  the  circulating 
juices,  threw' the  patient  into  lweats,  and  reliev’d  him  of  his  diforder.  And 
Ballonius («)  teftifies,  that  the  fame  method  fucceeded  with  him  allb,  in  in¬ 
tolerable  hemicranias,  that  return’d  every  day,  at  a  certain  hour.  In  the 
cafe  of  this  young  man,  there  was  certainly  fomething  hereditary ;  for  his 
mother,  who  was  more  than  leventy  years  of  age,  had  been  feiz’d  a  little  be¬ 
fore,  with  fo  great  a  pain  in  her  head,  that  fhe  loft  the  fight  of  one  eye ;  yet: 
{he  was  {till  afflidled  with  violent  pains,  which  recurr’d  from  time  to  time. 
But  as  thefe  pains  did  not  begin  always  in  the  fame  place,  but  fometimes  in 
the  vertex,  and  fometimes  within  the  nofe,  (fo  that  fluffing  up  warm  milk 
was  of  fervice)  and  did  not  return  at  the  fame  hour,  I  found  more  eafe  in 
removing  the  pain  of  the  mother,  than  that  of  the  fon  and  being  cur’d  of 
her  pain,  the  fight  of  her  eye  was  by  degrees  reftor’d.  Among  other  things, 
bleeding  was  of  fervice  to  her  j  but  not  fo  much  what  was  perform’d  by  my 
order,  as  what  fhe  perform’d  for  herfelf,  by  untying  the  bandage  from  her 
arm  in  her  fleep,  by  which  fhe  loft  a  confiderable  quantity:  fo  that  nearly 
the  fame  fuccefs  attended  bleeding,  even  in  a  woman  of  that  age,  which  Val- 
lifneri  ( x )  afterwards  remark’d  in  one  of  fixty.  But  let  us  return  to  the 
difieftions. 

12.  A  young  woman,  who  was  the  wife  of  a  poor  man,  and  the  daughter 
of  an  epileptic  mother,  being  extremely  hot  after  a  journey  in  the  month  of 
February,  was  feiz’d  with  a  violent  pain  in  her  head,  and  an  acute  fever. 
She  had  no  delirium,  but  was  often  refervedly  filent;  and  with  thefe  fymp- 
toms  in  three  or  four  days  fhe  died.  As  fhe  gave  fuck,  and  yet  had  her 
menftrua  upon  her,  bleeding  was  for  a  long  time  deferr’d ;  but  as  fhe  grew 
much  worfe,  and  yet  the  pulfe  and  flrengtn  of  the  arteries  was  firm;  half  a 
pound  of  blood  was  taken  from  her  foot,  which  was  quickly  and  ftrongiy 
coagulated ;  but  it  happen’d  that  her  death  immediately  follow’d  the  lofs  of 
it.  The  head  was  brought  into  the  theatre  to  finifh  the  anatomy  of  that 
year  1738;  but  not  the  other  parts,  as  I  wifh’d.  The  infide  of  the  fkulF 
had  a  fomewhat  red  appearance  degenerating  into  brown  -,  and  the  outfide  of 
the  pia  mater,  where  it  cover’d  the  upper  part  of  the  brain,  was  fmear’d 
over  with  a  yellowilh  kind  of  matter,  not  much  indeed  in  quantity,  but 
fpread  equally  all  over;  its  confiftence  was  fomewhat  thick,  and  though  it 
was  perfectly  inodorous,  yet  from  the  whole  of  fits  appearance,  it  feem’d  to 
myfelf,  and  to  the  other  phyficians  and  furgeons  who  were  prefent,  to  be  pus. 
However,  we  could  not  find  any  where,  in  the  meninges,  or  cerebrum,  which- 
was  difcolour’d,  any  traces  of  diforder,  or  any  place  from  which  we  might 
fuppofe  this  matter  had  proceeded. 

13.  If  it  was  really  pus,  lhall  we  fuppofe  that  it  was  taken  up,  from  fome 
other  part  of  the  body,  by  the  fanguiferous  vefiels,  and  tranflated  to  the' 
head,  agreeably  to  what  is  hinted  of  a  fimilar  cafe  in- the  Sepulchretum  (jy) 

(k)  Epidem.  lib.  2.  conft,  hyem.  a.  1575.  (•*)  Eph.  n-  c.  cent.  5.  obf.  7. 

i  v)  Sed»,  hac  1 .  obf.  40, 

Certainly/ 


i  4  Book  I.  Of  Difeafes  of  the  Head. 

Certainly  for  this  reafon,  I  fhould  have  been  much  more  chagrin’d,  that  I  was 
not  permitted  to  examine  the  reft  of  the  body,  in  order  to  have  determin’d 
the  queftion  ;  had  not  the  rationale  of  the  cafes  been  different,  and  other 
hiftories  come  under  my  knowledge,  wherein,  as  in  that  of  Valfalva  before 
mention’d  (2),  no  fanies  was  any  where  found  but  about  the  brain,  which 
was  itfelf  in  every  other  refpeCt  found.  Could  this  pus-like  matter  then, 
have  its  origin  from  the  finall,  and  almoft  in vifible  foramina,  of  the  meninges, 
from  which,  in  a  natural  ftate,  only  a  little  limpid  humour,  to  moiften  their 
furfaces,  is  difcharg’d  ?  could  it  be  prefs’d  out  by  the  force  of  the  difeafe,  as 
frequently  happens  to  the  glands  of  the  reCtum  and  bladder  in  the  tenefmus 
or  dyfuria.  Certainly,  that  the  meninges  were  entirely  free  from  difeafe, 
neither  the  violent  pain  of  the  head,  nor  the  colour  of  the  fkull,  where  it 
was  contiguous  to  the  meninges,  fuffer  us  to  believe. 

14.  Speaking  of  that  colour  brings  to  my  mind  the  hiftory  of  another 
woman,  whofe  head  I  differed  in  the  beginning  of  the  year  1717.  Being 
firft  affefted  with  the  lues  venerea,  and  after  that  with  a  fever,  join’d  to  fe- 
vere  pains  of  the  head  and  delirium,  Hae  died  of  this  complication  of  disor¬ 
ders  in  the  hofpital  at  Padua. 

Her  fkull  alfo,  when  it  was  open’d,  appear’d  of  a  blackifh  red  in  fome 
places ;  and  the  dura  mater,  where  it  lay  neareft  to  the  upper  and  middle 
region  of  the  lateral  finus  on  the  right  iide,  was  much  thicken’d,  and  per¬ 
fectly  coalefc’d  with  the  pia  mater,  and  even  with  the  fubftance  of  the  brain  : 
the  meninges  and  brain  were  in  that  part  alfo  femiputrid,  and  glar’d  with  a 
very  difagreeable  colour,  which  was  compos’d  of  a  yellowifh,  mix’d  with  an 
afh  like  hue,  efpecially  in  the  cortical  part  of  the  cerebrum.  Moreover,  the 
external  furface  of  the  cerebellum  was  fo  firmly  connected  with  the  two  me¬ 
ninges,  that  when  I  drew  it  out  from  the  cavity  of  the  dura  mater,  a  part  of 
its  fubftance  was  left  adhering  thereto.  But  the  extent  of  the  adhefion  was 
not  fo  great  as  in  the  cerebrum,  as  it  did  not  exceed  the  breadth  of  two  fin¬ 
gers.  The  veffels  of  the  brain  likewife,  which  creep  through  the  pia  mater, 
were  larger  than  they  naturally  are,  and  diftended  with  a  black  blood,  fuch 
as  was  alfo  found  in  the  finufies  of  the  dura  mater.  And  through  the  me¬ 
dullary  fubftance  of  the  brain,  when  diffefted  piece-meal,  the  fanguiferous 
veffels  appear’d  to  be  very  frequent  in  feveral  places,  and  more  diftinCt  than 
ufual.  The  lateral  ventricles  were  full  of  a  brownifh  water,  with  which 
colour  alfo  their  furfaces  were  tinged.  Finally,  the  pineal  gland  was  firmer, 
larger,  and  whiter  than  common  ;  and  feem’d  to  contain  within  it  a  kind  of 
loculi  or  cells.  I  will  not,  however,  conceal  a  remark,  which  may  be  join’d  to 
that  curious  obfervation  extant  in  the  Commentaries  of  the  imperial  academy 
at  Peterfburgh  ( a ) ;  I  mean,  that  from  the  birth,  or  at  leaft  from  early  infancy, 
the  woman  had  this  peculiarity  in  her  fkull,  that  the  right  fide  pofteriorly, 
had  a  larger  curve  outwards  than  the  left;  for  which  reafon  its  internal  ca¬ 
vity,  and  the  hemifphere  of  the  brain  contain’d  therein,  were  evidently  larger 
en  that  fide  than  the  other.  The  fame  circumftance  occurr’d  to  me  alfo  in 
another  woman  (/*),  and  feem’d  the  more  worthy  of  attention,  becaufe  the 
whole  cavity  of  the  fkull  was  made  oblique  and  winding;  the  right  temple 
being  more  hollow’d,  the  left  more  contracted ;  and  vice  verfa ,  the  right 

(a)  Tcm.  7.  p.  222  &  feq.  (£)  Vid.  ut  in  aliis  quoque,  epift.  62.  n.  15. 

fide 


(*)  N.  2. 


Letter  I.  Articles  is,  i  6.  15* 

lide  of  the  occiput  being  more  contradted,  anfwered  to  the  lefr,  which  was 
more  hollow’d.  But  though  in  this  woman  alfo  the  lateral  ventricles  were 
full  of  a  turbid  water,  yet  as  this  hiftory  does  not  immediately  relate  to  our 
prefent  fubjedt,  we  fhall  for  that  reafon  give  it  you  hereafter  (7). 

15.  For  I  do  not  know  whether  this  woman  had  been  fubjedt  to  pains  of 
the  head;  nor  yet  whether  fhe  whofe  hiftory  was  juft  now  related  in  full, 
had  been  troubled  with  them  before  fhe  was  afflidted  with  a  fever :  notvvith- 
ftanding,  I  know  very  well  from  other  obfervations,  “  that  a  mifhapen  figure 
“  of  the  head  is  believ’d  to  be  of  great  confequence,  in  bringing  on  obfti- 
tc  nate  pains which  words  are  copied  in  the  Sepulchretum  ( d )  all'o,  but  the 
author’s  name,  to  wit,  Rolfinc  (<?),  through  negledt,  is  omitted.  But  to  re¬ 
turn  to  the  hiftory  deferibed.  If  this  woman,  and  the  other  young  woman 
fpoken  of  above  (f)  in  like  manner,  had  been  men,  and  almoft  continually 
employed  in  fmoking  tobacco,  that  brown  and  almoft  black  colour  obferved 
on  the  infide  of  their  fkulls,  fome  would  have  thought,  and  efpecially  for¬ 
merly,  very  eafily  to  be  accounted  for  from  thence ;  that  is,  from  the  foot  and 
dregs  of  the  fmoke  being  drawn  up  and  harbour’d  there  ;  nor  indeed  did  they 
negledt  to  account  for  it  from  thence,  as  we  have  (hewn  by  what  goes  be¬ 
fore  (g).  We  however,  as  fome  rednefs  was  mixed  with  that  colour,  did  not 
hefitate  to  attribute  it  to  the  ftagnating  blood.  For  though  the  woman  la¬ 
boured  under  a  lues  venerea,  yet  there  was  no  where  any  caries  in  the  (leu If, 
which  from  the  (harp  pains  might  pofiibly  have  been  fufpedted  with  fome 
reafon ;  although  the  external  furface  of  the  head  gave  no  mark  of  it  either 
by  colour,  or  tumor.  And  this  is  evident  from  many  obfervations,  but  efpe¬ 
cially  from  that  of  the  beautiful  (trumpet,  which  I  remember  to  have  heard 
from  Novefio  at  Bologna,  who  afterwards  publilh’d  it  (h).  The  thicknefs 
then  of  the  dura  mater,  and  its  coalition  with  the  interior  lamina  of  the  (hull, 
is  fufficient  to  account  for  the  remora  of  the  blood  in  the  fmall  vefiels,  as 
we  fhall  (hew  elfewhere.  And  I  think  it  is  equally  fufficient  to  account  for 
thofe  pains,  even  from  the  arguments  which  were  above  (i)  fet  forth. 

16.  And  that  you  may  more  fully  underhand,  how  coalitions  of  that  kind, 
by  being  an  impediment  to  the  blood,  may  bring  on  pains  of  the  head,  re¬ 
member,  that  as  fome  of  the  fanguiferous  vefiels  are  veins,  and  fome  arteries, 
the  blood  which  is  carried  through  the  latter,  will,  when  it  meets  with  an  ob- 
ftacle,  whereby  its  progrefs  is  made  flower,  not  only  injure,  by  diftending  the 
fibres,  but  alfo  by  encreafing  the  ftrokes  of  the  vefiels.  That  is  to  fay,  as 
many  arterial  pulfations  as  there  are  in  the  meninges,  fo  many  ftrokes  will 
they  receive  ;  and  thefe  ftrokes  will  be  fo  much  the  greater,  as  the  tranfit  of 
the  blood  is  more  difficult.  Thus  Brunnerus  (£)  attributed  the  violent  pains 
of  the  head,  in  a  man  whofe  dura  mater  was  befet  with  many  verrucas  of  the 
bignefs  of  a  pea,  which  were  fcattered  up  and  down,  but  efpecially  about  the 
ramifications  of  the  arteries,  to  the  feveral  ftrokes  of  thefe  vefiels ;  although 
he  confidered  the  force  of  the  diftenfion  only,  and  not  of  the  percuffion. 
However,  not  only  coalitions,  by  diminiftiing  the  capacities  of  the  vefiels, 

(r)  Epift.  12.  n.  2  (fj  N.  12  (^)  N.  8 

(d)  Seft.  hac  i.  Tub  obf.  46  (£)  Lettres  1.  6 

( e )  Ord.  &  meth.  cognofe.  dolorem  cap.  1.  2.  (?)  N.  11 

f.  2.  art.  1 .  p.  1.  c.,24  ( k )  Eph.  n.  c.  cent.  1.  obf.  69 


which 


i  6  Book  I.  Of  Difeafes  of  the  Head. 

which  pafs  through  them,  but  alio  whatever  by  pricking  and  vellicating,  or 
comp  re  fling,  can  produce  the  fame  effedls,  will  give  occafion  to  pains  of 
the  head. 

By  pricking  did  that  fharp  bony  particle,  fltuated  betwixt  the  meninges, 
give  occafion  to  pain,  of  which  you  will  read  in  oblervat.  iii.  an.  vii.  dec.  iii. 
Ephemer.  Caefare^  Nat.  Cur.  Academ.  And  by  comprefling,  that  interior  ex- 
oftofis  of  the  cranium,  defcrib’d  in  obfervation  ccliii.  dec.  iii.  an.  x.  the  blood 
being  thereby  fo  obftrudted  in  the  meninges  in  like  manner,  that  they  were 
almoft  a  finger’s  breadth  in  thicknefs,  and  had  the  appearance  of  fungous 
flefh  :  as  alfo  that  in  cent.  vi.  obferv.  xxi.  which  by  the  remark  added  to  it, 
does  not  Hand  alone ;  but  efpecially  that  which  is  extant  in  obfervation  xcix. 
vol.  ii.  of  the  Acts  of  the  fame  academy.  And  I  defignedly  coliedt  you  fe- 
veral  examples  from  the  lets  antient  books,  becaufe  I  fee  that  many  things 
from  tbofe  books  which  were  publifh’d  before  the  fecond  edition  of  the  Se- 
pulchretum,  have  been  defervedly  transferr’d  thither. 

17.  Nor  do  we  want  examples  taken  from  other  obfervators,  to  add  to 
thefe ;  two  of  which  I  will  mention,  as  they  are  not  inelegant  obfervations, 
and  are  much  to  the  purpofe  of  the  above  difiedtion  of  the  woman  ;  for  they 
fhew,  that  too  great  a  quantity  of  blood  diftending  the  veflels  within  the 
fkull,  will  create  pains  of  the  head.  One  example  is  that  given  by  Cowper 
in  his  Englifh  Anatomy  of  the  human  body,  or  if  you  have  not  this  book, 
in  the  Adta  Erud.  Lipf.  (/),  and  another  you  will  read  in  the  Commercium 
Laterarium  (m).  The  firil  example  is  of  a  man,  who  from  his  youth  had  been 
liable  to  the  pain  of  which  we  fpeak,  in  a  violent  degree;  and  in  him  the 
vefiels  of  the  dura  mater  were  fo  diftended,  as  to  equal  the  bignefs  of  a 
goofe-quill.  And  left  you  fhould  imagine  that  this  happened  on  the  attack 
of  the  apoplexy,  which  was  his  late  and  final  difeafe,  I  will  prove  to  you 
that  this  phenomenon  was  of  a  very  early  date ;  for  the  fulcior  beds  of 
thefe  vefiels,  in  the  internal  lamina  of  the  fkull,  were  fo  deep  and  fo  large, 
as  to  anfwer  entirely  to  the  thicknefs  of  the  vefiels  themfelves.  And  to  this 
obfervation  you  may  alfo  add  a  fimilar  one  of  Bajerus  ( n ).  The  fecond  ex¬ 
ample  is  that  of  a  woman,  who  in  like  manner  had  been  fubjedt  from  her 
youth  to  great  pains  in  her  head  *,  and  thefe  were  always  encreas’d  in  pro¬ 
portion  to  the  encreas’d  quantity  or  rarefadtion  of  the  blood.  For  in  her  the 
right  kidney  being  out  of  its  proper  fituation,  had  fo  comprefs’d  the  aorta 
and  vena  cava  againft  the  lower  vertebrae  of  the  loins,  that  where  this  vein 
receiv’d  the  tfood  of  the  left  iliac,  a  varix  was  form’d,  the  diameter  of 
which  exceeded  the  diameter  of  the  cava  in  almoft  a  double  proportion  :  and 
from  this  it  is  manifeft,  that  in  proportion  as  the  blood  was  impeded  in  its  free 
courfe  to  the  lower  extremities,  the  greater  quantity  muft  have  been  confe- 
^quently  carried  to  the  upper  parts,  and  to  the  head  itfelf.  And  you  eafily 
fee  what  thefe  examples  tend  to  prove ;  to  wit,  that  the  quantity  of  blood 
with  which  I  faw  the  vefiels  of  the  meninges,  and  the  minute  veflels  of  the 
brain,  diftended  fo  as  to  enlarge  their  peripheries,  was  fufficient  to  account 
for  thofe  fevere  pains  of  the  head,  with  which  the  woman  had  been  affedted. 

(!)  A.  1699  M.  Feb.  ad  Tab.  91  ( m )  A.  1744  Hebd.  43.  1 

fo)  Aft.  n.  c.  t.  3.  obf.  121. 


18.  As 


Letter  II.  Articles  i,  2.  17 

18.  As  to  the  other  things  which  the  hiftory  contains,  Tome,  for  inftance 
the  circumftance  of  water  being  found  in  the  ventricles,  I  have  explain’d 
already  (0)  •,  and  the  remaining  circumftances  will  be  explain’d  elfewhere. 
For,  as  I  faid  in  the  beginning,  pain  of  the  head  is  generally  complicated 
with  other  diforders.  Thus  I  have  given  you  what  occurr’d  to  me  at  prefent 
concerning  this  diforder :  and  fliall  go  on  to  confider  others  in  the  fame  man* 
ner,  if  thefe  firft  obfervations  fnould  not  be  difagreeable  to  you.  Farewel. 


LETTER  the  SECOND. 

Which  treats,  firft,  of  the  Apoplexy  in  general ;  and  then  in 
particular  of  the  Sanguineous  Apoplexy. 

1.  T70U  tell  me,  that  you  was  pleafed  with  my  late  letter  on  pain  in  the 
X  head :  but  that  you  expedt  thofe  which  fhall  relate  to  the  apoplexy, 
and  other  diforders  in  their  courfe,  will  be  fo  much  the  more  agreeable  to 
you,  as  the  diforders  are  more  grievous,  and  attended  with  more  danger. 
You,  at  the  fame  time,  afk,  whether  the  apoplexy  be  really  more  frequent  in 
thefe  days  than  before,  fince  you  fee  two  learned  phyficians  of  different  opi¬ 
nions  :  and,  what  is  ftill  more  wonderful,  as  you  find  both  of  them  appealing 
to  Celfus  for  a  confirmation  of  their  opinions. 

2.  To  begin  then  with  this  enquiry  :  It  cannot  be  deny’d  that  the  following 
paffage  is  found  in  Celfus  (a) :  Attonitos  quoque  raro  videmus ,  quorum  &  cor- 
pus ,  Gf  mens,  Jiupet.  Fit  interdum  idtu  fulminis,  interdum  morbo ,  hunc  atoot^Uv 
Graeci  appellant.  “  It  fometimes  alfo  happens,  though  but  rarely,  that  we 
“  fee  perfons  fuddenly  ftricken,  fo  as  to  have  both  body  and  mind  render’d 
“  utterly  inadtive.  It  is  fometimes  the  effedt  of  a  thunderftroke,  and  fome- 
fct  times  of  difeafe  ;  the  Greeks  call  it  apoplexy.”  But  neither  can  it  be  de¬ 
ny’d,  that  having  juft  propos’d  a  very  fhort  method  of  cure  for  thefe  atto¬ 
niti,  or  fuddenly  ftricken,  he  goes  on  to  fubjoin  ( b ),  At  refolutio  nervorum 
frequens  ubique  morbus  eft.  Sed  interdum  tota  corpora ,  interdum  partes  infeftat. 
Veteres  authores  illud  «,Voxah£i/su'  ;  hoc  w&p&hveiv  nominarunt.  Nunc  utrumque 
'xapxMiriv  appellari  video.  “  But  a  refolution  of  the  nerves  is  every  where 
“  a  frequent  difeafe.  Sometimes,  however,  it  attacks  the  whole  body ; 
“  and  fometimes  a  part  of  it  only.  Antient  authors  have  call’d  the  firft 
“  apoplexy :  the  laft  paralyfis.  But  now  I  fee,  that  each  of  them  is 
“  term’d  paralyfis.”  But  do  not  imagine  that  this  apoplexy,  which  he  fays 
was  fo  common  every  where,  and  was  at  that  time  us’d  to  be  call’d  para¬ 
lyfis,  was  a  palfy  of  the  whole  body,  rather  than  a  true  apoplexy ;  for  you 
muft  obferve,  that  not  only  the  whole  body  was  refolv’d  by  it,  fo  that  it 
might  be  call’d  paraplexia  (r),  but  alfo  that  it  fufpended  the  adtion  of  the 

ft)  N.  3  ft)  Vid.  Galen,  apud  Gomeum  defin,  med. 

(a)  De  medicina  1.  3.  c.  26  to'  ri. 

(b)  Initio  Icq.  c.  27  (<J)  Cit.  cap.  27 

•  VOL.  I, 


D 


mind : 


1 8  Book  I.  Of  Difeafes  of  the  Head. 


mind  :  for  in  his  method  of  cure  for  this  diforder,  Celfus  {d)  prefently  pro¬ 
nounces,  pofi  J 'anguinis  miffimem  ft  non  redit  &  motus  &  mens ,  nihil  ftei  fu - 
•pereffe •,  “  if  after  bleeding  motion  and  fenfe  do  not  return,  there  remains 
“  no  hope  f  not  to  add  a!fo,  that  a  paraplexy  often  fucceeds  to  an  apo¬ 
plexy  (e)  fo  that  if  the  one  is  frequent,  the  other  of  courle  cannot  be  rare. 
What  diforder  then,  you  will  fay,  was  that  apoplexy  firft  fpokenof  by  Celfus  ? 
in  which  he  fays,  both  body  and  mind  were  inactive ;  but  that  it  was  feldom 
to  be  met  with.  If  Mercurialis  (f)y  and  other  learned  men,  both  before  and 
after  him,  had  not  determin’d  that  to  be  the  true  apoplexy,  which  Celfus 
there  names  the  attonitus  morbus  (although  attonitus,  as  Rubaeus  (g)  obferves, 
refers  more  properly  to  a  perfon  ftricken  with  the  difeafe,  than  to  the  difeafe 
itfelf)  I  fhould  perhaps  have  taken  upon  me  long  ago,  to  doubt,  whether  the 
word  stVoTTAnf/ai'  was  a  corrupt  or  a  genuine  one.  For  I  fometimes  fufpedted, 
even  when  I  wrote  the  laft  epiftles  on  Celfus,  that  fome  other  diforder,  fup- 
pofe  the  catalepfy,  or  fome  one  fimilar  thereto,  which  we  lee  but  rarely,  was 
intended  by  him  in  that  paffage :  for  in  the  catalepfy  both  the  mind  and  the 
body  are  inactive ;  and  this  alfo  happens  fometimes  from  a  thunder-ftroke, 
from  whence  they  are  properly  call’d  attoniti,  or  thunder-ftruck  (h).  And 
indeed  I  ho’p’d  that  my  fufpicion  was  confirm’d,  and  that  fome  reafons  for 
an  emendation  of  the  paffage  might  be  drawn  from  Cselius  Aurelianus ;  who 
having  treated  more  largely  of  the  catalepfy  (i)  than  any  of  the  ancients 
whole  works  are  extant,  has  taught  us,  who,  in  the  early  ages,  firft  fepa- 
rated  this  diforder  from  others,  and  gave  it  that  name;  and  what  method 
of  cure  was  made  ufe  of  by  each.  But  being  ftraiten’d  for  want  of  time, 
and  delay’d  by  a  kind  of  inconftancy,  which  ought  perhaps  to  be  attributed 
to  the  bookfellers ;  and  as  I  found  that  it  afferted,  that  Afclepiades  “  had 
“  called  it  catalepfy,”  and  prefently,  “  that  he  had  not  given  it  this  new  name, 
“  but  his  followers I  thought  it  would  take  up  a  great  deal  of  time  and 
pains  to  difcufs  the  fubjeft  ;  nor  was  I  willing  to  compare  the  method  of  cure 
of  Celfus  with  that  of  Themifon,  who  had  liv’d  fome  time  before.  What 
you  will  determine  upon  I  can  eafily  guefs,  not  fo  much  perfuaded  by  my 
own  opinion,  as  by  that  of  the  very  learned  Gerard  Van  Swieten,  who,  in 
juftice  to  his  merits,  is  the  ennobled  and  imperial  archiater.  For  when  I 
perus’d  the  third  volume  of  his  Commentaries  (£),  which  was  very  kindly 
lent  to  me  while  1  was  revifing  this  epiftle,  I  was  rejoic’d  to  find  that  he  had 
made  the  fame  conjedure  with  myfelf ;  and  unlefs  you  agree  with  it,  I  hope 
you  will  find  fome  method  to  reconcile  the  difficulty  that  occurs ;  which  is, 
that  one  and  the  fame  diforder  is  feldom  feen,  and  is  yet  common  every 
where. 

3.  But  that  before  and  after  Celfus,  the  apoplexy  was  a  frequent  diforder, 
not  only  Hippocrates  has  Ihewn,  but  other  obfervers  of  difeafes  have  con¬ 
firm’d  ;  for  if  this  diforder  had  been  but  rarely  feen,  Hippocrates  would 
Scarcely  have  number’d  it  among  the  difeafes  which  happen  for  the  moft 
part  “  in  very  rainy  weather  (/),”  and  alfo  “  in  winter  (*»)  5”  and  the  other 
obfervers  alfo,  when  they  quoted  his  opinions,  not  only  did  not  doubt  of 


O  Apud  Gorra’um  Icc.  citat. 

(f)  Pr»ied.  Patav.  1.  1.  c.  19 

( g )  Annot.  in  cit.  Celfi  c.  26 
O  Servias  ad  v.  172.  1,  iEneid 


(/)  Acut.  morb.  1.  2.c,  10.  11.  12.  &  Cbron. 
1.  2.  c.  5 

(k)  In  Boerhaav.  Aphorefm.  §  1007 
(/)  Seft.  3.  Aph.  16  ( m )  Ibid.  Aph.  23 

their 


Letter  II.  r  Articles  4 ,  $.  19 

their  truth,  but  even  confirm’d  them  by  their  own  obfervations.  Thus  Hob 
lerius  (to)  gives  an  account  of  many  whom  he  faw  become  apopieftic,  44  in 
“  a  cold  and  damp  ftate  of  atmofphere.”  Thus,  not  to  be  too  prolix, 
Foreftus  (5),  after  producing  his  obfervations,  fays,  46  the  whole  ftate  of 
tc  weather  was  at  that  time  rainy,  attended  with  foutherly  winds ;  and  from 
45  the  beginning  of  December  to  the  eighteenth  day,  many  died  apopledtic 
“  and  convuls’d.”  And  indeed  he  has  in  general  afterted,  44  that  in  his  moift 
u  and  cold  regions  of  Holland,  the  apoplexy  was  not  rare,  but  even  very 
44  common  ;  common  alfo  in  places  which  were  cold  by  their  natural  fitua- 
44  tion;  as  at  Florence,  Luca,  and  Bologna,”  where  he  had  ftudied  for  fome 
time;  44  and  alfo  in  Germany  and  Britain,  from  the  nature  of  the  climates.” 
And  thefe  two  phyficians  had  obferv’d  thefe  things  about  a  hundred  and  fifty 
years  before  the  beginning  of  the  prefent  age  ;  or  if  Foreftus  was  a  little  later, 
Jacchinus  (p)  certainly  was  not;  and  from  him  many  of  thefe  things  are  let 
down  in  his  own  words,  though  Foreftus  conceal’d  his  name. 

4.  But  do  not  believe,  that  I  fay  thefe  things  in  order  to  difavow  what  I 
very  well  remember ;  I  mean,  that  about  the  beginning  of  this  age  fudden 
deaths  were  fo  common,  that  the  people  were  aftonilh’d  and  terrify’d  with 
the  novelty  of  it.  But  this  I  fay,  that  it  has  happen’d  in  our  times,  and  in 
other  times  alfo  ;  fometimes  at  longer,  and  fometimes  at  fhorter  intervals,  as 
the  nature  of  the  feafons  has  admitted ;  and  not  only  of  thofe  which  are 
mention’d  for  the  fake  of  example,  but  of  others  alfo,  as  I  fhall  (hew  on  a 
proper  occafion  ( q ) ;  and  that  more  or  lefs,  according  to  the  fituation  and  con- 
ftitution  of  the  countries,  and  the  manner  of  living  more  or  lels  agreeably 
to  the  feafons.  There  even  was  a  time  when,  among  other  peftilential  dif- 
orders,  which  were  perhaps  the  confequences  of  a  noxious  air  from  the  ad¬ 
jacent  places;  and  certainly  of  changing  a  laborious  life  into  an  idle  and  lux¬ 
urious  one ;  44  that  moft  fevere  difeafe,  the  apoplexy,”  rag’d  alfo  ;  as  you 
will  learn  from  Agathia(r).  Who  alfo  defcribing  another  peftilence  in  the 
fame  fixth  century  (j),  after  enumerating  other  kinds  of  death,  fays,  44  that 
44  a  great  number  died  of  a  fudden  likewile,  as  if  they  had  been  feiz’d  with 
44  that  dreadful  diforder  the  apoplexy.”  Then  add  this  alfo,  that  not  all  the 
fudden  deaths  at  the  beginning  of  our  century,  were  the  effedts  of  apoplexy, 
but  many  were  from  fyncope,  and  fome  from  fuffocation.  Laft  of  all,  I  affert, 
that  of  the  many  who  died  of  an  apoplexy  in  the  fame  month,  or  even  in 
the  fame  day,  all  did  by  no  means  difcover  the  fame  injuries  in  the  brain; 
but  fome  of  thefe  appearances  were  widely  different  from  others,  and  pro¬ 
ceeded  from  different  caufes  ;  and  fome  of  them  were  not  recent,  but  of  long 
Standing,  as  foregoing  fymptoms  had  teftified.  And  this  being  in  like  manr 
ner  obferv’d  from  diftedtions,  gave  much  eafe  to  the  minds  of  thofe,  who 
were  ready  to  attribute  the  great  frequency  of  fudden  deaths,  to  fome  com¬ 
mon  caufe  which  lay  hidden  in  -the  air. 

5.  For  although  the  proximate  caufe  of  every  apoplexy,  and  that  which 
contains  the  difeafe,  feems  to  be  one ;  that  is,  a  fudden  diminution  of  the 
internal  motions  perform’d  in  the  brain,  to  wit,  when  we  move,  think,  or 

(n)  De'Morb.  Int.  1.  i.  c.  7.  in  Schol.  '  (?)  Epift.  3.  n.  13.  29 

(0)  Obferv.  Med.  1.  10.  obf.  70  (r)  De  Bello  Gotth.  1.  2 

(p)  Vid.  Init.  c.  9.  Com.  in  Raf.  (i)'l.  5  - 

D  2  perceive: 


2o  Book  I.  Of  Difeafes  of  the  Head. 


perceive  :  and  though  this  imminution  is  fometimes  To  great  as  to  approach 
almoit  to  a  ceffation,  or  immediately  to  degenerate  into  it;  yet  there  are 
many  and  various  caufes  that  bring  it  on.  Tome  of  which  entirely  efcape  the 
notice  of  the  fenfes,  though  others  fall  under  their  obfervation.  And  we 
will  endeavour,  as  far  as  we  can,  to  form  a  conjecture  about  the  former  of 
thefe  caufes,  where  the  cafe  fhall  fometimes  compel  us.  But,  at  the  fame 
time,  1  lhall  fpare  no  pains  to  defcribe  clearly,  and  diftin&ly,  thofe  which  are 
generally  manifelt,  and  appear  within  the  fkull. 

6.  Thefe  lad-mention’d  caufes,  for  the  mod  part,  exift,  either  in  the 
blood,  or  the  ferum,  though  fometimes  they  are  otherwife  applied.  But  we 
will  purlue  the  two  more  frequent  caufes  fird  ;  and  leave  the  more  rare  to 
be  confider’d  in  the  lad  place.  For  this  being  frequently  obferv’d,  gave  rife 
to  that  celebrated  divilion  of  the  apoplexy  into  fanguineous  and  ferous :  and 
they  who  have  difapprov’d  this  divifion,  have  done  it,  I  fuppofe,  partly  for 
this  reafon  •,  becaufe  they  fhould  then  confider  the  continent  caufe,  more 
than  the  efficient  caufes,  and  the  advantage  proceeding  therefrom  in  the 
prognodication  and  cure ;  but  partly  alfo,  becaufe  they  did  not  confider  the 
effufion  of  ferum  as  a  caufe,  but  as  an  effeCt.  Though  of  this  matter  I  have 
already  fpoken(/),  and  will  again  fpeak ;  and  I  believe  that  one  reafon  for 
rejecting  it  was,  becaufe  they  wiffi’d  to  explode  all  the  opinions  of  the  an- 
tients  :  and  with  them  this  dogma  was  perpetually  inculcated,  that  apo¬ 
plexies  in  general  had  their  origin  from  too  vifcid  a  ferum,  in  the  ventricles 
of  the  brain.  But  doubtlefs  the  prejudices  of  the  moderns,  againd  antient 
doCtrines,  have  often  carried  them  too  far  beyond  proper  bounds. 

7.  Yet  the  more  learned  phyficians  have  by  no  means  been  ignorant,  that 
even  the  fathers  of  phyfic  acknowledg’d  an  apoplexy  from  a  fanguineous  caufe; 
though  the  greater  part  of  them  believ’d  the  contrary.  I  fhall  not  bring  quo¬ 
tations  from  Hippocrates  and  Galen,  for  you  have  them  in  theSepulchretum(«), 
as  alfo  the  words  of  Turrifanus  (x),  who,  in  the  fourteenth  century,  fhew’d 
that  fuch  a  pafiage  exided.  And  others,  in  the  fifteenth  and  fixteenth  cen¬ 
turies,  efpecially  among  the  Italians,  went  on  to  do  the  fame.  Among  thefe, 
were  Jo.  Matthaeus  de  Gradi  (y),  Jacobus  Berengarius  (z),  Leonardus  Jac- 
chinus  (a),  but  particularly  Petrus  Salius  my  neighbour  (£),  in  the  whole  of 
that'  leparate  chapter,  which  he  entitled,  “  Of  the  fanguineous  apoplexy.’* 
Although  fome  of  thefe  underdood  the  thing  differently  from  others,  yet 
perhaps  none  of  them,  except  Salius,  believ’d  that  the  diforder  was  brought 
about  in  the  manner  we  generally  fee  it,  and  as  I  have  frequently  inculcated; 
and  he  himfelf  even  thought  it  happen’d  but  rarely.  Yet  Avicenna  (r) 
formerly  advanc’d  this  doCtrine,  to  wit,  when  he  pronounc’d  that  the  caufe 
of  the  fecondj  and  more  frequent  kind  of  apoplexy  from  repletion,  “  was 
“  either  a  fanguineous  humour,  effus’d  fuddenly  about  the  ventricles,  or  a 
“  phlegmatic  humour,  which  for  the  mod  part  gave  rife  to  the  fecond  fpe- 
“  cies  of  apoplexy.”  But  a  little  before  Salius  wrote,  another  Italian,  Leo¬ 
nardus  Botallus,  and  Ludovicqs  Duretus,  a  Frenchman,  though  his  book 


(/)  Ep’ft.  1.  n.  3.  &  Epift.  4.  paffim. 

(&)  1.  1.  S.  2.  in  Addit,  in  Schof  ad  obf.  1 
&  J.l 

(x)  Ibidem  (j>)  Prax.  tr.  2 


(2)  Ifag.  ubi  de  Anat.  part,  colli. 
(«)  c.  9.  cit. 

(b)  c.  2.  de  AfFedl.  particularib. 
(<-)  Canon.  1.  3.  F.  1.  tr.  5.  c.  12 


was 


Letter  II.  Article  8.  21 

was  publifh’d  fomewhat  later,  had  feen  the  blood  effus’d  about  thofe  ventri¬ 
cles  of  apopleCtic  bodies,  as  the  words  of  both  which  are  quoted  in  the  Se- 
pulchretum  (d)  evidently  fliew;  lb  that  it  is  altogether  amazing,  that  Cafpar 
Hoffman  (<?),  who  was  in  every  other  refpeCt  fo  learned  a  phyfician,  fhould 
afk,  “  Who  ever  law  the  ventricles  fill’d  with  blood  in  an  apoplexy  r”  More¬ 
over,  Profper  Martianus  (/)  thought,  that  the  apoplexy  happen’d  fo  fre¬ 
quently,  from  blood,  not  extravafated,  in  the  ventricles,  or  fomewhere  elfe 
within  the  cranium,  or  at  leaft  from  fome  other  caufe,  befide  a  cold  humour; 
that  he  did  not  hefitate  to  affirm,  “  that  of  the  three  fpecies  of  apoplexy, 
<c  one  only,  and  that  rarely  feen,  was  to  be  afcrib’d  to  the  cold  juices,  ac- 
“  cording  to  the  opinion  of  Hippocrates.”  To  this  you  may  add,  that 
Variolus  (£),  writing  to  Mercurialis,  had  appeal’d  to  the  diffeCtions  of  thofe 
perfons  who  die  apopleCtic  ;  and  in  conlequence  of  his  own  diffeClions,  fpoke 
thus :  “  In  the  ventricles  of  the  brain  of  apopleCtic  perfons  (I  hope  you  will 
“  believe  me)  no  greater  quantity  of  excrementitious  matter  is  found,  than 
“  is  commonly  found  in  thofe  of  others  and  this,  confider’d  with  the  for¬ 
mer  teftimonies,  will  plainly  convince  yon,  that  not  only  before  the  more 
modern  times,  there  were  fome  who  allow’d  of  a  fanguineous  apoplexy,  but 
that  there  were  even  fome  who  afferted,  that  an  apoplexy  very  feldom,  I  will 
not  fay  never,  ow’d  its  origin  to  excrementitious  ferofitics  effus’d  in  the  ven¬ 
tricles. 

8.  However,  that  this  diforder  is  at  one  time  to  be  accounted  for  from  blood,, 
and  at  another  from  ferum,  is  not  only  confirm’d  by  the  many  obfervations 
collected  in  the  Sepulchretum,  but  alfo  by  many  others  publifii’d  fince  the 
fecond  edition  of  that  book;  and  thefe  I  fhall  mention  hereafter,  as  occafion 
may  require ;  but  at  prefent  fhall  fpeak  only  of  what  were  committed  to 
writing,  at  the  fame  time  with  thofe  of  Duretus  and  Botallus ;  and  in  France 
likewile,  by  an  Italian  phyfician,  as  he  feems  to  have  been,  and  whofe  other 
obfervations  certainly  very  well  deferve  to  be  publifh’d,  by  the  very  learned 
Targioni,  as  he  was  certainly  no  common,  but  an  eminent  man,  as  we  may 
judge  from  thefe  remarks  of  his  given  us  by  Targioni  (h).  “  In  the  diffec- 

“  tion  of  Madam  de  Mauvoifin,  who  died  in  child  bed,  apopleCtic  and  epi- 
“  leptic  at  the  fame  time,  I  obferv’d  that  the  whole  left  ventricle  of  the  brain 
“  was  full  of  a  watry  blood,  ferous,  putrid,  and  difcolour’d,  and  that  the 
“  veins  of  the  plexus  retiformis,  together  with  the  arteries,  were  tumid,  as 
“  if  inflated,  and  of  a  black  colour:  as  alfo  in  Monfieur  de  Boy  fly,  great 
“  fhield-bearer  of  France,  the  whole  right  ventricle  was  moiften’d  with  blood. 
“  Therefore,  it  is  not  without  reafon,  that  Lampridius  fays  of  Severus  Csefar, 
“  that  he  died  from  a  ftroke  of  the  blood,  which  they  call  an  apoplexy ;  for 
“  in  moft  who  die  of  apoplexies,  we  fee  extravafations  of  blood  in  the  ven- 
“  tricks.”  Nor  would  I  have  you  difpleas’d  to  find  that  he  has,  in  making 
a  memorandum  for  his  own  life,  happen’d  to  forget  names,  and  has  fet  down 
Severus  inftead  of  Lucius  Verus,  and  Lampridius  inftead  of  Sextus  Aurelius 
ViCtor,  whofe  words  in  the  epitome,  concerning  Lucius,  are  thefe  (/),  to- 

(d)  Sett.  cit.  obf  n.  n.  2  &  obf.  16  ft)  De  Nervis  optic.  Epift.  2 

(e)  Vid.  Schol.  ad  cit.  obf.  11  ( b )  In  fine  della  Defcriz.  d’un  Tumore  Foil ic. 

{/)  Adnot.  in  Hippocrat.  de  morbis  1.  2.  ft)  Hift.  Aug,  Epilom.  in  M.  Antonin. 

vexf.  64. 


2  2  Book  II. ,  Of  Diforders  of  the  Head. 

wit,  that  he  died  “  of  a  ftroke  of  the  blood,  which  difeafe  the  Greeks  call 
44  apoplexy  from  whence  you  will  underftand,  that  even  in  the  fourth 
century,  the  fanguineous  apoplexy  was  known-,  or,  if  you  are  in  the  number 
of  thofe  who  afcribe  this  epitome  to  an  uncertain  author,  turn  to  Eutropius’s 
hiftory  (£),  which  was  written  in  the  fourth  century  alfo,  and  before  the  epi¬ 
tome,  and  you  will  read,  that  Verus  died  44  fuddenly,  ftricken  with  blood, 
“  a  falling  difeafe  which  the  Greeks  call  apoplexy.”  And  that  the  difoider 
of  Verus  was,  in  effieCt,  no  other  than  a  fanguineous  apoplexy,  is  prov’d  from 
what  Julius  Capitolinus  (/),  in  the  third  century,  had  laid  of  his  life,  dif¬ 
eafe,  method  of  treatment,  and  death.  For  after  defcribing  his  banquets  and 
his  plate,  he  fays,  44  that  he  was  feiz’d  fuddenly,  as  he  was  travelling  near 
44  Altinum,  with  the  diforder  call’d  apoplexy  and  being  taken  out  of  the 
44  vehicle,  and  let  blood,  he  was  carried  to  Altinum,  where,  after  lying  three 
44  days  fpeechlefs,  he  died.”  And  with  this  paffage  of  Capitolinus  we  mull 
not  omit  the  remark  made  by  Egnatius  (m)  a  little  above,  where  the  fame 
hiftorian  had  mention’d  that  apoplexy  of  Verus  as  it  will  make  us  more 
and  more  underftand,  how  frequent  a  diforder  it  was  in  the  fixteenth  century: 
44  The  apoplexy,”  fays  he,  44  being  a  very  frequent  difeafe  among  the  peo- 
44  pie,  in  thole  years  wherein  thele  commentaries  were  written,  by  reafon  of 
44  the  immoderate  ufe  of  wine  and  venery.” 

But  I  return  to  prove  the  exiftence  of  ferous  apoplexies ;  and  that  from 
the  writings  of  the  fame  obfervator,  who  has  allur’d  us,  that  in  moft  apo¬ 
plectic  patients  he  faw  blood  pour’d  out  into  the  ventricles.  For  thefe  words 
are  intermix’d  with  thofe  given  above:  44  In  others  who  died  of  apoplexies, 
44  I  faw  the  ventricle  lull  of  the  moft  limpid  water;  whereas  in  a  natural 
44  ftate  it  is  entirely  empty.”  And  the  exiftence  of  the  two  fpecies  will  be 
equally  confirm’d,  by  the  obfervations  which  you  will  fee  taken,  firft  from 
Valfalva’s  papers,  and  then  from  my  own.  Yet  I  will  not  do  here  what  is 
done  in  the  bepulchretum  :  that  is,  I  will  not  mix  with  thefe  diforders  thofe 
which  were  the  confequence  of  wounds  and  blows  on  the  head  ;  but  will  defer 
them  to  a  more  proper  opportunity  :  and  thofe  which  v/ere  publifh’d  before, 
by  either  of  us,  I  fhall  only  refer  to.  Yet  even  with  thefe  omiflions,  this 
letter  would  be  very  long  ;  unlefs  we  fhould  give  you,  at  prefent,  only  the 
greater  part  of  the  diffeCtions  which  relate  to  the  fanguineous  apoplexy;  and 
leave  the  remainder  of  them,  and  thole  that  relate  to  the  ferous,  to  be  fub- 
jeCts  of  a  future  letter. 

9.  To  begin  with  a  great  man;  whofe  hiftory  is  for  that  reafon  more  ac¬ 
curately  defcrib’d  by  Valfalva:  The  Cardinal  Antonio  Francefco  Sanvitalis 
was  of  a  moderate  ftature,  or  fomewhat  taller,  of  a  full  flefhy  habit,  and  a 
florid  colour :  he  had  been  much  given  to  ftudy  and  clofe  application ;  was 
alfo  Fubjedt  to  the  gout,  and  had  fome  years  before  been  attack’d  with  a  cer¬ 
tain  ineffectual  irritation  of  the  fauces,  to  fpit :  and  befide  this,  he  was  alfo 
troubled  at  intervals,  with  convulfive  motions  in  his  feet  and  hands.  Fi¬ 
nally,  when  he  was  five-and-fifty  years  of  age,  having  liv’d  for  two  months 
together  in  a  mountainous  country,  on  which  the  fouth  winds  generally  blew, 
and  the  air  of  which  he  had  at  other  times  found  extremly  inimical  to  him ; 

(*)  Hift.  Rom.  1.  8.  (/)  In  Vero  Imperat,  (m)  Annot.  ad  Capitolini  M.  Antonion.  Philof. 

•  . '  ’  -  and 


Letter  II.  Article  io.  25 

and  being  alfo  troubled  with  cares  and  anxieties  of  mind,  and  the  winter 
folftice  of  the  year  1714  being  at  hand,  he  fell  into  a  vertiginous  diforder  ; 
after  which,  although  he  was  freed  therefrom,  he  fhew’d  a  conflant  fadnels, 
and  propenlity  to  fleep.  Within  about  twenty  days  the  vertiginous  diforder 
return’d,  and  brought  a  vomiting  with  it.  Yet  both  thefe  were  in  a  fhort 
fpace  remov’d,  and  after  that  a  violent  pain  of  the  head,  which  had  fucceeded 
them.  But  the  day  following,  at  the  fame  hour  on  which  the  vertigo  had 
feiz’d  him,  all  fenfe  of  feeling  and  power  of  motion  was  loft  in  the  left  part 
of  his  body,  and  he  lay  as  if  overcome  with  a  profound  deep.  His  refpira- 
tion,  however,  was  natural*,  but  his  pulfe  frequent,  large,  and  vehement; 
and  though  it  was  in  vain  to  irritate  the  left  limbs,  yet  the  fame  irritations 
being  applied  to  the  foie  of  the  right  foot,  and  the  ufual  ones  to  the  noftrils, 
he  was  fomewhat  rous’d,  fo  as  to  fay  many  things  by  figns,  and  fome  even 
by  proper  words.  But  thefe  irritations  had  a  happier  efFedt  after  blood  being 
taken  away  ;  more  efpecially  on  the  dxth  day  from  the  apoplexy,  when  the 
right  jugular  vein  was  open’d  by  Vallalva’s  order;  for  about  four  hours  after, 
his  internal  fenfes  were  awaken’d;  and  his  fpeech,  for  more  than  an  hour, 
was  reftor’d.  The  fame  change  happen’d,  about  the  fame  hour,  on  the  fol¬ 
lowing  night,  and  was  more  evident,  and  of  longer  duration.  But  this 
roufing  was  his  laft :  for  from  that  time  he  gradually  declin’d  ;  and  was 
leiz’d  with  convullive  motions  on  his  right  fide,  efpecially  in  his  hand  and 
foot:  his  whole  face  was  likewife  convuls’d,  but  efpecially  about  his  eyes, 
and  perhaps  the  heart  itfelf ;  for  he  frequently  at  the  fame  time  lay  entirely 
without  pulle.  In  fine,  thefe  fymptoms  recurring  about  the  beginning  of  the 
tenth  day,  he  died. 

In  the  belly  and  cheft  every  thing  was  found  in  a  natural  ftate.  The  brain, 
however,  was  flaccid  ;  and  in  the  left  ventricle  was  a  little  ferum  ;  but  the 
right  contain’d  more  than  two  ounces  of  coagulated  blood.  The  plexus 
choroides  was  here  torn  through,  and  the  parietes  of  the  ventricle,  even  on 
the  external  fide,  toward  the  back  part,  were  corroded  into  the  form  of  a 
deep  ulcer. 

10.  Many  things  concurr’d  to  difpofe  this  great  man  to  an  apoplexy  : 
ftudies,  clofe  applications  to  important  bufinefles,  anxieties  of  mind,  and 
even  the  gout  itfelf,  which  often  draws  after  it  a  calculous,  and  at  other  times 
an  apopledlic,  affedtion.  In  reading  hiftories  of  this  kind,  pleafe  to  ob ferve, 
among  the  reft,  thofe  of  a  prince,  and  a  count,  both  of  whom  were  gouty, 
both  apopledlic  (»)  :  and  befides  cyftic  calculi  in  each,  the  lateral  ventricles 
of  one  were  full  of  ferum ;  but  thofe  of  the  other,  which  is  more  to  our 
prefent  purpofe,  were  full  of  extravafated  blood.  Many  of  thofe  common 
ligns  which  Caelius  Aurelianus  (0)  formerly  collected,  foretold  the  apoplexy 
of  the  cardinal,  to  wit,  the  convulfive  motions  of  the  hands  and  face  ;  and 
even,  as  I  think,  the  convulfive  motion  of  the  fauces  too :  next  to  thefe, 
the  repeated  vertigoes,  which  were  follow’d  by  a  pronenefs  to  fleep,  fadnefs, 
and  a  violent  pain  of  the  head  ;  which  fo  far  proclaim’d  the  approach  of  an 
apoplexy,  that  the  laft  vertigo  may  be  in  fome  meafure  taken  for  a  kind  of 
flight  apopledlic  paroxyl'm,  inafmuch  as  a  more  heavy  one  iucceeded  it  on 

(«)  Eph.  N.  C.  Cent.  4.  obf.  169.  (c)  Acut.  Morb.  1.  3.  c.  5. 

the 


24  Book  I.  Of  Difeafes  of  the  Head. 

the  following  day,  at  the  fame  hour.  That  this  apoplexy  was  fanguineousr, 
the  quantity  of  blood,  demonftrated  by  the  florid  colour,  might  have  (hewn, 
as  alfo  the  rarefaction  brought  on  by  the  fouth  winds  ;  the  veflels,  now  grow¬ 
ing  rigid  with  age,  being  prefently  flreighten’d  by  the  winter,  and  on  both 
thefe  accounts  made  eafily  liable  to  rupture.  Nor  yet  was  the  apoplexy  vio¬ 
lent  in  its  beginning  or  progrefs ;  as  the  natural  relpiration,  and  the  power  of 
feeling  and  moving,  not  being  wholly  taken  away,  even  on  the  left  fide,  con- 
curr’d  to  fhew.  This  was  alfo  teftify’d  from  the  fpeech,  together  with  the  inter¬ 
nal  fenfes,  being  once,  and  again,  and  even  a  third  time  reflor’d ;  ’till  at  length,  a 
laceration  in  the  brain  being  encreas’d,  and  the  blood  more  effus’d,  the  diforder 
became  fatal.  Nor  was  the  febrile  pulfe  of  the  leaft  advantage,  though  it  at¬ 
tended  from  the  very  beginning  of  the  diforder :  nor  yet  the  fever  itfelf,  if  you 
will  allow  me  to  fuppofe  what,  I  think,  the  remiffion  and  exacerbation,  fome- 
times  obferv’d  at  the  fame  hour,  did  in  fome  meafure  fhew.  I  will  even  ven¬ 
ture  to  fay,  that  it  was  of  great  difadvantage,  by  ftrongly  agitating  and  im¬ 
pelling  the  blood :  fo  that  among  the  many  and  various  things  given  out  by 
the  interpreters  cf  Hippocrates,  and  other  antient  as  well  as  modern  phyficians, 
of  a  fever  fucceeding  an  apoplexy,  this  leems  to  claim  the  firfi:  place  here, 
that  although,  in  the  ferous  apoplexy,  it  may  fometimes  be  ufeful,  yet  it  is 
rather  hurtful  in  the  languineous ;  and  the  very  experienc’d  (/>)  Werlhof  has 
affirm’d,  that  an  apoplexy  is  rarely  folv’d  by  a  fucceeding  fever.  But  on 
the  other  hand,  blood-letting  had  all  the  advantage  it  couid  poflibly  have, 
efpeciaf  y  from  the  jugular  vein  ;  and  that  the  right  too.,  asValfalva,  who  flew 
from  Bologna  to  the  cardinal,  has  laid  down  as  a  maxim,  taken  from  his  ob* 
fervations  on  patients  afflicted  with  a  hemiplegia  ( q ),  and  as  difieCtion  alfo  at 
that  time  confirm’d.  For  the  mifchief  was  in  the  right  fide  of  the  brain, 
whereas  the  left  fide  of  the  body  was  refolv’d  ;  whic  h  you  will  find  was  alfo 
the  cafe  in  the  dilTeCHons  that  follow.  But  I  would  have  you  obferve,  that 
in  opening  the  jugular  vein,  Valfalva  took  care,  that  what  has  been  objected 
to  many  who  ufc  that  remedy  in  apoplexies,  fhould  not  be  objected  to  him: 
that  is  to  fay,  he  took  care,  that  the  difficulty  of  relpiration,  already  fo 
noxious  to  patients  of  this  kind,  inafmuch  as  it  refifts  the  return  of  the  blood 
from  the  brain,  fli  uld  not  be  encreas’d  by  a  bandage  round  the  neck.  Or 
if  by  the  method  wdiich  the  celebrated  Heifter  ( r )  recommends,  a  more  lax 
bandage  be  drawn  downwards  to  the  cheff,  fo  as  to  comprels  the  jugular 
veins,  and  leave  the  afpera  arteria  free  •,  yet  he  was  aware,  that  even  this  pref- 
fure  impedes  the  return  of  the  blood:  and  the  manner  alfo  at  prefent  approv’d 
of  by  fome,  which  Berengarius  Carpenfis  ( s  )  formerly  defcrib’d,  could  not 
take  place  in  an  apoplectic  perfon  •,  or  if  it  fhould  be  made  life  of,  it  would 
not  only  by  confining  refpiration  obftruCt  the  blood  that  was  defending  from 
the  brain,  but  by  means  of  the  girdle  with  which  the  belly  is  conftring’d,  would 
caufe  much  more  blood  alfo  to  be  carried  to  the  head.  Valfalva,  therefore, 
order’d  the  jugular  vein  to  be  open’d  in  apoplexies,  not  only  preferving  the 
natural  refpiration,  but  alfo  taking  care  to  have  the  quantity  of  blood  dimi- 

(p)  Vid.  Commere.  Litterar.  a.  1734.  hebd.  ( r )  Inftit.  Chirurg.  p.  2.  f.  1.  c.  7.  n.  1. 

49,  in  fin.  '  ( s )  Jfagog.  in  Anat.  ubi  de  anat.  aliquar. 

(g)  Trad,  de  Aure,  c.  5.  n.  8.  part,  colli. 


nifli’d 


Letter  II.  Article  io.  25 

nifh’d  by  prior  ven&feCtions.  So  that  there  was  lefs  danger  now  from  the 
compreffion  of  the  jugular,  (though  the  compreffion  of  the  finger  only,  I 
know,  is  us’d  at  other  times)  than  hope  from  its  incifion  ;  and  there  was  lefs 
realon  to  fear,  left  a  ftreighter  bandage  fhould  be  afterwards  neceftary  to  com- 
prefs  the  orifice  of  the  vein.  For  as  to  its  being  moreover  objected  by  others, 
that  though  it  indeed  be  true,  that  by  opening  the  jugular  vein,  blood  is  im¬ 
mediately  drawn  down  from  the  brain,  yet  that  fo  much  the  more  is,  for  this 
very  reafon,  carried  up  thither  by  the  carotid  artery;  certainly  Valfalva  was 
by  no  means  ignorant,  that  the  external  jugular,  which  we  open  in  the  neck, 
does  not  immediately  bring  back  the  blood  from  the  brain,  but  the  internal, 
which  we  cannot  come  at  to  open.  Fie  knew  alfo,  that  the  internal  carotid 
artery,  which  carries  blood  to  the  brain,  did  not  anfwer  to  the  external,  but 
internal  jugular  ;  and  that  the  external  carotid,  which  goes  to  all  parts  of 
the  head,  fituated  on  the  outfide  of  the  brain,  correfponded  to  the  external 
jugular-,  and  that  confequently,  as  upon  this  vein  being  open’d,  the  refiftanc.e 
of  the  blood,  flowing  to  thefe  external  parts,  is  taken  off,  more  blood  is  of 
courfe  carried  by  the  external  carotid,  and  lefs  remains  to  circulate  through 
the  internal  to  the  brain.  Nor  am  I  here  afraid  left  you  objeCt,  that  there 
are  fome  communications  betwixt  the  external  and  internal  jugular-,  for  you 
fee  it  does  not  for  this  reafon  happen,  that  blood  is  immediately  drawn  down 
from  the  brain  :  and  ftill  lefs,  that  it  is  drawn  in  fo  great  a  quantity,  as  mult 
neceflariiy  happen,  if  it  were  allowable  to  open  the  internal  jugular  ;  for  the 
internal  jugular  is  a  continuation  of  thofe  finufies,  in  which  the  whole  quan¬ 
tity  of  venal  blood  from  the  brain  is  collected,  and  has  a  much  greater  dia¬ 
meter  than  the  external ;  not  to  fay,  than  fome  little  branches  of  the  external, 
which  I  have  affirm’d  to  communicate  with  thofe  finufles.  And  among  thefe 
branches,  if  you  pleafe,  you  may  reckon  the  occipital  vein  ;  for  you  will 
find,  that  on  account  of  this  immediate  communication,  I  have  recommended 
(/)  taking  blood  from  this  vein,  in  many  diforders  of  the  brain  -,  but  elpeci- 
ally  in  a  certain  obftinate  lethargic  diforder,  as  the  celebrated  Fleifter  (u)  has 
obferv’d.  But  I  would  not  have  it  underftood,  that  bleedings  or  cuppings 
from  fmall  veins,  are  by  any  means  to  be  compar’d  with  bleedings  in  the 
veins  of  the  arm,  or  jugular,  in  the  cure  of  a  fanguineous  apoplexy  :  and 
this  caution  I  give,  becaufe  fome  will,  perhaps,  be  led  to  imagine  it  from  the 
reading  of  Hoffman  (#).  Hoffman,  however,  did  right  not  to  negleCt  to 
mention  this  kind  of  affiftance,  as  it  was  fo  much  approv’d  by  Soranus,  as  I 
afterwards  obferv’d  (y),  “  in  complaints  of  the  head  and  by  that  eminent 
phyfician  Ingraffia,  “  in  hot  affections  of  the  brain;”  and  fince  it  is  fome- 
times  neceftary  even  in  the  apoplexy  itfelf,  as  you  will  gather  from  the  ob' 
fervation  of  Zacutus,  which  I  formerly  pointed  out.  For  by  means  of  two 
deep  fcarifications  and  cuppings  in  the  occiput,  he  reftor’d  an  apoplectic 
young  man,  who  had  fo  feeble  a  pulfe,  that  his  death  feem’d  at  hand,  and 
who  was  incapable  of  difpenfing  with  any  more  violent  remedies.  Mead  (z) 
alfo,  the  illuftrious  Englifh  phyfician,  confirms  “  the  very  great  utility  ”  0 1 

(/)  Sett.  cit.  c.  5,  n.  2.  [y )  Epift.  Anat.  4.  n.  11. 

(»)  Adv.  Anat.  VI.  animad.  83.  ( z )  Monit.  Medic,  c.  2.  f.  1. 

( x )  Medic.  Rat.  t.  4.  p.  2.  f.  2.  c.  7.  Thef. 

Therap.  §  3. 

Vol.  1.  E 


this 


26  Book  I.  Of  Difeafes  of  the  Head. 

this  practice  y  and  fays,  that  tc  having  made  the  experiment  in  feveral  cafes 
“  of  the  molt  dangerous  apoplexy,  it  had  greatly  alleviated  the  diforder.” 
But  no  body  has  treated  more  copioufly  and  accurately  of  this  remedy, 
than  the  celebrated  German  profelfor  Aug.  Fred.  Walther,  who,  as  well  as 
Mead,  always  teftify’d  great  humanity  towards  me.  This  gentleman,  in  his 
Difiertation  “  on  the  fcarification  of  the  occiput,  and  its  ufe  in  many  diforders 
“  of  the  head,”  when  he  mentions  its  utility  in  other  diforders,  among  which 
are  the  phrenitis,  the  paraphrenitis,  convulfive  and  lethargic  difeafes,  and  the 
epilepfy  itfelf  *,  as  alfo  long-continued  ophthalmies ,  angina,  vertigo,  and  obfti- 
nate  headachs,  though  from  the  beginning  fympathic,  fo  that  they  are  but 
from  the  blood  ;  mentions  alfo  the  ufe  of  it  in  fanguineous  apoplexies, 
and  proves  it  from  the  obfervations  of  others,  but  efpecially  from  his  own. 
And  befides  thefe  two  modern  authors,  I  would  refer  you  on  this  head  to 
Aret^us  ( a ),  that  great  mailer  of  healing  among  the  antients ;  who  gives  us 
this  admonition  as  to  the  method  of  cure  in  apoplexies  :  “  When  the  difeafe 
“  is  long  protracted,  and  the  caufe  is  in  the  head,  cupping- glafifes  mult  be 
“  fix’d  to  the  occiput,  and  blood  muft  be  plentifully  drawn  •,  for  this  appli- 
“  cation  is  of  more  ufe  than  vengefedlion,  and  by  no  means  reduces  the 
“  ftrength,  &c.”  But  let  us  return  to  the  obfervations  of  Valfalva. 

11.  A  man  of  fixty  years  of  age,  of  a  fanguineous  temperament,  and  en¬ 
dow’d  with  a  good  habit  of  body,  by  accident  had  a  fall  in  walking,  and 
flruck  his  head  violently  againft  the  ground.  Being  (lightly  ftupid,  his  fore¬ 
head  being  bruis’d,  and  blood  gufhing  out  from  his  noftrils,  as  alfo  a  palfy 
of  the  left  arm  having  follow’d  thele  fymptoms,  fo  that  neither  fenfe  nor 
motion  remain’d  in  it,  he  was  brought  into  *he  hofpital  of  Sandla  Maria  de 
Vita  at  Bologna.  He  had  a  full  red  colour  in  his  face,  a  laborious  refpiration, 
a  hard  and  moderately  quick  pulfe  ;  but  in  every  other  refpeCt  there  was  no 
preternatural  appearance,  except  the  paralyfis  already  fpoken  of.  On  the 
fourth  day  he  was  fpeechlefsj  on  the  beginning  of  the  fifth  he  died.  In  the 
belly  and  cheft  every  thing  was  natural  :  the  os  frontis  bore  no  mark  of  in¬ 
jury,  that  the  fenfes  could  perceive  *,  though  a  little  blood  was  taken  away 
from  between  the  teguments  and  bone,  which  had  (lagnated  therefrom  the 
contufion.  Upon  opening  the  fkull,  the  dura  mater  (hew’d  only  a  (light  mark 
of  contufion,  which  did  not  reach  to  the  pia  ;  but  in  the  right  ventricle  of 
the  brain,  about  two  ounces  of  extravafated  blood  were  found  concreted  :  and 
the  corpus  ftriatum,  with  a  part  of  the  plexus  choroides,  was  fo  much  eroded, 
that  fcarce  any  veftige  of  it  remain’d. 

12.  Do  not  imagine,  that  when  I  introduce  this  hiftory  here,  I  forget  my 
own  refolution  ;  and  that  this  (liould  be  rather  related  with  thofe  which  de¬ 
rive  their  origin  from  blows  of  the  head.  It  is  true,  that  thofe  hi ftories  alfo, 
as  you  will  fee  in  the  proper  place  (£),  furprifingly  confirm  the  obfervation. 
of  Yallalva  in  hemiplegias,  which  I  mention’d  above  (c)  y  but  I  do  not  want, 
them  at  prelent.  This  hiftory,  however,  I  transferr’d  into  the  prefent  letter, 
becaufe  his  opinion  and  mine  of  this  apoplexy  are  different.  Nor  do  I  at¬ 
tribute  it  to  his  accidental  fall,  but  the  fall  to  it  ;  and  I  am  induc’d  by  the. 

(«)  De  Morb.  Acut.  Cur.  I.  i.  c,  4,  (£)  Epift.  51.  (<-)  N.  10. 


argument, 


Letter  II.  Articles  13,  14.  07 

argument,  which  Laubius  (d)  could  not  ufe,  to  determine  a  fimilar  queftion, 
in  almoft  a  fimilar  cafe.  That  is  to  fay,  my  argument  in  the  cafe  before  us, 
is  from  the  nature  of  the  mifchief,  which  lay  hid  in  the  brain ;  and  from  its 
likenefs  to  that  which  you  have  read  of  above.  From  both  of  them  a  fatal 
apoplexy  at  length  happen’d,  as  above  explain’d  (e) ;  but  the  former  difeafe 
was  the  more  flight ;  as  the  latter  not  only  entirely  took  away  the  power  of 
feeling  and  moving  in  the  upper  limb  *  but  feems  alfo  to  have  taken  away, 
for  a  little  time,  the  power  of  moving,  at  leaft,  in  the  lower :  fo  that,  in  the 
beginning  of  the  diforder,  the  man  muft  inevitably,  and  fuddenly,  fall.  But 
however  you  may  determine  on  this  queftion,  you  will  fee  that  the  dodrine, 
for  which  Valfalva  was  an  advocate,  is  always  confirm’d  by  this  obfervation. 
But  I  will  give  you  Fill  a  ftronger  argument  of  this,  from  an  obfervation  of 
V  alfalva’s. 

13.  A  woman  of  feventy  years  of  age,  had  for  many  months  declin’d  in 
her  memory;  nor  did  flie  always  fee  objects,  when  plac’d  in  a  certain  pofition; 
and  as  fhe  walk’d,  fcarce  rais’d  her  feet  from  the  ground.  She  having  been 
feiz’d  a  year  before  with  a  fudden  diforder  of  her  head,  had,  by  good  for¬ 
tune,  immediately  recover’d :  but  now  ihe  fell  down  fuddenly,  as  fhe  was 
eating;  and  became  paralytic  on  the  whole  left  fide  of  her  body,  and  in  her 
right  arm.  Her  refpiration  was  altogether  natural,  and  nearly  fo  the  colour 
of  her  face,  which  in  her  was  pale,  nor  did  any  convulfions  appear  ;  but 
her  head  fell  juft  like  that  of  a  dead  perfon ;  nor  did  fhe  give  any  fign  of 
underftanding  or  feeling,  unlefs  that  when  an  incifion  was  made  into  the  ju¬ 
gular  vein,  fhe  in  fome  meafure,  contracted  herfelf.  She  liv’d  nine  hours. 
The  ventricles  of  the  brain  were  found  to  be  fill’d  with  a  fluid  blood,  and 
the  right  was  very  much  eroded,  as  well  about  the  external  margin  of  the 
corpus  ftriatum,  as  of  the  thalamus  nervi  optici ;  but  the  left  about  the  tha¬ 
lamus  alone,  and  that  flightly.  The  plexus  choroides  could  fcarcely  be  ob- 
ferv’d.  The  other  parts  were  all  found. 

14.  You  fee  that  the  brain  had  the  leaft  injury  on  that  fide  on  which  the 
body  was  mod  refolv’d  ;  and  on  the  other  hand,  that  on  the  fide  where  the 
brain  was  injur’d  mod,  the  body  was  leaft  refolv’d;  and  the  mifchief  done 
to  the  thalami  of  the  optic  nerves,  correfponded  to  the  defect  of  vifion. 
But  fome  other  things  may  be  gather’d  from  this  hiftory.  Petrus  Salius  (/), 
indeed,  the  better  to  diftinguifh  a  fanguineous  apoplexy  from  that  which 
has  its  origin  from  cold  humours,  has  given  us  many  marks,  for  this  purpofe, 
which  are  by  no  means  contemptible;  unlefs  any  one  fliou Id  forget,  that 
marks  of  this  kind  are  not  to  be  confider’d  apart  from  each  other,  but  that 
mod  of  them  are  to  be  confider’d  in  conjunction.  For  they  who  had  at¬ 
tended  only  to  thefe  things,  “  that  if  a  perfon  labouring  under  an  apoplexy, 
“  be  old,  or  be  a  woman ;  if  there  be  not  a  rednefs,  but  palenefs  in  the 
tc  countenance,  the  diforder  is  from  cold  humours ;”  would  have  been  much 
deceiv’d  in  this  pallid  feptuagenary.  And  thefe  things  I  obferve  for  this  rea- 
fon,  becaufe  I  remember,  that  when  a  nun  of  eighty  years  of  age,  who  was  re¬ 
lated  to  me,  was  feiz’d  with  a  flight  apoplexy,  which  threaten'd  a  more  vio¬ 
lent  one,  1,  though  a  young  man,  did  not  hefltate  to  agree  with  that  phyfi- 

{d)  Eph.  N.  C.  Cent.  9.  ob £63.  ft)  n.  10.  (f)  1.  et  c.  cit.  fupra  ad  n.  7. 

E  2  cian, 


28  Book  I.  Of  Difeafes  of  the  Head. 

cian,  who  thought  blood-letting,  and  the  more  temperate  remedies,  fhould 
be  made  ufe  of,  rather  than  agree  with  others,  who,  difapproving  this  treat¬ 
ment,  inculcated  a  contrary  method  of  cure.  Thefe  gentlemen  confider’d  the 
age  only  ;  but  we  confider’d  the  other  figns  which  indicate  a  fanguineous  apo¬ 
plexy.  The  event  vindicated  the  refolution ;  for  by  this  method  the  patient 
was  once  and  again  reftor’d  :  and  this  method  might  have  been  more  ftrongly 
defended,  againft  thofe  who  difiented  from  it,  if  the  obfervation  of  Lan- 
cifi  (g),  made  upon  a  merchant  of  a  great  age,  had  been  then  publifti’d. 
This  merchant  had  very  grievous  fymptoms  of  an  approaching  apoplexy, 
which  \vere  much  alleviated  by  a  lofs  of  blood  from  his  nofe,  to  the  quan¬ 
tity  of  eleven  pounds :  and  after  fifteen  days,  he  was  entirely  cur’d,  by  the 
return  of  this  haemorrhage,  to  the  quantity  of  four  pounds.  In  refpeCt  to 
thofe  two  alfo,  of  whom  we  have  written  before,  and  as  many,  of  whom 
we  fhall  write  prefently,  if  you  had  attended  to  their  age  only,  you  would 
have  deny’d  that  the  dilorder  was  a  fanguineous  apoplexy.  And  it  has  even 
happen’d,  that  out  of  twenty-three  oblervations,  made  by  Valfalva  and  my- 
felf,  which  now  lie  before  me,  if  you  reckon  thofe  two  produc’d  in  the  Anato¬ 
mical  Epiftles(£),  there  are  to  be  found  in  them  all,  but  juft  three  cafes  which 
relate  to  youths,  and  four  which  relate  to  middle- ag’d  men.  And  though 
it  is  more  frequently  true,  that  the  apoplexies  of  old  men  degenerate  into 
long-continu’d  palfies,  and  thofe  of  young  men  are  foon  mortal :  yet  I  have 
feen  the  contrary  happen  in  both  cafes,  and  that  not  rarely.  And  that  thofe 
are  the  moft  violent,  and  much  the  fooneft  mortal,  which  have  their  origin 
from  blood,  extravafated  within  the  cranium,  we  not  only  have  daily  proofs 
of  ourfelves,  but  it  has  alfo  been  frequently  obferv’d  by  others.  But  not 
thofe  only  are  mortal,  nor  all  of  them,  or  certainly  not  at  all  times  of  the 
difeafe.  Tor  the  woman  whofe  hiftory  is  laft  defcrib’d,  liv’d  only  nine  hours: 
yet  the  great  man,  of  whom  I  firft  wrote,  was  preferv’d  to  the  tenth  day. 
So  that  the  effufion  of  blood  does  not  feem  to  have  happen’d  on  the  firft 
days  of  the  difeafe,  but  rather  on  the  laft,  as  I  faid  above  (7) ;  and  there¬ 
fore  it  feems,  that  the  apoplexy  at  firft  was  not  violent,  as  I  have  confirm’d 
by  the  ftate  of  the  fymptoms,  and  efpecially  by  the  natural  refpiration.  For 
you  know,  that  the  principal  criterion,  by  which  phyficians  determine  the 
ft  ranger  or  weaker  degrees  of  apoplexy,  is  the  greater  or  lefler  change  of 
the  refpiration  from  its  natural  ftate.  Although,  by  way  of  proof  that 
icarcely  any  thing  is  perpetual  in  medicine,  you  fee,  that  in  the  cafe  of  this 
woman,  the  refpiration  was  not  only  “  equable  and  regular,”  as  in  another 
woman  differed  by  the  celebrated  Veratti  (X'),  which  cafe  fhould  be  com¬ 
par’d  with  this-,  but  that  it  was  altogether  natural.  And  in  the  old  man, 
whole  hiftory  I  am  about  to  relate,  you  will  be  able  eafily  to  judge,  how  late 
alter  the  effufion  of  blood  into  the  ventricles  of  the  brain,  deatn  follow’d. 

1 5.  A  certain  old  man,  long  before  death,  had  been  feiz’d  with  an  apo¬ 
plectic  dilorder,  and  from  thence  the  whole  right  part  of  his  body  had  re¬ 
main’d  paralytic.  Ilis  fkull  being  open’d  arter  death,  the  inferior  part  of 
the  left  ventricle  was  found  corroded,  together  with  its  plexus  choroidesr 

(g)  De  Subit.  Mort.  J.  2.  c.  5.  n.  8.  (^)  Comment.  Bonon.  Sc.  Acad.  Tom.  2. 

(&}  XI.1I.  n.  19.  &  25.  (/)  r,.  ic.  P.  1.  in  Medicis. 


about 


Letter  II.  Article  1 6.  29 

about  which  were  polypous  concretions  of  blood.  So  that  this  apoplexy 
feem’d  to  have  had  its  origin  from  the  corrofion  of  both  thefe  parts,  and  from 
the  blood  that  was  confequently  pour’d  into  the  cavity  of  the  ventricle. 

16.  If  Valfalva,  in  this  hiftory,  feems  to  write  wonderful  things  ;  how  much 
more  wonderful  mull  they  feem,  which  are  related  in  the  Sepulchretum,  and 
taken  from  Wepfer  (/),  another  very  grave  writer.  In  a  certain  noble  Pole, 
44  without  apoplexy,  or  any  other  grievous  fymptoms,”  not  only  within  the 
cranium  and  meninges,  but  alfo,  as  he  fays,  44  in  the  very  fubftance  of  the 
44  brain  itfelf,  blood  was  extravafated,  without  any  diforder  being  the  conie- 
44  quence.”  46  But  with  reafon,”  fays  the  perfon  who  copies  ir,  44  do  we,” 
as  Wepfer  himfelf  does,  “  put  fuch  things  in  the  catalogue  of  thofe  that  are 
“  moft  rare.”  Yet  Brunnerus  (m),  a  man  of  folid  judgment,  in  the  cafe  of 
a  woman  whom  he  had  cur’d  of  an  apoplexy  aim  oft  five  years  before  her 
death,  did  not  doubt  to  colle<5t  arguments,  either  from  what  he  had  obferv’d 
in  her  life-time,  or  what  appear’d  in  her  brain  when  dead,  which  induc’d 
him  to  believe,  that  blood  was  even  at  that  time  effus’d  into  the  fubftance  of 
the  brain.  For  in  one  hemifphere  he  found  44  three  little  caverns,  which 
“  had  been  long  form’d,  lying  round  about  the  corpus  ftriatum,  now  grown 
44  callous,  and  cover’d  over  with  a  cicatrix  *,  the  whole  hemifphere  being  for 
“  that  reafon  flaccid,  of  a  dark  yellowifh  colour,  and  appearing  fhrivell’d,  as 
44  if  from  an  atrophy  and  I  would  have  you  obferve  with  me,  that  fome 
things  fimilar  to  this  occurr’d  to  thofe  worthy  men,  Anthony  Leprotti  and 
Jano  Planci,  who  were  in  the  number  of  my  friends.  For  this  is  part  of  a 
letter  that  Planci  wrote  to  me  on  the  firft  of  April,  in  the  year  1721,  from 
Rimini.  44  A  few  days  ago  we  differed  the  body  of  that  man,  who  con- 
44  fulted  you  laft  June  at  Padua,  upon  a  hemiplegia,  which  had  remain’d  in 
44  his  left  fide,  from  a  violent  fit  of  apoplexy.  Yet  he  did  not  die  of  this 
44  diforder,  but  from  a  dilatation  of  the  heart  and  precordia,  which  you,  from 
44  the  remedies  you  fo  aptly  prefcrib’d,  feem  to  have  been  fenfible  of  at  that 
44  time.  But  the  right  hemifphere  of  the  brain,  towards  the  temple,  feem’d 
“  to  have  been  eroded  with  a  kind  of  abfcefs  ;  for  there  the  fubftance  of  is 
44  was  wanting  to  about  four  inches  in  breadth,  and  an  inch  and  half  in 
44  depth.  And  the  thalamus  nervi  optici,  on  that  fide,  was  lefs  by  two 
44  thirds,  than  the  left:  befides,  it  was-  of  a  dun  yellow,  and  appear’d  to 
44  have  been  clos’d  by  a  cicatrix.”  Nor,  indeed,  was  1  myfelf  without  a 
particular  obfervation  of  this  kind,  before  l  read  over  again  this  letter,  when 
lent  back  by  you  ;  and  this  1  [hall  lend  you,  with  fome  others  («).  And,  in- 
deen,  I  alfo  happen’d  to  light  on  an  obfervation  of  Jo.  Wilhelmus  Albrech- 
tus  (0),  in  which,  under  the  cranium,  that  had  been  depreis’d  thirty  years 
before,  but  never  perforated  ;  and  under  the  meninges,  which  were  unhurt, 
he  found  a  pit  or  cavity  in  the  brain  fufncient  to  receive  his  finger;  a  re- 
markab.e  portion  of  the  medullary  fubftance  being  confum’d.  And  as  this 
could  not  happen  without  a  laceration  of  the  fanguiferous  veflels,  he  doe3 
not  doubt,  but  that  the  extravafated  blood,  or  purulent  matter,  was  by  the 
mere  afliftance  of  nature  reabl'orb’d  into  the  veins.  But  tilde  things,  you 

(/)  £cho1.  ad  obf.  6.  5n  Addit,  ad  Se£l.  2.1.  I.  («)  E p» ft.  3.  n.  6. 

(«)  Ibid,  in  Schol.  ad  obf.  12.  n,  3.  {*)  Obf.  anat.  circa  duo  Cadav.  §  13. 


30  Book  I.  Of  Difeafes- of  the  Head. 

fay,  are  rare,  and  contrary  to  the  general  opinion:  for  what  phyfician  is  there, 
who  will  not  pronounce,  that  blood  being  extravafated,  and  confin’d,  within 
the  very  fubftance  of  the  brain,  is  mortal  ?  Rare  indeed !  even  let  them  be 
very  rare  ;  though  perhaps  not  fo  rare  as  you  before  believ’d  for  which  rea- 
fon  it  is  proper  for  us  to  mention  them,  not  to  make  us  forget  that  what  ge¬ 
nerally  happens  in  medicine,  is  chiefly  to  be  attended  to  by  us;  but  left 
we  fhould  be  ignorant,  that  thofe  things  alfo  may  happen,  which  have  in 
effect  fometimes  happen’d.  Almoft  with  the  fame  defign,  I  have  elfewhere  ( p ) 
referr’d  to  fome  difledtions  of  apoplectic  perfons ;  even  two  of  them  I  have 
let  forth  at  large,  the  one  from  Valfalva,  and  the  other  my  own  obfervation, 
which,  like  that  of  the  lethargic  boy,  copied  from  Foreftus  into  the  Se- 
pulchretum  (^),  fhew  that  the  injury  of  the  brain  is  fometimes  on  the  fame 
fide  with  the  paralyfisof  the  body  :  although  that  the  cafe  is  generally,  not  to 
fay  almoft  always,  otherwife,  is  plain  from  the  obfervations  of  Valfalva.  And 
although  he  did  by  no  means  commit  to  writing,  all  his  obfervations  relating 
to  the  languineous  apoplexy  ;  yet  thofe  which  we  have  defcrib’d  above,  re¬ 
main  ;  as  thofe  alfo  do  which  I  am  about  to  defcribe. 

17.  An  old  man  of  leventy  years  of  age  fell  down  fuddenly  on  the  ground, 
having  loft  the  power  of  moving  and  feeling,  on  the  left  fide ;  and  the 
right  being  confiderably  agitated  by  convulfive  motions.  His  face  was  red. 
In  lefs  than  twenty-four  hours  he  died.  His  fkull  being  open’d,  coagu¬ 
lated  blood  was  found  between  the  right  pofterior  lobe  of  the  brain,  and 
the  dura  mater  ;  and  a  kind  of  concreted  ferum  betwixt  the  fanguiferous 
vefiels  of  the  pia  mater,  which  being  cut  through,  a  little  ferum  flow’d  out. 

18.  If  you  fhould  happen  to  enquire  why,  out  of  the  five  apoplectic  pa¬ 
tients,  whofe  hiftories  are  related,  this,  whofe  original  diforder  was  not  in 
the  brain,  but  upon  it,  fhould  be  the  only  one,  to  whom  violent  convulfive 
motions  happen’d,  on  the  fubjedted  fide,  (for  in  that  firft  delcrib’d,  violent 
convulfions  are  not  faid  to  have  happen’d,  and  in  the  three  others,  they  are 
not  only  not  related,  but  in  the  woman  they  are  exprefsly  deny’d  to  have 
•exifted  :  and  yet  in  all  thefe,  the  injury,  and  that  of  the  brain  itfelf,  was 
much  greater)  I  contefs  it  is  not  eafy  to  account  for,  unlefs  you  can  pof- 
fibly  fuppole,  that  the  coagulated  blood,  and  lerum,  did  not  more  comprefs 
the  brain,  than  irritate  the  meninges,  which  they  were  contiguous  to  in  this 
patient  only ;  for  as  the  right  and  left  parts  of  the  meninges  do  not  decuflate 
each  other  like  the  fibres  of  the  brain,  but  defcend  ftrait  down  with  the 
fpinal  marrow  and  the  nerves,  each  into  their  proper  fide  •,  fo  you  may  fup- 
pofe,  that  the  fide  of  the  body  which  was  fubjedted  to  the  irritated  part  of 
the  meninges,  was  agitated  with  convulfive  motions,  in  confequence  of  this 
irritation  :  or  if  the  irritation  could  be  propagated  to  the  oppofite  fide  alfo, 
you  may  fay,  that  the  mufcles  of  that  fide,  being  become  paralytic,  could 
not  be  excited  into  motion.  But  if  you  are  pleas’d  with  this  reafoning,  then 
fee  how  you  can  account  for  the  irritation  of  the  meninges  in  the  firft  apo¬ 
plectic  patient ;  in  whom  there  were  at  leaft  fome  convulfive  motions,  though 
not  fo  great.  And  attend  alfo  to  fome  of  the  following  hiftories,  in  which, 
though  a  caufe  was  not  wanting  to  irritate  the  meninges,  yet  no  convulfive 

(/)  Epift.  Anat,  13.  n.  19.  &  25.  (y)  1.  1.  S.  3.  obf.  34. 

motions 


Letter  II.  Articles  19,  20.  31 

motions  are  taken  notice  of  by  Valfalva.  But  perhaps  we  (hall  endeavour 
to  inveftigate  thefe  things  more  thoroughly  in  another  place. 

19.  A  man  of  fifty-eight  years  of  age,  of  a  good  natural  conftitution,  but 
much  given  to  the  ufe  of  tobacco,  fell  down  fuddenly,  as  he  buckled  his 
fhoes.  His  fpeech  was  enirely  loft  ;  he  had  no  motion.  His  face  was  pale, 
then  grew  fomewhat  yellow,  as  in  a  jaundice,  and  prefently  grew  pale  again  : 
fome  little  drops  of  faliva  flow’d  out  of  his  mouth.  In  a  quarter  of  an  hour 
he  died.  His  belly  being  open’d,  every  thing  was  found  ;  and  in  the  thorax 
alfo,  although  the  inferior  part  of  the  lungs  adher’d  to  the  diaphragm  and 
back,  and  both  the  lobes  were  very  red  with  blood,  efpecially  the  right, 
which  was  fo  turgid  therewith,  that  on  a  flight  laceration  a  great  quantity 
burft  forth.  But  in  the  cranium,  a  good  quantity  of  coagulated  blood  was 
found,  under  the  pia  mater,  on  the  anterior  convexity  of  the  brain,  particu¬ 
larly  on  the  right  fide.  In  the  right  alfo,  and  the  left  ventricle  of  the  cere¬ 
brum,  a  little  blood  was  feen,  with  a  flight  coagulum  ;  but  the  plexus  cho- 
roides,  although  it  was  found,  might  feem  to  have  been  affedted  with  an  in¬ 
flammation. 

20.  But  I  fhall  now  give  you  obfervations  of  blood  being  effus’d  about  the 
trunk  of  the  medulla  oblongata,  and  cerebellum.  A  fervant-man,  of  two- 
and-twenty  years  of  age,  of  a  fprightly  wit,  endow’d  with  ftrong  health,  and 
undaunted  by  any  labour,  while  he  ran  very  faft  after  the  chariot  of  his  mafter,. 
in  the  depth  of  winter,  and  when  fnow  was  falling  on  the  ground,  was  thrown 
into  an  univerfal  and  profufe  lweat ;  yet  without  changing  his  cioaths,  he  re¬ 
turn’d  in  the  evening  to  his  ufual  buflnefs.  But  the  day  after,  when  he  leap’d 
out  of  bed  in  the  morning,  having  loft  all  fenfe,  he  fell  down  three  times 
headlong.  Being  lifted  up,  he  complain’d  of  a  deep-feated  pain  in  his  head* 
but  efpecially  in  the  occiput ;  and  was  foon  after  affedted  with  a  fever,  at¬ 
tended  with  a  fenfe  of  laffitude  and  pain  in  his  whole  body.  The  day  fol¬ 
lowing  he  was  purged  with  the  pillula  Galeni.  On  the  third  day  he  was  let 
blood,  but  in  vain  *  for  the  encreafing  diforder  grew  into  a  kind  of  lethargy. 
On  the  fifth  day  he  was  fcarified  on  the  fcapulte,  and  blood  was  drawn  away 
by  cupping-glafles.  On  the  eighth  he  was  fuddenly  taken  fpeechlefs,  and  lay 
immoveable  for  an  hour,  as  if  in  an  apoplexy.  After  that,  the  pain  of  the 
occiput  was  exafperated,  and  was  extended  even  to  the  Ihoulders  and  lpine, 
in  a  moft  violent  manner.  On  the  ninth  day  he  loft  blood  in  the  other  arm, 
from  which  the  fymptoms  feem’d  to  remit  j  till  at  length  the  apople&ic  pa-? 
roxyfm  returning,  his  life  was  exchang’d  for  death. 

The  abdomen  and  thorax  being  examin’d,  nothing  was  obferv’d  in  the 
latter,  but  a  lmall  polypous  concretion  in  the  right  auricle  of  the  heart:  but 
from  the  belly,  the  omentum  had  fallen  down  into  the  fcrotum,  and  had 
form’d  an  epiplocele ;  and  the  whole  internal  fubftance  of  the  tefticle  on  that 
fide,  was  chang’d  into  a  membranous  body.  The  head,  the  feat  of  the  difeafe, 
was  next  enquir’d  into ;  and  where  the  medulla  goes  out  from  the  cranium, 
fome  grumous  blood  was  found,  which  had  flow’d  out  from  the  lacerated 
trunk  of  the  internal  carotid  artery.  The  ventricles  of  the  brain  contain’d 
a  great  quantity  of  faltifti  water :  the  right  and  left  contain’d  alfo  a  portion 
of  condens’d  blood.  Finally,  throughout  the  crura  medullae  oblongatae, 

many.. 


3  2  Book  I.  Of  Difeafes  of  the  Head. 

many  little  prominent  bodies  were  feen,  which,  except  that  they  were  pel¬ 
lucid,  refembled  the  little  grains  of  millet  feed. 

21.  Thefe  corpufcles  recal  to  my  rnind  44  the  little  prominent  papillae,  of 
44  the  fize  of  a  frnall  pin’s  head,”  which  Brunnerus  (r)  faw  in  the  back  part 
of  the  right  ventricle,  into  which  the  ferous  blood,  in  an  apopleCtic  woman, 
had  overflow’d  •,  and  44  which  had  alfo  been  obferv’d  by  him  fometimes  be- 
<c  fore,  on  the  othervvife  fmooth  and  polith’d  furfaces  of  the  ventricles,  when 
“  there  was  a  difeale  of  the  brain  :  and  who,  without  being  a  foothfayer, 
44  would  not  venture  to  affirm,  that  thefe  were  the  little  duds  which  dif- 
44  charg’d  this  latex  into  the  difeas’d  brain.”  Very  pertinent  alfo  in  this  place, 
perhaps,  is  that  obfervation  made  by  BonfllioSo  on  a  horfe,  and  related  by 
Malpighi  (s'),  on  account  of  the  fimilitude  of  the  external  foregoing  caufe  : 
“  This  horle,  after  vehement  motion  and  extreme  heat,  being  expos’d  to 
44  the  winter’s  cold,  and  a  ruffiing  wind,  died  ;  and  in  him  the  pleura  was 
44  univerfally  rough  with  vehicles,  which  were  in  great  plenty,  and  turgid  with 
44  ichor.”  The  other  appearances  defcrib’d  in  Valfalva’s  hiftory,  except 
what  relates  to  the  epiplocele,  which  will  be  confider’d  hereafter  (/),  very 
well  account  for  the  grievous  pain  of  the  head,  and  fet  forth  its  internal 
caufes.  As  for  inftance,  the  great  quantity  of  faltifh  water,  together  with  a 
portion  of  condenfated  blood,  found  in  the  ventricles,  but  efpecially  the  ex- 
travafated  blood  which  was  concreted  in  fuch  a  place,  that  it  would  at  once 
p refs  upon  the  beginning  of  the  medulla  fpinalis  and  the  cerebellum,  and  by 
this  means  the  cerebrum,  and  at  the  fame  time  be  contiguous  to  the  me¬ 
ninges  ;  fo  that  the  rationale  of  the  lethargic  and  apoplectic  diforders,  of 
pain  deep  feated  in  the  occiput,  and  extended  from  thence  to  the  whole  fpine, 
is  ealily  underflood.  And  it  is  indeed  much  to  be  wonder’d  at,  that  death 
was  not  fooner.  brought  on,  which  has  been  the  cafe  with  others,  who  had 
blood  extravafated  about  thefe  parts  •,  as  in  a  failor,  whofe  hiftory  you  may 
read  in  the  ACta  Cefarere  Academiae  (u)  or  in  him,  whofe  hiftory  is  given 
immediately  below  :  unlefs  perhaps,  in  the  fervant-man  in  queftion,  the  ca¬ 
rotid  artery,  being  but  little  lacerated  at  firft,  did  not  emit  much  blood, 
though  it  was  difcharg’d  freely  at  laft. 

22.  A  man  of  about  fixty  years  of  age,  who  drank  freely  of  generous 
wine,  though  he  was  frequently  us’d  to  fall  down  with  a  vertigo,  was  at 
length,  on  a  certain  day,  juft  after  dinner,  when  he  feem’d  to  be  very  well, 
except  that  his  cheeks  were  redder  than  ufual,  found  lying  dead  on  the 
ground,  his  upper  limbs  being  extremely  contracted,  and  the  foeces  alvi 
emitted.  The  cranium  being  fawed  through,  and  the  dura  mater  perforated 
anteriorly,  a  limpid  water  burft  from  betwixt  this  and  the  pia  :  and  the  pia 
mater,  which  was  of  a  p  difh  colour,  contain’d  a  gelatinous  concretion  of 
ferum  in  the  interftices  of  its  veflels.  In  the  lateral  ventricles,  fome  of  the 
glands  of  the  plexus  choroides  were  fo  turgid,  as  to  equal  the  largeft  lentils 
in  magnitude ;  and  in  the  right  were  two  grumous  concretions  of  blood.  In 

(r)  Vide  Sepulchret.  in  Addit,  ad  fed.  cit.  (/)  Epift.  43.  n.  12. 

obf.  12.  &  in  fchol.  ad  obf.  5.  («)  Tom.  2.  obf.  log, 

( 5 )  Epift.  de  Struit.  Gland. 


both 


Letter  II.  Articles  *3,  24.  £3 

both  Tides  of  the  cerebellum,  the  blood  was  To  coagulated,  as  to  refeinble  one 
folid  polypous  body  ;  but  the  right  Tide  had  the  largeft  quantity  of  blood, 
even  an  ounce  ;  and  that  portion  of  the  cerebellum  which  layabout  this  kind 
of  concretion,  had  a  foft  confiftence,  like  rotten  fruits. 

23.  That  this  fudden  death  was  from  a  fanguineous  apoplexy,  not  only 
the  antecedent  fymptoms  argue,  but  the  appearances  in  the  diffeCted  head 
abundantly  prove  •,  yet  that  a  convulfion  was  in  fome  meafure  join’d  with  it, 
that  great  contraction  of  the  upper  limbs  Teems  to  fhew.  But  that  this  apo¬ 
plexy  Thould  happen,  when  the  patient  Teem’d  very  well,  doubtlefs  teftines 
to  us  how  much,  according  to  the  words  of  Celfus,  thofe  over  whom  this, 
or  any  other  dileafe,  from  a  rupture  of  an  artery  or  vein,  hangs  threat’ning, 
fufpebia  habere  bona  fua  debent  (x),  “  ought  to  be  fufpicious  of  their  prefent 
<c  welfare.”  For  by  how  much  more  languidly  the  heart  and  arteries  contract 
themfelves,  by  To  much  lefs  will  the  danger  of  that  rupture  impend  :  on 
the  contrary,  the  more  ftrongly  they  act,  and  impel  the  blood,  as  in  healthy 
perfons,  in  To  much  greater  danger  of  rupture  are  the  debilitated  parts  of  the 
veffels.  And  this  Tpeculation  we  have  often  Teen  confirm’d  by  obfervation  ; 
but  never  more  evidently  than  in  the  facred  orator,  whofe  fudden  death,  from 
a  fanguineous  apoplexy,  will  be  mention’d  in  the  next  letter  (y). 

24.  But  that  the  defcrib’d  apoplexy  was  very  violent,  the  thing  itfelf  ffiews, 
and  the  difcharge  of  the  fceces,  eipecialiy  if  we  attend  to  the  opinion  of  fome 
phyficians  (z),  did  not  obfcurely  teftify  :  for  they  affert,  that  unlefs  the  difor- 
der  be  very  violent  indeed,  even  when  all  the  other  parts  of  the  body  are 
paralytic,  the  fphinCter  ani  will  (till  be  contracted.  But  the  fphinCter  may. 
iometimes  Teem  not  to  be  paralytic,  although  it  be;  becaufe  the  inteftines 
themfelves  being  more  inert  in  apopleCtic  patients,  and  the  mufcles  of  the 
abdomen  not  being  ftrong  enough  in  their  impulfe,  the  foeces,  which  are  hard 
and  few,  are  rather  not  expell’d  by  the  contraction  of  thofe  mufcles,  than  re¬ 
tain’d  by  the  aCtion  of  the  fphinCter  :  yet  I  would  not  deny  this,  that  the  re¬ 
tention  of  thofe  things  injeCted  into  the  inteftines,  often  fhews  that  the  aCtion 
of  the  fphinCter  is  fufficientlv  preferv’d  ;  and  that  by  means  of  the  commu¬ 
nication  of  the  fame  nerves,  by  which  the  motions  of  moft  of  the  vifcera, 
but  efpecially  the  heart  and  lungs,  are  fupported.  And  that  thofe  nerves 
receive  fpirits,  if  not  chiefly  from  the  cerebellum,  at  leaft  from  that  as  well 
as  from  the  cerebrum,  Teems  an  undeniable  truth.  But  that  the  cerebellum 
is  lefs  frequently  hurt  in  apoplexies,  than  the  cerebrum,  in  part  happens,  from 
its  being  lefs  than  the  cerebrum  :  and  befides,  though  it  lhould  be  a  little, 
injur’d,  it  is  not  ridiculous  to  fuppofe,  that  it  may  ftill  do  its  office  to 
thofe  nerves,  longer  than  the  cerebrum,  becaufe  it  has  a  greater  quantity  of 
cortical  fubftance,  and  feems  tofecrete  a  greater  quantity  of  fpirits  in  propor¬ 
tion  thereto.  .And  another  not  improbable  reafon  may  alfo  be  given  for  this, 
to  wit,  that  the  paffages  through  which  the  cerebellum  fends  lpirits  to  thofe 
nerves,  are  wider  than  the  fimilar  paffages  from  the  cerebrum  ;  inafiUuch  as 
the  cerebellum,  when  every  thing  was  in  its  firft  tender  ftate,  began  fooner 
to  perform  its  office.  For  obfervations  are  not  wanting  to  prove,  that  the 
cerebellum  is  much  fooner  perfected  than  the  cerebrum  ;  and  what  it  then  firft 


(*)  De  Medic.  1.  2.  c.  2.  (j)  N.  17. 

vol.  r. 


(2:)  Sennert. Med.  Praft.  1.  3.  p.  z.  f.  2.  c.  1 1. 

F  began, 


34  Book  I.  Of  Difeafes  of  the  Head. 

began,  it  goes  on  without  intermiffion  to  perform,  either  in  a  waking  or  a 
fleeping  ftate.  But  the  more  neceflary  thofe  nerves  are  to  the  prefervation 
of  thefe  motions,  and  to  the  fupport  of  their  influence,  the  fooner  all  thefe 
vital  powers,  and  of  confequence,  life  itfelf,  is  loft  :  for  the  paflages  of  the 
nerves,  which  were  fo  open,  and  which  us’d  to  convey  fuch  a  quantity  of  fpirits, 
being  now  precluded,  that  is,  the  cerebellum  being  injur’d,  the  power  of  the 
vital  vilcera  muft  of  confequence  fail ;  and  that  fo  much  the  fooner,  in  pro¬ 
portion  as  the  cerebellum  is  more  violently  and  fuddenly  injur’d.  And  an 
injury  in  both  thefe  refpeCts  does  actually  happen,  when  blood,  and  that  in 
confiderable  quantity,  is  fuddenly  extravafated  upon  the  cerebellum,  or  rather 
in  its  fubftance.  Nor  fhould  that  kind  of  rotten  foftnefs,  obferv’d  in  the  ce¬ 
rebellum,  where  the  blood  was  furrounded  with  its  fubftance,  make  you  the 
lefs  believe,  that  the  laceration  was  Ridden.  For  you  will  fee,  from  other 
of  our  letters  (<?),  that  any  little  part  of  the  cerebellum  may  gradually,  and 
almoft  latently,  be  difpofed  to  laceration  ;  and  when  at  length  this  fuddenly 
happens,  an  injury  of  that  kind  may  appear  in  the  furrounding  fubftance, 
which,  though  it  be  in  effeCt  recent,  yet  may  eafily  be  taken  for  an  erofion 
of  long  ftanding. 

25.  I  wifli  I  could  at  any  time  determine,  or  rather  divine,  what  it  was 
Valfalva  meant  by  what  he  formerly  laid  to  me,  but  never  left  in  writing 
that  I  know  of;  I  mean,  that  when  a  certain  porter  had  died  of  an  apoplexy, 
he  from  the  inipeCtion  of  the  naked  body,  had  foretold,  that  the  caufe  of  the 
diforder  would  be  found  in  the  cerebellum  ;  and  had  prov’d  it  from  diflec¬ 
tion.  For  that  I  had  conjectur’d  on  which  fide  of  the  cerebrum  the  diforder 
was  feated,  by  only  obferving  on  which  fide  the  patient  had  fall’n,  I  have  al¬ 
ready  obferv’d  (b) ;  but  how  to  determine,  whether  the  mifchief  be  in  the 
cerebrum,  or  cerebellum,  from  the  infpedion  of  the  body,  I  confefs  I  do 
not  clearly  underftand.  I  fufped,  however,  that  it  might  be  in  fome  mea- 
fure  afcertain’d,  from  what  1  have  already  hinted  ;  to  wit,  from  refpiration 
being  fuddenly  fupprefs’d,  the  faeces  of  the  inteftines  being  emitted,  and  other 
circumftances  of  that  kind.  Harderus,  indeed,  in  a  patient  who  died  Rid- 
cienly  of  an  apoplexy,  concluded  that  a  fuflfocation  had  happen’d  from  the 
following  marks  ;  “  the  face  and  lips  were  livid  ;  bloody  lines  ran  in  the 
“  courfe  of  the  fpine,  and  were  difpers’d  in  various  directions  round  about 
“  it and  agreeably  to  his  conjecture,  was  found  “  grumous  blood  lying 
“  about  the  cerebellum  and  this  obfervation  you  have  alfo  in  the  Sepul- 
chretum(r).  But  you,  according  to  your  u fual  and  well-known  fagacity,  will 
enquire  after  lefs  ambiguous  matters.  In  the  mean  while  farewel,  and  expeCt- 
the  conclufion  of  my  obfervations  on  the  fanguineous  apoplexy  in  my  next' 
letter,  having  already  fufficiently  detain’d  you  in  this. 

(«)  Epift.  ^.  n.  3.  (r)  Vide  in  Addit,  ad  Sepulchret.  L  1.  f.  2* 

{ b )  Advert.  Anat,  VI.  animadv.84.  &.Epift.  obf.  5.  cam  fchol. 

Anat.  VII,  n.  6.  &  XIII.  u.  16. 


LETTER 


Letter  III.  Articles  1,2, 


35 


% 


LETTER  the  THIRD. 


Which  concludes  the  Obfervations  on  the  Sanguineous 

Apoplexy. 

1.  A  I  SHE  obfervations  of  Valfalva,  on  the  fanguineous  apoplexy,  you  have 
I  already  in  my  lad  letter :  and  now,  in  purfuance  of  my  promife, 
you  will  have  mine. 

2.  A  Venetian  woman,  aged  fifty-five  years,  of  a  florid  countenance,  a 
large  ftature,  and  a  full  habit  of  body,  was  fubjedt  to  violent  pains  of  the 
cholic.  This  woman,  befides,  had,  ever  fince  a  certain  time  of  her  delivery 
in  child-birth,  (for  (he  was  the  mother  of  many  children)  grown  fo  promi¬ 
nent  in  her  belly,  that  fhe  was  thereby  prevented  from  going  about  mod:  of 
her  domeftic  offices,  with  promptnefs  and  expedition.  On  account  of  thefe 
complaints,  ffie  faid  ffie  could  not  bear  to  drink  her  wine  diluted  ;  fhe  there¬ 
fore  drank  it  in  a  pure  ftate,  and  that  not  fparingly.  She  was  now  flothful, 
dull,  and  inclin’d  to  fleep  ;  and  for  fome  days  pall,  this  fymptom  alfo  had 
attack’d  her,  either  for  that  reafon,  or  becaufe  her  head  was  in  pain,  that 
ffie  heard  a  very  troublefome  noife,  of  which  ffie  often  complain’d.  At 
length,  about  the  third  hour  of  the  night,  fhe  faid  fhe  was  very  ill ;  and 
mention’d  particularly  a  pain  in  her  right  temple  and  right  eye ;  and  while 
ffie  was  fitting  down  on  a  chair,  and  afking  for  affiftance,  ffie  was  feiz’d  with 
an  apoplexy,  in  confequence  of  which  ffie  fell  on  her  left  fide;  but  the  mo¬ 
tion  of  the  right  hand  was  not  loft  till  an  hour  afterwards.  At  the  fame 
time,  ffie  threw  up  from  her  ftomach,  the  wine  which  fhe  had  drunk  that 
day,  though  the  quantity  of  it  had  not  been  greater  than  ufual  :  but  her  ex- 
.ertions  in  vomiting  were  very  weak  and  feeble.  I  don’t  find  fhe  had  any 
more  affiftance,  than  that  of  being  put  into  bed,  where  ffie  began  to  have  a 
ftertor  ;  and  though  fhe  certainly  liv’d  till  the  fixth  hour  of  the  night,  yet 
in  the  morning  fine  was  found  dead  and  cold;  fo  that  it  was  conjectur’d,  fhe 
died  about  the  ninth  hour.  The  weather  was  now  extremely  cold,  for  it  was 
before  the  middle  of  February  1708. 

I  difleCted  the  body,  in  conjunction  with  that  excellent  anatomift  Jo.  Do¬ 
minico  Santorini,  other  learned  friends  being  prelent.  The  abdomen  was 
turgid,  and  rather  abounded  in  fat,  as  did  the  omentum  alfo.  Almoft  the 
whole  colon  was  in  a  manner  like  that  of  a  dog:  the  cells  were  fo  few  and 
fo  rare  !  and  for  a  confiderable  traCt,  it  was  much  more  narrow  than  is  na¬ 
tural.  But  before  it  degenerated  into  the  reCtum,  it  took  a  turn  towards 
the  navel,  making  larger  folds  than  ufual.  The  colon  had  a  kind  of  fmell, 
like  that  of  an  incipient  gangrene,  and  the  fmall  inteftines  were  of  a  more 
faturated  blood  colour  than  ufual,  here  and  there :  and  though  the  weather 
was  fo  cold,  as  I  have  faid,  yet  fome  heat  ftiii  remain’d  in  the  belly,  no.r- 

-  F  2  withftandibg 


3  6  Book  I.i  Of  Difeafes  of  the  Head. 

withftanding  it  was  thirty  hours  after  death,  when  it  was  open’d.  Moreover,, 
the  fpleen  was  diftinguith’d  by  fome  little  bloody  drops  on  the  furface  *,  yet, 
in  other  refpects,  found:  and  in  the  gall-bladder,  which  was  more  contracted 
than  ufual,  was  contain’d  a  kind  of  bloody  bile.  But  the  liver  was  connected 
to  the  feptum  tranfverfum  by  more  connexions  than  common,  and  thofe 
were  very  irregular  too  *,  fo  that  it  feem’d  to  have  been  affebted  formerly 
with  inflammation :  on  the  furface  which  lay  towards  the  diaphragm,  it 
was  here  and  there  livid  ;  and  on  the  other,  almoft  univerfally  fo :  yet  this 
livor  did  not  penetrate  deeply,  and  the  vilcus  was,  in  other  refpebts,  whitilh. 
The  fplenic  artery  had  on  the  fide  of  it,  a  kind  of  diverticulum,  of  a  he- 
mifpherical  figure,  which  was  bony,  and,  to  appearance,  full  of  concreted 
blood.  » In  the  pericardium  was  a  kind  of  bloody  water,  in  a  moderate  quan¬ 
tity  5  in  the  heart,  and  the  great  vefiels,  were  no  polypous  concretions :  but 
blood  only,  and  that  neither  harder  nor  fofter  than  it  Ihould  be.  The  valves 
of  the  aorta,  at  their  lower  circumference,  were  very  hard,  and  near  to  ofli- 
fication.  The  lungs  were  found  to  the  touch,  but  in  fome  places  redder 
than  ufual.  Before  we  open’d  the  head,  we  obferv’d  a  large  fpot,  of  fuch  a 
kind,  about  the  mouth,  that  we  doubted,  whether  it  was  from  the  wine 
that  had  been  brought  up,  or  whether  blood  alfo  had  come  with  it.  Thp 
mouth  itfelf,  which  certainly  had  not  been  obferv’d  in  the  firft  hours  of  the 
apoplexy,  was  difiorted  to  the  right  fide ;  nor  was  it  the  effebt  of  a  convul- 
fion  i  for  befide  that  the  limbs,  and  the  neck,  tvere  very  flexible,  I  reduc’d 
the  mouth  to  its  proper  place  with  my  hand,  the  parts  eafily  following  with¬ 
out  any  force,  and  remaining  where  they  were  plac’d  •,  fo  that  the  paralyfis 
of  the  face  feem’d  alfo  to  have  happen’d  on  the  left  fide.  Having  cut 
through  the  cranium,  which  we  thought  was  thicker  than  ufual,  we  imme¬ 
diately  law  blood  to  be  extravaiated  beneath  the  dura  mater,  and  to  be 
fliining  through  its  fubfiance.  And  that  blood,  as  we  perceiv’d  by  diflebt- 
ing  farther,  cover’d  the  whole  right  hemifphere  of  the  brain  •,  for  it  even  lay 
under  the  bafis  of  the  brain,  and  was  form’d  into  one  continued  lamina  every 
where.  This  lamina  being  remov’d,  not.only  the  fanguiferous  vefiels  of  the 
pia  mater,  both  in  the  left  and  right  hemifphere,  were  found  to  be  more 
turgid  than  ufual,  here  and  there  ;  but  we  alfo  perceiv’d  two  or  three  fora¬ 
mina  in  that  part,  which  cover’d  the  outer  fide  of  the  right  hemifphere, 
from  which  the  blood,  we  have  fpoken  of,  ifiu’d  out  betwixt  the  two  me¬ 
ninges.  For  thefe  foramina  led  into  a  certain  large  and  longitudinal  cavity, 
form’d  in  the  medullary  fubftance  of  the  fame  hemifphere,  between  the  ex¬ 
ternal  fide  and  the  lateral  ventricle,  fo  as  to  be  equal  to  two  fingers  breadth 
in  width,  and  in  length  to  fix,  or  more.  This  cavity  was  contain’d  within, 
unequal,  and  almoft  eroded  parieties  *,  it  was  full  of  a  grumous  blood,  and 
had  a  communication  with  the  right  ventricle  towards  its  pofterior  part:  by 
means  of  which  communication,  a  fmall  quantity  of  blood  had  been  pour’d 
into  that  ventricle,  and  a  fmall  portion  had  even  pafs’d  over  into  the  left, 
by  breaking  through  the  pofterior  part  of  the  feptum  lucidum  :  but  the 
blood  had  form’d  itfelf  into  a  laminated  concretion  in  each  of  the  ventricles. 
It  teem’d,  however,  that  fome  other  veflfel  alio,  mutt  have  been  ruptur’d  *, 
fince  a  lamina  of  blood  was  found  below  the  tranfverfe  procel's  of  the  dura 
mater,  covering  the  whole  cerebellum,  though  of  a  moderate  thicknefs :  for 

you. 


Letter  III.  Article  3.  37 

you  very  well  know,  that  in  a  natural  (late,  there  is  no  paflage,  from  the 
cavity  of  the  meninx,  that  inverts  the  cerebrum,  to  that  which  inverts  the 
cerebellum.  Moreover,  in  the  fpinal  tube,  as  far  as  we  could  look  into  it 
from  above,  a  quantity  of  blood  lay  extravafated  about  the  fpinal  marrow. 
But  fome  parts  of  the  brain  were  of  a  {lightly  yellowiih  colour  ;  the  plexus 
choroides  were  flaccid,  and  in  a  manner  dertitute  of  blood;  and  the  finulfes 
of  the  dura  mater  were  empty. 

3.  The  blood,  to  begin  with  that  circumrtance,  is  fometimes  effus’d  into 
the  tube  of  the  fpine,  and  thence  flows  up  to  the  cerebellum  ;  or,  at  other 
times,  defcends  from  the  cavity  of  the  cranium  to  that  of  the  fpine ;  and 
even,  fometimes,  veffels  may  be  ruptur’d  in  both  cavities,  and  blood  confe- 
quently  extravafated  in  both.  A  remarkable  example  of  the  firft  cafe,  was 
obferv’d  by  Boerhaave  (<2),  in  a  certain  victualler,  who  was,  for  that  rea- 
fon,  firrt  made  parapledtic,  and  then  apoplectic.  But  if  a  confiderable 
quantity  of  blood,  pour’d  into  the  cavity  of  the  vertebra,  does  not  flow  out 
from  thence ;  a  mortal  difeafe  is  brought  on:  “  the  many  nerves  of  the 
<c  fpinal  marrow,  which  give  rife  to  the  branches  of  the  intercoftal,  being 
<c  comprefs’d,  and  confequently  the  motion  of  the  interior  parts  ceafing.” 
And  this  du  Verney  (b)  had  long  ago  exceedingly  well  conjedur’d  ;  who  had 
obferv’d  another  cafe  of  this  kind ;  in  which  cafe,  though  join’d  with  a  pa¬ 
raplegia,  “  the  fenfes  ftill  remain,”  nor  does  a  true  apoplexy  happen.  But 
in  the  cafe  I  have  now  propos’d,  as  preceding  fymptoms  had  (hewn  that  the 
brain  was  difpos’d  to  apoplexy,  and  as  mifchief  enough  of  its  own  was 
found  therein,  there  is  no  reafon,  why  we  fhould  have  recourfe  to  blood, 
flowing  up  from  the  fpine  into  the  cranium,  to  account  for  it:  but  whether 
any  part  of  the  extravafated  blood  had  pafs’d  from  the  cranium  into  the 
fpine,  or  from  the  fpine  into  the  cranium,  or  whether  it  was  extravafated  in. 
both  at  once,  I  leave  entirely  open  to  conjedure.  If,  therefore,  we  fet  af?de 
the  conflderation  of  thefe  things,  as  uncertain  ;  and  defer  thole  which  relate 
to  other  circumftances,  and  elpecially  to  the  cholic  pains,  to  be  confider’d, 
in  their  proper  place  (c) ;  two  things  only  in  this  hirtory  remain  to  be  parti¬ 
cularly  confider’d.  The  one  relates  to  the  dogma  confirm’d  by  Valfaiva  ; 
for  in  this  woman  alfo,  though  the  paralyfis  happen’d  on  the  left  fide,  yet 
the  injury  in  the  brain  was  found  to  be  on  the  right.  The  other  relates  to 
the  dileas’d  appearance  of  the  brain  itfelf:  that  we  may  enquire,  from  what 
caufe,  and  in  what  manner,  it  was  brought  about.  We  will  begin  with  the 
latter :  and  as  to  the  former,  when  we  /hall  have  confirm’d  it  by  more  ob- 
fervations  in  this  letter,  it  will  then  be  not  improper  to  fay  fomething  upon 
that  alfo. 

There  is  an  old  dodririe,  and  perhaps  none  is  older,  obferv’d  by  Varo- 
lius  (d)  and  explain’d  by  Marcianus  (e),  in  his  own  way  ;  who  acknowledges, 
“  acrid  and  eroding  matter  ”  to  be  a  caufe  of  apoplexies  ;  which  dodririe 
is  exprefsly  advanc’d  by  Hippocrates,  or  at  leaft  by  the  author  of  the  book 
Be  Glandulis  (f),  faying,  “  that  if  the  brain  be  really  eroded,  that 

(a)  Pradeft.  ad  Inftat.  §  401.  [d)  De  nervis  Optic.  Epift.  2. 

(b)  Vide  du  Hamel  R.  Sc.  Acad.  Hift.  I.  3.  (<■)  Annor,  in  Hippocr.  de  Gland,  vers.  103. 

$.  5.  c.  2.  n.  1.  (f)  n.  cj,  in  edit.  MarinelL 

(0  Epift.  33.  n*  3. 

n 


diforder 


3  8  Book  I.  Of  Difeafes  of  the  Head. 

<i  diforder  is  brought  on,  which  is,  among  the  Greeks,  call’d  apoplexy.” 
And  the  brain  never  leems  to  be  more  eroded,  than  when  large  and  preter¬ 
natural  cavities  are  found  within  its  fubftance  ;  fuch  as  1  have  defcrib’d  in  this 
woman,  full  of  blood,  and  with  parietes  fo  horribly  lacerated,  and  bloody, 
that  there  is  nothing  which  they  more  effectually  refemble  than  deeply  eroded 
ulcers  of  the  external  parts ;  therefore  you  fee,  that  Valfalva,  in  the  four 
firft  diffeCtions,  produc’d  in  the  former  epiftle  (£),  has  us’d  the  words  ero- 
flon  and  corrofion,  and  the  li^nilitude  of  deep  ulcers  alfo.  Do  not  how¬ 
ever  imagine,  that  thefe  were  real  ulcers  in  the  plexus  choroides,  or  in  the 

neighbouring  fides  of  the  lateral  ventricles,  fo  encreas’d  by  degrees,  as 
to  attain  to  the  magnitude  defcrib’d.  For  not  to  enquire  here,  whether 
thofe  parts  could  long  bear  diforders  of  that  kind,  and  yet  life  and  the  func¬ 
tions  thereof  continue  •,  it  is  lufficient  to  obferve  one  thing ;  that  although 
we  all  of  us  diffeCt  fo  many  heads,  and  the  heads  of  thofe  who  were  difpos’d 
to  a  languineous  apoplexy  from  the  fame  caufe ;  yet  that  we  never  meet 
with  ulcers  of  that  kind  in  the  parts  fpoken  of,  which  are  begun,  and  ftill 

little  •,  but  only  fee  them  already  form’d,  and  of  a  confiderable  flze,  in  thofe 

whom  a  violent  ftroke  of  the  diforder  has  carried  off.  Yet  I  do  not  deny, 
nay  even  readily  acknowledge,  that  the  beginning  of  fuch  large  lacerations 
is  from  eroding  matter :  but  I  fay,  that  this  beginning,  whether  it  be  from 
the  erofion,  or  diftraCtion  of  tfre  coats  of  one  or  more  of  the  fmall  veffels, 
which  carry  blood  through  the  brain,  is  wont  to  be  fo  fmall  and  obfcure, 
that  although  I  have  very  frequently  differed,  piece-meal,  the  brains  of  fo 
many  perfons  of  all  kinds  ;  it  never  yet  happen’d,  that  any  thing  of  this  na¬ 
ture  fell  under  my  notice.  What  then  is  the  reafon,  you  will  fay,  why  it 
fo  fpeedily  brings  on  fuch  devaluation,  and  produces  fuch  prodigious  cavities 
in  the  brain  ?  I  will  tell  you  :  but  let  me  firlt  give  you  another  oblervation 
or  two  of  the  fame  kind. 

4.  A  porter,  a  flout  mufcular  man,  in  the  fortieth  year  of  his  age,  who 
was  faid  never  to  have  had  any  difeafe  before,  died,  at  the  fourth  hour  of  the 
night,  of  an  apoplexy.  His  body,  which  was  publicly  given  me  for  the  ana¬ 
tomical  purpofes  of  the  year  1734, 1  examin’d  the  more  accurately,  as, except¬ 
ing  the  brain,  and  a  few  other  parts,  it  was  more  proper  for  oblervation  than 
almoft  all  the  others  before  demonftrated,  and  as  at  that  time  I  had  more 
leifure  than  ufual.  For  which  reafons  I  can  lafely  affirm,  that  there  was  no¬ 
thing  preternatural  in  this  body,  except  thofe  things  which  I  fhall  obferve  ; 
and  yet  even  all  thofe  were  by  no  means  preternatural.  For  the  fkin  was  uni- 
verfally  brown,  but  this  was  natural ;  as  the  face,  unlefs  in  fome  parts  where 
it  was  livid,  was  much  lefs  brown  than  the  other  parts  of  the  body,  and  even, 
when  compar  d  with  thefe,  was  fair.  The  inteftine  colon  was  very  much  con¬ 
tracted,  except  at  each  extremity,  where  it  was  turgid  with  flatus.  When 
the  colon  was  firfi  mov’d,  although  we  open’d  the  belly  the  day  after  death, 
and  that  in  the  month  of  February,  yet  the  inteftines  which  lay  upon  the 
k  ins,  flill  Ifnoak’d.  But  I  will  tell  you  what  was  evidently  preternatural. 
The  extremity  of  the  ileum  itfelf  was  fwell’d  on  its  internal  furface,  though 
mot  univerfally  ^  and  was  of  a  red  colour,  degenerating  to  livid nefs.  The 

■  *  *  *  *  _  ;  1  1  » 1  \  ,  1  "j  { 

is)  n-  9-  J3 •  15- 


liver 


Letter  III.  Article  5.  39 

liver  was  hard,  and  being  externally,  in  colour,  like  a  reddifh  marble,  varie¬ 
gated  with  white,  was  internally  like  a  liver  that  has  been  boil’d,  and  in  both 
places  fhew’d,  here  and  there,  the  fmall  lobules  of  which  it  is  compos’d.  It 
had  befides,  a  foramen  on  its  convex  furface,  where  its  fubftance  feem’d  to 
have  been  originally  deficient.  This  foramen  was  at  the  diftance  of  an  inch 
from  the  lower  edge,  and  open’d  into  the  finus,  which  is  hollow’d  out  on  the 
pofterior  furface  of  the  liver,  for  the  gall- bladder  to  lie  in  •,  fo  that  the  ex¬ 
treme  part  of  the  fund  of  the  cyft  appear’d  through  the  foramen,  as  we 
look’d  from  that  furface.  Yet  the  gall-bladder  was  not  fhorter  than  common  •, 
but  being  firft  contracted  in  its  middle,  and  then  again  dilated,  its  fundus 
was  bent  upwards  and  forwards,  and  thus  became  vifible  through  the  fora¬ 
men,  as  deferib’d.  This  unufual  kind  of  veficle  contain’d  a  deeply  green, 
and  almoft  blackifh,  bile,  which  however  ftain’d  paper  of  a  dirty  yellow  ;  and 
in  its  fund  were  black  calculi,  or  concretions,  of  different  figures  ;  but  all  of 
them  fo  irregular,  that  you  might  compare  them  to  the  fragments  into  which 
any  hard  body  fhould  be  accidentally  fhiver’d  by  being  broken.  One  of 
thefe  calculi  being  immediately  applied  to  the  flame,  did  not  burn,  but  only 
crackl’d:  the  others  being  thrown  into  water,  lay  fcarcely  a  moment  on  the 
furface,  before  they  all  fell  to  the  bottom.  They  were  all  fmall  •,  but  one,  a 
little  larger  than  thefe,  lay  hid  within  the  cyftic  duCt.  This,  however,  was 
ftill  fo  fmall,  that  it  could  not  hinder  the  paffage  of  the  bile  into  the  in- 
teftines  :  for  that  the  bile  had  accefs  to  the  inteftines,  the  fceces,  which  wt  re¬ 
ting’d  with  a  greenifh  colour,  fufficiently  prov’d  •,  although  the  little  emi¬ 
nence,  which  points  out  the  entrance  of  the  biliary  duct  into  the  duodenum,, 
nor  the  fraenulum,  which  is  wont  to  be  attach’d  to  it,  were  confpicuous.  The 
kidneys  feem’d  fmall  for  the  bulk  of  the  body. 

Some  of  the  valves  that  are  plac’d  at  the  orifices  of  the  heart,  which  receive 
the  venous  blood,  difeover’d,  on  thole  furfaces  that  are  turn’d  towards 
one  another,  little  glands  as  it  were,  which  protuberated  to  the  edge  of  the 
valve,  and  were  made  up  internally  of  a  denle,  firm,  and  compact  fubftance. 

But  from  the  abdomen  and  thorax,  I  come  at  length,  as  you  expedt,  to  the 
brain.  And  here  the  right  hemifphere  difeover’d  an  extravafation  of  blood, 
begun  under  the  pia  mater,  at  that  part  where  it  is  contiguous  to  the  lefc 
hemifphere  anteriorly  :  the  veffels  were  alfo  more  turgid  than  .in  the  left. 
Yet  in  this  left  hemifphere,  a  great  cavern  lay  hid,  form’d  internally  almoft 
in  the  middle  of  its  fubftance,  and  hollow’d  out  from  the  medullary  part 
longitudinally  ;  which  cavern  was  full  of  the  moft  black  and  half-concreted 
blood  ;  and  for  this  reafon,  the  veffels  of  that  fide  were  dels  turgid  than  in 
the  other.  The  parietes  of  this  cavity  were  not  only  here  and  there  lace¬ 
rated,  but  alfo  open’d,  through  the  body  of  the  corpus  ftriatum,  into  the 
left  ventricle,  by  a  foramen  big  enough  to  admit  the  point  of  a  finger;  and 
by  this  paffage,  much  bloody  ferum  feem’d  to  have  elcap’d,  which  had  fill’d 
both  the  left  and  the  right  ventricle,  the  feptum  lucidum  being  broken 
through.  However,  the  fornix,  and  the  plexus  choroides,  were  found  ;  but. 
the  veffels  of  the  cerebellum  were  likewife  very  turgid  on  the  left  fide. 

5.  If  what  we  were  inform’d  of  was  true,  (and  the  examination  of  the 
vifeera  is  not  very  repugnant  thereto)  that  this  man  had  never  been  affiidted 
with,  any  difeafe,  after  fo  long  a  tranquility,  how  great,  and  how  long  conti- 
*1:  '  '  nusdi 


40  Book  I.  Of  Bifeafes  of  the  'Head. 

nued  a  dorm  impended,  as  is  generally  the  cafe,  you  will  eafiiy  conjecture 
from  the  ftate  of  the  liver.  Yet  this  threat’ning  was  doubtlefs  averted  by 
that  very  acute  difeafe,  which  fuddenly  depriv’d  the  man  of  his  life.  But  can 
we  poffibly  fuppofe,  that  this  acute  difeafe  was  brought  on  by  thofe  calculi 
found  in  the  gall-bladder  ?  Certainly  there  have  not  been  wanting  thofe  who 
would  pronounce  the  calculi  or  that  bladder  to  be  the  caules  of  apoplexies  (£)> 
and  they  have  produc’d  the  obfervations  made  by  themfdves  and  others,  who 
have  met  with  them  in  the  diffeCtion  of  apoplectic  patients  :  and  we  can 
moreover  encreafe  the  number  of  thefe  obfervations,  by  the  addition  of  our 
own  (?').  On  the  contrary,  Weitbrecht  (k),  when  in  the  fame  difeafe  he  had 
found  ten  angular  calculi  in  that  cyft,  and  among  thofe  two  pretty  large  ones, 
lays,  “  Can  calculi  of  that  kind  be  confider’d  as  the  caufes  of  an  apoplexy  ? 
“  To  me  there  feems  to  be  fo  great  a  chalm  in  this  reafoning,  that  I  dare 
“  not  undertake  to  fill  it  up.”  And  certainly,  in  moil  cafes,  it  would  re¬ 
quire  a  long  and  tedious  explication,  drawn  through  a  manifold  feries  of  caufes 
and  effeCts,  to  deduce  it  from  this  origin.  For  I  fliould  think,  that  thofe 
cafes  are  to  be  excepted,  to  which  Frederic  Hoffman  referr’d  (/),  to  wit,  when 
the  patient  was  liable  “  to  pains  from  a  calculus  in  the  bladder,  and  gall- 
4‘  bladder  alfo  fo  that  fpafmodic  contractions  being  brought  on  in  the  belly, 
and  the  neighb’ring  veflels  being  thereby  conftring’d,  an  unufual  quantity  of 
blood  was  retain’d  in  the  upper  parts.  But  as  the  porter  in  queftion  is  faid 
never  to  have  been  afflicted  with  any  of  thele  diforders,  we  will  refer  the 
conlideration  of  his  bilious  calculi,  and  thofe  of  others,  to  fome  other  oc- 
cafion  (w)  •,  inafmuch  as  thefe,  for  the  moft  part,  create  only  a  mild,  and  a 
fluggifh  diforder :  and  we  will  now  confine  ourfelves  to  the  molt  violent  and 
dangerous,  of  which  the  following  is  the  third  example. 

6.  A  woman,  of  forty  years  of  age,  and  much  given  to  drinking,  was 
feiz’d  with  an  apoplexy.  From  this  the  became  paralytic  in  both  fides,  and 
was  brought  into  the  hofpital  at  Padua,  and  there  fhe  foon  died.  In  her 
body,  by  reafon  of  the  unfeafonable  heat  of  the  weather,  for  it  was  not  yet 
the  middle  of  March  1/40,  I  fcarcely  examin’d  any  other  part,  in  the  hofpital, 
but  the  head.  The  fkull  feerrfd  narrow  in  its  cavity,  in  proportion  to  the 
length.  There  was  polypous  blood  in  the  falciform  finus.  The  veffels  of  the 
pia  mater  were  fo  diftended  with  blood,  that  the  larger  ones  were  almoff  black ; 
and  the  fmalleft  made  a  very  beautiful  appearance,  as  if  injeCted  with  red 
wax.  The  cerebrum  and  cerebellum  were  fo  foft,  that  the  pia  mater  was 
eaffly  drawn  away  from  them  by  the  hand.  While  I  cut  here  and  there  into 
the  fubfiance  of  the  brain,  not  only  bloody  points  and  filaments  appear’d  more 
frequently  than  ulual  up  and  down,  but  in  the  medullary  fubltance  of  each 
of  the  hemifpheres  a  cavity  was  found.  One  of  thefe  cavities  was  fmall ; 
and  being  fftuated  at  the  external  fide  of  the  thalamus  of  the  right  optic 
••nerve,  was  of  fuch  a  fize  and  fhape,  that  it  would  juft  admit  a  very  fmall 
oval  prune.  It  was  almoft  clos’d,  unlefs  that  it  was  ftuff’d  up,  in  fome  mea- 
fure,  with  a  brown  gluten,  or  half-dried  mucus.  But  the  other  cavity  was 

( h )  Vide  Epb.  N.  C.  cent.  4  obf.  169.  (/)  Med.  Rat.  t.  4.  p.  2.  f.  1.  c.  7.  Thef. 

(/)  Epifl.  JV.  n.  13.  &  V.  n.  6,  19.  Pathol.  §  10. 

(/:)  Commere.  Litter,  a.  17.34.  hebd.9.  n.  2.  (m)  Epift.  37.  n.  37. 


in 


Letter  III.  Articles  7,  8.  41 

In  every  dimenfion  large,  more  efpecially  in  length  ;  for  it  was  produc’d  to 
t he  whole  extent  of  the  left  ventricle,  lying  upon  its  external  fide,  and  was 
full  of  blood,  fuch  as  I  have  already  defcrib’d  in  the  porter (n)  ;  a  fmall  part 
of  which  blood  had  penetrated  into  that  ventricle,  and  from  thence  into  the 
third  ventricle,  two  foramina  having  been  made,  reaching  from  that  cavity 
through  to  the  left  ventricle,  the  one  at  the  external  fide  of  this  ventricle 
forwards,  and  the  other  backwards.  The  right  ventricle,  whofe  plexus  cho- 
roides  was  fomewhat  pale,  did  not  contain  much  water,  and  that  was  entirely 
free  from  blood.  When  I  inverted  the  cerebrum,  the  trunk  of  that  artery 
into  which  the  vertebrals  are  conjoin’d,  exhibited  a  fmall  white  elliptical  fpot ; 
but  upon  examination,  1  found  it  was  not  of  that  kind,  which  is  generally 
us’d  to  be  the  beginning  of  an  offification,  as  I  had  thought ;  but  fomewhat 
loft  in  the  parietes  of  the  artery  itfelf,  and  rather  in  the  interior  coat  ;  yet 
there  was  no  prominence  either  internally  or  externally.  L.aft  of  all,  looking 
downward  Irons  above,  I  perceiv’d  the  pituitary  gland  to  be  very  low  in  the 
fella  equina.  And  whatever  I  have  here  written,  I  demonftrated  to  many  pu¬ 
pils,  who  were  prefent. 

7.  I  was  much  chagrin’d,  (which  however  muft  often  be  borne  with,  in 
country-people,  among  the  lower  clafs,  and  in  foreigners)  that  neither  in  the 
cafe  of  the  porter,  nor  of  this  woman,  it  could  be  certainly  known,  whether, 
on  the  attack  of  the  apoplexy,  they  became  paralytic  in  both  fides  equally, 
or  in  one  only  firft,  and  in  which  *,  for  both  of  them  Ihould  feem  to  have 
been  paralytic  in  the  right.  But  in  regard  to  the  woman,  I  bore  it  more 
hardly  Hill,  that  nobody  could  even  tell,  whether  flse  had  been  feiz’d  with  an 
apoplexy  at  any  other  time.  To  me  it  leem’d  fo,  and  that  thence  a  paralyfis, 
or  debility,  remain’d  in  the  limbs  on  the  left  fide,  when  I  conlider’d  that  lefler 
cavity,  which  I  have  defcrib’d  to  you,  and  compar’d  it  with  thole  obfervations 
pointed  out  in  the  former  letter  ( 0 )  ;  but  efpecially  when  I  compar’d  it  with 
the  obfervations  of  Brunnerus,  who  even  then  found  fome  moifture  in  the 
cells  of  that  kind.  But  what  puzzled  every  body,  was  to  account  for  the 
manner,  in  which  thole  great  caverns,  defcrib’d  in  the  three  foregoing  dif- 
fedtions,  and  overflowing  with  blood  (  *  ),  were  fo  fuddenly  form’d  *,  and  this, 
as  I  promis’d  above,  I  will  endeavour  to  make  fome  conje&ure  upon. 

8.  Nothing  is  more  natural,  when  we  fee  thefe  caverns  in  the  brain,  and 
blood  femi-concreted  therein,  or  effus’d  in  great  quantity  into  the  neighb’ring 
parts,  than  to  call  to  mind  the  rupture  of  aneurifms  in  the  belly  or  thorax, 
and  even  to  imagine,  that  fomething  fimilar  to  this  might  fometimes  happen 
within  the  cavity  of  the  cranium  j  efpecially  as  thole  lymptoms  often  precede 
the  moft  dangerous  apoplexies,  which  would  of  themfelves  lead  us  to  ima¬ 
gine  fuch  a  circumftance.  Thus  two  aneurifms  preceded  that  apoplexy,  which 
in  twelve  hours  carried  off  my  worthy  and  learned  collegue  Bernardin  Ra- 
mazzini.  Thefe  aneurifms  were  no  bigger  than  beans  •,  and  what  is  very  ex¬ 
traordinary,  each  of  them  was  feated  in  the  fame  place,  that  is,  on  the  back 
of  each  hand,  at  the  point  of  the  angle,  between  the  thumb  and  the  fore-finger. 
I  very  well  remember,  that  the  good  old  man  was  us’d  often  to  fhew  me  thefe 

(n)  Epift.  37.  n.  4.  (*)  Cavernas  hujufmodi  vid.  etiam  epift.  60. 

( 0 )  n.  16.  n.  2  &  6.  in  cerebro  &  cerebello. 

Vol.  I.  G  aneurifms. 


42  Book  I.  Of  Difeafes  of  the  Head. 

aneurifms,  which  came  upon  him,  in  the  laft  years  of  his  life,  and  at  the  fame 
time  to  mention  what  he  had  fuffer’d  before  ;  both  the  violent  palpitation  of 
his  heart,  and  the  no  lefs  violent  hemicrania  which  fucceeded  it :  and  in  this 
diforder  it  was,  he  faid,  that  Philip  Maffieri,  doubtlefs  a  fkilful  furgeon,  as 
his  writings  (hew,  found  out  a  moft  wonderful  circumftance  in  him,  when  he 
was  very  old,  to  wit,  a  feparation  of  the  futures  of  the  cranium :  many 
examples  of  which  kind,  I  know,  are  related  by  Bonetus  (y>),  by  Etmuller  (j), 
by  Stalpartfr),  by  Helwich  (j),  by  Platner  (7),  and  by  the  illuftrious  Haller  (a); 
but  how  many  in  old  men  ot  feventy,  fuch  as  Ramazzini  then  was,  I  know  not. 
Nor  am  1  ignorant,  how  difficult  it  is  to  difunite  the  futures  in  bid  men  by 
alf  the  power  of  art;  and  this  is  moreover  confirm’d  by  Bergenius  (x).  Laft 
of  all,  a  blindnefs  alfo,  firft  of  one  eye,  and  then  of  the  other,  which  came 
on  after  the  palpitation  and  hemicrania  had  left  him,  and  lafted  to  the  end  of 
life,  preceded  the  apoplexy  of  Ramazzini.  From  attending  to  all  thele  cir- 
cumftances,  (for  he  us’d,  by  reafon  of  the  benevolent  opinion  he  entertain’d 
of  me,  to  communicate  all  his  indifpofitions  to  me)  it  feem’d  not  improbable, 
that  an  internal  hemicrania  had  been  brought  on  by  the  fame  caufes,  which 
had  before  excited  the  palpitation  ;  and  that  fome  of  the  arteries  within  the 
cranium,  and  perhaps  in  the  plexus  choroides,  the  blood  being  o.bftrudted  by 
the  painful  con traft ions,  were  leiz’d  with  the  fame  diforder,  that  we  faw  exter* 
nally  in  each  hand ;  which  increafing  by  degrees,  and  preffing  upon  the  tha¬ 
lami  of  the  optic  nerves,  brought  on  blindnefs;  till  at  length  the  coats  of 
thofe  fmall  arteries  being  broken  through,  and  blood  effus’d  into  the  ven¬ 
tricles,  a  fatal  apoplexy  was  the  confequence. 

q.  As  the  body  of  this  good  old  man  was  not  open’d  after  death,  I  do 
not  know  whether  I  conjecture  right  or  not.  This,  however,  I  know,  that 
fhould  any  one  choofe  to  account  for  thofe  caverns,  which  I  have  defcrib’d, 
within  the  fubitance  of  the  brain,  by  fuppofing  them  to  arile  from  aneurifms, 
or  varices;  he  nuift  take  care,  for  reafon s  above  mentioned  (jy),  not  to  fup- 
pofe  that  thefe  caverns  were  the  real  cavities  of  aneurifms,  or  varices,  gra¬ 
dually  expanded  to  that  bignefs.  It  is  much  better,  and  more  agreeable  to 
that  ftendernefs  of  coat,  which  is  peculiar  to  all  the  veffels  of  the  brain,  to 
imagine,  that  when  they  have  come  to  a  fmall  dilatation,  which  is  fcarcely, 
and  perhaps  not  at  all,  perceivable  to  the  eye,  whether  gradually  or  foon, 
they  are  fuddenly  ruptur’d  ;  and  that  according  to  the  various  diameters  of 
the  veffels,  and  the  largenefs  of  the  rupture,  and  the  quantity  of  the  blood, 
and  the  impetus  with  which  it  is  continually  urg’d  from  behind,  and  even 
the  laxity  of  the  brain,,  a  little  fooner  or  later,  larger  or  leffier  caverns  are 
form’d  :  and  that  thefe,  according  to  the  larger  or  fmaller  lacerations  of  the 
parietes,  or  according  to  the  various  feat  of  the  laceration,  are  fornetimes 
fhut  up;  but  fornetimes  open  into  the  ventricles,  or  externally  through  the 
furface  of  the  brain  ;  and  fornetimes  even  both  ways  at  once.  For  the  jub¬ 
ilance  of  the  brain,  being  very  foft,  yields,  and  admits  the  impelled  blood  ; 


(/>)  Sepulchr.  I.  i.  f.  i.  obf.  gz.  8c  fchol. 
&  append. 

(q)  Prax.  1.  2.  f.  2.  c.  3.  art.  7. 

(>-)  Cent.  1.  obf.  1.  &  fchol. 

(.<)  Eph.  N.  C.  cent.  10.  obf.  31. 


[t)  Difput.  do  Off.  EpipH.  §  37. 

(u)  Ad  Boerhaav.  Praelt'ifl.  in  Inflit.  §  304. 
( x )  Method,  cran.  oil'd  diffuendi. 

OO  N.  3- 


fo 


Letter  III.  Articles  io,  11.  4  3. 

fo  that  an  apoplexy  and  a  cavern  are  form’d  at  the  fame  time  :  and  this  ca¬ 
vern,  as  long  as  the  force  of  the  heart  and  arteries  does  not  languifh,  is  frill 
farther  encreas’d,  and  the  apoplexy  is  encreas’d  with  it,  unlefs  the  phyfi- 
cian,  or  rather  fome  very  rare  accident,  to  aftift  the  phyfician,  intervene, 
and  prevent  the  progrefs  of  it  (z).  Nay,  the  very  quantity  and  weight  of 
blood,  extravafated  into  the  cavern,  or  from  thence  into  the  ventricle,  may, 
even  fometimes  after  death,  break  through  fome  fmall  and  tender  part,  fup- 
pofe  the  feptum  lucidum  for  inftance;  elpecially  when  the  head  of  the  body 
is  fhaken  after  death,  or  inclin’d  upon  the  found  fide  of  the  cerebrum.  But 
as  to  what  I  have  laid,  in  regard  to  the  production  of  a  cavern,  by  blood 
effus’d  from  a  veifel,  ruptur’d  by  diftenfion  •,  you  will  eafily  fuppofe  the 
fame  to  take  place  alfo,  if  blood  be  pour’d  forth  from  a  veffel  that  is  eroded. 
For  the  veffels  of  the  brain,  like  thofe  of  other  parts,  are  liable  to  more 
than  one  kind  of  diforder ;  and  that  is  evident  in  the  veffels  which  are  fome- 
what  larger  than  the  others,  as  I  lhall  fhovv  prefently  (a) :  and,  indeed,  a 
peculiar  diforder,  of  this  kind,  I  have  already  deferib’d,  in  the  artery  of  the 
woman  (i>),  whofe  diffeCtion  I  juft  now  propos’d. 

10.  It  does  not  efcape  me  that  Brunnerus,  in  his  obfervation  of  that  kind, 
which  I  have  fo  often  commended  (c),  where  he  feems  to  underftand  a  cavern 
by  the  name  of  “  large  hiatus,”  or  “  fiffu re,”  alfo  adds  beneath,  “  that 
“  he  had  leen  elfewhere,  little  arteries,  affe&ed  with  diforder,  or  aneurifm, 
“  which  feem’d  to  have  pour’d  out  this  very  large  quantity  of  blood.”  But 
does  not  point  out  their  fituation,  and  the  diameter  of  the  aneurifm.  Wep- 
fer,  whofe  obfervation  you  alfo  have  in  the  Sepulchretum  (d),  is  more  clear 
in  this  matter;  he  defcribes  a  “  cavity,  or  antrum and  although  he  ufes 
the  example  of  “  an  aneurifm,”  yet  I  do  not  fee,  that  he  underftands  the 
thing  otherwife  than  I  do  •,  nor  does  he  call  it  a  true  aneurifm,  but  properly 
enough  a  “  fpurious”  one  (e)  •,  fo  that  if  we  are  to  depend,  rather  upon  the 
judgment  of  others,  than  our  own,  in  explications  of  this  kind,  I  had  ra¬ 
ther  you  would  follow  the  decifion  of  fo  great  a  man,  than  mine.  But  now 
let  us  go  on  to  other  hiftories. 

11.  Anthony  Tita,  the  fame  who  publifh’d  here,  in  the  year  1713,  the 
“  Catalogus  Plantarum  Horti  Mauroceni,”  was  carried  off  among  the  firft 
of  thofe  who  died  fuddenly  at  Padua,  in  the  beginning  of  May,  1729.  For 
at  that  time,  numbers  were  fwept  away,  to  the  great  confternation  of  every 
body  *,  and  that  without  lying  ill  more  than  a  fewr  hburs,  though  they  ge¬ 
nerally  died  immediately.  The  weather  was  then  confiderably  hot,  and  had 
begun  to  be  fo  fuddenly,  after  long-continued  cold,  and  damp  feafons :  for 
the  autumn,  the  winter,  and  even  the  fpring,  had  been  rainy  till  that  time. 
Tita  was  feventy-three  years  of  age,  yet  even  then  robuft,  and  brawny,  of 
a  fquare  well-fet  body,  and  fomewhat  fat :  he  was  us’d  to  be  much  expos’d 
to  the  fun,  and  to  drink  of  undiluted  wines  without  drunkennefs :  he  had 
been  troubled  for  fome  years  paft  with  inflammations  of  his  eyes ;  and  had 
lately  complain’d  to  my  celebrated  collegue,  Anthony  Vallifneri,  of  a  full- 
nefs  in  his  head.  On  the  fourth  of  May,  when  the  fun  was  unufually  hot, 

(c)  12  in  Addit,  ad  S.  2.  1.  i.  Sepukhr. 

\d)  1 8.  S.  cit.  (f)  Ibid,  in  Schol. 

G  2  having 


(A  Vid.  Epift.  2.  n.  1 6. 
(a)  n.  22.  (4)  n.  6. 


44  Book  I.  Of  Difeafes  of  the  Head. 

having  fpent  the  whole  day  in  the  open  air,  and  flipp’d  in  the  evening  as  ufual  ; 
he  fuddenly  cried  out,  while  at  table,  that  he  was  feiz’d  with  a  violent  difeafe ; 
and  as  he  fpoke,  loft  the  ufe  of  his  left  limbs,  and  his  tongue  alfo ;  at  leaft  fo 
far,  that  moft  of  his  words  could  fcarcely  be  underftood.  Being  immediately 
call’d,  and  very  near  at  hand,  I  ran  to  him  inftantly  :  and  found  him  juft  as  I 
tell  you  :  his  fenfes  at  the  fame  time  were  perfect ;  the  colour  of  his  face,  re- 
fpiration,  and  the  heat  of  his  body,  were  natural ;  his  pulfe,  in  like  manner, 
was  full  and  ftrong  •,  and  he  complain’d  of  no  pain  or  diforder  in  his  head, 
but  feem’d  to  himfelf  to  be  fleepy.  Attending  to  this,  and  ftill  more  to 
what  I  related  above,  I  lent  one  perfon  to  call  a  prieft,  and  another  to  call 
a  furgeon,  fearing  he  might  have  another,  and  a  more  violent  attack.  I  or¬ 
der’d  a  proper  quantity  of  blood  to  be  taken  from  the  healthy  arm  imme¬ 
diately,  a  pretty  fmart  glyfter  to  be  prepar’d,  and  then  oil  of  amber  to  be 
brought,  and  frequently  applied  to  his  noftrils ;  but  the  fpirit  of  fait  ammo¬ 
niac  I  exprefsly  forbad,  left  it  fhould  immoderately  excite  the  circulation  of 
the  blood,  from  which  I  foretold  that  a  fatal  event  might  happen:  thesreft, 
I  left  to  his  own  phyficians,  who,  1  knew,  were  coming,  and  return’d  home. 
One  of  thefe  thought  proper  to  give  an  emetic  •,  which  I  fhould  not  have 
thought  improper  before,  if  I  had  only  confider’d  the  circumftances  that  he 
did.  But  foon  after  the  agitation  of  vomiting,  about  the  fifth  hour  of. the 
night,  an  attack  came  on,  fo  much  more  violent  than  the  former  I  have  de- 
fcrib’d,  that  his  fpeech  was  entirely  loft;  and  a  ftertor  began,  join’d  wirh 
violent,  and,  as  1  fuppofe,  convulfive,  motions  and  ftrugglings  of  body. 
On  the  morning  following,  therefore,  he  died. 

On  the  fixth  of  May,  his  head  was  differed  in  my  prefence,  by  the  go¬ 
vernor’s  order.  The  dura  mater  adher’d  fo  much  more  clofely  than  ufual 
to  the  fkull,  that  great  force  was  requir’d  to  pull  it  away.  It  was  alfo 
blackifh  from  the  fullnefs  of  the  veffels,  but  from  the  fmaller  veffels  only ; 
for  the  falciform  finus  was  empty.  In  the  pia  mater,  the  vefiels  were 
diftended  with  blood  ;  but  the  right  ventricle  much  more.  For  it  contain’d 
fo  much  black  and  concreted  blood,  as  would  fill  the  ftiel-1  of  a  hen’s  egg, 
and  that  in  its  pofterior  part ;  and  the  part  neareft  to  that,  where  it  defcends 
forwards  with  the  hippocampus.  In  the  three  other  ventricles  alfo,  there 
was  blood,  though  in  much  lefs  quantity,  and  fo  fluid,  that  I  fhould  rather 
believe  it  was  only  a  bloody  ferum,  prefs’d  out  from  the  coagulated  blood, 
and  fall’n  down  upon  thofe  ventricles.  For  the  brain  was  found,  and  the 
fubftance  of  the  hemifpheres  entire  •,  fo  that  it  did  not  appear,  from  whence 
fuch  a  quantity  of  ferum  could  have  been  dilcharg’d.  However,  towards 
the  pofterior  part  of  each  lateral  ventricle,  but  efpecially  of  the  right,  the 
plexus  choroides  had  veficles  full  of  water,  of  fuch  a  magnitude,  that  I  do 
not  remember  to  have  feen  bigger  ;  for  they  were  of  the  fize  of  large  grapes;, 
but  the  fituation,  in  which  we  found  the  greateft  quantity  of  blood,  and 
that  coagulated  too,  made  us  think  it  probable,  that  this  had  been  effus’d 
from  the  ruptur’d  veffels  of  the  left  plexus,  and  the  neighbourhood  thereof. 

12.  To  begin  with  thefe  veficles  :  you  will  read  in  the  Sepulchretum  (/) 
that  Wepfer  not  only  faw  fome  pretty  large  bodies  of  this  kind  in  thole 

(f)  Se£t.  2.  clt.  obf.  40. 

plexuftes. 


Letter  III.  Article  12.  45* 

plexuffes,  but  even  one  that  was  folid :  yet  did  not  from  thence,  or  at  lead 
not  immediately  from  thence,  deduce  the  caufe  of  the  apoplexy  (g).  You 
will  alfo  read,  that  Warthon(^),  in  like  manner,  though  he  had  frequently 
found  the  glands  of  the  fame  plexufles,  tumid  in  apople&ic  perfons,  and 
the  ventricles  of  the  brain  fill’d  with  blood  •,  neverthelefs,  attributed  no  other 
efledt  to  thefe  glandules,  but  the  giving  occafion  to  fuch  an  effufion  of  blood, 
by  reafon  of  the  circulation  through  their  veffels  being  obftrufted  ;  and  you 
will  perhaps  think,  that  this  is  confirm’d  by  the  obfervation.of  Drelincurt  (/), 
who,  in  an  apoplectic  woman,  found  thofe  plexufles  fill’d  with  “  the  molt 
tc  tumid  watry  vehicles,  united  and  conglobated  together,”  and  ruptur’d  in 
the  middle,  fo  as  to  have  pour’d  out  much  blood.  But  whether  thefe,  or 
other  things  alfo,  as  I  fuppofe,  were  the  caufes  of  diftenfion,  and  rupture, 
in  my  friend  Tita ;  you  will  certainly  eafily  understand  by  this  relation,  that 
from  the  very  time  in  which  rupture  and  extravafation  have  bern  begun,  we 
ought  to  take  the  utmoft  care,  not  to  agitate  and  impel  the  blood,  by  trou- 
blefome  concufiions.  Nor  can  I  believe,  that  Brunnerus  (£),  when  he  had 
happily  freed  an  apopleCtic  woman  from  the  firft  paroxyfm  by  bleeding,  and 
“  whatever  could  make  revulfion  from  the  head,”  was  pleas’d,  that  in  the 
fecond,  “  he  had  applied  burning  fulphur  to  the  noftrils  or  that  by  pour¬ 
ing  liquor  into  the  mouth,  “  he  had  twice  or  thrice  excited  a  cough  or  at 
lead,  not  when  after  her  death,  which  loon  follow’d,  he  found  mo  ft  of  the 
ventricles  of  the  brain  fill’d  with  blood,  and  the  whole  cerebrum  itfelf  cleft 
afunder  internally  from  the  eruption  of  it.  So  in  that  Danilh  embaffador, 
of  whom  Weitbrecht  ( / )  has  given  us  an  obfervation  ;  what  freezings 
and  vomitings,  if  they  had  been  brought  about,  as  was  attempted,  were 
likely  to  have  effected,  you  will  fee  from  a  diffe&ion  which  is,  in  the  prin¬ 
cipal  things,  very  Similar  to  that  of  Tita  ;  as  you  will  learn  below  ( m ). 
But  I,  from  the  foregoing  fymptoms,  fearing  that  death  would  happen  fo 
much  the  fooner  from  the  agitation  of  the  blood,  not  only  in  the  cafe  of 
Ramazzini,  fpoken  of  above,  prevented  a  phyfician,  a  man  of  iome  emi¬ 
nence,  who  was  inclin’d  to  the  feCt  of  empirics,  from  pouring  into  his 
mouth  an  emetic  medicine,  which  he  could  not  have  Swallow’d  ;  but  would 
alfo  have  prevented  the  other,  who  adminilter’d  one  to  Tita,  had  I  been 
prefent.  But  it  was  neceffary,  you  will  fay,  that  what  this  man  had  taken 
into  his  Stomach  at  fupper,  fhould  be  difcharg’d  by  vomiting  ;  left,  being 
taken  into  the  circulation,  the  quantity  and  impetus  of  the  blood  Should  be 
encreas’d  thereby.  This  were  certainly  to  be  wish’d  ;  provided  it  could  be 
done  without  Straining  or  violence.  Otherwife,  there  is  fo  much  the  lefs 
reafon  for  attempting  it,  as  that  future  increafe  of  the  blood  might  be  ren¬ 
der’d  of  no  effect,  by  previous  evacuations  of  it;  but  the  prefent  danger,  of 
increafing  the  rupture  of  the  veSTels,  and  the  effufion  of  the  blood,  from  vio¬ 
lent  Strainings  and  agitations  of  the  body,  could  be  by  no  means  prevented.. 
I  knew  a  gentleman,  nor  was  he  the  only  one  (»),  who  being  very  full  of 


(g)  Ibid,  in  Schol. 

(/>)  Ibid.  obf.  10.  §  2  cum  Schol. 

(?)  Ibid.  obf.  12. 

{k)  Obf.  fjc.p,  cit.  12.  in  Addit,  ad  eandera 

Sed, 


(/)  Commere.  Litterar.  A.  1734*  Hebd.  9». 
n.  2. 

(m)  n.  8. 

(«)  Vide  etiam  infra,  n.  zz, 

blood* 


4 6  Book  I.  Of  Difeafcs  of  the  Head. 

blood,  was  fnatch’d  away  by  the  moft  violent  apoplexy,  while  he  was  drain¬ 
ing  to  go  to  ftool.  The  fame  thing  alfo  Yalfalva  law,  and  confirm’d  by  dif- 
leflion,  as  I  have  faid  in  a  former  work  (<?).  And  the  obfervation  of  Adol¬ 
phus  ( p )  is  of  that  kind ;  for  he  tells  us  of  a  fatal  apoplexy  arifing  from 
46  a  very  ffrong  and  unfeafonabie  draining”  of  a  woman  in  labour;  by  which 
the  plexus  choroides  was  ruptur’d,  and  the  brain  violently  comprefs’d  by  ex- 
travafated  blood.  And  how  much  more  blood  is  urg’d  into  the  veffels  of 
the  brain,  by  fuch  drainings  ;  and  at  the  fame  time  how  much  lefs  can  re¬ 
turn  from  thence,  the  celebrated  Van  Swieten  has  (hewn  (y).  And  examples 
are  by  no  means  wanting  of  thofe  (r)  who,  when  the  veffels  of  their  brain 
have  been  didended,  “  have  had  them  ruptur’d  by  the  flighted  commotion,  as 
46  from  a  fall,  a  box  on  the  ear,  an  inclination  of  the  head,  and  the  like.”  And 
if  there  was  a  time  in  which  “  many  died  fuddenly  while  they  fneez’d  (j),” 
1  fhould  believe,  that  this  could  hardly  happen  from  any  other  caufe.  And 
if  vdfels,  which  are  as  yet  found,  may  be  ruptur’d  by  concudions ;  how  na¬ 
tural  is  it  to  conclude,  that  ruptures,  already  made,  mud  be  dill  farther  en- 
creas’d  ?  And  fo  far  it  is  from  being  reafonable  to  give  warm  medicines,  or 
liquors  of  any  kind  that  dir  up  the  circulation,  though  fo  frequently  thrown 
into  the  domachs  of  apoplectic  perfons  by  fome  phyficians,  without  any 
didindtion  of  ferous  or  languineous  apoplexies ;  that  nothing  of  this  kind 
ought  even  to  be  applied  to  the  nodrils.  And  I  am  amaz’d  that  a  certain 
great  phyfician,  when  living,  and  who,  in  other  refpedts,  defervedly  taught 
the  fame  dodtrines  as  his  cotemporaries,  was  fo  far  from  avoiding  this  prac¬ 
tice,  among  others  which,  I  think,  ought  to  be  avoided  here ;  that  in  this 
hemorrhage  of  the  brain,  of  which  we  now  treat,  he  particularly  recom¬ 
mended  fpirit  of  lalt  ammoniac,  or  its  volatile  fait,  applied  to  the  internal 
nodrils  by  a  feather,  or  even  blown  in  by  a  quill. 

13.  It  will  not  be  improper  to  fubjoin  fomething  concerning  the  feafon,  in 
which  Tita,  and  fo  many  others,  died  of  a  rupture  of  the  fanguiferous  veffels. 
There  is  certainly  great  danger  of  this  diforder,  either  in  the  depth  of  winter, 
or  the  height  of  dimmer;  the  external  veffels  being  drongly  contradled  by 
the  one,  and  the  blood  greatly  expanded  by  the  other  :  and  when  the  external 
veffels  are  contradted  by  cold,  not  only  a  greater  quantity  is  thrown  into  the 
internal  veffels,  but  the  fluids  are  alfo  encreas’d  by  the  matter  of  infenfible 
perfpiration  being  obftrudted  ;  and  when  the  blood  is  expanded  by  heat,  the 
fame  thing  happens,  as  if  its  quantity  were  encreas’d.  But  as  it  is  flowly,  and 
by  degrees,  that  we,  for  the  mod  part,  come  to  the  fevered  cold,  or  the  mod 
extreme  heat,  fo  the  veffels  are  gradually  contradted,  and  expanded,  to  ac¬ 
commodate  themfelves  thereto :  for  which  reafon,  there  is  much  lefs  danger 
than  when  either  of  them  happens  to  come  on  fuddenly,  as  was  the  cafe  at 
that  time.  For  the  fudden  heat  of  the  weather  caus’d  an  unufual  expanfion 
of  the  blood;  when  at  the  fame  time,  by  reafon  of  the  foregoing  cold,  the 
veffels  were  neither  dilated,  nor  the  blood  diminifh’d  in  its  quantity  by  in- 
fenfible  perfpiration.  Befides,  the  fibres  of  the  veffels  were  render’d  lb  weak 

(0)  Epift.  Anat.  13.  n.  19.  (r)  Vid.  Schol.  ad  obf.  1.  Se£h  cit.  Sepulchr. 

(p)  Act.  N  C.  t.  1.  obf.  241.  (j)  Vid.  apud  Stradam  Proluf.  Acad.  1.  3. 

(f)  Comment,  in  Boerh.  Aph.  §  1010.  3  Y.  Prol.  4.  n.  3. 


and 


Letter  III.  Article  14.  47 

and  relax’d  by  the  long-continu’d  rains,  that  they  were  on  this  account  the  more 
liable  to  rupture.  So  that  you  eafily  fee,  from  all  thefe  circumftances,  what 
things  are  to  be  particularly  avoided  at  fuch  feafons,  by  thofe  perfons  who  are 
under  a  general  danger  of  thefe  diforders..  But  thofe  who  are  peculiarly 
liable  to  thefe  diforders  in  the  brain,  ought  alfo  to  beware  of  other  things ; 
and,  among  the  reft,  they  fhould  avoid  intenfe  thinking,  efpecially  in  a  re¬ 
cumbent  pofture,  when  the  blood  has  a  very  eafy  afcent  to  the  head,  and  de- 
fcends  with  difficulty.  Thus,  I  knew  a  learned  man  at  Bologna,  who,  if  at 
any  time  he  fix’d  his  mind  upon  abftrufe  fpeculations,  before  he  rofe  in  a 
morning,  as  men  of  letters  generally  do,  had  always  fome  drops  of  blood 
falling  from  his  nofe  when  he  got  up.  And  1  would  have  you  beware  of  the 
arguments  of  thofe  who  aflert,  “  that  the  force  of  gravity,  in  proportion  to 
“  the  other  powers  which  generate  motion  in  the  blood,  is  nothing.”  Be¬ 
ware,  1  fay,  giving  fo  much  heed  to  them,  as  to  forget  the  utility  which 
prudent  phyficians  experience  from  an  ereft  fituation,  in  preventing  too  great 
a  quantity  of  blood  being  carried  to  the  head,  either  in  certain  diieafes  them- 
felves,  or  in  the  mere  difpofitions  to  them.  And  at  the  fame  time,  do  not 
forget  what  is  fo  evident  to  every  body,  that  upon  Hooping  the  head,  the 
face  very  loon  grows  red  and  hot :  but  enough  on  this  fubjed  at  prefent. 

14.  An  old  man,  who  had  been  us’d  for  a  long  time  paft,  by  reafon  of 
a  large  ulcer  in  one  of  his  legs,  to  fit  begging  at  the  gate  of  St.  Anthony’s 
church,  being  accuftom’d  to  eat  very  plentifully,  as  I  hear  moft  of  thele 
people  do,  and  ufing  very  little  or  no  exercife  for  the  reafon  above  mention’d,, 
wasl'eiz’d  with  an  apoplexy,  whereby  his  internal  fenfes,  the  ufe  of  his  tongue 
and  left  fide,  were  entirely  taken  away  *,  fo  that  he  died  within  three  or  four 
days.  v 

As  the  body,  by  reafon  of  its  putrid  fmell,  and  the  bad  colour  of  the  in- 
teftines,  which  had  a  mixture  of  red  and  brown,  was  unfit  for  the  anatomical 
demonftrations  that  1  gave  at  the  hofpital,  in  the  year  1741,  1  order’d  it  to 
be  buried,  preferving  only  the  head.  When  the  head  was  to  be  open’d,  in 
the  prefence  of  a  number  of  learned- men,  and  young  Undents,  to  find  out 
the  caufe  of  the  apoplexy,  I  by  chance  obferv’d  a  flight  contufion  on  the  an¬ 
terior  borders  of  the  temporal  mufcle,  on  the  left  fide.  Having  enquir’d 
into  it,  I  found  that  this  contufion  was  the  confequence  of  his  falling  from 
his  feat,  when  the  apoplexy  had  feiz’d  him:  upon  which  I  did  not  hefitate 
immediately  to  foretel,  that  if  the  caufe  of  this  apoplexy  fhould  fall  under 
the  notice  of  the  fenfes,  and  had  not  its  origin  from  ferum,  it  would,  ac¬ 
cording  to  a  certain  conjecture  of  mine,  (hinted  (t)  in  the  laft  letter)  be  found 
in  the  oppofite,  that  is,  in  the  right  fide  of  the  cranium.  And  in  this  con¬ 
jecture  I  was  much  more  confirm’d,  when  it  was  alio  added,  that  the  man 
had  been  paralytic  on  his  left  fide,  as  I  have  already  faid  ;  which  by  chance 
till  then  I  had  not  heard.  At  length  the  fkull  being  cut  through,  and  a 
little  water  having  flow’d  out  in  the  operation,  all  the  parts  beneath  imme¬ 
diately  appear’d  more  full  of  blood  than  they  generally  do.  Having  drawn 
afide  the  dura  mater,  in  whofe  upper  finus  a  little  polypous  concretion  was 
found  ;  not  only  the  veflels  of  the  pia  mater  were  more  tumid  with  blood  on 


(0  N.  25. 


the 


4 3  Book'll.  Of  Difordcrs  of  the  Head. 

the  right  than  on  the  left  fide,  hut  alfo  on  the  right  hemifphere  of  the  brain ; 
and  on  that  only,  appear’d  fome  half-concreted  blood,  which  feem’d  to  have 
come  from  fome  of  thole  tumid  vefleis,  and  to  have  flow’d  downwards.  For 
under  the  bafis  of  the  anterior  part  of  the  pofterior  lobe  of  the  right  hemi¬ 
fphere,  a  little  more  of  the  fame  kind  of  blood  appear’d,  in  like  manner, 
betwixt  the  two  meninges.  Nor  was  there  any  other  extravafation  of  blood 
within  the  cranium,  but  that  which  I  have  mention’d  •,  and  this  was  about 
the  quantity  of  two  fpoonfuls.  Thefe  things  being  demonftrated  thus  to  all 
who  were  prefent,  other  things  alfo  were  fnewn,  which,  though  they  feem’d 
of  lefs  confequence,  yet  were  relative  to  the  prefent  enquiry.  The  iummary 
of  them  is  this.  A  kind  of  gelatinous  humour  was  feen  to  fhine  through 
the  fubftance  of  the  pia  mater.  The  veflkls  were  not  only  diftended  in  the 
medullary  part  of  the  brain,  as  a  number  of  points,  darting  with  blood  here 
and  there,  teftify’d,  but  alfo  the  velTels  which  creep  through  the  furface  of 
the  lateral  ventricles.  Thefe  ventricles  did  not  contain  much  water  ;  yet  at 
the  poderior  part  of  the  choroid  plexuffes  were  a  great  number  of  veficles, 
though  not  of  the  larged  kind  •,  but  thofe  in  the  right  were  fomewhat  lefs 
than  in  the  left ;  and  lefs  water  alfo  was  contain’d  in  the  former  than  the 
latter.  The  plexuffes,  however,  were  fo  far  from  having  lod  their  colour, 
that  they  were  even  more  fill’d  with  blood  than  ufual.  Lad  of  all,  at  the 
anterior  bads  of  the  pineal  gland,  was  found  fomething  yellowifh,  but  not 
hard. 

1 5.  How  much  plentiful  eating,  without  exercife,  tends  to  accumulate 
blood,  and  render  it  impure,  efpecially  where  deprav’d  and  acrimonious  par¬ 
ticles  are  ablorb’d  from  any  large  ulcer,  and  taken  into  the  circulation,  like 
other  things  which  I  pafs  over  as  felf- evident,  needs  no  explanation.  But 
what  mifehief  may  refult  even  from  a  little  blood  being  fuddenly  extravafated 
within  the  fkull,  and  the  manner  in  which  this  mifehief  is  brought  about, 
will  be  fhewn  on  another  occafion  ( u )  :  for  the  other  circnmdances  obferv’d 
in  this  brain,  are  often  found  even  where  there  is  no  apoplexy.  And  as  to 
the  blood,  which  was  extravafated  on  the  right  fide,  bringing  on  a  paralyfis 
in  the  left ;  this  agrees  with  almofi  all  the  obfervations  of  Valfalva,  and  with 
mine.  And  you  will  have  obfervations  of  this  kind  relating  to  other  fpecies 
of  apoplexies,  at  another  time  ( x ).  But  now  you  have  in  this  (y)  and  the 
former  (z)  letter,  out  of  various  obfervations  relating  to  the  fanguineous  apo¬ 
plexy,  thofe  at  leaft  which  Valfalva  and  I  committed  to  writing;  and  would 
have  had  many  more,  if  in  giving  fuch  obfervations,  and  fetting  them  forth 
with  all  their  circumfiances,  1  had  fufficiently  accuftom’d  myfelf  to  depend 
upon  my  memory  alone,  though  lome  fpace  of  time  had  pafs’d  between.  In 
the  place -of  thefe,  therefore,  which  for  that  reafon  I  omit,  I  will  here  finifli 
an  obfervation  common  to  Vailalva  and  me;  for  I  obferv’d  the  difeafe,  but 
he  dififefted  the  head  with  me,  and  publifh’d  (a)  fuch  a  part  of  the  hiftory 
only,  as  was'  fufficient  for  his  purpoie  at  that  time.  The  following  is  the 
•memorandum  I  made  of  it  at  the  time. 

(z)  N.  2,  1 1,  14. 

(«)  Tiaft.  de  Aure,  c.  2.  n.  15.  in  fin. 


{a)  Epift.  4.  n.  32,  &  feq. 

(x)  Epift.  11. 

0)  Epift.  2.  n.  9,  u,  13,  15,  17. 


16.  A  man, 


Letter  IIL  Articles  1 6,  17.  49 

tr 

16.  A  man,  aged  forty  years,  being  liable  to  a  vertigo,  from  the  intem¬ 
perate  ufe  of  wine,  was  feiz’d  with  an  apoplexy,  about  the  beginning  of  Fe¬ 
bruary,  1703.  Being  immediately  brought  into  the  hofpital  of  St.  Mary  de 
Vita,  when  I  was  there,  as  1  us’d  to  be  every  morning,  he  appear’d  to  be 
already  fomewhat  reliev’d  of  himfelf.  The  phyficians  order’d  his  legs  and 
his  feet  to  be  vehemently  rubb’d,  fpirit  of  fait  ammoniac  to  be  applied  to  his 
noftriF,  and  even  fome  drops  of  it  in  a  proper  vehicle  to  be  pour’d  into  his 
mouth,  and  blood  to  be  taken  away  from  his  arm  The  blood  was  taken 
from  the  left  arm,  on  which  fide  he  was  moft  affeCted  with  a  paralyfis.  While 
thefe  things  were  doing,  the  man  was  twice  feiz’d  with  a  tremor,  began  to 
move  his  cheeks  and  his  mouth,  and  to  be  feemingly  more  and  more  affedled 
with  palfy  •,  and  flight  convulfive  motions  prefentlv  appearing  on  the  right 
fide,  a  more  violent  apopledtic  paroxyfm  return’d  on  the  fame  day,  which 
carried  him  off  about  the  fecond  hour  of  the  night. 

While  the  head  was  fever’d  from  the  body,  much  blood  flow’d  out,  part 
of  which  came  from  the  mouth.  Then  Valfalva  faid  to  me,  this  apoplexy, 
unlefs  my  obfervations  fail  me,  was  brought  on  by  blood  injuring  the  right 
fide  of  the  brain.  In  mean  while,  as  we  took  off  the  common  involucra  of 
the  cranium,  we  faw  even  the  fmalleft  blood-vefiels  of  the  periofteum  to  be 
manifelt  and  diftinCl :  yet  we  prefently  faw  the  fmall  veflels  of  the  meninges 
ftill  more  diftended,  efpecially  through  the  left  fide  of  the  pia  mater*,  where 
befides,  on  the  top  of  the  hemifphere,  there  was  fome  extravafated  blood, 
which  refembled  the  blacknefs  of  a  contufion.  But  when  we  came  to  the 
lateral  ventricles,  I  admir’d  the  truth  of  Valfalva’s  prediction.  For  though 
there  was  in  the  left  ventricle  fome  portion  of  extravafated  blood,  yet  it  was 
what  feem’d  to  have  flow’d  there  from  the  right.  For  in  this  laft- mention’d 
ventricle,  there  was  not  only  a  greater  quantity  of  black  and  concreted  blood, 
but  alfo  a  great  hiatus  from  whence  it  had  proceeded  *,  as  if  any  one,  with  a 
large  blunt  knife,  had  penetrated  through  the  external  fide  of  the  corpus 
ilriatum  and  thalamus  nervi  optici,  and  had  turn’d  both  of  thefe  parts  over 
the  fornix  and  the  third  ventiicle.  Other  things  which  relate  to  the  paflage 
of  the  blood  that  was  difcharg’d  from  the  mouth,  you  will  find  fufliciently 
explain’d  by  Vfdfalva  (b). 

17.  Why  the  phyficians  chofe  to  take  blood  from  the  arm  which  was 

difeas’d,  whether  for  a  reafon  fimilar  to  that  which  is  contain’d  in  the  Sepul- 
chretum  (r),  and  Baglivi  follow’d,  or  for  other  realons,  is  not  eafy  to  deter¬ 
mine.  Nor  were  the  obfervations  of  Valfalva  yet  made,  nor  the  doCtrines 
drawn  therefrom  *,  to  which  weight  is  added  by  the  precept  of  Aretaeus  (d). 
In  an  apoplectic  perfon,  fays  he,  44  w'e  mult  confider  the  parts  that  are  af- 
“  feCted  with  palfy  *,  whether  the  refolution  is  on  the  right,  or  on  the  left 
44  fide:  for  we  mult  take  blood  from  the  healthy  parts  (as  we  commonly  fay), 
44  fince  by  this  means  it  is  eafily  drawn  off,  and  a  derivation  alfo  is  made  from 
44  the  injur^l  parts  that  is,  from  the  injur’d  hemifphere  of  the  brain,  inaf-- 
much  as  he  taught  that  the  difeas’d  fide  of  the  brain  would  anfwer  to  the 
found  fide  of  the  body  :  and  this  I  have  already  fhewn  by  a  quotation  pro¬ 
lyl  Tratt.  de  Aure,  c.  2.  n.  14.  in  fin.  (.7)  De  Morb.  Acut.  Cur.  1.  ii  c.  4. 

(r)  In  Addit,  ad  cit.  2.  fe£h  obi.  13. 

VOL.  I. 


H 


duc’d 


So  Book  I.  Of  Difeafes  of  the  Head. 

duc’d  from  him,  in  a  former  work  ( e ).  But  concerning  the  precept  and  doc¬ 
trine,  which  were  juft  now  fet  forth  in  the  words  of  Aretaeus,  the  celebrated 
Oederus  (/)  thus  determines  :  that  he  thinks  the  precept  truly  commendable, 
and  approves  the  firft  reafon,  of  the  blood  flowing  more  eaflly  from  the  veins 
of  the  found  arm,  than  from  the  veins  of  that  which  is  difeas’d  *,  and  even 
farther  illuftrates  and  confirms  it.  But  the  other  reafon,  though  fupported  by 
the  obfervations  of  Valfalva,  which  he  acknowledges  the  truth  of,  he  rejects 
for  this  reafon  only,  becaufe  it  depends  upon  the  common  doCtrine  of  deri¬ 
vation  ;  which  he  very  learnedly  and  nervoufly,  as  far  as  he  could,  under¬ 
took  to  difprove.  Wherefore  he  denied,  that  the  doCtrine  was  at  all  confirm’d 
by  the  obfervation  of  Paulus  Salanus,  and  thofe  of  other  excellent  men  ;  as 
it  had  feem’d  to  Valfalva  (g)  and  me.  But  he  compromifes  his  difienfion  from 
me  with  fo  much  humanity,  that  I  fhould  think  myfelf  very  uncivil,  if  I 
were  not  to  fubmit  thefe  few  things  which  I  fhall  fay,  to  his  judgment  and 
decifion.  Valfalva  and  I  were  afraid  to  ‘attribute  that  which  Salanus  faw,  to 
chance*,  fince  we  oblerv’d,  that  it  agreed  with  obfervations  which  Valfalva 
pointed  out,  as  well  as  with  others  which  I  laid  were  omitted  by  me.  And 
it  agreed  with  reafon  alfo  *,  for  the  veins  of  the  right  arm  communicate  more 
with  the  right  internal  jugular,  than  the  left ;  that  is,  by  their  depletion, 
they  feem  more  to  favour  the  depletion  of  that  jugular,  and  confequently  of 
the  veins  which  flow  from  the  right  fide  of  the  cerebrum  into  the  right 
finufles  :  and  that  Salanus  let  blood  from  the  arm,  we  thought  could  be  eafily 
underftood  j  becaufe  in  the  difcourle  made  by  Valfalva  and  me  on  the  hemi- 
plexia,  no  mention  is  made  of  venaefeCtion  in  any  other  part.  In  the  mean 
while,  I  don’t  doubt  but  this  candid  gentleman  will  give  me  leave,  in  con¬ 
junction  with  Segnerus,  that  very  grave  profefior  of  medicine  and  mathe¬ 
matics,  and  his  prefident  (/6),  “  to  adhere  in  one  general  opinion,  to  thofe 

things,  which  faithful  authors  have  advanc’d,  if  not  with  full  certainty, 
“  at  leaft  with  great  probability,  concerning  the  choice  of  veins  to  be  open’d 
“  in  particular  difordersj  fince  no  danger  can  pofiibly  arife  from  it.” 

But  to  return  to  the  difleCtion  :  you  will  alk  me,  perhaps,  whether  others, 
befide  us,  happen’d  upon  the  fame  thing,  and  found  the  internal  caufe  of 
the  hemiplexia,  not  on  the  fame  fide  with  the  difeafe,  but  on  the  oppofite  ? 
I  have  already  pointed  out  fome  who  faw  it  before  Valfalva,  but  negleCted 
it  as  accidental,  as  Wepfer(z)  and  Baglivi(£).  However,  after  the. obfer¬ 
vation  of  Valfalva  was  publilh’d,  I  do  not  doubt  but  many  faw  the  fame 
thing :  and  that  fome  did,  I  know  (/).  For  the  fame  year  that  I  confirm’d 
the  doCtrine  of  Valfalva,  in  the  Venetian  woman,  fpoken  of  in  the  begin¬ 
ning  of  this  letter  (ot),  l  was  inform’d,  when  I  came  by  accident  to  Padua* 
that  the  fame  thing  was  found  in  a  man,  lately  difleCted  here,  as  in  her ;  ex¬ 
cept  that  the  cavity  which  the  blood  had  form’d  for  itfelf,  in  the  hemifphere 
oppofite  to  the  paralytic  part,  though  it  had  dilcharg’d  fome  of  its  blood  be- 

(e)  Epiit.  Anat.  13.  n.  17.  (b)  fn  Epift.  Differt,  citatae  fubnexa. 

(/)  Differt,  de  Deriv.  k  Revulf.  per  V.  S.  (/)  Epiit.  Anat.  13.  n.  22. 

$29.  {k)  Adde  qure  infra  Epift.  11.  n.  10. 

(g)  Epift.  modo  indie,  n.  24.  (/),  Vide  qu<e  mox  n.  18.  (m  )  N.  2. 


twixt 


,  .•  Letter  III.  Article  18.  51 

twixt  the  meninges,  by  breaking  through  the  pia  mater;  yet  had  not,  in  like 
manner,  communicated  with  the  ventricle,  though  it  was,  in  every  refpedt, 
dole  to  it.  I  had  fcarcely  heard  this  account,  when  I  receiv’d  letters  from 
Venice,  which  i  (till  preferve  ;  in  thefe  I  was  inform’d,  by  Alexander  Bonis, 
a  learned  phyfician,  and  my  worthy  friend,  of  a  fa£t,  which  he  himfelf  was 
witnefs  to.  A  monk,  while  he  was  haranguing,  was  feiz’d  with  an  apo¬ 
plexy  ;  he  liv’d  only  four  hours  after  his  feizure,  and  mov’d  only  his  left 
hand  :  in  the  left  ventricle  of  the  cerebrum  were  found,  at  lead,  two  ounces 
of  concreted  blood  :  and  the  parietes  of  that  ventricle  were  lacerated  ; 
whereas  the  other  was  entirely  found,  and  contain’d  only  a  little  portion  of 
blood,  which  had  flow’d  from  the  left,  by  a  rupture  of  the  feptum  lucidum. 
This  is  the  facred  orator,  referr’d  to  in  the  former  letter  (») ;  and  a  little 
time  after,  when  I  went  again  to  Venice,  I  heard  this  anecdote  concerning 
him ;  that  he  had  for  many  days  before  his  death  abftain’d  from  preaching, 
becaufe  he  complain’d  that  he  was  far  from  being  well :  but  that,  on  the  day 
of  his  death,  he  had  affirm’d  to  thole  about  him,  that  he  had  never  been 
better  than  at  that  time  ;  and  that  he  afcended  the  pulpit  with  great  fpirits 
and  alacrity,  to  begin  that  difcourfe  which  he  was  not  permitted  to  finifh. 
This  brought  to  my  mind  the  cafe  of  king  Attalus  (<?),  who,  “  while  he  ex- 
“  horted  the  Boetians  to  an  alliance  with  the  Romans,  at  Thebes,  fell  down 
“  half-dead,  fo  that  he  expir’d  foon  after;”  yet  not  fome  hours,  but  forne 
days  after  :  for  (p)  “  he  being  carried  in  this  difeas’d  Hate  from  Thebes  to 
“  Pergamus,  died  there  in  the  feventy-firfl:  year  of  his  age which  age, 
join’d  with  infirm  health,  render’d  him  lefs  liable  to  a  violent  apoplexy  ;  if 
that  be  really  a  fragment  of  Livy,  which  was  read  in  the  beginning  of  the 
thirty- third  book,  in  the  old  Bamberg  Codex.  For  the  paffage  runs  thus : 
“  Attalus  {poke  firft.  He  had  no  fooner  begun,  than  being  too  old  and  in- 
<s  firm  to  fup port  the  fatigue  of  fpeaking,  he  was  filent  and  fell  down, 
“  ftricken  in  a  part  of  his  limbs :  yet  the  force  of  the  difeafe  did  not  feem 
“  to  bring  on  prefent  danger  of  his  life,  but  a  debility  of  his  limbs  only.” 

But  this  monk  was  not  more  than  fifty  years  of  age,  and  in  full  {Length  ; 
efpecially  on  that  day,  as  the  colour  of  his  face,  and  the  whole  habit  of  his 
body,  fhew’d.  When,  therefore,  to  this  fulnefs  of  blood,  the  energy  of 
{peaking  was  added,  he  was  feiz’d  with  a  violent  apoplexy  in  the  middle  of 
his  difcourfe,  to  which  he  foon  fell  a  facrifice,  as  I  have  already  faid  in  the 
foregoing  letter  {q\  and  juft  now  in  this  (r). 

18.  You  fee,  by  attending  to  what  fl  have  faid  on  a  former  occafion  (j), 
that  in  determining  the  internal  caufe  and  event  of  an  apoplexy,  I  not  only 
confider  the  age  of  the  patient,  but  other  things  alfo.  A  certain  man,  aged 
feventy  years,  but  a  ftout  healthy  fellow,  and  by  trade  a  blackfmith  (/), 
died  on  the  fixth  day  after  an  attack  of  the  apoplexy,  being  paralytic  in  his 
whole  right  fide.  Yet  the  caufe  of  it  was  found  to  be,  black  blood,  extra- 
vafated  from  the  rupture  of  a  lateral  branch  of  the  left  carotid  artery ;  which 
had  diffus’d  itfelf  all  over  the  left  hemifphere  of  the  brain,  and  injur’d  it 

( r )  n.  i  2.  (s)  Epift.  2.  n.  14. 

(/)  A&.  Helvet.  voi.  1- 


II  2 


(<?)  n.  23. 

(0)  apud  Livium  HifL  1.  37. 
(/)  h  33-  (?)  n-  23- 


even 


5  2  Book  I.  Of  Difeafes  of  the  Head. 

even  to  the  very  recedes  of  the  ventricles.  Other  remarks  occurr’d,  too 
long  to  be  defcrib’d  here.  But  we  mult  not  omit  that  remark  of  the  very 
large  tumour,  which  adher’d  to  the  right  kidney,  and  was  fill’d  with  a  great 
quantity  of  blood ;  and  had  alfo  a  kind  of  fubftance  “  made  up  of  lamellae 
“  lying  one  upon  another,”  fo  as  to  give  fufpicion  of  an  aneurifm  in  fome 
branch  of  the  emulgent  artery,  to  which  the  other  lefler  one  (as  1  conjec¬ 
tur’d  before,  on  the  fimilar  cafe  (a)  of  Ramazzini)  in  the  lateral  branch  of 
the  carotid  artery,  correlponded.  But  of  whatever  nature  the  tumour  was, 
this  certainly  ought  not  to  be  denied  ;  that  the  aorta  being  prefs’d  by  fuch  a 
weight  lying  upon  it,  could  not  admit  its  ufual  quantity  of  blood ;  and 
therefore,  that  a  greater  quantity  than  ufual  being  of  courfe  carried  to  the 
head,  the  tender  vefiels  of  the  cerebrum  would  be  much  more  liable  to  di¬ 
latation  and  rupture.  If,  therefore,  we  Ihould  know,  that  in  any  apoplectic 
perfon  there  is  a  comprefiion  of  this  kind  upon  the  defcending  aorta,  the 
age  of  the  patient,  though  never  fo  great,  Ihould  not  prevent  us  from  fup- 
pofing,  that  the  diforder  may  be  fanguineous. 

In  the  cafe  of  the  Danifh  ambafiador  alfo,  (lightly  mention’d  before  (*), 
there  mult  have  been  fome  other  peculiar  difpofition  to  be  join’d  with  the 
liver,  “  inclin’d  to  hardnefs.”  For  being  threefcore  and  four  years  of  age, 
he  was  fciz’d  with  a  fudden  pally  of  the  left  fide,  and  prefently  after  with 
an  apoplexy,  fo  that  he  died  in  eight  hours  •,  that  is,  fooner  by  far  than  the 
fmith,  a  larger  extravafation  of  blood  having  been  made.  And  he  had,  be- 
fides  many  hydatids  of  the  plexus  choroides,  in  the  right  ventricle  of  the 
brain,  “  more  than  four  ounces  of  grumous  blood :  by  which  the  parts  that 
form’d  this  cavity  were  greatly  diflolv’d.”  And,  at  the  fame  time,  I 
would  have  you  obferve,  that  both  thefe  obfervations,  if  you  confider  the 
contrail  between  the  fide  that  was  paralytic,  and  the  hemifphere  of  the  brain 
that  was  injur’d,  altogether  agree  with  the  obfervations  of  Valfava.  And 
you  will  alfo  find  other  obfervations  that  agree  with  them  ;  and  among  thofe, 
that  of  a  man  (y),  who,  though  he  was  very  old,  yet  by  conftituticn,  and 
even  formerly  by  his  occupation,  as  well  as  by  recent  irregularities  in  diet, 
was  difpos’d  to  a  fanguineous  apoplexy.  But  perhaps  you  will  defire  to 
know  the  reafon  of  other  things,  which  you  obferve  in  the  cafes  given  you 
in  this,  and  the  former  letter,  whether  they  were  from  Valfalva  or  me;  or 
whether  they  were  defcrib’d,  or  only  hinted  at,  from  any  other  author,  not 
even  excepting  thofe  two  given  in  the  thirteenth  of  the  Epiftolse  Anatomi- 
cm  (2),  one  of  which  was  obferv’d  by  Valfalva,  and  the  other  by  myfelf : 
and  you  will  probably  a  fie,  how  it  Ihould  happen,  that  in  almoft  all  thefe 
cafes,  but  efpecially  in  thofe  wherein  preternatural  cavities  are  mention’d,  or 
Conjectur’d  upon  pretty  good  foundation,  which  have  had  blood  collected  in 
them,  or  pour’d  out  from  them  j  thefe  cavities  have  been  generally  found  in 
the  corpus  Itriatum,  or  thalamus  nervi  optici,  or  in  both,  or  near  one  or 
both  of  them ;  and  then  generally  attended  with  a  perforation  and  laceration 
pf  one  or  both  of  thefe  parts  :  and  again,  why  thefe  cavities  were  never  pro¬ 
duc’d  through  the  poftericr  lobe  of  the  cerebrum  to  the  occiput;  feeing,  that 

(«)  a.  8.  ( x )  tu  12,  (j)  Eph,  N.  C.  Cent.  9.  obf.  3.  (z)  n.  19  &  25. 


in 


I 


Letter  III.  Article  19.  3*  3 

in  one  example,  related  by  Wepfer  ( a ),  they  were  carried  through  the  ante¬ 
rior  lobe  of  the  brain,  quite  to  the  forehead :  and  laft  of  all,  fince  thofe  in- 
ftances  are  fifteen  in  number,  why,  in  ten  of  them,  the  cavities  fhould  be 
on  the  right  fide  •,  in  two,  both  on  right  and  left ;  and  in  three  only,  on  the 
left.  In  fa£l,  I  believe,  though  it  feems  otherwife  at  firft,  that  chance  has 
had  the  greateft  fhare  in  thefe  matters  :  or  if  a  longer  and  more  accurate  fe¬ 
ries  of  obfervations  fhould  (hew  that  thefe  things  really  happen’d  fo,  for  the 
moft  part ;  we  muft  look  for  the  caufes  of  them,  in  the  ftru&ure  of  the 
brain,  or  in  the  diftribution  of  its  internal  veffels.  Suppofe,  for  inftance, 
that  about  the  pares  in  queftion,  either  a  greater  number  of  veffels,  or  thole 
of  larger  diameter,  fhould  be  diftributed.  Thus,  upon  cutting  the  corpora 
ftriata  in  pieces  horizontally,  I  remember,  fometimes,  to  have  obferv’d,  in 
the  external  and  anterior  fide  of  each,  a  kind  of  foveola  or  little  pit,  through 
which  a  blood  veffel  manifefkly  pafs’d :  and  at  other  times,  when  I  cut  it 
obliquely  and  flowly,  that  in  the  fame  fide,  many  red  lines  or  ftreaks,  that 
is  fanguiferous  veffels,  appear’d ;  being  parallel  to  each  other,  and  thicker 
than  in  other  parts.  And  the  proximity  of  the  cavities  of  the  ventricles, 
feems  to  be  one  reafon  why  lefs  refiftance  fhould  be  given,  to  the  perforation 
of  their  parietes.  But  when  from  thefe,  or  from  other  circumftances  of  this 
kind,  you  fhall  have  conjedtur’d  the  caufe  of  thofe  things,  which  you  en¬ 
quir’d  after  in  the  firft  and  fecond  place  -,  you  will  be,  perhaps,  lefs  folicitous 
about  the  third  (3),  when  you  confider,  that  the  right  parts  of  the  body  are 
accuftom’d  generally  to  more  frequent  motion  than  the  left ;  and  confequently 
that  all  the  veffels  of  the  right  fide,  though  remote  from  the  limbs,  are,  by 
means  of  communication  and  confent  of  parts,  us’d  to  contradi  more  flrongly, 
and  be  more  largely  dilated. 

19.  But  in  regard  to  the  obfervations  of  Valfalva,  fo  often  mention’d  and 
confirm’d,  that  if  the  left  parts  are  paralytic,  the  injury  is  on  the  right  fide 
of  the  brain  ;  and  if  the  right,  on  the  left ;  I  don’t  fee  what  elfe  you  can* 
require  of  me.  For  you  know  very  well,  that  whatever  I  had  to  fay  on  this 
head,  either  of  antient  or  modern  explications,  or  of  exceptions,  or  of  ad¬ 
ditions,  and  of  every  other  kind  of  matter  relating  to  this  doctrine,  all  thefe- 
I  have  in  general  thrown  together  into  that  anatomical  epiftle  (c)  juft  now 
mention’d  ;  fo  that  it  is  needlefs  to  repeat  them  here.  One  or  two  things 
only,  which  refpedt  thofe  two  firft  heads,  I  may  juft  add :  for  if  you  happen 
to  read  Cafpar  Hoffman  (d),  who  in  regard  to  thofe  ancient  explications  writes 
as  follows  j  “  This  was  the  opinion  of  Aretaeus  before  Galen,  which  Caflius 
“  Jatrofophifta  follows  in  his  forty-firft  problem.  Th.  a  Veigaalfo  mentions 
“  Haly  Abbates  and  Felix,  which  I  have  never  feen*,  nay,  I  do  not  even 
“  know  who  this  Felix  is I  fay,  if  you  read  this,  I  would  not  have  you 
fufpedl,  that  in  this  Felix  I  have  omitted  any  very  ancient  writer,  who  deferves 
to  be  mention’d  with  Aretaeus  and  Caflius.  For  this  very  Felix,  who  is  un¬ 
known  to  Hoffman,  is  the  fame  with  Caflius,  fometimes  call’d  Caflius  Felix, 
as  you  may  know  from  Lindenius  Renovatus  (e). 

(а)  Sepulchret.  Seft.  hac  %,  obf.  18.  (d)  Comm,  in  Galen,  de  ufn  past.  1.  io.  c.. 

(б)  Vide  tamen  Epift.  1 1,  n.  1 2.  imo  Epift.  12  &c. 

62.  n.  7.  9.  11.  (c)  13.  ab  n.  14.  ad  27.  (<?)  de  Scriptis  Medic.  1.  1.  vid,  Caflius  Felix.. 

But 


54  Book  I.  Of  Difeafes  of  the  Head. 

But  this  refpedts  the  exceptions  to,  or  at  leaft  the  illuftration  of,  the  doc¬ 
trine  confirm'd  by  Valfalva;  which  is,  that  notwithftanding  where  one  fide  of 
the  body  is  paralytic,  the  diforder,  if  it  be  organica),  and  fall  under  the 
notice  of  the  fenfes,  is  in  the  oppofite  fide  of  the  brain  ;  yet  it  does  not 
follow,  on  the  other  hand,  that  as  often  as  any  milchief  of  this  kind  is  in 
one  or  the  other  fide  of  the  brain,  the  oppofite  fide  of  the  body  mull  be  pa¬ 
ralytic  •,  for  by  the  fame  method  of  reaioning,  this  ought  never  to  happen, 
which  however  fometimes  does  happen  :  I  mean,  that  though  the  brain  is  in¬ 
jur’d  on  both  lides,  yet  neither  fide  of  the  body  is  paralytic  ;  whether  becaufe 
thefe  injuries  are  brought  about  without  fudden  laceration,  or  comprefiion  of 
the  brain,  or  from  any  other  caufe.  But  this  we  will  endeavour  to  enquire 
into,  and  explain,  when  we  come  to  confider  obfervations  of  that  kind.  At 
prefect,  1  (ball  give  you  the  remaining  ones  relative  to  the  fanguineous  apo¬ 
plexy,  and  refer  the  others  to  their  proper  places. 

20.  A  man,  pretty  far  advanc’d  in  years,  had  died  of  an  apoplexy,  not 
immediately  indeed,  but  after  many  days.  Whether  he  was* hemipledtic  or 
not,  1  could  not  certainly  learn  ;  much  lefs  could  I  learn,  what  was  his  habit 
of  health  before  this  attack.  This  only  I  was  inform’d  of,  that  when  he  lay 
in  the  apopledfic  paroxyfm,  he  had  a  ftrong  pulfe,  but  not  a  difficult  refpi- 
ration. 

His  body  was  given  to  the  theatre,  about  the  end  of  January  1731.  The 
vifiera  being  diligently  examin’d,  there  was  nothing  preternatural  in  the  belly  ; 
but  in  the  thorax  were  fome  preternatural  appearances,  which,  as  far  as  it 
can  concern  any  one  to  know,  I  will  relate  to  you.  The  lungs  were  on  all 
fides  connedted  to  the  pleura.  The  heart  was  lo  fat,  though  the  man  was  in 
no  other  refpedt  fat,  that  looking  upon  the  anterior  furface  of  it,  you  could 
fee  nothing  but  fat.  The  valve  of  the  coronary  vein  was  every,  where  fix’d, 
and  pierc’d  through  with  little  foramina,  as  is  defcrib’d  in  the  fifteenth  of 
the  Epiftolns  Anatomicas  (/).  Laft  of  all,  the  left  vertebral  artery  took  its 
origin  from  the  curve  of  the  aorta  itfelf,  betwixt  the  left  carotid  and  fubcla- 
vian.  And  at  the  fame  time  that  I  fhew’d  its  origin  from  thence,  inftead  of 
the  fubclavian,  whence  it  us’d  to  arife,  I  took  notice  that  it  was  poffible  this 
unufual  origin  might  be  found,  in  fome  meafure,  to  account  for  the  apoplexy. 

After  fome  days,  as  the  order  of  demonftration  requires,  when  the  cranium 
was  open’d,  1  found  and  demonftrated  blood  effus’d,  to  the  quantity  of  half 
a  pound,  betwixt  the  dura  and  pia  mater ;  or  rather  between  the  dura  mater, 
and  another  little  membrane,  the  arachnoides  ;  which  membrane,  being  there 
made  fomewhat  thick  with  the  extravafated  blood,  was  oppofite  to  the  anterior 
region  of  the  left  temple  bone,  and  the  parts  thereabout.  Befides,  almoft 
in  the  middle  of  the  falx,  was  an  offification,  within  the  duplicature  of  that 
procefs,  near  to  the  lower  edge,  lying  longitudinally  to  the  breadth  of  three 
fingers  or  more,  and  being  almofi;  an  inch  and  half  in  depth,  moderately 
yet  unequally  thick.  For  the  whole  circumference  of  it  was  thin,  and  at 
each  of  its  extremities,  feem’d  to  end  in  a  fimple  ftratum  of  parallel  bony 
fibres  ;  and  on  its  right  and  left  furfaces,  but  efpecially  on  the  right,  it  had 
large  protuberances  like  ftuds  or  bofles,  as  any  body  may  fee  in  my  collection  : 


(/)  N,  20. 


for 


Letter  III.  Article  21.  $5 

for  I  ftill  preferve  it,  cover’d  over,  as  it  was,  with  the  membrane  of  the  falx', 
which  adher’d  very  firmly  to  it  on  all  fides.  Finally,  the  pofterior  right 
branch  of  the  carotids,  which  are  at  the  bafis  of  the  fkull,  was  thicker  than 
was  natural ;  but  the  left  was  very  thin,  nor  join’d  with  thofe  branches  that 
go  from  the  artery,  with  which  the  vertebrals  anaftamofe.  And  although  I 
have  feen  the  firft-mention’d  appearance  fometimes  in  other  bodies,  and 
even  at  that  very  time  in  the  brain  of  a  dropfical  perfon,  which  we  difledted ; 
and  though  I  have  feen  this  great  thinnefs  of  one  or  both  arteries  much 
oftener,  and  even  the  want  of  conjundtion  with  the  veffels  fpoken  of  above, 
which  is  a  more  rare  phenomenon,  perhaps  more  than  once  •,  1  was,  never- 
thelefs,  willing  to  inform  you  of  thefe  things,  left  you  fhould  think  I  pafs 
any  thing  over,  that  is  worthy  of  remark. 

21.  As  to  other  circumftances,  and  among  thefe  the  univerfal  adhefion  of 
the  lungs  to  the  pleura,  without  any  difficulty  of  breathing,  I  (hall  take 
another  occafion  to  treat  of  them  (£).  I  was  much  chagrin’d,  upon  finding  fo 
large  an  offification  in  the  falx,  that  no  body  could  inform  me,  what  com¬ 
plaints  this  man  had  made  in  the  years  preceding  the  apoplexy  :  for  fince 
Francefco  Antonio  Catto,  a  Neapolitan  anatomift,  firft  publifh’d  an  account, 
of  the  falx  being  in  fome  part  degenerated  into  a  hard  bone  (h)  (who,  by  the 
way,  was  nor,  as  far  as  I  fee,  fo  defpicable,  that  he  fhould  be  unknown  to 
all  thofe  who  have  fpoken  of  medical  and  anatomical  writers,  inafmuch  as  he 
was  alfo  the  firft  who  really  publifh’d  a  difledtion  of  a  bipartite  uterus  (/)  in 
a  woman)  many  other  obfervations  of  the  fame  kind  have  been  alfo  publifh’d. 
by  feveral  authors  ;  as  Botallus  (£),  Horn  (/),  Skeidius  (/«),  Wepfer  (n) 
ChefTelden  (0),  Vaterus  (p),  Gohlius  (q)y  Mayerus  (r)  •,  and  many  others, 
fome  of  whofe  names  1  fhall  mention  prefently.  Befide  thefe,  there  are  fome 
given  us  in  the  hiftory  and  memoirs  of  the  Royal  Academy  of  Sciences  at 
Paris  (s) ;  yet,  among  all  thefe,  I  do  not  remember  to  have  read  of  a  bone 
which  could  be  put  in  competition  with  that  above  defcrib’d  •,  ft  we  except 
from  fo  great  a  number  of  fakes  a  few  only,  in  one  of  which  Riolanus  (/) 
fays,  that  the  bone  was  four  inches  broad,  and  that  which  Volckhamer  («) 
found  “  in  one  half  of  its  length  entirely  bony,”  but  efpecially  that  which*, 
in  this  very  anatomical  theatre  at  Padua,  Offredus  (x).  faw  “  entirely  bony.” 
And  you  would  imagine,  that  Henry  Albertus*  Nicolai  (jy)  had  feen  one 
equal  to  that  of  Offredus,  did  he  not  add  that  Volckhamer  “  had  obferv’d 
“  the  fame,”  and  Offredus  “  a  fimilar  one fo  that  there  is  realon  to  doubt 
whether  he  meant  the  whole,  or  only  a  part  of  the  falx,  when  he  lays, 
that  he  found  it  “  entirely  bony:”  and  there  is  alfo  much  reafon  for  doubt 
from  hence,  that  we  read  a  certain  obfervation,  in  which  that  very  word 
“  entirely”  is  omitted. 


(g)  Epift.  16.  (4)  Fagog.  Anar.  c.  20. 

(/)  Ibidem,  c.  3.  (k)  Obf.  Anat.  2. 

(/)  Annor,  ad  eandem. 

(»)  Differt,  de  duob.  ofllculis  in  apopleft. 
(»)  Exercit.  de  loco  affett.  in  apopl. 

\o)  The  Anat.  of  the  hum.  body,  tab.  XJ. 
(/-)  Abr.  in  DifT.  qua  ofteogenia,  &c.  in 
proem,  &  in  progreff.  quo  obferv.  calculor.  &c. 


(y.)  Apud  eund.  in  cit.  progreff. 

(/)  Commere.  Litterar.  a  1731.  fpecim.  42« 
n.  2. 

0)  A.  1 71 1,  1713,  1734»  *  !7o6* 

(/)  C.  32.  Comm,  in  Gal.  de  offib. 

( u )  Eph.  N.  C,  Dec.  1.  a.  6.  obf.71. 

(^r)  Earund.  Dec.  2.  a.  1.  obf.  127. 

(j)  Dec.  Obf.  i Hull.  Anat.  obf.  5. 

But. 


$$  *  Book  I.  Of  Difeafes  of  the  Head. 

But  I  was  not  fo  much  difappointed,  that  nobody  could  inform  me  of  what 
I  defil’d  to  know,  relating  to  the  man  in  whom  this  bone  was  found,  be- 
caufe  I  fuppos’d,  or  now  fuppofe,  that  he  fuffer’d  any  great  inconveniences 
from  it,  unlefs  we  fhould  chocle  to  believe,  that  fome  fenfe  of  weight,  or 
diftra&ion,  muft  have  arifen  from  thence:  but  rather,  becaufe  I  wifh’d  to 
confirm  by  my  own  obfervation,  that  very  circumftance  which  1  had  gather’d, 
either  from  the  filence,  or  the  exprefs  declaration,  of  moft  of  thofe  authors 
mention’d  •,  that  uniefs  the  bones,  form’d  within  or  upon  the  falx,  or  in 
any  other  part  of  the  meninges,  not  exceeding  the  bounds,  in  magnitude 
and  weight,  of  thofe  which  they  have  found  to  this  time  j  I  fay,  unlefs  their 
figure  or  fituation  be  l'uch,  as  to  prick  or  irritate  the  meninges,  they  do  not 
only  generally  not  produce  any  violent  diforder  of  themfelvesj  but  even  not 
a  conftant  fenfe  of  pain  :  fo  that  I  think,  for  thefe  reafons,  we  fhould  en¬ 
quire,  whether  the  oblervations  of  Volckhamer  and  Offredus,  and  others  of 
the  like  kind,  contain  any  thing  in  them,  repugnant  to  the  ufes  that  are 
afcrib’d  to  the  falx. 

22.  Yet  I  would  not  deny,  but  that  bones  of  this,  or  of  any  other  kind, 
preternaturally  generated  or  encreas’d,  may  fometimes  give  occafion  to  in¬ 
ternal  diforders  of  the  head  ;  and  particularly  to  the  apoplexy,  if  other 
caufes  are  added.  For  firft,  in  an  old  man  of  Trent  (z),  whom,  having 
been  before  attack’d  with  a  flight  apoplectic  paroxyfm,  a  fucceeding  and 
more  violent  one  carried  off  in  an  inftant,  while  he  went  to  (tool,  fcarcely 
an  hour  after  taking  a  purging  medicine-,  not  only  the  ligament  betwixt  the 
os  facrum  and  the  iichium  was  found  oifified,  as  related  in  the  third  of  the 
Adverfaria  ( a )  -,  but  1  alfo  faw  a  little  bone  within  the  very  fubftance  of  the 
heart,  in  that  place  which  one  of  the  valvulae  mitrales  cover’d,  of  a  moderate 
thicknefs,  but  fo  long,  that  it  exceeded  a  finger’s  breadth.  The  internal  fur- 
face  of  the  aorta  was,  in  like  manner,  cover’d  here  and  therewith  little  bony 
plates  -,  fo  that,  if  I  had  been  allow’d  to  learch  into  the  more  hidden  receffes 
of  the  brain,  it  is  very  probable  I  fhould  have  found  there  other  oflifications 
slfo.  And,  in  the  fecond  place,  it  is  not  uncommon  with  me,  in  fad,  to 
find  in  the  brain  of  old  perl'ons,  that  the  veffels  frequently  have  their  coats 
rigid,  from  the  (peeks  of  beginning  oflifications  -,  and  efpecially  the  carotids, 
where  they  make  fo  confiderable  a  flexure  at  the  fides  of  the  fella  equina. 

In  heads  of  that  kind  it  was,  doubtlefs,  that  Cortefius  ( b )  faw  the  preter¬ 
natural  appearance  he  mentions ;  though  he  himfelf  fets  it  forth  as  if  it  were 
nothing  but  what  was  extremely  natural :  for  he  writes,  “  that  in  the  cavity 
“  of  thofe  arteries,  where  they  are  contiguous  to  the  pituitary  gland,  were 
“  contain’d  two  things  worthy  of  obfervation,  yet  hitherto  taken  notice  of  by 
“  none  ;  the  firfl  is,  that  there  are  fome  very  fmall  cells  the  other,  that 
<l  there  are  fome  fmall  bones,”  (was  Riolanus  ( c )  alfo  impos’d  upon  by  fucb 
appearances  afie:-waid  ? )  “  like  thofe  which  are  found  at  the  joints  of  the 
“  fingers,  call’d  ofia  feffamoidea :  but  the  arteries  not  only  contain  little 

bones  in  this  part,  but  in  others  alfo,  as  experience  itfelf  has  hitherto  „ 

(0  Animad.  in  Bartholin,  anat.  1.  de  venis 
c.  2.  in  tin. 


<( 


(z)  De  quo  Epift.  43.  n.  28. 
.(«)  Animad.  45 

{&)  Mifcell.  Med.  Dec.  1.  c.  7. 


prov’d.” 


Letter  III.  Article  23.  57 

il  prov’d.”  And  he  goes  on  to  fay,  “  that  he  thinks  this  was  not  done 
tc  without  the  greateft  providence  of  nature,  which  perpetually  takes  care 
<c  that  they  be  kept  open  and  elevated,  in  fuch  a  manner,  as  to  be  able  to 
“  fupport  the  dilatation.”  I  however  fee,  that  the  circulation  of  the  blood 
is  To  regulated  in  all  parts,  and  efpecially  in  the  brain,  that  if  any  thing  arife 
from  the  force  of  difeafe,  which  delays  the  ingrefs  or  egrefs  of  the  blood, 
more  than  was  appointed  by  nature,  and  by  that  means  renders  its  motion 
more  flow,  it  cannot  be  without  detriment  to  the  machine  :  and  the  ingrefs 
of  the  blood  is  delay’d  by  reafon  of  the  arteries  being  lefs  able,  on  account 
of  thefe  bony  particles  generated  in  their  coats,  to  contract  themfelves,  and 
prefs  on  the  blood  ;  and  whatever  ftreightens  the  diameters  of  the  venous 
canals,  or  takes  away  from  them  certain  kinds  of  diverticula,  into  which,  on 
occafion,  a  part  of  the  redundant  blood  may  in  fome  meafure  retire,  actually 
delays  the  egrefs  of  the  blood.  So  becaufe,  in  the  fkulls  of  old  men,  the 
fmaller  foramina  are  obliterated  by  the  over-growth  of  the  bony  fubflance  •, 
for  in  dance,  as  1  have  elfe  where  (d)  taken  notice,  thole  through  which  the 
occipital  veins  communicate  with  the  lateral  fi  nu  fifes  *,  it  happens  from  this 
circumftance,  I  believe,  among  others,  that  many  are  more  liable  to  diforders 
of  the  brain  in  old  age.  But  there  are  alfo  many  kinds  of  caufes,  which  may 
ffreighten  the  venous  canals  •,  and  among  thefe,  if  we  attend  to  Scheidius  (<?), 
are  bones  generated  in  the  falx,  which,  “  by  drawing  the  procefs  downwards, 
“  in  fome  meafure,  by  their  weight,  and  flretching  it, -render  the  longitu- 
“  dinal  finus,  which  is  joined  to  it,  more  narrow,  efpecially  in  that  part, 
“  and  confequently  prevent  a  free  paflfage  to  the  refluent  blood.”  And  if  it 
were  credible,  that  this  could  happen  from  one  of  Scheidius’s  bones,  though 
very  fmall,  and  not  heavy-,  how  much  more  likely  is  it,  that  it  fhould  happen 
from  mine,  which  fo  much  exceeded  his,  both  in  bignefs  and  weight  ? 

23.  But  in  order  that  an  extravafation  of  blood,  within  the  cranium,  fhould 
fucceed  a  coarflation  of  this  kind  in  the  finuflfes,  as  he  had  found  in  an  apo- 
pledtic  woman,  he  juftly  concludes,  that  from  fome  caufe  or  other,  11  the 
“  blood  imuft  neceffarily  flow  in  more  copioufly  tnan  ufuai.”  And  I  think 
the  fame  in  regard  to  our  apopleflic  patient ;  and  the  more  readily,  as  the 
blood  was  carried  with  a  greater  impetus  into  the  arteries  of  the  brain.  For 
although,  to  moderate  that  impetus,  the  coats  of  the  veflels  are  made  thinner, 
as  I  laid  above  (/),  and  therefore  lefs  fit  to  urge  on  the  blood  ;  and  though 
anaflamofes  are  form’d  betwixt  the  carotid  and  vc-rtebral  arteries,  and  both  of 
thefe  arteries  are  more  than  once  inflected  in  their  courfe  to  the  brain  ;  there 
is  {till  one  more  contrivance  added  to  retund  the  impetus  of  the  blood,  that 
I  would  have  you  attend  to  with  me  :  which  is,  that  no  other  artery  but  the 
carotid,  fhould  arife  immediately  from  the  curvature  of  the  aorta,  and  go  to 
the  brain  ;  for  nature  has  order’d,  that  the  vertebrals  take  their  rife  from  the 
fubclavian,  as  we  well  know  that  the  blood  is  da/h’d  with  fo  much  force 

againfl:  the  arch  of  the  aorta,  by  the  immediate  power  of  the  heart,  as  to 

make  it  the  molt  frequent  feat  of  aneurifms.  But  the  left  vertebral,  in  our 
apopledlic  man,  did  not  arife  from  the  fubclavian,  but  from  the  curve  of  the 

(A  Epift.  Anat.  4.  n.  11.  (*)  DifT.  fupra  ad  n.  21.  cit.  qussft.  4.  Sc  5.  (f)  N.  9. 


VOL.  I. 


I 


great 


5  2  Book  I.  Of  Difeafes  of  the  Head. 

great  artery  itfelf ;  and  ran,  together  with  its  fellow,  into  that  artery,  which, 
as  I  have  laid,  form’d  a  large  anaftamofis  with  the  right  carotid,  but  none 
with  the  left ;  fo  that  by  how  much  more  the  impetus  of  the  blood  was  broken 
and  reprefs’d  in  the  one,  by  fo  much  lefs,  or  indeed  not  at  all,  was  it  counter¬ 
acted  in  the  other,  With  greater  impetus,  therefore,  did  the  blood  run 
through  the  left  fide  of  the  brain  ;  fo  that  we  need  not  wonder,  if  the  very 
fiender  veffels  of  that  fide,  being  by  degrees  more  and  more  weaken’d  in  their 
coats,  and  the  coardtation  of  the  longitudinal  finus  being  encreas’d  by  the 
bone  before  fpoken  of,  the  blood  fhould  be  effus’d,  not  only  on  the  left  fide, 
but  anteriorly  alfo,  from  whence  it  fhould  have  gone  on  into  the  finus,  at  that 
part  where  the  impediment  was  thrown  in  its  way.  I  am  not  ignorant,  how¬ 
ever,  that  the  fame  vertebral  artery  has  been  found  to  arife  from  the  arch  of 
the  aorta  in  fome  bodies,  not  only  by  others,  but  by  myfelf  alfo  (g),  at  other 
times;  but  whether  the  perfons,  when  living,  had  been  fubjedt  to  diforders 
of  the  head,  or  not,  I  neither  could  know  myfelf,  nor  do  I  remember  it 
was  obferv’d  by  them.  And  we  may  venture  to  fay  the  fame  thing  of  the 
large  anaftamofis  of  the  bafilary  artery  with  one  of  the  carotids,  and  not 
with  the  others.  But  I  know  that  a  little  bone  has  been  generated  on  the 
upper  part  of  the  longitudinal  finus  of  a  man,  who  never  complain’d  of  any 
pain  in  his  head  on  that  account  ( h )  ,  though,  I  fuppofe,  the  finus  muft  have 
been  prefs’d  upon,  and  ftreighten’d  thereby:  but  I  do  not  remember,  that 
all  thofe  circumftances  were  ever  found  to  concur  together,  as  in  the  perfon 
we  fpeak  of  at  prefent.  But  we  have  now  fpoken  iufnciently  of  this  cafe. 

24.  A  youth  of  Bologna,  of  fourteen  years  of  age,  who- had  black  hair, 
and  was  fubjedt  to  be  troubled  with  worms,  had  been  accuftom’d,  from  the 
flighted  exercife,  or  even  from  fitting  by  the  fire,  to  have  large  hemorrhages 
from  his  nofe  ;  and  having  a  habit  of  drinking  fpirituous  liquors  more  than 
was  proper  for  any  body,  but  especially  for  one  of  his  age,  he  became  fud- 
denly,  and  without  any  apparent  caufe,  chang’d  from  a  lively  and  brifk  ftate, 
to  a  more  dull  and  heavy  one.  After  a  few  days,  when  in  the  morning  he 
had  convers’d  in  the  family  with  his  former  chearfulnefs  and  alacrity,  and  had 
even  din’d  among  them  in  his  utual  manner,  he  was  found  afterwards  ex- 
tended  on  the  bed,  upon  which  he  had  vomited,  compreffing  his  head  fre¬ 
quently  with  his  hands,  as  if  he  felt  great  pain  there,  without  fpeech,  and 
very  ibon  without  motion.  A  phyfician  being  fent  for,  order’d  a  vein  to  be 
open’d,  from  which  he  feem’d  to  be  a  little  better.  Spirit  of  fait  ammoniac 
was  alfo  apply’d  to  his  noftrils,  and  a  few  drops  given  internally.  Soon  after 
he  relaps’d  into  his  former  palfy  and  ftupidity,  yet  feem’d  to  underftand  what 
was  faid,  as  he  fignify’d  by  certain  nodds.  His  pulfe  was  low  and  inter¬ 
mitting  ;  his  refpiration  was  bad  ;  and  he  had  fome  foam  at  his  month.  For 
thefe  reafons,  cupping-glaftes  were  order’d  to  his  back,  which  he  did  not 
feel  ;  but  on  having  them  apply’d  to  his  thighs,  he  felt  them  fo  much,  that 
he  cry’d  out  in  a  fomewhat  inarticulate  manner,  and  endeavour’d  to  remove 
them  with  his  hands.  But  thofe  diforders  we  laft  fpoke  of  fcill  continuing, 
and  the  former  diforders  foon  returning,  he  died  about  the  ninth  hour  in  the 
night. 

(^)  Epift.  15.  n.  22.  &  epiil.  56.  n.  10,  &21. 


3 


(/’)  Commere.  Litterar.  a.  1737.  hebd.  34. 

Ex  a  mining 


Letter  III.  Articles  23%  26. 

Examining  the  body  the  day  after,  which  was  the  twenty-third  of  De¬ 
cember  1703,  we  obferv’d,  that  the  calves  of  his  legs,  and  the  back  parts 
ot  his  thighs,  and  other  parts  on  which  he  lay,  were  very  livid,  by  realon 
of  the  blood  ftagnating  in  them.  And  when  I  cut  into  the  integuments  of 
his  head,  which  was  the  only  part  I  difledled,  more  blood,  and  that  more 
black  and  fluid  than  ufual,  was  difcharg’d.  Only  a  few  drops  of  the  fame 
kind  of  blood  were  found  in  the  finus  of  the  falx,  which  was  in  every  other 
refpedt  empty.  In  the  lateral  ventricles,  and  in  the  third,  fomc  little  quan¬ 
tity  of  ferum  appear’d.  But  ,under  the  cerebellum,  the  fubftance  of  which 
was  more  foft  than  it  ought  to  be,  almoft  in  the  middle,  I  found  about  two 
fpoonfuls  of  black  and  concreted  blood. 

25.  If  I  had  defcrib’d  this  hiftory  to  you  among  the  fir  ft,  as  I  did  for¬ 
merly  by  way  of  memorandum  for  myfelf,  many  more  remarks  would  na¬ 
turally  have  arifen,  as  well  in  regard  to  this  laft  chearfulnefs,  as  to  the  me¬ 
thod  of  cure,  and  the  difledtion.  But  as  thofe  things  are  already  lpoken  of 
in  this  letter  (/),  and  the  former  alfo  (£),  it  is  to  no  purpofe  to  repeat  them 
here,  it  is  fufficient  juft  to  hint,  that  if  there  be  any  difference  betwixt  this 
hiflory,  and  any  other  of  this  kind  given  elfewhere,  as  that  which  is  in  the 
Epiftolae  Anatomicae  (/} ;  this  difference  is  to  be  accounted  for  from  the 
place,  time,  manner  and  quantity  of  the  blood  extravafated  about  the  ce¬ 
rebellum  *,  and  from  the  quantity  or  blood  compar’d  with  the  magnitude  of 
the  cranium  and  cerebellum,  which  are  various  in  various  ages.  But  this 
hiflory  was  put  here  among  the  laft,  that  this,  like  the  others,  might  an- 
fwer,  as  far  as  pofiible,  in  order,  to  the  h  ftories  of  the  fanguineous  apo¬ 
plexy,  taken  from  Valfalva,  But  becaufe  this  apoplexy  may  arife,  not  only 
from  blood  extravafated,  but  alfo  from  blood  obftrudted,  and  collected  to¬ 
gether,  in  the  veffels  of  the  brain ;  I  will  therefore  give  you  an  example  of 
this  kind,  before  I  conclude. 

26.  Peter  Fafolati,  an  engraver,  at  Padua,  in  the  fixty-fecond  year  of  his 
age,  yet  ftill  of  a  full  habit,  and  liable  to  no  indifpofition,  died  at  the  very 
fame  feafon  as  Tita  (: m ),  and  even  the  very  day  after  him,  in  the  following 
manner.  He  had  gone  through  no  labour,  had  not  been  troubled  with  care 
and  anxiety,  as  he  had  been  us’d  at  other  times,  and  made  no  complaint  of 
any  thing.  Pie  had  even  fupp’d  heartily,  for  he  always  us’d  to  eat  freely ; 
and  defir’d  to  go  to  bed  more  early  than  ufual,  which  he  did :  but  two 
hours  afterwards,  his  wife  happening  to  wake,  found  him  not  only  dead, 
but  even  cold,  and  ftretch’d  out  in  the  fame  manner  he  had  lay’d  himfelf 
when  he  went  to  bed. 

The  day  following,  when  the  integuments  of  the  cranium  were  cut  into, 
and  while  the  upper  part  of  the  fkull  was  faw’d  through,  and  taken  off, 
much  blood  was  difcharg’d.  Yet  there  was  none  at  all  extravafated  within 
the  fkull ;  none  in  the  fubftance  of  the  cerebrum,  or  cerebellum :  and  both 
thefe  parts  feem’d,  to  the  touch,  to  be  perfectly  natural :  there  was,  I  fay, 
nothing  ruptur’d,  nothing  injur’d  in  any  part.  There  was  fome  water  in 
the  lateral  ventricles  almoft  limpid,  but  in  fmall  quantity  *,  and  fome  alfo 

feem’d  to  flow  from  the  fides  of  the  cerebellum,  which  was  found,  as  I  have 

% 

(0  n.  i2.  (i)  n.  21  Si  feqq.  (!)  XIII.  n.  23.  (m)  Vide  fupra  n.  11. 

I  2  Paid  5 


bo  Book  I.  Of  Difeafes  of  the  Head. 

laid  ;  or  might  it  not  come  from  the  tube  of  the  vertebrae  ?  But'  fuch  a 
quantity  of  fluid  blood  diftended  all  the  veffels  in  and  about  the  brain,  that 
I  do  not  remember  to  have  feen  the  like  before :  even  fome  fmall  veffels, 
which  us’d  to  be  fcarcely  perceptible,  were  extremely  large  and  turgid  (*). 

I  order’d,  however,  that  the  thorax  Iflould  be  open’d  alio.  The  lefc  lobe  of 
the  lungs  was  ftrongly  connected  to  the  ribs,  but  both  of  them  were  found. 
The  colour  of  the  fat,  in  the  mediaftinum,  was  brown;  which  J  attributed 
to  the  blood  remaining  in  the  fmalleft  veffels.  In  the  pericardium  was  fome 
bloody  water,  but  not  much.  The  heart  was  large,  and  its  proper  veffels 
and  auricles  turgid  with  blood,  which  came  forth  very  black  and  grumous, 
while  the  heart  was  cut  off  from  its  larger  veffels,  that  I  might  examine  it 
the  more  clofely,  out  of  the  body.  The-  blood  was  alfo  black  and  grumous 
in  the  ventricles  of  the  heart,  yet  not  in  very  great  quantity.  The  right 
valvula  mitralis  was  white;  and  in  like  manner  fome  of  the  lemilunar  valves: 
the  former  were  much  harder  than  ufual,  and  the  latter  a  little  fo  :  but  in 
both  mitral  and  femilunar,  the  membranous  nature  had  degenerated  alrnoft 
into  the  nature  of  a  ligament.  In  the  middle  and  pofterior  furface  of  the 
heart,  a  kind  of  little  membrane  protruded,  of  a  white  colour,  and  look’d 
like  the  remains  of  an  hydatid.  On  the  right  auricle  externally,  alfo,  were 
fome  white  fpots.  But  the  aorta  and  other  veffels,  as  far  as  I  could  fee, 
were  according  to  their  natural  appearances. 

27.  It  does  not  efcape  me,  that  you  may  think  this  man’s  death  is  rather 
to  be  imputed  to  a  fyncope,  than  to  an  apoplexy  ;  as  well  when  you  confi- 
der  the  celerity  of  it,  as  the  fudden  coldnefs  of  the  body  at  that  hot  feafon, 
and  in  bed  ;  or  even  the  appearances  obferv’d  in  the  heart.  But,  to  begin 
with  thefe  laft,  and  to  compare  them  with  the  quantity  of  blood  found  within 
the  cranium  ;  we  certainly  find  greater  marks  of  diforder  in  the  hearts  of 
thofe,  who  had  not  the  flighted  appearance  of  fainting,  and  much  lefs  the 
moil  violent  fyncope.  And  Galen  has  taught  us,  that  an  apoplexy  may  be 
form’d  from  fuch  an  abundance  of  blood  within  the  cranium,  though  I  have 
never  feen  any  other  cafe  of  the  kind  that  I  remember :  Galen’s  ( n )  words 
are,  “  By  this  means  apoplexies  are  brought  on,  to  wit,  by  much  blood 
“  ruffling  tumultuoufly  into  the  principle  of  animation.”  Nor  did  Petrus 
Salius  (0),  who  firft  wrote  a  feparate  chapter  on  the  fanguineous  apoplexy, 
as  I  have  mention’d  in  the  former  letter  (p),  imagine,  that  the  diforder  was, 
in  general,  brought  about  by  other  means,  in  the  cerebrum,  than  from 
“  too  great  a  repletion  of  the  veins,  arteries,  and  finuffes,  with  blood ;  for 
*'•  which  reafon  a  very  great  ftricture  is  brought  upon  the  brain,  whereby, 
44  not  only  the  free  paffage  of  the  fpirits  is  prevented,  but  they  are  even 
“  choak’d  up,  and  fuffocated  thereby  ;  fo  that  fenfe  and  motion  are  fuddenly 
“  loft,  and  the  intelligent  faculties  are  fufpended  :  that  is,  a  true  and  exadt 
“  apoplexy  fucceeds.”  And,  indeed,  fuch  a  quantity  of  blood  could  not 
be  collected  in  all  the  veffels  within  the  cranium,  but  that  the  fifft  fubftance 
of  the  cerebrum  and  cerebellum  muft  be  violently  comprefs’d,  both  from 
within  and  from  without;  the  fmall  veffels  alfo,  which  efcape  the  fenfes,  be- 

..  0 

(*)  yid.  etiam  Epift.  60.  n.  12.  ( 0 )  Ibid. 

(//)  Vid.  apud  Salium  de  AfFed.  partic.  c.  2.  (/)  n.  1. 

in-or 
‘•‘o- 


6 


Letter  III.  Article  28.  61 

ing  ftreighten’d,  the  circulation  of  the  blood  is  intercepted  ;  and  confe- 
quently  the  fecretion  of  fpirits,  which  cannot  happen  without  it,  is  prevent¬ 
ed  :  for  as  there  is  no  vacuity  in  the  cranium,  and  the  bones  of  it  are  inca¬ 
pable  of  giving  way,  the  whole  force  of  the  prefilire  muft  be  expended  on 
the  brain.  Thei'e  things  cannot  happen  to  the  cerebellum,  as  it  feems,  and 
as  I  have  already  faid  (q),  without  a  fudden  fuffocation  of  refpiration  and 
the  motion  of  the  heart,  being  the  confequences  thereof;  that  is,  without 
fudden  death  :  and  this  death,  if  you  would  rather  have  it  fo,  from  a  fyn- 
cope ;  but  a  fyncope  that  would  proceed  from  the  head,  and  not  from  the 
heart;  or  if  from  the  heart  alfo,  on  account  of  the  appearances  fpoken  of, 
yet,  at  leaft,  certainly  more  from  the  head,  than  from  the  heart.  But 
wherever  there  is  a  fyncope,  from  whencefoever  it  proceeds,  there  is  no  rea- 
fon  to  wonder  at  the  fudden  coldnefs  of  the  body  :  though  I  fhould  rather 
fuppofe,  that  it  was  only  a  diminution  of  warmth,  which  feem’d  to  a  woman 
who  was  herfelf  warm,  to  be  cold.  And,  as  far  as  I  can  judge,  you  would 
not  err  much,  if  you  fhould  call  that  kind  of  fyncope,  which  Herophilus  (r) 
feems  to  have  particularly  pointed  out,  an  apoplexy  from  the  cerebellum  : 
for  he  fays,  “  When  fudden  death  happens  without  any  manifeft  caufe,  then 
it  is  owing  to  a  pally  of  the  heart  :**  for  what  an  apoplexy  from  the  cerebrum 
does  in  other  parts  of  the  body,  the  fame  an  apoplexy  from  the  cerebellum 
does  in  the  heart :  but  in  an  apoplexy  which  proceeds  both  from  cerebrum 
and  cerebellum  at  the  fame  time,  motion  is  deftroy’d  in  all  parts  of  the 
body  at  once.  And  fuch,  I  think,  was  the  cafe  under  confideration,  fince 
there  was  evidently  a  material  caufe  of  comprefTion  upon  them  both  ;  nor 
did  I  find  that  any  of  thofe  fymptoms  had  preceded,  which  are  generally  an¬ 
tecedent  to  a  fyncope  from  the  heart,  or  any  of  its  neareft  veftels. 

28.  But  if  you  fay,  that  neither  were  any  of  thofe  inconveniencies  ob- 
ferv’d,  which  often  precede  an  apoplexy  ;  indeed  I  confefs  it :  but  at  the  fame 
time  I  will  venture  to  fay,  that  it  is  lefs  an  objection  to  me,  who  account 
for  this  apoplexy,  not  from  an  organical  diforder  in  the  cerebrum,  or  cere¬ 
bellum,  but  from  blood  collected,  and  condens’d,  in  the  veftels  of  both. 
The  man  was  extremely  plethoric,  which  his  habit  of  body,  and  plentiful 
manner  of  eating,  fufficiently  fliew.  He  had  eaten  a  full  fupper,  and  gone 
to  bed  fooner  than  ufual ;  that  is  to  fay,  with  a  ftomach  much  fuller  than 
ufual,  whereby  he  comprefs’d  the  aorta,  which  carries  blood  to  the  lower 
parts,  fo  that  a  greater  quantity  of  blood  was  neceflarily  thrown  to  the  upper 
parts  :  and  the  quantity  of  blood  carried  to  the  head  was  fo  much  the  greater, 
as  the  fituation  of  his  body,  in  lying  down,  was  fo  much  the  more  conve¬ 
nient  for  its  afeent,  and  the  lefs  convenient  for  its  return,  as  we  have  already 
prov’d  (j).  And  if  the  diftended  ftomach  does  not  itfelf  prefs  upon  the 
trunk  of  the  great  artery,  at  leaft  it  pre fifes  its  own  arteries,  and  others  that 
are  branches  of  it,  and  refifls  the  motion  of  the  diaphragm  ;  fo  that  by  mak¬ 
ing  refpiration  more  difficult,  it  renders  more  difficult  the  return  of  the 
blood  from  the  head.  Now  call  to  mind  what  nature  has  done,  that  the 
blood  fhould  be  carried  with  lefs  impetus,  and  confequently  with- lefs  cele¬ 
rity,  and  in  lefs  quantity,  to  the  brain;  moll  of  which  circumftances  have 

(y)  Epift.  z.  n.  24.  ft)  Apud  Cal.  Aurelian.  Chronic.  1,  z.  c,  i.  ft)  n.  *3* 

been, 


6 1  Book  I.  Of  Difeafes  of  the  Head.  » 

been  already  obferv’d  (J).  For  by  this  means,  fuppofing  all  the  data  I  juft 
now  mention’d,  you  will  the  more  •eafily.  underhand,  that  fo  much  the  more 
danger  is  there  from  congeftion  of  blood  in  the  brain,  in  proportion  as  na¬ 
ture  has  taken  the  more  pains  to  avoid  it.  But  if  any  one  of  thofe  things, 
which  nature  has  ordain’d,  even  from  the  very  birth  itfelf,  being  chang’d  ; 
as  when  the  blood,  by  reafon  of  a  ffiorter  pafiage,  is  carried  with  more  im¬ 
petus  to  the  brain,  as  in  thofe  who  have  iliort  necks,  ( 'parvicolles  Caelius  («) 
call’d  them)  and  are  therefore  liable  to  the  fanguineous  apoplexy;  not  only 
congeftions  of  blood  in  the  brain,  but  even  ruptures  of  the  veftels  eafily 
happen ;  how  much  more  eafily  then  will  they  happen,  when  many  things 
fhall  be  chang’d,  at  the  fame  time,  in  fuch  a  man  as  we  have  deferib’d  ! 
For  let  us  alio  add  to  thofe  things  that  have  been  faid,  this  alfo,  which  is 
gather’d  from  the  obfervations  of  Ridley,  and  my  own,  formerly  pointed 
out (x) ;  and  drawn  from  fome  diverticula,  as  it  were,  and  duplications  of 
the  fmuflfes,  and  their  fituation,  efpecially  in  the  bafis  of  the  fkull.  For  as 
all  thefe  circumftances,  and  others,  to  which  we  muft  alfo  add,  that  remark¬ 
able  dilatation,  at  the  beginning  of  the  internal  jugular  vein,  have  a  ten¬ 
dency  to  retard  the  motion  of  the  blood  returning  from  the  brain  ;  fo  fome 
certain  caufes  of  delay  are  alfo  encreas’d  from  the  very  pofition  of  the  head 
in  a  fupine  pofture  of  body,  and  the  greater  occafion  is  given  to  congeftions 
of  blood  in  the  brain.  And  this,  I  think,  leaves  us  at  no  lofs  about  the 
reafon,  why,  of  thofe  who  die  fuddenly  on  account  of  the  difficulty  of  its  mo¬ 
tion,  whether  that  difficulty  of  its  return  be  from  thicknefs  and  lentor,  or  from 
plenitude,  moft  of  them  are  found  dead  in  their  beds. 

29.  But  perhaps  you  will  fay,  why  did  not  this  apoplexy  happen  before, 
fince  the  fame  circumftances  were  before  in  the  brain,  and  he  had  not  only 
fupp’d  heartily  very  often,  but  doubtlefs  had  gone  to  bed  very  early  fome- 
times  ?  Certainly  becaufe,  though  moft  things  were  in  the  fame  ftate  in  the 
brain  before,  yet  by  no  means  all.  Nor  do  I  lpeak  of  the  ftrength  of  the 
velfels  only,  which  in  old  men  is  diminiffi’d  more  and  more  every  day,  but 
of  the  feafon  alfo,  and  of  this  chiefly  ;  by  the  force  of  which,  in  thofe  days, 
many  others  were  fo  frequently  and  fo  fuddenly  lnatch’d  away.  For  after 
the  cold,  not  only  in  the  winter,  and  even  in  the  preceding  autumn,  but 
protra&ed  by  an  extraordinary  continuance  through  the  long  fpring  that  fuc- 
ceeded  it ;  the  heat  then,  for  the  firft  time,  brake  out,  and  that  not  gradually, 
but  violently,  and  all  at  once ;  fo  that  the  blood,  for  this  reafon,  expanding 
itfelf  fuddenly,  the  fame  thing  happen’d,  as  if  the  veftels  were  fuddenly 
diftended  with  a  double  quantity  thereof.  But  this  being  fufficiently  ex¬ 
plain’d  above  (jy),  there  is  no  occafion  to  repeat  the  explication  here. 

30.  It  is  better,  if  any  obfervations  have  come  abroad  befides  thefe  which 
are  pointed  out,  up  and  down,  in  this  letter,  relative  to  the  fanguineous  apo¬ 
plexy,  to  point  them  out  alfo  ;  not  all  indeed,  but  only  thofe  which  at  prefent 
occur  to  my  mind. 

On  the  perfons  of  princes  three  obfervations  are  at  hand,  two  of  which  are 
mention’d  from  Dionyfius,  in  the  A£ta  Erudit.  Lipf.  (z)  and  were  from  blood 

(/)  n.  23.  («)  1.  2.  cit.  paulo  fuprac.  12.  (j)  n.  13. 

(, x )  Adverf.  6.  Anim.  6.  (z)  A.  1711.  M,  Septembr. 

extravafated 


Letter  IV.  Article  i .  6  3 

extravafated  in  the  ventricles  of  the  cerebrum  •,  the  third,  in  the  Commercium 
Litterarium  (a),  and  was  from  a  congeftion  of  blood  in  its  veins  and  arteries, 
by  reafon  of  which  the  whole  brain  beneath  the  pia  mater  was  turgid  and  livid. 
To  thefe  two  we  may  add  that  which  we  read  in  the  ACts  of  the  Caefarean 
Academy  (£),  of  a  fhepherd’s  wife-,  and  two  others,  perhaps,  which  Dominic 
Gagliardi  (c)  has  given  us ;  the  one  in  a  fat  old  man,  who  had  fcarcely  any 
traces  of  a  neck,  and  was  too  much  addicted  to  drinking  fpirituous  liquors  i 
the  other,  in  a  man  who  had  imprudently  flopp’d  a  hemorrhage  from  his  nofe, 
by  aflringent  powders.  But  this  one  at  leaft  we  mull  certainly  add,  as  it  was 
made  by  the  perlbn  himfelf  who  relates  it.  The  cafe  was  of  a  plethoric  priefb, 
who  while  he  was  afking  afliftance  from  a  phyfician  for  an  obflinate  pain  in 
his  head,  fell  down  dead  as  he  fpoke  •,  fo  that  he  in  vain  took,  out  a  penknife 
to  let  him  blood  :  and  the  lateral  ventricles  were  found  to  be  extremely  full 
of  blood.  This  phyfician  was  Jo.  Baptift.  Molinario,  whofe  excellent  book, 
entitled,  “  Specimen  de  Apoplexia,”  (, d )  1  fhonld  on  other  occafions  have 
commended,  if  it  had  been  publifh’d  at  the  time  that  I  wrote  thefe  letters  to 
you.  And  thefe  obfervations  alfo  came  out  after  the  fecond  edition  of  the 
Sepulchretum.  But  one  among  the  reft  was  publifh’d  before  it,  in  which, 
though  the  apoplexy  was  from  an  external  caufe,  yet  for  this  very  reafon  it 
deferves  to  be  related  here.  For  who  would  eafily  have  imagin’d,  that  a 
country-boy,  being  lay’d  hold  of  by  the  hair  on  the  crown  of  his  head, 
by  his  enrag’d  fchoolmafter,  and  fuddenly  drawn  to  him  with  violence  and 
lhaking,  fliould  for  that  reafon  only,  be  made  apoplectic,  and  die  the  following 
night  ?  Yet  Slevogtius  ( e )  faw  it,  and  found  out  the  caufe.  For  the  peri¬ 
cranium  on  the  crown  of  the  head  had  been  pull’d  away  from  the  perioiteum, 
and  he  found  blood  largely  extravafated  on  the  dura  mater  j  and  from  the 
veflels  that  connect  this  membrane  to  the  parts  beneath  it  being  ruptur’d, 
blood  was  effus’d  within  the  lobes  of  the  cerebrum,  and  had  penetrated  quite 
down  into  the  ventricles.  And  now  you  have  this  addition  alfo  to  thofe 
things,  that  I  had  promis’d  you,  concerning  the  fanguineous  apoplexy.  If  I 
find  that  you  think  it  not  altogether  ufelefs,  or  unpleafirrg,  I  fhall  then  more 
readily  go  on  to  confider  other  things.  Farewel. 


LETTER  the  FOURT  H. 

Which  treats  of  the  Serous  Apoplexy. 

>.  if 

i.IITHEN  I  faid  in  my  fecond  letter  (a)>  that  the  celebrated  divifion 
Y  V  apoplexies  into  ferous  and  fanguineous,  was  not  to  be  rejected  ; 
I  was  not  unaware  of  the  realons,  which  prevented  fome  of  the  molt  learned 
men,  both  among  the  ancients  and  moderns,  from  acknowledging  the  ferous 

(d)  Part.  2.  f.  r.  n.  9. 

(*)  Diff.  de  dura  matre,  §  14. 

(a)  N.  6.  &  feq. 


(a)  A.  1744.  Heb.  3.  n.  2. 

(b)  Tom.  3.  obf.  121. 

\c)  Deli’  Infermo  libuito.  p.  2.  Veglia22, 


6  4  Book  I.  Of  Difeafes  of  the  Head. 

apoplexy.  Nor,  indeed,  ami  in  the  number  of  thofe,  who  when  they  find 
a  little  water  within  the  fluill  of  an  apople&ic  perfon,  immediately  conclude 
that  this  was  the  caufe  of  the  diforder.  And  1  even  give  you  leave  to  fup- 
pofe,  that  of  the  obfervations  produc’d  here  from  Valfalva’s  difiedtions,  or 
mine,  as  many  as  you  pleafe  fhould  be  referr’d  to  another  origin  ;  fo  you  will 
but  grant  me  thefe  things  in  return  :  firft,  that  though  it  happen’d  to  Varolius, 
as  I  have  faid  in  that  letter  (£),  that  in  the  bodies  of  apopledic  perfons  which 
he  chanc’d  to  difled,  “  no  greater  quantity  of  recrementitious  matter  was 
<c  found  in  the  ventricles  of  the  brain,  than  was  generally  found  in  all  others,” 
yet  that  it  happens  quite  otherwife  in  many.  Secondly,  that  this  water,  though 
it  is  not  the  caufe  of  the  diforder  in  fome,  yet  encreafes  it ;  and  for  that 
reafon,  ought  neither  to  be  unknown  to,  nor  negleded  by,  the  phyfician. 
Laftly,  that  not  only  a  great  quantity,  but  fometimes  even  a  little  water,  may 
be  the  caufe  of  an  apoplexy  ;  and  that  not  in  one  way  only,  as  I  fhall  endea¬ 
vour  to  prove  now  and  then  in  the  proper  places.  And  if  you  attend  to  all 
thefe  things,  I  believe,  you  will  very  well  underhand,  why  I  retain  this  di- 
vifion  of  apoplexies,  and  with  what  intention  I  lend  you  fo  many  and  fo  va¬ 
rious  hiftories,  beginning,  according  to  cuftom,  with  thofe  which  I  find  in  the 
papers  of  Valfalva. 

2.  Who  Valerio  Zani  was,  you  know  from  many  circumftances,  but  ef- 
pecially  from  our  life  of  Valfalva  :  and  you  fhall  now  hear  many  other  things 
of  him,  which  relate  to  the  prefent  cafe  •,  and  thefe  were  fo  much  the  more 
accurately  remark’d,  as  Valfalva  was  with  him  often,  even  almoib  every  day. 

Zani’s  father  had  died  of  an  apoplexy  •,  and  his  uncle,  when  he  was  more 
than  threefcore-and-ten,  of  a  done  in  the  bladder.  He  himfelf  was  of  a 
grofs  habit  of  body ;  his  mufcles  were  foft,  his  neck  fhort  and  flefhy,  and  his 
face  very  red.  He  was  addidfed  to  a  fedentary  life,  and  clofe  literary  appli¬ 
cation  ;  and  was  alfo  accuftom’d  to  high  living,  as  noblemen  generally  are. 
In  the  forty-firft  year  of  his  age,  he  began  to  be  troubled  with  the  Hone, 
and  difeharg’d  many  ;  and  at  the  fame  time  had  a  conftant  difeharge  of  fait 
faliva,  which  afterwards  rotted  all  the  teeth  out  of  their  fockets.  Before  the 
completion  of  his  fixty-firft  year,  the  falivary  difeharge  left  him  ;  but  he  was 
now  and  then  vifited  with  pains  of  his  head,  which  occafion’d  a  great  heavi- 
nefs  therein.  At  length,  about  the  fixty-thfrd  year  of  his  age,  which  he 
never  completed,  after  having  very  ftridtly  obferv’d  the  folemn  fail:  of  forty 
days,  which  in  former  years,  by  reafon  of  his  dubious  ftate  of  health,  he  had 
negledted  to  do,  he  began  to  complain  of  a  pain  in  making  water  j  and  this 
pain  afterwards  became  more  violent,  and  for  the  moil  part  periodical :  for 
it  return’d  almoft  every  month,  and  fometimes  oftener,  after  making  a  large 
quantity  of  watry  urine,  and  efpecially  at  the  time  of  finifhing  the  difeharge, 
this  difeharge  being  alfo  attended  with  difficulty  •,  and  thus  it  lafted  miny 
days.  Befides  thefe  fymptoms,  he  was  alfo  afflidted  with  heavy  pains  in  his 
head,  after  having  had  his  mind  affedted  with  any  emotion  :  and  a  dullnefs 
of  his  fenfes,  laft  of  all,  came  upon  him,  with  a  debility  of  motion  in  his 
right  fide.  As  autumn  drew  nigh,  his  legs  fwell’d,  and  became  cedema- 
tous ;  and  the  right  leg  having  the  fkin  a  little  eroded,  emitted  a  great 


{b)  N.  7. 


quantity 


•  s 

Letter  IV.  Ankle  3.  6$ 

quantity,  of  liquid  ferum  *,  which  coagulated  with  heat,  and  refembled  the 
white  of  an  egg.  Yet  the  patient  was  fo  far  from  being  reliev’d,  by  fuch  a 
great  difcharge  of  ferum,  that,  on  the  contrary,  he  grew  much  worfe.  For 
he  firft  became  fleepy  ;  then  the  winter  folftice  approaching,  and  the  fouth 
wind  blowing,  he  was  found  fpeechleis,  his  right  fide  being  almoft  immove¬ 
able  •,  nor  indeed  was  it  mov’d  at  all,  unlefs  pinch’d  pretty  fharply,  and  even 
then  but  little.  After  taking  fome  drops  of  fpirit  of  fait  ammoniac,  he  could, 
again  fpeak,  and  pretty  readily  move  his  right  fide  •,  but  in  a  quarter  of  an 
hour  after,  he  was  again  ftricken  fpeechlefs,  yet  fhew’d  that  he  underftood 
every  thing  which  was  faid  *,  and  even  fometimes  himfelf  brought  forth  a 
word,  but  with  great  difficulty  of  utterance,  and  a  low  voice.  At  length, 
on  the  fifth  day  of  this  kind  of  apopledtic  diforder,  he  died. 

His  belly  being  open’d,  the  ftomach  was  found  to  be  turgid  with  air,  the 
kidneys  were  very  foft  but  found,  and  the  bladder  was  found  alfo  ;  yet  in  it 
was  contain’d  a  (tone,  as  big  as  a  pullet’s  egg,  and  nearly  of  an  oval  figure, 
fomewhat  deprefs’d :  its  furface  was  very  rough  ;  its  colour  not  white,  as  in 
that  of  his  uncle,  but  reddiffi. 

In  the  thorax  the  lungs  had  a  natural  appearance,  except  that  they  were  a 
little  redder  than  ufual.  The  heart  was  large,  and  in  its  left  ventricle  was 
the  flight  beginning  only  of  a  polypous  concretion  ;  for  the  blood  was  fo  fluid, 
that  a  little  before,  when  a  branch  of  the  iliac  was  cut  by  accident,  it  burft 
forth  almoft  as  in  a  living  man. 

Having  faw’d  through  the  fkull,  the  dura  mater  appear’d  corrugated  •,  but 
under  the  pia  mater,  within  the  fulci  or  furrows  of  the  brain,  fo  limpid  a 
ferum  ftagnated,  that  this  membrane,  before  it  was  cut  through,  refembled 
a  tranfparent  glafs.  There  feem’d  alfo  to  be  a  greater  quantity  of  that  ferum 
in  the  right  hemifphere,  than  in  the  left.  A  ferum  of  the  fame  kind  was 
likewife  found  in  the  larger  ventricles,  to  the  quantity  of  two  ounces  •,  and 
this  was  of  a  faltiffi  tafte.  And  although  of  all  that  ferum  which  was  within 
the  cranium,  not  much,  efpecially  in  a  pure  ftate,  could  be  collected,  yet  it 
was  divided  into  three  parts  :  and  one  of  thefe,  being  put  upon  the  fire, 
evaporated  away  perfectly ;  another,  being  mix’d  with  fpirit  of  fait  ammo¬ 
niac,  and  gently  fhaken,  precipitated  in  a  little  time  to  the  bottom  fome 
blood  which  happen’d  to  be  contain’d  in  it  •,  but  the  third,  being  mix’d  with 
fpirit  of  vitriol,  fuffer’d  no  change.  In  the  right  ventricle,  the  plexus  cho- 
roides  had  a  veficle  of  the  bignefs  of  a  filbert ;  and  in  the  left  it  had  alfo  fome 
fmall  veficles.  Finally,  both  the  carotid  and  vertebral  arteries  fhew’d  every 
where,  in  their  internal  coats,  white  and  firm  corpufcles,  lying  at  fome  diftance 
from  each  other  •,  but  they  were  not  all  of  equal  firmnels,  for  moft  of  them 
were  almoft  of  the  nature  of  a  cartilage  only,  whereas  fome  approach’d  nearly 
*  to  that  of  a  bone. 

3.  Zani  was  affiiCted  with  two  difeafes  chiefly,  and  both  of  them  feem’d  to 
be  hereditary.  But  as  to  the  ftone-of  the  bladder,  we  ftrall  confider  that  in 
another  place  (r).  At  prefent,  we  will  attend  only  to  what  relates  to  the  im¬ 
perfect  kind  of  apoplexy,  of  which  he  died.  Valfalva  imagin’d,  that  the 
caufe  of  this  diforder  was  to  be  fought  for  in  the  extravafated  ferum.:  and  he 

(c)  Epift.  42. 

K 


VOL.  I. 


had 


* 

66  Book  I»  Of  Bifeafes  of  the  Head. 

had  determin’d  formerly,  as  I  have  learnt  from  his  papers,  to  make  many 
experiments  about  the  caufe  of  the  apoplexy.  For  inftance,  whether  it  could 
be  artificially  brought  on,  by  throwing  into  the  carotid  arteries  of  beads  this 
or  that  thing  :  whether  thefe  arteries  being  tied,  the  animal  would  neverthelefs 
feel :  whether  the  blood  of  apopledtic  perfons  differs  from  that  of  others,  and 
in  what  manner  :  finally,  what  is  the  fault  or  depravity  of  the  ferum,  fo  often 
effus’d  within  the  fkulls  of  apopledic  perfons  *,  and  what  is  the  difference  be¬ 
twixt  this  and  that  which  is  often  found,  in  like  manner,  extravafated  in  the 
pain  of  the  head.  You  fee  how  he  endeavour’d  to  examine  this  ferum  in 
Zani,  nor  found  it  coagulable  by  heat,  as  fome  think,  and  as  that  which  had 
flow’d  out  of  the  foot  before,  adtually  was.  And  at  the  fame  time  you  un¬ 
derhand,  how  much  care  muff:  be  taken  that  nothing  be  mix’d  with  the  ferum, 
and  how  eafily  blood  may  be  mix’d  with  it  in  difleftion  ;  but  efpecially,  how 
long  a  feries  of  experiments  is  requir’d,  and  how  cautioufly  and  ingenioufly 
colle&ed.  While  thefe  are  wanting,  if  we  may  be  allow’d  to  ufe  conjedlure, 
and  attend  to  that  which  is  pretty  manifeft;  it  is  not  incredible,  that  from  a 
ferum  of  this  kind,  both  pain  of  the  head  and  apoplexy  is  brought  on  ;  but 
the  one  or  the  other,  according  to  its  various  quantity  and  acrimony  ;  and  the 
apoplexy  finally  after  the  pain.  So  you  have  in  the  Sepulchretum  (d),  the  cafe 
of  a  matron,  who  had  long  been  fubjedt  to  a  hemicrania,  and  who  was  at 
length  taken  off  by  an  apoplexy,  in  whofe  cranium  were  found  “  about  five 
medicinal  pints  of  a  yellowifh,  and  moderately  fait,  water.”  Compare  this 
matron  with  Zani,  and  both  of  them  with  the  man  mention’d  in  the  firft 
letter  (^),  who  had  pains  of  the  head  firft,  and  then  an  apoplexy,  and  within 
whofe  fkull  we  defcrib’d  water  being  found,  both  upon  the  cerebrum,  and 
in  it.  Nor  are  we  to  fuppofe,  becaufe  the  faltnels  of  the  ferum  was  not 
mention’d  in  his  cafe,  that  therefore  it  was  wanting  ;  but  rather  that  it  was 
not  enquir’d  after.  Nor  is  my  conjecture  to  be  flighted,  becaufe  it  was  not 
in  fo  great  a  quantity  in  either  of  thefe,  as  it  was  in  the  matron,  till  you  have 
read  the  next  hiftory,  and  the  remarks  I  fhall  make  thereon. 

4.  A  public  profeffor  of  law  at  Bologna,  about  fixty  years  of  age,  whofe 
face  was  of  a  red,  inclining  to  a  leaden,  colour,  had  complain’d  for  a  month 
of  a  kind  of  weaknefs,  or  pain,  at  his  ftomach,  by  which  his  ftrength  was  fo 
much  diminifh’d,  that  he  was  forc’d  to  reft  himfelf  often,  though  he  walk’d 
but  a  very  little  way  *,  for  reft  gave  him  eafe.  At  length  it  happen’d,  on  the 
fourth  day  after  the  firft  quarter  of  the  moon  in  March,  when  the  fouth  wind* 
blew,  and  he  fat  in  the  great  church  of  Saint  Petronio,  that  he  fuddenly  fell 
down  with  a  confus’d  kind  of  howling,  and  a  certain  peculiar  contorfion  of 
body.  His  face  was  very  livid;  he  foam’d  at  the  mouth;  the  fceces  were 
difcharg’d ;  and  not  the  leaft  motion  appear’d.  He  therefore  died  in  lefs 
than  an  hour. 

Soon  after  death,  his  face  grew  pale  ;  yet  after  twenty-four  hours,  fome 
lividnefs  ftill  appear’d  behind  his  ears,  and  in  other  parts  of  his  body.  While 
the  brain  was  taken  out  from  the  cranium,  a  little  quantity  of  ferum  ran 
out.  The  fanguiferous  veflels  of  the  brain  were  not  very  turgid  ;  but  at  the 
fides  of  fome  of  them  was  a  gelatinous  concretion  of  ferum.  The  pia  mater 


(d)  L.  1.  feel.  2.  obf.  45,- 


(0  N.  4. 


was 


Letter  IV.  Article  6) 

was  eafily  feparated  ;  the  whole  cerebrum  was  extremely  flaccid,  and  look’d 
of  a  dilute  colour  :  in  the  lateral  ventricles  was  a  little  ferum,  fcarcely  worthy 
notice,  which  was  alfo  of  a  faltifii  tafte.  The  cheft  being  open’d,  the  lungs 
feem’d  to  have  been  dy’d,  as  it  were,  with  ink,  yet  were  not  connected  with 
the  pleura.  In  the  pericardium  was  a  proper  quantity  of  water,  with  a 
flaccid  heart;  and  nothing  in  its  ventricles  worthy  of  notice.  Near  to  the 
heart,  the  aorta  had  fome  little  bony  fcales. 

5.  Valfalva  did  not  examine  the  abdomen,  I  fuppofe,  becaufe  he  thought 
that  dilorder  of  the  ftomach,  as  the  patient  call’d  it,  was  owing  to  the  flac- 
cidity  of  the  heart;  for  in  molt  of  our  cities,  people  who  are  ignorant  of 
anatomy,  mean  by  the  word  ftomach,  the  lower  and  anterior  region  of  the 
thorax,  where  the  heart  is  fttuated.  A  heart  of  this  kind,  indeed,  does  not 
feem  to  have  been  very  able  to  propel  the  blood  ;  efpecially  in  walking,  when 
it  is  thrown  more  haftily  through  the  heart  :  and  perhaps  the  black  colour  of 
the  lungs  was  alfo  owing  to  the  weaknefs  of  the  heart.  However  this  may 
be,  the  apoplexy,  which  carried  the  patient  off  in  fo  fliort  a  time,  might 
arile  from  that  ferum,  though  in  fo  fmall  a  quantity  ;  inafmuch  as,  by  reafon 
of  the  flaccidity  and  weaknefs  of  the  heart  and  brain,  he  was  lei's  able  to 
refill  its  preffure  ;  and  inafmuch  as  the  ferum,  by  its  faltnefs,  might  vellicate 
the  pia  mater,  with  which  alfo  the  ventricles  are  invefted,  fo  as  to  create  at 
firft  a  kind  of  epileptic  paroxyfm,  which  prefently  degenerated  into  an  apo- 
pledtic  one.  For  as  Martianus(/)  juftly  fays,  44  it  is  not  contradictory  to 
“  fuppole,  that  one  and  the  fame  humour  fhould  fometimes  bring  on  an 
“  epilepfy,  and  fometimes  an  apoplexy  ;  fince  it  is  every  day  obferv’d,  that 
44  molt  epileptic  patients  are  taken  away  by  a  fucceeding  apoplexy  and  there 
he  not  only  teaches,  44  that  convulfive  motions  depend  upon  a  ftimulus  in 
44  the  brain,”  but  alfo,  that  Hippocrates  “  judg’d  it  impoffible  that  the 
44  brain  Ihould  not  be  convuls’d,  while  it  was  irritated  by  that  acrid  matter.” 
And  indeed,  in  the  paffage  of  that  moft  ancient  writer  which  he  quotes,  it 
is  exprefsly  faid,  44  that  if  the  brain  be  irritated,  an  apoplexy  is  the  confe- 
44  quence ;  for  the  fenfes  are  thereby  deftroy’d,  the  brain  is  convuls’d,  and 
44  the  whole  fyftem  of  the  man  is  overturn’d.”  You  fee,  therefore,  that  it 
is  not  altogether  repugnant  to  probability,  if  we  think,  agreeably  to  the 
opinion  of  fo  great  men,  that  an  apoplexy  may  be  caus’d  by  even  a  little 
ferum,  fo  it  be  but  irritating;  which  will  bring  on  a  convulflon,  and  conle- 
quently  a  conftriClion  of  the  meatus,  or  tubes,  of  the  brain.  And  from 
hence  you  will  know,  in  what  manner  I  think  four  or  five  very  fliort  hifto- 
ries  of  Valfalva,  which  I  fhall  immediately  fubjoin  without  any  remark 
added  to  them,  may  be  in  general  explain’d.  For  whether  you  read,  that 
with  a  pretty  large  quantity  of  ferum,  neither 'a  perfeCt  apoplexy,  nor  a  very 
fudden  death,  was  join’d,  as  in  the  two  firft  of  them ;  or  you  find  that  with 
a  very  little  ferum,  it  happen’d  in  the  fame  manner,  as  in  the  third  ;  or  in  a 
quite  different  manner,  as  in  the  two  remaining  obfervations ;  you  will  fup¬ 
pofe,  that  in  every  one  of  thofe,  I  do  not  fo  much  regard  the  great  or  fmall 
•quantity  of  the  ferum,  as  a  fuppos’d  faltnefs  and  acrimony,  in  different  de¬ 
grees. 


(fj  Annot.  in  1.  Hippoc.  de  Gland,  verf.  103. 

K  2 


6.  A 


68  Book  I.  Of  Difeafes  of  the  Head. 

6.  A  (lender  man,  of  forty  years  of  age,  labour’d  under  an  acute  fever. 
About  the  ninth  day,  in  the  night,  he  loft  the  power  of  fpeaking.  And 
being  fpoken  to,  he  did  not  give  the  leaft  fign  of  underftanding.  In  all  his 
limbs  only  a  (light  faculty  of  feeling  and  motion  remain’d.  His  face  was 
not  red.  At  length  he  died,  about  the  thirteenth  day.  The  brain  was  found 
in  every  refpeCt  nacural  ;  except  that  ferum  ftagnated  betwixt  that  and  the 
meninges  ;  and  the  ventricles  were  alfo  full  of  it. 

7.  Another  man,  of  fixty  years  of  age,  of  a  fallow  complexion,  had  long 
been  afflicted  with  ulcers  in  his  legs.  Thefe  being  almoft  dried  up,  he  was 
l'eiz’d  with  an  aphonia,  or  lofs  of  ipeech ;  together  with  a  ftupefadtion,  and 
dullnefs  of  his  fenfes ;  and  the  day  following  he  died.  Serum  was  found 
betwixt  the  meninges  of  the  fpinal  marrow  and  the  brain;  and  in  the  ventri¬ 
cles  of  the  brain  alfo. 

8.  A  woman,  who  had  been  deaf  before,  on  the  laft  day  of  December 
loft  the  power  of  motion ;  and  her  pulfe  alfo  on  the  fame  day.  Her  whole 
body  was  cold  ;  unlefs  that  the  left  fide,  efpecially  upwards,  retain’d  fome 
little  warmth.  Sometimes  fhe  breath’d  quicker,  fometimes  (lower  ;  but  (fie 
had  more  generally  an  eafy  and  quick  infpiration  ;  but  her  expiration  was 
querulous  and  (low.  Thus  (lie  liv’d  three  days.  In  the  body,  after  death, 
the  blood  was  all  fluid.  In  the  ventricles  of  the  brain  was  a  little  thick  kind 
of  ferum. 

9.  A  woman,  aged  fifty-feven  years,  was  feiz’d  with  a  febrile  chilnefs,  to 
which  a  heat  attended  with  third,  a  fenfe  of  pain,  and  weaknefs  in  the  whole 
body,  fucceeded.  This  fever  attack’d  lier  twice  a  day  with  the  fame  fymp* 
toms :  and  on  the  l'econd  day  her  pulfe  intermitted  ;  but  on  the  third  the 
intermiffion  ceas’d.  On  thefe  days  (lie  made  much  water,  which  was  like 
that  of  a  healthy  perfon ;  but  the  quantity  diminifli’d,  as  the  diforder  pro¬ 
ceeded.  On  the  fifth  and  fixth  day,  the  fever  recurr’d,  not  only  twice,  but 
three  times ;  and  was  very  much  exacerbated  by  a  difficult  refpiration,,  a  pain 
in  the  head,  a  great  third,  and  a  very  parch’d  tongue;  which,  however,  had 
a  good  colour.  In  the  night  fucceeding  the  fixth  day,  the  woman  flept  well, 
and  in  the  morning  die  role  to  have  her  bed  made ;  and  then,  from  her  own 
confeffion,  her  ftrength  and  fpirits  were  good.  The  fever  which  us’d  to  re¬ 
turn  in  the  morning,  did  not  now  return:  the  pain  of  her  head  was  entirely 
gone;  and  the  patient  feem’d  to  herfelf  to  be  recover’d  from  her  diforder: 
the  pulfe  gave  good  refiftance  to  the  prefliire  of  the  fingers ;  yet  the  face 
had  fomewhat  of  a  cadaverous  appearance.  She  ate  her  dinner  very  well ; 
yet  her  third  was  greater  than  ufual.  Then  fhe  talk’d  with  a  female  ac¬ 
quaintance,  in  a  very  fprightly  manner.  But  this  woman  was  fcarcely  gone, 
when  her  daughter  returning  into  the  chamber,  found  her  dead.  The  bed 
was  wet  with,  urine. 

The  Ikin  of  the  carcafe  was  almoft  univerfally  cover’d  with  purple  fpots.: 
efpecially  on  the  back  and  limbs.  The  belly  being  open’d,  the  ftomach 
was  found  contracted  ;  the  inteftines  and  kidneys  were  fomewhat  turgid  with 
blood;  the  fpleen  was  flaccid;  and  the  gall-bladder  contain’d  but  a  fmali 
quantity  of  bile.  In  the  thorax,  the  lungs  no  where  adher’d  to  the  pleura* 
but  were  turgid,  and  had  here  and  there  black  fpots  on  their  furface  ;  but 
on  the  back  part  were  univerfally  red  with  blood.  The  right  ventricle  of  the 

.  heart; 


Letter  IV.  Articles  io,  11.  69 

heart  had  a  fmall  polypous  concretion.  But  the  blood  was  here,  and  every¬ 
where  elfe,  extremely  fluid.  When  the  fkull  was  faw’d  through,  and  the  brain 
divided  from  the  fpinal  marrow,  a  thick  kind  of  ferum  flow’d  out.  About 
the  pia  mater  was  a  gelatinous  concretion ;  and  in  the  ventricles  a  little  ferum. 
The  brain  itfelf  was  fomewhat  flaccid. 

10.  Although  I  intended  to  have  made  no  remark  upon  thefe  five  hiftories 
of  Valfalva;  yet  I  cannot  help  wondering  a  little,  as  you  I  fuppofe  do,  at 
the  unexpected  death  of  the  woman,  after  fo  great  a  remifiion  of  the  difor- 
der.  For  though  I  muft  confefs,  that  the  diforder  bore  confiderable  marks, 
not  only  of  being  violent  and  acute,  but  of  being  malignant  alfo ;  yet  that 
fprightlinefs  and  ftrength,  which  are  defcrib’d  in  the  patient,  when  fhe  was 
juft  on  the  borders  of  death,  do  not  feem  much  to  agree  with  that  malignity. 
But  if  we  confider  all  the  circumftances  attentively,  there  were  other  things 
which  might  have  warn’d  the  phyfician,  whoever  he  was,  not  to  truft  that 
remifiion  of  the  diforder ;  but  even,  on  the  contrary,  to  be  the  more  fufpi- 
cious  of  danger.  The  woman  was  better.  But  whence  was  that  unufual 
thirft  ?  whence  that  cadaverous  appearance  of  the  countenance,  which  fhould 
be  always  attended  to  ?  in  fhort,  what  critical  evacuation  had  been  made 
from  the  body  of  the  patient  ?  and  what  good  omens  had  preceded  it,  that 
this  great  change  fhould  not  feem  unnatural,  and  unexpected  ?  Doubtlefs 
that  deprav’d  matter,  which,  being  difpers’d  through  the  body,  had,  by  its 
irritation,  given  occafion  to  the  general  diforder,  was  collected  into  one  part, 
and  that  the  molt  excellent,  the  brain.  For  this  matter  had  not  been  op¬ 
portunely  check’d  and  corrected,  by  the  ufe  of  the  Peruvian  bark  ;  which, 
at  that  time,  it  was  not  the  cuftom  to  give  againft  fevers  of  this  kind  :  and 
I  very  well  remember,  that  I  have,  by  the  ufe  of  this  medicine,  happily 
prevented  the  return  of  fome  kind  of  apopleCtic  fits,  which  attended  a  ma¬ 
lignant  fever,  that  had  periodical  returns  ;  which  fits  wrould,  doubtlefs,  have 
otherwife  return’d,  and  prov’d  fatal,  as  they  did  in  thofe  with  whom  this_ 
method  was  not  taken.  Jnftances  of  this  kind  you  will  have  on  another  oc¬ 
cafion  (£•),  in  the  noble  count  M.  Antonio  Trend,  and  his  eminence  the  car¬ 
dinal  Francefco  Barbadici,  bifttop  of  Padua.  But,  to  return  to  our  hiftory  : 
there  is  room  to  doubt,  1  think,  whether  the  matter,  which  by  irritating, 
and  bringing  convulfions  on  the  woman’s  brain,  became  the  caufe  of  her. 
death,  was  in  fmall  quantity  or  not ;  fince  not  only  ferum  was  found  in  the 
ventricles;  but  alfo,  befide  a  gelatinous  concretion  about  the  pia  mater,  a 
thicker  kind  of  ferum  was  feen  :  and  this,  perhaps,  flow’d  out  from  the 
fourth  ventricle,  while  the  brain  was  divided  from  the  fpinal  marrow.  Nor 
is  the  hiftory  of  the  lawyer,  which  I  have  defcrib’d  above  (&),  free  from  a, 
like  occafion  of  doubt.  I  fhall  now,  therefore,,  give  you  a  fifth  hiftory,  which 
is  common  to  Valfalva  and  me  :  it  is  of  that  citizen  of  Bologna,  of  whom,, 
on  account  of  a  difficulty  in  hearing,  and  the  caufe  of  it,,  mention  is  made, 
in  the  ieventh  of  the  Epiftolte  Anatomicas  (i). 

11.  This  citizen  was  about  fe.venty  years  of  age,  cf  a  pallid  countenance*, 
had  a  difficulty  of  hearing,  and  was  fometimes  liable  to  a  vertigo,  and  faint- 
nefs :  he  had  alfo  a  tremor,  which  was  attributed  to  his  having,  handled 

(*)  Epkf  49-  3°-  3U  FO  R-  4>;  (0  n*  6* -  .  , 

quickfilver.-  ■ 


7o  Book  I.  Of  Difeafes  of  the  Head. 

quickfilver  for  many  years  pad:  and  laft  of  all,  he  had  a  large  internal 
rupture  on  the  right  fide  of  his  fcrotum.  But,  in  other  refpeCts,  he  was 
healthy  and  robuft  •,  fo  that  he  frequently  indulg’d  himfelf  in  the  plealures 
of  venery,  with  a  wife  who  was  in  the  prime  of  her  life.  And  this  he  had 
done  the  day  before,  when,  being  very  fprightly,  and  found,  both  in  body 
and  mind,  he  walk’d  abroad  with  a  friend  ;  but  fcarce  had  he  parted  from 
his  friend  an  hour  and  half,  when  he  was  found  dead  in  the  road.  We  ob- 
ferv’d,  that  the  upper  limbs  were  very  rigid  and  contracted  after  death  •,  and 
that  even  then  there  was  a  little  heat  about  the  lower  ribs  on  the  right  fide, 
though  four  and  twenty  hours  had  elaps’d  fince  death.  The  abdomen  we 
did  not  open  ;  but  diligently  infpefied  all  the  vifcera  and  veffels  of  the  tho¬ 
rax,  and  found  them  all  found.  In  the  head,  we  obferv’d  the  mouth  to  be 
diftorted  to  the  right  fide,  and  on  the  fame  fide  we  obferv’d  alfo  a  large 
blacknefs  •,  but  whether  it  was  from  the  blow  in  falling,  or  from  the  blood 
fettling  there,  from  the  pofition  of  the  head,  I  could  not  determine  :  indeed 
the  blood  was  found,  in  general,  to  be  very  fluid  •,  but  there  was  no  appearance 
on  the  flail  1,  or  within  it,  which  correfponded  with  that  external  blacknefs. 
The  brain  was  rather  foft,  flaccid,  and  difcolour’d  *,  and  in  it  a  little  ferum 
was  obferv’d,  but  more  upon  removing  the  dura  mater,  than  in  the  ventricles. 
The  plexus  choroides  were  befet  with  turgid  vehicles,  as  they  frequently  are. 
And  in  the  left  vertebral  artery,  very  near  to  its  anaftomofis  with  the  other 
arteries,  were  thin  fmall  plates,  fome  refembling  a  tendinous,  fome  a  carti¬ 
laginous,  and  others  a  bony  confiftence. 

12.  If  you  let  afide  thefe  lafb  circumftances,  and  other  things,  which, 
though  they  may  be  in  fome  meafure  acceffary  to  the  caule  of  an  apoplexy, 
are  neverthelefs  found  in  many  who  are  not  apoplectic,  then  that  little  quan¬ 
tity  of  ferum  will  remain,  to  the  acrimony  of  which  you  may  refer  the  caufe 
of  the  convulfion  of  the  brain ;  which  was  fufficiently  indicated  by  the  rigid 
contraction  of  the  upper  limbs,  and  the  diftortion  of  the  mouth. 

In  thofe  fifteen  days,  which  happen’d  in  May,  1740,  when  many  of  the 
inhabitants  of  Bologna  were  carried  off  by  apoplexies  ;  it  is  not  very  won¬ 
derful  that  this  man  fhould  fall  a  facriflce  to  the  fame  diforder-,  fince  he  was 
fome  times  fubjeCt  to  a  vertigo,  and  languor  in  his  ftrength,  but  always  to  a 
tremor :  and  moreover  was,  for  his  age,  fo  intemperate  in  venery.  I  am 
very  lorry  that  I  have  forgotten,  what  was  the  nature  of  the  feafon  at  that 
time,  and  the  one  preceding  it.  But  as  this  is  the  month  when,  in  Italy,  the 
heat,  which  was  before  mild,  is  wont  confiderably  to  encreafe  *,  it  is  proba¬ 
ble  that  this  May  might,  in  many  circumftances,  agree  with  that  which  we 
have  fpoken  of  (£)  in  the  year  1729;  efpecially  as  fome  of  the  apoplexies 
had  a  very  different  caufe  from  this  man’s  •,  that  is,  blood  extravafated  within 
the  cranium  :  in  which  number  was  that  of  a  noble  fenator  of  Bologna.  But 
as  Valfalva  has  left  nothing  more  relating  to  the  feafon  than  I  have  remem- 
ber’d,  I  fhall  omit  this  confideration,  and  fubjoin  my  own  obfervations  to 
his,  as  I  intended  :  beginning  with  a  very  great  man. 

13.  Jo.  Baptifta  Anguiffola,  that  excellent  prelate,  was  of  a  large  ftature, 
a  ruddy  complexion,  and  liable  to  diforders  of  the  urinary  paffages.  The 

(/{■)  Epift.  3.  n.  1 1  &  1 3. 

year 


I 


Letter  IV.  Article  13.  71 

year  1707  was  his  fixty-firft  year,  when  having  dried  np  an  old  ulcer  of  his 
leg,  he  was*firft  feiz’d  with  a  fainting-fit,  as  he  was  row’d  in  his  gondole ; 
for  he  was  then  at  Venice,  upon  an  embaflfy  from  the  pope.  After  that,  he  felL 
down  at  home  in  his  chamber,  without  any  apparent  caufe  *,  and  laft  of  all, 
was  feiz’d  with  an  apoplexy  :  fo  that  the  phyficians  already  foretold  a  fpeedy 
death.  But  though  thefe  things  all  happen’d  about  the  middle  of  July,  he 
did  not  however  die  till  the  middle  of  Auguft.  In  the  mean  while,  they  gave 
him  purging  medicines  :  he  was  let  blood  in  the  foot,  the  arm,  the  hand,  and 
the  forehead :  epifpaftics  and  veficatories  were  applied  to  the  {kin,  and  cup- 
ping-glaffes  to  the  crown  of  the  head  :  fpirits,  as  they  call  them,  and  other 
things  of  that  kind,  were  adminifter’d.  Yet,  they  could  never  bring  back 
the  patient  to  his  fpeech,  nor  recover  the  motion  of  the  right  fide,  which 
was  paralytic.  In  the  mean  time,  a  fever  came  on,  of  the  putrid  kind, 
againft  which  the  Peruvian  bark  was  made  ufe  of.  There  was  alfo  a  fufpicion 
of  an  inflammation  in  the  thorax.  Laftly,  under  one  fide  of  the  chin,  an 
abfcefs  was  form’d,  which  was  open’d  fome  days  before  his  death  •,  but  it 
did  not  difcharge  much.  At  length  the  ftertor,  whic\  had  before  frequently 
attended,  becoming  more  troubleiome,  he  died.  Thefe  accounts  I  had  from 
his  intimate  friends,  when  they  deflr’d  me  to  attend  the  opening  of  the  body  j 
which  was  perform’d  by  the  Rinaldi’s,  both  father  and  fon,  in  the  prefence 
of  other  phyficians. 

The  abdomen  being  open’d,  the  convex  furface  of  the  liver  appear’d, 
mark’d  with  long  lines  of  a  red  colour,  degenerating  into  a  brownifh  one, 
which  reach’d  from  the  upper  part  to  the  lower  ;  but  it  was  in  other  relpc&s 
found,  except  that  the  gall-bladder  contain’d  three  or  four  calculi,  as  I  have 
alfo  taken  notice  in  the  firft  anatomical  epiftle(/).  The  other  vifeera  were 
all  entirely  natural,  except  the  urinary  bladder,  which  feem’d  to  be  much 
thicken’d  in  its  coats ;  but  this  might,  perhaps,  be  partly  owing  to  its  being 
more  than  ufually  contracted.  In  the  vifeera  of  the  thorax  nothing  morbid 
appear’d  ;  for  the  lungs  were  neither  hard,  nor  turgid,  nor  connected  to  the 
pleura  :  yet  fome  did  not  lcruple  to  find  fault  with  the  appearance  of  them 
©n  the  pofterior  furface,  which  was  black.  But  this  I  thought  was  unjuft  ^ 
and  you  will  think  fo  too,  becaufe  you  know  very  well,  that  this  is  common 
to  all  dead  bodies  ;  the  blood  by  its  natural  gravity,  in  the  fupine  p  oft  a  re  of 
the  body,  all  flowing  together  there.  And  this  Chriftopher  Guarinoni  (jn) 
formerly  hinted. 

While  the  integuments  of  the  cranium  were  taken  off,  a  rednefs  was  even 
then,  obferv’d  in  the  pericranium,  where  the  cupping-glafs  had  been  fix’d. 
In  cutting  through  the  cranium,  fome  water  flow’d  out  from  its  cavity  :  and> 
the  fkull  being  taken  off,  and  the  dura  mater  remov’d,  a  fort  of  afh-colour’d 
jelly  fhone  here  and  there  through  the  pia  mater,  lying  upon  the  convolutions 
of  the  brain  :  and  the  veftcls  that  ran  upon  the  furface  of  the  cerebrum  and 
cerebellum,  were  a  little  more  turgid  with  blood  than  ufual.  In  the  fubfhtnce- 
©f  the  brain  no.  diforder  appear’d,  except  perhaps  a  laxity  thereof.  In  the 
ventricles,  however,  I  faw  fome  water,,  but  not  much. 

(/)  N.  48*  (/«)  Vid  Sepukhr.  1.  4.  f.  1.  in  addit,  obf.  8.  &  13. 

14,  The 


2  Book  If.  Of  Diforders  of  the  Head. 

14.  The  turgid  {late  of  the  veflels,  in  this  prelate,  brings  two  things  to 
my  mind.  As  to  that  which  I  have  already  obferv’d  above  (0),  that  a  littfb 
water,  fo  it  be  but  irritating,  might  bring  on  an  apoplexy,  and  that  this  de¬ 
pended  upon  its  convulfing,  and  confequently  conftringing,  the  meatufles  of 
the  brain  ;  I  would  have  you  now  add  to  this,  that  the  conftri&ion  will  be  fo 
mu'ch  the  more  dangerous,  as  it  may  alfo  happen,  that  thefe  meatufles,  or 
tubes,  are  already,  or  fhali  be,  eonftring’d  from  another  caufe,  at  the  fame 
time ;  fuppofe,  for  inftance,  from  the  blood,  with  which  all  the  veflels 
within  the  cranium  are  more  than  ufually  diftended.  And  hence  you  will 
eaflly  conclude,  how  far  we  are  to  receive  what  renown’d  phyflcians  have 
taught,  that  vensefedtion  is  not  only  ufelefs,  but  pernicious,  in  the  ferous 
apoplexy,  and  that  in  the  fame  degree,  in  which  it  is  ufeful  in  the  fanguineous  ; 
explaining  that  paflage  of  Celfus(<?)  fo  as  to  fupport  their  opinion,  “  if  all 
“  the  limbs  are  extremely  paralytic,  taking  away  blood  either  kills  or  cures. ” 
And  indeed  we  cannot  deny,  that  if  an  apoplexy  be  from  water  only,  it  would 
be  equally  abfurd  to  attempt  the  cure  of  it  by  blood  letting,  as  the  cure  of 
an  alcites.  But  where  the  great  diftenflon  of  the  blood-veflels  encreal'es  the 
conflridtion,  which  is  made  by  a  frnall  quantity  of  water,  will  not  taking  away 
blood  fafcly  diminifh  the  conftridtion  ? 

15.  We  are  not  treating  here  of  thedropfy  of  the  brain,  in  which  there  is 
a  great  quantity  of  water,  and  but  little,  and  that  an  impoverifli’d  blood-,  fo 
that,  if  you  diminifh  its  quantity,  the  veflels  are  comprefs’d  by  the  weight 
of  the  water,  and  the  languid  circulation  of  the  blood  is  entirely  intercepted. 
For  in  this  cafe  the  blood  mull  be  ftrengthen’d,  and  the  fibres  of  the  cere¬ 
brum  and  cerebellum  alfo,  which  are  lax,  as  if  they  had  been  macerated  in 
water  :  fo  that  it  is  neceflary  to  ufe  internal  and  external  corroborants,  as  far 
as  they  can  be  us’d  with  fafety,  to  obviate  thefe  inconveniences  ;  which  me¬ 
thod,  as  I  have  juftly  aflerted  (/>),  muft  utterly  be  avoided  in  the  fanguineous 
apoplexy.  Therefore,  as  an  apoplexy  may  be  brought  on  from  an  ill, habit 
of  body,  I  would  not  haftily  and  rafhly  fly  to  that  kind  of  remedy,  from  the 
abufe  of  which  a  bad  habit  of  body  is  often  brought  on,  and  in  confequence 
of  that  bad  habit,  an  apoplexy  :  for  you  have  it  in  Zacutus  (<7),  that  an  apo¬ 
plexy  arifing  from  this  caufe,  after  immoderate  blood-letting,  was  remark’d 
both  by  Galen  and  Avicenna ;  and  there  is  alfo  an  obfervation  of  the  cele¬ 
brated  Trew  (r),  which  may  be  referr’d  to  the  fame  clafs.  Nor  would  I  fly 
to  this  remedy,  if  any  one,  efpecially  an  old  man,  and  weak,  who  labour’d 
under  a  diforder  proper  to  the  head,  and  not  from  fympathy  with  other  parts, 
having  been  fent  by  incautious  phyflcians,  whofe  opinion  I  always  refilled, 
when  it  was  in  my  power,  to  drink  acidulated  waters,  lhould  be  feiz’d  with 
an  apoplexy  on  his  return  from  thence.  For  you  will  read,  in  the  Sepul- 
chretum,  that  confirm’d  by  obfervation  which  my  conjecture  points  out;  to 
wit,  that  “  the  brain  is  then  diluted  with  much  water.”  But  on  the  other 
hand,  when  1  conjeftur’d,  that,  befide  the  water,  there  was  a  turgefcency 
ef  the  veflels,  I  did  not  defer  blood-letting.  Thus  in  a  prieft,  my  fellow- 

(»)  N.  5.  ( 0 )  De  Medic.  1.  3..  c.  27.  (r)  In  Aft.  Nat.  Cur.  tom.  4.  obf.  136. 

(/>)  E pill.  3.  n  1 1,  12.  (j)  L.  1.  £  2.  obf.  48. 

(7)  De  Medic.  Princ,  Hilt.  1.  1.  hilt.  5.  in 

paraphr. 


citizen, 


Letter  IV.  Article  i  6.  73 

citizen,  (whofe  younger  brother  I  hear  was  taken  off  by  an  apoplexy,  while 
1  wrote  this  letter)  who  had  been  fubjeft  every  year  to  convulfive  affections 
of  the  hypochondria,  and  had  been  wont  to  be  freed  from  them  by  watry 
itools ;  in  the  year  1711,  thefe  watry  difcharges  having  begun,  but  fuddenly 
ftopping,  and  a  heavy  pain  of  the  head  coming  on,  attended  with  a  ftupor 
of  the  fenfes,  and  a  lofs  of  fpeech  •,  I  order’d,  immediately  on  being  call’d, 
a  vein  to  be  open’d  in  the  arm  :  and  while  the  blood  was  yet  flowing,  he 
recover’d  the  power  of  fpeech,  and  foon  after  the  vigour  of  his  mind  ;  no¬ 
thing  elfe  which  was  proper  being  omitted,  and  blood  letting  being  repeated 
the  lame  day.  For  I  was  led  to  conjecture,  that  part  of  the  ferum  which  had 
us’d  to  be  dilcharg’d  by  ftool,  but  was  now  flopp’d,  was  effus’d  into  the 
cranium  ;  yet  I  alio  believ’d,  that  the  fanguiferous  veffels  of  the  abdomen 
were  conftring’d,  as  is  generally  the  cafe  in  thofe  convulfive  affeCtions  of  the 
hypochondria ;  and  that  for  this  reafon,  the  veffels  of  the  brain  were  more 
diftended  with  blood.  The  fame  practice  I  have  follow’d  in  others  with 
equal  luccefs ;  and  fhould  have  done  it  in  thofe  whofe  hiftories  I  fhall  next 
fubjoin,  if  I  had  happen’d  to  have  been  call’d  to  them,  or  rather,  if  the 
fuddennefs  of  the  dilorder  would  have  given  time  to  attempt  any  method  of 
cure. 

16.  There  was  a  young  man  at  Venice,  of  twenty-nine  years  of  age, 
crooked,  and  much  given  to  drinking  ;  who  made  it  his  bufmefs  to  carry 
fome  kind  of  provifions  up  and  down  the  city,  and  fell  it  to  the  loweft  of 
the  people.  As  he  was  doing  this,  on  fome  day  in  October  1707,  he  firfl 
ftagger’d  in  the  ftreet,  prefently  fell  down,  and  immediately  died.  His  face 
was  livid,  and  the  wine  he  had  drunk  flow’d  out  from  his  mouth  and  his 
nofe,  together  with  a  bloody  fluid.  Examining  the  body  the  day  after,  with 
the  celebrated  Santorini,  we  found  the  arms  cold  and  contracted :  the  body 
itfelf  had  a  moft  filthy  and  deform’d  appearance  •,  and  moreover,  there  was 
a  recent  cicatrix  of  a  bubo  in  the  groin.  We  then  cut  into  the  belly  :  the 
liver  and  fpleen  were  enlarg’d  ;  but  the  latter  was  flaccid,  and  the  former 
hard,  and  fomewhat  white.  The  pancreas  alfo  was  hard.  The  ftomach  ftretch’d 
the  antrum  pylori,  as  it  is  call’d,  downwards ;  fo  that  it  lay  exactly  under 
the  navel  :  and  the  arch  of  the  colon,  which- is  wont  to-  lie  under  the  fto- 
mach,  defcended  below  the  navel,  through  the  middle  of  the  belly  longitu¬ 
dinally,  and  was  very  narrow.  But  ail  the  vertebrae,  which  ran  from  the 
lower  part  of  the  neck  to  the  os  facrum,  were  far  more  unnatural  in  their 
fituation.  For  the  whole  traCl  of  the  fpine,  between  thefe  bounds,  was  bent 
fo  much  to  the  left  fide,  that  the  middle  of  the  curvature  was  more  than  feven 
inches  diftant  from  a  right  line  drawn  between  thefe  two  points.  Belides, 
the  anterior  furface  of  the  fpine  was  fo  turn’d  to  the  left  fide,  that  the 
pofterior  procefies  were  almoft  on  the  right.  From  which  pofition  it  follow’d, 
that  the  beginnings  of  the  left  ribs  cover’d  the  fpine  behind  ;  and  thence 
bending  themselves  immediately  inwards  and  forwards,  and  embracing  the 
fide  of  the  fpine,  they  lqft  that  fide  of  the  thorax  very  much  confin’d  be¬ 
twixt  themfelves  and  the  fpine,  fo  as  to  refemble  a  very  narrow  fiffure  only. 
The  defending  aorta  alfo  naturally  follow’d  this  curvature  of  the  fpine  ;  and 
without  doubt,  the  fituation  of  the  ftomach  and  colon,  which  I  have  de- 
icrib’d,  had  its  origin  in  great  meafure  from  thence  :  and  you  eafily  under- 
Vol.  I.  ‘  L  ’  ftand 


74  Book  I.  Of  Difeafes  of  the  Head. 

fiand  how  much  ffiorter  and  narrower  the  cavity  of  the  thorax  muft  be  for 
that  reafon.  For  although  the  cheft  was  much  more  convex  than  ufual  an¬ 
teriorly,  yet  the  fituation  of  the  left  ribs  took  away  much  of  its  breadth  ;  and 
the  fpine  and  the  fternum,  which  reprefented  the  fegment  of  a  ring,  as  they 
were  more  curv’d,  fo  much  more  did  they  bring  the  higheft  part  of  the 
diaphragm  near  to  the  upper  borders  of  the  thorax :  and  by  this  means,  the 
heart,  which  was  rather  large,  had  the  upper  part  of  its  bafis  not  at  a  great 
diftance  from  the  neck.  In  the  ventricles  of  the  heart  was  a  little  coagulated 
blood  ;  and  the  right  auricle  all'o  contain’d  a  fmall  polypous  concretion.  The 
lungs  were  conneXed  here  and  there  to  the  pleura  forwards,  by  loft  and  thin 
membranes ;  but  behind,  the  whole  upper  lobe  was  thus  connected  on  one 
fide.  There  was  a  kind  of  foam  in  the  bronchia,  which  in  fome  places  was 
a  little  red,  but  in  very  fmall  quantity  :  yet  in  other  refpeXs,  the  lungs, 
the  afperia  arteria,  and  the  larynx,  were  found. 

The  fkull,  which  was  thick,  being  taken  away,  and  the  finuffes  of  the 
dura  mater  being  open’d,  in  that  which  is  call’d  the  longitudinal,  a  fmall 
polypous  concretion  was  feen  ;  and  in  the  lateral  fin  us,  on  the  right  fide, 
the  blood  was  very  grumous  and  coagulated  ;  with  which  alfo  the  fmall  veffels 
were  turgid,  but  efpecially  thofe  that  ran  in  the  pia  mater,  on  the  right  and 
inferior  fide  of  the  brain.  Under  this  membrane,  alfo,  ferum  lay  here  and 
there,  in  the  convolutions  of  the  brain,  fo  that  you  could  eafily  feparate  it 
therefrom  by  the  hand.  But  no  ferum  at  all  flow’d  from  the  tube  of  the 
fpine,  and  but  little  was  found  in  the  lateral  ventricles:  and  the  palenefs,  not 
only  of  the  veffels  in  the  parietes  of  the  ventricles,  but  of  thofe  which  make 
up  the  choroid  plexufles  alfo,  was  a  proof  that  this  was  not  the  firft  time  of 
its  irruption.  Befides,  in  thofe  plexufles  were  vehicles  full  of  water.  In, 
other  refpeXs,  however,  the  cerebrum  and  cerebellum  were  perfectly  na¬ 
tural  i  and  were  fo  far  from  being  flaccid  in  their  fubftance,  that  they  were 
even  firm,  but  efpecially  the  cerebrum. 

17.  In  lb  great  a  propinquity  of  the  heart  to  the  brain,  and  fo  great  a 
difficulty  in  the  defcent  of  the  blood,  by  reafon  of  the  inflexions  of  the  aorta, 
it  would  not  have  been  wonderful,  efpecially  in  a  young  man  given  to  drinking, 
if  fome  blood-vefiels  had  been  ruptur’d  within  the  cranium.  It  is  lefs  won¬ 
derful,  therefore,  that  a  diftenfion  of  the  veffels  of  the  pia  mater  ffiould  be 
added  to  the  water  that  was  effus’d  under  it,  and  confequently  encreafe  the 
conftriXion.  But  why  fo  great  a  firrnnefs  of  the  brain  did  not  refift  the  con¬ 
ftriXion  thereof,  or  at  lealt  prevent  the  man  from  being  kill’d  in  an  inftant 
of  time,  if  you  afk  the  caufe,  I  think  this  might  be  it ;  that  as  the  cortical 
fubftance  of  the  brain  is  us’d  to  be  lefs  firm  than  the  medullary,  from  which,, 
as  it  offers  itfelf  in  greater  portions  to  the  diffeXor,  and  is  conglobated  in 
kfelf,  we  for  the  moft  part  judge  of  the  firrnnefs  of  the  brain  ;  the  more  firm 
in  this  young  man  the  medullary  part  was,  the  greater  was  the  conftriXion  of 
the  cortical,  inafmuch  as  it  lay  comprefs’d  between  the  more  firm  and  me¬ 
dullary  part,  on  one  hand,  and  the  water  and  blood  diftending  the  veffels,  on 
the  other.  Or,  whereas  the  cerebellum,  for  this  very  reafon,  becaufe  it  con- 
fifts  chiefly  of  the  cortical  part,  is  wont  to  be  lefs  firm  than  the  cerebrum, 
and  in  this  youth  certainly  was-,  if  the  former  rationale  does  not  pleale  you, 
imagine  thus :  that  by  how  much  the  more  the  cerebrum  by  its  firrnnefs 

6  refitted. 


Letter  IV.  Articles  18,  19.  75 

refitted  the  compreflion,  by  fo  much  the  lefs  could  the  cerebellum,  which  was 
weaker,  refill  it.  For  when,  befides  the  bulk  of  the  cerebrum,  an  unufual 
quantity  of  blood  and  ferum  were  added,  nor  the  parietes  of  the  cranium, 
as  they  are  bony,  could  at  all  yield  ;  and  the  cerebrum  itfelf,  by  reafon  of 
its  great  firmnefs,  would  not  give  way  fo  much  as  in  another  man  ;  it  re¬ 
main’d,  that  the  greater  impetus  mutt:  be  of  courfe  made  on  the  cerebellum, 
from  whence  the  moll  fpeedy  death  may  happen  :  as  I  have  (hewn  on  a  for¬ 
mer  occafion  (/). 

18.  Nor  would  I  have  you  be  difturb’d,  to  find  me  now  afcribing  thefe 
effects  to  compreflion,  whereas  before  I  afcrib’d  them  to  irritation  and 
convulfion,  confequent  therefrom.  For  convulfion  and  compreflion  both 
bring  on  the  fame  effects  of  conftridlion.  And  we  cannot  doubt,  when  we 
confider  the  properties  and  weight  of  water,  but  that  it  mutt  comprefs : 
as  when  we  confider  its  acrimony,  we  cannot  doubt  but  it  will  irritate  and 
convulfe.  Wherefore  the  fame  water  may  frequently  bring  on  compreflion, 
and  convulfion  :  and  by  compreffing,  or  convulling,  or  both,  may  obftrudt 
the  blood  in  the  fmalleft  veflels,  from  whence  the  larger  vefiels  wiil  become 
turgid,  and  increale  the  compreflion.  And  in  this  manner  you  may  conjec¬ 
ture  the  caufes  of  a  milder  or  a  more  grievous  apoplexy,  of  a  flower  or 
more  fudden  death  •,  either  in  this  youth,  where  all  thefe  circumftances  met 
together  •,  for  the  rigid  and  contradi ed  date  of  his  arms,  in  fome  mealure, 
was  a  proof  of  a  convulfion  •,  or  in  the  man  of  whom  I  am  juft  going  tofpeak, 
where  no  marks  of  convulfion  were  obferv’d. 

19.  An  oftler,  near  fixty  years  of  age,  tall  and  fat,  being  us’d  to  eat  much, 
and  drink  very  freely,  had  been  brought  three  times  before  into  the  holpital 
at  Padua  ;  once,  on  account  of  a  fever,  though  not  violent,  and  fhort ;  and 
again,  on  account  of  an  apoplexy,  of  which  he  went  out  cur’d  ;  and  the 
third  time,  which  was  in  the  laft  fummer,  for  an  inflammation  of  his  throat, 
at  which  time  there  were  fome  pretty  evident  marks  of  an  incontinency  of 
urine.  Finally,  he  was  brought  in  the  fourth  time,  for  a  fecond  apoplexy, 
but  one  that  by  delay  and  negligence  had  been  render’d  incurable.  For  in 
the  middle  of  December,  the  coldeft  leafon  of  that  year,  1725,  not  having 
been  obferv’d  the  day  before,  he  was  found  the  day  after  in  the  corner  of  the 
liable,  apoplectic  and  naked  ;  lying  in  the  blanket  in  which  he  had  wrapp’d 
himfelf  three  days  before.  He  was  molt  paralytic  in  his  right  arm*,  he  lifted 
up  his  head,  and  attempted  to  fpeak.  Yet  he  could  not  be  fav’d ;  for  whe¬ 
ther  the  water  was  made  more  acrid  by  ftagnation,  or  whether  you  would 
rather  fuppofe  that  its  quantity  being  encreas’d  by  a  new  extravafation,  a 
new  paroxyfm  was  brought  on  ;  or  whether  by  urging  its  ftimulus,  or  com¬ 
preflion,  {till  more  and  more,  it  brought  him  to  his  end.  Fie  died  in  the 
-middle  of  the  night,  ten  hours  after  he  was  thus  found. 

His  body  I  examin’d  diligently  for  fome  days,  efpecially  for  the  fake  of 
.the  ftudents  who  were  about  me,  and  found  thefe  things  worthy  of  notice. 
The  abdomen  being  open’d,  the  bladder  of  urine  immediately  prefented  it¬ 
felf;  but  the  omentum  it  was  neceftary  to  feek  for;  as  it  lay  entirely  con¬ 
ceal’d  betwixt  the  ftomach,  and  the  tranfverfe  turn  of  the  colon.  The  fto- 


(/)  Epift.  2.  n.  24. 
L  2 


mach 


7  6  Book  I.  Of  Difeafes  of  the  Head. 

mach  was  extremely  contracted :  which  was  wonderful  in  a  man  of  this  kind, 
even  after  fo  long  an  abftinence :  neverthelefs  it  was  found,  except  that  in 
the  middle  of  its  pofterior  and  external  furface,  there  was  a  roundifh  tuber¬ 
cle,  though  of  the  fame  colour  with  the  ftomach,  which  being  cut  into, 
feem’d  to  be  made  up  of  the  fame  fubftance  as  mod  of  the  fibres  of  the  fto¬ 
mach.  Then  turning  our  hands  and  eyes  to  the  bladder,  which  having 
driven  up  the  fmall  inteftines  before  it,  extended  itfelf  quite  to  the  navel ; 
we  found  it  cover’d  with  fat,  and  diftended  with  urine,  as  we  prefently  found 
the  ureters  and  kidneys  were  alfo.  Thefe  parts  were  likewife  cover’d  over 
■with  fat  in  like  manner,  and  that  in  large  quantity,  hard,  and  adhering  very 
clofely  thereto.  Externally  both  of  them  had  an  unequal  furface,  nor  were 
without  marks  of  a  former,  as  well  as  a  prefent,  ulcerous  diforder  ;  but  in¬ 
ternally,  as  their  cavities  were  more  enlarg’d,  they  were  furrounded  with 
the  lefs  fubftance  about  them  :  Was  it  becaufe  the  urine,  being  often  obftrudt- 
ed,  had  extenuated  it  by  diftenfion  ?  or  was  it  rather  from  erofion  ?  which 
did  not  feem  altogether  improbable.  All  thefe  things  appear’d  rather  in  the 
right  kidney,  which  had  a  cell  partly  prominent  outwards,  and  partly  hollowed 
out  from  the  fubftance  of  the  kidney,  full  of  a  fluid  like  urine.  In  regard  to 
the  ureters  alfo,  though  both  of  them  were  much  enlarg’d,  as  I  fhall  immediately 
explain  ;  yet  the  left  was  a  little  lefs  than  the  right.  For  this  laft,  where  it  came 
out  from  the  kidneys,  had  the  bignels  of  a  hen’s  egg  cut  off  at  the  top  •,  and  in 
the  other  parts,  almoft  wholly,  did  not  a  little  exceed  the  trunk  of  the  aorta, 
when  neareft  to  the  iliac  arteries  ;  except  that,  juft  at  the  infertion  of  it  into 
the  bladder,  it  was  a  little  contracted  ;  and  in  its  extreme  orifice  fcarcely  ad¬ 
mitted  the  point  of  the  little  finger.  And  fo  much  longer  was  it  made  by  its 
dilatation,  that  it  exceeded  thirty  fingers  breadth,  when  extended;  for  it 
often  form’d  angles  by  bending  itfelf  here  and  there ;  and  at  thefe  angles  it 
feem’d  to  be  furnifti’d  with  a  kind  of  valves  internally  :  but  this  appearance 
vanifn’d  when  it  was  ftretch’d  out  in  a  ftrait  line.  With  the  length  and 
breadth  of  the  coats,  the  thicknefs  alfo  had  encreas’d  :  fo  that  it  was  eafy 
for  me  to  obferve  fome  things  relative  to  their  ftruCture,  of  which  it  is  not  a 
proper  place  to  fpeak  here.  Moreover,  the  coats  of  the  bladder  were 
thicken’d ;  and  its  fundus  began,  in  fome  places,  to  be  almoft  ulcerated. 
This  circumftance,  and  the  glans  penis  being  naked,  for  the  fkin  with  which 
the  glans  us’d  to  be  cover’d,  was  drawn  back,  almoft  as  in  a  paraphimofis ; 
and  I  know  not  what  obftacle  which  occurr’d  near  the  extremity  of  the  glans, 
when  a  probe  was  introduc’d,  and  the  urethra  foon  after  disjoin’d  from  the 
bodies  of  the  penis,  but  was  immediately  remov’d ;  made  me  open  the  ure¬ 
thra,  and  examine  it  diligently,  beginning  from  the  bladder,  and  going  on 
to  its  orifice ;  but  I  found  no  mark  of  diforder,  if  you  except  fome  fmall 
white  and  oblong  lines,  which  were  a  little  prominent  obliquely,  before  one 
fide  of  the  caput  gallinaginis;  and  two  other  fimilar  lines,  which  I  found 
at  about  the  diftance  of  three  fingers  breadth,  from  the  extremity  of  the  mea¬ 
tus  urinarius. 

Taking  off  the  fternum,  the  lungs  were  feen  to  be  flirunk  up  on  each  fide 
to  the  back,  fo  as  to  leave  a  very  fat  mediaftinum  altogether  uncover’d. 
The  right  lobe  of  them,  on  its  lateral  and  pofterior  furface,  coher’d  clofely 
with  the  pleura :  as  did  alfo  the  whole  furface  of  the  heart,  with  the  peri¬ 
cardium,  and  the  furface  of  the  right  auricle ;  yet  the  right  ventricle  adher’d 

more 


I 


T  "  -  .  --  • 

Letter  IV.  Article  19.  77 

more  clofely  than  the  left.  In  both  of  thefe  was  contain’d  black  blood, 
which  almoft  refembled  tar-,  but  that  was  much  more  like  it  which  flow’d  out 
in  large  quantity,  and  very  black,  from  the  vena  cava,  when  it  was  cut  into, 
dole  to  the  diaphragm.  The  carotid  arteries,  as  they  went  up  the  neck, 
were  very  large.  But  the  aorta  itfelf,  and  whatever,  either  of  veffels  or  vi'f- 
cera,  I  defignedly  pals  over,  were  natural  in  their  appearance,  as  I  am  wont 
to  hint  by  my  filence;  and  the  mufcles  were  even  well  colour’d  ;  and  elegant 
in  their  texture,  as  well  as  in  their  colour. 

Finally,  I  differed  the  brain,  on  the  feventh  day  after  death.  And 
I  found  the  whole  cerebrum  to  be  endow’d  with  a  remarkable  hardnefs; 
whereas  the  cerebellum  was  but  of  a  moderate  firmnefs  -,  and  there  was  water 
within  the  cranium  in  a  pretty  large  quantity.  For  befides  that,  1  could  with 
the  greateft  eafe  draw  afunder  the  lamellas  of  the  cerebellum  :  in  reality, 
water  had  flow’d  out  from  the  cranium,  when  it  was  divided  from  the  neck, 
and  when  cut  open  with  the  faw :  and  there  was  ftill  fome  water  under  the 
pia  mater-,  and  even  no  fmall  quantity  was  found  in  the  lateral  ventricles, 
when  I  diffedted  the  brain  in  its  fituation,  as  l  generally  do.  ,  For  I  am  ac- 
cuftom’d  to  do  this,  not  only  more  certainly  to  determine  the  natural  fitua¬ 
tion  of  the  parts,  as  I  have  already  obferv’d  in  the  Adverlaria  {u) ;  which 
others  have  fince  follow’d,  and  fome  before  me  had,  as  l  imagine,  pointed 
out,  as  they  not  only  defcrib’d  in  their  figures  the  brain  taken  out  from  the 
cranium,  but  alfo  reprefented  it  diffedted  in  its  natural  fituation  in  the  fkull; 
but  for  this  reafon  alfo  ;  left,  when  extravafated  ferum  or  fluid  blood  is  in  the 
ventricles,  the  brain  being  much  handled  and  fhaken,  and  the  infundibulum 
broken  through,  they  fhould  either  change  their  fituation,  or  in  great  mea- 
fure  elcape.  I  have  even  often  determin’d,  whenever  I  was  permitted,  to 
begin  a  diffedtion  of  that  kind  from  the  head,  leaving  the  body  perfedtly 
found;  left,  when  the  jugular  veins,  or  the  fuperior  cava,  are  cut  through,, 
blood,  which  was  not  concreted,  fhould  flow  out  from  the  finuffes  :  but  it 
is  not  always  permitted,  or,  for  fome  other  reafons,  is  not  convenient,  which 
was  the  cafe  here.  And  therefore  I  did  not  greatly  wonder,  that  all  the 
finuffes,  and  all  the  receptacles  about  the  fella  equina,  were  empty.  1  found 
the  veffels  which  ran  through  the  pia  mater,  however,  more  turgid  than 
was  ufual  ;  yet  it  feem’d  to  be  more  from  ferum,  and  air,  than  from  blood. 
But  to  return  to  the  ventricles:  in  the  duplicature  of  the  feptum  lucidum 
I  found  a  little  water;  and  in  the-choroid  plexuffes,  which  were  not  of  a 
pale  or  dilute  colour,  a  great  number  of  velicles  full  of  the  fame  fluid.  At 
length,  having  inverted  the  brain,  I  found  both  the  pofterior  branches  of 
the  carotid  arteries,  which  are,  for  the  moft  part,  very  fmall,  fo  exceedingly 
dilated  ;  that  if  they  had  been  naturally  fo,  fcarce  Willis’s  delineation  (*)  ci¬ 
thern  would  be  blameable.  Nor  were  the  little  branches,  which  go  off  from 
that  artery  with  which  the  vertcbrals  anaftamofe,  lefts  dilated  in  proportion, 
than  the  pofterior  carotids,  with  which  they  communicate.  And  befides,  the 
left  of  thofe  fmall  branches  in  one  part,  and  the  left  vertebral  alfo  near  its 
anaftamofis,  was  become  white.  For  this  reafon  I  open’d  both  of  thefe  ar¬ 
teries,  and  on  their  internal  lurfaces  I  found  a  little  white  body,  thickiib, 

(«)  VI.  Anim.  10.  (.*•)  Cerebr.  Anat.  Fig.  r. 

fomewhat 


7"8  Book  1.  Of  Dif<^tfes  of  the  Head. 

fomewhat  hard,  and  even  aim  oft  cartilaginous ;  and  it  could  not  but  happen 
that  they  mud,  in  fome  meafure,  ftop  up  the  cavity,  as  they  protuberated 
internally*,  for  the  external  furface  of  the  veffels  was  quite  fmooth,  nor  had 
any  prominence  ;  fo  that  this  diforder  did  not  feem  only  to  belong  to  the 
dais  of  offifications,  but  in  fome  meafure  alfo,  to  that  of  internal  excref- 
cences  in  the  veflels.  Lad  of  all,  when  I  would  have  pull’d  away  the  pitui¬ 
tary  gland  from  its  feat ;  a  pellucid  yellowiih  mucus  ifiiied  from  it,  on 
-the  flighted  compreffion  :  this  mucus  was  not  in  fmall  quantity,  in  pro¬ 
portion  to  the  fize  of  the  gland,  and  was  almoft  like  what  is  found  at  the 
os  uteri,  except  that  it  was  not  fo  tenacious :  and  you  would  have  thought, 
that  the  created  part  of  the  gland  had  degenerated  into  mucus ;  for  only  a 
fmall  and  diapeleis  portion  of  it  remain’d,  and  that,  as  far  as  I  could  judge 
by  the  fight,  or  by  the  touch,  was  natural :  but  the  other  part  of  the  gland 
and  its  appendix  were  no  where  to  be  found.  However,  the  infundibulum, 
which  1  had  cut  off  a  little  before,  as  far  as  I  could  find  by  its  external  ap¬ 
pearance,  was  jud  as  it  is  in  general. 

20.  The  more  prolix  the  hidory  was,  the  diorter  will  the  annotations  be. 
As  to  the  diforder  of  the  kidneys,  the  ureters,  the  bladder,  and  the  urethra, 
we  diall  take  another  oocafion  to  treat  of  them  (y).  It  is  diffident,  at  pre- 
fent,  jud  to  gather  this  one  obfervation  from  them,  which  certainly  relates 
to  his  death.  It  is  probable,  that  the  man  had  drunk  much  more  than  was 
ufual,  and  that  much  lefs  than  ufual  had  efcap’d  through  the  invidble  fora¬ 
mina  of  the  fkin,  by  reafon  of  the  extreme  coldnefs  of  the  feal'on ;  but  the 
urinary  pafiages  and  receptacles,  in  this  fleeping,  and  afterwards  apopleCtic 
date,  contracting  themfelves  fo  much  the  lefs,  as  by  reafon  of  thefe  difor- 
ders,  they  were  the  lefs  fenfible  to  dimulus,  and  had  the  lefs  power  of  con¬ 
duction,  became  thus  didended  with  a  great  quantity  of  urine ;  nor  was  it 
drawn  off  by  art,  as  well  becaufe  the  fatnefs  of  the  abdomen  conceal’d  the 
tumour  of  the  bladder,  as  becaufe  his  known  incontinency  of  urine  did  not 
fuffer  us  to  lufpeCt  it:  for  all  thele  reafons  I  believe  it  happen’d,  that  when 
the  parts,  dedin’d  to  receive  the  urine,  were  already  fo  far  didended  as  to 
admit  of  no  farther  collection,  and  the  blood  dill  abounded  with  the  ferum  he 
had  taken  in,  the  remainder  of  it  either  ruffi’d  fuddenly  on  the  brain,  or 
was  gradually  extravalated  there,  and  fo  put  an  end  to  the  man’s  exidence. 
But  why  the  cerebrum  ffiould  be  particularly  inundated,  you  may  eafily  un- 
derdand  from  the  preceding  apoplexy,  as  alfo  from  the  vitiated  date  of  the 
arteries  going  to  that  part,  and  perhaps  even  from  the  vitiated  date  of  the 
pituitary  gland :  and  what  mifehief  may  proceed  from  the  one  is  already 
pointed  out  (z) ;  and  that  which  may  proceed  from  the  other,  will  be  taken 
notice  of  below  (a).  Moreover,  the  cohefion  of  the  right  auricle  of  the 
heart  with  the  pericardium,  might  eafily  prevent  it  from  impelling  the  blood 
into  the  heart,  fo  expeditioufly  as  was  intended  by  nature ;  for  which  reafon 
it  mud  flow  back  from  the  brain,  as  well  as  from  other  parts  of  the  body, 
with  lei's  celerity  and  difpatch.  But  the  cohefions  of  the  auricle  and  heart 
with  the  pericardium,  and  of  the  right  lobe  of  the  lungs  with  the  pleura, 
mud  be  fuppos’d  to  have  had  their  origin  from  the  inflammation  of  the  tho- 

(j)  Epift.,42.  n.  19.  20.  (z)  Epift.  3.  n.  22.  (a)  n.  36. 

*  -  rax, 


Letter  IV.  Article  21.  79 

rax,  with  which  the  patient  had  been  affl  idled  the  fummer  before.  His  pulfe 
and  refpiration,  at  that  time,  were  in  the  flate  they  generally  are  in  a  diforder 
of  that  kind  j  but  I  could  not  learn  any  thing  certain  about  them  fince  that 
time. 

Laft  of  all,  this  circumftance  is  to  be  added  to  the  hiflory  *,  that  two  years 
after,  in  the  fame  month  of  December,  his  brother,  who  was  alfo  fat,  was  carried 
off  by  an  apoplexy.  And  it  was  related  to  me,  that  his  lungs  were  connedled 
with  the  pleura,  and  that  the  aorta  was  in  feveral  places  bony  in  the  thorax : 
which  1  could  eafily  believe  ;  for  I  found  the  trunk  of  the  fame  artery,  in  its 
whole  tradl  through  the  belly,  vitiated  here  and  there,  and  become  bony, 
when  I  difledted  the  organs  which  ferve  to  the  fecretion  of  the  femen  and 
urine.  In  thefe  organs,  I  obferv’d  the  bladder  of  that  fize,  and  in  part  of 
that  figure,  which  it  naturally  contradis,  when  it  has  been  frequently  diftended 
with  urine.  The  other  parts,  and  efpecially  thofe  contain’d  within  the  cranium, 
had  been  buried  before  thefe  which  1  have  fpoken  of  were  diffedted.  The 
dileafe  of  the  aorta  calls  to  my  mind  the  hifbory  of  another  apopledlic  perfon, 
in  whom  this  artery  was  alfo  difeas’d,  though  in  a  lefs  degree. 

21.  N.  Ferrarini,  a  prieft  of  Verona,  who  had  formerly  been  fuppos’d. 
confumptive  at  Venice,  and  had  labour’d  under  a  hemicrania  ten  years  be¬ 
fore  at  Padua,  having  now  completed  his  forty-third  year,  the  hair  of  his 
head  was  grey,  and  his  face  was  fometimes  too  red ;  his  habit  of  body  was 
(lender,  yet  not  lean ;  and  though  he  feem’d  fprightly  and  joyful,  he  was 
very  anxious  with  diffembled  cares,  and  was  very  prone  to  anger.  He  us’d 
alfo  to  complain  of  pains  within  his  thorax,  the  feat  of  which  he  pointed  out, 
by  laying  his  hand  upon  his  flernum.  And  he  had  even  faid  to  his  furgeon, 
the  day  before,  that  he  was  not  well ;  and  that  he  would  therefore,  as  foon  as 
poffible,  ufe  all  proper  remedies  at  this  convenient  time  of  the  year.  This 
was  in  the  very  May  in  which  Tita  (b),  and  others  (c),  died  fuddenly  in  this 
city  although  the  feafon  being  become  warm  and  dry,  it  was  now  the  ninth 
day  fince  this  had  happen’d  to  any  one.  Yet  he  fupp’d  chearfuliy  with  his 
companions,  but  within  bounds  •,  nor,  indeed,  was  he  us’d  to  be  at  all  ir¬ 
regular  in  his  diet,  whether  you  regard  the  quality  or  quantity  thereof.  Early 
on  the  following  morning,  however,  he  was  found  dead  in  a  perfect  fleeping 
poflure,  and  lying  fupine,  without  any. foam  at  his  mouth ;  but  his  arms  were 
fo  rigid,  that  they  could  not  be  drawn  afunder  without  force  :  as  I  faw,  when 
I  came  to  his  houfe  before  evening,  with  my  collegues,  the  primary  pro- 
feffors  of  medicine. 

The  face,  neck,  back,  and  fides  of  the  body  were  of  a  reddiih  colour, 
which  frequently  became  livid.  I  order’d  the  fkull  to  be  firft  open’d.  While 
that  was  doing,  fome  blood  flow’d  out,  almoft  of  a  dirty  colour.  The  dura, 
mater,  at  the  fagittal  future,  was  black  with  blood,  fome  quantity  of  which, 
but  not  polypous,  was  alfo  found  in  the  firms  of  the  falx.  The  veffels  of  the 
pia  mater  were  difiended  with  blood  :  as  thofe  alfo  were  which  run  on  the 
fides  of  the  lateral  ventricles,  and  through  the  upper  part  of  the  plexus  cho- 
roides,  which  were  in  other  refpedls  pale.  But  the  medullary  lubftance  of 
the  brain  was  brown,  as  I  fhould  have  fuppos’d  from  the  quantity  of  blood  ; 
and  certainly  fanguiferous  veffels  appear’d  through  its  fubftance  •,  if  I  had 

(i)  Epift.  3.  n.  ii,  (c)  Ibid.  n.  26.  &  Epift.  26.  n.  35.  Vid,  ibid.  &  n.  17. 


not 


Bo  Book  I.  Of  Difeafes  of  the  Head. 

not  feen  in  others  a  greater  quantity  of  blood,  and  more  fanguiferous  veffels, 
and  yet  the  medullary  fubftance  ftill  white.  In  the  ventricles  was  a  pretty 
large  quantity  of  water;  and  a  good  deal  I  alfo  found  in  the  tube  of  the 
cervical  vertebras.  There  feem’d  to  be  no  diforder  in  the  cerebellum  ;  nor 
yet  in  the  brain,  nor  about  the  brain,  any  thing  which  related  particularly  to 
the  hemicrania,  wherewith  he  had  been  afflided  formerly,  and  which  was 
perhaps  external.  '1  here  was  nothing  remarkable  in  the  lungs,  except  a 
large  quantity  of  blood.  In  the  pericardium  was  almoft  no  moifture.  In 
the  right  ventricle  of  the  heart  was  a  polypous  concretion,  partly  entangled 
in  the  fibrillas  of  the  valvulae  tricufpides,  four  or  five  inches  long,  an  inch 
and  half  broad,  and  of  a  very  compad  ftrudure ;  fo  that  they  who  readily 
fuppofe  polypi,  might  well  have  taken  this  for  a  polypus  form’d  before 
death.  With  this  polypus  was  fome  black  half-concreted  blood,  fuch  as  was 
alfo  in  the  neighbouring  auricle.  In  the  left  ventricle  was  blood  in  lefs 
quantity,  and  lefs  coagulated.  The  columnas  of  this  cavity  were  in  a  manner 
inflat’d,  and  the  femilunar  valves  rather  harder  than  was  natural.  The 
trunk  of  the  great  artery,  from  the  heart  quite  to  the  place  where  it  begins 
to  defcend,  had  an  unequal  furface  externally,  as  if  it  in  fome  meafure  rofe 
up  here  and  there,  after  the  manner  of  knots  in  a  tree ;  but  internally,  in  all 
that  fpace,  there  was  only  a  wrinkled  furface,  and  two  little  obfcure  marks 
of  a  beginning  ofiification.  But  the  aorta  in  the  back,  and  all  its  afcending 
branches,  were  of  their  natural  appearance. 

The  abdomen  gave  no  teftimony  of  diforder  worthy  to  be  taken  notice  of. 

I  gather’d,  however,  from  the  examination  thereof,  the  time  about  which 
he  died.  For  as  the  food  was  no  longer  in  the  ftomach,  nor  any  ladeals  ap¬ 
pear’d  through  the  mefentery,  it  was  eafy  from  thence  to  conjedure,  that  he 
had  not  died  long  before  he  was  found  dead. 

22.  I  judg’d  that  this  prieft  was  taken  off  by  an  apoplexy,  as  water  was 
extravafated  in  the  cranium  ;  which  by  convulfing,  as  the  ftate  of  the  arms 
demonftrated,  and  at  the  fame  time  by  comprefilng,  with  the  quantity  of  blood 
obftruded,  had  conftring’d  both  the  cerebrum  and  cerebellum.  And  that 
brown  colour  of  the  medullary  fubftance  confirms  my  opinion  ;  for  whatever 
it  was,  that,  being  depofited  up  and  down  between  the  fibres  of  the  brain, 
had  given  a  brown  colour  to  the  whole  fubftance,  as  much  fpace  as  it  took 
up  within  the  cranium,  fo  much  more  dangerous  did  it  make  the  con- 
ftridion.  I  believe  the  difeafe  of  the  aorta,  in  like  manner,  as  I  have  fard 
before  (d),  confpir’d  to  the  formation  of  the  apoplexy.  For  what  you  may 
poffibly  fufped  of  a  fyncope,  is  iufficiently  invalidated  by  the  appearances  feen 
within  the  cranium,  and  by  the  lividnefs  of  the  face,  without  adding  any 
thing  elfe.  Nor  fuffer  yourfelf  to  be  eafily  impos’d  upon  by  th  t  polypous 
concretion  ;  for  that  polypi,  even  more  large  and  more  compad  than  this, 
may  be,  and  really  have  been,  form’d  after  death,  I  will  confirm  in  another 
place  (<?),  inconjundion  with  that  very  eminent  man  Andrew  Pafta,  who  ever 
fince  the  time  that  he  was  my  auditor,  has  been  defervedly  dear  to  me;  nor 
will  others,  who  attentively  difild  bodies  of  every  kind,  difallow  it.  But 
this  prieft  was  wont  to  fhcw  that  he  had  pains  in  the  thorax,  by  putting  his 

ft)  Epift.  24. 

right 


ft/)  Epift.  3.  n.  22. 


Letter  IV.  Article  23.  81 

right  hand  upon  the  fternum.  I  grant  it  *  but  difeafe  was  not  wanting  in 
that  portion  of  the  aorta,  which  lay  oppofite  to  the  fternum,  deep  within  the 
thorax :  and  that  alacrity  and  promptitude  to  aftion,  were  fufficient  proofs, 
that  the  right  ventricle  of  the  heart  was  not  obftru&ed  by  this  concretion,  in 
the  living  body. 

23.  But  as  I  find  a  great  deal  attributed  to  polypi  by  fome,  in  the  pro¬ 
duction  of  an  apoplexy,  I  muft  not  conceal  what  I  have  obferv’d,  and  what 
feems  reafonable  to  me,  on  this  head.  Polypous  concretions  have  been  alfo 
obferv’d  by  ancient  anatomifts,  and  among  thefe  by  Coiterus  (f),  who  writes, 
that  he  “  had  drawn  out  from  the  finufies  of  the  dura  mater  of  a  woman, 
“  who  died  of  a  phrenzy,  thick  fibres  or  filaments,  not  unlike  worms,  made 
“  up  of  a  white  pituita,  as  he  had  at  other  times  done  from  the  brains  of 
Ci  perfons  who  were  hang’d ;  and  that  he  had  taken  the  fame  kind  of  con- 
“  cretions  from  the  ventricles  of  the  heart and  thence  he  thinks  the  miftake 
arofe  of  many  people,  who  fay  that  they  had  feen  worms  in  the  brain,  and 
in  the  heart.  ButNymmannus,  when  he  had  found  concretions  of  that  kind 
about  the  torcular  herophili,  imagin’d  that  this  vein  was  obftrufted  thereby, 
from  whence  the  blood  was  believ’d  to  be  carried  into  the  whole  brain  •,  and 
fuppos’d  an  apoplexy  to  arife  therefrom.  You  have  the  doftrine  of  Nym- 
mannus  in  the  Sepulchretum  ( g ),  fo  renew’d  according  to  the  laws  of  the 
circulation  of  the  blood,  that  concretions  of  this  kind,  not  about  the  tor¬ 
cular,  but  at  the  beginning  of  the  internal  jugular  veins,  are  fuppos’d  to 
obftru<5t  the  blood,  not  as  it  is  going  into  the  brain,  but  as  it  is  returning 
from  it :  and  this  is  thought  “  frequently  to  happen  in  apopleftic  perfons.” 
You  will  alfo  read  in  the  fame  place  this  addition  •,  that  if  concretions  of  that 
kind,  brought  from  the  heart  to  the  arteries,  be  by  chance  broken,  from  any 
violent  commotion  of  the  blood,  and  by  the  impetus  be  driven  upwards, 
they  muft  of  confequence  come  to  more  narrow  pafiages,  that  is,  to  the  parts 
of  the  carotid  and  vertebral  arteries,  which  will  not  yield,  and  fo  will  of 
courfe  ftop  up  every  way  of  accefs  to  the  brain.  And  you  will  find,  that 
what  Fracafatus  has  mention’d,  his  having  found  in  the  bodies  of  apo- 
pleflic  perfons,  difie&ed  by  order  of  the  great  duke  of  Tufcany,  is  in  like 
manner  not  omitted  (b)  *,  to  wit,  concretions  in  the  fanguiferous  vefiels  of  the 
lungs,  and  the  ventricles  of  the  heart.  But  if  we  will  allow  the  truth,  Fra- 
cafatus  (/)  himfelf  there  confefs’d,  “  that  this  difeafe  was  not  to  be  call’d  an 
46  apoplexy  neverthelefs,  but  a  fyncope.” 

However,  as  for  what  relates  to  thofe  two  opinions  fpoken  of,  although  it 
ftiould  be  allow’d,  that  polypous  concretions  might  certainly  exift  in  the 
vefiels  of  living  bodies ;  yet  it  would  not  eafily  happen,  that  all  the  ways 
of  ingrefs,  or  egrefs,  to  the  blood,  fhould  be  at  the  fame  time  ftopp’d  up  in 
the  brain  *,  unlefs  almoft  the  whole  arterial  or  venal  fyftem,  and  the  cavities 
of  the  heart,  were  fill’d  with  concreted  blood  :  yet  from  hence  a  flow  fyn¬ 
cope  would  fooner  happen,  than  a  fudden  apoplexy.  Indeed,  I  have  often 
found  fuch  concretions  even  in  vefiels  going  to  the  brain  *,  but  it  has  in  fa<5t 
fo  happen’d,  that  I  have  very  feldom  found  them  in  apopledtic  bodies,  and 

(f)  Obf.  Anat.  ( h )  In  additam,  ad  fett.  cit.  obf.  I. 

( g )  L.  1.  f.  2.  obf.  i.  cum  fchol.  (/'}  Diflert.  de  cerebro. 

Vot.I. 


M 


when 


Si  Book  I.  Of  Difeafes  of  the  Head. 

when  I  have  met  with  them,  they  have  been  generally  very  fmall :  and  this 
the  former,  the  prefent,  and  the  following  letters,  will  all  fufficiently  Ihew. 
So  that  I  can  by  no  means  confirm,  from  my  obfervations,  that  this  is  very 
frequent  in  apoplectic  bodies  ;  lb  far  has  it  been  from  happening  to  me,  as 
it  happen’d  to  a  certain  perfon,  of  whom  you  will  read  in  theSepulchretum  ( k ): 
I  mean,  that  “  how  many  bodies  of  apopleCtic  patients  foever  he  open’d,  in 
“  every  one  of  them  he  found  thofe  concretions,  either  in  the  heart,  or  in 
«  the  brain,  or  in  both.”  You  deny,  therefore,  you  will  fay,  the  commen¬ 
tary  of  Martianus  (/),  “  that  Hippocrates  thought  a  ftagnation  of  the  blood 
“  might  happen  in  the  veins  or  arteries  of  the  whole  body  ;  but  in  the  apo- 
«  plexy,  that  thole  were  particularly  obftru&ed,  which  are  fituatedjin  the  neck 
“  and  thorax.”  But  I  only  deny,  or  rather  only  doubt  of,  what  feems  cer¬ 
tain  to  many  others  after  Martianus,  and  very  frequent  in  the  explication  of 
that  queftion  which  I  fpoke  of  above ;  although,  as  to  the  obftru<5tion  of 
veftels  in  the  neck,  how  far  this  may  contribute  to  that  effeCt,  mull  be  efti- 
mated  from  the  ancient  experiments  of  Galen,  which  Salius  allb  objeCls  ( m ). 
But  to  compare  thofe  with  what  were  made  by  Valfalva,  would  take  up  a. 
longer  dilquiiition  than  the  prefent  purpofe  allows  j  for  which  reafon,  it  will 
be  deferr’d  to  another  occafion  («).  I  Ihall  now  fubjoin  other  hiftories  of 
the  like  kind. 

24.  A  fifhmonger,  whofe  fhop  was  at  Venice,  oppofite  to  the  gate  of  the. 
public  arfenal,  of  a  middle  age,  a  good  habit  of  body,  and  rather  fat,  was. 
never  fo  chearful  as  ufual  fince  an  illnefs  which  he  had  undergone  fome 
months  before :  yet  he  never  made  any  complaint  of  his  head,  nor  had  the 
previous  diforder  at  all  affeCted  that  part.  On  the  fourth  of  Auguft,  in  the 
year  1708,  without  airy  evident  previous  caufe,  except  perhaps  from  his  food, 
in  which  even  on  the  laft  days  of  his  life  he  was  irregular ;  his  left  cheek 
lwell’d  extremely,  and  the  tumour  extended  itfelf  from  thence  under  his  chin 
and  his  ear.  Yet  he  was  in  his  fhop  juft  as  ufual,  and  manag’d  himfelf,  as 
to  his  bufinefs  and  diet,  juft  as  before.  But  on  the  fixth  of  May,  he  had 
fcarcely  rifen  in  the  morning,  after  a  good  night’s  deep,  and  put  on  his 
cloaths,  when  on  a  ludden  he  walk’d  two  or  three  times  acrofs  his  chamber, 
with  amazing  vehemence  and  hafte  ;  then  immediately  fat  down-,  and  being 
afk’d  how  he  found  himfelf,  he  anfwer’d,  oh  !  oh  !  oh  !  and  immediately 
expir’d  on  his  feat. 

The  body  was  open’d  by  the  celebrated  Santorini  before  evening,  while 
other  phylicians,  and  among  them  myfelf,  look’d  on.  The  limbs  were  fome- 
what  rigid,  the  abdomen  very  fat,  as  were  in  like  manner  the  omentum,  me- 
fentery,  and  mediaftinum.  Part  of  the  fmall  inteftines  was  livid  and  varie¬ 
gated,  to  the  length  of  a  fpan,  or  more.  The  fpleen  was  bigger  and  fofter 
than  it  ought  to  be,  and  on  its  convex  furfacc  had  fome  broad  white  fpots. 
The  hollow  lu rface  of  the  liver  had  here  and  there  a  kind  of  livid  red nefs ; 
its  edge  was  entirely  livid  ♦,  and  its  whole  fubftance  refilled  the  knife  much 
more  than  in  its  natural  ftate.  The  cavity  of  the  thorax  was  almoft  wholly 

(*)  Se£t.  cit.  obf.  37.  §  1.  (m)  De  Affett.  Particularib.  c.  2. 

( l )  Annot,  in  Hippocr.  1.  2,  de  morbis  verf.  («)  Epift.  19. 

•64. 


fill’d 


Letter  IV.  Article  2 5.  83 

fill’d  by  the  lungs,  being  very  turgid,  and  heavy  •,  but  dill  lefs  heavy  than 
turgid  :  for  they  contain’d  a  great  quantity  of  air,  and  not  much  ferum  : 
for  which  reafon  they  were  foft,  and  of  a  natural  colour.  In  the  pericardium 
was  a  moderate  quantity  of  fomewhat  bloody  ferum.  In  the  finuffes,  au¬ 
ricles,  and  veflels  of  the  heart,  was  no  where  any  thing  polypous :  but  we 
obferv’d  the  blood  to  be  quite  fluid,  as  in  both  the  ventricles,  the  pulmonary- 
artery,  and  the  aorta.  And  the  diameter  of  the  aorta,  juft  above  the  heart, 
feem’d  larger  than  natural.  Before  the  fkull  was  cut  open,  we  enquir’d  into 
the  nature  of  the  external  fwelling  I  have  fpoken  of,  and  what  was  the  in¬ 
ternal  feat  of  it.  The  parotid  gland  was  itfelf  found  only  the  membranes 
which  envelop’d  this  and  the  neighb’ring  parts,  but  efpecially  the  adipofe 
membranes,  were  turgid  with  ferum,  which  had  ftagnated  therein.  And  the 
blood  itfelf  ftagnating,  and,  as  it  feem’d,  almoft  extravafated,  had  ftain’d 
the  back  part  of  the  pharynx,  and  other  internal  parts  of  the  neck.  On 
feeing  which,  I  beckon’d  Santorini  to  take  the  pharynx,  and  the  afpera  ar¬ 
teria,  with  the  larynx,  and  the  other  parts  connected  with  them,  quite  out 
of  the  body  j  that  we  might  examine  them  alfo.  This  being  done,  we  found 
the  membranes  which  cover  the  root  of  the  tongue,  the  tonfils,  and  all  the 
external  furface  of  the  pharynx,  very  turgid,  with  a  tough  yellowifh  ferum  : 
yet  the  tonfils  themfelves,  and  the  canals  which  I  have  mention’d,  were  alto¬ 
gether  natural  internally.  While  he  was  taking  them  out,  the  internal  ju¬ 
gular  veins  appear’d  to  be  much  diftended  with  blood.  In  the  mean  while, 
the  fkull  being  open’d  by  the  furgeon,  the  veflels,  in  like  manner,  of  the 
cerebrum  and  cerebellum,  which  ran  upon  the  furface,  and  thofe  alfo  that 
lie  upon  the  corpus  callofum,  were  found  more  turgid  than  ufual,  but  the 
blood  in  them  was  fluid :  and  indeed  no  concreted  blood  was  feen  through 
the  whole  diffedtion.  But  ferum  was  met  with  under  the  pia  mater,  which, 
for  that  reafon,  was  eafily  drawn  off  from  the  brain  ;  and  a  pretty  large 
quantity  was  contain’d  in  the  ventricles,  and  fome  flow’d  out  from  the  tube 
of  the  vertebras.  In  the  choroid  plexuffes  were  vehicles  fomewhat  larger  than 
are  commonly  feen.  Yet  they  were  not  white,  nor  was  the  fubftance  of  the 
cerebrum  or  cerebellum  flaccid,  but  of  a  proper  firmnefs ;  for  I  examin’d  it 
with  my  fingers. 

25.  If  this  man  had  not  fpoken  at  the  inftant  of  his  death,  nor  had  Ihown 
any  ftruggles  in  refpiration,  I  fhould  have  judg’d  that  he  died  rather  of  a 
fuffocation  than  an  apoplexy.  During  this  diffedtion,  the  diffedtion  of  an¬ 
other  man,  as  it  generally  happens,  came  into  my  mind  *,  a  diffedtion  which 
I  had  perform’d  at  Bologna,  three  or  four  years  before,  and  which  was,  in 
fome  meafure,  fimilar  to  this.  At  that  diffedtion  were  prefent  the  celebrated 
Jacob  Bartholomew  Beccario,  now  profeffor  at  Bologna,  and  prefident  of  the 
academy  of  fciences  there ;  and  that  very  experienc’d  phyiician  Heraclito 
Manfredi,  who  aflifted  in  the  diffedtion,  and  who  then  difcharg’d  the  office 
of  afliftant  phyfician  to  the  hofpital  of  St.  Mary  de  Morte,  with  great  dili¬ 
gence  and  reputation.  And  I  would  have  you  underftand,  that  thefe  two 
excellent  men  were  not  only  witneffes,  but  companions  of  my  labours, 
whenever  I  fay  that  hiftories  were  obferv’d  in  that  hofpital :  for  it  was  our 
cuftom,  at  that  time,  to  fee  the  patients  together,  and  to  examine,  in  con- 

M  2  jundtion 


84  Book  I.  Of  Difeafes  of  the  Head. 

junction  into  the  latent  diforders  after  death,  both  from  a  defire  of  improving 
our  ftudies,  and  from  a  mutual  regard  to  each  other. 

26.  A  hufbandman,  of  forty  years  of  age,  being  affe&ed  with  violent  per¬ 
turbations  of  mind,  arifing  from  a  grievous  misfortune,  and  at  length  being 
feiz’d,  about  the  beginning  of  December,  17 05,  with  a  violent  fever,  was 
taken  into  the  hofpital  1  fpoke  of  above.  After  fome  days,  the  heat  and 
drynefs  of  the  tongue  feem’d  to’  remit.  On  the  other  hand,  the  arteries, 
which  from  the  beginning  had  been  foft,  and  of  different  force  in  different 
pulfations,  mov’d  ftill  more  unequally.  On  the  fixteenth  of  December,  in 
the  morning,  the  pulfe  was  worfe,  and  lower.  His  eyes,  which  was  alfo  ob- 
ferv’d  in  the  beginning,  were  intent,  and  fix’d.  His  third:,  in  like  manner, 
remain’d.  Yet,  except  this,  he  complain’d  of  nothing  at  all.  And  even, 
upon  being  particularly  afk’d,  whether  he  had  any  internal  heat,  or  any  un- 
eafinefs  in  his  head,  cheft,  belly,  or  elfewhere,  he  faid  no  :  however,  he  juft 
added,  that  his  head  feem’d  a  little  heavy,  and  that  in  a  flow,  fubmiffive, 
tone  of  voice,  as  he  generally  us’d  -,  but  he  fpake  clearly  and  explicitly.  It 
was  not  yet  half  an  hour  after  he  made  this  anfwer,  when,  as  he  was  drink¬ 
ing  fome  water,  which  he  had  drunk  on  former  days,  and  was  prefcrib’d  by 
the  phyfician,  his  upper  lip  being  drawn  up,  before  the  eyes  of  the  attend¬ 
ants,  he  fuddenly  died.  We  ran  to  him  upon  the  outcrie  of  thofe  about 
him.  The  body  being  yet  warm,  we  tried  every  part  where  there  is  gene¬ 
rally  a  pulfe,  to  fee  if  any  life  remain’d,  but  in  vain  $  for  the  man  was  en¬ 
tirely  dead. 

When  I  open’d  the  belly,  on  the  day  following,  I  obferv’d  a  little  more 
moifture  in  it  than  ufual :  and  the  omentum  was  fo  contradted,  that  it  entirely 
lay  hid  under  the  angle  of  the  left  ribs.  But  the  colon,  where  it  forms  its 
lower  flexure,  and  joins  with  the  redtum,  was  fo  prominent  before  the  ileum, 
under  which  it  generally  lies,  that  in  the  middle  it  was  almoft  contiguous 
to  the  bones  of  the  pubes  ;  and  adtually  lay  upon  the  bladder,  which  was 
full  of  urine.  The  external  coats  of  the  jejunum  were  fprinkled  here  and 
there  with  fome  red  and  almoft  livid  fpots  •,  yet  they  were  few  and  minute, 
and  from  them,  when  flightly  wounded,  fome  fmall  drops  of  blood  came 
forth.  But  the  ileum  was  reddifh,  and  a  little  hard  in  two  places,  under  one 
of  which  (for  I  forgot  to  open  the  inteftine  in  the  other)  was  an  ulcer,  two 
inches  wide,  and  three  inches  long,  which  having  deftroy’d  the  interior  coat, 
had  penetrated  quite  to  the  flefhy  coat :  yet  the  finus  was  clean,  and  the  lips 
were ’not  tumid.  On  the  edge  of  the  liver  was  a  lividnefs,  yet  it  did  not  go 
far  into  the  fubftance  thereof.  I  pour’d  out  from  the  gall-bladder,  which 
was  of  an  un ufual  figure,  thick  and  turbid  bile,  not  much  unlike  the  water 
in  which  frefh  meat  has  been  wafh’d.  The  fpleen  was  large  and  flaccid. 

In  the  thorax,  on  each  fide,  was  fome  bloody  water,  fueh  as  was  in  the 
pericardium  alfo.  The  lungs  were  found,  except  that  there  feem’d  to  be 
more  moifture  than  ufual  in  the  bronchia;  although  they  adher’d  on  one  fide 
to  the  pleura,  and  were  black  pofteriorly  on  both  fides :  and  this  happen’d 
from  the  fame  caufe,  to  which  the  immoderate  rednefs,  and  blacknefs  of 
the  neck,  back,  and  other  parts,  on  wiiich  the  body  lay,  was  owing.  For 
the  blood  was  not  coagulated,  nor  become  grumous,  but  was  univerfally 
fluid  in  the  whole  of  this  body :  when  the  aorta  was  cut  into,  near  the  dia¬ 
phragm. 


Letter  IV.  Article  27.  85 

phragm,  it  came  forth  fluid;  and  fluid  did  it  come  from  the  veflels  of  the  neck, 
when  the  head  was  cut  off :  and  from  all  the  veflels,  whencefoever  we  faw  it  flow. 
The  blood  was  fluid,  and  without  the  leaft  polypous  concretion  in  the  heart  itfelf, 
which  was  very  flaccid,  and  had  all  the  valves  belonging  to  the  left  ventricle 
here  and  there  pretty  hard,  as  they  are  wont  to  be  before  they  become  bony. 

The  brain  was  alfo  very  lax,  and  under  the  pia  mater,  in  fome  places, 
were  feen  little  bubbles,  but  every  where  a  moifture.  The  lateral  ventricles 
contain’d  a  little  bloody  water.  Yet  neither  the  veflfels  which  run  on  their 
parietes,  nor  the  plexus  choroides,  were  pale.  In  the  pofterior  part  of  the 
plexus  on  each  fide  were  veficles,  turgid  with  a  pellucid  fluid.  Lad  of  all, 
the  pituitary  gland  was  fo  low  and  contracted,  that  there  fcarcely  feem’d  to 
be  any.  After  feeing  thefe  things,  I  had  a  mind  that  the  larynx,  and  the 
parts  about  it,  fhould  be  infpeCted  ;  which  1  frequently  do  in  cafes  and  in 
bodies  of  this  kind.  But  the  teeth  were  fo  clofely  and  ftrongly  join’d  toge¬ 
ther,  that  we  could  not  draw  them  afunder,  without  the  utmoft  force : 
whereas  the  other  parts  were  by  no  means  rigid,  or  contracted,  nor,  except 
the  upper  lip,  which,  as  we  laid  above,  was  drawn  upwards  when  he  died, 
did  any  other  mark  appear,  which  fnew’d  a  diftenfion  of  the  nerves.  The 
mouth,  however,  being  at  length  open’d,  the  firft  thing  that  appear’d  was 
a  tumour,  almoft  as  big  as  a  walnut,  which  occupy’d  the  right  fide  of  the 
palate,  with  the  gum  adjoining  to  it,  where  the  dens  molaris  was  much  vi¬ 
tiated  and  deftroy’d  ;  and  this  tumour  was  turgid  with  pus,  almoft  concoCted. 
Moreover,  the  membrane  with  which  the  uvula,  and  the  contiguous  parts, 
and  the  external  part  of  the  larynx,  even  to  the  extreme  point  of  the  epi¬ 
glottis,  are  cover’d,  was  livid  on  the  furface ;  and  being  cut  into,  fhew’d  in¬ 
numerable  cells  beneath  it,  the  reddifh  and  thin  fides  of  which  were  diftended 
with  a  kind  of  jelly.  The  parts  beneath  thefe  cells  appear’d  found  ;  but  the 
inner  part  of  the  larynx  was  ting’d  with  a  reddifh  colour  near  the  glottis  ;  and 
the  fides  of  the  glottis,  which,  in  other  refpeCts,  were  white  as  ufual,  were 
much  more  than  ufually  collaps’d. 

27.  In  this  hufbandman,  you  fee  the  blood  was  every  where  fluid,  as  it 
was  in  the  fifhmonger  :  and  in  both  of  them  you  fee  how  eafily  a , collection 
of  a  pretty  vifcid  kind  of  ferum,  in  the  cellular  membranes,  inverting  the 
larynx,  and  the  neighbouring  parts  externally,  was  join’d  with  a  tumour  that 
arofe  at  the  flde  of  the  mouth.  By  reafon  of  that  collection  about  the  larynx, 
a  fufpicion  firft  arofe,  that  the  hufbandman  was  fuffocated  as  he  was  drink¬ 
ing.  But  what  immediately  remov’d  this  fufpicion  was,  that  no  ftruggles, 
however  ineffectual,  were  feen  in  him  when  he  was  dying,  in  order  to  expe¬ 
dite  refpiration.  It  remain’d,  therefore,  that  I  fhould  rather  believe  he  was 
luddenly  ftricken  with  an  aooplexy,  from  convulfions.  And  the  convulfion 
of  his  upper  lip,  but  efpecially  of  his  under  jaw,  was  an  indication  of  the 
latent  one  in  the  brain.  Nor  is  it  wonderful,  that  a  man  with  a  very  flaccid 
heart,  and  with  fo  lax  a  luhftance  of  brain,  fhould  thus  fuddenly  perifh  : 
this  laxity  was  before  demon  ftr-ated  by  the  ftupor,  in  not  being  fen  Able  to 
the  ftimulus  of  the  urine,  though  the  bladder  was  full,  nor  of  the  ulcerated 
ileum,  nor  the  gum,  and  the  tumour  upon  the  roof  of  the  mouth,  nor 
even  of  the  external  membranes  of  the  larynx  being  occupied  by  a  edn- 
geftion  of  ropy  ferum;  though  every  one  of  thefe  circumftances  was  fo  evj* 

dent 


8  6  Book  I.  Of  Difeafes  of  the  Head. 

dent  in  the  dead  body.  And  you  will  not  wonder,  that  a  fmall  quantity  of 
fluid  was  able  to  bring  on  a  convulfion,  fince  you  know,  that  a  few  drops  of 
any  fluid,  fo  it  be  but  acrid,  refting  upon  a  nerve,  will  bring  on  a  great 
diftenfion  of  the  whole  fyftem.  And  you  cannot  avoid  believing  this  water 
to  have  been  acrid,  inafmuch  as  from  a  fever  of  that  kind,  it  fell  fuddenly 
on  the  brain,  and  its  membranes,  as  on  the  parts  which  were  weakeft  in  this 
man.  But  if  I  had  been  fo  ready  as  Valfalva,  at  tailing  certain  humours  found 
in  the  difledlion  of  bodies ;  or  if  any  thought  had  ftruck  me  while  I  was 
differing,  of  any  other  method,  which  was  not  altogether  uncertain,  of  en¬ 
quiring  into  its  nature;  1  would  alfo  very  willingly  have  communicated  to 
you  my  difcoveries  on  this  head.  However,  fince  this  is  now  out  of  my 
power,  I  hope  you  will  receive  in  good  part  what  I  can  at  prefent  commu¬ 
nicate.  For  fince,  not  only  in  thefe  two,  but  in  many  others  whole  hiftories 
are  defcrib’d  in  this  letter (0),  the  blood  was  found  fluid;  confider  whether 
you  think  proper,  with  JLancifi  (/>),  in  forne  of  them  at  leaft,  to  acknowledge 
a  redundance  of  acrid  and  irritating  falts,  from  this  confideration. 

28.  A  woman  of  fixty  years  of  age,  who  had  been  confin’d  to  her  bed 
many  years,  by  reafon  of  a  contradbion  of  the  mulcles,  that  mov’d  the  lower 
limbs,  and  who  was  as  well,  certainly,  as  fhe  had  been  on  preceding  days, 
having  eaten  rather  more  than  fhe  was  us’d  to  do ;  gave  a  fudden  turn  to  her 
eyes,  and  immediately  died.  The  abdomen,  thorax,  and  cranium  being 
open’d,  and  examin’d  by  me,  in  the  hofpital  for  incurables  at  Bologna,  in 
the  year,  as  I  remember,  1704;  I  obferv’d  nothing  in  either  of  thole  cavi¬ 
ties,  which  could  appear  morbid,  except  water ;  and  that  was  but  in  fmall 
quantity. 

29.  Although,  in  that  contorfion  of  the  eyes,  a  fign  of  convulfion  was 
not  wanting ;  yet  if  you  would  prefer  compreflion  in  this  cafe,  or  choofe  to 
have  compreflion  join’d  with  convulfion,  you  have  my  Tee  confent.  But 
perhaps  you  doubt  here,  and  have  doubted  before,  whether  I  do  not  impute 
too  much  to  compreflion,  from  fo  fmall  a  quantity  of  water.  For  in  the  firft 
place  you  are  not  ignorant,  that  many  aflert  the  conflant  exiflence  of  a  fmall 
quantity  of  water  in  the  ventricles  of  the  brain,  even  in  their  moft  natural 
flate.  And  you  know  very  well  befides,  that  there  cannot  poflibly  be  a 
greater  quantity,  on  any  occafion,  than  in  an  internal  hydrocephalus ;  and 
yet  you  know  that  Vefalius  (y),  who  found  in  a  girl,  that  had  labour’d  under 
•this  diforder,  “  almoft  nine  pints  of  water,”  aflerts,  that  the  fame  patient 
•“  had  enjoy’d  all  her  fenfes  perfedlly  till  death,  nor  were  her  limbs  and  joints 
•“  paralytic,  though  they  were  weak  indeed,  and  relax’d.”  To  thefe  things 
we  may  add,  that  tumours  have  been  found  within  the  cranium,  which  had 
been  follow’d  by  no  apoplexy,  as  you  know  extremely  well,  from  a  great 
number  of  difledlions,  and  even  from  many  that  are  to  be  met  with  in  the 
Sepulchretum. 

But  to  begin  from  thefe  lad,  I  have  myfelf  formerly  obferv’d  in  the  Ad- 
verfaria  (r),  that  I  had  feen,  in  three  bones  of  the  cranium,  an  accefiion 
of  new  bony  fubftance,  from  which  they  protuberated  much  internally,  and 

(0)  N.  2.  8.  9.  1 1.  (y)  De  corp.  hum.  fabr.  1.  1.  c.  5.  Vid.  & 

(/>)  D.  Subit.  Mort.  obf.  Phyf.  Anat.  4.  in  Sepulchr.  1.  1.  S.  16.  obf.  6. 

Schol.  n.  4.  (r)  VI.  Animad.  84, 


comprefs’d 


Letter  IV.  Article  30.  87 

comprefs’d  the  brain ;  and  yet  that  no  diforder,  much  lefs  an  apoplexy,  was 
generated  thereby.  But  at  the  fame  time  I  inform’d  my  readers,  that  I 
believ’d  no  diforder  was  the  confequence,  becaufe  that  compreffion  had  been 
made  and  encreas’d  by  degrees  :  and  this  is  ftill  my  opinion,  and  I  fuppofe 
will  be  yours ;  for  there  are  innumerable  examples,  by  which  we  may  un- 
derftand,  that  the  bodies  of  animals  will  bear  even  the  greateft  changes  with 
little  or  no  detriment,  fo  they  are  but  gradually  brought  about ;  but  that 
they  cannot  bear  even  thofe  of  a  far  lefs  confiderable  nature,  if  they  are  made 
fuddenly  and  at  once.  And  fuppofe  the  fame  of  the  hydrocephalus,  that  I 
have  faid  of  tumours  :  for  you  know,  that  it  always  comes  on  by  degrees  ; 
as  that,  of  which  Vefalius  fpeaks,  “  was  about  feven  months,  more  or  lefs,” 
in  collecting;  to  fay  nothing  of  the  yielding  of  the  bones  of  the  cranium, 
when  this  fpecies  of  dropfy  begins.  Laft  of  all,  though  I  confefs  that  the 
ventricles  of  the  brain  are  naturally  moift,  yet  that  in  all  bodies,  and  at  all 
times,  as  much  water  is  contain’d  therein,  as  I  have  found  in  thofe  apoplectic 
perfons,  where  I  fpoke  of  a  little  only,  I  deny  ;  becaufe  it  is  repugnant  to  a 
great  number  of  obfervations,  which  1  have  made  on  other  bodies. 

And  fince  this  is  the  cafe,  you  need  not  doubt  to  acknowledge,  a  dangerous 
comprefiion  of  the  brain  in  thofe,  who,  having  fcarcely  any  water  therein 
before,  have  it  at  once,  or  at  leaft  in  a  very  fhort  time,  collected  in  a  confi¬ 
derable  quantity,  efpecially  if  other  caufes  are  added  to  ftreighten  and  con- 
ftringe  the  brain  •,  which  caufes  I  have  in  part  already  defcrib’d,  and  fhall  im 
part  fubjoin,  when  I  have  given  you  the  next  hiftory. 

30.  A  ruftic  of  the  territory  of  Bologna,  of  more  than  fixty  years  of  age, 
had  for  a  long  time  paft  had  filthy  ulcers  in  his  legs,  which  he  eagerly  defir’d 
lhould  be  heal’d.  Therefore,  although  he  was  of  a  bad  habit  of  body,  for 
the  molt  part,  nor  went  to  ftool  for  fix  days,  without  taking  purging  medi¬ 
cines,  or  having  gl)  Iters  thrown  up  ;  yet  having  got  a  very  officious  furgeon, 
he  brought  the  matter  fo  far  to  a  conclufion,  that  afcer  three  months,  the 
ulcers,  being  cleans’d,  began  to  heal.  The  cicatrix  was  not  completed,  when 
he  began  fuddenly  to  complain  of  a  very  great  vveaknefs  in  his  head ;  and, 
indeed,  the  pulfations  of  the  arteries  were  very  fmall  and  languid.  The  day 
after,  the  ftrength  of  his  arteries  return’d  as  ufual,  nor  did  he  take  food  un¬ 
willingly.  But,  on  the  third  day,  he  firft  began  to  be  delirious,  and  pre- 
fently  to  lofe  the  fenfe  of  feeling  in  his  whole  body  :  however,  he  ftill  ftretch’d 
his  arms  out,  when  he  was  order’d,  that  his  pulfe  might  be  felt.  Signs  of 
a  diftenfion  of  the  nerves  were  obferv’d  foon  afterwards  in  both  arms :  and  at 
length,  being  depriv’d  of  all  power  of  feeling  and  moving,  and  a  ftertor 
coming  on,  he  died ;  a  fmall  quantity  of  a  yellow  humour  being  difcharg’d 
out  of  both  noftrils  after  death. 

I  difteCted  this  body  in  the  beginning  of  the  year  1705,  Valfalva  being 
prefent.  The  mufcles  of  the  abdomen  were  of  a  very  good  colour,  were 
cover’d  with  a  fufficient  quantity  of  fat,  and  had  alfo  a  proper  quantity  difr 
pers’d  among  their  fibres  •,  and  this  fat  was  of  a  very  good  colour.  But  in 
the  loins,  at  the  fides  of  the  fpine,  water  was  contain’d  in  the  cellular  mem¬ 
branes,  inftead  of  fat.  The  colon  went  from  the  right  hypochondrium  quite 
down  below  the  navel,  lying  before  all  the  fmall  inteftines  ;  thence  bending 
itfelf  upwards  again,  it  pafs’d  over  to  the  right  hypochondrium.  Moreover, 


S3  Book  I.  Of  Difeafes  of  the  Head. 

the  inteflines,  but  efpecially  the  colon,  and  the  other  large  inteflines,  were 
diftended  here  and  there  with  hard  excrements.  The  liver  was  diftinguifh’d 
by  very  fmall  fpots  of  a  tawny  colour,  variegated  like  marble,  and  had  a 
kind  of  difagreeable  fmell.  The  gall-bladder  was  in  a  contracted  ftate,  and 
contain’d  but  little  bile  :  yet  the  liver  was  not  harder  than  ufual,  but  a  little 
larger.  The  fpleen,  however,  was  very  large,  and  had  a  filthy  appearance, 
being  cover’d  with  large  oblong  lpots,  of  a  black  colour,  as  if  from  inflam¬ 
mation  ;  but  this  was  externally,  for  internally  its  appearance  was  not  bad. 
The  veficulas  feminales  were  alfo  externally  black.  But  on  each  of  the 
tefticles,  within  the  tunica  vaginalis,  was  plac’d  a  large  hydatid,  of  which 
the  left  was  the  largeft:  they  were  in  the  middle  of  the  bag,  hanging  alrnofl 
loofe,  and  free  from  all  other  parts.  The  fluid  which  was  contain’d  in  them, 
being  apply’d  to  the  fire  in  a  metal  fpoon,  did  not  coagulate,  but  evaporated, 
leaving  only  a  thin  pellicle  behind  it.,  In  the  cavity  of  the  thorax  and  ab¬ 
domen  was  a  little  water  contain’d. 

Both  lobes  of  the  lungs  had  very  confiderable  adhefions  to  the  pleura :  the 
right  adher’d  by  its  lower  and  pofterior,  and  the  left  by  its  lateral  and  fu- 
perior  furface  :  and  their  adhefions  were  on  both  fides  by  a  membranous 
texture  of  fibres.  Neverthelefs,  they  were  entirely  found,  as  other  parts 
alfo  were  ;  which  I,  therefore,  as  ufual,  pafs  by  with  filence.  While  I  di¬ 
vided  the  cervical  vertebras  from  the  thoracic,  water  flow’d  out  from  their 
tube  :  and  upon  opening  the  fkull,  a  thin  fluid  was  found  betwixt  the  two 
meninges,  and  in  like  manner  between  the  pia  mater  and  brain. 

31.  There  are  fome  things  in  this  hiftory,  which  do  not  come  under  con- 
lideration  here,  but  {hall  be  explain’d  every  one  in  its  proper  place  *,  though 
I  now  give  a  detail  of  each  circumftance,  as  I  always  do  when  I  have  it  in 
my  power,  whether  they  relate  to  the  prefent  purpofe  or  not :  that  the  hiftories 
may  not  feem  lame  and  imperfect,  as  they  frequently  are  in  the  Sepulchretum. 

If  apoplexies  from  a  ferous  caufe  were  always  brought  on  fo  flowly  and 
gradually  as  this  was,  or  as  that  which  is  defcrib’d  by  the  celebrated  Trew  (j), 
in  a  man  whom  he  differed  himfelf,  and  others  of  that  kind  ;  what  Martia- 
nus  (/)  afferts  would  be  altogether  true,  “  that  an  apoplexy  from  an  affluxion 
s‘  of  cold  humours,  does  not  come  on  fuddenly,  as  it  happens  in  thofe  of 
“  other  kinds.”  But  as  the  preceding  letter  («)  fhews,  that  fome  of  thofe, 
which  took  their  rife  from  an  effufion  of  blood  in  the  brain,  began  mildly, 
and  rag’d  by  degrees >,  fo  the  prefent  letter  ( x )  gives  you  many  examples  of 
very  fudden  attacks  from  an  effufion  of  water  within  the  cranium  :  to  which 
others  might  alfo  be  join’d,  efpecially  one  defcrib’d  by  Brunnerus,  and  tranf- 
ferr’d  into  the  Sepulchretum  ( y ).  And  among  thofe  which  have  been  ob- 
ferv’d  fince  the  publication  thereof,  with  its  Additamenta,  that  ferous  apo¬ 
plexy  (2)  deferves  notice,  by  which  an  old  man,  who  was  a  foldier,  without 
any  complaint  relating  particularly  thereto,  having  been  in  the  country  that 
day,  and  after  flipping  as  ufual  having  gone  to  bed,  was  fnatch’d  away  fo 
fuddenly,  that  his  wife  found  him  dead  in  the  bed. 

(s)  Adi.  Nat.  Cur.  t.  4.  obf.  135.  cum  fchol.  (*)  N.  4,6,  9,  11,  16,  21,  26,  28. 

(/)  Annot.  in  Hippoc.  1.  2.  de  morb.  verf.  ( y J  L.  1.  f.  2.  in  Addit,  obf.  1 1. 

64.  (2)  Commere.  Litterar.  a.  1741.  hebd.  44» 

'  {u)  N.  1 1,  20,  24.  n.  i. 

32.  But 


Letter  IV.  Article  32.  89 

32.  But  the  apoplexy  laft  defcrib’d,  which  had  evident  marks  of  a  con- 
vulfion  join’d  with  it,  muft  naturally  be  attributed  to  irritation  and  acrimony  ; 
the  water  contain’d  within  the  cranium  being,  doubtlefs,  impregnated  with  the 
erofive  particles,  which  were  us’d  to  be  difcharg’d  by  the  ulcers ;  as  we  have 
already  (hewn  in  fimilar  hiftories,  both  from  Valfalva’s  papers,  and  mine. 
Yet,  let  us  fuppofe  that  it  happen’d  from  this  little  quantity  of  water,  and 
that  the  water  could  not  injure  except  by  its  compreflion  ;  and  even  then  I 
think  we  may  eafily  conceive,  how  a  great  compreflion  may  be  brought  on 
by  a  little  quantity  of  water.  For  what  would  be  but  a  fmall  quantity  to 
fome,  may  be  a  large  quantity  to  others ;  to  thofe,  for  inftance,  who  have 
lefs  fpace  within  the  fkull  by  nature,  or  from  any  preceding  or  acceding  caufe, 
even  at  the  time  when  the  water  is  extravafated  or  encreas’d.  But  do  not  ima¬ 
gine,  that  among  the  caufes  of  other  kinds,  which  may  pofiibly  happen,  I 
certainly  reckon  what  Piccolhominus  (a)  does  not  hefitate  to  lay  down  as 
certain,  “  that  at  the  full-moon  the  brain  is  fo  turgid  with  moifture,  that  it 
“  fills  the  whole  cavity  of  the  cranium.”  For  in  regard  to  this  matter, 
though  by  reafon  of  the  obfervation  of  Falloppius  (£),  we  fhould  not  haftily 
rejeft  it,  yet  there  does  not  feem  to  be  any  thing  in  it  *,  whereas,  on  the  con¬ 
trary,  I  think  the  fame  circumftance  may  happen  from  blood,  from  whatever 
caufe,  diftending  all  the  veflels  in  a  very  great  degree,  as  I  have  explain’d 
above  (c).  And  if  to  this  diftenfion  of  the  veflels,  be  by  chance  added  an 
encreas’d  force  of  the  arteries,  which  by  their  ftroke  and  dilatation  alternately 
raife  up  the  brain  j  the  more  you  fhall  fuppofe  this  force  to  be  encreas’d,  the 
more  muft  you  conceive  that  the  fpace  within  the  cranium  is  diminifh’d  :  and 
whether  the  veflels  are  diftended  at  the  time  of  the  extravafation  of  the  water, 
or  long  before,  the  cafe  is  exactly  the  fame.  So  in  the  foldier,  who,  though 
he  went  well  to  bed,  was  yet  found  dead  therein  by  his  wife,  as  I  related  be¬ 
fore  (d)>  veflels  were  feen  through  the  furface  of  the  brain  turgid  with  blood  ; 
but  when  he  went  to  bed,  he  does  not  feem  to  have  had  either  turgid  veflels, 
or  extravafated  water.  And  in  a  certain  crooked  mountebank  ( e ),  the  veflels 
which  compofe  the  choroid  plexufles,  being  chang’d  into  a  hardifh  tumid  body, 
of  a  flefliy  colour,  which  change  could  not  have  happen’d  in  a  fhort  time, 
fufficiently  fhew’d,  that  the  l'udden  death  of  this  man  did  not  arile  from  the 
tumour  only  ^  for  then  it  muft  have  happen’d  long  before ;  but  alfo  from  the 
efl'ufion  of  much  limpid  water,  which,  as  it  found  the  fpace  within  the  cranium 
already  diminifh’d  by  this  tumid  body,  could  fo  much  the  fooner  occupy  the 
fpace  that  remain’d  •,  and  thus  by  entirely  comprefilng  the  brain,  put  an  in¬ 
flant  flop  to  exiftence.  But  all  thefe,  and  other  caufes  of  this  kind,  belong 
to  the  latter  of  thofe  two  clafles,  which  I  mention’d  above.  For  the  caufes 
of  the  firft  clafs,  or  thofe  which  render  the  fpace  narrower  at  all  times,  in 
fome  men,  as  they  exift  from  the  birth,  or  from  infancy  at  leaft,  muft  be  ac¬ 
counted  for  from  the  bulk  of  the  cerebrum,  or  cerebellum,  being  difpropor- 
tion’d  to  the  cavity  of  the  cranium  •,  or,  on  the  other  hand,  from  the  capacity 
of  the  cranium  being  diiproportion’d  to  the  bulk  of  the  brain.  And  as  this 
want  of  fymmetry  frequently  happens  betwixt  other  parts,  why  may  it  not 

{a)  Anat.  Prreled.  1.  5.  led.  1.  (</)  N.  31. 

(b)  Trad,  de  Vain.  c.  12.  (<-)  N.  14.  \e)  Commere.  Litterar.  a.  1736.  hebd.46. 

■  Vol.  I.  N  fometimes 


90  Kook  I.  Of  Difeafes  of  the  Head. 

fometimes  happen  betwixt  thefe  alfo  ?  Indeed,  when  I  firft  made  mention  in 
the  Adverfaria  (/)  of  the  different  capacity  in  the  fkulls  of  different  perfons, 
in  order  to  iiluftrate  the  fubjedt  now  in  quefiion  ;  I  was  led  to  it,  if  you  afk 
me,  by  obferving  it  fo  different  in  different  perfons,  and  by  obferving  in  fome 
how  very  deep  a  hollow  was  form’d  for  the  veffels  that  are  prominent  in  the 
dura  mater.  But  the  very  fagacious  Hunauld  (g)  has  evidently  confirm’d  the 
tacit  caufe  of  my  conjecture,  and  enlarg’d  upon  it-,  who,  I  find  by  letters 
that  I  receiv’d  from  my  very  benevolent  friend,  the  celebrated  Reaumur,  while 
I  wrote  thefe  letters,  is  prematurely  fnatch’d  from  the  Royal  Academy  of 
Sciences  at  Paris,  and  from  me.  For  Hunauld  has  obferv’d,  that  fometimes 
in  the  fkulls  even  of  boys,  the  coronal  and  fagittal  futures  are  prematurely 
clos’d  and  cemented  together  -,  and  that  the  bones,  for  this  reafon,  not  giving 
way,  the  growing  brain  is  fo  confin’d  and  prefs’d,  that  in  a  boy  where  thele 
futures  were  entirely  obliterated,  the  bones  were  much  more  hollow’d  out, 
both  in  the  forehead  and  finciput,  to  receive  the  convolutions  of  the  brain. 
And  fince  thefe  things  are  fo,  you  very  well  fee  what  caufes  may  exift  at  all 
times  in  fome  perfons,  or  may  occafionally  happen  in  others,  which  by  taking 
up  the  fpace,  may  render  that  water,  which  would  be  very  far  from  doing 
injury  in  thole  perfons  where  other  caufes  do  not  exiff,  fo  extremely  noxious, 
that  by  its  fudden  or  fpeedy  effufion  it  may  caufe  compreffion  and  apoplexy  ; 
and  that  even  fooner,  perhaps,  than  an  equal  quantity  of  blood  extravafated 
within  the  fkulls  of  thofe  perfons,  who  had  a  larger  capacity  of  fpace. 

I  do  not,  however,  forget,  that  there  are  many  very  learned  men,  who  do 
not  chufe  to  acknowledge  any  vacuity,  or  fpace,  in  the  great  cavities  of  the 
body  -,  but  fuppofe  fo  great  a  plenitude  in  all,  that  nothing  more  can  be  added 
thereto.  But  this  is  not  the  place  to  treat  fully  and  accurately  of  fuch  a 
queflion,  or  to  confider  whether  it  is  neceffary  to  fuppofe  the  cranium  entirely 
full,  when  the  continued  appendix  of  that  cavity,  I  mean  the  tube  of  the 
vertebrae,  is  not  every  where  full  of  the  fpinal  marrow,  which  is  the  appendix 
of  the  brain  :  for  you  know  very  well,  that  the  fpinal  marrow  is,  through  a 
confiderable  tract  efpecially,  fo  attenuated,  that  it  cannot  come  in  contadt  with 
the  dura  mater.  Nor  will  I  here  enquire,  whether  the  corpus  callofum,  which 
is  not  convex  on  its  internal  furface,  where  it  forms  the  roof  of  the  lateral 
ventricles,  lies  in  fuch  a  manner  on  the  corpora  ftriata,  and  the  thalami  ner¬ 
vorum  opticorum,  by  the  protuberance  of  which  not  only  the  bafis,  but 
the  fides  of  the  ventricles  are  form’d (/6),  fo  as  to  leave  no  interval  at  all  be¬ 
twixt  them  :  nor  yet,  whether  any  fpace  at  all  be  left  betwixt  the  fides  of  the 
fourth  ventricle,  that  are  fo  prominent  -,  or  betwixt  the  hollow  lurfaces  of  the 
anterior  and  pofterior  part  of  the  fame  ventricle;  or  in  the  canal,  which  is 
call’d  the  paffage  to  the  fourth  ventricle  :  and  finally,  whether  there  be  any 
cavity,  by  which  moifture  can  penetrate  from  the  ventricles  to  the  infundi- 
»  bulum,  and  the  pituitary  gland  ;  both  of  which  parts  otherwife  might  feem 
to  be  created  in  vain.  But  I  omit  enquiring  after  thefe  things  here,  fince 
that  may  be  fufficient  at  prefent,  which  they  themfelves  exprefly  confefs  ;  I 
mean,  that  the  brain  “  has  cavities,  fo  that  it  may  fometimes  be  relax’d,  when 

* 

(f)  VI.  Animad.  84.  ( h )  Adverf.  indie,  anitnad.  10. 

( g )  Hift.  de  i’Acad.  R.  des  Sc.  a  1734. 


1 


“  thefe 


Letter  IV.  Article  33.  91 

tc  thefe  cavities  are  empty,  and  may  fometimes  be  comprefs’d,  when  thefe  ca- 
“  vities  are  full  :**  and  in  another  place,  “  that  no  arteries  are  more  dilatable 
“  than  thofe  which  are  contain’d  in  the  cranium,  but  that  they  are  confin’d 
“  and  ftreighten’d  thereby.  When,  therefore,  the  arteries  of  the  pia  mater 
<c  are  fill’d  with  a  greater  quantity  of  blood,  they  take  up  a  greater  quantity 
“  of  fpace,  and  that  l'pace  is  taken  away  from  the  other  parts  of  the  brain. 
“  Hence  fleep  is  brought  on  by  drinking  fpirituous  liquors.”  I  do  not  doubt, 
therefore,  but  that  fpace  which  they  acknowledge,  and  which  they  fay  can 
be  mutually  diminifh’d  and  reftor’d,  without  exceeding  the  bounds  of  na¬ 
ture,  is  different  in  different  bodies,  as  it  happens  in  other  things;  and  in 
thofe,  confequently,  where  the  fpace  is  rather  larger  than  in  others,  there, 
from  the  fame  quantity  of  water,  neither  the  fame  comprefiion  of  the  brain, 
nor  the  fame  injury  will  happen,  as  in  thofe  where  the  capacity  of  the  cranium 
is  more  confin’d. 

33.  But  perhaps  you  are  in  the  number  of  thofe,  who  would  never  fup- 
poie  water  to  be  the  caufe  of  an  apoplexy,  but  only  the  effedt  of  the  fame 
caufe  which  produces  the  apoplexy  ;  for  inftance,  of  blood  obftrudted  in  the 
veffels,  which  are  in  and  about  the  brain.  And  I  have  fo  far  afiented  to  the 
opinion  of  thefe  learned  men,  in  my  firft  letter  to  you  (/),  and  ftill  farther 
in  the  Adverlaria  (£),  yet  without  making  any  greater  conceffion  than  is  fuf- 
ficient  for  other  very  wife  men  ;  I  mean,  that  the  cafe  is  “  for  the  moft  part’* 
as  they  fuppofe  it.  I  have  done,  therefore,  in  this  letter,  perhaps,  which  I 
now  fend  you,  what  lefs  inconfiderate  men  are  us’d  to  do  in  courts  and 
procefles  at  law ;  who,  that  they  may  obtain  from  their  adverfaries  what  is 
juft  and  right,  afk  fometimes  for  a  little  more  than  is  juft.  For  it  is  fufficient 
to  my  purpofe,  that  water,  by  convulfing,  or  comprefling,  or  by  doing  both 
together,  may  fometimes  be  the  caufe  of  an  apoplexy.  As  you  are  quite  at 
liberty  to  ufe  your  own  judgment,  which  I  permitted  you  from  the  begin¬ 
ning^)»  if  you  do  not  think  proper,  in  all  thehiftories  that  I  have  produc’d,  to 
attribute  fo  much  effedt  to  the  water  as  I  have  feem’d  to  attribute,  do  not,  how¬ 
ever,  refufe  to  do  it  in  l'ome  ;  and  at  leaft  attend  to  the  reafons,  by  which  I  have 
endeavour’d  to  Ihew,  that  either  the  water  adtually  was,  or  certainly  might 
have  been,  the  caufe  of  the  diforder.  But  if  it  fhould  happen,  that  I  feem 
to  have  prov’d  nothing  at  all  by  thofe  reafons,  and  you  chule,  at  all  events, 
that  the  water  fhould  rather  be  the  effedt  than  the  caufe  of  the  diforder;  take 
care,  left  your  own  reafoning  compel  you,  though  unwillingly,  to  confefs, 
that  the  extravafation  of  blood  muff;  alfo  be  the  effedt,  and  not  the  caufe,  of 
apoplexies.  They  who  have  imagin’d  this,  do  not  feem  fufficiently  to  have 
attended  to  thofe  circumftances  ;  that  extravasations  of  blood  do  not  always 
depend  upon  the  rupture  of  diftended  veffels,  nor  rupture  upon  the  prefent 
remora  of  the  blood  ;  for  the  coats  of  the  veffels  may  be  pierc’d  through  by 
erofion  alfo,  as  I  have  faid  before  (m) ;  or  after  they  have  been  much  atte¬ 
nuated  by  foregoing  and  repeated  diftenfions,  or  impetus  of  the  blood,  may 
be  altogether  broken  through  by  any  fudden,  though  flight,  impulfe  that  is 
given  them.  But  do  the  apoplexies,  which  are  the  coniequents  of  extrava- 

(0  N.  5.  (.£)  Adverf.  indie.  Adimad.  84.  (/)  N.  j.  (m)  Epift.  3.  n.  3. 

N  2 


fated 


p  2  Book  II.  Of  Diforders  of  the  Head. 

fated  blood,  owe  their  origin  to  the  blood  obdrudted  in  the  veffels,  or  to  that 
which  compreffes  the  brain  on  the  outfide  of  the  veffels  ?  Certainly,  what 
a  compreffion  of  the  brain  alone  can  bring  about,  we  have  known  demon- 
ftrated  both  by  art,  and  by  chance,  as  well  in  men  as  in  brutes*,  where,  by 
accident,  a  pretty  large  part  of  the  fkull  has  been  taken  away  :  for  by  lay¬ 
ing  the  hand  upon  the  brain,  and  preffing  it,  the  fame  fymptoms  came  on 
which  attended  an  apoplexy  *,  and  by  taking  away  the  hand,  they,  gradually, 
vanifh’d.  And  that  we  may  not  give  up,  in  the  lead,  that  compreffion  which 
is  made  from  extravafated  blood  i  call  to  mind  what  the  furgeons  frequently 
fee,  or  rather  read  it  in  the  Sepulchretum  (»).  “  That  compreffion  alone, 

“  from  blood  ftagnating  in  the  fpace  betwixt  the  two  meninges,  is  fufficient 
“  to  bring  on  an  apoplexy,  they  abundantly  prove,  who  being  depriv’d  of 
“  ail  fenfe  and  motion,  are  deliver’d  from  inflant  death  by  the  trepan  alone.” 
From  which  examples  you  may  alfo  gather,  wherewith  to  reply  to  thofe 
who  acknowledge,  that  an  apoplexy  ariles  from  compreffion  indeed  ;  but 
from  that  compreffion  only  which  urges  the  brain,  not  in  one  particular  part, 
but  almoft  on  all  fides.  And  anatomical  examples  alfo  militate  againfl  this 
doftrine,  as  thofe  two  which  are  mention’d  by  the  celebrated  Van  Swieten  (o). 
For  it  is  evident,  that  blood  extravafated,  to  the  quantity  of  two  fpoonfuls, 
or  even  of  one  fpoonful  only,  can  by  no  means  comprefs  the  brain  on  all 
fides.  And  if  to  thofe  two,  you  add  that  which  I  have  given  you  in  the  lad 
letter  (p)  *,  you  will  underlland,  that  two  fpoonfuls  of  blood,  preffing  only 
a  parr,  and  that  an  external  part  of  the  brain,  may  bring  on  an  apoplexy. 
And  in  what  manner  a  little  blood  may  bring  on  a  great  compreffion,  you 
will  know  from  the  arguments  I  made  ufe  of  above  (q). 

34.  If,  therefore,  extravafated  blood,  by  compreffing  the  brain,  caufes  an 
apoplexy  j  in  like  manner  extravafated  water,  in  a  given  proportion,  may  do 
the  fame  ;  or  at  lead,  when  join’d  to  fome  other  caufe,  which  alone  could 
not  effedl  it.  So  that  if  by  chance,  to  blood,  not  yet  fo  obftructed  in  the 
velfels,  as  to  be  able  to  bring  on  an  apoplexy,  an  extravafation  of  water,  in 
the  mean  time,  be  added,  this  effufion  will  be,  if  you  will  have  it  fo,  the 
effedl  of  that  remora  *,  but  the  compreffion,  which  will  be  added,  from  the 
extravafated  fluid,  will  be  the  ultimate  caufe  of  the  apoplexy. 

But  although  I  plead  liberally  with  you  in  this  difpute;  yet,  that  you  may 
not  imagine  I  am  perhaps  more  enclin’d  to  the  other  fide  of  the  quedion, 
the  merits  of  which  I  have  not  yet  examin’d,  and  have  therefore,  right  or 
wrong,  attributed  fuch  furprizing  effedts  to  water,  I  will  lad  of  all  give  you 
a  hidory  of  a  man,  in  whom  much  water  was  found  within  the  cranium,  al¬ 
though  he  had  no  apoplexy  *,  and  will  omit  partly,  and  partly  defer  to  an¬ 
other  occafion,  other  hidories  of  apopledlic  perfons,  in  whole  fkulls  this  fluid 
was  found.  And  when  I  have  finifh’d  this  hidory,  and  added  a  few  things 
concerning  one  manner  in  particular,  among  the  red,  by  which  water  is 
colledled  in  the  brain,.  I  will  give  the  finiffiing  droke  to  this  prolix  letter. 

35.  An  old  man,  near  fourfcore  years  of  age,  who  had  been  formerly 
troubled  with  ulcers  in  his  legs,  as  the  fears  evidently  fhew’d,  and  had  his. 


fkin,. 


(»)  I.  1.  S.  2.  obf.  9.  in  Schol. 

(0)  Com.  in  Boerh.  Aph.  §  ro-io.  t.  Sc  4. 


(P)  »•  14» 
(?)  n*  3*' 


Letter  IV.  Article  3  6.  93 

fkfh,  at  that  time,  almoft  cover’d  with  filthy  puftules,  was  taken  in  about 
the  evening  to  the  hofpital  of  St.  Mary  de  Morte  at  Bologna.  His  pulfe 
was  not  quick,  but  weak  and  unequal ;  nor  was  it  fo  ienfible  in  one  arm  as 
in  the  other.  His  eyes  g'liften’d,  and  were  fix’d,  but  feem’d  to  look  at  dif¬ 
ferent  objedts.  Being  afk’d  if  his  head  was  painful,  or  heavy,  or  drowfy,  he 
anfwer’d  no.  But  he  faid  that  he  had  vomited ;  and  this  he  feem’d  to  fay 
with  a  faultering  tongue,  and  a  hefitation  of  fpeech.  Yet  fenfe,  feeling,  and 
motion  remain’d.  In  the  night  his  diforder  encreas’d  j  and  the  next  morning 
he  died. 

The  abdomen  being  open’d,  every  thing  appear’d  found,  except  that  the 
vifcera  were  much  moifter  than  ufual,  the  liver  whitifh,  and  lbmewhat  hard, 
and  its  bladder  fill’d  with-a  blackifh  bile  :  and  finally  the  colon,  if  you  fup- 
pofe  that  to  relate  to  the  prefent  cafe,  was  contracted  to  the  thicknels  of  a 
finger,  below  the  ftomach.  It  was  then  eleven  hours  fince  his  death,  and 
the  body  had  lain  in  the  open  air,  which  was  cold  ;  for  it  was  the  middle  of 
December,  A  1705,  yet  the  inteftines  were  ftill  warm.  The  lungs  were  on 
all  fides  connected  with  the  pleura,  and  while  I  leparated  them  with  my 
hand,  in  the  left  fide,  fome  water  iflued  forth  ;  but  whence  it  proceeded,  or 
where  it  ftagnated,  I  could  not  certainly  tell.  In  the  heart,  as  in  the  other 
parts  alfo,  the  blood  was  fluid.  When  the  head  was  cut  off,  water  diftill’d 
from  the  great  foramen  of  the  cranium  •,  and  indeed  a  fluid  was  every  where 
within  the  fkull,  but  efpecially  under  the  whole  pia  mater,  through  which  it 
(hone  like  frothy  faliva,  having  bubbles  mix’d  with  it  here  and  there.  The 
plexus  choroides  had  fome  veficles  upon  them  diftended  with  water :  yet  they 
themfelves  were  not  become  white,  from  the  water  which  was  found  in  the 
ventricles.  The  brain  was  very  lax ;  and  the  pituitary  gland  was  almoft  an¬ 
nihilated. 

36.  Whether  there  was  a  larger  fpace  in  this  fkull,  in  proportion  to  the 
bulk  of  the  brain  •,  or  whether  the  veflels  of  the  brain  (which  I  could  neither 
ob ferve  to  be  turgid,  nor  had  the  puliation  of  the  arteries  indicated  it)  were 
not  at  all  over-loaded,  or  the  water  had  been  collected  flowly,  and  by  de¬ 
grees  ;  be  thele  things  as  they  will,  there  was,  you  fee,  no  apoplexy  in  this 
man,  and  yet  much  water  in  the  cranium.  But  I  could  more  ealily  have 
determin’d,  in  'what  manner  it  was  collected,  if,  inftead  of  a  pretty  large 
quantity  of  water  in  the  ventricles  particularly,  there  had  been  a  (till  much 
greater  quantity,  and  the  plexufles  had  been  difcolour’d.  For  when  I  faw 
the  pituitary  gland  fo  greatly  extenuated,  I  could  not  help  fufpeCting,  that 
it  had  not  fully  perform’d  its  functions  ;  juft  as  we  fee  the  mammary  glands, 
the  thymus,  and  the  teftes,  fo  much  the  more  contracted,  as  they  have  the 
longer  ceas’d  from  their  offices.  But  if  the  office  of  this  gland  is  to  receive 
the  moifture  that  diftils  from  the  ventricles,  by  the  infundibulum,  why  was 
there  not  a  greater  quantity  of  water  in  the  ventricles,  and  marks  of  longer 
maceration,  if  I  may  fofpeak,  in  the  plexufles  ?  Nor  were  thefe  marks,  nor  yet 
the  very  large  quantity  of  water,  found  in  the  hufbandman,  nor  in  the  oftler. 
Who  are  fpoken  of  above  (r)  •,  though,  in  the  firft,  the  gland  was  contracted,, 
as  much  as  in  this  old  man,  and  in  the  oftler  was  almoft  deftroy’d.  Flow  is 


(r)  N.  2.6  Sc  ipt 


It 


94  Book  I.  Of  Difeafes  of  the  Head. 

it  then?  Is  the  ufe  of  this  gland,  which  is  fo  commonly  taught  us,  to  be. 
call’d  into  queftion  ?  or  rather,  becaufe  this  office  is  not  obfcurely  argu’d, 
from  the  very  ftrudture  and  fituation  of  the  parts,  muft  we  explain  it  in  a 
particular  manner,  fo  as  to  fuppofe  that  the  difeafes  we  obferv’d  in  this  gland, 
might  obftruct  the  defluxion  of  moifture  from  the  ventricles,  but  not  fo 
much  as  it  feem’d  to  us  that  they  naturally  ffiould  ?  As  for  inftance,  if  there 
are  paflfages  beflde  the  infundibulum,  whether  fuch  as  fome  have  imagin’d, 
or  of  any  other  kind  whatever,  lefs  manifeft  indeed,  but  in  greater  number, 
through  which  part  of  the  moifture  may  be  difpatch’d  from  the  ventricles. 
For  by  thefe  means,  unlefs  thefe  paffages  be  at  the  fame  time  obftrudted, 
the  ventricles  will  not  be  fill’d  ;  and  if  they  are,  a  great  dropfy  of  the  brain 
will  be  the  confequence.  Therefore,  as  I  fuppofe  they  were  ftopp’d  up,  in 
that  hydrocephalus,  where  Hunauld  (s)  found  no  fenfible  diforder,  either  in 
the  infundibulum,  or  pituitary  gland  ;  fo  I  ffiould  believe  they  were  ob- 
lfrudted,  in  like  manner,  in  another  hydrocephalus,  in  which  “  no  traces 
“  of  the  pituitary  gland  remain’d,”  as  you  read  in  the  Sepulchretum  (/) ; 
and  {till  more  in  another,  which  you  read  of  in  the  fame  place  (u),  in  which 
the  gland  was  “  flaccid,  and  very  large,”  nor  much  lefs  in  a  third,  and  a 
fourth  in  like  manner,  there  describ’d  (#),  or  mention’d :  in  one  of  which, 
there  was  contain’d  in  the  gland  “  an  undtuous  humour,  adhering  to  the 
“  probe  like  bird-lime,  yet  tranfparent and  in  the  other,  “  where  the  in- 
“  fudibulum  was  inferted  into  that  gland,  it  was  entirely  fill’d  with  a  vifcid 
“  kind  of  jelly,  to  the  bignefs  of  a  fmall  bean.”  In  all  thefe,  therefore,  I 
believe,  that  the  other  paffages  were  obftrudted  ;  but  not  in  the  three  apo- 
ple&ic  perfons  whom  I  have  fpoken  of  above  *,  nor  yet  in  him  whofe  cafe  is 
defcrib’d  in  the  Sepulchretum  (jy),  in  whom  “  the  pituitary  gland,  that  was 
“  twice  as  big  as  ufual,  was  found  to  have  a  finus  fill’d  with  mucus,  which 
“  was  concreted  into  a  yellowifh  and  tranfparent  jelly.”  For  in  thefe  I  af- 
cribe  no  more  to  the  gland  than  “  its  contributing,  in  fome  meafure,  to  the 
“  accumulation  of  water,”  which  was  alfo  the  opinion  of  Wepfer  (z),  the 
author; of  this  laft  obfervation,  in  that  part  of  the  Scholia,  “which,  as  well  as 
his  name,  is  omitted  in  the  Sepulchretum.  And  if  you  join  this  obfervation, 
as  well  as  thofe  two  of  the  hydrocephalus,  that  I  laft  pointed  out,  with  the 
hiftory  of  theoftler(^),  as  far  as  it  relates  to  the  difeafe  of  the  pituitary  gland, 
you  will  readily  underftand,  that  among  other  of  its  diforders,  a  congeftion 
of  vifcid  mucus  therein  does  not  very  rarely  happen  *,  and  to  this  caufe,  per¬ 
haps,  we  muft  refer  that  tumour  of  the  fteatomatous  kind,  found  in  this 
gland  in  the  year  1707,  by  the  fame  Manfredi  whom  1  commended  above  (b). 
And  that  the  other  paffages  may  alfo  be  fometimes  ftopp’d  up,  you  will 
conceive,  if,  when  you  read  in  the  Sepulchretum  (r),  the  defcription  given 
by  Pechlinus,  of  a  difledtion  of  a  hydrocephalus,  you  obferve,  that  under  a 
great  quantity  of  limpid  ferum,  “  there  was  in  the  bottom  of  the  ventricles 


(j)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1740. 

(/)  1.  1.  S.  16.  obf.  7. 

(z i)  Obf.  8.  vide  tamen  de  utraque  hac  ob- 
fervatione  Epilf.  12.  n  4. 

(*)  Cit.  Sedt.  16.  in  Addit,  obf.  12.  &  in 
Schol.  ad  eandem  in  fine. 


(j)  1.  1.  S.  2.  obf.  41. 

(z)  Obf.  ex  cadav.  Apopl.  in  Audi.  Hill.  16. 
(<a)  Supra  n.  19. 

[b)  n.  25. 

(r)  In  cit.  Addit,  ad  Sedt.  16.  obf.  5. 


cc 


a  ropy 


Letter  V.  Article  i .  95 

sc  a  ropy  and  pituitous  lymph,  which  had  applied  itfelf,  like  glue,  to  the 
“  iides  of  the  medullary  fubftance  of  the  brain,  and  the  edges  of  the  ven- 
“  tricies.” 

37.  An  occlufion  of  the  infundibulum,  however,  hinders  the  defluxion  of 
moiflure,  from  all  the  ventricles  of  the  brain,  into  the  pituitary  gland,  as 
that  did  which  Brunnerus  gives  the  relation  of  (d)  ;  and  in  like  manner,  thole 
which  Littre(f),  and  others,  amonglt  whom  is  the  celebrated  Haller  (f), 
have  given  inftances  of  from  their  own  knowledge.  But  how  far  a  coalition 
of  the  borders  of  the  fornix  with  the  bafls  of  the  lateral  ventricles,  or  a 
very  clofe  compreflion  of  thefe  parts  to  one  another,  can  hinder  a  defluxion 
from  thofe  cavities,  remains  yet  to  be  enquir’d.  But  at  length  I  will  conclude 
this  letter,  as  I  promis’d  you.  Farewel. 


LETTER  the  FIFTH. 

Which  treats  of  the  Apoplexy,  as  ariling  neither  from  a 
Sanguineous  nor  a  Serous  Caufe. 

i.fnr^HE  apoplexy,  as  Boerhaave  (a),  according  to  cuftom,  excellently 
fays,  tc  is  properly  divided  into  the  fanguineous  and  pituitous  ; 
“  but  the  diviflon  is  by  no  means  perfedt,  fince  there  are  alfo  apoplexies 
“  from  ferum,  from  atrabilis,  from  polypi,  and  from  other  caufes.”  And  I 
am  alfo  of  the  fame  opinion  with  him,  fome  little  points  excepted,  who  have 
in  like  manner,  taken  my  notions  of  this  diforder  from  the  anatomical  in- 
«  fpedtion  of  bodies  that  died  of  this  dileafe.”  Therefore,  when  I  divided 
apoplexies  into  fanguineous  and  ferous  (£),  I  did  not  divide  the  difeafe  it¬ 
felf,  but  rather  the  more  frequent  difledtions  of  apopledlic  bodies,  which  had 
happen’d  to  others,  but  elpecially  to  Vallalva  and  me  :  at  the  fame  time  in- 
genuoufly  confefling,  that  other  caufes  of  apoplexies,  beflde  blood  and  fe¬ 
rum,  were  frequently  found,  fome  of  which  I  will  now  propofe  in  this  letter, 
as  I  at  that  time  promis’d  you.  And  I  us’d  the  diftindlion  of  ferous,  in  op¬ 
position  to  fanguineous,  rather  than  pituitous,  becaufe  I  confider’d  it  as  the 
more  frequent.  For  though  I  do  not  doubt  the  veracity  of  Columbus  (c}T 
when  he  fays,  “  that  he  had  more  than  once  difledted  thofe  who  died  ot  a 
“  violent  apoplexy,  and  that,  in  their  brain,  he  had  found  a  great  quantity 
«  of  water;  but  tranfparent  and  glutinous;”  yet  I  believe  he  faw  what  was 
lefs  frequently  to  be  met  with  ;  unlefs  you,  perhaps,  can  fuppofe,  that  he 
attended  rather  to  the  appearance,  than  the  real  nature,  of  that  fluid,  under 

(d)  Ibid.  obf.  12.  (a)  Aphor.  de  cognofc.  morb.  §  1012. 

(<?)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1707.  (6)  EpiiL  2.  n.  6. 

(f)  Icon.  Anatom.  Fafcicul.  7.  in  Explic.  (c)  De  Re  Anat,  1.  15. 

Tab.  1.  ad  P.  not.  C. 

the 


9  6  Book  I.  Of  'Difeafes  of  the  Head. 

the  pia  mater  (J)  ;  which,  at  firft  fight,  appears  like  a  jelly.  But  if  he  did 
really  find  a  fluid  of  a  pituitous  nature,  which  was  at  that  time  commonly 
believ’d  to  be  the  caufe  ot  apoplexies,  he  did  right  to  infert  his  obfervations 
of  that  kind,  in  a  book  which  he  entitled.  Be  iis  qu a  raro  in  anatome  rcpe- 
riuntur.  Nor  was  Varolius  (e)  lefs  in  the  right,  (whofe  pafiage,  though  alfo 
quoted  before  (/),  it  is  perhaps  more  juft  to  interpret  after  this  manner)  if 
with  a  view  to  the  fame  pituita,  he  denied,  “  that  a  greater  quantity  of  recre- 
4<  mentitious  matter  was  found  in  the  ventricles  of  the  brain  of  apoplectic 
“  perfons,  than  is  generally  found  in  others.”  But  let  me  go  on  to  fulfil 
my  promife,  beginning  with  two  hiftories  from  Valfalva.  >- 

2.  A  man,  of  three-and-thu  ty  years  of  age,  of  a  fanguineous  temperament, 
(lender,  and  afflicted  with  a  rupture,  vvas  much  given  to  the  ule  of  wine  and 
tobacco.  This  man  began  to  have  a  pain  in  the  left  part  of  his  head,  efpe- 
cially  at  the  occiput  *,  which  was  follow’d  by  a  pain  and  weaknefs  of  the 
mufcles  of  the  neck,  on  the  fame  fide.  At  firft  there  was  a  violent  fever; 
but  it  afterwards  feem’d  to  remit ;  and  his  pulfe  not  only  became  flow,  but 
weak  alfo,  and  had  little  powrer  of  refiftance  :  at  the  fame  time  his  ftrength 
began  to  decay  •,  fo  that  every  motion  of  the  body  was  difficult.  Moreover, 
after  an  interrupted  delirium,  an  aphonia  came  on,  nor  could  the  patient 
move  himfelf  any  more  ;  but  dying  thus  in  a  very  flow  manner,  at  length, 
after  the  fourteenth  day,  was  no  more. 

While  the  brain  was  taken  out  of  the  cranium,  a  little  purulent  matter 
was  obferv’d  on  its  bafis.  This  being  wip’d  way,  while  the  brain  was  handled, 
frefh  matter  was  feen  in  the  fame  place :  that  is  to  fay,  it  had  come  out  from 
the  ventricles,  through  the  infundibulum  ;  and  both  the  ventricles,  but  efpe- 
cially  the  right,  overflow’d  with  it.  For  in  the  corpus  ftriatum  of  this  ven¬ 
tricle  was  a  foramen,  which  communicated  with  a  finuous  ulcer,  that  occu¬ 
pied  a  third  part  of  the  fubftance  which  compos’d  the  bafis  of  the  brain  on 
the  right  fide.  The  brain  was' not  vitiated  on  the  left  fide.  Having  infpedted 
thefe  things,  we  difte&ed  the  ferotum  on  account  of  the  hernia,  and  found 
the  inteftines  fo  clofely  adhering  to  the  tefticle,  and  its  involving  membranes, 
that  they  could  by  no  means  be  replac’d 

3.  If  extravafated  blood  were  converted  into  pus,  you  would  perhaps 
think,  from  comparing  this  with  other  difiedtions  defcrib’d  in  the  third  let¬ 
ter  (£),  that  this  cafe  alfo  was  an  apoplexy  anfing  from  extravafated  blood, 
which  had  firft  hollow’d  out  for  itlelf  that  cavern  in  the  brain  ;  and  prefently 
being  turn’d  into  pus,  had  broken  through  the  corpus  ftriatum,  and  rufh’d 
into  the  ventricle  which  lay  over  it,  and  fo  into  the  other.  But  as  other 
hiftories  already  produc’d,  and  to  be  produc’d  on  future  occafions  (/?),  will 
fufficiently  prove,  that  blood  really  continues  in  its  original  form,  and  does 
not  become  pus  ;  it  is  better  to  conjedture,  that  an  abfeefs  being  by  degrees 
form’d  in  the  brain,  a  violent  fever  was  excited,  at  the  fame  time  when  its 
matter  was  converted  into  pus ;  which  being  done,  the  fever,  according  to 
cuftom,  remitted  (*');  but  that  prefently  this  pus,  having  made  its  way  through 

(d)  Vid.  Epift.  6.  n.  12,  13.  *  ( b )  Epift.  Anat.  13.  n.  23.  &  Epift.  Anat. 

(<0  De  nerv.  optic.  Epift.  2.  Med.  2.  n.  13. 

(f)  Epift.  2.  n  7.  &  epift.  4.  n.  I.  (i)  Hippoc.  f.  2.  aph.  47. 

( g )  Vid.  praefertim  n.  4. 


the 


Letter  V.  Articles  4,  97 

the  corpus  ftriatum,  and  overflow’d  into  the  ventricles,  that  diforder  of  the 
apoplectic  kind  was  brought  on.  There  is  an  obfervation  of  Laubius  (£) 
extant,  which  1  fhall  probably  take  notice  of  in  another  place,  that  might  be 
compar’d  with  this,  if  the  feat  of  the  abfeefs  was  more  clearly  pointed  out ; 
although  an  apoplexy  from  pus  fucceeded  a  violent  fever  after  a  much  longer 
time.  For  it  appears,  that  the  pus  flow’d  out  from  the  left  hemifphere  of 
the  brain,  above  the  os  petrofum  ;  but  I  do  not  fo  well  underfeand,  where 
“  towards  the  thalami,”  (both  the  thalami,  doubtlefs,  as  thefe  words  always 
fignify,  not  to  fpeak  of  the  preceding  affedtion  of  both  eyes)  I  fay,  where  the 
pus  was  “  before  fhut  up  towards  the  thalami  nervorum  opticorum.”  Yet 
the  fource  of  that  pus,  which  was  feen  by  Valfalva  in  another  diffedtion,  was 
ffill  more  obfeure  ;  and  this  alfo  happen’d  in  a  patient,  who  died,  if  not  of 
a  true  apoplexy,  at  leaft  of  a  diforder  of  that  kind.  The  hiftory  is  as  follows  : 

4.  A  woman,  more  than  forty  years  of  age,  after  having  her  monthly 
evacuations  greatly  diminifh’d,  was  attack’d  with  a  cancerous  tumour  in  her 
left  leg  •,  which  being  afterwards  ulcerated,  and  other  ulcers  alfo  beginning 
in  the  fame  leg,  confiderable  pain,  and  almoft  continual  fever,  came  on.  She 
had  now  borne  it  a  year  and  more,  when  quite  tir’d  of  her  continual  pains 
and  uneafinefs,  fhe  begg’d  of  Vallalva  that  he  would  amputate  the  leg,  which 
was  now  incurable  by  any  method  whatever.  Valfalva  confented,  and  per¬ 
form’d  the  operation  with  luccefs  ;  but  when  it  came  to  the  third  day,  a  livid 
colour  appear’d  in  the  flump,  which  continuing  two  days,  a  plafter  of  emol¬ 
lients  and  volatiles  was  applied,  and  the  lively  colour  was  reftor’d  to  the  part. 
In  the  mean  while,  the  fever  became  every  day  more  violent,  and  degene¬ 
rated  into  an  acute  one.  The  right  parotid  gland  was  fo  much  fwol’n  and 
enlarg’d,  that  for  more  than  twenty-four  hours  fhe  could  not  fwallow  even 
liquid  aliment.  But  profufe  fweats  coming  on,  the  fever  remitted,  the  fuel¬ 
ling  of  the  parotid  was  difeufs’d,  and  every  thing  feem’d  to  proceed  very  well. 
Moreover,  when  about  the  thirtieth  day,  by  reafon  of  foine  error  in  diet, 
the  acute  fever  had  return’d,  and  lafted  fome  days,  it  was  again  carried  off 
by  fweats.  Notwithftanding  thefe  circumftances,  the  cure  of  the  wound  was 
not  prevented  going  on,  till  at  length  the  cicatrix  being  almoft  completed,  a 
perfect  cure  feem’d  at  hand,  But  about  the  third  month  after  the  ampu¬ 
tation,  when  the  patient  was  taken  out  of  bed,  fhe  was  feiz’d  with  a  diforder 
of  the  apopledtic  kind.  For  a  diminution  of  feeling  and  motion,  in  the 
whole  right,  fide  of  the  body,  was  join’d  with  delirium  and  convulfions: 
which  diforders,  though  they  teem’d  to  remit  for  fome  days,  yet  return’d 
more  violently,  and  carried  off  the  patient.  Thefkull  being  open’d,  a  large 
quantity  of  pus  was  found  ftagnating  in  the  left  ventricle  of  the  brain  •,  but 
no  injury  was  found  in  the  brain  itfelf :  yet  it  might  be  fufpedted,  that  the 
matter,  which  had  been  before  carried  into  the  leg,  was  now  carried  into  the 
brain. 

5.  This  fufpicion,  however,  has  a  very  difficult  and  obfeure  explication  : 
for  the  matter,  which  had  been  before  carried  into  the  leg,  was  made  pus  in 
the  ulcers  of  the  leg,  but  in  the  brain  no  ulcer  was  any  where  found.  Or  if 
we  fuppofe  that  part  of  the  purulent  matter  was  carried  back  into  the  blood, 

(£)  Eph.  N.  C.  cent.  7.  obf.  39. 

Vol.  I.  O  why 


9  8  Book  I.  Of  Difeafes  of  the  Head. 

why  did  not  this  flow  rather  to  the  wound,  which  was  not  yet  perfeftly  heal’d  ? 

I  fhould  rather  chufe  to  fufpeft,  that  at  the  time  of  the  acute  fevers,  matter 
was  colle&ed  in  forne  internal  part  of  the  body,  and  an  abfeefs  was  form’d  ; 
if  Valfalva  himfelf,  who  was  fo  diligent  in  his  attendance  on  the  woman,  and 
fo  ftudious  to  enquire  into  all  her  complaints,  and  their  caufes,  had  not  more 
than  fufficiently  prov’d,  that  no  fuch  thing  had  ever  happen’d,  by  thinking 
that  it  was  not  neceflary  to  difleft  any  other  part  of  the  body  but  the  head. 
What  then  ?  Shall  we  believe  that  it  was  rather  a  pus  like  humour,  than  a 
true  pus  ?  The  great  fkill  of  Valfalva  in  chirurgical  matters  does  not  fuffer 
us  to  believe  this,  as  he  exprefsly  fays,  that  he  found  pus  in  the  ventricle. 
It  is  better  therefore  to  wait  till  light  is  thrown  on  it  by  fome  other  hiflory, 
than  to  give  out  any  rafh  or  hafty  decifion.  In  the  mean  while,  I  fball  go 
on  to  deferibe  to  you  fome  of  my  own  hiftories  *,  the  two  firfb  of  which  leem, 
in  fome  meafure,  to  anfwer  to  thofe  two  of  Valfalva  juft  now  related. 

6.  A  woman  of  Padua,  by  name  Jacoba,  the  wife  of  Angelo  Zanardi,  (for 
by  reafon  of  finding  thirteen  ribs  on  each  fide  of  her,  I  enquir’d  out  her 
name,  and  noted  it  down,  which  I  am  not  us’d  to  do  among  the  common 
people)  being  in  the  fifty  ninth  year  of  her  age,  was  feiz’d  with  an  apo¬ 
plexy.  To  this  a  violent  fever  lucceeded.  And  on  thefe  accounts  being 
brought  into  the  hofpital,  fhe  continued  to  live  fome  days.  Although  fhe 
could  not  fpeak,  yet  fhe  feem’d  to  underftand  on  the  firft  day  ;  for  fhe  gave 
of  her  own  accord  the  found  arm  to  the  phyficians,  to  have  hef  pulfe  felt. 
The  found  arm  was  the  left-,  for  the  right  limbs  had  neither  feeling  nor  mo¬ 
tion,  and  moreover,  feem’d  to  be  in  fome  meafure  contracted  from  convulfion. 
So  the  eye-lids  of  the  right  eye  were  paralytic,  ard  almoft  clos’d.  Her  face 
was  red.  She  had  no  difficulty  in  fwallowing  fluids. 

When  I  heard  that  the  woman  was  dead,  and  heard  this  relation  of  her,  I  fo 
much  the  more  willingly  undertook  the  diflection  of  the  body,  for  the  fake 
of  the  ftudents ;  becauie,  if  the  injury  in  the  brain  was  organical,  they  hop’d 
they  fhould  certainly  fee  it  on  the  left  fide,  according  to  the  obfervations  of 
Valfalva,  confirm’d  in  an  epiftle  (/),  at  that  time  lately  publifh’d  by  me.  They 
attended  this  difle&ion,  therefore,  in  great  crowds,  together  with  many  learned 
men,  and  others  •,  for  the  difiedion  was  accurately  perform’d,  and  lafted 
many  days.  However,  1  fhall  fpeak  of  nothing  here  but  what  was  found  to- 
be  preternatural,  or  unufual. 

Firft:  of  all,  I  obferv’d  the  unequal  nutrition  of  the  body,  which  was  in 
other  relpeds  of  a  proper  ftature.  For  the  trunk  and  thighs  were  fat*,  but 
the  feet  and  legs,  and  particularly  the  upper  limbs,  were  (lender  and  lean. 
It  was  thirteen  hours  after  death,  when  the  abdomen  was  open’d ;  and  though 
the  weather  was  cold,  for  it  was  in  the  laft  days  of  the  year  1740,  yet  the 
fmoaking  vifeera  retain’d  a  fmart  warmth  even  then,,  and  an  hour  after.  The 
omentum  v/as  drawn  up  to  the  ftomach,.  which  appear’d  fmall*,  whereas  the 
fmall  inteftines,  and  part  of  the  large  ones,  were  fomewhat  turgid  with  air.. 
The  inteftines  had  alfo  been  carried  up  by  the  bladder,  which  being  diftended 
with  urine,  and  having  no  covering  but  its  own  fat,  rais’d  itfelf  fix  inches 
above  the  os  pubis.  On  comprefiing  the  bladder  with  my  hand,  a  high- 


(/}  Egift,  Anat.  13, 


colour’d 

4 


Letter  V.  Article  6. 

colour’d  lixivious  urine,  but  not  foetid,  came  forth  with  difficulty,  and  hy¬ 
drops  ;  for  the  fanguiferous  veflels,  at  the  upper  orifice  of  the  urethra,  and 
fame  fpace  above  it,  were  very  much  diftended  with  blood,  and  blackifh  -y 
and  in  like  manner,  thofe  which  ran  through  the  internal  furface  of  the 
urethra,  though  not  in  quite  ib  great  a  degree  :  and  from  thence  you  will 
naturally  imagine,  that  thefe  parts  had  not  been  merely  inflam’d,  but  evert 
were  on  the  point  of  mortification.  Moreover,  the  internal  furface  of  the 
bladder  was  diftinguiffi’d  here  and  there  with  bloody  points.  In  the  cavity 
of  the  uterus  we  obferv’d  fomewhat  of  a  yellowiffi  humour.  Nor  was  there 
any  thing  more  to  obferve  of  the  vifcera,  in  the  abdomen,  except  that  the 
gall-bladder  was  very  turgid  with  a  brown  bile,  as  it  feem’d  to  the  eye,  but 
which  flain’d  with  a  high  yellow  ;  and  with  this  inteftine  the  colon,  where 
it  lay  neareft  to  the  gall-bladder,  was  colour’d.  In  that  bile  were  fome  few* 
concretions,  all  fmall  and  foft,  except  one,  which  was  compared  into  a  firm 
hard  calculus,  and  equal  in  diameter  to  the  point  of  your  little  finger.  The 
figure  of  it  was  round,  and  its  furface  everywhere  granulated ;  fo  that  ex¬ 
cept  its  colour,  which  was  cineritious,  and  its  having  fomewhat  tranfparent 
in  it,  it  might  very  eafily  have  been  taken  for  one  of  that  fort  of  fweet-meats 
commonly  call’d  fugar-plumbs,  which  are  made  of  coriander-leeds,  cover’d 
over  with  fugar,  fo  as  to  have  a  rough  furface. 

In  the  thorax,  the  right  lobe  of  the  lungs  was  in  great  meafure  connedted 
to  the  pleura  ;  and  the  upper  part  of  it,  pofteriorly,  fo  corrupted,  perhaps 
from  an  old  diforder,  that  it  difcharg’d  a  very  ill-tmelling  humour.  This 
being  wip’d  away,  and  the  vifcera  taken  out,  both  from  thence  and  from  the 
abdomen,  I  obferv’d  and  demonftrated  two  things;  the  one  in  the  diaphragm, 
and  the  other  in  the  ribs  and  vertebrae :  which,  though  they  have  no  re¬ 
ference  to  the  prefent  diforder,  are  neverthelefs  worthy  to  be  related,  on  ac¬ 
count  of  their  extraordinary  nature.  In  the  diaphragm  were  two  foramina, 
very  near  to  each  other,  but  quite  diftindt ;  which  gave  paflage  to  veins  from 
the  belly  to  the  cheft.  For  befides  the  larger  foramen,  which  is  always  to  be 
found,  and  ferves  to  tranfmit  the  trunk  of  the  vena  cava  itfelf,  another  alfo 
apprar’d  near  the  anterior  border  of  the  firft,  carrying  through  it  one  of  the 
hepatic  veins,  to  be  inferted  a  little  higher  than  ufual,  that  is,  above  the  dia¬ 
phragm,  into  the  trunk  of  vena  cava  :  and  the  ribs  were  fix  and-twenty  in 
number.  For  on  each  fide,  below  the  twelfth,  was  another  little  one,  join’d 
by  a  true  articulation  with  the  body'  of  the  firft  lumbar  vertebra  ;  but  they 
were  fo  fhort,  that  the  length  of  either  did  not  exceed  two  inches,  whereas 
the  other  twelve  on  each  fide  feem’d  to  be  longer  than  ufual.  The  number 
of  the  lumbar  vertebras  was  fix ;  or,  if  you  chufe  to  reckon  that,  to  which 
the  little  ribs  were  affix’d,  among  the  vertebrm  of  the  thorax,  (though  in 
other  refpedts  it  was  moft  like  the  lumbar)  then  there  were  thirteen  of  thofe,- 
and  five  lumbar.  But  the  body  of  the  fifth,  having  its  ufual  magnitude  and 
form,  and  the  fame  proceffes  join’d  to  it,  unlefs  that  the  pofterior  was  a  little 
lefs  than  ufual,  was  fo  fituated,  that  it  inclin’d  forwards,  and  to  the  right. 
It  was  divided  from  the  os  facrum  by  a  very  thin  cartilage;  and  even  the 
left  border,  being  connate  therewith,  was  join’d  to  it  in  another  manner 
likewife.  For  a  kind  of  bony  wing  was  lent  out  on  each  fide,  which  leaving 
a.  foramen  for  the  paflage  of  the  nerves,  and  filling  up  almoft  the  whole  in- 

O  2  terval, 


ICO 


Book  I.  Of  Difeafes  of  the  Head. 

terval,  was  plac’d  betwixt  the  tranfverfe  procefles  of  the  vertebrae,  and  the 
upper  fides  of  the  os  facrum,  and  was  clofely  connected  with  them  by  the 
joint  call’d  ginglymus.  And  the  os  facrum  was  a  little  fhorter  than  ufual, 
lefs  hollow’d  in  its  anterior  furface,  and,  as  it  went  down,  inclin’d  a  little  to 
the  right  fide.  But  if  we  except  this  lower  vertebra  already  fpoken  of, 
there  was  nothing  at  all  in  the  whole  chain  of  them  that  was  preternatural. 

But  let  us  now  go  on  to  the  head,  for  the  fake  of  which,  principally,  this 
diflebtion  was  perform’d.  While  the  fkull  was  faw’d  through,  a  quantity 
of  ferum  came  forth  ;  and  the  upper  part  of  it  being  taken  off,  and  the 
brain  being  differed  in  its  natural  lituation,  we  firft  obferv’d,  that  the  dura 
mater  was  thicken’d.  And  the  veffels  that  ran  through  the  pia  mater,  were  all 
diftended  with  blood,  as  if  they  had  been  fill’d  by  injection.  This  blood  was 
fuch  as  that  of  the  whole  body  was,  black,  and  not  very  fluid.  And  under 
the  fame  membrane,  in  the  convolutions  of  the  brain,  was  feen  a  tranfparent 
water,  of  the  fame  kind  with  that  which  was  found  in  the  lateral  ventricles 
only,  afterwards;  yet  the  choroid  plexufles  were  not  at  all  difcolour’d,  al¬ 
though  they  had  veficles  upon  them,  turgid  with  water,  and  one  of  thefe 
vehicles  was  equal  even  to  the  bignefs  of  a  grape.  This  was  in  the  left  plexus, 
which  being  taken  off,  the  thalamus  nervi  optici  appear’d  not  of  the  fame 
colour  as  the  right  thalamus,  but  brown.  As  I  cut  the  brain  into  fmall 
pieces,  I  obferv’d,  that  every  other  part  of  it  was  natural  and  found ;  but 
that  the  medullary  fubftance,  which  was  on  the  external  fide  of  the  left  tha¬ 
lamus,  fpoken  of  above,  was  very  foft,  and  liquefied,  and  was  found  to  be 
mixt  with  a  certain  bloody  fluid,  of  a  colour  almoft  effete  ;  fo  that  nothing 
but  a  dilagreeable  fmell  was  wanting  to  make  us  pronounce  it  abfolutely 
rotten.  1  he  fpace  of  the  brain,  which  this  diforder  occupied,  was  larger 
than  that  which  the  larged  walnut  would  have  taken  up;  and  that  colour  of 
the  bloody  fluid  was  mod  manifed  in  the  middle  thereof.  It  was  more  na¬ 
tural  to  take  notice  of  this  difference,  becaufe  the  cerebrum,  in  general,  as 
I  laid,  was  of  its  natural  colour;  and  not  only  more  hard  than  the  cerebel- 
hi  m,  but  even  endow’d  with  a  wonderful  hardnefs  every  where,  efpecially 
in  the  whole  right  hemifphere  ;  and  had  only  in  that  place  I  have  mention’d 
a  kind  of  bloody  colour,  and  a  loofe  ill-compacded  fubdance. 

7.  I  believe  that  this  was  an  apodem  fui  generis  {m\  which  is  agreeable 
to  the  opinion  even  of  Avicenna  («),  that  an  apoplexy  might  have  its  origin 
M  from  an  apodem  form’d  by  repletion  ;”  the  violence  of  which  w?as  en- 
creas’d  jn  the  patient  in  quedion,  by  the  water  being  extravafated,  and  by 
the  veffels  being  diflended.  But  this  apodem  happen’d  about  the  very  place, 
in  which,  as  I  have  already  faid,  organical  injuries  mod  frequently  happen, 
according  to  my  obfervations  (0) :  and  in  the  fird  hifiory  of  Valfalva,  we 
have  an  apoplexy  arifing  from  an  abfcefs,  which  was  form’d  in  the  very  lame 
place  (p).  Moreover,  both  in  that,  and  in  the  other  (j),  and  this  of  mine 
alfo,  you  fee  this  dobtrine  confirm’d,  that  the  injury  of  the  brain  is  found 
in  that  hemifphere,  which  is  oppofite  to  the  paralytic  fide  of  the  body. 

(m)  Vid.  Epift.  9.  n.  1 6,  8c  feq.  ufq.  ad  20.  (c)  Epift.  3.  n.  18.  ( p )  Supra,  n.  2. 

(»)  Canen.  1.  3.  F.  1.  tr.  5.  c.  12.  (^)  n.  4. 


2 


8.  But 


Letter  V.  Articles  8,  9,  10.  101 

8.  But  the  inflammation  of  the  bladder  in  our  apopleftic  patient,  and  its 
great  diftenflon  with  urine,  in  confequence  thereof,  brings  to  my  mind  that 
large  colle&ion  of  urine,  which  I  found  in  the  oftler,  whofe  hiftory  I  have 
given  you  (r)  ;  and  that  alfo,  which  was  no  lefs  confiderable,  that  I  found 
in  the  bladder  of  an  old  woman,  whofe  hiftory  I  fhall  give  you  hereafter  (s'). 
From  thefe  obfervations,  and  others  of  this  kind,  you  will  underhand  how 
eafily  it  may  happen,  that  when  apoplectic  perfons  drag  on  life  a  little  longer 
than  ufual,  a  new  acceffion  of  diforders  fhall  be  brought  on  from  a  retention 
of  urine ;  which  retention  is  lefs  likely  to  be  obferv’d,  becaufe,  as  they  can 
fwallow  but  few  things,  and  thofe  liquid  only,  and  the  urine  frequently,  by 
reafon  of  the  weaknefs  of  the  fphinfter  veficae,  runs  away  by  drops,  and  wets 
the  bed  ;  the  attendants  are  fatisfied  with  thefe  difcoveries,  and  never  think 
of  warning  the  phyfician  of  a  retention  of  urine.  It  fhould  be  the  bufinefs 
of  phyficians,  therefore,  to  order,  that  the  lower  part  of  the  belly  be  now' 
and  then  felt,  fo  that  if  a  fulnefs  of  the  bladder  indicate,  that  the  urine  is 
not  difcharg’d,  fome  art  fhould  be  made  ufe  of-,  and  if  the  cafe  require  it, 
a  fllvcr  catheter,  which  is  eafily  done  in  women,  fhould  be  introduc’d  by  the 
hand. 

9.  But  perhaps  you  will  expeCl,  that  I  fay  fomething  of  thofe  two  circum- 
fiances,  which  I  mention’d  merely  on  account  of  their  extraordinary  nature* 
I  will  therefore  tell  you,  what  I  immediately  laid  on  that  occafion,  to  thofe 
who  were  prefent,  as  I  am  us’d  to  do.  As  to  the  two  foramina,  obferv’d  in 
the  feptum  tranfverfum,  through  one  of  which  one  of  the  hepatic  veins  pafs’d, 
to  go  up  to  the  vena  cava ;  I  confefs  it  was  rare ;  but  it  was  much  more  ex¬ 
traordinary,  that  I  demonftrated  the  very  fame  circumftance  three  times  in 
the  fpace  of  two  months :  twice  in  the  theatre,  in  the  month  of  February, 
and  once  in  the  hofpital,  the  month  after.  But  I  have  not  only  feen  two,  as 
in  thefe  three  bodies,  but  I  have  even  feen  three  foramina  in  the  diaphragm, 
once  and  again  (*)  one  very  large  to  tranfmit  the  cava,  and  two  lefler  ones 
to  give  paffage  to  two  hepatic  veins :  the  firft  time  was  at  Bologna,  in  the 

'year  1700,  in  a  diaphragm  which  was  publicly  demonftrated  there,  when 
I  afiifted  Valfalva  in  his  difledtions ;  a  rough  fketch  of  which,  drawn  by  my- 
felf,  I  ftill  preferve-,  and  the  fecond  at  Padua,  before  the  year  1726,  which 
one  obfervation  only,  I  mention’d  in  the  firft  of  the  Epiftolse  Anatomi¬ 
cae  (/),  without  ever  thinking,  as  frequently  happens,  of  the  other,  which 
was  of  a  more  ancient  date ;  and  to  this  paffage  it  is,  that  the  very  learned 
and  ingenious  anatomift  Haller,  refers  ( u ),  where  he  confirms,  that  what 
“  I  have  obferv’d  is  indeed  very  rare.” 

10.  But  in  regard  to  the  number  of  ribs  ;  as  I  once  faw  only  eleven  (.v), 
fo,  I  fay,  I  once  faw  thirteen,  and  not  oftner  ;  and  I  confefs  that  Galen 
wrote  truly  (y),  when  he  aflerted,  “  thefe  appearances  to  be  fo  rare,  that 
“  you  will  fcarcely  find  fo  great  a  number  of  ribs  in  one  among  a  thoufimd 
yet  he  declar’d  the  firft  number  to  be  m-uch  more  extraordinary  than  the 


(r)  Epift.  4.  n.  19. 

( s )  Epift.  56.  n.  12. 

(*)  Vid.  &  Epift.  60.  n,  6. 
(/)  n.  26, 


(«)  Differt,  de  Mufc.  Diaphragm,  ad  §.  7* 
litt.  c. 

(*)  Vid.  Adv.  Anat.  2.  Anim.  33.  in  fin. 
(y)  de  Anat.  Admin.  1.  8.  c.  1. 


other» 


10  2. 


Book  I.  Of  Difeafes  of  the  Head. 

other.  In  refpedt  to  the  fecond  number,  however,  which  is  thirteen,  Arch- 
angelus  Piccolhominus  (2),  without  doubt,  believ’d  what  he  laid  to  be  true, 
when  he  affirm’d,  “  that  all  antiquity  had  obferv’d,  that  if  the  ribs  exceed 
“  their  natural  number,  it  was  in  one  fide  only  that  a  fupernumerary  one 
tc  was,  and  not  in  both.”  And  indeed  Columbus  (a)  alfo,  had  found  “  only 
<c  one  little  rib,”  befide  the  twenty-four,  as  what  he  has  added  fign’ffies, 
and  the  marginal  notes  confirm.  Neverthelefs,  not  to  mention  Biuhin  (/>), 
whom  Piccolhominus  could  not  have  read,  and  who  fays,  that  he  had  found 
thirteen  ribs  on  each  fide,  in  fuch  a  manner,  that  in  the  left  eight  were  true, 
and  in  the  right  fix  fpuriousj  he  might  have  known,  that  Columbus  himfelf 
had  afterwards  feen(c)  even  “  fix  and  twenty  ribs.”  And  that  Falloppius(d) 
had  found,  “  in  two  bodies,  the  number  of  the  ribs  encreas’d  to  thirteen  in 
“  each  fide,  by  the  addition  of  two  ribs,  fo  fmall,  that  they  feem’d  rather 
“  to  be  rudiments  of  ribs  only.”  And  with  thefe  obfervations  of  Fallop- 
pius,  mine  very  well  agrees,  as  it  does  alfo  in  that  which  he  adds,  “  that  the 
“  coarticulation,  which,  in  other  men,  is  us’d  to  be  in  the  twelfth  vertebra 
“  of  the  thorax,  was  not  at  all  varied  in  thefe.”  But  you  readily  fee  how 
far  what  he  has  faid  differs  from  my  obfervations,  when  he  tells  us,  “  that 
“  he  had  found  thirteen  thoracic  vertebrae  in  them,  but  in  the  loins  only 
“  four-,”  which  Columbus  and  Bauhin  faid  nothing  of.  Though,  perhaps, 
you  may  think,  there  is  fome  reafon  to  fufpedt,  that  the  vertebra  deicrib’d 
by  me,  as  a  fifth  lumbar,  belong’d  in  fa£t  to  the  os  facrum  j  but  if  you  at¬ 
tend  to  all  the  circumftances ;  or  rather,  if  you  look  never  fo  (lightly  on  the 
bone,  which  1  preferve  by  me-,  there  is  no  doubt  but  you  will  determine  at 
firft  bluffi,  that  it  is  rather  to  be  reckon’d  among  the  vertebra*  of  the  loins. 
Nor  indeed  have  I  been  more  prolix  on  this  head,  becaufe  I  was  ignorant 
how  many  anatomilfs  after  him  have  feen  the  fame  thing-,  but  becaufe  I  was 
not  willing,  that  in  reading  this  obfervation  you  fhould  be  uninform’d  of 
thofe  circumftances  which  others  have  omitted  For  you  know,  that  by  rea¬ 
fon  of  the  fituation  in  which  the  two  thirteenth  ribs  were  found,  not  being 
l'pecify’d,  Hunauld  had  undertaken  (e)  to  explain  their  origin  in  fuch  a  man¬ 
ner,  that  his  explication  takes  place  when  they  are  in  the  fame  fituation  in 
which  he  faw  them,  to  wit,  above  the  two  uppermoft  ribs  -,  2nd  not  when 
they  are  where  I  found  them,  to  wit,  below  the  two  low'ermoft.  Nor  does 
the  fulpicion  of  fome  people  efcape  you,  that  when  they  are  found  in  this 
place,  they  are  nothing  more  than  the  tranfverfe  procelles  of  the  firft  lumbar 
vertebrae,  a  little  longer  than  uftial:  and  not  true  ribs  befide  them,  con- 
nedled  by  a  moveable  joint,  as  I  have  fhewn.  But  let  us  return  to  thofe 
things  which  are  really  preternatural. 

11.  A  taylor,  who  us’d  to  drink  very  hard,  being  taken  fpeechlefs,  died 
within  two  days.  Alexander  Bonis,  whom  I  have  before  commended,  and 
other  learned  Venetian  phyficians,  and  the  young  ftudents  in  anatomy,  not 
being  able  to  inform  themfelves  of  any  more  circumftances  relative  to  him, 
and  having  had  the  body  given  to  them,  begg’d  of  me,  that  I  would  difiett, 

(0  1-  15- 

(d)  Obf.  Anat. 

\e)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1741. 

and 


(z)  1.  8.  Anat.  Prasleft.  8. 
(a)  de  Re  Anat.  1.  1.  c.  19. 
(£)  Anatom.  1.  a.  c ,  S. 


Letter  V.  Article  12,  103 

and  carefully  demonftrate  the  brain.  This  was  about  the  end  of  March,  in  the 
year  1708.  The  vifcera  of  the  abdomen  were  all  found.  In  the  left  cavity  of 
the  thorax,  was  a  little  bloody  water.  The  lungs  were  rather  heavy,  and  upon 
preffure  emitted  a  kind  of  froth,  yet  their  fubftance  was  found.  The  heart  was 
flaccid  ;  and  in  the  right  ventricle,  auricle,  and  pulmonary  artery,  were  po¬ 
lypous  concretions,  in  the  left  fide  were  none,  but  only  a  little  half-con¬ 
creted  blood  in  the  ventricle.  The  aggeres,  as  Valfalva  has  fince  call’d  them  rf), 
of  the  femilunar  valves,  were  very  prominent,  and  of  the  hardnefs  almofl 
of  a  cartilage.  In  the  aorta,  and  the  carotids,  was  a  large  quantity  of  fluid 
blood,  but  flill  more  in  the  pulmonary  artery. 

When  the  head  was  fever’d  from  the  trunk,  much  water  ran  out  of  the 
vertebral  tube,  and  the  fame  kind  of  fluid  was  prelently  feen  under  the  pia 
mater,  in  great  quantities,  not  without  an  appearance  of  jelly.  But  what 
It  ruck  us  moft  was  a  kind  of  white  fanies,  extended  over  all  the  furface  of 
the  anterior  lobes  of  the  cerebrum;  which  matter,  when  accurately  examin’d, 
appear’d  to  be  a  true  fanies,  but  inodorous,  being  inherent  in  the  very  fub- 
ftance  of  the  pia  mater ;  the  furface  of  the  brain  being,  as  far  as  we  could 
judge  by  our  lenfes,  altogether  unhurt.  This  membrane  alfo  was  eafily  fe- 
parated  from  the  brain,  by  the  gentle  drawing  of  the  hand  ;  and  the  cere¬ 
brum,  cerebellum,  and  nerves,  had  the  greareft  flaccidity  imaginable.  All 
the  vefiels,  even  the  fm  a  lie  ft  and  internal  veflcls,  were  turgid  with  blood  ; 
and  in  the  finufies,  efpecially  the  largeft,  were  polypous  concretions.  In  the 
lateral  ventricles  we  obferv’d  there  was  a  little  water,  and  that  the  colour  of 
the  plexuffes  was  fomewhat  pale  and  dilute  ;  and,  finally,  in  the  pineal  gland, 
was  a  very  little  bit  of  hardifh  matter. 

12.  Even  our  Adverfaria  will  prevent  you  from  infilling  upon  this  little 
bit  of  hardifh  fubftance  (g),  as  therein  I  have  mention’d,  that  the  fame  kind  of 
matter  has  often  been  found  in  the  pineal  gland  both  by  me  and  by  others  ; 
and  our  letters  to  you  alfo  will  prevent  it,  as  in  thefe  you  will  fee  that  obfer- 
vation  confirm’d  (£).  Do  not,  however,  imagine,  that  I  do  not  fuppofe  it 
a  diieale,  for  I  do ;  but  a  difeafe,  the  effedts  of  which  are  very  obfcure  and 
uncertain,  becaufe  it  fometimes  occurs  without  any  foregoing  fymptoms, 
forne  times  has  evident  iigns  of  diforder  preceding  it,  and  at  other  times  is 
join’d  with  different  diforders  of  the  brain.  And  indeed,  John  Salzman, 
who  was  when  living  a  very  learned  phyfician,  in  his  “  Diflertation  on  the 
“  pineal  gland  becoming  ftony,”  after  having  more  diligently  than  any  other 
to  this  day,  collected  almofl  all  the  examples  of  this  gland  being  calculous, 
which  were  at  that  time  extant,  did  not  doubt  (/),  but  that  it  was  the  caul'e 
of  intolerable  pains  in  the  head,  or  of  idiotifm,  when  it  was  become  uni- 
verfally  ftony,  as  in  the  man  fpoken  of  by  Pfeilius  in  Schenck,  in  a  virgin 
by  Mangetus  from  Drelincurt,  and  in  the  old  man  from  King,  as  it  is  found 
in  the  Philofophical  Tranfactions  of  England.  But  it  is  not  certain,  whether 
the  done  found  by  Pfeilius  was  this  gland  petrified  ;  and  King  found  greater 
diforders  than  that  in  the  brain,  at  the  fame  time ;  and  Drelincurt  did  not 
only  find  the  gland  ftony,  but  encreas’d  even  to  the  bignefs  of  a  hen’s  egg : 

(f)  Differt.  Anat.  I.  n.  io.  (£)  VI.  n.  12.  X.  n.  17.  XI.  n.  ix. 

(g)  Vi..  Anim.  9,  ’  (.*')  Thef.  15. 

: ;  '  fo 


io4  Book  I.  Of  Difeafes  of  the  Head. 

fo  that,  had  it  been  an  hydatid,  or  any  thing  elfe  whatever,  it  would  doubt* 
lefs,  by  its  encreas’d  bulk,  have  brought  on  confiderable  diforder.  But  as  to 
■what  relates  to  the  nature  of  this  diforder,  it  has  feem’d  to  fome  men  of 
learning,  and  particularly  to  Jo.  Valentinus  Scheidius,  in  that  diftertation  ( k ) 
in  which  I  fee  he  has  far  exceeded  thofe  celebrated  obfervators  in  other  in- 
ftances,  who  have  afierted,  that  the  brain,  being  become  a  ftony  concretion, 
as  was  believ’d,  was  only  degenerated  into  bone  ;  it  feem’d,  I  fay,  that  this 
induration  found  in  the  pineal  gland,  was  to  be  referr’d  to  the  clafs  of  bony, 
rather  than  of  ftony,  concretions.  Which  though  I  cannot  deny  of  thofe 
little  bodies,  that  were  feen  by  neither  of  us,  yet  I  can  fafely  affirm  of  thofe 
which  I  myfelf  found,  that  they  were  to  appearance  ftony  •,  inafmuch  as 
being  comprefs’d  betwixt  my  fingers,  they  feparated  into  little  rough  fandy 
particles,  and  were  therefore  evidently  friable ;  which  property  he  gives  as 
the  chief  criterion  whereby  to  diftinguifh  the  one  from  the  other.  And  to 
this  purpofe,  alfo,  is  applicable  what  I  fhall  lpeak  of  hereafter  (/),  that  I  have 
fometimes  found  within  this  gland  a  mucous  yellowifti  matter ;  and  often  the 
lame  matter,  and  of  the  fame  colour,  on  the  outfide  of  the  gland,  and  on 
its  anterior  furface,  and  elpecially  at  its  bafts  anteriorly  (m)  :  which  matter 
being  fometimes  not  very  hard,  or  fcarcely  harden’d  at  all,  yet  when  com¬ 
prefs’d  between  the  fingers,  feem’d  evidently  to  contain  fome  little Tandy  par¬ 
ticles.  But  in  the  fame  places,  in  other  bodies,  it  was  manifeftly  concreted 
into  fmall  granules  (») ;  or  though  this  matter  itfelf  was  not  found,  yet  fome 
hardifh  little  bodies  were  found  in  its  place  (0).  But  is  it  not  more  probable, 
that  thefe  corpufcles,  whether  they  were  within  or  without  the  body  of  the 
gland,  fince  they  appear’d  to  us  of  the  fame  colour,  as  that  fandy  matter 
generally  is,  to  wit,  yellow,  or  yeliowifh,  and  to  Vieufieus  alfo  (p),  to  Lau- 
bius  (^),  and  to  Salzman  (r),  were  really  calculi,  form’d  by  degrees  from 
the  earthy  particles  of  that  matter  concreted,  as  the  watry  were  more  and 
more  conlum’d,  than  little  bones?  efpecially  fince  others  who  have  feen  them, 
a  very  few  excepted,  have  call’d  them,  fand,  gravel,  and  fmall  ftones  j  and 
not  only  thofe  who  are  fpoken  of  by  Salzman,  but  others  alfo  who  had  written 
before,  and  among  thofe,  two  whom  the  celebrated  Haller  (j)  points  out, 
Pechlinus  and  Brunnerus,  and  thofe  who  liv’d  afterwards,  whom  we  read  of, 
for  inftance,  in  the  A£ta  Casfar  N.  C.  Acad.  (/) ;  and  befides  thefe,  that  ce¬ 
lebrated  man  Phil.  Conradus  Fabricius  (u)  \  and  becaufe  we  cannot  mention 
all  of  them  particularly  by  name,  he  at  leaft  whom  we  very  lately  read,  the 
ingenious  Martinetti  (x),  by  whom  three  calculi  of  this  kind  were  found  in 
the  difle&ion  of  the  archbiffiop  of  Ravenna.  But  if  you  examine  the  author, 
who,  when  I  attend  to  my  peculiar  obfervations  of  thefe  appearances  occurring 
on  the  outfide  of  the  gland,  feems  to  be  by  far  the  firft  who  has  made  mention 
of  them,  you  will  naturally  objedt,  that  the  ancient  phyficians  look’d  upon 


(i)  De  duob.  ofiic.  in  cerebr.  apopl.  quaeft. 
2,  &  3. 

(/)  Epift.  21 .  n.  24. 

( m )  Epift.  1.  n.  10.  epift.  3.  n.  14.  epift.  8. 
n.  9,  &  epift.  14.  n.  35. 

(/?)  Epift.  8.  n.  6. 

(0)  Epift.  7.  n.  15.  epift.  8.  n.  15. 


(p)  Neurogr.  1.  1.  c.  11. 

(y)  Eph.  N.  C.  cent.  9.  obf.  63. 

(r)  Difti  cit.  Thef.  13. 

(j)  Ad  prafteft.  Boerh.  §  296.  not.  p. 

(/)  T.  5.  obf.  68.  t.  6.  obf.  14. 

(«)  Idea  Anat.  pratt.  fe&.  4. 

(*)  Lettera  della  Separaz.  degli  umori. 

thefe 


Letter  V.  Article  13»  105 

thefe  little  bodies  as  bony  or  cartilaginous.  That  is  to  fay,  Galen,  in  his 
book  De  anatomicis  adminijirationibus  (y),  the  title  of  which  promiles  no¬ 
thing  of  that  kind,  (and  for  this  reafon,  I  fuppofe,  it  has  happen’d,  that  his 
■words  have  never  been  quoted  by  any  author  on  this  occafion,  as  far  as  I 
know,  unlefs  perhaps  moft  authors  have  underftood  them  as  VefaliUsfg)  did, 
who  was  on  that  account  blam’d  by  Riolanus  (a) ;)  Galen,  I  fay,  writes,  that 
in  his  time  it  was  enquir’d,  “  whether  any  thing  cartilaginous,  or  bony,  was 
“  contain’d  within  the  gland  of  the  cerebrum,  which  from  its  turbinated 
“  figure,  or  its  likenefs  to  a  pine-nut,  is  call’d  by  the  Greeks  mirclpiov  ?  in  like 
<c  manner  alfo,  whether,  in  every  heart,  it  was  common  to  find  a  cartilaginous, 
<c  or  bony  particle,  or  in  large  hearts  only.”  Nor  let  your  opinion  be  biafs’d 
by  this  circumftance,  that  Galen  places  both  thefe  queftions  among  the  fri¬ 
volous  fubjedts  :  for  he  fhews,  that  the  fecond  is  a  ufeful  one,  both  in  this 
work  (£),  and  in  that  entitled,  De  ufu  partium  (c)  ;  fince  he  has  treated 
of  it  too  largely  to  fuffer  us  to  fuppofe  that  he  could  efteem  it  trifling  ;  fo 
that  you  fee  what  he  meant  by  the  word  frivolous.  And  why  he  endeavour’d 
to  disprove  the  firft,  you  will  know  from  Riolanus  (d).  But  in  our  days  we 
confider  both  kinds  of  bone,  not  as  naturally,  but  praeternaturally  form’d  ; 
and  even  I  confefs,  that  not  only  what  I  have  hitherto  found  on  the  outfide  of, 
but  within  the  gland,  has  feem’d  to  me  to  be  much  lels  a  bone,  than  a  con¬ 
cretion  fimilar  to  a  calculus,  for  the  reafons  I  have  pointed  out  above.  And 
you  may  alfo  add  this  argument,  that  green  concretions  (and  little  Hones  of 
this  colour  have  been  found  by  Veftius(^)  in  that  place)  may  more  eafily  be 
form’d  from  a  green  matter,  than  that  green  bones  could  be  at  any  time  ge¬ 
nerated.  But  however,  if  any  appearances  of  this  kind  fall  into  my  hands 
again,  I  have  determin’d  not  only  to  attend  to  their  hardnefs,  or  the  fmell  of 
them  when  burnt,  but  alfo  to  enquire  into  their  nature,  by  other  experiments ; 
and  in  the  mean  while,  to  leave  the  fubjedt  at  large,  as  1  have  done  on  other 
occafions. 

13.  And  I  am  Hill  more  under  a  neceflity  of  doing  fo,  in  regard  to  the 
fource  of  that  true  fanies,  which  I  defcrib’d  in  the  hiftory  of  the  taylor  above. 
I  fhould  fufpedt,  it  was  tranflated  from  the  lungs  into  the  fkull,  if  as  1  found 
them  of  a  veryftrong  fmell,  fo  I  had  found  them  injur’d  in  any  part;  as  it 
feems  that  fanies  has  been  fometimes  carried  from  the  brain  to  the  urinary 
paffages,  both  from  other  obfervations,  and  from  that  which  the  learned 
Hippol.  Franc.  Albertini  related,  as  oblerv’d  by  him  in  a  barber;  who  being 
feiz’d  with  pain  in  the  head,  and  a  fenfe  of  weight  in  the  vertex,  from  too 
long  continuance  in  the  heat  of  the  fun,  and  at  length  with  fever,  delirium, 
diftenfions  of  the  nerves,  lethargy,  and  palfy,  was  freed  from  his  diforder  by 
a  fudden  flow  of  urine,  in  which  pus  fubfided.  And  indeed  he  was  bad  in 
his  head  fome  years  ;  yet  when  thefe  things  were  related  to  me,  he  was 
living,  well,  and  found.  And  that  pus  might  be  carried  from  the  lungs  to  the 
brain,  (as  1  faid,  I  fhould  have  conjedtur’d  in  the  cafe  of  the  taylor)  or  from 


(y)  4' c*  *• 

(z.)  De  corp.  hum.  fabr.  1.  i .  c.  6. 
(a)  In  1.  Galen,  de  ofiib,  poll  c.  32. 


VOL.  I. 


P 


(b)  L.  7.  c.  10.  (0  L.  6.  c.  19. 

(<*)  C.  cit. 

(*)  Apud  Salzmann.  Thef.  cit.  13. 


the 


i  o  6  Book  L  Of  Difeafes  of  the  Head. 

the  pleura  in  like  manner,  Duretus  did  not  doubt,  and  Parrey  feems  to  have 
alcertain’d,  as  you  read  in  the  Sepulchretum  (/). 

14.  But  bdi'des  pus  being  generated  in  the  brain,  or  tranftated  thereto, 
I  have  no  flight  lufpicions,  from  the  diffedtions  I  am  about  to  relate,  that  other 
caufes,  hitherto  lei’s  obferv’d,  may  fometimes  bring  on  an  apoplexy,  or  con¬ 
cur  in  the  produdtion  of  it.  The  firft  diffedtion,  though  not  perform’d  in 
my  prefence,  I  fhall  neverthelefs  give  to  you,  juft  as  if  it  were  my  own. 
For  Nicolas  Mediavia,  public  demonftaror,  and  moft  defervedly  dodtorof  the 
facred  college  of  phyticians  and  philofophers,  was  prefent,  to  whom  I  would 
trull  as  readily  as  to  myfelf,  by  reafon  of  his  known  diligence,  for  thefe 
eight  and  thirty  years  paft ;  for  it  is  fo  long  fince  I  began  to  exercife  him  in 
anatomical  bufinels ;  and  fo  great  is  his  afliduity,  that  he  has  not  only  been 
prefent  at  almoft  all  the  diffedtions  I  have  perform’d  at  Padua,  but  alfo  fre¬ 
quently,  by  diffedling  and  demonftrating  with  me,  has  given  me  very  ufeful, 
and  very  laudable  affiltance.  In  this  manner,  therefore,  he  made  me  the  relation 
of  a  patient’s  hiftory,  whom  he  had  in  courfe  attended,  as  phyfician  at  the 
hofpital  in  Padua,  and  whom  he  order’d  to  be  diffedted  after  death,  under 
his  infpedtion.  This  was  on  the  twenty-fourth  day  of  March,  in  the  year 
1740}  and  on  the  fame  day  he  related  it  to  me. 

15.  An  old  man,  who  had  an  ulcer  in  his  leg,  was  Suddenly  Seiz’d  with  a 
pain  in  his  head.  As  fome  diforder  Seem’d  to  threaten  the  brain,  he  was  imme¬ 
diately  let  blood  that  morning.  Neverthelefs,  at  the  twentieth  hour,  he  was 
attack’d  with  an  apoplexy,  and  a  pally  of  the  right  limbs.  A  palfy  of  all 
the  lower  parts  foon  follow’d  this,  and  in  a  few  days  death. 

The  head  being  examin’d,  that  artery  with  which  the  vertebrals  anafto* 
mofe,  and  thofe  which  are  carried  diredtly  over  the  corpus  callofum,  were  tur¬ 
gid  with  blood ;  but  the  remaining  vellels  were  not  fo.  In  both  the  lateral 
ventricles  was  a  good  quantity  of  water,  and  the  plexus  choroides  were  pale. 
The  Septum  lucidum  was  broken  through  anteriorly.  But  what  was  moll 
linking,  all  the  medullary  fubltance  of  the  right  hemisphere  was  very  brown ; 
yet  not  that  of  the  left. 

16.  When  I  heard  this  relation,  it  brought  to  my  mind  the  prieft  of 
Verona,  in  whom,  after  dying  Suddenly  of  an  apoplexy,  I  found  the  whole 
medullary  fubltance  of  the  brain  become  brown,  as  I  have  written  to  you 
before  (£).  Whatever  the  caufe  of  this  change  may  be,  for  I  then  told  you, 
that  it  did  not  feem  to  be  blood  from  whence  that  white  fubltance  is  fo  taint¬ 
ed,  Should  it  not  have  a  place  among  the  caufes  of  apoplexy?  For  although 
in  this  old  man,  the  firft  pally  was  on  the  right  fide,  and  the  difcoloration 
obferv’d  on  the  fame  fide  of  the  brain,  and  not  on  the  oppolite  ;  yet  you  know 
that  the  dodtrine  of  Valfalva  anfwers  almoft  in  all ;  though  not  altogether  in 
all  ( h ).  But  let  us  now  go  on  to  lefs  obfeure  fubjedts. 

17.  There  was  an  ./Ethiopian  at  Venice,  who  was  thirty  years  of  a.g;e,  of 
a  mufcular  make,  and  in  good  health,  unlefs  that  in  the  laft  months  he  had 
been  l’ubjedt  to  a  certain  languor  of  his  ftomach,  join’d  with  a  flight  Sweating, 
which,  however,  immediately  went  off,  on  taking  food.  This  man,  about 
the  middle  of  July,  in  the  year  1708,  being  very  chearful  with  his  friends 

(f)  L.  1.  f,  1.  obf.  40.  {g)  Epift.  4.  n.  21.  (Z>)  Epift.  2.  n.  l6. 

at 


Letter  V.  Article  1 8.  *  107 

at  breakfaft,  for  it  was  in  the  morning,  and  {landing  to  play  on  the  trumpet, 
as  he  us’d  to  do  -,  while  he  was  playing,  fell  backwards  fo  gradually  and 
flowly,  that  his  companions  would  have  thought  he  did  it  by  way  of  amule- 
ment,  if  they  had  not  oblerv’d  certain  tremors  running  over  his  whole  body 
as  he  fell.  He  died,  however,  the  very  moment  that  he  fell. 

The  celebrated  Santoiini,  as  he  generally  us’d,  folicited  me  to  be  prefect 
at  the  difledtion.  It  was  about  the  twelfth  hour  after  death.  We  obferv’d 
the  upper  limbs  to  be  fomewhat  rigid,  the  neck  was  blacker  than  the  other 
parts  of  the  body,  as  if  from  ftagnating  blood,  and  the  eyes  were  like  the 
eyes  of  a  living  man.  In  the  abdomen  every  thing  was  natural,  except  that 
the  omentum  was  too  fhort,  and  the  edge  of  the  liver  itfelf  almoft  livid, 
and  the  membrane  of  the  fpleen  on  its  adhering  furface,  grown  white,  and 
almoft  tendinous,  in  a  certain  fpot.  Therefore  nothing  took  up  our  atten¬ 
tion  more  than  a  great  number  of  ladteal  veffels,  diftended  with  chyle,  and 
knotty,  which  embrac’d  the  fmall  inteftines  on  the  one  hand  by  many  roots, 
even  on  the  parts  oppofite  to  the  mefentery  •,  and  on  the  other  hand,  went 
in  a  radiated  manner,  towards  the  center  of  the  mefentery,  where  very  long 
and  large  glands  appear’d.  As  we  were  about  to  open  the  thorax,  we  much 
wonder’d  at  the  unufual  hardnefs  of  the  cartilages,  that  join’d  the  fternum  to 
the  ribs,  and  efpecially  in  that  age.  The  lungs  were  entirely  found,  although 
the  right  lobe  was  in  fome  places,  and  the  left  lobe  in  its  whole  upper  part, 
connedted  to  the  pleura,  by  membranous  bands  •,  and  both  of  them  contain'd 
more  ferum  internally  than  ufual.  In  the  pericardium  alfo,  was  a  larger 
quantity  of  water  than  ufual,  and  that  was  thick  and  turbid.  But  the  heart 
was  of  its  natural  firmnefs :  and  in  its  cavities  was  a  fluid  blood,  which  was 
alfo  found  in  confiderable  quantity  in  the  aorta,  and  efpecially  in  the  pulmo¬ 
nary  artery.  On  the  external  furface  of  the  heart,  and  in  the  whole  of  the 
thorax,  the  blood-veflels  were  very  confpicuous.  At  length,  having  open’d 
the  brain,  water  was  found  under  the  pia  mater :  moreover,  in  the  lateral 
ventricles,  but  efpecially  in  the  left,  was  more  fluid  contain’d  than  is  natural : 
yet  the  plexus  choroides  were  of  their  ufual  colour,  and  had  no  hydatids 
among  their  veflels:  and  the  cerebrum  was  of  its  natural  firmnefs.  The 
veflfels  of  the  brain,  and  its  finufles,  were  rather  empty  than  full  •,  and  what 
little  blood  they  had  in  them,  was  without  the  leaft  concretion-,  fo  that  in 
this  body  the  blood  was  found  to  be  every  where  fluid.  But  we  law  no  where, 
except  within  the  cranium,  that  appearance,  for  the  fake  of  which,  princi¬ 
pally,  I  undertook  to  defcribe  this  hiftory  to  you.  That  is,  the  fanguife- 
rous  veflels,  which  were  alfo  fpoken  of  in  the  former  difledtion,  that  pafs’d 
over  the  corpus  callofum,  were  diftended  with  air,  intermix’d  with  a  little 
ferum.  So  that  artery  likewife,  which  goes  through  the  bafis  of  the  medulla 
oblongata,  and  takes  its  origin  from  the  jundtion  of  the  vertebrals,  and  other 
veflels  alfo,  in  the  upper  furface  of  the  brain,  were  tranfparent  from  the  in-, 
eluded  air,  that  diftended  them. 

18.  Although  other  caufes  of  this  fo  fudden  death  do  not  feem  to  have 
been  wanting  within  the  cranium,  if  thole  things,  which  were  propos’d  in 
the  laft  letter,  pleafe  you ;  yet  whether  you  believe,  that  they  are  not  alto¬ 
gether  fatisfadlory  here,  or  you  think  that  this  laft  caufe,  whenever  it  oc¬ 
curs,  is  principally  to  be  attended  to,  I  will  not  conceal  what  my  opinion, 

P  2  v  or 


ip 8  Book  I.  Of  Difeafes  of  the  Head. 

or  rather  my  conjeXure,  is  thereon  *,  and  this,  after  having  confidefM  all  the 
arguments  that  were  made  ufe  of  by  the  Italians,  in  their  difputations,  about 
the  beginning  of  this  century.  And  I  fhall  do  it  the  more  readily,  becaufe 
I  have  obferv’d  the  blood  of  other  bodies,  and  not  this  only,  to  be  frothy, 
and  intermix’d  with  air-bubbles.  It  is  then  certain,  that  air  is  naturally  con¬ 
tain’d  in  the  humours,  and  particularly  in  the  blood  ;  for  to  omit  other  more 
ambiguous  proofs,  if  a  fegment  of  a  veifel,  fuppole  a  venous  one,  of  a 
living  animal,  be  tied  very  tight  with  a  bandage  on  each  fide,  and  be  cut 
off  from  its  connexions,  and  put  into  the  machine  of  Boyle,  fo  that  the  cir¬ 
cumambient  air  may  be  drawn  away,  the  air  which  is  included  within  the 
veffel  will  then  greatly  diftend  it.  And  indeed,  if  it  were  not  fo,  the  force 
of  the  external  air,  with  which  we  are  furrounded,  and  every  where  com- 
prefs’d,  would  have  fueh  an  efteX  on  the  veffels,  as  to  put  an  immediate 
ilop  to  the  circulation  of  the  blood  •,  which  is  now  prevented  by  an  equal 
refiftance  within.  For  fince,  like  this  external  air,  to  ufe  the  words  of  Plato(/), 
“  when  it  is  preternaturally  comprels’d,  by  its  natural  elafticity,  it  endea- 
“  vours  to  recover  its  former  fituation  therefore,  while  neither  prevails, 
but  a  perfeX  equilibrium  is  kept  up,  no  danger  can  happen.  But  that  it 
may  afford  this  and  other  advantages  to  the  blood,  which  it  is  needlefs  to 
mention  now,  and  no  detriment;  it  is  neceffary  that  the  air  fhould  be  dif- 
pers’d  in  fmall  particles,  fo  as  to  be  alrnoft  diffolv’d,  and  imperceptibly  mix’d 
therewith.  For  if  they  once  extricate  themfelves  from  the  embrace  of  thefe 
particles  of  blood,  and  one  particle  of  air  meet  with  another  •,  like  fmall  glo¬ 
bules  of  quickfilver,  they  immediately  coalefce  into  larger  globules,  and  form¬ 
ing  to  themfelves  a  kind  of  coat  from  the  vifcid  ferum  of  the  blood,  appear 
very  confpicuoufly  in  the  form  of  bubbles ;  or,  to  ufe  the  words  of  Plato  (k) 
once  more,  “  Bubbles  are  form’d  from  the  included  air  being  furrounded 
“  with  moifture,  which,  though  they  cannot  be  feen  feparately,  by  reafon 
C£  of  their  fmallnefs,  yet,  when  join’d  together,  and  fwell’d  into  a  larger 
“  bulk,  they  become  extremely  confpicuous.”  But  thefe  bubbles,  or  the 
air  itfelf,  which  is  let  at  liberty  by  their  rupture,  if  it  be  interpos’d  in  any 
quantity,  betwixt  the  portions  of  blood,  oppofes  their  motion ;  nor  does  it 
fuffer  the  portions  which  are  behind  to  be  in  contaX  with  thofe  that  go  be¬ 
fore,  or  to  communicate  to  them  the  impulfe  which  they  have  receiv’d  from 
the  heart,  and  larger  arteries.  And  the  blood  alfo  is  lefs  capable,  on  this  ac¬ 
count,  of  being  lenfible  to  the  impetus  ;  for  the  air  being  with  difficulty 
impell’d  into  the  fmailer  arteries,  muft  have  much  more  difficulty  to  pervade 
their  more  narrow  defiles,  as  it  is  thruft  farther  into  the  veffels :  and  this 
anatomifts  are  well  acquainted  with  from  experience,  as  frequently  fame  in¬ 
cluded  air  Hands  in  the  way  of  the  liquor  they  have  injeXed.  The  air,  in 
the  mean  while,  not  only  diftends  the  fmailer  veffels,  and  ftreightens  others 
contiguous  to  them,  but  alfo  takes  away,  in  great  meafure,  the  power  of 
contraXion  from  thofe  which  it  has  diftended-.  And  this  being  the  flate  of 
the  queftion,  it  appears,  that  if  air  fhould  befet  many  of  the  fmailer  veffels 
of  any  certain  part  at  one  time,  the  motion  of  the  blood,  and  every  thing 
depending  thereon,  mu  ft  be  interrupted.  Suppofe  then,  that  this  part  is  the 


(/)  In  Tim»o. 


(i)  Ibidem. 


brain. 


Letter  V,  Article  19.  109 

brain,  and  you  will  inflantly  underftand  how  an  apoplexy  may  arife  there¬ 
from:  and  you  will  commend  Hollerius  (/),  who  exprefsly  fays,  that  apo¬ 
plexies  are  brought  on,  even  when  the  carotid  arteries  are  obftrudted,  in 
44  the  retiform  plexus,  by  flatus,  or  by  any  thing  elfe and  you  will  com¬ 
mend  Hill  more  Hippocrates  himfelf  ( m ),  whofe  words  are  thefe:  “  It  much 
“  flatus,  or  air,  is  difpers’d  through  the  whole  body,  the  whole  man  is  pia- 
44  nec-flruck  j  if  through  a  part,  that  part  is  blafled  and  a  little  lower, 
where  he  aferibes  even  the  epilepfy  to  flatus,  that  is,  44  when  a  great  quan- 
46  tity  of  air  is  mixt  with  the  blood  through  the  whole  body ;  for  then,”  lays 
he,  44  many  obftruftions  happen  in  many  places  throughout  the  veins  ;  and 
44  when  the  air  comes  into  the  larger  veins,  and  thofe  that  are  fuller  of  blood, 
44  and  its  progrefs  is  check’d  for  a  confiderable  time,  the  courfe  of  the  blood 
44  is  interrupted  thereby  ;  for  the  air  Magnates  in  fome  places,  and  pene- 
44  trates  into  fome  parts  more  flowly,  and  others  more  quickly.”  Perhaps 
you  will  here  enquire,  by  what  method  the  air  gets  at  liberty  from  the  par¬ 
ticles  of  blood  with  which  it  is  involv’d,  fo  as  to  make  this  confufion.  And 
I  will  tell  you  what  is  my  conjedure  on  this  head,  if  you  will  give  me  leave, 
firfl,  to  deferibe  and  explain  to  you  the  laft  hiftory,  in  which  air  was  not  only 
found  in  the  veflels  within  the  cranium,  but  in  all  the  veflels  of  the  body 
alfo,  and  that  in  great  quantity. 

19.  A  fifherman  of  Venice,  of  more  than  forty  years  of  age,  of  a  tall 
flature,  and  afflided  with  a  rupture,  being  liable  to  flatulent  complaints  in 
his  belly,  was  fuddenly  ieiz’d  with  them  as  he  fat  in  his  boat,  and  immedi¬ 
ately  died.  I  difieded  the  body  in  company  with  my  friend,  whom  I  men¬ 
tion’d  above,  the  celebrated  Santorini,  on  the  day  after  his  death,  which  was 
in  the  year  1707,  a  little  before  the  middle  of  Odober.  His  abdomen  was 
fwell’d,  from  the  ftomach  and  inteflines  being  diftended  with  air.  The  flo- 
mach  was  alfo  pretty  red,  from  the  veins  which  go  into  the  gaftro- epiploicae, 
being  turgid  with  blood.  And  the  trunk  of  the  gaftro  epiploicae  itfelf,  which 
was  in  this  body  Angle,  was  fo  tumid,  that  it  would  every  where  admit  my 
forefinger.  Yet  no  l'ooner  was  it  cut  into,  but  it  fhrunk  ;  for  it  contain’d  a 
large  quantity  of  air,  with  a  little  frothy  and  black  blood.  The  larger  trad: 
of  the  fmall  inteflines  was  red  for  the  length  of  a  fpan,  except  that  for  about 
three  fingers  breadth,  where  it  went  down  into  the  hernial  fac,  in  the  form  of 
a  fmall  arch,  it  was  difcolour’d  with  a  gangrenous  appearance  \  yet  its  fub- 
flance,  as  well  as  that  of  the  other  inteflines,  was  pretty  firm.  The  fac  alfo 
was  ting’d  with  the  fame  colour,  but  not  fo  much,  and  loofely  furrounded 
the  inteftine,  without  cohering  with  it :  it  was  compos’d  of  the  relax’d  pe¬ 
ritoneum,  and  lay  very  near  the  tunica  vaginalis  of  the  fpermatic  cord,  what¬ 
ever  that  be  •,  but  ftill  on  the  outfide  thereof.  Not  far  from  this,  almoft 
over  the  middle  of  the  bones  of  the  pubes,  was  another  lac  form’d,  not  very 
large,  into  which,  in  like  manner,  another  portion  of  the  inteftine  had  been 
us’d  to  fall ;  but  it  was  at  that  time  empty.  The  concave  furface  of  the 
liver  was  here  and  there  livid,  yet  to  a  very  little  depth  in  the  iubftance.  In 
the  gall-bladder  was  contain’d  bile,  of  a  very  deep,  and  almoft  black,  yel¬ 
low  j  and  in  this  bile  was  a  calculus,  which,  in  its  fize,  blacknefs,  and  gra* 

(/)  Comment,  in  Hippocr.  S.  3.  .Aph.  23.  (m)  de  Flatib.  n.  19.  &  21. 

1  nulated 


ito-  Book  I.  -  Of  Difeafes  of  the  Head. 

nutated  furface,  refembled  a  mulberry  ;  and  this  being  held  over  burning 
wax,  did  not  take  fire.  The  fpleen  was  large,  but  firm.  Before  we  touch’d 
the  vifcera,  we  had  1'een  bloody  ferum  in  the  cavity  of  the  abdomen,  in  luch 
a  quantity,  that  we  were  oblig’d  to  make  ufe  of  fponges,  to  abforb  it. 

In  the  cavity  of  the  thorax,  however,  was  nothing  of  that  kind.  But 
the  pericardium  was  fo  connected  on  all  fides  with  the  heart,  that  by  pulling 
away  the  former,  the  latter  was  in  forne  places  torn.  The  heart  was  large 
and  flaccid.  And  black  frothy  blood,  fcarcely  coagulated  in  any  part  of  it, 
v/as  found  in  both  the  ventricles :  the  fame  kind  was  alfo  found  in  the  right 
auricle,  though  with  a  more  compact  concretion ;  but  in  very  fmall  quan¬ 
tity.  Nor  was  there  any  vein  through  the  whole  body,  wherever  we  infpedted 
it,  which  was  not  diftended  with  frothy  and  black  blood.  And  a  little  of 
the  fame  alfo  was  feen  in  the  aorta  and  carotids,  as  they  pafs  through  the 
neck.  And  the  trunk  of  the  pulmonary  artery  was  not  only  very  turgid 
with  this  kind  of  blood,  but  with  air  alfo.  The  lungs  were  found,  notwith- 
ftanding  the  internal  furface  of  the  afpera  arteria  was  befet  with  a  kind  of 
filthy  humor,  partly  of  a  cineritious  colour,  and  partly  of  the  colour  of  to¬ 
bacco.  And  the  fame  tube  where  it  lay  on  the  neck,  but  the  larynx  Bill 
more,  was  internally  black,  livid,  and  gangrenous  •,  and  the  parts  lying  near 
it  were  in  the  fame  fituation.  While  we  were  examining  thefe  parts,  a  thin 
pus,  as  if  from  a  ruptur’d  abfcefs,  flow’d  down  into  the  pharynx,  from  the 
pofterior  noftrils,  in  a  moderate  quantity. 

In  the  cavity  of  the  cranium,  the  finufies,  but  particularly  the  other  vef- 
fels,  which  go  through  the  dura  mater,  were  turgid  with  frothy  blood ;  as 
were  all  the  veflels  whatever,  that  ran  through  the  pia  mater,  whether  in  the 
bafis,  or  circumference,  of  the  cerebrum,  and  cerebellum,  or  in  the  ventri¬ 
cles  •,  and  the  fmaller  veflels  were  {till  more  turgid  than  the  large  ones. 
Moreover,  from  the  fubftance  of  the  cerebrum  and  cerebellum,  when  cut  in 
pieces,  more  large  drops  than  I  have  ever  feen,  flow’d  out  fpontaneoufly  in 
every  part.  Between  the  two  meninges  was  a  little  ferum,  and  under  the  lower 
ftill  more;  fo  that  it  was  eafily  drawn  off  from  the  brain.  There  was  a  fmall 
quantity  of  the  fame  kind  of  ferum  in  the  lateral  ventricles.  Yet  the  plexus 
choroides,  notwithftanding  they  had  many  vehicles  diftended  with  water  on 
the  pofterior  part,  were  very  red ;  and  the  fubftance  of  the  brain,  far  from 
being  lax,  was  very  firm.  In  this  body,  however,  I  obferv’d  two  circum- 
flances,  which  are  defcrib’d  in  the  Adverlaria  (#) :  the  firft  was  a  cavity  within 
the  beginning  of  the  fpinal  marrow,  of  fo  large  a  fize,  that  I  never  faw  the 
like,  or  any  thing  approaching  thereto,  before,  or  fince ;  and  as  I  then  ex- 
prefsly  acknowledg’d,  that  it  was  far  beyond  the  bounds  of  nature,  fo  now, 
I  do  not  doubt,  but  it  was  much  enlarg’d,  from  the  expanfion  of  the  extri¬ 
cated  and  elaftic  air.  The  fecond  was  a  vehement  inflation  of  the  interior 
membrane  of  the  fcrotum  with  the  fame  air,  being  made  up,  as  it  naturally  is, 
of  cells  every  where  communicating  with  one  another.  Which  inflation  was 
ftill  more  to  be  attended  to,  becaufe  the  fcrotum  was  fcarcely  at  all  tumid, 
before  we  touch’d  the  body  ;  yet  in  the  little  time  in  which  the  diffedlion  was 
perform’d,  it  was  extended  to  that  immenfe  fize.  But  this  difle&ion  was 


[/?)  VI.  Animad.  14.  &  IV.  Animad.  1. 


the 


Letter  V.  Articles  ic,  21.  tri 

the  fooner  finifh’d,  becaufe  the  gangrenous  flench  could  be  no  longer  born, 
either  by  me,  or  by  thole  who  affifted  me  in  the  difletftion. 

20.  I  have  heard  and  read  of  difledtions,  in  feme  meafure,  fimilar  to  this. 
For  I  remember  that  Valfalva  laid,  he  had  met  with  all  the  veins  and  the 
heart  diftended  with  air,  in  a  body  he  had  dilfe&ed  :  but  he  neither  left  a 
memorandum  of  it  in  writing,  nor  did  he  mention  of  what  death  the  man 
died.  And  I  know  from  the  celebrated  Verdriefius  (0),  that  Pechlinus,  whofe 
obfervations  are  not  now  in  my  hands,  ct  faw  in  the  body  of  a  man  who 
“  had  died  from  the  oppreflion  of  long-continued  pains  in  the  belly,  and 
“  ftreightnefles  in  the  cheft,  not  only  the  abdomen,  and  ftomach,  fill’d  with  a 
46  large  quantity  of  flatus,  and  blown  up  like  a  bladder,  but  alfo  the  cavity 
“  of  the  heart,  and  its  right  auricle,  immenfely  encreas’d  from  the  fame  caufe; 
<c  fo  that  the  heart  was,  by  two  parts  in  three,  larger  than  its  natural  fize, 
t£  but  entirely  empty  of  blood.  And  befides  this,  the  veins  of  the  whole 
“  body,  the  coronary  not  excepted,  were  diftinguifh’d  by  included  air,  and 
“  exhibited  to  the  eye  a  molt  beautiful  picture  ;  that  is,  an  alternate  mixture 
tc  of  columns,  of  purple  juice  and  aerial  fluid,  l'uch  as  is  feen  in  fome  kinds 
“  of  thermometers.”  So  the  learned  Jo.  Henricus  Grsetzius  (p)  mentions  a 
woman,  “  who  died,  in  a  very  miferable  manner,  of  continual  faintings,  pain, 
“  and  fuffocating  anxieties  ;  in  whofe  heart  not  the  lead  drop  of  blood  was 
“  found,  but  the  cavities  of  it  were  univerfally  diftended  with  air  :  fo  that 
“  you  would  have  call’d  it  a  tympany  of  the  heart.”  And  lad  of  all, 
Ruyfch  aflerts  that  he  found,  “  in  a  woman  who  died  fuddenly,  a  heart 
“  enlarg’d  to  an  amazing  magnitude  with  air,  of  which  it  was  full,  almoit 
“  without  any  blood  :  and  this  was  evidently  prov’d ;  for  on  thrufting  the 
“  point  of  a  knife  into  the  heart,  it  fubfided  fuddenly,  as  if  it  had  been  a 
“  bladder  fill’d  with  air,  and  touch’d  with  the  point  of  a  knife.”  But  ail 
thefe  found  the  heart  itfelf  diftended  with  air,  which  I  never  faw.  And  even 
Ruyfch  thought,  that  the  woman  had  died  from  that  caufe,  that  is,  “  from 
“  too  great  a  quantity  of  air  being  colledted  together  in  the  heart,  and  pre- 
“  venting  the  entrance  of  the  blood  thereinto.” 

21.  That  death  alfo,  which  happens  in  quadrupeds  from  air  being  injedted 

into  their  veins,  feems  to  be  referable  to  this  clafs ;  I  mean,  as  is  the  cafe 
in  the  Wepferian  experiment,  as  Brunnerus  (r)  call’d  it.  And  indeed,  Ver¬ 
driefius,  whom  I  have  already  commended  (j),  has  mention’d  that  experi¬ 
ment  as  made  by  Wepfer,  “  who  only  by  inflating  with  his  mouth  the  ju- 
“  gular  vein,  did,  once  on  a  time,  lay  proftrate  and  kill  an  ox,  of  a  ftupen- 
“  dous  fize.”  And  Rudolphus  Jacobus  Camerarius  (/)  confefles,  that  he 
was  ftirr’d  up  to  make  the  like  experiments  with  Wepfer,  from  the  example 
of  the  ftieep  and  the  cow,  that  were  thus  kill’d  by  him.  But  if  Wepfer  was 
really  the  author  of  that  experiment,  he  muft  have  perform’d  it  long  before 
they  wrote  of  it ;  yet  I  do  not  remember  to  have  found  the  leaft  mention  of 
this  affair  in  any  of  thofe  writings  which  he  publifh’d  before  the  year  1667  r. 

(0)  Differt.  Epift.  de  inflat,  ureter.  (r)  Eph.  N.  C.  dec.  3.  a.  4.  obf.  73. 

(p)  Difp.  de  hydr.  pericard.  in  procem.  (j)  Diff.  cit. 

(f)  Refp.  ad  Epiil.  probl.  16.  (/)  Eph.  cit.  dec.  2.  a.  5.  obf.  53. 


I  I  2 


Book  I.  Of  Difeafes  of  the  Head. 

in  which  year  Redi  (a),  in  a  letter  to  Stenoni,  mentions,  that  he  had  kill’d 
inftantly,  by  the  fame  experiment,  two  dogs  and  a  hare  ;  and  within  the  fix- 
teenth  part  of  an  hour,  in  like  manner,  a  fheep  and  two  foxes  ;  and  there¬ 
fore,  he  had  been  us’d,  ever  fince  that  time,  to  affirm,  that  the  intermiffion 
of  the  pulfe  was  generally  owing  to  fome  large  bubble  of  air,  which  was 
paffing  through  the  heart:  and  this  opinion  he  declar’d  in  a  conlultation  (.v), 
on  behalf  of  a  perfon  who  labour’d  under  an  intermiffion  of  the  pulfe.  But 
whoever  made  this  experiment,  even  before  Redi,  Antonius  Heydius,  in 
thofe  obfervations  which  he  publiffi’d  in  the  year  1683  (_y),  takes  notice,  that 
when  he  had  at  times  injected  air  by  the  crural  vein  in  dogs,  “  it  pafs’d 
“  through  the  abdomen  with  a  rumbling  noife,  and  in  almoft  a  moment  of 
<c  time  reach’d  the  heart;  then  that  the  dog  was  feiz’d  with  convulfions; 
<c  that  refpiration,  and  the  motion  of  the  heart,  as  far  as  could  be  perceiv’d, 
“  was  lo  much  at  a  (land,  that  the  dog  was  cut  open  as  being  dead  ;  that  no 
<c  blood  then  flow’d  out  from  the  intercoftal  veins  ;  that  the  cheft  being 
“  open’d,  a  motion  was  perceiv’d  in  the  right  auricle,  which  continu’d  long  after; 
“  that  the  heart,  together  with  the  right  auricle,  was  very  much  expanded ; 
<c  and  that  the  point  of  the  ventricles  being  cut  off,  pure  unmix’d  air  firft 
<c  came  forth,  after  that  frothy  blood,  and  laft  of  all  a  fluid  blood.”  That 
Heydius  did  not  injeeffc  a  fufficient  quantity  of  air,  or  at  leaft  did  not  defer 
the  difle<5tion  fo  long  as  was  requir’d  for  the  animal  to  be  quite  dead,  you 
may  eafily  gather  from  the  experiments  of  Brunnerus  and  Camerarius.  For 
Brunnerus  (z)  began  his  experiment  in  the  fame  manner  ;  and  hearing  a  noife 
in  the  prsecordia,  he  faw,  prefently  after,  the  dog  fall  proftrate,  as  if  feiz’d 
with  a  tetanus,  and  breathing  very  quick  and  faft,  and  to  all  appearance 
about  to  expire ;  yet  the  animal  foon  after  arofe:  but  at  the  diftance  of  an 
hour’s  time,  by  repeating  the  experiment,  he  foon  compell’d  him  to  die, 
being  immediately  feiz’d  with  that  kind  of  convulfion  which  is  call’d 
oTi^orov a?,  and  his  foeces  being  difeharg’d,  and  moft  of  his  veflels  turgid 
with  blood  :  and  though  no  air  was  contain’d  in  the  arteries,  yet  a  great  quan¬ 
tity  was  collected  in  the  vena  cava,  and  the  auricles  of  the  heart.  But  Ca¬ 
merarius  (a)  firft  threw  air  in  fmall  quantity  and  gently  into  the  jugular  veins  ; 
then,  after  fome  interval,  vehemently  and  in  large  quantity  :  yet  he  never 
obferv’d  any  rigor  of  the  limbs,  nor  any  concuffion,  but  rather  always  a 
laxity,  and  refolution.  At  the  firft,  indeed,  he  perceiv’d  that  the  animal  be¬ 
came  mute  and  quiet,  yet  within  half  a  quarter  of  an  hour,  it  gradually  re¬ 
cover’d  :  but  after  the  air  was  forc’d  in  with  vehemence,  he  died  very  foon, 
with  frequent  bowlings  and  gafpings.  And  in  one  of  them,  for  he  made  the 
experiment  on  two,  when  it  was  diflefted,  he  found  the  ventricles  and  veflels 
of  the  heart  fo  diftended  with  air,  that  the  pericardium  was  entirely  fill’d  by 
the  heart,  and  the  coronary  veflels  of  that  vifeus  contain’d  more  air  than 
blood.  But  the  right  auricle,  particularly,  which  could  not  be  more  ex¬ 
panded  by  any  art  whatever,  contain’d  no  blood  :  yet  blood,  altogether  fluid, 
and  frothy,  flow’d,  together  with  air,  from  the  ventricles,  when  wounded. 

(z)  Comment.  in  Pantt.  Secund.  c.  9. 

(a)  Ob f.  cit.  53. 


(u)  Opera  tom.  5. 

(x)  Confulti  medic!. 

(y)  Cent.  Obf.  Med.  obf.  90. 


And 


Letter  V.  Article  22.  1  1  3 

And  in  the  whole  round  of  the  body,  arteries,  as  well  as  veins,  exhibited 
manifeft  bubbles  of  air,  even  in  the  fmaller  branches.  Harderus  ( b )  alfo 
threw  air  into  the  jugular  vein  of  a  dog,  but  much  more  ftrongly  than  the 
others;  and  the  animal,  after  having  howl’d  a  little  while,  immediately  ceas’d 
to  refpire :  and  being  open’d,  his  heart  was  found  to  be  entirely  diftended; 
yet  the  fides  of  it,  being  wounded,  immediately  became  collaps’d,  “  flaccid 
“  and  enervate,”  containing  only  a  little  frothy  blood.  Frothy  bubbles  alfo 
were  every-where  feen.  Finally,  that  experienc’d  man  Sproegelius  (r),  as  I 
have  learn’d,  while  I  read  over  again  this  letter,  when  he  had  impeH’d  a 
fmall  quantity  of  air  into  the  lame  vein  of  a  whelp,  found,  that  death,  after 
fome  flight  convulflons,  was  in  a  fhort  time  the  confequence  ;  and  he  found 
after  death,  the  right  auricle  of  the  heart,  and  its  annex’d  ventricle,  were 
extremely  diftended  with  air,  as  in  like  manner,  all  the  veins  of  the  belly. 
And  as  upon  frequently  repeating  the  experiment  in  dogs,  and  differing 
them  after  dying  immediately  therefrom,  he  confirm’d  the  opinion,  that  the 
heart  was  fo  diftended  with  air,  that  it  could  not  contradi  itfelf ;  fo  he  alfo 
confirm’d,  that  therefore  the  motion  of  the  blood  was  immediately  flopp’d, 
but  always  found  fluid  by  him,  even  more  fluid  than  natural ;  and  not,  as 
fome  have  affirm’d,  and  as  one  has  faid  he  faw  it  in  the  lungs,  coagulated. 
For  as  to  what  relates  to  Bohn  (d),  he  feems  to  have  referr’d  to  the  quicknefs 
with  which  air  kills  when  injected  into  the  veins,  and  not  the  change  that  it 
brings  about  in  the  blood  ;  for  he  was  fpeaking  of  this,  when  he  faid,  “  that 
“  it  kill’d  the  animal,  like  the  moft  powerful  coagulator,  or  any  other 
“  poilon.”  Nor  will  I  omit  the  obfervation  of  Vallifneri  (<?),  after  having 
repeated  the  experiments  of  Redi,  that  not  only  dogs  die  fooner,  and  from 
the  injection  of  lefs  air,  than  fheep,  weathers,  and  rams  ;  but  even  that  ffieep 
do  not  die,  if  little  air  be  injedled. 

22.  And  all  thefe  things  I  was  willing  to  mention,  that  it  might  more  eafily 
be  underftood  what  was  common  in  the  experiment ;  and  what  differences, 
in  like  manner,  there  were  in  the  effects,  according  to  the  different  vein  into 
which  the  air  is  driven,  or  the  various  quantity  and  impulfe  thereof,  and 
finally,  from  the  various  nature  of  the  animals,  and  the  different  difpofition  of 
their  blood,  and  its  paffages.  And  there  are  even  fome  animals,  in  whofe 
blood  do  naturally  exift  many  air-bubbles,  being  mix’d  with  it  here  and 
there,  as  tortoifes,  for  inftance  ;  for  in  the  fpecies  of  this  animal  that  lives  at 
fea,  Redi  (/)  found  the  fanguiferous  veffels  really  full  of  cold  blood,  though 
the  animals  were  then  alive,  and  the  blood  extremely  full  of  air-bubbles. 
This  feem’d  to  him  very  wonderful,  and  he  determined  to  make  the  fame 
experiments  in  the  land  and  river  tortoiles.  Which  when  Caldefi,  from  his 
admonition,  as  I  fuppole,  had  done  (g),  he  appears  to  have  feen,  through  the 
coats  of  all  the  veffels,  which  were  traniparent,  by  reafon  of' their  thinnefs, 
thofe  bubbles  in  great  number  fludluating  within  their  blood,  which  is  actually 
always  cold,  yet  concretes  like  the  blood  of  other  animals.  I  have  myfelf, 
beyond  a  doubt,  feen  thefe  bubbles,  not  only  in  the  fea,  but  in  the  land 

(£)  Apiar.  obf.  25.  in  fchol.  ( e )  Suppi,  al  Giorn.  de’  Letter,  t.  3.  art  2. 

( c )  Exper.  circa  venena,  $  42.  (f)  Cit.  tom.  5. 

\d)  Circa  Anat.  Prog.  4.  (g)  OlTe.v.  Anat.  int.  alle  Tartarughe. 

Vol.  L  tortoife; 


i  1 4  Book  I.  Of  Difeafes  of  the  Head. 

tortoife;  and  befides,  in  very  great  quantity  in  vipers,  and  in  trout,  and 
in  carp  from  the  Lago  di  Guarda,  asLancifi(F)  did  in  the  hedge  hog ;  which 
ipecies  of  animals  have  their  blood  cold,  and,  for  the  mod  part,  a  very  per- 
fevering  motion  of  the  heart.  And  perhaps  this  will  help  us  to  account  for 
what  was  obferv’d  a  little  before  (/),  that  dogs  were  fooner  kill’d  by  this  ex¬ 
periment  than  fheep,  by  fuppofmg  that  the  ipecies  of  fheep  is  colder  than 
the  canine,  and  therefore  lefs  affedted  by  air  being  thrown  into  the  veins. 
But  that  we  may  not  be  too  much  in  a  hurry  to  draw  general  conclufions, 
which  is  a  fault  many  naturalilts  and  philofophers  have  fall’n  into,  let  me 
obferve,  that  in  the  ferpent,  fo  iimilar  to  the  viper,  I  have  fought  for  thefe 
bubbles  in  the  blood  in  vain. 

23.  Let  us  now  return  to  animals  of  a  warm  nature,  and  for  that  reafon 
bearing  fo  much  the  more  analogy  to  ourfelves  ;  and  we  find  it  is  manifeft, 
that  whichfoever  of  thefe  creatures  has  been  open’d,  after  dying  from  this  in¬ 
jection  of  air  into  the  veins,  that  fluid  has  always  been  found  collected  in  great 
quantity  in  the  heart,  or  its  auricles,  and  fo  diftending  the  parietes  of  its  ca¬ 
vities,  that  they  who  have  feen  the  appearance,  Brunnerus  (£),  Camerarius  (/), 
Harderus  (w),  and  Sprasgelius  (»),  have  all  agreed  in  this  opinion  ;  that  the 
air,  by  its  very  great  and  obftinate  diftenfion  of  the  heart,  prevents  its  fibres 
from  contracting,  in  the  fame  manner,  as  an  immoderate  congeftion  of  urine 
in  the  bladder  hinders  the  contraction  of  the  mufcular  coat  thereof.  And 
Harderus  even  thought,  that  the  fibres  of  the  heart  were  weaken’d,  and 
enervated,  in  the  fame  manner  as  thofe  of  the  bladder.  And  if  we  attend 
ciofely  to  the  fubjedt,  we  fhall  find,  that  Heydius  (0)  was  nearly  in  the  fame 
opinion  with  them  :  and  if  to  thefe  obfervations  you  transfer,  as  it  is  juft  you 
ihould,  thofe  which  I  quoted  above  (p)  from  Valfalva,  Pechlinus,  Graetzius, 
and  Ruyfch,  of  the  human  heart  being  equally  diftended  with  air,  you  can¬ 
not  avoid  attributing  the  death  of  thefe  animals,  and  thofe  men,  to  the 
fundtions  of  the  heart  being  obftrudted. 

24.  And  if  I  had  found  in  the  fifherman,  whofe  hiftory  I  have  given 
you  (q),  the  heart  or  its  auricles  diftended  with  air,  I  fhould  readily  have  be¬ 
liev’d  that  he  died  of  the  fame  kind  of  death.  But  now,  although  1  am- 
willing  to  acknowledge,  that  by  reafon  of  the  pulmonary  artery  being  fo  di¬ 
ftended  with  air,  as  I  adtually  faw  it,  the  circulation  was  impeded  in  the  prae¬ 
cordia  ;  yet  becaufe  I  found  the  veflels  in  no  other  part  equally  tumid  with 
frothy  blood,  as  thofe  of  the  cerebrum  and  cerebellum,  it  does  not  feem  to 
me,  that  I  fhould  trefpafs  beyond  the  bounds  of  reafon,  if  I  fhould  account 
for  the  man’s  apoplexy,  and  fudden  death,  from  the  motion  of  this  frothy 
blood  being  obftrudted  by  the  bubbles  of  air  that  were  in  it.  For  the  narrow 
paflages  of  thofe  fmall  arteries  might  eafily  be  flopp’d  up,  their  {lender  coats' 
enervated  by  diftenfion,  and  the  origins  of  the  nerves  comprefs’d  thereby. 
Nor  are  other  difledtions  of  apopledtic  perfons  wanting,  in  the  vefiels  of  whofe 
cerebrum  air  has  been  found.  I  fhall  produce  two  from  Brunnerus  (r)  below. 


(t>)  De  Mot.  Cord.  Poflul.  15.  in  fchol.  & 
1.  1.  f  1.  c.  2.  digr.  1. 

(0  N.  2!. 

(d  Eph.  N.  C.  dec.  3.  a.  2.  obf.  223. 


(/)  In  fchol.  ad  obf.  33.  cit.  fupra,ad  n.21, 
( m )  Schol.  ibid.  cit.  (»)  §  42.  cit. 

(0)  Obf.  ibid.  cit.  90.  (/>)  N.  20. 

(?)  Supra,  n.  19,  (r)  N.  30. 


And 


Letter  V.  Article  2  5.  115 

And  even  in  Johannes  Wilhelmus  Albrechtus,  profefibr  of  anatomy  at  Got¬ 
tingen  (j),  when  a  kind  of  fleepinefs,  attacking  him  fuddenly,  had  taken 
away  his  ienfation  and  fpeech,  and  within  two  days  his  life,  fo  that  there 
were  phyficians  who  judg’d  his  diforder  to  be  a  real  apoplexy,  air  was  very 
evidently  leen  in  the  vefiels  of  the  brain.  But  in  thefe  three  were  other  caufes 
exifting  in  the  brain,  from  which,  without  that  air,  an  apoplexy  might  happen-» 
the  force  of  which  caufes  you  may  fuppofe  to  have  been  encreas’d  thereby, 
though  they  did  not  take  their  origin  from  thence.  But  in  the  difleCtions  of 
the  ./Ethiopian  (/),  and  of  the  fifherman,  which  I  have  given  you,  were  no 
other  caufes  in  the  brain  that  could  be  put  in  competition  with  them,  except 
the  air:  and  (till  lefs  in  a  woman,  who  being  to  all  appearance  in  good  health, 
like  the  /Ethiopian,  fell  down  dead  luddenly.  For  her  body  being  differed 
accurately,  according  to  cuftom,  by  that  excellent  anatomifl  Philippus  Con- 
radus  Fabritius  («),  when  he  look’d  for  the  caufe  of  that  kind  of  apoplexy, 
he  not  only  found  the  fubftance  of  the  brain  firm,  as  I  did  in  the  two  above 
mention’d,  but  even  without  a  drop  of  blood,  or  ferum,  any  where  effus’d : 
fo  that  he  exprefly  affirm’d,  that  every  true  and  fpeedily-fatal  apoplexy  did  by 
no  means  arile  from  blood,  or  ferum,  being  extravafated,  nor  from  a  con- 
geftion  of  blood  in  the  vefiels  of  the  brain  for  in  that  woman,  the  arteries 
and  veins  of  the  brain,  and  the  finuffes  of  the  dura  mater,  were  found  empty 
of  blood,  “  but  diftended  with  air.” 

25.  Now  it  remains  only  for  me  to  endeavour  to  anfwer  your  queftion  (x) 
fatisfaflorily,  if  it  is  poflible  to  conjecture  by  what  method  the  air,  which  is 
fo  accurately  intermix’d  with  the  particles  of  the  blood,  can  extricate  itfelf 
therefrom,  fo  as  to  form  fuch  a  number  of  bubbles  on  a  fudden.  And  Littre, 
indeed,  has  lay’d  it  down  as  a  poltulate  ( jy),  that  the  air  continues  to  be  in¬ 
timately  mix’d  with  all  the  humours  of  our  body,  as  long  as  they  preferve 
their  natural  motion  and  fluidity-,  but  if  thefe  two  are  diminifh’d,  that  the 
air  immediately  detaches  itfelf  from  them,  Therefore,  having  found  in  the 
bodies  of  thofe  who  had  died,  a  little  after,  large  effufions  of  blood,  many 
fmall  branches  of  veins  full  of  air  (2),  and  giving  two  reafons  for  this  ap¬ 
pearance,  he  brings  this  as  the  firft,  that  the  motion  of  the  blood  was  flower, 
by  real'on  of  the  ftrength  being  broken,  and  that  it  was  alfo  very  thick  and 
denfe,  which  he  actually  faw,  and  therefore  the  air  had  reftor’d  itfelf  co  li¬ 
berty  ;  the  particles  of  the  blood  itfelf  having  been  accefiary  thereto,  fince 
they  were  under  a  necefiity  of  preffing  out  the  particles  of  air  from  betwixt 
them,  in  order  to  come  nearer  to  each  other,  and  be  condens’d.  But  I  think, 
if  we  were  not  to  add  other  things  to  the  arguments  of  this  experienc’d  man, 
which  would,  in  my  opinion,  illuftrate  his  hypothefis,  it  would  certainly  fol¬ 
low,  that  we  fliould  fee  extricated  and  elaftic  air  much  more  often  in  difleCtions 
than  we  do.  However,  I  {hall  not  add  them  here,  becaufe  in  the  /Ethiopian 
I  found  no  concreted  blood,  and  in  the  fiflierman  but  a  very  fmall  portion  : 
fo  that  the  explication  is  to  be  enquir’d  after  in  another  place,  Yet  it  will 
not  be  ufelefs  to  have  produc’d  the  hypothefis  of  Littre  :  for  as  the  fame  ef- 

(j)  Commere.  Litter.'a.  1736.  heb.  12.  n.  1.  ( x )  Supra,  n.  18.  in  fin. 

(/)  Supra,  n.  17.  (j)  Hift.  de  1’  Acad.  R.des  Sc.  a.  1 7 1  -4-* 

(a)  Propemptic.  ad  Diflert.  Jo.  Barth.  HofF-  (z)  Memoir  de  la  memo  annee. 
manni. 

Qg  2  fe&s 


1 1  6  Book  I.  Of  Difeafes  of  the  Head. 

feels  may  happen  in  different  bodies  from  different  caufes  ;  and  as  this  effect 
is  to  be  met  with,  according  to  Ruyfch  (^ ),  “  frequently  in  thofe  who  die 
41  fuddenly;”  it  will  certainly  be  of  advantage  to  know  many  caufes,  that 
you  may  choofe  out  at  one  time  and  at  another,  whichsoever,  all  things  con- 
iider’d,  may  feem  beft  to  anfwer  your  purpofe. 

2 6.  And  with  this  intention  we  Shall  alfo  confider  the  other  caufe  of  Littre, 
(which,  though  it  does  not  relate  to  the  extrication  of  air,  ytt  relates  to 
the  too  great  quantity  of  it  exifting  in  the  blood,  which  Ruyfch  and  I  have 
finally  in  view)  I  fhall  now  confider,  I. fay,  the  fecond  of  thofe  two  caufes, 
which  Littre  invented  ;  or  rather,  if  we.  fpeak  only  of  this  fecond,  that 
which  he  had,  in  fome  meafure,  receiv’d  from  Mery.  For  Mery  ( b )  having 
prick’d  the  vena  cava  of  a  living  dog,  above  the  emulgents,  and  obferv’d 
that  as  the  vein  emitted  its  blood,  it  was  fill’d  with  air  bubbles,  entering  in 
together  with  the  blood  from  the  roots  of  the  veins,  and  being  the  larger, 
as  the  blood  was  more  exhaufted  •,  did  not  doubt,  but  thefe  bubbles  pro¬ 
ceeded  from  the  air ;  which  being  taken  in  by  refpiration,  and  carried  to 
the  pulmonary  veins,  was  convey’d  from  thence,  together  with  the  blood, 
into  the  right  ventricle  of  the  heart,  and  aorta,  and  at  length  into  the  roots 
of  the  vena  cava.  This  explication  was  fo  much  the  more  ready  and  con¬ 
venient  to  Mery,  as  he  denied,  that  the  air,  even  when  admitted  naturally 
by  the  pulmonary  vein  into  the  blood,  could  be  intimately  mix’d  therewith 
inafmuch  as  it  was  already  fufhciently  replete  with  air,  which  was  clofely 
united  with  its  particles,  as  it  had  been  before  with  the  particles  of  food  and 
liquor,  of  which  it  was  compos’d.  Wherefore  he  judg’d,  in  fa<5t,  that  this 
air  was  intimately  mix’d  with  the  blood,  much  in  the  fame  manner  as  fait  is 
diffolv’d  in  water ;  and  confequently,  that  it  would  pafs  through  any  of  the 
emunCtories  or  ftrainers  of  the  body,  together  with  the  humours  fecreted  from 
the  blood  but  that  the  other  taken  in  by  the  pulmonary  vein,  like  fait 
added  to  water,  already  faturated  therewith,  will  always  remain  unmix’d, 
and  in  its  original  form  ;  and  therefore  can  never  efcape  from  the  channels 
of  the  blood,  unlefs,  when  it  comes  to  the  pulmonary  artery  together  with 
the  blood,  it  return  by  the  afpera  arteria,  the  fame  way  that  it  enter’d.  But 
Mery  (r)  himfelf,  had  been  fome  time  before  this  of  a  different  opinion  ; 
when  he  fuppos’d,  that  the  air,  abforb’d  by  the  lungs,  was  “  exquifitely 
mix’d  with,  the  blood  in  the  pulmonary  veins ;  and  that  left  at  any  time,  be¬ 
ing  too  much  encreas’d,  it  fhould  impede  the  contraction  of  the  heart,  “  it 
te  was  thrown  off  by  infenfible  perfpiration and  as  this  was  done  “  very 
“  flowly,  in  a  tortoife,”  therefore  air  abounded  in  its  veffels.  And,  in  con- 
fequence  of  this,  Littre,  as  he  follow’d  the  more  antient  opinion  of  Mery, 
in  a  ftate  of  body,  that  is  found  and  natural;  fo  when  the  blood  was  di- 
minifh’d  by  profule  hemorrhages,  and  more  condens’d,  he  fo  far  approv’d 
of  this  more  recent  opinion,  as  to  deny  with  him,  that  the  air  could  at  that 
time  be  intimately  mix’d  with  a  blood  of  this  kind,  and  to  bring  the  bub¬ 
bles  by  the  fame  way  as  Mery  did,  into  the  roots  of  the  veins. 

{a)  Refp.  ad  Epift.  probi.  1 6.  (<r)  Vid.  Du  Hamel.  R.  Sc.  Acad.  Hill.  1. 

\h)  Idem,  de  l’Acad,  R,  des  Sc.  A.  1707.  4.  S.  2.  c.  3.  n.  12  &  13. 


27.  But 


Letter  V.  Article  27.  117 

27.  But  it  is  not  neceffary,  nor  indeed  is  it-  poffible,  to  confider  accurately 
here,  all  the  arguments  relative  to  the  paffage  of  air  to  and  from  the  blood  ; 
Since,  as  Celfus  has  faid  on  another  fubjedt(d),  “  thefe  things  have  been 
<c  often  treated  of  by  phyficians,  through  many  volumes,  with  great  earneft- 
“  nefs  of  difputation,  and  will  ft  ill  be  a  matter  of  contention.”  There  were 
formerly,  and  there  are  now,  thofe  who  contend,  that  air  is  even  admitted, 
and  emitted,  through  the  pores  of  the  Skin  •,  and  they  fay,  that  Afclepiades 
had  a  view  to  this,  when  he  attributed  fo  much  efficacy  to  fridtions,  to  wit, 
that  they  open’d  a  paffage  outwards  for  the  air,  which  was  corrupted,  and 
fpoil’d,  by  long  retention,  and  gave  entrance  to  thal  which  was  freffi  and 
wholefome.  And  there  are  fome  among  thefe,  who  hold,  that  it  is  carried 
in  and  out  by  the  afpera  arteria,  efpecially  in  that  manner  which  Jo.  Alphonfo 
Borelli  (e)  has  previously  hinted,  that  is,  mix’d  with  a  watry  humour,  and  in 
fotne  meafure  diffolv’d  ;  fo  that  they  think,  it  may  eafily  enter  the  lympm- 
dudts,  and  the  veins.  But  I  cannot  help  wondering  at  fome  of  them,  who, 
though  they  admit  air  fo  freely  through  the  lungs  of  the  fkin,  do  not  equally 
admit  of  its  paffing  by  the  way  of  the  chyle,  \fith  which  it  can  be  Shewn  to 
be  intimately  mix’d,  in  the  fame  manner  as  with  the  blood,  according  to 
what  I  faid  above  (/) ;  but  either  take  no  notice  of  this  paffage,  or  entirely 
deny  it.  Nor  does  it  efcape  me,  that  there  are  fome,  on  the  other  hand, 
who  openly  diffent  from  all  thefe  opinions.  And  in  regard  to  the  lungs,  I 
very  well  remember  hearing  a  celebrated  dodtor,  when,  from  the  roftrum, 
he  deny’d,  that  if  we  take  the  moft  recent  lungs,  having  cut  off  their  vef- 
fels  at  the  bafis  of  the  heart,  put  them  into  water  moderately  warm,  and  in¬ 
flate  them  more  Strongly  than  frequent  refpiration  generally  does  j  he  de¬ 
ny’d,  I  fay,  that  the  lead  bubble  of  air  ever  appear’d  in  the  water  •,  which 
was  a  manifeft  proof,  that  the  air  was  in  no  manner  tranfmitted  into  the  pul¬ 
monary  vein.  But  however,  at  the  time  when  I  was  making  many  experi¬ 
ments  on  the  parts  both  of  animal  and  human  bodies,  with  my  friends  at 
Venice,  I  faw  the  trunk  of  the  pulmonary  vein  fill’d  with  a  frothy  humour» 
by  inflating  the  lungs,  efpecially  by  repeated  and  long-continued,  though 
not  violent,  inspirations:  and  after  others,  I  read  Berge-rus(^),  who  testifies, 
that  water  injedted  by  the  bronchia,  without  applying  any  force,  paSs’d * 
through,  and  came  frothy  into  the  pulmonary  vein ;  and  that  being  injedted 
by  a  branch  of  the  pulmonary  artery,  it  alfo  return’d  by  the  bronchia.  And 
from  that  time  I  was  never  So  averfe  to  the  opinion  of  thofe  who  thought 
that  the  air,  not  only  enter’d  the  blood  by  innumerable  and  Separate  little  fo¬ 
ramina,  that  it  might  be  better  mix’d  therewith,  or  at  leaft  of  thofe  who 
confider’d  its  being  perform’d  in  the  fame  manner  that  Borelli  taught,  but 
who  thought  that  it  came  out  the  fame  way  •,  I  fay,  I  was  not  fo  averfe  *, 
for  though  I  can  anfwer  to  fome  things  which  are  objedted  to  this  dodtrine, 
yet  I  leem  not  to  be  able  to  anfwer  equally  to  the  others.  But  if  you  can, 
you  not  only  have  enough  already,  from  whence  you  may  underftand,  with 
Littre,  by  what  means  air  abounds  in  the  blood,  after  large  hemorrhages  ^ 

(d)  De  Medicina  in  prsef.  (f)  Supra  ns  18. 

(e)  De  Mot.  Animal,  p.  2.  Propof.  113.  ^  (gj  Phyfiol.  Med.  1.  r.  c.  4. 


% 


r  i  8  Book  I.  Of  Diforders  of  the  Head. 

but  perhaps  alio,  from  which  to  conjecture,  how  the  fame  thing  fometimes 
happens,  even  when  thofe  caules  have  not  preceded. 

28.  For  if  thofe  fmall  orifices,  through  which  air  is  to  pals  out  from  the 
blood,  be  by  any  means  conftring’d,  or  flopp’d  up,  the  others  continuing 
pervious,  whole  office  it  is  to  admit  air  into  the  blood,  inafmuch  as  they  are 
appendages  of  the  pulmonary  vein,  and  not  of  the  pulmonary  artery;  you 
fee,  that  immediately  too  great  a  quantity  of  air  will  be  collected  in  the 
blood  ;  and  you  fee  alio,  how  near  Thomas  Bartholin  {b)  came  to  this  con¬ 
jecture,  when  he  wrote,  that  through  this  artery,  44  in  bodies  that  were  found, 
44  recrementitious  matter  was  difcharg’d  in  expiration,  which  is  nothing  elfe 
44  but  the  aerial  particles  excited  in  the  blood  of  the  heart,  and  the  other 
44  parts  of  the  body (or,  as  he  had  faid  before,  44  nothing  but  the  air  and 
44  luperfluous  flatus  of  the  crude  blood)  from  whence  alfo  the  flatus,  that 
44  was  troublefome  in  the  veins,  according  to  Hippocrates  and  Galen ;  which, 
44  if  not  evacuated  by  the  common  fan  of  the  body,  not  only  bring  on  va- 
44  rious  painful  fymptoms,  but  even,  if  they  ftagnate,  may  caufe  a  rupture 
44  of  the  veins,  or  raife  the  whole  body  into  a  tumour.”  And  Plato  (i)  alfo, 
kerns  not  only  to  have  touch’d  upon  the  whole  of  this  hypothefls,  but  that 
likewife  which  I  {hall  afterwards  fubjoin  :  and  I  am  not  forry  to  quote  his 
own  words  on  the  occafion.  For  he  fays,  44  When  the  lungs,  the  guard, 
44  and  as  it  were  ftore-keeper  of  breath  itfelf,  being  obftrufted  by  defluxion, 
44  has  not  its  vents  free  and  open;  and  on  one  hand,  no  air  is  difcharg’d; 
44  and  on  the  other,  more  than  is  neceflary,  is  receiv’d;  then  thofe  parts, 
44  which  want  refpiration  and  cooling,  wither  away.  But  that  which  is  re- 
44  ceiv’d  over  and  above,  being  carried  through  the  veins,  tortures  them, 
44  and  melts  down  the  body.”  And  a  little  after :  44  Air  is  often  generated, 
44  even  within  the  body,  when  the  flefli  is  flabby  and  rarefied;  which,  as  it 
44  cannot  get  forth,  gives  the  fame  pains  as  air  would  that  came  in  from 
44  without.  But  it  then  gives  molt  excruciating  pains,  when  it  inflates  and 
44  diftends  the  nerves  and  veins  that  lie  round  it.” 

29.  But  as  all  thele  explications,  and  thofe  of  a  like  nature,  may  perhaps 
have  place  given  them,  on  different  occafions,  at  other  times,  fo  I  fear  they 
claim  no  place  in  the  hiftories  which  I  have  defcrib’d ;  as  in  thefe  the  blood 
had  been  neither  too  denfe,  nor  too  flowly  circulated,  nor  previoufly  dimi- 
niffi’d  ;  nor  any  mark  of  the  orifices  of  air  in  the  lungs  being  fhut  up,  or 
conftring’d,  had  preceded.  Yet  figns  of  a  vitiated  concobtion,  or,  if  you 
would  rather  have  it  fo,  of  that  folution  which  is  made  in  the  ftomach  and 
inteftines,  had  preceded  :  for  the  ^Ethiopian  had  been  fubjedl  to  a  languor  of 
his  ftomach,  and  the  fifherman  to  flatulent  diforders  of  the  belly.  Is  it  pof- 
flble  then,  that  from  the  food  being  ill-digefted,  bubbles  of  air  coming  forth 
in  greater  quantity  than  natural,  for  the  reafon  pointed  out  by  Brunnerus  (£), 
or  any  other,  and  mix’d  with  the  chyle,  fhould  havp  gradually  dilated  the 
orifices  of  the  labfeal  veflels ;  fo  that  at  length,  a  great  number  being  form’d, 
as  it  were,  into  a  phalanx,  broke  in  altogether  upon  the  blood,  together 
with  the  chyle  ?  Or  ffiall  we  rather  believe,  that  becaufe  thefe  bubbles,  being 
thus  extricated  and  fet  at  liberty,  might  have  obftrudted  their  own  paflage 

{ h }  Diatrib.  de  Puhn.  fubft.  S.  2.  (/)  in  Tinueo.  (i)  Gland.  Duoden.  c.  10. 


I 


in 


Letter  V.  Article  30.  1  1  p 

in  thofe  veins,  and  prohibited  all  accefs  through  the  {freights  of  the  mefen- 
teric  glands,  as  1  faid  before,  in  regard  to  the  fanguiferous  veffels  (/)  •,  ffiall 
we  rather  believe,  I  fay,  that  they  were  intimately  mix’d  with  the  chyle,  but 
in  fo  much  the  greater  number,  as  the  matter  which  furnifh’d  out  the  chyle, 
was  longer  retain’d  in  the  ftomach  and  inteftines,  by  reafon  of  the  weaknefs 
of  theie  parts  ;  and  that  thus  they  were  brought  into  the  circulation,  and 
there  at  length  began  to  expand  and  difentangle  themfelves,  iome  unufual 
preternatural  cauie  being  acceffary  thereto  ?  For  why  may  not  the  fame 
thing  happen  within  the  veins,  which  we  frequently  fee  happen  without  the 
body  ;  that  the  lame  humour,  being  mix’d  with  any  one  liquor,  emits  no 
bubbles,  but  being  mix’d  with  another,  emits  many  ?  We  fee,  in  like  man¬ 
ner,  in  regard  to  other  juices  out  of  the  body,  that  while  they  are  corrupted 
and  putrefy,  not  lefs  of  bubbles  than  of  ftench  proceeds  from  them.  And 
how  ftrong  a  fmell  came  from  the  body  of  the  fiffierman,  how  many  manifcft 
ligns  of  fudden  corruption,  and  even  of  putrefaction,  appear’d,  the  hiftory 
of  itfelf  fufficiently  fhews.  Certainly,  under  our  very  hands  and  eyes,  par¬ 
ticles  of  air  began  here  and  there  to  difengage  themfelves  ;  certain  bonds 
being,  as  it  were,  broken,  which  feem  to  confine  them  fo  long  as  the  blood 
retains  its  nature.  And  it  is  pofiible,  that  fome  of  thefe  bonds  may,  before 
death,  at  fome  times,  and  in  fome  places,  begin  to  be  fufficiently  broken,  in 
order  to  bring  about  this  effeCt,  if  not  entirely  diffolv’d. 

30.  But  in  the  ^Ethiopian,  as  there  were  more  obfcure  marks  of  putre¬ 
faction  only,  fo  were  there  fewer  bubbles,  and  none  indeed  that  were  confpi- 
cuous  in  any  other  veffels  than  thofe  of  the  brain.  And  why  in  thofe  veffels- 
only  ?  Was  it  becaufe  they  could  be  more  eafily  feen  through  the  fides  of 
thefe  veffels  than  of  others,  as  they  are  conftruCted  of  the  thinned  coats  of 
all  the  fanguiferous  tubes  ?  Or  was  it,  rather,  from  fome  peculiar  caufe  in 
them  ;  for  inftance,  from  their  great  narrownefs,  which  would  be  diffident 
to  retain  even  the  fmalleft  bubbles,  and  make  them  unite  into  larger  ones 
which  by  again  joining  themfelves  to  others,  would  form  dill  larger,  become 
more  confpicuous,  and  didend  the  neighb’ring  parts  of  the  veffels  ?  Or  whe¬ 
ther  that  happen’d  by  fome  accident,  I  ffiall  not  take  upon  me  to  affirm.  But 
if  you  could  have  afk’d  me  that  quedion  formerly,  when  the  doCtrine  of  va¬ 
pours  was  in  common  edeem,  and  the  head  was  us’d  to  be  compar’d  with  an 
alembic,  it  would  have  been  very  eafy  for  me  to  have  refolv’d  it ;  and  you, 
perhaps,  by  comparing  it  with  what  I  had  feen  in  the  ^Ethiopian,  would, 
judge,  that  the  cafe  might  be  better  interpreted  according  to  the  founder 
doftrine  of  Avicenna  (m) ;  which  is,  “  that  a  great  pain  of  the  head  is- 
brought  on,  by  reafon  of  the  arteries  bringing  noxious  vapours  to  the  brain.” 
And  I  now  fee,  what  you  alfo  may  know  from  the  Sepulchretum  (n),  that 
the  learned  man  Brunnerus,  to  whom  this  fame  appearance  happen’d,  in  fome 
meafure,  before  me,  left  it  entirely  unexplain’d.  For  whereas,  in  the  bodies 
of  two  perfons,  and  apopleCtic  perfons  too,  he  had  found,  at  the  fides  of 
the  brain  of  one,  <k  the  arteries  very  large,  and  almad  empty,  and  the  veins 
“  very  large  alfo,  and  diftended  with  flatus  *”  and,  in  like  manner,  had  found 

(/)  Supra  n.  18.  («)  1.  i.  S.  z.  in  Additam,  obf.  i.i  &  12. 

(w)  Canon.  1.  3.  Fen.  1.  tr.  2.  a.,  i. 


120 


Book  I.  Of  Difeafes  of  the  Head. 

in  the  other,  “  the  veins  that  went  into  the  longitudinal  finus  containing  air, 
“  which  he  puflTd  backwards  and  forwards  with  the  point  of  his  finger *,” 
yet  in  the  fcholia,  which  he  fubjoin’d  to  each  diffeCtion,  although  he  fpoke 
diffufely  of  other  things,  which  he  met  with  in  them,  he  did  not  fay  a  Tingle 
word  of  this  flat  us  :  whether  becaufe  other  caufes  were  not  wanting  in  the 
brain,  and  more  evident  than  this,,  to  account  for  the  apoplexy*,  or  whether 
it  Teem’d  to  him,  that  it  might  be  very  eafily  explain’d  from  thence,  why  air 
Ihould  be  in  the  neighb’ring  veffels  ;  or  finally,  whether  he  thought,  that 
nothing  was  to  be  rafhly  attempted  in  a  fubjeCt  never  agitated  by  any  one 
before  that  time.  I  would  not  have  you,  therefore,  believe  me  to  be  ex¬ 
tremely  audacious  :  for  which  reafon,  farewel. 

1  '  i 


LETTER  the  SIXTH. 

/ 

Which  treats  of  the  remaining  Soporific  Diforders. 

I.  XT'  O  U  are  pleas’d  to  tell  me,  that  my  laid  letter  was  the  more  agreeable 
to  you,  pn  account  of  the  long  difquifition  which  I  made  in  regard 
to  the  quantity  of  air  found  in  the  blood  ;  and  I  rejoice  that  I  have  been  thus 
far  obfequious  to  your  pleafure.  But  I  would  have  you  at  the  fame  time  ob- 
ferve,  that  if  1  go  on  at  this  rate  with  conjectures,  and  dwell  thus  long  upon 
explications,  I  fhall  certainly  not  have  room  to  communicate  all  the  obfer- 
vations  of  Valfalva,  and  myfelf,  relative  to  the  remaining  diforders.  Yet 
this,  you  know,  was  my  chief  and  original  defign  in  writing,  and  is  alfo  more 
worthy  both  of  you  and  me.  Let  us,  therefore,  for  the  future,  be  more 
Tparing  in  our  conjectures,  the  evidences  of  which  we  cannot  at  the  fame 
time  afford  *,  and  let  us,  if  it  be  not  difagreeable  to  you,  dwell  chiefly  upon 
hiftories,  the  truth  of  which  I  can  readily  affirm.  Yet  I  have  but  few  ob- 
fervations  which  belong  to  the  next  feCtion  that  follows  ( a )  in  the  Sepul- 
chretum,  De  reliquis  affeCtibus  foporofis  \  and  none  at  all  that  belong  to 
the  two  next  feCtions  after  that  (£),  to  wit,  Be  catalepfi ,  de  infomnits, 

L?  incubo ;  under  which  heads  there  are  very  few  obiervations  even  in  the 
Sepulchretum.  For  the  incubus,  or  night-mare,  and  the  horrid  dreams  which 
ufually  attend  it,  not  only  happen  very  rarely,  but  are  never  mortal  till 
they  have  degenerated  into  other  diforders.  And  the  catalepfy  is  ftill  more 
rare  ;  and,  in  fhort,  all  the  other  foporific  diforders,  except  the  apoplexy, 
though  they  often  happen  indeed,  are  neverthelefs  feldom  alone,  but  join’d 
with  other  difeafes,  and  efpecially  with  fevers.  We  fhall  probably,  therefore, 
fay  more  of  foporific  affeCtions  on  other  occafions  *,  and  we  will  even  here 
produce  thofe  hiftories,  in  which  though  they  were  obferv’d  in  fome  peculiar 
manner,  yet  they  were  generally  attended  with  fome  other  diforder  before  the 
patient  fell  a  facrifice  thereto.  And  firft,  I  fhall  give  you  five  from  Valfalva, 

(*)  &  &  £> 


{a)  L.  I,  3. 


four 


Letter  VI.  Articles  2,  3,  4,  5'.'  121 

four  of  which  I  found  in  his  papers,  and  the  fifth  he  formerly  related  to  me, 
with  which  I  will  immediately  begin. 

2.  Aloyfio  Ratta,  brother  to  the  fenator  of  Bologna  of  that  name,  being 
a  man  advanc’d  in  years,  and  having  been  liable,  for  a  long  time  paid,  to 
the  hypochondriac  affection,  and  vertigo,  began,  in  the  fummer  of  the  year 
1705,  to  have  an  immoderate  third;  and  in  the  month  of  November  fol¬ 
lowing,  as  far  as  I  can  remember,  he  was  fuddenly  leiz’d  with  the  diforder, 
which  I  fhall  deferibe  in  a  few  words.  For  a  delirium  was  join’d  to  a  good 
pulfe,  and,  what  was  the  chief  fymptom,  a  very  great  fleepinefs.  Of  thefe 
diforders,  in  about  two  days,  he  died. 

In  the  abdomen  and  thorax,  when  open’d,  every  thing  appear’d  found  ; 
and  although  there  was  a  fmell  of  that  kind,  which  is  ufual  in  thofe  who  have 
worms,  that  made  fome  fneeze,  and  brought  tears  into  the  eyes  of  others, 
yet  no  worms  were  any  where  found.  The  fkull  being  faw’d  open,  a  gela¬ 
tinous  water  lay  among  the  convolutions  of  the  brain  :  there  was  water  alfo 
in  the  ventricles,  and  where  the  medulla  oblongata  defeends  into  the  tube  of 
the  fpine ;  but  in  both  places  it  was  in  fmall  quantity  only. 

3.  A  fever  of  the  word:  kind  feems  to  have  been  join’d  with  a  comatofe 
diforder  ;  although  the  brain  alfo,  having  been  liable  to  long-continued  indif- 
pofitions,  and  for  that  reafon  lefs  able  to  refill  the  caufe  of  the  diforder 
that  was  fallen  upon  it,  might  perhaps  haften  his  death.  If  worms,  as  well 
as  the  odour  of  them,  had  been  any  where  found,  then  you  would  have  a 
hiltory  in  the  Sepulchretum,  which  you  might  compare  with  this  (c) ;  for  in 
that,  a  girl  of  nine  years  of  age  was  taken  off,  even  fooner  than  Valfalva’s 
patient,  by  a  foporific  diforder,  which  had  its  origin  from  worms.  And  in 
the  fame  place  you  will  find  Ballonius  (d)  afiferting,  that  even  men  have  been 
fometimes  opprefs’d  with  great  drowfinefs  from  the  fame  caufe.  But  let  us 
now  attend  to  a  diforder,  fucceeding  in  like  manner  to  a  fever  of  the  word: 
kind,  which  might  have  been  referr’d  to  that  fpecies  of  diforder  call’d  carus. 

4.  A  woman,  aged  five-and-twenty  years,  was  fe-iz’d  with  a  malignant 
fever,  attended  with  deafnefs  in  the  beginning.  On  the  feventeenth  day,  a 
fleepy  diforder  came  on,  which  became  fo  heavy,  that  the  patient  neither 
open’d  her  eyes  when  fhe  was  fpoken  to,  nor  return’d  the  leaft  anfwer  to  any 
one.  After  death,  her  brain  was  found  to  be  entirely  natural  :  only  that  it 
emitted  a  little  quantity  of  ferum  through  the  infundibulum,  when  it  was 
taken  out  from  the  cranium.  But  in  the  cavity  of  the  tympanum,  and  the 
neighbouring  finuofities,  was  a  fanious  matter. 

5.  That  Valfalva  had  frequently  found,  the  deafnefs  which  came  on  in 
acute  diforders  to  be  attended  with  redundant  water  in  the  tympanum,  I  have 
laid  on  a  former  octafion  (e).  But  this  began  with  the  fever  itfelf,  and  was 
from  fanies.  Moreover,  that  pus  is  fometimes  form’d  in  the  heads  of  le¬ 
thargic  patients,  that  dodlrine  of  the  ancients  (/)  feems  to  aflert,  which  makes 
lethargy  to  confill  in  inflammation  and  impolthumation  of  the  brain  ;  and 
the  oblervations  let  forth  in  the  Sepulchretum  (g)  confirm.  Among  which, 

(<r)  Sett.  hac  3.  obf.  42.  (f)  Vid.  apud  Senert.  Med.  Pradl.  1.  1. 

( d )  In  fcho!.  p.  2.  c.  20. 

<0  Epift.  Anar.  7.  n,  6.  (^)  Sect.  3.  cic.  obf.  31,  33,  34. 

V*OL.  I. 


R 


when 


12  2 


Book  I.  Of  Difeafes  of  the  Head. 

when  I  read  over  one  that  gives  the  relation  of  a  boy  being  dead  from  a  fo- 
porific  pain  of  the  head,  and  of  pus  flowing  out  from  the  cavity  of  the 
lkull,  through  the  noftrils,  after  death ;  another  hiftory  came  into  my  mind, 
which  Hippol.  Franc.  Albertini,  a  phyfician  whom  I  am  wont  with  great 
juflice  to  praife,  had  inform’d  me  of.  A  parifh-prieft,  after  being  long  ex¬ 
pos’d  to  the  jun,  for  he  liv’d  in  the  country,  was  fo  far  affiibted  with  a  vio¬ 
lent  and  continual  double  tertian  fever,  and  with  delirium,  convulfions,  and 
lethargy,  which  were  foon  after  added  thereto,  that  being  given  up  by  the 
phyflcians  as  defperate,  he  was  fuppos’d  to  be  dying  on  the  fourteenth  day  ; 
yet  on  that  very  day,  after  a  great  difcharge  by  urine  and  fweat,  he  was  al- 
moft  entirely  fieed  from  his  fever.  But  Albertini,  feeing  that  the  lethargy 
dill  continu’d,  and  that  the  common  difeafe  of  the  whole  body  was  fubdu’d, 
but  not  the  difeafe  of  the  particular  part,  determin’d  to  attempt  the  removal 
of  that  alfo  :  for  he  fufpe&ed  that  there  v/as  an  impofthume  latent  in  the 
head,  and  that  anteriorly,  becaufe  the  diforder  had  begun  with  a  pain  in  the 
forehead.  He,  therefore,  was  bold  enough,  to  ufe  his  own  words,  to  attempt 
the  rupture  of  the  impofthume,  by  applying  fnuff  to  the  noftrils  of  the  pa¬ 
tient,  and  calling  upon  him  at  the  fame  time  to  draw  in  his  breath  ftrongiy. 
By  which  means  a  fneezing  was  brought  on,  and  a  bloody  pus  in  confiderable 
quantity  difcharg’d  from  the  noftrils  :  and  the  patient  being  purg’d  by  this 
way,  was  very  well  on  the  twenty-firft  day,  except  that  he  was  fubjeft  to  a 
vertigo,  flinging  of  the  ears,  and  other  complaints  of  that  kind  ;  and  con¬ 
tinu’d  lb  for  lbme  years.  He  was,  however,  living,  and  in  good  health, 
when  this  relation  was  made  to  me. 

It  were  greatly  to  be  wifh’d,  that  the  heads  of  thofe  perfons,  upon  whom 
fuch  obfervations  have  been  made,  fhould  after  death  fall  into  the  hands  of 
fome  diligent  diflfedfor,  and  one  who  fhould  not  be  ignorant  of  what  had 
preceded  ;  in  the  manner  it  has  been  done  fometimes,  as  I  have  fhewn  in  the 
fecond  letter  to  you($)  :  fo  that  it  might  be  evident,  from  ocular  demon- 
ftration,  that  the  pus  had  really  come  from  the  cavity  of  the  cranium,  and 
not  from  the  pituitary  finuffes.  But  to  lay  afide  this  wifli,  which  we  can 
very  rarely  put  into  execution,  there  are  very  few  inftances,  among  the  great 
number  of  obfervations  colledted  in  the  Sepulchretum,  if  you  except  the 
cafes  of  wounded  perfons,  which  we  are  always  fuppos’d  to  do  here,  of  pus 
being  found  in  the  cavity  of  the  cranium  after  foporific  diforders.  We  read 
that  water,  for  the  moft  part,  was  found  ;  and  this  you  will  alfo  remark  in 
thefe  obfervations  of  Valfalva,  and  mine,  either  in  fmall  quantity,  as  you 
law  in  the  examples  above,  or  in  large  quantity,  as  you  will  fee  in  the 
example  which  follows  next. 

6.  A  young  man  of  fifteen,  who  was  liable  to  a  vertigo,  fell  fuddenly  on 
the  ground,  all  fenfe  and  motion  being  fupprefs’d.  An  hour  after,  he  came 
to  himfelf,  but  the  motion  of  his  tongue  was  fomewhat  impair’d.  A  few 
days  after  this,  he  fell  into  an  acute  fever,  which  was  follow’d  by  a  foporific 
diforder,  attended  with  flight  convulfive  motions  :  his  face  was  red.  At 
length  he  died.  A  great  quantity  of  ftagnating  ferum  was  found  in  the 
brain. 


(£)  N.  1 6. 


letter  VI.  Articles  7,  8,  9,  10.  123 

7.  To  the  great  number  of  obfervations,  that  I  faid  juft  now,  were  con¬ 
tain’d  in  the  Sepulchretum,  from  various  authors,  of  water  being  found  in 
the  brain,  after  foporiAc  affections,  others,  which  are  extant,  might  be  added. 

I  will  point  out  two,  and  no  more;  one  from  an  ancient,  and  the  other  from 
a  more  modern  anatomift.  Jacobus  Sylvius  (z)  fays,  that  he  “  had  feen  in 
“  fome,  who  had  died  of  a  earns  or  catoche,  the  ventricles  of  the  brain  entirely 
<c  full  of  a  ferous  humour.”  And  William  Chefelden  (£)  afferts,  that  he  had 
always  found  the  brain  full  of  water,  in  the  diffeCtion  of  lethargic  patients. 

8.  A  drinking  man,  near  the  age  of  fixty,  who  labour’d  under  an  acute 
fever,  being  brought  into  the  hofpital  only  in  the  latter  part  of  his  difeafe, 
lay  ftupid,  and  anfwer’d  nothing  to  thofe  who  afk’d  him  any  queftions.  He 
frequently  threw  off  the  clothes,  as  if  he  were  burnt  with  a  great  heat ;  yet, 
if  you  touch’d  him,  he  felt  fcarcely  warm,  and  in  the  extreme  parts  of  his 
body  was  even  cold.  At  fome  times  no  pulfe  could  be  perceiv’d  ;  and  fome- 
times  again  it  rofe  higher  ;  but  was  hard,  fmall,  and  intermittent.  Yet  his 
refpiration  was  natural.  In  this  manner  pafs’d  the  latter  days  of  his  difeafe, 
and  he  died  about  the  fourteenth.  His  abdomen  and  thorax  being  open’d, 
the  ftomach  and  inteftines  were  found  painted  over  with  a  flight  rednels,  as 
if  they  had  begun  to  be  inflam’d  ;  and  in  the  ventricles  of  the  heart  was 
fome  thickifti  blood,  but  fluid.  On  opening  the  Ikull,  cutting  through  the 
dura  mater,  and  taking  the  brain  out  from  the  cranium,  a  little  limpid  fe¬ 
rum  came  forth.  Under  the  pia  mater  alfo,  which  bore  marks  of  a  flight 
inflammation,  the  furrows  that  go  down  betwixt  the  convolutions  of  the 
brain,  were  full  of  the  fame  ferum.  Laft  of  all,  a  little  ferum  was  found 
in  the  lateral  ventricles,  which  was  tinCtur’d  with  the  colour  of  blood. 

9.  This  fever  was  a  as rrvpUs,  as  the  remarks  made  on  the  living  and  the 

dead  body  fignify.  And  if  we  fet  aflde  that  inflammation  obferv’d  in  the 
ftomach,  inteftines,  and  pia  mater,  which  belongs  particularly  to  the  fever 
itfelf,  and  which  feem’d  more  flight,  according  to  my  opinion,  becaufe  it 
was  of  the  eryfipelatous  kind ;  then  the  water  will  remain, 

whereto  you  may  aferibe  the  ftupor,  which  was  fo  great,  that  he  lay  like  one 
half-afleep,  and  made  fcarcely  any  anfwer  to  queftions  that  were  afk’d  him. 
And  frequent  drunkennefs  had  not  only  furnifh’d  fufficient  matter  for  inflam¬ 
mation,  but  alfo,  by  weak’ning  the  brain,  had  difpos’d  it  to  the  fecretion 
of  that  water.  For  which  the  foregoing  frequent  vertigo,  and  Anally  the 
apopledtic  paroxyfm,  had  prepar’d  the  young  man  of  whom  I  fpoke  of  above. 

10.  A  man  of  fixty  years  of  age  was  feiz’d  with  a  pain  in  the  left  part 
of  his  thorax  :  he  lay  on  his  back.  About  the  tenth  day  a  foporiAc  diforder 
came  on,  by  which  all  the  internal  fenfes  were  entirely  deftroy’d  :  he  even 
fcarce  mov’d  himfelf ;  and  when  he  did,  it  was  flowly  and  heavily.  His  feet 
were  violently  pinch’d,  yet  he  did  not  difeover  the  leaft  feeling.  At  length 
he  died. 

In  the  thorax,  -the  left  lobe  of  the  lungs  was  indurated.  In  the  right 
ventricle  of  the  heart  was  a  polypous  concretion.  Within  the  cranium, 
about  the  veffels  that  creep  through  the  dura  mater,  was  the  beginning  ot  a 

(;)  Calumn.  Depalf.  z8.  (£)  The  Anat.  of  the  hum.  body,  book  3.  ch.  14. 

„  R  2  gelatinous 


i  24  Book  I.  Of  Difeafes  of  the  Head. 

gelatinous  concretion :  and  in  the  ventricles  of  the  brain  a  little  ferum  was 
found. 

11.  The  pain  of  the  thorax,  and  indurated  lungs,  fhew  an  inflammation 
thereof.  The  remaining  appearances  fhew  the  moffc  grievous  veternus,  or 
lethargy,  which  degenerated  into  an  apoplexy;  and  this  into  death.  And 
how  eafily  a  veternus  and  inflammation  of  the  lungs  may  be  join’d  toge¬ 
ther,  you  will  gather  from  Hippocrates,  Ballonius,  and  others,  whom  you- 
will  fee  commended,  on  occafion  of  obfervations  of  this  kind  (/),  in  the  Se- 
pulchretum  (m).  And  to  the  fame  effect  are  thofe  two  of  my  own,  which  I 
lhall  immediately  fubjoin  to  the  five  already  delcrib’d  from  Valfalva ;  befides 
one,  which  is  to-  be  written  to  you  at  another  time  («). 

12.  An  old  man,  who  was  feventy  years  of  age  within  one,  of  a  pallid 
complexion,  and  had  complain’d,  for  fome  time,  of  a  flight  pain  in  his  neck; 
v/as,  by  reafon  of  the  encreafe  thereof,  receiv’d  into  the  hofpital  of  St.  Mary 
de  Morte,  at  Bologna.  He  was  very  weak,  his  pulfe  fmall  and  frequent. 
And  though  he  had,  in  other  refpects,  his  fenfes  about  him,  fo  that  he  law 
and  heard  well,  yet  he  was  flow  to  underhand,  or  to  adl,  like  one  that  was 
half-afleep.  And  this  one  fymptom  continu’d  through  the  whole  of  the  dif- 
eafe,  and  even  encreas’d  ;  whereas  the  others,  and  among  thefe  the  pain  of 

•  the  neck,  had  very  foon  remitted.  But  after  fome  days,  he  complain’d  of  a 
pain  in  his  bread,  which  had  attack’d  him  in  the  night;  and  pointed  out 
the  feat  of  it,  by  touching  the  flernum  with  his  hand.  For  this  reafon,  a 
few  ounces  of  blood  were  immediately  taken  away  from  the  hand,  and  thofe 
things  applied  inwardly,  and  outwardly,  befides,  which  are  us’d  in  an  inci¬ 
pient  inflammation  of  the  breaft.  After  this,  the  pain  left  him  within  a  day  ; 
fo  that  he  never  complain’d  of  this,  or  any  other  inconvenience  in  his  thorax 
again.  But  upon  the  pain  leaving  him,  a  fiertor  fucceedec],  with  a  rattling  of 
phlegm  in  the  afpera  arteria,  which  lafted  two  days ;  and  the  pulfe,  in  the 
mean  while,  was  become  very  faltering;  yet  upon  being  examin’d  very  often, 
and  very  particularly,  whether  he  felt  any  thing  painful  or  troublefome  to 
him,  and  where,  he  made  no  anfwers,  but  fuch  from  whence  you  might  ga¬ 
ther,  that  his  head  feem’d  heavy  to  him,  and  that  he  had,  befides  this,  an 
internal  pricking  at  the  right  temple.  In  the  mean  time,  though  the  ftertor 
was  gone  off,  and  he  was  at  freedom  to  lye  on  either  fide,  notwithftanding 
he  lay  generally  on  the  right ;  and  finally,  though  the  faltering  of  the  pulfe 
was  abated  ;  yet  this  ftate  of  things  did  not  pleafe  us ;  and  that  with  reafon. 
For  on  the  fourth  or  fifth  day  after  the  pain  had  gone  off,  which  was  about 
the  middle  of  January,  in  the  year  1706,  he  was  found,  in  the  morning,  to 
be  ftill  more  ftupid,  and  more  like  one  half-afleep ;  with  his  pulfe  weak,  and 
his  ftrength  decreas’d  :  and  on  the  following  night,  after  having  taken  l>is 
fupper  as  ufual,  he  very  foon  fetch’d  a  deep  figh,  immediately  began  to  ex¬ 
pire,  as  it  were,  and  within  an  hour  died. 

The  abdomen  being  open’d,  we  found  the  liver  white,  and  fomewhat  hard, 
and  its  bladder  difiended  with  a  large  quantity  of  bile;  the  ilomach  was 
plac’d  lower  than  ufual,  but  found.  The  right  cavity  of  the  thorax  had  a 

(/)  Sed..  hac  3.  obf.  39.  48.  &  in  Addit.  (m)  In  Schol.  ad  cit.  obf.  39. 
obf.  4.  («)  Epiit.  21.  n.  23. 

pretty 


Letter  VI.  Article  13.  125 

pretty  large  quantity  of  ferum  in  it,  turbid,  and  partly,  as  it  were,  famous  ; 
and  the  left  contain’d  a  little  alfo,  but  bloody.  The  left  lobe  of  the  lungs 
was  connedled  laterally  here  and  there,  by  membranes,  to  the  pleura  ;  and 
in  its  upper  part,  had  a  hard  portion  on  its  furface,  which  feem’d  to  be 
an  old  dilorder :  as  to  other  things,  it  was  moderately  diftended  with  air; 
and  if  you  cut  into  its  fubftance,  pour’d  out  a  frothy  humour,  which  might 
poflibly  have  been  fqueez’d  out  from  the  right  lobe  by  the  bronchia ;  inaf- 
much  as  the  fubftance  of  this  lobe  was  become  very  hard,  and  compact,  as 
you  will  immediately  underftand.  For  at  its  upper  part,  where  it  alfo  ad¬ 
her’d  to  the  pleura,  it  feem’d  corrupted ;  but  in  the  remaining  part,  which 
was  much  the  greater  part  of  its  fubftance,  it  was  very  hard,  extremely 
fwell’d,  and  felt  very  heavy,  if  you  rais’d  it  with  your  hand.  Externally,  it 
was  of  a  flefhy  colour.  And  internally,  wherever  you  cut  ir,  it  feem’d  to 
be  made  up  of  flefhy  particles  clufter’d  together,  like  fo  many  globules, 
the  vefiels  on  both  fides  being  more  black  and  diftinft  than  ufual,  from 
the  quantity  of  blood  included  in  them :  therefore,  the  uppermoft  part  of 
the  upper  lobe,  by  reafon  of  its  vefiels  being  in  greateft  number,  was  en¬ 
tirely  black.  But  a  large  quantity  of  putrid  humour  came  out  from  this 
right  lobe  of  the  lungs,  when  it  was  cut  into. 

From  the  four  orifices  of  the  heart  began  fo  many  polypous  concretions,, 
being  produc’d  from  thence  into  the  trunks  of  the  corrdponding  vefiels, 
and  into  the  branches  of  thofe  trunks  alfo,  as  we  certainly  faw  in  the  pul¬ 
monary  artery  and  vein.  Thofe  two  were  the  largeit  of  them,  which  were 
carried  into  the  veins  clofe  to  each  auricle;  and  they  even  expanded  them- 
felves  into  the  auricles,  but  efpecially  into  the  right.  They  were  all  com¬ 
pos’d,  in  great  part,  of  a  white,  tenacious,  and,  as  it  w’ere,  fibrous  fubftance. 
The  fkull  being  open’d,  a  fiender,  polypous  concretion,  but  of  the  fame 
fubftance  with  the  former,  was  feen  in  the  firms  of  the  falx.  Betwixt  the  two- 
meninges  was  a  pretty  large  quantity  of  water.  There  was  a  good  deal  in 
the  furrows  of  the  brain,  under  the  pia  mater;  and  even,  as  1  learn’d  by 
attentive  infpedtion,  within  the  very  membranous  fubftance  of  the  laft-men- 
tion’d  covering  of  the  brain ;  and  the  fluid  was  feparated  into  a  kind  of  mu¬ 
cous  cells,  as  it  were  ;  fo  that  1  obferv’d  it  to  have  the  appearance  of  a  ge¬ 
latinous  confidence,  though  it  was  really  fluid.  In  the  lateral  ventricles,, 
was  a  little  bloody  water;  yet  the  vefiels,  which  ran  through  their  furface,. 
were  not  pallid,  nor  thofe  of  which  the  plexus  choroides  are  compos’d  :  ne- 
verthelefs,  in  the  pofterior  part  of  thefe  plexufies,  were  hydatids.  The  pi¬ 
neal  gland,  which  was  by  no  means  lax,  had  within  it  a  little  unequal  body, 
of  the  bignefs  of  a  fmall  pepper- corn,  and  of  a  hardifh  fubftance,  but  nei¬ 
ther  bony,  cartilaginous,  nor  manifeftly  ftony.  The  cerebrum  and  nerves 
were  not  very  flaccid,  and  the  cerebellum  feem’d  fomewhat  pale.  From  the 
tube  of  the  1'pine  juft  a  few  drops  of  water  flow’d  down. 

13.  If  it  were  allowable  to  pick  out  fome  things  from  the  words  of  Hip- 
pocrates,  as  if  from  oracles,  and  accommodate  them  to  our  iubjeCt  in  queftion, 
certainly  out  of  thofe  things  which  he  wrote  concerning  lethargic  patients  ( o)y 
thefe  would  agree  very  well  with  the  hiftory  propos’d  :  Scporati ,  decolores 

(a)  In  Coae.  Prjenot. Dureto  interpr.  1.  i.  n.  145. 


cum 


1 16  Book  I.  Of  Difeafes  of  the  Head. 

cum  pulfu  fepulto ,  — cervicis  dclore  angi  queruntur — Quicunque  fervantur,  fere 
purulenti  redduntur :  or,  44  Sleepy,  pallid,— with  a  very  low,  weak  pulfe. — 

44  They  complain,  that  they  are  tortur’d  with  a  pain  in  the  neck. — Thole 
44  who  efcape  have  generally  a  fuppuration.”  That  is,  as  Duretus  interprets 
the  pafiage,  44  they  have  a  vomica,  or  abfcefs,  of  the  lungs,  unlefs  they  are 
44  previously  taken  elf  by  a  peripneuniony,  arifing  from  the  defcent  of  this 
“  corrupt  matter,  the  ftrength  being  already  deftroy’d  by  the  lethargy.”  But 
whatever  we  are  to  think  of  thefe  things,  and  especially  of  that  defcent  of 
corrupt  matter,  without  doubt,  the  old  man,  whofe  hiftory  I  have  related, 
perifh’d  at  the  fame  time  from  the  peripneuniony,  and  from  his  ftrength 
being  impair’d  by  the  foporific  diforder.  For  the  lungs  really  become  tumid, 
denfe,  hard,  and  heavy,  in  this  manner,  from  a  peripneumony,  which  can¬ 
not  be  refolv’d  •,  as  1  Shall  Shew  at  large  on  future  occafions  ( p ).  Wherefore, 
in  the  laft  hiftory  of  Valfalva,  I  took  it  for  granted,  that  the  lungs  had 
been  inflam’d,  from  one  of  its  lobes  being  found  indurated,  after  pains  in 
the  breaft(j).  And  an  inflammation  of  this  kind  could  not  be  refolv’d  in  a 
weak  old  man,  who  lay  half-afleep,  as  he  was  neither  able  to  difcharge  the 
matter  while  it  lay  moveable  and  rattling  in  the  bronchia,  nor  even  fo  much 
as  endeavour’d  to  do  it.  Therefore,  though  the  pain  firft  went  off,  and  foon 
after  the  ftertor,  yet  we  did  not  fuffer  ourfelves  to  be  flatter’d  therewith  j  as 
we  conjedtur’d,  how  much  milchief  might  certainly  lurk  under  that  ap¬ 
pearance  of  quiet.  And  this  mifchief  was  fo  much  the  more  encreas’d,  be- 
caufe  there  was  much  matter  in  his  impoverifli’d  blood,  which  was  prone  to 
concretion,  when  at  reft  •,  as  the  polypi  found  after  death,  which  were  fo  large, 
and  in  fo  great  number,  evidently  prove. 

But  that  kind  of  mucous  appearance,  under  the  pia  mater,  is  not  to  be 
accounted  for  from  concretion  ;  becaufe,  although  it  appear’d  to  be  a  jelly, 
vet  it  was  aclually  fluid  water  ;  and  whatever  appearance  of  mucus  there  was, 
arole  from  the  fibres  and  particles  of  the  membrane  being  divided  and  torn 
afunder.  And  I  doubt  not  but  this  appearance  has  Sometimes  impos’d  upon 
me,  and  upon  others  •,  although  Wepfer  ought  to  have  given  us  forne  fufpicion 
of  it,  who  has  more  than  once  (r)  remark’d,  that  when  he  had  feen,  in  the 
fame  place,  45  a  jelly,  upon  pricking  it  with  his  knife,  water  flow’d  out.” 
It  is  true,  he  did  not  obferve  from  whence  that  appearance  proceeded.  Nor 
was  I  folicitous  about  its  true  fituation,  when  I  found  out  from  whence  it 
proceeded:  which  ingenuous  confeflion  I  judg’d  it  was  proper  to  make  to 
you  here,  that  whenever  I  fay  in  thefe  letters,  that  I  found  water  under  the 
pia  mater,  or  mention  this  membrane  in  thofe  places  where  nature  has  not 
disjoin’d  the  tunica  arachnoides  from  it,  you  may  always  underftand,  that  both 
of  thefe  membranes  are  comprehended  under  one  and  the  fame  name,  after 
the  manner  of  the  ancients  •,  and  that  calling  to  mind  the  great  number  of 
44  fibrous  connexions,”  by  which  Ruyfch  (j)  has  taught  that  they  were  both 
naturally  join’d  betwixt  themfelves,  you  may  with  the  later  anatomifts  fup- 
pofe,  that  water  was  colleffed  in  the  interftices  of  thefe  relax’d  connexions. 
But  the  old  man  we  fpeak  of,  had  this  great  quantity  of  water  within  the 

( p )  Epift.  20&2I.  (>■)  Sepulchr.  1.  I .  f.  2.  obf.  47.  Sc  f.  15. obf.3 . 

tp)  Supra,  n.  11.  (r)  Refpcmf.  ad  Epilt,  problem.  9. 

cranium. 


Letter  VI.  Articles  14,  15*..  127 

cranium,  becaufe  his  blood,  being  of  the  nature  defcrib’d,  circulated  (lowly  ; 
and  alfo  becaufe,  at  that  age,  the  conftitution  abounds  with  ferum,  and  the 
head  is  more  infirm,  as  the  debilitated  habit  proves.  What  we  read,  there¬ 
fore,  in  one  of  the  books  that  goes  under  the  name  of  Hippocrates,  entitled. 
De  hominis  Jlruttura  (t),  “  When  the  brain  is  fill’d  with  cold  humours,  hence 
“  thediiorder  call’d  lethargy  is  brought  on,”  if  taken  in  a  fomewhat  lax  fenfe, 
you  fee  confirm’d  by  this,  and  the  other  difiedions  given  you  in  this  letter  •, 
and  in  two  others  befides,  that  relate  to  foporific  aftedions,  the  obfervations 
of  which  are  inferted  in  the  firfl:  (#)  and  fecond  (x)  of  thefe  letters.  And  you 
will,  perhaps,  fee  it  confirm’d  in  others  alfo  •,  as  certainly  in  that  which  I  now 
go  on  to  defcribe  to  you,  fince  I  have  already  Laid  what  I  had  to  fay  con¬ 
cerning  hard  corpufcles  in  the  pineal  gland  not  very  rarely  occurring,  in  the 
preceding  letter  (jy). 

14.  A  man,  who  was  a  foreigner,  and  to  appearance  about  fifty  years  of 
age,  died,  in  the  hofpital  at  Padua,  of  an  inflammation  in  the  lungs,  which 
had  been  join’d  for  four  days  with  a  foporific  diforder.  This  was  in  the 
month  of  March,  of  the  year  17  1  7.  The  celebrated  men,  who  were  at  that 
time  my  affiftants  in  mod  of  my  cliffedions,  but  afterwards  defervedly  chofen 
into  the  number  of  public  profeffors,  Julio  Pontedera,  and  John  Baptift 
Vulpius,  took  care,  according  to  cuflom,  that  thole  parts  fhould  be  brought 
to  me  which  I  wanted-,  and  at  that  time  I  was  accidentally  enquiring  into- 
fome  things  relating  to  the  ftrudure  of  the  head,  and  the  parts  of  gene¬ 
ration.  Neither  they  nor  I  were  at  that  time  folicitous  about  the  vifeera  of 
the  thorax,  becaufe  there  was  a  very  manifeft  inflammation  of  the  lungs.. 
From  the  genitals,  it  was  eafy  to  difeover,  as  you  will  know  from  the  pecu¬ 
liarities  they  had,  which  are  defcrib’d  by  me  in  another  place,  to  be  produc’d 
on  a  future  occafion,  that  the  pleafure  of  venery  had  never  been  known  to 
this  man.  And  in  the  brain,  though  my  enquiry  was  of  another  nature,  I 
neverthelefs  obferv’d  the  appearances  which  relate  to  the  prefent  occafion  : 
for  there  was  water  in  the  ventricles,  as  alfo  here  and  there  under  the  pia 
mater,  in  great  quantity,  and  of  a  yellow  colour.  And  up  and  down  in  the 
velfels,  which  were  diftended  with  blood,  polypous  concretions  were  found. 

15.  In  the  cranium  of  this  man  alfo,  you  lee,  as  I  laid  before,  there  was 
water  contain’d.  But  this  was  yellow  as  alfo  in  the  comatofe  girl ;  in  the 
taylor,  whom  a  deep  deep  now  and  then  feiz’d  -,  and  in  the  lethargic  boy ; 
whole  diflfedions  you  have  in  the  Sepulchretum  (z).  Do  not,  however,  for 
that  reafon,  haftily  reject  what  is  quoted  there  on  the  occafion,  from  Carolus 
Pifo  ( a ),  that  the  ferum  of  the  blood  “  is  foporific,  if  it  be  mix’d  with  the 
cc  recremencitious  mucus  of  the  brain,  or  with  any  other  of  the  humours,, 
c<  except  bile.”  For  in  that  girl,  an  epileptic  fit  had  preceded,  and  in  the 
boy,  a  great  pain  of  the  head  ;  and  the  taylor  had  not  only  the  fame  pain, 
but  was  alfo  alternately  troubl’d  with  intenle  watchings,  and  opprefiive  fleep  : 
nor  was  perhaps  any  thing  of  this  kind  wanting  in  the  man  whofe  hiflory  I 
have  given,  if  any  one  would  have  diligently  enquir’d  into  it..  Nor  yet  am. 


(0  N.  3. 

( x )  N.  20. 

(y)  N..'l2, 


(z)  Seft.  hac  3.  cbf.  12.  &  43.  Sc  in  Addit., 
obf.  1. 

(.u)  Se6t.  ead.  obf.  8.  in  Schol. 

6.  I  igncb- 


(»)  N.  2. 


i  iS  Book  I.  Of  Diieafes  of  the  Head. 

I  ignorant,  that  it  is  related  in  the  fame  volume  (b),  from  Francifcus  Sylvius, 
that  in  the  bile  itfelf,  which  is,  like  opium,  exceedingly  bitter,  «  a  ftrong 
“  narcotic  quality”  is  plac’d  ;  and  that  other  circumftances  of  difeafe  befide 
water,  but  efpecially  veflels  diftended  with  blood,  are  not  rarely  found  in  the 
heads  of  lethargic  perfons  ;  and  even  in  fome  (c),  “  that  the  brain  is  found 
cc  entirely  free  from  any  dropfy,  or  ferous  colluvies,  with  which  lethargic 
“  patients  are  generally  affeCted.”  Nor  do  I  deny  any  of  thefe  things  ;  but, 
on  the  contrary,  add  what  I  have  heard,  that  in  dogs  who  were  made  fleepy 
from  Aval  lowing,  opium,  all  the  arterial  veffels  of  the  brain  appear’d  to  be  ex¬ 
ceedingly  turgid  with  blood.  Yet  this  I  fay,  it  is  ufeful  to  know,  that  fopo- 
rific  affections  are  brought  on  in  others  differently,  and  from  a  different  caufe  ; 
but  that  it  is  ft  ill  more  ufeful  to  know,  what  is  “  for  the  moft  part”  wont  to 
be  found  after  fuch  diforders,  even  from  the  confeffion  of  others. 

1 6.  But  now,  fince  we  have  treated  fufficiently  of  ferum,  which  is  for  the 
moft  part  found,  let  me  alfo  fay  fomething  of  the  diftenfion  of  the  veffels, 
(which  I  myfelf  judg’d  to  be  the  cafe  in  that  foporific  diforder,  wherein  I 
order’d  the  occipital  veins  to  be  open’d,  with  great  fuccefs  (d),  and  I  confefs 
that  it  is  frequently  found,  together  with  water,  as  the  ACta  Cefareae  Aca- 
demias  alfo  (e),  and  other  obfervations  of  ours  (/),  confirm);  let  me,  I  fay, 
fpeak  a  little  of  that  fubjeCt,  efpecially  as  this  diftenfion  was  not  wanting  in 
the  man,  whofe  hiftory  I  am  conftdering.-  I  believe  that  the  larger  quantity 
of  blood  he  had  in  his  body,  and  the  lefs  it  could  be  circulated  through  the 
inflam’d  lungs,  the  more  of  it  mu  fi  have  remain’d  in  the  veins  of  the  brain, 
and  have  ftagnated  there.  For  thefe  veins  have  not  the  affiftance  of  mufcles, 
lying  round  them,  and  receive  their  blood  from  arteries,  which  being  made 
up  of  very  flender  coats,  are  not  able  to  prefs  on  ftrongly  the  circulating 
fluid,  nor  to  apply  great  force,  in  order  to  impel  it  from  behind.  And  the 
more  the  blood  is  delay’d  in  its  progrefs,  fo  much  the  more  ferum,  if  nothing 
prevents,  is  feparated  from  it,  and  fo  much  the  more  is  the  brain  opprefs’d 
from  both  caufes  ;  moreover,  the  greater  this  opprefflon  is,  the  more  heavy 
is  the  deep  ;  fo  that  as  the  oppreffion  is  ftill  more  encreas’d,  this  deep  de¬ 
generates  into  an  apoplexy.  Senertus  (g),  therefore,  admonifhes  us,  that  if 
a  carus  is  fo  much  encreas’d  as  to  hurt  refpiration,  “  an  apoplexy  is  then  at 
“  hand,”  And  even  Boerhaave  (h)  exprelsly  fays,  that  a  carus  is  a  dight 
apoplexy,  and  a  lethargy  a  dighter  fpecies  of  apoplexy  ;  which  I  take  notice 
of,  that  you  may  not  wonder  to  fee  me  acknowledge  any  thing  to  be  the. caufe 
of  foporific  diforders,  which  I  before  laid  down  among  the  caufes  of  apo¬ 
plexy.  But  why  the  fame  caufes  feem  fometimes  to  be  greater  in  the  heads 
of  thofe  who  died  of  thefe  diforders,  than  in  others,  who  were  taken  off  by 
apoplexies,  you  will  fufficiently  conjecture  of  yourfelf,  from  what  has  been 
faid  in  the  fourth  letter  (i).-  And  I  am  not  willing,  as  I  have  faid,  to  indulge 
conjectures  in  a  very  prolix  manner  here.  In  the  mean  while,  you  will  take 
all  in  good  part,  as  a  friend.  Farewel. 


(.q  Ibid,  in  Schol.  ad  obf.  13. 

(•-)  Obf.  30. 

(4)  Adverf.  6.  Anim.  83. 

p)  Vol.  I.  obf.  152.  &  IV.  obf.  39. 


(f)  Epift.  10.  n.  17. 

(g)  Medic.  Pratt.  1.  1.  p.  2.  e.  32. 

(/.>)  Aphor.  de  cogtiof.  morbis  §  1045  &  1049. 

(0  "•  31- 


LETTER 


Letter  VII,  Articles  1,2,  129 


L  E  T  T  E  R  the  SEVENTH. 

Which  treats  of  the  Phrenitis,  Paraphrenitis,  and 

Delirium. 

1.  TI  T  H  Y  I  rauft  pafs  over  the  two  fedtions  which  follow  the  44  foporific 

VV  affedlions”  in  the  Sepulchretum,  you  eafily  underftand,  from  thofe 
reafons  that  I  hinted  at  in  the  beginning  of  the  former  letter.  And  I  have 
nearly  the  fame  reafons  for  pafTing  over  the  fedtion  which  fucceeds  thole  two* 
entitled,  De  vigiliis  prater  naturam.  For  thefe  preternatural  watchings,  alfo, 
are  not  alone  when  they  are  mortal,  but  are  join’d  with  fome  other,  and  more 
violent  diforders.  You  will,  therefore,  find  no  example,  where  watchings 
were  the  only  fymptoms,  among  all  thofe  that  are  there  produc’d  :  which, 
however,  are  eight  in  number,  and  no  more  ;  and,  indeed,  not  fo  many  as 
eight,  for  the  feventh  obfervation  is  the  fame  as  the  fourth.  And  I  wonder 
more  at  this  one  not  being  obferv’d  within  fo  few  lines  of  the  other,  than  I 
do  at  the  numerous  repetitions  which  are  made  in  the  following  feventh 
fedtion  *,  for  the  thirty-fifth  obfervation  is  no  other  than  the  thirty-third,  nor 
the  thirty  fourth  than  the  thirty-ninth.  And  I  could  wilh,  that  in  the  three 
preceding  fedtions,  the  fame  carelefinefs  was  not  obvious.  Certainly,  in  the 
firft,  it  might  have  been  eafily  obferv’d,  that  the  thirty-fecond  obfervation 
did  not  differ  from  the  fixteenth,  nor  the  thirty-fourth  from  the  nineteenth, 
nor  the  fixty-third  from  the  thirty-fifth,  nor  the  eighty-fifth  from  the  forty- 
fourth,  nor  the  hundred-and-third  from  the  ninety-fifth.  Nor,  in  the  fecond 
fedtion,  the  twenty-eighth  from  the  twenty  fourth,  or  twenty-fecond,  or  from 
the  fecond  in  the  Additamenta.  Nor,  in  the  third  fedtion,  the  twenty -third 
obfervation  from  the  twentieth,  or  the  thirty- eighth  from  the  forty-fourth. 
And  if  thefe  have  occurr’d  to  me,  who  was  upon  another  enquiry,  it  is  na¬ 
tural  to  fuppofe,  that  they  who  would  look  diligently  after  them,  would  find 
many  more.  However,  thefe  things,  and  many  others  of  that  kind,  will 
be  feen  by  thofe,  who  fhall  publifh  a  third  edition  of  thefe  books.  But,  that 
we  may  return  to  our  purpofe,  I  now  pafs  on  to  the  feventh  fedtion,  which 
I  faid  follow’d  thefe,  putting  off  the  examples  of  watchings,  and  other 
diforders.  That  fedtion  is  entitled,  De  phrenitide,  par aphreni tide,  &  delirio. 
And  I  find,  in  the  papers  of  Valfalva,  thefe  four  hiftories  particularly  taken 
notice  of,  which  are  relative  thereto. 

2.  A  young  man,  about  twenty  years  of  age,  lay  ill  in  the  hofpit'al  of  Saint 
Mary  de  Morte,  at  Bologna.  He  had  a  flow  fever,  with  a  third;  ;  yet  his 
urine  and  pulfe  were  very  much  like  thofe  of  perfons  in  health  :  fo  that  the 
diforder  feem’d  but  (light.  Yet  about  the  eighth  day,  a  violent  delirium 
came  on,  which  lafted  ieven  days.  And  when  this  ceas’d,  the  patient  lay 
almoft  as  if  he  were  without  any  fenfe,  unlefs  that  he  feem’d  to  be  a  little 
rous’d  at  fome  particular  times.  At  length  he  died. 

Vol.  I.  S 


The 


i  3o  Book  I.  Of  Difeafes  of  the  Head. 

The  carcafe,  on  its  out-fide,  even  inclin’d  a  little  to  lividnefs,  efpecially 
under  the  nails  of  his  hands ;  and  the  mufcular  fiefh  was  rather  of  a  brownifh 
colour,  than  of  its  native  red.  The  blood  was  alfo  blackifh,  and  very  thick, 
but  (till  fluid.  In  the  belly  and  thorax  all  the  parts  were  found,  except  that 
there  were  no  traces  of  water  in  the  pericardium.  The  cranium  being  faw’d 
through,  and  rais’d  up,  a  kind  of  gelatinous  concretion  was  obferv’d,  which 
lay  on  the  lides  of  the  fanguiferous  veflels  that  ran  through  the  pia  mater. 
And  this  membrane  being  torn  at  the  bafis  of  the  brain,  a  quantity  of  water 
iffu’d  forth,  in  colour  and  thicknefs  refembling  the  whey  of  cow’s  milk.  But 
the  whole  brain  was  found. 

3.  This  fever  was  a  malignant  one,  as  it  is  call’d  ;  and  it  is  manifeft,  that 
the  delirium  which  was  added  to  it,  was  a  phrenitis.  But  why  was  there  no 
inflammation  in  the  meninges  ?  no  diftenfion  in  the  veflels  ?  Will  you  be¬ 
lieve,  that  the  inflammation  was  diflolv’d,  when  the  phrenitis  was  chang’d  into 
a  flupor  •,  but  that  it  was  not  wanting  before,  and  at  the  fame  time  that 
this  quantity  of  water  was  fecreted  ?  Be  this  as  it  will,  you  will  not  meet 
with  any  mention  of  diftenfion  of  veflels  in  the  meninges,  in  the  two  next 
obfervations. 

4.  A  man,  about  five-and- thirty  years  of  age,  was  feiz’d  with  a  pain  in 
the  bread,  and  with  a  fever.  His  pain  going  oft',  a  delirium  was  added  to 
the  fever  j  which,  as  the  fever  was  continually  becoming  more  violent,  lafted 
till  death  came  on.  This  happen’d  about  the  eleventh  day.  The  thorax  being 
open’d,  the  back  parts  of  the  lungs  were  found  a  little  hard  and  red.  In  both 
the  ventricles  of  the  heart  was  found  a  polypous  concretion,  but  in  the  left 
fomewhat  larger  than  in  the  right  *,  which  Valfalva  wonder’d  at,  becaufe  he 
had  always  obferv’d  the  larger  to  be  in  the  right,  till  that  time.  While  the 
brain  was  taken  out  of  the  cranium,  a  little  ferum  flow’d  out  from  the  me¬ 
ninges.  In  each  of  the  large  finufles  of  the  dura  mater,  was  a  polypous 
concretion.  The  whole  brain  was  foft;  and  in  its  left  ventricle,  the  plexus 
choroides  was  very  turgid,  like  varices. 

5.  This  is  not  a  proper  place  to  fpeak  of  the  caufes  and  differences  of  po¬ 
lypous  concretions.  But  that  caufe,  which  gave  rife  to  an  incipient  perip- 
neumony,  feem’d  in  this  man  to  have  been  tranflated  to  the  head,  and  re¬ 
main’d  there  till  his  deaths  and  it  would  naturally  be  fuppos’d,  that  it  fhould 
have  brought  on  a  confpicuous  inflammation  of  the  meninges.  Yet  it  had 
not  done  it  *,  and  that  kind  of  varices,  in  one  plexus  choroides  only,  was 
certainly  a  dilorder  of  long  (landing. 

6.  A  porter,  labouring  under  an  ardent  fever,  was  afflided  with  a  violent 
pain  in  his  head,  to  which  a  delirium  fucceeded.  After  death,  a  little  ferum 
was  found  betwixt  the  two  meninges,  part  of  which  had  concreted  among 
the  fanguiferous  veflels,  after  the  manner  of  a  jelly  ;  and  in  the  finus  of  the 
falx,  was  a  thin  and  long  concretion.  But  the  whole  brain  was  perfectly 
natural. 

7.  And  a  man,  of  five-and  thirty  years  of  age,  fell  ill  of  a  bad  fever: 
he  was  delirious  •,  his  eyes  gliften’d  ;  his  pulfe  was  vehement.  At  length  he 
died.  The  brain  was  in  a  good  ftate  *,  but  the  blood-veflels  thereof  were 
turgid  with  blood,  and  the  ventricles  contain’d  a  little  ferum.  But,  except 
fome  polypous  concretions  in  the  heart,  all  the  blood  in  this  body  was  fluid.  • 

8  8.  Do 


Letter  VII.  Article  8.  i  q  i 

8.  Do  not  be  furpris’d,  that,  except  this  one,  Valfalva  did  not  fee  the 
re (Tels  of  the  brain  diftended  in  any  of  thefe  delirious  perfons,  whole  difiec- 
tions  he  gives.  Ir  you  read  over  again  all  the  examples  of  delirious  perfons, 
which  I  related  from  him  in  the  former  letters  (a)  •,  for  the  delirium  alfo  is 
in  the  number  of  diofe  affe&ions,  which,  though  they  may  fometimes,  even 
if  disjoin’d  from  other  more  grievous  diforders,  prove  mortal,  yet  they  more 
frequently  are  join’d  with  others ;  I  fay,  read  over  thefe  examples,  and  you 
will  find  none  in  which  he  remark’d  a  diftenfion  of  the  veffels  of  the  brain, 
but  many  in  which  water  was  found.  This,  however,  is  indeed  true,  that 
thofe  deliria  were  not,  for  the  mod  part,  fuch  as  are  fuppos’d  to  have  an 
inflammation  of  the  meninges  conjoin’d.  But  yet  there  are  fome  obfervations 
extant  in  the  Sepulchretum  ( \b ),  in  which,  though  it  was  very  probable,  yet 
there  was  in  fadt  no  true  inflammation  •,  and  if  the  veffels  were  diftended, 
“  they  were  turgid  with  a  watry  and  pituitous  blood.”  And  the  difledtions 
and  opinion  of  Willis  are  produc’d  ft),  who  thinks,  that  foporific  diforders 
are  rather  brought  on  by  inflammation  of  the  meninges,  than  a  phrenitis,  the 
brain  being  comprefs’d  by  the  obftrudted  blood  ;  or  if  an  inflammation  of 
that  kind  be  found  after  a  phrenitis,  that  it  is  then  found,  when  a  phrenitis 
is  at  length  chang’d  into  a  carus,  or  lethargy.  On  the  contrary,  in  moft  of 
thofe  obfervations,  which  are  related  of  phrenitic  or  delirious  patients,  in 
this  fedtion  of  the  Sepulchretum,  you  will  fee,  that  an  inflammation  of  the 
meninges,  or  at  leaft  a  diftenfion  of  their  veffels,  is  fpoken  of,  though  they 
had  not  been  feiz’d  with  a  fleepinefs  before  death.  There  are,  indeed,  learned 
men,  who  follow  Willis  fo  far  as  to  acknowledge,  that  a  phrenitis  is  not  always 
brought  on  from  an  inflammation  of  the  meninges ;  but  they  think  it  cannot 
be  denied,  that  the  brain,  or  at  leaft  the  cortical  fubftance  of  it,  is  always 
inflam’d  in  a  phrenitis.  Yet  this  was  exprefsly  denied  by  that  excellent  ana- 
tomift  Henricus  Meibomius,  when  he  lay’d  down  this  pofition  (d),  “  In  a 
“  phrenitis  the  fubftance  of  the  brain  itfelf  is  not  inflam’d.”  But  I  not  only 
do  not  deny,  that  it  is  fometimes  inflam’d,  but  can  add  fome  obfervations 
thereof  to  thofe  which  are  already  contain’d  in  the  Sepulchretum  ;  as  that  of 
Lanzonus  ft),  who  in  a  young  man  that  had  been  delirious,  in  a  malignant 
fever,  found  “  the  brain  every  where  fprinkled  over  with  red  fpots,  and  the 
“  membranes  livid,”  which  were  no  obfeure  marks  of  a  foregoing  inflam- 
mation  ;  and  that  of  Moglingius  (/),  who  faw  the  “  cerebrum,  with  its  mem- 
it  branes,  every  where  inflam’d,  and  in  fome  meafure  lphacelated,  and  the 
“  ventricles  fill’d  with  ferum.”  But  after  having  added  thefe,  and  other  obfer¬ 
vations,  I  muft  not  conceal  the  great  number  in  which  no  inflammation  was 
any  where  found  in  the  brain-,  of  which  kind,  not  to  depart  from  the  Se¬ 
pulchretum,  almoft  all  thofe  are,  that  are  brought  to  ftiew,  that  in  a  phre¬ 
nitis  there  was  no  inflammation  of  the  meninges.  And  amongft  them,  I 
would  have  you  particularly  attend  to  that,  in  which  the  excellent  anatomift 
Coiterus  (g)  fays,  “  I  could  find  no  inflammation,  neither  in  the  membranes, 

(a)  I.  n.  2.  &  4.  V.  n.  2.  &  4.  VI.  n.  2.  ft)  Eph.  N.  C.  dec.  3.  a.  9.  obf.  1 13. 

ft)  Ex  gr.  13,  14,  1 6.  hujus  fept.  fed.  (f)  Earund.  cert.  6.  obf.  22. 

ft)  Ibid.  obf.  i.  cum  Schol.  (g)  Sed.  hac  7.  Sepulch.  obf.  16. 

(d)  Coroll.  4.  in  calce  Exercit.  de  Obferv. 
raxiorib. 

—  S  2 


“  nor 


i  32  Book  I.  Of  Difeafes  of  the  Head. 

“  nor  in  the  fubftance  of  the  brain and  fubjoin  to  this,  what  another 
•  fkilful  diflfeftor  has  obferv’d,  which  fhould  be  read  rather  in  the  words  of 
.Rhodius  {h)  himfelf,  than  in  the  Sepulchretum.  For  Rhodius,  when  he  had 
already  related  one  diflfedfion  of  a  phrenitic  perfon,  in  whom  he  had  found 
an  inflammation  of  the  meninges  and  brain  ;  adds,  “  But  Fabricius  Barto- 
“  letus,  a  diligent  and  ingenuous  man,  confefs’d  to  me,  that  he  had  found, 
“  in  the  bodies  of  many  perfons  who  died  phrenitic,  the  pia  mater  inflam’d, 
“  without  the  lead  diforder  in  the  brain.”  But  if  you  fhould  not  be  very 
ready  to  believe,  that  the  cortical  part  of  the  brain,  at  lead,  did  not  con¬ 
tradi  fome  injury  from  the  contiguous  meninges  j  yet  take  care  how  you 
imagine,  that  when  the  cortical  fubdance  of  the  brain  is  inflam’d,  a  phre¬ 
nitis  is  always  the  confequence.  For  the  fame  Willis,  who  very  often  faw 
that  a  phrenitis  was  ablent  when  the  meninges  were  inflam’d,  has  taught,  in 
the  fame  place  (z),  that  it  was  even  abfent  “  fometimes,  when  he  found  the 
“  external  circumference  of  the  brain  befet  with  an  inflammatory  tumour.” 
Nor  are  other  obfervations  wanting  to  confirm  this  •,  and  among  the  red,  that 
which  is  extant  in  the  fourth  book  of  the  Sepulchretum  (/e) ;  for  4t  the  pia 

mater  was  itfelf  red,  and  under  it  was  a  pus  fomewhat  thick  and  red ;  yet 
“  the  patient  had  not  been  at  all  delirious.”  How  is  it  then  ?  When  you 
have  attended  to  all  that  is  faid,  you  mud  come  back  to  this  concluflon,  at 
lad,  that  the  caufes  of  thefe  deliria  feem  to  be  different  at  different  times, 
and  thofe  according  to  the  various  nature  of  the  blood,  humours,  or  the  af¬ 
fected  part  of  the  brain ;  or  from  the  original  conditution,  and  foregoing 
diforders  thereof,  or  from  other  things  of  that  kind  ;  or  from  the  various 
conjundfion,  fometimes  of  many  of  thefe  circumdances,  fometimes  of  all, 
adting  differently  in  different  perfons,  fo  as  to  produce  one  diforder  at  one 
time,  and  another  at  another.  1  here  will  be,  for  that  reafon,  in  fome,  an 
inflammation  of  the  brain,  in  many  an  inflammation  of  the  meninges,  or  at 
lead  that  didenfion  of  the  veffcls,  but  not  fo  as  to  comprefs  more  than  to 
irritate,  in  others,  water  is  extravafated,  but  this  is  irritating  alfo-,  for  I 
agree  with  Bonetus  (/),  or  any  other  perfon  who  afferts,  “  that  pure  unmix’d 
46  ferum  without  acrimony  is  not  able  to  excite  a  delirium.”  Finally,  in  many, 
to  omit  other  caufes,  there  will  be  a  conjundfion  of  all  thofe  that  I  have  jud 
now  enumerated.  To  which  purpofe  alfo,  are  fome  obfervations  that  are  to 
be  feen  in  the  Sepulchretum  (m),  and  many  of  mine,  fome  of  which  I  have 
already  written  to  you  (#),  or  am  to  write  in  other  letters  j  and  five  of  them 
I  will  immediately  fubjoin  in  this. 

9.  An  old  man,  in  his  eightieth  year,  being  admitted  into  the  hofpital  of 
Sr.  Mary  de  Morte,  at  Bologna,  for  various,  but  flight  indifpofitions  ;  while  he 
was  there,  his  pulfe  not  only  became  more  quick  and  frequent,  but  alfo  more 
turgid,  than  feem’d  fuitable  to  his  age.  He  alfo  began  to  be  delirious,  and 
often  to  ttemble  in  his  lower  jaw,  and  limbs,  as  if  from  a  convulfion.  Then 
being  quedion’d,  what  complaints  he  had  in  his  head,  he  faid  exprefsly,  that 
he  perceiv’d  a  weight,  and  nothing  elfe.  Moreover,  when  his  delirium  had 

(/)  Sett,  hac  7.  1.  1.  in  Schol.  ad  obf.  27. 
(«/)  Sett.  ead.  obf.  16  &  in  Addit,  obf.  1. 
(«)  I.  n.  14. 


( h )  Cent.  1.  Obf".  Med.  40. 
4  )  Obf.  1.  c  t. 

{k)  Se&.  3.  tbf.  10.  §  7. 


continu’d, 


Letter  VII.  Article  9. 

1 

continu’d,  and  he  had  trembled,  in  the  manner  I  have  faid,  for  fifteen  or 
fixteen  days  ;  his  pulfe,  at  length,  which  had  been  oblerv’d  to  be  lower  fome- 
times  before,  became  very  low ;  and  within  two  days,  from  that  time,  a 
ftertor  coming  on,  he  ceas’d  to  be  delirious  and  to  live  at  the  fame  time.  The 
belly  and  cheft  being  open’d,  fourteen  hours  after  death,  the  vifeera  were 
even  at  that  time  warm,  although,  for  the  whole  fpace  of  time,  the  body 
had  been  expos’d  to  the  open  air,  and  in  the  cold,  as  it  was  then  about  the 
beginning  of  the  year  1706.  The  inteftines,  where  they  touch’d  one  an¬ 
other,  and  on  their  inferior  furface  alfo,  were  a  little  red  ;  but  the  edge  of 
the  liver  was  livid  :  laft  of  all,  a  great  part  of  the  membrane,  which  cover’d 
the  convex  furface  of  the  flaccid  fpleen,  was  become  very  thick,  and  hard 
like  a  cartilage.  Thefe  were  the  appearances  in  the  belly. 

And  in  the  cheft,  the  right  lobe  of  the  lungs  coher’d  with  the  pleura,  on 
its  inferior  fide  ;  and  on  its  upper  part,  it  had  a  kind  of  hard  portion,  in 
which,  when  difiedted,  all  the  veflels  of  the  lungs  feem’d  obftrubled  and 
dried  :  fo  that  I  fhould  believe  it  was  a  diford er  of  long  (landing.  And  the 
inferior,  and  efpecially  the  pofterior,  parts  of  the  lungs,  were  not  only  black, 
as  they  generally  are,  but  fomewhat  hard  alfo.  The  pericardium  contain’d 
fcarcely  any  water-,  and  the  heart  had  two  polypous  concretions  therein;  one  in 
the  right  ventricle,  that  was  yellowifh,  and  vifeid  ;  which,  in  the  auricle,  and 
near  the  orifice  of  the  pulmonary  artery,  where  however  it  did  not  enter, 
became  white,  and  fomewhat  hard  ;  and  another,  white  and  hard,  in  the 
right  ventricle,  and  the  beginning  of  the  great  artery.  The  valves  alfo  of 
the  aorta,  and  the  mitrales,  were  here  and  there  hard,  yet  not  bony.  But  the 
trunk  of  this  artery,  if  you  look’d  on  it  externally,  as  it  goes  down  upon 
the  vertebrae,  (hew’d  the  fanguiferous  veflels,  which  run  upon  its  coats,  to 
be  much  diftended  with  blood.  And  if  you  look’d  upon  its  internal  furface, 
it  had  here  and  there  hardifh  little  feales,  and  was  even  already  bony  in  many 
places,  and  that  where  the  trunk  of  it  went  down  into  the  abdomen,  and  in 
a  luperior  branch  thereof :  but  thefe  were  lefs  hard  near  the  heart.  Befides, 
between  the  feales,  in  fome  places,  the  internal  coat  was  wanting,  and  the 
next  coat  feem’d  alfo  to  be  there  ulcerated,  corroded,  and  converted  into  lit¬ 
tle  bits  of  red,  putrid  fubftance,  which  were  prominent  in  the  cavity. 

As  we  were  about  to  open  the  cranium,  while  we  mov’d  the  temporal 
mufcles,  we  obferv’d  them  to  be  extremely  thin  and  (lender,  I  fuppofe,  be- 
caufe  they  had  for  a  long  time  paft  been  unus’d  to  any  ftrong  adtion,  in  an 
old  man  who  was  almoft  toothlefs.  But  while  the  head  was  fever’d  from  the 
top  Of  the  fpine,  a  little  water  flow’d  out  of  the  tube  of  the  vertebra,  and  a 
large  quantity  from  the  great  foramen  of  the  os  occipitis.  And  for  this  reafon 
the  dura  mater  was  prefently  found  to  be  much  corrugated.  Yet  under  the 
pia  mater,  in  the  convoluted  furrows  of  the  brain,  a  water  remain’d,  much 
like  that  in  which  frefh  meat  has  been  walh’d ;  and  fome  portion  of  the 
fame  kind  of  water  was  found  in  the  lateral  ventricles  ;  yet  the  veflels  con¬ 
tain’d  therein  were  not  pale.  Moreover,  I  faw  many  veflels  in  the  pia  ma¬ 
ter,  loaded  with  a  black  and  coagulated  blood  ;  and  in  the  Anus  of  the  falx 
a  long,  (lender,  polypous  concretion.  However,  although  the  cranium  and 

the  brain  of  this  man  had  I  know  not  what  kind  of  difagreeable  odour ; 

yet 


I 


134  Book  I.  Of  Bifeafes  of  the  Head. 

yet  the  ftjbftap.ee  of  both  cerebrum  and  cerebellum  was  found  :  except  that 
the  firft  was  a  little  lax,  and  the  latter  exceedingly  fo. 

10.  You  fee,  that  notwithstanding  this  man  was  fo  old,  as  to  have  the  aorta 
here  and  there  become  offilied  ;  and  that  in  a  delirium  perpetual,  indeed,  but 
not  fierce,  there  was  a  diftenfion  of  the  vefiels  in  the  pia  mater,  together 
with  water.  But  let  us  go  from  this,  where  I  purpofely  began,  to  another 
old  man,  not  fo  far  advanc’d,  who  had  a  more  violent  delirium  ;  as  we  (hall 
have  a  more  convenient  opportunity  of  confider-ing  the  appearances  in  the 
body  of  the  former  on  a  future  occafion. 

11.  A  potter  of  feventy  years  of  age,  by  nature  chearful,  and  a  great 
drinker,  after  anxieties  of  mind,  and  fatigues  of  body  in  his  bufinefs,  greater 
than  ufual,  and  more  than  his  age  could  bear,  fell  into  a  fever,  and  at  the 
fame  time  had  a  violent  pain  of  his  left  fide.  Wherefore,  about  the  fifth  of 
April,  of  the  fame  year,  1706,  he  was  immediately  receiv’d  into  the  hofpital 
above  mention’d,  and  blood  was  immediately  taken  from  his  left  arm.  On 
the  fourth  day,,  the  fever  was  very  much  encreas’d.  And  on  the  fixth,  the 
delirium  came  on  in  fuch  a  manner,  that  it  was  neceflary  to  bind  him  down, 
to  prevent  him  leaping  out  of  bed.  His  pulfe  was  quick,  but  equal;  his 
refpiration  difficult;  and  he  had  no  expectoration.  Therefore,  although  he 
loft  blood  on  that  day  from  his  foot,  yet  every  thing  growing  worfe,  on  the 
day  following  he  had  a  ftertor ;  thus  lying  fupinely,  and  being  moift  with  fweat 
over  his  whole  body,  he  died. 

The  face  of  the  carcafe,  the  ffioulders,  and  arms,  were  yellow,  juft  as  in 
jaundic’d  perfons  ;  and  the  other  parts  likewife,  but  lefs  fo ;  and  the  ilia  were- 
fomewhat  livid.  The  belly  being  open’d,  we  obferv’d  the  omentum  was 
.very  ffiort,  and  drawn  upwards ;  and  the  coat  of  the  fpleen,  where  it  inverted 
the  lower  part  of  the  gibbous  furface,  was  very  hard ;  but  the  liver  was 
connected  by  its  whole  convex  furface  to  the  diaphragm,  except  its  edge, 
and  the  parts  about  it.  This  edge  was  livid  to  fome  extent ;  and  the  greateft 
part  of  the  hollow  furface,  together  with  the  fubftance  that  was  neareft  to 
it,  to  the  depth  of  two  lines :  the  remainder  thereof  was  pallid,  and  varie¬ 
gated  like  marble,  and  the  whole  of  the  vifcus  was  fomewhat  hard.  The 
bile  in  the  bladder  was  in  fmall  quantity,  and  like  corrupted  blood,  or  tur¬ 
bid  water  in  which  meat  has  been  waffi’d.  There  was  no  obftruCtion  to  its 
defcent  into  the  duodenum  ;  and  that  it  had  defcended,  the  colour  of  the  in- 
teftinal  contents  evidently  prov’d.  The  inteflines  were  turgid  with  air,  and 
a  yellow  fat  adher’d  to  them  :  there  was  alfo  a  little  quantity  of  water  about 
them,  in  the  lower  part  of  the  pelvis.  And  that  part  of  the  fmall  inteftines 
which  lay  in  the  pelvis,  was  a  little  reddiffi  in  its  colour,  and  inclining  to 
brown  ;  as  alfo  the  neighbouring  portion  of  the  ureters.  But  the  urinary 
bladder,  and  the  urine,  with  which  we  found  it  diftended,  were  both  yellow* 
and  the  fanguiferous  vefiels,  towards  the  cervix,  both  in  its  pofterior  and  in¬ 
terior  part,  were  turgid.  In  the  fides  of  this  bladder  it  was  that  I  faw  thole 
cells  and  herniae,  as  it  were,  which  are  defcrib’d  in  the  Adverfaria  (<?),  not 
without  a  conjecture  at  their  caufes ;  for  which  reafon  there  is  no  neceffity 


(0)  III,  Anim.  36, 


for 


Letter  VII.  Article  n.  135* 

for  their  being  defcrib’d  again  here ;  efpecially  as  you  may  fee  many  more 
of  them  delineated  by  my  very  good  and  experienc’d  friend  Heftier  (p)> 
I  will,  however,  add  this  one  thing  :  that  having  taken  care  to  enquire  of 
the  intimate  acquaintance  and  domefticks  of  this  potter,  whether  they  knew 
he  had  been  ever  us’d  to  complain  of  any  diforder  in  his  bladder,  they  faid 
exprefsly  that  he  had  not;  and  the  fame  of  the  hernia  varicofa;  which  ap¬ 
pear’d  to  me  in  this  manner.  A  great  number  of  veins,  dilated  and  thicken’d, 
embrac’d  the  tefticle  all  round,  the  fubftance  of  which  was  fo  compadt,  that 
it  could  not  be  refolv’d  into  (lender  tubes,  as  it  is  in  general  very  eafy  to  do. 
There  was,  befides,  beneathvthe  teftis,  a  fmall  bony  body.  All  thefe  things 
were  comprehended  in  tke  tunica  vaginalis,  which  was  grown  to  the  tefticle 
all  round,  unlefs  on  the  upper  part,  where  there  were  two  veffels  full  of  yel¬ 
low  water.  The  tunica  vaginalis  was  alfo  incorporated  with  the  other  tefticle, 
except  where  the  body  of  the  epididymis  came  between,  and  prevented  it ; 
for  in  that  place  was  a  cavity  which  was  fill’d  with  water  of  the  fame  kind. 
Turning  then  our  eyes  to  the  penis,  neither  in  the  glans,  nor  in  the  praepu¬ 
tium,  did  we  obferve  any  thing  of  the  fraenum ;  or  at  leaft,  there  was  only 
a  white  mark.,  where  the  fraenum  fhould  have  been,  or  where  it  formerly 
was.  We  flit  the  urethra  quite  up  from  beginning  to  end,  but  faw  nothing 
worthy  of  obfervation,  except  a  few  fmall  granules  of  concreted  mucus, 
that  look’d  like  the  powder  of  tobacco;  which  were  on  each  fide  of  the  fe¬ 
minal  caruncle,  and  the  caruncles  themfelves  feem’d,  as  it  were,  to  be  glew’d 
down  to  the  urethra.  Then  the  proftate  gland  being  diftedted,  I  found, 
wherever  I  cut  into  its  fubftance,  the  fame  kind  of  granules  like  tobacco,  in 
the  left  fide  as  well  as  in  the  right ;  but  ftill  more  in  the  right  fide  than  in 
the  left. 

Coming  now  to  the  thorax,  the  firft  things  that  occurr’d  to  us  were  the 
cartilages,  by  which  the  inferior  true  ribs  are  join’d  with  the  fternum,  pro¬ 
tuberating  outwards  from  the  right  fide,  as  if  there  had  been  fomething 
within  which  had  forc’d  them  outwards.  But  there  was  nothing  of  this  kind  ; 
therefore  I  conjedtur’d,  that  this  appearance  was  to  be  aferib’d  to  the  too 
great  adtion  of  the  right  pedtoral  mufcle,  in  his  puerile  ftate,  and  to  the 
violent  exertions  which  the  initiating  into  his  art,  perhaps,  requir’d.  In  the 
right  cavity  of  the  thorax,  when  laid  open,  every  thing  was  found  :  but  in 
the  left  was  a  confiderable  quantity  of  yellowifh  water,  which  being  exhaufted, 
there  appear’d,  ftrew’d  over  the  furface  of  the  lungs,  pieces  of  a  kind  of 
thick,  and  as  it  feem’d,  yellow,  and  eafily  lacerable,  membrane  ;  fo  that 
though  it  refembled  a  reticular  kind  of  texture,  I  neverthelefs  judg’d  it  to 
be  no  more  than  a  concretion  of  the  groffer  particles,  which  fwam  in  that 
yellow  water.  And  there  were  large  portions  of  the  fame  kind,  efpecially 
throughout  the  inferior  furface  of  the  inferior  lobe  of  the  lungs,  and  betwixt 
one  lobe  and  the  other.  But  that  inferior  lobe  was  almoft  univerfally  hard, 
and  heavy ;  and  being  cut  into,  was  found  compadted  of  a  thick  fubftance, 
not  as  the  lungs  generally  are,  but  like  that  of  the  liver  :  fo  that  though  I 
jfhould  fay  nothing  on  the  fubjedt,  yet  from  what  I  deliver’d  in  the  preceding 
letter  (q),  you  would  underftand,  that  it  was  aiTedled  with  a  peripneumony.  And 

(/)  InfUt.  Chirurg.  Tab.  32.  Fig.  1  &  2.  (?)  n.  12  &  *3* 

the 


136  Book  I.  Of  Difeafes  of  the  Head. 

the  inflammation  Teem’d  to  have  begun  to  pafs  over  into  a  fuppuration  :  for 
the  fubftance  of  it  was  white,  not  red  ;  and  a  thick  white  matter  was 
here  and  there  prefs’d  out  from  certain  orifices,  which  I  fuppofe  were  openings 
that  we'had  cut  into  the  bronchia.  But  the  fuperior  lobe,  in  its  upper  part, 
being  turgid  with  frothy  blood,  was  alfo  black  and  hard  ;  and  To  very  hard, 
that  you  would  think  it  rather  a  dilorder  of  long  {landing,  than  a  recent  one. 
In  the  remaining  part,  however,  it  was  free  from  moitture,  and  nearly  re- 
fembled  the  lungs  of  a  found  perfon  :  yet  it  was  laterally  and  anteriorly  con¬ 
nected  to  the  pleura,  by  many  red  and  ftrong  fafciculated  fibres,  which,  how¬ 
ever,  were  of  a  membranous  nature.  But  it  no  where  adher’d  more  clofely 
to  the  pleura,  than  at  the  upper  part  •,  and  the  pleura  was  there  thicker,  and 
eafiiy  to  be  pull’d  away  from  the  ribs  :  which  was  alfo  eafy  to  be  done,  even 
where  it  was  under  the  inferior  lobe,  in  which  part  it  was  pretty  thick  and 
red.  The  external  furface  of  the  pericardium,  but  only  on  its  left  fide,  was 
red,  from  the  fmall  vefifels  being  turgid  with  blood.  Within  was  a  little 
yellow  water.  In  the  right  auricle  was  a  thick  polypous  concretion  ;  in  the 
pulmonary  artery,  and  its  branches,  was  another  round  one  •,  a  round  one  alfo 
in  the  aorta :  nor  were  they  entirely  wanting  in  the  left  auricle  and  ventricle. 
The  fubftance  of  all  thefe  concretions,  when  confider’d  longitudinally,  was 
partly  finuous  and  yellow,  partly  fibrous  and  brown.  Above  the  valves  of 
the  great  artery,  under  the  very  internal  coat,  were  bony  lamellae  •,  and  I 
even  obferv’d,  that  not  only  in  the  trunk  of  the  afpera  arteria,  but  in  the 
beginnings  of  the  bronchia,  the  annular  cartilages  anteriorly,  that  is,  in  the 
middle  of  each,  were  oflified  :  fo  that  they  had  but  little  flexibility  •,  and  if 
you  broke  them  afunder,  they  fhew’d  fomething  in  that  middle  part,  which 
might  be  fuppos’d  to  be  the  beginning  of  marrow. 

At  length  proceeding  to  the  difiebtion  of  the  brain,  in  the  left  lateral  finus, 
in  the  fourth,  and  in  like  manner  in  the  third,  and  in  fome  of  the  veins  com¬ 
municating  therewith,  I  faw  a  white,  firm,  and  {lender  polypous  concretion. 
But  the  remaining  vefiels,  which  ran  through  the  pia  mater,  even  where  it 
invefts  the  cerebellum,  were  fo  diftended  with  blood,  that  the  fmall  trunks 
<of  them  were  turgid,  and  the  fmalleft  branches  diftinbtly  confpicuous.  Thefe 
things,  however,  appear’d  only  on  the  left  fide  of  the  brain.  Yet  neither 
the  vefiels  palling  through  the  medullary  fubftance  of  the  brain,  nor  thofe 
which  creep  upon  the  parietes  of  the  lateral  ventricles,  appear’d  to  be  di¬ 
ftended  with  blood  :  and  though  there  were  hydatids  in  the  plexus  choroides* 
and  ferum  in  the  ventricles,  yet  the  plexuftes  were  not  difcolour’d.  How¬ 
ever,  there  was  a  great  quantity  of  water,  externally,  in  the  convolutions  of 
the  brain,  which  fhining  through  the  pia  mater,  bore  the  refemblance  of  a. 
jelly  :  but  there  was,  in  fabt,  no  fuch  thing;  it  was  only  a  fluid  ferum. 

12.  Do  not  expebt,  that  I  {hall  give  you  as  long  an  explanation  as  I  have 
given  you  a  hiftory  ;  for  many  of  the  circumftances  belong  to  other  places, 
and  fhail  not  be  neglebted  in  other  letters  on  proper  occafions  :  yet  it  was 
neceflary  not  to  omit  them  here,  left  the  hiftory  fbauld  be  lame  and  imperfebt. 
You  fee,  that  to  a  peripneumony,  and  even  a  pleuroperipneumony,  a  deli¬ 
rium  was  join’d  ;  which  has  alfo  happen’d  to  others  (r),  whofe  cafes  I  refer 

(r)  Vid.  &  Jacotii  Comment,  in  Coac.  fed. 2.  1.  1.  aph.  2t. 


to 


Letter  VII.  Article  13.  137 

to  other  letters.  But  I  chofe  to  produce  this  at  prefent,  becaufe  the  delirium 
was  more  vehement,  and  becaufe  you  will  immediately  pronounce,  that  a 
phrenitis  “  from  inflammation  of  the  lungs”,  as  Hippocrates  has  taught 
us,  “  is  bad.”  And  I  am  very  well  afiur’d,  that  in  fome  inflammations 
of  the  lungs,  which  were  in  a  manner  epidemic  here,  efpecially  in  the  winter 
of  the  year  1754,  whenever  a  delirium  came  on,  and  it  did  come  on  in 
many,  the  patient  never  efcap’d.  For  which  reafon,  it  was  of  more  ccn- 
fequence  to  commit  to  writing  the  cure  of  a  woman,  who  labour’d  under  a 
complication  of  both  thefe  dileafes  (/),  not  becaufe  others  are  not  fometimes 
fav’d,  but  becaufe,  though  each  of  them  was  violent*  and  attended  with  the 
word  fymptoms,  yet  they  were  critically  folv’d,  from  great  difeharges  of  of- 
fenfive  matter,  for  four  days  together,  by  ftcol,  which  were  of  a  colour 
partly  red,  and  partly  black.  But  to  return  to  the  potter :  as  the  lungs, 
pleura,  and  pericardium,  were  inflam’d  on  the  left  fide,  fo  the  dura  mater 
was  inflam’d  on  the  fame  fide  alfo  ;  an  inftance  that  has  not  been,  as  far  as 
I  know,  obferv’d  by  any  one.  And  yet,  perhaps,  it  may  be  explain’d  in  the 
fame  manner  as  that  greater  rednefs  in  the  cheek,  which  anfwers  to  the 
difeas’d  lungs  on  that  fide ;  and  other  things  of  this  kind,  which  happen 
hat  t%tv,  as  the  interpreters  of  Hippocrates  fay,  and  among!!  thefe  Duretus(a), 
where  he  explains  the  pafiage  that  refers  to  the  fubjedt,  “  If  in  peripneu- 

monic  patients  the  whole  tongue  is  white  and  rough,  both  fides  of  the 
“  lungs  are  inflam’d  *,  but  if  half  the  tongue  only  has  this  appearance,  then 
“  the  lobe  of  that  fide  only  is  affedted.”  But  this  method  of  explication, 
although  it  is  difficult  and  abftrufe,  or  certainly,  if  you  fly  to  the  influence 
of  the  nerves,  ambiguous,  as  is  eafy  to  imagine,  both  from  the  writings  of 
thofe  of  former  ages,  and  thofe  of  the  prefent,  who  have  endeavour’d  to  ex¬ 
plain  it,  yet  it  fometimes  may  have  a  little  lefs  difficulty,  as  in  the  prefent 
cafe;  where,  we  may  fuppofe,  that  the  upper  part  of  the  left  lobe  of  the 
lungs,  not  only  by  its  old  hardnefs,  but  by  a  newly-added  turgency,  from 
the  frothy  ferum,  and  from  the  pleura,  which  was  in  that  place  become 
thicker  than  ufual,  might  in  fome  meafure  urge  the  left  fubclavian  vein  with 
compreffion,  and  confequently  delay  the  return  of  the  blood  from  the  left 
fide  of  the  head,  which,  befides,  is  thought  to  be  more  infirm  than  the 
right.  Be  this  as  it  will,  (for  what  things  may  be  objedted  I  do  not  know, 
but  if  you  grant  me  never  fo  little  on  a  fubjedt  of  this  kind,  I  ffiall  be  fatis- 
fied)  at  leaft  you  fee  what  I  propos’d,  concerning  the  diftenfion  of  the  veflels 
of  the  dura  mater,  join’d  with  extravafated  ferum,  was  true  alfo  in  this  phre- 
nitic  patient.  Now  I  will  fhew  you,  that  the  fame  diftenfion  was  found  in 
a  greater  degree,  in  a  paraphrenitic  patient,  and  attended  with  water. 

13.  A  tall  and  lean  man,  who  was  fubjedt  to  inflammation  of  the  cheft, 
from  the  trade  of  hemp-dreffing,  which  he  follow’d,  and  with  which  he  laid 
he  had  before  been  fix  or  feven  times  troubl’d,  with  a  vomiting  of  bilious 
and  green  matter  in  one,  and  a  delirium  in  another,  was  of  late  fo  affedted 
in  the  organs  of  his  voice,  by  the  dull  of  the  hemp,  which  he  had  taken 
in  at  his  work,  that  he  feem’d  rather  to  fcreech  than  to  fpeak.  For  that 

(j)  Seft.  7.  aph.  12.  (?<)  In  Coae.  1.  2.  c.  16.  n.  31. 

(r)  Aft.  Nat.  Cur.  tom.  8.  obf,  63. 

VOL.  I. 


T 


reafon. 


i  3  8  Book  I.  Of  Difeafes  of  the  Head. 

reafon,  he  chofe  out  hemp  which  was  lefs  dufty,  and  comb’d  it  feparately 
from  his  companions,  and  by  that  means  had  juft  recover’d  his  natural  voice, 
when  being  tir’d  with  carrying  a  burthen,  he  was  feiz’d  with  a  febrile  cold- 
nefs,  and  a  pricking  pain  at  his  left  breaft.  For  which  reafon  he  was 
brought  into  the  fame  hofpital  as  the  two  former,  and  about  the  middle  of 
February  in  the  fame  year.  Although  he  had  taken  frefh-drawn  oil  of  al¬ 
monds  at  home,  and  had  loft  blood  from  his  left  arm,  he  was  again  bled  in 
the  other  arm  :  for  he  breath’d  with  difficulty,  and  expectorated  nothing. 
Fie  often  lay  on  his  affected  fide  :  he  threw  up  bilious  and  green  matter  from 
his  ftomach.  On  the  fifth  day,  a  phrenitis  came  on,  being  fometimes  joyful, 
and  fometimes  ferious,  and  fometimes  fierce,  or  at  leaft  fo  far,  that  fie  us’d 
to  fpit  in  the  faces  of  thofe  who  went  near  him.  The  phyfician  order’d  blood 
to  be  taken  away  from  his  leg,  near  the  ancle,  and  a  certain  cataplafm  to  be 
put  upon  his  head  after  {having  ;  which  I  ffiall  more  conveniently  tell  you 
the  nature  of,  when  I  treat  of  maniacs  (x).  In  the  mean  while,  convulfive 
motions  began  to  be  obferv’d,  at  firft  flight,  as  in  the  fubfultus  of  the  ten¬ 
dons  of  the  wrift,  and  then  more  confiderable.  Laft  of  all,  his  refpiration 
was  not  difficult ;  and  if  you  afk’d  him  whether  he  felt  any  pain,  or  unea- 
finefs,  in  any  part,  he  anlwer’d  in  the  negative :  yet  he  fometimes  cried  out, 
and  his  urine  flow’d  from  him  into  the  bed,  without  his  knowledge.  At 
length,  his  pulfe  growing  weaker,  but  not  irregular,  he  died  a  little  after 
the  end  of  the  feventh  day. 

In  nis  body,  after  death,  the  right  fide  of  the  neck  was  livid ;  as  in  like 
manner  was  the  edge  of  the  liver,  when  the  belly  was  open’d,  for  a  confi¬ 
derable  traCt,  but  to  very  little  depth.  The  gall-bladder  was  contracted,  and 
contain’d  but  little  bile,  which  refembled  the  dilute  colour  of  tobacco.  The 
ftomach  was  found  :  the  pancreas  thickiffi  and  hard.  In  the  thorax  no  ferum 
was  extravafated.  The  right  lobe  of  the  lungs  was  every  where  clofely  tied, 
by  interpofmg  membranes,  both  to  the  ribs  and  to  the  diaphragm  i  the  left, 
on  the  contrary,  only  in  a  few  places,  and  that  anteriorly.  But  then  the  right, 
on  the  other  hand,  was  in  a  natural  ftate  ;  and  the  far  greater  part  of  the  left 
was  difeas’d.  For  firft,  the  fuperior  lobule,  though  in  other  refpeCts  pretty 
found,  was  lank  and  contracted ;  and  in  its  upper  part  contain’d  a  white  pu¬ 
rulent  matter,  within  a  kind  of  tubercle.  And  thefe  appearances,  like  the 
great  number  of  clofe  adhefions  in  the  right  lobe,  feem’d  to  be  the  effeCts  of 
the  foregoing  inflammations.  But  the  inferior  lobule,  being  red,  hard,  and 
heavy,  and  its  fubftance  condenfated,  and  in  its  upper  part  pus,  or  a  matter 
like  pus,  flowing  out  from  the  feCtions  of  the  bronchia,  ffiew’d  a  prefent 
inflammation,  which  was  beginning  to  luppurate.  The  pleura,  alfo,  on  the 
fame  left  fide,  was  almoft  wholly  inflam’d  •,  for  its  fmall  veffels  were  too  con- 
fpicuous,  and  the  whole  of  it  was  eafily  drawn  away  from  the  ribs  at  one 
pull.  And  the  diaphragm,  in  that  part  only  of  its  centrum  tendineum,  as 
it  is  call’d,  which  lies  under  the  left  lobe  of  the  lungs,  had  even  its  fmalleft 
veffels  fo  diftended,  that  you  would  not  doubt  but  it  was  there  inflam’d.  In 
the  pericardium  was  a  little  reddiffi  and  turbid  ferum.  Polypous  concretions 
were  drawn  through  all  the  orifices  of  the  heart :  they  began  in  the  ventricles. 


(*)  Epift.  8.  n.  8. 


were 


Letter  VII.  Article  14.  139 

were  produc’d  into  the  veffels,  and  were  all  made  up  of  a  folid  fubftance* 
except  the  beginning  of  that  which  went  through  the  pulmonary  artery, 
that  was  very  thick  indeed  in  the  right  ventricle,  but  compos’d  of  a  kind 
of  mucous  and  yellowifh  fubftance. 

While  the  head  was  cut  off,  long  portions  of  concreted  blood  were  drawn 
out  from  the  jugular  veins,  like  fwords  from  their  {heaths.  The  veffels  of 
the  meninges  were  extremely  diftended  with  blood.  And  a  polypous  con¬ 
cretion,  white  and  compact  in  its  ftrudlure,  did  not  only  poifefs  the  finus  of 
the  falx,  but  even  went  into  molt  of  the  veins  that  communicated  therewith. 
In  the  three  other  finuffes  of  the  dura  mater  was  alfo  coagulated  blood. 
But  the  pia  mater  had  all  its  veffels,  even  the  fmalleft,  fo  turgid  with  blood, 
that  it  was  univerfally  very  red.  And  ferum  was  beneath  it,  in  the  wind¬ 
ings  of  the  brain.  In  the  lateral  ventricles  alfo  was  ferum,  of  a  reddifh 
colour,  but  in  fmall  quantity.  On  the  pofterior  part  of  the  plexus  choroides, 
were  many  large  hydatids,  However,  not  only  the  veffels  which  pal's  through 
the  furface  of  the  lateral  ventricles  were  diftended  with  blood,  and  for  that 
reafon,  much  more  manifeft  than  they  generally  are ;  but  if  you  nightly 
ferap’d  the  corpora  ftriata,  and  the  thalami  nervorum  opticorum,  or  if  you 
cut  deeply  into  that,  or  any  other  part  of  the  medullary  fubftance  of  the 
brain,  veffels  occurr’d  every  where,  after  the  fame  manner,  proportionably 
full  and  manifeft.  But  in  the  cortical  fubftance  of  the  cerebrum  and  cere¬ 
bellum  we  could  fcarcely  diftinguifh  any. 

14.  How  noxious  the  duft  is,  that  muft  be  neceffarily  drawn  into  the  afpera 
arteria  and  lungs,  during  the  drefting  of  hemp,  ourRamazini  has  fhewn  (7), when 
he  frequently  aferibes  the  continual  cough,  and  afthmatic  affection,  of  thefe 
workmen  thereto.  But  that  occafion  is  given  to  acute  difeafes  of  the  lungs 
from  thence,  when  co-operating  with  the  ftate  of  the  blood,  which  leave 
behind  them  other  chronic  diforders,  or  at  length  themfelves  deftroy  life,  is 
manifeft  from  the  hiftory  I  have  given  you.  For  after  the  man  had  elcap’d 
the  firft  inflammation  of  the  lungs,  his  work  did  not  fuffer  that  vifeus  to 
grow  perfedtly  healthy  ;  therefore  he  was  taken  with  others,  and  others  after¬ 
wards,  till  fome  one  not  having  had  a  perfect  crifis,  left,  as  it  were,  the  be¬ 
ginning  of  a  confumption,  as  the  leannefs  and  alteration  of  voice,  but  efpe- 
cially  that  colledlion  of  pus,  within  a  kind  of  tubercle,  fhew’d.  And  to  this 
was  added,  the  laft  pleuro-peripneumony,  which  was  fucceeded  by  a  phrenitis, 
and  even  a  paraphrenitis,  and  all  thefe  join’d  together  carried  off  the  patient. 
But  I  do  not  ufe  the  word  paraphrenitis  in  fuch  a  fenfe  as  to  fuppofe  it 
a  diforder  arifing  from  the  moft  grievous  inflammation  of  the  diaphragm, 
and  attended  with  thofe  violent  fymptoms,  with  which  Boerhaave  (2)  deferibes 
it :  and  for  this  reafon  I  do  not  engage  in  thefe  controverfies,  which  are  very 
learnedly  agitated  in  the  Commercium  Literarium  (a).  It  is  fufficient  for 
me,  that  by  this  word  you  now  underfland  a  diforder,  which  may,  in  fome 
meafure,  be  referr’d  to  the  paraphrenitis.  For  if,  by  the  name  of  paraT 
phrenitis  (£),  you  underfland  a  delirium,  which  happens  without  the  head 

(y)  Dietrib.  de  Morb.  Artific.  c.  26.  (<2)  A.  1 736.  Hebd.  22  n.  2.  Hebd.  41.  b.  1. 

\z)  Aphor.  de  cognofc.  morb.  §  909.  Hebj.  52.  n.  2.  &  A.  1737.  Hebd.  16.  n.  1. 

(&)  Vid.  Sennert.  Med.  Praft.  1. 1 .  p.  2.  c.  6. 

T  2  being 


i  40  Book  I.  Of  Diforders  of  the  Head. 

being  primarily  affedted  *,  then,  certainly,  an  inflammation  of  the  pleura  and 
lungs  had  preceded  here.  Or  if  you  underftand  it  to  be  a  delirium,  from 
the  inflammation  of  the  feptum  tranfverfum  ;  we  aifo  found  the  feptum  to 
be  inflam’d.  But  I  would  not  have  you  believe,  that  I  neceflarily  conjoin  a 
delirium  with  diforder  and  inflammation  of  the  diaphragm.  For  I  know  the 
obfervation  of  Fernelius  (c),  which  militates  againft  it,  and  is  older  than 
thofe  produc’d  in  the  Sepulchretum  (d'9  from  Willis.  But  as  neither  of 
them  exprefsly  mentions  the  inflammation  of  that  part  of  the  feptum  parti¬ 
cularly,  which  is  moft  of  all  attended  to  by  thofe  who  account  for  a  delirium 
from  inflammation  of  the  diaphragm,  I  mean  of  the  centrum  tendineum, 
but  each  of  them  produces  dilbrders  of  the  flefhy  part,  I  will  juft  take  no¬ 
tice,  that  I  have  feen  its  tendinous  part  alfo  inflam’d,  when  the  mind  had 
been  fcarcely  confus’d,  or  in  the  leaft  delirious,  in  the  laft  period  of  the  dif- 
eafe  ;  as,  when  I  treat  of  the  peripneumony,  I  (hall  (e)  Ihew.  There  are, 
however,  two  obfervations^  in  the  Sepulchretum  (/),  one  of  Blafius,  and 
the  other  of  Lselius  a  Fonte,  the  latter  of  whom  law  the  diaphragm  fuppu- 
rated  after  a  delirium,  and  the  former  greatly  inflam’d  after  a  phrenitis. 
And  as  I  faw  that  both  of  thefe  obfervations  made  mention  of  convulfive 
motions  alfo,  which  had  in  like  manner  been  obferv’d  by  me;  and  as  I  re¬ 
member  Galen  (g)  has  written,  that  64  they  who  have  the  feptum  tranfver- 
“  fum  inflam’d,  are  liable  to  convulfions  and  as  I  alfo  obferv’d,  that  Bla¬ 
fius  had  not  only  feen  an  inflammation  of  the  lower  part  of  the  liver,  but 
alfo  a  polypous  concretion  in  the  fame  finus  of  the  dura  mater,  as  1  did,  and 
extended  into  the  fame  veins ;  I  did  not  think  it  would  be  altogether  ufelefsy 
if  I  (hould  read  over  thofe  obfervations  in  the  books  of  each  author.  But 
the  trouble  of  feeking  was  greater  than  the  utility,  by  reafon  of  the  ambi¬ 
guous  mark  with  which  the  fixth  part  of  Blafius  is  pointed  out,  and  the  de¬ 
ceitful  number  of  the  confultation  of  Lselius,  which  points  out  132,  inftead 
of  130;  although  I  found  there  was  fome  amendment  neceflary  in  defcribing 
the  obfervation  of  one,  and  fomething  to  be  added  to  the  description  of  the 
other.  Yet  this  I  was  affur’d  of,  that  Blafius,  who  open’d  the  head,  for 
Laelius  never  touch’d  it,  really  had  not  mention’d  the  inflammation  of  the 
pia  mater.  So  that  you  have  a  more  diftindt  example  of  the  parephrenitis 
in  his  obfervation,  than  in  mine ;  becaufe,  if  not  primarily,  at  leaft  after¬ 
wards,  this  membrane  was  fo  much  inflam’d,  that  I  never  remember  to 
have  feen  it  more.  But  however  thefe  things  may  be,  let  me  fhew  you  alfo 
a  delirium  attended  with  an  inflammation  of  the  dura  mater,  or  at  leaft, 
with  a  diforder  approaching  thereto. 

15.  A  woman,  who  had  been  long  before  in  the  hofpital  at  Padua,  for  a 
blow  on  her  head,  and  being  cur’d,  had  gone  out,  fell  afterwards  into  a 
fever,  was  delirious,  and  died..  The  head  only  being  brought  into  the  ana¬ 
tomical  theatre,  about  the  end  of  the  public  demonftrations  which  I  made 
in  the  year  1 736,  I  carefully  difledted  the  brain,  in  its  fituation.  There  was 
no  where  any  particular  mark  of  that  blow.  The  dura  mater  being  taken 

( C )  Pathol.  1.  5.  c.  11.  (f)  Se<a.  cit.  obf.  15  &  37.  quae  fufius  1.2. 

\d)  Se£t.  hac  7.  obf.  1.  S.  4.  obf.  19. 

(e)  EpilL  21.  n.  35.  (g)  De  Pulf.  ad  Tyr.  c.  11. 


away;; 


I 


Letter  VII.  Article  16.  141 

away,  its  internal  fur  fare  appear’d  to  be  diftinguifh’d  with  frequent  fcarlet 
fpots,  like  drops  of  blood.  The  veffels  of  the  pia  mater  were  turgid 
with  blood;  and  under  that,  in  fome  places,  was  ferum,  which  there  was 
not  in  the  ventricles.  In  the  pofterior  part  of  the  plexus  choroides  were 
veficles.  And  before  the  pineal  gland  was  a  little  yellowifh  matter.  Every 
thing  eile  was  natural  and  found  ;  unkfs  that  the  cerebellum  was  very  lax. 
I  found  no  polypous  concretion  in  any  of  the  veffels. 

16.  In  violent  deliria,  it  is  not  only  certain,  that  the  veffels  of  the  dura- 
mater  are  found  cs  very  turgid,”  as  Slcvogtius  (h)  fays,  but  that  the  very 
iubftance  thereof  is  alfo  frequently  inflam’d  :  to  which  you  may  refer  thofe 
fcarlet  fpots  of  that  membrane.  But  in  this  woman,  befides  a  fulneis  of  the 
veffels,  water  was  not  wanting  under  the  dura  mater.  Nor  was  it  wanting, 
there  in  the  man,  of  whom  Valentinus  (i)  fpeaks,  as  having  labour’d  under 
a  fever,  and  violent  deliria:  for  at  the  fame  time  that  the  veins  were  very 
turgid,  in  the  whole  brain,  “  immediately  under  the  pia  mater  much  pituita, 
“  and  yellowifh  water,  condenfated  into  the  form  of  a  jelly,”  were  found. 
And  I  have  alfo  given  an  account  above,  of  the  ventricles  being  full  of  fe¬ 
rum,  from  Moglingius  (k)  to  omit  other  examples  of  water  in  the  brain 
of  delirious  perfons.  But  thefe  things  now  bring  to  my  mind  a  conjecture 
of  mine  •,  of  which,  that  you  may  the  more  eafily  judge,  I  mult  go  pretty 
far  back  to  relate  it.  In  the  beginning  of  the  month  of  February,  in  the 
year  1711,  fevers  of  the  word  kind  began  to  fpread  very  much  in  the  place 
of  my  nativity.  The  pulfe  in  all  of  them,  even  the  moft  robufl  young  men, 
was  very  final],  weak,  obfcure,  and  confus’d.  In  moft  of  them  was  a  ftrong 
fublultus  tendinum  at  the  writ,  and  a  foporific  affection.  And  in  fome  fi¬ 
nally,  was  a  iingultus,  and  extreme  dejection  of  the  (Length  and  fpirits, 
with  a  lividnefs  of  the  face,  and  the  fingers,  and  other  fymptoms  of  the 
fame  kind.  I  was  the  firfb  who  obferv’d  thefe  fevers  and  even  after  all 
thefe  bad  fymptoms,  which  I  have  mention’d,  with  the  divine  affiftance,  I 
very  happily  lav’d  patients  that  were  already  confider’d  as  the  dead  that  were 
to  be  mourn’d  for  ;  two  of  whom  were,  fome  years  ago.  Hill  living,  as  Cor¬ 
nelio  Denti,  a  nobleman,  who  recover’d  by  means  of  a  long  and  large  cri¬ 
tical  difcharge  of  urine  •,  and  Ignatio  Garavini,  an  ingenious  mechanic,  who 
recover’d  by  means  of  a  critical  diarrhea.  About  the  end  of  February, 
the  convulfive  fubfultus,  fingultus,  and  lividnefs,  were  not  obferv’d  in 
thofe  fevers  ;  but  deliria  began  to  come  on,  yet  were  not  violent,  and  only 
when  the  fever  was  exacerbated.  Yet  thofe  who  were  thus  affected,  (till 
efcap’d,  and  among  thefe,  that  noble  prieft  Tullio  Caftellini;  who,  I  remem¬ 
ber,  although  he  had  receiv’d  no  benefit  from  thefe  evacuations,  by  which 
the  others  were  reliev’d,  efpecially  by  a  long  moifture  of  the  (kin,  yet  found 
himfelf  begin  to  be  much  better,  after  having  difcharg’d  by  his  mouth  a  red 
round  worm,  longer  than  a  fpan,  and  thicker  than  a  quill  with  which  we 
write.  But  at  length,  in  the  month  of  March,  ..although  the  fevers  were 
attended  with  fymptoms,  much  milder  in  appearance,  and  the  pulfe  and 
tongue  leem’d  to  promife  a  happy  event,  contrary  to  what  they  did  in  the 
former  ;  yet  the  cure  went  on  lets  profperoufly  than  in  the  former,  deliria  com- 

{b)  Differt.  de  Dura  Matre  §  29.  (/)  Eph,  N.  C.  Cent.  10.  obf.  94.  (t)  n.  8. 


8 


ing 


14-  Book  I.  Of  Difcafes  of  the  Head. 

ing  on  differently  from  what  they  had  in  them,  and  attacking  the  patients 
after  a  violent  pain  of  the  head.  But  to  imitate  the  Hippocratic  fnnplicity 
in  both  refpedts,  being  call’d  in  at  the  middle  of  the  difeafe,  by  fenior  phy- 
fleians,  we  could  by  no  means  fave  two  patients,  Vincent  Mangazzini,  a  very 
refpedtable  young  man,  and  J.erom  Gnocchio,  a  nobleman  and  a  prieft.  But 
we  perceiv’d  beforehand,  that  a  vehement  phrenitis  threaten’d  the  former, 
from  the  figns  which  were  taught  us  by  our  anceftors,  among  which  we  par¬ 
ticularly  remark’d  this,  that  the  patient  leem’d  to  himfelf  to  hear  continually 
the  mufic  of  the  organ,  which  is  us’d  in  churches  and  confecrated  buildings  ; 
like  the  perfon,  who  faid  to  the  colledors  of  the  Bibliotheca  Anatomica  (/),  on 
the  laft  days  of  a  fatal  fever,  “  that  he  perpetually  heard  a  kind  of  very 
“  fweet  concert,  or  melody,  to  which  a  delirium  at  length  fucceeded.”  In 
Gnocchio,  this  leem’d  worthy  of  remark,  that  the  delirium  always  came  on 
immediately  when  his  whole  body  was  in  a  fweat,  and  at  that  time  only. 
And  though  we  may  alfo  account  for  this  very  peculiar  circumftance,  by 
fuppofing,  that  much  ferum  being  taken  away  from  the  blood  by  the  difeharge 
of  fweating,  the  parts  of  this  that  remain’d,  as  they  were  lefs  dilute,  fo  they 
were  more  acrid,  and  more  apt  to  irritate :  yet,  perhaps,  nothing  forbids  to 
deduce  it  from  that,  whence  I  feem  to  have  digrefs’d  ;  I  mean,  from  too  acrid 
a  water,  which  in  the  former  patients,  as  the  very  cold  feafon  at  that  time 
difpos’d  them,  was  fo  copioufly  difeharg’d  by  the  kidnies,  but  in  this  patient, 
fecreted  from  the  blood  under  the  pia  mater,  at  the  fame  time  with  the  fweat, 
and  from  the  fame  caufe.  But  as  I  was  not  permitted  to  enquire,  by  diffedtion, 
which  conjedture  of  the  two  might  feem  to  be  the  molt  juft,  I  will  rather  go 
on  to  fliew,  that  there  has  been  a  flight  delirium,  where  I  found  fcarcely  any 
traces  of  water,  whether  this  happen’d  by  chance  or  otherwife  ;  and  at  the 
fame  time,  produce  an  example  of  the  {lighter  fpecies  of  delirium,  that  is, 
of  a  paraphora,  as  phyfleians  fometimes  underftand  this  word,  after  I  have 
given  you  inftances  of  the  phrenitis,  paraphrenitis,  and  more  violent  deliria. 

17.  An  old  woman,  being  feiz’d  with  a  flight  fever,  which  the  phyfician 
hop’d  to  have  been  able  to  overcome  with  the  Peruvian  bark,  it  not  only  did 
not  yield  thereto,  but  degenerating  into  an  acute  fever,  with  flight  wan¬ 
derings  of  mind,  fhe  died. 

Some  of  the  vifeera  of  the  belly  and  thorax,  together  with  the  head,  being 
brought  into  the  theatre,  I  differed  them,  not  many  days  before  I  diffedted 
the  brain  of  the  former  woman.  Some  things  that  were  unufual,  indeed, 
but  not  altogether  unnatural,  offer’d  themlelves  to  our  infpedlion,  in  the  right 
kidney,  and  in  the  heart  itfelf ;  which,  as  they  did  not  feem  unworthy  to  be 
demonftrared  to  every  one  who  was  prefent  at  that  time,  fo  I  think  are  not 
unworthy  of  being  related  to  you  at  prefent.  For  from  that  kidney  two 
ureters  proceeded,  the  upper  ftom  a  more  Ample  pelvis,  and  fmall ;  but  the 
inferior,  fomewhat  thicker,  inafmuch  as  it  proceeded  from  a  pelvis,  which 
was  render’d  larger  and  more  prominent,  by  the  confluence  of  many  tubuli 
into  it.  As  the  origin  of  each  ureter  was  diftindt,  fo  was  its  progrefs  and  in- 
fertion  •,  for  betwixt  the  orifices  of  the  two  tubes,  was  an  interval  of  a  finger’s 
breadth.  Both  were  oblong,  and  open’d  by  an  oblique  line,  as  they  ought, 

{/)  Tom.  2.  in  Adnot.  ad  da  Verney  Trait,  de  Audit.  Org.  p.  3. 


I 


into 


Letter  VII.  Article  i  8.  14.3 

into  the  bladder ;  fo  that  one  was  quite  fuperior  to  the  other.  But  in  the 
heart,  inffead  of  the  valve  of  the  coronary  vein,  I  found  a  kind  of  net-work, 
not  differently  form’d  from  one  of  thofe  varieties  of  the  valves,  which  you  will 
fee  defcrib’d  by  me  in  the  lafb  place  but  one,  in  the  Epiftolae  Anatomicae  (m). 
But  thefe  appearances,  as  I  have  faid,  are  not  altogether  fo  preternatural  as 
what  I  faw  in  the  great  artery,  but  efpecialiy  as  what  I  faw  in  the  uterus.  For 
in  the  aorta  I  faw,  internally,  white  beginnings  of  offiffcations,  a  little  above 
the  femilunar  valves,  and  at  the  vertebrae  of  the  loins.  But  when  the  uterus 
was  open’d,  I  found  in  the  pofterior,  and  at  the  fame  time,  fuperior  part 
of  its  fundus,  an  excrefcence,  of  the  circumference  of  a  circle,  of  a  colour  ex¬ 
ternally  bloody,  and  ftretch’d  out  from  the  right  lide  towards  the  left  •,  almoff: 
a  third  part  of  its  border,  which  lay  inferior  and  more  to  the  left,  being  dif- 
join’d  from  the  uterus,  fo  that  it  might  be  lifted  up  with  a  probe  being  put 
under  it.  The  remaining  part  of  it  was  very  intimately  connected  with  the 
fubffance  of  the  uterus,  and  indeed  feem’d  to  be  made  up  of  the  fame  fub- 
ftance,  unlefs  that  the  whole  excrefcence,  by  cutting  into  it,  was  found  to  be 
more  white,  hard,  and  compact,  than  the  uterus  itfelf.  Without  doubt* 
this  was  a  fchirrus,  or  if  you  would  rather  have  it  fo,  the  beginning  of  a 
cancer,  at  that  time  occult,  very  low,  plane,  and  fmooth,  nor  bigger  than- 
fo  as  to  be  cover’d  by  the  point  of  my  thumb,  when  extended.  If  you  con- 
fider’d  the  ftruCture  and  fu  perficies,  of  the  neighbouring  cervix  uteri,  and  the 
membranous  ring  of  the  hymen,  which  was  of  little  depth  in  its  furface  in¬ 
deed,  but  no  where  lacerated,  you  would  readily  conclude,  that  this  woman 
had  had  but  very  little  commerce,  if  any  at  all,  with  man. 

The  cranium  at  length  being  cut  open,  and  the  brain  accurately  examin’d* 
nothing  offer’d  itfelf  any  where  to  me  which  was  worthy*of  notice,  except 
the  veffels  of  the  pia  mater  diftended  with  blood,  and  this  membrane  itfelf, 
which  was  eafily  drawn  off  by  the  fingers  from  the  brain  where-ever  you 
pleas’d  :  fo  that,  although  I  fcarcely  faw  any  water,  yet  I  conjectur’d,  even 
from  this  mark,  that  it  was  not  altogether  wanting. 

18.  If  you  fhould  expeCt,  that  before  I  make  an  end  of  writing,  I  begin 
to  point  out  in  what  part  of  the  brain,  and  in  what  manner,  the  motions 
are  made,  or  what  kind  of  motions  they  are,  when  deliria  are  excited  : 
you  would  feem  not  yet  to  be  fufficiently  acquainted  with  me.  For  all  I 
could  do  would  be  only  to  give  you  forne  general  hypothefes,  which  for  that 
reafon  are  known  to  you  and  to  others  •,  and  even  thofe  1  fhould  give  you  very 
timoroufly  and  cautioufly.  The  other  confiderations,  I  think,  muff;  be  re- 
ferr’d  to  that  time,  in  which  phyficians  thought  it  praife-worthy  to  enquire, 
in  fuch  a  manner,  not  only  into  all  abftrufe  things,  but  even  thofe  which  are 
plac’d  beyond  our  capacity,  that  when  they  could  not  find  out  the  real  caufes 
of  them,  they  made  no  fcruple  to  invent  others.  And  I  could  wiffi  that  fo 
much  place  was  not  given  to  thefe  random  conjectures  in  the  fcholia  of  the 
Sepulchretum  ;  for  they  frequently  take  up  more  room  there,  than  the 
hiffories  of  the  diforders  of  the  head,  or  even  many  put  together.  And  it 
is  Hill  more  to  be  wifh’d,  that  the  fame  things  were  not  fometimes  repeated 
over  again  in  one  and  the  fame  fcholium  (») ;  efpecialiy  fuch  things  that  you 
may  learn  to  be  entirely  contrary  to  all  probability,  from  almoft  every  de¬ 
fection  which  I  (hall  give  the  relation  of  in  the  next  letter.  Farewel. 


( m )  Epift.  15.  n.  23. 


(«)  Ad  obf.  1.  fe&.  6.  I.  i. 

LETTER 


1 44  Book  I.  Of  Difeafes  of  the  Head. 


LETTER  the  EIGHTH. 

Wherein  Madnefs,  Melancholy,  and  Hydrophobia,  arc 

treated  of. 

i.  f  JT\  W  O  fedtions  follow  in  the  Sepulchretum,  one  of  which  is  entitled, 
1  De  mania,  rabie ,  feu  hydrophobia ;  the  other,  De  melancholia ,  & 

(ijfeftione  hypochondriaca.  But  it  is  not  my  intention  to  treat  feparately  of  this 
laft  diforder,  becaufe  I  confider  that  it  does  not  prove  mortal,  except  when 
it  is  attended  with  others  more  violent ;  as  even  the  examples,  which  are  pro¬ 
duc’d  in  the  Sepulchretum,  fufficiently  prove  :  for  this  reafon,  then,  what¬ 
ever  relates  to  this  diforder,  will  be  treated  of,  together  with  thofe.  Mad¬ 
nefs,  to  ufe  the  words  of  Willis,  which  are  produc’d  in  the  fame  volume  ( a), 
16  is  fo  far  a-kin  to  melancholy,  that  thefe  diforders  often  mutually  inter- 
“  change  their  appearances,  and  go  over  one  into  the  other.”  And  you 
often  fee  phyficians  doubting,  on  the  one  hand,  from  taciturnity  and  fear, 
and  on  the  other,  from  loquacity  and  boldnefs,  every  now  and  then  alter¬ 
nately  appearing  in  the  fame  patient,  whether  they  fhould  pronounce  him  to 
be  afflidted  with  madnefs,  or  with  melancholy.  And  this  confideration  made 
me  endure,  with  more  patience,  the  anfwers  which  I  have  frequently  receiv’d, 
when,  upon  difiedting  the  heads  of  perfons  who  had  been  diforder’d  in  their 
fenfes,  I  have  enquir’d  with  which  of  the  two  deliria  they  had  been  affedted; 
anfwers,  which  were  frequently  ambiguous,  and  often  repugnant  to  each 
other,  and  yet  perhaps  true  in  the  long  courfe  of  the  difeafe.  Wherefore, 
although  in  the  dilfediions  I  am  going  to  deferibe  to  you,  I  fhall  fignify  when 
I  know  that  the  patient  inclin’d  moft  to  the  one,  or  to  the  other  flate  of  the 
diforder  ;  yet,  as  I  fhall  be  able  to  do  that  but  feldom,  I  chofe  rather  to  com¬ 
prehend  in  this  one  letter  what  relates  to  either  of  thefe  deliria,  and  in  the 
conclufion  to  add  thofe  hiftories  which  belong  to  the  hydrophobia  •,  efpecially 
as  I  have  but  one  hiftory  from  Valfalva  relative  to  thefe  fpecies  of  deliria,  and 
with  this,  as  ufual,  I  begin. 

2.  A  virgin,  of  more  than  twenty  years  of  age,  being  extremely  defirous 
to  withdraw  into  a  nunnery,  and  being  refus’d  what  fhe  defir’d,  her  mind 
began  to  be  a  little  weak  and  unfleady,  from  the  moment  fhe  heard  the  news 
of  her  repulle :  and  very  foon  after,  fhe  began  to  reafon  incongruoufly,  which 
encreas’d  on  her  more  and  more  every  day  ;  fo  that  fhe  frequently  refus’d  to 
take  food.  Some  months  were  thus  pals’d,  in  which  time,  befide  a  fever 
that  attack’d  her  many  times  by  irregular  returns,  a  more  violent  madnefs 
came  on,  without  a  fever  j  fo  that  fhe  endeavour’d  to  ftrike  thofe  who  fat  by 
her:  and  her  ftrength  decreafmg  by  degrees,  fhe  died. 

The  fkull  being  open’d,  fome  little  white  bodies  were  feen  at  the  fides  of 
the  longitudinal  hnus,  in  the  dura  mater  externally  j  fome  of  which  were 


(a)  In  fchol.  ad  obf,  i.  fed.  8.  ejufd.  1. 


round, 


Letter  VIII.  Articles  3,  4.  145- 

round,  others  oblong,  and  fome  of  a  figure  perfectly  irregular,  but  all  fofc 
in  their  confidence :  Valfalva  thought  that  they  had  their  origin  from  a  con¬ 
creted  humour,  for  this  reafon  •,  becaufe  he  had  feen  fimilar  bodies,  from 
concretions  of  pus,  ftagnating  about  the  fame  membrane,  in  patients  who 
had  died  from  wounds  of  the  head.  But  in  that  finus  was  a  (lender  polypous 
concretion,  which  extended  itfelf  through  the  whole  length  of  the  cavity. 
The  brain  was  moift ;  and  in  its  larger  ventricles  was  a  little  quantity  of  le- 
rum.  However,  in  the  plexus  choroides  pretty  large  glandular  bodies  were 
prominent,  which  had  been  indurated  into  a  folid  body,  yellow,  and  fome- 
what  globular  in  its  form. 

3.  If  befides  this  virgin,  whofe  delirium  had  degenerated  from  melancholy 
into  madnefs,  Valfalva  had  had  as  frequent  opportunities  of  differing  other 
bodies  of  infane  perfons,  as  he  had  of  attending  to  their  diforders  while  living; 
I  doubt  not  but  he  would  certainly  have  obierv’d,  what  I  have  obferv’d  in 
all  I  have  hitherto  examin’d,  that  is,  a  confiderable  hardnefs  in  the  brain. 
But  as  to  what  relates  to  thofe  tumid  bodies  in  the  plexus  choroides,  and 
to  the  little  bodies  which  he  deferib’d  at  the  fides  of  the  longitudinal  finus  ; 
I  believe,  I  have  already  mention’d  to  you  a  larger  extuberance  in  that 
plexus  than  either  of  thefe  (£),  and  yet  not  in  the  head  of  a  maniac,  or  me¬ 
lancholic  perfon.  And  I  fufpect  that  thofe  corpufcles,  which  rais’d  them- 
felves  up  here  and  there  from  the  dura  mater,  were  probably  of  the  fame 
kind  with  thefe,  which  were  afterwards  call’d  glands  by  Pacchioni,  which 
are  feated  in  thofe  very  places,  being  fometimes  lefs,  yet  often  (till  much 
more,  confpicuous.  But  although  thefe  are  neither  preternatural,  as  the  ca¬ 
vities,  or  pits,  imprefs’d  on  the  infide  of  the  Ikull,  to  receive  thele  little 
mafies,  evidently  (hew,  nor  were  unknown  to  anatomifts  two  ages  ago,  after 
Vefalius  (c),  who  calls  them  tubercula ;  and  though  they  were  even  again  fet 
forth  as  new  appearances,  a  little  before  Valfalva  was  born ;  yet  at  the  fame 
time  in  which  he  wrote  that  obfervation,  they  had  been,  in  fome  meafure, 
forgotten  again.  But  I  (ball  demonftrate  all  thefe  things,  more  at  large,  in 
another  place ;  nor  will  I  conceal  the  experiments  which  1  have  made,  in  or¬ 
der  to  afeertain  the  nature  of  thofe  corpufcles.  At  prefent,  it  will  be  more 
proper,  I  think,  to  confirm  by  the  produdtion  of  fix  or  feven  dilfedtions, 
that  very  lingular  hardnefs,  which,  1  fay,  I  have  always  obferv’d  in  the  ce¬ 
rebrum  of  maniac  or  melancholic  perfons. 

4.  A  tall  robuft  youth  was  feiz’d  with  madnefs,  in  the  year  1729.  The 
phyficians  order’d  blood  to  be  taken  from  his  temporal  artery,  to  the  quan¬ 
tity  of  a  pound,  which  was  about  the  end  of  June.  Scarcely  an  hour  pafs’d 
from  the  time  in  which  the  furgeon  had  perform’d  the  operation,  when  the 
young  man  was  found  dead,  with  his  tongue  hanging  out  of  his  mouth. 
That  you  may  not  accufe  a  kind  of  remedy,  which  has  been  us’d  by  ancient 
and  modern  pra<5titioners  in  medicine ;  and  approv’d  of  by  the  happy  fuc- 
cefies  of  M.  Aurelius  Severinus  (d),  (inftead  of  whom  I  fee  that  Hildanus 
is  heedlefsly  commended  by  many)  and  others  ( e ) ;  and  fometimes  even  found 

(l)  Epift.4.  n.  33.  (/)  De  efficac.  Medic.  1.  i.  p.  2.  ubi  de  Ar- 

(c)  De  hum.  corp.  fabr.  1.  7.  c.  2  &  Explic.  teriot. 

Fig.  1.  ejufd.  libr.  7.  ad  K.  ( e )  Eph.  N.  C.  Cent.  3.  obf.  60. 

Voii.  I. 


u 


to 


14  6  Book  I.  Of  Difcafcs  of  the  Head. 

to  adminifter  an  immediate  cure,  as  in  the  cafe  of  the  robuft  virgin*,  and 
that  you  may  not  blame  the  undeferving  phyficians,  as  the  vulgar  are  wont 
to  do,  or  throw  the  fault  upon  the  lurgeon  ;  and  alfo,  that  you  may  the 
better  form  a  judgment  of  fome  things  which  were  remark’d  in  the  body 
after  death,  I  mutt  not  conceal  from  you,  what  the  perfon  who  had  com¬ 
mitted  the  fa£t  could  not  fufficiently  conceal.  The  fadt  was  this  :  the  patient, 
in  confequence  of  his  madnefs,  had  remov’d  the  bandages,  which  had  been 
juft  applied  to  the  wounded  artery,  lb  that  they  were  immediately  under  a 
neceftity  of  being  replac’d,  after  the  lofs  of  a  very  little  blood.  At  this  re* 
fradtory  madnefs,  however,  the  perfon  to  whofe  cuftody  the  patient  had  been 
committed,  was  fo  enrag’d,  that  after  having  miferably  beaten  him  with  his 
fills  about  his  belly  and  eyes,  being  grown  more  mad  than  the  madman  him- 
felf,  he  threw  a  very  {freight  bandage  about  his  neck,  and  departed. 

Examining  the  body  the  day  after,  I  did  not  wonder,  for  the  reafons  I 
have  mention’d,  that  the  face  was  of  a  black,  purple,  and  livid  colour*,  tba« 
on  the  feat  of  the  nafal  bones,  which  by  feeling  with  my  fingers,  I  knew  to 
be  broken,  the  fiefh  was  almoft  entirely  black  j  or  that  the  belly  was  turgid, 
and  in  many  places  of  a  green  and  livid  complexion.  And  having  ex- 
min’d  the  thorax,  fo  far  as  to  obferve  the  lungs  . to  be  moderately  tumid,  a 
foam  in  the  afpera  arteria,  though  not  in  confiderable  quantity,  and  a  large 
quantity  of  fluid  blood  in  the  pulmonary  vein  *,  and  that  the  valves  of  the 
pulmonary  artery  were  harder  than  naturally  they  are ;  every  thing  elfe  feem- 
ing  to  be  very  natural,  I  immediately  pafs’d  over  them,  in  order  to  enquire 
more  accurately  into  the  ftate  of  the  brain.  The  veflels  of  both  the  me¬ 
ninges  were  diftended  with  a  black  and  fluid  blood,  as  thofe  were,  in  like 
manner,  which  crept  through  the  fides  of  the  feptum  lucidum,  and  the  re¬ 
maining  parietes  of  the  right  and  left  ventricle.  And  thefe  ventricles  alfo  ... 
contain’d  a  great  quantity  of  turbid  water.  Yet  the  plexus  choroides  were 
red :  and  many  veficles  lay  on  their  pofterior  part,  which  were  fill’d  with 
water,  and  among  thefe  was  one  equal  in  bignefs  to  the  fize  of  a  moderate 
grape ;  through  the  coat  of  which,  veflels  pafs’d,  equally  as  big  as  thofe  in 
the  neighbouring  membrane  of  the  plexus,  and  in  the  fame  manner.  But 
nothing  occurr’d  which  was  more  worthy  of  obfervation  than  the  hardnefs  of 
the  cerebrum.  For  whether  you  cut  into  its  medullary  or  cortical  fubftance, 
you  perceiv’d  the  fubflance  to  be  very  hard,  at  the  fame  time  t.hat  the  fub¬ 
ftance  of  the  cerebellum,  or  at  leaft  the  cortical  part  of  it,  was  even  rather 
fofter  than  it  generally  is. 

5.  In  order  to  keep  the  more  audacious  madmen  within  bounds,-  Celfus 
has  admonifh’d  (/),  “  that  ftripes  alfo  fhould  be  applied,  and  that  they 
tc  who  behav’d  themfelves  with  more  violence  fhould  be  bound,  that  they 
“  may  not  hurt  themfelves  or  any  others.”  Yet  all  this  ought  to  be  within 
bounds,  like  a  parent  who  corre&s  his  children,  and  not  like  an  executioner, 
who  ufes  all  kinds  of  violence  againft  his  prifoners.  I  remember  that  VaU 
falva,  when  he  had  under  cure  maniac  or  phrenitic  patients,  whofe  arms 
it  was  neceflary  to  confine  with  bands,  was  accuftom’d  to  inculcate  carefully, 
into  his  domeftics  and  keepers,  that  they  mull  be  cautious  left  the  patient 


(f)  De  Medic.  1.  3.  c.  18. 


ihould 


Letter  VIII.  Article  5.  -  147. 

fhould  get  any  injury  from  thence:  that  the  bands,  indeed,  fhould  beftrong, 
but  neither  tight  nor  hard  ;  and  for  this  real'on  he  would  have  foft  linen  or 
woollen  cloth  few’d  within  the  leather  ftraps  (g). 

As  I  have  once  or  twice  fpoken  of  maniac  patients,  cur’d  by  Valfalva, 
you  will  perhaps  afk  me,  whether  he  had  any  thing  peculiar  in  his  treatment 
of  them  ?  He  made  ufe  of  the  fame  kind  of  remedies  as  mod  others  do  j 
but,  as  it  becomes  a  good  phyfician,  he  made  ufe  of  different  kinds  on  dif¬ 
ferent  occafions,  but  on  all  occafions  he  made  ufe  of  as  few  and  as  agreeable 
as  he  could:  fo  I  remember,  that  fome  were  reftofd  by  him,  even  byemul- 
fions  made  only  from  the  feeds  of  mdons,  to  which  he  had  neither  added  the 
feeds  of  poppies,  nor  what  he  knew  by  experience  to  be  more  efficacious  than 
them  againft  watchings,  the  fyrup  of  poppies ;  fo  far  do  little  matters  fome- 
times  perform  what  violent  methods  can  by  no  means  atchieve.  A  phyfician, 
of  undoubted  veracity,  has  more  than  once  affirm’d  to  me,  that  when,  in  cafe 
of  infuperable  phrenzy,  he  had  order’d  five  or  fix  grains  of  opium  to  be 
diffolv’d  in  thofe  waters,  with  which  raggs  were  to  be  moiften’d,  and  applied  to 
the  forehead  •,  and  thefe  waters  had,  by  the  miftake  of  thofe  who  attended 
the  patient,  been  given  to  him  for  drink,  hefaw  no  effect  from  thence.  And 
concerning  this  fubjed,  there  was  a  very  fingular  opinion  of  Francefco  Spo- 
leti,  formerly  primary  profefibr  of  medicine  in  this  college ;  who  returning 
from  Condantinople,  where  he  had  practis’d  phyfic,  with  fuccefs,  even  in 
the  feraglio  of  the  Grand  Signor,  for  fome  time,  and  confirming  to  us  what 
we  read  of  opium  being  much  more  pure  and  efficacious  there,  than  among 
us,  inafmuch  as  it  verges  to  the  colour  of  cinnamon,  and  has  a  very  narcotic 
odour,  as  we  fay  amongd  us,  and  is  there  taken  by  many  accuftom’d  to  that 
pradice,  not  to  make  them  fleep,  but  that  they  may  watch  chearfully  ;  and 
that  in  the  dofe  of  a  drachm,  or  at  lead,  as  a  chemical  friend  of  mine,  who 
had  been  with  him,  had  feen,  to  the  quantity  of  a  fcruple  •,  added  his  fuf- 
picion,  that  the  caufe  of  the  different  effed  thereof  upon  them,  and  upon  us, 
confided  in  this,  that  a  much  greater  weight  of  fome  medicines  mud  have 
quite  contrary  effeds  to  a  very  fmall  one  :  jud,  faid  he,  as  if  a  thread,  lying 
round  a  fibre,  be  moderately  tied,  you  will  then  comprefs  the  fibre  j  but  if 
you  draw  the  dring  with  a  much  greater  force,  you  break  afunder,  not  com¬ 
prefs,  the  fibre:  as  if  it  were  poffible  to  cut  the  fibre  afunder,  without  fird 
greatly  compreffing  it !  But  he  rather  meant  this,  which  I  will  fhew  by  an 
inverted  example  :  if  a  very  flight  wind  agicate  a  flame,  the  flame  is  thence  en- 
creas’d  ;  if  a  violent  one,  it  is  extinguiffi’d  :  although  by  this  it  is  not  under- 
dood,  why  thofe  who  are  accudom’d  to  it  there,  can  do  that ;  and  they  who  are 
unaccudom’d,  as  here,  cannot  do  it ;  that  is,  watch  chearfully  and  brilkly,  after 
taking  a  fcruple  of  opium.  For  I  do  hot  enquire,  why  they  do  not  fleep 
there,  or  why  they  do  not  watch  in  a  heavy  and  befotted  date,  like  thofe  who 
are  drunk  ;  but  why  mod  of  them  watch  with  alacrity  and  livelinefs  ?  As  I 
am  not  ignorant,  that  there  are  among  us,  and  in  other  places,  fome  to  whom, 
as  they  accudom  themlelves  to  it  by  degrees,  a  fcruple  of  opium,  or  more 
than  that,  was  not  only  not  noxious,  but  even  ufeful  againd  pains  ;  and  that 
there  are,  among  the  Turks,  fome  who  devour  much  more  opium  than  Spo- 


(g)  Vid.  Epift.  16.  n.  4. ; 

U  2 


leti 


148  Book  I.  Of  Difeafes  of  the  Head. 

leti  faid,  yet  are  thence  made  ftupid  and  fottiffi,  and  that  in  the  higheft  de¬ 
gree.  But  thefe  things  draw  us  a  great  way  from  our  hiftories,  to  which, 
therefore,  it  is  proper  that  we  return. 

6.  A  butcher,  who  had  been  diforder’d  in  his  fenfes  for  fourteen  months, 
from  the  effects,  as  was  faid,  of  a  love-potion,  at  length  died,  in  the  be¬ 
ginning  of  the  year  1719,  by  the  violence,  as  was  fuppos’d,  of  the  very  cold 
ieafon,  from  which  he  took  no  care  to  fecure  himfelf.  Looking  through  the 
belly  and  thorax,  I  obferv’d  nothing  worthy  of  remark,  except  the  heart, 
every  where  connected  with  the  pericardium  ;  and  under  the  abdomen,  (light, 
ulcers  of  the  praeputium,  cicatrices  of  the  urethra,  and  very  few  of  thole 
canals  which  I  have  particularly  defcrib’d  in  the  Adverfaria.  As  to  what  re¬ 
lates  to  the  head,  although  I  found  water  extravafated  under  the  pia  mater, 
yet  the  cerebrum  was  of  fuch  a  firmnefs,  that  I  then  never  remember’d  to. 
have  dilfedted  one  more  hard.  Moreover,  in  the  fuperior  and  pofteiior  fur- 
face  of  the  corpus  callofum,  I  did  not  find  thofe  two  prominences  which. 
Lancifi  (h)  calls  nervuli  longitudinales  ;  but  inftead  of  them,  two  pretty  deep, 
furrows.  And  having  cut  into  the  fornix,  which  was  itfelf  hard,  not  far 
from  that  part  of  it  which  is  call’d  its  bafis,  and  having  turn’d,  it  back,  to¬ 
gether  with  the  plexus  choroides,  I  faw  a  kind  of  pellucid  lymphasdudf, 
creeping  feparately  through  each  of  the  knots  of  that  bafis,  which  were  con¬ 
tinu’d  on  each  fide  through  the  medullary  tradbs,  with  which  the  upper  bor¬ 
ders  of  the  third  ventricle  are  adorn’d  (Lancifi  (/)  call’d  them  frequently. 
“  proceffes,  or  little  nerves,  coming  out  from  the  bafis  of  the  pineal  gland)”; 
and  as  they  crept  through  thofe  trails,  they  feem’d  a  little  more  evidently 
to  contain  lymph,  and  to  be  diftinguifh’d  with  little  knots  ;  and  finally,  they, 
feem’d  to  bend  their  courle  towards  that  gland  ;  to  which  was  annex’d,  at  its 
anterior  part,  a  little  congeries  of  yellow  matter,  form’d  into,  minute  gra¬ 
nules.  But  it  was  matter  of  great  chagrin  both  to  me  and.to  the. celebrated 
Vulpius,  who  was  prefent,  that  this  fpecies  of  pellucid,  veffels,  which  appear’d 
to  us  in  the  manner  1  have  defcrib’d  to  you,  were  entirely  vanifii’d  before 
we  could  certainly  determine  what  they  were  ;  although  we  tried  every  me¬ 
thod  to  find  it  our,  that  our  unprepar’d  (late  would  admit  of.  Yet  this 
vexation  was  in  fome  meafure  alleviated  by  the  unufual  firmnefs. of  the  cere¬ 
brum;  allur’d  by  which,  I  fought  after  more  eafily,  and  more  clearly  difir 
cover’d,  many  things  in  the  fubltance  of  that,  and  of  the  medulla  oblongata  ; . 
fo  that  I  think,  the  brain  of  infane  perfons  of  this  kind  is  the  mod  fit  of  all 
to  trace  internally  the  origins  of  the  nerves  upon,  and  the  courfe.  of  theic 
tradts,  and  other  things  of  the  fame  kind  ;  the  inveftigation  cf  which  is 
much  more  difficult  and  obfeure  in  a  more  foft  brain,  as  it  generally  happens 
to  be :  fo  that  the  fame  things  be  but  fufficiently  confirm’d  afterwards,  in 
the  brain  of  fome  healthy  men,  which  is  lefs  foft  than  they  commonly  are. 
when  differed. »+ 

7.  That  madnefs  may  be  brought  on,  by  a  philtre,  or  love-potion,  is  cer¬ 
tain  (k).  Buc  whether  this  man  was  mad,  is  uncertain  ;  efpecially  if  he  pe¬ 
riod  by  the  violence  of  the  cold,  of  which  diforder’d  perfons  of  that  kind 

m  Diflert.  Var.  VII.  fig.  j.  litt.  dd. 

(0  Ibid.  fig.  4.  litt.  gg. 


(<$)  Vid,  P.  Borcll.  Hill.  cent.  1.  obf.  65. 


Letter  VIII.  Article  7.  149: 

are  generally  us’d  to  be  extremely  patient,  and  with  impunity.  And  from 
this  mark  1  am  induc’d  to  fulpedt,  that  the  two  women,  whofe  hiftories  I 
final!  prelently  lubjoin,  did  not  labour  under  a  madnefs,  at  that  time  at  lead, 
when  the  one  in  the  depth  of  winter  contracted  an  angina,  and  the  other  an 
inflammation  of  the  thorax.  But  becaufe  this  is  generally  true,  yet  not  al¬ 
ways,  nor  in  all  cales  (/),  I  will  leave  the  matter  undetermin’d.  But  what¬ 
ever  kind  of  delirium  this  was,  that  appearance  which  was  feen  by  me  in 
the  corpus  callofum  of  this  infane  man,  might  feem  to  confirm  the  opinion 
of  Lancifi,  concerning  the  feat  of  the  anima  cogitans ,  or  foul  (*»),  if  we 
had  feen  any  thing  of  that  kind  in  others  alfo  (»).  But  you  will  know, 
when  we  come  to  the  lad  {o')  of  thefe  difledtions,  what  is  feldom,  what  often, 
and  what  always,  found.  In  the  mean  while,  thofe  things  that  I  hinted  to 
you,  of  fome  common  internal  remedies  for  madnefs  and  phrenitis,  in  the 
former  letter  (/>),  bring  back  to  my  mind  that  I  promis’d  to  declare,  what 
was  the  compofition  of  a  certain  external  remedy  againft  both  thefe  diforders. 
But  don’t  fuppofe  that  I  fhall  here  take  notice  of  what  a  certain  phyfician, 
who  was  a  friend  of  Valfalva’s,  afierted  in  my  hearing,  that  he  could  not 
cure  a  maniacal  perfon,  who  was  known  to  both  of  them,  before  he  had  taken 
care  to  have  his  head  fhaved,  as  often  as  the  hair  grew  to  the  height  of  a 
finger’s  breadth.*,  and  when  this  was  firftdone,  that  much  more  ill  fuelling 
fordes  were  found,,  adihering.  to  the  fkin,  than  any  one  would  have  imagin’d. 
Nor  expeft  me  here  to  produce  any  foreign  remedy  externally  applied  to 
procure  fleep  occafionally  *,  although  my  friend  Ramazzini  teftified  to  me, 
that  even  opium  itfelf  diffolv’d  in  wine,  with  which  he  had  order’d  the 
temples  to.  be  bath’d,  in  obftinate  watchings,  or  doflils  of  lint  dipp’d  therein, 
and  applied  to  the  internal  noftrils,  had  but  juft  brought  on  a  flight  deep. 
It  was  a  remedy  eafily  prepar’d,  and  worthy  of  the  verfe  of  Samonicus, 
which  a  phyfician  was  accuftom’d  to  ufe  againft  phrenzy  and  madnefs,  whom, 
if  nothing  elfe,  at  leaf!;  a  long  age  and  experience  feem’d  to  recommend. 
He  then,  us’d  frefh  cheefe,  of  the  coarfer  fort,  mix’d  with  oil  of  violets,  and 
laid  it  upon  the  crown  of  the  head,  after  being  frefh  fhav’d,  and  order’d  the 
application  thereof  to  be  renew’d  three  times  everyday.  You  will  afk,  whether 
this  was  done  with  fuccefs  ?  And  I  will  anfweryou,  by  telling  you  what  I  faw. 
A  ftrong  man,  by  trade  a  blackfmith,  having  been  liable,  from  a  boy,  to 
the  incubus,  and  vertigo,  which  had  been  brought  on  him  by  a  fright,  fell 
down  fuddenly  in  the  winter-time,  and  complain’d,  in  confus’d  words,  of  an 
internal  pain  in  his  breaft.  Being  immediately  brought  into  the  hofpital,  he 
anfwer’d  fcarcely  any  thing  to  thofe  who  afk’d  him  queftions  \  but  ftiut  his 
eyes,  and  cover’d  his  face  with  the  fheet,  like  a  man  out. of  his  fepfes.  He 
was  hot  at  the  fame  time,  and  trembl’d  j  nor  had  di unkennels,  or  any  other 
caufe  of  that  kind  preceded  :  and  a  fever  likewife  attended.  On  the  fol¬ 
lowing  day,  he  began  to.  leap  out  of  bed,,  to  cry  out,  to  threaten,  and 
even  to  ftrike,  all  about  him  ;  fo  that  being  evidently  a  maniac,  it  was  ne- 
ceflary  that  he  fhould  be  confin’d  with  bands.  He  cried  out  violently  and! 

(/)  Vid.  Etmuller.  Prax.  1.  2.  f.  3.  c.  4.  arr.2.  (»)  Vid.  Epift.  61,  n.  6. 

3.  (0)  N.  13. 

{in)  Differt.  VII.  paulo  ante  cit.  (/)  N.  13. 


continually  y. 


r/ o'  Book  I.  Of  Difeafes  of  the  Head. 

continually,  and,  at  the  fame  time,  his  whole  body  was  agitated  with  con» 
vulfive  motions.  Then  the  phyfician,  having  order’d  a  vein  in  the  foot  to 
be  open’d,  and  a  pound  of  blood  to  be  taken  away,  alfo  order’d  the  cata- 
plafm  I  have  told  you  of,  to  be  laid  upon  his  head,  after  being  (hav’d.  Do 
you  afk  me  what  was  the  event  ?  Why,  by  this  means,  within  twelve  hours, 
he  was  reftor’d  to  perfect  fanity  •,  but  whether  the  cure  was  accidental,  or  the 
effedt  of  blood-letting  only,  or  in  fome  meafure  owing  to  the  afilftance  of 
the  external  remedy,  I  will  leave  you  to  determine.  Thofe  who  foment  the 
heads  of  infane  patients  with  milk,  will  readily  believe,  that  the  cataplafm 
contributed  thereto.  But  yon,  v/hether  you  think  that  nothing  is  to  be  neg¬ 
lected  in  the  art  of  phyfic,  or  whether  you  wilh  that  nothing  Ihould  be  left 
obfcure,  or  unexplain’d,  among  thofe  things  that  I  have  written  to  you,  will 
perceive,  that  I  have  fatisfied  you  in  each  of  thefe  particulars.  But  do  you 
give  no  account  of  your  own  pradlice?  You  will  fay,  give  me  leave,  I  be- 
feech  you,  firft  to  produce  the  difieCtions  of  the  two  women,  of  whom  I 
fpoke  a  little  before.  Then,  in  obedience  to  your  commands,  I  lhall,  perhaps, 
go  on  to  talk  triflingly ;  but  whether  my  difcourfe  is  trifling  or  grave,  afl’ure 
yourfelf,  that  1  fhall  produce  nothing  but  what  is  true.. 

—  8.  A  woman,  of  forty  years  of  age,  who  was  diforder’d  in  her  fenfes,  was 
carried  off  by  an  angina.  Her  body  was  brought  to  me  at  the  college,  before 
the  middle  of  February,  in  the  year  1719,  when  I  was  publickly  teaching 
anatomy.  As  the  body  was  not  proper  for  the  purpofes  to  which  I  wanted  it, 
brcaufe  the  mufcles  of  the  abdomen  were  already  green,  though  it  was  but 
a  few  hours  after  death,  and  the  inteftines,  which  were  diftended  with  flatus, 
were  not  entirely  free  from  inflammation,  having  juft  examin’d  the  uterus, 
the  fmallnefs  of  which  was  a  proof  that  (he  had  not  borne  any  children,  the 
breafts  confirming  the  fame,  as  although  they  had  a  little  milky  ferum  in 
them,  they  were  yet  very  fmall ;  I  undertook  only  to  dilfedl  the  brain,  as  I 
was  then  much  ftreighten’d  for  time.  And  this  I  found  to  be  very  hard, 
juft  as  1  had  done  before  in  the  butcher. 

9.  Another  woman,  who,  it  was  very  certain,  had  been  brought  to  bed 
•  of  a  child  the  year  before,  nor  had  been  any  the  better  in  her  fenfes  after  it, 
continu’d  to  run  about  through  the  public  ftreets,  as  before,  unlefs  prevented 
by  any  one,  yet  without  doing  any  injury  to  thofe  fhe  met,  as  far  as  I  could 
learn.  She  had  begun  to  be  infane  almoft  nine  years  before  the  time  I  fpeak 
of,  on  account  of  the  man  whom  fhe  lov’d  being  kill’d  the  day  before  he 
was  to  have  been  married  to  her.  At  length  fhe  died  of  an  inflammation  of 
the  breaft,  in  the  beginning  of  December,  in  the  year  1725. 

I  differed  the  head  only.  Under  the  pia  mater  was  water,  not  without 
air-bubbles  here  and  there  ;  which  I  faw  alfo  in  fome  of  the  veflels,  in  a  very 
crowded  ftate,  fo  as  to  fill  them.  .But  there  was  no  water  in  the  lateral  ven¬ 
tricles  ;  in  which  the  plexufifes  and  the  vefifels  were  red.  To  the  bafis  of  the 
pineal  gland,  anteriorly,  adher’d  a  little  white  matter,  degenerating  into  a 
yellow  colour,  which  feem’d  to  be  a  congeries  of  calculi  •,  but  being  examin’d 
by  the  touch,  it  was  not  found  to  be  calculous,  and  even  fcarcely  at  all  hard. 
As  1  cut  the  brain  into  pieces,  I  remark’d,  that  the  medullary  fubftance  was 
not  very  white,  but  brownifli :  and  this,  perhaps,  was  owing  to  the  fangui- 
.fsrous  veflels  being  fuller  than  ufual ;  for  the  deeper  I  went  from  the  cortical 

3  fubftance, 


letter  VIII.  Article  1  o.  15 1 

fub'ftance,  the  Ids  brown  did  the  medulla  feern  to  be.  This,  however,  is 
very  certain,  that  the  fame  medullary  fubftance,  throughout  the  whole  cere¬ 
brum,  and  in  the  parts  of  it  that  are  feen  in  the  ventricles,  was  of  an  unufual 
hardnels  •,  and  that  the  nerves  themfelves,  within  the  cranium,  appear’d  to 
be  more  firm,  and  lefs  moift,  than  ufual,  when  they  were  cut  into.  But  as 
in  the  cerebrum,  the  cortical  fubftance  was  alfo  pretty  firm,  fo  it  was  very 
foft  in  the  cerebellum ;  although  the  pedunculi,  and  the  internal  medullary 
part  of  the  cerebellum,  which  lay  round  them,  were  indeed  pretty  firm. 

10;  Now,  if  I  tell  you  what  I  have  found  ufeful,  in  women  or  men  of  that 
kind,  who  were  delirious  without  a  fever,  I  jfhall  feem  only  to  do  what  is 
already  done.  For  that  in  the  beginning  of  the  difeafe,  efpecially  when 
there  was  an  hypochondriac  melancholy,  or  when  any  particular  place  or 
objedt  gave  occafion  to  its  origin,  I  have  found  nothing  better  than  for  the 
patient  immediately  to  undertake  a  long  journey,  in  the  company  of  prudent 
and  chearful  friends  :  or  if  this  couki  not  be  done,  that  the  faccharum  fa- 
turni,  cautioufiy  given,  was  of  ufe  to  fome,  and  to  others  bathing,  and  to  > 
many  length  of  time,  more  than  all  remedies :  1  fay,  though  I  fhould  relate 
thefe  things,  and  others  of  the  like  kind,  to  you,  yet  I  ffiall  have  faid  no¬ 
thing  which  you  do  not  often  read. 

It  will  be,  perhaps,  more  ufeful  to  defcribe  perfpicuoufiy  and  accurately,, 
yet  in  as  few  words  as  can  poffibly  be,  on  fo  long  and  various  a  fubjedl,  a  pe^ 
culiar  fuccefiion  of  difeafes, the  laft  of  which  was  a  mania,  and  that  in  a  ffiort 
time  cur’d.  In  the  year  1711,  when,  by  the  bleffing  of  God,  I  very  hap¬ 
pily  cur’d  Ludovico  Albertini,  a  very  worthy  archdeacon  in  the  church  of . 
Forli,  in  a  very  difficult  cafe  •,  he  had,  among  the  reft  of  his  fervants,  a  run¬ 
ning  footman,  of  twenty-three  years  of  age,  {lender,  and  of  an  unhealthy 
complexion,  whom,  being  tir’d  with  much  labour,  a  fever  had  feiz’d  in  the 
beginning  of  September :  the  fever  was  continual  •,  and  though  it  feem’d  to 
approach  to  a  double  tertian,  yet  it  was  very  irregular,  and  attended  with 
various  other  fymptoms  of  difeafe.  For  fometimes  pain  and  heat  of  the  head, 
back  .and  loins*,  fometimes  watchings,  and  at  other  times  ftupidnefs,  fo  that 
he  would  fcarce-anfwer  any  body  who  afk’d  him  a  queftion  *,  fometimes  a  » 
fenfe  of  internal  heat,  and  unaccountable  anxiety ;  at  others,  a  thirft,  flight 
delirium,  and  coldnels  of  the.  feet  came  upon  him  ;  but  fome  at  one  time, 
and  lome  at  another,  without  any  order  at  all.  A  fmallnefs  and  weaknefs  of 
the  pulfe  was  almoft  an  univerfal  attendant  of  the  difeafe.  Blood  being  taken  . 
from  his  arm  twice  within  the  firft  eight  days,  the  ferum  was  of  a  faffron 
colour,  and  the  craflamentum,  at  the  firft  bleeding,  but  (till  more  at  the  fe- 
cond,  had  a  thick  cruft  covering  it,  which  was  fomewhat  of  a  livid  colour. 
His  urine  was  at  firft  thick  and  red,  but  afterwards  thin ;  and  although  the 
quantity  of  it  anfwer’d  very  well  to  what  he  drank,  and  even  fometimes  ex¬ 
ceeded  that  proportion,  and  finally,  although  it  had  frequently  fomething  iwim- 
ming  in  it,  yet  it  never  depofited  any  fediment  at  the  bottom  of  the  glafs. 
He  had,  at  one  time,  a  diarrhea,  with  many  very  liquid  ftools,  otherwife  he  ; 
was,  in  that  refpedt,  as  if  he  had  been  in  health,  but  his  ftools  were  fome¬ 
times  yellow  *,  and  he  once  difcharg’d  a  couple  of  worms  therewith.  A. 
fweat  broke  out  twice  over  the  whole  body,  but  generally  only  on  the  fore¬ 
head,  and  in  that  part  it  was  fometimes  cold.  Once  blood  flow’d  out  of  his 

noftrils* 


r  5  2  Book  I.  Of  Difeafes  of  the  Head. 

nodrils,  but  in  fmall  quantity  only.  Moreover  a  pain,  which  began  about 
the  ear  and  the  fingers,  feem’d  fometimes  to  indicate  an  endeavour  of  nature 
to  depofit  fomething  upon  thofe  parts.  Thus  he  went  on  to  the  fourteenth 
day,  when  convulfive  motions  appear’d  on  that,  and  fome  of  the  following 
days.  Yet  on  thefe  days,  the  patient  was  more  lively  and  brilk,  and  had  a 
better  afped: ;  for  a  little  before,  his  face  had  been  fwollen,  and  fomewhat 
livid.  As  the  convulfive  motions  went  off,  the  ilcin  of  the  fhoulders  and 
bread  began  to  have  a  flight  rednefs,  and  become  a  little  rough.  And  to 
fhow  you  that  this  endeavour  of  nature  was  not  altogether  ufelefs,  though 
not  diffidently  ufeful ;  neither  watchings,  nor  third,  nor  any  indifpofition  of 
that  kind,  now  any  longer  remain’d  ;  and  even  the  pulfe  was  very  nearly  re- 
dor’d  to  its  natural  regularity.  But  his  domach  was  not  drong,  and  blood 
eafily  diddl’d  from  his  node,  if  he  wip’d  it  in  the  lead  with  his  handkerchief ; 
and  prefently,  after  pains  of  the  belly,  he  had  fluid  dools,  of  the  colour  of 
tobacco ;  and  a  few  days  after  his  fever  was  encreas’d,  but  not  without  a  cold- 
nefs  preceding. 

Therefore,  although  throughout  almod  the  whole  month  of  September, 
I  endeavour’d  to  aflifl  nature,  as  occafion  feem’d  to  require,  and  took  the 
iitmofl  caution,  led  I  fhould  impede  her  in  any  of  her  motions,  or  pull 
down  the  drength  of  the  patient ;  yet  he  was  fo  far  from  becoming  well, 
that  one  diforder  continually  rofe  after  another,  For  the  day  after  the  fever 
was  fomewhat  encreas’d,  as  I  have  faid,  his  continual  complaints  of  third, 
the  dwelling  of  his  face  and  his  hands,  and  the  belly  railing  itfelf  up  above 
the  navel,  in  an  equal  tumour,  ihew’d  that  a  dropfy  was  at  once  threaten’d, 
and  at  hand.  And  this  dropfy,  moreover,  encreas’d  fo  fad,  that  although 
he  made  no  fmall  quantity  of  water,  which  I,  in  fome  meafure,  promoted, 
and  foon  after  very  large  quantities  were  fecreted,  yet  the  third  not  only  be¬ 
came  more  violent,  and  the  watry  tumour  extended  itfelf  under  the  fkin  uni- 
verfally,  but  a  dry  cough  alfo  came  on,  which  was  fo  much  the  more  trou- 
blefome,  as  colourlefs  blood  frequently  flow’d  down  from  his  node,  even  of 
itfelf,  and  without  any  impetus  being  applied  ;  the  patient  was  at  the  fame  time 
opprefs’d  with  a  difficult  refpiration  and  flertor,  and  had  his  mufcular  drength, 
and  that  of  his  pulfe  greatly  decreas’d ;  fo  that  within  five  days,  and  not 
more,  the  affair  feem’d  thus  far  brought  to  an  ifllie,  that  the  faculty  of  fpeech 
being  alfo  lod,  he  was  look’d  upon  by  every  body  as  defperate,  and  at  the 
point  of  death.  But  to  me,  who  did  not  omit,  either  before  or  now,  what¬ 
ever  I  could  do  in  fo  dangerous  a  cafe,  be  it  never  fo  little,  fome  profpeft- 
remain’d,  from  the  quantity  of  water  which  dill  continu’d  to  be  excreted.  And 
my  hopes  were  prefently  encreas’d,  by  obferving  fome  very  minute  kind  of 
fandy  p>articles,  which  were  in  very  great  number,  and  almod  cover’d  the 
whole  lides  of  the  urinal  internally.  For  this  fign  of  a  happy  folution  of  the 
difeafe,  which  I  have  obferv’d  in  many  patients,  as  I  will  tell  you  more 
largely  on  another  occafion  (y),  I  had  never  found  fallacious  to  that  time. 
And  indeed  the  patient  foon  began  to  be  a  little  better,  and  even  to  fpeak : 
and  the  tumour  of  his  whole  body  and  third  to  decreafe ;  nor  did  blood  any 
more  flow  out  from  his  nofe.  Yet  the  dertor  even  then  continued.  But 


/ 


(f)  EpiU.  49.  n.  21. 


three 


Letter  VIII,  Article  i  o.  153 

tnree  days  had  fcarcely  elaps’d,  from  the  time  in  which  he  feem’d  to  be  giving 
up  the  ghoft,  when  fcarcely  any  difficulty  of  breathing  remain’d,  and  two 
days  more  being  added,  there  were  in  no  part  any  traces  of  a  dropfy  ;  fo 
that  as  many  days  as  it  took  up  in  its  increale,  fo  many  did  it  take  in  its  de- 
creafe.  The  cough  now  and  then  recurr’d,  but  feldom  ;  and  once  only 
forc’d  a  little,  but  well-colour’d  blood  from  the  nofe,  and  fometimes  difturb’d 
his  eafy  fleeps.  This,  however,  it  was  not  difficult  to  obviate,  nor  yet  to 
take  off  the  conftridtion  of  the  belly,  which  was  now  tGO  great;  and  at  the 
fame  time  to  deterge  it.  At  length,  after  a  long  want  of  appetite,  a  defire 
after  food  began,  and  the  pulfe,  which  was  before  no  longer  weak,  but  had 
continu’d  frequent,  began  now  to  be  lefs  frequent  :  the  patient  had  a  natural 
ftool  every  day,  and  his  firength  was  by  degrees  reftor’d,  fo  that  he  could 
fit  up  a  long  while  in  bed,  without  any  detriment. 

Every  thing  now  feem’d  to  be  very  fafe,  unlefs  that  the  urine,  which  con¬ 
tinu’d  to  flow  in  great  quantities,  even  after  the  dropfy  had  iubfided,  though 
it  return’d  gradually  to  its  natural  bounds,  never  fhew’d  that  kind  of  fedi- 
ment  in  the  bottom  of  the  glafs,  which  is  nfual  in  thofe  cafes,  and  which 
I  earneftly  wifh’d.  Wherefore  fome  error  having  likewife  been  committed 
in  the  article  of  eating  and  drinking,  as  I  afterwards  found  out,  the  urine 
not  only  became  decreas’d  in  its  quantity,  but  all'o  appear’d  red,  and  thick  : 
and  immediately  a  quantity  of  bilious  matter  was  difeharg’d  by  ftool,  at¬ 
tended  with  gripings  and  tormina  of  the  inteftines :  and  this  began  on  the 
tenth  day,  after  the  dropfy  had  been  perfectly  refolv’d.  Although  I  was  not 
ignorant  (r),  “  that  in  difeafes,  where  one  continually  fucceeds  another,  they 
<c  are  generally  mortal and  although  I  was  fearful,  left  a  frequent  and 
copious  difeharge  of  the  inteftines,  attended  with  much  pain  and  torture, 
fhould  fo  far  afflidt  a  patient,  who  had  now  fuffer’d  for  fifty  days,  all  the 
manifold  and  grievous  fymptoms  1  have  deferib’d,  that  I  ffiould  never  be 
able  to  raife  him  again ;  yet  at  firft  I  refolv’d  to  wait  a  little  while,  and  fo 
far  to  purfue  an  intention  of  cure,  as  to  fee,  that  he  was  not  grievoufly  ex¬ 
cruciated  with  his  pains. 

I  had  not  waited  quite  two  days,  when  behold  the  patient  was  attack’d 
with  a  fourth  difeafe,  the  third  ff ill  remaining;  I  mean  a  mania,  for  the 
fake  of  which  1  determin’d  to  give  you  this  hiftory,  that  is  longer  than  I 
intended  in  the  beginning  it  ftiould  be.  And  firft,  indeed,  I  thought  it  was 
a  phrenitis  ;  for  it  feem’d  once  and  again  to  grow  ftronger  with  a  fever.  But 
after  I  had  obferv’d  the  fury  ft  ill  to  remain,  when  the  lever  was  gone,  fo  that 
it  was  not  fafe  for  any  of  the  affiftants  to  come  near  the  patient,  who  was 
free  from  confinement ;  I  no  longer  doubted  but  it  was  in  faeft  a  madnefs ; 
and  I  learn’d  that  this  kind  of  infanity  may  be  excited,  after  a  long  autum¬ 
nal  fever;  although  this  was  not  of  the  intermittent  kind,  which,  as  Syden¬ 
ham  (j)  had  admonifli’d  us,  is  fucceeded  by  a  peculiar  kind  of  madnefs,  and 
as  Boerhaave  (/),  who  follows  him  in  this,  has  confirm’d.  But  that  this  kind 
of  delirium  lometimes  is  the  conlequence  of  other  fevers,  an  obfervation  of 

(>-)  Hippoc.  1.  de  AfFe&ion.  n.  23.  (/)  Aphor.  de  cogn.  morb.  §  1125. 

(/)  Obf.  Med.  circa  Morb.  Acut.  S.  1.  c.  3. 

Vol.  I.  X 


Borelli 


154  Book  I.  Of  Difeafes  of  the  Head. 

Bcrelli  (u)  teaches,  and  in  like  manner  another,  commended  by  Etmuller  (x). 
But  this  of  mine  exhibits  a  madnefs,  which  fucceeded  a  fever  indeed,  but 
ftill  more  properly  a  dropfy,  by  which,  that  a  madnefs  is  us’d  at  other  times 
to  be  critically  folv’d,  or  at  leak  diminiih’d,  the  aphorifm  of  Hippocrates  (-y)y 
though  the  celebrated  Pafta  has  fome  doubts  upon  this  head  (2),  demonftrates_ 
44  A  difordcr  of  the  inteftines,  a  droply,  or  flight  delirium,  lucceeding  to  a 
44  furious  madnefs,  are  favourable  figns.”  With  which  opinion  Jacotius  {a)y 
comparing  another  of  Hippocrates,  44  Epileplies  that  happen  in  dropiical 
*•  diforders  are  fatal,”  has  added  the  following  words  :  44  For  which  reafon, 
44  any  thing  that  fliould  feem  to  be  of  advantage,  not  only  is  of  no  advan- 
44  tage,  but  even  has  a  contrary  effedt ;  fo  that,  for  inftance,  to  a  dropfy 
44  fome  grievous  diforder  of  the  head  is  added  ;  and  that  this  is  extremely 
44  bad,  is  very  certain  for  many  reafons.” 

But  thefe  words  are  to  be  confider’d  as  relating  to  a  diforder  that  is  added 
to  another,  and  not  equally  to  a  lucceeding  one  :  therefore,  it  was  not  without 
fome  hope  that  I  attempted  the  cure  of  my  inlane  patient  •,  though,  by  reafon 
of  what  he  had  before  luffer’d,  I  could  not  p.urfue  that  practice  which  is  re¬ 
commended  by  the  celebrated  Borelli,  to  uie  a  bath  of  fvveet  water,  or  vence- 
ledlions  ;  efpecially  as  the  face  and  eyes  were  not  red  in  this  patient,  nor  the 
motions  of  the  arteries  very  much  quicken’d.  Nor  could  I  follow  another 
method,  propos’d  by  Sydenham,  to  ufe  warmer  remedies,  and  keep  the  belly 
coftive  :  for  bilious  matter  was  difcharg’d  from  the  inteftines,  though  not  fr> 
frequently,  nor  any  longer  attended  with  tormina  •,  and  l  was  fo  far  from 
thinking,  that  this  would  injure  the  patient,  that. I  even  hop’d,  according  to 
the  aphorifm  above- mention’d,  that  it  would  be  likely  to  be  of  fervice. 
Therefore,  inftead  of  vensdecftions,  I  order’d  cupping  glafles  to  be  fix’d  down 
to  the  lower  limbs,  without  fcarification,  and  then  to  be  pull’d  away ;  and 
fuch  things  to  be  laid  upon  the  head,  as  are  faid  to  be  fedative,,  and  promote 
fleep  ;  and  fometimes  even  compofing  medicines  to  be  given  at  the  beginning 
of  the  night,  in  fuch  a  manner  however,  as  always  to  have  regard  to  the 
ftrength  of  the  patient,  and  the  prefervation  of  the  difcharge  by.ftool,  which 
I  had  determin’d  not  to  check.  And  when  I  had,  by  means  of  thefe  medi¬ 
cines,  procur’d  fome  little  reft,  and  faw  that  the  delirium  was,  in  confequence 
thereof,  more  mild  ^  this  was  the  only  difagreeable  circumftance  on  the  fol¬ 
lowing  days,  that  the  difcharge  from  the  inteftines  was  ftopp’d.  For  either 
there  was  fome  hope,  that  by  this  way  the  matter  might  at  length  be  entirely 
eliminated  from  the  body,  which  had  kept  up  the  diforder  fo  long,  and  in  fo 
many  fhapes  :  or,  as  other  ways  had  been  before  attempted  in  vain,  it  re¬ 
main’d,  that  I  fhould  prepare  a  new  one,  by  brnging  on  an  ulcer,  if  poflibly 
that  matter  could  be  expell’d  by  this  way,  which  could  not  be  expell’d 
by  others  •,  fuppofe  44  fome  kind  of  virus,  or  1  know  not  what  malignant 
44  ftimulus*,”  for  that,  if  we  believe  Ballonius  (b\  44  any  fudden  change, 
44  or  tranfition,  of  one  difeafe  into  another,  is  a  proof  of.”  Therefore,  as. 
the  purging  of  the  belly  did  not  laft  above  one  day,  and  afterwards  its  difl- 

(«)  Cent.  4.  obf.  42.  .  (2)  Not.  ad  eum  aphor. 

(*)  Membr.  3.  cit.  fupra  ad  n.  7.  (3)  Comment.  1.  6.  in  Coac.  f.  2.  a.  30. 

(y)  5.  f.  VIE  (£)  Epidem.  1.  2.  ad  ver  a.  1578. 

charge 


Letter  VIII.  Article  t 1 .  155 

charge  was  like  that  of  a  perfon  in  health,  and  the  encreas’d  quantity  of 
urine,  though  thick,  was  of  no  advantage  *,  I  open’d  that  new  way  in  one 
arm,  by  applying  a  cauftic  thereto  •,  and  by  this  drain,  a  great  quantity  of 
humour  being  foon  carried  off,  and  continuing  to  be  difcharg’d  for  fome 
days,  the  patient  was  all  this  time  more  quiet  •,  fo  that  he  could  rife,  and  walk 
about  the  houfe,  without  any  danger  to  himfelf,  or  to  others.  Yet  he  was 
lefs  reftor’d  to  his  fenfes,  than  was  neceffary  for  him  *,  for  he  would  not  fuffer 
that  the  lore  in  his  arm,  which  it  was  neceffary  to  keep  open  fome  time  longer, 
fhould  be  any  more  at  all  touch’d  by  the  furgeon.  When,  therefore,  the 
ulcer  was  almoft  heal’d,  and  his  mind  was  not  yet  fufficiently  calm  and  fteady, 
nature  brought  in  that  affiftance  which  I  had  before  wifh’d.  For  a  great 
quantity  of  bilious  matter  flowing  down  by  the  inteftines,  he  was,  after  the 
beginning  of  November,  freed  at  once  from  the  remainder  of  his  madnels, 
and  from  the  danger  of  a  new  diforder.  For  although,  when  he  was  left  to 
his  own  difcretion,  a  little  afterwards,  and  for  that  realon  walk’d  and  ate  more 
than  was  neceffary,  his  legs  were  again  a  little  lwollen,  yet  this  fwelling  eafiiy 
went  off,  as  foon  as  ever  he  kept  himfelf  temperate  in  thefe  two  points. 

Thus  you  have  all  that  I,  who  was  then  a  young  man,  was  able  to  obferve, 
to  adt,  or  to  think,  in  a  particular  inftance,  relating  to  the  fucceffions  of 
difeafes  •,  a  fubjedt,  doubtlefs,  very  ufeful  to  phyficians,  and  for  that  realon 
attempted  by  Baglivi  ( c )  in  his  very  outlines,  and  neverthelefs  much  wifh’d 
for  by  him,  by  Reufnerus  (i),  and  by  others,  fuppofing  that  till  their  time 
no-body  had  ever  attempted  to  treat  of  the  fubjedt.  Yet  that  Profper  Al¬ 
pinus  did  enter  upon  this  fubjedt,  thefe  words  of  Boerhaave  fhew  ( e )  :  “  I 
“  wiffi  we  had  this  book  of  that  fame  Alpinus,”  De  variis  permutationibus 
morborum .  And  that  Stephaniis  Rodericus  Caftrenfis  publifh’d  a  little  work 
upon  this  fubjedt,  entitl’d,  Qua  ex  quibus ,  our  very  celebrated  Gianella  (/) 
has  inform’d  us ;  who  did  not,  for  that  reafon,  think  it  was  fuperfluous  in 
him  to  treat  of  the  fame  fubjedt  learnedly  and  diftindtly ;  efpecially  as  that 
little  work  of  Caftrenfis  (which  was  divided  into  four  books,  and  went  through 
four  editions,  in  the  former  age,  as  you  will  fee  in  Lindenius  Renovatus )  was 
fo  difficult  to  be  found,  that  he  fought  it  in  vain,  though  he  us’d  all  poffible 
diligence  in  the  fearch.  1  happen’d,  however,  to  light  on  it  lately.  But  the 
too  prolix  narration  in  regard  to  the  young  man,  who,  after  fuch  a  long  fuc- 
ceffion  of  diforders,  being  at  length  maniacal,  recover’d  his  former  health 
and  fanity,  in  a  fhort  time,  prevents  my  faying  any  thing  on  that  head  now. 
Let  us,  therefore,  return  to  the  diffedtions  of  thole  patients  who  died  infane. 

1 1.  In  the  latter  end  of  the  year  1723,  I  diligently  diffedted  the  head  and 
neck  only,  of  a  man  who  had  long  been  diforder’d  in  his  fenfes,  and  who  had 
been  taken  off  in  the  holpital  at  Padua  by  a  (low  fever.  Among  the  circum- 
ftances  that  occurr’d  in  this  diffedtion,  I  ffiall  now  only  mention  fuch  as  relate 
to  the  prefent  fubjedt.  In  the  neck,  I  found  the  carotid  arteries,  and  internal 
jugular  veins,  wider  than  natural.  The  upper  part  of  the  'fkull  being  taken 
away,  there  was  water  under  the  meninges  ^  but  none  was  contain’d  in  the 

(c)  Specim.  trium  reliquor,  libror,  de  Fibra  (?)  Prseleft.  in  Inft.  §  942. 

IVlotr.  -c.  1.  (f)  De  Succeffione  Morbor.  1.  1.  c.  1. 

(j*)  Eph.  N.  C.  cent.  5.  olbf.  8< 

X  2 


ventricles, 


i  56  Book  I.  Of  Difeafes  of  the  Head. 

ventricles  •,  and  confequently,  none  between  the  two  lamella?  of  the  feptum,' 
by  which  thole  ventricles  are  divided  from  each  other.  Yet  I  found,  the  ce¬ 
rebrum  hard,  though  it  was  the  fifth  or  fixth  day  after  death.  The  cere¬ 
bellum,  on  the  contrary,  was  flaccid  and  loft.-'' 

12.  We  had  the  fame  parts  of  another  maniacal  man  to  diffedt  in  public, 
in  the  year  1734.  In  the  neck,  an  appearance  was  found  which  deferves  to 
be  taken  notice  of  here,  on  account  of  its  rarity,  though  it  does  not  relate 
to  the  prefent  purpofe.  The  mufculus  ftemoihyroidaeus,  on  each  fide,  was 
entirely  wanting  •,  for  which  reafon,  the  hy.othyroidaei,  not  only  on  the  inner 
fide,  but  on  the  exterior  alfo,  extended  themfelves  to  the  bafis  of  the  feu* 
tiform  cartilage,  taking  up  that  fpace,  which  from  the  upper  and  contracted 
part  of  the  fternothyroidaei,  on  the  furface  of  the  cartilage  above-mention’d, 
us’d  to  be  vacant,  as  I  have  already  (g)  explain’d  and  delcrib’d.  And  as  J 
look’d  upon  this  furface  attentively,  after  the  mufcles  were  rais’d,  and  com-r 
par’d  it  with  other  larynxes,  which  were  at  hand,  I  faw  that  it  had  a  much 
Ids  prominence  than  thole  on  that  part  of  the  cartilage,  where  thefe  mulcles 
are  wont  to  be  inlerted.  Bcfides  thefe  variations,  1  could  not  lee  any  other 
in  the  remaining  mufcles  and  cartilages,  that  belong’d  to  the  larynx,  or  in 
the  adjoining  trunk  of  the  afpera  arteria.  For  although,  when  1  demonftrated 
thefe  appearances  in  the  theatre,,  I  attributed,  in  fome  meafure,  to  the  crico-, 
thyroidfei  and  fternohyoidaei  mufcles,  the  office  of  fupplying  the  place  of  the 
others  that  were  deficient,  and  they  were  in  fadt  large  and  firong ;  yet  they 
did  not  feem  to  be  proportionably  ftronger  and  larger  than  ufual.  And  wher 
ther  this  man,  when  living,  had  any  thing  in  the  motion  of  the.  larynx,  which 
was  worthy  of  peculiar  attention,  I  could  not  poffibly  inform  myfelf,  nor  yet 
of  what  di.forder  he  at  laft  died. 

In  the  brain  I  obferv’d  the  veffels  to  be  diftended,  which  might  alfo  be 
owing  to  the  laft  difeafe.  But  as  to  what  relates  to  the  madnefs,  the  fubftance 
of  the  cerebrum  itfelf  was  in  general  hard*,  whereas  fome  internal  parts,  and 
among  thefe  the  fornix,  and  pineal  gland,  were  extremely  lax.  Bcfides,  this 
gland  was  very  much  ffirunk,  and  had  a  flight  yellowiffi  tinge  mix’d  with  the 
brown,  which  was  its  general  colour.  And  that  there  was  fome  water  under 
the  pia  mater,  is  fufficiently  prov’d,  F  think,  by  this  circumftance,  that  the 
membrane  we  are  fpeaking  of  could  be  very  eafily  drawn  off  from  the  cere- . 
brum,  cerebellum,  and  medulla  oblongata. 

13.  If  you  join  thefe  fix  diffe&ions  of  mine  with  that  which  I  deferib’d  to 

you  in  the  firft  letter  (F),  and  compare  them  all  with  thofe  you  have  in  the 
Sepulchretum,  or  other  books,  you  will  immediately  perceive,  that  among 
thole  things  which  others  have  obferv’d,  fome  of  them  have  been  never  found 
by  me,  a  few  rarely,  many  often,  and  others  indeed  always.  For  example, 
that  I  did  not  find,  even  in  the  man  who.  was  in  like  manner  believ’d  to  be 
made  mad  from  a  philtre,  the  pia  mater  not  w  infinuating  itfelf  as  ufual, 

4‘  between  the  convolutions  of  the  brain,”  my  filence  on  this  head,,  in  the 

hiftory  of  the  butcher  (k)>  plainly  ffiews.  And  that  I  never  faw  worms  in  the 
brain,  and  indeed  never  expe&ed  to  fee  them,  the  firft  letter  fufficiently 

(j-)  Adverf.  j.  n.  6-  &  Tab.  1.  ad  litt.  q  [i)  Seputchr.  1.  i.  f.  9.  in  Addit.,  obf.  i._ 

dexteram.^  (£)  N.  10.  ( k )  Supra,  n.  6. 


fhews  1 


Letter  VIII.  Article  14.  157 

Chews  (/) :  and  for  this  reafon  I  am  the  more  difpleas’d,  that  the  pafiage  which 
elcap’d  Riolanus  (m)  ffiould  be  transferr’d  into  the  Sepulchretum  (;;),  which 
is  this,  “  Does  the  worm  which  is  generated  in  the  brain,  and  is  the  c a ufe 
M  of*  madnefs  in  a  horfe,  owe  its  origin  to  a  putrefaction  of  humours  ?  or 
“  does  it  a  rife  from  a  vermiform  apophylis  of  the  cerebellum ,  degenerating 
“  into  a  worm  ?  ”  Yet,  certainly,  1  never  faw  any  other  things,  which  were 
more  worthy  to  be  added  to  the  Sepulchretum.  Baglivi  (0)  affirms,  “  that 
“  he  had  diffeCted  two  maniacs  at  Naples,  and  that  he  had  found  the  dura 
“  mater  hard,  as  a  piece  of  board,  and  almoft  dried  up.”  Although  it  was 
not  there  neceffary,  that  Willis  ffiould  argue  in  thefe  words,  “  He  ought  to 
“  have  inveftigated,  and  examin’d,  in  thofe  maniacs,  the  ftate  of  the  me- 
c<  ninges,  for  he  would  have  found  a  difference  yet  in  thofe  1  differed, 

1  certainly  know  that  there  was  not  any  :  and  even  as  to  that  appearance, 
which  I  deferib’d  in  the  firfb  letter  (/>),  as  being  found  in  the  dura  mater,  the 
diforder  was  not,  I  think,  to  be  referr’d  to  this  kind,  that  Baglivi  and  Willis 
take  notice  of,  as  it  was  contain’d  within  a  certain  fmall  fpace.  Yet,  fince 
them,  two  very  experienc’d  men,  Littre  (q)  and  Geoffroy  (r),  each  of  them, 
found  both  the  meninges  difeas’d,  in  feparate  maniacal  patients  :  in  the  one, 
it  was  more  compaCt  •,  in  the  other,  it  was  more  thick  and  firm :  not  to  fay 
any  thing  of  the  falciform  procefs,  which  Geoffroy  faw  at  the  fame  time,  al- 
moft  every  where  cover’d  with  bony  laminae,  or  plates.  And  this  firmnefs  or 
thicknefs  of  one,  or  both,  of  the  meninges,  in  maniacs,  has  been  remark’d 
alfo  by  others,  as  you  will  read  in  Alexander  Camerarius  (j),  and  the  cele-r 
brated  Van  Swieten  (/)  :  and  I  ffiould,  perhaps,  be  ready  to  believe  that  this 
appearance  was  brought  on  by  long  and  violent  deliria,  if  I  did  not  know 
that  the  fame  had  been  feen  by  Wepfer  (#),  and  even  after  melancholy  deliria 
by  King(x),  after  fooliffinefs  or  idiotifm  by  others  (jy),  and  even  by  myfelf  (z} 
in  thofe  whofe  underftanding  had  been  perfectly  found.  Yet  I  fee,,  that  this 
is  much  lefs  rarely  to  be  found,  than  thofe  large  kinds  of  glands  in  the  in¬ 
terior  parts  of  the  brain,  which  are  deferib’d  in  the  obfervation  of  Valfalva(rz)  j 
although  at  the  fame  time  I  know,  that,  in  two  melancholic  perfons  {b)\.  ap¬ 
pearances,  in  fome  meaffire  fimilar  to  thefe,  have  been  found  in  the  fame 
places.  Nor  have  the  fame  things  ever  occurr’d  to  me,  which  have  occurr’d 
to  Santorini  (c),  in  two  old.  men,  one  an  idiot,  and  the  other.  Highrly  difor- 
der’d  in  mind  ;  I  mean,  foveolas,  or  little  pits,  fill’d  with  lymph,  or  a  yeL- 
lowiffi  little  body  in  the  meditullium  of  the  brain  :  and  (bill  lefs  what  Willis  (*/), 
Kerckringius  (*),  and  King  (/),  have  feen,  the  bulk  of  the  brain  much  lefs 
than  it  naturally  is. 

14.  But  rarely,  and  indeed  only  once,  have  I  feen,  in  the  diffeClion  of  in-. 


li)  N.  8.  &  9., 

(m)  Anthropogr.  1.  4.  c.  2 
(»)  L.  I.  f.  8.  obf.  5.  §  3 
(0)  Specim.  1.  1.  de  Fibra  Motr.  c.  5.  ;  co¬ 
roll.  10.  (/>) 'N.  cit.  jQ. 

(?)  (r)  Mem.  de  l’Acad.  R.des  Sc.  a.  1705, 
&  1706. 

(j)  Difp.  de  apofpafm.  Viae  Matr. 

(/)  Comm,  in  Boerh.  Aphor.  Ji2i.» 


(«)  Audi.  Hid.  Apopl.  hifl.  15. 

(x)  Aft.  Lipf..a.  1688.  m.  Maj. 

(y)  Vid.  Sepulchr.  1.  i.  f.  I.  obf.  I. 

(z)  Epift«V.  n.  6.  &  Epift.  XLIX.  n.  1 6. 
(a)  {b)  (c)  Supra,  n.  z. 

\d)  Wepfer.  Hift.  cit.  15.  &Hift.  de  l’Acad. 
R.  des  Sc.  a.  1700. 

(e)  Obf.  Anat.  c.  3.  §  6.  ^ 

(f)  Sepulchr.  1,  1.  f.  10.  obf.  3,  9,  IQ* 


i  5  8  Book  I.  Of  Difeafes  of  the  Head. 

fane  perfons,  thofe  deep  fulci  in  the  corpus  callofum,  or  the  aerial  bubbles 
in  the  fanguiferous  vdfels  of  the  brain,  and  the  medullary  lubftance  thereof 
brown  (g),  mo(^  of  which,  1  fuppofe,  are  merely  accidental  in  diforders  of 
this  kind  ;  and  I  have  certainly  defcrib’d  them  to  you  in  others  who  were 
not  infane.  Nor  do  I  fee  that  they  have  been  oblerv’d  in  thofe  by  others  : 
nay,  Lancifi  (h)  remark’d  in  an  idiot,  that  the  lubftance  of  the  brain  was 
“  more  white  than  natural as  he  alfo  remark’d  fome  things  different  in 
the  corpus  callofum.  On  the  other  hand,  1  have  often  feen  the  veflels  of 
the  brain  diftended  with  blood,  and  more  often,  water  under  the  meninges, 
or  in  the  ventricles ;  nor  perhaps  fhould  rarely  have  lit  upon  an  enlarg’d  or 
fchirrhous  fpleen,  if  I  had  always  had  time  to  examine  the  vifcera  of  thofe 
whofe  brain  1  differed.  All  which  the  celebrated  Hoyerus  faw,  at  one  time, 
in  the  body  of  a  maniac  (i)  :  and  Van  Swieten  (k)  faw  the  vefiels  diftended 
■cc  with  a  very  black  and  pitch-like  blood,”  in  a  melancholic  woman  ;  as  that 
very  fkilful  anatomift  Phil.  Conrad.  Fabricius  found  the  plexus  choroides 
“  frequently  turgid  and  inflated,”  in  maniacs  (/)  :  and  a  quantity  of  extra- 
vafated  water  not  only  in  an  idiot,  King  (;«),  and  others,  but  alfo  in  a  melan¬ 
cholic  woman,  Wepfer  (;z) ;  and  in  maniacal  perfons,  thofe  who  are  mention’d 
with  honour  by  Van  Swieten  (0),  who  thence  explains  the  aphorifm  which  we 
have  mention’d  above  (/>),  if  a  dropfy  comes  on  after  madnefs,  ’tis  a  good 
fig n ,  by  fuppofing  that  the  water  is  reabforb’d  from  the  brain,  and  carried 
to  fome  other  part.  And  finally,  Hoyerus  (q),  when  he  tells  you  that  he 
had  found  fchirrhous  fpleens,  in  fome  bodies,  after  intermittent  fevers,  fays, 
“  that  fuch  fubjedls  had,  for  the  molt  part,  been  previoufly  affefled  with 
“  grievous  melancholic  deliria.”  I  am  not,  however,  ignorant,  that  in  three 
perfons,  who  were  fo  delirious  from  melancholy  as  to  put  an  end  to  their  own 
lives,  the  fpleen  was  neither  large  nor  hard,  and  even  in  one  of  them  was 
much  Ids  than  it  fhould  be  (r)  *,  and  that  the  excellent  Heifter(j),  who  dif¬ 
fered  two  of  them,  had  rather  obferv’d  morbid  appearances  in  the  pancreas 
and  bile.  Which  obfervations,  although  all  of  them  are  worthy  to  be  inferted 
in  the  Sepulchretum,  yet  I  would  have  you  obferve  in  regard  thereto,  how 
many  particulars  they  in  general  contain,  which  are  common  to  other  diforders 
.alfo.  And  for  this  reafon  I  cannot  help  the  more  wond’ring,  that  in  thofe 
hiftories  of  maniacal  and  melancholic  perfons,  which  are  given  you  in  the 
Sepulchretum  (/),  though  the  greateft  part  of  thefe  diforders,  and  even  thofe 
'which  are  more  common,  be  frequently  repeated,  yet  thefe  two  are  fcarcely 
once  taken  notice  of ;  the  firft  of  which  has  very  frequently,  and  the  other, 
in  fad,  always  occurr’d  to  me,  in  the  diffedtion  of  patients  who  had  been 
.diforder’d  in  their  minds.  For  hitherto,  I  have  four  times  found  difeafes  of 
the  pineal  gland  (»)  •,  and  feven  times,  that  is  always,  the  hardnels  of  the 
.cerebrum.  And  that  you  may  not  fufpedt  this  to  have  happen’d  by  fome 


(g)  Sepulchr.  1.  1.  f.  10.  obf.  5.  , 

(b)  Difl".  Var.  VII. 

p)  Aft.  N.  C.  vo!  4.  obf.  39. 

(k)  Comm.  cit.  ad  §  1010.  2.  verf.  fin. 

( l )  Idea  Anat.  Praft.  Seft.  4, 

(m)  (n)  Locis  cit. 

(a)  Comm.  cit.  ad  §  J124. 


(/)  N.  10. 

(q)  Aft.  N.  C.  vol.  5.  obf.  68. 
{;*)  Eph.  N.  C.  cent.  7.  obf.  60. 
( s )  Earund.  cent.  6.  obf.  28. 

(/)  Cit.  feft.  8,  &  9. 

(u)  Vid. -etiam  epilt.  1.  n.  10, 


accident 


Letter  VIII.  Articles  i  5,  i  <4.  159 

accident  of  other,  I  will  immediately  fubjoin  another  hiftory,  communicated 
to  me  by  my  friend  Mediavia,  on  the  lecond  of  January,  in  the  year  1729. 
For  on  this  day,  being  fo  taken  up  with  other  avocations,  that  I  could  not 
be  prelent  myfelf,  I  committed  the  whole  difledtior)  to  his  well-known  dili¬ 
gence  and  fkill. 

15.  A  man,  who  was  delirious,  without  a  fever,  through  the  imprudence 
of  thole  who  had  been  his  very  diligent  keepers  for  many  days,  leap’d  out 
of  bed,  in  the  night,  in  luch  a  manner,  that  dafliing  his  head  vehemently 
againft  the  wall,  or  againft  the  floor,  he  immediately  died  thereupon.  The 
fkull  and  the  cerebrum  fliew’d  no  peculiar  marks,  which  were  the  effects  of 
the  blow.  There  was  a  little  water  betwixt  the  meninges  :  in  the  right  and 
the  left  ventricles,  there  was  fo  far  from  being  a  little,  that  they  were  half 
full  *,  and  the  water  which  was  contain’d  in  them,  had  a  mixture  of  red  and 
yellow.  The  plexus  choroides  were  red  •,  the  remaining  veflels  alfo  were 
fuller  than  ufual  with  blood  ;  and  the  coats  of  the  arterial  tubes  were  more 
firm  and  ffrong  than  they  naturally  are.  The  dura  mater  was  thicker  than 
it  generally  is.  At  the  anterior  bafis  of  the  pineal  gland  were  thofe  hardifh 
little  bodies.  But  what  feem’d  the  moft  worthy  of  remark,  although  the 
cortical  fubflance  of  the  cerebellum  was  furprifingly  lax,  and  that  of  the 
cerebrum  itfelf  a  little  fofter  than  ufual;  and  although  the  medullary  portion, 
which  is  envelop’d  in  the  cerebellum,  as  alfo  the  protuberantia  annularis, 
were  fomewhat,  though  not  extremely  hard  ;  the  beginning  of  the  fpinal 
marrow,  and  the  whole  medullary  fubflance  of  the  cerebrum  itfelf,  were  ex¬ 
tremely  hard.. 

16.  Add  the  encreas’d  thicknefs  of  the  dura  mater  to  the  obfervations  of 
others,  a  little  before  (T)  taken  notice  of ;  but  the  diforders  of  the  pineal 
gland,  and  the  har-dnefs  of  the  cerebrum,  to  mine,  and  to  thofe  of  fome 
learned  men.  And  very  few  things  occur  at  prefent,  indeed,  on  the  l'ubjedt 
of.  the  pineal  gland.  For  Diemerbroeck  (jy),  although  he  points  out  many 
obfervations,  that  have  been  made  by  others,  of  land  and  calculi  being  found 
in  that  gland,  yet  he,  at  the  fame  time,  denies,  his  having  read  in  any  of 
thofe  authors,  in  like  manner,  that  in  thefe  perlbns,  where  fuch  appearances 
were  found,  “  an  inconvenience  had  happen’d  in  refpedl  to  the  animal  ao 

tions and  I  contend,  that  they  were  not  all  maniacs,  or t melancholic 
perfons,  in  whom  I  have  feen  this  diforder,  but  that,  on  the  contrary,  many 
had  labour’d  under  other  diforders,  as  the  former  letters  (2)  fufficiently  prove. 
But  thefe  things  I  fay :  firft,  that  although,  as  Santorini  (a)  has  faid,  “  it  is 
“  now  manifeft  among  anatomifts,  that  concretions  of, this  kind  are  fome - 
“  times  found  yet  that  in  no  other  part  of  the  brain,  which  he  ought  to 
have  obferv’d,  are  they  fo  often  found :  next,  that  though  they  are  often 
found  in  this  part,  yet  it  has  fo  happen’d  to  me,  that  I  have  more  often  feen 
them  in  perfons  who  had  been  diforder’d  in  their  minds,  than  in  thofe  who 
had  been  afflidled  with  any  other  kind  of  diforder  whatever.  And  he  was 
certainly  an  idiot,  in  whom  Edmund  King  (J?)  found  the  gland  become. 

(.v)  N.  13.  .  (tf)  Obf.  Anat.  c.  3.  n.  8. 

(y)  Anatom.  1.  3.  c.  6.  (6)  loc.  cit.  fupra,  ad  n.  is* 

(z)  V.  n,  ii.  &  Vh  n.  i%t 

3 


ftony  5 


'i6o  Book 'I.  Of  Difeafes  of  the  Head. 

ftony -,  as  the  patient  alfo  was  ftupid,  from  a  furprifing  lofs  of  memory,  in 
whom  Berlingerius  Gipfeus  (c)  faw  the  fame  appearance.  Laft  of  all,  1  fay» 
t  that  befides  this,  there  are  other  difeafes  of  the  pineal  gland,  and  thofe  alfo 
found  in  fome  perfons,  whofe  minds  had  been  diforder’d  •,  one,  for  inftance, 
which  Lancifi  obferv’d,  in  the  fame  idiot  whom  we  fpoke  of  above  (d) j  that 
is,  fuch-an  amazing  fmallnefs,  as  in  a  man  of  fixty-fix  years  of  age,  44  fcarcely 
44  to^qual  a  feed  of  hemp  in  its  fize.”  And  not  far  different  from  this  was 
that  which  I  before  deferib’d  to  you  (e),  as  being  very  much  fhrunk,  and  at 
the  fame  time  very  lax,  in  a  man  whofe  mind  had  been  diforder’d.  But  an¬ 
other  diforder,  and  one  which  is  quite  different  from  this -,  fo  far  even,  that 
if  you  confider  its  very  great  laxity  in  the  former  cafe,  it  is  altogether  oppo- 
lite  thereto,  you  have  in  the  Sepulchretum  (/) :  this  diforder  was  remark’d 
by  Theodorus  Zwingerus,  and  was  of  fuch  a  kind,  that  the  gland  44  was  uni- 
44  verfally  red,  and  much  more  folid  than  ufual.” 

1 7.  And  though  there  is  no  more  than  one  obfervation  extant  in  the  whole 
Sepulchretum,  as  I  have  in  like  manner  hinted  above,  of  that  appearance 
which  has  always  been  found  by  me,  in  perfons  diforder’d  in  their  minds ;  I 
mean  that  of  Henricus  ab  Heer  (g),  who,  in  a  man  that  had  been  maniacal, 
found  the  brain  to  be  hard  •,  yet  other  examples  are  not  wanting,  which  might 
with  juftice  be  added.  For  firft  of  all,  thofe  gentlemen  of  the  Royal  Academy 
of  Sciences  at  Paris,  whom  I  have  already  commended  (£),  Littre  and  Geof- 
froy,  found  in  the  two  maniacs,  fpoken  of  above,  that  the  fubftance  of  the 
cerebrum  alfo  was  much  more  firm  than  it  us’d  to  be-,  whereas  the  cerebellum 
was  almoft  of  its  natural  foftnefs :  and  even  in  that  very  idiot,  whom  I  have 
once  and  again  made  mention  of  (/),  Lancifi  obferv’d  44  the  whole  fubftance 
46  of  the  brain  to  be  more  compact  than  ufual,”  and  the  corpus  callofum 
itfeif  14  to  be,  in  like  manner,  pretty  hard.”  To  thefe  we  muft  alfo  add 
Santorini  (£),  who,  in  an  old  man  that  was  an  idiot,  not  only  found  other 
appearances,  but  alfo  found  the  cerebrum  44  much  more  firm  than  this  part 
“  is  accuftom’d  to  be  fo  that  “  he  could,  by  reafon  of  its  greater  firm- 
41  nefs,  more  conveniently,  and  perfpicuoufly,  enquire  into,  and  diftinguifh 
44  fome  appearances,”  which  I  alfo,  for  the  fame  reafon,  had  done  before,  and 
have  done  fince,  as  is  already  related  (/).  And  Boerhaave  (m),  perhaps,  ani¬ 
madverted  to  other  hiftories,  which  had  fall’n  under  his  notice,  when  he  af- 
ferted,  44  from  anatomical  diffeftions,  that  the  cerebrum  of  maniacal  per¬ 
fons  was  dry,  hard,  friable,  and  yellow  in  its  cortical  fubftance.”  But  al¬ 
though  even  Geoffroy  (;;)  deferib’d  a  great  drynefs  of  the  brain  -,  yet  out  of 
all  the  obfervations  which  are  known  to  me,  that  only  comprehends  all  thofe 
circumftances,  which,  as  I.fai-d  it  was  the  only  one  that  mentions  the  hard- 
nefs  of  the  cerebrum  in  the  Sepulchretum  ;  fo  I  obferve  it  is  the  only  one 
out  of  all  I  remember  to  have  read,  which  very  ufefully  teaches,  that  the 
fame  cerebrum  was,  neverthelefs,  44  confiderably  foft  and  moift  about  the 


( c )  Apud  Contulum  de  Lapid.  Podagr.  & c. 
c.  5. 

(d)  n.  14. 

0)  n-  12- 

(f)  Obf.  ! .  Sett.  cit.  9  in  Addit. 

(g)  j.  in  Sed.  8.  qua?  5.  eft  in  Sed.  4. 


(Jj)  loc.  eit.  fupra  ad  n.  13. 

(/)  rv.  14  &  16. 

(/£)  c.  cit.  n.  6. 

(/)  fupra,  n.  6. 

(m)  Aphor.  de  cognofc.  morb,  §  1121. 

(/;)  loc.  cit. 

44  bafis 


Letter  VIII.  Article  i  8. 


i  6  i 


l*  bafis  and  the  ventricles.”  And- that  all  parts  of  the  brain  are  not  found  to 
be  of  equal  hardnefs  in  maniacal  or  melancholic  perfons,  and  that  even  fome 
are  more  loft  fometimes  than  they  ought  to  be,  the  difieCtions  which  I  have 
defcrib’d  to  you,  when  compar’d  one  with  another,  fufficiently  fhew. 

1 8.  But  although,  probably,  it  was  not  owing  to  mere  chance,  that  as 
in  the  infane  perfons  whom  thefe  worthy  men  difleCted,  fo  in  all  thefe  who 
were  examin’d  by  me,  there  was  a  hardnefs  of  the  whole  cerebrum,  or  cer¬ 
tainly  as  I  always  found,  at  lead  a  hardnefs  of  the  medullary  fubfiance  of 
its  hemifpheres  •,  and  though  I  think  that  the  circumltance  is  not  to  be  neg¬ 
lected,  by  any  means,  yet  I  do  not  believe,  that  fo  much  is  to  be  attributed 
to  it,  that  we  fhould  afcribe  diforders  of  the  mind  to  this,  as  to  their  only 
caufe,  and  prove  our  hypothefis  by  very  fubtle  and  fpecious  explications : 
which  would  not  be  wanting  on  this  occafion,  as  we  might,  in  the  firft  place, 
for  inftance,  enquire,  whether  this  hardnefs  be  brought  about  by  drynefs, 
that  is,  by  a  lefs  quantity  of  moifture  flowing  in  upon  its  fubftance ;  or 
whether  it  be  the  effeCt  of  fome  auftere  and  aftringent  juice  i  and  finally, 
whether  fuch  a  hardnefs  being  brought  on,  from  any  caufe  whatever,  is  an 
obftruCtion  to  reafon  and  underftanding,  either  by  ftreight’ning  fome  very 
(lender  and  narrow  paflfages,  or  by  fo  draining  the  fibres,  that  they  tremble 
at  any  very  flight  motion  much  more  than  they  ought  ;  or  by  rend’ring  them 
fo  flexible,  that  they  are  never  agitated  but  at  certain  motions,  and  then 
always  in  the  fame  manner.  But  thefe,  and  other  fuch  inextricable  difpu- 
tations,  I  have  avoided  being  drawn  into,  as  I  would  being  drawn  into 
friares  ;  and  for  that  reafon,  have  of  choice  made  remarks  of  any  other  kind 
upon  the  hidories  propos’d,  rather  than  fall  into  hypothefis  and  conjecture. 
And  that  you  may  underdand,  why  I  do  not  lay  fo  much  drefs  upon  this 
hardnefs,  I  would  have  you  know,  that  in  fome  perfons  likewife,  whofe 
minds  had  not  been  diforder’d,  I  did  not  find  the  cerebrum  lefs  hard  than  in 
thefe  :  as  in  one  who  died  of  an  inflammation  of  the  thorax  ;  and  in  another 
who  died  of  a  fraCture  of  the  thigh  •,  and  in  a  very  old  man  alfo,  whom  age 
itfelf,  rather  than  dileafes,  had  gradually  brought  to  his  end. 

But  becaufe  that  excellent  anatomid  Haller  ( o )  has  aflerted,  “  that  the 
<c  brains  of  old  men,  even  from  the  tedimony  of  the  knife,  are  harder  than 
tc  others,”  and  thinks  that  from  thence  “  their  weaknefs  of  memory  and 
underdanding”  is  to  be  accounted  for  •,  let  us  fet  afide  this  very  aged  man, 
and  you  can  remember,  that  when  I  related  the  difleCtions  of  apopleCtic  per¬ 
fons  to  you,  I  mention’d,  that  the  cerebrum  of  the  woman,  who  had  thirteen 
ribs  on  each  fide,  was  of  an  amazing  hardnefs  throughout  its  lubdance  (/>) ; 
and  in  like  manner,  of  a  very  remarkable  hardnefs  in  the  odler  (q),  in  whom 
indeed  it  was  fo  great,  that  whereas  I  difleCted  his  brain  not  many  days  after 
I  had  examin’d  the  brain  of  that  fecond  infane  woman,  as  above  defcrib’d  (r), 
I  eafily  obferv’d,  which  I  then  exprefsly  remark’d  in  the  Adverfaria,  that  his 
brain  was  altogether  equal  in  hardnefs  to  her’s.  Yet  neither  of  thefe  apo¬ 
pleCtic  patients  were  decrepid. 

But  the  fame  or  fimilar  appearances  have  occurr’d  to  others,  in  a  much 

(0  Ad  Prseleft.  Boerh.  §  475.  not.  g.  (7)  Epift.  4.  n.  19. 


(/)  Epift.  5.  n.  6. 

VOL.  I. 


Y 


CO  N.  9. 


lefs 


i  6  2  Book  I.  Of  Diforders  of  the  Head. 

Ids  age,  fometimes.  Let  it  fuffice  to  mention  two  or  three,  Phil.  Conrad. 
Fabricius,  Littre,  and  Fantonus  the  elder.  Fabricius  (j),  in  a  woman  of  a 
middle  age,  who  died  fuddenly,  when  fhe  feem’d  to  be  very  well,  found 
“  the  fubftance  of  the  cerebrum  fo  firm  and  dry,”  that  he  thought  it  worthy 
of  remark.  And  Littre  (/),  in  the  body  of  a  young  man,  who  was  a  con¬ 
demn’d  criminal,  found  the  fubftance  of  the  cerebrum,  cerebellum,  and  me¬ 
dulla  oblongata,  to  be,  both  to  the  eye  and  to  the  touch,  more  denfe  and 
compadt  than  ufual.  This  young  man,  to  avoid  the  indignity  of  public 
execution,  ran  violently  with  his  head  againft  a  wall,  by  the  dafti  of  which 
he  immediately  kill’d  himfelf,  juft  as  the  madman  did,  whom  I  gave  an 
account  of  in  the  laft  hiftory  («);  the  internal  caufe  of  whofe  death,  not  coming 
much  more  under  the  notice  of  the  fenfes,  than  that  of  this  criminal,  you 
might  have  conjedtur’d,  from  the  account  which  Littre  has  given,  if  the 
fame  things  had  been  obferv’d  in  both  cafes,  and  he  had  not  endeavour’d  to 
account  for  it,  from  that  hardnefs,  as  if  produc’d  by  the  blow.  But  Fan¬ 
tonus,  even  in  a  tender  infant,  who  had  been  carried  off  by  convulfions  ( x ), 
found  “  the  medullary  fubftance  and  medulla  oblongata”  very  hard  :  and 
what  conjectures,  and  with  what  modefty  and  caution,  his  excellent  fon  has 
made  concerning  the  caufes  of  this,  it  will  not  be  altogether  foreign  to  the 
prefent  purpofe  to  inform  yourfelf  from  the  fcholium,  which  he  not  only 
fubjoin’d  to  his  father’s  obfervations  at  firft,  but  even  upon  a  revifal  of  the 
work.  You,  therefore,  fufficiently  underftand,  that  the  brain  may  be  hard, 
without  the  fenfes  being  diforder’d  :  and  you  may  likewife  add,  that  there 
may  be  a  diforder  in  the  fenfes,  without  hardnefs  of  the  brain.  For  neither 
in  idiots  only,  differed  by  Tulpius(y),  Kerckringius  (z\  King  (a),  and 
Scheidius  (b),  was  the  cerebrum  lax  and  flaccid  ;  but  the  laft  of  them  fays, 
“  that  this  generally  is  the  cafe  in  thole  who  are  depriv’d  of  their  under- 
“  Handing,  as  we  alio  frequently  find  it  in  maniacal  perfons.”  And  although 
this  differs  from  our  obfervations,  according  to  which  we  think  that  the  hard¬ 
nefs  of  the  brain  is  not  to  be  negledted  in  this  fpecies  of  diforder,  yet  it  is 
one  reafon  why  I  am  by  no  means  forry  to  have  determin’d  (c),  that  this  ap¬ 
pearance  is  not  folely,  or  chiefly,  to  be  attended  to. 

19.  But  now  I  will  add  what  relates  to  the  hydrophobia,  as  I  promis’d  in 
the  beginning.  Although  fince  Salius  {d),  Caefalpinus  (*?),  Codronchius  (/), 
and  Aromatarius  (g)  had  affirm’d,  that  many  have  the  hydrophobia  without 
delirium,  a  number  of  fcatter’d  hiftories,  befides  thofe  which  I  fhall  now 
produce  (b),  came  forth,  that  prov’d  the  obfervations  of  thofe  very  excellent 
phyfici.ms  ;  and  even  although  Theodorus  Zwingerus  (i)  has  fo  diftinguifh’d 
the  hydro  hobia  from  the  rabies,  that  he  not  only  aflerts  the  former  may 
happen  without  the  latter,  which  is  true,  but  has  aflerted,  that  the  latter 


(j)  Propemptic.  ad  difT.  J.  B.  Hoffman. 
(/)  Hili.  de  1’  Acad.  R.  des  Sc.  a.  1705. 
(u)  Supra,  n.  15. 

(x)  Obferv.  Anat.  Med.  20. 

(y)  Sepulchret.  1.  1.  f.  10.  obf.  16, 

(z)  Ibid.  obf.  5. 

( а )  Ubi  fupra  ad  n.  13. 

(б)  De  duob.  officul.  &  c.  qu.  4. 

\c)  Vid.  etiam  epift,  61,  n.  8.. 


(d)  De  Aifedl.  Particularih.  c.  19. 

(f)  Art.  Med.  1.  3.  c.  34. 

(f)  De  Rabie,  1.  1.  c.  1. 

(g)  Difp.  de  Rab.  p.  z.  partic.  1. 

(b)  Infra,  n.  22,  23. 

(*)  Eph.  N.  C.  oec.  3.  a.  2.  obf.  104.  in 
fchol.  addita  poftea  extra  ord.  Sepulchr.  1.  1. 
f.  13.  in  fin. 

can 

8 


1 


Letter  VIII.  Article  19.  163 

can  never  happen  without  the  former,  which  is  not  equally  true •,  yet  becaufe 
Bonetus,  who  neverthelefs  gives  one  obfervation  of  the  hydrophobia,  in 
which  the  fenfes  were  unhurt  (£),  chol'e  rather  to  follow  thofe,  who  had 
plac’d  this  diforder,  long  ago,  among  the  fpecies  of  madnefs,  and  added  the 
difiedtions  of  perfons,  who  labour’d  under  the  hydrophobia,  to  thofe  of  the 
maniacal  patients,  I  will  not  here  recede  from  his  order  *,  efpecially  as  I  muft 
confefs  that  a  delirium,  either  maniacal,  or  melancholic,  is  frequently  join’d 
to  the  hydrophobia •,  or  at  lead  a  delirium  compounded  of  both:  and  that 
a  mania  may  be  join’d  with  a  hydrophobia,  the  illuftrious  Mead  (/)  confirms, 
who  faw  a  man  labouring  under  this  diforder,  44  have  the  ftrength  of  his 
44  mufcles  fo  prodigioufly  encreas’d,  that  in  his  prefence  he  broke  through, 

44  at  one  attempt,  all  the  ropes  with  which  he  was  tied  down  in  his  bed.” 
And  others  alfo  (m)  have  given  an  account  of  a  young  man,  who  was  at 
times  fo  furious  from  this  difeafe,  44  that  he  could  fcarce  be  held  quiet  by 
44  four  men and  ftijl  others  («)  of  a  boy,  of  five  years  of  age,  44  whofe 
44  fury  a  very  ftrong  man  was  not  able  to  reftrain.  And  thefe  things  I  have 
hinted,  in  order  to  fhow  you,  that  there  may,  and  even  muft  be,  great  dif¬ 
ferences  between  the  difiedtions  of  patients  who  labour’d  under  this  difeafe, 
according  to  the  variety  of  the  fymptoms  with  which  they  are  afftidted ;  for 
many  who  have  a  hydrophobia,  are  fo  far  from  having  any  delirium,  that 
they  have  not  even  the  leaft  traces  of  fever,  as  appears  from  the  obfervations 
of  almoft  all  the  gentlemen  here  commended,  and  others.  For  I  would  not 
have  you  imagine,  that  this  fymptom  of  dreading  water,  and  yet  being 
thirfty,  is  a  delirium  •,  neither  that  all  do  dread  it :  fince  fome  of  them  do 
order  it  to  be  brought  to  them,  and  endeavour  to  drink.  Yet  they  do  not 
generally  drink,  and  that  for  very  fufficient  reafons.  For  fome  having  en¬ 
deavour’d  to  fwallow  gradually,  even  the  fmalleft  portion  of  liquor,  did  it 
with  the  greateft  uneafinefs  and  pain,  as  the  boy  whom  Mead  gave  an  account 
of,  to  the  Royal  Society  (0)  at  London :  but  others  being  either  worfe,  or 
having  drunk  more,  have  been  feiz’d  with  violent  convulfions,  or  inftant 
fuffbeation  arifing  from  thence,  and  immediately  died.  And  the  former  of 
thefe  accidents  happen’d  to  a  virgin  of  Modena,  whom  I  fhali  fpeak  of  be¬ 
low  (p)  ;  and  the  latter  to  thofe  that  Avicenna  (q)  has  mention’d,  who,  fpeak- 
ing  of  the  patient  in  a  hydrophobia,  and  of  water,  writes  thus  :  44  And  fome- 
44  times  he  fups  fome  of  it,  for  which  reafon  he  is  thereby  fuffocated,  and 
44  dies.”  But  others,  who  have  been  afk’d,  whether  they  were  perfectly  in 
their  fenfes,  why  they  did  not  drink,  have  anfwer’d  that  they  could  not,  by 
reafon  of  the  great  conftridlion,  and  narrownels  of  their  fauces,  or  gula ;  as 
Salius(r)  teftifies,  and  Aromatarius  confirms  (j).  And,  indeed,  in  thofe  parts, 
they  do  in  reality  feem  to  have  fome  obftrudtion  to  the  fwallowing  of  liquor ; 
fo  that  Casfalpinus  (/)  compar’d  them  with  44  fome  patients,  who  labour  un- 
44  der  an  angina,  in  whom  what  is  drunk,  returns  by  the  noftrils,”  and  did 

(k)  8.  in  S.  8.  1.  ejufd.  i.  (0)  Saggio  delle  Tranfaz.  Filof.  p.  2.  c.  8. 

(/)  Traft.  de  Venen.  Tent.  2.  n.  3.  (/>)  n.  29. 

[m)  apud  Swieten.  Comm,  in  Boerh,  Aph;  Canon.  1.  4.  F.  6.  tr.  4.  c.  7. 

^  1137.  (r)  c.  19.  cit.  (0  P.  cit.  partic.  7«. 

(»j  Eph.  N.  C.  Cent.  7.  obf.  54.  (/)  c.  cit. 

Y  2 

.. 


not 


164  Book  I.  Of  Difeafes  of  the  Head. 

not  doubt,  u  but  that  the  gula  in  them  was  fpafmodically  drawn  together.** 
Which  paflage  being  read  by  Aromatarius  (&),  it  Teem’d  very  wonderful  to 
him,  that  neither  Salius,  nor  Csefalpinus,  had  by  any  means  inferr’d,  what 
he  thought  he  could  not  help  concluding  from  thence  ;  I  mean,  that  this 
diforder  “  was  nothing  elfe  but  a  kind  of  angina.” 

20.  From  that  time  to  this,  there  have  been  more  obfervations  publifh’d, 
relative  to  the  diforder  itfelf,  than  to  the  diffedtion  of  the  bodies  after  death. 
Yet  among  thefe  latter,  fome  feem  to  favour  the  opinion  of  Aromatarius  ; 
as  that  which  was  made  by  Th.  Zwingerus  (#),  who  faw  “  the  membranous 
“  interfaces  of  the  cartilaginous  circles  of  the  afpera  arteria  very  intenfely 
“  red;”  and  ft  ill  more,  that  which  a  furgeon  related  to  Mead  (jy),  of  the 
fauces  being  greatly  inflam’d  ;  and  that  which  was  made  by  Tauvry,  and  re¬ 
lated  to  the  Royal  Academy  of  Sciences  at  Paris  (z),  of  the  gula  being  inflam’d, 
and  the  afpera  arteria  in  fome  meafure  alfo.  Although  the  two  former  like- 
wife  mention’d  the  lungs  being  partly  or  entirely  full  of  blood,  effus’d  into 
the  vehicles ;  and  this  blood,  Zwingerus  alfo  writes,  was  concreted  in  the 
heart,  and  the  large  veflels  that  were  about  it ;  and  that  the  inteftines,  more¬ 
over,  but  efpecially  the  ftomach,  were  diftinguifh’d  with  red  fpots.  Bu.t 
Tauvry,  although  he  obferv’d  none  of  thefe  things,  yet  remark’d  almoft  all 
the  others,  which,  together  with  a  part  of  thefe,  you  may  fee  recounted  by 
Boerhaave  (a).  On  the  other  hand,  there  is  a  difleftion  againft  Aromatarius, 
made  by  Mead,  upon  the  boy  fpoken  of  above  (b) ;  for  having  examin’d  the 
throat,  brain,  thorax,  and  ftomach,  he  found  no  where  any  thing  that  was 
unnatural,  except  a  large  quantity  of  green  and  vifcid  bile,  in  the  laft-men- 
tion’d  cavity.  Thofe  things  may  alfo  Teem  to  be  repugnant  to  this  doCtrine, 
which  you  will  find  hinted  in  the  Sepulchretum  (c),  and  exprefsly  oppos’d 
to  “  a  phyfician  of  great  name,”  (that  is  to  Aromatarius,  as  1  fuppofe), 
“  who  referr’d  this  diforder  to  an  inflammation  of  the  fauces,  and  a  kind  of 
<k  angina  join’d  therewith.”  “  But  the  bodies,  when  open’d,”  which  Rolfinck, 
in  confequence  of  thefe  obfervations,  immediately  fubjoins,  “  fhew’d  no  figns 
14  of  inflammation.”  Aromatarius,  however  (d),  as  he  was  very  well  vers’d 
in  the  reading  of  the  ancient  phyficians,  had  ftudied  to  avoid  many  of  the 
objections  which  might  be  made  to  him,  under  colour  of  their  authority, 
by  contending,  that  a  diforder  which  is  in  any  part  of  the  gula,  or  trunk  of 
the  afpera  arteria,  and  even  fometimes  that  which  is  not  acute,  or  attended 
with  a  fever,  is  to  be  confider’d  as  an  angina ;  inafmuch  as  it  confifts  in  any 
ftreightnefs  or  obftruftion  of  thofe  pafiages,  if  it  happen  from  convulfion 
only,  or  purpofely  to  omit  other  things,  from  mere  phlegm  occupying  the 
paffages,  without  any  concomitant  inflammation.  And  although,  as  you  fee 
in  the  fame  Sepulchretum  (<?),  he  feems  to  determine  the  angina,  attending 
the  hydrophobia,  to  this  laft  fpecies  of  the  diforder,  or  that  which  occupies 
the  larynx ;  yet  taking  even  this  for  granted,  he  fufficiently  avoids  the  ob¬ 
fervations  of  Rolfinck.  But  if  you  do  not  make  thus  ftiort  of  the  matter. 


(«)  Panic,  ead.  7. 

( x )  Obf.  cit.  104. 

(y)  n.  3-  c>t. 

( z )  Hilt.  A.  1699. 

(#)  Aphor.  de  cogn.  ir.orb.  §  1140. 


(6)  n.  19. 

(<-)  1.  1 .  S.  8.  obf.  10. 

(d)  Difp.  cit.  p.  3.  partic.  1  &  4. 

( e )  Addit,  ad  S.  cit.  8.  obf.  1. 


you 


Letter  VIII.  Article  14.  164 

you  will  alfo  believe,  that  the  obfervation  of  Brechtfeld,  which  you  have 
loon  after,  in  the  Sepulchretum  (/),  is  likewife  favourable  thereto,  as  he 
found  44  the  whole  tradt  of  the  cefophagus  very  narrow,  and  in  a  manner 
44  confixi  ng’d.” 

21.  But  although  it  may  at  firfi:  feem  very  commendable  in  Aromatarius  Qr), 
that  from  the  moil  obvious  fymptom,  of  all  thofe  which  attended  the  hy¬ 
drophobia,  he  propos’d  afeertaining  to  himfelf,  the  nature  and  feat  of  the 
diforder ;  yet  I  would  not  have  you  fuppofe,  that  I  fhall  readily  embrace  his 
opinion.  Nor  do  I  fay  this,  becaufe,  if  that  were  granted,  it  would  not  be 
underifood,  why  patients,  who  labour  under  a  hydrophobia,  fwalldw  food 
without  much  difficulty,  and  even  fome  with  none  at  all,  as  Caefalpinus  (b) 
and  others  have  feen  ;  or,  as  the  excellent  Brechtfeld  fays,  44  take  down  rea- 
44  dily  any  kind  of  iolids  whatever  ”  for  many  have  fall’n  into  this  difficulty, 
befides  Salius  (i)  and  Aromatarius  (k)  j  as  it  takes  place  alfo  in  fome  other 
cafes  of  injur’d  deglutition,  where  the  hydrophobia  is  not  at  all  in  queftion. 
I  fay  it,  therefore,  rather  for  other  reafons,  which  he  alfo  faw,  but  did  not 
Efficiently  explain  j  and  efpecially  on  account  of  that  admirable  power,  which 
is  join’d  therewith,  of  propagating  itfelf  by  contagion,  after  a  long  interval 
of  time.  For  it  is  very  certain,  though  Salius  (/),  and  with  him  others, 
did  not  believe  it,  that  a  very  violent  hydrophobia  has  been  generated  without 
any  bite,  even  only  from  the  laliva  falling  on  the  naked  fkin  ( m ).  It  is  alfo  cer¬ 
tain,  that  this  virus,  being  infinuated  into  any  part  of  the  body,  may  often  lie 
latent  for  a  long  time,  fometimes  even  for  twenty  years  («),  not  to  fay  for- 
ty  (0),  without  any  injury ;  till  being  excited  by  fome  caule,  whatever  that 
may  be,  it  break  forth,  and  be  carried,  from  the  part  originally  affedted,  to 
others,  and  others,  till  certain  deftrudlion  is  the  conlequence.  And  that  it 
lies  hid  in  this  place,  feems  to  be  fhown  by  that  fymptom  which  precedes  the 
appearance  of  the  diforder,  and  which  Salius  (p)  formerly  obferv’d,  44  as  the 
44  chief  and  infallible  fign,  and  unknown  to  all  ;”  that  is  to  fay,  44  a  certain 
44  pain  beginning  in  the  part  that  had  been  bitten,”  and  was  now  heal’d  ; 
which  arifing  from  thence,  extended  itfelf  44  from  part  to  part,”  and  in  a 
fhort  time  to  the  brain,  according  to  his  obfervation  ;  or  at  lead  upwards, 
fuppofe  from  the  hand  to  the  axilla,  according  to  Zwingerus  (q)  and  Scaramuc- 
cius  (r).  But  whoever  faw  an  angina  communicated  by  the  faliva  of  a  per- 
fon  affedled  therewith,  falling  upon  the  fkin  of  thofe  who  attended  him  ? 
and  much  1  efs  Its  fomes,  if  it  could,  by  chance,  ever  have  been  communi¬ 
cated,  lying  torpid,  and  inactive,  for  a  long  time,  in  any  certain  part,  and  at 
length  exerting  its  influence  therefrom  ?  For  the  incapacity  of  fwallowing  li¬ 
quids  is  by  no  means  the  proper  fign  of  the  hydrophobia,  unlefs  join’d  with  other 
fymptoms,  and  efpecially  with  the  power  of  propagating  itfelf.  For  the  hy¬ 
drophobia  is  a  peculiar  fpecies  of  angina,  arifing  from  a  peculiar  fpecies  of 

(f)  Ibid.  obf.  2.  (a)  Dec.  ead.  9.  A.  9  &  10.  obf.  43. 

(g)  Difp.  cit.  p.  2.  partic.  6.  (&)  Vid.  Gafp.  a  Reies  Elyf.  jucund.  Quaeih 

\b)  c.  cit.  (/)  c.  cit.  Camp.  qu.  61.  n.  11. 

(^)  Difp.  cit  p.  4.  partic.  2.  (/)  c.  cit.  (p)  c.  cit.  (y)  Schol.  cit. 

(m)  Eph.  N.  C.  Dec.  1.  A.  6  &  7.  obf.  142.  (r)  Eph.  N.  C.  Dec.  3.  A.  9  &  10.  in  Ap- 

Vid.  &  Epift.  61.  n.  13.  pend.  n.  6. 


poifon. 


166  Book  I.  Of  Difeafes  of  the  Head. 

poifon.  Whoever,  therefore,  profeffes  to  have  found  out  the  nature  of  this 
diforder,  muft  demonftrate  the  nature  of  this  poifon.  But  I  do  not  even  fee, 
that  the  feat  of  this  diforder  is  confirm’d.  For  although  Aromatarius  ( s ) 
fays,  that  the  fituation  which  he  afiign’d  to  it,  “  might  very  eafily  appear 
“  from  diflfedtion  yet  he  does  not  produce  the  leaft  anatomical  example 
of  his  own,  in  behalf  of  fuch  an  alfertion  :  and  it  was  not  in  his  power  to 
produce  examples  from  others,  fince  even  at  his  time,  as  far  as  I  know,  no 
difie&ion  of  a  perfon,  affefled  with  a  hydrophobia,  was  extant,  except  that 
of  our  countryman  Cappivacci,  of  which  an  account  is  given  in  the  Sepul- 
chretum  (/).  And  thofe  difiedtions  which  have  been  made  fince,  are  the 
fame  we  have  pointed  out  above ;  and  if  you  receive  the  dodtrine  of  angina, 
i*.i  a  confin’d  fenfe,  you  will  fee  how  far  they  favour  it,  or  whether  they  fa¬ 
vour  it  at  all :  but  if  you  even  fuffer  it  to  have  its  mold  extenfive  fignification, 
I  fear  that  the  advantage  of  fo  general  a  dodlrine  will  be  much  lefs  than  fuf- 
ficient  to  fatisfy  our  prefent  purpofe. 

22.  What  then  is  the  cafe?  I  really  doubt,  that  in  proportion  to  the 
abftrufe  nature  of  fo  very  violent  a  difeafe,  we  have  not  yet  had  fufficient 
difiedtions  to  determine  any  thing  from  (a) ;  and  I  am  very  forry,  that  it  has 
not  yet  been  in  my  power  to  difiedt  the  body  of  a  patient  who  died  of  this 
diforder,  and  even  the  bodies  of  many,  as  the  occafion  would  amply  re¬ 
quire  ;  either  becaufe  I  was  not  permitted  to  do  it,  or  becaufe,  when  I  had 
it  in  my  power  in  other  refpedts,  I  was  prevented  by  ill  health,  or  by  the 
molt  important  bufinefs,  which  feem’d  to  arife  from  a  certain  fatality  in  my 
affairs.  For  firft  I  faw  a  boy  at  Bologna,  about  twelve  years  of  age,  who 
after  more  than  forty  days  from  the  time  that  the  dog  had  bitten  him,  in 
that  part  whence  the  danger  is  far  more  fpeedy  and  fatal  than  from  all  other 
parts,  I  mean  the  face,  and  even  in  the  cheek,  being  feiz’d  with  this  moft 
lamentable  diforder,  became  juft  like  a  furious  perfon,  anxious,  crying  out, 
red  in  his  face,  and  not  able  to  ftand  ftill  in  any  place  •,  yet  he  was  at  the 
fame  time  fenfible,  and  for  that  reafon  hurt  no  body,  but  dragg’d  his  father 
about  the  city  with  him,  who  in  vain  endeavour’d  to  hold  him  by  his  hand. 
But  if  any  one  offer’d  him  water,  he  endeavour’d  with  all  his  power  to  avoid 
it,  faying  that  he  fliould  certainly  be  fuffocated  therefrom.  This  boy  did 
not  live  more  than  twenty-four  hours  after  the  appearance  of  the  difeafe  : 
but  I  was  not  permitted  to  open  his  body  *,  nor  that  of  another  boy  in  this 
place,  who  did  not  live  even  twenty  hours  after  the  time  in  which  he  firft 
began  to  have  an  averfion  to  water.  It  was  five  months  before  his  death,  that 
he  had  been  bitten  in  the  leg  by  a  dog  ;  and  as  it  was  uncertain  whether  the 
creature  had  been  mad,  lefs  care  was  taken  of  the  wound,  which  however 
bore  a  very  good  appearance  externally,  and  was  therefore,  without  fcruple, 
brought  to  a  cicatrix.  And  when,  after  a  fhort  fpace  of  time,  an  ulcer  had 
again  appear’d  in  that  very  part  of  the  leg,  there  was  fome  reafon  why  it 
fhould  be  imputed  to  other  caufes  *,  for  the  boy  having  a  fcald-head,  and 
being  blotch’d  with  a  kind  of  leprofy,  and  abounding  with  deprav’d  hu- 

(«)  Vid.  tamen  alias  infra,  n.  31.  &  Epiit. 
61.  n,  9. 


(j)  Difp.  cit.  p.  4.  part.  2. 
(/)  S.  cit.  8.  obf.  7. 


mours. 


Letter  VIIL  Article  23.  1  6y 

moui's,  was  for  that  reafon,  if  we  are  to  believe  Palmarius  (#),  and  even 
Aetius(_y),  more  liable  to  be  feiz’d  with  a  hydrophobia.  In  the  mean  while, 
he  was  luddenly  feiz’d  with  an  anxiety,  and  prefently  after,  in  the  evening, 
a  dread  of  water  came  on.  In  the  morning,  his  lips  were  black,  and  his 
pulfe  almoft  entirely  gone  :  and  at  noon  he  died. 

On  the  other  hand,  I  was  permitted  to  diffeft  the  bodies  of  two,  who  died 
of  a  hydrophobia  ;  but  my  affairs,  as  I  have  already  faid,  preventing  me,  I 
begg’d  of  my  friend  Mediavia,  that  he  would  undertake  the  difteiftion  hitn- 
felf,  and  make  report  of  his  obfervations  to  me.  I  will  fubjoin  both  of  the 
hiftories  -,  and  will  add  a  third  alfo,  which  was  fent  to  me  from  Rome,  by 
Jaques  de  Machy,  a  Parifian,  a  diligent  and  worthy  man,  who,  in  the  way 
of  his  office,  had  often  vifited  the  patient,  in  the  hofpital  of  St.  John  in  the 
Laterane,  and  had  diffedted  him  when  dead.  This  worthy  man,  after  attend¬ 
ing  my  ledtures  fome  years,  having  departed  thither,  and  loving  me  when 
abfent,  as  he  had  diligently  obferv’d  me  when  prefent,.was  there  untimely 
taken  off  by  a  confumption,  and  left  me  almoft  inconfolable  for  his  lofs. 

23.  A  man,  who  had  been  bitten  fome  months  before  by  a  mad  dog,  was 
feiz’d  at  length  with  a  manifeft  hydrophobia ;  and  having  medicines  admi- 
nifter’d  internally,  water  was  alfo  order’d  to  be  pour’d  upon  his  head.  As 
he  feem’d  to  be  a  little  better  for  this  method  of  cure,  he  was  order’d  to  go 
into  the  bath.  He  not  being  delirious,  and  acknowledging  that  whatever  was 
done,  was  done  for  his  advantage,  immediately  fet  out  to  go  thither,  begging 
this  one  thing  only  of  thofe  who  attended  him,  that  as  he  would  go  in  of 
his  own  accord,  they  might  not  plunge  him  in  by  force.  But  when  he  came 
there,  he  began  to  trifle  and  delay,  and  to  fay  that  he  could  by  no  means 
venture.  Upon  this,  he  was  immediately  thrown  in,  and  held  down,  fo  that 
he  drank  the  water.  As  he  was  then  very  earned  to  be  taken  out,  they  took 
him  out,  and  laid  him  in  bed,  where  he  remain’d  very  quietly.  Not  long 
after,  however,  he  began  to  grow  cold,  and  the  next  night  he  died. 

Although  the  body  was  differed  at  the  fixteenth  hour  after  death,  and  not 
later,  and  the  feafon  was  more  inclin’d  to  be  cold,  than  it  generally  is  here 
at  that  time,  for  it  was  the  middle  of  September,  in  the  year  1723  ;  yet  it 
had  already  fo  ftrong  a  fmell,  that  it  oblig’d  the  perfon  who  open’d  it  to  make 
hafte,  and,  having  obferv’d  a  very  black  bile  in  the  gall-bladder,  to  carry 
away  the  vifeera  of  the  thorax,  which  were  taken  out,  and  the  head,  which 
was  feparated  from  the  body,  into  an  open  place,  where  they  might  be  very 
accurately  infpedted.  The  lungs  themfelves  alfo  fmell’d  very  ftrong,  and 
were  black.  The  right  auricle  of  the  heart  was  extremely  dilated,  though 
not  in  confequence  of  what  it  contain’d  ;  the  left  was  very  narrow :  and  in 
the  ventricles  were  thin  polypous  concretions.  The  dura  mater  contain’d, 
within  its  finuffes,  fome  concretions  of  the  fame  kind  ;  but  eafily  foluble, 
and  in  a  manner  adipofe.  Beneath  this  membrane  were  fome  bubbles  of  air. 
All  the  veffels  of  the  brain  were  full  of  blood  fo  that  the  choroid  plexuffes 
were  black.  There  was  no  extravafation  of  ferum.  The  fubftances  of  the 
cerebrum  and  cerebellum  were  rather  dry  than  moift.  The  parts  which  re¬ 
main’d  befides  thefe,  were  not  infpedted,  for  the  reafon  before  mention’d. 

(x)  L.  de  morf.  canis  rab.  c.  2.  (y)  Tetrabib!.  2.  ferm.  2.  c.  24, 

This 


i  6  8  Book  I.  Of  Difeafes  of  the  Head. 

This,  however,  was  in  general  obferv’d,  that  the  blood  was  of  filch  a  kind, 
as  to  have  a  tendency  rather  to  concretion  than  folution. 

24.  When  the  phyficians  order’d  the  head  of  this  patient  to  have  much 
water  pour’d  upon  it,  they  perhaps  had  an  eye  to  fome  fuccefsful  cures,  which 
had  been  perform’d  almoft  after  the  fame  manner,  as  mention’d  in  the  books 
of  the  Royal  Academy  of  Sciences  at  Paris  (z).  That  the  patient  went  to 
the  bath  knowingly  and  voluntarily,  is  lefs  to  be  wonder’d  at,  than  that  the 
boy  taken  notice  of  by  Mead  (a),  when  he  was  plung’d  into  the  water,  fhould 
deny  that  he  was  afraid  of  water,  and  fhould  remain  very  quiet  therein  for 
a  little  while.  At  length,  that  the  right  auricle  of  the  heart  was  found  ex¬ 
tremely  diftended,  and  yet  not  from  its  contents,  1  eafily  underftand  in  this 
manner :  I  mean,  that  it  was  preferv’d  in  a  ftate  of  diftenfion  by  air,  which 
probably  could  not  be  feen,  as  has  fometimes  happen’d  in  others  (b) ;  fince 
in  fo  great  a  corruption  of  humours,  as  that  very  grievous  fmell  and  black- 
nefs  of  the  lungs  demonftrated,  the  air  might  efcape  without  difficulty  from 
the  other  component  parts  of  the  blood  (7) ;  and  this,  the  aerial  bubbles  found 
under  the  dura  mater  confirm’d.  And  in  the  fame  manner,  perhaps,  are  we 
to  underftand  thole  things,  which  we  find  written  in  the  diftedtion  of  a  hy¬ 
drophobic  patient  by  Brechtfeld  (d)  :  “  The  right  auricle  of  the  heart  was 
“  amazingly  fwell’d  :  the  right  ventricle  was  full  of  grumous  blood,  and  in 
“  the  left  was  a  blood  altogether  fluid  for  why  did  he  lay  what  the  ven¬ 
tricles,  which  were  not  tumid,  contain’d,  and  yet  did  not  fay  what  the  auricle, 
which  was  fo  greatly  diftended,  contain’d  ?  In  regard  toother  things,  which 
I  have  defcrib’d  as  being  feen  in  the  body  juft  fpoken  of,  I  will  confider 
them  hereafter  (e). 

25.  A  man,  who  had  a  month  before  been  bitten  by  a  mad  dog,  was 
feiz’d  with  an  evident  hydrophobia.  But  this  man  was  delirious,  was  conti¬ 
nually  crying  out,  and  had  a  fever.  Being  once  immers’d  in  water,  when 
it  was  perhaps  too  late,  and  he  was  grown  weak,  he  was  fcarcely  taken  out 
again,  but  he  immediately  exchang’d  for  death  his  every-way  miferable  life. 

The  body  of  this  man,  who  had  been  afflidted  with  fo  grievous  a  diforder, 
even  after  more  than  twenty  four  hours,  and  in  the  hotteft  feafon  of  the  year, 
that  is,  before  the  end  of  July,  did  not  fmell  very  ftrong.  His  face,  indeed, 
leem’d  like  that  of  a  patient,  who  died  in  the  laft  ftage  of  a  confumption ; 
but  the  remaining  parts  of  his  bod/  were  lufficiently  flelhy  and  plump.  His 
neck  was  fo  far  ting’d  with  a  livid  colour,  that  even  after  much  blood  had 
flown  out  in  difledtion,  it  was  Hill  livid.  The  belly  was  tumid,  from  the 
ftomach  and  inteftines  being  fill’d  with  air  j  and  though  thefe  vifcera  feem’d, 
in  other  refpedts,  to  be  fufficiently  natural,  yet  the  vefiels  which  creep  throuo-h 
the  ftomach,  were  diftended  with  blood,  almoft  as  much  as  when  we  fee  them 
fill’d  by  any  injedted  liquor.  In  the  ftomach  itfelf,  befide  air,  was  a  water, 
partly  yellow,  and  partly  greenifh.  A  great  part  of  the  liver  was  livid  ;  but 
its  veficle  was  very  full  of  bile,  not  black  however,  but  brown. 

The  diaphragm  was  not  altogether  free  from  inflammation.  The  lungs,  on 
their  whole  pofterior  part,  were  not  only  black,  but  even  fwoll’n,  from  the 

(c)  Ibid.  n.  29. 

(O  N.  30. 

blood. 


(z)  Hill.  a.  1699. 

\a)  Supra,  19,  &  20. 


(b)  Epift.  5/n.  20. 
(d)  Supra,  n.  20. 


Letter  VI1L  Article  2 6.  169 

blood,  as  it  feern’d,  ftagnatirig  in  them  ;  but  they  were  not  at  all  hard.  The 
blood  in  this  body  was  black,  not  polypous  indeed,  but  by  no  means  dif- 
folv’d.  The oefophagus  in  the  thorax,  and  lower  part  of  the  neck,  was  found; 
but  the  upper  part  thereof,  where  it  was  near  to  the  pharynx,  and  the  whole 
pharynx,  larynx,  and  afpera  arteria,  on  their  internal  furfaces,  were  of  a 
blackifh  red ;  fo  that  they  did  not  feem  to  have  been  inflam’d,  only  to  have 
been  very  near  to  a  gangrenous  ftate :  yet  they  were  not  fwoll’n,  and  the 
uvula  even  feerh’d  very  fmall,  although  the  tongue  was  very  thick.  And  the 
pharynx,  even  to  the  pofterior  foramina  of  the  nofe,  and  the  very  roof  of 
the  mouth,  was  full  of  a  yellow  and  greenifh  foam.  Laft  of  ail,  in  the  me¬ 
ninges,  the  veffels  were  extremely  diftended  with  blood;,  and  the  internal 
fubftance  of  the  brain  was  every  where  diftinguifh’d  with  bloody  points,  and 
a  kind  of  bloody  filaments.  In  the  lateral  ventricles  was  a  fmall  quantity 
of  ferum,  and  that  a  little  reddifh. 

26.  That  which  was  formerly  recommended  in  the  writings  of  Celfus  (/), 
as  “  the  only  remedy”  for  this  molt  violent  difeafe,  that  the  patient  “  be 
“  thrown  into  a  pond  of  water,”  does  not  fo  often  fucceed  with  phyficians, 
as  you  would  perhaps  believe,  from  feeing  fo  many  of  them  commended  on 
this  account  by  Etmuller  ( g ).  For  if  you  turn  to  the  obfervations  of  Fo- 
reftus  and  Tulpius,  to  the  “  experience”  of  whom  he  appeals,  you  will 
find,  that  the  plunging  into  water  does  not  refer  to  the  method  of  cure,  to 
which  that  propos’d  by  Celfus  refers,  but  only  to  the  prefervation  from  the 
dilorder.  And  you  will  find,  that  the  matter  comes  juft  to  the  fame  thing, 
excepting  only  one  obfervation,  of  a  kind  of  mad  mule,  if  you  confider 
“  the  many  examples  of  dog-madnefs  fo  cur’d,”  which  are  faid  to  be  extant 
in  Schenck  ;  and  you  will  even  perceive,  that  Schenck  has  produc’d  that  of 
Andrew  Baceius  (&),  from  which  you  will  underftand,  that  the  diforder  was 
not  cur’d,  but  rather  encreas’d,  by  this  method  of  treatment.  And  finally, 
in  that  chapter  of  Parey,  which  is  referr’d  to  (i),  the  happy  fuccefs  of  it  is 
fo  far  from  being  prov’d,  that  the  inutility  of  the  remedy  is  confirm’d.  And 
although,  in  the  chapter  before  (£),  Aetius  is  faid  to  have  related  of  a  phi- 
lofopher,  that  u  having  immers’d  himfelf  in  a  bath,  and  drunk  intrepidly 
“  of  the  water,”  he  came  out  found  and  well ;  yet,  if  you  examine  Aetius  (/), 
you  will  find  that  he  did  drink  indeed,  but  you  will  not  find  that  he  plung’d 
himfelf  into  the  water.  Among  fo  many  authors,  therefore,  commended  by 
him,  Van  Helmont  only  remains  (m),  who  faw  an  old  man,  “  labouring 
“  under  a  hydrophobia,  freed  from  his  diforder,”  by  being  three  times  im¬ 
mers’d  in  the  fea ;  to  which  example  you  will  alfo  add  the  cure  of  the 
girl,  which  you  will  read  in  the  hiftory  of  the  Royal  Academy  of  Sciences 
at  Paris  (n).  Yet  it  muff  have  fucceeded  very  differently  with  others  ;  fince, 
beflde  Baccius,  and  him  whom  Parey  (0)  pointed  out,  the  cardinal  Pontzettus, 
not  only  Salius  (j>)  has  written,  “  that  he,  after  feveral  times  experience,  had 

(f)  De  Medic.  1.  5.  c.  2 7.  n.  2. 

(g)  Prax.  1.  2.  f.  3.  c.  4.  art.  4.  m.  1. 

(£)  Vid.  Schenck.  1.  7.  obferv.  med.  22. 

(i)  14.  1.  20.  (k)  13. 


cc 


(l)  C.  24.  cit.  fupra,  ad  n.  22. 

\m)  Demens  idea.  n.  47. 

(?;)  A.  cit.  1699.  ( 0 )  Cit.  c.  14. 

(/>)  De  Affeft.  Particularib.  c.  19. 


VOL.  I. 


z 


found 


'170  Book  I.  Of  Difeafes  of  the  Head. 

“  found  no  advantage  from  this  remedy,”  but  alfo  Caelius  AureliantJS  (q) 
exprefsly  dilcommended  it,  as  injurious.  But  Julius  Palmarius  (r)  has  ad- 
monifh’d  us,  “  that  it  was  certain,  from  the  experience  of  many,  that  this 
“  method  of  treatment  had  been  very  unfuccefsful.”  And  left  you  (hould 
believe,  that  this  might  happen,  becaufe  they  had  not  us’d  a  pool,  or  pond, 
but  the  fea,  as  Palmarius  tells  us,  it  is  certain,  that  Aromatarius  (j)  did  not 
ipeak  of  the  fea,  when  he  laid,  “  that  this  remedy  of  Celfus  was  a  very 
“  dangerous  one,  as  it  was  wont  certainly  to  fuffocate  the  patient.”  What 
fhall  we  fay  then  ?  Did  the  experiment  fucceed  lei's  happily,  becaufe  they 
neglected  to  take  care,  as  Celfus  has  taught,  “  left  a  weak  body,  being  over- 
“  come  by  the  immerfion  in  cold  water,  fhould  be  carried  off  by  a  diftenfion 
“  of  the  nerves,”  that  is,  “  by  putting  him  into  warm  oil,  immediately 
“  after  coming  out  of  the  pond,”  which  fome  have  particularly  thought  ne- 
ceffary  in  the  winter  ?  although  we  fee  that  the  boy,  taken  notice  of  by 
Mead  (/),  was  foon  feiz’d  with  convulfions,  even  in  the  warm  water  itfelf. 
Or  was  it  becaufe  they  did  not  obferve  the  other  precept  of  Celfus,  “  and 
“  throw  him  into  the  pond  fuddenly,  and  at  unawares,  without  his  having 
“  feen  it  before  ?  ”  which  Etmuller  (a)  inculcates,  and  the  obfervation  of 
Ridley  feems  to  intend  (x).  Or  was  it  becaufe  they  plung’d  them  in  too 
late,  when  they  were  now  “  quite  overcome  with  thirft,  and  with  the  fear  of 
“  water  ?  ”  although  Celfus  propos’d  even  this  remedy  to  thefe  very  perfons. 
Or  was  it  becaufe  they  neglected  what  Boerhaave  (y )  thought  was  previouQy 
neceffary  to  be  done  ?  which,  though  they  may  not  be  fuitable  to  all,  and 
altogether,  yet,  I  believe,  are  certainly  to  moft  patients,  and  in  fome  meafure. 
Or,  fince  in  the  old  man,  and  the  young  girl,  none  of  thefe  things  feem’d 
greatly  to  be  obferv’d,  and  moreover  the  former  was  plung’d  into  the  fea, 
and  the  latter  into  fait  water,  nor  were  they  ignorant  of  it,  or  opprels’d  with 
the  difeafe,  nor  afterwards  dipp’d  into  warm  oil  ;  is  it  not,  I  fay,  more  pro¬ 
bable  perhaps,  that  as  different  hydrophobic  patients  are  feen  to  be  differently 
affedted,  both  living  and  dead,  that  therefore  the  fame  remedy  can  not  equally 
be  of  advantage  to  all  ?  for  which  reafon,  the  more  pains  ought  to  be  taken 
in  prelervation  againft  the  diforder;  though  I  do  not  doubt,  but  even  with 
this  view,  a  different  method  is  to  be  purfu’d  in  different  patients.  And  I 
wifh  that  the  fign,  which,  as  I  have  faid  before  (z),  was  firft  remark’d  by 
Salius,  offer’d  itfelf  in  all,  and  that  no  matter  of  doubt  could  remain  in  what 
feems  to  follow  thereon.  And  it  would  not  be  fo  difficult  to  guard  againft  the 
diforder  that  even  now  threaten’d,  unlefs  the  condition  of  the  wounded  part 
was  an  obftrudlion  thereto,  if  as  foon  as  ever  pains  or  itching,  or,  as  fome- 
ti mes  happens,  a  change  arifes  in  the  flefh  that  has  been  cicatriz’d,  imme¬ 
diately  a  little  more  was  cut  off  from  the  part  than  had  been  formerly  bitten,, 
or  the  fame  were  «deeply  cauteriz’d  ;  or,  at  leaft,  that  were  done  which  Fo- 
reftus  {a)  has  related  from  Gilbert,  an  Englifbman,  who  treats  of  this  fub- 
ject :  “  The  firft  intention  is,  that  the  wound  may  not  be  clos’d  up;  or,  if 


(q)  Acutar.  PafT.  1.  3.  c.  16. 

(>•)  C.  3.  1.  cit.  fupra,  ad  n.  2.2. 

(/)  Difp.  de  Rabie,  part.  5.  partic.  3 
(/)  Supra,  n.  24.  (u)  Art.  &  m.  ci't. 


( x )  Ad.  Erud.  Lipf.  a.  170c.  M.  Mart. 

(y)  Aphor.  de  cogn.  morb.  §  1144... 

(z)  Supra,  n.  21. 

(c)  L.  10.  obf.  med.  27. 


“  it 


Letter  VIII.  Article  27.  171 

M  it  be  clos’d  tip,  that  it  may  be  immediately  open’d,  for  the  putrefaction 
“  and  fanies  to  flow  out,  becaufe  the  poifon  is  wont  to  lie  dormant  for  a  long 
<c  time,  &c.”  But  concerning  the  preventative  cure,  I  fhall  again  treat  fome- 
what  more  below  (b).  However,  that  it  may  at  prefent  be  more  evident,  as 
I  faid  a  little  time  ago,  that  different  hydrophobic  patients  are  found  differently 
affedted,  both  in  the  courfe  of  the  difeafe  and  the  difiedtion;  take  the  third 
hiftory  which  I  promis’d  you,  in  the  following  manner. 

27.  An  old  man  of  fixty  years  of  age,  robuft,  and  nervous,  partly  of  a 
choleric,  and  partly  of  a  fanguineous  conftitution,  had  been  bitten  three 
months  before,  in  the  left  wrift,  by  a  mad  dog.  When  the  wound  was 
brought  to  a  cicatrix,  the  old  man  did  not  difcover  the  lead  fign  of  a  hydro¬ 
phobia,  nor  even  after  it  was  perfedtly  heal’d,  till  within  twenty  days  of  his 
death  :  when,  having  receiv’d  Severe  threat’nings  and  grievous  ftripes,  from  a 
certain  perlon,  he  began,  immediately  from  that  time,  to  be  agitated  with  a 
furprifing,  unufual,  and  unreasonable  fear ;  fo  that  he  not  only  trembl’d  at 
every  little  noife  he  heard,  but  even  immediately  look’d  upon  every  ftranger, 
whom  he  met  with,  to  be  a  betrayer,  and  if  it  was  poffible  by  any  means, 
would  fly  to  a  hiding-place  to  avoid  him,  Scon  after  thefe  Symptoms,  he 
was  Seiz’d  with  a  dread  of  water  and  light,  and  was  brought  into  the  hofpital, 
where  he  liv’d  two  days.  While  he  was  there,  he  was  order’d  to  drink  water, 
which  he  attempted  to  do,  though  it  was  (lowly,  and  with  Such  contorfions 
of  body  that  floew’d  him  to  be  unwilling,  and  like  one  who  was  conftrain’d. 
And  indeed  it  was  with  great  difficulty  and  uneafinefs  that  he  began  to  Swallow 
it;  but  when  he  had  drunk  with  difficulty  the  firft  part  of  the  draught,  he 
got  the  remainder  down  without  difficulty.  No  foam  was  ever  obferv’d  at 
his  month  :  he  Spat  indeed,  but  his  Saliva  was  fluid.  However,  that  incre¬ 
dible  fear,  and  the  averffon  to  water,  and  the  difficulty  and  uneafinefs  in  the 
beginning  of  Swallowing,  continu’d  unto  the  very  time  of  his  death. 

His  belly  being  open’d,  the  inteffines  Seem’d  all  to  be  very  much  diffended 
with  air,  befide  which,  they  contain’d  hardly  any  thing.  In  the  Stomach  was 
a  thickifh  fluid,  not  in  great  quantity,  nor  vifcid,  but  of  a  cineritious' colour! 
The  gall-bladder  contain’d  but  little  bile,  which  was  of  a  high  yellow,  and 
had  ftain’d  the  duodenum  with  the  Same  colour,  and  that  part  of  the  liver 
alfo,  which  was  neareft  to  the  gall  bladder.  The  iliac  veins  were  fo  turgid 
with  blood,  that  they  equall’d  the  natural  diameter  of  a  Small  inteftine  ;  but 
their  corresponding  arteries  were  entirely  empty. 

In  the  thorax,  the  lungs,  to  ufe  the  wrords  of  Boerhaave  (V),  were  coacer¬ 
vato  omni  fere  cruore  incredibiliter  -pleni,  that  is,  “  incredibly  fill’d  with  aimed 
“  all  the  craffamentum  of  the  blood,  colledted  and  condens’d  together:” 
and  in  their  back  part  might  even  be  faid  to  be  affedted  with  a  gangrene. 
In  the  pericardium  was  a  yellowuffi  water,  perhaps  to  about  the  quantity  of 
three  ounces:  in  the  heart  was  a  Small  quantity  of  blood,  which  refemblcd, 
in  its  colour  and  confidence,  black  pitch  that  is  half-melted.  The  vena 
azygos,  or  fine  pari,  contain’d  a  very  Small  quantity  of  blood :  but  in  the 
neck,  both  the  carotid  arteries,  and  the  internal  jugular  veins,  were  entirely 
empty.  The  organs  of  deglutition  were  wnthout  any  mark  of  inflammation, 
unlefs  that  at  the  top  of  the  pharynx,  Some  little  rednels  was  diicover’d  ; 


Z  2 

# 


.(/>)  N.  29. 


(c)  Aph.  cit.  §  1 1 40. 


but 


i  7  2  Book  I.  Of  Difeafes  of  the  Head. 

but  the  membrane  which  inverted  the  cartilage,  call’d  epiglottis,  was  be¬ 
come  crifp  and  ffirivell’d.  The  veffels  of  the  meninges,  both  arterial  and 
venous,  were  immoderately  full  of  blood,  and  that,  as  it  was  in  every 
other  part,  very  black.  The  optic  nerves  were  thicker,  but  more  lax 
and  flaccid  than  ufual.  Nor  indeed  were  the  cerebrum,  cerebellum,  and 
fpinal  marrow,  more  dry  than  they  generally  are,  nor  yet  the  vifcera  of  the 
thorax  and  abdomen,  nor  any  of  the  mufcies.  In  the  ventricles  of  the  brain 
was  a  yellowifh  water,  to  about  the  quantity  of  three  ounces.  This  diffebtion 
Was  perform’d  on  the  twenty-firft  of  May,  in  the  year  1727. 

28.  Ahhough  the  fear  of  death,  which  was  imprefs’d  by  threatnings  and 
blows,  feerns,  at  the  fame  time,  to  have  excited  the  latent  virus  of  the  hy¬ 
drophobia,  and  to  have  moderated  its  effebts,  yet  it  cannot' be  deny’d,  that 
this  diforder  belong’d  to  the  lpecies  of  hydrophobia,  inafmuch  as  the  bite  of 
a  mad  dog  had  preceded,  and  the  dread  of  water  had  been  the  confequence 
of  it :  unlefs  you  would  perhaps  rather  choofe  with  the  followers  of  Andreas, 
that  it  ffiould  be  call’d  a  Pantaphobia.  For  they,  as  it  is  in  Caelius  Aurelia¬ 
nus  (d),  afferted,  <c  that  thofe  were  Pantaphobi  whom  we  may  call  Omniponi, 
“  for  they  are  faid  to  fear  every  thing which  diforder,  “  if  it  could  really 
“  happen,”  Caelius  would  have  to  be  thus  diftinguifh’d,  u  that  it  brought 
“  on  not  only  a  fear  of  drink,  but  of  all  things.”  But  if  we  conrtder  the 
difficulty,  fuch  as  it  was,  of  {wallowing  fluids,  that  was  obferv’d  in  the  old 
man  treated  of ;  and  ftill  more,  if  we  conrtder  the  bite  of  a  mad  clog,  which 
had  preceded,  we  ffiall,  I  think,  eafily  fee  why  there  is  no  reafon,  on  the 
fcore  of  other  accidental  fears,  which  were  join’d  with  it,  to  fuppofe  it  a 
diforder  of  any  different  kind  from  a  hydrophobia.  For  if  he  had  happen’d 
to  have  had  a  dread  of  fome  things  only,  and  not  of  ail,  befide  water,  as  of 
light  for  inftance ;  ffiould  we,  for  that  reafon,  have  laid,  that  it  was  a  dif¬ 
ferent  diforder  ?  in  imitation  of  thofe  whom  Caelius,  in  like  manner,  fpeaks 
of  (e),  who  would  have  call’d  the  fear  of  air,  for  example,  aerophobia,  had 
it  not  been  that  “  it  was  generally  afcrib’d  to  phrenicic  perfons for  fome 
of  thefe  are  afraid  of  the  “  bright”  air,  and  fome  of  the  obfcure.” 

But  common  lymptoms,  and  thofe  which  are  attendant  upon  various  dif- 
eafes,  are  to  be  feparated  from  the  proper  ;  although  it  often  happens  to  hy¬ 
drophobic  patients,  that  they  are  afraid  of  the  air.  Nor  do  I  fay  this,  be- 
caufe,  when  the  diforder  is  now  coming  on  them,  there  is  wont  to  be  ob¬ 
ferv’d  in  them,  as  Ctelius  (/)  has  indeed  afferted,  “  an  unufual  complaint  of 
“  the  air,  as  if  ftormy,  when,  at  the  fame  time,  there  was  a  perfebt  ferenity 
“  of  weather.”  But  I  fay  it  for  this  reafon,  becaufe,  when  the  hydrophobia 
is  already  come  on,  many  are  afraid  of  the  air  when  it  is  agitated.  Thus  he 
of  whom  Zwingerus  (g)  fpeaks,  “  had  an  equal  dread  of  the  free  air,  as  of 
“  liquids ;  and  if  the  windows,  or  doors,  were  open’d,  his  fymptoms  were 
“  all  render’d  immediately  more  vehement.”  And  another  of  whom  you 
will  read  in  the  Sepulchretum  (h\  “  took  the  utmoft  pains  that  they  ffiould 
“  be  kept  fhut,”  being  extremely  terrified  with  the  noife  “  of  a  thundering 
“  wind,”  which  he  feem’d  to  himfelf  to  hear.  But  a  man,  whole  cafe  was 
laid  before  the  Royal  Society  of  England,  by  Prym  (/'),  feem’d  to  himfelf 

(d)  Acut.  Paff.  I.  3.  c.  12.  (£)  L.  x.  fed.  8.  append.  §  2. 

(*)  Ibid.  (f)  L.  cit.  c.  11.  (?)  Saggio  delle  Tranfaz.  p.  2.  c.  8.  n.  4. 

(/)  Vid.  obf.  cit-.  fupra,  ad  n.  19. 


to 


Letter  VIII.  Article  29.  173 

to  be  fu  {located,  even  from  the  flighted  breath  of  air.  And  a  woman, 
whofe  hiftory  is  written  by  Platerus  (£),  fell  into  a  danger  of  fuffocation 
from  the  lame  cauie  •,  although  (he  had  not  contra&ed  this  diforder  from  a 
mad  animal;  as  others  alfo  befide  her  had  not,  of  which  many  examples  are 
extant;  unlefs  you  are  perhaps  ready  to  fufpebt  with  ibme,  that  flnce  this 
virus  is  not  only  contracted  very  eaflly,  by  contagion  (/),  but  alfo,  when 
contracted,  lies  latent  a  long  time  ;  that  all  thefe  perlons  became  hydropho¬ 
bic,  either  from  a  contagion,  that  was  not  at  all  taken  notice  of,  or  that  had 
entirely  efcap’d  their  memory.  Although,  on  the  other  hand,  it  may  alfo 
be  lui'peCted,  by  any  one,  that  if  not  always,  at  lead  fometimes,  we  are 
ready,  without  reafon,  to  refer  thefe  diforders  to  the  foam  that  was  thrown 
out  from,  or  a  wound  that  was  inflicted  by,  a  creature  who  was  perhaps  not 
mad,  when  we  fhould  rather  afcribe  them  to  fome  poifon  of  the  fame  kind 
generated  within  the  conditution.  But  led  this  difcuffion  fhould  lead  us  too 
far  from  our  intended  purpoles,  we  will  conflder  of  thefe  fufpicions  farther, 
hereafter  (/»).<£ 

29.  But  here  to  the  four  examples  of  hydrophobia  being  join’d  with  the 
fear  of  air,  we  will  add  a  fifth,  by  fubjoining  the  promis’d  hiftory  of  the 
virgin  of  Modena  (»),  led  it  fhould  perhaps  perifh  with  that  Italian  anfwer, 
in  which  I  formerly  read  it  at  Bologna,  in  manufcript  (*j,  and  which  my 
friend  Ramazzini  wrote  aimed  fourlcore  years  ago,  againd  the  fourth  cen- 
fure  of  Jo.  Andr.  Moniglia,  but  was  forbidden  to  publifh.  It  was  the  fiftieth 
day  after  this  virgin  had  been  bitten  by  her  own  lap-dog,  in  her  lip ;  when 
Ihe  being  in  extreme  good  health,  and  fufpeCling  nothing  lefs  than  that  fhe 
fhould  prelently  be  affeCted  with  a  hydrophobia,  while  file  was  by  chance 
paffing  over  a  kind  of  dream,  manifestly  fnew’d  herfelf  to  labour  under  that 
diforder.  Among  other  fymptoms  with  which  fhe  was  affli&ed,  was  the  fenfe 
of  a  very  fmall  wind,  driking  upon  her  head  ;  for  which  reafon  fhe  cried  out 
vehemently,  again  and  again,  that  the  windows  and  doors  might  be  clofely 
fihut  up.  And  at  the  lead  motion  which  happen’d  in  the  bed,  die  cried  out ; 
but  if  any  one  fhook  up  the -clothes,  or  offer’d  her  a  fan,  then  fine  was  exceed¬ 
ingly  frighten’d,  and  was  feiz’d  with  the  mod  violent  convulfions.  She  was 
alfo  compell’d,  by  a  perfon  who  was  with  her,  to  drink  that  water  which  (lie  fo 
much  hated,  and  that  in  a  large  quantity.  After  which  fhe  lod  the  power 
of  fpeech,  and  being  tortur’d  with  the  mod  cruel  convulfions,  fhe  loon  ceas’d 
to  live.  At  the  very  time,  when  fhe  was  juft  giving  up  the  ghod,  fomebody 
happening  to  put  a  bifeuit  to  her  mouth,  with  one  end  of  it  moiden’d  in 
wine,  fhe  refus’d  it ;  then  being  offer’d  that  part  which  was  dry,  fhe  accepted 
of  it,  nor  refus’d  to  eat  it.  This  is  nearly  what  I  remember  to  have  read  in 
that  obfervation  of  Ramazzini ;  from  which,  and  from  other  things,  he  alfo 
gather’d,  that  neither  an  acute  fever,  nor  a  delirium,  always  accompanies  a 
hydrophobia;  but  that  to  compel  thofe,  who  labour  under  fuch  dilorders,  to 
drink,  or  to  plunge  them  into  water,  brings  on  a  more  fpeedy  dedruftion  : 
and  that  it  was  not  without  reafon  they  dreaded  water,  inafinuch  as  being 

(£)  Obf.  1.  1.  («)  Supra,  n.  19. 

(/)  Vid.  fupra,  n.  21,  (*)  Nuper  interea,  cum  tota  illa  Controver¬ 
ts)  n.  31.  "  fia,  typis  Mutiuenfibui,  ut  audio,  edita. 

feiz’d 


174  Book  I.  Of  Difeafes  of  the  Head. 

feiz’d  with  a  diforder  of  deglutition,  and  not  of  the  mind,  they  certainly, 
with  reafon,  dread  the  danger  of  fuffocation.  I  did  not,  however,  bring 
this  obfervation  merely  to  confirm  what  I  had  before  advanc’d,  that  the  dread 
of  agitated  air  was  often  join’d  with  the  hydrophobia,  but  alfo  to  confirm 
other  things.  For  this  obfervation,  join’d  to  that  which  will  prefently  be 
produc’d  from  Foreflus,  and  {till  more  with  that  which  is  read  in  Mathiolus(^), 
of  Baldus  J.  C.  will  be  a  confirming  proof  to  you  of  what  I  afferted  above, 
to  have  been  feen  by  me  in  a  boy  (/>),  although  his  face  was  bitten  by  a  mad 
dog  in  that  place  where  the  venom  can  eafily  communicate  with  the  faliva  *,  yet 
that  not  very  fpeedily,  as  in  others,  from  a  bite  of  the  fame  parts,  was  the 
hydrophobia  brought  on,  but  after  forty  days  only.  It  will  alfo,  perhaps, 
make  you  attend  to  what  Salmarius  (q)  has  added,  after  having  admonifh’d 
us,  that  though  the  bath  has  been  profitable  to  moft  people,  when  it  was  us’d 
by  way  of  precaution  after  the  bite,  yet  the  deaths  of  many  fufficiently  de- 
monftrate,  that  it  is  not  altogether  to  be  depended  upon  as  a  remedy.  “  For 
“  in  moft  perfons,”  fays  he,  “  the  fight  of  the  water  ftirs  up  and  excites  the 
“  hydrophobia  more  fpeedily,  by  putting  the  poifon  which  is  within  the  body 
“  in  motion,  and  which  otherwife  might  have  lain  latent  much  longer,  with- 
“  out  any  inconvenience  to  the  patient,  and  perhaps  have  been  fubdu’d  and 
“  extinguish’d  by  means  of  alexipharmacs.”  Thus  I  fee  it  happen’d  to  a 
monk,  who  almoft  two  months  after  a  whelp,  which  he  had  held  in  his  lap, 
had  bitten  his  lips  and  his  cheeks,  as  Foreltus  (r)  relates  it,  was  not  feiz’d 
with  a  dread  of  water  before  “  he  was  palling  over  a  ditch,  walking  on  a 
“  plank,  and  leaning  on  a  ftaff ;  for  upon  feeing  the  water  he  was  {truck  with 
“  fear,  and  was  not  able  to  go  over  without  great  horror  and  dread  :  and 
“  hence  was  to  him  the  firft  origin  of  the  hydrophobia.”  So  it  happen’d  to 
the  virgin  of  whom  1  have  fpoken,  the  external  caufe  of  whofe  diforder,  as 
alfo  the  firft  manifeftation  of  it,  were  entirely  after  the  fame  manner  with  the 
laft,  although  the  other  Symptoms  were  widely  different. 

Do  not,  however,  imagine,  that  I  efteem  the  external  ufe  of  water,  whether 
you  would  chufe  to  make  ufe  of  the  bath  in  a  common  way,  or  the  fudden 
and  unexpected  immerfion  recommended  by  Celfus,  as  a  noxious  or  ufelefs 
experiment,  by  way  of  prevention,  fo  that  it  be  but  early  and  fufficiently 
apply’d  to  :  although  Mead  (s)  affirms,  that  the  bath,  join’d  however  with 
his  remedy,  even  us’d  late  in  the  difeafe,  has  neverthelefs  been  of 
equal  advantage,  yet  concerning  the  happy  fuccefs  of  immerfion,  which  is 
principally  us’d  among  the  Dutch,  two  of  their  moft  eminent  phyficians, 
Tulpius(/),  and  Stalpart  («),  are  by  no  means  agreed.  For  doubtlefs,  as 
Tulpius  and  Mead  deny,  that  after  fo  many  experiments,  they  have  known 
of  any  one,  to  whom  their  particular  methods  of  treatment,  in  the  preventative 
cure,  when  early  and  ftrenuoufiy  made  ufe  of,  were  not  falutary  ;  it  is  cer¬ 
tainly  reafonable  to  fuppofe,  that  at  leaft  moft  of  them  were  in  this  manner 
fav’d  :  and  if  moft  of  them,  it  certainly  will  not  be  juft  to  fuppofe,  that  all 

(c)  Comm,  in  Diofcor.  I.  6.  c.  36.  (j)  Trad:,  de  Venen.  Tentam.  2. 

(/>)  N.  22.  (0  Obf.  Med.  1.  1.  c.  20. 

{7)  L.  de  morf.can.  rab.  c.  3.  ( u )  Obf.  rar.  cent.  j.  in  fchol.  ad  obf.  100. 

(r)  L.  10.  Obf.  Med.  27.  in  fchol. 


of 


Letter  VIII.  Article  30.  175 

i 

of  them  efcap’d  for  this  reafon  only,  becaufe  they  were  not  at  all,  or  but 
flightly,  infedtedpvith  the  poifon.  Nor  does  it  efcape  me  at  prefent,  what  dif¬ 
ference  there  may  be  betwixt  one  bite  and  another,  either  as  it  may  be  more  la¬ 
cerated,  or  not  lacerated  at  all,  (although  to  the  fatal  examples  of  both  kinds 
of  wounds,  others  are  at  hand,  which  might  be  added  (x)  )  or  becaufe  the 
dog  which  bites  is  not  yet  evidently  mad  ;  or  even  if  he  be,  fo  that  he  has  but 
wip’d  away  all  his  faliva,  by  fixing  his  teeth  upon  other  perfons,  or  by  patting 
them  through  thick  doublings  of  garments,  or  any  thing  elfe  of  that  kind  : 
yet  I  fhould  not  eafily  perfuade  myfelf,  that  in  fo  great  a  number  of  perfons 
who  have  been  fav’d,  they  were  all  bitten  in  fuch  a  manner  as  to  contrait 
little,  or  fcarcely  any  at  all,  of  the  venom  ;  or  that  among  thofe  almoft  in¬ 
numerable  perfons,  who  are  fpoken  of  by  Tulpius  or  Mead,  there  was  not 
one  who  had  really  receiv’d  the  poifon  into  the  conflitution.  And  I  fhould 
even  think  it  much  more  probable,  to  thofe  who  confider  what  generally  hap¬ 
pens,  to  fuch  as  have  us’d  no  prefervative  methods  of  cure,  after  the  bite  ;  I 
fay,  it  is  doubtlels  much  more  probable,  that  out  of  the  prodigious  numbers 
of  thofe,  who,  having  us’d  one  method  of  cure  or  other,  have  efcap’d  the 
hydrophobia,  molt  of  them  mull  have  been  feiz’d  therewith,  if  they  had  not 
averted  it  by  their  methods  of  cure. 

But  to  thele  varieties  alfo,  which  have  been  made  mention  of  in  the  bite, 
and  not  only  to  the  various  difpofitions  of  the  biting  dog,  or  of  the  fluid  and 
folid  parts  in  the  perfon  bitten,  would  I  willingly  atribute  thofe  very  many 
circumftances,  in  which  hydrophobic  perfons  differ  one  from  another  ;  fo  that 
fome  are  opprefs’d  fooner,  and  fome  later,  by  the  breaking  forth  of  this 
diforder,  and  in  both  claffes  different  perfons  differently.  For  there  are 
fome  who  are  violently  delirious  *,  and  fome  again,  even  to  the  very  laid,  re¬ 
tain  the  power  and  ufe  of  their  fenfes.  Some  cannot  bear  light,  or  white 
bodies,  or  the  flighted  motion  of  the  air ;  and  others,  again,  none  of  thefe 
things  affedt.  But,  not  to  repeat  all  thofe  things,  which  I  have  already  re¬ 
lated  or  quoted  above,  and  much  iefs  to  add  others,  there  are  fome  who  have 
fo  great  a  dread  of  liquors,  of  any  kind  whatever,  that  even  if  they  do  not 
fee  them,  but  only  hear  them  nam’d,  they  cry  out,  tremble,  are  convuls’d, 
and  fwoon  away.  And  thefe  things,  though  they  happen  in  mod,  yet  are 
fo  far  from  happening  in  all,  as  they  feem  to  believe,  who  contend  that  this 
dread  of  water  is  the  pathognomonic  fign  of  the  hydrophobia,  that  hydropho¬ 
bic  patients  are  not  wanting  who  drink  wine  ;  nor'  fuch,  who  not  only  do  not 
fhudder  at  the  mention  of  water,  but  being  order’d  to  go  into  the  bath,  im¬ 
mediately  fee  out  to  go  thither,  even  when  the  diforder  is  far  advanc’d  ( y )  ; 
nor  finally,  fuch  as  will  drink  water  itfelf,  without  difficulty,  when  the  firfl: 
trouble  of  fwallowing  is  overcome  (z).-~ 

30.  And  as  there  are  many  things,  in  which  thefe  patients  while  living 
differ  one  from  the  other;  fo  there  are  not  fewer,  but  even  more,  in  which 
their  bodies  differ  after  death.  And  this  you  will  immediately  comprehend, 
if  you  compare,  one  with  another,  thofe  eight  obfervations  of  this  kind, 
which  were  before  publifh’d,  and  which  may  be  read  at  length,  partly  in  the 

(at)  Ut  Eph.  N^t.  Cur.  cent.  9.  obf.  37.  Sc  (j;)  Supra,  n.  23, 
aft.  eorund.  vol.  5.  obf.  5.  (2)  N.  27. 

s  Sepulchrctum, 


176  Book  I.  Of  Difeafes  of  the  Head. 

Sepulchretum,  and  partly  each  in  its  diftinft  author,  as  I  have  have  pointed 
out  above  (a) ;  and  moreover,  thefe  three,  which  I  have  now  added  for  the 
firft  time.  For  to  begin  with  the  external  parts,  and  proceed  inwards,  you 
will  find,  that  in  three  of  them,  a  lividnefs  was  found,  and  that  this  was  re¬ 
mark’d  in  the  fingers,  on  the  fhoulder,  on  the  back,  or  in  the  neck  :  Once 
the  whole  body  was  vehemently  extenuated,  as  in  a  hedtical  perfon  ;  once 
the  face  only:  in  one  the  mufcles  were  univerfally much  drier  than  natural, 
which  is  never  taken  notice  of  in  any  other  place,  and  even  once  exprefsly 
denied  :  and- upon  opening  the  belly  and  thorax,  once,  what  I  faid  juft  now 
of  the  mufcles,  which  has  been  once  taken  notice  of,  and  once  denied  :  once 
the  omentum  was  entirely  confum’d,  and  the  mefenteric  glands,  and  the 
pancreas,  extremely  extenuated  :  the  ftomach  once  turgid  with  air,  and  its 
vefifels  diftended  with  blood  :  its  internal  coat  once  corrupted,  and  the  others 
diftinguifh’d  with  red  fpots :  five  times,  indeed,  a  moifture  was  obferv’d  in 
it :  but  once  much,  three  times  little,  once  yellowifh,  once  green,  once  of 
a  yellow  colour  degenerating  into  green,  once  extremely  yellow,  once  cine- 
ritious,  twice  vifcid,  once  not  vifcid  :  the  inteftines  were  three  times  diftended 
with  air  •,  once  not  at  all,  but  ting’d  here  and  there  with  red  fpots,  diftiinft 
from  each  other :  the  liver  was  once  yellow  and  hard  ;  once  in  a  great  part 
of  it  inflam’d,  and  near  upon  a  ftate  of  gangrene-,  and  once  already  livid  ; 
but  its  veficle  was  once  full,  twice  very  full  of  bile,  which  was  three  times 
either  very  black,  or  approaching  to  it,  once  fome  what  green,  once  yellow, 
and  then  in  fmall  quantity.  Thus  far  of  the  belly. 

And  in  the  thorax,  the  whole  remaining  part  of  the  internal  furface  of  this 
cavity  was  red  and  livid  ;  but  in  one  body,  at  the  circumference  of  the  dia¬ 
phragm  only.  In  another,  the  diaphragm  was  alfo  not  entirely  free  from 
inflammation.  The  lungs  in  one  and  in  another  alfo  were  dry,  and  deftitute 
of  moifture  ;  in  one  with  veficles  here  and  there  on  the  furface;  in  five  they 
were  wholly,  or  partly,  black  ;  in  four  they  were  in  great  part  alfo  full  of 
blood :  in  one  the  pericardium  was,  in  fome  part  of  it,  almoft  friable  ;  in 
two  without  any  moifture  ;  in  one  with  a  very  little  only  ;  but  in  another,  it 
had  three  ounces  of  yellowifti  water  in  it :  in  two  the  right  auricle  of  the 
heart  was  dilated  with  air:  the  heart  itfelf  in  as  many  dry;  in  one  flaccid 
and  extenuated ;  the  ventricles  in  one  being  entirely  deftitute  of  blood,  and 
in  one  having  (lender  polypous  concretions :  yet  in  three  they  contain’d  blood  ; 
but  in  one  only  little,  and  like  melted  pitch  ;  in  another  concreted,  almoft 
without  any  ferum;  but  in  the  third,  in  fuch  a  manner,  that  the  right  was 
full  of  grumous  blood,  while  the  left  contain’d  it  altogether  fluid. 

As  to  the  neck  and  fauces,  the  cefophagus  of  one  was  narrow  in  thofe  parts, 
as  well  as  in  the  cheft,  and  in  a  manner  conftring’d  :  in  one  it  was  internally 
inflam’d  :  and  the  pharynx  in  three,  and  the  afpera  arteria  in  as  many,  were 
feiz’d  with  an  inflammation,  either  flight  or  great,  or  already  verging  to  a 
gangrene:  in.  one,  however,  the  oefophagus  was  free  from  difeafe  :  the  fauces 
of  fome  were  without  any  traces  of  inflammation, -and  the  membrane  of  the 
epiglottis  was  in  one  become  crifp’d  :  the  larynx  of  one  was  of  a  red  colour, 
degenerating  into  livid,  in  which  alfo  the  tongue  was  found  thicken’d,  and 
the  pharynx  entirely  full  of  a  foam  which  was  yellow,  but  degenerating  into 
green. 

(a)  N.  20. 


8 


Moreover, 


Letter  VIII.  Article  31.  177 

Moreover,  the  cerebrum  and  cerebellum  of  one  inclin’d  to  drynefs,  and 
in  one,  together  with  the  beginning  of  the  fpinal  marrow,  were  much  drier 
than  in  general  ;  but  in  one,  none  of  thefe  was  any  thing  drier  than  ufual, 
and  indeed  the  optic  nerves  were  pretty  lax :  finally,  in  one  or  two  of  them,- 
the  cerebrum  had  nothing  worthy  of  remark.  And  again,  in  the  ftomachs 
of  two  was  extravafated  water ;  but  in  one  of  them,  in  fmali  quantity,  and 
yellowiili  ;  in  the  other,  in  fmali  quantity  alfo,  but  reddifh  :  and  in  yet 
another,  there  was  no  appearance  of  it  at  all.  In  one  were  bubbles  of  air, 
under  the  dura  mater ;  and  in  the  finufles  of  the  fame  membrane  were  lax 
polypous  concretions.  In  three,  all  the  veffels  of  the  brain  were  extremely 
diftended  with  blood. 

» 

And  as  to  what  relates  to  the  blood  in  general,  the  arteries  of  one  were 
very  full  of  blood,  and  the  veins  almoft  empty  :  in  another,  the  vena  fine 
pari  was  almoft  empty,  but  the  iliacs  greatly  diftended  therewith,  and  their 
correfponding  arteries  empty  and  equally  empty  in  the  neck  were  both  the 
internal  jugular  veins,  and  the  carotid  arteries,  as  the  veffels  within  the 
cranium,  both  arteries,,  and  veins,  were  equally  full  •,  which  was  obferv’d  in 
two  others  alfo,  as  I  juft  now  pointed  out.  '  In  one,  in  like  manner,  was  none 
of  the  blood  concreted  in  any  part,  but  the  whole  of  it  was  very  fluid,  and 
did  not  coagulate  in  the  external  air,  though  cold.  But  in  another,  it  was 
rather  concreted  than  difiblv’d  •,  in  another,  not  polypous,  yet  not  diftolv’d. 
Moreover,  the  great  veftels  of  the  heart,  in  one  of  them,  had  the  blood 
entirely  concreted  ;  and  how  it  was  found  in  the  heart,  I  have  Laid  above. 
Laft  of  all,  in  two  or  three  of  them,  it  was  remark’d  to  be  black.  And 
that  we  may  omit  nothing  out  of  all  thofe  things,  which  come  under  a  ge¬ 
neral  view,  it  was  remark’d,  that  two  of  the  carcafies  fmell’d  very  ill  ;  but 
that  .the  leaft  fo,  which,  according  to  appearances,  ought  to  have  been  the 
worft. 

31.  Nor,  indeed,  have  I  found  lefs  variety  in  other  difledftlons  of  hydro- 
phobic  patients,- -which  were  obferv’d  or  publifh’d  by  learned  men,  before  I 
revis’d  thefe  papers  •,  for  inftancc,  by  Richard  Mead  (£),  whom  I  have  fpoken 
of  already,  Janus  Plancus  (r),  Laurence  Cajetano  Fabbri  (J),  Dominico  Bro- 
giani  ( e ),  and  fome  others  befides  (/),  whofe  books  have  not  come  to  my 
hands.  And  in  order  to  compare  thefe  obfervations  with  thofe  juft  now  pro¬ 
duc’d,  prelerving  the  fame  method  of  proceeding,  I  muft  begin  with  one  of 
the  celebrated  Ph:l.  Eberh.  Dillenius  (£),  who  being  forbidden  to  difledt  the 
body,'  obferv’d  here  and  there  external  Jividnefles,  and  as  it  were  blacknefles, 
from  <:ontuftons,  but  efpecially  about  the  breaft.  Among  the  reft,  there  is 
one  who  takes  notice  of  the  mufcles  oLthe  belly  being  once  inflam’d,  and 
one  of  the  mufcles  being  univerfally  tumid  and  robuft.  There  is  one,  .who, 
having  examin’d  thirteen  bodies,  writes,  that  there  was  for  the  molt  part, 
icarcely  any  fat,  and  that  even  the  omentum  was  in  a  manner  wafted  ;  but 

•(/>)  Traft.  de  Venen.  Tentam.  2.  -  ( e )  Traft.  de  Venen.  Animal,  p.  2. 

ft)  Apud  Simon.  Cofmopolit.-Epift.  Apolog.  (/)  Apud  Swieten.  in  Comm,  in  Boerh. 
pro  Plane?,  &  alibi.  Aphor.  §.  1140. 

{a)  Difiert.  3.  intorno  ad  alctine  malattie,  (g)  Eph.  N.  C.  cent,  7.  obf.  54. 

r ,  62. 


VOL.  I. 


A  a 


among 


i  7  8  Book  I.  Of  Difeafes  of  the  Head. 

among  the  more  common  appearances,  were  confiderable  inflammation  in  the 
primas  vi^,  laceration,  and  gangrene.  Another  fays,  that  in  one,  all  the 
vifcera  of  the  abdomen  were  (lightly,  and  in  another  conllderably,  inflam’d. 

But  particularly  in  fome,  the  cavity  of  the  domach  was  foul  with  foetid 
and  black  bile;  and  fometimes  mark’d  here  and  there  with  bloody  points  as 
it  were.  In  one,  all  the  inteftines,  with  the  mefentery,  were  (lightly  inflam’d; 
in  another,  a  little  tumid  and  inflam’d;  and  in  fome  the  ileum  in  particular. 
The  liver  was,  not  uncommonly,  tenfe,  turgid,  and  browniflh  ;  and  the  gall¬ 
bladder  in  fome  almod  empty,  and  in  others  difbended  with  a  glutinous, 
and  black  bile.  In  three,  the  bladder  of  urine,  and  at  the  fame  time  the 
penis,  had  been  feiz’d  with  a  (light  inflammation ;  and  by  obfervations  of 
this  kind  you  perceive,  that  we  may  fufpeft  cantharides  to  have  been  made 
ufeof;  a  remedy,  in  other  refpe&s,  not  only  recommended  formerly  a»aind 
this  difeafe  by  the  Arabians,  or  believ’d  to  be  the  latent  bafis  of  certain°pow- 
ders,  made  ufe  of  as  arcana  againft  the  fame  difeafe,  by  Scaramuccius  (/6), 
and  others,  but  exprefly,  and  openly,  as  far  as  I  fee,  commended  in  this  our 
age,  not  by  one  nation  only;  and  even  by  the  Hungarians  (*'),  edeem’d  as 
4C  an  infallible  fpecific,”  in  the  cure  of  even  the  mod  violent  hydrophobia  : 
although,  among  our  countrymen,  fcarcely  any  one  will  readily  exhibit  them, 
by  way  of  precaution,  to  whom  fo  many  various  other  remedies,  which  have 
been  highly  celebrated  for  the  fame  effect,  are  lefs  unknown,  and  thofe,  in 
fabt,  fuch  as  are  not  fo  very  acrid,  and  yet  promote  urine  equally. 

Bur,  to  pafs  on  to  the  thorax:  the  feptum  tranfverfum  was  in  fome  found 
to  be  inflam’d ;  and  there  were  very  frequent  marks  of  inflam’d  lungs ;  and 
here  and  there  (light  adhefions  of  the  vifcera,  as  alfo  in  the  abdomen  ;  the 
pericardium  was  in  fome  without  moifture;  the  left  ventricle  of  the  heart 
was  in  one  altogether  empty,  whereas  the  right  contain’d  very  black  blood  ; 
but  in  another,  both  of  them  were  full  of  florid  and  fluid  blood,  in  the  fame 
manner  as  the  pulmonary  artery  and  the  vena  cava  were. 

But  of  thofe  parts  which  are  betwixt  the  thorax  and  brain,  the  larynx  in¬ 
deed  was  the  mod  feldom  and  the  lead  inflam’d ;  yet  in  one,  all  its  mufcles, 
and  thofe  of  the  os  hyoides  and  tongue  were  inflam’d,  and  fometimes  the 
papillae  of  the  tongue  were  fwell’d,  and  in  one  were  a  few  little  tubercles  at 
its  root,  fome  of  which  appear’d  fuppurated.  As  to  the  pharynx,  though  it 
had  frequently  no  inflammation,  yet  in  general,  a  confiderable  one  was  feen 
therein,  efpecially  towards  the  tongue.  And  if  you  compare  this,  and  the(e 
appearances,  that  have  been  found  in  the  lungs,  intedines,  and  domach,  as 
I  have  already  faid,  with  thofe  which  the  celebrated  Kochlerus  (£)  obferv’d 
in  the  fame  parts,  when  he  open’d  the  body  of  a  man  of  high  dation,  who 
without  any  previous  bite  of  a  mad  animal  was  taken  off  by  a  hydrophobia, 
you  will  be  furpris’d  to  fee  how  far  they  agree  one  with  another.  A  hydro¬ 
phobia  of  the  fame  kind  (/),  and  from  the  fame  external  caufe,  to  wit,  from 
drinking  very  cold  liquors  when  extremely  hot,  he  had  alfo  obferv’d  in  a 
Jbldier;  but  was  fo  taken  up  with  other  employments,  that  he  could  not 

{h)  In  append,  cit.  fupra,  ad  n.  21.  (<£)  Commere.  Litt.  a.  1743,  hebd.  5.  n.  2. 

P)  Commere.  Litt.  a.  1735,  hebd.  11,  n.  3,  (/)  Ineod.  Commere,  a.  1740,  hebd. 36.  n.i. 


diffect 


/. 

Letter  VIII.  Article  3 1 .  '  1  79 

direct  the  body.  The  celebrated  Genfelius  (in),  however,  faw  a  hydrophobia 
which  had  its  origin  from  the  fame  caufe,  and  found  the  mufcles  of  the 
pharynx,  indeed,  and  glands,  pretty  red,  but  the  whole  ftomach  was  in  a 
manner  dried  up;  yet  the  re  It  of  the  vifcera,  and  among  thefe  the  lungs, 
were  in  their  natural  ftate.  This  hydrophobic  patient,  although  he  trembl’d 
at  the  fight  of  light,  and  white  linen,  and  could  not  endure  to  look  upon 
fome  kinds  of  fluids  ;  yet  he  was  not,  like  the  two  former,  vehemently  tor¬ 
tur’d  at  the  bare  mention  of  them,  or  when  offer’d  at  the  greateft  diflance, 
did  not  faint  away.  Which  things  I  mention  for  this  reafon,  that  they  who 
place  the  pathognomonic  fign  of  the  hydrophobia  in  thefe  things,  and  are 
unwilling  to  fuppofe,  that  they  can  never  exifl:  without  the  bite  of  a  mad 
animal,  may,  by  adding  thefe  two  hiftories  to  fo  many  others  which  are  extant 
elfewhere,  and  efpeciallyin  the  obfervations  of  Schenck  («),  acknowledge,  that 
the  true  hydrophobia  can  even  be  brought  on  without  contagion ;  although, 
out  of  the  antient  obfervations,  thofe  only  which  Marcellus  Donatus  (<?)  has 
tranfmitted  to  posterity,  ought  to  be  fufRcient  to  make  them  acknowledge  it. 
For  who  can  believe,  that  out  of  five  patients,  which  one  and  the  fame  phyfi- 
cian  faw,  within  a  few  years,  feiz’d  with  a  hydrophobia  of  that  kind,  there  was 
nobody  who  would  have  oblerv’d,  or  remember’d,  that  they  had  been  infected 
by  a  mad  animal;  but  that  all  the  patients,  and  all  their  domeftics  and  friends, 
were  equally  ftupid,  and  equally  forgetful  ;  fo  that  not  the  lead  fufpicion  of 
any  taint,  which  might  have  been  contracted,  fhould  remain. 

But  let  us  return  to  the  remaining  heads  of  the  comparifon  we  undertook. 
There  were  fome  in  whom  the  dura  mater,  and  even  both  the  meninges,  were 
found  more  or  lefs  inflam’d,  the  vefiels  being  turgid  with  black  blood,  and 
not  without  fome  little  fuppuration  towards  the  vertex,  in  one  of  the  bodies ; 
and  even  in  a  mad  dog,  not  without  ulcers.  The  cerebrum  itfelf  was  fome- 
times  inflam’d,  or  its  cortical  part,  but  this  flightly,  and  more  of  a  brown 
colour,  or  its  medulla  fprinkled  over  with  bloody  points.  But  the  ventricles 
in  one,  and  another,  appear’d  by  no  means  moiflr.  The  fpinal  marrow  was 
much  drier  than  ufual. 

But  even  the  whole  body  in  one  was  dry,  and  inflam’d ;  and  in  another, 
of  a  violet  colour,  from  inflammation  on  the  whole  furface.  Moreover,  by 
one  author  was  remark’d  a  particular  drynefs  and  tenfion  of  all  the  folid  parts, 
among  the  more  frequent  appearances,  and  efpecially  of  almoft  all  the  mem¬ 
branous  parts.  But  in  regard  to  the  blood,  with  which  fome  write  that 
the  arteries  were  very  full,  and  that  very  fluid,  fo  as  fcarcely  to  coagulate  in 
the  open  air ;  there  are  not  wanting  thole  who  teach,  that  the  arteries  in  one 
fubjeCt  were  indeed  full,  but  that  the  vena  cava  was  fullalfo  •,  and  in  another, 
that  all  the  blood  was  contain’d  in  the  veins,  and  was  deftitute  of  lerum.  And 
there  is  even  one,  who  affirms,  that  in  thirteen  carcafles,  the  veins  were  al¬ 
ways  feen  to  be  fill’d  with  blood,  which  was  as  fluid  as  it  generally  is  *,  but 
that  the  arteries  were  empty.  And  he  who  denies,  that  in  four  bodies  he 
faw  any  of  thofe  things,  which  Boerhaave  laid  down  as  general  appearances, 
from  the  difleftions  of  others  (p),  mull  of  confequence  agree  with  that  laft 

(m)  Eph.  N,  C.  cent.  3.  obf.  50.  (a)  De  Med.  Hifl\  Mirabili,  1.  6.  c.  1. 

(«)  Obf.  Med.  1.  7.  ubi  de  Venen.  ex  Qua-  (/)  Aphor.  de  cognof.  morb.*§T  x  140. 
dr  up.  obf.  17.  - 

A  a  2  obfervator 


i  Bo  Cook  I.  Of  Difeafes  of  the  Head. 

obfervator  in  this,  but  in  other  things  he  mull  necefftrily  differ  •,  as  for  in- 
fiance,  in  the  drynefs  of  the  fo lid  parts.  Finally,  I  have  read,  that  the  body 
of  a  woman,  who  died  of  a  hydrophobia,  was  entirely  putrid  within  fifteen 
hours  after  death,  and  that  in  the  middle  of  winter. 

32.  Since,  therefore,  the  whole  fummary  of  thefe  matters,  which  can  be 
collected  from  all  the  obfervations  compar’d,  that  have  ever  come  to  my 
knowledge,  amounts  nearly  to  this,  you  very  well  underhand,  that  the  dead 
differ  much  more,  from  one  another,  than  the  living.  For  while  they  live, 
they  certainly  all  agree  in  this,  that  they  cannot  drink  water  without  diffi¬ 
culty',  and  mod  of  them  even  not  without  great  horror  and  detriment.  But. 
in  what  peculiar  circu enhance  the  carcaffes  of  them  all  agree,  I  do  not  fee. 
For  as  to  its  being  laid,  both  now  and  formerly,  that  an  evident  drynefs  was 
found  in  them,  it  is  certainly  not  found  in  all,  nor  is  perhaps  greatly  to  be 
attended  to  in  thofe  where  it  is  found  •,  fince  it  is  frequently  to  be  rather  im¬ 
puted  to  the  remedies,  or  charg’d  to  the  account  of  fome  other  caufes,  which- 
have  brought  on  great  evacuations,  either  fuch  as  fall  under  the  notice  of  the- 
fenfes,  or  rather  fuch,  for  the  moh  part,  as  efcape  them  :  in  which  clafs  are 
a  great  number  of  alexipharmacs,  and  frequently  acute  fevers,  and  often  con¬ 
tinual  clamours,  and  violent  agitations  of  the  body,  efpecially  as  the  patient 
drinks  nothing,  or  at  leah  very  little.  And  therefore  you  might  have  feen, 
that  in  the  old  man  (<7),  who  drank,  and  was  not  agitated  with  a  maniacal 
fury,  but  was  rather  under  the  government  of  a  melancholic  fear,  there  was  fo- 
far  from  being  a  drynefs,  that  the  pericardium,  and  the  ventricles  of  the  brain, 
contain’d  a  pretty  large  quantity  of  water. 

Nor,  indeed,  is  any  one  of  the  appearances,  which  I  have  obferv’d  to  be- 
found  in  differing  of  thefe  bodies,  more  common  to  all  hydrophobic  pa¬ 
tients  than  this  drynefs.  For  they  are  fo  different  in  different  bodies,  that 
if  you  confider  them  feparately,  you  will  believe,  that  not  only  every  parti¬ 
cular  opinion  of  the  ancients,  which  Ctelius  (r)  has  related,  concerning  the- 
feat  and  nature  of  this  diieafe,  was  really  true,  but  that  mod  of  the  others 
are  true  alfo,  which  have  been  fince  publifh’d  :  yet,  if  you  confider  them  all 
in  general,  you  will  perceive  that  none  is  certain,  but  that  one  is  more  pro¬ 
bable  than  the  reft.  “  That  the  part  fuffers  firft  on  which  the  wound  was 
“  inflidled,”  and  that  from  thence  the  diforder  proceeds  to  other  parts,  no¬ 
body,  as  Caelius  fays,  denies  ;  and  from  the  time  that  Salius  (s)  pointed  out 
that  fometimes  evident  fign  of  its  progrefs,  which  has  been  long  delay’d,  it 
is  not  to  be  denied,  that  the  diforder  does  proceed  from  the  wounded  part, 
at  lead  in  fome  meafure.  But  from  the  progrefiion  of  the  pain  upwards, 
and  from  what  Salius  obferv’d  it  to  terminate  in,  a  certain  confufion,  un- 
fteadinefs,  and  weaknefs  of  the  mind,  that  virus  does  not  feem  to  be  carried 
through  the  veins-,  but  by  the  nerves,  up  to  their  origins  :  and  in  thefe 
parts,  or  in  the  motions  that  are  made  in  them,  fome  certain  but  inexplicable 
change  being  brought  about,  which,  according  to  the  different  dilpofitions 
in  different  perfons,  is  greater  or  fmaller,  more  or  lefs  diffufe,  nothing  cart 
now  happen  to  hydrophobic  patients,  which  we  may  not  particularly  deduce 
from  thence.  Some  (as  in  natural  antipathies  different  perfons  are  averfe  to 

(<l)  Supra,  n.  27.  (r)  Acut.  Morb,  1,  3.  c.  14.  (/)  Supra,  n.  31. 

*  different. 


Letter  VIII.  Article  32.  181 

different  things,  though  we  fee  the  antipathies  ftronger  in  one  than  in  another) 
will  have  fo  great  an  averlion  to  water,  that  they  begin  fuddenly  to  Ihudder, 
not  only  at  the  fight,  but  even  at  the  name  thereof ;  and  others  will  not 
deny  the  poffibility  of  their  drinking  it,  till  they  have  made  the  trial,  and 
found  a  difficulty  in  fwallowing  it.  Some  will  be  delirious,  and  in  others  per¬ 
fectly  fenfible.  Thefe  will  be  feiz’d  with  great  inflammations,  and  thofe  with 
none.  But  though  they  vary  one  from  another  in  thefe  and  in  other  things,  yet 
the  external  or  internal  convulfion  will  doubtlefs  exift  in  all  •,  and  to  the  va¬ 
riety  of  this  in  particular,  and  its  difpofition,  that  very  great  variety  in  the. 
living  patients,  and  in  their  bodies  after  death,  mult  be  owing.  And  you 
perceive,  that  the  conjecture  of  thofe  feems  very  probable  to  me,  who. 
thought  with  Democritus,  and  Gains,  a  follower  of  Herophilus  (/),  that 
“  the  nerves”  and  “  brain”  were  the  principal  feats  of  this  difeafe*,  to  which 
opinion,  you  know,  the  chief  phyficians  of  our  age  are  not  averfe,  And 
with  a  reference  to  this  opinion,  a  very  grave  man  related  to  me  an  anecdote, 
when  I  was  applying  myfelf  to  the  ftudy  of  phyfic  at  Bologna,  concerning, 
Alberto  Fabbri,  who  was  certainly  the  firft  of  phyficians  in  that  very  learned 
city,  a  little  before  my  time.  For  this  gentleman,  being  feiz’d  by  one  hand, 
and  ftrongly  held,  by  a  patient  labouring  under  a  hydrophobia,  while  he  was 
feeling  his  pulfe  with  the  other,  fell  immediately  into  fo  great  a  dejeCtion  o£ 
mind,  that  having  fcarcely  any  command  over  his  reafon,  the  intention  of 
killing  himfelf  frequently  enter’d  into  his  thoughts.  'When  he  had  already* 
for  feven  days,  avoided  company  on  that  account,  it  happen’d,  that  being 
fix’d,  and  rivetted,  as  it  were,  to  his  perpetual  fadnefs,  he  was  wetted  quite 
through  with  a  very  great  fhower,  before  he  even  perceiv’d  that  it  was  at 
hand.  The  place  he  was  then  in  was  quite  folitary,  and  very  remote  from 
any  houfes,  fo  that  he  could  not  get  to  any  fhelter,  till  he  was,  in  a  manner, 
thoroughly  bath’d  all  over  *,  and  by  the  time  he  had  reach’d  a  covering,  his 
melancholy  was  all  entirely  walk'd  away.  What  he  thought  himfelf  of  the 
matter,  I  do  not  know  ;  but  many  believ’d  that  this  was  the  beginning  of  a. 
hydrophobia,  with  which  the  brain  was  firft  attack’d.  Yet  it  is  more  pro¬ 
bable,  that  this  learned  phyfician,  calling  to  mind,  perhaps,  what  he  had 
read  in  Diofcorides  (&),  had  not  been  a  little  afr.aid,  left  the  fame  thing  fhould 
happen  to  him,  which  happen’d  to  Themifon,  when  he  had  a  friend  of  his, 
a  hydrophobic  patient,  under  his  care  *>  efpecially  if  thofe  things  came  into 
his  head,  which  many  writers  have  deliver’d  down,  concerning  this  difeafe 
being  contracted,  even  without  a  bite*,  and  he  held  them  all  as  truths,  which 
many  are  apt  to  do,  to  their  own  danger,  and  at  their  own  expence  (for  we 
fee,  that  Stalpart  (#),  who  believ’d  nothing  at  all  of  all  this,  when  he  had 
felt  the  pulfes  of  thofe  who  fufpeCted  they  fhould  afterwards  prove  to  have  a 
hydrophobia,  always  walk'd  his  hands) :  I  fay,  it  is  more  probable,  that  being 
feiz’d  with  vehement  fear  on  this  account,  he  fell  into  a  kind  of  melancholic 
delirium,  which  the  fudden  perfufion  of  water,  as  it  was  very  recent,  re¬ 
mov’d  ;  and  the  more  eafily,  if  the  remembrance  of  that  kind  of  remedy 
againft  the  hydrophobia  affilted  the  imagination,  which  had  given  rife  to  the 
difeafe,  to  take  it  off.  But  explain  this  as  you  pleafe. 

(/)  Apud  Cslium  ibidem.  («)  De  Med.  Mat.  1.  6.  c,  36,  (*)  Schol,  cit.  fupra,  adn.  29. 

4  ’  A.3j- 


i '8  2  Book  I.  Of  Difeafes  of  the  Head. 

As  to  what  I  faid,  however,  of  the  convulfion,  which  was  no  doubt  to  be 
fuppos’d  in  all  hydrophobic  patients,  even  the  mere  difficulty  of  fwailowing 
water  fcems  fufficiently  to  prove  it.  For  whether  there  is  no  inflammation  of 
the  fauces  or  gula,  you  have  already  feen  above  (jy),  that  in  order  to  explain 
this  difficulty,  Caffialpinus  formerly,  and  Aromatarius,  have  fuppos’d  a  con¬ 
vulfion  of  thefe  parts,  Ridley  (z),  and  others  among  the  modern  writers, 
following  them.  Or  whether  thole  parts  are  inflam’d,  you  may  fee  that  the 
celebrated  Van  Swieten  (a)  deduces  this  inflammation  from  a  frequent  con¬ 
vulfion,  as  an  effedt  from  a  caufe ;  and  from  thence  even  draws  a  very  pro¬ 
bable  reafon,  why  a  boy,  who  was  very  foon  taken  off  by  a  hydrophobia, 
fhould  be  free  from  that  inflammation  •,  and  that  a  young  man,  who  lay  longer 
in  the  agonies  of  it  before  he  died,  fhould  not  be  free  therefrom,  bo  in  re¬ 
gard  to  the  other  parts,  in  like  manner,  and  the  vifcera,  why  they  are  found, 
in  fome  hydrophobic  patients,  to  be  very  much  inflam’d,  and  in  others,  not  at 
all,  you  may  deduce  alfo  from  the  more  or  iefs  frequent,  or  violent,  convulfion 
of  thefe  nerves,  which  go  to  thofe  parts.  And  even  that  “  too  great  ten- 
“  fion  and  drynefs  of  the  nervous  membranes,”  from  which  Mead  (b)  very 
learnedly  drew  this  conclufion,  “  that  they  fed  more  acutely  than  naturally” 
in  hydrophobic  patients,  and  thus  “  the  accuftom’d  impreffions  of  objedts 
“  create  no  longer  a  grateful  fenfation,  but  give  uneafinefs  and  pain  :  ”  I 
fay,  that  tenfion,  if  it  is  not  from  a  total  drynefs,  as  it  feems  not  to  be  in 
the  firft  days  of  the  difeafe,  you  may  alfo  account  for  from  the  convulfions ; 
which  effedt  thereof  was,  in  fadt,  found  by  the  very  ingenious  Brogiani  (r) 
to  remain  after  death,  in  moft  bodies  at  leaft,  if  not  all.  I  pafs  by  other 
arguments,  which  are  brought  by  many,  to  prove  that  the  hydrophobia  is 
a  convulfive  difeafe.  If,  therefore,  in  this  difeafe,  fo  much  is  to  be  attri¬ 
buted  to  convulfions,  nor  the  caufe  of  them,  inafmuch  as  it  is  inviflble  in 
the  brain,  nor  the  change  induc’d  upon  the  nerves,  but  their  effedts  only, 
and  thofe  different,  according  to  their  different  flages,  and  in  proportion  to 
the  varied  violence  of  them,  fall  under  the  notice  of  our  fenfes,  in  the  dead 
body  ;  you  very  well  underftand,  that  in  order  to  confirm  or  difprove  thofe 
things  which  we  have  already  faid,  or  now  fay,  too  few  diffedtions  have  hi¬ 
therto  been  made.  For  there  are  but  few  in  fo  great  a  number,  which  a 
hiftory  fufficiently  accurate  precedes  •,  not  only  of  the  age  and  conftitution  of 
the  man,  bur  of  the  manner  and  time  in  which  the  virus  was  communicated, 
and  whence  it  was  contradled  ;  as  alfo  for  what  time  it  lafted,  and  with  what 
greater  or  lefs  fiercenefs,  and  continuance,  of  all  the  fymptoms,  and  on  what 
day  of  the  difeafe  each  of  them  began  :  then,  after  that,  we  ought  to  have 
a  hiftory  of  all  the  appearances,  as  far  as  is  poffible,  which  are  found  to  be 
preternatural,  in  all  the  parts,  and  in  every  diftindt  part,  of  the  fame  body; 
left,  if  any  thing  of  the  fmalleft  importance  fhould  by  chance  be  omitted,  it 
may  be  fuppos’d,  that  fome  other  appearances  were  not  fo  much  wanting  in 
the  body,  as  not  diligently  fought  after. ^ 

33.  1  would  not  have  you,  however,  readily  imagine,  that  among  thefe 
preternatural  appearances,  worms  have  ever  been  found  to  abound  in  the 

(y)  N.  19,  &  20.  ( h )  Tentam,  cit.  fupra,  ad  n.  31. 

(z)  Vid.  Ad.  Lipf.  cit.  fupra,  ad  n.  26.  (r)  P.  2.  ibid.  cit. 

.  (<z)  Comm,  in  Eoerh.  Aphor.  §  1140. 

•*k  brain ; 


Letter  VIII.  Article  33.  183 


brain  •,  notwithstanding  you  read  in  the  Sepulchretum,  that  they  have  been 
feen  in  the  brain  of  a  mad  dog  ( d)  •>  and  notwithstanding  what  Aromatarius(y) 
has  written,  44  that  it  had  been  obferv’d  a  worm  was  fometimes  generated  in 
<£  the  anterior  part  of  the  head,  both  in  a  mad  dog,  and  a  hydrophobic 
44  man.”  For  l  believe  this  mutt  be  understood  of  the  cavity  of  the  note, 
or  the  recedes  of  fome  fmus  which  communicate  therewith,  and  not  of  the 
cavity  of  the  cranium,  as  I  have  already  Shown  (/).  Nor  do  I  understand, 
in  any  different  manner,  thofe  things  which  are  produc’d  a  little  before  in 
the  Sepulchretum  (g),  from  the  epiftles,  not  from  44  the  observations”  of 
Bartholin,  of  worms  which  men  of  ruttical  employments  are  fa  id  to  have  ob-' 
ferv’d  44  to  be  in  the  heads  of  horfes,  Sheep,  and  oxen,”  but  in  the  44  phre- 
44  nitis  and  vertigo  j”  and  not  in  that  diforder  which  is  there  treated  of,  the 
44  Rabies  under  which  one  word,  how  many  various  diforders  are  intended, 
the  juftly  commended  Aromatarius  ( h )  lias  Shown.  By  turning  to  thefe 
things,  you  will  alfo  meet  with  thofe,  which  are  added  in  the  Scholium,  to 
the  obfervation  that  I  now  point  out,  in  the  firft  place,  in  the  Sepulchre¬ 
tum  (z).  That  obfervation  fpeaks  of  worms  as  really  exifting  in  the  brain  of 
a  mad  dog,  or  rather  as  obferv’d,  44  in  pretty  large  bubbles,  elevated  on  the 
44  vifcous  and  putrid  liquor  of  the  brain,  or  from  an  internal  motion,”  But 
whether  the  cranium  was  Sufficiently  examin’d,  that  no  paffage  was  open’d, 
through  which  worms  might  perhaps  enter,  and  this  in  confequence  of  an¬ 
other  difeafe ;  or  whether  it  was  Sufficiently  enquir’d,  if  they  were  really 
worms  or  not ;  or  whether  they  had  not  been  before  in  the  grafs,  upon  which, 
the  brain  was  fpread  far  and  wide,  by  falling  down  thereupon,  the  observa¬ 
tion  of  itfelf  will  Sufficiently  Shew.  And  I  confefs  I  fear  that  if  44  Reyfius,” 
as  the  author  wiffi’d,  had  been  prefent,  he  would  not  very  eafily  have  ex¬ 
pung’d  what  he  had  written  (&),  44  that  the  report,”  fpoken  of  by  Jacobus 
de  Partibus,  44  as  if  the  canine  rabies  had  proceeded  from  a  worm,  gene- 
44  rated  in  the  brain  of  a  dog,  was  a  mere  figment  confirm’d  by  nobody  that 
44  he  knew  of.”  Do  not,  however,  imagine,  that  if  this  fame  obfervation 
had  been  more  accurately  made,  I  Should  nevertheless  ftill  with-hold  my  af- 
fent,  as  if  I  thought  it  could  by  no  means  ever  happen,  that  worms  Should 
excite  the  rabies,  of  which  we  treat,  in  a  dog ;  Since  Zwingerus  (/)  relates 
the  ftory  of  a  dog,  who  was  fo  mad,  that  a  boy  whom  he  had  bitten,  pe- 
riffi’d  before  the  fortieth  day  •,  and  yet  this  dog  was  entirely  cur’d  of  his 
madnefs,  after  his  mafter  had  open’d  a  Slight  tumour  in  his  foot,  which  he 
was  continually  biting,  and  from  the  pain  of  which  he  was  continually  run¬ 
ning  about,  driven  as  it  were  to  anger  and  madnefs,  and  drew  out  a  living, 
white,  and  thickiffi  worm.  That  the  dog  was  really  mad  Zwingerus  knew,, 
who  was  phyfician  to  the  boy  in  the  hydrophobia.  That  the  dog  alfo  was 
cur’d  in  Such  a  manner,  as  he  was  a  neighbour  to  the  dog’s  mafter,  he  could 
not  but  know.  Yet  I  had  rather  that  he  himfelf  had  examin’d  this  worm, 
in  order  more  certainly  to  know,  that  a  true  worm,  and  not  any  thing  in  the- 
Shape  of  a  worm  only,  had  come  out  from  the  tumour. 


(d)  L.  1.  S.,  8.  in  Addit,  obf.  3. 
(*)  Difp.  de  Rabie  P.  4.  part.  7» 

(f )  Epift.  1 .  n.  8,  &  9. 

(g)  S.  cit.  8.  obf.  i  l. 


(b)  Difp.  cit.  p.  1.  partic.  2-. 

(if)  Obf.  3.  cit. 

(4)  Elyf.  jucund.Quaeft.  Camp,  qu.61.  n.fc, 
(/)  Eph.  N.  C.  dec.  3.  a.  2.  obf.  105. 

34*  Lor 


% 


i  84  Book  I.  Of  Difeafes  of  the  Head. 

04.  For  we  often  “readily  believe  things  to  be  worms,  which  are  not  fa, 
“  It  is  vulgarly  a  her  ted  of  a  mad  dog,”  fays  Etmuller  {in),  44  that  under  his 
«  tongue  lies  hid  a  certain  oblong  worm,  which  fome  even  affirm  to  have 
“  been  feen  by  themfelves  •,  and  that  this  being  early  taken  away,  no  dog 
*«  becomes  mad  but  if  it  be  not  taken  away,  and  encreafe,  madnefs  is  ne¬ 
ts  cefiarily  the  confequence  •,  whence  lome  perions  are  wont,  by  way  of  pre- 
14  caution,  to  extract  this  worm  ;  and  fome  indeed  think,  that  it  is  not  a  real 
44  worm,  but  look  upon  it  to  be  a  particle  of  grumous  blood,  collected,  and 
44  ftagnati'ng  in  the  ranine  veins  under  the  tongue.  But  I  leave  this  fubjedt 
44  undetermin’d  myfelf,  as  not  yet  fufficiently  examin’d  into.”  A  man  of 
fuch  prudence  1  commend :  and  if  others  would  make  him  their  example, 
we  ffiould  have  fewer  fables  than  at  prefent.  And  I  doubt  not  but  this 
opinion  has  arifen  from  what  Pliny  (n)  had  written  on  the  fubjedl:  his  words 
are,  44  There  is  a  worm  in  the  tongues  of  dogs,  which  is  call’d,  by  the  Greeks, 
44  Lytta ;  and  this  being  taken  out,  when  they  are  young  whelps,  they  nei- 
44  ther  become  mad,  nor  feel  any  ficknefs  or  loathing.”  For  Aromatarius  {0) 
thinks,  to  omit  others  at  prefent,  that  Sextus  the  philofopher,  had,  in  lome 
meafure,  affented  to,  or  copied  from,  Pliny,  who,  he  lays,  has  teftified  44  in 
44  the  ninth  chapter,  De  Medicina  Animalium ,  that  worms  are  found  under 
44  the  tongues  of  mad  dogs.”  But  this  I  dare  not  undertake  to  affert  of 
Demetrius  of  Conftantinople  (p),  if  he  has  faid,  not  that  he  found  a  worm 
in  the  inferior  part  of  the  tongue,  but  44  the  effigy  of  a  worm,  and  the  like- 
44  nefs  of  a  white  nerve:”  nor  ol  Fracaftorius  (j),  though  for  quite  a  dif¬ 
ferent  reafon ;  for  he  really  fuppofes  44  an  injurious  and  deftrudtive  worm,” 
but  as  far  as  I  underftand,  not  under  the  tongue :  and  there,  I  imagine,  he 
fpeaks  as  a  poet ;  for  where  (r)  he  recounts  the  figns  of  dogs  being  mad, 
he  does  not  fay  a  [ingle  word  of  worms  in  the  tongue,  or  about  the  tongue. 
Yet  I  would  not  deny,  that  real  worms  may  fometimes  be  found  there ;  but 
that  there  is  a  worm,  which,  as  Pliny  feems  to  take  for  granted,  exifts  natu¬ 
rally  in  all  dogs,  and  which  is  frequently  taken  out  from  their  tongues,  I  ex- 
prefsly  deny.  And  this  Codronchius  (j),  more  than  others,  formerly  denied. 
44  You  muft  know,”  fays  he,  44  that  the  part  which  is  taken  out  is  not  a 
44  worm,  but  a  nerve  of  the  figure  of  a  round  worm.”  And  in  the  fame 
year  i  6^9,  in  which  Codronchius  wrote  this,  thePentaefthefeion  of  our  coun¬ 
tryman  Cafferi  was  pubhfh’d  ;  in  which  (/),  having  delineated  the  inferior 
furface  of  a  dog’s  tongue,  he  Ihows  a  vermiform  little  body  therein,  which 
he  alfo  delineates  by  itfelf,  with  its  poflerior  extremity  drawn  out  in  a  ftrait 
line,  into  a  very  long  tail,  that  by  degrees  contradis  itfelf  into  an  incredible 
fmallnefs.  And  he  fays,  that  it  is  44  a  mufcle  with  which”  dogs  44  lick  or 
44  lap,”  or  44  made  to  lick  or  lap,  and  that  it  is  hidden  in  the  middle  of  the 
44  apex  of  the  tongue  he  alfo  boafls  himlelf  the  44  inventor,”  inaimuch  as 
it  was  44  unknown  to  others”  to  that  time. 


(m)  Art.  &  m.  cit.  fupra  ad  n.  19. 

(n)  Natur,  hift.  ].  29.  c.  5. 

(0)  Difp.  de  -Rabie  p.  2.  partic.  5. 

(/>)  1.  de  Cura,  &  Medic.  Canum,  Gillio 
jeterpr. 


{ q )  in  Alcon,  extremo. 

(r)  De  Ccntag.  See.  1.  2.  c.  10, 
(/)  De  Rabie  1.  2.  c.  10. 

(0  1.  2.  Tab.  5.  Fig.  4  & 


35' 


Letter  VIII.  Article  33%  1  8  £ 

35.  But  Caflferi  had  not  attende^  to  that  pafifage  of  Pliny,  as  his  p  adage, 
and  that  qf  Condronchius  had  ailo  efqip’d  me,  when  I  formerly  obfc.rv’d  the 
lame  corpufcle  in  the  tongues  of  dogs,  and  afterwards  took  often  into  en¬ 
quiry  ;  and  1  do  not  know  whether  any  other  anatomids,  within  thefe  hun¬ 
dred  and  fifty  years,  have  defcrib’d  or  delineated  it.  But  I  ihall  not  make  a 
longer  difquifition,  for  this  reafon  chiefly  ;  but  rather  left  any  learned  man 
Ihould  be  fo  far  impos’d  upon,  as  to  take  it  for  a  worm  any  longer ;  which  I 
fulpedl  has  even  happen’d  in  this  very  age.  I  believe  it  is  dill  taken  out  by 
the  common  people  from  fome  dogs  in  this  country  •,  for  whereas  I  fought  for 
it  in  fifteen,  of  every  kind,  magnitude,  and  age  *,  1  found  it  only  in  fourteen  : 
the  only  one  which  was  entirely  without  it,  was  one  of  thofe  dogs  that 
butchers  ufe,  and  the  larged  of  them  all,  fo  that  he  ought  to  have  had  one 
much  larger  than  the  others  ;  but  if  I  had  at  that  time  thought  of  the  words 
of  Pliny,  I  would  have  look’d  diligently  after  the  traces  of  the  cicatrix ; 
which,  however,  could  be  by  no  means  very  evident  •,  otherwife  it  mud  of 
itfelf  have  occurr’d  to  the  eye.  And  in  another  dog  likewife,  who  was  very- 
large,  I  remember,  that  this  part  was  much  fmaller,  than  in  proportion  to 
the  body neverthelefs  it  was  not  fo,  in  other  dogs  equally  large.  I  even 
found  it  in  one  great  dog  three  inches  long  ;  whereas,  in  moderately-fiz’d 
dogs,  it  rarely  exceeds  two,  and  is  generally  about  that  length.  In  like 
manner,  in  another  rather  of  a  large  fize,  than  fmall,  as  the  tongue  was  eight 
inches  in  length-,  this  body  was  three  inches,  or  even  more,  without  the 
flendered  part  of  its  tail.  For  as  this  round  body  refembles  nothing  more, 
if  you  condder  the  fliape  only,  than  a  fpindle,  fo  it  is  extenuated  on  both 
fides  in  fuch  a  manner,  that  the  anterior  extremity,  which  is  often  extended 
to  the  very  border  of  the  tongue’s  apex,  and  fometimes  only  within  a  little 
of  it,  is  lefs  fharp  and  long  -,  the  poderior  extremity  not  only  contracts  itfelf 
by  degrees,  more  and  more,  but  when  a  pretty  confiderable  fpace  is  pafs’d 
over  thereby,  it  dwindles  fuddenly  into  a  kind  of  tendinous  thread,  very  thin, 
and  white  *,  which  often  equalling  the  length  of  the  body  from  whence  it 
proceeded,  feldom  being  lefs  than  that,  and  often  more,  and  once  found  by  me 
at  lead  twice,  or  more,  if  not  three  times,  as  long,  it  goes  through  that  middle 
interdice  of  the  mufcles,  which  are  prominent  on  one  fide  and  the  other  of 
the  lower  furface  of  the  tongue,  till  it  comes  to  the  back  part,  feating  itfelf 
deeply  amongd  them.  And  in  the  fame  interdice,  produc’d  forwards,  both 
the  poderior  extremity,  and  the  remaining  part  of  the  body  alfo,  is  plac’d  ; 
but  this  latter  part  fo  much  the  more  externally,  that  by  its  protuberance  it 
touches  the  very  membrane  of  the  tongue,  and  is  feen  through  it.  So  that 
when  this  membrane  is  Oightly  cut  into,  and  together  with  thofe  two  mufcles 
is  diffidently  drawn  afide,then,  indeed,  this  body  appears  like  a  kind  of  worm  ; 
for  whitenefs  and  fmoothnefs  are  added  to  its  dgure,  to  make  the  refemblance 
more  complete.  And  if  you  feparate  it  from  the  tongue,  by  means  of  the 
knife  or  fingers,  which  is  very  eaflly  done,  you  fee  it  alfo  fmooth  on  the  fide 
which  lay  hid,  but  a  little  reddifh.  Therefore,  that  part  of  this  body,  which 
is  the  thicked,  confids  of  two  fubdances,  very  clofely  connected  with  one 
another,  the  one  white,  and  the  other  reddifh  which  latter  you  would  readily 
believe  to  be  flefhy,  as  that  other  alfo,  which  goes  on  even  to  the  extremities, 
you  would  fuppofe  to  be  tendinous.  But  the  reddifh  fubdance  is  not  made 
Vol.  I.  B  b  up 


i  8  6  Book  I.  Of  Difeafes  of  the  Head. 

up  of  manifeft  fibres,  and  the  white  is  harder  than  a  tendinous  fubftance ; 
fo  that  it  Teems  to  be  of  a  middle  nature  betwixt  ligament  and  tendon.  And 
indeed,  as  I  rubb’d  it  betwixt  my  fingers,  it  Teem’d  to  me,  more  than  once, 
to  approach  almoft:  to  the  nature  of  a  cartilage  ;  and  frequently,  not  to  have 
a  continu’d  furface,  but  divided,  as  it  were,  into  fragments,  and  thofe  un¬ 
equally  diftributed.  As  often  as  ever  I  cut  the  middle  of  this  body  tranf- 
verfely  through,  that  fedtion,  in  faft,  generally  refembl’d  the  area  of  a  circle  ; 
but  the  white  fubftance  almoft:  always  occupy’d  the  greater  fegment  of  that 
area,  and  very  rarely  the  reddifh.  Nor  is  the  diameter  of  the  whole  area 
any-where  great,  but  even  where  it  is  the  moft  diftant  from  the  extreme 
parts,  very  fmall.  Nor  has  the  anterior  extremity  a  fiffure,  nor  any  thing  elfe, 
which  refembles  a  mouth  ;  nor  the  body  of  it  any  thing  within,  that  is  foft 
or  hollow.  And  although  the  fibres  of  the  neighb’ring  mufcles  adhere  to 
this  body,  yet  they  do  not  go  into  it,  nor  are  continu’d  thereto  •,  but  it  is  di¬ 
vided  from  thele  mufcles,  by  a  thin  interpofing  membrane  ;  fo  that  it  may, 
on  this  account,  be,  as  I  faid,  eafily  difengag’d,  and  the  furface  of  it  be 
every-where  preferv’d  fmooth  and  even.  And  if  this  fucceeds  in  the  dead 
body,  how  much  more  eafily  may  we  luppofe  it  will  lucceed  in  the  living 
body  P  And  fince  matters  are  thus  fituated,  as  it  is  eafy  to  underftand,  that 
this  little  body,  although  it  is  not  a  worm,  is  that  which  has  been  taken  away 
from  the  tongues  of  dogs,  and  fuppos’d  to  be  a  worm  ;  fo  it  is  equally  well 
underftood,  that  it  is  neither  a  nerve,  as  it  feem’d  to  Condronchius  and  others, 
nor  a  part  of  any  neighb’ring  mufcle.  But  whether  it  be  itfelf  a  mufcle, 
which  Cafferi  believ’d,  given  to  lick  or  lap  with,  or  rather  a  peculiar  body, 
compos’d  of  a  manifold  kind  of  fubftance,  with  which  the  tongue  of  a  dog, 
that  is  fiender,  in  proportion  to  its  length,  is  made  firm,  and  aftifted  in  its 
motions,  I  leave  undecided  for  the  p  re  Tent  ;  efpecially  as  I  am  hitherto  ig¬ 
norant,  whether  it  is  in  like  manner  given  to  otiier  certain  animals,  and  what 
difference  there  is  in  the  tongue’s  motions,  betwixt  thofe  dogs  from  whom  it 
is  taken  out,  and  others. 

36.  But  although  in  the  conclufion  of  this  fedlion  (u),  which  treats  of  the 
mania,  and  rabies,  two  obfervations  are  added  in  the  Sepulchretum,  De  fu¬ 
rore  uterino ,  and  after  the  next  fedlion,  intitled,  De  melancholia ,  of  which  we 
have  treated  at  the  fame  time,  another  fedlion,  De  imaginatione,  ratiocina¬ 
tione,  &  memoria  depravatis ,  abolitis  do  not  you,  however,  expedi,  that 
]  fhall  add  any  other  things  to  this  very  long  letter.  For  it  has  happen’d 
neither  to  Valfalva,  nor  to  me,  that  we  ever  fhould  diffedl  the  body  of  any 
one  confum’d  by  a  furor  uterinus,  and  find  any  thing  elfe,  perhaps,  of  in¬ 
ward  diforder,  befides  a  furprifing  bignefs  of  the  ovarium,  which  I  have  feen 
in  many,  not  labouring  under  the  furor ;  whereas,  in  the  obfervations  of  the' 
Imperial  Academy,  befides  that,  which  is  almoft  always  (x),  and  the  enlarg’d 
ftate  of  the  clitoris  (y),  which  is  fometimes,  found,  we  read,  at  other  times, 
of  different  appearances,  and  among  thefe  of  the  inflammation  of  the  uterus  (2). 

Turning  over  thefe  obfervations,  as  examples  occurr’d  (a),  of  Tome  young 
women,  who  putting  themfefves  to  death,  renew’d  the  fatal  memory  of  the 

(«)  8.  1.  1.  (y)  Ibid; 

(,*•)  Cent.  4.  obf.  142.  &  Cent.  8.  obf.  3.  &  (s)  Ibid.  &  Dec.  3.  A.  5.  obf.  124. 

Atl.  Tom.  7.  obf. '3 o.  (a)  cit.  3.  obf.  Cent.  8. 


Mile  flan 


Letter  IX.  Articles.  '  187 

Milefian  virgins,  and  the  women  of  Lyons  ( b )  fo  others  offer’d  themfelves, 
from  which  the  caufe  of  that  feminine  madnefs  may  feem  capable  of  being* 
compar’d  with  the  caufe  of  a  certain  peftilence,  as  it  were.  For  in  the  fmall 
compafs  of  one  county  only  (c),  in  the  fummer  of  the  year  1698,  fo  many 
women  labour’d  at  the  fame  time  under  this  diflemper,  that  one  phyfician 
only,  had  eighteen  of  thefe  patients,  whom  he  vifited  ;  which  circumftan  :e 
lhew’d  it  to  be  an  epidemic  difeafe  :  and  in  the  lame  houfe,  often  two,  three, 
or  more  women,  were  found  feiz’d  with  the  fame  difeafe  ;  which,  together 
with  other  things,  proved  it  to  be  contagious. 

But  concerning  the  diforders  of  thofe  intellectual  faculties,  mention’d  a 
little  above,  I  have  collected  whatever  I  could,  into  this  very  letter,  and 
others  ( d )  •,  which  1  am  not  difpos’d  to  repeat,  as  you  will  fee  is  done  in  the 
Sepulchretum  :  where,  out  of  twenty  obfervations,  relating  to  thofe  faculties 
we  mention’d,  which  the  tenth  fedtion  lets  forth,  you  will  fir  ft  lee  it  is  ex- 
prefsly  faid,  that  thirteen  of  them  had  been  more  largely  deferib’d  in  other 
iedtions  j  and  then  if  you  confider  a  little  more  diligently,  you  will  eafily 
find,  that  in  this  very  tenth  fedtion,  fome  are  let  down  once  and  again.  So 
the  tenth  obfervation  feems  to  be  the  fame  as  the  third,  and  the  thirteenth 
entirely  the  fame  as  the  feventh  ;  the  fifteenth  as  the  firft ;  the  feventeenth  as 
the  eighth  ;  which  the  forty-fourth  obfervation  of  the  firft  fedlion  of  the 
fourth  book  will  demonftrate,  and  the  fixteenth  obfervation  of  the  fixteenth 
fedtion  of  the  firft  book,  and  the  fifth  obfervation  of  the  fourth  fedtion  of  the 
lame  book  :  not  to  enquire  into  others  now,  nor  to  fay  that  the  ninth,  which 
is  fufficiently  acknowledg’d  in  the  fcholium,  has  no  reference  at  all  to  the 
matter.  But  thus  far  at  prefent.  Farewel. 


L  E  T  T  E  R  the  NINTH. 

Which  treats  of  the  Epilepfy. 

i.fT^HE  vertigo,  which  is  treated  of  in  the  Sepulchretum,  in  the  next 
JL  and  eleventh  fedtion,  frequently  degenerates  into  an  apoplexy,  or 
other  foporofe  diforders  ;  and  many  thus  aftedted,  at  length,  die  vertiginous. 
And  as  this  is  fhewn  by  the  obfervations  produc’d  in  that  fedtion,  and  efpe- 
cially  by  the  firft  and  eleventh  ;  fo  alfo  it  is  confirm’d  by  others  given  in  > 

the  former  letters  ( a ).  And  the  cafe  being  thus,  I  think  it  is  better,  that 

without  any  repetition  of  thefe  things  here,  we  go  on  immediately  to  the 
twelfth  fedtion,  which  treats  of  a  diforder  into  which  the  vertigo  often  de¬ 
generates,  that  is,  the  epilepfy.  For  vertigoes,  as  Galen  has  rightly  taught 

0 b )  Apud  Schenckium.  Obf.  Med.  1.  1.  ubi  [d)  Epift.  I.  n.  10.  &  II.  n.  13. 

de  mania,  &  ex  ea,  mortuis,  obf.  1.  \a)  II,  n.  92.  III.  n.  16.  IV.  n*  II.  VI/ 

(<-)  Decur.  3.  Nat.  Cur.  a.  7.  in  append,  n.  2,  6. 
ad  n.  8.  ‘  ,  .  ) 

*  B  b  2  us. 


1 83  Book  I.  Of  Difeafes  of  the  Head. 

us  ( b ),  “  approach  very  near,  in  their  nature,  to  the  falling  ficknefs,  and 
“  that  which  they  call  apoplexy,  lb  as  to  precede  both  the  one  and  the 
“  other.”  Of  an  epilepfy,  which  was  of  itfelf  mortal,  as  it  feems  to  me, 
Valfalva  has  left  but  one  obfervation  only,  and  that  very  Ihort,  which  runs 
after  this  manner. 

2.  An  old  man  of  fixty  years  of  age,  being  fubjedt  to  epileptic  fits,  was 
feiz’d  with  a  fever.  This  was  fuddenly  follow’d  by  an  epilepfy,  of  which  he 
died.  Between  the  dura  and  pia  mater,  befides  a  quantity  of  ferum  every¬ 
where  effus’d,  a  portion  of  extravafated  blood  was  alfo  found  on  the  fide  : 
the  ventricles  were  alfo  fill’d  with  ferum,  and  in  them  the  plexus  choroides 
had  their  turgid  glandules. 

3.  If  you  impute  that  portion  of  extravafated  blood,  as  it  moft  probably 
ought  to  be,  to  the  laft  epileptic  convulfions,  which,  as  the  fever  had  con- 
ftring’d  the  fwelling  vefiels,  might  eafily  bring  about  fome  rupture  of  them, 
where  they  were  more  lax,  and  this,  as  it  is  eafy  to  believe,  apoplexy  and 
death  were  immediately  the  confequence  of ;  yet  the  ferum  will  ftill  remain, 
to  which  you  may  perhaps  attribute  the  epileptic  paroxyfms,  or  at  leaft  this 
laft  of  them.  For  you  have,  even  in  the  very  fedtion  we  are  fpeaking  of, 
and  in  its  additamenta,  hiftories  of  epileptic  patients,  not  unlike  this,  where 
ferum  was  found  to  be  redundant  within  the  cranium  :  the  moft  antient  of 
which  is  that  fixteenth  of  Hippocrates,  transferr’d  from  fheep,  and  “  efpe- 
cially  from  goats,  who  are  very  frequently  feiz’d  with  this  dilorder,”  to  men. 
And  notwithftanding  thefe  hiftories  are  in  great  number,  (although,  by  turning 
over  the  page,  you  will  perceive,  that  the  fifth  is  the  fame  as  that  which  is 
produc’d  under  number  ten)  yet  I  think  it  will  not  be  ungrateful  to  you,  if 
I  add  others,  one  of  which  was  made  in  the  laft  age,  and  the  others  in  this. 
The  former  is  one  of  Michael  Gavafietti,  a  phyfician,  indeed,  but  not  pro- 
feffor,  at  Padua,  as  fome  writers  call  him.  “  1  remember,”  fays  he  (f),  “  that  I 
“  faw  the  illuftrious  cardinal  Commendoni  fuffer  fixty  epileptic  paroxvfms,  in 
“  the  fpace  of  twenty-four  hours,  under  which  nature  being  debilitated  and 
“  opprefs’d,  he  at  length  fank,  and  died.  His  fkull  being  immediately  taken 
“  off,  I  found  that  his  brain  was  affedted  with  a  diforder  of  the  hydroce- 
“  phalous  kind.”  And  of  three,  which  the  learned  Balthaf.  Walthieri  lent 
to  me  from  Venice,  on  the  laft  day  of  March,  of  the  year  1727,  I  will 
mention  two  in  particular,  which  come  nearer  to  the  nature  of  that  related 
by  Valfalva.  For  the  hiftories  are  of  two  old  women,  even  of  a  greater  age 
than  the  man  of  whom  Valfalva  gives  the  account;  one  of  whom  had  been 
long  fubjedt  to  an  epilepfy,  and  the  other,  having  labour’d  under  an  anafarca, 
was  feiz’d  with  three  violent  epileptic  paroxyfms  on  the  farne  day  that  fhe 
died.  Both  of  them,  indeed,  had  water  betwixt  the  brain  and  pia  mater,, 
and  in  like  manner  in  the  ventricles.  Both  alfo  had  many  veficles,  in  the 
plexus  choroides,  tumid  with  water  ;  but  the  firft  had  all  thefe  circumftances 
in  a  much  greater  degree  than  the  laft.  For  though  the  lateral  ventricles  of 
the  laft  were  almoft  full  of  ferum,  yet  in  the  firft,  every  part  was  fo  diftended 
with  the  fame  kind  of  ferum,  as  to  be  almoft  ready  to  burft ;  wherefore,, 
upon  the  flighted  touch,  they  poured  forth  a  great  quantity  thereof.  Yet 

( l ),  In  Ajdior.  Comment.  3.  17,  (<■}  De  Indie.  Curat,  c.  39. J 

water 


1 


Letter  IX.  Articles  4,  189 

water  is  often  found  in  far  lefs  quantity  in  the  cranium  of  epileptic  patients, 
even  in  the  cranium  of  infants  themfelves,  in  whom  that  it  is  found  in  great 
quantity  at  other  times,  the  fame  fedtion  of  the  Sepulchretum  teaches  (d). 
In  the  leventh  obfervation,  for  inftance,  in  a  girl  of  a  year  old,  you  fee  that 
it  was  found  to  the  quantity  of  five  pints ;  whereas  in  a  boy,  who  was  a  little 
older,  it  was  fcarcely  to  the  quantity  of  two  ounces;  as  that  diligent  ob- 
lerver,  and  at  the  fame  time  celebrated  phyfician,  Hyppolito  Francefco  Al- 
bertini  related  to  me,  in  the  following  manner,  when  I  refided  at  Bologna, 
for  the  fake  of  profecuting  my  ftudies. 

4.  A  boy  feventeen  months  old,  the  firft-born  of  noble  parents,  having 
been  conceiv’d  during  an  uneafy  ftate  of  mind  of  the  mother,  and  his  father 
having  but  weak  nerves,  had  a  head  bigger  than  natural,  and  for  that  reafon 
heavier,  his  eyes  being  heavy  and  fad,  one  part  of  his  thorax  deprefs’d,  his 
legs  not  fufficiently  firm,  and  his  flefh  flaccid.  This  child  having  been  be¬ 
fore,  when  he  had  fcarce  arriv’d  at  a  full  year,  taken  with  diforders,  that  made 
it  neceflary  to  lofe  two  ounces  of  blood,  and  prefently  after  being  freed  from 
thofe  difficulties,  having  fuffer’d  fomewhat  of  an  epileptic  diforder  from  den¬ 
tition,  laft  of  all,  when  one  of  the  dentes  canini  began  to  come  forth  in  the 
upper  jaw,  fhew’d,  that  the  aphorifm  of  Hippocrates  is  true  (e),  which  af- 
ferts,  “  that  fevers  and  convulfions  are  moft  threat’ning  to  children  when 

the  dentes  canini  are  cutting  through  the  gums.”  For  being  firfl  feiz’d 
with  a  fever,  then  with  a  fudden  and  very  violent  epilepfy,  he  was  found  by 
the  phyficians  who  were  call’d  to  him,  already  to  have  a  ftertor,  and  to  lie 
without  the  leafl;  figns  of  a  pulfe.  In  this  extremity,  the  phyficians  order’d 
the  neck,  temples,  and  noflrils,  to  be  rubb’d  well  with  oleum  fuccini,  and 
applied  to  his  nofe,  not  the  fpirit  of  fait  ammoniac  by  itfelf,  but  only  a  flight 
odour  of  it,  and  pidgeons  open’d  alive  to  his  feet :  by  which  means  the  diforder 
remitting  a  little,  and  the  arteries  beating  again,  they  did  not  hefltate  to  take 
blood  away  from  his  arm,  to  the  quantity  of  three  ounces.  From  which  re- 
fpiration,  indeed,  became  lefs  difficult ;  and  the  boy  returning,  as  it  were, 
to  himfelf,  lifted  up  his  little  arm,  and  rubb’d  his  forehead.  But  never- 
thelefs,  as  his  head,  which  was  opprefs’d  by  the  force  of  the  difeafe,  was 
not  at  all  reliev’d,  and  as  even  when  the  fingers  of  the  phyficians,  for  the 
fake  of  the  experiment,  were  mov’d  clofe  to  his  eyes,  they  neverthelefs  con¬ 
tinu’d  open,  and  difcern’d  nothing,  it  was  concluded  that  the  child  could  not 
be  fav’d  ;  who  accordingly  died  at  the  fixth  hour  from  the  beginning  of  the 
fit. 

The  cranium  being  open’d  by  the  very  learned  phyfician  Peter  Molinelli, 
not  more  water  appear’d  than  I  faid  before,  and  that  a  little  bloody,  as  well 
in  the  cerebrum,  which  was  very  foft,  as  every-where  about  it,  but  efpecially 
at  its  bafis,  perhaps  in  confequence  of  the  difledlion.  The  thorax,  in  that 
part  which  was  narrower  than  natural,  contain’d  a  little  extravafated  blood  ; 
and  the  part,  by  which  it  had  iflfu’d  from  the  lungs,  feem’d  to  be,  in  a  manner, 
eroded,  and  corrupted. 

5.  You  will  alk,  perhaps,  whether  I  believe,  that  fuch  a  fmall  quantity  of 
water  could  excite  fuch  great  tumults,  when  even  from  the  Sepulchretum 


(i)  Obf.  5.  5  2.  obf.  7.  &  in  addit,  obf.  7. 

7 


itfelf 


to  25-  3’ 


i  90  Book  I.  Of  Difeafes  of  the  Head. 

itfelf  (/),  you  learn  that  Fernelius,  and  Eraflus,  had  declar’d,  that  an  epi- 
lepfy  was  not  often  brought  on  from  a  large  quantity,  but  rather  foporofe 
diforders,  which  our  former  letters  alfo  confirm  •,  and  even  that  Willis  (g), 
and  long  before  him  that  Henricus  Petraeus  (£),  had  brought  arguments  from 
the  Hidden  attacks  and  folution  of  an  epilepfy,  from  which  he  was  led  to 
fuppofe,  that  it  could  never  happen  from  water  :  and  in  thofe  cafes  it  does 
not  feem  poffible  to  difprove  it,  in  which  nothing  at  all  preceded  the  attack, 
or  fucceeded  the  folution,  that  could  fhew  the  brain  to  be  in  any  manner  hurt, 
or  debilitated.  Yet  it  does  not  follow  here,  that  epileptic  diforders  cannot 
be  brought  on  from  water  in  other  cafes,  and  that  even  in  fmall  quantity,  as 
I  fhall  declare  below,  after  having  firft  produced  lome  examples  of  thefe 
cafes,  which  difagree,  one  with  another,  in  many  circumftances,  and  in 
which  I  fhall  readily  acknowledge,  that  there  was  even  no  water  at  all.  For, 
firft,  I  have  formerly  heard  of  a  nobleman  of  Padua,  who  was  fixty-four 
years  of  age  *  that  when  he  was  in  his  forty-fecond  year,  being  feized  with 
violent  anger,  and  almoft  at  the  fame  time  with  his  firft  epileptic  paroxyfm, 
he  fell  down  ;  and  after  a  long  time  having  pafs’d  between,  when  he  had 
by  chance  leen  the  perfon  with  whom  he  was  angry,  that  he  fell  down  again  ; 
and  after  that,  the  fame  happen’d  to  him,  even  when  he  did  not  fee  the  per¬ 
fon,  and  that  repeatedly,  till  in  the  two,  or  three  laft  years,  he  was  only  forne - 
times  attack’d  with  a  little  kind  of  privation  of  the  lenfes  ;  whether  becaufe  the 
length  of  time  had  now  broken  the  violence  of  the  difeafe,  in  great  part,  or 
the  powder  of  tobacco,  which,  according  to  the  common  cuftom,  he  had 
begun  to  take  by  way  of  fnuff,  had  diminifh’d  the  caufes  of  the  diforder-,  for 
by  this  means,  indeed,  much  moifture  had  been  difcharg’d  from  the  nofe. 
But  although  you  may  believe,  that  this  was  added  to  the  firft  caufe  of  the 
epilepfy  •,  yet  you  will  certainly  not  imagine,  that  it  was  then  the  caufe  of  that 
diforder,  when  the  fight  of  a  perfon  whom  he  hated,  fuddenly  laid  proftrate 
a  man  in  the  moft  found  ftate  of  health. 

6.  But  when  I  attended  upon  that  great  mafter  in  the  healing  part,  whom 
I  commended  above,  Hippolito  Francefco  Albertini,  I  remember  that  a  noble 
young  gentleman,  among  the  citizens  of  Bologna,  and  now  a  moft  honour¬ 
able  fenator,  being  feiz’d  with  an  epilepfy  from  a  fright,  which  frequently  re- 
curr’d,  and  ufing,  on  that  account,  a  drink,  in  which  the  herb  betony, 
primrofe,  baum,  and  carduus  benedibtus,  had  been  boil’d,  adding  a  few 
drops  of  the  fpirit  of  human  blood,  he  began,  not  only  to  make  more  water 
than  in  proportion  to  what  he  drank,  but  even  to  the  quantity  of  ninety 
ounces  every  day.  But  as  neither  the  difcharge  of  fo  great  a  quantity  of  wa¬ 
ter,  nor  the  greater  laxity  of  the  belly  than  ufual,  diminifh’d  the  number  or 
vehemence  of  the  attacks ;  Albertini  turning  to  me,  faid,  though  we  lhould 
by  art  draw  off  all  the  ferum  from  the  body  of  this  patient,  it  would  be  in 
vain,  fince  nature  profits  nothing  thereby.  You  therefore  fee,  that  this  dif¬ 
order  was  neither  primarily,  nor  fecondarily,  produc’d  by  ferum,  which  the 
cure  alfo  confirm’d.  For  the  cure  was  completed  within  forty  days,  not  by 
drawing  out  the  water,  which  had  not  been  intended,  even  in  the  beginning, 

(/)  Se£t.  'hac  12.  ohf.  2.  in  fchol.  &  obf.  ( g )  Obf.  1.  in  fchol. 

34.  §  2.  [b)  Obf.  14.  in  fchol. 

'  "*  '  *  6  but 


Letter  IX.  Article  6.  f  9  1 

but  by  quieting  the  tumultuary  motions  with  fedatives.  Twice  every  day 
oil  was  injected  by  the  reftum,  but  in  its  fimple  ftate,  that  it  might  do  no¬ 
thing  but  relax  the  djftended  nerves,  and  keep  them  in  an  undiftended  ftate. 
For  by  thole  accdftons  it  was  found,  that  the  internal  and  external  nerves, 
were  irritated  much  more  than  the  cerebrum  ;  and  that  the  patient  found 
much  benefit  while  he  was  agitated  by  the  difeafe,  if  the  whole  fpine  was 
rubb’d  with  a  loft  hand,  and  anointed  with  oil,  recently  exprefs’d  from  fweet 
almonds,  in  which  earth  worms  had  been  boil’d,  and  to  which  a  little  oil  of 
amber  had  been  added.  And  to  thole  remedies,  which  the  patient  took  in¬ 
wardly,  opium  was  added  with  advantage.  And  they  were  fuch  as  are  judg’d 
proper  againft  difeafes  o"f  the  nerves,  and  commonly  known  :  for  Albertini 
did  not  attribute  much  efficacy  to  lecrets;  which  I  could  wifh  were  circulated' 
in  fmaller  numbers,  and  of  a  more  certain  effedc.  Among  thefe  arcana  I  have 
lately  heard  much  extoll’d,  a  frnall  ftone,  which  is  generated  in  that  little 
animal,  that  we  call  among  the  Italians,  lurnacone  ignudo ,  or  the  naked  fnail, 
yet  not  fo  recommended  as  to  cure  all  epileptic  patients ;  and  I  have  heard 
that  thofe  paroxyfms  which  have  their  origin  from  fear,  as  thole  now  in 
queftion  had,  were  much  lefs  frequent,  from  the  time  that  a  warm  liquor 
made  from  the  flowers  of  the  herb  verbafcum,  or  torch-weed,  in  the  manner 
of  tea,  began  to  be  drank  by  the  diredlion  of  a  Frenchman.  Yet  very  often, 
thofe  things  which  have  carried  off  a  lympathic  epiiepfy,  are  cried  up  to 
take  away  alfo  an  idiopathic  one,  not  lefs  vainly,  than  unfkilfully  and  rafhly  ; 
and  hence  the  number  of  arcana  is  ufelefsly  multiplied. 

But  the  medicines,  which  Albertini  made  ufe  of  in  this  cafe,  leaving  off 
that  which  prov’d  too  diuretic,  were  reduc’d  to  that  of  the  human  fkull, 
which  he  order’d  to  be  rafp’d,  and  beaten  in  a  mortar,  and  to  be  moiften’d 
with  the  water  diftiil’d  from  black  cherries,  then  to  be  dried  in  the  fhade ; 
and  this  procefs  to  be  repeated  often,  till  it  was  reduc’d  to  a  pollen,  or  im¬ 
palpable  powder;  for  what  they  call  magifteries,  he  with  juftice  difapprov’d: 
but  from  that  pollen  lozenges  were  form’d,  opium  being  added  to  them,  and 
diftributed  with  fuch  care,  that  fcarce  more  than  one  grain  was  in  all  thofe 
which  were  to  be  taken  at  intervals  through  a  whole  day. 

Perhaps  you  will  afk,  whether  he  took  away  blood  ?  and  blood  he  did 
take  away,  as  foon  as  ever  the  ftrft  attack  was  at  an  end,  which  he  would  have, 
done,  even  if  no  epiiepfy  had  follow’d  fo  great  a  fright.  For  he  us’d  this 
practice,  I  believe,  becaufe,  after  his  friend  Malphigi  (/),  he  had  obferved, 
as  I  alfo  have  fometimes,  that  after  fuch  an  affection  of  the  mind,  the  blood- 
becomes  prone  to  concrete  ;  from  which  circumitance  many  and  various  dil- 
orders  arife,  and  perhaps  becaufe,  as  often  happens,  fome  traces  of  a  de¬ 
prav’d  difpofition  remain  imprefs’d  upon  the  brain  therefrom,  which  are  dil- 
cover’d  by  unreafonable  fears,  or  terrifying  dreams  :  and  blood-letting,  as- 
it  refifts  that  pronenefs  to  concretion  in  the  blood,  fo  it  is  ufeful  to  overcomc- 
this  kind  of  convulfive  difficulties  in  the  brain. 

And  he  wonder’d,  if  at  any  time  he  heard,  that  there  were  any,  who,  con¬ 
trary  to  the  admonitions  of  Caelius  (£),  excited  fternutation  in  epileptic  pa- 
dents,  with  the  doubtful  hope,  either  of  changing  for  the  better,  the.  motions* 


of* 


(;)  Difiert.  de  Polypacord. 


(/£)  Morborum  Chron.  1.  i.  c.  4. 


192  Book  I.  Of  Disorders  of  the  Head. 

of  the  fpirits,  or  of  moving  forwards  the  blood,  which  was  almoft  ftagnated 
in  the  veflfels  of  the  cerebrum.  For  who  could  anfwer  for  it,  that  the  motion 
we  would  with  to  quiet,  would  not  be  made  worfe  from  thence  ?  And  can 
we  fuppofe,  that  the  blood,  which  is  probably  retarded  from  the  fibres  being 
convuls’d,  in  difeafes  of  this  kind,  will  have  its  pafiage  expedited  from  thefe 
fibres  being  ftill  more  irritated  ?  Wherefore,  he  thought  this  kind  of  remedy 
rather  more  proper  in  thofe  apoplexies  where  the  paUage  of  the  blood  was 
obftruCted,  by  reafon  of  the  fibres  being  extremely  relax’d  ;  although,  at  the 
fame  time,  he  thought  it  a  remedy  of  fuch  a  kind,  in  general,  that  it  was 
indeed  very  rarely  to  be  recurr’d  to,  by  fkilful  phyficians,  Nor  did  he  him- 
felf,  certainly,  apply  any  thing  to  the  noftrils  of  epileptic  patients,  befides 
oil  of  amber ;  for  thofe  medicines  which  are  call’d  fpirits,  he  referr’d  entirely 
to  apoplexies  of  the  kind  I  fpoke  of  juft  now,  and  other  fimilar  affec¬ 
tions,  by  reafon  of  the  injuries  obferv’d  therefrom,  in  thofe  whom  the  ancients 
call’d  warm  conftitutions,  and  who  labour’d  under  diforders  from  a  warm 
caufe  *,  efpecially  in  hyfterical  women,  in  whom,  when  l'eiz’d  with  an  epi- 
lepfy,  perfumes  of  that  kind,  he  had  always  found,  left  at  leaft  a  fullnefs  of 
the  head  behind  them,  if  nothing  more. 

But  he  chofe  rather  that  the  patient’s  head,  when  attack’d  with  this  difeafe, 
fhould  be  laid  very  high,  and  preferv’d  fo,  as  much  as  could  be  poffibly 
done  j  for  by  this  means  the  humours  were  lefs  accumulated  in  it,  and  the 
breath  was  more  eafily  drawn  :  and  he  replied  to  thofe  who  perhaps  objected, 
that  thus  the  foam  was  with  more  difficulty  difcharg’d  from  the  mouth,  that 
it  would  be  form’d  in  the  mouth  in  lefs  quantity,  inafmuch  as  the  head  and^* 
lungs  would  be  lefs  loaded  ;  and,  indeed,  that  this  foam  did  not  always,  as 
is  generally  believ’d,  proceed  from  the  lungs,  though  Pechlinus  denies  it  (/), 
but  was  rather  made  from  the  faliva  being  agitated  in  the  mouth;  for  he  had 
obferv’d  fome  little  ftreams,  as  it  were,  of  this  fluid,  without  any  foam  or 
froth,  frequently  flow  down  from  the  mouths  of  epileptic  patients,  when 
the  head  was  by  chance  inclin’d  to  the  other  fide.  But  doubtlefs,  while  I 
am  led  by  a  grateful  regard  towards  the  memory  of  my  preceptor,  and  by 
your  affeblion  for  him  alfo,  which  I  am  fully  convinc’d  of,  to  purfue  his  me¬ 
thods  and  practices  in  the  art  of  healing,  I  am  carried  away  too  far  from  the 
prefen t  defign. 

7.  To  which,  therefore,  that  I  may  return,  I  will  juft  fkim  over,  in  as  few 
words  as  I  fhall  be  able,  thofe  many  things  which  I  have  obferv’d,  for  a  long 
time,  in  my  fellow-citizen  Anaftafio  Poggi,  a  grave  and  worthy  prieft.  He 
was  in  his  iixty- eighth  year,  of  a  habit  moderately  fat,  and  of  a  florid  com¬ 
plexion,  when  he  was  firft  feiz’d  with  the  epilepfy,  which  left  behind  it  the 
greateft  flownefs  of  pulfe,  and  in  like  manner  a  coldnefs  of  the  body.  But 
this  coldnefs  of  the  body  was  overcome  within  feven  hours,  nor  did  it  return 
any  more,  though  the  diforder  often  return’d  •,  but  the  flownefs  of  the  pulfe 
ftill  remain’d.  The  firft  epilepfy  had  fucceeded  \o  a  pain  of  the  right  hypo¬ 
chondrium,  which  was  refolv’d  by  bilious  dejections :  the  other  paroxyfms, 
which  were  flighter,  generally  fucceeded  to  the  fenfation  of  a  kind  of  fmoke, 
afcending  up  to  the  head  from  the  hypochondria,  the  fullnefs  of  which  parts 


(/)  De  aeris  &  alim.  def,  c.  7. 


was 


Letter  IX.  Article  7.  193 

was  continually  troublefome  to  the  patient,  and  was  certainly  encreas’d  from 
the  ingeila,  but  efpecially  from  liquids.  And  this  being  the  ftate  of  the  cafe, 
and  as  the  pain  of  the  head,  and  all  the  marks  of  its  being  affe&ed  of  itfelf, 
were  abfent,  the  fenior  phyficians,  who  had  not  wifh’d  for  me  to  be  their 
companion,  in  the  cure  of  this  refradtory  diforder,  lefs  than  the  patient  him- 
felf,  made  no  fcruple  to  pronounce,  that  it  arofe  from  the  irritation  of  the  hy¬ 
pochondria.  And  indeed,  as  you  have  it  alfo  in  this  fedtion  of  the  Sepul- 
chretum  (ot),  there  is  extant  in  Galen  a  hiftory  of  a  certain  grammarian, 
"  who,  having  abftain’d  too  long  from  food,  became  epileptic,  from  no  other 
caufe  than  bile.”  And  examples  are  very  common  of  adults  («),  not  only 
of  children  ( 0 ),  who  have  been  troubl’d  with  epilepfies,  from  worms  harbour’d 
in  the  inteftines.  And  to  this  purpofe  alfo  is  that  obfervation  of  Spigellius  (/>), 
on  a  whelp  thus  kill’d  by  worms  ;  not  very  unlike  to  which,  is  that  formerly 
written  by  me  to  Vallifneri,  and  by  him  publifh’d  ( q ).  And  you  know  that 
this  diforder  often  arifes,  alfo,  from  other  vifcera  of  the  belly  being  dileas’d, 
which  the  fedtion,  that  I  have  already  quoted,  confirms  (r). 

But  although  that  kind  of  cure  was  applied  to  my  fellow-citizen  Poggi, 
with  my  aiTent,  which  was  proper  to  open,  cleanfe,  and  relax,  the  hypo¬ 
chondria,  yet,  neverthelefs,  the  acceflions  ftill  return’d  frequently  j  fo  that 
we  now  began  to  fear,  left  the  head  itfelf  had  alfo  contracted  the  injury, 
efpecially  as,  upon  a  very  quick  turn  of  the  head,  the  epileptic  infults  re- 
curr’d,  and  left  a  lenfe  of  weight  with  ftupidnefs  in  the  head  j  and  frequently 
fome  blood  came,  together  with  the  mucus,  from  the  nofe.  Wherefore,  as 
in  the  beginning,  they  had  already  drawn  blood  once  and  again  from  the 
arm,  nor  had  omitted  to  give  fuch  things  as  are  generally  of  ufe  to  the  head, 
I  perfuaded  them  to  let  blood  be  taken  away  from  thofe  veins,  which  lie 
about  the  anus  alfo  ;  and  that  feveral  things  fhould  be  given  internally,  which 
are  recommended  as  extremely  proper  againft  this  difeafe,  by  the  moft  ex¬ 
cellent  phyficians.  Thefe  remedies,  however,  were  of  no  advantage  ;  but 
the  bleeding,  whether  it  reliev’d  the  head,  or  rather  thofe  viicera  which  are 
ferv’d  with  blood  by  the  vena  portarum,  was  fo  far  of  advantage,  that  for  a 
fhort  time  the  paroxyfms  were  quiet.  When,  therefore,  they  return’d  again 
more  frequently,  it  was  of  ufe  to  make  the  patient  fit  up,  fometimes  to  rub 
the  lower  limbs,  and  fometimes  to  tie  them  alternately  with  bandages  thrown 
round  about,  and  fometimes  to  fix  cupping-glafles  without  fcarification,  and 
prefently  to  vex  the  patient  by  taking  them  off  j  for  thus  he  feem’d  to  have 
a  longer  intermiftion  from  his  paroxyfms.  And  I  was  even  afiur’d,  that 
when  they  fometimes  attack’d  him  much  more  often,  the  fpiritof  fait  ammo¬ 
niac,  applied  to  the  noftrils,  had  driven  them  away  as  they  were  coming  on  ; 
or,  even  when  they  were  already,  in  a  manner,  begun,  had  fupprefs’d  them, 
although  the  patient  was  entirely  without  the  power  of  fmelling.  They  were, 
for  the  moft  part,  very  fhort,  but  by  no  means  flight.  For  diftortioris  of 
the  eyes,  agitations  of  the  limbs,  and  a  fufpenfion  of  all  the  fenles,  always 

( m )  Seft.  12.  in  fchol.  ad  obf.  19.  (p)  Ibid.  obf.  41.  §1.  ' 

(»)  Ibid,  fchol.  ad  obf.  41.  Confideraz.  in.  alia  gener,  de’  Vermi. 

(0)  Obf.  ead.  §  2.  &  fchol,  ad  obf.  15.  in  (r)  Obf.  39.  cum  fchol, 
addicam. 

Vol.  I.  C  c  accom- 


i  94  Book  I.  Of  Difeafes  of  the  Head. 

accompanied  the  attack :  oftentimes  there  was  a  ftrangulation,  and  that  fome- 
times  join’d  together  with  a  ftertor ;  and  even,  now  and  then,  an  involuntary 
efflux  of  urine  attended.  But  he  was  exceedingly  bad  that  day  on  which 
the  folftice  happen’d,  and  in  like  manner,  that  on  which  the  eclipfe  of  the 
fun  happen’d. 

And  though  you  may  fuppofe  this  might  be  by  chance,  yet  you  cannot 
fuppofe  it  merely  accidental,  that  when  the  quantity  of  urine  was  either  na¬ 
turally  or  artificially  encreas’d  (j),  the  epileptic  paroxyfms  not  only  became 
not  (lighter,  but  were  even  very  frequently  exafperated.  For  we  were  oblig’d 
to  have  regard  to  this  excretion  fometimes,  when  a  fudden  difficulty  of 
breathing  rous’d  the  patient,  as  he  was  beginning  to  deep,  and  compell’d  him 
to  fit  up ;  which  fymptom,  doubtlefs,  gave  us  fome  fufpicion  of  a  dropfy  of 
the  thorax ;  and  the  more  fo,  becaufe  the  patient  told  us,  that  his  right  leg 
had,  for  a  long  time  pad,  been  accuftom’d  to  fwell  a  little  with  water,  and 
that  even  then,  which,  when  he  told  us,  we  examin’d  into,  the  fwelling  was 
afcending  up  the  thigh.  But  it  was  eafy  to  encreafe  the  quantity  of  urine, 
by  obvious  and  innocent  remedies,  and  therefore  to  diminifii  the  tumour,  and 
that  fufpicion,  which  was  afterwards  entirely  remov’d ;  but  not  fo  the  force 
of  the  attacks,  which,  from  the  encreas’d  afflux  of  urine,  and  that  of  itfelf, 
fometimes  opaque,  and  blackifh,  was  fo  far  from  being  weaken’d,  or  dimi- 
niffl’d,  that  even  on  the  contrary,  as  I  faid  above,  they  grew  ftronger  and 
ftronger.  When  thefe  things,  and  others,  which  for  the  lake  of  my  promis’d 
brevity  I  pafs  over,  were  of  no  effedt  againft  the  inroads  of  this  difeafe,  and 
even  fuch  as  had  been  fometimes  ufeful  to  retard  or  fupprefs  them,  as  I  faid 
above,  were  now  of  no  advantage,  as  they  did  not  continue  to  afford  thefe 
effects  ;  there  was  one  thing,  "however,  which  was  canftantly  of  fervice  ; 

I  mean  opium,  given  at  the  beginning  of  the  night,  in  the  quantity  of  half 
a  grain.  For  the  frequency  and  force  of  the  infults,  and  added  to  thefe  alfo, 
obftinate  watchings,  fo  weaken’d  the  patient  in  other  refpedts,  that  we  were 
under  a  neceffity  of  gaining  a  truce  by  fome  means  or  other.  And  by  this 
means,  good  nights,  and  eafy  fieeps,  were  procur’d  to  the  patient  :  and  fo 
far  was  his  head  from  being  made  heavy,  or  dull,  by  theufeof  this  medicine,, 
that  even  the  heavinefs  and  dullnefs,  left  behind  by  the  daily  attacks,  were 
by  this  means  taken  away;  which  otherwile,  "that  is,  when  the  ufe  of  the 
opium  was  intermitted,  continu’d,  while  the  former  reftlefsnefs  and  watchings 
alfo  opprefs’d  him.  And,  indeed,  after  he  had  pafs’d  a  night  of  that  kind, 
which  was  far  more  troublefome  than  the  reft,  when  to  the  greateft  rarity  of 
the  pulfe,  which  i  mention’d  in  the  beginning,  an  inequality  had  lliddenly 
been  added,  fo  that  very  often  they  were  perceiv’d  to  be  even  much  more 
rare,  then  not  more  fo,  than  ufual,  and  prefently  much  rarer  again  ;  which 
lymptom  made  us  the  more  uneafy,  becaule  the  difeafe,  at  that  time,  was 
wont,  firft  of  all,  entirely  to  obfcure  the  pulfe,  and  then  immediately  to 
begin  its  attack  ;  and  when  we  had  tried  all  the  remedies,  recommended  to 
difiblve,  and  promote,  the  circulation  of  the  blood,  in  vain  upon  giving 
the  opium  again,  the  quiet  nights  again  return’d,  and  diminifh’d  that  ine¬ 
quality  of  the  pulfe:  and,  by  the  continu’d  ufe  of  opium  every  night,  it 
was  entirely  remov’d,  and  even  the  former  rarity  was  diminifh’d. 

(s)  Vid.  infra,  n.  u. 


But, 


Letter  IX.  Article  8.  r  195 

But,  perhaps,  you  will  fufpect,  whether  the  rarity  of  the  pulfe  be,  in  faCt, 
a  very  uncommon  fymptom,  to  remain  after  an  epilepfy,  in  hypochondriac 
patients,  when  you  fhall  have  compar’d  this  obfervation  of  mine  with  that 
of  the  celebrated  Gerbezius  (/),  which  deferibes  the  pulfe  of  a  ftrong  hypo¬ 
chondriac  man,  “  who  was  now  and  then  fubjeCt  to  [light  epileptic  pa- 
“  roxyfms,”  even  when  he  was  in  health,  “  as  being  fo  very  flow,  that  be- 
“  fore  the  fubfequent  pulfation  follow’d  that  which  went  before,  three  puifa- 
“  tions  would  certainly  have  pafs’d  in  another  healthy  perfon.”  But  to  re¬ 
turn  to  my  fubjeCt  *,  after  that  no  fit  had  now  return’d  for  thirteen  days,  and 
the  ufe  of  opium  was  intermitted,  the  firft  night  indeed  was  not  bad  ;  but  the 
following  ones,  by  reafon  of  the  continual  watching,  and  reftlefihefs,  and  at 
length  by  reafon  of  that  difficulty  of  breathing,  which  I  fpoke  of  above, 
were  exceedingly  troublefome  ;  fo  that  we  were  oblig’d  to  have  recourfe 
again  to  the  opium,  in  order  to  procure  quiet  nights,  which  nothing  but 
opium  would  procure.  And,  to  comprehend  all  in  a  few  words  *,  that  the  at¬ 
tacks  of  the  difeafe,  from  being  very  frequent,  as  they  had  happen’d  every 
day,  in  the  month  of  June,  had  been  fo  far  reduc’d  in  their  number,  that 
but  one  happen’d  in  July,  one  in  Auguft,  nor  more  in  September,  and  af¬ 
ter  that  none  in  the  two  next  months  at  leaft,  and  upwards,  till  I  departed 
to  teach  medicine  publicly,  we  judg’d  was  owing  to  the  ufe  of  opium,  given 
opportunely,  fometimes  every  night,  fometimes  every  other  night,  and  at 
length  at  the  intervals  of  many  nights.  For  by  that  medicine  we  were  able 
to  appeafe  the  tumultuary  motions,  which  arofe,  and  frequently  by  a  very 
manifeft  fenfation,  from  the  hypochondria,  to  the  thorax,  and  head ;  and  by 
this  means  procure  a  truce,  both  for  nature  and  art :  and  this  gave  us  fuffi- 
cient  time  to  cleanfe  and  confirm  the  hypochondriac  vifeera,  which  we  had 
determined  to  do,  in  the  beginning,  but  in  vain  attempted,  among  thole 
firft  continual  tumults,  with  which  the  patient  was  harrafs’d  :  and  from  thefe 
vifeera  alone,  and  not  from  water  being  redundant  in  the  brain,  that  thefe 
fudden  commotions  arofe,  this  hiftory,  or  I  am  much  deceiv’d,  indeed,  evi¬ 
dently  ffiews. 

8.  But  if  you  defire  other  examples  befides  thefe,  of  the  epilepfy  arifing 
fudden-ly,  either  from  paffions  of  the  mind,  in  a  healthy  man  ;  or  having  its 
beginning,  in  a  part  remote  from  the  brain  •,  you  will  find  many  fuch,  among 
thofe  cafes  collected  by  Schenk  (a) :  although  it  is  fo  ancient  an  obfervation, 
of  its  beginning,  “  either  from  the  fide,  the  hand,  or  the  foot,”  that  parti¬ 
cular  mention  of  it  is  made,  as  being  then  more  eafily  curable,  in  the  fecond 
book  of  Predictions  (x)  j  which  if  it  be  not  one  of  the  books  of  Hippocrates, 
is  at  leaft  the  work  of  fo  ancient,  and  fo  much  efteem’d  a  writer,  that  this 
paflfage  of  his  book  has  been  transferr’d  into  the  writings  of  Celfus  (jy),  in 
the  following  manner;  <c  Where,  in  an  epileptic  perfon,  the  fenfe  of  the  ap- 
“  proaching  fit  begins  from  any  one  part  of  the  body,  it  is  beft  that  it  be- 
“  gin  from  the  hands,  or  the  feet :  next  to  thefe  from  the  fides :  and  worft 
“  of  all  from  the  head.”  The  force  of  which  ancient  prediction,  Willis, 
perhaps,  did  not  fufficiently  attend  to,  when  he  contended  that  thofe  very 

(/)  Eph.  N.  C.  Cent.  7.  in  Append.  (a:)  n.  16. 

( u )  Obf.  Medic.  1.  1.  ubi  de  Epilepfia.  (y)  De  Medic.  1.  2.  c.  8. 


C  c  2 


epilepfies. 


1 9  6  Book  I.  Of  Difeafes  of  the  Head. 

epilepfies,  which  Teem  to  begin  in  a  part  very-remote  from  the  brain,  do  ne- 
verthelefs  “  not  uncommonly”  take  their  origin  from  the  brain  ;  as  you  have 
it  in  the  Sepulchretum  (z).  Which  though  it  may  fometimes  happen,  yet 
that  it  happens  much  Id's  often  than  he  imagines,  not  only  the  predi&ion  I 
have  mention’d,  as  it  is  confirm’d  by  phyficians,  teaches,  but  very  fre¬ 
quent  obfervations,  if  they  are  rightly  attended  to,  fufficiently  prove.  And 
that  we  may  not  draw  thefe  observations  from  any  other  Source,  than  that 
of  the  Sepulchretum ;  turn,  I  befeech  you,  to  that  obfervation  on  the  epi- 
lepfy  by  Tulpius  ( a ),  which  was  excited  “  by  the  mere  prefiure  of  a  finger 
“  upon  the  region  of  the  fpleen  then  turn  to  another  (£),  and  a  third 
alfo  (r),  of  the  fame  difeafe,  beginning  from  the  lole  of  the  foot,  or  great 
toej  l'o  that  if  a  tight  bandage  was  timely  thrown  round  the  leg,  the  dileafe 
did  not  proceed  :  if  not,  it  finifh’d  its  courfe  to  the  upper  parts,  and  through 
the  whole  body. 

But  there  is  alfo  an  old  hiftory,  in  the  books  of  Galen,  which  is  likewife 
taken  notice  of,  in  the  Sepulchretum  ( d ),  although  he  did  not  fay  that  the 
diforder  arofe  from  the  “  great  toe,”  as  you  will  read  there,  and  in  the  writ¬ 
ings  of  Saxonia  ( e ),  but  that  it  had  its  origin  “  from  the  internal  part  of  the 
<c  leg  and  he  alfo  lubjoin’d,  what  makes  much  to  the  prefent  queftion,  but 
is  omitted  in  the  Sepulchretum,  that  the  paroxylm,  which  was  wont  to  at¬ 
tack  the  patient,  every  day,  was  prevented  from  returning,  after  other 
things,  that  were  preferibed  by  the  phyficians,  “  by  binding  the  limb  in  the 
“  middle  of  it,  above  that  part,  to  wit,  which  was  affeefted  with  the  primary 
“  difpofition.”  Other  obfervations  I  pafs  over  :  but  left  you  think  thefe  too 
few,  take  thus,  what  I  heard  even  from  one  phyfician,  Ramazzini,  for¬ 
merly  my  collegue  and  friend,  when  I  happen’d  to  be  prefent  at  one  of  his 
public  le&ures ;  that  he  had  feen  feveral  epileptic  patients,  whofe  paroxylm 
beginning  from  the  foot,  and  afeending  upwards,  was  eafily  reftrain’d  by  a 
bandage  being  plac’d  upon  the  leg.  In  all  thefe  examples,  and  others  of 
the  fame  kind,  can  you  now  believe,  that  there  is  room  for  the  explication 
“  not  uncommonly”  of  Willis,  when  you  fee,  that  by  the  communication 
being  timely  intercepted,  betwixt  that  part  and  the  brain,  the  rifing  diforder 
was  check’d  and  prevented  ;  but  that  this  communication  not  being  cut  off, 
neither  was  the  diforder  reftrain’d  ?  For,  if  it  had  its  origin  from  the  brain, 
why  did  it  always  go  to  that  part  firft  ?  or  if  it  could  not  go  to  this  part,  by 
reafon  of  the  bandage  being  tied  about  the  leg,  why  did  it  not  go  to  fome 
other  ?  And  that  not  the  leaft  doubt  may  remain,  why  does  the  diforder 
return  no  more,  if  any  one  take  away  the  caufe  thereof  from  that  part  ? 
Examples  of  cures  of  this  kind,  are  extant  in  the  writings,  both  of  the  ancient 
and  modern  phyficians.  Let  it  fuffice  however,  from  amongftthem,  juft  to 
point  out  Marcus  Gatinaria  (/),  who  not  only  diretfts  it  to  be  done,  but  even 
confirms  it  by  producing  his  own  obfervation :  and  among  thefe  likewife, 
that  phyfician,  of  whom  the  celebrated  Van  Swieten  (g)  lpeaks,  when  he 


(z)  Se<ft.  hac  12.  in  fchol.  ad  obf.  44. 

( a )  Ibidem  in  fchol.  ad  obf.  39. 

( b )  Obf.  44.  in  append. 

(<■)  in  Addit,  obf.  5.  in  fin. 


(d)  in  fchol.  cit.  ad  obf.  39. 

( e )  Pradeft.  Pra<5t.  p,  1.  c.  16. 

(/)  De  Cura  AEgritud.  ubi  de  epilepfia. 
(g)  Comiji.  in  Boerh.  Aph.  §.  1084. 


very 


Letter  IX.  Article  9.  197 

very  learnedly  teaches  how  to  diftinguifh  the  cafes  (&),  in  which  Willis  may 
be  follow’d,  from  thofe,  in  which  he  ought  not  to  be  follow’d,  fince  there 
certainly  are  thofe,  in  whom  the  beginning  of  the  epilepfy  can  by  no  means 
be  believ’d  to  be  in  the  brain  *,  thofe  numbers,  for  inltance,  of  this  kind, 
which  we  have  actually  produc’d,  and  are  more  than  of  any  other  ;  in  whom, 
to  ufe  the  words  of  this  celebrated  man,  “  the  figns  of  the  incipient  pa- 
4C  roxyfm  are  always  obferv’d  in  the  fame  part,  and  not  in  various  parts,” 
or  in  different  parts  at  different  times.  Therefore,  if  the  beginning  is  not 
within  the  brain,  neither  can  it  be  attributed  to  water  fiagnating  there. 

But,  as  I  have  not  only  candidly  acknowledg’d,  but  even  confirm’d,  much, 
more  at  large  than  was  neceffary,  if  I  did  not  write  to  you,  who  particularly 
require  it  of  me,  that  there  are  many  inftances  of  the  epilepfy,  in  which  the 
diforder  is  neither  brought  on  from  water  being  extravafated  in  the  brain,  nor 
does  it  even  feem  poflible  it  fhould  be  •,  fo  I  think  it  muft  be  granted  to  me 
alfo,  that,  on  the  contrary,  there  are  cafes,  in  which  it  may  even  happen 
from  a  fmall  quantity  of  water :  and  this  I  will  demonftrate^  after  the  next 
obfervation. 

9.  A  young  man  of  eighteen  years  of  age,  having  liv’d  in  marfhy  grounds, 
where  his  bufinefs  was  to  cut  down  the  weeds,  with  which  the  coopers  flop 
up  the  chinks  of  their  veffels,  fell,  naturally,  from  his  manner  of  life,  into 
a  dropfy,  and  that  a  general  one.  When  he  was  brought  into  the  hofpital 
at  Padua,  having  taken  fome  diuretics,  his  fwelling  was  fomewhat  abated  ; 
but  then  he  began  to  be  feiz’d  with  an  epilepfy,  with  which  he  had  never 
been  troubl’d  before  :  the  fits  of  which  frequently  return’d,  on  the  laft  feven 
days,  join’d  with  a  fillynels,  and  a  propenfity  to  deep,  to  which,  at  length, 
an  acute  fever  was  added.  Under  fuch  a  complication  of  diforders,  he 
could  not  but  fink. 

The  head  was  the  only  part  which  underwent  a  difife£tion,  in  that  place, 
on  the  eighteenth  of  March,  in  the  year  1741.  The  face  was  very  tumid, 
from  water  lying  in  the  cellular  membranes.  The  fkull  being  taken  away, 
and  held  up  to  the  light,  fhew’d  the  borders  of  all  the  bones,  which  form 
the  true  futures,  to  be  tranfparent,  to  the  breadth  of  half  an  inch.  All  the 
veileis  that  were  within  the  cranium,  contain’d  but  little  blood  if  you  ex¬ 
cept  the  lateral  finufifes,  which  contain’d  a  black  blood.  Under  the  pia  mater 
there  feem’d  to  be  fomething  like  jelly,  mix’d  with  bubbles  of  air.  The  ce¬ 
rebrum,  but  not  the  cerebellum,  was  found  to  be  harder  than  it  fhould  be  : 
yet  the  fornix  was  lax,  and  the  plexus  choroides,  which  were  pale,  were  flill 
more  lax  j  fo  that  the  membrane  lying  betwixt  the  right  and  the  left,  might 
be  torn  by  a  mere  touch  only.  The  anterior  part  of  the  left  corpus  flriatum, 
where  it  looks  towards  the  right,  being  compar’d  with  that  which  anfwer’d 
to  it,  on  the  other  fide,  was  found  to  be  more  protuberating,  even  at  the  firft 
glance  of  the  eye  :  nor  was  there  any  danger  of  deceit  in  this  matter,  fince 
the  brain,  according  to  my  general  cuftom,  was  differed  in  its  natural  fitu- 
ation.  This  part,  however,  was  externally  found,  and  as  far  as  I  could  judge, 
internally  alfo  •,  although,  at  the  fame  time,  I  ought  not  to  conceal,  that  the 
cineritious  fubftance,  which  is  interpos’d  with  the  white  ftriae,  or  lines,  feem’d 

( h )  Ibid,  ad  §  1078. 

to 


i  p  8  Book  I.  Of  Difeafes  of  the  Head. 

to  my  worthy  friend  Mediavia  to  be,  as  it  were,  fomewhat  porous.  Nor  did 
the  feptum  lucidum,  nor  the  pineal  gland,  nor  any  part  whatever  of  the 
brain,  which  was  diligently  difledted,  (hew  the  lead  diforder  befides  thofe, 
un^esfthat  a  little  water,  of  a  yellowifh  colour,  was  found  in  the  cavity  of 
the  lateral  ventricles. 

Oo.  You  have  here  the  hiftory,  juft  as  I  committed  it  to  paper,  when  I 
return’d  home,  as  is  my  cuftom  :  for  I  diftruft  my  memory  on  luch  occafions. 
Take  care,  therefore,  how  you  believe  that  I  am  eafily  deceiv’d  thereby,  if 
at  any  time  you  fee  any  one  of  my  obfervations  propos’d  in  a  fomewhat  dif¬ 
ferent  manner  from  what  is  related,  by  any  one  of  thofe  who  were  prefent  at 
the  difle&ion  :  yet,  why  this  circumftance  (hould  happen  to  the  prefent  ob- 
fervation,  I  can  rather  wonder,  than  underftand. 

But  I  do  not  imagine,  that  you  exped  I  fhould  (hew  you  all  the  caufes  of 
fo  many  difeafes,  and  even  of  the  death  of  this  young  man,  when  you  ob- 
ferve,  that  no  part  but  the  head  was  brought  to  me  to  be  difteded ;  and 
even  if  the  whole  body  had  been  difteded  quite  through,  that  the  caufe  of 
the  acute  fever,  for  inftance,  which  is,  at  lead,  not  lefs  fatal  than  the  others, 
among  the  number  of  which  it  is,  generally  efcapes  the  eyes  of  anatomifts. 
It  remains,  therefore,  that  we  confider,  from  thole  appearances  which  I  found 
in  the  head,  whether  there  be  any  thing  which  we  may,  perhaps,  with  pro¬ 
bability,  fuppofe  to  be  the  caufe  of  the  epilepfy,  join’d  with  a  fillynefs,  and 
proclivity  to  deep.  And  I  fay,  there  is  fomething  which  may,  perhaps,  be 
fuppos’d  :  for  that  it  was  really  the  caufe,  or  was  not  the  caufe,  is  neither 
my  bufinefs,  nor  yours,  nor  that  of  any  other  man,  to  pronounce,  in  cafes 
of  this  kind.  Therefore,  fetting  afide  the  tranfparency  of  the  (kull,  about 
the  futures,  for  the  date  of  thefe  futures  was  far  different  from  what  is  be¬ 
liev’d  by  many  to  be  the  caufe  of  epilepfies  (7),  and  my  oblervation  on  that 
fubjed  is,  perhaps,  lefs  to  be  attended  to  in  this  young  man  ;  i  fulped, 
that  in  almoft  all  the  other  appearances  which  were  obferv’d,  if  not  the  caufe, 
at  lead  the  force,  which  was  lufficient  to  affift  the  caufe  of  that  epilepfy 
whereof  we  fpeak,  might  be  fought  for,  and  cor.jedur’d  :  but  I  fulped,  that 
the  chief  caufe  may  be  plac’d  in  the  water  which  was  found  in  the  ventricles, 
whether  it  was  in  fmall,  or  in  great  quantity,  in  the  living  body.  It  is  pro¬ 
bable,  however,  that  there  was  mu.  h  water  in  a  dropfical  perfon  :  which  the 
palenefs  of  the  plexus  choroides,  in  the  judgment  of  Willis  alfo  (£),  feems 
to  confirm  *,  and  in  like  manner,  their  laxity,  and  that  of  the  fornix,  and 
that  kind  of  jelly  which  lay  under  the  pia  mater.  Nor  is  it  repugnant  thereto, 
that  little  water  was  found  within  the  cranium  after  death.  For  it  might  eafily 
happen,  than  when  the  head  was  fever’d  from  the  neck,  the  much  greater 
part  of  the  water  might  flow  out  through  the  tube  of  the  vertebra :  and  if 
it,  therefore,  was  in  large  quantity,  fo  much  the  more  did  it  prefs  upon  the 
lax  fornix,  in  proportion  as  the  remaining  part  of  the  cerebrum,  in  confe- 
quence  of  its  fubftance  being  harder  than  natural,  refifted  fo  much  the  more 
the  compreflion  of  the  water.  And  the  fornix  would  alfo  be  the  more  prefs’d 
upon,  in  proportion  as  there  was  lefs  fpace  in  the  cavity  of  the  ventricles, 

( i )  Se£t.  hac  Sepulchr.  12.  in  append,  ad  (k)  Sed.  proxima  13.  obf.  7. 
obf.  32.  &  in  additam,  obf.  4. 


which 


Letter  IX.  Article  i  i .  199 

which  naturally,  and  at  other  times,  if  not,  as  fome  contend  for,  without 
fpace  at  all,  is  certainly,  in  fact,  very  fmall  *,  1  fay,  in  proportion  to  the 
fpace  in  the  cavity  of  the  ventricles  being  diminifh’d,  by  reafon  of  the  greater 
protuberance,  of  one  of  the  corpora  ftriata  j  whether  this  had  been  from 
the  original  formation,  or  had  grown  out  afterwards,  by  reafon  of  thofe 
pores  being  internally  added  :  and  you  may  fee  an  obfervation  in  the  Sepul- 
chretum  (/),  of  the  ventricles  of  the  cerebrum  being  “  too  narrow,”  in  an 
epileptic  patient. 

But,  if  you  would  rather  have  it,  that  no  water  flow’d  out  from  the  cranium, 
and  was  even  in  fmall  quantity  in  the  living  body ;  it  might  alfo  in  this  way, 
be  the  chief  caufe  of  that  epilepfy,  in  particular,  as  it  was  join’d  with  a  pro- 
penflty  to  fleep,  and  with  that  fymptom,  which  almoft  conftantly  follows  it, 
a  fillynefs  or  idiotifm  ;  or  that  kind  of  flllynefs  at  leaft,  which  is  for  the  molt 
part  conjoin’d  with  it,  as  we  fee  in  perfons,  who  are  much  inclin’d  to  fleep. 
For  although  a  fmall  quantity  of  water  would  prefs  the  fornix  lefs  ;  yet  it 
relax’d  ftill  more,  that  which  was  already  lax,  and  by  this  means  might  ren¬ 
der  the  man  drowfy,  and  heavy.  You  will  afk,  for  what  reafon  ?  Doubtlefs 
becaufe,  as  the  ufe  of  the  fornix  is  not  known,  nothing  forbids  us  to  fufped 
its  ufe  to  be  of  fuch  a  kind,  that  we  are  under  a  neceflity  of  being  fleepy, 
when  this  becomes  lax.  Perhaps  you  will  believe  I  am  not  ferious  now. 
However,  I  joke  very  fafely ;  for  I  maintain  that  there  is  nobody,  who  can 
demonftrate  my  fufpicion  to  be  really  a  falfe  one.  But  let  us  difmifs  this  fub- 
jed,  flnee  a  propenfity  to  fleep,  may,  perhaps,  not  only  be  accounted  for, 
from  that  defed  of  blood,  which  we  faw  there  was  in  the  vefiels  of  the  brain 
but  it  is  alfo  fufficient  here,  as  fleepinefs  has  been  already  explain’d  by  me, 
in  another  place,  to  fbew  the  only  thing,  which  I  undertook  to  (hew,  at  that 
time,  in  the  hofpital  alfo,  that  an  epilepfy  might  be  excited,  either  from  a 
fmall,  or  from  a  large  quantity  of  water. 

ii.  For  when  I  had  enumerated  thofe  marks  which  are  mentioned  above, 
of  much  water  having  been  previoufly  colleded,  and  had  pointed  out,  for 
the  fake  of  example,  how,  according  to  the  dogmas  of  Bellini  (*»),  from  too 
great  a  quantity  of  moifture,  fometimes  relaxing,  and  fometimes  contrading, 
thele,  or  thofe  nerves,  an  epilepfy,  without  even  fuppoflng  any  power  of 
Bimulus,  may  be  brought  on ;  this  other  fide  of  the  queftion  however,  I 
only  juft  touch’d  upon,  being  prevented  by  ftreightnefs  of  time-,  I  mean,, 
that  neverthelefs,  this  diforder  might  alfo  be  excited  by  the  power  of  a  ft  imu¬ 
lus,  and  even  might  have  been  excited  in  the  young  man,  at  prefent  treated 
of,  efpecially  as  a  mark  of  ftimulus  was  not  wanting,  which  I  there  alfo 
mention’d,  to  wit,  a  yellowifh  colour  of  the  water.  And  indeed  among 
thofe  phyficians,  who  fiourifh’d  before  the  more  modern  ones,  our  country¬ 
man  Saxonia  (»),  was,  in  preference  to  others,  of  the  fame  opinion.  Who, 
as  he  deduc’d  the  epileptic  convulfion  from  an  irritation  of  the  thin  mem¬ 
brane,  which  furrounds  the  ventricles  of  the  brain,  went  fo  far  as  to  fay, 
“  that  the  water,  fo  it  be  not  mix’d  with  a  bilious  juice,  and  therefore  be 
“  not  of  a  yellow  colour,  or  green,  does  not  bring  on  an  epilepfy.'’ 

(1)  Se&.  hac  12.  obf.  28  &  29.  (»)  c.  1 6.  cit.  fupra  ad  n.  8. 

I>e  raci'b.  Capit. 


7 


It 


200  Book  I.  Of  Difcafes  of  the  Head. 

It  is  true,  indeed,  that  there  are  frequently  found  in  the  heads  of  epilep* 
tic  patients  “  yellow  ftagnating  waters,  a  yellow  and  acrid  ferum,  a  yellowilh 
“  lymph,  and  a  citron-colour’d  ferum,  which  affedts  the  tongue,  after  the 
«  manner  of  a  fait,”  as  you  may  underftand,  even  from  this  fedtion  (0),  of 
the  Sepulchretum.  But  yet  Saxonia  ought  to  have  known,  that  Coiterus, 
who  was  indeed  a  mod  excellent  anatomift,  “  had  feen  many  times  in  epilep- 
“  tic  patients,”  a  water  “  like”  to  that,  which  he  had  feen  in  other  patients, 
who  had  labour’d  under  complaints  in  the  head ;  that  is,  “  limpid,  thin,  and 
«  pure and  this  “  much  more  often,  than  that  which  was  yellow,  or  like 
«  in  its  colour  to  bile,”  which  you  have  in  the  fame  fedtion  (/>)  :  alfo  to  fet 
in  oppofition  to  what  follows,  from  Saxonia,  a  little  after,  in  obfervation  the 
nineteenth,  and  efpecially  to  that  ipfe  dixit  of  his,  which  1  juft  now  produc’d  ; 
and  which  you  will  alfo  read  in  the  fcholia  fubjoin’d  to  that  obfervation.  From 
the  yeliowifh  colour  therefore,  when  water  is  impregnated  therewith,  I  con- 
jedture  indeed,  that  a  ftimulus  is  therein  ;  but  do  not  confine  all  the  means, 
by  which  it  may  ftimulate,  to  that  colour  only.  For  who  can  doubt,  but  that 
the  “  acrid  property,  and  that  which  affedfs  the  tongue  in  the  manner  of  a  fait,” 
as  we  mention’d  juft  now,  may  be  latent  even  in  limpid  water  ?  You  certainly 
fee  in  the  fifteenth  obfervation  of  this  fedtion,  “  that  an  epileply  has  fome- 
“  times  taken  its  origin  from  a  limpid,  warm,  and  fait  humour,  almoftlike 
46  the  aqua  fortis  that  is  ufed  in  gilding  nor  in  the  thirteenth  obfervation 
does  Mangoltius,  nor  in  the  fixteenth  Hippocrates,  fpeak  of  the  water,  which 
was  the  caufe  of  the  epilepfy,  being  ting’d  with  any  colour  ;  but  the  latter 
indeed  fays,  that  he  found,  in  an  ill-fmelling  brain,  “  an  eroding  and  col- 
“  liquating”  pituita,  and  the  former  “  a  fait,  fubacid,  acrid,  and  fomewhat 
tc  corrofive  tafte.”  Therefore  when  you  fliall  read,  that  Slevogtius  (q)  found 
in  a  dog,  who  was  epileptic,  “  a  turbid  and  citron-colour’d  water”  about  the 
ventricles  of  the  brain  ;  or  in  the  Ephemerides  Cefareae  Academiae  (r),rthat  in 
two  epileptic  patients,  a  boy,  and  a  man,  “  a  large  quantity  of  yellowilh  fe¬ 
rum”  had  occurr’d  within,  or  about,  the  cerebrum  ;  do  not  more  readily 
fuppofe,  that  there  might  have  been  a  ftimulus  in  thefe,  than  where  you  will 
learn  from  the  fame  Ephemerides  (/),  that  within  the  brain  of  a  young  man, 
and  in  like  manner  of  a  girl,  and  an  infant,  a  large  quantity  of  “  lymph”  had 
been  found,  as  it  was,  if  not  as  Gerbezius  there  thought,  ”  without  doubt” 
at  leaft  with  the  higheft  degree  of  probability,  “  acrid.”  What  if  water,  by 
its  quantity  alone,  can  irritate  ?  But  whether  it  be  much,  or  whether  it  be 
little,  fo  that  either  by  ftagnation,  or  by  ftimulating  particles  of  any  kind, 
being  now  and  then  added,  in  greater,  or  in  finaller  numbers,  in  proportion 
to  the  quantity  of  water,  which  then  is  colledted,  and  in  proportion  to  the 
fenfation  of  the  membranes,  which  are  more  or  lefs  tenfe,  it  become  irritating-, 
there  is  room  enough  for  us  to  conceive,  or  1  am  much  deceiv’d  indeed,  in 
what  manner  it  may  then  excite  an  epilepfy  ;  and  in  like  manner  alfo,  how 
it  came  about,  that  when  the  young  man  we  fpoke  of,  had  his  urine  en- 
creas’d  by  diuretics,  that  then  for  the  firft  time,  the  epileptic  paroxyfm  hap- 

( 0 )  Ob f.  10.  §  2.  &  in  addit,  obf.  7,  8,  16.  ( r )  Dec.  3.  A.  6.  Obf.  181.  &.  Cent.  10. 

(/>)  Sett,  hac  12.  obf.  6.  obf.  94. 

it)  Diflert.  de  Proceflib.  Mammillar.  §  33.  (/)  Cent.  3.  obf.  14.  n.  2.  &Cen.  7.  append. 

pen’d, 


/ 


8 


20  1 


Letter  IX.  Article  i  2. 

pen’d  ;  nearly  in  the  fame  manner,  that  Poggi  (t)  had  his  urine,  and  at  the 
lame  time  the  force  of  the  attacks  augmented  :  for  by  this  encreafe  of  the 
urinary  difeharges,  the  watry  humour  was  drawn  off  from  the  body,  with 
which  the  ftimulating  corpufcles,  whatever,  or  wherefoever  they  were,  had 
been  diluted  ;  and  in  proportion  as  this  diluting  fluid  was  decreas’d,  in  the 
conffitution,  the  ftrength  of  thefe  attacks  leem’d  to  encreafe.  And,  certainly, 
the  caufe  of  fo  violent  a  difeafe  is  not  to  be  eftimated  from  the  bulk  of  it, 
but  Irom  dts  power  and  properties.  Thus  Fernelius  («)  found,  “  at  one 

time  about  the  meninges,  and  at  another  time,  in  the  fubffance  of  the 
“  brain,  a  kind  of  putrid  and  glutinous  fanies,  in  quantity  about  the  bignefs 
“  of  a  bean,  which  was  the  fomes  of  this  vehement  and  cruel  difeafe.” 

In  anfwer  to  all  thefe  things,  however,  I  am  not  ignorant  that  two  objedtions 
may  be  made  •,  one,  that  there  are  perfons,  who,  relying  upon  obfervation 
and  experiment,  deny,  that  convulfions  arife  from  an  irritation  of  the  mem¬ 
branes  of  the  brain  ;  and  the  other,  that  this  very  water,  which  we  here  fup- 
pofe  to  be  the  caufe,  may,  perhaps,  be  the  effedi.  As  to  the  firft  objection, 
I  fhallhave  a  proper  occafion  of  examining  into  that,  below  (x) ;  and  as  to  the 
latter,  it  is  by  no  means  neceffary,  that  I  go  about  to  difeufs  it,  either  becaufe 
water  is  not  always  found  in  epileptic  patients,  though  convulfions  have  al¬ 
ways  preceded,  which  even  that  very  fedtion  of  the  Sepulchretum  teaches  (y)  *, 
or  for  other  reafons ;  fince  I  think  it  is  quite  lufficient,  on  this  occafion,  to 
retort  one  thing,  which  is,  that  I  do  not  affirm  for  a  certainty;  that  water  is 
fometimes  the  caufe  of  an  epilepfy,  but  only  fufpedt,  and  conjecture  :  and  it 
is  by  no  means  fair  or  equitable,  to  fuppofe,  that  one  fufpicion  is  entirely 
rooted  up,  by  another  fufpicion  being  objected  to  it.  But  let  us  go  on  to 
other  obfervations  of  my  own,  or  thofe  of  my  friends,  in  which  water  was 
fometimes  found,  and  fometimes  not. 

12.  A  man,  who  exercis’d  the  bufinefs  of  a  cook,  having  been  before 
fubject  to  diforders  of  the  urinary  paffages,  was  brought  into  the  hofpital  of 
St.  Mary  de  Vita,  at  Bologna,  on  account  of  a  violent  and  continual  fever, 
with  which  he  had  been  feiz’d.  I  faw  the  blood  that  had  been  taken  from 
him,  which  was  fo  concreted  in  the  glals  veflfel,  into  which  it  had  flow’d,  that 
adhering  all  round  to  the  fides  thereof,  it  had  fqueez’d  out  all  the  ferum 
above  it,  which  was  in  fmall  quantity,  and  bloody.  He  continu’d  to  grow 
worfe,  elpecially  in  an  evening.  About  the  twelfth  day  from  the  beginning 
of  the  fever,  he  died  epileptic.  As  I  had  not  paid  much  attention  to  this 
man’s  diforder,  fo  neither  was  I  prefent  at  the  diffedtion  ;  which  was  perform’d 
by  the  gentleman  who  afterwards  gave  me  the  narration,  Sebaftian  Anthony 
Trombelli,  at  that  time  a  very  diligent  ftudent,  but  afterwards  a  very  eminent 
phyfician,  and  furgeon,  at  Bologna. 

The  belly  had  nothing  worthy  of  notice,  except  the  kidneys :  one  of 
which,  being  round,  and  in  fome  meafure  refembling  a  cancer,  contain’d 
calculi  within  it ;  but  the  other,  I  fuppofe,  becaufe  it  fupplied  the  office  of 
both,  was  almoft  twice  as  big  as  it  naturally  Ihould  be.  The  thorax,  befide 
an  inflam’d  pleura,  exhibited  the  heart  and  great  veffels  turgid  with  a  very 

(/)  Supra,  n.  7.  (at)  N.  21. 

(«)  In  addit,  ad  hanc  fett.  obf.  1.  (y)  Obf.  34,  36,  38,  &C. 

Vol.  I.  D  d 


black 


20  2  Book  I.  Of  Difeafes  of  the  Head. 

black  and  fluid  blood,  which  was  then  quite  warm,  though  ten  hours  after 
death.  Finally,  in  the  head,  all  the  fmall  veflels,  whatever,  that  creep  on 
the  furface  of  the  brain,  were  very  red  and  turgid  •,  and  in  the  ventricles  of 
the  cerebrum  was  a  little  quantity  of  water,  and  that  limpid,  like  lymph. 

13.  If  you  do  not  chufe  to  lay  any  thing  to  the  charge  of  the  water  here, 
you  may  afcribe  the  epilepfy  to  the  ftate  of  all  the  fmall  veflels  of  the  brain  ; 
which  being  fo  diftended  with  a  blood  of  this  kind,  that  was  alfo  agitated, 
and  comminuted  by  the  fever,  diftrafted  the  pia  mater,  in  which  they  are 
inwoven,  and  could  not  but  irritate  it.  But  if  the  epilepfy  does  not  attack 
all  in  whom  the  veflels  are  thus  turgid,  perhaps  the  caufe  of  the  difference 
is  to  be  fought  for,  in  that  membrane’s  being  in  a  ftate  of  lefs  tenfion.  The 
fame  feCtion  of  the  Sepulchretum,  which  we  are  now  upon,  certainly  (hews, 
that  not  a  few  perfons  have  fall’n  into  epileptic  paroxyfms,  from  thefe  veflels 
being  diftended.  For,  topafs  by  the  twentieth  obfervation,  which  is  again  pro¬ 
pos’d  alfo  under  number  thirty-three ;  the  fecond  obfervation  in  the  addita¬ 
menta,  which  itfelf  likewife  is  again  repeated,  with  the  fame  inconfideratenefs, 
under  number  eleven,  exhibits  part  of  the  cerebrum  “  inflam’d  the  fixth, 
thofe  veflels  “  tenfe  and  turgid  and  the  fifteenth,  “  very  turgid.”  But 
you  will  fay,  that  in  all  thofe  bodies  there  was  not  only  a  turgefcency  of  the 
veflels,  but  alfo  extra vafated  blood,  in  the  cavity  of  the  cranium.  1  confefs 
it ;  but  in  all  thefe,  likewife,  there  was  not  only  an  epilepfy,  but  moreover 
an  apoplexy,  and  that  a  moft  grievous  one,  if  you  attend  to  it,  which  fuc* 
ceeded  to  the  epilepfy  :  fo  that  it  is  natural  to  conjecture,  that  fo  long  as  there 
was  only  a  diftenfion  of  the  veflels,  though  they  were  very  near  upon  rupture, 
by  the  diftraCtion  of  the  fibres  of  the  pia  mater,  an  epilepfy  alone  was  pro¬ 
duc’d  ;  but  when  they  were  already  ruptur’d,  and  their  contents  pour’d  out, 
that  then  a  fatal  apoplexy  was  the  confequence.  And  left  you  fhould  happen 
to  think,  that  this  is  juft  faid  at  a  venture,  read  the  following  very  Ihort  ob¬ 
fervation,  which  my  friend  Nicolaus  Mcdiavia  communicated  to  me. 

14.  A  porter,  about  forty  years  of  age,  having  on  thofe  days,  that  is, 
about  the  middle  of  Auguft,  in  the  year  17 29,  been  exercis’d  with  much 
labour  and  fatigue,  even  more  than  he  was  accuftom’d  to,  and  having  alfo 
over-fili’d  himfelf  with  food,  but  efpecially  with  fruits,  fell  into  an  epilepfy, 
which  he  had  never  before  been  troubl’d  with-,  and  being  brought  into  the 
hofpital,  he  died  in  a  few  days.  The  head,  which  was  the  only  part  difle&ed, 
had  nothing  at  all  in  it  worthy  of  attention,  if  you  except  the  turgency  of 
the  veflels  of  the  cerebrum. 

1 5.  If  you  read  over  the  cafe  of  Apellajus  Lariflaeus,  which  you  lee  men-, 
tion'd  in  the  laft  fcholium  to  the  nineteenth  obfervation  of  this  feCtion,  in  the 
fifth  book  of  Epidemics,  from  whence  it  is  taken  (z),  you  will  fee,  that  it 
was  fo  far  fimilar  to  this  juft  deferib’d,  that  he  was  carried  off  by  a  diforder 
of  that  kind,  when  he  had  been  “  very  voracious  of  a  great  quantity  of  food, 
*l  and  had  wteftl’d,  and  ftrain’d  himfelf  much.”  And  at  the  fame  time  you 
will  confefs,  that  to  guard  againft  epilepfies,  elpecially  of  this  kind,  the 
blood  fhould  neither  be  agitated  by  great  labours  and  fatigues,  particularly 

in  the  fummer  feafon,  nor  be  encreas’d  by  great  quantities  of  food,  efpecially 

•  / 

-  (a)  N.  U... 

•  ,o£ 


Letter  IX.  Article  1 6.  2  o  3 

of  the  fermenting  kind  j  and  that,  if  by  accident  it  has  been  encreas’d,  it 
ought  to  be  diminifh’d  by  convenient  bleedings,  according  to  thofe  happy 
examples  of  the  phyficians,  which  you  will  find  taken  notice  of  in  the  fcholia 
to  obfervation  the  thirty- fifth,  and  in  the  third  place.  From  which  you  may 
underlland,  that  although  the  diftenfion  of  the  languiferous  veffels  within  the 
cranium,  was  not  itfelf,  as  we  conjecture  in  a  certain  difpofition  of  the  me¬ 
ninges  and  cerebrum,  the  very  caufe  of  the  epilepfy,  yet  it  will  not  be  alto¬ 
gether  a  ufelefs  matter,  to  know,  what  can,  at  dealt,  cherifh,  and  encreafe  the 
ltrength  of  the  caufe  which  gives  origin  to  the  difeafe.  And  I  would  have 
you  fuppofe  this  to  be  faid  in  regard  to  fome  other  appearances,  which  were 
leen  by  me,  not  only  in  the  cerebrum  of  epileptic  patients,  but  in  others 
alfo  ;  as  the  former  letters,  compar’d  with  this,  will  fhew.  For  whatfoever  I 
find  that  is  preternatural,  in  the  diffeCtion  of  any  body,  I  never  fupprefs; 
but  enquire,  whether  of  itfelf  it  could  be  the  caufe  of  the  foregoing  diforder, 
or  only  when  join’d  together  with  others  •,  generally,  however,  making  pro¬ 
bable  conjeClures  only,  and  leldom  abfolutely  deciding  upon  any  thing.  Nor 
does  it  all  efcape  me,  that  it  is  poffible,  the  true  caufe  of  the  diforder  may 
be  altogether  imperceptible  to  our  ferries ;  and  that  not  only  in  thefe,  whofe  na¬ 
ture,  where  the  brain  is  concern’d,  is  fo  particularly  abftrufe,  but  even  in  many 
other  diforders  alfo :  and  that  for  this  reafon,  fometimes,  no  traces  of  injury 
whatever  were  any-where  found  in  the  brain,  by  the  mod  inquifitive  and  pene¬ 
trating  men,  after  an  epilepfy,  which  had  even  been  idiopathic,  as  fome  ob- 
fervations,  which  are  transferr’d  into  the  Sepulchretum,  teach  us  (a) ;  al¬ 
though,  indeed,  there  is  room  to  doubt,  whether  all  thefe  obfervations  were 
taken  from  patients,  who  had  labour’d  under  an  idiopathic  epilepfy  :  and 
Saltzmann  did  very  prudently,  when  he  conjectur’d,  in  regard  to  the  firft  of 
them,  that  the  woman  who  was  faid  to  be  epileptic,  and  had  no  difeas’d  ap¬ 
pearance  in  the  brain,  “  either  had  not  labour’d  under  an  epilepfy,  or  that 
“  the  epilepfy  had  been  fympathic,  or  from  confent.”  And,  indeed,  Thomas 
Bartholin  alfo  fays  (/>),  “  An  epilepfy  from  the  confent  of  the  inferior  parts, 
“  feldom  leaves  any  traces  behind  it  in  the  brain.”  But  let  us  come  to  thofe 
diforders  which  are  manifefi,  and  peculiar  to  the  brain  itfelf.  —  ' 

16.  A  woman,  aged  fixty  years,  who  had  for  almoft  two  years  been  fubjeCt 
to  an  epilepfy,  was  at  length  receiv’d  into  the  hofpital,  about  a  month  before 
her  death,  after  having  got  a  blow  upon  her  head,  by  falling  down  in  one 
of  her  fits.  At  firft,  no  external  figns  of  injury  appear’d  upon  the  cranium, 
nor  yet  any  internal  fymptoms  of  the  brain’s  being  injur’d.  It  was  after¬ 
wards  underftood,  that  the  blow  had  been  receiv’d  on  the  middle  of  the  os 
bregmatis,  on  the  left  fide  ;  yet  when  the  bone  was  there  uncover’d,  no  lefion 
appear’d.  And  in  regard  to  the  brain,  that  was  no-way  affected,  but  by 
the  epilepfy,  which  was  a  diforder  of  long  (landing;  and  its  paroxyfms  ge¬ 
nerally  recurr’d  after  this  manner.  The  patient  at  firft  trembl’d  (lightly,  then 
lay  in  a  manner  rigid,  immoveable,  and  filent,  till  (he  came  entirely  to  herfelf. 
Then,  indeed,  (he  might  once  have  been  thought  to  be  delirious  ;  if  it  had 
not  rather  been  believ’d,  that  (he  anfwer’d  lels  properly  to  any  queftion,  from 
a  kind  of  ftupidity,  which  was  left  behind,  by  the  epileptic  attack,  from 

{a)  Sett,  hat  1  z.  obf.  36,.  38.  §  prsefertim  2.  (i)  Cent.  2.  Hift.  Anat.  92. 

2  D  d  2  which 


2  04  Book  I.  Of  Difeafes  of  the  Head. 

which  ftie  had  juft  emerg’d.  But  laft  of  all,  there  was  an  evident  delirium  ; 
and  this  was  join’d  with  an  acute  fever,  which  however  was  flight,  nor  at¬ 
tended  with  any  mark  of  the  brain’s  being  affefted  with  any  diforder  befides 
this.  And  even  on  the  three  or  four  laft  days,  the  pulfe  being  quite  funk, 
Ike  was  perfedtly  fenflble,  till  at  length  flie  died  about  the  middle  of  De¬ 
cember,  in  the  year  1741. 

Befide  the  head,  I  difle&ed  only  the  urinary  and  genital  parts.  In  thefe 
nothing  appear’d  which  was  not  natural,  except  the  fund  of  the  uterus,  whole 
internal  furface  we  found  entirely  of  a  blood  colour,  degenerating  into  black- 
nefs ;  yet  in  fuch  a  manner,  that  this  colour  did  not  penetrate  deeply  into  the 
fubftance  of  the  uterus.  And  that  this  was  not  to  be  imputed  to  the  men- 
ftruous  blood,  not  only  the  age  of  the  woman  was  a  prefumption,  but  even 
the  preffure  of  the  uterus  between  the  fingers  confirm’d  ;  for  by  that  means 
no  blood  came  forth.  The  cranium  being  diligently  examin’d,  on  its  internal 
furface,  offer’d  nothing,  indeed,  that  was  worthy  of  remark  ;  although,  ex¬ 
ternally,  that  part  of  the  bone  was  red,  which  I  mention’d  above.  More¬ 
over,  although  the  pofterior  and  external  furface  of  both  the  fincipital  bones- 
appear’d  to  be,  in  a  manner,  deprefs’d,  yet  nothing  was  feen,  internally,  cor- 
refponding  thereto,  which  was  found  to  be  unufual,  or  preternatural.  The 
meninges  were  every-where  found,  fo  as  not  even  to  have  any  fullnefs,  or 
diftenfion,  in  their  veffels.  But  fcarcely  was  the  dura  mater  taken  off,  when 
we  obferv’d,  that  in  the  left  hemifphere  of  the  brain,  the  third  and  anterior 
lobe  was  much  lower  than  its  fellow,  and  much  fofter;.  and  not  only  in  the 
upper  part,  but  entirely  throughout  its  fubftance,  the  bafis,  as  well  as  the 
other  parts,  not  excepted.  Without  doubt,,  it  had  funk  thus  by  reafon  of 
that  foftnefs  ;  which  was  very  evident  in  the  cortical  fubftance,  but  much 
more  fo  ftill  in  the  medullary.  For  this  laft,  in  particular,  was  chang’d  into 
a  kind  of  jelly,  in  the  greateft  part  of  it,  which  was  of  a  cineritious  colour, 
degenerating  into  brown,  and  yet  almoft  tranfparent.  And  this  diforder  had 
alfo  affedted  the  anterior  portion  of  the  lateral  ventricle,  which  was  com¬ 
prehended  within  that  part  of  this  hemifphere  pointed  out.  There  was  no¬ 
where  any  ftrong,  or  difagreeable  fmell  •,  no-where  any  pus,  or  any  thing 
bloody,  in  this,  jelly  :  fo  that  it  feem’d  to  be  a  diforder  of  a  peculiar  kind. 
In  the  remainder  of  the  cerebrum,  and  cerebellum,  every  thing  was  found  ; 
fo  that  fcarcely  as  much  water  as  could  be  contain’d  in  a  fpoon  at  once,  which 
was,  perhaps,  fomewhat  red  from  the  blood  that  had  been  mix’d  with  it,  in 
diffedlion,  was  found  in  the  lateral  ventricles.  Yet  a  little  quantity  of  water; 
had  flow’d  out,  while  the  cranium  was  faw’d  round  about. 

1.7.  It  feem’d  very  furprifing  to  every  one,  who  was  prefent  at  the  diffec- 
tion,  that  this  woman  had  liv’d  fo  long,  with  fo  great  diforder  of  the  brain,, 
as  is  defcrib’d  above  ;  whether  this  diforder  had  begun  before  the  blow,  which 
her  head  had  receiv’d,  or  its  origin  was  to  be  dated  from  thence.  The  latter 
of  which  fuppofitions  feems  to  be  argu’d,  from  the  injury  of  the  brain  being 
fituated  on  the  fame  fide,  where  the  blow  had  been  receiv’d.  Yet  if  this  was 
the  caufe  of  the  epilepfy,  a  difeafe  which  had  fo  long  before  infefted  the  pa¬ 
tient,  it  muft  neceffarily,  according  to  our  former  fuppofition,  have  exifted 
for  a  long  time,  before  the  blow  was  inflidted.  Nor  am  I  without  having 
other  examples,  of  a  corruption,  or  rottenn.efs  of  this  kind,  without  any 

previous. 


Letter  IX.  Articles  i  8,  19.  205 

previous  blow  of  the  brain  ;  one  of  which  you  will  eafily  acknowledge,  in 
another  woman,  if  you  read  over  again  the  fifth  letter  (c) ;  although  that 
medullary  fubftance  of  the  cerebrum,  which  was.  in  a  manner  colliquated,  and 
inodorous,  had  fomething  of  a  bloody  mixture,  and  had  brought  on  an 
apoplexy,  with  a  palfy  on  the  oppofite  fide  of  the  body  ;  and  not  an  epi- 
lepiy,  although  it  took  up  much  lefs  room,  than  the  dilorder  we  at  prefent 
treat  of.  But  this  difference  is  perhaps  to  be  attributed  to  the  different  part 
which  it  occupied,  to  wit,  the  fide  of  the  optic  nerve,  which  ought  particu¬ 
larly  to  be  attended  to  •,  at  leaft  as  much  as  the  other  example,  that  I  am 
going  to  relate,  will  permit. 

18.  A  man  of  a  low  flature,  and  a  {lender  habit,  being  feiz’d  with  a  violent 
return  of  the  epilepfy,  which  he  had  been  before  wont  to  be  afflicted  with, 
was  taken  off  thereby,  in  a  very  few  days.  On  diligently  examining  the 
principal  parts  of  the  body,  after  death,  in  April  1722,  l  obferv’d,  that  in  the 
abdomen,  the  right  kidney  was  larger  than  the  left.  In  the  thorax  were  here 
and  there  little  beginnings  of  offification,  in  the  curvature  of  the  aorta,  in 
the  head,  befides  unequal  dilatations,  in  fome  parts  of  one  of  the  vertebral 
arteries,  and  that  into  which  it  open’d,  call’d  bafilary,  by  the  celebrated 
Window  ( d ),  there  was  nothing  at  all  in  the  other  veffels,  worthy  of  our  at¬ 
tention,  which  were  neither  empty,  nor  prasternaturally  diftended  with  blood. 
Nor  was  water  any  where  extravafated.  But  at  the  extreme  part  of  each 
thalamus  of  the  optic  nerves,  the  colour  degenerating  from  yellow  to  black, 
made  a  difcovery  of  the  diforder,  in  the  medulla  which  lay  under  it :  and 
indeed,  to  as  great  a  depth,  as  this  fubftance  was  ting’d  with  that  colour, 
defcending  into  it,  fo  far  was  it  fofter  than  it  ought  to  be,  and  appear’d  in  a 
manner  half-corrupted,  to  thofe  who  look’d  upon  it. 

19.  Has  that  “  fpot”  any  reference  to  the  prefent  cafe,  concerning  which, 
the  paifage  of  Henricus  Petraeus  is  quoted  in  the  Sepulchre-turn  (e)  ?  “  In 
“  the  diffedlion  of  thofe,  who  have  died  of  an  epilepfy,  no  trace  of  obftruc- 
44  tion  appears,  but  fometimes  a  fpot,  fometimes  a  black  humour,  and  frothy, 
“  and  fometimes  nothing  at  all.”  Certainly  the  fpot  in  both  the  examples 
produc’d  (/),  was  a  difcovery  to  me  of  the  diforder  that  lay  near  it,  which 
by  cutting  deeper  into  it,  was  of  itfelf  fully  difcover’d.  But  to  this  peculiar 
kind  of  corruption  in  the  brain,  this  feems  to  relate,  which  was  obferv’d  in 
that  great  man  Alexander  Marchetti,  who  was  taken  off  by  a  violent  apoplexy, 
after  having  fuffer’d  two  attacks  of  an  epilepfy,  within  the  fpace  of  a  few. 
days  (g).  For  “  the  cortical  fubftance  of  the  brain  was  very  tender,  fo  that 
“  by  a  flight  touch  it  was  converted  into  a  fluid  fubftance,  as  if  it  had  never 
<e  coher’d.”  And  that  corruption,  alfo,  has  an  affinity  with  this,  except  its 
being  much  deeper,  which  Erneft  Gotti.  Schmidtius  ( h )  faw  in  a  foldier,  after 
very  grievous  pains,  and  other  diforders  of  the  head,  that  were  the  confe- 
quence  of  a  blow  thereon  •,  and,  in  like  manner,  that  which  Carlo  Curti  (/) 
obferv’d  in  a  young  woman,  after  an  apoplexy.  For  the  firft  not  only  found 

(<■)  n.  6.  fgj  Eph.  N.  C.  cent.  7.  in  append.. 

(^)  Expof.  anat.  tr.  des  arter,  n,  99.  &  f<q.  ( b )  Obf.  Chir.  Tetr,  obf.  3. 

\e)  Se£t.  hac  iz.  obf.  14.  (;)  Difcufficni  di  u/i  rgro  raorbo  cutan,  &c. . 

(y)  n.  17,  &  18,  in  una  nota. 


a  trau  fr 


2o  6.  Book  I.  Of  Difeafes  of  the  Head. 

a  tranfmutation  of  the  whole  right  hemifphere  of  the  brain,  fo  that  its  fub-< 
ftance  “  was  like  a  kind  of  pretty  fluid  jelly,  or  rather  a  colliquated  matter, 

“  which  flow’d  abroad  with  the  leaft  touch  but  the  fame  tranfmutation  alfo 
“  had  in  like  manner  proceeded  in  various  places”  to  the  left  hemifphere. 
And  the  other  found  the  whole  right  hemifphere,  and  its  meninges,  chang’d 
into  a  mucous  fubftance ;  fo  that  following  the  point  of  the  knife,  which  rais’d  • 
it  up,  it  was  drawn  out,  after  the  manner  of  a  thread.  But  the  anterior  ex¬ 
tremity  of  each  hemifphere,  in  a  man  whom  the  celebrated  Kaavius  dif¬ 
fered  (£),  had  pafs’d  into  a  more  evident  abfcefs,  or  at  leaft  not  a  dis¬ 
order  of  this  kind,  though  the  man,  and  his  hiftory,  were  both  unknown, 
as  he  was  found  dead  in  the  public  way.  For  the  cortical  part  of  the  brain 
“  was  converted  into  a  foetid,  yellow  mucus,  fo  that  the  vefiels  of  the  pia 
“  mater  floated  loofely  therein.”  Here  you  fee  the  diforder  had  a  foetid 
fmell  attending  it,  which  is  fpoken  of  in  no  other  of  the  obfervations, 
that  have  been  produc’d,  and  even  in  one,  is  exprefsly  deny’d,  and  was  cer¬ 
tainly  wanting  in  the  four  made  by  me  *,  the  laft  of  which  I  took  from  an  old 
woman  who  died  of  an  apoplexy,  and  fhall  fend  the  account  of  to  you,  on 
another  occafion  (/).  But,  to  return  to  the  woman  who  had  the  contuflon  on 
her  head  ( m ) ;  whether  the  diforder,  which  we  found  in  her  brain,  had  its 
origin,  as  in  the  three  others  differed  by  me,  and,  in  like  manner,  as  in 
Marchetti,  and  the  woman  that  Curti  mentions ;  or  whether  it  was  rather 
the  confequence  of  that  blow,  as  in  the  foldier  whom  the  celebrated  Schmid - 
tius  fpeaks  of;  I  leave  entirely  to  your  judgment  to  determine,  and  even  (till 
more  in  one,  and  another,  of  whom  I  fhall  now  give  you  an  account. 

20.  A  man  being  ftricken  on  the  head,  by  a  log  of  wood  falling  upon 
him,  was  thereupon  feiz’d  with  an  epileptic  diforder,  to  which  it  was  faid  he 
had  been  before  liable  ;  however,  he  was  certainly  attack’d  with  them  much 
more  often,  in  the  few  months  which  he  liv’d  afterwards,  and  Still  more  often 
in  the  laft  week  of  his  life.  He  was  befides,  fhaken  with  fo  great  a  tremor, 
that  they  were  oblig’d  to  confine  him  with  bands,  left  he  fhould  fall  out  of 
bed.  An  amaurofis  alfo  had  come  on ;  for  he  now  difcern’d  nothing,  al¬ 
though  no  diforder  appear’d  in  the  eye,  befide  a  dilatation  of  the  pupil.  But 
as  to  the  other  actions,  which  are  call’d  animal  actions,  he  neither  complain’d 
himfelf,  nor  did  he  feem  to  others  to  be  injur’d,  unlefs  that  he  was  not  quite 
fo  ready  as  ufual,  in  anfwering,  when  a  queftion  was  afk’d  him.  Being  thus 
affe&ed,  he  died  away  by  degrees.  The  head  came  to  me  to  be  differed, 
when  I  was  teaching  anatomy  in  the  college,  in  the  month  of  February,  1728. 
The  upper  part  of  the  cranium,  if  you  except  fome  places,  in  which  it  was 
naturally  thick,  protuberated  inwards,  and  was  every  where  fo  thin,  that  it 
was  hardly  credible.  And  even  in  one  place,  which  belong’d  to  the  right  bone 
of  the  finciput,  it  had  a  foramen  almoft  of  an  elliptical  figure,  a  little  lefs 
than  to  admit  the  point  of  a  little  finger,  {hut  up  with  a  membrane,  without 
the  leaft  fign  of  caries  round  about  the  edges  thereof,  or  any  where  in  the 
whole  cranium.  Neverthelefs,  to  this  foramen,  which  was  Ihut  up  as  I  have 
defcrib’d,  a  little  foramen,  in  the  dura  mater  beneath  it,  correfponded, 

(&)  Nov.  Comm,  Acad.  Sc.  Petropol.  T,  1.  (/)  Epift.  57.  n.  14.  VicL  &  Epift.  60.  n.4. 

obf.  Anat.  3.  (m)  Supra,  n.  16. 


from 


Letter  IX.  Article  21.  207 

from  which  a  ferum  of  a  brown  colour  iftu’d  out.  This  fmall  foramen 
communicated  with  a  cavity,  big  enough  to  receive  the  bulk  of  a  large  egg, 
full  of  the  fame  kind  of  brown  ferum,  in  which  a  fmall  quantity  of  coagu¬ 
lated  blood  had  fubfided.  This  cavity  was  of  an  irregular  form,  and  had  an 
unequal  furface  internally  \  and  the  parts  of  the  brain,  which  were  neareft  to 
it,  round  about,  had  loll  their  natural  colour,  and  were  ting’d  of  a  dirty 
brown,  which  was  an  indication  of  the  fubftance  being  half-corrupted  :  but 
more  efpecially,  that  part  of  the  bafis  of  the  cerebrum,  which  is  plac’d  upon 
the  pofterior  region  of  the  right  orbit,  and  alfo  the  anterior  part  of  the  right 
corpus  ftriatum,  which  lay  above  that.  And  even  the  thalamus  nervi  optici, 
on  the  fame  fide,  although  it  was  pretty  remote  from  the  cavity,  yet  feem’d 
to  be  fhrunk  and  wafted.  Yet  both  of  the  optic  nerves,  when  infpefted  on 
the  infide,  and  on  the  outfide,  of  the  cranium,  as  alfo  the  feveral  parts  of 
both  eyes,  though  diligently  dififedted  by  me,  fhew’d  no  fault,  or  diforder, 
any  where,  that  could  fall  under  the  notice  of  thefenfes,  whether  I  confider’d 
the  colour,  the  magnitude,  the  firmnefs,  or  the  ftrudure  thereof.  But  al¬ 
though  the  left  hemifphere  had  none  of  thofe  appearances,  which  were  re¬ 
mark’d  in  the  right-,  yet  in  the  left  lateral  ventricle  was  much  pellucid  wa¬ 
ter,  and  the  plexus  choroides  were  pale,  and  colourlefs,  with  a  few  fmall  ve- 
ficles  upon  them  :  the  whole  cerebrum  alfo  was  of  a  dirty  yellowifh  colour, 
and  its  veflels  were  very  turgid  with  black  blood.  Finally,  the  pituitary 
gland  was  very  much  deprefs’d,  and  fmall,  but  not  hard. 

21.  Concerning  the  amaurofis,  which  had  fall’n  on  each  eye,  although  the 
brain  was  only  injur’d  on  one  fide  ;  this  is  not  the  proper  occafion  of  examin¬ 
ing  into  it  (»)  nor  yet  in  regard  to  thofe  continual  tremors,  or,  if  you  chufe 
rather  to  call  them  fo,  convulfive  motions.  But  in  regard  to  the  abfcefs. 
exciting  the  epilepfy,  or  at  leaft  much  more  frequently  than  ufual  in  the  fame 
man,  I  would  have  you  compare  therewith,  the  difiedtion  of  Alexander 
Marchetti  (0),  above  pointed  out ;  for  in  his  brain,  befide  what  I  have  there 
taken  notice  of,  there  was  alfo  an  abfcefs  not  very  diftimilar  to  this.  You 
have  befides,  in  the  Sepulchretum  (p),  the  obfervations  of  Fernelius  and 
Smetius  the  former  of  which,  though  you  will  fee  them  repeated  in  another 
place,  I  had  rather  you  would  read  in  the  firft  place  they  are  lpoken  of, 
where  he  fays,  in  regard  to  the  epilepfy  which  has  its  origin  from  the  brain, 
“  that  he  had  fometimes  found  the  caufe,  to  be  an  abfcefs  of  the  cerebrum : 
«  and  fometimes  a  corrupted  portion  of  the  meninx,  adhering  to  the  Ikull.” 
For  in  the  hiftory  given  by  me,  you  have  both  caufes  to  recur  to,  that  is, 
the  abfcefs  of  the  cerebrum,  and  a  corruption  of  both  the  meninges,  though 
but  fmall,  brought  on  from  the  moft  filthy  humour,  which  had  corroded 
and  perforated  them.  But  Willis,  you  will  fay,  did  not  admit  of  this  fecond 
caufe  i  inafmuch  as  he,  as  you  will  alfo  read  in  the  Sepulchretum  {q\  neither 
from  an  abfcefs  form’d  in  the  dura  mater,  nor  from  the  moft  foetid  pus,  dif- 
charg’d  from  thence,  and  corroding  the  pia  mater  alfo,  nor  even  from  a 
great  laceration,  by  the  trepan  of  an  unlkilful  furgeon,  did  ever  fee  any  dif¬ 
order  of  an  epileptic  kind  brought  on.  And  I,  befides  thefe  things,  am  by 

(»)  Vid.  epift.  13.  n.  6v  ,  {£)  Seft.  hat  12.  obf.  2.  &  2J.  n.  1,  &  2», 

\o)  n.  19.  •  -  v  /  (j)  ibid,  in  fchul.  ad  obf.. 1. 

no. 


2  0  3'  Book  I.  Of  Difeafes  of  the  Head. 

no  means  ignorant  of  the  experiment  of  Ridley  (r),  that  he  made  upon  a 
dog,  which,  after  a  perforation  of  the  dura  mater,  “  was  free  from  convul- 
“  fion  of  every  kind.”  None  of  all  thefe  things  would  I  dare  to  deny.  I 
will  rather  feek  the  reafon  of  the  difference  between  thefe,  and  the  contrary 
obfervations,  and  contrary  experiments  of  other  perlbns.  And  to  contrait 
my  difcourfe  upon  many  things,  into  a  few  words  ;  you  have  doubtlefs  read 
in  the  hiftory  of  the  Royal  Academy  of  Sciences  at  Paris  (/),  that  in  a 
young  man  who  had  labour’d  under  an  epilepiy  of  long  ftanding,  and  which, 
in  procefs  of  time,  had  encreas’d  in  the  number  and  violence  of  its  accefiions*, 
the  caufe  thereof  was  found  to  be,  fotne  exceedingly  fmall  bones  which  had 
their  bales  in  the  dura  mater,  and  their  very  acute  apices,  or  points,  fo  turn’d 
againft  the  pia  mater,  that  they  could  not  but  prick  and  irritate  it,  and  fo 
much  the  more,  the  more  they  encreas’d.  You  have  alfo  feen,  to  pafs  over 
other  experiments  of  the  Italians  at  prefent;  you  have,  I  fay,  feen  in  the 
commentaries  of  the  academy  of  Sciences  at  Bologna  (/),  that  when  the  ce¬ 
lebrated  Peter  Paul  Molinelli  “  often  prick’d  the  dura  mater,”  which  was 
partly  laid  bare,  in  a  living  dog,”  he  obferv’d  that  the  dog  was  diftorted, 
with  various  convulfions,  “  efpecially  when  that  part  of  the  dura  mater  was 
“  prick’d,  which  adher’d  the  mod  clofely  to  the  bone.” 

Shall  we  therefore  account  for  the  apparent  difference  from  this  latter  part 
of  the  experiment,  and  conjecture  that  which  reafon  itfelf  feems  alfo  to  con¬ 
firm,  that  unlefs  the  meninges  are  equally  tenfe,  equal  effeCts  are  not  to  be 
expeCted  from  their  irritation  ?  And  this  greater  tenfenefs  may  be  brought 
about,  not  only  by  an  adhefion  to  the  bone,  but  by  other  circumftances  alio ; 
as  for  inltance,  by  a  diftenfion  of  the  vefilds  in  both  of  the  membranes,  and 
by  too  great  a  hardnefs  of  the  cerebrum  in  the  pia  mater,  that  immediately 
invefts  it.  Which  two  appearances,  you  will  remember,  were  remark’d  by 
me,  in  fome  bodies,  that  I  fpoke  of  above  (u),  and  particularly  in  this  which 
I  fpeak  of  at  prefent  ;  and  if  not  conjointly,  at  leaft  feparately.  For  thus  you 
will  more  readily  admit  the  conjectures,  which  I  advanc’d  in  refpeCt  of  thefe 
patients,  concerning  the  irritation  of  the  membranes  of  the  brain.  And  af¬ 
ter  the  fame  manner  alfo,  you  will  be  able  to  underftand  that  which  is  related 
<  in  another  part  of  the  hiftory  of  the  Royal  Academy  already  commended  ( x ), 
of  the  fharp  points,  or  prickles  of  little  bones,  flicking  out  from  one  fide  of 
the  upper  part  of  the  finus  of  the  falx,  and  exciting  epileptic  paroxyfms,- 
without  any  alleviation,  except  from  large  evacuations  of  blood.  On  the 
other  hand,  in  the  dog  fpoken  of  by  Ridley,  “  a  hemorrhage”  had  preceded  the 
perforation  of  the  dura  mater,  which,  if  it  had  been  flight,  would  not  have 
been  mention’d  by  the  author  of  the  experiment.  And  from  this  caufe, 
with  fo  much  the  more  eafe,  a  laxity  might  happen,  as  that  part  of  the  dura 
mater  which  was  perforated,  no  more  adher’d  to  the  bone.  And  nothing 
forbids  us  to  fufpeCt,  that  in  one  or  two  obfervations  of  erofion,  or  perfora¬ 
tion,  of  the  dura  and  pia  mater,  induftrioufly,  perhaps,  feleCted  by  Willis, 
from  a  great  number,  to  fuit  his  prefent  purpofe  and  opinion,  there  were  at 
leaft:  fome  caufes  of  laxity,  if  not  of  the  fame  kind  as  thefe :  which  laxity,  if 

(r)  A&.  Erud.  Lipf.  M.  Maj.  («)  n.  9,  12,  14. 

(s)  A.  1 7 1 1 .  obf.  Anat.  6.  (*)  A.  1734.  obf.  Anat.  2. 

(/)  Tom.  I.  ubi  Anatomica. 


it 


Letter  IX.  Articles  22,  23.  209 

it  had  exifted  in  the  young  man,  and  in  like  manner  in  that  general,  one  of 
whom  you  read  of  in  the  fourth  obfervation  in  this  fedtion  of  the  Sepulchretum, 
and  the  other  in  the  twenty-feventh  obfervation,  and  more  at  large  in  the  firfl: 
fedtion,  obfervation  fixty-nine,  though  erroneoufly  mark’d  by  the  printer 
forty-nine,  I  believe  the  dura  mater  44  being  eroded”  with  puftules,  would 
not  have  brought  an  epilepfy  on  the  former  ;  nor  in  the  latter  44  a  pretty  large 
bone,  that  was  (harp  like  a  ftar  ftone,  would,”  with  fo  much  eafe,  44  have 
44  given  occafion,  by  the  point  thereof,  to  the  inflammation,  and  corruption 
44  of  the  dura  mater,  join’d  with  an  epilepfy.” 

22.  But  that  lharp  bone  found  44  in  the  middle  of  the  brain,”  as  it  hurt  the 
dura  mater  by  its  point,  makes  me  conjedture  that  it  was  plac’d  betwixt  the 
two  hemifpheres ;  fo  that  it  belong’d  to  the  falx,  and  the  neighbouring  parts 
of  the  meninges,  and  not  to  the  fubflance  of  the  brain  ;  efpecially  as  the  au¬ 
thor  of  the  obfervation,  in  order  to  remove  all  fufpicion  of  the  bone  having, 
perhaps,  fall’n  down,  from  the  neareft  part  of  the  cranium,  which  might 
formerly  have  been  broken,  into  that  place,  has  by  no  means  faid  what  he 
ought  not  have  omitted  to  inculcate,  that  there  had  never  been  any  previous, 
violent,  and  confiant  fymptoms  of  that  fubftance  being  wounded  ;  but  has 
only  added,  44  that  no  mark  of  the  cranium  having  been  formerly  broken, 
44  or  of  a  remaining  cicatrix,  was  obferv’d.”  Which  words  put  me  in  mind 
of  obviating  your  doubt.  For  you  may,  perhaps,  enquire,  whether  I 
think,  that,  in  the  man  of  whom  we  now  treat,  the  foramen,  which  was  ob¬ 
ferv’d  in  the  fkull,  is  to  be  attributed  to  the  bone  being  taken  away,  by  the 
furgeon,  after  a  blow,  or  to  the  bone  being  formerly  eroded  ?  But  I  can¬ 
not  admit,  on  this  occafion,  either  one  caufe  or  the  other,  fince  I  know  that 
no  mention  was  made  of  furgery  having  been  applied  to,  in  confequence  of 
the  blow  ;  and  I  faw  no  trace  of  a  cicatrix,  either  above,  or  below  the  fora¬ 
men,  nor  the  lead  mark  of  the  bone  having  ever  been  affected  with  a  caries ; 
fo  that  I  have  fometimes  rather  been  tempted  to  think,  much  in  the  fame 
manner  as  Lancifi  did  (r),  in  relation  to  a  foramen  altnoft  fimilar  to  this, 
found  in  the  fame  bone  of  an  apopledtic  man  ;  I  mean,  that  the  bone  had 
been  imperfect  from  its  original  formation,  nor  that  this  part  of  the  bone 
had  been  fill’d  up-,  efpecially,  as  the  general  thinnefs  of  the  cranium  prov’d 
an  original  deficiency  of  bony  matter.  Neverthelefs,  when,  on  the  other 
hand,  I  call  to  mind  the  abfeefs  deferib’d  in  the  brain,  and  the  cavity  of  it, 
which  was  fubjedled  to  that  foramen,  and  in  the  fame  place,  the  twv  menin¬ 
ges  pierc’d  through  with  a  fmall  foramen,  which  comunicated  with  the  cavity, 
i  confefs,  that  I  am  not  a  little  in  doubt  upon  the  decifion.  Wherefore,  1 
will  rather  add,  in  this  place,  the  obfervation  of  Nicolaus  Mediavia,  which 
you  may  compare  with  this  ;  for  in  that  an  abfeefs  of  the  cerebrum,  and  an 
epilepfy  were,  at  the  fame  time,  join’d  with  certain  erofions  of  the  cranium. 

23.  A  woman  had  two  venereal  tumours,  in  the  upper  part  of  her  fore¬ 
head,  of  the  fame  kind  with  thofe  that  are  call’d  44  gummata.”  Mercury 
being  given  to  her  on  that  account,  a  falivation  was  excited.  In  confequence 
of  which,  the  left  tumour  fubfided,  but  the  right  remain’d.  And  where  the 
tumour  had  fubfided,  a  pulfating  protuberance  appear’d.  It  was  certain, 

(y)  De  Subir.  Mortib.  obf.  i.  mortuor. 

E  e 


Vo L.  L 


that 


2io  Book  I.  Of  Difeafcs  of  the  Head. 

that  the  woman,  before  the  ufe  of  mercury,  had  been  fubjedt  to  an  epilepfy : 
and  once  indeed. in  the  middle  of  the  cure,  and  again,  when  this  was  com¬ 
pleted,  (he  was  agitated  with  convulfioas,  attended  v/ith  a  foam  flowing  out  of 
her  mouth.  At  length,  without  having  any  part  of  her  body  aflfedted  with  a  pa- 
ralyfis,  but  lying  for  fome  days,  in  a  kind  of  fleep,  as  it  were,  fo  that  Ihe 
leldom  fpoke,  Ihe  died,  about  the  middle  of  October,  in  the  year  1739. 

Upon  diligently  examining  the  cranium,  and  cerebrum,  it  was  found  that 
the  prominence,  which  I  mention’d  above,  was  cover’d  over  with  a  kind  of 
membrane,  not  thinner  than  that  thickeft  fort  of  paper  which  is  commonly 
call’d  pafteboard,  but  flaccid ;  fo  that  being  rubb’d  together,  betwixt  the 
fingers,  it  was  eafily  broken  afunder.  This  membrane  occupy’d  the  place  of 
both  meninges  in  that  part;  for  the  cortical  iubftance  of  the  cerebrum  was 
immediately  under  it,  which  was  from  thence,  quite  to  the  medullary,  much 
harder  than  it  ought  to  have  been,  that  is,  not  lefs  hard,  than  the  fubftance  of 
the  liver.  But  the  remainder  of  the  left  hemifphere,  except  the  polterior 
part,  was,  on  the  contrary,  much  more  foft  than  it  naturally  fhould  be. 
And  within  it  was  a  cavity,  of  the  bignefs  of  a  fmall  wallnut,  contain’d 
within  very  foft  and  livid  parietes  of  the  medullary  fubftance ;  from  which,  hav¬ 
ing  an  aperture  at  the  upper  part,  a  humour,  at  firft  blackifh,  then  of  the 
colour  and  confidence  of  ferum,  in  which  a  kind  of  filaments  fwam, 
flow’d  out ;  not  having  any  ill  fmell  whatever.  This  cavity  lay  over  the  an¬ 
terior  part  of  the  lateral  ventricle,  with  which,  however,  it  did  not  in  the 
leaf!:  communicate  ;  nor  yet  with  that  prominence  which  is  defcrib’d  ;  and 
was  even  diftant  from  it  about  two  fingers  breadth.  But  in  the  cranium  was 
a  foramen  of  an  eliptic  form,  correlponding  to  this  prominence,  having  its 
borders  every  where  equal  and  regular,  as  if  they  had  been  fmooth’d  down 
with  a  file.  Thefe  were  the  appearances  on  the  left  fide.  And  on  the  right 
was  nothing  worthy  of  remark  in  the  cerebrum.  As  to  what  belongs  to  the 
brain  •,  the  tumour  on  the  right,  which  had  not  fubfided,  had  not  yet  pene¬ 
trated,  by  its  corrofion,  to  the  internal  furface  of  the  bone.  But  in  the  other 
place,  where  the  bone  was  entirely  wanting,  a  kind  of  thick  membrane  lay 
beneath  :  was  it  becaufe  the  other  tumour,  upon  taking  of  mercury,  had 
fall’n  away  from  thence  before  ? 

24.  If  you  compare  this  difledtion  with  thofe  few,  in  this  fedtion  of  the 
Sepulchretum,  Be  epilepjia ,  which  we  are  now  upon  (2),  that  relate  to  the 
venertai  caries  of  the  cranium,  and  gummata  ;  you  will,  perhaps,  let  the 
greater  value  upon  it,  becaufe  it  fhews  what  has  been  the  confequence  of 
gummata  in  the  cranium,  and  the  cerebrum,  that  was  fituated  near  them. 
But  you  will  not,  I  fuppofe,  imagine,  that  the  abfcefs  belong’d  altogether 
to  the  gummata  (a)  *,  as,  on  the  other  hand,  you  will,  no  doubt,  judge  that 
the  hardnefs,  which  was  left  in  the  cortical  portion  of  the  cerebrum,  lying 
under  the  gumma,  had  a  reference  thereto.  And  yet  it  is  certain,  that  both 
the  one  and  the  other  are  fometimes  met  with  in  epileptic  perfons.  But  as 
to  the  abfcefs,  lince  this  is  evident,  even  from  many  obfervations  in  the  fame 
fedlion  (b) ;  I  will  pals  over  that,  to  point  out  fome  upon  the  hardnefs  of  the 

(2)  O'of.  3.  &  in  Additam.  obf.3.  ( b )  Obf.  z,  20,  21.  §.  2.  &  in  Addit. 

(a)  Vid.  tamen  epift.  58.  n.  9.  obf.  5. 

brain. 


2  I  I 


Letter  IX.  Articles  25,  16. 


brain.  Wherefore  omitting  thofe,  which  refer  to  the  firmnefs  of  the  whole 
cerebrum  being  greater  than  natural,  one  of  which  kind  is  in  the  fame  fec- 
tion(c),  another  in  the  Hiftory  of  the  Royal  Academy  of  Sciences  at  Paris  (J), 
and  a  third  above  defcrib’d  by  me  (e)  •,  you  will  remember  that  Anthony 
Pacchioni  (/)  has  remark’d  the  hardnefs  of  a  certain  part;  for  in  an  epi¬ 
leptic  cardinal  he  found  the  cortical  part  of  the  cerebrum,  where  it  anfwer’d 
to  a  large  hydatid,  “  grown  to  fuch  a  confidence  as  to  refill;  preffure,  and  to 

feem  entirely  fchirrhous and  that  the  celebrated  John  Fantonus  Q*),  in 
the  head  of  a  boy,  who  had  been  carried  off  by  an  epilepfy,  had  found  “  a 
“  portion  of  the  corpus  callofum  of  the  cerebrum,  very  hard,  and  no  other 
“  morbid  appearance.”  Add  to  thefe  gentlemen,  the  celebrated  Abr.  Ka- 
avius  (£),  and  Balthafar  Walthieri.  For  the  firft  in  a  marine  foldier,  who 
had  long  been  fubjedt  to  epileptic  attacks,  and  in  the  laft  of  thefe,  which 
was  by  far  the  moll  violent,  had  luddenly  died,  obferv’d,  among  other  things, 
that  the  cortical  fubftance  of  the  brain  was  not  only  every  where  “  much 
“  indurated,  but  in  many  places  fchirrhous,  and  in  others,  in  a  manner,  car- 
“  tilagineous,  efpecially  the  nearer  it  was  to  the  vertex.”  And  Walthieri, 
together  with  other  obfervations  which  I  have  before  (/)  mention’d,  fent  alfo 
this  to  me,  the  fubftance  of  which  I  will  immediately  commit  to  writing. 

25.  A  man  aged  thirty-five  years,  of  a  (lender  habit,  being  feiz’d  with  a 
pain  in  the  head  towards  the  forehead,  join’d  with  a  fenfe  of  weight,  and 
having  tried  a  great  number  of  remedies  in  vain,  which  for  the  fpace  of  two 
years  before  had  been  prefcrib’d  him  by  the  moft  celebrated  phyficians,  fell 
into  a  flux  of  blood  from  the  noftrils,  which,  after  having  been  difcharg’d  in 
great  quantity,  ceas’d  of  itfelf  to  flow  any  longer.  After  this  he  was  de¬ 
priv’d  of  the  faculty  of  fmelling,  and  then  feiz’d  with  epileptic  infults ;  and 
with  thefe  he  was  very  often  afflicted  for  two  years,  till  at  laft  he  died.  The 
fkull  being  open’d,  nothing  was  found  preternatural,  except  at  the  anterior 
parts  of  the  cerebrum,  where,  on  the  left  fide  indeed,  fome  little  quantity 
of  blood  was  extravafated,  but  on  the  right,  towards  that  procefs,  which 
anatomifts  call  the  crifta  galli,  the  cerebrum  itfelf  was  hard,  and  callous, 
and  was  found  to  be  very  clofely  connected  with  the  dura  mater. 

26.  It  is  probable,  that  the  animal  fpirits  are  put  out  of  their  courfe,  and 
reflected  into  tumultuary  motions,  as  often  as  being  more  fwiftly  agitated, 
from  any  caufe  whatever,  they  come  to  fome  certain  places  of  the  brain, 
which  by  reafon  of  a  callous  hardnefs,  or  an  interpos’d  abfcefs,  are  altogether 
impervious :  although,  indeed,  it  feems,  that  even  the  ablcefs  alone  may, 
by  emitting  fomething  from  itfelf  into  the  neighb’ring  parts,  excite  tumults 
in  the  brain.  However  this  may  be,  if  from  the  hardnefs  of  the  cerebrum, 
or  from  abfcefs,  or  an  impoftume  fui  generis,  or  from  a  diftenfion  of  the 
veffels,  or  from  water  in  large  quantity,  or  fin  all,  yellow  or  limpid,  or  if 
from  any  other  caufes  whatever  an  epilepfy  may  have  its  origin ;  or  whether 
you  choofe  rather  to  confider  any  of  thefe  circumftances  as  effects,  rather 


(<r)  in  Addit,  obf.  8. 

(a/)  A.  1705.  Obf.  Anat.  I. 

(e)  n.  9. 

(f)  EpilL  ad  Scrok. 


(g)  in  Pacchion.  Animadv.  zz. 

(h)  in  Comment,  cit.  fupra  ad  n.  19.  obf. 
Anat.  2. 

(0  n.  3. 


E  e  2 


than 


■1  1  2 


Book  h  Of  Diforders  of  the  Head. 

than  caufes  •,  but  do  not  deny  that  the  diforder  may  be  preferv’d,  cheriffi’d, 
and  encreas’d  thereby  ;  you  certainly  fee,  upon  any  of  thefe  fuppofitions, 
how  difficult  the  cure  of  it  fometimes  will  happen  to  be,  and  fo  far  even 
as  to  exceed  all  the  force  and  power  of  art.  You  alfo  fee,  when  the  epi- 
lepfy  is  not  beyond  the  reach  of  art,  how  various  the  method  of  cure  ought 
to  be ;  and  that  not  only  when  the  caufe  is  without  the  cranium  ;  of  which 
ipecies,  together  with  its  various  treatment,  I  have  given  you  fome  examples 
above;  but  alfo  when  it  is  within  the  cranium.  And  for  this  reafon  phyfi- 
cians  are  fometimes  defervedly,  and  fometimes  undefervedly,  accus’d ;  but 
ddervedly,  in  particular,  with  great  reafon,  thefe  who  attempt  the  cure5 
of  every  epilepfy,  indifcriminately,  in  one  method  and  manner.  But  this 
neceffity  of  a  various  and  manifold  method  of  cure,  which  is  abundantly 
evident  from  other  diforders  alfo,  caufes  the  greateffc  difficulty  in  the  art  of 
healing  properly :  and  as  anatomifts  are  always  demonftrating  this  more  and 
more,  by  difcovering  the  various  caufes  of  one  and  the  fame  diforder ;  fo  I 
would  to  God,  that  phyficians,  by  more  accurately  obferving  the  various 
figns  of  thefe  various  caufes,  might  equally  dill  more  and  more  extenuate 
and  lelfen  this  difficulty ;  and  this  indeed  is  by  no  means  to  be  altogether 
defpair’d  of,  lothat  both  the  anatomifts,  and  phyficians,  fhall  unanimoufty  con¬ 
cur,  as  is  their  duty  to  do,  the  firft  by  accurate  difieblions,  and  the  laft  by 
diligent  obfervations,  every  one  to  abt  his  part  well,  in  an  affair  of  fuch  great 
moment.  Both  of  which,  or  at  leaft  one  or  other,  I  befeech  you  to  under¬ 
take  ;  nay  rather  fee  to  it  that  you  do,  if  you  find  that  I  do  not  defert  my 
polls.  Farewel. 


LETTER  the  TENTH. 

In  which  Convulfion,  and  ConvuHive  Motions,  are 

treated  of. 

i.  mHESE  diforders,  which  are  treated  of  in  the  thirteenth  feblion  of 
the  Sepulchretum,  are  often  fo  complicated  with  others,  that  in 
moft  of  the  obfervations  belonging  thereto,  Bonetus  exprefly  admonifhes  us, 
that  they  relate  to  other  febtions  of  his  work.  However,  as  it  is  by  no 
means  my  cuftom,  not  only  in  any  one  feblion,  to  repeat  the  fame  obfervations, 
which  every  now  and  then  efcapes  him,  and  even  in  this  very  feblion  (*) ;  but 
as  it  is  even  not  cuftomary  with  me,  to  repeat  the  fame  obfervations  in  dif¬ 
ferent  places  of  the  fame  work,  do  not  expebt,  that  I  fhould  here  give  you 
a  great  number  relative  to  this  diforder,  which  is  at  all  times  not  uncommon  : 
but  if  you  would  have  a  large  number,  you  will  feek  for  them  in  thofe 
letters  which  I  fhall  fend  to  you  at  another  time,  efpecially  in  thole  which, 

(a)  Confer  obf.  7.  cum  22.  §.  1.  obf.  13,  cum  33.  obf.  19.  §.  2.  cum  §.  4. 

relate 


✓ 


3 


Letter  X.  Articles  2,  3.  213 

relate  to  wounds,  or  even  in  the  greater  part  of  thofe  that  I  have  already 
fent,  and  befides  the  others,  in  the  laft.  For  without  convulfive  agitations, 
a  true  epilepfy  can  by  no  means  happen  ;  although  convulfive  agitations  ma  / 
happen,  as  we  frequently  fee,  without  an  epilepfy.  The  plain  and  certain 
reaion  of  which  difference,  1  would  have  you  demand  of  him,  who  fuppofes 
that  he  knows,  what  motions  are  made  in  the  brain,  and  in  what  part  they 
are  made,  when  we  perceive,  or  in  any  manner  think.  I,  who  can  give 
nothing  but  conjectures,  had  rather  produce  hiftories  than  conjectures,  which, 
if  they  are  in  any  meafure  definitive,  rauft  be  entirely  romantic  here,  and, 
if  we  would  make  probability  our  guide  in  conjectures,  would  be  here  too 
generally  and  univerfally  devis’d.  Yet  I  ufe  the  latter  rather  than  the  former, 
whenever  it  is  neceffary  to  ufe  them  •,  fuch,  that  is  to  fay,  as  feem  far  Ids 
liable  to  errors,  and  hand  in  need  both  of  fewer  words  and  fewer  postulates 
than  others,  and  thefe,  postulates,  which  are  fo  eafy  and  perfpicuous,  that 
they  are  more  often  fuppos’d  than  exprelYd.  As  for  inltance,  if  I  fay,  that 
the  irritation  which  caules  convulfions,  if  it  be  of  fuch  a  kind,  that  it  can 
either  by  force,  manner,  or  place,  or  in  any  other  way  whatever,  intercept, 
or  altogether  pervert,  for  fome  time,  the  motions  which  are  perform’d  in 
the  brain,  in  order  to  perceive,  or  think  ;  that  then  not  only  convulfions, 
but  an  epilepfy  itfelf,  will  be  brought  on  thereby.  But  let  us  go  on,  firft, 
to  the  hiftories  of  Valfalva,  and  after  that  to  mine. 

2.  A  young  man,  about  twenty-fix  years  of  age,  had  firft  a  flight  fwelling 
of  the  fauces  ;  and  his  appetite  was  pall’d.  To  thefe  complaints,  after 
fome  days,  a  convulfion  of  the  left  arm  was  added,  fo  that  it  was  entirely 
immoveable  and  inflexible-,  and  foon  after,  the  fame  thing  happen’d  to  the 
whole  body,  of  a  fudden,  which  had  happen’d  to  the  arm  :  fo  that  the  patient 
now  was  not  able  to  move  himfelf  to  any  fide,  but  continu’d  ftretch’d  out  in 
a  ftrait  pofture,  as  he  was  taken,  his  body  being  immoveable  and  rigid,  ex¬ 
cept  that,  a  little  while  after,  he  was  able,  in  fome  meafure,  to  move  his 
hands  and  his  feet  only.  He  was  brought  into  the  hofpital  of  St.  Mary  de 
Vita,  at  Bologna,  where  the  fever  and  convulfion,  with  which  he  had  been 
feiz’d,  were  found  to  be  that  diforder  which  the  Greeks  call  7 ir&vcf.  From 
the  firft  day,  in  which  he  was  feiz’d  with  it  in  his  whole  body,  even  to  the 
very  day  of  his  death,  he  had  profufe  fweatings.  But,  on  the  beginning  of 
the  fifth  day,  death  was  the  confequence  of  a  new  contraction,  which  bent 
his  body  entirely  to  one  fide. 

On  the  fkin  of  the  body  after  death  were  many  red  fpots  j  but  in  the  brain 
nothing  occurr’d  worthy  of  obfervation,  except  a  little  ferum,  and  that  faltifh, 
in  the  left  ventricle..  The  thorax  being  open’d,  in  its  left  cavity,  fome 
ounces  of  water  were  found  :  both  lobes  of  the  lungs  were  very  red,  efpe- 
cially  in  their  pofterior  part :  the  pericardium  was  entirely  full  of  ferum. 
The  blood  had  loft  but  little  of  its  natural  fluidity. 

3.  To  this  diforder,  which  is  not  very  frequent,  that  moreover  v/as  added, 
which  to  our  Mercurialis  ( b )  would  have  feem’d  much  more  rare  ;  J  mean, 
that  the  body  fiiould  be  bent,  to  one  or  the  other  fide,  by  a  convulfion.  For 
he  fays,  ‘‘  You  will  never  fee,  that  perfons  who  are  convuls’d  are  drawn  to- 


<1 


F)  Prasleft.  Patav.  1.  1,  c.  25. 


wards. 


2  r  4  Book  I.  Of  Difeafes  of  the  Head. 

“  wards  any  other  part,  or  into  any  other  figures,  than  the  three  enumerated 
“  ones that  is  to  fay,  that  they  are  either  quite  ftrait,  or  bent  forwards,  or 
backwards ;  but  never  to  the  right  fide,  or  to  the  left. 

But  did  the  beginning  of  the  tetanus  lie  hid  under  that  diforder  of  the 
fauces,  which  preceded  it  for  fome  days  ?  For  thus  did  Wepffer  “  fometimes” 
obferve,  as  you  will  read  in  this  fedtion  of  the  Sepulchretum  (c),  a  diforder 
beginning  “  in  the  upper  part  of  the  cefophagus,  with  fome  difficulty  of 
“  deglutition,  which  on  the  third  day  a  manifeft  tetanus  fucceeded.”  And 
again,  did  the  quantity  of  fweat,  which  was  continually  difcharg’d  from  this 
young  man,  bring  that  alleviation  to  his  diforder,  which  render’d  his  hands 
and  feet  in  fome  meafure  moveable  ?  Bontius,  indeed,  as  you  will  fee  in 
the  fame  fection  (d)  of  the  Sepulchretum,  having  learn’d  by  experience  among 
the  Indians,  where  this  kind  of  dileafe  is  as  much  familiar,  as  it  is  in  other 
places  rare,  among  other  things,  recommends  fuch  remedies  as  produce  fweat. 
But  this,  perhaps,  is  more  ufeful,  when  the  diforder  has  fucceeded  to  a  raffi 
expofal  of  the  body,  when  heated,  to  cold  ;  as  in  a  foldier,  of  whom  he 
fays  (e),  “  that  he  lay  on  the  ground  drunk,  through  the  whole  night  ;**  and 
in  three  others,  whom  I  know  of,  at  Padua,  that  having  expos’d  themfelves 
to  the  cold  air,  when  they  were  warm  with  wine,  they  in  like  manner  became 
rigid,  and  in  like  manner,  “  within  four  days,  ”  one  only  efcaping  with  dif¬ 
ficulty,  were  carried  off:  as  that  boy,  who,  you  will  fee  in  the  fame  place(/), 
had  fallen  into  a  tetanus  of  molt  parts  of  his  body,  “  from  a  fweat  being  fud- 
“  denly  fupprefs’d  in  a  febrile  paroxyfm,”  efcap’d  by  means  of  a  malignant 
fever  that  follow’d  it.  And  thefe  two,  doubtlefs,  as  well  as  the  former, 
and  indeed,  in  great  meafure,  the  young  man  of  whom  we  treat,  made  good 
the  prediction  of  Hippocrates  (g),  although  others  have  prov’d  the  contrary  ; 
which  prediction  is  thus  render’d  by  Cornelius  Celfus  (h) :  “  Thefe  diforders 
“  often  carry  off  the  patient  within  the  fourth  day :  but  if  they  have  efcap’d 
“  this,  the  diforder  is  then  without  danger.”  Yet  the  very  learned  Van 
Svvieten  (/),  obferves,  that,  in  another  part  of  his  works,  Hippocrates  has  fee 
longer  bounds  for  the  termination  of  this  diforder  ;  and  has  alfo  fhewn,  that 
it  does  fometimes  happen  to  continue  longer,  by  an  accurately  written  ob- 
fervation  upon  the  tetanus,  in  confirmation  thereof ;  which  is  very  fimilar,  in 
fome  things,  to  the  above  hiflory  of  Valfalva.. 

4.  As  to  the  red  fpots,  with  which  the  fkin  of  the  carcafe  was  thickly  be- 
fet,  would  you  account  for  them,  according  to  the  decifions  of  Boerhaave  (£), 
from  “  the  mufcles  being  too  rigid,  and  excluding  the  blood,”  which  for 
that  reafon  pour’d  itfelf  out  under  the  fkin,  where  the  cellular  coats  of  the 
mufcles  give  lefs  refiftance  ?  For  as  to  the  rednefs  of  the  lungs,  and  that 
more  at  the  pofterior  part,  efpecially  as  the  blood,  even  after  death,  preferv’d 
its  fluidity,  it  need  not  much  excite  our  admiration.  But  by  reafon  of  the 
blood  being  excluded  from  the  mufcles,  and  ftagnating  more  or  lefs  here  and 
there,  you  will  underftand  that  there  v/as  a  more  eafy  fecretion  of  the  watry 


(r)  In  addit,  obf.  2.  Sc  in  fchol. 
[a)  Obf.  15.  in  fchol. 

(e)  Obf.  ead. 

(f)  Obf.  32.  in  fchol. 


(g)  Sect.  5.  aph.  6. 

\b)  De  Medic.  1.  4.  c.  3. 

(i)  Comm,  in  Boerh.  aph.  §  712, 

(i)  Prajleft.  Acad,  in  Med.  indie.  §  732. 


parts, 


Letter  X.  Articles  £,6.  21$ 

parts,  which  would  give  rife  to  that  great  quantity  of  fwe3t,  and  the  extra- 
vafation  of  ferum  into  one  or  other  of  the  cavities  of  the  body;  unlefs  you 
would  rather  chufe  to  fuppofe,  that  it  was  there  collected,  by  reafon  of  the 
pafiages  through  which  it  ought  to  have  pafs’d,  being  contracted  by  the  con- 
vulfion.  And  if  you  fulpeCt,  that  there  were  no  other  reafons,  for  which 
ferum  fhould  be  alio  found  in  the  brain,  and  confequently  fuppofe,  that  this 
was  the  effeCt,  and  not  the  caufe,  of  the  tetanus,  especially  as  there  was  but 
very  little,  and  that  only  in  one  ventricle  ;  I  would  have  you,  at  the  fame 
time  obferve,  that  this  was  ialt :  which  circumftance  Valfalva  has  by  no  means 
obferv’d,  in  the  ferum  of  die  thorax,  and  pericardium  :  and  likewife  that  the 
greater,  or  at  lead  the  extreme  force  of  this  convulfion  appear’d  particularly 
in  one  fide  of  the  body. 

5.  A  virgin,  almoft  of  the  fame  age  as  the  young  man  whofe  hiftory  I 
have  juft  given,  labouring  under  an  acute  fever,  was  feiz’d  with  a  convul¬ 
fion  about  the  feventh  day,  fo  that  being  afk’d  a  queftion,  {he  laugh’d  with 
the  rifus  fardonicus ;  and  the  convulfive  motions  were  fo  vehement,  that  fhe 
was  oblig’d  to  be  tied  down  in  her  bed.  A  delirium  accompanied  thefe 
motions.  Yet  all  thefe  fymptoms  were  quieted  an  hour  before  death  :  which, 
as  the  refpiration  became  every  day  more  and  more  laborious,  happen’d  on 
the  ninth  day.  A  little  ferum  was  obferv’d  to  flow  out  of  the  right  ear  of 
the  body,  after  death.  The  cerebrum  was,  however,  altogether  found  ;  nor 
was  any  thing  elfe  remark’d  in  the  head,  except  that  when  the  dura  mater 
was  tom  in  fome  places,  by  pulling  it  away  from  the  fkull,  a  few  drops  of 
ferum  burft  forth;  and  that  a  little  blood  likewife,  diluted  with  a  large  quan¬ 
tity  of  ferum,  had  flow’d  out  from  fome  very  fmall  vefiels  which  were  by  ac¬ 
cident  broken  through. 

In  the  right  cavity  of  the  thorax,  the  lungs  of  which  adher’d  to  the  fter- 
num,  and  to  the  ribs  laterally,  eight  or  nine  ounces  of  ferum  had  ftagnated. 
And  to  the  fame  lobe  of  the  lungs,  on  the  part  oppofite  to  the  clavicle,  a 
kind  of  matter  had  externally  grown,  of  a  middle  nature  betwixt  fat  and  a 
gelatinous  concretion,  like  that  which  fometimes  fwims  in  the  water  found  in 
hydropic  bodies ;  fo  that  there  might  perhaps  be  fome  fufpicion,  that  this 
virgin  had  before  the  prefent  difeafe,  labour’d  under  an  affection  of  the  tho¬ 
rax.  In  each  ventricle  of  the  heart  was  contain’d  a  Angle  polypous  concre¬ 
tion,  almoft  like  mucus,  but  that  in  the  right  was  larger  than  that  in  the 
left. 

6.  Although  I  am  willing  to  allow,  that  the  caufe  of  convulflons  fo  vehe¬ 
ment,  might  entirely  efcape  our  moft  intimate  refearches ;  I  would  not  how¬ 
ever  deny  this,  that  thofe  few  drops  of  ferum  might  be  of  fuch  a  nature,  as 
to  irritate  the  dura  mater  moft  violently  ;  and  I  have  fhewn,  in  the  former 
letter  (/),  that  all  ftimuli  are  to  be  eftimated  from  their  powers  and  proper¬ 
ties,  and  not  from  their  bulk.  Nor  indeed  is  it  a  romantic  fuppofltion,  that 
the  ferum  which  is  found  in  the  brain  of  patients  of  this  kind,  is  of  fuch  a 
nature,  that  it  may  irritate;  fince,  that  it  has  been  found  to  be  fair,  when  its 
properties  have  been  explor’d  by  the  tafte,  not  only  the  preceding  hiflory 
teaches,  but  thofe  alfo  that  you  have  in  the  Sepulchretum  confirm  ( m ),  which 


(/)  n.  11. 


( m )  Sett,  hac  1 3.  obf.  1. 


produce 


2  i  6  Book  I.  Of  Difeafes  of  the  Head. 

produce  marks  “  of  a  fait  ferum  ”  (»),  and  even  “  a  ferum  acrid  and  brack- 
“  ifh  (<?),  a  fait  ferum  (p),  a  ferous  humour  which  bit  the  tongue  very  keenly.” 
Add  to  thefe  alfo,  that  which  John  Saltzmann  (q)  has  publifli’d,  of  a  young 
man,  who  dying  “  of  the  mod  grievous  convulfions,  had  fuch  a  remarkable 
“  quantity  of  a  ferous  humour,  under  the  dura  mater,  more  thin  than 
“  ufual,  and  of  fuch  a  fharpnefs,  ”  that  it  could  corrode  this  membrane, 
and  the  interior  lamina,  of  the  additamentum  of  the  os  occipitis,  and  even 
the  inferior  lamina  alfo*,  and  by  this  means  prepare  an  exit  for  itfelf,  out  of 
the  cavity  of  the  cranium.  Wherefore  I  think  it  is  not  at  all  improbable, 
that  “  the  lymph  ”  of  which  Michael  Bern.  Valentinus  (r)  found  a  remark¬ 
able  quantity  in  the  ventricles  of  the  brain  of  a  little  boy,  “  who  at  length 
“  died  of  horrible  convulfions,”  was  alfo  of  an  acrid  and  irritating  nature ; 
and  that  the  ferum  was  of  the  fame  kind,  in  like  manner,  which  is  mention’d 
by  me,  in  the  obfervation  I  have  given  you  already,  and  in  the  fubfequent 
ones. 

7.  A  girl  of  five  months  of  age  was  feiz’d  with  a  fever,  and  a  flux  of  the 

belly.  The  day  after  her  feizure,  a  fever  only  remain’d.  On  the  third  day, 
fhe  was  attack’d  by  a  violent  clonic  convulfion  of  the  upper  limbs :  which 
was  alfo  extended  to  the  pofterior  mufcles  of  the  thorax,  but  (lightly  ;  and 
more  (lightly  frill  to  the  glutasi.  About  the  end  of  the  fifth  day,  the  con- 
vulfion  remitted  *,  but  by  intervals  only  ;  yet  by  no  means  difcover’d  itfelf 
when  the  child  flept :  however,  a  jaundice  fucceeded,  in  the  mean  time, 
through  the  whole  body.  The  (kin  of  the  body,  after  death,  was  every 
where  diftinguifti’d,  but  efpecially  on  the  back,  with  red  fpots  inclin’d  to 
blacknefs.  « 

In  the  belly  was  nothing  worthy  of  remark,  except  the  inteftinum  rec¬ 
tum,  which  was  ting’d  with  a  black  hue.  In  the  thorax,  the  pericardium 
was  full  of  water,  and  that  yellow  :  but  the  right  ventricle  of  the  heart  con¬ 
tain’d  a  polypous  concretion,  which  reach’d  to  the  pulmonary  artery,  and 
refembl’d  concreted  mucus.  The  remaining  part  of  the  blood  was  altoge¬ 
ther  fluid  :  yet,  when  expos’d  to  the  air,  after  fome  time  coagulated.  Fi¬ 
nally,  within  the  cranium  all  things  feem’d  to  be  extremely  natural,  except 
that  between  the  dura  and  pia  mater  a  ferous  humour  was  found,  which  had 
concreted  about  the  fanguiferous  veflels,  in  the  form  of  a  jelly. 

8.  Did  the  convulfion  remain  quiet  when  the  girl  was  afleep,  for  this  rea- 
fon  ;  becaufe  fhe  flept  ?  or  was  it  rather,  that  fhe  flept  becaufe  the  convulfion 
was  quiet,  which  muft  otherwife  have  awak’d  her  when  (he  flept  ?  Doubtlefs 
the  latter  of  thefe  opinions  is  the  more  probable,  and  brings  back  to  my  mind, 
the  difcourfe  which  pafs’d,  in  former  years,  betwixt  me  and  that  very  learned 
phyfician,  and,  at  the  fame  time,  mod  humane  man,  Francefco  Serao,  when 
he  (poke  of  the  utility  of  veficatory  medicines,  as  they  call  them  here,  even 
fometimes  in  convulfions.  He  related  a  cafe  of  a  boy  of  five  years  old,  who 
liv’d  at  Naples,  and  who  had  fall’n  into  epileptic  convulfions  a  year  or  two 
before,  which  recurr’d  as  often  as  the  boy  began  to  deep  ;  whence  being 
made  ftupid,  and  paralytic  in  his  legs,  fo  that  he  could  no  longer  walk  upon 

(»)  Obf.  3.  (5)  Obf  4.  (7)  Aft.  N.  C.  Tom.  2.  cbf.  98. 

($)  in  Additam,  obf.  3.  (r)  Eph.  N.  C.  Cent.  3.  cbf.  1. 

them, 


Letter  X.  Article  9.  217 

them  ;  and  having  us’d  innumerable  remedies  in  vain,  he  was  cur'd  by  a  ve- 
ficatory  medicine  alone,  being  apply’d,  as  he  had  order’d,  to  the  pofterior 
extremity  of  the  fagittal  future.  For  the  paroxyfms,  which  were  before  in¬ 
numerable,  began  foon  to  be  fewer,  and  lefs  violent  *,  and  within  fifteen  days, 
they  entirely  left  the  patient,  the  power  of  Handing,  and  walking,  at  the 
fame  time,  returning  to  him.  And  the  fame  learned  gentleman  confirm’d, 
that  not  only  in  this  cafe,  but  at  other  times,  in  other  patients,  veficatory 
applications  had  fucceeded  well  with  him  againft  convulfions *,  fo  that  Hip¬ 
pocrates  feem’d  to  be  in  the  right,  when  he  afferted  (r),  “  that  convulfions 
“  were  brought  on  either  from  repletion  or  inanition  which  two  caufes, 
Galen  alfo  laid  down  as  the  chief,  though  he  fometimes  added  another  (/), 
which  afterwards  pleas’d  the  greater  part  of  the  phyficians  fo  much,  that 
they  rejected  the  two  firft •,  I  mean,  that  which  is  drawn  “  from  a  biting  and 
“  thin  humour  gnawing  the  nervous  parts  that  is  to  fay,  from  irritation, 
which  is,  neverthelefs,  by  fome  learned  men  in  our  times,  referr’d  to  the  ar¬ 
ticle  of  repletion.  However  this  is,  certainly  when  convulfions  are  brought 
on  from  repletion,  as  in  this  boy,  they  will  not  be  remov’d,  unlefs  that 
matter  is  taken  away,  which  by  overloading,  or  diftra&ing  the  fibres,  gave 
occafion  to  their  attacks.  In  this  manner,  nearly,  faid  he. 

But  as  to  what  concerns  the  other  circumftances,  related  in  the  hiftory  ; 
did  the  jaundice  make  its  appearance  in  the  conftitution  for  this  reafon  ;  be- 
caufe  the  convulfion  had  conftring’d  even  the  biliary  du£ls,  through  which 
the  bile,  in  order,  perhaps,  to  produce  a  falutary  flux,  had  already  begun 
to.flow  ?  Was  the  bile’s  being  retain’d  in  the  blood,  in  the  number  of  thofe 
caufes,  which  aflifted  to  preferve  its  fluidity  ?  For  that  there  were  fome  foreign 
caufes,  confpiring  thereto,  I  think  may  be  argu’d  from  the  concretion  of  the 
blood,  when  expos’d  to  the  air,  whether  from  the  watry  particles,  or  from 
others,  which  kept  up  an  inteftine  motion,  being  evaporated.  I  fhould  alfo 
be  glad  to  afcertain,  if  that  blacknefs  of  the  inteftinum  reftum  was  one  of 
the  effects  of  the  convulfion  ;  whether  the  canals  of  the  veins  being  ftreight- 
en’d,  by  delaying  the  blood  only,  or  by  obftrudting  it  fo  long  as  to  caufe  a 
gangrene,  had  given  rife  to  this  deprav’d  colour.  For  as  to  the  red  fpots  in 
the  fkin,  and  the  quantity  of  water  in  the  pericardium,  I  have  fpoken  fuf- 
ficiently  before  («)  on  thele  fubjedts.  Laft  of  all,  as  to  no  ferum,  but  a 
kind  of  jelly,  being  found  about  the  meninges  *,  do  not  underftand  it  in  fuch 
a  manner  as  if  ferum  had  been  wanting  there,  having  an  eye  to  what  I  have 
before  (x)  written  of  the  very  thin,  pellucid,  and  cellular  lamellae  having 
ferum  fo  intercepted  between  them,  that  by  reafon  of  their  interpofition,  it 
appear’d  in  the  form  of  a  jelly. 

9.  A  little  boy,  (born  of  a  valetudinarian  mother,  who,  efpecially  while 
(he  was  pregnant  with  this  child,  having  been  liable  to  various  and  compli¬ 
cated  dilorders,  had  frequently,  in  order  to  quiet  them,  us’d,  by  the  advice 
of  the  women  about  her,  pretty  liberal  draughts  of  generous  wine)  was  firft 
taken  with  a  fcald  head  j  after  that,  being  troubl’d  with  a  fcabies,  when  the 
puftules  ceas’d  to  be  moift,  he  was  feiz’d  with  a  fever.  But  this  fever  leav- 

(j)  S.  6.  Aph.  39.  (a)  n.  4. 

( 1 )  Meth.  Med.  1.  12.  in  fin.  (*)  Epift.6.  n.  12,  1 3.  &  epill.  7.  n.  11. 


VO L.  I. 


Ff 


ing 


2i  8  Book  I.  Of  Difeafes  of  the  Head. 

ing  the  child,  when  the  pullules  began  again  to  weep  a  plentiful  ichor,  the 
fcabies  began  to  rage  more  grievoufly,  and  the  infant  to  grow  lean  and  thin. 

At  length,  after  an  interval  of  many  days,  the  pullules  being  again  dried 
up,  he  was  troubl’d  with  a  diarrhea,  and  convulfive  motions  frequently, 
within  the  fpace  of  eight  days  ;  and  about  the  latter  end  of  the  eighth  month 
of  his  life,  when  his  incifor  teeth  were  about  to  cut  through  the  gums,  he 
died. 

All  the  vifcera  of  the  belly  were  found,  and  the  magnitude  of  the  liver 
itfelf  correfponded  in  proportion  with  the  others.  In  the  thorax,  the  right 
lobe  of  the  lungs  very  clolely  adher’d  to  the  pleura  all  round  ;  yet  both  right 
and  left  were  altogether  uninjur’d,  and  undiftinguilh’d  by  any  fpots.  The 
heart  contain’d  no  polypous  concretion.  Between  the  meninges  of  the  brain, 
a  fmall  quantity  of  ferum  (lagnated  :  and  the  pofterior  part  of  the  cerebrum 
itfelf,  being  not  of  a  convex  figure,  feem’d  rather  to  approach  to  a  cubical 
form. 

10.  It  appears  from  this  hiftory,  in  the  firft  place,  of  how  much  importance 
it  is,  that  mothers,  in  the  time  of  their  pregnancy,  fhould  have  good  health, 
nor  take  too  freely  of  pure  wine  ;  and,  fecondly,  that  the  fcald-heads,  and 
fcabies  of  infants,  fhould  not  be  unfeafonably  dried  up.  For  dentition,  as  I 
have  before  faid  ( jy),  actually  brings  on,  not  only  diftenfions  of  the  nerves, 
but  fluxes  of  the  belly  alfo  ;  which,  however,  provided  they  be  within 
bounds,  are  of  ufe  in  alleviating  the  other  fymptoms  :  but  the  former  fymp- 
toms  prevail  more  than  the  latter,  if  at  the  fame  time  the  blood  abounds 
with  a  quantity  of  irritating  particles,  which  were  wont  to  be  thrown  out  ,by 
another  way,  as  in  this  cafe.  And  that  the  external  figure  of  the  cerebrum, 
which  is  us’d  to  follow  the  form  of  the  flkull,  may,  when  it  is  not  natural, 
indicate  fomething  alfo  in  the  internal  (IruCture,  which  is,  in  like  manner, 
entirely  foreign  to  the  intention  of  nature,  and  which  renders  it  more  prone 
to  difeafes,  does  not  feem  entirely  to  be  denied. 

Thus  far  I  have  given  you  the  obfervations  of  Valfalva ;  but  now  I  go 
on  to  my  own,  beginning  with  two  that  I  formerly  made  in  conjunction  with 
him,  and  committed  to  writing,  which  it  was  hardly  poffible  for  him  to  do, 
as  he  was  fo -greatly  taken  up  with  avocations. 

11.  Bartholomew  Manzoli,  a  marquis,  and  grave  fenator  of  Bologna,  the 
fame  whom  Valfalva  (z)  and  I  (a)  have  fpoken  of,  on  account  of  fome  co¬ 
lours,  and  other  furprifing  appearances,  flying  before  his  eyes,  was  at  the 
fame  time  afflicted  with  other  fymptoms  of  difeafe,  (which  we  then  touch’d 
upon  but  briefly  and  (lightly)  in  the  following  manner.  He  had  formerly, 
when  he  was  in  the  vigour  of  his  life,  expectorated  fuch  matter,  and  at  the 
fame  time  was  feiz’d  with  fuch  diforders,  that  two  very  learned  and  eminent 
phyficians,  Fabri  and  Malphigi,  believ’d  him  to  be  consumptive.  He  efcap’d, 
however.  After  that,  he  was  fubjeCt  to  the  (lone.  And  when  he  was  become 
an  elderly  man,  he  was  attack’d,  about  fix  years  before  death,  with  a  vertigo, 
and  other  diforders  of  that  kind,  in  the  head.  But  within  the  lad  year  of 
his  life,  he  was  frequently,  though  (lightly,  feiz’d  both  with  convulfive  and 
paralytic  attacks,  join’d  with  a  particular  numbnefsuof  the  w7hole  fide,  fome- 

( y )  Epift.  9.  n.  4.  &  Epift  in  SamonicJ.  («)  Epift.  anat.  18.  n.  5. 

(«)  Differt.  Anat.  2.  n.  9. 


times 


Letter  X.  Articles.  219 

times  of  the  right,  and  fometimes  of  the  left,  but  for  the  moft  part  of  the 
left  *,  which  numbnefs,  when  it  at  any  time  threaten’d  a  greater  evil,  was 
immediately  reliev’d  by  blood  being  taken  away  from  the  oppofite  arnn  He 
was,  alfo,  fometimes  troubl’d  with  a  a  difficulty  of  breathing.  Afterwards, 
his  legs  began  to  fwell,  and  break  out  into  fores,  and  at  length  to  dfcharge 
a  watry  humour.  But  for  almoff  a  month  before  his  death,  the  fwelling  be¬ 
gan  todecreafe  ;  at  which  time  his  urine  was  alio  diminiffi’d.  There  was  now 
a  continual  difficulty  of  breathing,  and  in  that  difficulty  a  certain  unealv  fen- 
fation,  the  feat  of  which  the  patient  pointed  out,  about  three  fingers  above 
the  navel,  but  internally,  whence  he  alfo  faid  the  diforder  began,  and  was 
carried,  as  it  were,  upwards,  as  often  as  an  acceffion  of  more  difficult  refpi- 
ration  was  impending  :  yet  there  was  no  thirff,  no  fenfe  of  weight,  nor  any 
thing  elle  in  the  thorax,  from  which  the  patient  ffiould  fuppofe  that  he  had 
water  collected  in  the  cavity  thereof ;  fo  that  he  infilled  upon  it,  when  the 
phyficians  fufpetted  fuch  a  thing,  that  he  could  not  agree  with  them  in  their 
opinion,  and  chofe  rather  to  accufe  convulfive  diforders  of  the  llomach,  to 
which  he  had  been  alfo  fometimes  liable.  In  the  mean  while,  his  abdomen 
grew  tumid  •,  and  convulfions,  with  a  Hammering  of  fpeech,  came  upon  him, 
efpecially  on  the  laff  days.  Moreover,  on  the  two  laft  days,  the  Hammering 
was  much  encreas’d,  and  what  he  faid  was  generally  foreign  to  the  purpofe ; 
and  hanging  down  his  head,  as  if  he  could  no  longer  fupport  it,  more  violent 
convulfions,  which  at  length  began  with  a  difiortion  of  the  mouth,  foon 
carried  off  this  nobleman. 

The  belly,  though  it  was  tumid  alfo  in  the  dead  body,  and  a  watry  tumour 
difiended  the  involucra  of  the  fubjecled  colon,  nor  water  was  wanting  betwixt 
the  integuments  of  the  inguina,  yet  had  itfelf  none,  or,  at  leafi,  very  little 
moifiure  effus’d  :  for  the  inteflines  being  diffended  with  air,  had  render’d  the 
abdomen  protuberating.  The  liver,  both  in  colour  and  firmnefs,  was  fome- 
what  beyond  the  bounds  of  nature  ;  but  a  little  only  :  and  the  pelvis  of  each 
kidney  contain’d  granulated  and  yellowiffi  calculi.  Nor  was  any  thing  elfe 
obferv’d  in  the  belly.  But  the  thorax  was,  on  each  fide,  full  of  the  greateff 
quantity  of  water  imaginable  ;  and  in  this  cavity  the  lungs  were  of  a  purple 
colour,  degenerating  into  black,  yet  no- where  hard,  or  bearing  any  marks 
of  the  cicatrix  of  a  pall  abfeefs,  and  fcarcely  at  all  adhering  to  the  pleura, 
except  by  one  very  (mail  furface.  In  the  pericardium  was  a  great  quantity 
of  ferum  ;  and  in  that  the  heart  was  very  lax,  and  broad,  and  had,  at  its 
right  ventricle,  a  fmall  polypous  concretion.  Finally,  the  flcull  being  open’d, 
there  was  much  water  between  the  meninges,  and  not  a  little  in  the  convo- 
luted  furrows  of  the  brain,  where  it  feem’d  to  be  fomewhat  more  glutinous. 
There  was  alfo  a  little  quantity  at  the  bafis,  and  fome  in  the  ventricles.  The 
plexus  choroides  were  paliffi  ;  and  in  them  were  fome  tumid  veficles.  The 
brain  itfelf  was  pretty  lax. 

12.  Thofe  things  which  were  remark’d  in  the  carcafe,  being  feen,  and  com¬ 
par’d  with  the  hiffory  of  the  difeafe,  Valfalva  was  fo  far  from  doubting, 
whether  the  water  had  been  extravafated  in  the  head,  long  before  it  was  ex- 
travafated  in  the  cheff,  that  he  believ’d,  it  then  began  at  length  to  be  depo- 
fited  in  the  laff-mention’d  cavity,  when  the  former  was  fo  full,  that  it  could 
admit  no  more nearly  in  the  fame  manner,  to  wit,  as  in  wounds  of  the 

F  f  2  head. 


220  Book  I.  Of  Difeafes  of  the  Head. 

head,  that  are  redundant  with  a  quantity  of  pus,  a  part  of  which  is  fre¬ 
quently  carried  to  fome  other  part  of  the  body,  and  frequently  to  the  thorax 
itfelf.  Be  that  as  it  will,  this,  however,  at  lead,  it  does  not  leem  poffible  to 
deny,  that  then,  particularly,  the  water  was  collected  in  the  thorax,  when 
the  fwelling  of  the  legs  falling,  and  the  urine  being  diminiffi’d,  a  continual 
difficulty  of  breathing  came  on  :  although  the  convulfions  alfo  may  feem  to 
have  confpir’d  therewith,  to  render  this  difficulty  more  grievous  •,  that  fenfe 
of  the  diforder,  beginning  three  fingers  breadth  above  the  navel,  but  inter¬ 
nally,  and  thence  alcending  to  the  thorax,  perhaps  indicating,  that  the  caufe 
of  the  convulfion  was  feated  in  the  great  plexus  of  the  mefenteric  nerves. 
But  the  cafe  was  differently  explain’d  by  Valfalva,  to  wit,  that  the  diaphragm 
being  overloaded  and  irritated  by  the  water,  the  appendages  of  it  could  not 
but  be  affedted  ;  for  that  a  like  fenfe  of  uneafinefs  had  been  remark’d  by  him 
in  a  prieft,  at  the  very  fame  place  ;  and  yet  after  death,  nothing  preter¬ 
natural  was  any-where  found,  except  water  in  the  thorax.  However  this  is, 
certainly  both  explications  refer  to  the  parts  which  lie  on  the  anterior  furface 
of  the  lumbar  vertebras,  or  thofe  that  are  the  neareft  to  them.  And  that 
you  may  not  imagine  this  fituation  to  be  too  far  back,  and  fuppofe  it  impro¬ 
bable,  that  the  patient  ffiould  point  out  the  fpine,  rather  than  the  abdomen 
itfelf  i  pray  call  to  mind,  how  far  that  furface  of  the  vertebra  is  diftant  from 
the  extremities  of  their  pofterior  proceffes,  and  how  much  it  is  curv’d,  and 
protuberates  forwards  into  the  cavity  of  the  belly :  fo  that  I  have  feen  the 
hardnefs  of  it  more  than  once  impofe,  not  only  upon  patients  themfelves, 
but  even  upon  phyficians,  who  were  but  little  fkill’d  in  anatomy.  And  this 
has  happen’d  particularly  in  lean  and  thin  people,  where  they  fometimes,  with 
God’s  leave,  would  fain  have  convinc’d  me  of  there  being  a  very  remarkable 
hardnefs  in  the  mefentery,  which  I  have  found  by  laying  my  hand  upon  it, 
to  be  nothing  more  than  this  anterior  furface  of  the  fpine  whereof  we  fpeak. 
And  I  remember  that,  once,  having  call’d  afide  a  formerly  celebrated  phy- 
fician,  (as  my  cuftom  is  on  fuch  occafions)  to  admoniffi  him  of  his  miftake, 
in  this  affair,  he  gave  me  great  thanks  for  my  admonitions,  and  bad  adieu 
to  the  defpifers  of  anatomy. 

13.  A  man,  of  more  than  forty  years  of  age,  who  was  by  occupation  a 
hemp-dreffer,  being  of  a  pallid  countenance,  but  feemingly  in  good  health, 
began,  two  years  before,  to  have  a  fwelling  at  the  lower  part  of  the  cheft, 
near  the  cartilago  enfiformis ;  which,  though  it  gave  him  no  trouble,  was 
not,  however,  agreeable.  Wherefore,  he  applied  many  remedies,  recom¬ 
mended  by  different  perfons,  but  in  vain  for  the  tumour  grew  more  and 
more,  though  gradually  :  fo  that  it  now  began  to  give  fome  little  uneafinefs 
in  drawing  his  breath.  Fifty  days  before  his  death,  he  was  attack’d  with  a 
paih  in  the  inferior  vertebrae  of  the  thorax,  as  if  from  fomething  that  prick’d 
him,  and  was  at  the  fame  time  a  weight  upon  him  ;  and  this  pain  fometimes 
extended  itfelf  downwards  to  the  loins,  and  fometimes  upwards  to  the  fca- 
pulas.  With  thefe  diforders  were  join’d  a  laffitude  and  weaknefs  of  the  whole 
body.  But  eleven  days  before  his  death,  his  lower  limb,  on  the  right  fide, 
was  feiz’d  with  a  numbnefs,  and  foon  after,  before  any  affiftance  could  be 
brought,  with  a  palfy  ;  yet  in  fuch  a  manner,  that  the  power  of  moving, 
rather  than  of  feeling,  was  taken  away.  Three  days  after,  he  could  not 

make 


Letter  X.  Article  i  3.  221 

make  water*,  fo  that  it  was  neceffary  to  have  it  drawn  off  by  the  hand  ;  which 
on  the  firft  few  days,  indeed,  fucceeded  very  well  *,  but  afterwards,  either  none 
at  all  was  drawn  forth,  or  if  at  any  time  the  urine  began  to  flow  through 
the  catheter  with  impetus,  it  immediately  flopp’d,  as  if  fomething  had  op¬ 
pos’d  its  progrefs.  And,  indeed,  the  extremity  of  the  filver  tube  feem’d  to 
have  been  obftru&ed,  by  a  kind  of  mucous,  and  almoft  purulent  humour* 
Two  things  were  alfo  obferv’d,  when  the  catheter  was  firft  introduc’d  :  one, 
that  there  was  fome  obftrudtion  near  the  bladder,  which  prevented  the  pipe 
flipping  freely  *,  the  other,  that  the  whole  abdomen  was  tumid,  and  it  was 
uncertain  how  long  a  time  it  had  been  fo.  The  patient  was  thirfty  $  and  as 
he  could  not  lie  down  now,  by  reafon  of  the  pain  in  his  back,  if  he  at¬ 
tempted  it,  he  breath’d  with  much  greater  difficulty  :  yet  his  legs,  and  his 
feer,  were  not  iwell’d.  In  the  midft  of  thefe  complaints,  alfo,  he  began  to 
be  tortur’d  with  convulfions  of  the  upper  limbs,  and  with  tonic  convul- 
fions  of  the  trunk  itfelf ;  which  recurr’d  at  intervals,  and  continu’d  for  a 
quarter  of  an  hour,  and  at  the  fame  time  excited  both  a  vomiting  of  a  yellow 
humour,  and  threw  fome  little  clouds  over  the  underftanding,  which  was  at 
other  times  very  ftrong  and  clear.  And  now  the  left  lower  limb,  alfo,  was 
taken  with  a  palfy,  in  the  fame  manner  as  the  right.  Finally,  although  the 
day  before  his  death  he  was  fo  exceedingly  bad,  that  his  pulfe  could  no  more 
be  perceiv’d,  it  return’d  again,  neverthelefs,  a  few  hours  before  death,  and 
the  patient  feem’d  to  be  a  little  better,  and  likely  to  drag  on  a  while  longer. 
But  (what  ought  to  make  phyflcians  cautious,  efpecially  where  convulfions 
are  every  now  and  then  returning)  he  was  foon  after  fuddenly  taken  off  by 
the  return  of  the  convulfions. 

In  the  belly  we  faw  much  water,  and  that  turbid  ;  and  the  inteftines  were, 
in  fome  places,  join’d  to  one  another,  by  a  kind  of  flaccid  membranes.  The 
fpleen,  which  was  otherwife  found,  had  a  whitenefs  externally.  The  liver 
was  of  the  fame  colour,  except  that,  in  the  middle  of  its  convex  furface,  a 
black  fpot  appear’d,  in  the  form  of  a  circle,  but  not  larger  than  to  be  co¬ 
ver’d  with  a  farthing  *,  and  under  this  was  a  cavity,  not  very  deep,  which 
was  fill’d  with  half-coagulated  blood.  The  left  kidney,  internally,  not  far 
from  the  beginnings  of  the  pelvis,  ftiew’d  a  little  white  pus.  The  bladder 
contain’d  urine,  but  not  in  a  great  quantity  :  its  membranes  were  become 
thicken’d,  and  the  internal  furface  was  diftinguifh’d  with  veffels,  which  the 
ftagnating  blood  had  render’d  extremely  confpicuous.  In  the  urethra  we 
look’d  for,  and  found,  that,  which  lying  near  the  bladder,  had  fomewhat  re¬ 
filled  the  paffage  of  the  catheter  *,  for  we  found  a  kind  of  flelhy  fibrilla;, 
which  I  remember  alfo  to  have  met  with  at  other  times,  defcending  here  and 
there,  on  the  fides  of  the  feminal  caruncle,  in  an  oblique  courfe,  but  parallel 
to  each  other,  and  being  there  prominent  through  the  internal  furface  of  the 
urethra.  The  teftes,  and  the  coats  that  lay  round  them,  and  even  the  fcrotum 
itfelf,  were  at  that  point  of  inflammation,  which  verges  to  gangrene. 

The  tumour  of  the  lower  part  of  the  breaft,  when  I  accurately  examin’d 
it  with  my  hand,  before  it  was  touch’d  with  a  knife,  feem’d  to  confift  en¬ 
tirely  of  the  lower  bone  of  the  fternum,  and  cartilages  of  the  ribs  on  the 
right  fide,  which  were  annex’d  to  it,  being  curv’d  outwards  more  than  was 
natural,  by  fome  force  impelling  from  within,  whatever  that  force  might  be„ 

Not 


222  Book  I.  Of  Difeafes  of  the  Head. 

Nor  did  the  difie&ion  difprove  my  fuppofition  •,  but  alfo  fhew’d,  that  the 
caufe  of  this  curvature  was  not  immediately  fubjetfted  to  that  bone,  and  the 
cartilages,  but  was  even  fituated  far  off,  in  the  very  fpine  of  the  thorax,  the 
figure  of  which  we  faw  was  not  natural.  But  we  firft  met  with  thefe  things 
only  in  the  thorax,  that  were  worthy  of  remark.  In  the  pericardium  was  a 
turbid  water,  and  not  in  fmall  quantity.  At  all  the  orifices  of  the  heart  were 
polypous  concretions,  of  a  white  colour,  pretty  large  in  the  auricles,  and 
fmall  in,  the  arteries.  Throughout  the  internal  furface  of  the  aorta,  were 
fprinkl’d,  here  and  there,  fmall  beginnings  of  offification,  white  and  fome- 
what  round,  not  yet  hard,  but  the  more  thickly  fown,  as  it  were,  the  nearer 
they  approach’d  to  the  heart.  The  veflels  of  the  diaphragm,  even  the 
fmalleft,  Were  juft  as  confpicuous  from  the  blood  ftagnating  in  them,  as  if 
they  had  been  fill’d  by  an  anatomical  inje&ion. 

The  upper  part  of  the  cranium,  and  the  dura  mater  which  lay  under  it, 
being  taken  away,  a  few  drops  of  extravafated  blood  were  feen  on  the  pia 
mater,  under  the  vertex,  and  near  to  the  left  fide  of  the  longitudinal  finus  : 
and  the  veflels  which  crept  through  this  fame  membrane,  where  it  invefts 
the  right  hemifphere  of  the  brain,  were  very  much  diftended  with  blood, 
and  of  a  biack  colour.  In  all  the  windings  betwixt  the  convolutions  of  the 
brain,  an  almoft  limpid  water  ftagnated.  In  the  ventricles  was  fcarcely  any 
water.  But  at  the  great  foramen  of  the  occiput,  was  a  large  quantity,  which 
made  it  natural  to  conclude,  that  it  could  not  but  have  flow’d  from  thence, 
down  into  the  tube  of  the  fpine  j  from  which  the  water  did,  in  fa<ft,  pre- 
fently  flow  out,  when  the  fpine  was  cut  afunder,  at  the  lower  part  of  the 
thorax.  The  marrow  was  in  that  place  white,  and,  as  far  as  we  could  judge 
by  the  eyes,  found  alfo.  This  diftedtion  was  perform’d  about  the  middle  of 
J«iy,  1705,  in  the  Hofpital  of  Incurables,  at  Bologna,  the  celebrated  Lau¬ 
rence  Bonazoli,  my  friend,  and  pupil  in  difle&ions,  aflifting  me  therein,  (as 
he  generally  did  in  moft  others,  which  I  fhall  mention  as  being  perform’d 
there)  who  at  that  time  being  a  young  man,  bore  the  office  of  affiftant  phy- 
fician  there-,  but  afterwards,  very  defervedly,  fill’d  up  the  office  in  that  ce¬ 
lebrated  college,  which  Valfalva,  by  differing  and  demonftrating,  had  before 
fuftain’d. 

14.  This  hiftory  relates  to  many  difeafes.  In  the  firft  place,  to  gibbofity, 
or  incurvation  of  the  fpine,  which  but  rarely  begins  to  appear  at  that  age, 
and  which,  I  fuppofe,  was  the  reafon,  why  that  fwelling  of  the  cheft  had 
impos’d  on  fo  many  perfons,  they  not  knowing,  and  even  not  fufpecfting,  in¬ 
deed,  from  whence  it  had  its  origin.  And  that  the  inflexion  of  the  fpme  to 
one  fide,  if  it  was  not  then  begun,  was  at  leaft  then  encreas’d,  that  curvature 
of  the  cheft,  which  did  not  exift  before,  and  was  the  confequence  thereof, 
fufficiently  proves.  But  whether  the  beginning,  or  increafe,  of  fuch  an  in¬ 
flexion,  is  to  be  accounted  for  from  a  blow,  a  fall,  or  a  ftrain,  rather  than 
from  an  internal  caufe,  is  uncertain. 

The  hiftory  relates,  in  the  fecond  place,  to  pain  of  the  back,  which  muft 
be  imputed  to  that  inflexion  already  greatly  encreas’d,  or  perhaps  even  to  the 
water  which  had  been  colledted  in  the  tube  of  the  fpine,  as  Wepfer  (<£) 

(£)  Vid.  Sepulch.  T.  1.  f.  15.  in  fchol.  ad  obf.  3. 


2 


judg’d 


Letter  X.  Article  i  223 

judg’d  in  a  fimilar  cafe.  And  to  this  water,  doubtlefs,  the  palfy  of  the 
lower  limbs  is  to  be  afcrib’d ;  as  alfo  to  the  palfy  affecting  the  nerves,  that 
go  to  the  mufcular  coat  of  the  bladder,  and  thofe  alfo,  perhaps,  which  are 
partly  diftributed  to  the  kidneys,  that  kind  of  double  ifchuria  is  to  be  attri¬ 
buted;  I  mean,  firft,  that  of  the  bladder  ;  and,  in  the  next  place,  that  of  the 
kidneys ;  for,  if  the  latter  of  thefe  vifcera  had  gone  on  to  difcharge  their  of¬ 
fices  compleatly,  in  the  lafb  days  of  the  difeafe,  a  far  greater  quantity  of  wa¬ 
ter  muft  have  been  found  in  the  bladder.  This  cafe,  therefore,  relates  to 
thofe  ifchuriae  and  to  the  paralyfis.  v> 

But  befides  thefe,  it  relates  alfo  to  the  afcites;  for  the  production  of  which, 
the  man’s  blood  could  certainly  fupply  fufficient  matter,  being  extremely 
pale,  though,  perhaps,  not  fo  much  from  nature,  as  in  confequence  of  his 
trade  ;  and  how  fuch  an  occupation  may  hinder  refpiration,  and  confequently 
the  perfection  of  the  blood,  is  not  difficult  to  conceive :  and  has  even  been 
already  ffiewn,  on  a  preceding  occafion  (r).  Laft  of  all,  this  hiftory  relates 
alfo  to  convulfions :  and  as  thefe  carried  off  the  patient,  I  had  rather,  for 
this  reafon,  that  the  hiltory  ffiould  be  chiefly  confider’d  in  this  view. 

1 5.  Thefe  convulfions  were  not  only  external,  but  internal  alfo,  as  the  vo¬ 
mitings,  which  were  join’d  with  them,  fhew’d.  But  the  humour  which  was 
difcharg’d  thereby,  was  not  of  fuch  a  kind,  that  it  leem’d  poffible  for  it  to 
have  been  the  caufe  of  the  convulfions,  as  that  44  brown”  humour,  or  hu¬ 
mour  44  like  the  j<ffice  of  a  leek,”  which  Galen  (d)  fuppos’d  to  be  the  caufe 
of  the  convulfions,  for  this  reafon,  becaule  that  being  thrown  up,  they  en¬ 
tirely  ceas’d  :  with  a  humour  of  which  kind,  44  aeruginous  and  black,” 
Mercurialis  writes,  that  44  the  fund  of  the  ftomach”  was  found  44  entirely - 
44  fill’d”  (e)  in  a  young  man,  a  native  of  Bergamo,  who  ftudied  at  this  uni- 
verfity,  and  whom  the  molt  violent  convulfions  had  taken  off,  within  twenty- 
four  hours.  But  in  the  man,  whofe  hiftory  we  are  now  fpeaking  of,  it  is 
natural  to  fuppofe,  that  the  convulfions  took  their  origin  from  the  water  ir¬ 
ritating  the  meninges,  both  of  the  fpinal  marrow,  and  brain  ;  when,  at 
length,  the  portion  of  urine,  which  was  wont  to  be  fecreted,  began  to  be 
retain’d  in  the  blood,  and  the  water  was  thereby  render’d  fait.  And  if  all 
the  nerves,  which  go  to  the  mufcles  of  the  lower  limbs,  had  not  been  alto¬ 
gether  refolv’d  ;  it  is  very  probable,  that  they  might,  at  leaff,  have  been  af¬ 
fected  with  fome  convuifion,  if  not  fo  much  as  the  upper  limbs,  and  the 
trunk  itfelf.  You  have,  in  the  Sepulchretum  (/),  a  celebrated  hiftory  point¬ 
ed  out,  from  the  firft  book  of  the  Epidemics,  in  which  a  woman,  who, 
44  at  firft,  began  to  have  a  pain  in  the  loins,”  having  that  pam  extended  to 
the  neck  and  the  head,  44  had  her  right  hand  feiz’d  with  a  weaknefs  and 
44  convuifion,  after  the  manner  of  an  apoplexy.”  Interpreters  allow  both  a 
paralyfis,  and  a  convuifion  of  the  fame  hand.  But  Vallefius,  as  you  fee  in 
the  fame  place,  does  not  allow  of  them  both  at  the  fame  time :  Duretus  (g), 
indeed,  at  the  fame  time,  but  the  paralyfis  in  the  nerve,  and  the  convuifion 
in  the  mufcle ;  and  Martianus  (£),  in  oppofition  to  both,  allows  them  to 

(<r)  Epift.  7.  n.  14.  (gj  In  Coae.  I.  2.  c.  12.  n.  9. 

(< d )  De  loc.  afF.  1.  5.  c.  6.  -  ( h )  In  Epidem.  1.  1.  fett.  3.  &  in  Coac. 

( e )  Praelett.  ad  Hippccr.  Aphor.  i/libri  5.  left.  2.  verf.  104. 

(f)  Sett,  hac  13.  in  fchol.  ad  obf.  8. 


have 


224  Book  I.  Of  Difeafes  of  the  Head. 

have  exifted,  both  at  the  fame  time,  and  in  the  fame  nerve.  If  I  might  be 
allow’d  to  add  any  thing  after  fuch  great  men,  I  think  it  cannot  be  deny’d, 
that  both  the  affections  might  fubfid,  at  the  fame  time,  and  in  the  fame 
part  -,  efpecially  as  Martianus  produces  a  clear  obfervation  of  his  own,  relat¬ 
ing  to  this  quedion  :  but,  that  difeafes  fo  diflimilar  in  themfelves,  are  rather 
to  be  imputed  to  different  nerves,  than  to  the  fame. 

And  for  this  reafon  I  faid,  that  if,  in  the  man  of  whom  I  fpeak,  thefe 
nerves  had  not  been  all  entirely  refolv’d,  that  is,  if  fome  of  them,  which 
move  any  of  the  mufcles  of  the  lower  limb,  or  rather  any  fmaller  portions  of 
one  mulcle,  which  are  incapable,  by  themfelves,  of  moving  the  whole  limb  ; 
if  they,  therefore,  at  lead,  had  been  unaffected  with  a  paralyfis,  they  might, 
upon  a  violent  attack  of  the  convulfions,  in  fome  meafure,  have  contracted 
a  part  of  the  lower  limbs.  Certainly  the  very  words  of  the  Coaca  Praeno¬ 
tiones. ,  which  Duretus  explains  by  the  example  of  that  woman,  feem  to  Mar¬ 
tianus,  as  well  as  to  Duretus  alfo,  not  to  fignify  an  abfolute  paralyfis,  nor 
indeed  to  fignify  any  other  kind  of  convulfion,  than  “  flight  convulfive  mo- 
“  tions.”  But,  as  in  the  upper  limbs  of  this  man,  there  was  nothing  paraly¬ 
tic,  that  is,  as  all  the  nerves  lay  naked,  open,  and  fenfible  to  the  vellicating 
caufe  ;  it  is  not  at  all  to  be  wonder’d  at,  if  very  grievous  convulfions,  and 
l'uch  as  laded  for  a  quarter  of  an  hour,  that  is,  tonic  convulfions,  often  at¬ 
tack’d  him.  And  as  the  caufe  of  thefe,  and  of  chlonic ,  that  is  to  fay,  of 
convulfive  motions,  is  the  fame  •,  they  feem  to  differ  in  thifone  thing  chiefly, 
that  in  the  latter  the  convulfion  acts  after  very  fhort  intervals,  and,  as  it  were, 
alternately;  but  in  the  former  it  acts  continually:  although,  I  fhould  fup- 
pofe,  that  it,  perhaps,  adts  condantly  in  both ;  but  that  acting  more  mildly 
in  the  chlonic ,  it  is  alternately  overcome,  either  by  the  natural  drength,  or 
weight  of  the  parts :  but  that  in  the  tonic ,  it  adts  mod  vehemently,  fo  that 
the  effedts  of  it,  unlefs  any  thing  elfe  interrupt,  fhall  condantly  perfid,  nor, 
as  it  feems,  fhall  fometimes  be  overcome  even  by  death  itfelf.  For  what 
Caefalpinus  lays  down  is  by  no  means  perpetual  (/),  “  that  the  carcaffes  of 
“  thole  who  had  died  of  convulfions,  were  not  at  all  tenfe,  but  relax’d  ” 
But  on  the  contrary,  that  fometimes  happens  which  Vefalius  (k)  “  remem- 
“  ber’d  once  to  have  feen,”  that  one  fide  “  remain’d  convuls’d  even  after 
“  death,  in  a  certain  perfon,  who  had  been  wounded  in  the  head and,  to 
omit  other  examples,  the  celebrated  Heider  (/),  while  he  was  about  to  ex¬ 
amine  farther,  into  the  carcafe  of  a  man,  who  had  died  in  the  hofpital  at 
Noremberg  of  convulfions,  after  having  demondrated  the  chirurgical  ope¬ 
rations  upon  it,  in  the  theatre  at  Altorf,  found  the  abdominal  mufcles,  when 
he  was  about  to  examine  the  body  internally,  even  then  “  drawn  fo  much 
<c  inwards,”  that  the  linea  alba  lay  almod  upon  the  vertebrae  of  the  loins. 

1 8.  But  what  that  can  be,  which  interrupts  the  action  of  the  prefent  caufe, 
as  we  faid,  fo  that  the  limbs  be  not  again  contracted,  till  after  long  intervals, 
is,  for  the  mod  part,  fo  obfcure,  that  it  leaves  room  for  no  conjectures,  but 
thofe  of  fuch  a  kind,  that  I  faid  I  was  entirely  averfe  to.  If  any  thing, 
however,  in  regard  to  the  convulfions,  is  difficult  to  be  explain’d ;  certainly, 

(<)  Quaeft.  Med.  1.  2.  c.  1 6.  (/)  Eph.  N.  C.  Cent.  2.  obf.  98.  n.  2. 

(k)  Chirurg.  magn.  1.  3.  c.  5. 

*  fome 


Letter  X.  Article  -i  7.  225 

fome  things  are  much  more  difficult  of  explanation,  in  a  hiftory  which,  if 
Valfalva  had  not  left  it  in  his  papers,  I  ffiould  not  eafily  believe,  nor  fhould 
give  you  the  defcription  of  here.  A  boy  of  eight  years  o!d,  having  been 
long  lubject,  but  by  intervals,  to  pains  of  the  belly  ;  at  laft,  upon  their  re¬ 
turn,  took  mercurius  dulcis,  as  it  is  call’d,  prefcrib’d  by  an  empiric  indeed, 
but  in  a  proper  dofe  enough  :  a  little  after,  he  became  blind  of  both  eyes, 
the  upper,  and  lower  limbs,  and  the  head,  were  convuls’d  on  the  right  fide, 
and  remain’d  in  the  convuls’d  pofture.  After  a  few  days,  he  recover’d  the 
fight  of  his  eyes,  and,  in  a  little  time  alfo,  the  motion  of  his  head.  Laft  of 
all,  while  he  was  attempting  to  walk,  the  lower  limb,  which  had  been 
convuls’d,  was  feiz’d  with  a  very  great  pain  •,  yet,  neverthelefs,  recover’d 
its  natural  motion.  But  then,  immediately  the  upper  limb,  on  the  right 
fide,  which  had,  in  like  manner,  been  convuls’d  before,  as  I  have  faid, 
was  ftill  much  more  convuls’d,  efpecially  at  the  flexure  of  the  cubit :  yet 
this  convulfion  alfo  did  immediately  remit,  and  the  hand  only,  at  the  extre¬ 
mity  of  the  limb,  remain’d  convuls’d.  And  now,  if  any  one  endeavour’d 
to  extend  all  the  fingers  of  this  hand,  then  immediately  the  other  healthy 
hand  was  feiz’d  with  convulfions,  and  was  ftrongly  contracted  :  but,  if  one 
finger  only  was  extended,  immediately  the  correfponding  finger  in  the  other 
hand  was  convuls’d  ;  and  the  convulfion  lafted  as  long  in  the  one,  as  the 
violent  extenfion  was  continu’d  in  the  other*  However,  from  the  time  that 
the  boy  was  taken  with  convulfions,  the  pains  of  his  belly  return’d  no  more. 

17.  A  young  man  of  one  and  twenty  years  of  age,  and,  by  trade,  a  wool- 
comber,  was  feiz’d  with  a  violent  fever,  to  which  a  delirium  alfo  was  added, 
fo  that  it  was  neceflary  to  tie  him  down  in  bed.  His  delirium  having  lome 
remiffion,  he  was  brought  into  this  hofpital,  where  convulfive  motions  of  his 
upper  limbs,  and  fubfultus  tendinum  in  both  the  wrifts,  were  obferv’d  :  in 
the  blood,  however,  that  was  taken  from  him,  no  inflammatory  cruft  ap¬ 
pear’d,  but  its  fubftance  was  very  denfe  and  compaCt.  A  very  heavy  fopo- 
rific  diforder  alfo  came  on  *,  fo  that  for  the  laft  three  days,  he  lay  without 
fpeaking  a  word,  and  thus  died. 

As  l  was  to  make  ufe  of  this  body,  not  only  to  demonftrate  to  my  pupils 
fome  things  within  the  cranium,  but  alfo  within  the  upper  part  of  the  fpine, 
I  firft  open’d  the  thorax,  and  finding  nothing  worthy  of  remark  there,  except 
that  one  of  the  lobes  of  the  lungs  was  obferv’d  to  be  very  hard,  I  remov’d 
thefe,  and  all  the  other  vifcera,  from  the  parts  that  were  to  be  examin’d  and 
demonftrated  ;  and  while  I  disjoin’d  the  fifth  vertebra  of  the  thorax  from  the 
fixth,  much  water  flow’d  out  of  the  tube  of  the  fpine.  A  little  alio  ifiu’d 
out  from  the  cranium  foon  after,  when  it  was  faw’d  round  about.  And  the 
upper  part  of  the  cranium,  and  the  dura  mater  which  lay  under  it,  being  re¬ 
mov’d,  we  faw  the  veflels  that  creep  through  the  pia  mater,  on  the  pofterior 
part  of  the  left  hemifphere  of  the  brain,  to  be  diftended  with  black  blood 
(fuch  as  had  flow’d  out  in  great  quantity,  when  the  veflels  of  the  neck  were 
divided)  •,  and  there  alfo  we  faw,  under  the  fame  pia  mater,  in  fome  places, 
a  kind  of  jelly,  as  it  were,  not  without  bubbles  of  air  being  interpos’d  with 
it :  notwithstanding,  there  was  not  the  leaft  bad  fmell  in  any  part  of  the  body, 
nor  was  it  the  time  of  the  year,  being  about  the  middle  of  March  1745» 
when  a  carcafe  fhould  grow  putrid  in  left  than  three  days.  The  brain  being 

Vol.  I.  G  g  directed, 


ii 6  Book  I.  Of  Difeafes  of  the  Head. 

differed,  was  found  to  be  very  hard,  and  (hew’d,  up  and  down  in  its  me¬ 
dullary  fubftance,  bloody  points,  which  prefently  dilated  themfelves  into 
bloody  drops,  and  were  ample  proofs  of  a  great  quantity  of  fluid  blood.  But 
even  in  the  lateral  ventricles,  which  contain’d  fcarcely  any  water,  the  plexus 
choroides  were  of  a  red  colour,  degenerating  into  black.  And  thefe  ven¬ 
tricles  were  (horter  than  ufual.  This,  however,  was  naturally  fo :  but  that 
which  I  (hall  relate  to  you  now,  arofe  from  a  diforder,  partly  acute,  and  of 
a  late  date,  partly  (low,  and  of  a  long  (landing.  For  it  was  owing  to  an 
acute  diforder,  that  the  pineal  gland  was  of  a  rofy  colour ;  and  to  a  chronic 
one,  that  the  anterior,  and  pollerior  furfaces  were  not  deprefs’d,  as  I  have 
been  us’d  to  fee  them,  but  rather  turgid  and  full :  or  at  leail,  if  this  might 
happen  from  an  acute  diforder,  that  hardnefs  certainly  muft  have  been 
caus’d  by  a  (low  one,  which  was  of  fuch  a  nature,  that,  upon  perceiving  it, 
I  immediately  fufpedled,  and,  in  reality,  found,  when  I  cut  into  the  gland, 
that  feveral  fmall  kind  of  calculi  were  contain’d  in  it :  among  which,  one 
refembl’d  a  millet  feed,  both  in  magnitude  and  form,  but  was  of  the  hard¬ 
nefs  of  bone,  and,  perhaps,  of  the  nature  too,  as  the  fmell  of  it,  when  ap- 
ply’d  to  the  flame,  feem’d  to  indicate. 

Finally,  the  fpinal  marrow  being  accurately  infpedled,  from  the  cranium 
down  to  the  fifth  thoracic  vertebra,  I  faw  all  the  veflels,  that  ran  upon  its 
pia  mater,  fo  very  full  of  blood,  efpecially  on  the  pofterior  furface,  that  they 
feem’d  like  veflels,  which  had  been  immoderately  diftended,  by  a  red  injec¬ 
tion.  But  I  all’o  obferv’d  fanguiferous  veflels,  in  the  number  of  thofe  which 
attended  the  fpinal  nerves,  efpecially  fome  of  them,  to  be  very  turgid  with 
blood.  The  abdomen  I  did  not  open. 

1 8.  That  the  lobe  of  the  lungs  was  very  hard,  does  not  at  all  relate  to  the 
lad  difeafe,  in  which  no  fymptoms  of  that  vifcus  being  vitiated,  were  ob¬ 
ferv’d.  But,  doubtlefs,  it  was  either  the  remains  of  another  diforder,  which 
had  been  very  violent,  or  the  bafis  and  foundation  of  a  future  one ;  which  is 
not  at  all  to  be  wonder’d  at  in  a  wool-comber.  For  workmen  of  this  kind, 
are  well  known  to  be  often  affedled  in  their  lungs,  and  often  to  die,  from 
fuch  difeafes  ;  by  reafon  that  they  take  into  their  trachea,  the  filthy  vapour 
of  the  oil,  in  refpiration,  with  which,  not  only  their  wool  but  themfelves 
are  continually  hefmear’d ;  and  by  reafon  alfo,  that  they  fpend  their  lives, 
almoft  naked,  in  hot  places,  and  by  the  fide  of  the  burning  (loves  •,  from 
whence  they  often  go  out,  when  they  are  extremely  hot,  and  at  the  fame 
time  half-naked,  into  the  open  air.  Neither  did  the  corpufcles,  found  with¬ 
in  the  pineal  gland,  any  more  than  the  hardnefs  of  the  lungs,  relate  to-  the 
lad  difeafe,  whether  they  were  calculi,  or  rather  in  this  fubjedt,  indeed,  of  a 
bony  nature,  according  to  the  opinion  of  Scheidius,  which  1  have  mention’d 
before,  in  another  place  (m).  But  the  rofy  colour  of  the  pineal  gland  feem’d 
to  have  arifen  from  the  fame  caufr,  which  had  lately  given  occafion  to -the 
blood’s  (lagnating  in  the  pia  mater,  and  even  in  the  neighbouring  plexus 
choroides,  annex’d  thereto.  And  are  we  to  fuppofe,  that  this  caufe  was  a 
convulfion,  which/  by  corrugating  the  pia  mater,  had  ftreighten’d  the  blood - 
veflels  here  and  there,  fo  that  the  circulation  being  retarded,  the  neared 


( m )  Epift.  5.  n.  12. 

7 


branches 


Letter  X.  Article  19.  227 

branches  were  diftended  ?  For  you  fee,  that  the  fame  thing  happen’d  about 
the  fpinal  marrow,  on  that  part,  which  looks  towards  the  brachial  nerves, 
that  were  convuls’d :  and  you  even  fee,  alfo,  in  the  man  whole  hiftory  was 
given  laft  before  this  (»),  that  there  was  the  fame  diftenfion  of  the  veffels, 
about  one  of  the  hemifpheres  of  the  brain  :  which  1  mention  here,  left  you 
fhould  refer  this  appearance  to  the  delirium  alone,  which  had  preceded. 
But  as  it  is  by  no  means  certain,  that  a  convulfion  exifted  before  the  de¬ 
lirium  •,  and  as  the  veffels  may  be  diftended  with  fluid  blood,  in  fome  certain 
parts,  rather  than  in  others,  in  confequence  of  the  fupine  pofition  of  a  dying, 
and  dead  man  ;  I  believe  it  will  be  better  here  to  luppofe,  that,  which  is  in¬ 
dicated  by  the  great  quantity  of  blood,  flowing  out  from  the  veffels  of  the 
neck,  and  by  thofe  red  points,  which  appear’d  wherever  you  cut  into  the 
white  fubftance  of  the  cerebrum,  and  prefently  dilated  themfelves  into 
bloody  drops  •,  I  mean,  that  all  the  veffels  of  the  brain,  whatever  had  been 
the  caufe  thereof,  were  diftended  with  blood.  And  this  blood,  while  it  began 
to  enlarge  the  ways  for  itfelf,  here  and  there,  through  the  very  (lender  veffels, 
feems  to  have  excited  a  delirium,  by  difturbing  the  motion  of  the  animal 
fpirits,  in  the  neareft  medullary  fibres ;  but  after  it  was  gather’d  together  in 
fuch  a  quantity,  that  by  preffing  upon  and  overloading  thofe  fibres,  it  ferv’d 
to  conftringe  them  more  and  more,  it  feems  then  to  have  brought  on  fleepinefs, 
and  at  length  death.  Yet  it  is  certain,  that  there  was  at  the  fame  time  a 
large  quantity  of  water,  efpecially  about  the  fpinal  marrow ;  perhaps,  becaufe 
the  blood,  by  its  quantity,  had  been  the  occafion  of  remora  to  itfelf ;  and 
it  was  therefore  extravafated,  from  the  time  that  the  blood  firft  began  to  be 
collected  :  and  in  this  water  nothing  forbids  us  to  fufpedft  a  power  of  velli- 
cating  the  meninges,  according  to  the  examples  before-mention’d  (0),  lefs, 
however,  than  in  the  man  fpoken  of  before  ;  and  what  was  above  hintedf/»), 
concerning  the  manner  in  which  convulfive  motions  were  brought  on,  leaves 
us  alfo  at  liberty  to  conjecture  on  that  fubjedl. 

19.  A  porter,  who  was  an  old  man,  or  at  lead  hoary-headed,  was  brought 
into  the  fame  hofpital,  on  the  firft  of  February,  in  the  fame  year  1745.  He 
was  already  without  fpeech,  and  almoft  without  pulfe  *,  but  not  without  con¬ 
vulfive  motions.  Wherefore  he  died  on  the  fame  day.  Nor  was  it  poffible 
to  learn  any  thing  farther  of  his  difeafe,  becaufe  no  furgeon  or  phyfician  had 
vifited  him  at  home,  except  one,  who  being  call’d  to  him  juft  before  he  was 
brought  to  the  hofpital,  found  him  in  the  fame  ftate  that  I  have  related. 

The  body  was  carried  into  the  theatre,  as,  except  the  hands  being  fome- 
what  tumid,  and  oedematous,  and  the  upper  part  of  the  cheft  lefs  high  on 
the  left  than  the  right  fide,  it  feem’d  very  fit  for  the  purpofes  of  anatomy, 
which  I  was  then  teaching,  efpecially  as  it  was  large,  mufcular,  and  brawny. 
Thefe  things,  however,  which  I  fhall  recount  to  you,  were  more  or  lefs  pre¬ 
ternatural. 

In  the  belly,  the  liver  was  fomewhat  hard,  and  both  internally  and  exter¬ 
nally,  was  variegated  with  a  whitifh,  and  dirty  yellow,  colour  ;  and  the 
gall-bladder  was  full  of  a  bile  that  was  green,  but  inclining  to  yellow.  The 
fpleen  was  large  and  turgid  5  and  the  membrane  that  inverted  it  had,  on 

(*)  N.  13.  (<?)  N.  6.  (/)  N.  15. 

G  g  2  ,  its 


% 


) 


228  Book  I.  Of  Difeafes  of  the  Head. 

its  convex  furface,  two  bony  fcales,  one  of  which  was  not  very  (mail ;  but 
the  fubftance  of  this  vifcus,  though  of  its  ufual  colour,  was,  however,  ex¬ 
tremely  lax,  and  had  almoft  the  confidence  of  a  poultice.  One  of  the  kid¬ 
neys  might  have  been  compar’d  with  the  leaf  of  alarum,  in  its  figure,  and 
that  with  much  more  propriety  than  has  frequently  been  done  at  other  itnes, 
by  many  perfons  •,  for  it  was  much  more  fhort  than  the  other,  more  contracted 
into  itfelf,  and  incurvated.  It  had,  moreover,  not  only  a  fmall  hydatid  on 
-  the  top  of  it,  but  even  under  its  proper  membrane,  at  the  other  extremity, 
two  cavities,  not  fmall,  and  full  of  moifture,  fuch  as  I  have  delcrib’d  in  the 
Adverfaria  (<?),  and  Willis  alfo  has  delcrib’d,  as  you  fee  in  this  very  fed'ion 
of  the  Sepulchretum  (r).  The  bladder,  when  it  was  inflated,  exhibited  a 
figure,  which  has,  indeed,  been  obferv’d  by  me(j);  but  fhew’d,  at  the  fame 
time,  a  fmallnefs  much  to  be  wonder’d  at  in  fo  large  a  body,  if  I  had  not, 
upon  cutting  into  it,  found  the  parietes  very  thick,  and  for  that  reafon  not 
eafily  to  be  extended  :  fo  that,  though  the  bladder  was  in  other  refpeds  found, 
I  Ihould  make  no  doubt,  but  the  patient  had  labour’d  under  fome  difordcrs, 
in  which  the  urine  was  concern’d  ;  as  the  relation  I  have  given  you  feems  to 
prove. 

The  integuments  and  mufcles  being  taken  from  the  cheft,  it  was  manifeft, 
that  the  upper  part  of  the  fternum  was  not  carried  fo  high  on  the  left  fide,  as 
on  the  right  ;  and  that  the  left  clavicle  was,  for  that  reafon,  join’d  to  the 
fternum  lower  than  the  right :  fo  that,  for  this  reafon,  you  would  rather  be¬ 
lieve  this  formation  to  have  exifted  from  the  womb,  than  that  it  had  been 
caus’d  by  his  having  carried  too  heavy  loads  on  his  left  fhoulder,  when  a  boy. 
The  lungs,  on  their  pofterior  furface,  were  not  only  red,  which  is  cuftomary 
with  them,  but  they  were  alfo  harder  than  ufual  ;  yet  fo  far,  as  to  be  the 
remaining  proof  of  fome  diforder  only,  that  they  had  formerly  undergone, 
and  certainly  not  of  the  laft.  While  I  look’d  upon  the  lungs  anteriorly,  I 
obferv’d  an  appearance,  which  I  never  had  feen  before.  For  betwixt  the 
right  fuperior  and  inferior  lobes,  a  body  was  interpos’d,  an  inch  and  half 
broad,  and  three  or  four  inches  long,  and  white,  as  if  it  had  been  compos’d 
of  fat,  being  intercepted  betwixt  certain  membranes.  But,  on  examining 
into  it  more  diligently,  when  I  perceiv’d  the  branches  within  it,  made  up  of 
the  ufual  cartilaginous  fedtions  of  circles,  and  finally  connected  to  the  right 
bronchia,  and  even  continu’d  therefrom  I  plainly  perceiv’d,  that  it  had  been 
formerly  that  third  little,  or  middle  lobule,  of  the  right  lobe  of  the  lungs, 
which,  from  fome  caufe  or  other,  being  in  a  manner  effete  and  dead,  was  fo 
contradled  in  its  fubftance  and  its  veffels,  that  it  no  more  refembl’d  the  lungs, 
either  in  colour,  in  foftnefs,  or  in  ftrudture.  Within  the  pericardium,  which 
was  harder  than  ufual,  the  heart  was  cover’d  with  fat ;  and  the  valvulse  tri- 
cufpides,  and  mitrales,  had  their  lower  borders,  as  I  have  often  feen  them  at 
other  times,  very  thick  and  hard,  and  a  little  tuberous  here  and  there,  as  if 
their  fubftance  had  been  fill’d  with  glands.  And  the  femilunar  valves  were 
not  only  here  and  there  hard,  but  even  in  fome  places  bony*  fo  that  it  was 
lefs  to  be  wonder’d  at  afterwards,  that  on  the  internal  furface  of  the  aorta, 
both  near  to  the  heart,  and  at  a  diftance  from  it,  to  wit,  even  in  the  iliacs, 

(?)  III.  Animad.  33.  (r)  13.  obf.  1.  ( s )  Epift.  Anat.  1.  n.  61. 


8 


white 


*  Letter  X.  Articles  20,  21.  229 

white  fpots  fprinkl’d  here  and  there  fliould  occur,  as  the  marks  of  future  of- 
fifications.  The  diaphragm,  whichever  furface  you  look’d  upon,  whether 
in  its  fituation,  or  taken  out  of  it,  had  in  every  refpeCt  the  foramen,  through 
which  the  oefophagus  palles  to  the  fiomaeh,  much  Ihorter  than  it  is  wont  to 
be,  infomuch  that  I  never  remember  to  have  feen  the  like.  Finally,  the 
cranium,  when  it  was  law’d  through,  had  a  little  water  flowing  out  from  its 
cavity.  Looking  upon  the  cerebrum,  1  law  the  appearance  of  a  jelly,  under 
the  pia  mater;  and  the  veflels,  which  creep  through  the  parietes  of  the  lateral 
ventricles,  very  turgid  with  blood.  But  there  was  nothing  elfe  worthy  of 
oblervation  in  the  diffeCtion. 

20.  Faffing  by  other  circumftances,  which  I  put  down,  in  order  to  make 
the  hi/lory  compleat,  although  fome  of  the  appearances  relate  to  different 
parts  of  this  work  ;  thefe  laft  few  things  remain  to  be  faid,  which  may  feem 
to  refer  to  the  caufe  of  convulflve  motions.  But  if  you  would  rather  chufe 
to  conjecture  differently  on  the  fubjeCt,  I  will  not  be  againft  it.  For  he  was 
very  weak,  and  very  near  death,  when  thefe  convulflve  motions  were  obferv'd. 
And  Boerhaave  fays(/t),  “  In  the  greateft  debility,  and  in  an  animal  who  is  about 
“  to  die,  fpafms  and  convulfions  are  wont  to  precede ;”  not  becaufe  the  force 
of  the  mufcles,  in  contracting  themfelves,  is  encreas’d,  but  becaufe  the  force 
of  their  antagomfts  is  diminifh’d,  as  in  a  palfy.  And  there  are  fome  who 
refer  to  this  thofe  prognoftics  of  Hippocrates :  “  A  convulflon  from  a  hae¬ 
morrhage  is  fatal,”  in  aphorifm  the  fifth,  number  two ;  “  a  convulflon  from 
“  taking  too  much  hellebore  is  fatal,”  in  the  fame  place,  number  one.  And 
though  the  names  of  thele  perfons  have  partly  flipt  my  memory,  yet  you, 
perhaps,  will  not  be  very  diftant  from  the  truth,  if  that  convulflon,  which 
Hippocrates  foon  after  pronounces  “  bad  («),”  that  is,  when  fucceeding  either 
a  too  great  evacuation  of  blood,  or  a  too  great  evacuation  by  the  inteftines, 
you,  at  leaft  fometimes,  attribute  to  fo  great  a  want  of  blood  and  fpirits,  that 
as  they  are  not  able  to  flow  into  all  the  mufcles  equally,  thefe  into  which  they 
are  carried  in  lefs  quantity  give  way,  while  thofe  into  which  they  are  carried 
in  greater  quantity  exceed  and  overcome  ;  and  this,  if  it  continue,  gives  the 
idea  of  a  tonic  convulflon  :  yet  if  the  contractions  are  not  permanent,  but 
are  by  turns,  in  different  mufcles,  which  in  that  laft  perturbation  of  na- 

‘  ture,  it  is  eafy  to  imagine,  then  you  have  an  exprefs  image  of  fublultus, 
and  chlonic  convulflon.  For  that  is  by  no  means  truly  and  properly  a  con¬ 
vulflon,  where  the  mufcles  contract  themfelves,  by  reafon  of  the  refolution, 
or  palfy,  of  their  antagonifts  *,  and  when  they  are  contracted,  can  eaflly,  and 
without  pain,  be  extended  by  the  hands  being  applied  for  that  purpofe.  In 
this  man,  therefore,  if  you  would  have  it,  that  there  was  a  kind  of  image, 
or  fhadow,  of  convulflve  motions,  rather  than  convulflve  motions  themfelves, 
by  reafon  of  his  great  weaknefs,  I  fball  not  violently  controvert  your  opinion. 

21.  But  that  true  convulfions,  and  thofe  which  are  properly  fo  call’d, 
may  be  excited  without  any  intervening  palfy,  as  for  inftance  from  punc¬ 
tures,  and  vellications  of  the  nerves,  both  in  wounded  men,  and  in  beafts, 
but  efpecially  in  beafts,  for  the  fake  of  experiment,  is  extremely  well  known 
to  every  body.  And  this  the  pain  allb  confirms,  that  is  join’d  with  the  tonic 

(/)  Pradeft.  in  Inftit.  §  401.  (a)  Seft.  5,  Aph.  3  &  4. 

convulflon. 


2  Book  I.  Of  Difeafes  of  the  Head. 

convulfion,  at  that  time  particularly,  when  any  one  endeavours,  as  I  faid 
before,  to  extend  the  contracted  limb  with  his  hand,  and  reduce  it  to  its  na¬ 
tural  pofition.  And  this  the  method  of  cure  alfo  confirms,  which  in  a  pally 
would  certainly  be  of  the  higheft  prejudice.  I  remember  to  have  heard 
from  Albertini,  of  a  wicked  chymift,  who  took  more  pains  and  labour  to 
prepare  the  molt  inftantaneous  poifon,  than  others  do  to  prepare  the  mod 
fpeedy  remedies  •,  and  if  he  could  have  brought  this  to  perfection,  he  hop’d 
it  would  kill  by  its  very  vapour.  This  wicked  wretch  then  having  thrown 
many  and  various  things  together  into  a  mattrafs,  of  which  it  is  better  not 
to  mention  the  names  (for  phyficians  have  imprudently  committed  many  of 
thefe  things  to  writing,  and  fome  of  them  in  particular,  things  which  I  wifh 
could  be  abolifn’d)  and  having  by  a  length  of  time,  and  by  much  ’art  and 
toil,  chang’d  them  from  a  bad  to  a  much  worle  and  more  noxious  nature  ■„ 
reap’d  himfelf  the  firft  fruits  of  his  wickednefs.  For  his  veffel  having  fall’n, 
in  being  broken,  as  it  was  carried  from  one  place  to  another,  and  he  being 
almoft  diftraCted  at  the  lofs  of  his  time,  labour,  and  expences,  was  pre- 
lumptuous  enough  to  take  up  with  a  fponge  what  he  could  of  the  liquor  that 
had  been  fpilt,  and  to  prefs  it  out  into  another  veffel.  No  fooner  had  he 
done  it,  but  behold  he  was  immediately  feiz’d  with  convulfions  fo  violent, 
that  being  haftily  carried  to  bed,  he  was  prefently  thrown  out  of  the  bed, 
upon  the  floor,  by  the  violence  thereof ;  and  there  Albertini,  being  fent  for 
with  fpeed,  found  him  writhing  himfelf  like  a  ferpent,  with  his  eyes  almolt 
fcarting  forth  from  his  head,  and  bellowing  in  a  horrid  manner,  with  his 
tongue  hanging  out  from  his  mouth.  In  this  very  delperate  cafe,  having 
us’d  many  remedies,  he  found  nothing  of  equal  advantage  with  that  of  bath¬ 
ing  him  all  over  in  warm  oil,  by  letting  him  down  into  a  veffel  prepar’d  for 
that  purpofe  *,  for  by  this  means  his  convulfions  were  quieted.  But  Anthony 
Vallifneri  related  to  me,  that  when  a  nobleman  had  already  labour’d  with 
convulfive  affections  for  a  whole  year,  nor  any  thing  elfe  had  been  of  fervice 
to  him  ;  he  had  lucceeded  in  the  cure,  by  ordering  only,  that  he  fhould  ac- 
cuftom  himfelf  to  take  every  night,  inftead  of  fupper,  two  ounces  of  oil  of 
almonds  recently  exprefs’d.  But  on  fo  obvious  a  fubjeCt,  let  it  be  fufficient 
to  have  made  mention  of  thefe  two  examples,  which  1  receiv’d  from  two  very 
celebrated  men,  one  of  an  acute,  and  the  other  of  a  chronic,  difeafe.  Thus 
far  of  convulfions.  Of  the  palfy  1  fhall  write  to  you  in  the  next  letter. 
Fare  w  el. 


LETTER  the  ELEVENTH. 

On  the  Palfy. 

i.  THAT  convulfion,  of  which  I  v^rote  in  the  laft  letter,  is  to  the  epi- 
W  lepfy,  the  fame  is  pally,  of  which  I  fihall  write  at  prefent,  to  the 
apoplexy.  For  as  to  the  fe&ion  which  fucceeds  next  in  the  Sepulchretum, 

de 


Letter  XI.  Articles  2,  3.  231 

de  Stupore ,  7° orpore,  T remore.  Horrore ,  Rigore ,  Anxietate ,  doubtlefs  you  per¬ 
ceive,  that  fome  of  thefe  diforders  belong  to  the  palfy,  fome  to  convulfion, 
and  fome  fhould  be  plac’d  under  other  heads:  and  this  the  obfervations  alfo 
in  that  febtion,  when  compar’d,  demonftrate,  inafmuch  as,  a  few  of  the  prin¬ 
cipal  only  excepted,  fome  of  them  are  taken  from  one  fedtion,  and  fome 
from  another,  as  you  will  fee.  And  indeed  that  fifteenth  fedlion,  which  is 
entitled  de  Paraly/i ,  has  many  in  like  manner,  which  are  transferr’d  from 
other  places.  But  I,  however,  fhall  prefcrve  my  cuftom,  and  fhall  bring 
over  again  in  this  place,  under  the  head  of  palfy,  none  of  the  obfervations 
which  I  have  already  given  you,  under  the  head  of  apoplexy  ;  nor  fhall  I 
take  any  from  thofe  that  relate  to  blows  and  wounds,  which  you  will  receive 
hereafter.  Wherefore  I  fhall  give  you  only  three  from  Valfalva’s  papers, 
and  four  from  mine. 

2.  An  old  man  of  fixty,  being  troubl’d  with  a  flux  of  the  belly,  join’d 
with  gripings,  and  continual  watchings  befides,  anointed  his  belly  with  oil 
of  quinces.  And  although  the  flux  continu’d  quite  to  the  time  of  his  death, 
yet  on  the  following  night,  without  any  previous  fymptom  of  his  head,  he 
was  fuddenly  feiz’d  with  an  hemiplegia,  fo  that  the  whole  right  fide  of  his 
body  remain’d  immoveable.  On  the  firft  day,  however,  after  bleeding,  and 
irritating  medicines  being  applied  to  the  foies  of  his  feet,  he  could  move 
both  his  hand  and  his  foot  a  little ;  yet  the  day  after  could  not  move  them 
at  all.  As  to  the  other  parts,  his  right  eye  was  half-fhut,  his  cheeks  were 
red,  he  fcarcely  fpoke  at  all,  and  when  he  did,  he  Hammer'd ;  but  he  an- 
fwer’d,  in  fuch  a  manner,  by  nods  and  figns,  to  thofe  who  afk’d  him  quef- 
tions,  that  you  might  perceive  his  internal  fenfes  to  be  flrong  and  perfect. 
In  the  beginning  of  the  diforder  his  refpiration  was  eafy  •,  but  it  became  dif¬ 
ficult  a  day  or  two  before  his  death,  which  happen’d  on  the  beginning  of  the 
fourth  day. 

While  the  brain  was  taken  out  from  the  cranium,  and  efpecially  while  the 
infundibulum  w>as  divided  from  the  pituitary  gland,  a  limpid  ferum,  and  a 
fluid  blood  came  forth.  On  the  left,  and  by  the  fides  of  the  fanguiferous 
vefiels  of  the  meninges,  a  little  matter  was  obferv’d,  which  had  the  appear¬ 
ance  of  a  jelly.  And  on  the  fame  fide,  in  like  manner,  under  the  pia  mater, 
the  very  fubftance  of  the  brain  feem’d  to  be  a  little  eroded  in  two  places : 
which  was  more  manifeft  in  the  ventricle  of  the  fame  fide.  For  the  corpus 
flriatum  was  found  to  be  entirely  feparated  from  the  remainder  of  the  cere¬ 
brum,  by  reafon  of  an  erofion,  perhaps  brought  on  by  ferum  which  ftagnated 
in  the  ventricles. 

3.  But  whatever  was  the  caufe  of  this  feparation  of  the  corpus  ftriatum, 
I  have  already  fhewn  you  in  the  third  letter  (a),  which  1  fent  you,  how  often 
a  hemiplegia  is  wont  to  happen  from  an  injury  in  one  or  other  of  thefe  bo¬ 
dies,  or  their  neighbourhood.  Add  to  this,  what  the  Sepulchretum  teaches  (/>), 
that  Willis  alfo  having  fometimes  examin’d  the  bodies  “  of  thofe  who  died 
“  after  a  long  palfy,  and  a  very  grievous  refolution  of  the  nerves,  had  al- 
“  ways  found  thefe  bodies  lefs  firm  than  others  in  the  brain,  being  difco- 
fi  lour’d  like  lees  of  oil,  and  having  their  ftriae  greatly  obliterated.” 

(«)  n.  18.  (1)  Se&.  hac  15.  obf.  1. 

4.  Another 


2  32  Book  I.  Of  Difeafes  of  the  Head. 

4.  Another  old  man,  of  the  fame  age,  fell  down  fuddenly,  at  the  lame 
time  loft  the  power  of  moving,  and  feeling,  in  the  right  fide  of  his  body* 
When  he  was  afk’d  queftions,  he  fcarcely  anfwer’d  at  all ;  yet  what  he  did 
fay  was  with  Hammering.  In  all  the  time  that  he  furviv’d  this  ftroke,  he 
made  but  little  water,  and  never  went  to  (tool  without  the  affiftance  of  glyfters. 
Finally,  in  the  beginning  of  the  21ft  day,  a  difficult  refpiration  coming  on, 
he  died.  The  thorax  being  open’d,  the  lungs,  but  efpecially  the  right  lobe, 
were  found  to  have  been  feiz’d  with  a  phlegmon,  in  their  pofterior  parts. 
The  ventricles  of  the  heart  contain’d  fmall  polypous  concretions,  which  ex¬ 
tended  themfelves  into  the  neighb’ring  veffels.  In  fawing  through  the  cranium, 
the  dura  mater  being  wounded,  a  limpid  water  flow’d  out.  The  fame  kind 
of  water  was  found  in  the  right  ventricle  of  the  brain  ;  but  in  the  left,  it 
was  ting’d  with  an  asruginous  colour,  and  had  form’d  an  ulcerous  cavity  in 
the  bafis  thereof. 

5.  The  corpus  ftriatum,  you  know,  makes  up,  in  great  part,  the  bafts  of 
the  lateral  ventricle.  The  injury  of  this  part,  or  thofe  about  it,  being  lels,  or 
lefs  acute,  than  in  the  former  cafe,  might  luffer  this  man  to  drag  on  his  life 
a  little  longer  than  the  other.  But  did  the  rerugjnous  water  produce  that 
ulcer  ?  or  was  the  water  itfelf  produc’d  by  the  ulcer?  As  it  was  limpid  in 
the  right  ventricle,  it  feems  that  it  mult  have  been  ting’d  with  that  colour 
by  the  ulcer  ;  which,  perhaps,  Willis  would  have  thought  very  favourable  to 
his  opinion,  inafmuch  as  he  believ’d,  that  “  an  extraneous,  and,  as  it  were, 
“  vitriolic  matter,  was  always”  the  caufe  of  a  paralyfis  of  that  kind,  which 
opinion  is  alfo  mention’d  in  the  Sepulchretum  (*).  But  what  I  imagine  that 
ulcer  to  have  been,  I  will  point? out  below  (d). 

6.  An  old  man  of  feventy,  who  had  been  very  voracious  in  his  diet,  being 
feiz’d  with  an  apoplexy  long  before,  and  after  that  with  a  palfy  of  the  whole 
right  fide  of  the  body,  was  frequently  agitated  on  the  other  fide  with  con- 
vulfions.  His  fenfes  were  alfo  affedted  ;  and  he  fometimes  difeharg’d  calculi 
with  his  urine.  The  abdomen  being  open’d  after  death,  the  omentum  was 
feen  to  be  fo  far  drawn  upwards,  as  to  cover  the  whole  anterior  part  of  the 
ftomach.  But  the  lefc  lobe  of  the  liver,  which  is  us’d  to  lie  over  a  part  of 
the  ftomach,  fcarcely  touch’d  it  at  all,  in  confequence  of  being  drawn  up  by 
the  diaphragm,  to  which  it  was  firmly  attach’d.  Moreover,  the  ftomach, 
although  it  was  corrugated,  was,  however,  when  extended,  much  bigger 
than  it  generally  is.  And  the  fpleen  was  evidently  twice  as  big  as  it  ought 
to  have  been,  and  of  a  very  dark  colour.  In  the  left  kidney  were  found 
four  (tones  ;  one  of  the  bignefs  of  a  chefnut,  the  others  lefs.  The  thorax 
was  not  at  all  open’d.  While  the  brain  was  taken  out  of  the  cranium,  fome 
ferum,  which  was  contain’d  betwixt  the  dura  and  pia  mater,  flow’d  out.  Jn 
the  left  ventricle,  the  plexus  choroides  had  in  it  a  body  of  the  bignefs  of 
a  horfe-bean,  made  up  of  feveral  hydatids  :  and  under  the  fame  ventricle 
was  a  firms,  the  fides  of  which  confifted  of  the  fubftance  of  the  cerebrum,  that 
was  yellow  and  flaccid,  and  feem’d  alfo  to  be  corrupted. 

7.  This  third  old  man,  as  he  was  more  advanc’d  in  years  than  the  other, 
and  befides,  had  been  more  voracious  in  his  appetite,  which  the  fize  of  the 

(c)  Schol.  ad  hujus  Seft.  obf,  2.  '  (d)  N.  8. 


ftomach 


Letter  XI.  Article  8.  233 

ftomach  confirm’d,  was  not  only  feiz’d  with  a  hemiplegia,  as  others  had  been, 
but  alfo  with  “  diforders  of  the  kidneys  and  apoplexy,”  which  Hippocrates 
has,  on  other  occafions,  number’d  among  the  diforders  of  old  men  (e)\  add 
to  thefe,  likewife,  that  his  underftanding  was  impair’d  ;  and  finally,  that  he 
had  convulfive  motions  in  the  left  part  of  his  body  ;  and  thefe  I  fuppofe  had 
their  origin  from  a  fait  ferum  ;  which,  as  it  lay  between  the  meninges,  fo 
by  irritating  both  fides  of  the  brain,  muft  have  brought  on  convulfions  in 
the  right  fide,  as  well  as  in  the  left,  if  this  had  not  been  previoufly  paraly¬ 
tic.  But  you  fee,  alfo,  in  this  cafe,  that  the  caufe  of  the  paralyfis  lay  under 
the  lateral  ventricle,  or,  in  other  words,  under  the  corpus  ftriatum,  and  its 
neighbourhood.  And  the  reafon  1  have  for  including  the  neighbouring  parts 
of  this  body,  1  draw  from  many  oblervations,  produc'd  in  other  places;"  but 
particularly  from  that  which  is  given  us  by  Chriftian  Vate>\(/),  who,  after  a 
palfy  of  one  arm,  found  a  little  bone,  or  a  very  hard  gypfeous  concretion,  in 
the  oppofite  thalamus  of  the  optic  nerve. 

8.  1  do  not  in  the  leaft  doubt,  but  that  the  fame, injury  of  the  brain, 
which  I  deferib’d  in  this  laft  old  man,  was,  at  once,  the  caufe  of  the  long- 
continu’d  hemiplegia,  and  of  the  preceding  apoplexy,  bearing  in  mind 
what,  from  the  obfervations  and  opinion  of  Brunnerus,  I  have  already  writ¬ 
ten  to  you  on  another  occafion  ( g ).  And  I  certainly  bdieve,  that  what  Val- 
falva  has  there  call’d  a  finus,  the  parietes  of  which  were  made  up  of  the 
corrupt  fubftance  of  the  brain,  was,  in  fatft,  a  fmall  cavern,  that  had  been 
formerly  and  fuddenly  produc’d,  in  the  fame  manner  that  I  have  already  ex¬ 
plain’d  to  you  in  another  letter  (b) :  and  which,  fince  then,  had,  by  the  heip 
of  art,  but  ftill  more  by  the  help  of  nature,  contra&ed  itfelf  into  the  form 
of  a  finus.  So  I  imagin’d,  that  the  leffer  cavern,  full  of  half-dry ’d  mucus, 
which  I  deferib’d  as  being  found,  together  with  a  much  larger,  which  was 
fill’d  with  blood,  in  an  apopledic  woman  (/),  was  to  be  referr’d  to  the  fame 
clafs.  Nor  Ihould  I,  perhaps,  be  very  far  wide  of  the  truth,  if  I  fhould  fay, 
that  thofe  two  caverns  alfo,  were  nearly  of  the  fame  kind,  which,  when  I 
treated  of  the  epilepfy  (a  ),  I  took  notice  of,  one  in  a  man,  and  in  like  man¬ 
ner,  one  in  a  woman ;  in  her,  lefs,  and  full  of  ferum,  which  was  in  part 
black,  and  had,  as  it  were,  fome  threads  floating  in  it;  but,  in  him,  larger, 
and  containing,  within  unequal  parietes,  a  portion  of  blood  mix’d  with  the 
ferum  :  although  there,  indeed,  l  chofe  rather,  that  they  fhould  be  com¬ 
prehended  under  the  general  name  of  impofthume  or  abfeefs,  as  the  one 
might  feem  to  arife  from  the  blow  that  had  been  given;  and  the  other,  gra¬ 
dually,  from  the  lues  venerea :  which  was,  perhaps,  the  reafon,  not  to  fay 
any  thing  of  the  fituation  of  either,  why,  to  the  other  diforders,  an  apoplexy 
or  palfy  of  the  limbs  w;as  not  added.  And  to  the  fame  purpofe,  is  the  ob- 
fervation  we  read  in  Brunnerus  (/),  of  a  calf,  in  the  fubftance  of  vvliofe 
brain,  three  hydatids  were  found,  of  the  bigneis  of  a  pigeon’s  egg,  and  full 
of  a  tranfparent  water ;  yet,  in  this  animal,  no  apoplexy  had  been  brought 


(e)  Sett.  3.  Aph.  3  j . 

(f)  Eph.  N.  C.  Dec.  3. 
165. 

( g )  EpilT.  2.  n.  16. 

{b)  Epift.  3.  n.  3,  8,  9. 
VOL.  I. 


(/)  Ibid.  n.  6. 

A.  9.  Sc  10.  obf.  (6)  Epift.  9.  n.  20,  &  23. 

(/)  Sepulchr.  1.  i,  f.  i 6.  in  Addit,  fchol. 
ad  obf.  1 2. 

I 

H  h  on, 


234  Book  I.  Of  Difeafes  of  the  Head. 

on,  but  a  vertigo  only.  However,  although  fome  caverns  may  be  produc’d 
gradually,  and  "by  ferum,  rather  than  by  blood,  it  does  not  therefore  follow, 
that  they  may  not  be  form’d  from  the  coats  of  the  veflels  of  the  brain  be¬ 
ing  eroded,  or  ruptur’d.  They  even  may  be  form’d  therefrom,  fo  that  the 
erofion,  or  rupture,  be  but  flight,  and  the  blood  gently  exude,  rather  than 
break  forth  with  violence,  and  in  a  large  quantity  at  once  ;  provided,  at  the 
fame  time,  it  be  alfo  ferous,  rather  than  thick :  to  which  the  nature  of  the 
blood  itfelf,  in  fome  bodies,  contributes,  when  it  is  more  watry,  lefs  in  its 
quantity,  and  flower  in  its  motion  than  ufual.  But  if  thefe  caverns  are  rup¬ 
tur’d  ;  they  may  feem,  in  the  bodies  after  death,  to  have  been  nothing  elfe 
but  ulcers,  much  the  fame  as  thofe  which  are  fill’d  up  with  blood  (tn) :  and 
this,  I  fuppofe,  had  happen’d  in  the  fecond  old  man,  whofe  hiftory  is  above 
defcrib’d  («),  by  which  means  the  water  was  ting’d  with  an  asruginous  colour. 
For  in  the  firlt  (0),  the  fluid  blood  burfting  forth,  with  the  limpid  ferum, 
indicates  that  a  cavern,  which  had  feparated  the  corpus  ftriatum  from  the 
other  part  of  the  brain,  had  been  fuperadded  to  thofe  which  are  more  gradu¬ 
ally  form’d,  as  1  have  explain’d  in  the  third  letter  (p). 

9.  And  when  you  fhall  have  confider’d  all  thefe  things  well;  I  would  then 
have  you  read  that  obfervation  of  Wepfer’s,  in  the  Sepulchretum  ( q ), 
wherein  he  defcribes  the  difledtion  of  a  virgin,  who  died  hemipledtic,  and 
gives  an  account  of  two  caverns,  in  the  right  ventricle  of  the  brain  ;  one  not 
yet  open’d,  of  the  bignefs  of  a  hen’s  egg ;  another  which,  though  he  had 
broken  into  it  by  accident,  as  he  was  opening  the  ventricle,  yet  he  fuppos’d, 
as  far  as  he  could  eftimate,  from  the  quantity  of  turbid  water  that  flow’d 
out  therefrom,  which  was  of  the  fame  kind,  as  he  alfo  found  in  the  firft, 
that  it  could  “  not  have  been  much  lefs”  than  the  other,  as  he  fubjoins  in 
the  annex’d  fcholia  :  he  moreover  fays,  “  that  the  corpora  firiata,  and  a  por- 
ct  tion  of  the  corpus  callofum  at  the  fundus  and  fides  of  the  ventricle,  had 
“  appear’d  unequal,  ulcerated,  and  in  a  manner  lacerated.”  But  if  you  at¬ 
tend  clofely  to  all  the  circumftances,  it  will  be  eafy  to  perceive,  that  “  the 
tc  furface  which  appear’d  unequal,  and  in  a  manner  corroded  and  ulcerated,” 
was  not  on  the  outfide  of,  but  within,  the  ruptur’d  cavern.  For  if  the  one 
cavern  had  been,  like  the  other,  whole  and  entire,  and  “  inverted  with  a. 
“  coat  peculiar  to  itfelf,  of  the  thicknefs  of  a  crow  quill or  at  leaft,  if  like 
the  other,  it  had  been  “  included  in  a  follicle,”  as  he  feems  to  hint,  when 
he  calls  both  the  caverns  folliculi ;  he  would  then  certainly  have  defcrib’d* 
both  the  coat,  and  the  fituation  of  this  cavern,  as  well  as  of  the  other,  nor 
would  have  been  conftrain’d  “  to  conjedture  ”  the  bignefs  thereof,  from 
the  quantity  of  water  alone.  For  which  reafon  I  fliould  believe,  that  this, 
cavern  was,  properly  fpeaking,  inverted  with  no  follicle  ;  but  that  its  pa¬ 
rietes  were  made  up  of  the  very  fame  fubftance,  which  after  the  rupture  of 
the  cavern,  appear’d  in  a  manner  corroded,  and  ulcerated. 

10.  However  the  dodtrine  of  Valfalva  (r),  which  I  have  before  fpoken  in 
commendation  of,  is  confirm’d  by  this  obfervation  of  Wepfer,  as  well  as  by 
the  three  foregoing  difiedtions  of  the  old  men.  For  the  hemiplegia  had  been 
in  the  left  fide  of  the  body,  whereas  the  injury,  as  we  have  feen,  was  on  the 

(m)  EpiU.  3.  n.  3.  («)  n.  4.  ( q )  Scft.  hac  15.  obf.  4, 

(0)  n.  2.  (/>)  r.  3.  8.  9.  (r)  Epift.  3.  n.  16,  17. 

right 


6 


Letter  XI.  Article  10.  235* 

right  fide  of  the  brain  :  and  this  is  what  I  had  never  attended  to,  till  I  look’d 
over,  very  accurately,  this  fedtion  of  the  Sepulchretum  ;  nor  yet  in  another 
oblervation,  inferted  in  the  fame  place,  from  John  Bauhin  (s)9  where  the  pa- 
ralyfis  was  found  to  be  in  the  left  fide,  but  the  impofthume  in  the  right  fide 
of  the  brain.  Yet  furely  it  is  not  fo  much  to  be  wonder’d  at,  that  thefe 
things  fhould  have  elcap’d  me,  as  that  Wepfer,  who  had  obferv’d  the  cir- 
cumllance  once,  and  again  (*),  fhould  have  taken  fo  little  notice  of  it.  For 
he  fays  («),  “  I  do  not  indeed  deny,  that  thofe  tumours  of  the  right  ventri- 
“  cle  may,  in  fome  meafure,  have  confpir’d  to  the  produdtion  of  a  hemi- 
“  plegia  in  the  left  fide  ;  for  1  myfelf,  with  many  others,  have  obferv’d,  that 
“  one  fide  of  the  brain  being  affedted,  the  oppofite  fide  of  the  body  had 
“  been  feiz’d  with  a  palfy :  but  I  believe  that  the  concomitant,  and  perhaps 
“  primary  caufe,  of  the  hemiplegia,  in  thefe  cafes,  was  ferum  ;”  without 
doubt,  that  with  which  he  thought  the  fmall  pores  of  the  brain  were  after¬ 
wards  obftrudted.  If  he  had  not  faid,  that  he  had  obferv’d  it,  “  with  many 
“  others,”  it  might  perhaps  be  fufpedled,  that  he  had  obferv’d  it  from  a 
long  feries  of  dilfedtions,  where  it  happen’d  from  an  internal  caufe,  as  Val- 
falva  has  done  fince  him.  But  now  we  naturally  underftand,  that  Wepfer 
had  feen  the  fame  thing  that  “  many  others”  had  feen  before  him;  I  mean, 
that  this  contrail  betwixt  the  injury  of  the  brain,  and  the  palfy  of  the  body, 
had  been  frequently  the  confequence  of  blows  and  of  wounds.  Moreover, 
he  does  not  only  attribute  but  little  to  thefe  tumours,  which  had  comprefs’d 
the  right  fide  of  the  brain  fo  long,  and  confequently  prevented,  or  at  leafl 
diminilh’d,  the  influx  of  animal  lpirits,  into  the  left  part  of  the  fpinal  mar¬ 
row,  for  a  long  time;  but  he  even  did  not  think,  that  there  was  much  more 
to  be  attributed  to  this  part  of  the  fpinal  marrow,  which  for  that  realon,  per¬ 
haps,  “  feem’d  lefs  than  the  right.”  His  words  are,  “  Nor  does  it  much 
“  help  forwards  the  demonftration  of  this  fubjedt,  that  the  left  part  of  the 
“  fpinal  marrow  was  lefs  than  the  right;  for  if  it  had  been  any  thing  preter- 
“  natural,  the  foot  muft  have  been  incapable  of  motion  equally  with  the 
“  arm ;”  as  if,  in  fa£l,  this  difference  did  not  frequently  occur  in  perfons 
who  are  afflidted  with  a  hemiplegia,  nor  he  himfelf  had  a  little  before  pointed 
out  the  caufe  of  this  difference,  in  a  difprder  of  the  axillary  nerves,  which 
was  very  refradtory  to  all  remedies ;  “  which  axillary  nerves,”  fays  he,  “  are 
<c  more  (lender  and  more  tender  than  the  nerves  that  go  down  from  the  os 
“  facrum  to  the  thighs  and  the  feet.”  For  as  to  his  faying,  tc  that  the  me- 
“  thod  of  cure,  which  depended  on  difcufling,  abforbing,  and  evacuating 
“  the  ferum,”  was  the  method  which  fucceeded  ;  there  is  no  doubt  but  it 
lucceeded  by  drawing  downwards,  and  diverting  the  ferum,  by  which  the 
rumours  had  been  before,  I  fuppofe,  much  more  diflended,  nature  firft  lend¬ 
ing  her  alfiftance,  by  promoting  “  a  very  frequent  and  copious  difcharge  by 
“  urine ;”  and  not  by  this  only,  but  by  other  diforders  all'o  ;  to  wit,  by  the 
afcites,  and  by  a  considerable  oedematous  tumour,  and  by  a  quantity  of  yel¬ 
low  water  being  redundant  betwixt  the  meninges,  which  by  diverting  the  af¬ 
flux  of  ferum,  would  prevent  the  encreafe  of  thofe  tumours  that  muft  other- 
wile  have  happen’d. 


0)  1 8. 


(/)  Vid.  Epift.  cit.  3.  n.  17. 

H  h  2 


(«)  in  Schol.  ad  cit.  obf. 


But 


23  6  Book  I.  Of  Difeafes  of  the  Head. 

But  I  would  have  you  confider  all  I  have  faid  in  fuch  a  light,  as  to  under- 
ftand,  that  I  do  not  intend  any  enmity  againft  Wepfer,  whole  memory  and 
great  merits  you  are  not  ignorant  that  I  hold  in  high  efteem  ;  but  I  fay  this 
agreeably  to  the  plan  I  have  laid  down  to  myfelf,  not  to  conceal  any  of  my 
conjectures  from  you,  whatever  they  may  be,  upon  thefe  fubjeds  ;  and  tor 
which  I  would  not  have  you  give  more  credit,  than  you  pleafe,  or  fhall  think 
they  deferve.  But  having  given  the  hiftories  l  promis’d  you  from  Valfalva, 
let  us  now  proceed  to  mine. 

if.  A  hufbandman,  about  forty  years  of  age,  from  his  appearance,  lay 
ill  in  the  hofpital  of  St.  Mary  de  Morte  at  Bologna.  He  had  been  lirft  feiz’d 
with  an  unfix’d  pain  in  the  thorax,  attended  with  a  fenfe  of  pricking-,  after 
that  with  a  paralyfis  of  the  tongue,  and  of  his  right  limbs,  fo  however,  that 
he  had  ftill  fome  motion  left.  At  firft  he  feem’d  to  know  his  acquaintance, 
and  underftand;.  but  foon  after,  neither  the  one,  nor  the  other.  His  pulfe 
was  vehement  and  frequent,  but  equal.  His  refpiration,  except  when  he 
drew  near  to  his  death,  was  not  bad.  His  abdomen  being  open’d  after  death, 
exhibited  a  fpleen  larger  than  any  I  had  ever  before  feen,  every  thing  elfe  in 
the  judgment  of  the  fenfes  being  found  ;  but  the  lower  edge  of  the  liver  was 
a  little  livid.  The  thorax,  in  both  of  its  cavities,  had  a  fmall  quantity  of 
bloody  water,  and  the  lungs  adher’d  to  the  pleura  ;  on  their  posterior  lur- 
faces,  however,  though  they  were  red,  withinlide,  and  without,  they  were 
not  hard.  In  the  pericardium  was  a  thick  water,  but  in  fmall  quantity,  and 
like,  in  colour,  to  that  in  which  frelh  meat  has  been  walk’d.  The  heart 
itfelf  was  flaccid,  in  the  fame  manner  as  the  reft  of  the  mufcles,  and  in  its 
right  auricle,  and  ventricle,  was  a  large  polypous  concretion,  like  a  yellow- 
ilh  mucus.  But  another,  which  was  contain’d  in  the  pulmonary  vein,  was 
firmer  than  this,  afcending,  as  if  it  were  from  a  kind  of  bafts,  from  an  ex- 
crefcence  to  which  it  was  connected,  of  a  cineritious  colour,  and  growing  to 
the  fubftance  of  the  valvulae  mitrales. 

While  the  brain  was  taken  out  of  the  cranium,  fome  water  burft  forth 
from  between  the  dura  and  pia  mater,  and  even  from  between  the  pia  mater 
and  brain,  from  which  this  membrane  was,  for  that  reafon,  eafily  feparated. 
The  fmaller  trunks  of  the  velfels,  which  were  carried  through  the  upper  part 
of  the  fame  membrane,  were  diftended  with  blood,  and  the  fubftance  of  the 
cerebrum  was  lax.  The  lateral  ventricles  being  open’d,  and  the  nates  and 
teftes,  together  with  the  pineal  gland,  being  laid  bare,  I  found  that  the  gland 
confided  almoft  wholly  of  a  yellow  and  hardifh,  but  almoft  friable,  matter; 
and  that  the  colour  of  thofe  four  protuberances  inclin’d  a  little  to  yellow.. 
In  the  right  and  left  ventricle  was  a  little  water,  like  that  which,  I  have  faid', 
was  contain’d  in  the  pericardium,  except  that  it  was  not  turbid.  And  the 
furface  of  each  ventricle  was  lefs  fmooth  than  it  is  wont  to  be  ;  but  in  the 
left  was  a  difeas’d  appearance,  befide  this,  which  was  more  obvious  to  the 
eye.  For  not  only  that  medullary  trad,  which  lies  between  the  thalamus 
nervi  optici,  and  corpus  ftriatum,  and  was  yellow,  and  in  a  tender  and  almoft 
fluid  date,  but  this  very  body  itfelf,  when  compar’d  with  the  right,  fubftded 
in  a  very  lank  and  wrinkled  date,  as  if  there  had  been  a  kind  of  tabes  in  its 
fubftance  :  and  from  the  middle  of  it,  a  tubercle  was  prominent,  of  the- 
bignefs  and  fhape  of  a  large  bean,  but  of  a  red  colour,  fuch  as  you  fee  in» 

the- 


Letter  XI.  Articles  i  2,  1  3.  237 

the  fkin  from  a  recent  contufion.  This  being  cut  into,  fhew’d  nothing  pe¬ 
culiar  in  its  fubftance,  except  that  fame  redneis;  whereas  the  remaining  part 
of  the  corpus  ftriatum  was  entirely  yellow,  and  had  fuch  a  laxity,  that  it  was 
almoft  fluid. 

12.  I  fhall  conflder  other  parts  of  this  hiflory  at  another  time.  But  at  pre- 
fent,  I  fhall  conflder  that  part  of  it,  for  which  the  whole  hiflory  is  here 
chiefly  written ;  and  you  fee,  that  it  does  not  lefs  confirm  the  dodlrines  of 
Willis  and  Valfalva,  than  thofe  which  I  have  defcrib’d  or  quoted  above  ; 
the  dodtrine  of  the  latter,  becaufe  the  injury  in  the  brain  was  in  the  fide  op- 
poflte  to  that  fide  of  the  body  which  was  paralytic  ;  and  of  the  former  (#), 
becaufe,  in  a  paralylis  which  was  neither  violent,  nor  of  long  continuance* 
the  original  dilorderwas  not  only  in  the  neighbourhood  of  the  corpus  ftria¬ 
tum,  but  in  the  corpus  ftriatum  itfelf,  and  indeed  was  of  fuch  a  nature,  that 
this  part  was  dilcolour’d,  and  lax.  And  thefe  things  you  may  add,  to  what 
I  have  written  in  the  third  letter  (jy),  concerning  the  moft  grievous  injuries 
happening,  for  the  moft  part,  in  the  corpus  ftriatum,  or  its  neighbourhood,, 
more  than  in  all  the  other  parts  of  the  brain  :  and  if  it  is  not  improper  to 
compare  diforders  one  with  another,  that  are  not  of  the  fame  kind,  you  may 
ftill  have  more  reafon  to  fear,  left  it  was  owing  to  chance  merely,  that  out 
of  thefe  obfervations,  almoft  all  exhibit  the  injury  of  the  brain  on  the  right 
fide,  fince  all  which  are  hitherto  defcrib’d  in  this  letter,  three  from  Valfal- 
va’s  papers,  and  one  from  mine,  fhew  it  to  have  exifted  in  the  left.  The 
obfervation  of  Peyronius  (2)  is  very  much  fimilar  to  this  of  mine,  except 
that,  on  the  other  hand,  it  fhews  the  diforder  to  have  exifted  on  the  right  fide 
of  the  brain  for  ;  almoft  in  the  middle  of  the  corpus  ftriatum  of  a  young 
man,  he  found  a  hard  tubercle  of  the  thicknefs  of  a  bean,  that  is  much 
flatten’d,  and  this  young  man  had  labour’d  under  a  pally,  on  the  oppofite  fide. 

Now,  after  having  read  fo  many  examples,  defcrib’d  at  large,  or  quoted 
by  me,  in  this  and  other  letters,  of  the  moft  grievous  diforders  being  the 
confequence  of  injuries  in  the  corpora  ftriata ;  you  will  then,  fo  much  the 
more  willingly,  approve  of  the  conclufion,  which  the  celebrated  Langban- 
fius  (a)  has  made,  from  the  obfervation  of  diforders  fimilar  to  thefe;  I  mean, 
that  thefe  ftriated  protuberances  are  the  moft  noble  parts  of  the  brain  ;  nor  is 
it  to  be  wonder’d  at,  fince  they  make  up  the  greateft  portion  of  its  crura, 
and  confequently  give  origin  to  the  trunk  of  the  marrow,  that,  if  they  are 
injur’d,  the  brain,  and  the  other  parts  of  the  body,  is  affedted  with  diforders, 
and  very  often  with  fatal  ones,  as  I  have  already  (hewn. 

13.  An  old  man,  who,  after  an  apoplexy,  was  troubl’d  with  an  hemiplegia, 
in  the  right  fide  of  his  body,  and  who,  except  his  head,  which  was  very  well, 
had  not  retain’d  any  power  of  feeling,  or  moving,  was  admitted  into  the 
hofpital  of  Incurables  at  Bologna.  There  being  l'eiz’d  with  a  fever,  and  a 
difficulty  of  breathing,  which  was  neither  attended  with  a  fenfe  of  weight, 
nor  any  pain  in  the  thorax;  and  his  pulfe  being  very  weak,  on  the  laft  days  or 
his  illnefs,  and  a  gangrene  of  the  penis  coming  on,  he  died,  in  the  year  1704. 

(z)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1741. 
Qu  .trit  ms  obferv. 

(a)  Difi'.  de  conftnfu  part.  corp.  hum.  §  88. 

The 


('*)  Vid.  fupra,  n.  3. 

(yj  n*  18. 


.238  Book  I.  Of  Difeafes  of  the  Head. 

The  abdomen  had  in  it  nothing  remarkable,  befide  the  inteftines  being 
•turgid  with  air.  The  left  cavity  of  the  thorax  contain’d  water,  though  but 
in  imall  quantity  ;  the  right  had  the  upper  lobe  of  the  lungs  of  a  purple 
colour,  degenerating  into  black,  which  was  hard,  and  of  a  compact  fubftance. 
In  the  pericardium  was  no  water  at  all  j  and  the  heart  was  extremely  flaccid, 
fo  that  I  don’t  remember  ever  to  have  feen  the  like  before  •,  for  it  fell  all  to¬ 
gether,  and  became  fo  flat,  as  hardly  to  be  of  the  thicknefs  of  a  finger’s 
breadth.  And,  indeed,  all  the  other  mufcles  were  very  lax.  From  the 
Cranium,  while  it  was  cut  through,  a  quantity  of  water  flow’d  down  ;  and 
we  law  water  predntly  at  the  bafis  of  the  cerebrum,  and  in  the  tube  of  the 
vertebrae.  In  the  lateral  ventricles,  alfo,  was  a  portion  thereof  contain’d  : 
but  afar  greater  portion,  I  fuppole,  had  been  harbour’d  under  the  pia  mater*, 
for  this  membrane,  where  it  anfwer’d  to  the  fulci,  which  are  betwixt  the 
convolutions  of  the  brain,  was  almod  white.  Befides  thefe  things,  there  was 
nothing  worthy  of  remark  in  the  cerebrum  or  cerebellum,  except  that  in  the 
plexus  choroides,  at  leaf:  on  the  left  fide,  there  were  vehicles  turgid  with 
water. 

14.  I  would  not  have  you  fuppofe,  that  I  (hall  eafily  determine  the  caufe 
of  the  hemiplegia,  in  this  old  man,  who  died  of  an  inflammation  of  the 
lungs,  to  have  confided  in  thofe  vehicles,  which  were  found  turgid,  in  the 
part  oppofne  to  the  paralytic  fide:  for  I  have  often  found  thefe  appearances 
even  in  thofe  who  had  no  paralyfis  at  all.  And  much  lefs  dill  do  I  fuppofe, 
that  it  was  owing  to  the  water  found  within  the  cranium,  inafmuch  as  it  did 
not  prefs  the  left  part  of  the  brain  more  than  the  right.  And  I  wonder  that 
home,  and,  among  the  reft,  Willis,  as  you  fee  in  that  fifteenth  fedtion  of 
the  Scpulchretum  had  not  attended  thereto,  (except,  by  the  carelefsnefs 
of  the  printer  at  Geneva,  or  Lyons,  any  thing  is  perhaps  omitted)  ;  for  if 
he  had,  he  would  not  have  deduc’d  the  comprefiion  of  one  of  the  corpora 
ftriata  rather  than  the  other,  or  the  paralyfis  of  one  fide  rather  than  the 
other,  from  a  ferous,  or  bloody  illuvies,  filling  the  anterior  cavity  of  the  ce¬ 
rebrum.  What  then  was  the  caufe  of  this  hemiplegia  ?  I  fhall  prefently, 
after  having  added  another  obfervation,  conjedlure  (r).  Nor,  indeed,  do  I 
think  it  fo  difficult  a  queftion,  as  if  you  fhould  afk  me,  how  it  could  happen, 
that,  when  an  old  gentleman  was  at  the  fame  time  feiz’d  with  an  hemiplegia, 
and  a  jaundice  ( [d ),  the  jaundice  fhould  fo  “  accurately”  contain  itfelf  within 
the  fame  right  fide,  which  was  paralytic,  cc  that  even  the  right  fide  of  the 
fl  nole  was  jaundic’d,  while  the  left  retain’d  its  natural  colour,”  notwith- 
(landing  the  fame  yellow  ferum  of  the  blood  mud  neceflarily  pafs  through 
the  left  fide,  in  the  fame  manner  as  through  the  right ;  unlefs  you  can  pof- 
fibly  fuppofe,  that  being  more  flowly  circulated  through  the  paralytic  fide, 
by  reafon  of  the  laxity  of  its  fibres,  it  had  more  time  to  tinge  the  parts,  as 
it  pafs’d  through  them. 

15.  A  little  old  woman,  who  had  labour’d  under  an  hemiplegia,  for  three 
years,  which  had  fucceeded  to  an  apoplexy,  though  (he  dill  retain’d  the  power 
of  feeling,  was,  eight  days  before  her  death,  receiv’d  into  the  fame  hofpital  of 
Incurables  at  Bologna,  after  having  had  a  mortification  come  on  in  her  buttock, 

(£)  Obf.  9.  cum.  Schol.  (r)  N.  17.  (A  Eph.  N.  C.  cent.  3.  obf.  64. 

from 


V 


Letter  XI.  Article  i  6, 


2  3  9 


from  conftantly  lying  upon  it,  or  from  fome  other  caufe.  A  few  days  after 
her  reception,  the  was  ieiz’d  with  a  violent  pain,  firft  in  the  paralytic  fhouider, 
and  afterwards  in  the  tongue  ;  but  thefe  parts,  when  infpe&ed,  ffiew’d  not 
the  lead  fign  of  diforder,  which  could  fall  under  the  notice  of  the  fenfes. 
An  aphonia,  or  lofs  of  l'peech,  fucceeded  the  pain,  which  was  itfelf  foon 
fucceeded  by  death ;  yet  fhe  was  carried  off  gradually,  and  without  any  en- 
creafe  of  the  paralyfis.  The  head  and  neck  only  of  this  woman  were  dif¬ 
fered.  In  the  neck,  I  found  that  diforder  of  the  thyroid  gland,  which,  as 
it  was  defcrib’d  on  a  former  occalion  (<?),  it  is  needlefs  to  repeat  here.  There 
was  alfo,  in  a  fmall  arterial  trunk,  in  the  neighbourhood  of  this  gland,  a  con¬ 
cretion  betwixt  the  coats,  confiding  of  a  yellow  matter,  which  had  a  middle 
nature,  betwixt  foft  and  friable,  fmall  indeed,  but  prefixing  much  inwardly, 
fo  as  to  ftreighten  the  cavity  of  the  veffel.  Finally,  in  one  of  the  parotid 
glands,  were  little  fragments  of  a  kind  of  tartarous  matter,  which  after¬ 
wards  contradi ed  the  hardnefs  of  a  bone. 

But  before  I  touch’d  the  head  and  the  neck,  while  the  head  was  divided 
from  the  thorax,  thofe  who  were  prefent  afferted,  that  fo  great  a  quantity  of 
water  had  burft  forth  from  the  canal  of  the  vertebrae,  both  from  above  and 
below,  that  they  did  not  doubt,  but  it  wpuld  have  fill’d  a  common  wine- 
bottle.  For  this  reafon,  there  was  little  left  about  the  brain,  or  in  its  ven¬ 
tricles  ;  befides  which,  there  was  nothing  worthy  of  obfervation. 

1 6.  It  is  not  difficult  to  conceive,  that  particles  of  the  moft  acrimonious 
kind,  being  carried  from  the  gangrenous  parts,  into  the  common,  channel  of 
the  circulation,  might  have  attack’d,  not  only  the  nerves  of  the  tongue,  but 
efpecially  fome  of  thofe  of  the  fhouider,  which  by  reafon  of  their  having  been 
at  reft  three  years,  were,  perhaps,  lefs  able  to  refift  the  acrimony  that  had 
fall’n  upon  them,  and  thus  have  given  occafion  to  thofe  pains  which  I  have 
mention’d  in  the  hiftory.  But  we  do  not  for  the  fame  reafon  underftand, 
how  fo  great  a  quantity  of  water  was  collected  within  the  tube  of  the  ver¬ 
tebras,  and  the  cavity  of  the  cranium  •,  and  how,  when  it  was  collected,  it 
brought  on  aphonia  indeed,  and  death,  but  not,  at  the  fame  time,  the  other 
genuine  fymptoms  of  an  apoplexy.  Was  it  becaufe  it  happen’d  to  be  col¬ 
lected  in  fuch  a  quantity  by  degrees  (/)  ?  And,  indeed,  we  may  with  reafon 
fuppofe,  that  from  the  very  time  of  the  beginning  hemiplegia,  there  had  been 
much  water  contain’d  in  that  tube,  or  in  the  fiftula  facra,  as  it  is  call’d.  For 
thus  it  is  often  found  in  hemipjectic  patients,  as  Coiterus  has  firft  demon- 
ftrated,  whofe  obfervations  you  have  in  the  Sepulchretum  (g) ;  and  after  him, 
Wepfer,.  who,  to  make  the  more  certain  enquiry  into  this  affair,  was  wont, 
after  all  the  contents  of  the  cranium  were  evacuated,  to  incline  it  in  fuch  a 
manner,  that  the  water,  by  reafon  of  the  declivity,  might  have  a  ready  egrefs 
from  the  fiftula  facra,  by  the  orifice  thereof :  which,  though  it  has  been  ge¬ 
nerally  neglecfted,  by  moft  anatomifts,  in  the  diffecftions  of  fome  certain 
bodies,  yet  I  have  not  omitted  frequently  to  enquire  into,  by  the  fame,  or  at 
kaft,  fome  other  method,  as  you  might  have  underftood,  even  from  the- 
former  letter  ( h ).  And  you  may  fee  the  obfervations  of  Wepfer,  not  only 


(<f)  Epift.  Anat.  9.  n.  38.  (g)  Sefl  hac  15.  obf.  6,  &  7; 

(/)  Vid.  Epift.  4.  n.  2$,  ( 'b )  N.  13. 

m, 


24 P  Book  I.  Of  Diforders  of  the  Head. 

in  this  feCtion  (i),  but  in  the  fecond  alfo  ( k ) ;  in  Tome  of  which  he  particularly 
fpecifies  his  having;  feen  “  much  ferum,”  and  “  a  great  quantity  of  ferum,” 
iifue  forth  from  that  tube.  For  as  to  the  cafe,  wherein  he  faw  an  ounce  of 
water  difcharg’d  from  the  orifice,  there  is  no  great  reafon  why  we  fhould 
much  attend  to  it,  if  we  mu  ft  acknowledge,  that  fome  quantity  of  ferum  is 
naturally  contain’d  in  the  filtula  facra,  at  its  lower  part;  which  feems  entirely 
to  have  been  unknown  to  him  and  Coiterus  :  but  how  far  I  am  able  to  decide 
on  this  queftion  from  my  own  difcoveries,  I  fhall  take  occafion  to  (hew  you 
hereafter.  Nor,  indeed,  is  it  difficult  to  conceive,  that  by  carrying  or  turning 
about  a  carcale,  in  different  ways,  as  it  generally  happens,  a  portion  of  that 
natural  moiifure  might  pafs  from  the  lower  part  of  the  tube  to  the  upper  : 
but  when  it  is  in  a  much  larger  quantity  than  natural,  or  has  properties  dif¬ 
ferent  from  thofe  of  a  healthy  date,  we  may  then  eafily  underfland,  how  it 
may  injure  by  thefe  different  properties,  or  by  its  quantity  being  greatly  en- 
creas’d,  and  not  now  lying  round,  thofe  lower  nerves  of  the  cauda  equina 
only,  but  the  trunk  of  the  fpinal  marrow  likewife,  which  is  much  tenderer 
than  they ;  io  that  by  comprefhng  or  relaxing  it  more  than  ufual,  a  paralylis 
of  the  limbs  is  brought  on.  But  how  it  happens,  that,  as  it  lies  in  general 
round  about  the  medullary  trunk,  it  neverthelefs  preffes  or  relaxes  more  on 
the  right  fide  than  the  left,  or  on  the  left  more  than  the  right,  fo  that  a 
pally  of  the  right  and  not  of  the  left,  or  of  the  left  and  not  of  the  right,  is 
brought  on,  is  not  intelligible  from  thence.  Wherefore,  the  fame  difficulty 
that  occurr’d  to  me,  concerning  the  water  in  the  cranium  (/),  occurs  alfo  here 
in  regard  to  the  fiftula  facra,  unlefs  we  can  affign  fome  other  reafons, .  befide 
thefe,  to  account  for  it. 

17.  And,  perhaps,  thefe  reafons  are  to  be  drawn  from  the  preceding  dif- 
pofition  of  fome  part  of  the  brain,  or  the  fpinal  marrow,  whether  it  be  owing 
to  natural  formation,  or  to  dileafe  ;  as  for  inftance,  if  the  inward  ftrufture  of 
any  of  thofe  parts  be  lefs  firm  than  that  of  the  others ;  or  if,  as  in  the  apo¬ 
plexy,  which  1  delcrib’d  on  a  former  occafion  ( m ),  that  h^d  its  origin  from  a 
convulfion  of  the  meninges,  one  hemifpherc  of  the  brain  is  more  conftring’d 
and  comprefs’d,  by  the  more  violent  convulfion  of  the  meninges,  on  that 
fide,  than  the  other.  And  if  to  a  native  weaknefs  of  that  kind,  or  one  that 
is  left  by  difeafe,  in  either  fide  of  the  body,  which  of  itfelf,  indeed,  could 
fcarcely  be  of  any  great  detriment ;  I  fay,  if  to  that,  a  quantity  of  water 
lying  round  the  brain,  or  fpinal  marrow,  be  added,  you  then  doubtlefs  un¬ 
derfland,  that  the  firm  fide  of  the  brain,  or  fpinal  marrow,  will  refift  this 
force,  while  the  more  infirm  fide  is  not  able  to  withfland  it. 

18.  But  as  to  what  I  faid  of  the  brain,  or  its  appendix,  the  fpinal  marrow’, 
being  injur’d  by  the  convulficns  of  its  meninges,  the  fame  1  have  alfo  faid  of 
the  nerves,  going  from  the  one  or  the  other  of  thefe  parts,  in  a  former  work(«) ; 
and  I  even  now  the»» more  willingly  repeat,  as  it  is  the  more  eafy  to  under- 
iland,  that  not  only  the  pia  mater,  but  the  dura  mater  alfo,  may  be  con¬ 
tracted  all  round  about  the  nerves  that  they  cover,  more  readily  than  about 


( m )  Adverf.  6.  anim.  84.  Sc  Epift.  Anat. 
13.  n.  27. 

(«)  Ibid. 


(?)  Obf.  3. 

(^’)  Obf.  40.  &  47. 
(/)  N.  14. 


either 


Letter  XI.  Articles  19,20.  241 

either  fide  of  the  cerebrum,  or  fpinal  marrow.  Thus,  in  a  young  man  (0), 
who,  from  worms  irritating  the  inteftines,  was  feiz’d  with  a  palfy  of  the 
tongue,  which  went  off,  indeed,  within  a  few  days,  but  recurr’d  every  month, 
and  was  attended  with  tortures  of  the  bowels  ;  1  would  explain  the  cafe 
from  a  convulfion  being  produc’d  by  a  kind  of  confent,  from  the  inteftines 
to  the  meninges,  which  furround  the  nerves  of  the  tongue,  flight  indeed,  fo 
that  the  paralyfis  was  foon  carried  off,  but  return’d  when  the  convulfion  of 
the  bowels  return’d.  Wherefore,  if  any  nerves  whatever,  except  thofe  of 
the  harder  kind,  are  conftring’d,  either  by  the  convulfion  of  their  own  me¬ 
ninges,  or  by  that  of  contiguous  mufcular  fibres ;  or  if  water,  lying  round 
them,  prefs  upon,  or  relax  them,  when  they  are  not  extremely  conftring’d, 
and  would  confequently  foon  recover  their  natural  condition  ;  the  parts  to 
which  thefe  nerves  go,  will  be  paralytic.  And  from  hence,  all'o,  you  may 
have  a  clue  to  underftand,  why  in  fome  cafes,  notwithftanding  all  the  nerves 
that  come  from  the  brain,  or  fpinal  marrow,  are  often  equally  furrounded 
with  water  at  the  fame  time,  they  neverthelefs  are  not  all  relax’d. 

19.  And,  certainly,  an  uncommon  cafe,  which  was  feen  for  about  eight 
days,  together,  in  the  fame  hofpital  of  Incurables  at  Bologna,  ought  to  be 
number’d  in  the  clafs  of  thofe,  that  arife  from  a  compreffion  of  the  fpinal 
nerves,  by  their  meninges  being  convuls’d ;  though  in  this  cafe  they  were 
comprefs’d  only  for  a  certain  time,  and  that  not  clofely.  The  cafe  was  of 
a  virgin,  who  feem’d  to  be  about  forty,  and  who,  after  a  long-continu’d 
and  obftinate  pain  of  the  head,  became  by  degrees  paralytic  on  one  fide  of 
the  body  ;  fo  that  at  length  fhe  had  no  ufe  of  it  at  all,  either  for  fenfe  or 
for  motion.  While  fhe  was  thus  affefted,  ftie  was  feiz’d  alfo  with  the  fame 
kind  of  palfy,  every  day  about  the  evening,  on  the  healthy  fide,  which  went 
entirely  off,  as  the  morning  came  on.  And  after  this  diforder  had  attack’d 
her,  in  the  fame  manner,  feven  or  eight  times,  at  the  fame  hour,  or  at  leaft, 
not  more  than  one  hour  fooner  or  later-,  then,  indeed,  an  inflammation  of 
the  thorax  immediately  came  on,  which  took  oft'  the  patient :  and  the  dif- 
fe&ion  of  her  body,  contrary  to  my  intention,  was  omitted.  But  other 
examples  of  palfies,  from  a  caufe  of  that  kind,  are  like  wife  produc’d  by  me 
in  other  places. 

20.  And  examples  are,  in  like  manner,  pointed  out,  of  thofe  which  feem 
to  happen  from  mufcular  fibres  being  convuls’d,  about  the  nerves.  Nor,  in¬ 
deed,  would  I  deny,  that  it  may  fometimes  be  explain’d  in  that  manner  which 
is  thus  defcrib’d  by  Boerhaave  (p) :  “  The  hardnefs  of  a  convuls’d  mufcle, 
“  if  it  be  too  great,  deftroys  the  mufcles,  and  leaves  it  paralytic,  as  fre- 
“  quently  happens  after  convulfions although,  where  fenfation  is  taken 
away,  at  the  fame  time  with  motion,  it  is  better  to  accufe  the  conftriflion  of 
the  nerve,  at  that  time  comprefs’d,  fo  it  be  not  one  of  the  harder  nerves, 
than  the  deftrudtion  of  the  mufcular  fabric,  as  from  this  conftridtion  alone» 
both  the  one  and  the  other  may  have  their  origin. 

And  as  to  the  opinion  of  Boerhaave  (5),  “  that  the  palfies  of  the  limbs, 
tc  where  there  is  no  injury  in  the  brain,  and  which  are  for  that  reafon  cu- 

(0)  Adt.  N.  C.  tom.  2.  obf.  160.  (/)  Pradedt.  in  Inftit.  ad  §  401,  (?)  Ibid,  ad  §  282. 

Vol.  I.  I  i  “  table. 


242  Book  I.  Of  Difeafes  of  the  Head. 

<4  rable,  by  external  medicine  that  thefe,  I  fay,  have  “  their  feat  in  the 
«  cellular  membranes,”  with  which  all  the  veffels  of  the  nerves  are  fur- 
rounded  *,  this  explication  alfo  is  worthy  of  its  praife,  if  we  ufe  it  properly, 
and  without  any  addition-,  for  otherwife,  it  feems  liable  to  many  difficulties, 
in  the  fame  manner  as  the  others.  For  if  you  turn  to  the  Sepulchretum  (r), 
or  rather  to  the  book  itfelf  (j),  which  is  there  very  negligently  copied,  you 
will  fee  what  Wepfer  oblerv’d,  in  hydropic  patients,  who  were  entirely 
unaffected  in  the  lenfation,  and  motion  of  their  vifcera,  and  lower  limbs, 
to  wit,  “  that  in  the  abdomen,  the  nerves  and  the  nervous  plexuffes  were  not 
“  only  inundated  with  a  copious  ferum,  but  that  they  were  even  incruftecr 
64  with  a  kind  of  jelly,  the  water  being  confin’d  in  a  thin  membrane,  and  that 
“  in  the  feet,  which  were  oedematous  -,  and  that  from  the  foies  thereof  to  the 
44  hip,  and  even  to  the  very  loins,  the  Ik  in,  the  fat,  the  membranes,  and  the 
14  mufcles  themfelves,  were  wet,  and  turgid  with  water,  like  a  fponge 
fo  that  it  cannot  be  doubted,  but  thofe  cellular  webs,  with  which  the  veffels 
of  the  nerves  are  furrounded,  were  themfelves  alfo  diftended  with  water,  and 
are  fo  in  other  hydropic  patients,  whom  we  fee  aimoft  every  day,  without 
any  paralyfis  being  the  confequence  thereof. 

21.  But  although  that  which- we  have  in  the  book,  intitled,  Be  locis  in  ho * 
mine  (/),  concerning  difeafes  of  the  nerves  -,  if,  however,  the  queftion  is  there 
of  the  fame  nerves,  which  we  fpeak  of  at  prefent,  to  wit,  44  that  the  difeafe, 

.  “  which  has  fall’n  upon  them,  refts  in  the  fame  place,  and  it  is  difficult  to 
44  draw  it  from  thence  I  fay,  although  this  is  for  the  molt  part  true,  yet 
it  is  lefs  fo,  when  the  caufe  of  the  diforder  confifls  in  their  cellular  webs,  where-, 
as  I  have  laid  above,  Boerhaave  found  by  experience,  that  they  would  yield 
to  excernal  remedies.  And  the  diforder  even  fometimes  becomes  obedient 
to  external  applications  fooner  than  is  convenient  for  the  patient ;  as  when 
limbs  that  have  recently  become  paralytic,  the  body  not  yet  being  Efficiently 
prepar’d,  are  committed  to  warm  baths,  or  their  warm  lediments  too  haftily 
and  raffily for  the  ferum  being,  by  this  means,  drawn  away  from  the  ig¬ 
noble  parts,  eafily  falls  upon  the  more  noble as  for  example,  the  cavity  of 
the  cranium,  the  fiftula  facra,  the  brain,  or-  medulla  fpinalis,  and  makes  the 
patient  fuffer  egregioufly  by  the  exchange,  efpecially,  where  there  is  a  pre^ 
vious  difpofition  to  an  apoplexy,  or  paraplegia.  To  which  I  partly  refer  the 
obiervations  of  Willis  (#),  when,  from,  the  ufe  of  the  bath  waters,  which  had 
been  generally  fo  ufeful  to  other  paralytic  patients,  he  faw  fome,  “  who  had 
44  their  limbs  more  univerfally,  and  more  grievoufly  refolv’d,  than  before.” 
And  to  the  fame  effect,  certainly,  is  that  paffage  of  T.  Livy  (x) :  44  Cneius 
44  Cornelius  the  conful,  as  he  was  returning  from  Mount  Albanum,  fell 
44  down  fuddenly,  and  being  ftricken  in  a  part  of  his  limbs,  went  to  the 
44  waters  of  Cumae;  but  the  diforder  growing  more  violent,  he  died  at  Cu- 
44  mae.”  And  as  to  this  paffage,  although  I  do  not  remember,  that  it  has 
been  obferv’d,  by  thofe  who  have  written  on  the  ufe  of  the  waters  of  Cuma?, 
and  the  neighbouring  ones  of  Bais ;  yet  what  kind  of  cafe  is  there  fpokem 

(r)  Sett,  hac  15.  Append,  ad  obf.  <j.  (/)  n.  9. 

p)  Audi.  Hift.  Apopl,  Hill.  13.  in  Schol.  ( u )  De  Anima  Brut.  p.  2.  C.  9. 

«.2.  (A  Hift.  1.  41. 


of,' 


Letter  XI.  Articles  22,  23,  243 

of,  is  plainly  (hewn  by  the  manner  of  fpeech,  which  Livy  ufes  on  another 
occafion,  as  I  have  before  produc’d,  by  way  of  example  (jy),  and  explain’d  *, 
1  mean  that  concerning  Attalus  being  all  of  a  fudden  filent,  and  falling  down, 

as  he  was  haranguing  :  “  he  fell  down . ftricken  in  a  part  of  his  limbs.” 

But  let  ns  return  to  our  hiftories,  and  even  let  us  come  to  the  very  laft  of 
them. 

22.  A  woman,  who  had  been  before  feiz’d  with  an  apoplexy,  was  attack’d 
again  therewith,  and  was  left  ftupid  and  half-paralytic.  A  month  or  two 
after  this,  fhe  was  attack’d  with  a  molt  violent  fever,  as  the  pulfe,  and  the 
third:,  demonftrated  •,  and  of  this  (he  died  in  the  hofpital  of  St.  Mary  de  Vita 
at  Bologna.  THe  veflels  of  the  cerebrum  were  fomewhat  turgid  with  black 
blood  •,  and  the  cerebrum  itfelf  was  fo  lax,  that  in  fome  places,  the  cortical 
fubftance,  join’d  together  with  the  pia  mater,  follow’d  the  dura,  as  it  was 
drawn  off  by  the  hand.  There  was  a  little  water  in  the  third  ventricle.  But 
the  remaining  vifcera  were  found.  And  while  we  were  examining  into  them, 
and  drawing  out  a  polypous  concretion  from  the  left  fide  of  the  heart,  Val- 
falva  coming  in  by  chance,  faid  to  us,  you  will  find  another  on  the  right 
fide.  And  in  fa<5t,  upon  cutting  into  the  right  auricle,  we  prefently  faw  one 
reaching  from  thence,  with  its  branches,  into  the  vena  cava.  But  the  left 
being  not  lefs  full  of  branches,  had  a  more  firm  trunk,  refembling  inwardly 
the  lubftance  of  a  firm  compact  fiefh,  which  a  kind  of  nervous  body  fur- 
rounded. 

23.  Concerning  polypous  concretions,  I  fhall  have  a  more  proper  opportu¬ 
nity  of  fpeaking  hereafter  (2}.  It  is  fufficient  here,  to  deduce  the  ftupor  of 
the  woman,  and  the  femiparalyfis  from  the  great  laxity  of  the  cerebrum. 
For  it  was  impoflible,  that  in  this  ftate,  it  fhould  be  able  to  fecrete  fpirits 
enough,  and  difpatch  them  to  the  limbs.  And  as  this  is  fufficiently  obvious, 
it  is  to  no  purpofe  to  fay  much  upon  the  fubjedt ;  notvvithftanding  you  fee, 
that  in  order  to  confirm  this,  one  and  the  fame  obfervation  is  produc’d  twice 
over,  in  the  Sepulchretum  (a),  with  fo  few  between  them,  that  it  is  lefs  to 
be  wonder’d  at,  that  almoft  two  pages  from  Willis  (£),  which  are  copied  in 
the  Scholia,  to  obfervation  the  third,  fhould  be  again  copied  in  the  fame 
manner,  as  a  fcholium  to  obfervation  the  thirtieth.  But  of  this  kind  are 
thofe  palfies  in  particular,  in  which  remedies  are  applied  to  the  paralytic 
parts,  to  remove  the  caufe,  in  vain,  I  fay  to  remove  the  caufe.  For  Val- 
falva  faid,  that  he  applied  them  with  a  view  to  preferve,  in  fome  meafure, 
the  tone  of  the  fibres  againft  a  greater  laxity  :  and  for  the  fame  reafon,  when 
he  order’d  blood  to  be  taken  away,  from  thofe  who  had  already  been  long 
half-paralytic,  he  order’d  at  the  fame  time,  that  wine  fhould  be  made  warm 
inftead  of  water,  and  that  their  hands  fhould  be  bath’d  therein,  which  it  is 
the  cuftom  at  that  time  to  do.  And  this,  as  you  ar«  fo  defirous  of  knowing 
the  practice  of  Valfalva,  I  was  not  willing  to  conceal. 

Moreover,  there  are  other  caufes  of  a  palfy,  and  thefe  on  the  outfide  of 
the  cranium  alfo,  againft  which  the  ufe  of  external  remedies  is  of  no  advan¬ 
tage.  It  will  be  fufficient  to  mention  fome  feledt  examples  of  this  kind  from 

(a)  SeA  cit.  obf.  8  Sc  13. 

(£)  c.  cit. 

I  i  2 


(y)  Epift.  3.  n.  17. 

(2)  Epift,  24.  n.  26.  &  feqq. 


Cowper 


244  Book  1.  Of  Difeafes  of  the  Head. 

Cowper(r),  and  Saltzmann  (d).  Both  of  thefe  gentlemen  found,  that  a  pa- 
ralyfis  of  the  inferior  limbs  happen’d  from  caufes  of  this  kind ;  Covvper 
from  an  internal  tumour,  which  had  fo  corroded  the  bodies  of  two  of  the 
vertebras  of  the  back,  that  in  confequence  of  their  caries,  a  foramen  was 
form’d,  large  enough  to  afford  a  paffage  for  the  finger,  quite  to  the  fpinal 
marrow  itfelf ;  and  Saltzmann  from  the  very  marrow,  not  injur’d  by  a  de¬ 
prav’d  humour  of  that  kind,  but  entirely  without  moifture,  in  the  fuperior 
vertebras  of  the  loins :  and  when  he  fays,  that  in  another  patient,  this  dif- 
order  had  obtain’d  “  in  all  the  vertebrae  of  the  loins it  is  plain,  that  not 
only  the  marrow  which  terminates  in  the  uppermoft  of  them,  but  that  a  con- 
fiderable  part  of  the  cauda  equina,  as  they  call  it,  muft  have  been  affedted 
by  the  fame  diforder :  I  wifb,  however,  that  Saltzmann  had  been  more  ex¬ 
plicit,  or  more  clear,  upon  this  point.  But  you  may  colled  the  fymptoms, 
which  would  point  out,  in  fome  meafure,  the  latent  feats  of  this  palfy,  in  the 
living  body,  by  reading  over  the  obfervations  of  both  thefe  authors. 

24.  Finally,  left  you  fhould  wonder,  that  a  fever,  which,  according  to 
fome  of  the  predidions  of  Hippocrates,  when  fucceeding  to  an  apoplexy,  is 
a  favourable  crifis  thereto,  deftroy’d  the  woman  of  whom  I  fpeak  at  prelent 
fee  Martianus  (e),  where  he  diftinguifhes  the  qualities  of  fevers,  and  fets 
the  following  paffage  from  the  Coae #  Praenotiones^  in  oppofition  to  thofe 
predidions :  “  Apopledic  diforders  that  come  on  fuddenly,  and  leave  a  pa- 
“  ralyfis  behind  them,  if  after  a  time,  a  fever  alfo  be  added,  are  dangerous.’* 
And  this  fever,  to  omit  other  things,  did  not  come  on  till  a  month  or  two 
after  the  apoplexy.  But  I  have  now  faid  enough  of  the  palfy.  Farewel. 


LETTER  the  TWELFTH. 

Of  the  Hydrocephalus,  and  Watry  Tumours  of  the  Spine, 

1.  \  LT HOUGH  hydrocephalus  is  a  fingle  term  only,  yet  it  compre- 
hends  in  itfelf,  as  you  know  very  well,  many  diforders,  that  differ 
from  each  other,  both  in  their  fituation  and  effeds.  And  firft,  that  I  may 
give  you  the  whole  diftindion  within  the  compafs  of  a  few  words,  it  figni- 
fies  a  colledion  of  water,  between  the  cranium  and  its  integuments;  fecond- 
ly,  within  the  cavity  of  the  cranium  ;  and  that  either  enlarg’d,  as  generally 
happens  in  fcetuffes,  and  children,  by  the  bones  of  the  fkull  being  drawn 
afunder,  or  without  the  bones  being  drawn  afunder,  and  continuing  after 
the  manner,  in  which  we  fee  it  in  adults  :  though,  indeed,  this  laft  kind  of 
diforder  is  not  call’d  hydrocephalus,  even  by  all  thofe  who  call  it  a  dropfy 
of  the  brain.  That  firft  and  external  kind  of  hydrocephalus,  although  I 
have  feen  it  in  the  living  body,  and  efpecially  in  a  noble  infant,  whom,  in 

{ c )  Aft.  Lipf.  A.  1699.  M.  Feb.  ad  Tab.  93.  (e)  Annot.  in  Hippocr.  1.  2.  de  Morb.  S.  2,. 

Aft.  N.  C.  T.  2.  obf.  102.  Vo. 67. 

confutation. 


Letter  XII.  Article  2.  245* 

confutation  with  other  phyficians,  I  cur’d  without  the  affiftance  of  the  chi- 
rurgical  knife  j  yet  it  has  not  happen’d  either  to  Valfalva,  or  myfelf,  that 
we  have  had  an  opportunity  of  examining  it  in  the  dead  body.  But  the  firft 
internal  kind  of  hydrocephalus,  at  leak  after  the  water  had  been  difcharg’d, 

I  believe  I  have  feen  in  thole  foetulfes,  whom  I  have  difteCted,  and  found 
without  any  brain,  as  I  fhall  explain  hereafter.  And  as  to  the  other  kind, 
both  Valfalva  and  I  have  had  frequent  opportunities  of  making  obfervations 
thereon,  as  feveral  of  the  former  letters  fhow.  None  of  which,  it  is  my  in¬ 
tention  to  repeat  here ;  but  I  will  rather  give  you  one,  for  which  you  will 
readily  lee,  there  was  no  convenient  place  in  the  letters  above.  And  when 
I  fhall  have  produc’d  this  obfervation,  I  will  then  mention  what  1  have  feen 
belonging,  as  I  fuppofe,  to  the  firft  kind  of  internal  hydrocephalus :  nor 
will  I  be  filent  upon  the  fubjeCt  of  the  fpina  bifida,  as  it  is  call’d,  nor  other 
watry  tumours  of  this  noble  part. 

2.  An  elderly  woman,  after  having  old  ulcers  of  her  legs  gradually  dimi- 
nifh’d,  and  difcharging  lefs  and  lefs  every  day,  till  at  length  they  appear’d 
quite  dry,  was  gradually,  as  it  were,  confum’d  by  old  age,  till  line  died. 
The  body  was  brought  to  this  college,  when  the  fecond  courfe  of  anatomy, 
that  was  given  here  in  the  year  1725,  was  almoft  at  an  end.  Wherefore,  I 
examin’d,  myfelf,  almoft  all  the  vifcera,  and  found  the  liver  and  fpleen  to 
exceed,  in  fome  meafure,  their  natural  bignefs ;  nor  was  their  fubftance  al¬ 
together  natural.  The  ureters  alfo,  and  the  pelvis  of  both  kidneys,  were 
much  bigger  than  ufual,  which  was  no  obfcure  indication,  that  the  woman  * 
had  formerly  been  fubjeCt  to  the  ftone,  or  other  diforders  of  the  kidneys 
and  to  this  I  thought  we  muft  refer  the  fmallnefs  of  the  right  kidney,  which 
was  lefs  by  one  half  than  the  left.  The  left  Falloppian  tube  had  coalefc’d,  at 
its  extremity,  into  one  fubftance  with  its  correfponding  ovary,  having  its 
fimbriae,  and  the  orifice  that  lies  betwixt  them,  entirely  obliterated.  The 
fundus  uteri  being  open’d,  an  excrefcence  was  feen  in  the  left  fide  of  it, 
which  in  its  fize  and  form,  refembl’d  half  a  lupin,  its  bafis  only  being  con¬ 
nected  with  the  uterus,  and  both  its  furfaces  being  quite  loofe  and  fmooth, 
and,  like  the  whole  internal  furface  of  the  uterus,  red.  The  figure  of  the 
cranium,  and  confequently  of  the  brain,  was  entirely  irregular,  as  I  have 
defcrib’d  in  the  firft  letter  ( a )  ^  for  this  is  the  woman,  of  whom  I  made  a 
flight  mention,  in  the  latter  end  of  a  hiftory,  in  fome  meafure,  fimilar  to  this, 
promifing  to  give  the  remainder  of  it  elfewhere,  which  promife  I  at  prefent 
perform.  The  lateral  ventricles  were  very  full  of  turbid  water.  The  plexus 
choroides  were  white.  In  cutting  the  corpora  ftriata  piece-meal,  wh,ere-ever 
you  directed  the  knife,  you  found  them  confift,  almoft  univerfally,  of  the 
cineritious  fubftance  *,  and,  to  the  aftonifhment  of  all  who  were  prefent,  there, 
appear’d  no-where  any  medullary  ftri^,  but  only  medullary  points,  lying 
at  a  diftance  from  each  other.  The  cerebellum,  as,  in  like  manner,  the  me¬ 
dulla  oblongata  alfo,  was  flaccid.  Laft  of  all,  having  obferv’d  the  pituitary 
gland  to  be  very  low,  and  fhrunk  in  its  fubftance,  I  carefully  extracted  it, 
and  firft  faw  that  it  was  without  its  appendix,  as  defcrib’d  in  the  fixth  of  the 
Adverfaria  (£),  and  reprefented  in  a  plate  j  next,  that  its  body  was  of  a  brown 


( a )  N,  14.  in  fin. 


(£)  Anim.  25.  &  tab.  I.  fig.  4.. 
4 


colour? 


24  6  Book  I.  Of  Difeafes  of  the  Head. 

colour,  degenerating  into  yellow ;  and  that,  as  it  was  contracted,  and  lank 
in  its  fubftance,  efpecially  as  to  height,  it  protuberated  upwards  much  lefs 
than  it  ufually  does. 

3.  If  any  one  had  accurately  remark’d  the  old  and  the  recent  fymptoms 
of  diforder  under  which  this  woman  had  labour’d,  from  the  very  time  that 
1  could  learn  any  thing  about  her,  by  enquiring  i  as  I  fhould  not  have  omitted 
to  confider  many  things  here,  which  I  obferv’d  in  the  dilTedtion,  fo  I  fhould 
certainly  have  referr’d  this  obfervation  to  another  place,  rather  than  to  this. 
Which  might  alfo  have  been  done  with  home  of  thole,  that  are  given  in  this 
fixteenth  fedtion  of  the  Sepulchretum,  efpecially  with  that  given  under 
number  fix,  and  with  the  firit  and  lecond,  which  are  fet  down  in  the  Addi¬ 
tamenta,  under  number  feven :  and,  indeed,  the  greateft  part  of  obfervers 
do  not  allow  the  diforder  to  be  a  hydrocephalus,  where  the  head  is  not  en¬ 
larg’d.  Yet  there  is  not  the  leaf!:  doubt,  but  that,  when  a  large  quantity  of 
water  is,  by  degrees,  collected  in  the  cranium,  a  tumour  of  the  head  mult 
infallibly  arife  therefrom,  if  it  were  poffible  for  the  bones  to  yield  to  the 
extenfion,  as  they  do  in  young  creatures  :  nor  can  it  be  doubted,  but  fome 
of  the  caufes,  which  give  rife  to  the  congeftion  of  water  in  the  heads  of 
tender  infants,  are  the  fame  that  give  rife  to  the  congeftion  in  adults ;  the 
rupture  of  hydatids  of  the  plexus  choroides,  or  any  other  part  within  the 
cranium,  however,  being  excepted,  of  which  I  fhall  fpeak  below  (c).  Sup- 
pofe,  for  inftance,  either  fuch  a  ftru&ure,  or  conftitution,  of  the  pineal  gland, 
that  it  can  tranfmit  no  water,  as  in  that  Englifhman  (d),  whofe  ventricles 
being  full  of  ferum,  had  this  gland  lying  under  them,  very  hard  in  one  part 
of  it,  and  in  the  other  wafted  ;  or  fuch  a  quality  of  the  water,  that  it 
cannot  be  tranfmitted  to,  or  through  this  gland  ;  tne  former  of  which  may 
happen  when  the  water  is  only  limpid  ;  and  the  latter,  when  the  ventricles  are 
diftended  with  turbid  water,  fuch  as  was  obferv’d  by  Brunnerus  (<?),  in  the 
diffedtion  of  a. princely  patient,  and  by  me  in  the  diffedtion  of  the  woman 
of  whom  I  now  treat.  For  in  this  woman,  as  the  ichor  which  us’d  to  be 
difcharg’d  by  the  ulcers  of  the  legs,  was  diverted  to  the  ventricles  of  the 
brain,  it  might,  by  irritating,  and  corrugating  the  extreme  tubuli  of  the  in¬ 
fundibulum,  obftrudt  its  own  palfage  into  the  pituitary  gland  ;  which  for  that 
reafon,  as  all  other  parts,  when  they  ceafe  from  their  office  of  receivino 
juices,  are  wont  to  do,  would  fubfide,  and  become  contracted  in  its  fubftance. 

But  if  thick  ferum,  without  any  ftimulus,  or  power  of  irritating,  infinuate 
jtfelf  into  this  .gland,  and  cannot  get  out,  that  which  will  ftili  continue  to 
flow  down  from  the  ventricles,  will  render  this  receptacle  extremely  tumid, 
as  Peyronius  has  feen(/),  but  muft  at  length  preclude  all  accefs  to  the  re¬ 
maining  moifture. 

Yet  in  others,  caufes  of  a  different  kind  may  arife,  which  may  prevent 
the  pafiage  even  of  thin  water  through  the  gland.  For  that  there  is,  by  the 
very  intention  of  nature,  thin  and  limpid  water  in  the  ventricles,  but  fcarce 
more  than  is  lufficient  juft  to  keep  their  furfaces  moift,  cannot,  I  think,  be 
denied.  And  if  Littre  (g)  did,  perhaps,  find  more  in  thofe  whelps,  whole 

(0)  N.  6.  (f)  Memoir,  de  1’AcaJ.  R.  de  Sc.  a.  1741. 

\d)  Aft.  Lifp.  a.  1688.  m.  Maj.  {g)  Hift.  de  la  meme  Acad.  a.  17 11.  Obf. 

".(*)  Eph.  N.  C.xen,  6.  obf.  1.  in^fin.  Anat.  7. 

heads 


Letter  XII.  Article  4.  247 

heads  he  cut  off*  at  one  blow,  yet  they  were  then  fucking ;  and  there  is,  na¬ 
turally,  in  all  the  cavities  of  foetufies  and  animals  lately  born,  more  water 
than  in  adults:  wherefore,  it  were  to  be  wifh’d,  that  he  had  made  the  fame 
experiment  in  adult  animals,  which  he  made  in  thole  who  fuck’d.  For  it  is 
to  be  flip  pos’d,  that  water  abounds  then  only  in  adults,  when  either  more 
than  a  proper  quantity  is  fecreted,  or  when  there  is  any  caufe,  which  inter¬ 
cepts,  wholly  or  in  part,  the  pafifage  of  the  water  to  the  pituitary  gland. 
And  whatever  I  fay  of  this  gland,  I  would  have  underftood  of  the  other  latent 
paflages  alfo,  through  which  I  fuppofe  that  an  exit  is  prepar’d  by  nature  for 
the  water  collected,  as  I  have  already  (h)  deferib’d  to  you  more  at  large,  and 
is  needlels  now  to  repeat. 

4.  But  rather  let  me  add,  what  then  efcap’d  me,  that  in  this  fixteenth 
fed  ion  of  the  Sepulchretum,  three  hiftories  of  one  hydrocephalus  are  pro¬ 
duc’d,  every  one  of  them  from  different  perfons  •,  under  number  feven  by 
Cummius,  under  number  eight  by  Paifenius,  and  laft  of  all,  under  number 
five,  in  the  Additamenta,  by  Pcchlinus.  All  thefe  three  gentlemen  wens 
prefent,  when  the  body  of  that  infant  was  difle&ed,  by  Hornius,  at  Leyden, 
in  the  year  1666.  As  the  firft  two,  therefore,  publifh’d  each  his  own  obfer- 
vation,  in  the  firft  Decuria  Ephemer.  Nat.  Cur.  the  one  in  year  the  firft  (7), 
and  the  other  in  the  year  the  fourth  and  fifth  (k) ;  Pechlinus,  at  length,  in  the 
Obfervat.  Phyf.  Med.  (7),  added  his,  giving  pretty  broad  hints,  that  thehiftory 
was  not  very  accurately  deliver’d  by  the  others.  For  he  fays,  “  I  will  lay 
“  it  open  more  accurately,  inafmuch  as  it  is  rare,  and  hitherto  not  deferib’d 
ct  in  proportion  to  its  worth.”  And,  indeed,  there  are  great  differences  even 
in  the  very  v/eight  of  the  water  •,  whereas  Pechlinus,  from  whom  Paifenius 
differs  very  little  in  this  point,  fuppofes  it  to  have  been  a  hundred  and  fixty- 
three  ounces,  which  Cummius  had  fuppos’d  to  be  “  thirty-fix.”  1  he  other 
differences  you  will  fee  yourfelf,  by  comparing  them  together,  and  that 
in  particular  which  relates  moft  to  our  prefent  purpofe ;  for  Paifenius 
fays,  “  that  the  pituitary  gland  was  flaccid,  and  confiderably  enlarg’d  but 
Cummius,  on  the  contrary,  denies,  “  that  any  traces  of  the  pituitary  gland 
“  appear’d  and  Pechlinus  takes  no  notice  at  all  of  the  fubjeft :  fo  that  it 
might  well  be  fufpedfted,  that  each  of  them  meant  to  deferibe  the  difledtion 
of  a  different  hydrocephalus,  perform’d  in  the  fame  year  at  Leyden,  by 
Hornius,  if  Pechlinus  had  not  admomfh’d  us,  that  an  obfervation  of  this 
kind  is  rare,  as  indeed  it  is  •,  and  fo  many  other  circumftances  did  not  fuf- 
ficiently  demonftrate,  that  the  cafe  was  one  and  the  fame.  Which  of  the 
three,  then,  (hould  we  rather,  give  credit  to  ?  Brunnerus  (*»),  who  might  have 
read  each  of  the  three  deferiptions,  certainly  gave  credit  to  Cummius  in  this, 
that  “  the  pituitary  gland  was  entirely,  deficient.;”  for  he  can  have  no  other 
defeription  in  view,  than  that  of  Cummius;  although  there  is  a  miftake  in 
the  year,  even  in  the  relation  (»)  which  is  copied  in  the  Sepulchretum  :  for  it 
is  not  always  to  be  imputed  to  the  printers,  who  have  made  miftakes  enough 
on  other  occafions,  nor  yet  that  very  great  obfeurity  of  the  firft  obfervation. 


(h)  Epift.  4,  n.  ?6, 
(0  obf.  47. 

\k)  Obf.  196. 

{()  E.  1.  obf.  61,’ 


(/»)  Seft.  hac  16.  in  fchol.  ad  obf.  12.  in 
addit,  ad  fin. 

(»)  Eph.  N.  C.  dec.  3.  a.  1.  obf.  152.  in 
fchol.  ad  fin. 

lEi 


2 4$  Book  I.  Of  Difeafes  of  the  Head. 

in  this  fedlion  ;  for  it  is  read  after  the  fame  manner  in  the  Opufculum  of  Bar¬ 
tholin  (0),  whofe  name,  however,  ought  to  have  been  fubjoin’d  to  the  fcholia 
alfo,  which  are  annex’d  to  that  obfervation. 

But  to  return  to  the  point  •,  I  will  believe  each,  in  the  circumftances 
wherein  they  agree  :  where  they  difagree,  I  will  either  doubt ;  or,  if  a  regard 
is  to  be  had  to  experience,  diligence,  and  the  time  in  which  he  wrote,  I 
will  believe  Pechlinus.  And  I  could  wiffi,  that  this  matter  of  doubt,  con¬ 
cerning  the  three  obfervations,  were  inferted  in  the  Sepulchretum.  You 
have,  already,  what  I  think,  in  regard  to  thofe  two  obfervations,  which  I 
pointed  out,  in  the  firft  place,  in  the  Sepulchretum,  when  I  wrote  to  you  on 
another  occaficn  (p),  concerning  the  office  of  the  pituitary  gland. 

5.  I  will  now  mention,  what  I  have  obferv’d  in  thofe  foetuffes,  whom  1 
fuppofe  to  have  been  killed,  by  an  internal  hydrocephalus.  I  will  mention, 
I  fay  •,  for  there  is  no  occafion  to  repeat  here,  what  I  have  before  publiffi’d  : 
it  is  fufficient  to  point  it  out;  and  if  any  thing,  perhaps,  is  to  be  added,  by 
way  of  illuftration,  to  add  it  thereto. 

Firft  of  all  then,  I  would  have  you  read  over  again,  what  is  fet  forth  in  the 
Epiftolas  Anatomicas  (q),  of  a  foetus  that  I  differed  at  Forli,  which  had 
been  born  without  any  brain  ;  and  I  would  have  you  obferve  this,  in  particu¬ 
lar,  that  the  brain  was  certainly  not  originally  wanting  ;  but  that  being  ex¬ 
tenuated,  by  the  hydrocephalus,  and  refolv’d  into  water,  it  had  been  carried 
away,  through  the  foramen,  in  the  upper  part  of  the  fpine.  And  though  I 
had  not  leifure,  at  that  time,  as  I  there  confefs’d,  to  look  over  the  greateft 
part  of  the  obfervations  of  this  kind,  that  have  been  made  by  others,  and  to 
compare  them  with  this  explication  of  mine,  which,  at  that  time,  I  luppos’d 
to  be  original,  and  peculiar  to  myfelf ;  yet,  after  the  publication  of  the  book, 
having  a  little  more  time,  I  foon  began  to  do  it ;  and  was  glad  to  find,  from 
the  very  firft  account  I  lit  on,  which  was  that  of  the  celebrated  Marcot  (r\ 
that  it  had  appear’d  to  him,  juft  in  the  fame  light  in  which  it  had  appear’d 
to  me.  And  after  having  remark’d  the  obfervations  which  Wepfer  (fj,  and 
Stalpart  (/■),  had  formerly  collected,  and  the  more  modern  ones,  which  the 
celebrated  Brinius  (u)  has  mention’d,  and  others,  in  order  to  feledt  thofe 
which  more  immediately  belong’d  to  this  qucftion  ;  and,  whenever  it  fhould 
be  in  my  power,  to  compare  them-,  I  faw  that  fo  many  of  them  were  pointed 
out  in  other  places,  by  learned  men,  in  books  publiffi’d  in  the  mean  time, 
that  I  doubted  whether  I  fhould  ever  have  leifure,  I  will  not  fay,  to  examine 
them  all,  but  even  to  find  them  among  their  authors;  with  fo  little  care  do 
moft  of  the  printers  fet  down  the  names  of  the  works  referr’d  to,  or  mark 
down  the  paffages  their  authors  quote  ! 

Wherefore,  leaving  to  others  to  collate  thefe  cafes,  it  is  fufficient,  for  me, 
to  have  perceiv’d,  from  the  confideration  of  not  a  few  of  them,  at  leaft, 
which  it  was  in  my  power  to  colled,  that  where  the  brain  was  really  deficient, 
it  might  have  happen’d  from  that  caufe,  and  be  wanting  in  the  fame  manner, 
which  werejuft  now  pointed  out.  But  if  you  wiffi  to  fee  another  example 

(0)  Confil.  Med.  de  Comet.  ft)  Eph.  N.  C.  Dec.  1.  A.  3.  obf.  129. 

(/>)  Epift.  4.  n.  36.  (0  Cent.  1.  Rar.  obf.  2. 

(?)  XX.  0.56,  57.  («)  Inquif.  de  Spirit.  Animal,  n.  35.  &feqq. 

(r)  Mem.  dc  1’  Acad.  R.  des  Sc.  A.  1716. 

of 


I 


Letter  XII.  Article  5.  24.9 

of  mine  more  fully  deferib’d,  or  one  of  my  friends,  which  has  not  yet  been 
publifh’d,  turn  to  that  which  Vallifneri  (x)  has  mention’d,  as  his,  and  mine, 
and  which  is  deferib’d  by  me  in  the  Adverfaria  (y) ;  and  let  me  add  this  one 
thing  only,  to  the  defeription,  which  I  very  certainly  remember,  to  wit,  that 
there  was  no  part  of  the  cranium,  but  its  bafis,  in  that  fubjedt,  and  even, 
that  this  was  not  entire  ;  for  whatever  part  of  it  there  us’d  to  be,  behind  the 
foramen  magnum  occipitis,  was  entirely  wanting. 

But  a  few  months  before  I  differed  that  girl,  that  is,  about  the  end  of 
the  year  1711,  when  I  went,  by  chance,  to  Venice,  I  heard  from  my  friends 
there,  and  particularly  from  him  whom  I  have  commended  to  you  on  other 
occafions  (a),  Alexander  Bonis,  a  learned,  and  diligent  phyfician,  that  he 
had  been  prefent,  not  long  before,  when  Santorini  himfelf  alio  difledted  a 
girl,  like  that  deferib’d  by  me  (for  though  thefe  cafes  do  happen  in  males 
alfo,  yet  I  think  they  happen  more  frequently  in  the  female  fex  :  and  the 
cafe  I  have  mention’d  to  you  above,  in  the  body  difledted  at  Forli,  was  of  a 
female  fubjedt(^) )»  and  that  he  faw  a  child,  well  nourifh’d,  and  of  a  very 
proper  fize,  fo  as  to  agree  not  only  with  one  who  died  immediately  after  be¬ 
ing  born,  but  with  one  who  was  brought  into  the  world  at  its  proper  time  : 
and  he  obferv’d,  that  the  upper  part  of  the  head  only,  was  extremely  de- 
prefs’d  :  from  which,  when  the  thick  membrane  was  remov’d,  that  was 
grown  quite  firmly  to  the  hairy  fcalp;  he  faw  no  upper  part  of  the  cranium, 
no  cerebrum,  but  only  a  kind  of  bladder,  in  which  nothing  was  contain’d 
but  a  yellowifh  water :  and  entirely  disjoin’d  from  this  bladder,  which  occu- 
py’d  the  anterior  parts,  in  the  bafis  of  the  cranium,  and  even  in  the  very 
feat  of  the  medulla  oblongata,  he  faw  a  fmall  fubftance,  not  bigger  than  the 
kernel  of  an  almond,  w'hich  might,  perhaps,  be  in  the  Head  of  a  cerebellum. 
You  perceive,  that  in  this  cafe,  the  cerebrum,  medulla  oblongata,  and  the 
greateft  part  of  the  cerebellum,  were  deftroy’d  by  the  hydrocephalus,  the 
water  of  which  had  not  yet  univerfally  flow’d  out :  but  in  thofe  fubjedts, 
which  I  have  fpoken  of,  as  difledted  by  me,  the  cerebellum  was  entirely  de¬ 
ftroy’d,  together  with  the  other  contain’d  parts,  and  feem’d  to  have  flow’d 
out  with  the  water. 

Nor,  indeed,  did  the  illuftrious  Haller  judge  that  thofe  cafes  could  be 
otherwife  explain’d,  not  only  in  other  places,  but  in  his  Opufcula  Anato¬ 
mica  (c)  •,  in  which,  from  his  great  humanity  to  me,  he  was  willing  to  make 
my  name,  little  as  it  is,  honourable,  when  he  alfo  gave  an  obfervation  of  this 
kind,  on  a  female  foetus,  very  accurately  made,  according  to  his  cuftom, 
and  took  notice  of  many,  from  others,  in  confequence  of  that  great  erudi¬ 
tion,  of  which  he  is  matter ;  and  pointed  out  the  circumftances  of  fuch  as 
were  moft  like  thofe  already  deferib’d.  He  therefore  confirms,  that  the  cere¬ 
brum  was  not  deficient,  in  the  original  formation  of  his  foetus  ( d ),  by  thofe 
reafons,  which,  in  the  fame  manner,  as  the  greater  part  produc’d  by 
the  celebrated  Laufferus  (<?),  may  be  transferred  to  other  foetufles  of  this 


(x)  Ift.  della  Generaz.  P.  2.  c.  17.  n. 
ad  litt.  b. 

(y)  II.  Animad.  35. 

(a\  Epift.  3.  n.  17.  &  Epift.  5.  n,  11. 

( b )  Vid.  &  Epift.  48.  n.  49. 

Yol.  I. 


6.  (r)  Opufc.  IX. 

(A  n.  9. 

(r)  Dili’,  qua  infans  fine  cerebro.  Sec.  §  3. 
&  feqq. 

K  k  kind. 


2 So  Book  I.  Of  Difeafes  of  the  Head. 

kind.  And  that,  afterwards,  a  caufe  was  added,  which  open’d  paflages  for 
the  cerebrum,  to  be  pour’d  out  of  its  containing  cavity.  And,  indeed,  you 
fee  that  thefe  paflages  were  manifeft  in  many ;  as  for  inftance,  a  foramen  in 
the  foetus  at  Montpelier  (/),  and  mine  at  Forli ;  and,  in  like  manner,  in  ano¬ 
ther  of  mine,  at  Padua  (g),  in  which  the  whole  had  not  yet  flow’d  out.  But 
in  fome  there  was  an  opening,  through  which  the  whole  contents  had  gone 
forth.  So  in  that  of  which  Gullmann  (b)  fpeaks,  “  the  occiput  was  open’d,  with 
“  a  great  extenfion  of  the  pericranium,  in  which  the  whole  bulk  of  the  brain 
“  was  included.”  And  other  examples,  of  this  kind,  you  will  have  from 
Haller  (?),  whether  it  be  a  hernia,  if  I  may  fo  fpeak,  of  the  pericranium,  or 
dura  mater,  or  rather,  of  both  together,  including  the  brain.  And  you  un- 
derftand,  how  eafily  thefe  membranes  being  diftended,  and  diftradted  with 
fuch  a  weight,  may  be  burft  afunder  at  length,  and  emit  their  too  heavy 
contents.  And  if  the  brain  be  d-flolv’d  by  the  water  of  the  hydrocephalus, 
the  water  will  not  only  encreafe  the  weight,  but  will  alfo  render  it  fo  fluid,  as 
to  give  it  an  opportunity  of  flipping  out  gradually,  fometirne?,  even  through 
very  fmall  foramina.  But  as  to  the  manner,  in  which  the  water  is  generated, 
and  how  it  diflolves  the  brain ;  the  firfl:  is  fufficiently  fpoken  of  above  (£), 
where  I  mention’d  leveral  means,  by  which  the  pituitary  gland  may  be  ob- 
ftrudted,  or  other  paflages,  which  ferve  to  carry  off  the  water,  colledted  in 
the  brain  :  and  it  was  alfo  hinted  in  the  fame  place,  that  a  congeftion  of  wa¬ 
ter  might  happen  alfo,  from  a  rupture  of  hydatids.  For  that  thefe  hydatids 
have  been  pretty  frequently  form’d,  not  only  within  the  cranium,  but  within 
the  cerebrum,  of  beafts,  obfervations,  which  have  been  pointed  out  already 
by  me,  from  the  Sepulchretum,  in  another  place  (/),  fufficiently  demon- 
ftrate  :  from  reading  which,  over  again,  you  will  perceive,  that  the  fame 
thing  has  alfo  happen’d  to  men,  fometimes.  And  that  hydatids  have  often 
been  found,  in  the  meninges  of  human  foetufles,  who  were  born  la¬ 
bouring  under  a  hydrocephalus,  or  without  a  brain,  that  cafe,  defcrib’d  by 
the  celebrated  Jo.  Rud.  Zwingerus  («2),  together  with  that  of  Montpelier,, 
of  Forli,  and  others,  do  jointly,  and  fuffic  iently,  prove. 

And  you  will  readily  I'uppofe,  that  the  well  known  obfervation  of  Wep- 
fer  (»},  may  be  referred  to  this  clafs,  where  the  whole  bulk  was  made  up  of 
innumerable  veffcles,  compacted  together,  full  of  the  mod  limpid  water  ; 
unlefs  you  chufe  rather  to  be  in  the  number  of  thofe,  who  have  fuppos’d, 
that  it  related  to  the  fubftance  of  the  brain  itfeif.  And  Haller,  certainly, 
when  he  points  out  the  obfervation  (0)  of  the  celebrated  Spoerlin,  of  hyda¬ 
tids  being  found  in  the  place  of  the  brain,  at  the  fame  time  admonifhes  us, 
“  that  many  more  examples  of  this  fabric  are  to  be  found  elfewhere.”  Ve¬ 
hicles,  therefore,  of  the  one,  or  of  the  other  kind,  if  from  their  over-diften- 
flon,  they  happen  to  be  ruptur’d,  will  pour  out  water  within  the  cranium, 
in  proportion  to  their  number,  and  magnitude  :  but  thofe  which  are  gene¬ 
rated  within  the  brain  itfeif,  as  they  are  driven  again!!:  its  fubftance,  by  the 


(f)  Marcot,  cit.  fupra  rd  n-.  5. 
(gj  Epift.  ibid,  indie,  n.  53. 

\b)  Eph.  N.  C.  Cent.  7.  obf.  92,, 
(v)  Opufc.  cit.  not.  3.  &  13. 

Kk)  n-  3- 


(/)'  Epift.  I.  n.  6. 

(/«)  Ad.  Helvetic,  t.  1.  c.  1. 

(*)  Obf.  129.  cit.  fupra  ad  n.  5. 
(0)  not.  cit.  3. 


alternate 


Letter  XIL  Article  7.  251 

alternate  pulfation  of  the  arteries,  10  Laufferus  (p)  has  endeavour’d  to  com¬ 
pute,  how  much  they  can  effedt,  towards  the  comminution,  and  difiolution, 
of  the  foft  medulla  of  the  cerebrum,  which  lies  around  them.  But  by  what 
means  i'oever,  and  from  what  fource  foever,  water  may  be  collected  preter- 
naturally,  within  the  theca  that  envelopes  the  brain ;  it  will  be  pofiible  for 
the  water,  by  its  interpofition,  to  prevent  the  growth  and  concretion  of  the 
brain,  if  it  is  not  yet  come  to  its  maturity  ;  or  if  the  brain  be  already  form’d, 
the  water,  by  infinuating  itfelf  betwixt  the  particles  thereof,  may,  by  degrees, 
disjoin  them,  more  and  more,  till  they  are  reduc’d  to  very  fmall  dimenfions, 
and  thus  become  eafily  mifcible  with  water,  nor  any  longer  to  be  difliri- 
guifh’d  therefrom.  An  inftance  of  which  disjundtion  gradually  proceeding, 
but  not  being  yet  perfedt,  you  have  given  you  in  a  very  clear  manner,  by 
Chriftian  Vater  (^),  from  a  new-born  infant,  that  he  difiedted  on  the  fcore 
of  a  hydrocephalus,  where  he  faw  the  hemifpheres  of  the  brain  “  expanded 
tc  by  the  water,  and  hollow’d  out  after  the  manner  of  a  fpecies  of  cabbage  ; 
“  for  there  were  no  ventricles,  no  convolutions,  but  fibres,  whitifh,  and  very 
“  turgid,  with  a  quantity  of  ferum,  diftributed  from  the  bafis,  and  trunk 
<c  of  the  medulla  fpinalis,  through  the  whole  compages  of  the  brain,  and 
“  going  in  great  numbers  to  the  cortical  fubftance,  like  the  ladteal  vefiels, 
“  through  the  mefentery  ;  and  in  their  way  they  feem’d  frequently  to  com- 
c<  municate  and  anaftomofe  with  each  other,  in  their  branches.”  But  in 
another  hydrocephalus ;  to  omit  examples  of  its  perfedt  disjundtion,  and  dif¬ 
folution  here,  which  1  (hall  mention  below  (r),  from  Kerckringius,  Tombi- 
nus,  and  .Laufferus  ;  in  another  hydrocephalus  I  fay,  whom  Rombergius  (s) 
difiedted,  in  dike  manner,  immediately  after  its  birth,  “  the  water,  which  was 
like  the  walkings  of  flefh,”  will  not  only  fhow  the  disjundtion  to  have 
been  then  .almoft  perfedt,  but  alfo  the  mixture  of  the  disjoin’d  particles  with 
the  water;  befides  which,  and  the  dura  mater,  he  could  “  fee  nothing  diftindt 
<c  in  this  fluid  kind  of  brain.”  Nor  is  it  to  be  wonder’d  at;  for  the  water, 
which  had  already  encreas’d  to  the  quantity  of  four  meafures,  rnuft  necefifa- 
rily  adt  with  a  great  force,  as  is  plainly  fhown,  from  its  “  burlting  forth 
“  with  impetus,”  at  the  firfl  imprefiron  of  the  knife,  and  from  all  the  bones 
which  go  to  make  up  the  fuperior  part  of  the  cranium,  being  fo  drawn  our, 
that  they  were  diftant  from  each  other  by  a  large  open  fpace,  and  could 
“  be  bent  here  and  there  in  a  very  eafy  manner-,”  whereas,  in  the  former 
infant,  they  were  only  pull’d  afunder,  as  generally  happens  in  this  difeafe. 

7.  Doubtlefs  the  force  of  the  water,  gradually  collected  in  a  hydrocepha¬ 
lus,  efpecially  if  the  foetus  be  tender,  is  very  urgent  and  manifeft,  and  the 
more  fo,  in  proportion  as  it  begins  the  fooner  to  act  on  the  lefs  refilling  parts 
of  the  cranium.  And  hence  the  approach  of  the  bones  to  each  other  is  not 
only  impeded,  but  alfo  the  very  growth  of  them,  fometimes  in  a  few,  and 
fometimes  in  the  greateft  part ;  fo  that  they  feem,  almoft,  to  be  entirely 
wanting.  But  moreover,  it  fometimes  happens,  that  the  whole  bulk  of  the 
tumour  does  not  only  prefs  upon  the  cranium,  but  alfo  upon  the  other  bones 
of  the  body,  in  fuch  a  manner,  that  the  face,  and  body  of  the  foetus  are 

(p)  DifT.  cit.  ,§  34.  (r)  n,  13. 

(f)  Eph.  N.  C,  Dec.  3.  A.  9.  obf.  166.  ft)  Eph.  N.  C.  A.  modo  cit.  obf.  hi. 

K  k  2  encreas’d 


252  Book  I.  Of  Difeafes  of  the  Head. 

encreas’d  rather  in  a  tranfverfe,  than  a  longitudinal  direftion.  An  example 
of  which  I  (hall  the  more  willingly  fubjoin,  becaufe,  having  read  over  moll 
of  the  obfervations  on  hydrocephali,  I  do  not  remember  to  have  met  with 
a  parallel  inftance  any  where.  1  have  a  fkeleton  by  me  which  was  made  up 
forty  years  ago,  or  more,  fo  that  I  do  but  juft  remember  to  have  heard, 
from  the  perton  who  made  a  prefent  of  it  to  me,  that  it  was  the  fkeleton 
of  a  female  foetus,  kill’d  in  the  womb  of  its  mother,  by  a  great  internal  hy¬ 
drocephalus.  And,  indeed,  the  cavity  of  the  cranium  is,  certainly,  now 
three  times  as  big  as  that  of  a  child  of  nine  months  old  ;  although,  when  you 
confider  the  greateft  part  of  the  bones,  in  the  whole  body,  you  will  eafily 
perceive,  that  it  was  lefs  than  feven  months  old  :  and  when  the  head  is  taken 
away,  if  you  confider  its  height,  you  will  find  that  it  is  fcarcely  bigger  than 
a  foetus  of  five  months.  For  all  the  oblong  bones  of  the  limbs,  in  propor¬ 
tion  as  they  are  thicker  than  natural,  fo  in  proportion  alfo  are  they  fhorter ; 
fo  that  the  caufe  which  prevented  them  growing  longitudinally,  feems  to  be 
the  fame  which  had  given  occafion  to  their  encreafing  tranfverfely.  But  all 
the  ribs,  in  like  manner,  are  broader,  and  thicker  than  ufual ;  and  the  face,  in 
particular,  as  much  as  is  taken  away  from  it  in  length,  has  fo  much  added  to  it 
in  breadth.  For  as  the  hydrocephalus  took  away  the  greateft  part  of  the 
length,  not  only  by  preventing  the  growth  of  the  two  frontal  bones,  but  alfo 
by  deprefiing  the  face  in  and  betwixt  the  orbits,  leaving  behind  no  appear¬ 
ance  at  all  of  the  nafal  bones ;  fo  it  enlarg’d  the  face  exceedingly  in  the  tranf¬ 
verfe  direction,  and  that  in  a  very  fingular  manner.  For  the  procefs  of  the 
fphenoidal  bone,  which  that  excellent  anatomift,  Window,  calls  the  tempo¬ 
ral  procefs,  and  the  fquamofe  portion  of  the  temporal  bone,  annex’d  thereto, 
were  on  both  fides  impell’d  outwards  and  forwards  by  the  water ;  and  the  latter 
was  at  the  fame  time  forc’d  downwards,  in  fuch  a  manner,  that  its  proceflus 
zygomaticus,  which  ought  to  have  been  horizontal,  afcends  forwards  pof- 
teriorly.  To  this  was  added  a  remarkable  protuberance,  which  encreas’d 
the  face  tranfverfely,  on  both  fides,  made  up  of  the  dura  mater,  joining  to¬ 
gether  the  bones,  which  I  fpoke  of  juft  now,  to  as  many  which  I  fhall  fpeak 
of  prefently,  in  fuch  a  manner,  that  no  final!  cavity  was  thus  added  to  the 
cavity  of  the  cranium,  already  too  much  extended  ;  and  that  not  only  in  it- 
felf,  but  by  the  deprefiion  of  the  os  ethmoides,  and  ftill  more  by  the  un- 
ufual  deprefiion  of  the  os  fphenoides,  to  fay  nothing  of  the  external  bony 
parietes  of  the  orbits  being  driven  into  the  very  orbits  themfelves.  But  now 
that  you  may  underftand  what  remains,  give,  me  leave  to  fay,  that  the  cra¬ 
nium,  of  which  we  fpeak,  was  made  up  of  two  diftinft  halves  of  a  cranium, 
the  pofterior  of  which  was  much  bigger  than  the  anterior,  that  we  have  hi¬ 
therto  confider’d.  For  after  the  os  occipitis  of  this  anterior  half  afcends  back¬ 
wards,  about  a  finger’s  breadth  from  its  great  foramen,  you  there  fee  another 
foramen,  larger  than  the  firft,  and  in  like  manner,  in  the  middle  of  the  bafis, 
not  leading  into  the  tube  of  the  vertebrae,  as  the  former  did,  but  into  a  bony 
foramen,  like  to  itfelf,  and  continu’d  from  thence  into  a  bony  canal,  not 
longer  than  the  breadth  of  the  tip  of  my  little  finger,  which  before  it  ter¬ 
minated  was  fhut  up  with  a  membrane.  From  this  foramen  afcends  its  os 
occipitis,  longer  than  in  a  nine  months  foetus,  but  narrower.  For  the  bones 
of  the  finciput  occupy,  on  each  fide,  a  part  of  the  fpace  that  was  due  to 
I  this. 


Letter  XII.  Article  8.  253 

this,  as  they  not  only  begin  anteriorly,  much  fooner  than  they  generally  do, 
but  terminate  behind  much  later.  Yet  to  this  breadth,  the  height  is  by 
no  means  anfwerable  ;  but  is  even  fo  far  unequal,  that  they  not  only  do  not 
reach  to  the  vertex,  but  even  each  of  them  is  fo  far  diftant  from  thence,  as 
to  leave  at  lcaft  the  fpace  of  three  fingers  breadth  between,  on  each  fide; 
for  the  foace  that  is  interpos’d  between  them  both,  is  fill’d  up  by  the  dura 
mater,  which  makes  up  the  upper  part  of  the  cranium,  quite  from  the  oc¬ 
cipital  bone,  even  almoft  to  the  orbit :  and  though  the  dura  mater,  in  that 
part,  is  now  dried  up,  yet  it  is  equal  to  about  feven  inches  in  breadth',  and 
is  more  than  nine  inches  in  length.  And  to  the  bones  of  the  fincipur,  inaf- 
much  as  they  are  common  to  either  cranium,  as  in  the  fore-part,  in  the 
manner  I  have  laid,  the  temporal  procefs  of  the  fphenoidal  bone,  and  the 
fquamofe  portion  of  the  temporal  bone  of  the  anterior  cranium,  are  on  both 
fides  fubje&ed  •,  fo,  in  like  manner,  thefe  bones  on  the  back  part,  where 
they  belong  to  the  pofterior  cranium,  are  depreiVd  in  fuch  a  manner,  that 
being  driven  outwards  and  backwards,  and  being  join’d  one  with  another, 
by  a  large  portion  of  the  dura  mater,  they  give  occafion  to  that  remarkable 
convex  protuberance  externally,  and  that  correfponding  cavity  internally,  on 
each  fide,  by  which  1  faid  that  the  breadth  of  the  face,  and  the  capacity  of 
the  cranium  was  not  a  little  encreas’d.  Finally,  to  each  fquamofe  portion  of 
the  temporal  bone,  the  petrofe  portion  alfo  correfponds  :  but  although  the 
temple  bones  happen’d  to  be  larger  in  the  pofterior  cranium ;  yet  in  the 
two  anterior  bones  only  the  membrane  of  the  tympanum  with  its  ring  ap¬ 
pears.  Here  then  you  have  a  defeription  of  no  common  monfter;  but  of 
a  hydrocephalous  monfter :  fo  that  after  you  have  fet  down  as  many  things 
as  you  pleafe,  to  the  account  of  a  monftrous  conftitution  •,  yet  ftill  more 
circumftances  will  remain,  that  you  mud  attribute  to  the  impelling  force  of  the 
water,  fuch  as  the  obftrudted  growth  of  fome  of  the  bones  of  the  cranium, 
the  depreflion  of  fome,  the  impelling  of  fome  to  one  fide,  and  the  drawing 
afunder  of  others. 

8.  But  if  water,  collected  by  degrees  in  the  hydrocephalus,  can  have  fo 
much  effe<5t,  even  upon  the  bones  of  a  foetus  *,  how  much  more  effedt  will 
it  be  able  to  exert  upon  the  tender,  and  almoft  fluid  brain  !  For  if  in  a  boy 
of  feven  or  eight  years  old,  whom  Hunauld  {t)  differed,  not  only  in  one  of 
three  years,  whom  Hildanus  differed,  as  you  have  it  in  the  Sepulchretum  (a), 
the  water  had  fo  extended  the  brain,  “  that  the  circumvolutions  and  turns 
<c  of  it  were  no  more  feen,”  which  are  at  other  times  fo  deep  in  its  furface, 
from  whence  it  may  then  be  enlarg’d,  as  much  as  the  confinement  of  the 
cranium  permits ;  what  will  it  not  do,  on  the  brain  of  a  foetus,  in  which 
there  are  not  yet  turns,  and  circumvolutions,  of  that  kind,  which  can  be 
drawn  out,  contrary  to  what  Paifenius  (x)  and  Pechlinus  (jy)  feem  to  have 
thought  in  one  whofe  head  “  had  fweli’d  immediately  from  its  birth  with  a 
cc  hydrocephalus.  And  if  the  thicknefs  of  the  parietes  of  the  lateral  ven¬ 
tricles  had  been  fo  extenuated  in  their  upper  part,  and  their  fides,  in  a  child 
of  five  years  old,  whom  Tulpius  (z)  remark’d,  not  to  fpeak  of  one  of  three 

(/)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1740.  (x)  (j?)  Obf.  cir.  fupra  ad  n.  4. 

(a)  Sedb  hac  16.  obf,  16.  ( z )  Sedt.  cit.  obf.  14. 

years 


2  Book  I.  Of  Difeafes  of  the  Head. 

years  old,  obferv’d  by  Hildanus  (<?),  or  of  two  years  old,  by  Vefalius  (£), 
by  the  force  of  the  water,  that  at  the  firft  infpe&ion  there  feem’d  to  be  none, 
whereas  “  it  adher’d,  like  a  pretty  thick  membrane,  all  round,  to  the  arch’d 
“  circumferences  of  the  diffolv’d  bones  •,”  there  is  no  doubt,  but  the  parietes, 
which  are  fo  much  more  thin  and  foft  in  a  foetus,  may  be  diftended  by  the 
water,  in  fuch  a  manner,  as  finally  to  be  almoft  altogether,  if  not  entirely, 
deftroy’d  :  and  frequently,  indeed,  the  water  may  burft  forth  through  thele 
parietes,  and  through  the  extended  and  lax  integuments  of  the  cranium  and 
brain,  which  are  join’d  into  one  with  them,  by  opening  a  way  into  the  uterus, 
where  the  parts  refift  leaft,  or  while  the  foetus  is  expell’d,  through  the  narrow 
neck  of  the  uterus,  in  the  birth,  carrying  with  it  the  fluid,  or  half-diffolv’d, 
brain.  And  as  to  what  I  have  faid  of  the  upper  and  lateral  parietes  of  the 
right  and  left  ventricles,  the  fame  may  happen  to  the  inferior  alfo,  and  even 
to  the  whole  medulla  oblongata,  cerebellum,  and  medulla  fpinalis;  although 
with  fomewhat  more  difficulty. 

And,  indeed,  the  celebrated  Pitfchelius  (c),  when  he  gives  the  relation, 
how  much  of  the  brain  was  diffolv’d,  and  of  the  medulla  oblongata  alfo,  in 
a  hydrocephalous  patient,  who  had  liv’d  eighteen  months,  fays  not  a  word  of 
the  diffolution  of  the  trunk  of  this  medulla,  nor  of  the  cerebellum.  More¬ 
over,  Vefalius,  without  doubt,  faw  the  cerebellum,  in  his  patient  of  two  years 
old  (d),  and  the  whole  bafis  of  the  cerebrum,  entirely  in  their  natural  ftate  ; 
and  Hildanus  (, e ),  in  his  patient  of  three  years  old,  in  fo  great  an  attenuation 
of  the  cerebrum,  except  “  the  cerebellum,  and  the  other  parts  in  the  bafis 
“  of  the  brain.”  Pecrlinus  (/),  alfo,  in  that  of  Hornius  of  feven  months 
old,  found  <c  the  cerebellum  entirely  found  :  ”  yet  you  will  fee  in  his  ac¬ 
count,  that  the  <c  root,  or  bafis,  of  the  cerebrum,  was  already  dififolv’d  into 
“  fibres  fo  that  you  may  perceive,  in  the  more  tender  creatures,  and  es¬ 
pecially  in  fcetuffes,  that  thofe  parts  alfo  in  the  cerebrum  are  at  length  dif¬ 
folv’d,  and  walled  away,  by  the  force  of  the  water,  which  refift  moll,  be- 
caufe  in  “  the  formation”  thereof,  as  Steno  (g)  obferves,  when  he  fpeaks  of 
the  remarks  he  had  made  on  a  calf  which  had  a  hydrocephalus,  “  they  are 
“  already  perfect”  in  their  ftrudture  and  connections,  “  when  the  other  parts, 
“  for  inftance,  the  lateral  parts,  are  ftill  acquiring  their  encreafe.” 

I  however,  after  fo  many  others,  know  very  well,  that  in  the  two  foetuffes, 
fpoken  of  above  (h),  the  hrft  that  1  differed  at  Padua,  and  the  one  I  differed 
at  Forli,  there  were  no  traces  either  of  the  cerebrum,  cerebellum,  or  me¬ 
dulla  oblongata  •,  and  I  even  found  in  the  fecond  (/),  that  the  fpinal  marrow 
“  was  rather  a  kind  of  rudiment,  as  it  were,”  very  thin  and  membranous, 
than  marrow  itlel  .  And  it  has  been  even  obferv’d,  that  this,  together  with 
the  brain,  was  entirely  wanting,  not  only  in  my  time,  but  before.  For 
Wepfer  (k)  mentions  that  Fontanus  had  feen  an  infant,  “  who  had,  inftead 
“  of  a  cerebrum,  and  fpinal  marrow,  the  moft  limpid  water  and  at  the 
fame  time  relates,  that  “  an  abortion,”  of  which  Maurice  Hoffman  wrote 


(a)  Ob f  cit.  16.  (£)  Ibid.  obf.  6. 

(c)  Epift.  ad  Kulmum  de  Hydroceph.  In¬ 
terno. 

(d)  ( e )  Obf.  modo  citatis. 

(f)  Obf  cit. 

7 


(A  Aft.  Hafn.  vol.  i.  obf.  iai. 

(I)  N.  5,  &  6. 

(?)  Vid.  Epift.  Anat.  20.  n.  56. 

(A  Ad  obf.  129.  cit,  fupraad  n.  5. 


to 


Letter  XII.  Article  9.  is  5 

to  Veflingius,  as  you  have  it  in  Velfch,  44  was  brought  forth  at  Noremberg, 
64  in  the  year  1641,  without  a  brain,  and  fpinal  marrow,— perforated  in  the 
“  neck,  fo  that  a  finger  might  be  introduc’d  into  the  cavity  of  the  vertebra; 
“  of  the  thorax  and,  in  like  manner,  that  Hornius,  in  the  year  1665,  had 
differed  a  feven-months  foetus,  in  which  there  was  44  no  internal  cavity  of 
44  the  cranium,  but  the  whole  was  bony  and  folid,  nor  yet  any  veftiges  of  a 
44  cerebrum,  or  cerebellum  and  of  the  fpinal  marrow,  44  not  the  lead;  par- 
44  tide  appear’d,”  inafmuch  as  the  tube  was  entirely  wanting,  and  the  fpine 
alfo  folid.  Finally,  he  points  out  the  obfervation  of  Kerckringius  (/),  under 
number  twenty-three,  of  a  monftrous  foetus,  whofe  44  cranium  contain’d  no 
44  brain,  nor  had  any  cavity and  the  fpine  being  bifid  above,  44  contain'd 
44  no  fpinal  marrow.”  To  which  obfervations  alio  Littre  (*»),  Fauvel  (»), 
Mery  (0),  Sue  it  (/>),  and  perhaps  others  (^),  in  this  age,  have  added  theirs  ; 
the  firft  in  a  foetus  of  eight  months,  the  laft  in  one  of  fix  months,  and  the 
others  in  twro  of  nine  months  ;  one  of  which  liv’d  two  Fours,  and  had  fome 
appearance  of  being  fenfible,  and  another  one-and-twenty  hours,  not  without 
taking  fome  little  aliment. 

Of  all  thefe  eight  obfervations,  I  do  not  fee  one,  except  the  third,  and 
in  part  the  fourth,  that  may  not  be  explain’d  by  a  dropfy  of  the  head  and 
the  lpine  *,  efpecially  as,  in  the  firft,  there  was  even  then  water  in  each  of 
the  cavities,  and  in  the  fecond  a  perforation  ;  fuch  as  I  faw  in  that  at  Forli  (r), 
of  the  fpinal  tube  in  the  neck.  In  the  fourth,  moreover,  and  the  eighth, 
this  fame  tube  was  perforated  to  a  much  longer  tradt  *,  and  in  the  fifth,  finally, 
it  was  open  from  the  inferior  to  the  fuperior  part. 

9.  And  water  may  be  collected  in  this  tube  of  the  fpine,  as  well  by  de¬ 
scending  from  the  cavity  of  the  cranium,  as  by  being  fecreted  therein  ;  fo 
that  there  may  be  fometimes  a  dropfy  of  both  together,  fometimes  of  one 
only,  nor  in  a  different  manner  in  fcetufles,  and  children,  from  what  it  is  in 
adults  •,  but  in  the  former  much  more  readily,  becaufe  in  them  it  is  found, 
that  the  bones  of  the  vertebrae  can  eafily,  and  do,  in  fa<51,  yield  in  the  fame 
manner  as  the  bones  of  the  head:  wherefore,  at  one  time,  fome  of  the  ver¬ 
tebrae  gaping,  and  at  another  time  all  of  them,  and  w'ater,  fometimes  in. 
greater,  fometimes  in  lefier  quantity,  prefling  upon  the  involucra  of  the 
fpinal  marrow,  a  tumour  is  form’d  on  the  pofterior  furface  of  the  fpine,  of 
a  fize  proportionable  to  the  quantity  of  water,  and  analogous  to  the  hydro¬ 
cephalus  in  its  nature.  But  the  bones  of  the  vertebrse  gape  there  chiefly, 
where  the  future  fituation  of  thofe  proceffes  is,  which  they  call  fpines,  not 
only,  as  is  believ’d,  becaufe  the  bones  are  there  disjoin’d,  at  that  time;  for 
they  are  alfo  disjoin’d  on  the  fides,  where  they  are  connected  with  the  bodies, 
of  the  vertebras  *,  but  moreover,  as  1  fuppofe,  becaufe  there  is  much  lefs  re- 
fiftance  about  the  fituation  of  the  fpinal  proceffes,  than  on  the  fides,  from 
mufcles  and  tendons  that  lie  over  it.  But  as  to  this  tumour  occurring  44  very 
44  rarely  in  the  inferior  and  exterior  part  of  the.  os  facrum,”  as  the  very  ex- 

(l)  Spicileg.  Anat.  (p)  Sc  a.  1746.  Obf.  Anat.  6. 

(wj)  Mem.  de  1’ Acad.  R.  des  Sc.  a.  1701.  (7)  Quin  vid.  etiam  Epift.  48,  n.  49,  &  feq. 

(»)  Hift.  de  )a  meme,  a.  1711.  Obf.  Anat.  3,  ( r )  Vid  Epift.  Anat.  cit.  20.  n.  56. 

(0)  Sc  a.  ij  12.  Obf.  Anat.  6. 


periencM 


2 56  Book  I.  Of  Difeafes  of  the  Head. 

perienc’d  Ruyfch  obferves  (j),  wond’ring,  at  the  fame  time  (A),  “  that  it  is 
“  not  more  frequent  in  the  faid  part,  as  it  always  has  an  opening  in  a  natural 
«  flate  that  happens,  I  imagine,  for  this  reafon,  becaufe  the  tube  of  the 
dura  mater,  containing  the  cauda  equina  of  the  medulla,  as  it  is  call’d,  with 
fome  quantity  of  water  in  it,  in  a  natural  date,  of  which  I  have  fpoken  be¬ 
fore  («),  does  not  go  down  quite  to  that  lowed  and  gaping  part  of  the  os 
facrum.  Yet,  fometimes,  the  force  of  morbid  water  urging  downwards,  the 
fheath  of  the  dura  mater  may  reach  to  that  part,  and  being  didended  out¬ 
wardly,  may  make  a  tumour  of  the  fame  kind,  in  that  place:  wherefore,  in 
that  place  alfo,  Ruyfch  (x)  once  faw  this  diforder,  and  I  know  that  it  was  feen, 
not  many  years  ago,  in  a  certain  infant ;  but  Genga,  in  particular,  faw  it  j 
and  with  a  very  extraordinary  fuccefs,  and  fuch  as  is  not  readily  to  be  hop’d 
for,  in  thefe  tumours,  open’d  it,  in  the  cafe,  which  that  great  man,  Lancifi, 
while  he  was  living,  defcrib’d  to  the  celebrated  Fantonus,  from  whom(y)  I 
would  have  you  read  it,  for  more  than  one  reafon  ;  but  paaticularly  for  this, 
that  you  may  underdand  it  to  have  been  a  dropfy  common  to  the  cranium 
and  fpine,  and  that  water  had  defcended  from  the  former  into  the  latter. 
For  when  a  hydrocephalus  had  fucceeded  to  a  contufion  of  the  head,  and  a 
month  after,  a  tumour  at  the  os  coccygis  had  fucceeded  to  the  hydrocephalus, 
I  believe,  becaufe  in  a  child  of  four  years  old,  the  bones  of  the  vertebrae 
were  lefs  eafily  relax’d,  than  the  integuments  might  be,  at  the  opening  of 
the  os  facrum,  of  which  I  have  already  fpoken  •,  not  only  from  this  lower 
tumour  being  open’d,  and  difcharging  much  water  for  a  long  time,  the  head 
was  gradually  diminifh’d  ;  but  when  Genga  comprefs’d  the  hydrocephalus 
with  his  hand,  which  dill  partly  remain’d  in  the  occiput,  “  immediately,”  and 
Lancifi  himfelf  faw  it,  “  a  palifh  ichor  rufh’d  forth  from  the  foramen  that 
“  was  open  in  the  os  occygis.”  Moreover,  water  feems  to  have  defcended 
from  the  cranium  into  the  tube  of  the  vertebra,  in  other  obfervations  alfo. 
For  in  that  hydrocephalous  infant,  whom  Mayerus  defcribes  (z),  a  turbid  and 
faltifh  water  flow’d  out  from  a  tumour  of  this  nature,  which  was  prominent 
about  the  middle  of  the  os  facrum,  and  ruptur’d  a  little  before  death:  and 
a  probe  being  pafs’d,  after  death,  through  the  tumour  and  fpine,  quite  to 
the  brain,  a  turbid  liquor,  in  like  manner,  flow’d  out.  But  as  the  water, 
which  was  contain’d  in  large  quantity,  between  the  meninges  of  the  brain, 
was  itfelf  alfo  fait,  indeed,  yet  limpid,  I  had  rather  you  would  atttend  to 
that  obfervation,  which  is  join’d  by  Brunnerus  with  the  twelfth  of  thofe,  that 
are  inferred  in  the  Additamenta  to  this  fedtion  of  the  Sepulchretum.  For  a 
tumour  of  this  kind,  being  cut  out  in  the  back,  from  the  os  facrum,  with 
very  ill  fuccefs,  as  generally  happens,  whence  more  than  a  pound  of  the  moft 
limpid  water  flow’d  out,  “  the  head  of  the  infant  was  immediately  obferv’d 
“  to  fubflde,  and  to  be  diminilh’d  in  bulk.”  Butin  that  twelfth  obfervation, 
the  fame  feems  to  be  prov’d  by  a  contrary  one.  For  when  a  tumour  of  the 
fame  kind  had  been  open’d  in  the  back,  from  whence  the  mod  limpid  water 
burft  forth,  which  flow’d  out  alfo  “  fix  times,”  on  the  following  days,  “  to 

(j)  Obf.  Anat.  Chir.  34.  ( x )  Obf.  cit  35.  ' 

(/)  Ibid.  obf.  35.  (yj  In  Pacchion.  Animad.  6. 

(a)  Epiil.  II.  n.  16-  (a)  Eph.  N.  C.  Cent,  i  &  2.  obf.  127. 

“  the 


Letter  XII.  Article  io.  257 

cc  the  quantity  of  three  ounces  every  time,  as  foon  as  ever,”  a  cicatrix  being 
induc’d,  44  no  more  ferum  diftill’d  therefrom,”  the  head  of  the  girl  began 
to  encreafe  in  its  fize,  and  in  a  fhort  time  44  a  hydrocephalus,  of  a  vaft  bulk, 
44  appear’d.”  So  in  the  fourth  obfervation,  in  the  fame  place,  Lechelius, 
when  he  defcribes  an  infant,  born  with  a  tumour  of  the  fame  nature,  reaching 
from  the  laft  vertebra  of  the  thorax  quite  to  the  os  coccygis,  relates,  that  on 
the  following  days  44  the  head  had,  in  the  mean  while,  been  gradually  extended 
“  into  a  preternatual  bulk  5”  fo  as  to  make  it  probable,  that  the  water,  for 
which  no  more  room  remain’d  in  the  cavity  of  the  fpine,  being  now  impell’d 
into  the  cavity  of  the  cranium,  had  enlarg’d  it  after  this  manner. 

When  you  fhall  have  confider’d  what  I  have  hitherto  written,  and,  perhaps, 
not  have  difapprov’d,  if  you  fhould  by  chance  light  upon  a  pafiage  of  Hip¬ 
pocrates,  which  runs  after  this  manner  (a):  44  Another  diforder  ariles  from 
44  a  defluxion  of  the  head,  by  the  veins,  upon  the  fpinal  marrow  •,  and  from 
C4  thence  it  makes  an  impetus  on  the  os  facrum,  where  the  marrow  itfelf  carries 
44  down  defluxion  5”  the  fame  thing  will,  perhaps,  come  into  your  mind,  as 
did  into  the  mind  of  a  learned  man,  who  thought,  that  in  thefe  words,  the 
diforder,  of  which  we  are  fpeaking,  feem’d  to  be  defcrib’d  ;  and  that  fo 
much  the  more  readily,  as  you  fhall  more  readily  recolledt  all  thofe  things 
which  I  have  faid,  upon  this  fubjedt,  juft  before.  But,  if  you  read  what 
immediately  follows,  you  will  perceive,  that  the  paflage  has  no  reference, 
either  to  this  diforder,  or  to  the  diforders  of  infants :  44  And  depofits  it  upon 
46  the  acetabulum  of  the  coxendix,  or  on  the  joint  itfelf  •,  and  if  it  come  to 
64  matter,  and  difcharge,  the  patient  lofes  his  flefh,  and  in  this  manner  waftes 
44  away  gradually,  till  he  has  himfelf  no  longer  any  defire  to  live  •,  for  im- 
44  mediately  both  the  fhoulder- blades  pain  him,  and  foon  after  both  the  feet 
44  and  the  legs  ;  and  they  at  laft  always  perifh,  after  having  undergone  long 
44  courfes  of  applications  for  their  recovery.”  For  how  can  it  be  faid,  that 
children  defire  either  to  live,  or  not  to  live  ?  and,  to  pafs  over  other  things, 
how  does  this  diforder  fuffer  a  long  courfe  of  application  for  recovery  ?  More¬ 
over,  if  anyone  fhould  imagine,  that,  in  the  two  laft- defcrib’d  obfervations, 
the  water  did  not,  perhaps,  flow  down  from  the  cranium  into  the  tube  of  the 
fpine,  but  that,  on  the  other  hand,  being  originally  collected  in  this  tube, 
after  it  came  to  fuch  a  quantity,  as  no  longer  to  be  capable  of  being  contain’d 
within  its  cavity,  even  when  dilated,  it  then  at  length  overflow’d  upwards 
into  the  cranium*,  although  the  appearances,  which  were  obferv’d  in  the  dif- 
fedtion  of  thofe  two  infants,  do  not  much  favour  fuch  a  fuppofltion  ;  yet  I 
do  not,  in  fadt,  fee,  that,  in  fome  other  cafes,  fuch  a  conjedture  is  to  be 
at  all  exploded. 

10.  Neither  do  all,  who  have  a  dropfy  of  the  fpine,  as  fome  would  wil¬ 
lingly  believe,  labour,  at  the  fame  time,  under  a  dropfy  of  the  head  alfo  ; 
at  leaft,  Ruyfch  (£),  in  the  obfervations  of  his,  which  I  mark’d  out  above, 
mentions  nothing  of  it ;  nor,  purpofely  to  omit  others,  Tulpius,  whole  three 
obfervations  of  this  kind  you  will  read,  not  in  this  fedtion  of  the  Sepul- 
chretum,  but  transferr’d  into  the  fecond  (c)  of  the  fourth  book  \  although, 

( a )  L.  de  Glandulis,  n.  10.  apud  Marinell,  ( c )  Sub  obf.  13.  etiam  in  Schol. 

\b)  Obf.  cit.  34,  35.  ut  neque  36. 

VOL.  I. 


LI 


as 


258  Book  I.  Of  Difeafes  of  the  Head. 

as  in  an  anatomical  defcription  of  the  found  parts,  we  do  not  disjoin  the 
fpinal  marrow  from  the  brain,  to  which  nature  has  continu’d  it,  fo  in  treating 
of  the  morbid  parts,  and  even  of  the  difeafes  themfelves,  the  dropfy  of  the 
one  does  not  feem  to  be  feparable  from  the  dropfy  of  the  other ;  nor  the 
tumours,  which  are  the  confequences  of  either  of  thefe  dropfies,  are  to  be 
plac’d  among  the  other  external  tumours,  more  than  thofe  which  are  the  con¬ 
fequences  of  internal  aneurifms,  when  the  ribs  and  integuments  of  the  thorax 
are  driven  outwards,  and  broken  afunder.  But  if,  to  return  to  the  difcourle 
I  had  begun,  thofe  two  tumours,  which  are  defcrib’d  in  the  fame  fecond 
fedtion,  the  one  under  the  thirteenth  obfervation,  from  Cafpar  Bauhin  (rf), 
the  other  in  the  Additamenta,  under  obfervation  the  fifth,  without  the  author’s 
name  being  added,  belong  to  the  fame  clafs  with  thefe  we  treat  of;  you  will 
not  fee  any  mention  of  a  hydrocephalus  therein.  But  you  will  believe,  that 
both  thofe  tumours,  which  were  foft,  and  like  a  bladder  full  of  water,  and 
lay  in  the  direction  of  the  lumbar  fpine,  ought  to  be  number’d  in  this  clafs ; 
and  ftill  more,  becaufe,  as  foon  as  ever  a  difcharge  of  ferum  was  made  from 
them,  convulfions  came  on,  and  death  was  foon  after  the  confequence.  For 
that  ferum,  purulent,  fcetid,  and  fomewhat  tindlur’d  with  a  blood  colour, 
came  forth,  is  by  no  means  to  be  wonder’d  at,  when  there  was  a  foramen 
“  between  the  laft  vertebra,  and  the  laft  but  one,  of  the  loins,”  which  had 
its  origin  from  erofion,  and  reach’d  quite  into  the  belly ;  nor  that  only,  for 
“  two  of  the  vertebras  of  the  loins  were  entirely  wanting,  the  reft  being 
“  found  and  in  thofe  watry  tumours,  of  which  we  now  treat,  that  the  ver¬ 
tebras  are  fometimes  much  confum’d,  Jo.  Ludovicus  Apinus  (e)  informs 
us ;  and  that  the  tumours  themfelves  are  eafily  feiz’d  with  corruption  and 
gangrene,  Bidloo  alfo  confirms,  from  an  example  thereof,  which  he  gives  a 
plate  of  (/).  Nor  did  Jo.  David  Mauchartus  (g),  and  Jo.  Henricus  Linc- 
kius  (b),  doubt,  but  the  tumours  which  they  defcrib’d  were  of  that  kind  ; 
becaule  a  purulent  ichor,  or  watry,  foetid,  and  purulent  matter,  i fill’d  there¬ 
from.  If,  therefore,  you  judge  the  fame  with  me,  concerning  thofe  two  tu¬ 
mours  of  which  we  began  to  fpeak,  two  things  will  follow :  one,  that  the 
obfervation  of  Bauhin  was,  perhaps,  the  firft  that  was  made  upon  tumours 
of  this  kind  ;  for  that  which  we  read  in  Foreftus  (*’),*  may,  perhaps,  even  it- 
felf,  be  alfo  the  firft  in  its  kind,  that  relates  to  tumours ;  not  indeed  of  a  dif- 
fimilar  nature,  or  lefs  dangerous  in  themfelves,  but  neverthelefs  communi¬ 
cating  rather  with  the  cranium,  than  with  the  lpine,  fuch  as  have  been  feen 
in  living  infants,  by  me  and  by  Ruyfch,  as  I  have  mention’d  in  a  former 
work  (k)  :  and  the  other  is,  what  I  have  already  advanc’d,  that  we  muft  not 
always  expedt  a  hydrocephalus  to  exift  in  the  fame  patient,  in  whom  there  is 
a  hydrorachitis ;  and  when  I  read  over  again  this  letter,  I  was  very  glad  to 
fee,  that  the  learned  and  celebrated  Trew  thought  juft  in  the  fame  manner 
of  thefe  things  as  I  did  (/).  Add  to  this,  that  the  water  of  which  I  have 


(<0  §  ». 

(e)  Eph.  N.  C.  Dec.  3.  a.  9.  obf.  180, 

(f)  Dec.  2.  Exerc.  Anat.  Chir.  7. 

(g)  Eph.  N-C.  Cent.  9.  obf.  38. 


[b)  A£l.  N.  C.  tom.  1.  obf.  74. 

(z)  L.  3.  Obf.  Chir.  7. 

( k )  Epift.  Anat.  20.  n.  57. 

(/)  Commere.  Litter,  a.  1741.  hebd.  21.  n.i. 


alfo 


V 


Letter  XII.  Article  1 1.  i  $  9 

alfo  fpoken  above  (02),  that  is  fecreted  within  the  lower  part  of  the  cavity, 
torm’d  by  the  dura  mater  of  the  fpinal  marrow,  may  of  itfelf,  if  it  exceed 
its  natural  bounds,  be  alfo  the  occafion  of  a  hydrorachitis.  But  take  care 
how  you  confound  this  water,  which  is  a  little  vifcid,  as  fome  do,  with  that 
vifcous  humour,  as  the  ancients,  who  are  pointed  out  by  me  (»),  call’d  it, 
with  which  the  vertebras  are  internally  fmear’d  over  :  for  that  is  neither 
water,  nor  does  it  adhere  anywhere  to  the  interior  part  of  the  dura  meninx ; 
nor,  indeed,  does  it  adhere  only  at  the  lower  part,  as  this  which  I  fee  is  alfo 
acknowledg’d  to  be  natural,  by  the  celebrated  Huberus  (<?),  and  even,  in¬ 
deed,  as  he  himfelf  delivers  it,  “  by  the  good  Malpighi  in  Pofth.  p.  39, 
“  and  with  him  by  Bellini,  in  the  lemmata  premis’d  to  his  Opufcula,  who 
“  neverthelefs  took  it  for  the  nervous  fluid  •,  an  error,  certainly,  which  it 
“  would  be  almoft  ridiculous  to  difprove.”  But  whether  they  fpoke  of  the 
fame  water  that  we  do,  you  yourfelf  will  fee  ;  and,  in  like  manner  (/>),  whe¬ 
ther,  in  fa<5t,  “  you  can  find  no  obfervation,  to  prove  a  defedt  of  the  fpinal 
“  marrow,  when  the  cerebrum,  or  cerebellum,  were  prefent.”  For  to  me 
it  feems,  from  two  obfervations  of  Carolus  Raygerus  (q),  which  I  have  well 
confider’d,  that  the  cerebrum,  indeed,  was  very  much  alter’d  from  its  na¬ 
tural  ftate,  but  not  deftroy’d  *,  whereas,  in  both  one  and  the  other,  “  was 
“  no  fpinal  marrow,  or  at  leaft,  nothing  in  the  tube  of  the  vertebras,  but 
<c  concreted  blood,  or  fomething  fimilar  thereto.” 

11.  But  whether  the  water,  with  which  thefe  fpinal  tumours  are  diftended, 
be  from  that  fource,  which  I  juft  now  pointed  out  •,  or  whether  it  flow 
down  from  the  cranium,  or  be  deriv’d  from  both  fources  at  the  fame  time  ; 
both  one,  and  the  other,  of  thele  origins  are  fo  probable,  that,  in  general, 
it  ought  not  to  be  accounted  for  from  any  other  caule.  For,  however  fuffer- 
able,  in  former  times,  the  error  of  thofe  might  be,  who  thought  that  into  a 
tumour,  fuch  as  Bauhin  defcrib’d  (r),  “  a  portion  of  the  urine  was  carried 
“  from  the  bladder who  can  now  bear  it,  after  the  nature  of  the  diforder 
has  been  more  and  more  known  ?  Yet  that  furgeon,  whom  the  learned 
Platner  defervedly  cenfur’d,  made  a  more  horrid  blunder  than  this  ( s ),  when 
he  fuppos’d  that  the  urinary  bladder  was  concern’d  therein,  which  “  had 
“  happen’d,  in  that  infant,  to  be  either  double,  or  more  capacious  than 
<£  common  which  blunder  I  fhould  not  have  touch’d  upon,  if  I  had  not 
known,  that  the  fame  opinion  had  been  entertain’d,  not  many  years  ago,  by 
another  furgeon,  of  fome  reputation,  in  Italy ;  fo  that  now,  for  the  third 
time,  the  fluid,  which  has  been  difcharg’d  from  thefe  tumours,  has  been 
fuppos’d  to  be  urine  (/).  With  more  wildom,  but  with  lefs  necefllty,  did  a 
man,  of  great  name,  deduce  this  water  “  from  a  droply  of  the  interior  cor- 
“  tex  of  the  fpinal  marrow which  cortex,  “  while  it  fwells,  divides  the 
<c  fpinal  marrow,  and  its  theca,  from  each  other.”  It  is  to  be  fuppos’d, 
that  he  follow’d  the  tradition  of  thofe,  who  («),  “  in  this  diforder,  would 
have  it,  that  the  vertebras  were  fo  bifurcated,  as  if  they  had  been  uni- 

(*»)  n.  9.  (»)  II.  Anim.  Z3.  &  29.  (r)  Obf.  13.  num.  fuperiore  cit. 

( 0 )  De  Med.  Spinal,  n.  6.  \s)  Progr.  M.  Nov.  A.  1754. 

(/>)  Ibid.  n.4.  (/)  Huc  adde  &  quarto  ex  n.  16.  infra. 

\q)  280.  in  Eph.  N.  C.  Dec.  1.  A.  3.  &  (a)  Apud  Ruyfch.  obf.  Anat.  Chir.  34* 

64.  A.  8. 

L  1  2  “  verfally 


26 o  Book  I.  Of  Diforders  of  the  Head. 

“  verfally  divided  into  two  parts,  in  the  manner  made  ufe  of  by  butchers,’* 
and  even  the  fpinal  marrow  itfelf;  eipecially,  as  he  quotes  Tulpius,  who  (*) 
fays,  “  that  this  diforder’d  fpine  was  feparated,  into  two  equal  parts,  from 
“  the  laft  vertebra  of  the  thorax,  even  to  the  fides  of  the  os  innominatum, 
“  this  wide  opening  being  cover’d  by  the  peritonaeum.”  Which  paffage  I 
quoted  for  this  reafon,  becaufe,  in  the  Sepulchretum,  where  I  told  you  ( y ), 
that  thefe  obfervations  of  Tulpius  were  related,  you  might  feek  for  it  in 
vain;  and  ftill  more,  the  figures,  in  which  he  has  delineated  thofe  ver¬ 
tebrae  ( z ).  For  the  figures,  which  are  publilh’d  by  the  authors  themfelves, 
together  with  their  obfervations,  although  they  are  often  ufeful,  and  fome- 
times  neceffary,  in  order  to  underftand  the  defcriptions  entirely,  are,  how¬ 
ever,  never  given  in  the  Sepulchretum,  where  they  might,  or  even  where 
they  ought  to,  have  been  given.  Without  doubt,  Tulpius  was  among  the 
firft,  who  illuftrated  this  diforder ;  but  when  he  was  making  diligent  re- 
fearches,  he  feems  to  have  lit  on  a  more  rare  circumftance,  if  he  be  com¬ 
par’d  with  others,  and  eipecially  with  Ruyfch  ( a ),  who  faw  it  much  more  of¬ 
ten  :  for  he  exprefsly  fays,  that  he  had  never  feen  it  in  this  manner ;  and, 
for  that  reafon,  fubjoins  another  figure  (£),  in  which  he  reprefents  the  ver¬ 
tebrae  drawn  afunder,  only  on  the  back  part,  as  he  had  found  it,  and  not  on 
the  fore  part :  the  bodies  of  which,  Theodore  Zwinger  (c)  faw  divided,  by 
a  deep  fulcus,  but  although  in  a  inonftrous  foetus,  having  a  pofterior 
fituation,  nor  without  the  fpinal  marrow  being  whole.  ^ 

But  as  to  the  divifion  of  the  marrow  itfelf;  I  have,  indeed,  read  the  ob- 
fervation  of  Brunnerus  ( d ),  which  feems  to  favour  the  opinion  of  a  droply, 
in  its  cortical  meditullium.  For  the  “  fpinal  marrow”  was  found  M  perfo- 
“  rated  in  the  meditullium,  and  fill’d  with  water,”  the  finus,  or  perforation, 
tending  that  way,  where  the  vertebras  were  open’d ;  and  there  had  been  a 
watry  tumour  in  the  back,  before  the  hydrocephalus.  Yet  I  do  not  remem¬ 
ber  to  have  read,  that  the  marrow  ever  became  bipartite,  by  the  force  of  the 
water.  For  as  to  the  other  tumour,  of  that  kind,  to  which  the  fame  au¬ 
thor  (e)  faw  many  nerves  tending,  from  the  fpine,  and  many  blood-vefifels, 
likewife,  going  to  it,  which  emerg’d  from  the  fame  place,  fo  that  “  the 
membrane,  which,  at  other  times,  involves  the  fpinal  marrow  beneath, 
“  appear’d  empty,  fo  far,  as  that  even  all  the  fpinal  marrow  feem’d  to  have 
<c  feceded  from  this  fheath,  and  to  be  terminated  in  the  faid  tumour;”  take 
care  how  you  imagine,  that  the  marrow  was  divided  into  fo  many  nerviform 
parts,  by  the  force  of  the  water.  For  this  tumour  was  “  in  the  back,  upon 
the  os  facrum  ;”  that  is,  in  the  courfe  of  the  lumbar  fpine,  in  which  nature 
itfelf  has  divided  the  marrow  into  the  cauda  equina,  or,  in  other  words, 
into  fo  many  nerves  ;  and  it  is  not  at  all  to  be  wonder’d  at,  that  thefe  nerves, 
together  with  the  fanguiferous  veffels,  were  compell’d  into  the  tumour,  by 
the  water,  in  that  place,  where  there  was  lefs  refinance.  In  the  fame  direc¬ 
tion  were  the  tumours  defcrib’d  by  Tulpius  (/),  by  Lechelius  (g)>  and  by 
Apinus  (£).  The  firft,  therefore,  faw,  in  thofe  three  infants,  “  the  nerves 

(.*)  Obf.  Med.  1.  3.  c.  30.  (d)  12.  in  Addit,  ad  Se£t.  hanc  Sepulchr.' 

(y)  num.  fuperiore.  (z)  Tab.  XI.  16.  (?)  Ibid. 

(a)  Obf.  cit.  34.  (£)  Fig.  37.  (f)  (gj  (b),  Obf.  citatis  hoc  n.  &  9.  Sc  10; 

(r)  Eph.  N.  C.  Cent.  7.  obf.  29. 

7  “  cf 


Letter  XII.  Article  1 1.  2  61 

“  of  the  fpinal  marrow,  diipers’d  here  and  there,  through  the  tumour ; 
44  and  carried  out  of  their  courfe:”  the  other,  upon  opening  the  tumour, 
44  found  nothing  of  the  fpinal  marrow,  if  you  except  fome  white,  and  very 
<c  (lender,  filaments ;”  which  he  himfelf  thought  to  be  44  rather  the  ruins  of 
16  the  membrane,  which  inverted  the  fpinal  marrow,  than  of  the  nerves 
the  third,  finally,  44  faw  the  fpinal  marrow  itfelf,  coming  forth  from  the 
44  cavity  of  the  fecond  lumbar  vertebra,  which  was  yet  found,  and  inferted, 
44  atleafl  one  half  of  it,  into  the  middle  vertex  of  the  tumour.”  But  as  the- 
marrow,  certainly,  according  to  nature,  cannot  come  out  from  that  vertebra, 
inafmuch  as  the  whole  of  it  is  already  divided  into  nerves;  I  confefs,  that  F 
hefitated  upon  this  obfervation  of  Apinus ;  as  I  did  alfo  upon,  another  of 
Schraderus  (2),  (not  to  fpeak  of  that  of  Brunnerus,  which  is  pointed  out? 
above  (k)  ),  though  from  quite  a  contrary  caufe.  For  Schraderus,  in  a  tu¬ 
mour  of  that  kind,  and  in  the  fame  fituation,  thought  it  was  worthy  of  ob¬ 
fervation,  that  the  marrow,  which  was  hitherto  found,  when  it  came  to  the 
opening  of  the  vertebrae,  there  “  became  evanid,  and  left  nothing  behind» 
“  it,  but  membranous  involucra;  in  fuch  a  manner,  however,  that  the  be- 
44  ginnings  of  the  nerves  emerging  from  thence,  offer’d  themfelves,  on  each 
“  fide,  here  and  there,  but  in  regular  order.”  Yet  the  flate  of  the  parts 
feems  to  have  been  quite  natural.  For  the  trunk  of  the  marrow,  as  I  faid, 
does  not  defcend  beyond  the  fecond  vertebra  of  the  loins ;  but  the  nerves, 
having  already  taken  their  origin  from  thence,  go  down,  regularly,  on  each, 
fide.  However,  as  he  fays,  that  the  tumour  was  “  about  the  beginning  of 
44  the  lumbar  vertebrae  it  may  be,  poffibly,  that  the  lower  part  of  the 
marrow  was  either  diffolv’d,  or  drawn  upwards.  But  in  the  infant,  ob- 
ferv’d  by  Apinus,  the  matter  was  quite  otherwife,  as  the  marrow  not  only 
defcended  below  the  fecond  vertebra  of  the  loins,  but  was  turn’d  outwards, 
and  was  inferted  into  the  middle,  and  internal  furface,  of  the  tumour, 
which  was  feated  44  in  the  region  of  the  laft  lumbar  vertebrae  *,”  as  you  will 
plainly  conceive  from  the  figures,  which  are  much  more  clearly  exhibited  in 
that  differtation  of  Charles  Frederic  Hoechlletter  (/),  in  which  this  very  hif- 
tory  of  his  praeceptor  Apinus  is  explain’d.  While  I  was  wond’ring  at  this 
circumftance,  I  happen’d  to  light  upon  the  obfervation  of  Mauchartus  ( m ), 
which  defcribes  a  tumour  in  the  inferior  part  of  the  loins  ;  that  is,  from  an 
aperture  of  the  two  lowed  of  thefe  vertebrae,  and  44  in  the  middle  of  this 
46  tumour,  the  fpinal  marrow  prominent  into  a  membrane,”  which  was  the 
inner  one  of  the  tumour,  lying  under  the  dura  mater,  44  extending  itfelf  all 
44  round,  by  the  mod  (lender  fibrillae,  and  entirely  terminating.”  Finally, 
when  1  lately  read  over,  what  was  found  by  the  very  ingenious  Trew  («), 
in  a  tumour,  which  anfwer’d  to  the  hiatus,  of  the  three  inferior  lumbir  ver¬ 
tebrae,  and  all  of  the  os  facrum  ;  and  when  I  firfl  examin’d  the  figures  vvh;ch 
were  added  (<?),  and  compar’d  them  one  with  another;  I  believ’d,  indeed* 
from  the  form,  which  was  at  firfl  round,  then  ending,  as  it  were,  gradually 
in  a  point,  that,  the  little  white  body,  mark’d  c,  d,.e,  was  the.  extreme  part 


t 


(m)  Cit.  fupra  ad  n.  10. 

(«)  Commere,  ibid.  cit.  hebd.  20.  Si  21» 
(o)  Tab.  I,  fig.  1 1.  &  12, 


(0  Dec.  2.  obf.  Anat.  Med.  2. 
(/£)  n.  g.  primo  loco. 

(/)  De  Spina  Bifida. 


2.62  Book  I.  Of  Difeafes  of  the  Head. 

of  the  marrow,  going  down  below  all  the  lumbar  vertebras,  within  the  os  fa- 
crum.  And  indeed,  the  author  faw  evidently,  that  this  body  “  coher’d,  by 
“  many  diftinft  and  fcatter’d  fibres,  with  the  fubjacent  parts  *,  and  that  it 
“  was  nothing  elfe,  but  the  extremity  of  the  fpinal  marrow,  which  confti- 
“  tutes  that  part  call’d  the  cauda  equina,  produc’d  here  a  little  on  theoutfide 
«  of  its  canal that  is,  carried  within  the  tumour,  under  whofe  tranfparent 
furface  it  was  leen.  Neverthelefs,  as  he  afterwards  writes,  that  it  was  “  a 
“  part  of  a  peculiar  conformation,  and  coher’d,  particularly,  with  the  extre- 
«  mity  of  the  fpinal  marrow,  and  the  fhoots,  or  branches,  that  go  from  it : 
«  and  that  the  extremity  of  the  marrow  was  here  ftretch’d  out  quite  to  the 
«  third  vertebra  of  the  loins,  and  prefently  ended  in  that  little  part  r,  d,  e , 
«  and  gave  out  its  nervous  branches,  or  fhoots  and  as  he  likewife  affirms, 
“  that  in  the  cavity  of  a  limilar  tumour,  were  found  only  filaments  of  a  fpi- 
“  nal  marrow,  interwoven  with  the  fanguiferous  veflels,  his  obfervation  alfo 
“  bearing  witnefs  thereto I  was  much  in  doubt,  whether  I  fufficiently  un- 
derftood  his  meaning,  and  whether  the  nerves  only  of  the  cauda  equina, 
forc’d  by  the  water,  at  their  upper  part,  into  one  body  as  it  were,  were  here 
intended  to  be  defcrib’d  *,  but  by  thofe,  whofe  names  I  mention’d  a  little  be¬ 
fore,  I  doubted,  whether  they  were  not,  perhaps,  taken  for  the  trunk  of  the 
marrow  itfelf,  fince  they  are  filent  in  regard  to  the  body  of  it,  which  they 
faw,  and  which  was  naturally  internal ;  or  whether,  which  I  fhould  rather 
believe  (/>),  they  faw  the  marrow  itfelf,  without  any  deception. 

There  is  a  pafiage  of  Ruyfch,  which,  without  doubt,  is  worthy  of  inter¬ 
pretation  ;  where,  fpeaking  of  this  kind  of  tumours  (g),  he  fays,  “  Below 
“  that  tumour,  I  find  the  fpinal  marrow  often  found,  and  in  good  condition.” 
If  you  underftand  this  of  the  tumour  in  the  loins,  and  fuppofe,  that  he  faw 
the  fame,  which  I  would  wifh  others  to  have  feen  ;  you  muft  conjecture,  that 
not  infra  “  below,”  but  intra  eum  tumorem ,  <c  within  that  tumour,”  was  writ¬ 
ten  by  the  author.  But  as  he  had,  a  little  before,  faid,  that  tumours  of  this 
kind  occurr’d  “  often,  in  the  back,  or  the  loins it  will  be  better,  perhaps, 
to  underftand  it  of  the  tumour  of  the  back,  beneath  which  he  might  fee  the 
marrow,  and  in  a  good  condition  alfo.  For  thus  he  certainly  faw  (r),  ct  in 
“  the  lower  vertebra  of  the  thorax,  a  very  fmall  and  found  portion  of  the 
“  fpinal  marrow ;  and  in  the  cavity  of  the  vertebra  of  the  loins,  the  nerves 
<c  alfo  found  and  natural whereas,  not  only  all  the  vertebra  of  the  neck, 
but  alfo  as  many  of  the  neareft  thoracic ;  as  the  figures  of  Kerckringius  (s), 
which  he  points  out,  demonftrate ;  <c  being  bifid,  on  their  pofterior  parts, 
“  and  without  any  portion  of  fpinal  marrow,”  fhew’d  that  the  foetus  had  la¬ 
bour’d  under  this  kind  of  dileafe,  both  in  the  neck  and  tlie  back,  at  the 
fame  time.  And  hence  you  have  the  method  of  interpreting  the  pafiage,  I 
have  quoted  from  Ruyfch,  as  many  are  doubtful  about  the  fenfe  thereof  •,  and 
by  the  way,  I  do  not  doubt,  but  he  had  feen  tumours  of  that  kind,  in  the 
back  of  other  fubjeCts  alfo,  (not  to  fpeak  of  Apinus  (/)  ) ;  and  you  fee,  at 
the  fame  time,  how,  by  joining  together,  the  descriptions  of  him,  and 
Kerckringius,  in  regard  to  the  fame  foetus,  and  by  amending,  and  illuftrat- 

(s)  Spicileg.  Anat.  Tab.  9. 

(t)  Apud  Hoechilctterum  n.  9.  DiiT.  cit. 
ad  n.  fuper. 

4  ing 


(p)  Vid.  n.  16.  infra. 

(^)  Obf.  34.  cit.  fupra  ad  n.  9. 
(r)  Thef.  Anat.  8.  n.  1. 


Letter  XII.  Article  12.  26  3 

ing  one,  from  the  other,  where  there  is  occaflon,  you  may  make  one  finilh’d 
and  compleat  defcription. 

12.  But  if  the  fpinal  marrow,  as  I  juft  now  fuppos’d,  or  at  leaft,  its  nerves 
and  veffels,  (in  the  fame  manner  as  the  cerebrum  in  the  hydrocephalus  of 
the  celebrated  Walther  («),  and  others,  and  part  of  the  cerebellum  in  the 
hydrocephalus  of  Lechelius  (x)  )  are  compell’d,  outwards,  into  the  tumour ; 
you  will  enquire  of  me,  in  what  manner  you  mnft,  therefore,  underftand, 
that  which  is  hinted  by  very  learned  men,  that  this  affedtion  of  the  fpine  may 
be  alfo  attributed  to  water,  ftagnating  in  the  cells,  which  furround  the  dura 
mater,  in  great  numbers,  externally,  and  contain  that  fat  in  their  natural 
ftate,  which  I  faid  was  call’d  by  the  ancients  “  a  vifcous  humour’*  (y) ;  fo 
that  this  diforder  is  very  much  like  the  droply  of  the  peritonaeum.  For  the 
dropfy  of  the  peritonaeum,  you  will  fay,  urges  the  vifcera,  which  it  furrounds, 
inwards ;  and  does  not  thruft  them  outwards  ;  nor  are  thofe  cells  on  the  an¬ 
terior  part,  but  chiefly  on  the  pofterior  part,  of  the  canal  of  the  vertebrae; 
fo  that  if  they  fwell,  they  cannot  drive  the  cauda  equina  outwards.  But  do 
not  imagine,  however,  that  there  may  not,  fometimes,  be  room  for  this  ori¬ 
gin  of  waters  and  tumours.  For  very  rarely  indeed,  but  fometimes,  never- 
thelefs,  tumours  of  that  kind  being  pundtur’d,  and  the  water  being  drawn 
out,  health  has  been  reftor’d  ;  as  in  that  infant,  whom  Jo.  Maurice  Hoffman 
defcribes,  and  gives  a  drawing  of  (2).  In  which  cafe,  if  you  deduce  the  wa¬ 
ter  of  the  tumour,  from  the  cells  that  fmear  over  the  internal  furface  of 
the  dura  mater,  being  diftradted  in  the  birth,  which,  from  the  complicated 
form  of  the  body  of  the  fcetus,  when  in  the  paflage,  and  from  the  immenfe 
ftrainings  of  the  ruftic  mother,  was  very  difficult ;  you  will  feem  to  lay 
probable  things  :  for  nothing  could  be  diftradted,  and  injur’d  fo  much,  in 
that  pofttion  of  the  child,  as  the  pofterior  part  of  the  fpine,  where  it  lies  in 
the  loins  ;  wherefore,  the  other  parts  being  found,  the  tumour,  which  at 
firft  did  not  exift,  began  to  arife  after  an  interval  of  a  few  days,  from  that 
part  of  the  fpine  only. 

There  were  fome,  even,  who  thought  that  the  tumour  on  the  os  coccygis, 
cur’d  by  Genga,  which  I  have  already  fpoken  of  above  (a),  was  caus’d  by  a 
humour,  which  had  made  a  paflage  for  itl'elf  thither,  from  the  cavity  of  the 
cranium,  by  means  of  finuffes,  even  betwixt  the  bones  and  dura  mater.  But 
they  who  have  conflder’d  with  Fantonus  (£),  the  difficulty  of  the  circum- 
ftance,  from  anatomical  difquifltions,  and  moreover  have  obferv’d,  that 
fpeedy  exit  of  the  ferum,  from  the  tumour,  as  foon  as  ever  the  occiput  was 
comprefs’d  with  the  hand,  would  not  chufe  rather  to  affign  any  paflage  to 
the  fluid,  than  that  which  nature  herfelf  has  prepar’d  for  it,  betwixt  the  me¬ 
ninges  ;  attributing  the  cure,  in  great  meafure,  to  the  age  of  the  child,  which 
was  four  years,  and  alfo  to  the  difference  of  the  diforder,  the  caufe  of  which 
was  in  this  cafe,  not  internal,  but  external.  For  an  internal,  and  efpecialiy 
a  congenial  caufe,  not  only  injures  the  parts  long,  but  more  intimately,  both 
folid  and  fluid,  and  the  more  grievoufly,  the  fofter  they  are,  and  not,  as  in 

(«)  Partus  Monftr.  Defcript.  (2)  Eph.  N.  C.  Dec.  2.  A.  6.  obf,  208. 

( x )  Obf.  cit.  fupra  n.  9.  (a)  n.  9. 

(yj  n.  10.  (£)  Animad.  ibid.  cit. 


✓ 


an 


2^4  Book  I.  Of  Difeafes  of  the  Head. 

an  age  fomewhat  advanc’d,  more  firm.  To  this  may  be  added,  that  the 
cauda  equina  of  the  medulla  does  not  reach  to  the  os  coccygis ;  which  was  per¬ 
haps  the  reafon,  why  Ruyfch(c),  tc  among  all,”  or  at  leaft,  if  you  read  his 
next  obfervation  (d),  nearly  amongft  all,  that  were  affedted  with  thefe  kinds  of 
tumours,  “  lav/  no  infant  who  furviv’d  the  diforder  fo  long,”  as  that  which 
had  the  tumour  upon  the  os  coccygis.  For  in  this  cafe,  it  does  not  happen, 
that  fo  many  nerves  are  infledtcd  outwardly,  thruft  out,  hurt,  and  broken  : 
from  the  injury  whereof  arifes  a  weaknefs,  and  palfy  of  the  lower  limbs, 
which  you  will  find  particularly  taken  notice  of,  in  moft  of  the  examples  of 
tumours  on  the  loins,  pointed  out  above,  and  in  others  befides,  that  I  pafs 
by,  two  of  which  you  will  fee  in  the  Ephemerid.  Nat.  Cur.  (e)  by  Jo¬ 
hannes  Burgius :  and  befides  this,  a  palfy  of  the  fphindter  ani  and  bladder 
is  avoided  (/),  which  would  fometimes  be  perceiv’d  and  remark’d,  if  chil¬ 
dren  could  drag  out  their  lives  long,  under  fuch  a  diforder  as  this.  But 
they  cannot,  as  well  for  other  reafons,  as  on  account  of  convulfions, 
which  are  the  confequences  of  thefe  injuries  on  the  nerves  •,  and  fo  much 
the  fooner,  if  by  opening  the  tumour,  you  prick  them,  or  expofe  them  to 
the  injuries  of  the  air.  And  why  convulfions,  or  palfies  of  the  lower  limbs, 
did  not  exift  in  thole  two  children  who  were  cur’d  of  this  diforder,  is  eafily 
underftood,  from  what  has  been  laid  of  both.  And  when  we  could  be  cer¬ 
tain,  that  none  of  thefe  exafperated  fympioms  were  prelent,  and  that  the 
diforder  deriv’d  its  origin  from  an  external  caufe -,  and  efpecially,  when  we 
have  obferv’d  all  thofe  things  which  the  celebrated  Trew  cautioufly,  and 
prudently,  admonifhes  us  of  (g),  it  feems  that  the  lurgeon  might  then  dare 
to  do  fomething ;  if,  however,  it  was  at  any  time  lawful  ior  him  to  undertake 
any  thing  of  this  kind,  in  a  diforder  fo  fallacious,  and  in  which  we  have  fo 
many  fatal  examples  of  the  bad  fuccefs  of  furgery. 

13.  For,  to  return  to  the  hydrocephalus,  the  ancient  phyftcians  (£),  in¬ 
deed,  acknowledg’d  two  fpecies  of  the  internal  kind :  the  one,  when  water 
is  collected  between  the  fkulk  and  the  dura  mater  ;  the  other,  when  it  is 
collected  between  rhe  dura,  and  the  pia  mater  ;  teaching,  at  the  fame  time, 
that  the  fecond  fpecies  was  mortal,  but  that  rhe  firft  was  not  incurable  ;  in 
which,  when  a  tumour  appears  between  the  diftradted  futures,  they  order’d, 
that  rhe  moft  prominent  and  pointed  part  fhould  be  cut  into.  But  Parey  (i) 
exprefsly  denies,  that  he  had  ever  leen  one  who  recover’d:  and  Jo.  Francus  (k) 
teftifies,  that  even  the  moft  tumid  part  being  open’d,  and  pure  and  limpid 
water  being  let  out,  the  infant,  “  after  fome  hours,  fell  into  an  epilcpfy,  and 
“  foon  died  thereof:”  nor  was  it  of  any  advantage  to  have  made  a  dif- 
charge  for  the  ferum,  that  was  included  therein,  by  a  foramen,  open’d  with 
the  potential  cautery,  as  it  is  call’d,  according  to  the  order  of  Urubelius  (/), 
that  infant  alfo  having  died,  “  a  few  days  after  •,’*  whereas  thofe  from  whom 
the  water  was  not  drawn,  liv’d  fome  feven,  nine,  eighteen,  and  thirty 

{c)  Obf.  35.  faspius  cit.  (hj  Apud  Fabric,  ab  Aquap.  de  Chirurg. 

\d)  Obf.  36.  Operat,  ubi  de  Hydroceph. 

(f)  Dec.  2.  A.  6.  obf.  58.  (/')  Opei-.  1.  7.  c.  1. 

(f)  Eph.  N.  C.  Cent.  1  &  2.  obf.  127.  &  \k )  Apud  Shenck.  Obf.  Med.  1.  j.  ubi  de 

■SedL  hac  16.  Sepul.  in  addit,  obf.  12.  verf.  fin  Hydroceph.  mort. 

(^)  Commere.  A.  &  hebd.  fupra  cit.  ad  n.  ic.  (1)  Eph.  N.  C.  Dec.  2.  A.  10.  obf.  42. 

months. 


Letter  XII.  Article  13.  265 

months,  as  you  have  it  affirm’d  in  the  A6t.  Helvet.  (m)  ;  not  to  fay  any  thing 
of  that  which  Riedlinus  knew  and  differed  («),  who  labour’d  under  a  hydro¬ 
cephalus  four  and  twenty  folid  years.  There  is  alfo  an  obfervation  afcrib’d  to 
Wepfer  by  the  celebrated  Fantonus  (0),  of  a  ruftic,  who  being  impatient  of 
a  long,  and  very  violent  pain  in  his  head,  from  water  being  confin’d  betwixt 
the  cranium  and  dura  mater,  compell’d  a  farrier  to  pierce  him  cn  the  fide 
of  his  head,  from  which  a  great  quantity  of  ferum  being  difcharg’d,  he  im¬ 
mediately  and  perfedtly  recover’d.  But  fuppole  that  fuch  raihnefs  had  a  hap¬ 
py  effedt  ;  fuppofe  that  there  was  a  furgeon  who  was  willing  to  imitate  this 
boldnefs,  in  the  hydrocephalus  of  any  infant ;  nor  imitate  it  only,  but  even, 
if  there  were  occafion  to  open  the  dura  mater,  as  is  practis’d  after  grievous 
blows  of  the  head,  to  exceed  it;  what  marks  or  fymptoms  fhall  he  fafely 
confide  in,  fo  as  to  lay  down  for  certain,  that  the  water  is  now  betwixt  the 
bones  and  the  dura  mater,  now  betwixt  the  dura  mater  and  pia,  and  at  an¬ 
other  time  betwixt  the  pia  mater  and  brain  ?  Nor  are  examples  wanting  of 
the  threefold  fituation  of  this  diforder;  as,  for  inftance,  of  the  firft,  in  the  hy¬ 
drocephalus  of  Velfius  (/>),  in  which  you  have  alfo  an  inftance  of  the  fecond  : 
and  of  this  alfo  in  thofe  difledted  by  Laubius  (q),  and  by  the  celebrated  Jo. 
Rudolphus  Zwinger  (r) :  and  of  the  third,  in  the  obfervation  of  Fallop- 
pius,  which  you  have  in  the  Sepulchretum  (s) ;  and  in  others  of  Mayerus(7) 
and  Raltfchmied  (a).  Let  us,  however,  fuppofe,  if  it  is  poffible,  that  we  can 
diftinguiffi  all  thefe  fituations  from  one  another,  and  that  we  could  promife 
ourfelves  the  fame  fuccefs,  in  the  hydrocephalus  of  infants,  as  we  fometimes 
fee  in  adults,  when  they  have  receiv’d  violent  blows,  at  a  time  that  they  were 
in  full  health,  if  there  was  a  neceffity  of  cutting  into  the  meninges,  and,  after 
that,  though  they  were  become  lax,  or  lacerated,  or  thicken’d,  in  bringing 
them  to  a  cicatrix  ;  what  ?  if  the  brain  indeed  be  under  the  water,  but  fo  flac¬ 
cid,  that  you  can  lcarcely  diftinguiffi  any  thing  therein,  befides  the  cortical 
and  medullary  fubftance,  as  in  thofe  obfervations  of  Mayerus,  and  Zwinger, 
which  I  juft  now  commended  :  what  ?  if  under  the  cortical,  the  medullary 
fubftance  “  be  all  corrupted,  and  turn’d  into  water,”  as  in  that  child  of 
Tombinus  (x),  of  whom  you  alfo  have  an  account  given  you,  in  the  Sepul¬ 
chretum  (jy)  :  what  ?  if  the  whole  brain  is  diftolv’d  into  44  mucous  water,”  or 
into  44  a  limpid  water,  fomewhat  tindtur’d  with  blood,”  as  in  thofe  obferva¬ 
tions  of  Kerckringius  (2),  and  Laufterus  (a) ;  or,  becaufe  this  is  more  rare, 
what  ?  if  from  the  quantity  of  water  being  included  in  the  ventricles,  as  in 
the  two  obfervations  of  Dodart,  wffiich  are  made  mention  of  by  Bohn(^), 
fuch  a  force  be  exerted  on  the  brain,  that  the  lateral  ventricles  make  one 
continued  cavity  with  the  third  ventricle;  which  very  circumftance,  it  is  fo 
much  the  lefs  poffible  to  conjedture,  fince  fome  patients  from  hydrocephali, 
as  thofe  two  infants,  44  labour  under  other  dil'orders,  which  can  by  no  means 


(«)  Vid.  A6t.  Helvetic.  Tom.  i.  c.  i.  n.  6. 
(»)  Eph.  N.  C.  Cent.  j.  obf.  29. 

0)  Animad.  cit.  fupra  ad  n.  9. 

(/>)  Difp.  de  mutuo  inteft.  ingrelT.  p.  2.  obf.2. 

( q )  Eph.  N.  C.  Cent.  10.  obf.  83. 

(r)  C.  cit.  n.  fuper. 

(j)  2.  in  Se£t.  hac  16. 

VOL.  I. 


(/)  Eph.  N.  C.  Cent.  1  &  2.  obf.  127. 
(a)  Progr.  de  nervis  Optic.  &c. 

(x)  Att.  Lipf.  M.  Nov.  A.  1686. 

(y)  Seft.  cit.  in  Addit,  obf.  8. 

(«)  Sedl.  ead.  obf.  1 1. 

{a)  Diff.  cit.  fupra  ad  n.  6. 

(^)  De  Renunc.  Vulner.  S.  2.  c.  1. 


M  m 


44  be 


266  Book  I.  Of  Difcafes  of  the  Head. 

“  be  call’d  diforders  of  the  head  :**  or  what  ?  if  from  the  weight  of  the  in¬ 
cumbent  waters,  or  their  preffure  round  about,  the  internal  ftru&ure  of  the 
'  bram  be  incurably  injur’d;  for  even  the  exterior  form,  and  the  bulk  itfelf 
fometimes,  by  no  means  refill.  So  Velfius  ( c )  law  the  hemifpheres  of  the 
brain,  no  more  convex,  but  deprefs’d  in  fuch  a  manner,  that  “  their  height 
m  was  in  the  fame  plane  parallel  to  the  horizon,  in  which  the  corpus  callo- 
“  fum  was.”  And  Parey  found  the  brain  fo  far  reduc’d  in  its  fize,  that  “  it 
«  fcarcely  was  equal  to  the  bulk  of  a  tennis-ball,”  which  paffage  is  not  accu» 
rately  enough  recited  in  the  Sepulchretum  ( d ).  Thus  Stegmannus  (e)  faw 
the  cerebrum  “  as  ftnall  as  an  ox’s  eye,  and  hardly  weighing  an  ounce  and 
“  half :”  add  alfo,  that  it  was,  “  at  the  fame  time,  entirely  putrefied  and  cor- 
“  rupted  :”  which  circumftance  brings  back  to  my  mind,  in  like  manner* 
grievous  injuries  of  the  cerebellum,  from  a  hydrocephalus,  as  in  the  obfer- 
vation  of  Velfius,  juft  now  commended,  and  (till  more  in  thofe  of  Littre(/), 
and  Jo.  David  Mauchartus  (£),  and  in  the  fame  from  Laubius,  which  was  a 
little  above  pointed  out. 

But  for  the  moll  part,  although  the  ancients  did  not  fuppofe  this  fpecies* .. 
the  water  of  the  hydrocephalus  is  in  the  ventricles,  as  Vefalius  in  particu¬ 
lar  (Jb)j  and  many  more  befides  him,  have  found  it  •,  for  inllance,  Schulzius  (/'), 
and  among  thofe  whom  I  have  nam’d  before,  Laubius,  Mauchartus,  Riedlinus, 
and  Littre  efpecially,  who,  in  fo  great  a  quantity  of  water,  with  which  the  ven¬ 
tricles  were  dillended,  found  none  betwixt  the  fkull  and  dura  mater,  nor  be-  . 
twixt  this  membrane  and  the  brain.  I  pafs  by  many  others,  befides  Brun- 
nerus  (£),  and  thofe  who,  like  him,  have  fpoken  of  an  extenuation  of  the 
fubllance  of  the  brain,  as  not  very  rarely  feen  in  hydrocephali  of  this  kind; 
Nor  did  I  give  thefe  hints  only  for  this  reafon  ;  in  order  to  fhew,  that  although 
the  furgeon  ffiould  be  bold  enough  to  perforate  the  meninges,  he  would  ne- 
verthelefs  often  meet  with  no  water  there,  or  would  not  draw  ofF  that  which 
was  in  the  greatell  quantity,  unlefs  he  perforated  the  cerebrum  alfo;  but  I 
touch’d  upon  it  for  this  reafon,  in  order  to  fhow  you,  how  eafily  it  might 
even  happen,  that  while  he  thinks  he  perforates  nothing  but  the  dura  mater; 
he  perforates  the  brain.  I  would  have  you,  therefore,  join  to  the  obferva- 
tion  of  Vefalius,  thofe  of  Hildanus  alfo,  and  Tulpius,  which  are  mention’d 
by  me  in  that  place,  where  I  fhew’d  (/),  that  by  the  force  of  the  water* 
dillending  the  ventricles,  their  upper  parietes  in  particular,  and  their  late¬ 
ral  parietes,  are  fometimes  fo  far  extenuated,  and  affix’d  with  the  meninges, 
to  the  bones  of  the  cranium,  or  pericranium,  that  it  ought  not  to  feem  won¬ 
derful,  if  any  one,  while  he  fuppofes,  that  he  cuts  only  into  the  cranium 
itfelf,  fhould,  at  the  fame  time,  pierce  through  the  dura  and  pia  mater,  and 
even  the  fubllance  of  the  cerebrum  itfelf,  which  adheres  to  the  meninges, 
and  to  the  bones  and  pericranium,  in  the  form  of  a  membrane.  Pleafe 
to  read  the  letters  which  were  fent  from  Jo.  Jacob  Schenkzer,  to  our  Vallif- 
neri  (m)  :  you  will  fee,  that  in  the  hofpital,  the  hydrocephalus  of  an  infant 


(r)  Obf.  fupra  cit.  2. 

{d)  Seft.  hac  obf.  12.  fed  Operum  1.  7.  non  8. 
(<■)  Sed.  ead.  in  Addit,  obf.  n. 

(f)  Hift.  de  l’Acad.  R.  des  Sc.  A.  1705. 

(g)  Eph.  N.  C.  Dec.  3.  A.  4.  obf.  59.  n.  9. 


(ti)  Sepulch.  Se&.  cit.  obf.  6. 

(/)  Apud  LaufFer.  in  DifT.  cit.  $  23. 
(/•)  Seft.  cit.  in  Addit,  obf.  12. 

(/)  Supra  ad  n.  8. 

(w)  Opere  Tom.  i.  S.  5.  in  fin. 


was 


% 

Letter  XII.  Article  14.  26  7 

was  open’d  with  the  chirurgical  knife,  “  in  confequence  of  a  general  conful- 
“  ration,  as  it  was  judg’d,  that  the  water  was  harbour’d  betwixt  the  cranium 
ct  and  dura  mater.”  You  will  fee,  at  the  fame  time,  “  how  difficult  it  is  to 
“  judge  in  fuch  cafes.”  For  though  the  convulfive  motions,  which  fuc- 
ceeded,  very  loon,  to  the  firft  drawing  off  of  water,  in  the  quantity  of  three 
ounces,  by  continuing  till  the  time  of  the  child’s  death,  which  happen’d  the 
day  after,  were  fuppos’d  to  indicate,  that  the  dura  mater  was  incis’d ;  the 
diifeftion  ffiew’d,  “  that  not  only  this  was  cut  through,  but  the  pia  mater 
44  alfo,  and  the  brain  itfelf.  For  the  brain  was  extended,  almod  to  the 
“  thinnels  of  a  membrane,  equal  to  the  internal  capacity  of  the  cranium  ; 
“  whereas  the  bulk  of  the  water,  which  was,  at  lead,  in  the  quantity  of 
“  eight  medical  pounds,  had  been  harbour’d  in  the  ventricles.” 

14.  From  fo  great  an  extenuation  of  the  brain,  and  adhefion  thereof  to 
the  upper  part  of  the  cranium,  it  happen’d,  without  doubt,  in  the  hydro¬ 
cephalus  of  Tulpius,  already  mention’d  (»),  that  when  the  water  was  dif- 
■charg’d,  “  mod  of  the  phyficians,  that  were  prefent,  imagin’d,  but  too 
“  hadily,  that  this  was  a  head  without  a  brain,”  in  like  manner  as  Steno  by  his 
.calf(fl),  “  did  notconfume  a  little  time,  in  leeking  the  brain  in  the  brain  itfelf, 
“  and  already  began,  almod,  to  believe  the  dories,  which  he  had  not  before  cre- 
“  dited,  to  wit,  that  men  had  been  found  without  a  brain.”  And,  indeed, 
-it  is  my  opinion,  that  nearly  in  this  manner,  whatever  there  may  be  of  truth 
in  the  obfervations  of  this  kind,  is  to  be  explain’d,  efpecially  of  thofe  who 
had  not  read  Tulpius,  and  Steno;  as  for  indance  Garnerus,  Zacutus,  or  any 
others,  who  are  laid,  in  the  Sepulchretum  (/>),  where  the  fcholia  are  given  to 
thefe  obfervations,  to  have  found  no  brain.  For  when  one  fays,  44  that  a 
“  very  thick  membrane  lupplied  the  place  of  the  brain  another,  that  in¬ 
dead  of  it,  “  the  dura  mater  appear’d  to  be  doubl’d,”  having  a  mod  limpid 
•water  within  it ;  you  eafily  underdand,  what  this  very  thick  membrane  was, 
or  that  fecond  lamina,  fuppos’d  to  be  a  doubling  of  the  dura  mater,  and 
what  might  lie  hid  under  that  appearance,  44  of  a  certain  mucofity  and  phlegm 
44  undigeded,”  which  immediately  offer’d  itfelf  to  Garnerus,  as  he  look’d 
flightly  within  the  meninges.  At  lead,  as  in  the  fame  place,  you  will  fee  the 
obfervation  of  Kerckringius  (4),  who  lays,  44  that  indead  of  the  brain  he 
44  found  a  mucous  water.”  You  will  alfo  fee,  in  the  fubjoin’d  fcholium,  that 
Diemerbroeck  fufpedted  much  the  fame  as  1  do,  concerning  this  mucous  wa¬ 
ter,  or  extenuation  of  the  brain  ;  and  yet  Kerckringius  had  not  only  read 
the  hidory  of  Tulpius,  but  even  mention’d  it  in  that  of  his  own,  and  was 
fpcaking  of  a  hydrocephalus  in  a  child,  not  fix  months  old,  who  might  have 
had  the  diffolutioTi  of  the  brain  bird  begin  in  the  uterus,  and  encreafe  upon 
it  by  degrees,  till  the  brain  being  entirely  diffolv’d,  it  would  naturally  die. 
And  Diemerbroeck,  befides,  objected  to  him,  what  you  would  alfo  objedt 
to  mod  who  have  publifh’d  hidories  of  this  kind,  as  a  very  drange  omiffion, 
that  they  never  once  made  any  mention,  whether  the  cerebellum,  and  me¬ 
dulla  oblongata,  were  wanting,  or  not.  But  in  the  hidory  of  Billotius  (r), 

(,*)  Supra  ad  n.  8.  ( o )  Ibid.  (y)  Sefts  ead.  obf.  n. 

(p)  L.  i.  St  ft.  j.  obf.  86.  &  Sect,  hac  16.  (»-)  Zodiac.  Med.  Gall.  A.  i.  M.  Dec.  obf.  3, 

obf.  13. 


M  m  2 


which 


268  Book  l.  Of  Difeafes  of  the  Head. 

which  is  generally  number’d  among  the  others,  you  not  only  want  this  cir- 
cumftance;  but  even  you  find,  that  the  cerebrum  itfelf  was  not  entirely 
confum’d,  fince  “  a  portion  of  its  lubftance  was  Hill  remaining,  though  fo 
“  finali,  as  fcarcely  to  equal  a  little  egg  in  bulk.”  So  alfo  in  the  dog,  who 
feem’d  to  be  fomewhat  mad,  or  vertiginous,  Elias  Rud  Camerarius  (j),  (for 
as  to  the  fheep  which  Kerckringius  (/),  and  others,  have  written  of,  the  hif- 
tories  generally  depend  upon  the  veracity  and  obfervation  of  the  butchers) 
Camerarius,  I  fay,  faw  “  not  the  leak  lubllance  of  the  cerebrum  or  cere- 
“  bellum,  except  a  very  fmall  portion  of  the  latter,  fcarcely  half  fo  big  as 

a  filbert  nut.”  To  all  which  things,  though  I  have  not  read  them,  I  con- 
fefs,  without  wonder,  and  even  not  without  fome  diftruft,  yet  1  will  add  this 
alfo.  I  remember,  when  I  was  a  young  man,  and  attended  every  day  in  the 
hofpital  of  St.  Mary  de  Morte,  at  Bologna,  that  I  heard,  more  than  once, 
jo.  Marc.  Bigatti,  an  honeft  man,  and,  at  the  fame  time,  a  phyfician  and 
furgeon  there,  of  good  reputation,  when  he  affirm’d  that  his  predecelfor, 
Jo.  Galeati  Manzi,  a  phyfician  and  furgeon,  who,  when  living,  was  to  be 
equaled  by  few,  had  feen  this,  which  I  fhall  relate  to  you,  juft  as  I  re¬ 
ceiv’d  it  from  him,  neither  adding  thereto,  nor  diminiffiing  therefrom.  Manzi 
had  under  his  care  the  wound  of  a  certain  man,  which  being  inflicted  on  the 
coronal  future,  reach’d  into  the  cavity  of  the  cranium-,  when  the  patient  be¬ 
gan,  about  the  twentieth  day,  to  be  troubl’d  with  two  things  j  the  one,  that 
as  often  as  the  wound  was  open’d,  fo  often  was  he  affefted  with  convulfive 
motions  of  the  lower  jaw ;  and  the  other,  that  as  often  as  he  was  afk’d  a 
queftion,  he  fhew’d  by  his  eyes,  that  he  underftood,  and  would  willingly  an- 
l'vver,  and  yet  for  fome  fpace  of  time,  he  could  not  begin  the  firft  word ; 
but  when  he  had  once  begun,  the  other  words  eafily  follow’d.  And  in  this 
manner  nearly,  in  general,  to  the  very  latter  end  of  his  life,  did  he  continue, 
being,  to  all  appearance,  in  his  perfect  fenfes  ;  till  at  length  being  taken  with 
a  kind  of  apoplecftic  fit,  he  died.  His  fkull  being  open’d,  nothing  was 
found  within  the  cavity,  but  a  fluid,  if  you  except  fome  red,  and  almoft 
fleffiy  fibres,  which  lay  under  the  wound.  As  I  with-held  my  afient,  when 
I  heard  this  ftory ;  fo  you  have  my  free  leave  to  with-hold  yours,  when  you 
read  it.  And,  indeed,  thefe  things  are  of  fuch  a  nature,  that  unlefs  you  fee 
them  yourfelf,  unlefs  you  examine  again  and  again,  with  accuracy,  into  them, 
as  in  this  cafe,  to  determine  what  thefe  red,  and  almoft  fleffiy,  fibres  were, 
with  what  membrane,  or  with  what  nerves,  perhaps,  they  were  join’d,  and 
even  after  you  had  examin’d  ever  fo  nicely,  you  would  fcarcely  know  what 
to  believe. 

The  queftion  is  here,  indeed,  concerning  the  confumption  of  the  brain 
being  the  confequence  of  a  wound  in  the  head,  as  in  the  children  obferv’d 
by  Zacutus,  and  Billotius.  But  in  the  firft,  the  fpace  of  three  years  had 
pars’d,  between  the  time  in  which  the  wound  was  inflifted,  and  that  in  which 
the  obfervation  was  made  and  in  the  other,  the  whole  cerebrum  was  not 
eonfum’d  :  in  both,  perhaps,  the  cerebellum,  and  part  of  the  medulla  ob¬ 
longata,  might  remain.  Nor  was  there  a  colliquation  of  the  brain,  in  the 
fecond  ^  but  only  a  lofs  of  its  fubftance,  which  burft  forth,  at  every  time 

(j)  Eph.  N.  C.  Dec.  i.  a.  3.  obf.  izg.  infchol.  (/)  Spicileg.  Anat.  obf.  46. 

of 


Letter  XII.  Article  14.  i6y 

of  drefilng  the  wound,  to  the  bignefs  of  a  nutmeg.  But  you  will  fay,  in 
the  child  of  Kerckringius,  who  was  five  months  old,  no  wound  had  pre¬ 
ceded  ;  none  in  that  of  Pombinus  (u),  which  was  two  years  old  ;  none  in  the 
girl  of  nine  years  old,  obferv’d  by  Neuhold  (x)  ■,  and  neverthelefs  in  her  the 
medullary  fubftance  of  the  brain  “  was  chang’d,  as  it  were,  into  a  mod  te- 
“  nacious  jelly  j”  but  in  the  fecond,  as  I  laid  before,  it  “  was  turn’d  into 
“  water  j”  and  in  the  firft,  the  whole  brain  was  chang’d  into  water.  But  to¬ 
me,  this  very  feries  of  changes  feems  to  fiiew,  that  the  diffolution  of  the  brain 
happens  with  fo  much  the  more  difficulty,  as  we  recede  the  more  from  the 
time  of  the  child’s  birth,  fo  that  the  Jubilance  of  the  brain  is  more  firm. 
But  it  this  r.eally  happen’d  in  that  man  of  Garnerus,  you  may  fee,  at  lead, 
how  great,  and  how  long-contmu’d  afflictions  he  bore.  And  how  Angular 
a  cafe  it  was  in  that  very  man,  may  be  underftood  from  hence,  that  it  is  not 
eafy  to  find  another  example  of  that  kind  in  an  adult,  amor.gft  all  the  writers 
of  credit  and  probity.  And,  indeed,  the  woman  of  whom  Raltfchmied  ( y ) 
gives  the  hiftory,  although  fhe  was  fo  miferably  afflidted  with  the  moft  cruel 
pains  of  the  head,  and  thole  happening  after  a  violent  blow  thereupon, 
that  unlefs  a  quantity  of  water  had  flow’d  from  her  nofirils,  (Tie  could  not 
have  liv’d  fo  long  •,  when  at  length  fhe  died,  in  the  tenth  year  after  the  blow', 
he  found  that  the  corpus  callolum,  indeed,  was  fo  extenuated  by  the  force 
of  the  ferum,  diftending  the  ventricles  of  the  brain,  that  “  it  fcarcely  had 
“  the  thicknefs  of  the  l'eptum  pellucidum  yet  was  there  no  fuch  thing  as 
the  cerebrum  being  diffolv’d  into  mucus.  Since,  therefore,  the  diflblution 
of  the  whole  cerebrum  into  mucus,  in  adults,  and  ftill  more  into  water,  is 
very  rare,  efpecially  if  it  be  underftood,  that  whatever  is  contain’d  in  the 
cranium  is,  at  the  fame  time,  difiolv’d  ;  you  fee  at  once,  why,  when  I  heard 
the  cafe  that  has  been  deferib’d,  I  did  not  give  my  aftent  to  it  •,  as  I  have 
always  doubted,  when  I  have  heard  the  fame,  or  much  lefs  than  this,  even  of 
a  child  •,  unlcls  it  fhould  be  added,  that  he  was  at  the  fame  time  without  a 
.foul,  and  liv’d  the  live  of  a  plant,  more  than  that  of  a  man.  But  kedi  (2), 
neverthelefs,  having  taken  out  the  brain  from  tortoifes,  you  will  fay,  law  that 
they  ftill  liv’d  a  long  time,  and  could  even  walk,  fometimes,  for  fix  months 
after.  But  I  fpeak  at  prelent  of  perfc<ft  animals,  as  they  are  call’d,  and  even 
of  man  j  and  you  tell  me  of  tortoifes,  which,  as  Ariftotle  himfelf  knew  very 
well,  “  can  perform  motions,  even  when  the  heart  is  taken  away  (<a)”.  Be- 
fides,  Redi  himfelf  feems  to  hint,  that  together  with  the  brain,  the  faculty 
of  feeing,  and  what  is  probable,  of  hearing  alio,  fmelling,  and  tailing,  was 
taken  away:  andCaldefi  (b)  has,  certainly,  given  a  very  probable  reafon  of  mo¬ 
tion  remaining  fo  long  j  I  mean,  the  great  thicknefs  of  their  lpinal  marrow,  in. 
proportion  to  the  brain,  which,  when  compar’d  to  the  marrow,  is  but  fmall. 
And  from  this  marrow  thofe  perfons  are  wont  to  account  for  the  animal 
fpirits,  who  take  pains  to  expiain  the  life  of  foetuftes  in  the  uterus,  when 
they  are  without  a  brain  ;  whom  you  may  follow  fo  far,  provided  you  do  not, 
however,  at  the  fame  time,  fuppofe  with  forne,  that  either  the  medulla  fpi- 


( i /)  Supra  ad  n.  13. 

(*)  Commere.  Litter,  vol.  1.  fpscim.  22. 
(y)  Prcgr.  cit.  fupra  ad  n.  1  3. 


I 


(2)  Degli  Anim.  viv. 

[a)  L.  de  Juventae.  I. 

G)  Qilerviiz.  int.  alle  Tartarughe. 


nalis 


ijo  Book  I.  Of  Difeafes  of  the  Head. 

nalis  is  always  thicker  in  them  ;  or  that,  becaufe  it  fends  out  many  more 
nerves  than  the  brain,  it  alfo  fends  out  many  more  fpirits,  even  at  the  time 
when  it  can  certainly  receive  no  more  fpirits  from  the  brain,  from  which  it  is 
wont  to  receive  the  greater  part  at  other -times  ;  or  that  this  medulla  certainly 
exifts  in  all  thefe  foetuffes  ;  whereas  I  have  mention’d  many  above  (c),  who 
had  nothing  at  all,  but  water  perhaps,  within  the  cranium,  and  in  the  tube 
of  the  vertebrae. 

But  you  will,  perhaps,  obje£t,  that  they  had  both  brain  and  marrow,  be¬ 
fore  either,  or  both  of  them  were  dififolv’d  by  the  water,  or  were  opprefs’d, 
or  thruft  out,  by  fome  other  force.  And  in  this  you  imagine  more  happily 
than  molt  of  thofe,  who,  having  attempted  to  explain  the  queftion,  have  by 
no  means  attended  to  this  circumftance.  But  if,  to  go  up  to  the  very  origin, 
you  contend,  that,  in  one  place,  and  the  other,  there  never  was  any  thing 
but  moifture,  and  that  the  fpirits  are  to  be  accounted  for  from  the  ganglions 
of  the  nerves,  indulging  in  fome  meafure  that  fufpicion,  which  I  formerly, 
though  but  in  two  or  three  words,  touch’d  upon(d'),  that  in  the  ganglions  of 
nerves  “  fome  fecretion  of  fpirits  was  probably  made  $”  I  indeed,  although 
lately,  in  particular,  in  two  ganglions  of  an  adult,  the  one  of  a  moderate, 
and  the  other  of  a  very  great  thick  nets,  amongft  thofe  nerves  which  go  to 
make  up  the  cervical,  prefently  to  become  the  brachial  ;  although,  Lfay,  in 
thcle  ganglions,  when  difiedted  longitudinally,  I  plainly  faw  a  fubftance  of 
a  cineritious  colour,  degenerating  to  brown,  and  demonftrated  it,  which 
being  nowhere  mix’d  with  the  white,  (the  quantity  of  which  was  much  greater, 
and  its  fituation  external  in  the  ganglions)  follow’d  the  axis  of  the  ganglions, 
yet  I  dare  not  add  2ny  weight  to  this  fufpicion  ;  and  if  1  dar’d,  I  fhould  be¬ 
lieve,  that  there  was,  perhaps,  fome  room  for  fuch  a  fufpicion,  in  thofe 
foetuffes  only,  whofe  brain  and  marrow  had  been  deftroy’d,  in  order  to  pre- 
lerve  them  for  fome  time-,  but  no:  in  thofe,  who  had  never  had,  either  a 
brain,  or  fpinal  marrow.  But  if  you  fhould,  perhaps,  ftill  think,  that  you 
muft  neverthelefs  perfilt  in  fuch  an  opinion,  which  I  cannot  believe;  this  one 
thing  I  will  fay,  that  if  the  firft  and  laft  part  of  the  life  in  the  uterus,  feems 
to  you  to  be  capable  of  companion  with  that  which  adults,  of  whom  this 
difeourfe  was  undertaken,  lead,  in  perceiving,  thinking,  judging,  anfwering, 
and,  as  occafion  requires,  in  moving,  you  have  the  better  of  the  argument ; 
but  if  nor,  you  mult  then  take  part  with  me  in  the  queftion. 

15.  You  have  of  the  hydrocephalus,  and  efpecially  of  watry  tumours  of 
the  Ipine,  fo  much  the  more  here,  as  they  are  the  lefs  commonly  known 
among  us  than  other  diforders  :  for  they  are  very  rare  in  this  country  ;  not, 
as  in  fome  others,  fo  frequent,  that  within  fourteen  months,  Burgius  (e)  law 
three  at  Vratiflavia.  But  if  you  fhould  defire  ftill  more  concerning  each 
diforder,  the  celebrated  Jo.  Rud.  Zwinger  (/)  will  be  able  to  fatisfy  you  on 
the  iubjedt  of  the  hydrocephalus  by  whom,  when  I  revis’d  this  letter,  I  not 
only  law  examples  thereof  colle&ed,  but  alfo  diligently  and  feparately  com¬ 
par’d  one  with  another.  And  in  regard  to  aqueous  tumours  in  the  fpine,  be- 
iide  George  Frederic  Orthius,  in  a  differtation  (g)  that  he  gave  out,  when 

( c )  N.  8.  (f)  Ad.  Helvetic.,  vol.  1.  c.  1. 

(rf)  Ad\erf.  Amt.  II.  Animad.  34.  (g)  Be  quibufd.  Tumorib.  Tunic.  Externis. 

„  (f)  Eph.  N.  C.  Dec.  2.  a.  6.  obi.  58. 


Letter  XII.  Article  i  (>;  271  • 

Jo.  Saltzmann  was  prefident,  which  is  very  ul'eful  and  worthy. to  be  read;  thofe 
very  learned  men,  Flatner  (&),  and  Trew  (/),  maybe  referred  to:  the  Br(t 
of  which,  when  he  made  fome  little  obfervations  upon  tumours  of  this  kind, 
pointed  out  himfelf  alfo  the  names  of  many  perfons  who  have  written  the 
hiftories  of  them  :  and  the  laft  not  only  added  other  authors,  but  alfo  gave 
his  own  obfervations;  and,  confidering  all  things  well,  treated  this  fubje£t, 
perhaps,  more  thoroughly,  accurately,  diftindtly,  and  at  large,  than  any  other 
perfon  whatever  ;  nor  did  he  omit  to  mention,  how  he  conjectures,  that  the 
cure  of  thefe  diforders  may  be  attempted  and  perform’d.  And  if  the  writings 
of  all  thofe  authors  had  come  into  my  hands,  before  I  firft  fent  thefe  letters 
to  you,  I  would  certainly  have  taken  pains  to  procure  fome  books  which  1 
am  at  prefent  without.  Neverthelefs,  I  have  taken  notice  of  the.  greateft 
part  of  the  examples,  which  are  extant,  of  either  diforder,  as  you  will  now 
be  able  to  fee  ;  and  I  have  added  fome  other  things,  which  are  either  over¬ 
look’d  by  thofe  whom  1  commend,  or  not  yet  publifh’d  when  they  wrote; 
which  is  very  eafy  for  all  who  write  laft  to  do.  In  the  mean  while,  you  will 
make  ufe  of  thefe  notices,  with  which  it  was  in  my  power  to  furnifn  \ou. 
Fa  re  w  el. . 

1 6.  I  had  fcarcely  feal’d  up  this  letter,  when  that  circumffance  happen’d 
tome,  which  never  happen’d  before,  and  was  the  more  furprifmg  at  this 
juncture,  as  I  did  not  in  the  lead:  expeCt  it,  or  even  think  of  it  ;•  I  mean, 
that  a  child  . was  brought  to  me  for  advice,  on  account  of  a  .tumour  being 
prominent  about  the  lumbar  vertebrae. .  While  they  , were  taking  off  its 
clothes,  for  me  to  look  at  it,  I  afk’d  them,  whether  he  was  flrong  in  his 
lawer  limbs  ?  and  when  they  anfwer’d  in  the  negative,  I  afk’d,  whether  the 
tumour  was  pellucid,  as  if  it  contain’d  water  ?  to  which  they  anfwer’d  in  the 
affirmative,  wond’ring  at  the  fame  time  that  my  queltions  were  fo  pertinent 
to  the  cafe.  What  1  had  concluded  from  their,  anfwers,  1  prefently  found  to 
be,  in  faCt,  true.  The  tumour,  indeed,,  was  fufficiently  foft  ;  and  the  con¬ 
tain’d  water,  in  many  places,  very  evidently  {hone  through  the  parietes. 
This,  tumour,. having  .been  very  fmall  at.  the  time  of  birth,  within  ten  months, 
had  grown  out  to  the  bignels  of  a  fift ;  fo  that,  it  was.  very  much  like,  in  its 
form,  as  well  as  its  fituation,  to  that  which  Ruyfch  has  given  a  plate  of  (k). 
The  boy  was  large-made,  ltrong,  and  well  nourilli’d,  even  in  his  lower 
limbs,  in  which  he  was  only  weak;  and  proportionably  fhap’d  in  every  parr, 
except  that  his  head  .was  bigger  than  it  ffiould  be;  which,  though  in  other 
refpe&s  found,  immediately  {truck  the  attention  of  every  one  :  1  fay,  he  was 
well-made,  alfo,  in  thofe  limbs  which  I  fpoke  of  juft,  now  ;  fo.that  from. this 
new  example,  added  to  many  others,  I  was  confirm’d  in  my  opinion,  .that 
they  are  deceiv’d,  who  fuppofe  all  the  children,  that  labour  under  a  tumour 
of  this  kind,  to  be  born  with  diftorted  Feet,  for  this  reafon,  becauie  they 
have  obferv’d,  that  fome  of  them  were  thus  born;  among!!  which,  whether 
ffiey  with  juftice  place  that  girl  whofe  hiftory  is  given  by  Staipart  (/),  you 

(£)  Progr.  cit.  fupra  adn.  1 1 .  (A)  Obf.  Anar.  Chir.  fig.  36. 

(/)  Cominerc,  cii.  fupra  ad  n.  10.  hebd.  20,  ( /;  Part.  1.  Cent,  z,  Obf.  ftar.  34.  ^ 

zj  t ,  3  i 

yourfelT 


272  Book  I.  Of  Difeafes  of  the  Head. 

yourfelf  will  judge.  I  plainly  fee,  indeed,  that  her  feet  were  miferably  di* 
florted  ;  but  it  is  by  no  means  fo  clear  to  me,  that  the  tumour,  with  which 
fhe  was  deform’d  in  her  loins,  was  of  the  fame  kind  with  thofe  we  treat  of 
at  prefen t. 

But  to  return  to  our  boy  :  not  being  ignorant  of  the  exceffive  credulity  of 
other  people,  at  fome  times,  I  afk’d,  however,  from  the  mother,  whether, 
as  die  was  in  the  flower  of  her  life,  and  both  fhe  and  her  hufband  healthy, 
fhe  had  ever  fall’n  on  her  back,  while  fhe  was  pregnant  with  this  child, 
which  was  her  firft-born,  or  had  receiv’d  a  blow  in  that  part  by  any  means, 
or  had  dreaded,  or  been  frighten’d  at  any  thing  ;  or,  in  fine,  whether  fhe  had 
long’d  for  any  thing  :  all  which  fhe  immediately  and  exprefsly  anfwer’d  in  the 
negative  ;  although  afterwards,  as  the  cuflom  is  with  thefe  weak  women,  it 
came  into  her  mind,  that  fhe  had  wi fil’d  for  a  fig. 

But  in  regard  to  the  advice  which  I  gave  them,  as  I  exprefsly  affirm’d,  that 
the  child  could  not  be  cur’d,  I  alfo  took  pains  to  inculcate  this  again  and 
again,  to  take  care  that  no-body  attempted  to  open  the  tumour  •,  for  if  they 
fuffer’d  this,  the  child  would  die  fo  much  the  fooner.  The  father  and  mother 
of  this  child  were  country  people ;  as  alfo  the  parents  of  that  child,  whom  1 
mention’d  above  (m),  in  whom  a  tumour  of  the  fame  kind  communicated  more 
with  the  cavity  of  the  cranium,  than  with  that  of  the  fpine.  But  they  were  wife 
enough  to  be  afraid  of  the  danger,  which  I  had  foretold  ;  and  bidding  adieu 
to  the  furgeons,  carried  their  child  home  again,  that  it  might  live  as  long  as 
it  fhould  pleafe  God  to  permit  it.  Yet  the  parents  of  the  child  I  am  fpeaking 
of  now,  were  no  fooner  departed  from  me,  but  they  happen’d  to  light  on  a 
furgeon,  who  confefs’d,  indeed,  that  he  had  never  feen  fuch  a  tumour,  and 
was  ignorant  what  it  was  ;  as  moft  of  the  furgeons  and  phyficians,  who  in- 
fpedted  it  before  me,  had  done  •,  and  neverthelels,  what  they  had  not  dar’d 
to  do,  becaufe  they  did  not  underfland  its  nature,  he  promis’d  that  he  would 
cure  it  for  them.  Being  perfuaded  by  the  age  and  confidence  of  the  man, 
they  e'afily  believ’d  what  they  ardently  defir’d.  This  man,  then,  although 
he  was  afterwards,  by  accident,  well-inform’d  of  the  advice  they  had  receiv’d 
from  me,  being  obftinate  in  his  defign,  thruft  a  knife  into  the  middle  of  the 
tumour  •,  upon  which  a  clear  water  immediately  burft  forth,  in  colour  fome- 
what  like  urine,  and  not  in  fmall  quantity,  but,  at  laft,  like  that  in  which 
frefii  meat  has  been  walh’d.  The  water  being  difcharg’d,  the  furgeon  put 
a  thick  tent  into  the  orifice,  which  being  drawn  out  every  day,  the  wound 
difcharg’d  every  day  frefh  water,  as  long  as  the  child  liv’d.  But  he  did  not 
live  quite  through  the  third  day  after  the  tumour  was  open’d.  And  from  the 
time  that  it  was  cut  into,  he  never  ceas’d  to  cry  and  weep,  though  he  had 
been  chearful  before,  and  much  given  to  laughing,  and  almoft  to  have  an 
averfion  to  the  breafi,  of  which  he  had  been  always  very  covetous.  In  the 
mean  while,  he  often  trembl’d  in  his  whole  body  ;  his  face,  which  was  before 
fmooth  and  well-  colour’d,  began  to  be  wrinkl’d  and  pale;  and,  in  fhort,  all 
things  portended  evil.  Yet  the  furgeon  alone  (till  hop’d  for  good  fuccefs, 
even  a  few  hours  before  death  attack’d  the  child  ;  which  came  upon  him  Gra¬ 
dually,  with  a  flight  difficulty  of  breathing.  At  length,  when  I  was°in- 


( m )  N.  10. 


form’d 


Letter  XII.  Article  i  6.  273 

form’d  of  all  thefe  things  having  happen'd,  I  bore  it  hardly  indeed,  that  the 
child  was  inadvertently  deftroy’d  ;  and  as  to  what  now  remain’d  to  be  done, 
being  defirous  of  examining  the  internal  contents  of  the  tumour,  I  immedi¬ 
ately  went  to  the  houfe,  where  the  parents  had  carried  the  child  a  little  before 
its  death-,  which  houfe  belong’d  to  a  neighbour,  and  a  friend  of  mine.  There, 
by  chance,  having  met  wrth  the  furgeon,  who  was  defirous  of  the  fame 
thing  that  I  was,  although  I  did  not  omit  to  blame,  as  indeed  -  my  duty 
was,  his  late  fupreme  confidence,  and  deftruCtive  boldnefs,  a  little  more  fe- 
verely  than  my  nature  and  cuftorn,  which  are  very  well  known  to  every- body 
here,  incline  me  to  do  ;  yet  that  he  might  be  more  cautious  and  confederate 
for  the  future,  as  he  was  now  very  docible,  and  entreated  it  of  me,  I  imme¬ 
diately  confented,  and  promis’d  him  that  I  would  be  prefent,  while  the 
tumour  was  diflfeCted,  and  explain  the  contents  of  it  to  him. 

Although  the  parietes  of  the  tumour  were  collaps’d  and  rugous,  and,  for 
this  reafon,  thicker  than  ufual  yet  when  they  were  prefs’d,  a  pretty  confi- 
derable  quantity  of  water  iflu’d  out  of  the  wound,  which  fmell’d  a  little 
ftrong,  and  was  like  a  pale  urine  j  which  likenefs,  as  1  have  faid,  being  ob- 
ferv’d  in  former  days,  and  being  made  known  among  the  furgeons,  had  been 
the  means  (»)  of  making  feme  fufpeCt  here  alfo,  that  the  urinary  bladder 
communicated  with  the  tumour.  The  parietes  being  cut  into,  by  two  lines 
eroding  each  other,  while  the  flaps  were  carefully  drawn  afunder,  as  I  di¬ 
rected,  the  fpinal  marrow  evidently  appear’d,  invefted  with  the  pia  mater, 
which  was  univerfally  red  with  diftended  veflels-,  and  the  body  of  the  marrow, 
together  with  the  nerves  that  come  from  it,  adher’d  clofely,  almoft  to  the 
middle  of  the  parietes  of  the  tumour,  longitudinally  (c)  ;  fo  that  I  was 
oblig’d  to  feparate  it  myfelf  from  them,  gently  with  my  hand  ;  and  it  was  evi¬ 
dent,  that  the  other  coats  of  the  marrow  had  coalelc’d  into  one  fubftance  with 
the  fame  parietes.  Nor  was  the  marrow  foft  or  fluid,  but  even  then  lufficiently 
firm  -,  which  1  perceiv’d,  by  prefling  it  betwixt  my  fingers,  and  foon  after 
confirm’d,  by  cutting  it  in  a  tranfverle  direction,  and  finding  that  the  white 
fubftance  round  about,  and  the  cineritious  internally,  were  both  of  them  pretty 
folid.  But  the  tumour  had  a  large  finus  in  every  direction,  the  bony  parts 
of  all  the  lumbar  vertebra,  which  us’d  to  be  behind,  being  prefs’d  to  the 
fides,  and  confum’d  even  to  their  very  bodies,  which  made  the  anterior  paries, 
or  boundary,  of  the  tumour.  There  was  nowhere  any  putrefaction,  nowhere  , 
any  blacknefs. 

Although  the  circumflances,  which  I  have  related  to  you,  Tam  as  certain 
ok  as  it  is  pofiible  to  be,  in  every  refpeCt  -,  yet  the  body  of  the  marrow  itfelf 
did  not  flop  at  the  firft  vertebrae  of  the  loins,  but  was  produc’d  almoft  to  the 
os  facrutn,  as  1  perceiv’d  both  by  my  eyes  and  my  hands.  But  whether  this 
happen’d  herefrom  a  peculiar  ftruCture,  or  becaufe  in  the  beginning,  the  body 
of  the  marrow  being  connected  to  the  pofterior  paries  of  the  tumour,  as  this 
gradually  increas’d,  and  curv’d  itfelf  outwards,  the  marrow  might  alfo  in- 
creafe,  and  follow  it,  is  not,  I  think,  eafy  to  determine.  And  this  confi- 
deration  made  me  defirous,  moreover,  of  examining  the  upper  vertebrae,  and, 
in  fhort,  of  opening  the  head,  which  was  fo  large ;  efpecially  as  when  this 

(»)  Vid.  fupra  n.  u.  (o)  Vid.  ibid. 

N  n 


VOL.  I. 


2  74  Book  I.  Of  Difeafes  of  the  Head. 

was  comprefs’d,  although  it  did  not  feem  to  give  way,  fome  water  had  fall’n 
out  of  the  evacuated  tumour,  before  it  was  open’d  by  us :  which,  I  fuppofe, 
happen’d  more  from  chance,  than  from  anything  elfe;  for  when  the  tumour 
was  differed,  the  head  being  again  comprefs’d,  no  water  iflu’d  out  of  it. 
But  neither  the  time,  nor  the  place,  nor,  in  particular,  the  cries  of  the  pa¬ 
rent?,  who,  as  I  faid,  were  ignorant  country-people,  and  who  had  with  dif¬ 
ficulty,  and  not  without  tears,  permitted  me  to  proceed  fo  far,  as  to  difledfc 
the  tumour,  fuffer’d  me  to  obfcrve  any  thing  more  in  this  fubject.  As  I  did 
not  doubt,  but  this  relation  would  be  very  pleafing,  I  was  determin’d  to  pen 
it  down  here,  on  the  very  day  that  I  examin’d  the  tumour,  which  was  on 
the  fourth  of  September,  in  the  year  1745.  Again  farewel. 


LETTER  the  THIRTEENTH. 


In  which  the  Catarrh  is  briefly  treated  of  ;  but  affections 

of  the  Eyes  more  at  large. 

1.  IT  AT  water  really  flows  down  from  the  cavity  of  the  cranium,  into 
I  the  tube  of  the  vertebrm,  is  confirm’d  by  me  alfo,  in  the  lad  letter 
which  l  fent  you.  But  the  ancients  made  no  doubt  of  humours  being 
drain’d  down  from  the  fkull,  upon  the  eyes,  ears,  nodrils,  mouth,  ched, 
belly,  and  limbs,  as  well  as  into  that  tube  Which  erroneous  dodrine,  that 
was  rather  the  fault  of  the  times,  than  of  the  men,  it  would  have  feem’d  to 
be  the  peculiar  dudy  of  Bonetus,  in  the  feventeenth  fedtion,  which  is  entitled 
de  Catarrho ,  to  root  out;  if  at  the  fame  time,  for  want  of  being  fufficiently 
deady  in  his  purpofe,  he  had  not  interfpers’d  fome  things,  here  and  there, 
which  patronize  this  dodrine.  Thefe  you  will  find  in  leveral  places,  but 
particularly  in  a  certain  prolix  fchoiium,  which  being  taken  from  Willis,  he 
fubjoin’d  to  the  eighth  article  of  the  appendix,  to  obfervation  the  fixteentb, 
as  if  he  had  not,  already,  given  a  part  of  the  fame  fchoiium,  even  in  the 
former  fedion,  under  obfervation  the  fixth,  and,  perhaps,  in  other  places  •, 
and  as  if  he  had  not  made  obfervation  the  leventh,  out  of  a  part  of  that 
fchoiium,  in  this  very  feventeenth  fedtion.  But  it  is  diffident  for  me,  who 
am  not  fond  of  repeating  what  has  been  faid  before,  to  admonifh  you,  that 
on  whatfoever  feat  of  the  body,  the  ancients  thought  a  catarrh  might  flow 
down,  that  part  is  always  furnifli’d  with  glands  of  its  own,  which  difcharge 
a  larger  quantity  of  humours  than  natural,  and  has,  likewife,  its  own  veflfels, 
from  which  thele  humours  flow  out,  betwixt  the  fibres  and  membranes  ;  To 
that  there  is  no  occafion  to  fetch  them  fo  far  as  from  the  brain,  and  brino- 
them  down  through  impervious  way-s.  This  will  be  made  manifed  in  other 
places  :  but  here  it  may  be  in  part  underdood  ;  fird,  indeed,  from  the 
things  which  I  (hall  hint  of  the  dileafe,  that  is  call’d  the  fuftocating  catarrh  ; 
and,  in  the  next  place,  from  the  greater  number  of  things,  which  I  fhali 

immediately 


Letter  XIII.  Articles  2,  3.  275 

immediately  add,  concerning  the  affections  of  the  eye  ;  of  which  the  nex% 
and  eighteenth  fedtion,  of  the  Sepulchretum,  treats. 

2.  That  the  term  Catarrhus  fujfocativus ,  or  prafccativus ,  “  is  not  to  be 
tc  found  in  the  monuments  of  the  Greeks,”  but,  finally,  in  the  interpreter 
of  Mefue,  Valefco  de  Taranta,  Savonarola,  and  others  more  modern,  you 
will  know  from  Schneider  (a)  ;  who  will  alfo  teach  you,  how  many  different 
difeafes  it  lignifies,  among  different  perfons  :  or,  if  you  cho  Fe  to  avoid  fo 
long  and  tortuous  a  ledtion,  the  obfervation  under  number  eleven,  and  four¬ 
teen,  and  thofe  two  which  are  fubjoin’d  to  this  lad,  in  the  feventeenth  ledtion 
of  the  Sepulchretum,  will  partly  point  out  to  you,  the  fubftance  of  it. 
Some  of  them  are  laid  to  be  the  effect  of  corrupt  lungs;  lbme,  of  a  flaccid 
brain  ;  and  others  of  polypi  of  the  heart,  or  brain.  The  effedt  of  which 
caufes,  and  others  whatloever,  that  are  able,  in  reality,  to  bring  on  fuffbca- 
tion  fuddenly,  or  the  danger  of  it,  I  do  not  believe,  feems  equally  worthy 
of  the  name  of  catarrh,  as  an  effedt  of  that  univerfal  conflitution  of  glands, 
in  the  afpera  arteria;  fo  that  they  difcharge  a  great  quantity  of  humour  in  a 
fhort  time,  efpecially  if  the  bronchia  are  already  either  half-full  of  a  humour  of 
that  kind,  or  from  any  other  caufe  whatever,  half-clos’d  and  obftrudted. 
For  a  large  and  fudden  defluxi  m  of  that  humour,  whether  it  be  from  a 
laxity,  or  from  a  plenitude,  of  thofe  glands,  turgid  from  any  caufe  what¬ 
ever,  with  a  great  quantity  of  blood,  may  not  only  occaflon  a  fenfe  of  a  ca¬ 
tarrh,  as  if  it  were  flowing  down  from  the  head,  upon  them,  but  may  really 
fuflocate.  Turn  now  to  the  fcholium  on  obfervation  the  fourteenth,  and, 
in  like  manner,  to  the  latter  part  of  the  fcholium  to  number  fixteen,  and  you 
■will  find,  that  I  follow  Willis,  and  Fernelius ;  the  latter,  in  that  I  require, 
at  the  fame  time,  an  infardlion  of  the  lungs,  and  defluxion,  to  make  up  a 
fuflbcating  catarrh  ;  and  Willis,  in  that  I  do  not  deduce  the  defluxion  from 
the  head  ;  nor  yet,  immediately,  from  the  veffels  of  the  larynx,  and  the  other 
parts  of  the  alpera  arteria,  but  from  the  glands,  which  are,  elfewhere,  de¬ 
scrib’d  in  both.  And,  to  a  fuflbcating  catarrh,  thus  explain’d,  1  fhould  be¬ 
lieve,  that  the  death  of  a  man,  moll  eminent  for  his  piety,  nobility,  and 
dignity,  was  to  be  imputed. 

3.  J.  Giovanni  Francefco  BarBadici,  a  cardinal  of  the  holy  church  of  Rome, 
and  bifhop  of  Padua,  being  almoft  feventy-two  years  of  age,  and  fubjebt  to 
catarrhs,  was  more  readily  taken  with  that  catarrhal  fever,  which  feiz’d  al- 
molt  every  body,  in  the  month  of  January,  1 730.  And  as  he  took  lefs  care 
of  himfelf,  than  others  did,  lie  was  one  of  the  few  who  perifh’d,  in  conie- 
quence  of  it.  For  he. found  himfelf  feiz’d  with  the  diforder,  in  the  night  of 
the  twenty-fecond  of  January.  Yet  he  role  on  the  next  morning,  being  a 
man  of  great  courage,  and  expos’d  himfelf,  frequently,  to  the  injuries  of  the 
air  ;  not  only  from  motives  of  the  public  office,  which  he  fuftain’d,  but 
trufting  alfo  in  his  ftrength,  which,  together  with  his  habit  of  body,  and 
colour  of  his  complexion,  feem’d  to  have  become  much  better,  even  than 
iffual ;  after  having,  two  months  before  this  time,  recover’d  from  a  fhort, 
but  molt  violent  fever  ( b ).  Fie  even  rofe  the  next  morning,  and  perform’d 
the  duties  of  his  facred  function ;  but  the  difeale,  in  the  mean  while,  grow- 

(a)  De  Catarrh.  1.  5.  f.  2.  c.  4.  (£)  Vid,  Epift.  49.  n.  30. 

ing 


N  n  2 


c  7  6  Book  I.  Of  Difeafcs  of  the  Head¬ 

ing  more  violent,  he  was  forc’d  to  take  to  his  bed  on  the  fame  day,  and  then 
fent  to  the  phyficians  for  the  firft  time.  But  out  of  three  of  us,  who  had 
been  with  him,  in  that  former  fever,  V allifneri  had  died,  feven  days  before, 
and  his  phyfician  in  ordinary,  and  I  ftill  languifh’d  under  one  common  dif- 
eale  ;  which  circumftances  I  relate  to  you,  for  this  reafon,  that  you  may  not 
wonder,  when  I  tell  you,  that  I  heard  fome  things  relating  to  the  diforder, 
lymptoms,  and  death,  of  the  patient,  and  all  that  relates  to  the  difieCtion 
of  him  after  death,  from  perfons  who  certainly  deferv’d  to  be  credited,  and 
whom  I  very  accurately  interrogated  upon  the  iub]eCt.  For  I  was  able  to- 
vifit  him  but  twice,  though  I  was  fent  for  feveral  times  over  ;  and  then  was 
carry’d,  not  without  conliderable  danger  to  myfelf,  to  this  very  great  man,, 
who  deferv’d  well  of  every  body.  My  firft  vifit  was  on  the  twenty  fifth  of  Ja¬ 
nuary,  and  my  fecond,  on  the  twenty-fixth  ;  and  I  heard,  that  he  flept  in  the 

night  after  firft  taking  to  his  bed  ;  and  that  he  had  expectorated  much,  and 

very  freely,  which  he  did  alfo  at  that  time  ;  the  matter  he  fpat,  being  very 
thick,  and  ting’d  with  a  kind  of  red  colour,  degenerating  into  yellow.  His, 
afpeCt  and  colour  were  natural,  his  cough  was  eafy,  and  he  could  lie  eafily 
on  either  fide,  when  he  pleas’d  ;  he  had  no  fenfe  of  weight,  pain,  or  heat 
in  his  breaft  j  his  thirft  was  flight',  his  tongue  moift,  and  white.  The  dis¬ 
charge  by  ft#ol,  was  in  every  refpeCt,  like  that  of  a  healthy  body.  His 
urine  was,  by  reafon  of  the  coldnefs  of  the  feafon,  already  turbid,  but, 

which  was  the  only  thing  1  could  judge  of,  without  any  high  colour..  His 

underftanding  was  quick  •,  but  when  he  fought  for  a  particular  word,  he  did 
not  call  it  to  mind.  His  pulfe  was  neither  weak,  nor  finall,  but  even  ftrong 
and  great :  not  hard  ;  but  fomewhat  tenfe  and,  at  the  fame  time,  very  fre¬ 
quent.  The  refpiration  was  fuitable  to  fuch  a  pulfe ;  and,  with  it,  was  a 
kind  of  bubbling  noile,  as  if  the  catarrh  was  boiling  in  the  lungs.  It  was 
now  manifeft  to  all,  not  only  to  the  phyficians,  that  the  diforder,  which  had 
been  defpis’d  on  the  firft  days  of  its  appearance,  had  degenerated  from  its 
nature,  and  was  become  grievous,  and  dangerous,  and  not  flight,  as  it  feem’d 
to  the  patient  only,  which  was  by  no  means  pleafing  to  me.  But  the  day 
after,  l  was  ftill  more  difpleas’d  with  the  fame  judgment,  which  the  patient 
gave  of  his  own  difeafe,  when  I  heard,  that  he  had  pafs’d  the  night  without 
fleepj  and  that  his  expectoration,  which,  in  the  middle  of  the  day,  had 
become  white,  and  been  in  little  quantity,  was,  at  that  time,  none  at  alkj 
and  faw,  that  his  refpiration  was  much  more  frequent,  and  deep-fetchkk 
notwithftanding  they  had  taken  pains  to  raife  him  up  a  little,  by  putting  pil¬ 
lows  under  his  neck  and  back  •,  that  his  thirft  was  encreas’d,  fo  as  to  make 
him  wifh  for  cold  water  ;  and  his  ftomach  languid,  fo  that  he  afk’d  for  a  lit¬ 
tle  wine.  For  though  he  was,  in  other  refpeCts,  as  he  had  been  the  day  be¬ 
fore  ;  and  the  pulfe  was  even  foft,  lefs  frequent,  and,  at  the  fame  time,  fuffi-- 
ciently  large  and  ftrong  •,  yet  we  were  very  folicitous  on  account  of  the  otheF 
fymptoms  j  and  on  account  of  this,  in  particular,  that  his  cough  continu’d 
violent  as  before,  yet  he  expe&orated  nothing.  Therefore,  going  away 
fufpended  in  my  mind,  and  even  fad,  and  foretelling  every  thing  that  was 
bad,  unlefs  his  expectoration  return’d,  I  recommended  many  things  to  the 
phyficians  ;  but  efpecially  this,  that  they,  who  were  well,  Ihould  vifit  him 
often  j  and  Ihould  ailift  him  as  occafion  requir’d,  according  to  cuftom  *,  and, 

moreover,,. 


\ 

Lettex*  XIII.  Article  4.  277 

moreover,  in  the  manner  that  had  been  agreed  upon,  among  us.  One  of 
them  return’d  foon  after,  nor  found  any  appearance  of  his  being  worfe. 
Two  others  came  alfo,  ^within  the  firfb  and  i’econd  hours  of  the  night,  and 
found  that  the  pulfe  was  dill  better,  and  that  he  had  even  expectorated  a 
littie  :  but  it  was  mot  an  hour  after  they  were  gone,  and  not  even  many  mo¬ 
ments- o~f  time,  after  feme  other  men  had  left  him,  not  phyficians,  indeed, 
but  perfons  accuftom’d  -ta.be  very  long,  and  attentively,  about  the  patient; 
who  having  obferv’d  no  change  at  all,  had  gone  to  lie  down  in  the  next 
chamber;  when  the  patient,  itooping  down,  to  lift  up  fotnething  which  had 
fall’n  from  the  bed,  but  not  being  able  to  reach  it,  call’d  up  his  fervant 
from  the  little  bed  that  was  by  him..  Who  running  to  him,  and  placing  his- 
mafter  in  his  former  fituation,  he  laid  it  was  not  poflible  for  him  to  continue 
in  it,  but  would  be  rais’d  up,  that  he  might  breathe  better  ;  and  both  of  them 
found,  that  death  was  at  hand.  Wherefore,  the  fervant  who  was  able, 
calling  for  help  with  a  loud  voice,  a  prieft  immediately  came  to  him,  who 
found  him  dying  indeed,  but  perfe&ly  in  his  fenfes,  touching  his  own  breaft, 
as  well  as  he  could;  with  his  trembling  hand,  and  marking  out  the  form  of 
a  crofs  thereon,  while  his  fault’ring,  but  pious  voice,  now  and  then,  inter¬ 
pos’d  the  molt  facred  murmurs.  And  in  this  manner,  very  foon,  as  he  had, 
above  all  things,,  wifh’d,  did  this  prelate,  who  was  worthy  of  a  much  longer 
life,  breathe  his  laft,  in  the  arms  of  the  prieft,  having  fcarcely  completed  the 
fourth  day,  from  the  beginning  ot  the  difeafe. 

The  body  being  differed  for  embalming,  nor  being  found  without  fat ; 
the  brain,  and  all  the  vifeera  of  the  belly,  appear’d  to  be  found,;,  except 
that  the  liver  feem’d  to  be  very  large,  brownifh,.  and  fomevvhat  hard  ; 
but,  without  doubt,  this  was  natural,  fince  there  had  been  no  peculiar 
mark  of'  this  vifeus  being  difeas’d,  either  in  this  diforder,  or  before.  And,, 
without  doubt,  the  fpine  of  the  thorax  having  been  diftorted,  from  the 
time  of  his  being  a  boy,  fo  as  to  refemble  the  letter  S,  made  one  of  its  ca¬ 
vities  much  more  ftreight  and  confin’d  than  the  other;  and  confequently, 
the  lobe  of  the  lungs  contain’d  in  it,  was  lefs.  Yet  into  neither  cavity  was>. 
any  fluid  extravafated.  There  was  nothing  polypous  in  the  heart.  The 
'  lungs  had  their  furfaces  quite  free,  and  unconnected  to  the  ribs,  and  the 
diaphragm,  which  was  found.  But  the  external  furface  of  them  was  whitifh,. 
and  had  the  appearance  of  being  fmear’d  over  with  a  kind  of  vernice ,  or 
varnifh,  as  we  call  it,  which  was  inclin’d  to  a  milky  colour.  The  lungs 
themfelves  were  heavy  ;  but  from  the  catarrhal  defluxion  that  they  con¬ 
tain’d,  which  burft  forth  in  great,  quantity,  from  the  bronchia,  wherever 
you  cut  into  them.  And  certainly,,  the  whole  of  their- fubftance  was  fo  far.* 
from  being  denfe,  or  compaCt,  that  it  was  found  to  be  flaccid. 

4.  If  you  compare  this  hiftory  with  what  I  have  hinted  above,  in  regard 
to  the  fuffocating  catarrh  (c),  you  will  certainly  explain  it  in  a  manner  agree¬ 
able  to  my  opinion.  A  great  quantity  of  the  catarrhous  humour  was  now 
in  all  the  bronchia  of  the  lungs,  as  the  dififeftion  has  confirm’d ;.  fo  that 
fhining  through  the  thin  membrane  on  the  furface,  the  lungs,  for  this  rea- 
fon,  I  fuppofe^  feem’d  to  be  fmear’d  over  with  a  white  varnifh.  Nothing: 


(<r)  n.  3* 


at:  alii 


2  7' 8  Book  I.  Of  Difeafes  of  the  Head. 

at  all  of  this  mucus  could  be  thrown  up  on  the  laft  day  of  his  difeafe,  as  the 
lungs  were  then  growing  more  and  more  flaccid.  And  to  this,  by  reafon  of 
the  fudden  and  improper  motions  which  he  us’d,  another  difficulty  was  ad¬ 
ded  •,  whether  it  was  from  a  defluxion,  falling  down  from  the  larynx,  and 
fu  perior  parts  of  the  afpera  arteria  •,  or  whether  it  happen’d  on  account  of  that 
inclination  of  the  fpine,  by  a  humour  devolving  from  the  lobe,  which  w’as 
perhaps  already  too  full,  and  therefore  ufelefs,  to  the  other,  which  was  half¬ 
full,  and  by  which  refpiration  had  been  hitherto  preferv’d :  and  it’  this  lobe 
was  much  lefs  than  the  other,  you  very  well  conceive  how  eafily  and  how 
foon,  even  from  a  fmall  quantity  of  humour,  which  partly  fell  fuddenly 
upon  it,  in  this  manner,  and  partly  continu’d  to  flow  down  from  above,  this 
lobe  alfo,  might  be  render’d  ufelefs.  And  thus  you  will  explain  his  fudden 
death :  which  to  account  for  from  an  apoplexy,  as  fome  chofe  to  do,  in  the 
cafe  of  a  mod  ferene  prince  (ff),  would  be  much  lefs  allowable  here,  be- 
caufe,  befides  “  fenfe  and  voluntary  motion  being  found,  and  perfect,  even 
“  to  the  very  laid  breath,  together  with  the  fpeecb,  which  all  phyficians  give 
“  their  aflfent  to,  as  the  mod  certain  figns  whereby  a  fuffbeating  catarrh  is 
“  to  be-didinguiffi’d  from  an  apoplexy,”  there  was  no  mark  of  difeafe  in  the 
brain.  In  that  prince  alfo,  “  the  fpine  of  the  back  was  like  to  the  letter  S,” 
and  from  the  lungs,  when  cut  into,  iflfu’d  “  a  pituitous  and  whitifh  hu- 
“  mour which  being  confider’d,  other  phyficians,  who  thought  more 
rightly  of  the  cafe,  quoted  the  opinion  of  Heucherius :  “  We  are,  in  pariicu- 
“  lar,  to  fuppofe  that  thofe  are  fuffocated  by  a  catarrh,  in  whom  the  ferum, 
“  or  lymph  of  the  blood,  being  vitiated  from  any  caufe  whatever,  very  co- 
“  pioufiy  occupies  the  organs  of  refpiration,  and  obdinately  dagnates  in  the 
“  bronchia  and  veficles  of  the  lungs.” 

And  in  our  patient  there  was  no  polypus  of  the  heart,  which  formerly  you 
would  have  accus’d,  in  conjunction  with  others:  although  I  ffiall  tell  you  in 
another  place  (e),  what  1  think  of  polypi  of  the  heart,  and  it  were  fufficient 
at  prednt  to  produce  the  opinion  of  a  learned  man  (/),  who  acknowledges 
them,  but  difients  from  thofe  w  ho  account  for  fuffocating  catarrhs  therefrom. 
“  The  caufe,”  fays  he,  “  in  fuffocative  catarrhs  is  evidently  enough  per- 
“  ceiv’d  externally  by  the  ear,  while  the  vifeidity,  being  copioufly  carried 
“  down  into  the  bronchia  of  the  lungs,  renders  the  refpiration  fonorous,  fo 
“  that  the  matter  of  the  catarrh  feems  in  them  to  be  as  it  were  boiling. 
“  Then,  after  death,  when  the  diffection  is  perform’d,  the  caufe  of  the 
“  fuffocating  catarrh  occurs  to  the  eyes,  and  the  hands,  while  the  bronchia 
“  are  found  to  be  almod  univerlally  fill’d  with  vilcidities  ”  Wherefore  there 
was  in  this  mod  eminent  prelate,  a  fuffocating  catarrh  ;  I  had  almod  faid 
fuch  a  one  as  that  was,  of  which  the  celebrated  Jo.  Seb.  Albrecht  (g),  when 
fpeaking  of  a  woman  of  fixty,  in  another  epidemical  catarrh,  has  written  thus: 
“  She  died  fuddenly,  of  a  fuffocating  catarrh,  which  fucceeded  to  a  perip- 
“  neumonic  fever.”  For  in  our  cafe,  not  only  the  principal  figns  of  a  pe- 

(d)  Hift.  vide  in  Append.  Vol.  7.  Adi.  N.  (t J  Adi.  modo  citator.  Vol.  4.  in  Append 

c.  n.  X.  n.  IV.  §  7. 

(0  Epift.  24.  (g)  Commere.  Litter.  A.  1743,  hebd.  14. 

n.  1.  in  iin . 


ripneumonic 


Letter  XIII.  Article  j*.  27  9 

ripneumomc  fever  were  wanting  in  the  pat  ent,  while  living,  but  alfo  that 
peculiar  mark  of  dileale  in  the  lungs  after  death,  which  1  lhall  fpeak  of 
hereafter  ( h ). 

But  this  epidemic  conftitution  of  ours,  which  was  productive  of  catarrhal 
fevers,  began  in  a  cold  and  dry  air,  the  fky  being  for  a  long  time,  both 
night  and  day,  ferene  •,  which  Hate  of  atmofphere  fucceeded  to  a  long  couife 
of  conflant  rains,  fouth  winds,  and  a  warm  damp  leafon.  And  you  know 
Hippocrates  (?)  has  taught,  that  this  fucceffion  of  fe?/ons,  although  at  other 
times  of  the  year,  is  always  the  caufe  of  various  diforders,  among  which  he 
exprefsly  threatens  old  men,  “  with  defluxions  which  are  fpeedily  mortal.” 
And  indeed  forne  other  old  men  died  among  us  at  that  time,  though  few. 
But  people  in  general  were  feiz’d  promiicuoufly  of  every  age,  on  occafion, 
as  it  feem’d,  of  the  cold  air,  and  had  a  fever,  cough,  and  catarrhal  expec¬ 
toration  ;  but  all  thele  fymptoms,  if  not  negledted,  were,  for  the  mofb  part, 
flight,  fhort,  and  falutary.  And  I  cur’d  myfelf,  in  faCt,  in  the  eafy  manner 
which  I  fhall  tell  you  of  prefently,  and  which  I  was  then  wont  to  ufe,  if  at 
any  time  a  little  catan  hous  fever  feiz’d  me  in  the  winter ;  from  which  I  pre- 
ferv’d  myfelf,  and  my  family  afterwards,  even  when  it  recurr’d  epidemically, 
and  that  for  many  years  together,  by  ufing  no  other  vegetables,  by  way  of 
fallad  to  fupper,  in  the  winter,  than  boil’d  collyfiower.  But  as  to  the  me¬ 
thod  of  cure  •,  on  the  very  firft  figns  of  perforation  being  obftrudted,  and  a 
fever  coming  on,  I  went  to  bed,  and  was  cover’d  well  with  clothes,  and 
us’d  the  fafeft  of  all  remedies,  little  and  fluid  nourilhment;  for  in  the  morn¬ 
ing  I  drank  a  bafon  or  two  of  weak  broth  warm,  as  indeed  I  took  every 
thing  warm,  and  waited  quietly  till  it  fhould  go  off  by  the  fkin,  or  by  urine, 
or  by  both  ways  together*,  then,  moreover,  I  added  a  third,  and  a  fourth. 
Thus  the  fever  foon  remitted,  and  not  long  after  went  quite  off,  unlels  per¬ 
haps  I  was  fo  bold  as  to  rife  too  foon,  and  expofe  my  body,  while  it  was  yet 
weak  and  fenfible,  to  frefli  injuries  of  the  air.  Moreover,  I  heard  that  the 
fame  epidemical  conftitutiomhad,  almofl  at  the  fame  time,  fpread  wide  through 
t  rance  and  Germany  *,  as  I  have  read  of  other  diforders  of  this  kind,  as  re¬ 
lated  in  medical  writers  at'  other  times.  Some  of  which  are  mention’d  by 
Jo.  Godfr.  Bergerus,  in  the  diflertation  ( k )  that  he  formerly  fet  forth  under 
his  uncle  Fafchius;  to  wit,  “  That  epidemical  catarrhs,  fuch  as  in  the  year 
“  1675,  rag’d  through  almoft  all  Germany  and  France,  as  obferv’d  by  Fo- 
“  reflus,  book  the  fixth,  obfervation  the  third,”  (that  is,  through  Holland, 
Germany,  and  France,  in  the  year  1580)  “  and  the  fame  have  been  obferv’d 
“  by  Valefco  de  Taranta,  at  Montpelier,  in  the  year  1387  in  which  very 
year  indeed,  even  in  the  place  of  my  nativity,  fo  far  dilfant  from  France,  in 
the  month  of  January,  epidemical  coughs,  with  catarrhs,  and  flow  fevers, 
were  fo  general,  as  to  fpare  nobody,  although  they  kill’d  few,  as  the  hifto- 
rical  monuments  of  my  country  (/)  teftify. 

5.  Hitherto  you  have  feen  the  catarrh,  whereof  the  feventeenth  feflion  of 
the  Sepulchretum  treats,  explain’d,  without  fuppofing  a  defluxion  of  hu- 

( b )  Epift.  20  &  2i.  -  (/)  Marcheli  Supplem,  Iilor.  di  Forli  1.  6, 

(;)  Sett.  3.  Aph.  12.  all’A.  1387. 

(i)  De  Circul.  Lymphas  c.  2.  §  7, 


mours 


280  Book  I.  Of  Difeafcs  of  the  Head. 

mours  from  the  brain.  And  you  will  now  obferve,  whether  I  make  ufe  of 
this  defluxion,  to  explain  the  diforders  of  the  eyes,  of  which  the  eighteenth 
feftion  treats.  And  efpecially  in  explaining  that,  to  which  the  firft  obferva- 
tions  relate,  I  mean  the  amaurofis,  which  was  formerly  term’d  by  barbarians 
gulta  ferena  ;  ferena ,  becaufe  we  then  fee  the  eyes  clear,  and  without  any 
diforder  that  is  perceivable  by  the  fenfes,  if  you  except  the  pupil  being,  for 
the  mold  parr,  larger  than  ufual,  and  almoft  immoveable;  and  it  was  call’d 
gutta ,  becaufe  phyficians  made  no  doubt,  but  that  an  obftrudting  tumour 
falls  down  from  the  brain  upon  the  optic  nerves,  from  whence  they  alfo  con¬ 
cluded,  that  this  diforder  always  attack’d  fuddenly.  Neither  of  which  is  ne- 
ceflary ;  for  that  they  alfo  happen  by  degrees,  the  obfervations  of  Brunne- 
rus  (w),  Laubius  (»),  and  Kaltfchmied  (0),  teach  us,  befides  others,  two  of 
which  you  have  in  the  Sepulchretum  (p),  wherein,  if  you  conflder,  more¬ 
over,  the  nature  of  thofe  caufes,  which  have  produc’d  an  amaurofis,  you 
will  eaflly  perceive,  that  even  what  I  have  faid  is  confirm’d  thereby  ;  and 
they  who  would  fometimes  willingly  find  out  obftruftion  to  be  the  caufe  of  this 
diforder,  may  look  for  it  in  thole  parts  of  the  brain,  whence  lpirits  are  car¬ 
ried  into  the  optic  nerves.  Nor  indeed  was  it  the  opinion  of  JPlaterus  him- 
felf,  and  Spigelius,  unlefs  very  rarely,  that  an  obftrudtion  of  thefe  nerves 
fhould  be  accus’d,  in  this  diforder  of  ours,  as  you  will  learn  from  the  fcho- 
lia,  that  are  added  to  thofe  obfervations,  which  I  juft  now  pointed  out  in 
the  Sepulchretum.  And  you  will  even  fee  Platerus  has  taught  us,  that  the 
caufe  of  an  amaurofis,  which  frequently  follows  violent  and  frequent  con- 
vulfions,  “  is  not  to  be  deduc’d  from  an  afflux  of  humour,  as  others  would 
“  have  it,”  but  that  it  is  to  be  accounted  for  from  convulfions  of  the  eyes 
themfelves ;  for  that  the  eyes  are  then  alfo,  together  with  the  other  parts, 
“  often  diftorted  and  convuls’d,  and  at  the  fame  time  very  much  thruft  out- 
“  wards,  and  infledted,  the  optic  nerve,  which  is  attach’d  to  them,  being, 
“  by  this  means,  too  much  ftretch’d,  and  dragg’d  out,  and  in  confequence 
“  thereof,  diftorted  and  injur’d.”  Which  dodtrine  may  feem  to  be  con¬ 
firm’d,  in  fome  meafure,  by  another  obfervation,  that  you  will  read  a  little 
afterwards  (^),  in  which  “  both  the  optic  nerves  ”  were  found  to  be  “  not 
“  obftrudted  or  ftreighten’d,  but  diftorted,”  whereas  the  amaurofis  had  hap¬ 
pen’d  “  from  childhood  in  which  age,  doubtlefs,  convulfions  happen  the 
moft  frequently,  according  to  that  aphorifm  (r)  of  Hippocrates  himfelf. 
But  I  have  already  declar’d  in  a  former  work  ( s ),  when,  and  how  far,  I 
think,  we  are  to  give  credit  to  explications  of  this  kind  ;  where  many  ex¬ 
amples  are  alfo  produc’d  of  an  amaurofis  arifing  from  convulfions,  and  go¬ 
ing  away  after  thefe  are  overcome.  And  I  would  not  encreafe  the  number 
of  thefe  here,  fince  you  may,  of  yourfelf,  in  the  volumes  of  the  Adta  Cre- 
fareas  Academiae  alone  (/),  and  efpecially  in  the  Parallelifmus  of  Lentilius  (#), 
find  a  great  number  more.  It  is  enough  to  add  this  to  what  I  then  wrote. 
When  an  occafion  having  there  offer’d  (x),  by  a  double  amaurofis  of  this 


■{ m )  Eph.  N.  C.  Cent.  1.  obf.  69. 

(«)  Earund.  Cent.  7.  obf.  39. 

( 0 )  Progr.  de  Nervis  Optic.  &c. 

XpJ  Obf.  I  &  5.  (?)  Obf.  8. 

(rj  25.  Sed.  3. 


( s )  Epift.  Anat.  18.  n.  3.  &  feqq. 

(/)  ut  Cent.  1.  obf.  78.  Sc  130.  Ad.  Vol.  3. 
obf.  44.  &  Dec.  3.  A.  9.  obf.  36. 

(«)  Dec.  ead.  A.  7.  in  Append,  n.  10.  ad 
obf.  50..  (*)  n.  7. 

kind 


Letter  XIII.  Article  5.  281 

kind  being  deferib’d  from  the  papers  of  Valfalva,  another  was  mention’d  by 
me  in  a  certain  matron,  which  was  the  confequence  of  a  wound  “  above 
the  eye-brow,”  flight  in  appearance-,  and  the  fame  was  explain’d  from  an 
injury  done  to  the  ophthalmic  branch  of  the  fifth  pair  of  nerves,  as  it  goes 
out  from  the  orbit,  and  aicends  over  that  to  the  forehead,  according  to 
what  was  faid  before  concerning  the  convulfive  conftridtion  of  the  optic 
nerve  and  that  an  explication  of  this  kind,  alio,  might  be  in  great  mea- 
fure  accommodated  to  that  paflage  in  the  Ccac<e(y)  of  Hippocrates,  <H 
o-\iv  cty.cLvfivTd.1,  &c.  that  is,  “  but  the  fight  is  obfeur’d  in  wounds  which 
“  are  inflicted  on  the  eye-brow,  or  a  little  higher.”  And  you  may  fee,  in 
what  manner  Jacobus  Hollerius  (2),  Defid.  Jacotius  (a),  and  Ludovicus  Du- 
retus  (£),  have  endeavour’d  to  account  for  the  caufe  of  this  amaurofis,  in  their 
commentaries  on  the  paflage. 

But  whether  there  can  be  room  for  that  explication  of  mine,  in  the  amau¬ 
rofis  alfo,  which  is  deferib’d  by  Elias  Camerarius  (c),  I  would  have  you  your- 
felf  think  and  determine.  For  although  that  hiftory  contains  many  things, 
the  caufe  of  which  you  certainly  can  with  fo  much  the  lefs  eafe  comprehend, 
as  it  is  lefs  determin’d  how  far  the  wound  at  length  reach’d  ;  yet,  as  it  was 
infii£t?d  exadfly  “  on  the  internal  canthus  of  the  left  eye,  and  on  the  con- 
“  fines  of  the  upper  eye-lid,”  you  plainly  fee,  that  nervous  twigs  from  this 
fame  ophthalmic  branch,  of  the  fifth  pair,  come  to  that  place  j  as  the  table  of 
ail  the  nerves  of  the  face,  which  was  prepar’d,  with  the  molt  confummate  di¬ 
ligence,  by  that  excellent  profefior  of  anatomy,  Meckel,  and  publifh’d  by 
the  famous  and  royal  Academy  of  Sciences  at  Berlin  (d\  very  clearly  de- 
monftrates.  And  all  thele  things  1  am  the  more  pleas’d  to  have  added  here, 
becaufe  when  I  revis’d  this  letter,  I  found,  from  books  that  were  brought  to 
me,  much  later  than  I  would  have  had  them,  that  very  celebrated  men,  who 
with  great  honour  took  notice  of,  and  explain’d,  the  obfervation  of  Valfalva, 
and  even  mine,  on  an  amaurofis  of  this  kind,  did  not  omit  the  mention  of 
Hippocrates.  Nor  did  the  illuftrious  Archiater  Nicholaus  Rofen  (t?)  alone 
do  this,  but  even  the  molt  learned  author  Platnerus  (/),  when  he  was  living, 
had  done  it  more  at  large  in  the  year  1741  ^  fo  that  he  neither  omitted  to 
mention  the  obfervation  of  Elias  Camerarius,  nor  the  three  interpreters  of 
that  paflage  of  the  Cosca,  whom  1  nam’d  juft  now  Martianus  being,  more¬ 
over,  added,  whole  interpretation  of  the  paflage  I  have  not  yet  been  able 
to  find,  in  the  place  where  it  ought  to  be.  And  among  the  diflertations 
which  I  lately  read,  was  that  of  Jo.  Bened.  Godofr.  Oehme  (g),  which  if  you 
will  read  over,  you  will  be  able  to  colledt  other  caufes  of  the  amaurofis,  many 
of  which,  indeed,  but  not  all,  I  undertook  to  mention  here  and,  befides 
thofe  you  have  there,  to  add  to  the  Sepulchretum,  the  difledtion  (h)  of  a 
young  man,  who  died  after  this  difeafe,  communicated  to  the  learned  pro- 


(y)  Sea  3. 

(z)  Comment,  in  Coae.  1.  1.  f.  3,  19. 

(«)  Ibid. 

(&)  In  Coac.  !.  3.  tr.  2.  c.  2,  12. 
ft)  Eph.  N.  C.  Cent.  3.  obf.  55. 
ftO  Hiiloire  a.  1752.  Claff.  de  Philof.  Ex- 
perim. 

VOL.  I.  ( 


ft)  DiiTert.  de  Offib-  Calvar,  p.  1,  §  16.  & 
not.  p. 

(f)  Vid.  'A6I.  Erudit.  Lipf.  a.  175 1,  m. 
Sepr.  p.  2.  ad  pag.  Probuf.  167,  &  feqq. 

(g)  DeAmaurofi. 

CO  §  8. 

o 


fefifor 


282  Book  I.  Of  Difeafes  of  the  Head. 

fefior  Gunzius,  who  was  then  living,  by  a  phvfician  at  Copenhagen  ;  as,  in 
like  manner,  an  explication  of  the  obfervation  of  Vallalva,  and  others  like 
that  (/').  And  I  would  have  you  oblerve,  that  where-ever  the  ciliary  nerves, 
being  drawn  into  confent,  are  luppos’d  to  help  forwards  the  explication  of 
amaurofes  obferv’d,  and  defcrib’d,  by  Vallalva  or  me,  it  is  not  that  they  are 
to  be  confider’d  as  having  already  enter’d  the  eye,  in  which  at  that  time  no 
diforder  was  feen  belonging  to  the  iris,  but  as  clofely  accompanying  the  invo¬ 
lucra  of  the  optic  nerve,  and  as  being  able  to  comprefs  them,  if  they  are 
diftended  themfelves,  either  by  diftending  them  alfo,  or  at  the  fame  time 
conftrirging  them,  together  with  the  included  marrow  of  the  nerve. 

6.  Moreover,  there  are  ftill  other  caufes  which  comprefs  the  optic  nerves, 
and  therefore  bring  on  an  amaurofis,  taken  notice  of  in  the  Sepulchretum, 
and  confirm’d  alfo  by  medical  obfervations  ( k )  j  as,  for  inftance,  too  great  a 
quantity,  and  turgefcency,  of  blood,  lweliing  the  arteries  and  veins,  which 
internally  and  externally  accompany  the  foft  iubftance  of  thele  nerves.  And 
this  explication  is  rightly  us’d  by  Boerhaave  (/),  in  order  to  explain  the  amau¬ 
rofis  of  Aetius,  which  “  follows  after  a  phrenzy,  and  other  very  hot  diforders 
“  of  the  head  nor  would  he  ule  it  improperly,  who  fhould  thus  explain 
thole  examples  of  women,  whom  Kolfinc  mentions  (m),  44  who,  as  6ften  as 
44  they  were  pregnant,  v/ere  always  blind,  to  the  very  time  of  their  delivery  f* 
or  others,  which,  with  the  celebrated  Heifter  («),  we  muft  refer  to  the  fame 
clafs.  To  this  Wepfer  (0)  has  added,  44  that  a  humour  diflilling  ”  from  the 
veffels  which  I  mention’d  juft  now,  44  was  fometimes  the  caufe  of  a  gutta 
“  ferena.” 

But  you  will  fee  fome  very  clear  inftances  of  that  comprefiion  of  the  optic 
nerves,  from  which  an  amaurofis  arifes,  produc’d  in  the  Sepulchretum  ;  as 
when  (p)  a  large  and  violent  kind  of  ftruma  was  generated  in  the  anterior 
part  of  the  brain,  and  upon  the  very  origin  of  the  optic  nerves  (to  wit,  being 
more  evident  than  their  origin,  and  more  readily  occurring  to  the  eye) ;  or 
w'hen  (q)  a  remarkable  bladder,  full  of  the  molt  limpid  watry  matter  44  had  oc- 
44  cupiecl”  thole  nerve^  44  about  their  crucifixion,”  that  is,  where  they  are  join’d 
one  with  another.  But  that  obfervation  is  not  equally  eafy  to  be  explain’d, 
in  which  (r)  the  caufe  of  blindnefs  is  laid  to  be  found  to  have  been  44  a  ftone, 
44  of  the  bignefs  of  a  pea,  in  the  origin,  and  even  in  the  very  fubftance,  of 
44  the  optic  nerves  unlefs  you,  perhaps,  underftand,  that  there  was  a  like 
ftone  on  each  fide  ;  for  one  of  that  fmallnefs  could  not  be  in  the  fubftance  of 
both  the  nerves,  and  prefs  upon  the  origin  of  both,  whether  you  mean  that 
maniftft  part  of  them  which  is  fpoken  of  now7,  or  the  other  that  is  more 
internal.  Which  internal  fubftance  was,  as  1  very  well  conceive,  comprefs’d 
in  that  cafe  of  blindnefs,  where  (s)  a  tumour,  44  of  the  bignefs  of  a  fift,  lay 
44  betwixt  the  cerebrum  and  cerebellum  and  from  the  fame  tumour,  in  faff, 
not  from  that  little  ftone,  I  conceive,  that  death  was  brought  on.  But  left 
you  ihould,  perhaps,  object  to  me  another  obfeivation  (/),  in  which,  although 


(/)  Ibid. 

(<£)  Append,  ad  obf.  2.  hujus  fed. 
(/)  Preeled.  Inft.  §  516. 

(m  Difp.  de  Gutta  Serena,  c.  5. 
(»)  DilT.  de  Amau.  n.  12. 


(0)  In  Additam,  ad  hanc  16.  feft.  obf.  3. 
(/>)  Ejufd.  fed.  obf.  1. 

(7)  Obf.  2.  (r)  In  Addit,  obf.  2. 

( s )  Ejufd.  fed.  obf.  10. 

(/)  Ibid.  obf.  14. 


both 


Letter  XIII.  Article  7.  283 

both  eyes  fuffer’d  a  diminution  of  fight,  yet  a  difeafe  of  any  confequence  was 
found  only  on  the  right  fide  of  the  brain;  or  that  very  observation  which  l 
have  already  («)  deforib’d  to  you,  in  which  the  fame  part  of  the  brain  only 
had  an  injury,  and  no  inconfiderable  one,  whereas  both  eyes  were  equally 
affeCted  with  an  amaurofis ;  I  would  have  you  read  both  obfervations  over 
again,  For  in  the  firft,  as  it  is  given  more  at  large  in  the  fecond  feCtion  (x), 
when  you  fhall  fee,  “  that  in  both  eyes  evident  beginnings  of  a  fuffufion 
“  might  be  feen,”  you  will  wonder,  perhaps,  why  it  was  not  foon  after 
pointed  out,  among  the  cafes  which  referr’d  to  fuffufion.  And  mine,  cer¬ 
tainly,  fhews,  that  fome  injury  was  not  wanting  even  on  the  left  fide  of  the 
brain,  fince  water  was  found  in  the  lateral  ventricle  of  that  fide,  in  great 
quantity. 

You  fee,  indeed,  in  the  Sepulchretum  (y),  that  compreffion  of  the  brain 
from  water  was  often  obferv’d  in  thofe,  who  had  been  affected  with  amau¬ 
rofis,  amblyopia,  and  blindnefs.  Or  if  you  fhould  think,  that  you  are  not 
l'ufficiently  fatisfy’d  by  this  reafoning,  as  you  may  poffibly  expeCt,  that  by 
reafon  of  the  water  urging  from  above,  whether  the  ventricles,  or,  what  is 
very  rare,  certain  oblong  facculi,  are  fill’d  therewith,  the  nerves  which  lie 
under  it,  fhould  appear  deprefs’d,  as  they  have  been  found  in  amauroles, 
from  caufes  of  the  fame  kind,  by  thofe  celebrated  men  Cheffelden  (2),  and 
Kakfchmied  (a) ;  do  but  attend  to  thofe  frequent  epileptic  convulfions,  which 
can  fo  eafily  pervert  the  internal  ftru&ure  of  both  optic  nerves  equally,  though 
this  perverfion  will  utterly  efcape  the  obfervation  of  the  fenfes. 

7.  But  you  think,  perhaps,  that  I  have  undertaken  a  very  needlefs  labour, 
by  encount’ring  difficulties,  and  doubts,  which  could  never  have  occurr’d  to  you. 
For  what  if  you  are  in  the  number  of  thofe,  who  think  that  the  optic  nerves 
are  not  only  join’d  one  with  another,  but  that  the  right  and  left  are  fo  blend¬ 
ed  together,  as  to  make  an  injury,  or  compreffion,  which  happens  above  the 
place  of  their  conjunction,  equally  common  to  both  of  the  eyes  ?  But  if 
you  fuppofe  this,  how  will  you  fay  it  happen’d,  in  the  obfervation  before 
mention’d  (£),  that  the  grievous  kind  of  flruma,  which  as  it  had  arifen  on 
the  left  fide- of  the  brain,  ought  to  have  equally  hurt  both  eyes,  yet  was,  at 
firft,  hurtful  only  to  the  left ;  but  after  that,  as  it  alfo  extended  itfelf  to¬ 
wards  the  right  fide,  became  injurious  to  the  right  alfo  ?  “  In  the  left 

“  eye  vifion  began  to  be  oblcur’d  ;  and,  after  a  month,  alfo  in  the  right  ’* 
And  moreover,  what  neceffity,  in  faCt,  can  there  be  forfuch  a  mixture,  if, 
which  you  have  even  in  the  Sepulchretum  (c),  from  Bartholin,  “  Vefalius, 
“  Aquapendente,  and  Valverda  have  fometimes  obferv’d,  that  the  optic 
“  nerves  remain’d  divided,  in  their  whole  courfe and  yet,  that  the  man, 
in  whom  Vefalius  faw  it  thus,  as  I  have  eifewhere  obferv’d  (d),  “  had  never 
“  complain’d  of  his  fight,  and  had  even  always  had  a  very  ftrong  fight  ?’* 
For  Valverdus  leems  really  not  to  have  aicertain'd  the  fad  in  his  cafes; 
and  our  Fabricius,  when  he  wrote  (e),  that  thefe  nerves  did  not  decuffate 

(z/)  Epift.  9.  n.  20.  ( b )  In  hac  feft. 

(x)  Oof.  j8.  (rj  Ibid.  obf.  26. 

(y J  Se£l.  hac  1 6.  obf.  7,  9,  12,  15.  (d)  Epift.  Anat.  16.  n.  14.  , 

(z)  Saggio  delie  Tranfaz.  & c.  T.  2.  p.  2.  (e)  De  oculo,  p.  3.  c.  11. 

(*?)  P  ogr.  cit,  fupra  ad  n.  5. 


O  O  2 


each 


284  Book  I.  Of  Diforders  of  the  Head. 

each  other,  as  “  anatomy  has  fometimes  afforded  the  moft  clear  teftimony, 
cc  fmce  they  have  been  found,  more  than  once,  not  join’d  together,  but  fepa- 
“  rated,”  may  feem,  perhaps,  to  Bartholin,  in  thefe  words,  to  have  referr’d 
to  his  own  obfervations  ;  though,  to  me,  he  feems  to  have  meant  no  other, 
than  the  obfervations  of  thofe  gentlemen.  But  the  obfervation  of  Vefalius 
is  of  fuch  a  kind,  as  even  of  itfelf  to  (hew,  “  that  out  of  fuch  a  number  of 
“  advantages  fuppos’d  from  this  conjunction,  of  whatfoever  kind  it  may  be, 
“  fcarce  any  one  is  found,  which  can  feem  fufficiently  probable,”  as  I  have 
laid  in  the  fame  place.  Nor  do  I  yet  retraCt  my  enquiry,  notwithftanding 
1  greatly  approve  the  reafon  of  that  celebrated  man  Daniel  Bemoullus  (/), 
why  thefe  nerves,  after  they  have  join’d  each  other,  are  infleCted  different 
ways;  for  it  by  no  means  neceffarily  requires,  that  they  fhou’d  be  join’d, 
much  lefs  mix’d,  together  ;  nor  is  the  fame  obfervation  of  Vefalius  repugnant 
thereto,  but  even  greatly  favourable,  fmce  though  he  defcribes,  and  deli¬ 
neates  them  (g),  feparate  from  each  other,  indeed,  he  neverthelefs  reprefents 
them  curv’d  in  fuch  a  manner  “  as  if  the  nerves  did  not  meet  together,  for 
“  the  fake  of  a  coalition,  but  that  they  might  conveniently  proceed  through 
“  their  forarnen,  out  of  the  fkull  into  the  orbit :  efpecially,  as  proceeding 
“  even  in  this  courfe,  they  are  not  inferted  into  the  middle  of  the  pofterior 
“  part  of  the  eye.” 

In  fhort,  purpofely  to  omit  other  things,  thofe  four  obfervations  of  Vefa¬ 
lius,  Csefalpinus,  Rolffnc,  and  Cheffelden,  which  are  commended  by  me  in 
the  fame  work,  by  no  means  agree  with  this  mixture  ;  which  obfervations 
Santorini  may  feem  to  have  forgotten  (£),  when  he  gives  his  own,  that  was 
fimilar  to  them,  in  fuch  a  manner,  as  if  he  thought  that  then,  for  the  firfb 
time,  the  contro.verfy  was  determin’d,  from  this  circumftance,  that  the  optic 
nerve,  which  belong’d  to  the  blind  eye,  as  it  was  in  the  orbit  •,  fo  in  like 
manner,  quite  up  to  its  origin,  it  was  more  (lender,  and  difcolour’d,  and 
remain’d  always  on  the  fame  Tide.  But,  of  how  much  weight,  in  that  con- 
troverfy,  obfervations  of  this  kind  are,  they,  whofe  hypothefes  are  contra¬ 
dicted  thereby,  fhew,  when  endeavouring  to  defend  their  hypothefes,  they  do 
not  put  the  faCts  fufficiently  beyond  a  doubt;  as  for  inftance,  Caefalpinus  (z), 
who,  to  fay  no  more,  fuppofes,  that  in  the  hemifphere  of  the  brain,  which 
he  neither  affirms  he  had  feen,  nor  the  others,  whom  I  have  mention’d,  faw ; 
nor  indeed,  as  the  caufes  were  different,  could  they  fee  ;  for  I  feem,  to  my- 
felf,  to  have  anfwer’d  fome  of  the  more  modern  ones  fufficiently,  in  the 
eighteenth  of  the  Epiftolte  Anatomicse  (k).  Yet  I  have  there  ingenuoufly 
confefs’d,  as  it  became  me  to  do,  that  being  very  defirous  of  repeating  an 
obfervation  of  this  kind,  and  as  I  could  not  do  it  on  a  human  fubjeCt,  by 
reafon  of  the  brain  having  been  buried  before,  having,  at  length,  made  the 
experiment  on  a  dog,  that  I  had  perceiv’d  the  diftinCtion  of  the  nerve,  which 
went  to  the  blind  eye,  quite  to  the  conjunction,  but  from  thence,  upwards, 
could  find  out  no  difference  at  all,  and  that  I  had  referr’d  the  reafon  of  this 
circumltance  to  the  blindnefs  not  having,  perhaps,  yet  continu’d  iong  enough. 
But  though  from  that  ume  I  pais’d  by  no  occafion  of  inveftigating  the  fubjeCt, 

(b)  Obf.  Anat.  c.  3.  n.  14. 

(/')  L.  2.  Quselt.  Med.  10.  (.£)  N.  40. 

and 


(f)  Comment.  Acad.  Sc.  Imp.  Petropol.  t,  1 . 
fgj  De  corp.  hum.  fabr.  J.  4.  c.  4. 


Letter  XIII.  Article  8.  285* 

and  happen’d  to  light  on  two,  the  fame  infelicity  ftill  follow’d  me  ;  as  you 
will  underftand  from  thele  oblervations,  which  I  fhall  immediately  fubjoin. 

8.  A  certain  man,  who  came  from  Tufcany,  and  who  was  almoft  deftroy’d 
by  a  very  large  and  foetid  ulcer  in  his  leg,  being  for  that  reafon  receiv’d  into 
this  hofpital,  died  about  the  middle  of  January  in  the  year  1740. 

I  had  begun  to  diffedt  the  head,  on  account  of  other  enquiries,  when  I  per¬ 
ceiv’d,  that  the  man  had  been  blind  in  one  eye  •,  but  from  what  caufe,  and 
how  long,  becaufe,  as  I  laid,  he  was  a  ftranger,  I  could  not  learn.  You 
will  conjedture,  from  the  defeription  of  the  eye.  The  left  eye  was  found 
neither  did  the  eye-lids  of  the  right  eye,  which  was  in  a  very  bad  Hate,  nor 
any  part  of  the  face,  or  head,  fhew  any  trace  of  a  foregoing  wound,  or  ulcer. 
But  there  was  much  fat  in  the  orbit,  as  there  generally  is,  with  mufcles  which 
were  pale  indeed,  but  by  no  means  fhrunk,  or  extenuated.  And  the  eye, 
being  contracted  into  icfelf,  was  lefs  even,  in  a  very  great  degree,  than  the 
left.  The  anterior  furface  of  it  was  white,  without  any  traces  of  the  cornea; 
and  was  divided  into  three  little  prominences,  in  fuch  a  manner,  that  you 
would  fuppofe  it  had  been  formerly  cut  into  three  different  ledtions.  Thefe 
prominences,  and  the  other  furrounding  parts  of  the  globe  of  the  eye,  and 
even  by  far  the  greatelf  part  of  the  fubftance  or-  the  eye,  were  made  up  of 
the  tunica  fclerotica,  which  was  harder  and  thicker  than  it  us’d  to  be,  in  con- 
fequence  of  its  being  contracted  into  itfelf.  The  fclerotica  alfo  included  the 
choroides,  which  was  equally  contradted,  and  was  even  at  that  time  moift  ^ 
but  there  was  nothing  befides  this  -,  fo  that  all  the  other  coats,  together  with 
all  the  humours,  feem’d  to  have  been  formerly  entirely  con  fum’d,  or  prefs’d 
out.  In  the  mean  while,  the  nerves  being  laid  bare,  not  only  in  both  orbits, 
but  within  the  fkull  alfo,  although  no  difference  appear’d  between  the  mo- 
tores  oculorum,  yet  the  greateft  difference  immediately  appear’d  between  the 
optic  nerves.  For  as  the  left,  in  like  manner  as  its  eye,  was  very  found, 
the  right,  on  the  contrary,  was  cineritious,  and  extenuated  to  a  very  great 
extent.  And  in  the  firft  place,  indeed,  from  the  eye  to  the  breadth  of  a 
finger,  or  a  little  more,  it  contain’d  nothing  of  a  nervous  fubftance,  but  only 
a  cineritious,  turbid,  glutinous,  and  thickifh  humour  ;  which  being  fqueez’d 
out  by  a  flight  comprefiion,  the  cavity  was  left  empty  ;  fo  that  the  coats  of 
the  nerve  feem’d  now  to  be  the  coats  of  fome  canal  -,  and  they  were,  as  in 
that  man  whom  I  fpoke  of  a  little  before  (/),  become  much  thicker  than 
ufual.  But  from  that  place  they  began  to  contain  a  fubftance,  which  was 
pretty  firm,  yet  of  a  cineritious  colour;  which  colour  the  nerve  preferv’d, 
both  inwardly  and  outwardly,  and  with  it  an  evident  flendernefs,  fo  far  as 
till  it  came  very  near  to  the  place  where  it  was  join’d  with  the  left.  And 
then,  fuddenly,  all  difference  betwixt  one  nerve  and  the  other  vanifh’d  away-, 
fo  that  the  right  was  now  perfectly  like  the  left,  both  within  and  without, 
before  it  reach’d  to  that  fituation  where  the  two  coalefc’d.  And  at  this 
junction,  not  only  upwards,  ev’n  to  the  origin,  whether  you  examin’d  the 
external  furface  diligently,  or  by  accurately  differing  the  nervous  fubftance, 
as  well  that  which  join’d  both  the  nerves  together,  as  that  which  kept  them 
feparate  and  diftindt,  there  was  nothing,  in  either  the  one  or  the  other,  which 


(/)  Vid.  Epift.  Anat.  18.  n.  40. 

4 


you 


286  Book  I.  Of  Difeafes  of  the  Head. 

you  would  not,  equally  on  both  fides,  acknowledge  to  be  natural.  And  this 
I  Tay,  not  only  from  my  judgment,  who  differed  the  fubjed,  but  from  the 
judgment  of  all  thole  who  were  prefent,  and  among  thefe  Mediavia ;  as  aifo 
in  a  woman,  who  was  diffeded  in  the  month  of  April,  in  the  following  year, 
and  of  whom  I  fhall  immediately  fpeak. 

9.  I  diffeded  the  head  of  a  woman,  whofe  lad  difeafe,  and  the  remaining 
circumftances  that  were  found  to  be  preternatural  in  her  diffedion,  I  lhall 
write  to  you  on  a  more  convenient  occafion  (m).  I  faw  the  left  eye  to  be 
not  larger  than  that  which  I  defcrib’d  on  the  right  fide  of  the  man,  but 
fomewhat  lefs  injur’d  in  its  fubftance.  For  it  had  a  cornea,  and  that  not  al¬ 
together  opaque  y  although  nearly  in  the  middle,  where,  perhaps,  there  had 
been  formerly  a  wound,  or  an  ulcer;  for  I  could  not  certainly  know.  It  ap¬ 
pear’d  fpotted  and  brown  ;  in  confequence  of  a  portion  of  the  uvea  adhering 
clofely  to  that  very  part  of  the  cornea,  and  Thining  through,  fo  as  to  re- 
femble  a  greater  diforder  in  the  cornea,  than  what  there  really  was.  The 
remaining  circumference  of  the  eye  was  fill’d  up  by  the  tunica  fclerotica, 
which  was  much  contraded,  and  for  that  reafon  thicker,  and  contain’d  the 
choroides,  which  adher’d  thereto  much  more  than  was  natural.  But  to  the 
choroides  was  fubjeded  a  white,  thick,  firm,  membrane,  which,  whether  it 
was  formerly  the  retina,  or  the  vitreous  coat,  or  both  together,  before  it  grew 
lb  thick,  you  will  judge  from  hence,  that  it  went  forwards,  covering  alfo 
that  part  of  the  eye,  where  the  corpus  ciliare,  and  chry ftalline  humour,  are 
wont  to  be:  are  wont  to  be,  I  fay  ;  for  there  was  nothing  in  this  eye,  which 
could  be  certainly  known  to  have  been  the  chryftalline  or  vitreous  humour, 
but  only  a  few  drops  of  turbid  and  brown  water.  Not  far,  however,  from 
the  natural  fituation  of  the  chryftalline  humour,  I  found  a  kind  of  hard  little 
body,  in  its  magnitude,  and  the  form  of  its  circumference,  not  much  dif¬ 
fering  from  the  chryftalline,  but  a  little  larger,  and  convex  on  its  anterior 
furface,  being  on  its  pofterior  concave  ;  fo  that  it  reprefented  a  kind  of  little 
fhield.  It  was  made,  in  great  part,  of  a  pretty  thick,  bony,  but  not  conti¬ 
nu’d  lamina,  which  I  ftill  preferve.  Part  of  the  remains  of  the  uvea  adher’d 
very  clofely  to  the  anterior  furface  of  that  body  ;  for  another  part,  as  I  laid 
before,  was  conneded  with  the  cornea.  But  the  hollow  furface  of  that  body 
was  invefted  by  the  fame  white  membrane,  which,  as  I  told  you  juft  now, 
might  be  the  retina,  or  vitreous  coat,  or  both  together,  and  left  it  to  you  to 
determine.  As  I  trac’d  the  optic  nerve  from  this  eye,  difeas’d  as  it  was,  to 
its  very  origin,  I  obferv’d  thefe  things:  It  was  more  (lender  than  the  right  ; 
and  when  1  cut  into  it,  it  was  of  a  more  compad  fubftance,  and  brownifh, 
as  well  in  the  orbit,  as  within  the  cranium  ;  whereas  the  right  nerve  was  in 
every  refped  natural,  whether  we  confider’d  its  thicknefs,  whitenefs,  or  the 
mode  of  its  fubftance.  And  this  difference  lafted  to  the  conjundion  :  but 
at  the  point  of  conjundion,  and  above  it,  by  whatever  means  you  enquir’d, 
nothing  but  foundnefs  could  be  leen,  equally  on  each  fide. 

10.  What  elfe  fhall  1  fay  here,  except  that  lefs  happy  occafions  have  oc- 
curr’d  to  me,  of  repeating  the  obfervations  of  Vefalius,  than  to  others  ?  If 
you  allow  of  the  dog,  I  have  made  the  experiment  three  times  ;  yet  have  J 


( m )  Epift.  15.  n.  8. 


never 


Letter  XIII.  Article  io.  287 

never  found  any  difference  at  the  conjunction  of  the  optic  nerve,  and  ftill 
lefs  beyond  it :  which  as  I  law  fo  plainly  beneath  the  point  of  coalition,  why 
could  I  not  equally  have  feen  it  above  all'o,  if  there  had  been  any  ?  for  that 
the  three  eyes,  in  whole  nerves  I  enquir’d,  were  certainly  as  blind  as  it  was 
poffible  for  them  to  be,  their  defcription  abundantly  fhews.  But  Caefal- 
pinus  in)  law  it,  as  you  have  it  all'o  in  the  Sepulchretum  (<?),  even  in  a  man 
whofe  “  fight  was  only  weak  and  Santorini  (p)  in  one,  who,  although  he 
had  been  long  blind,  yet  had  “  no  confpicuous  mark  of  diforder  nor  yet 
the  man  in  whom  Chelfelden  made  the  obfervation  (^),  of  whofe  blindnefs 
he  happen’d  to  know  nothing  at  all.  Had  the  blindnels,  then,  in  all  thefe 
inftances,  been  of  longer  ftanding  than  in  ours  ?  For  Vefalius  oblerv’d  it  (r) 
plainly  enough,  even  in  the  young  man,  whofe  eye  had  been  pull’d  out  “  a 
year  before,”  by  the  executioner.  Or,  finally,  can  it  be,  that  this  circum- 
ftance  is  peculiar  to  the  right  eye  only,  lince  it  has  happen’d  twice  to  Ve- 
falius,  once  to  Csefalpinus,  to  Santorini,  and  Chelfelden,  at  all  times,  that 
they  law  it  obtain  on  the  right  fide  ?  But,  befides  that  this  fuppofition 
does  not  at  all  feem  probable,  was  not  the  Tufcan  alio,  of  whom  I  have 
given  you  the  account  (j),  affecfled  in  the  right  eye  ?  Moreover,  fince  the 
time  that  I  wrote  thefe  things  to  you  firft,  not  only  other  opportunities  of 
enquiry  have  offer’d  themfelves  to  me  in  this  way,  but  it  has  even  happen’d 
twice  (/ ),  in  like  manner,  that  although  the  right  eye  had  been  long  blind, 
it  was,  neverthelels,  utterly  impofiible  to  perceive  any  difference  betwixt  the 
right  and  left  nerve,  beyond  the  place  of  conjunction.  Which  I  fee,  how¬ 
ever,  has  been  poffible  to  others,  in  fimilar  cafes,  befides  thofe  1  have  nam’d. 

For  lately,  when  I  was  looking  after  quite  another  thing,  I  lit  on  a  paffage 
of  Heilandus  (#),  where  he  wrote  in  this  manner  of  a  perfon  executed  for 
the  murder  of  an  infant:  “  One  eye  had  been  depriv’d  of  the  power  of 
“  feeing,  the  optic  nerve  being  not  only  more  flaccid,  and  lefs,  than  it  ought 
“  to  be,  but  this  difference  being  alfo  obferv’d,  even  beyond  the  ufual  com- 
“  bination  in  the  fella  turcica.”  Therefore,  while  we  wait  for  a  more  happy 
occaflon,  alfo,  let  us,  in  the  mean  while,  be  content  with  the  obfervations  of 
others.  Yet  I  am  not  altogether  forry  for  having  made  my  obfervations  : 
firft,  bccaufe  they  have  taught  us,  that  what  occurr’d  to  Vefalius,  does  not 
always,  and  even  not  very  often,  happen,  in  the  blindnefs  of  one  eye  :  and 
in  the  next  place,  becaufe  1  found  a  bone  within  the  eye,  which  is  a  circum- 
ltance  that  does  not  often  occur-,  as  we  fhall  fee  in  another  place,  where  I 
fhall  write  of  a  much  more  rare  appearance,  that  is,  of  the  retina  being  feen 
bony  by  me  (x)  :  but  in  regard  to  that  little  bone,  of  which  I  fpoke  juft 
now,  although  it  was  hollow’d  out  in  fuch  a  manner,  and  pretty  large,  yet 
it  is  not  an  eafy  queflion  to  determine,  whether  it  was  the  anterior  furface 
and  portion  of  that,  which  had  formerly  been  the  chryftalline  humour,  that 
finally  confifts,  in  great  meafure,  of  fibres  and  membranes  (jy),  and  when 
macerated,  is  enlarg’d  (z) ;  or  whether  it  was  rather  the  membrane,  or  cap- 


(«)  Qu.  cit.  fupra  ad  n.  7. 
(a)  Seft.  hac  obf.  17. 

(/>)  C.  cit.  fupra  ad  n.  7. 
(^)  Loc.  cit.  fupra  ad  n.  6. 
(r)  C.  cit.  fupra  ad  n.  7. 


(/)  Vid.  Epifl:.  52.  r.  30.  &  Epifl.  63.  n.  6. 
(«)  Eph  N.  C.  Dec.  3.  a.  7.  obf.  157. 

(*)  Epifl.  52.  n.  30,  31. 

(y)  Vid.  Epifl.  Anat.  17.  n.  30,  &  feqq. 

(z)  Ibid.  n.  32. 

fula, 


(0  N.  8. 


288  Book  I.  Of  Difeafes  of  the  Head.  • 

Tula,  thereof,  puffi’d  forwards,  and  become  thicken’d,  the  humour  itfelf 
being  confum’d  ( a ),  l  do  not  think  myfelf  capable  of  deciding  :  lift  of  all,  • 
becaufe,  by  this  means,  I  have  feen  various  confti  tut  ions  of  blindnefs  in  the 
eye,  from  various  difpofitions,  and  caufes,  which  you  may  compare  with 
others  ;  either  fuch  as  I  have  delcrib’d  already  (£),  on  other  occasions,  or  fhalT 
hereafter  delcribe  (c) ;  or  thofe  which  you  will  read  in  other  works,  and  efpe- 
ciahy  in  the  Sepulchretum  :  as,  for  inftance,  when  in  a  child  (r/),  “  all  the 
“  humours  of  the  eye  were  found  to  be  converted  into  a  febaceous  matter;” 
or  when  in  beads  (<?),  “  fometimes  no  humours  are  found,  but  the  interdice 
“  between  the  cornea  and  the  chryftalline  humour,  is  fill’d  up  by  a  kind  of 
“  callous  flefh,  fometimes  the  chryftalline  is  evidently  connected  with  the 
“  cornea,  and  fometimes  the  albuginea  appears  indurated  but  efpecially 
where  there  was  a  blindnefs  join’d  together  with  the  extenuation  of  the  optic 
nerve. 

ii.  And  of  this  laft  kind,  are  thofe  obfervations  to  which  thefe  arguments 
are  prefix’d  (/)  “  Blindnefs  from  extenuation  of  the  optic  nerves  (g),  amau- 
“  rods  from  the  fubfiding  of  the  ventricles  of  the  brain,  and  a  wafting  of 
“  the  optic  nerves  (b),  weaknels  of  the  fight  in  one  eye,  from  an  extenu- 
“  ation  of  that  optic  nerve  (/),  wafting  and  extenuation  of  the  right  eye, 
“  from  childhood,  by  reafon  of  the  right  nerve  being  more  {lender  than  the 
“  left,  beyond  the  conjunction  as  if  in  thefe,  which  are  mention’d  in  the 
firft  and  the  third  place,  there  had  not  been  an  extenuation  beyond  the  con¬ 
junction,  as  there  certainly  was ;  for  thofe  are  the  fame  that  I  have  Jpoken 
of  above  (k),  from  Rolfinc,  and  Casfalpinus,  to  whofe  purpofe  they  would 
not  at  all  have  been  fuitable,  if  it  had  been  otherwife  (/).  But  who  affirms 
for  a  certainty,  that  the  wafting  of  the  eye  was  to  be  accounted  for  from  the 
extenuation  of  the  optic  nerve  ?  Bartholin.  But  Vefalius  fays  nothing  of  this 
kind,  whofe  words  are  foon  after  fubjoin’d  in  a  feparate  place  (m)>  as  if  he 
had  been  relating  fome  other  obfervation  of  that  author  ;  although  he  by  no 
means  gives  you  the  whole  of  what  he  fays  upon  the  fubjedft.  And  Caefal- 
pinus,  and  Rolfinc,  do  not  mention  even  a  word  of  the  wafting  of  the  eye. 
Add  to  this,  another  inftance  of  filence,  on  a  fimilar  cafe,  in  Rolfinc  (#)  : 
the  cafe  was  of  a  woman,  whofe  right  optic  nerve  was  wafted  away  “  by  a 
“  tabes  fo  that  the  coats  thereof  coalefc’d  ;  “  and  in  that  eye  was  an  abo¬ 
lition  of  fight which  obfervation  he  made  at  Padua.  And  even  add  that 
obfervation  which  I  pointed  out  juft  now,  in  the  third  place,  from  the  fe- 
pulchretum,  that  was  alfo  made  at  Padua,  by  Scultetus,  and  in  a  woman  : 
for  it  feems  to  me  exprefsly  to  deny  the  extenuation  of  the  eyes,  “  The 
tc  optic  nerves,”  fays  he,  “  gradually  wafting  away,  (for  in  this  cafe,  they 

appear’d  to  be  lefs  by  one  half,  than  in  others)  an  amaurofis,  or  gutta  fe- 
“  rena,  was  brought  on  the  eyes,  which  were,  on  all  fides,  unhurt  in  their 
°  fubftance  *,  for  they  had  been  hitherto  well  nouriffi’d,  the  veins  and  the  ar- 


(a)  Vid.  Epift.  Anat.  18.  n.  19.  &  feq.  n.38. 
\b)  Ibid.  11.28,  29.  38,  40,  &c. 

(1 c )  Epift.  52.  n.  30.  &Epi(t.63.  n.  2.  &  feqq. 
(^)  Seft  hac  18,  obf.  25. 

{ e )  Obf.  19.  (f)  Obf.  3. 


(g)  Obf.  5.  (b)  Obf.  1 7. 

(1)  Obf.  26.  (/e)  N.  7. 

(l)  Vid  Epift.  Anat.  16.  n.  14. 

( m )  Obf.  26  §.  2. 

(«)  Difp.  de  Gutta  Serena,  c.  4. 

a 


teries 


Letter  XIII.  Article  12,  289 

et  teries  being  very  natural  and  well  confiituted.”  And  I,  in  like  manner  (0), 
in  a  dog,  where  one  of  the  nerves  was  more  (lender,  which  anfwer’d  to  the 
blind  eye,  faw  the  eye  “  in  a  good  condition,  and  of  its  natural  magnitude, 
“  and  fullnefs and  in  this  date  did  it  occur  to  Cheflfelden,  and  Santorini, 
in  perfons  affedfed,  as  it  feems,  with  an  amaurofis  alfo,  as  I  juft  now  hinted  (/>). 
And  what  will  you  fay  to  this,  that  Rolfinc  (q),  in  order  to  fhew,  that  the 
eyes  are  by  no  means  nourifh’d  by  the  optic  nerves,  fays,  “  If  thele  are  ob- 
<c  ftrudted,  whence  comes  the  nutrition  of  the  eye  ?  and  we  fee  the  eye,  in 
“  an  amaurofis,  or  gutta  ferena,  rather  enlarg’d  than  diminifh’d.”  And  when 
you  fhall  have  confider’d  all  thefe  things,  you  will  be  lefs  averfe  to  Abr. 
Vater  (r),  when  he  endeavours  to  prove,  although  from  one  obfervation  only 
of  ChetTelden,  tc  that  it  is  manifeft,  the  atrophy  of  the  eye,  in  one  of  the 
<£  examples  of  Vefalius,  had  not  deriv’d  its  origin  from  the  wafting  of  the 
“  optic  nerve,  but  from  another  caufe.”  And  indeed,  if  any  one  fhould 
affirm,  that  not  even  blindnefs  itfelf,  join’d  with  an  extenuation  of  that  nerve, 
is  always  to  be  accounted  for  from  thence ;  but  that  rather,  fometimes  this 
extenuation  fucceeds  to  the  blindnefs,  either  becaufe  the  nerve  ceafing  long 
from  its  office,  becomes  wafted,  as  moft  other  parts  do,  or  becaufe  it  is  in¬ 
jur’d  by  deprav’d  humours,  returning  from  the  corrupted  eye,  by  the  veflels 
which  accompany  the  nerve  itfelf,  both  internally  and  externally ;  I  fay  if 
any  one  ffiould  affirm  this,  it  is  in  nobody’s  power  to  refute  him.  For 
otherwife,  how  can  the  extenuation  of  the  optic  nerve  be  join’d,  at  the  fame 
time,  with  the  corruption  of  the  eye,  which  began  from  external  caufes  ? 
Or  how  could  this  extenuation  be  fo  evidently  obferv’d,  by  Vefalius  (j)  in 
that  young  man,  whole  eye  had  been  put  out  a  year  before,  by  the  execu¬ 
tioner  ?  I  pafs  by  that  which  I  fhall  fhow  on  another  occafion,  by  a  double 
obfervation  (/),  I  mean  that  the  optic  nerve  is  fometimes  extenuated,  and  yet 
the  eye  that  anfwers  to  it,  which  you  will  be  furpriz’d  at,  is  not  made  blind 
therefrom.  Yet  oftentimes  this  very  extenuation  of  the  nerve,  or  rather  the 
diforder,  of  which  this  extenuation  of  nerve  is  the  confequence,  is  the  caufe 
of  blindnefs,  as  in  the  amaurofis,  of  which  a  few  things  remain  yet  to  be 
fubjoin’d  on  the  prefent  occafion. 

12.  And  to  omit  this,  that  an  amaurofis  follows,  when  the  optic  nerves 
are  corrupted  j  for  it  is  both  felf-evident,  and  confirm’d  by  many  obferva- 
tions  in  the  Sepulchretum  («),  but  efpecially  in  the  twenty-third  •,  or  when 
they,  or  their  thalami,  are  affedfed  by  a  purulent  acrimony,  which  the  ob- 
fervations  of  Brunnerus  (#),  and  Laubius  ( jy),  jointly  demonftrate  ;  an  amau¬ 
rofis  even  follows,  when  either  the  nerves  themfelves  are  diffracted,  or  fome 
parts  of  the  brain,  which  are  fubfervient  to  them,  are  vehemently  fhaken 
and  difturb’d.  Which,  I  do  not  doubt,  happen’d  in  two  patients,  that  I 
have  feen,  and  affifted,  as  far  as  any  thing  could  be  done,  with  my  advice. 
In  both  their  cafes  a  violent  blow  on  the  head  was  the  caufe  of  all  their  mil- 
fortunes  :  and  to  both  of  them,  from  thence,  yet  not  after  a  fhort  interval 

( 0 )  Epift.  Anac  18.  n.  40.  (/)  Epift.  56.  n.  21.  &  EpifE  63.  n.  8. 

(f)  n.  10.  (q)  Difp.  cit.  c.  3.  ( u )  Se£t.  hac,  13.24. 

(r)  DilT.  qua  Vifus  vitia  duo  &c.  thef.  9.  (x)  Eph.  N.  C.  Cent.  1.  obf.  69. 

(j)  Supra,  n.  10.  (y)  Earund.  Cent.  7.  obf.  39. 


VOL.  I. 


Pp 


of 


290  Book  I.  Of  Difeafes  of  the  Head. 

of  time,  an  amaurofis  of  both  eyes  had  happen’d,  when  they  were  at  Con- 
ftantinople:  at  length,  in  both  of  them,  when  after  fome  time  they  had  re¬ 
turn’d  to  their  native  country,  in  different  parts,  an  apoplexy  put  an  end  to 
their  lives,  which  confirms  what  I  have  already  faid.  One  of  them  was  that 
knight,  in  whom  I  have  explain’d  lb  oppolite  effects,  in  the  different  mufcles 
or  the  right  and  the  left  eye,  from  one  and  the  fame  palfy  (2),  the  Count  AEneas 
Suardo,  and  the  other  was  a  very  learned  phyfician  whom  I  have  before 
commended  to  you  (a),  Francefco  Spoleto(^).  <7 

13.  Befides  thofe  caufes  of  an  amaurofis,  which  I  have  hitherto  confider’d, 
do  not  imagine  I  fhall  alfo  conlider,  that  which  is  produc’d  in  the  fixteenth 
obfervation  of  this  fedtion  in  the  Sepulchretum,  from  Rolfinc.  For  I  have 
pointed  out,  in  another  work  (t),  what  he  himfelf  thought  afterwards  of  his 
own  obfervation,  what  others,  and  what  I  have  thought  of  it,  when,  for  in- 
ftance,  I  made  public  my  old  obfervations  •,  for  I  have  a  new  one  alfo  (d)  ; 
of  the  chryftalline  and  vitreous  humours,  being  found  diffolv’d  into  water. 
But  whatever,  at  length,  is  the  caufe  of  the  true  amaurofis,  as  in  this  difor- 
der  the  eye  ought  to  appear  to  be  rightly  conffituted,  to  thofe  who  infpebl 
it,  for  which  reafon  it  is  by  fome,  as  I  faid,  call’d  gutta  lerena,  and  by  others, 
as  by  Rolfinc,  in  this  very  obfervation,  the  black  catarabt;  it  is  very  conve¬ 
nient  for  them,  who  for  certain  caufes  are  audacious  enough,  fometimes  to 
feign  a  difeafe,  to  pretend  that  they  are  feiz’d  with  this  in  particular,  and 
impofe  upon  phyficians,  even  thofe  of  great  name  among  the  common  peo¬ 
ple,  as  I  have  fometimes  i'een.  But  where  there  is  any  lufpicion  of  fraud, 
nobody  can  be  deceiv’d,  except  they  who  perhaps  never  obferv’d,  with  Pliny (<?), 
liow  rarely  perfons  are  to  be  met  with,  “  who  do  not  wink  againft  any  threat- 
“  ning  of  a  blow,  and  how  much  difficulty  there  is  in  avoiding  it.”  And 
I  even  remember,  when  in  a  dilfernbler  of  that  kind,  the  Rate  of  the  pupils 
being  neither  dilated,  nor  unmov’d,  much  encreas’d  my  fufpicion,  it  was 
lufficient  juft  to  move  my  fingers  towards  the  eyelids  filently,  as  if  for  the 
fake  of  more  clofely  obferving  the  diforder  ;  for  before  I  touch’d  them,  he 
immediately,  and  evidently,  clos’d  his  eyelids,  and  thus,  contrary  to  his  own 
intention,  difcover’d  his  fraud.  And  I  wonder  that  John  Baptift  Silvaticus 
fhould  have  omitted  fo  eafy  and  obvious  a  method,  in  his  little  book,  which 
is  entitled,  “  Of  difcovering  thofe  who  pretend  difeafe,”  and  which  is  in  other 
refpe&s  very  ufeful,  where  he  fhews  (/),  “  by  what  method  a  pretended  pri- 
“  vation  of  the  fenfes,  may  be  detected.”  For  to  place  before  the  eyes  the 
greateft  fplendors,  which  he  himfelf  feerns  to  hint,  is  an  exceedingly  dan¬ 
gerous  experiment,  for  this  very  reafon,  becaufe  by  thefe,  as  he  fays,  the 
fight  “  is  not  only  troubled,  but  deftroy’d.”  And  I  remember,  moreover, 
that  I  found  out  by  the  fame  method,  a  man  who  pretended  I  know  not 
what  kind  of  fits,  in  which,  he  faid  afterwards  to  his  friends  and  his  phyfi¬ 
cians,  that  he  was  depriv’d  of  all  power  of  feeling  and  moving;  and  that, 
at  the  very  time  1  was  bringing  fome  fievere  remedies  to  excite  him,  with  the 


(2)  Epift:.  Anat.  18.  n.  6. 

(<?)  Epift.  fuper.  8.  n.  9. 

(£)  Vid.  Giornale  de’  Letter,  d’  Italia  T. 
12.  Art.  13. 


(c)  Epift.  Anat.  18.  n.  38.  39. 
(A  Epift  63.  n.  6. 

(?)  Natur.  Hift.  1.  11.  c.  37. 
(f)  c.  n. 


4 


moll 


Letter  XIII.  Article  14.  '  291 

moft  cautious  filence.  For  as  he,  by  accident,  kept  open  his  eyes,  in  one 
of  thefe  fits  of  his,  and  I  (hook  my  fingers  over  them  *,  immediately  before 
I  touch’d  him,  he  plainly  fhow’d  to  all,  who  were  prefent,  by  winking,  that 
he  could  not  only  fee,  but  could  move  his  eyelids  alfo. 

14.  I  have  made  a  long  difiertation  on  the  amaurofis,  or  black  cataradl, 

I  will  now  make  one  fomewhat  fhorter,  on  the  fuffufion,  or  that  cataract, 
which,  by  reafon  of  the  colour  of  the  pupil  therein,  being  fo  far  different 
from  the  black  one,  which  is  natural,  is  call’d,  Amply,  the  cataradt ;  I  fay  I 
will  make  a  fomewhat  fhorter  difiertation.  For  that  the  caufe  of  this  difor- 
der,  though  call’d  cataradl,  is  not  an  immediate  defluxion  of  a  thick  humour 
on  the  eye,  from  the  brain  chiefly,  as  is  contended  for  (g)  by  the  words  of 
Plempius  in  the  Sepulchretum  ;  and  what  truth  there  is,  concerning  the  fi- 
tuation  and  nature  of  the  cataradt,  or  what  truth  there  is  not,  both  in  the 
laid  obfervations  of  Plempius,  and  thole  many  obfervations  which  are  related 
from  others,  in  that  fedfcion,  may  be  readily  underftood,  not  only  from  the 
writings  of  others,  but  from  mine  ( h )  alfo.  And  fome  things,  in  like  man¬ 
ner,  have  before  been  pointed  out  by  me  (z),  from  which  it  might  appear, 
when  and  how  far,  after  the  demonftrations  of  Chalefius  and  Pitcarn,  or 
others,  if  you  choofe  it  rather,  thofe  things  may  have  place,  which  are  wont 
to  be  given  out  in  the  beginnings  of  a  fuffufion,  as  you  fee  alfo  in  the  Se¬ 
pulchretum  ( k ) :  “  as  long  as  gnats  and  atoms  are  oblerv’d,  that  this  happens  ” 
from  corpufcles  fwimming  in  the  aqueous  humour:  although,  at  other  times, 
I  have  not  fcrupled  to  declare,  that  thefe  corpufcles  may  be  fome  injuries  in 
the  lafl  cells  of  the  vitreous  humour,  at  other  times,  in  the  optic  nerve,  and 
the  tunica  retina,  which  impofe  upon  you  for  gnats,  or  fpecks,  and  by  what 
method,  the  various  fituation  of  one,  or  the  other,  is  to  be  diftinguifh’d  : 
and  if  among  thefe  injuries,  you  place  the  diforders  of  the  vefiels,  that  are 
interwoven  with  the  retina,  fwelling  prteternaturally  here  and  there-,  you 
will  do  right,  fo  that  you  do  but  acknowledge,  there  may  fometimes  be 
other  caufes  befides  this. 

And  I  would  have  you  confider  attentively,  over  and  over  again,  even 
thofe  few  words  which  I  have  thrown  in,  as  it  were,  by  the  by,  among  my 
obfervations  of  the  aqueous  humour  under  the  chryftalline  coat(/) :  ‘6  I  fup- 
<c  pos’d,  that  the  fecretion  of  this  humour  being  obftru&ed,  the  chryftalline 
“  was  made  dry,  and  opaque,  almoft  as  it  happens  when  the  chryftalline  is 

<c  extracted,  and  dried.”  And  do  you  think  that  what  I  have  written  is 

repugnant  to  truth  ?  And  what  you  can  believe,  as  fome  relate  who  treat  of 
the  cataraeft,  of  which  I  do  not  make  the  leaft  mention  in  that  place,  was 
“  refuted  ”  in  particular  by  Petit  the  phyfician,  who  you  know  very  well 
taught  the  fame  dodlrine  that  I  had  taught  twelve  years  before  (m).  “  The 

“  chryftalline,”  fays  he,  “  cannot  grow  dry,  as  long  as  it  is  moiften’d  by 
ct  that  aqueous  liquor ;  yet  no  fooner  is  this  fluid  deficient,  than  it  becomes 
“  dry,  hard,  and  opaque.”  Truly  I  could  not  have  conceiv’d,  if  he  had 

(g)  Sett,  hac  18.  Schol.  ad  Obf.  20.  (/)  Adverfar.  indie.  Animad.  71. 

[h)  Epift.  Anat.  18  &  19.  («)  Memoir,  de  l’Acad.  R.  des  Sc.  A.  1730, 

(?)  Advert.  Anat.  6.  Animad.  75.  Mem.  de  la  Capfule  du  CriltaJlin. 

\k)  Sett.  cit.  Schol.  ad  obf.  22. 

P  p  2 


not 


2  9  2  Book  I.  Of  Difeafes  of  the  Head. 

not  refuted  himfelf  at  the  fame  time,  how  he  could  have  been  able  to  refute 
me  therein.  For  which  reafon,  I  the  more  willingly  read  over  the  letter  (#), 
which  came  at  length  into  my  hands,  being  publilh’d  againft  Hecquet,  and 
in  which  he  was  faid  to  have  done  that.  You  afk  me  -what  I  thought  of  it: 
he  fet  forth  my  opinion ;  in  regard  to  his  own,  which  was  entirely  the  fame, 
he  was  filent !  But  what  did  he  at  length  objedt  ?  why  fuch  things,  that  if 
they  had  been  objected  to  him,  he  would  have  anfwer’d,  by  faying,  that 
they  did  not  contradidt  his  opinion,  inafmuch  as  it  was  propos’d,  where  the 
queftion  was  not  at  all  of  the  cataradf,  as  if  I  had  treated  of  this  diforder, 
where  1  propos’d  mine.  And  if  I  had,  I  confirm’d  my  opinion  by  his  con- 
fent  being  fuperadded  (o) ;  but  nine  years  after  that  letter,  his  letter  was  pub- 
lifh’d,  nor  did  I  pronounce  univerfally,  on  that  caule  of  the  catarad,  as  he 
did  prefently,  in  the  fame  letter,  on  the  caufe  of  the  amaurofis ;  but  after 
having  given  this  opinion  among  many  others,  I  exprefsly  profefs’d,  in  re¬ 
gard  to  all,  “  that  I  affirm’d  nothing,  but  only  made  fome  conjedtures  (/>).’* 
Wherefore,  when  he  fent  that  letter,  he  had  no  reafon  to  make  this  objec¬ 
tion,  that  he  had  never  feen  the  chryftalline  humour  affected  with  a  cata- 
radt,  in  the  dead  fubjedt,  where  the  aqueous  humour  was  wanting ;  for  I 
could  not  only  with  truth  deny,  that  I  had  fpoken  of  the  cataradt,  but- 
Hecquet,  whom  he  urg’d  fo  violently,  if  he  had  liv’d  longer,  might  have 
anfwer’d  alfo,  that  neither  had  fanguiferous  veffels  ever  been  leen  by  him,  in 
any  chryftalline  humour  (j),  which  not  only  the  excellent  anatomift  Window  (r) 
has  fhown  to  have  been  l'ufficiently  feen  by  him,  but  fo  many  other  illuftrious 
men,  commended  by  the  very  ingenious  Zinnius(j),  who  himfelf  faw  therm, 
have  feen  them ;  and  on  the  other  hand,  that  thofe  twigs,  which  Petit  (/) 
had  taught,  without  any  doubt,  were  added  to  the  cilliary  nerves,  from  the 
fixth  pair,  and  went  into  the  interior  parts  of  the  eye,  could,  as  the  fame 
moft  learned  Zinnius  (#)  fays,  “  be  confirm’d  by  no  refearches  of  the  more 
“  modern  anatomifts.” 

But  to  leave  Hecquet,  and  return  to  myfelf  alone  ;  I  certainly  did  not 
propofe  a  conjedture,  of  the  total  defedt  of  this  aqueous  humour,  but  con¬ 
cerning  its  diminution  only,  not  even  when  I  ventur’d  to  fuppofe,  that  here¬ 
after  from  that  opinion  of  mine,  one  caufe  of  a  cataradt,  among  fo  many 
others,  might  be  argued  :  and  that  this  diminution  has  been  feen  in  that  dif- 
eafe  by  him,  Petit  certainly  has  not  denied ;  nor  indeed  if  he  had,  could  he 
have  done  it  juftly,  becaufe,  even  in  found  eyes,  fo  much  of  this  humour  is 
not  always  found,  and  even  is  frequently  in  fo  little  quantity,  that  it  feems 
to  be  wanting :  for  which  reafon,  as  you  would  believe  in  fome,  that  it  was 
pretty  naturally  diminifh’d,  fo,  on  the  contrary,  you  may  think,  that  in 
others  it  is  not  diminifh’d,  and  yet  in  both  cafes  judge  wrongly.  But  what 
will  you  fay,  when  I  tell  you,  that  Petit  himfelf  has  prefently  added  that 
which  he  had  alfo  confefs’d  before  (x)  ?  I  mean,  that  cataradfs,  however,  were 
not  wanting,  in  which  the  chryftalline  humour,  by  reafon  of  the  total  defedt 


(/?)  Lettre  IT.  fur  les  maladies  des  yeux. 
(<?)  Epift.  Anat.  18.  n.  16. 

(p)  n.  17.  (y)  Memoir,  cit. 

(r)  Expof.  Anat.  tr.  de  la  Tefte  n.  301. 


(j)  Defcript.  Anat.  Ocul.  hum.  c.  5.  §  4. 

( t )  Mem.  de  l’Acad.  R.  des  Sc.  A.  172 7. 

( u )  Defer,  cit.  c.  9.  §  8. 

(x)  Mem.  cit.  A,  1730. 

Of 


Letter  XIII.  Article  14.  293 

of  this  watry  latex,  has  become  fo  dry,  that  it  might  be  rubb’d  into  powder, 
as  he  has  found  it  in  many  bodies  :  fo  that,  if  I  had  faid  in  the  Adverfaria, 
that  the  lame  thing  fometimes  happen’d,  he  certainly  could  not  have  refuted 
me. 

You  fee,  then,  to  what  his  refutation  of  my  opinion  amounts  ;  fo  that  I 
am  almoft  ready  to  believe,  he  did  not  fo  much  intend  to  refute  it,  as  he 
wilh’d  to  be  thought  to  do  fo.  Neverthelefs,  as  he  is  faid  to  have  done  this, 
in  more  than  one  writing  of  learned  men,  that  have  been  publifh’d,  and  to 
have  denied,  what  you  lee  it  was  impoffible  for  him  to  deny,  I  judg’d  for 
this  reafon,  that  it  was  neceflary  to  reply  to  it  here,  left  you  ffiould,  perhaps, 
fuppofe,  that  I  negleCted  the  authority  of  a  man,  who,  when  living,  was  fo 
delerving  in  anatomy,  that  I  very  willingly  go  on  to  revere  his  memory, 
when  dead. 

But  to  return  to  my  Adverfaria :  I  did  not  finally  omit  this  circumftance 
relating  to  the  fuffufion  (y),  that  from  the  light  we  fee,  when  the  eye  is 
prefs’d,  I  endeavour’d  to  deduce  a  mark  of  the  retina  being  not  difeas’d  : 
which  knowledge,  as  it  is  neceflary  in  the  greateft  blindnefs  that  a  fuffufion, 
or  occlufion,  of  the  pupil  brings  on,  before  we  attempt  a  cure,  fo  perhaps, 
without  this  experiment,  cannot  be  fufficiently  attain’d  :  concerning  which 
fubjeCt,  I  greatly  defir’d  to  read  the  opinion  of  that  excellent  man,,  George 
Auguftus  Langguth ;  as  in  that  difiertation  (2),  which  he  wrote  on  the  fame 
light,  he  has  not  only  confirm’d  my  other  experiments,  in  the  moft  courteous, 
and  obliging  form  of  words,  but  has  alfo  prov’d  them  by  his  own  experi¬ 
ments.  For  as  to  thofe  experiments,  which  have  anfwer’d  in  the  fame  manner 
to  both  of  us,  and  that  in  particular,  which  he  was  willing  to  repeat  with 
a  friend  ;  if  you  undertake  to  explain  them,  not  in  general,  but  in  particular, 
you  will  perceive,  without  much  difficulty,,  to  the  opinion  of  which  of  us 
they  are  the  moft  confentaneous.  But  this  being  equally  laid  afide  here,  as 
in  the  Adverfaria,  if  you  attend  only  to  the  experiments,  which  every  one 
may  eaflly  make  upon  himfelf ;  I  do  not  doubt,  but  if  any  perfon  comes  to 
you,  to  be  cur’d,  who  was  blind  from  his  birth,  or  from  congenial  fuf- 
fufions,  or  a  privation  of  the  pupils,  you  would  previoufly  examine,  by  fo 
fpeedy,  and  fo  harmlefs  an  experiment,  whether  there  was  any  reafon  to 
expedi  a  cure  :  unlefs  you,  perhaps,  think,  that  in  eyes  of  this  kind,  al¬ 
though  the  optic  nerve,  and  the  retina,  be  found,  no  fenfe  of  light  is  excited 
from  preflure  *,  becaule  you  have,  perhaps,  heard  thofe  who  have  been  cur’d, 
deny,  that  they  had  any  idea  of  light  before,  though  it  could  fcarce  poffibly 
happen,  that  the  eyes  had  never  been  prefs’d  upon,  or  ftricken,  though  againffc 
the  will  of  the  patient.  But  nothing  forbids  your  trying,  as  I  faid  before,  if 
it  were  only  to  determine,  whether  they  could  at  all  deny  it  with  truth,  or 
how  far  they  might  deny  it :  but  in  others,  who  have  been  blind  long  indeed, 
yet  not  from  their  birth,  I  do  not  fee  that  there  can  be  this  doubt.  But  in 
both  the  one  and  the  other,  there  will  be,  perhaps,  that  one  doubt,  which 
I  afterwards  pointed  out  in  the  Epiftolas  Anatomicae  (a)  j  although  this  does 
not  very  eaflly  happen,  by  reafon  of  the  rare  conjunction  of  the  difeafe. 

(y)  Adverf.  6.  animad.  73,  &  74.  (»)  De  luce  ex  preffione  oculi.  ( a )  Epift.  19.  n.  9* 


294  Book  I.  Of  Difeafes  of  the  Head. 

But  to  return  thither,  at  length,  from  whence  my  difcourfe  on  the  cataract 
began :  As  you  may  read  elfewhere,  not  only  moil  of  thole  things  that  I 
have  mention’d  here,  in  a  hafty  manner,  but  alfo  the  obfervations  of  Val- 
falva  (b)  and  mine  (c),  on  the  fuffufion  ;  I  fhall  merely  give  you  here  what 
I  have  fince  feen,  that  are  to  be  referr’d  to  the  fame  diforder,  firft  in  a  man, 
and  then  in  a  woman. 

15.  A  builder,  or  mafon,  as  they  are  commonly  call’d,  being  fixty  years 
of  age,  had  now,  for  a  long  time,  fcarcely  difcern’d  any  thing;  but  what  he 
did,  was  laterally,  and  when  the  fun  was  bright  only.  He  having  died  of 
fome  diforder  or  other,  in  the  month  of  February,  in  the  year  174.0,  when  1 
was  teaching  anatomy  publicly,  his  head  was  brought  into  the  theatre.  As 
at  that  time  every  thing  was  ftiff  with  the  very  fevere  cold,  which  you  (till 
well  remember,  fo  that  the  neceifary  diffedtions  could  hardly  be  perform’d  ; 
the  diffe&ion  of  this  head  was  put  off  many  days,  even  to  that  time,  when, 
about  the  end  of  the  month,  the  cold  had  very  much  remitted.  Why  I 
mention’d  thele  circumffances,  you  will  fee  prefently. 

The  head,  firft,  fhew’d  many  fears  in  the  fkin  of  the  finciput,  and  oc¬ 
ciput  ;  for  the  man  had  formerly  fallen  from  a  great  height.  But  although, 
when  all  the  involucra  of  the  fkull  were  taken  off,  the  external  furface  of 
it  under  the  cicatrices  was  fomewhat  white ;  yet  the  internal  furface,  and  the 
contents  of  the  cranium  beneath,  were  unhurt,  except  that  the  cerebrum  was 
altogether  rigid  and  hard  ;  and  the  water,  which  had  fill’d  the  lateral  ventricles, 
was  found  to  be  fo  condens’d  by  the  froft,  that  being  laid  hold  of  with  the  hand, 
it  all  follow’d  at  once,  and  retain’d  the  form  of  the  ventricles  ;  juft  as  wax, 
which  is  melted  and  injedted  into  any  cavity,  may  be  taken  out  after  it  is 
become  cold.  And  yet  the  cold  had  now  remitted  more  and  more,  for  many 
days,  and  the  head  itfelf  had  always  been  not  far  from  the  fire  ;  and  even 
more  than  once,  when  they  had  fuppos’d  that  it  would  foon  be  diffedted,  but 
on  that  day,  particularly,  when  it  was  at  length  differed,  it  had  been  plac’d 
much  nearer  to  the  fire.  And  this  circumftance,  which  I  never  law  but  at 
that  time,  I,  who  am  an  Italian,  was  willing  to  mention  here  to  you,  who 
are  an  Italian  ;  although  Schneider  has  not  omitted  to  mention,  that  even  in 
Germany,  in  a  winter  which  was  much  harder  there  than  it  us’d  to  be,  in  the 
open  road,  and  in  the  head  of  a  young  boy,  the  fame  thing  had  happen’d  to 
the  brain,  and  the  little  moifture  which  was  contain’d  in  it ;  as  you  will  alfo 
fee  in  the  next  and  feventeenth  fedtion  of  the  Sepulchretum  (d).  And  this 
I  have  written,  in  order  to  inform  you,  that  the  head  was  not  only  kept  many 
days  after  death,  but  was  congeal’d  frequently  by  the  cold,  and  thaw’d  again 
by  the  heat ;  fo  that  when  we  came  at  length  to  diffedt  it,  the  eyes  were  flaccid 
and  Ihrunk  in  their  fubftance.  From  which  this  inconvenience  alfo  happen’d, 
that  induc’d  anatomifts  formerly,  as  they  were  us’d  to  diffe<5t  the  eye  the  laft: 
of  all  the  parts  of  the  body,  and  therefore  of  courfe,  when  flaccid,  to  give 
iefs  room  to  the  vitreous  humour  than  it  has  naturally,  and  in  a  frefh  body, 
and  to  place  the  chryftalline  almoft  in  the  very  center  of  the  eye ;  for  fo  it 
appear’d  to  me,  when  I  differed  one  e^e  on  the  fore  part,  for  which  reafon  I 

(6)  Diflert.  Anat.  2.  n.  15.  &  feq.  (c)  Epift.  Anat.  18,  &  19.  (d)  Obf.  i.  §  ult. 

began 


Letter  XIII.  Article  i  6.  29s 

began  the  difiedtion  of  the  other  behind :  but  I  do  not  think  there  was  any 
other  obftrudtion  of  confequence  to  our  obfervation.  For  in  the  firft  place, 

1  faw  the  optic  nerves  very  plainly,  both  within  and  without  the  fkull,  en¬ 
tirely  fimilar  to  each  other,  and  like  to  found  nerves,  unlefs  that  in  the  orbits, 
when  we  cut  them  acrofs,  both  appear’d,  in  like  manner,  cloath’d  with 
thicker  coats  than  ufual.  I  alfo  found  both  the  cornea,  and  the  fclerotica, 
to  be  without  any  traces  of  a  cicatrix.  And,  not  to  ufe  many  words,  the 
whole  of  the  diforder  was  found  to  exift  in  the  chryftalline  humours,  if  you 
except  a  kind  of  lentor  in  the  vitreous  humour,  by  which  it  adher’d  to  the 
fingers,  and  form’d  itfelf  into  long  threads,  following  the  fingers  as  they 
were  drawn  afunder :  and  what  prevented  me  from  attributing  this  altogether 
to  ffagnation,  and  the  other  caufes  which  I  mention’d  before,  was  the  dif¬ 
ference  that  I  found  betwixt  the  lentor  of  one  eye,  and  of  the  other.  For 
that  was  the  more  vifcid,  which  lay  round  the  chryftalline,  that  was  of  a  dirty 
yellow’  colour,  but  lefs  yellow  on  the  furface ;  and  it  was  alfo  the  fofter  of 
the  two  ;  and  even  the  nucleus  was  not  hard.  But  the  other  chryftalline  was 
made  up  of  a  whitifh  fubftance  in  the  circumference,  though  in  the  middle 
it  was  brown  ;  and  this  brown  fubftance  came  from  the  meditullium  to  the 
middle  of  both  furfaces,  being  fofter  than  the  whit.fh  fubftance,  which,  how¬ 
ever,  itfelf  was  not  hard.  Befides,  this  whole  chryftalline  was  not  only  much 
lefs  thick  than  naturally,  but  even,  at  one  fide  of  it,  was  deficient  in  a  part, 
and  that  no  fmall  one  ;  fo*  that  it  was  not  circular  in  its  circumference.  Nor 
did  1  find  any  thing  elle  preternatural  in  either  of  the  eyes. 

1 6.  if  it  had  been  poffible  to  know  for  certain,  whether  the  little  fight 
•which  the  man  had,  as  I  have  already  faid,  was  from  both  eyes,  or  from  one 
only,  and  on  which  fide  it  was;  it  would  have  been  more  eafy  to  fay, 
whether  he  faw  for  this  reafon,  becaufe  the  circumference  of  one  chryftalline 
humour  was  of  a  more  diluted  yellow,  or  becaufe  that  opaque  part  of  the 
other  was  wanting  on  the  fide.  But  this  queftion  being  now  left  undeter¬ 
min’d,  I  will  fay  that  which  is  certain,  to  wit,  that  the  chryftalline,  which  I 
defcrib’d  in  the  fecond  place,  was  much  more  morbid  in  its  condition  than 
the  other,  inafmuch  as  the  whole  of  it  was  more  opaque  and  fofter  in  that 
part,  where  it  is  wont,  efpecially  in  old  men,  to  be  harder :  befides,  it  was 
more  (lender  than  it  ought  to  be  naturally,  and  more  than  that,  mutilated. 
But  did  this  happen,  becaufe  the  fame  diforder  had  attack’d  that  part,  which 
was  wanting,  but  more  fharply,  which  had  alfo  made  the  middle  part  of  it 
more  foft  than  it  ought  to  be,  and  of  a  browq  colour,  that  is,  half-corrupted  ? 
There  was  nothing  of  this  kind  in  the  other  chryftalline  ;  but  the  yellow 
colour,  with  which  it  was  ting’d,  is  often  obferv’d  in  old  men,  and  in  that 
part  efpecially,  where  it  was  found  in  this  chryftalline  (e)  :  although  that  it 
was  far  lefs  dilute  here,  the  obftrudtion  of  vifion,  in  the  manner  1  have  faid, 
in  this  eye  alfo,  lufficiently  demonftrates.  But  the  two  circumftances,  which 
I  have  obferv’d  in  the  former  mutilation,  and  an  internal  brown  colour,  are 
of  fuch  a  kind,  that  you  have  an  example  of  the  firft  in  an  obfervation  of 
the  celebrated  Morand(/),  who  found  the  chryftalline  humour,  although  not 

(d  Vid.  Epift.  Anat.  18.  n.  26.  (f)  Mem.  de  PAcad.  R.  des  Sc.  a.  1730. 


lefs 


296  Book  I.  Of  Difeafes  of  the  Head. 

lefs  hard  than  the  hardeft  ftone,  worn  away  neverthelefs,  in  a  manner,  at  its 
upper  edge,  and  even,  as  the  figure  thereof  thews (£),  deficient,  in  one  place 
particularly  ;  and  that  not  from  the  furgeon’s  needle,  to  which  the  man,  like 
ours,  had  always  been  extremely  averfe.  And  I  will  give  you  an  inftance  of 
the  colour  being  not  only  brown  internally,  but  all’o  black,  on  another  oc- 
cafion  ( h ). 

17.  I  order’d  the  eyes  of  an  old  woman,  concerning  whofe  lafb  difeafe, 
and  difteCtion,  I  fhall  write  to  you  at  another  time  (7),  to  be  taken  out,  and 
brought  to  me,  as  I  found  fhe  had  been  blind.  Cutting  into  them,  I  per¬ 
ceiv’d  no  dilorder  at  all  in  one  of  them,  except  opacity  in  a  part  of  the 
cornea.  But  the  other,  although  it  had  moft  of  its  parts  in  good  condition, 
neverthelefs  fhew’d  the  chryftalline  humour  to  be  lb  much  diminilh’d,  ac¬ 
cording  to  all  its  dimenfions,  that  fcarcely  any  part  of  it  was  remaining ; 
and  what  did  remain  was  white  and  opaque,  although  internally  it  was  even 
then  moift.  It  all'o  adher’d  with  the  iris  to  the  cornea  •,  in  which  place  the 
cornea  was  more  opaque,  and  fomewhat  hollow’d  into  a  foveola,  or  little  ca¬ 
vity,  of  an  eliptical  circumference,  and  ting’d  with  a  dirty  yellow :  but  this 
difeas’d  appearance  did  not  reach  to  the  exterior  furface  of  the  cornea. 

18.  It  is  probable,  that  thele  diforders  are  to  be  imputed  to  an  internal 
inflammation  of  the  eyes,  which  had,  perhaps,  preceded.  This,  however, 
is  certain,  that,  befides  the  opacity  of  the  chryftalline  humour,  in  which  the 
nature  of  the  fuffufion  generally  confifts,  a  confumption  alfo  of  a  great  part 
of  it,  and  an  unufual,  and  even  immoveable  fituation,  had  happen’d  both  to 
this,  and  to  the  iris. 

But  neither  in  this  woman,  nor  in  the  mafon,  whom  I  fpoke  of  above  (£), 
were  drynefs  and  hardnefs  join’d  with  an  opacity  of  the  chryftalline  ;  fo  that 
Valfalva  would  very  readily  have  call’d  all  thele  cataraCts  (/).  But  that  ca¬ 
taracts  of  this  kind  come  more  flowly  to  their  real  maturity,  I  do  not  doubt ; 
of  which  kind,  1  fee,  was  one  of  the  two,  that  manifefted  themfelves  in  the 
eyes  of  that  woman  of  the  firft  rank  (m),  within  a  few  years,  in  which  I  had 
formerly  feen  kinds  of  ftriae,  or  lines  •,  and  that  the  other  was  of  this  kind, 

I  always  thought,  and  ftill  think.  For  the  one,  from  the  very  time  that  it 
firft  difcover’d  itfelf,  by  a  kind  of  whitenefs,  in  a  certain  part  of  the  chry¬ 
ftalline,  remain’d  juft  in  the  fame  ftate,  for  many  years,  without  the  leaft  fign 
of  increafe.  But  as  to  the  other,  which  had  made  the  whole  chryftalline, 
in  faCt,  white,  and  yet  had  not  render’d  it  fo  opaque,  as  was  to  be  expe&ed 
in  fo  long  a  fpace  of  time,  and  as  it  fhould  have  been,  when  others  did  not 
dare  undertake  to  difturb  it  ;  fome  ftranger  or  other,  who  was  a  great  boafter, 
and  who,  as  Cicero  fays  («),  properaret ,  cui  fora  multa  reflarent,  “  who  was 
“  in  a  hurry,  having  a  great  deal  of  bufinefs  to  do,”  without  the  knowledge 
of  any  of  the  others,  immediately  deprefs’d  it;  not  fo  much,  however,  but 
that,  after  fome  time,  a  white  opacity  again  appear’d  behind  the  pupil,  not 
indeed  to  fo  confiderable  a  degree,  as  that  which  is  mention’d  on  another  oc- 
cafion  by  me  ( 0 ),  as  having  happen’d  in  a  noble  virgin,  but  fuch  a  one,  ne- 

\g)  Pbg.  28.  litt.  D.  (»;)  Ibid.  n.  19. 

[h)  Epiil.63.r1.  6.  (7?)  Orat.  pro  Cluent. 

(0  Epift.  35.  n.  12.  (k)  N.  15.  (0)  Epift.  modo  indie,  n.  22,  23. 

(1)  Vid.  Epift.  Anat.  18.  n.  27. 

verthelefs. 


Letter  XIII.  Article  i  8.  297 

verthelefs,  as  teftides  the  method  of  cure,  and  even  makes  it,  to  be  entirely 
unfuccefsful.  But  it  was  not  thus  with  another,  who  was  a  filter  of  that 
matron,  as  in  her  the  fuffufion  was  deprefs’d,  when  it  was  come  to  its  ma¬ 
turity.  Yet  in  the  third  fitter,  in  whom  the  fame  ftranger  had  deprefs’d  the 
cataraft,  the  marks  of  an  unfuccefsful  method  of  cure  were  much  lboner 
difcover’d.  You  fee,  that  there  were  in  this  family  three  fitters,  and  that  all 
of  them  were  iubjedt  to  the  fame  difeafe  ;  with  which  not  one  of  the  three 
noble  brothers  was,  in  the  leatt,  affiidted.  So  I  fhall  tell  you,  on  another 
occafion,  of  a  family,  in  which  the  females,  who  were  born  of  a  deaf  mo¬ 
ther,  were  all  deaf,  but  none  of  the  males  (y>). 

The  mention  which  I  have  now  made  of  this  noble  virgin,  brings  to  my 
mind,  what  was  the  opinion  of  that  celebrated  man,  Gunzius,  in  a  little 
book,  that  was  publifh’d  at  Leipfic,  while  he  was  prefident,  and  which  cer¬ 
tainly  deferves  much  praife,  concerning  my  obfervation  on  her  eyes.  This 
book  came  out  in  the  year  1750  (q) :  and  therein  he  thought  the  obfervation 
to  be  fo  far  rare,  that  notwithftanding  there  are  fo  many  fpoken  of  in  that 
little  work,  yet,  depending  upon  this  alone,  he  conftituted  a  new  kind  of 
fuffufion.  And,  indeed,  when  I  came  to  confider  the  fubjeft,  in  every  point 
of  view,  I  hinted  that  it  might  poffibly  happen  (r),  that  44  hence  even  a 
44  fpecies  of  fuffufion  was  to  be  allow’d  on  the  outfide  of  the  chryftalline 
44  humour,  and  its  coat.”  But  I  did  not  think  the  obfervation  was  44  fo 
44  rare  nor  was  I  willing  to  determine,  in  the  lead,  as  I  have  once  and 
again  exprefsly  faid,  from  what  it  happen’d,  without  other  opportunities  of 
diffeftions  of  the  like  nature,  which  at  prefent  1  was  without  ;  fince  1  was 
neither  ignorant  myfelf,  nor  conceal’d  from  my  readers,  that  whatfoever  I 
might  conjecture  on  the  fubject,  would  be  liable  to  considerable  caufes  of 
doubt,  which  did  not  efcape  me.  And  I  hop’d,  indeed,  that  in  the  mean 
while,  fomebody  would  arile,  who  fhould  remove  thefe  caufes  of  doubt  from 
me.  But,  as  the  old  man  fays  in  Terence  (s'),  now  Incertior  fum  multo ,  quam 
dudum ,  44  I  am  more  at  a  lofs  than  ever.”  Nor  did  I  44  fuppofe,”  but  only 
propos’d  for  enquiry,  whether  the  chryftalline  coat  could  poffibly  have  con¬ 
tinu’d  ro  feparate  that  glutinous  matter;  and  I  myfelf  argu’d  againft  that 
very  fuppofition,  by  many  different  reafonings,  and,  in  particular,  made  ufe 
of  thofe  arguments  againft  it,  which,  to  my  great  furprize,  are  now  ob- 
jedled  againft  me  (/).  And  I  even  faid,  it  was  worthy  of  enquiry,  whether 
this  matter,  being  perhaps  difpers’d  through  the  aqueous  humour,  could 
poffibly  have  agglutinated  itfelf  afterwards  to  that  coat.  And  as  I  had  like- 
wife  admonifh’d,  that  we  ought  to  have  fome  doubt  upon  this  head,  efpe- 
cially  as  fuch  a  fuppofition  could  by  no  means  have  taken  place,  without  its 
being  agglutinated  to  the  iris  alfo,  and  to  other  parts  ;  I  fhould  never  have 
expe&ed,  that,  among  other  things,  this  anfwer  would  have  been  made  me : 
That  the  coat  of  the  chryftalline,  44  when  a  man  goes  to  deep,  at  which 
44  time  the  vifcous  particles  can  fubfide,  more  than  at  any  other  time,  is  cer- 
44  tainly  the  lower  part  of  the  eye  as  if  the  iris,  even  at  that  time,  were 

(p)  Epift.  48.  n.  48.  (r)  Epift.  Anat.  18.  n.  24,  25. 

( q )  Animadverf.  de  Suffufion.  natura,  &  cu-  (s)  Phorm.  Aft.  2.  Sc.  4. 
rat.  c.  1.  §  15.  (/)  C.  1.  cit.  §  6. 

Vol.  I.  Q^q 


cot 


2  9  8  Book  I.  Of  Difeafes  of  the  Head. 

not  inferior  to  the  greateft  part  of  the  aqueous  humour,  as  alfo  that  fide  of 
the  cornea,  to  which  the  head,  while  we  deep,  is  perhaps  inclin’d.  Nor  are 
the  doubts  only  not  taken  away  by  this  reafoning,  but  are  even  ffcill  more 
increas’d  by  thefe  words :  “  That  this  vifcid  matter  was  from  the  aqueous 
“  humour,  I  fo  much  the  lefs  doubt,  as  it  is  very  certain,  that  the  fluids  of 
6C  our  body,  and  efpecially  thofe  which  are  not  continually  mov’d  through 
“  the  vefiels,  very  often  acquire  a  vifcid  difpofition.”  But  I  doubt,  in  the 
flrft  place,  whether  this  humour  be  not  mov’d,  as  much  as  is  requiflte,  by 
the  vefiels  which  are  continually  conveying  it,  and  by  the  very  frequent  agi¬ 
tations  of  the  iris,  and  eye,  to  prevent  it  acquiring  a  vifcid  difpofition  :  and 
in  the  fecond  place,  I  doubt,  whether  it  does  often  acquire  this  vifcidity,  fince 
it  is  certain,  that  vifcid  fuffufions  are  not  often  found  therein.  And,  indeed, 
out  of  the  few  of  this  kind,  which  I  had  pointed  out,  that  taken  from  Wepfer, 
it  is  thought,  fhould  be  transferr’d  from  the  aqueous  to  the  chryftalline  hu¬ 
mour  •,  although  the  author  has  faid,  that  the  mucous  matter  was  not  within 
the  coat  of  the  chryftalline,  but  cover’d  it,  and  yet  not  all  round  about, 
though  he  ufes  the  word  circumcirca ,  I  fuppofe,  by  accident.  Other  things 
I  omit :  for  it  ought  to  be  enough  for  me  to  have  confider’d,  without  flander 
or  revilings,  whatever  may  have  been  urg’d  againft  me  without  flander  or  re¬ 
viling,  and  from  a  defire  after  truth.  And  I,  moreover,  very  chearfully  and 
readily  affirm,  that  this  little  book  is  in  the  number  of  thofe  few,  which  are 
written  learnedly,  methodically,  and  clearly,  on  the  fubjeft  of  fuffufion. 
And  as  almoft  all  the  examples  of  this  difeafe,  that  are  extant  among  ap¬ 
prov’d  authors,  are  taken  notice  of  in  this  work ;  fo  there  is  none  of  them, 
that  is  not  referr’d  both  to  a  certain  genus,  and  to  a  certain  fpecies,  the 
figns  by  which  they  are  to  be  diftinguiffi’d  not  being  omitted,  and  the  methods 
of  cure  being  pointed  out,  and  thefe  not  only  argued  from  the  advantages 
of  the  good  method,  but  from  the  mifehiefs  of  the  bad. 

But  as  I  have  faid,  that  almoft  all  the  examples  were  already  produc’d, 
you  will,  perhaps,  afk  me,  then,  what  are  ftill  wanting;  for  which  reafon,  I 
will  not  conceal  thofe  that  occur  to  me,  as  I  write.  That  very  excellent 
man,  Bure.  Dau,  Mauchartus  (u)  afiferts,  that  he  found  a  membranous,  folid, 
fibrous,  whitifti  cataraft,  in  each  eye  of  a  dog,  when  at  the  fame  time  the 
aqueous  humour,  through  both  the  anterior  and  pofterior  chamber  of  which 
it  was  extended,  and  the  other  humours,  were  pellucid.  And  the  fame 
Mauchartus,  together  with  another  very  eminent  profefifor,  John  Zellerus, 
faw  a  thin  and  blackifh  pellicle,  plac’d  in  fuch  a  manner  before  the  pupil  of 
each  eye,  in  a  woman,  that  it  firmly  adher’d  to  the  cornea,  near  its  internal 
circumference.  Nor  was  the  eye  without  thofe  diforders  of  the  vitreous  and 
chryftalline  humours,  which  are  mention’d  by  the  celebrated  Keckius  (a*). 
The  fkilful  anatomift  Jo.  Chriftoph.  May  ( jy),  in  a  woman,  whofe  cataracts 
had  been  formerly  deprefs’d,  the  one  with  fuccefs,  and  the  other  without, 
deferib’d  the  former  of  what  kind  it  was,  and  where  he  had  found  it ;  but 
inftead  of  the  other,  he  found,  as  he  thought,  the  anterior  furface  of  the 
coat  of  the  chryftalline,  not  as  in  the  firft  eye,  pellucid,  and  in  a  natural 

( u )  Synechiae,  §.  8.  (y)  Commere.  Litter,  a.  1733.  hebd.  4.  n.3. 

(x)  In  Praefat.  ad  Differt.  fuam  de  Eftropio. 

ftate, 


Letter  XIII.  Article  19.  299 

Rate,  but  very  thick  and  opaque.  And  the  celebrated  Trew(2)  has  told 
us,  what  difference  there  was,  betwixt  the  chryftaliine  humours  of  an  aged 
man,  in  one  of  which,  was  an  incipient,  and  in  the  other,  a  perfect  cataradt. 
Nor  do  I  doubt  but  my  Epiilolae  Anatomicae  will  alfo  furnifh  you  with  fome 
other  example.  For  certainly,  befide  the  great  number  of  obfervations 
which  are  already  taken  from  them,  they  have  one  alfo  (a),  that  is  defcrib’d 
fomewhat  more  at  large,  of  a  membranous  cataradl  in  a  woman,  from  the 
celebrated  Balth.  Walthieri,  which,  as  I  have  there  hinted,  is  alfo  delcrib’d 
by  the  famous  Royal  Society  at  London.  And  do  not  be  furpriz’d,  that  I 
have  mention’d  promifcuoufly,  as  they  now  come  into  my  mind,  examples 
of  this  diforder,  whether  in  men,  or  in  dogs  •,  for  we  all  ufe  promifcuoufly 
alfo,  thofe  inftances  that  are  taken  from  the  quadruped  kind,  efpecially  if 
they  have  any  thing  peculiar  in  them,  as  in  the  obfervation  of  Mauchartus, 
a  catarabt  is  fhewn  to  have  exifted,  even  in  the  firfb  chamber  of  the  aqueous 
humour,  which  happens  extremely  rare  :  and  to  this,  for  the  fame  realon,  I 
would  have  you  join  the  obfervation  of  Sprogelius  (b),  becaufe  it  demon- 
flrates,  that  at  the  fame  time,  in  one  certain  dog,  by  way  ot  a  rare  inftance, 
the  chryftaliine  humours  were  both  dried  up,  and  opaque,  and  the  vitreous 
humours  without  moifture,  and  corrugated,  while  the  optic  nerves  were  re¬ 
duc’d  to  the  thinnefs  of  a  fmall  thread,  and  that  there  were  other  things 
befide  thefe  of  a  peculiar  nature.  But  that  I  may  not  fay  more  of  the  fuffu- 
fion  than  of  the  amaurofis,  let  us  proceed  to  the  other  diforders  of  the  eye. 

19.  Concerning  the  myopia,  or  purblindnels,  however,  and  the  diforder, 
diametrically  oppofite  thereto,  it  is  fufficient  to  put  you  in  mind,  that  it 
would  have  been  better,  nothing  had  been  propos’d  in  the  Sepulchretum, 
than  that  (c)  which  you  will  read  there,  and  had  been  long  ago  rejected  by 
Plempius  (d).  Platerus,  indeed,  who  was  an  ingenious,  and  at  that  time, 
a  learned  man,  and  who,  if  he  did  not  firft  demonftrate  with  juftice  the  ufe 
and  office  of  the  retiform  coat,  and  efpecially  of  the  chryftaliine  humour, 
as  fome  think,  was  certainly,  however,  very  near  to  the  truth.  Yet,  as  if 
it  had  fall’n  out  by  chance,  in  thofe  obfervations  which  he  wrote  afterwards, 
he  was  not  altogether  confident  with  himfelf,  and  certainly  fuppos’d  fuch 
things,  concerning  the  feat  of  the  chryftaliine,  in  thofe  who  labour  under 
a  true  myopia,  which  agree  with  the  contrary  diforder,  and  vice  verfa : 
wherefore  the  true  caufe  of  thofe  diforders,  which  in  faff  is  accounted  for, 
in  the  former,  from  the  greater  diftance  of  the  chryftaliine  and  retina, 
and  from  the  leffer  diftance  of  thefe  two  parts  in  the  latter,  was  unknown  to 
Platerus,  contrary  to  what  others  imagine.  But  as  to  the  caufes,  which  de¬ 
pend  upon  other  crrcumftances,  as  for  inftance,  on  the  chryftaliine  being 
more  or  left  convex  and  denfe;  thefe  are  not  fo  much  as  mention’d  in  the 
Sepulchretum  :  although  thefe,  as  well  as  the  former,  may  be  cur’d,  and  by 
the  ufe  of  concave  or  convex  glaffes  •,  fo  that  I  wonder  a  certain  great  man 
fhould  fuffer  fuch  a  fentence  to  efcape  him,  61  that  thefe  diforders,”  to  wit, 

of  a  more  denle,  or  lax  chryftaliine,  do  not  admit  of  a  cure  from  glaffes.’’ 

(2)  Ejufd.  Commere.  A.  1745.  Hebd.  36.  (i)  Eph.  N.  C.  Cent.  7.  obf.  71. 

li.  3.  (r)  Sett,  hac  18.  Append.  2.  poll  obf.  33, 

(«)  Epift,  18.  n.  20.  (a1)  Ophthalmogr.  1.  4.  probl.  39. 

Q^q  2  Finally, 


3oo  Book  I.  Of  Difeafes  of  the  Head. 

Finally,  in  the  Sepulchretum  by  the  word  nydtalopia,  is  intended  a  difor- 
der,  oppofite  to  the  myopia,  as  we  fee  it  in  many  old  men,  which  for  that 
reafon  Scheidius,  with  juftice  thought,,  might  be  call’d  the  anti-myopia,  as 
he  tells  us  in  that  learned  and  ingenious  diftertation,  which  is  entitled,  Vifus 
Vitiatus  ( e ).  But  although  that  nydtalopia,  which  the  more  modern  Greeks 
intended  (/)  may  feem  to  be  fomewhat  lefs  different  from  the  diforder, 
which  is  diametrically  oppofite  to  the  myopia,  as  the  myopia  is  from  what 
Hippocrates  underftood  thereby  (g) ;  yet  thefe  diforders  are  very  far  different 
from  the  nyftalopia  of  one  and  of  the  other,  and  proceed  from  very  different 
caufes ;  for  which  reafon  they  do  not  admit  of  a  cure  by  glaffes  ;  for  what 
can  glaffes  do  towards  the  cure  of  the  firft,  that  is  an  evening  blindnefs, 
which  may  feem  to  arife  from  a  kind  of  refolution  of  the  retina,  or  to  the 
cure  of  the  fecond,  that  is  the  blindnefs  by  day,  w  hich  is  probably  owing  to 
a  too  great  tenfion  of  the  retina  ?  Therefore,  as  you  diftinguifh  them  by  this 
mark,  that  is  drawn  from  the  inutility  of  glaffes,  fo  it  is  neceffary  that  you 
diftinguifh  the  nydtalopia  by  name  alfo,  from  thofe  two  diforders.  But  to 
which  caufe  of  the  nydtalopia,  the  caufe  of  certain  dullneffes  of  fight,  arifing 
from  diforders  of  the  retina,  approach  the  neareft,  you  will  alfo  conjecture 
from  hence,  that  a  bright  light  is  troublefome  to  the  latter;  but  to  the  for¬ 
mer  is  ufeful,  juft  in  the  fame  manner  as  great  founds  have  been  ufeful  to 
thofe  who  are  deaf,  or  have  fome  difficulty  of  hearing,  on  account  of  a 
laxity,  as  Holder  (h)  and  Willis  (i)  have  affirm’d  in  their  writings.  And  as 
with  fome  of  all  the  diforders  which  have  been  mentioned,  the  dilatation 
of  the  pupil  is  frequently  join’d,  as  an  effeft  with  its  caufe,  and  with  others 
a  conftri&ion  thereof ;  take  care,  left  you  pronounce  that  the  caufe  of  the 
diforder,  is  then  in  the  lurrrounding  iris;  and  in  like  manner,  when  fome 
marks  of  a  beginning  opacity,  in  the  chryftalline,  or  any  other  humour,  dis¬ 
cover  themfelves :  but  when  you  fhall  have  well  weigh’d  all  the  fymptoms, 
which  have  preceded,  or  attend  the  diforder,  accurately;  then  judge  of  the 
caufes  which  produce  thofe  effeCls  in  the  pupil.  But  if  you  read  what  Mau- 
chartus(&)  has  publiffi’d,  concerning  the  morbid  dilatation  of  the  pupil,  or 
concerning  the  adhefion  of  the  iris  to  the  cornea ;  you  will  find  many  things 
that  may  be  ufeful  to  you,  both  in  your  ftudies  and  your  pra&ice. 

20.  Concerning  thofe  things,*  in  like  manner,  which  are  produc’d  in  the 
Sepulchretum,  either  of  the  pain  in  the  eye,  or  its  procidentia,  or  ftrabif- 
mus,  I  will  only  juft  hint  thefe  few  things.  In  regard  to  the  firft,  that 
either  the  twenty-ninth,  or  thirty-fourth  cbfervation,  ought  to  have  been 
omitted.  For  you  will  eafily  fee,  that  both  of  them  are  the  fame,  in  like 
manner  as  the  beginning  of  the  Scholia,  to  the  firft  article  of  the  firft 
obfervation,  is  the  fame  as  moft  of  the  words  which  are  foon  after  re¬ 
peated  in  the  fecond  article  of  that  obfervation.  But  concerning  the  proci¬ 
dentia,  that  which  Plempius  (/)  had  copied,  almoft  word  for  word,  from  our 
Spigelius,  though  he  fupprefs’d  his  name,  and  which  you  will  read  fubjoin’d 

(e)  Se£t.  i.  n.  32.  (?)  De  Anima  Brutor.  c.  14. 

(/)  Cg)  Vid.  apud  Plenp.  Ophthalm.  1.  5.  (-£)  Difl'ert.  de  Mydriafi,  &  DifT.  de  Syne- 

c.  26.  chia,  &c, 

(£)  A£t.  Philof.  Soc.  R,  in  Angl,  A.  1668.  (/)  Ophft.  1.  5.  c.  32.  *- 

Me  Maj.  n.  1. 


to- 


Letter  XIII.  Article  20.  301 

to  the  twenty-fifth  obfervation,  certainly  is  by  no  means  necefiary,  in  a  flight 
prolapfus  of  the  eye,  or  rather  in  a  not  very  immoderate  prominence  of  the 
eye,  without  the  orbit;  for  the  optic  nerve -is  not  naturally  tenfe,  within  the 
orbit,  but  fo  lax,  that  it  may  follow  the  eye,  as  far  as  1  have  faid,  without 
being  at  all  broken  through.  But  as  to  that  which  is  added  to  the  twenty- 
feventh  obfervation  from  Hildanus,  explaining  a  kind  of  procidentia  oculi, 
which  had  at  length  been  the  confequence  of  a  wound,  inflicted  upon  the 
eye-lid,  and  ill  cur’d,  it  cannot  be  eafily  prov’d,  unlefs  it  be  explain’d  in  a 
very  different  manner  from  that  in  which  he  explain’d  it.  For  although  it 
is  credible  that  the  wound  penetrated  into  the  right  frontal  finus :  yet  that 
the  whole  eye  was  infedted,  from  the  putrefied  blood  of  that  finus,  “  pene- 
“  trating  by  the  natural  foramina,  that  go  from  thole  finuffes  to  the  eyes,” 
who  can  grant,  unlefs  he  who  does  by  no  means  doubt,  but  thole  things 
which  he  had  touch’d  upon  a  little  before  (w),  concerning  thefe  kind  of 
foramina,  according  to  the  opinion  of  fome,  were  in  every  refpedl  consenta¬ 
neous  with  anatomy  ?  If  Hildanus  had  written,  either  in  this  place,  or  any 
other,  which  1  am  not  aware  of,  what  event  a  diforder  of  this  kind  had  ter¬ 
minated  in ;  it  might  then  have  appear’d,  whether  a  caries  did  not  rather 
open  a  way  for  itfelf,  and  for  deprav’d  humours,  through  the  bony  partition, 
which  lies  between  that  finus,  and  the  eye,  and  by  this  means  penetrate  into 
the  orbit. 

Finally,  of  the  flrabifmus  one  obfervation  only  is  propos’d  («),  and  that 
of  one  eye,  the  caufe  of  which  is  Suppos’d  to  be  “  from  a  great  quantity  of 
“  moifture  walking  the  brain  with  which  the  nerves,  call’d  motores  oculi, 
“  being  impregnated,”  were  convuls’d.  And  this  caufe  being  Suppos’d 
without  any  additamentum,  how  can  we  account  for  the  flrabifmus  not  having 
affefted  both  eyes  equally  ?  But  in  the  fcholium  which  is  added,  indeed, 
other  caufes  of  flrabifmus  are  mention’d  from  our  Saxonia,  to  wit,  “  a  bad 
“  Situation  of  the  pupil  or  the  chryftalline.”  But  many  others  are  at  the 
fame  time  pafs’d  by.  Nor,  indeed,  do  I  fpeak  of  internal  caufes  only,  as 
for  inflance,  if  the  chryftallines  are  in  both  fides  rightly  plac’d,  and  in  one 
eye,  that  part  of  the  retina  does  not  anfwer  to  the  pupil  which  ought,  but 
another,  and  plac’d  much  nearer  than  is  natural,  to  the  part  of  the  retina 
that  is  always  blind,  the  Situation  of  which  is  at  the  very  infertion  of  the 
optic  nerve,  fo  that  unlefs  the  mufcles  fhould  draw  it  a  little  to  one  fide  or 
other,  part  of  the  image  which  is  painted  in  the  retina,  would  fall  upon  that 
blind  Spot.  But  I  fpeak  of  external  caufes  alfo,  which  are  on  the  outfide  of 
the  eye,  and  thefe  of  different  kinds.  For  a  flrabifmus  may  happen,  not 
only  from  a  convulfion  of  fome  of  the  mufcles  of  the  eye,  but  even  from  a 
pally  thereof  likewife  ;  which  caufe,  the  author  of  the  Finitiones  Medic<e> 
that  are  afcrib’d  to  Galen,  long  before  Plempius,,  had  taught.  “  The  ftra- 

bifmusy”  fays  he,  “  is  a  refolution,  not  of  all  the  mufcles  of  the  eye,  but 
4‘  of  fome  only  ;  for  which  reafon  the  eyes  are  drawn  upwards,  or  down- 
“  wards,  or  to  one  fide.”  But  a  flrabifmus  alfo  happens  Sometimes,  from 
any  one  of  thefe  mufcles,  being  impregnated  with  humours,  not  freely  circu¬ 
lating  through  it,  as  I  faw  happen  in  the  wife  of  a  lawyer,  who  was  my 


(«0  Vid.  Cent.  5.  obf.  1» 


(*)  Obf.  37. 


friend 


30  2  Book  I.  Of  Diieafes  of  the  Head. 

friend  :  this  woman  having  a  humour  fettle,  as  the  vulgar  phrafe  is,  at  one 
fide  of  the  root  of  the  nofe,  and  the  parts  in  the  neighbourhood  thereof, 
was  feiz’d  with  this  diforder  of  the  eye,  of  which  I  cur’d  her  within  a  little 
time,  when  I  p«a<5tis’d  phyfic  in  the  place  of  my  nativity.  A  noble  prieft 
had  alfo  been  troubled  with  defluxions,  or  humours,  for  fome  little  while, 
fometimes  in  one  cheek,  and  fometimes  in  the  other,  when  he  was  fuddenly 
affected  with  this  kind  of  depravation  in  his  fight,  that  when  he  bent  his  eyes 
downwards  to  read,  as  our  cuftom  is,  all  the  letters  appear’d  to  lie  one  upon 
another,  and  in  a  manner  to  decuffate  each  other,  fo  that  the  whole  was  con¬ 
fus’d  ;  but  this  confufion  was  immediately  taken  away  upon  (hutting  one  or 
other  of  his  eyes ;  or  if  he  plac’d  the  book  diredtly  oppofite  to  both  his  eyes 
when  they  were  open  indeed,  but  not  call  downwards,  and  even,  if  he 
pleas’d,  when  they  were  turn’d  upwards.  Yet  fome  confufion  ff ill  remain’d, 
if  the  book,  thus  plac’d,  was  transferr’d  a  little  to  the  right  fide,  but  not  if 
it  was  remov’d  to  the  left.  I  was  confulted  upon  this  cafe  by  letters  ;  and 
from  the  account  which  I  have  juft  given  you,  there  feem’d  to  be  fome  fault 
in  the  right  abduefitor  mufcle,  whole  ftrength  was  not  altogether  correfpondent 
with  that  of  the  left  addudtor  mufcle  :  the  fame  fault  alfo  feem’d  to  be  in 
the  neighbouring  deprelfor  of  the  right  fide,  and  even  upon  a  more  ftrong 
conjecture,  to  wit,  that  it  could  not  deprefs  the  eye  equally  with  the  left  de- 
preffor  mufcle,  whereas,  in  other  refpedts,  the  remaining  mufcles  of  the 
eyes,  being  endow’d  with  their  natural  ftrength,  turn’d  both  of  them  equally 
to  the  left  fide,  and  mov’d  them  equally  upwards  •,  and  thus  the  images  of 
the  different  letters  were  painted  on  thofe  parts  of  the  retina,  in  both  eyes, 
where  they  are  us’d  to  be  painted  ♦,  but  if  the  eyes  were  caft  downwards,  or 
turn’d  to  the  right  fide,  as  they  were,  in  both  thefe  cafes,  by  the  fault  of  the 
deprefior  and  abdueftor  mufcles,  mov’d  unequally,  the  letters  then  appear’d 
to  be  doubl’d,  and  plac’d  one  upon  another.  I  therefore  conjectur’d  that 
there  was  a  flight  pally  in  the  two  mufcles ;  flight,  I  fay,  as  we  need  not 
fuppofe  it  very  conflderable,  in  order  to  account  for  this  little  inequality  in 
the  motions  of  the  eye  *,  for  I  could  not  conjecture,  that  either  retina  was 
affected  with  a  paralytic  diforder,  fince  it  was  very  plain,  that  all  the  parts 
of  the  eye-ball  itfclf  were  found,  and  natural,  as  he  faw  well  with  any 
one  eye,  which  way  foever  it  was  directed.  And  as  I  was  under  a  necefiity 
of  blaming,  either  convulfion,  or  paralyfis,  for  the  fudden  attack  of  this  dif¬ 
order  ;  I  rather  believ’d  it  to  be  palfy,  by  realon  that  it  had  no  fenfe  of  un- 
eafinefs  join’d  with  it,  and  gave  no  obftruction  to  any  motion  of  the  eye 
whatever:  which  marks  and  others  of  the  like  kind,  I  have  been  accuftom’d 
to  ule,  in  order  to  diftinguifh  diforders  from  one  another,  in  this  and  in  other 
parts,  as  alfo  thofe  marks  which  had  no  place,  in  the  confideration  of  1b  re¬ 
cent  a  diforder  as  this,  I  mean  the  length  and  difficulty  of  the  cure,  which 
are  generally  greater  in  a  pally  than  in  a  convulfion. 

It  alfo  happens  fometimes,  as  I  have  found,  that  a  mufcle  of  the  eye  coa- 
lefces  in  fuch  a  manner,  with  the  neareft  immoveable  part,  that  itfelf,  of  ne- 
ceffity,  becomes  immoveable.  But  thefe  many  and  various  external  caufes, 
of  which  I  fpeak,  are  all  adventitious.  What  ?  if  from  the  very  womb  any 
mufcle  of  either  eye  be  too  long,  or  too  fhort  ;  too  ftrong,  or  too  weak  ;  too 
detach’d,  or  too  confin’d,  in  its  motions !  Will  not  the  children,  who  have 

3  fuch 


Letter  XU!.  Article  21.  303 

fuch  mufcles,  be  born,  more  or  left,  with  a  ftrabifrnus,  in  proportion  to  the 
greater  or  left  degree  of  the  unnatural  conilitution  in  the  mufcle  ?  And  you 

O  CT  #  • 

know,  I  had  written  thefe  things  to  you  before  the  memoir  of  the  cele¬ 
brated  Bufion  came  out  (0),  fupported  .by  thole  experiments  relating  to  the 
caufe  of  the  ftrabifrnus,  and  its  frequent  and  fpeedy  cure,  that  are  regugnant 
to  the  more  common  dodtrine  according  to  which  I  had  written.  If  you  can 
meet  with  a  great  number  of  thofe  perfons  who  are  troubl’d  with  a  ftrabifrnus, 
fo  as  to  repeat  the  experiments,  which  is  not  in  my  power;  1  would  have 
you  follow  that  method  which  anfwers  belt  upon  trial.  Yet  I  would  have 
you  obferve,  that  his  enquiry  was  rather  of  the  innate  ftrabifrnus,  and  that 
which  has  its  origin  from  internal  caufes,  than  of  the  adventitious,  the  ex¬ 
ternal  caufes  whereof  are  principally  enquir’d  into  here  by  me,  to  which,  as 
far  as  I  remember,  even  his  dodtrine,  and  experiments,  are  not  repugnant. 

21.  Before  I  fay  any  thing  concerning  the  diforders  of  the  lachrymal  paf- 
fages,  it  is  proper  that  I  fubjoin  fome  hints,  at  lead,  concerning  the  inflam¬ 
mation  of  the  horny  coat,  and  other  diforders  thereof,  fince  I  here  fee  no 
obfervations  in  the  Sepulchretum  of  internal  inflammations  of  the  eye,  nor 
have  I  any  to  produce  rhyfelf;  except  that  I  remember,  in  a  blind  dog,  the 
retina  itfelf  feem’d  bloody,  and  almofl:  black  ;  fo  that  it  was  very  eafy  to 
conceive  what  might  happen  to  the  choroides,  which,  by  reafon  of  its  incre¬ 
dible  number  of  vefiels,  has  fometimes  appear’d  to  me  (/>),  ev’n  in  found 
eyes,  to  be  of  a  bloody  colour,  and  to  that  part  of  it  call’d  uvea :  concerning 
the  figns,  danger,  and  cure  of  which  inflammation,  Boerhaave,  according  to 
his  cullom,  has  taught  many  things  in  a  few  words  (q).  But  let  us  confider 
a  little  the  inflammation  of  the  cornea  :  the  caufes  of  which,  although  fre¬ 
quently  obvious  to  the  eye?  of  thofe  who  look  upon  the  difeas’d  eye,  are, 
nevertheleft,  fometimes  taken  for  the  efredts.  And  two  examples  of  this  I 
fhall  give  you,  that  I  have  myfelf  feen  ;  the  one  in  a  nobleman,  and  the 
other  in  a  miller.  This  miller  being  brought  to  me,  that  I  might  determine 
what  the  diforder  was,  which  had  begiTh  to  come  on  in  the  cornea,  from  a 
violent  ophthalmia;  1  obferv’d,  in  the  middle  thereof,  a  very  frnall  fpot,  in 
the  form  of  a  circle,  whitifh  on  its  outer  circumference,  and  almofl;  black 
in  the  center.  When  I  enquir’d  what  had  given  occafion  to  the  inflammation, 
he  laid  himfelf,  that  it  had  begun  from  the  very  time,  that,  while  he  was 
chipping  a  mill  Itone,  with  the  iron  inftrument  commonly  us’d  for  that  pur- 
pofe,  fomething  had  flown  into  his  eye,  which  however  he  had  immediately 
wafh’d  out.  As  I  fufpedted,  and  it  in  fadt  prov’d,  that  fome  little  particle 
of  the  (tone,  or  rather  of  the  iron,  had  been  fix’d  in  the  cornea,  and  kill  re¬ 
main’d  where  the  fpeck  was,  and  that  thence  the  inflammation,  which  was 
very  bad,  arofe  ;  I  brought  a  magnet,  of  moderate  powers  of  attradlion, 
once  or  twice,  pretty  near  to  the  eye,  and  1  immediately  perceiv’d,  that  the 
blackifn  centre  of  the  fpot,  which  I  fpoke  of  before,  was  now  fomewhat  pro¬ 
minent  from  its  furface  ;  and  for  this  reafon,  becaufe  in  (hutting  the  eye,  the 
upper  eye  lid  began  to  be  (enfible  of  fomething  rough,  which  irritated  its 
internal  furface,  in  that  part.  But  whether  the  figure  of  this  little  particle  of 

ft)  Mem.  de  l’Acad.  R.  des  Sc.  a.  1745.  (q)  Praeleft  in  Inflit-  §  841. 

(p)  Vid.  Epilt-  Anat.  17.  n.  2.  ' 

iron 


304  Book  I.  Of  Diforders  of  the  Head. 

iron  was  fuch,  that  its  lower  part  was  broader  than  its  upper,  or  whether 
the  fibres  of  the  cornea,  being  more  impregnated  and  turgid  with  humours, 
more  cloiely  embrac’d  and  retain’d  this  particle  that  was  fix’d  there,  though 
at  firft  it  might  have  been  eafy  enough  to  extradt  it,  before  the  inflammation 
had  thus  thicken’d  the  part ;  I  fay,  whichfoever  was  the  cale,  1  could  not, 
or,  at  leaft,  did  not  think  proper  to  extradt  it  that  day  ;  and,  indeed,  thought 
it  was  high  time  to  give  over  the  attempt  immediately,  fince  the  man  faid, 
that  as  often  as  the  magnet  was  brought  near  to  his  eye,  fo  often  did  he  feel 
his  eye  drawn  haftily,  as  it  were,  towards  the  magnet,  and  not  without  an 
increafe  of  pain.  Wherefore,  prefcribing  to  him,  what  had  been  hitherto 
negle&ed,  gentle  purging,  and  a  lofs  of  blood,  and  alfo  fuch  things  to  be 
applied  to  the  eye,  as  relax  the  fibres,  and  aflfuage  the  pain,  it  was  not  long 
before  the  iron  fcoria,  together  with  tears,  fell  out  from  the  eye,  upon  which 
all  the  fymptoms  vanifh’d  immediately,  and  with  eafe.  But  my  intention 
was,  if  it  had  not  fall’ll  out  of  itfelf,  to  try  the  magnet  again,  after  having  firft 
made  the  eye  firm,  by  fome  proper  instrument,  that  it  might  not  be  attracted, 
together  with  the  fcoria,  in  fo  troublefome  a  manner. 

22.  You  fee,  that  from  the  phenomenon  of  magnetic  attraction,  as  it  is 
commonly  call’d,  to  appearance  indeed  ufelefs.  among  thofe  p’nyficians,  who, 
if  they  obferve  you  to  attend  a  little  clofely  to  the  operations  of  nature, 
immediately  afk  you,  with  a  malignant  kind  of  curiofity,  what  you  draw 
from  thence  to  improve  the  practice  of  phyfic  ?  You  fee,  I  fay,  that  from 
this  phenomenon,  fome  advantage  may  now  and  then  be  deriv’d,  and  that 
not  in  order  to  afcertain  the  caufe  of  the  difeafe  only,  but  to  remove  it.  For 
there  is  no  doubt,  but  fcorise  of  this  kind  may  be  eafily  taken  out  by  the  help 
of  a  magnet,  either  in  the  beginning,  when  the  fibres  are  not  yet  conftricfted, 
or  afterwards  when  they  are  relax’d  :  or,  at  leaft,  there  is  no  doubt,  but  they 
may  be  fo  mov’d,  and  drawn  forwards,  as  to  be  eafily  laid  hold  of  by  the 
forceps,  if  they  do  not  fall  out  of  themfelves.  Nor  do  1  fay  this  in  regard 
to  the  eye  merely,  but  in  regard  to  any  other  part  whatfoever,  where  fuch 
fubftances  may  be  infix’d,  elpecially  as  they  fometimes  fcarcely  appear,  or 
are  attended  with  fo  much  pain,  that  you  could  not  lay  hold  of  them,  if  you 
would,  or  by  reafon  of  the  pain,  your  patients,  and  elpecially  children,  will 
not  fuffer  you  to  do  it.  But  as  1  knew,  that  our  anceftors  in  phyfic  had  often 
mix’d  with  their  plafters,  which  they  applied  to  extract  heterogeneous  fub¬ 
ftances,  load-ftone  ground  into  powder,  which  being  thus  comminuted,  and 
intercepted  by  other  particles,  was  not  able  to  exert  its  force  j  I  began  to 
enquire,  whether,  fince  that  time,  any  one  before  me  ever  thought  of  trying 
the  fame  method  that  I  had  tried  ;  which  being  fo  obvious,  made  it  almoft 
incredible,  that  no  body  had  thought  of  it.  As  I  began  with  the  moft  mo¬ 
dern  writers,  after  finding  a  deep  filence,  among  a  great  number,  on  this 
head,  I  at  length  lit  on  a  paftage  in  Kerckringius  (r),  which  relates  a  cafe  of 
a  needle,  that  had  ftuck  in  the  throat  for  nine  years,  being  extracted  by  a 
bit  of  a  load  ftone.  Although  he  mentions  none  among  the  former  authors, 
who  bad  made  the  like  experiments,  yet  I  went  on  to  enquire,  till  being  ad- 
monifh’d  by  the  index  of  Hildanus,  I  read  an  oblervation  of  his  (j) ;  in  which 

( s )  Cent.  4.  Obf.  Chir.  17. 

2 


* 


(r)  Spicileg,  Anat.  Obf.  44. 


he 


Letter  XIII,  Article  23.  30 y 

he  tells  you  by  what  remedies  the  fcoria  of  iron,  that  had  been  fix’d  in  the 
adnata,  were  remov’d.  And  the  cafe,  indeed,  i  found,  which  I  would  have 
you  read  over,  being  in  molt  circumftances  as  fimilar  to  mine,  2s  one  egg  is 
iimilar  to  another*,  but  not  a  word  of  the  load-ftone.  At  length,  what  that 
“  molt  copious”  index  had  not  difcover’d,  chance  itfelf  threw  in  my  way  : 
for  as  I  was  looking  after  quite  another  thing,  i  (tumbl’d  upon  his  other  ob- 
fervation  (/),  Be  fcoria  chalybis  corner  irfxa,  ejufdemque  ingemofifinia  curatione. 
And  this  cafe  was  happily  and  perfectly  cur’d  by  the  magnetical  power,  when 
all  other  remedies  had  been  of  no  efiedt.  Moreover,  as  Kerckringius  was 
not  afham’d  to  contcls,  that  what  had  never  come  into  the  mind  of  any  fu  rgeon, 
among  fo  great  a  number,  he  had  learn’d  from  a  certain  travelling  mountebank,, 
nor  Hiidanus  to  confels,  that  he  had  the  hint  from  his  wife  ;  for  it  is  the 
fact,  and  not  the  author,  that  we  are  to  confider;  fo  the  latter  of  the  two 
added  this  remark  to  his  obfervation,  that  we  mult  take  great  care,  left, 
perhaps,  that  Iurface  of  the  magnet  fhould  be  by  chance  turn’d  to  the  eye, 
which  repels  iron.  But  although  I  know  very  well,  that  this  power  of  re- 
pulfion  is  acknowledg’d  by  others,  in  one  iurface  of  a  load-done  againlfc 
another  load  (tone,  but  not  againft  iron  ;  and  although,  notwithstanding  Hil¬ 
da  n  u  s  teftifies,  that  this  property  was  exerted  by  his  load  (tone,  and  Ma- 
thiolus  (a)>  that  the  fame  effect  was  oblervable  in  his,  I  believe  that  they 
mud  have  lit  upon  iron,  which  was  impregnated  with  the  magnetic  virtues  ; 
yet  I  have  no  objection  to  your  making  the  previous  trial ;  for  nothing  for¬ 
bids,  and  the  experiment  is  very  eaiy.  But  this  one  thing  I  would  advife, 
that  you  chufe  a  load-ftone  of  moderate  properties  and  powers,  and  that  you 
bring  it  by  degrees  more  and  more  near  to  the  eye,  as  you  find  it  is  proper  ; 
left  the  iron  iticking.  perhaps,  very  elefely,  and  the  parts  not  being  fuf- 
ficiently  relax’d,  you  increale  the  pains  of  the  part  in  which  it  is  fix’d,  by 
an  untimely  extraction. 

23.  A  much  (lighter  caufe  brought  on  a  longer  and  more  dangerous  opth- 
thalmia,  in  a  relation  of  mine,  Thomas  Mangelli ;  to  whofe  cafe,  the  other 
example  that  1  promis’d  you,  relates.  For  there  was  not  one  of  the  phy- 
ficians,  or  iurgeons,  by  whom  the  patient,  though  very  averfe  to  medicines, 
was  at  length  compell  d  to  iuffer  his  eye  to  be  inipedled,  but  judg’d,  without 
the  leaft  hefitation,  that  an  ulcer  was  already  begun  in  the  cornea,  by  the 
force  of  the  inflammation,  and  for  the  fake  of  curing  it,  us’d  different  methods 
of  application,  both  internally,  and  externally,  and  fatigued  the  patient  greatly 
for  a  long  time,  who  fubmitted  to  every  thing  with  fear,  but  without  effteft. 
At  length  it  happen’d,  by  mere  accident,  that  one  of  the  Iurgeons  obferv’d 
fome  kind  of  fubftance  or  other,  begin  to  pufh  itfelf  out  from  the  bottom  of 
the  ulcer,  like  a  imall  plate,  or  fcale ;  and  as  it  ealily  follow'd  the  probe, 
with  which  he  was  endeavouring  to  lay  hold  of  it,  he  took  it  out  whole. 
Upon  examining  it  p  etc y  clolely,  after  he  had  taken  it  out,  he  perceiv’d 
that  it  was  the  wing  of  a  (mail  fly  ;  and  that  it  really  was  fo,  every  one  who 
favv  it  then,  and  afterwards,  without  the  leaft  doubt,  as  in  the  molt  evident 
thing,  confirm’d.  And  then  Mangelli  remember’d  alio,  that  a  little  before 
the  inflammation  had  begun,  a  fly  had  by  accident  flown  into  his  eye,  and 

(/)  Cent.  5.  obf.  21.  (a J  Comment,  in  1.  5.  Diofcor.  c.  105. 

Vol.  I.  R  r 


that 


30  6  Book  L  Of  Difeafes  of  the  Head. 

that  he,  haftily  putting  his  hand  betwixt  his  eye-lids,  as  we  generally  do  in 
that  cafe,  had  kill’d  and  thrown  it  away.  But  he  had  not  thrown  away  the 
whole  *  for  the  wing  remaining  behind,  had  fo  applied  itfelf  to  the  cornea, 
that,  without  the  help  of  a  furgeon,  it  could  not  have  been  loofen’d,  and 
remov’d  from  the  place.  Wherefore,  occafioning  an  irritation  by  its  ad- 
hefion,  it  had  given  origin  alfo  to  an  inflammation,  of  fuch  a  kind,  that  the 
fmall  libres  and  vefiels,  (welling  round  about,  reprefented  the  lips  of  a  fmall 
ulcer  ;  and  the  wing,  befet  round  about  with  a  thickifh  humour,  through 
which  it  was  feen,  put  on  the  appearance  of  the  bottom  of  a  fordid  ulcer. 
For  as  loon  as  ever  this  was  taken  away,  every  appearance  was  immediately 
chang’d  for  the  better  and  the  eye  grew  well  eaflly,  and  foon,  without  the 
leaft  cicatrix  being  left  behind.  I  am  not  ignorant,  however,  that  our  Fal- 
loppius  (x)  writes,  “  that  he  had  twice  fufler’d  ulcers  of  the  eyes,  from  the 
14  falling  in  of  fome  very  fmall  flies,  which  are  hard ;  and  if  they  fall,  or 
“  even  flip  gently,  into  the  eye,  they  immediately  ulcerate  it,  and  bite  chiefly 
44  in  the  night-time.”  But  it  was  not  their  fmallnefs,  hardnefs,  nor  biting 
by  night,  that  had  injur’d  him,  but  only  a  wing  left  behind,  which,  as  I 
have  already  faid,  refembl’d  an  ulcer  entirely  :  for  I  remember  extremely 
well,  that  1  had  then  feen  it,  being  a  very  young  man,  and  had  believ’d  that 
it  was  certainly  an  ulcer.  But  fuppofe  that  it  was  even  an  ulcer,  yet,  that 
wing  being  remov’d,  all  the  fymptoms  immediately  remitted,  the  caufe  being 
taken  away.  Of  fo  much  importance  is  it,  then,  diligently  to  enquire  into 
the  original  caufes,  and  beginnings,  of  diforders,  and  to  be  fo  folicitous 
therein,  as  to  negledt  no  occafion  of  doing  it. 

24.  Now,  as  I  have  fet  out  with  an  intention  to  treat  of  the  diforders  of 
the  cornea,  in  fuch  a  manner,  as  to  have  defcrib’d  thofe  which  I  had  made 
obfervations  upon  from  infpedtion  only,  and  not  by  any  difledtion  being  added 
thereto  ;  1  fhall  omit  to  fpeak  of  thofe  white  kinds  of  opacities,  which  feem 
to  be  on  the  outer  edge  of  the  cornea,  the  nature  of  which  I  could  not  dis¬ 
cover  without'  the  ufe  of  the  knife  ;  for,  if  you  pleafe,  you  may  read  of 
thefe  elfewhere  ( y).  And  I  wifh  the  fame  had  been  done  by  Mauchartus,, 
where  (2),  as  he  fhews,  44  that  this  obfervation  was  of  no  fmall  moment,” 
in  making  punctures,  and  incifions,  near  thofe  places  ;  fo  he  wonders,  at  the 
fame  time,  that  opacities  of  this  kind,  and  their  nature,  fhould  have  been 
44  overlook’d.”  Omitting  thefe  things,  therefore,  on  the  prefent  occafion, 
I  will  rather  remark,  what  has  frequently  happen’d,  while  an  ophthalmia, 
continu’d  violent,  that  phyficians  and  furgeons  have  fhewn  me  a  kind  of 
pus,  or  pus  like  matter,  cn  the  cornea  albuginea,  or  beyond  the  cornea,  as 
it  feetn’d  both  to  them,  and  to  me,  indeed,  at  the  firfl:  fight.  But  1  have 
more  than  once  obferv’d,  that  this  appearance  of  things  was,  in  fome  perfons,. 
nothing  elfe  but  little  external  ulcers  of  the  cornea,  which  if  you  look’d 
upon  from  a  fituation  direftty  oppoflte,  exceedingly  belied  the'  appearances 
I  have  mention’d  •,  but  when  you  Withdrew  to  the  fide,  and  look’d  upon 
ahem  obliquely,  they  immediately  betray’d  themfelves,  by  the  hollownefs  of 
their  figures.  For  the  cornea  is  eafily  ulcerated  in  acrid  inflammations  of 

(A  Tra£l.  de  Ulcerib.  c.  5S.  (x)  Differt,  de  Maculis  Cornere  §  9. 

(yj  Epift.  Anat.  16.  n.  2S. 

the 


Letter  XIII.  Article  24,  307 

die  tunica  adnata  ;  fo  that  I  fear’d  nothing  fo  much  as  this,  in  an  obftinate 
inflammation  of  the  eye,  with  which  I  was  feiz’d  when  1  was  a  young  man, 
at  Bologna,  about  the  beginning  of  the  prefent  age,  attended  every  now  and 
then  with  fo  acute  a  pain,  that  I  was  frequently  prevented  from  fleeping  by 
it,  unlefs  a  warm  poultice  of  fweet  apples  was  applied  to  my  eye- lids.  Many 
things  were  recommended  •,  I  tried  many  things,  but  in  vain.  One  thing  f 
unadvifedly  rejedled,  which  I  faw  afterwards  was  of  great  ufe  to  many,  and 
especially  to  a  man  of  Bologna-,  who  having,  by  means  thereof,  got  r«-^of 
the  inflammation  of  his  right  eye,  prefently,  when  the  left  was  troubl’d  with 
the  fame  diforder,  after  having  made  ufe  of  others  in  vain,  could  be  re¬ 
flor’ d  by  no  remedy  but  the  fame,  that  is,  by  ulcerating  the  Akin  behind  the 
ear,  by  applying  fuch  medicines,  as  have  the  power  of  eroding  it.  Having, 
therefore,  committed  every  thing  to  time  and  to  nature,  and  being  in  fome 
meafure  reliev’d,  yet  not  fo  much  as  to  read,  and  to  write,  even  then,  with¬ 
out  uneafinefs  and  pain,  and  depending  more  upon  my  memory  than  on  my 
prefent  ftudies,  I  underwent  the  ufual  examinations,  and  being  enroll’d  in  the 
lift  of  dodtors,  I  retir’d  for  a  little  time  to  the  place  of  my  nativity,  and  there 
I  entirely  recover’d.  All  which  things  I  have  faid  for  this  reafon,  that  you 
may  underhand,  after  how  great  a  diforder  of  my  eyes,  how  great  a  fhare 
of  ftrength  and  health  is  granted  to  me,  by  the  blefling  of  almighty  God  ; 
io  that,  being  at  this  time  about  feventy  and  eight  years  of  age,  1  fee,  with¬ 
out  glaflfes,  almoft  with  the  fame  eafe  I  did  before  that  inflammation  had 
feiz’d  me.  And  if  you  fhould,  perhaps,  afk  me,  by  what  means  I  have 
prevented  a  diforder  in  them  for  io  very  long  a  time,  notwithftanding  I  have 
applied  fo  clofely  to  my  ftudies  by  night  and  by  day,  I  fhould  anfwer,  by  no 
other  method,  than  by  wafhing  my  face  and  eye-lids  every  morning,  which 
I  began  to  do  from  that  very  time,  but  not  fo  as  to  ufe  any  water  that  jflrft 
came  to  hand,  but  that  only  which  was  juft  drawn  from  the  well :  for  this, 
though  it  is  indeed  cold,  yet  is  fo  far  cold  only,  that  it  can  reftore  and 
preferve  the  tone  of  the  fibres,  which  a  preceding  ophthalmia  had  weaken'd', 
without  thofe  dangers  which  Hildanus  (a)  fears  from  the  moft  cold  water. 
But  I  cannot  certainly  know,  whether  water  of  this  kind  be  what  the  cele¬ 
brated  Dethardingius  means  to  recommend  in  that  little  work  which  he  pub- 
lifh’d  at  Copenhagen,  in  the  year  1745.  entitl’d,  De  fpecifico  prcphylaffico  ocu¬ 
lorum  •,  although  the  very  learned  Haller  (£),  from  whom  alone  I  have  the 
knowledge  of  this  work,  fays,  that  the  fpecific  is  u  wafhing  with  cold  water.’* 
But  this  I  know  for  certain,  that  when  1  had  at  length,  through  indolence 
and  negledt,  omitted  the  ufe  of  the  water,  which  I  have  mention’d,  the  in¬ 
flammation,  that  had  been  gone  for  more  than  forty  years,  foon  return’d  ;  at 
firft,  indeed,  but  flight,  and  affedling  the  eye-lids  only,  but  of  long  con¬ 
tinuance  j  and  after  that,  when  it  feiz’d  moft  people  here  in  the  fumrner, 
the  tunica  adnata  was  fo  violently  affedted  with  it,  that  it  began  already  to 
degenerate  into  a  chemofis  :  which,  however,  was  overcome  without  bleeding, 
as  I  fhall  tell  you  in  another  part  of  this  work(c).  And  flnce  that  time, 
which  is  now  nine  years,  I  am  almoft  as  ftrong,  and  well  with  my  eyes,  as 

p?)  Cent.  1.  obf.  27,  ( b )  Ad  Boerh.  Meth.  Stud.  p.  14.  (r)  Epift.  57.  n.  9. 


R  r  2 


I  for- 


3o8  Book  I.  Of  Difeafes  of  the  Head. 

I  formerly  was  •,  nor  do  I  need  any  help  of  glafies.  May  God  grant,  that 
my  age,  Hill  increafing  more  and  more,  may  not  diminifh  their  ulbfulnels. 
But  let  us  now  return  to  thole  diforders,  which  I  have  feen  in  the  eyes  of 
others,  and  leave  thofe  which  I  have  fuder’d  in  my  own. 

25.  In  regard  to  the  unguis  oculi*,  for  thusCelfus  call’d (d)  in  Latin,  what 
with  the  Greeks  we  diould  call  xtsp vyicv,  and  that  nine  times,  and  yet  no 
where :  for  by  reafon  of  the  doubts  of  fome  in  regard  to  his  books,  as  they 
are  in  manufeript  copies,  or  printed,  I  fearch’d  into  them,  and  found  the 
reading  thus  various.  In  regard  to  the  unguis  oculi,  then,  you  are  not  ig¬ 
noram,  that  I  conjectur'd,  in  the  Adverfaria  (e),  the  more  frequent  origin- 
of  the  unguis  oculi  to  be  from  that  femilunar  membrane,  which,  as  fome 
feem  to  hint,  Vidus  Vidius  had  deferib’d,  at  the  internal  angle  of  the  eye, 
in  book  the  feventh,  chapter  the  fourth,  of  his  Anatorne  corporis  humani' \  in 
that  place,  1  fuppofe,  where  the  caruncle,  and  the  pundta  lachrymalia  being 
deferib’d,  he  fpeaks  aifo  of  a  gland,  at  the  internal  canthus,  in  the  human 
fubjedt,  and  even,  with  the  leave  of  God,  a  cartilage,  and  a  membrane  in^ 
volving  it.  But  I  did  not  conjecture,  that  the  origin  of  the  unguis  was  from 
the  membrane  of  the  cartilage,  in  a  bead,  but  from  the  membrane  which  I 
had  defcrib’d  before  the  human  caruncle.  1  had  fome  years  ago  an  oppor¬ 
tunity  of  confidering  this  diforder  very  attentively,  in  a  man  of  forty  years  of 
age,  who  in  each  of  his  eyes  had  an  unguis  that  had  begun  from  the  very 
time  when  he  was  a  young  man,  and  had  at  length  extended  itfelf  even  to  the 
very  middle  of  the  cornea  ;  when  coming  to  Padua,  to  the  very  experienc’d 
public  profedbr  of  furgery,  Jerom  Vandelli,  by  whom  he  was  cur’d,  he  came 
alfo  to  confult  me.  And  I  law,  that  the  unguis  confided  of  this  very  mem¬ 
brane,  which,  growing  out  from  a  broad  balls,  had  enlarg’d  itfelf  into  the 
form  of  a  triangle,  not  much  adhering  to  the  adnata,  and  even  fo  disjoin’d, 
to  the  middle  of  its  length,  that  Vandelli  pafs’d  a  probe,  of  a  moderate  fize, 
with  great  eafe,  between  the  two  :  but  it  was  clofely  connected  to  the  cornea, 
with  which  the  extreme  vertex  of  the  triangle  correfponded  ;  fo  that  when 
the  patient  turn’d  his  eye,  to  iook  at  thofe  things  which  were  on  one  fide 
of  him,  the  whole  unguis  was  necedarily  extended  :  and  hence  it  had  alfo 
happen’d,  that  the  lachrymal  caruncle  following  the  membrane  which  was  fix’d 
before  it,  was  not  only  made  much  longer,  but  alfo  drawn  forwards  from  out 
of  its  natural  fituation.  The  nearer  the  membrane  was  to  its  bafis,  fo  much 
the  lels  did  it  recede  from  its  natural  appearance,  being  red  from  the  vedels, 
with  which  it  was  fpread  over,  fo  that  in  this  part  you  would  readily  give 
it  the  name  of  pannus  \  the  other  parts  of  it  being  whitilh,  fo  that  it  would 
be  better  to  call  them  unguis.  They  were,  neverthelefs,  opaque ;  for  which 
reafon  a  great  part  of  the  rays  being  intercepted,  the  patient  might  feem,  in 
fome  meafure,  to  have  been  affedted  with  the  nydtalopia  of  Hippocrates  (/)  ; 
for  he  faw  better  in  the  evening  than  at  noon,  and  in  a  fomewhat  dark,  than 
in  a  light  place,  I  believe,  without  doubt,  becaufe  by  reafon  of  that  inter¬ 
ception  of  rays,  the  iris  had  accudom’d  itfelf  to  dilatation.  Yet  there  was 
no  great  pain  in  the  eyes,  nor  any  great  impediment  to  their  motion. 

(i)  De  Medic.  1.  7.  c.  7.  n.  4,  &  5.  (e)  VI.  animad.  44.  (fj  Vid.  fupra.  n-.  19. 

3 


2 6.  But 


Letter- XIII.  Articles  26,  27.  309 

26.  Rut  now  I  muft  fpeak  of  weeping  from  difeafe.  Thofe  things  which 
you  will  read  on  this  fubjed,  in  the  Sepulchretum,  would  either  have  been 
omitted,  or  not  fo  explain’d,  if  what  is  propos’d  concerning  the  natural 
weeping  in  the  fame  book  (£),  and  is  in  part  true,  could  have  been  con- 
ftantly  adher’d  to,  nor  confounded  with  the  falfities  that  are  mix’d  therewith. 
At  prelent,  out  of  four  obfervations,  relative  to  the  encreas’d  fecretion  of 
tears,  there  are  three  (£),  which  would  fain  obtrude  upon  us  for  the  caufe 
of  it,  the  exuberant  quantity  of  moifture,  within  the  fkull,  as  if  there  were 
a  paffage  from  thence,  for  the  tears,  to  go  to  the  eyes :  which  ought  fo  much 
the  lefs  to  have  been  done,  becaufe  that  exuberancy  of  tears,  efpecially  in  the 
women,  manifeftly  proceeded  from  grief,  or  from  pain.  Then  alfo  the  or¬ 
bicularis  palpebrarum  rnufcle  being  frequently,  ftrongly,  and  fora  long  time, 
contracted,  as  we  lee  happen  in  perlons  who  weep,  the  glandula  innominata, 
is  by  tbat  means  more  and  more  urg’d  to  fecrete  a  greater  quantity  of 
moifture,  and  pour  it  out  betwixt  the  eye-lids;  and  at  the  fame  time,  the- 
foft  and  {lender  pafiages,- which  convey  this  moifture  to  the  greater  lachry¬ 
mal  duct,  are  comprefs-’d,  fo  that  they  can  carry  off  lefs  of  the  fame  hu¬ 
mour  towards  the  nofe.  And  in  the  other  obfervation,  mark’d  thirty-three,- 
“  the  calculus  which  was  found  in  the  lachrymal  gland,”  for  fo  it  is  written,-. 
“  plac’d  at  the  internal  angle  of  the  eye,”  indeed  might  be  the  caufe  of  this 
morbid  fecretion  of  tears;  but  not  becaufe  “  it  render’d  the  whole  gland 
“  unfit  for  the  reception  of  the  humidity  that  was  to  be  transferr’d  to  the- 
“  nofe,”  for  this  is  not  a  gland,  (and  1  wonder  that  this  error  fhould  ftill 
prevail  among  fome  perlons)  but- is  only  a  caruncle,  which  has  its  furface- 
cever’d  with  very  fmail  febaceous  glands,  nor  does  it  receive  the  humidity 
into  itfelf :  yet  becaufe  the  calculus  was  not  only  “very  unequal,”  but' in' 
proportion  to  the  part,  in  which  it  was  fcated,  very  large  alfo,  as  the  deli¬ 
neated  figure  of  it  that  you  may  lee  in  the  author’s  work,  from  which  it  is- 
taken  (/),  evidently  ihews,  it  remov’d  the  punda  lachrymalia  from  being  in- 
contad  with  the  eye,  and  confequently  prevented  ti:em  from  receiving  that' 
humidity,  and  moreover  compreis’d  the  imall  and  (lender  canals,  proceeding., 
from  tliefe  punda.- 

27.  And  indeed  the  moft  frequent  and  obftinate  caufes  of  lachrymation, 
confift  in  the  compreftion,  obftrudiion,  and  coalition,  of  the  lachrymal  paf-- 
{'ages,  from  the -eye-lids  to  the  interior  parts  of  the  nofe.  And  it  happens- 
not  very  uncommonly,  when  I  demonftrate  the  internal  parts  of  the  nofe  in 
my  anatomical  courfes,  that  1  find  an  appearance  of  this  kind,  as  I  did  once, 
for  inftance,  in  a  dropfical  man,  in  whom,  the -lower  orifice  of  the  lachry¬ 
mal  dudt  being  wanting,  on  the  right  fide  only,  I  found  that  the  dud  itfelf  ‘ 
had  grown  up  :  and  the  lame  1  obferv’d  in  a  woman,  who  died  of  a  fever. 
But  in  this  laft  cafe,  although  the  lower  orifice  of  each  dud  was  fmail,  nor 
admitted  the  probe  very  high  ;  I  foon  ceas’d  to  wonder,  becaufe  1  found, 
when  I  was  about  to  pafs  it  from  the  eye-lids,  into  the  dud,  that  all  the 
four  punda  lachrymalia  were  entirely  fhut  up.  And  I  remember  that  for¬ 
merly,  in  another  woman,  whofc  eye-lafnes  had  almoft  all  fall’n  off,  from  the 

(g)  Sedl.  hac  j8:  port  obf.  33.  Append.  1,  ( b )  1.  modo  cit.  &  31.  32. 

&  3 dial,  ad  obfi  1.  in  Additam'.  (/)  Blafii-Obf.  Med.  Tab.  9.  Fig.  10. 

left 


3  i  o  Book  I.  Of  Difeafes  of  the  Head. 

left  eye,  as  the  effed  of  fome  difeafe  or  other,  one  of  the  puncta  lachryma- 
li a,  and  the  little  canal,  and  the  whole  remainder  of  the  dud,  even  to  the 
internal  part  of  the  nofe,  were  not  only  fhut  up,  but  had  degenerated  by  a 
coalition  of  the  parietes  into  a  folid  ligament  •,  yet  I  found  the  other  punc¬ 
tum,  with  its  little  canal,  not  only  open,  but  even  the  cavity  of  each  twice 
as  wide  as  it  us’d  to  be,  becaufe  the  humour  that  had  enter’d  into  it  indeed, 
but  had  been  oblig’d  to  day  there,  till  it  was  preis’d  out  with  the  finger,  had 
dilated  it  after  that  manner.  But  in  another  man,  I  do  not  remember  there 
was  any  dilatation,  although  each  duct  was  altogether  impervious,  below  the 
-fac,  as  it  is  call’d.  It  were  to  be  wilh’d,  that  we  could  be  inform’d  from 
what  diforders  thefe  appearances  in  each  of  them  had  happen’d,  and  of  how 
long  Handing  they  had  been  i  whether  they  happen’d  from  an  inflammation 
.of  the  eyes,  or  of  the  internals  of  the  nofe,  or  from  a  fuppuration  and  exul¬ 
ceration  of  thefe  parts,  and  with  what  difficulties  and  difeas’d  fymptoms  they 
had  been  attended  :  but  this  is  almoft  impoffible  in  the  common  people, 
who  are  very  often  unknown,  nor  ever  complain  of  any  other  difeafe,  than 
what  troubles  them  at  the  time,  when  they  come  into  hofpitals ;  and  it  is  in 
vain  to  make  enquiries  after  death.  But  two  things,  at  leaft,  are  certain, 
that  every  one  of  thefe  muff  neceffarily  have  had  a  morbid  weeping*,  the  le- 
cond  woman,  and  the  fecond  man,  from  one  eye,  but  the  firft  woman,  and 
the  laft  man,  from  both  eyes  :  nor  could  the  lachrymal  paflages  in  any  one  of 
thefe  have  been  freed  from  their  obftrudions,  and  laid  open. 

28.  But  in  thole  morbid  flowings  of  tears,  the  caufes  of  which  may  be 
either  obftrudions  of  the  paflages,  or  if  a  coalition,  that  only,  which  may 
have  happen’d  in  the  upper  or  lower  orifices,  and  compreffions  alfo,  but  fuch 
as  have  not  yet  brought  on,  a  very  great  coalition,  and  may  be  remov’d  by 
art,  for  inftance,  if  a  polypus,  or  if  a  fungus,  growing  out  from  a  neigh¬ 
bouring  ulcer,  fhould  have  comprels’d  the  lower  part  of  the  dud,  as  in  the 
obfervation  of  the  celebrated  Molinelli  (k) ;  there  is  not  the  leaft  doubt,  af¬ 
ter  fo  many  fuccefsful  experiments,  of  ingenious  men,  but  furgery  may  be 
of  ufe.  The  moft  mild  method  of  all  is  that  of  Mr.  Anell,  and  is  fufficient 
In  flight  obftrudions  *,  but  of  this  I  have  fpoken  on  a  former  occafion  (*). 
Yet  that  part  of  his  method,  which  confifts  in  pafiing  a  lfnall  probe,  through 
one  of  the  punda  lachry mafia,  into  the  nofe,  Valialva  affirm’d  in  cafes  of 
confukation,  which  I  have  read  in  his  papers,  that  he  had  adminifter’d  before 
Anell,  and  had  by  this  means  open’d  the  nafal  dud. 

29.  But  in  regard  to  encyfted  tumours,  into  which  the  glands  of  the  eye¬ 
brows  may  be  dilated,  and  in  regard  to  the  method  of  curing  them,  both 
he  (/)  and  I  have  written  (m)  on  other  occafions.  It  remains,  therefore,  to 
fubjoin  one  or  two  obfervations  on  the  diforders  of  the  eye-lafhes.  And  that 
feems  to  be  a  very  flight  diforder,  which  confifts  in  the  whitenefs  of  their 
colour.  Yet  it  mull  neceffarily  be  hurtful  to  vifion,  in  a  bright  light.  For 
it  cannot  fufficiently  keep  off  the  fupfcrfluous  rays.  Wherefore  an  example 
is  extant,  in  Cafpar  Hoffman  («),  of  a  certain  perfon  who  having  his  eye- 

(/£)  Comment.  Bcnon.  Sc.  Acad.  T.  2.  P.  1.  (/)  Tra£E  de  Aure  hum.  c.  4.  n.  4. 

in  Mcdicis.  ...  (;«)  Epift.  Anat.  13.  n.  2. 

(*)  Adv.  VI.  Animad.  62.  &  feqq.  («)  Comm,  in  Gal.  de  Uf.  Part.  1.  10.  c.  7. 

lafhes 


7 


Letter  XIII.  Article  29.  31  1 

ladies  white,  faw  better  as  often  as  they  were  painted  black.  I  have  lit  fre¬ 
quently  upon  men,  who  had  the  hairs  of  their  eye-lafhes  white,  from  their 
birth,  and  they  all  became  blind.  Could  this  happen  from  the  colour  of 
the  eye-laflies  only  ?  It  would  have  been  an  eafy  experiment,  if  time  and 
place  had  fuffer’d  us,  to  make  them  black.  But  what  is  it  I  have  heard  of 
thefe  perfons,  that  if  they  cut  the  hair  of  their  heads,  they  are  then  dill 
more  blind  ?  There  are  much  more  grievous,  and  much  more  dangerous 
diforders,  attending  the  eyes,  from  thc-fe  difeafes  of  the  eye-lalhes,  that  are 
call’d  trichiafis,  and  diftichiafis.  For  the  eye-ladies'  being  either  turn’d  in 
upon  the  eyes  themfelves,  or  another  row  of  hairs  ‘i  growing  under  them,” 
and,  as  Celfus  fays  (<?)>  pointing  quite  inwards  upon  the  eyes,”  the  eyes  are 
fo  muth  irritated,  that  an  inflammation  lucceeds  to  the  irritation,  which  is 
incurable,  unlefs  thefe  difeafes  are  remedied ;  and  a  blindnefs  may  eafily  be 
the  confequence  of  the  inflammation.  And  thefe  diforders  cannot  by  any 
means  be  taken  away,  in  fuch  a  manner  as  not  foon  to  return,  except  by 
thole  methods  of  cure,  which  are  attended  with  pain,  or  rather  with  torture, 
or  even  with  the  mutilation  of  the  edge  of  the  eye-lids :  and  I  am  afraid, 
left  bdide  the  deformity,  the  extremites  of  the  dufts  of  the  febaceous  glands, 
which  are  in  the  tarfus,  Ihould  be  perhaps  fhut  up  by  the  cicatrix,  that  is 
brought  on,  and  thus  give  origin  to  many  kinds  of  difeafes.  And  the  cafe 
being  thus,  it  were  indeed  very  much  to  be  wifli’d,  that  the  remedy,  at 
lea  ft,  to  prevent  fuch  an  irritation,  which  is  propos’d  by  the  celebrated  Ern- 
del  (/>),  might  have  a  fuccefs  equal  to  the  ingenuity  with  which  it  was  in¬ 
vented.  He  propos’d  putting  betwixt  the  eye-lids  and  the  eye,  a  fmooth 
arid  well-polifli’d  glafs,  made  juft  in  the  fame  manner  as  we  fee  the  artificial 
eyes  are,  except  that  it  Ihould  be  without  any  painting  :  and  thus  it  would 
happen,  that  the  hairs  indeed,  but  not  the  rays  of  l  ght,  mult  be  excluded. 
But  whether  fo  thin  a  glafs,  as  it  muft  neceflarily  be,  not  to  refract  the  rays, 
made  the  danger  of  breaking  it  be  much  dreaded,  or  whether  it  was  fear’d, 
left  the  effluvia  of  infenfible  perfpiration  fhould  conftantly  ftain,  and  darken 
the  glafs,  or  fhould  injure  the  eyes,  by  too  great  heat,  efpecially  in  thefummer 
time,  or,  being  grown  acrid  by  delay,  fhould  irritate  the  lurface  of  it,  or 
fhould  create  a  troublefome  and  dangerous  necefiicy,  of  taking  out  this  thin 
glafs  now  and  then,  in  order  to  wipe  and  replace  it,  or  whether  any  other 
caufes  whatever,  fcarcely  any  of  which  fall  upon  the  ufe  of  the  artificial  eye, 
have  deterr’d  us  from  the  experiment  •,  I  have  never  heard,  or  read,  of  any 
one  perfon,  who,  fince  the  twenty-fecond  year  of  the  prefent  age,  in  which 
this  remedy  was  publifh’d,  has  ever  made  ufe  of  it,  even  to  the  prefent  day  y 
or  who,  being  excited  by  the  knowledge  of  this,  has  endeavour’d  to  invent 
any  thing  better. 

The  fame  learned  gentleman  propos’d  a  conje&ure,  of  the  manner,  in  which 
the  hairs  break  forth,  in  a  diftichiafis,  in  an  improper  place  •,  which  place  he 
feems  to  point  out  much  higher  than  it  was  in  that  diftichiafis,  the  defcrip- 
tion  of  which  was  fent  to  me  by  the  celebrated  Tabarranus  ( q ).  For  he  ima¬ 
gines  he  law  the  hairs  coming  out  from  the  mouths  of  the  febaceous  glands, 

< 

(<?)  De  Medic.  1.  7.  c.  7.  n.  8.  (7)  In  Epift.  pnefixa  alteri  Editioni  fuar.  obfc 

(t)  Eph.  N.  C.  Cent,  icr,  obf.  75.  •  .Anat, 

which 


3i  2  Book  I.  Of  'Difeafes  of  the  Head. 

which  I  ipoke  of  juft  now.  I  do  not  doubt,  but  the  hairs  that  are  preter« 
natural  can  make  a  paffage  for  themfelves,  to  come  out  within  the  eye-lids, 
as  they  do  in  other  parts.  Yet  it  has  hitherto  never  happen’d,  either  in  living 
or  dead  bodies,  which  laft  I  would  prefer,  that  1  have  had  an  opportunity 
of  examining  thefe  things  accurately.  Nor  is  it  to  be  wonder’d  at:  for  if 
any  limb,  or  part  of  the  human  body,  confilfs  of  lo  many  fmaller  parts,  that 
it  is  very  difficult  to  get  opportunities  of  examining  all  the  difealcs  of  each 
dillindly,  in  dead  bodies,  how  much  more  difficult  mult  it  be  in  the  eye  ? 
which,  as  it  is  made  up  of  lo  many,  fo  various,  and  fo  tender  parts,  and 
that  not  only  in  its  own  fubdance,  but  in  the  appendages  which  lie  about  it 
externally,  and  as  it  is,  moreover,  expos’d  to  the  injuries  of  the  air,  and  other 
things,'  and  continually  given,  to  exercife,  unlefs  when  we  deep,  and  as,  for 
thefe  reafons,  it  is  liable  to  innumerable  dileafes,  both  internally  and  exter¬ 
nally,  phylicians  have  not  been  wanting  formerly,  nor  are  at  prefent  wanting, 
who,  under  the  name  of  ocuiifts,  have  applied  themfelves  only  to  the  cure 
of  dilorders  of  the  eye.  Wherefore,** I  would  have  you  be  fatisfied  with  re¬ 
ceiving  this  letter  from  me,  which  relates  to  fuch  dilorders  of  this  part,  ns 
it  has  fallen  to  my  lot  to  lee.  The  next  I  ffi.all  lend  you,  will  be  upon  the 
dilorders  of  the  ear.  Farewel. 


LETTER  the  FOURTEENTH. 


Of  the  Diforders  of  the  Ear,  and  tlie  Nofe.  To  which  are 
added  fome  Obfervations  on  Stammering, 


i.  A  S  you  know  very  well,  that  both  Valfalva  and  I  have  publiffi’d  more 
upon  the  ear  than  the  eye  •,  you  will  not  in  the  lead  wonder,  if  fewer 
things  remain,  out  of  the  obfervations  of  both  of  us,  to  be  written  to  you, 
on  the  one  lubjedt  than  on  the  other.  Wherefore  I  will  join  to  the  diforders 
of  the  ear,  thole  of  the  nofe.*,  efpecially  as  the  author  of  the  Sepulchretum 
has  comprehended  both  the  one  and  the  other  in  two  fhort  fections,  the  nine¬ 
teenth  and  the  twentieth. 

2.  To  the  firft  oblervation  of  the  nineteenth  fedlion,  you  will  eafily  per¬ 
ceive,  that  an  argument  is  prefix’d,  which  is  foreign  to  the  truth:  Aures  pu~ 
rulenice  ab  abfcejju  ce>esri.  For,  on  the  contrary,  the  abfeefs  of  the  brain,  no 
fymptoms  of  which  are  laid  to  have  preceded,  was  the  confequence  of  the 
fuppreffion  of  ichor  flowing  our  of  the  ear.  Neither,  certainly,  is  a  lecond 
oblervation,  given  in  the  lcholium  that  is  fubjoin’d,  to  be  explain’d  by  any 
other  method  than  this  *,  although,  after  death,  when  the  fkull  was  open’d, 
the  fanies,  which  us’d  formerly  to  be  difcharg’d  from  the  ear,  was  found 
within  the  cavity  of  the  cranium,  And  as  I  have  declar’d  this  already,  in 

a  former 


Letter  XIV.  Article  3.  313 

a  former  work  (a),  it  will  be  fufficient  to  confirm  it  here,  by  pointing  out 
the  obfervations  of  Du  Verney,  in  the  third  part  of  his  Treadle  of  the  Organ 
of  Hearing  :  from  which  treatife,  although  many  things  fliould  have  been 
produc’d,  in  the  additamenta  to  this  nineteenth  fe&ion,  both  what  I  have 
mention’d,  and  others,  they  are,  neverthelefs,  not  tit  all  pointed  out.  And 
you  will  immediately  underftand,  when  you  have  examin’d  them,  how  often 
phyficians  are  deceiv’d,  in  judgments  of  that-kind,  when  pus,  as  in  this  cafe, 
flowing  out  from  the  ear,  has  been  fupprefs’d,  and  the  patients  “  die,  as  it 
“  were,  fuddenly.”  But  you  will  fay,  the  ferum,  which  Du  Verney  found 
within  the  cranium,  was  not  of  the  fame  kind  with  that  which  iflu’d  out  by 
the  ear  j  but  here,  that  which  flow’d  out  from  the  ears  and  noftrils  after 
death,  in  great  quantity,  feems  to  be  the  fame  kind  of  fanies,  which  had 
before  flow’d  out  of  the  ear  :  as  if,  truly,  it  were  not  poffible  for  the  matter 
to  have  burft  forth  into  the  ears  and  the  noftrils,  except  from  the  cavity  of 
the  cranium  !  notwithftanding  the  pituitary  finufles  open  into  the  interiors  of 
the  nofe,  as  alfo  the  euftachian  tube  •,  for  in  thefe  linufles,  and  cavities  of  the 
ears,  conceal’d  from  the  phyficians,  the  fanies  might  have  been  fecreted  and 
preferv’d.  But  fee  what  different  opinions  you  and  I  entertain.  Certainly, 
though  I  had  not  only  feen  the  fame  kind  of  fanies  in  the  cavity  of  the 
cranium,  that  us’d  to  be  difeharg’d  from  the  ear,  as  I  have  faid,  but  had 
even  feen  the  paflage  made  by  a  caries,  through  which  it  had  free  accefs  to 
'  the  ear  *,  yet  I  fliould  not  immediately  have  pronounc’d,  that  it  came  from 
the  brain  to  the  ear,  but  rather  have  fuppos’d,  on  the  contrary,  that  it  went 
from  the  ear  to  the  brain.  And  why  fo  ?  I  will  tell  you,  when  you  fhall 
have  read  the  two  obfervations  which  I  fliall  immediately  fubjoin. 

3.  A  boy  was  troubl’d,  after  the  fmall-pox,  with  a  complaint  of  his  right 
ear,  which  had  its  rife  from  the  relics  of  that  difeafe.  At  length,  a  tumour 
began  to  appear  behind  the  fame  ear,  when  he  was  about  twelve  years  of  age. 
He  was  quite  deaf  on  that  fide,  and  the  ear  difeharg’d  a  purulent  matter. 
The  integuments  of  the  tumour  being  incis’d  by  the  furgeon  longitudinally, 
according  to  the  direction  of  the  head,  a  large  quantity  of  pus  iffu’d  out, 
fuch  as  had  us’d  to  be  difeharg’d  from  the  ear.  Some  hours  after  this  in- 
cifion,  the  boy  was  feiz’d  with  convulflons  •,  fo  that  he  had  a  fubfultus  in 
his  whole  body,  and  was  forc’d  to  emit  a  ftrange  kind  of  voice,  of  a  middle 
kind  between  crying  out  and  groaning.  Thefe  convulflons,  at  firft  recurring 
more  frequently,  and  then  more  rarely,  lafted  to  the  very  time  of  his  death. 
But  on  the  fame  day  that  the  convulflons  firft  began,  a  pain  alfo  came  on, 
in  the  place  where,  as  I  have  already  faid,  the  teguments  had  been  incis’d  ; 
and  a  certain  part  of  that  fedtion  was  of  fo  exquifite  a  fenfe,  that  it  would 
not  bear  even  the  flighted  touch.  On  the  following  days,  though  the  pus 
ftill  continu’d  to  flow,  the  patient  began,  neverthelefs,  to  be  delirious,  and  to 
be  entirely  deftitute  of  ftrength  and  pulfe.  After  this,  however,  the  de¬ 
lirium  went  off,  and  the  child  leem’d  to  recover  his  ftrength  and  pulfe,  in  fome 
•meafure,  fpeaking,  and  Iboking  chearfully  with  his  eyes.  But  although  he 
fpoke,  even  on  thofe  laft  days  of  his  life,  and  always  drew  his  breath  with 
eafe,  yet  becoming  worfe  again,  he  died  about  the  beginning  of  February, 

4«)  Epift.  Anat.  7.  n.  8. 

S  f 


VOL.  I. 


in 


2  i  4  Book  I.  Of  Bifeafes  of  the  Head. 

in  the  year  1740.  It  feem’cl  to  me,  when  this  hi  (lory  was  related  to  me,  by 
thole  who  attended  the  child  in  this  lall  difeafe,  that  the  grievous  complaints 
with  which  he  had"been  affiidted,  and  which  had  brought  him  to  his  end, 
did  not  proceed  from  the  incifion  of  the  tumour,  but  from  the  caries  of  the 
os  temporis,  which  had  excited  the  tumour,  and  at  the  fame  time  reach’d 
into  the  cavity  of  the  cranium,  and  thus  finally  had  open’d  a  paffage  for  the 
purulent  matter  into  that  cavity  alfo.  As  I  had  made  this  anfwer  in  the  theatre, 
where  the  head  o(  the  boy  was  brought,  I  determin’d  immediately  to  fee 
whether  my  conjeclure  had  deceiv’d  me,  or  not. 

1  he  face  was  even  then  fair,  and  of  a  rofy  colour,  (for  it  was  the  fourth 
day  after  death)  nor  at  all  l'carr’d  •,  fo  that  it  was  natural  to  conclude  from 
thence,  that  the  force  of  the  lmall-pox  had  thrown  itfelf  out  upon  the  fkirr 
but  little.  The  (hull  being  open’d,  and  the  lateral  finufiesof  the  dura  mater 
being  found  full  of  blood,  and  the  veflels  which  run  here  and  there  through 
the  pia  mater,  being  full  of  the  fame  ;  the  right  and  left  ventricles  were  firft 
open’d,  and  a  little  water  was  feen  in  the  former  of  the  two,  but  in  the 
latter  a  great  deal,  1  believe,  becaufe  by  reafon  of  the  pain,  he  chofe  rather 
to  lye  upon  the  left  fide,  than  on  the  right.  And,  indeed,  as  we  by  degrees 
lifted  up  the  corpus  callolum,  the  feptum  lucidum  feem’d  to  be  broken  in 
a  certain  place  •,  but  this  might  happen  in  the  difle&ion,  as  thofe  parts  of 
the  brain  were  extremely  lax.  However,  this  cuftom  of  lying  on  one  fide 
had,  at  lead,  caus’d  a  more  ready  effufion  of  pus  inwards  ;  which,  as  we 
presently  rais’d  up  the  cerebrum,  we  faw  in  the  cavity  of  the  fella  equina, 
and  a  little  after  that,  when  we  remov’d  the  cerebellum,  upon  the  right  fide 
of  this  alfo,  and  extended  in  fuch  a  manner,  that  fome  of  the  pus  feem’d  ta 
have  defcended  to  the  beginning  of  the  fpinal  marrow.  The  entrance  of 
the  pus  into  the  cavity  of  the  cranium,  as  I  evidently  demonftrated  to  all 
who  were  prefent,  was  on  that  furface  of  the  petrous  procefs  of  the  right 
temporal  bone,  which  fame  call  “  pofterior,”  and  others  “  internal  and  in- 
ferior.”  You  will  more  readily  conceive  of  it,  I  fuppole,  if  I  fay  it  was 
that  furface,  by  which  the  right  and  left  petrous  procedes  are  turn’d  towards 
one  another.  For  on  that  furface,  and  at  the  very  angle  of  it,  if  I  remember 
rightly,  which,  out  of  all  the  parts  that  are  adjacent  to  the  fella  equina,  lies 
between  the  lateral  and  fuperior  finus,  the  caries  had  made  a  foramen,  almofc 
of  a  circular  form,  and  of  the  bignefs  of  a  lentil.  And  by  this  foramen, 
pus  being  effus’d,  betwixt  that  furface  and  the  dura  mater,  had  eroded  both 
this,  and  the  other  thinner  covering  of  the  brain,  where  they  inveft  the  right 
fide  of  the  cerebellum  ;  and,  moreover,  had  vitiated  the  cerebellum  to  fuch 
a  degree,  that  part  of  its  furface  was  green,  and  purulent;  and  the  neareft 
portion  of  the  cerebellum,  internally,  which  anfwer’d  to  that  part,  was  ting’d 
of  a  brown  colour,  to  the  depth  of  a  thumb’s  breadth.  All  the  pus  which 
we  faw  in  the  cavity  of  the  cranium,  was  green,  but  not  of  a  bad  fmell :  nor 
was  the  cavity  of  the  tumour,  that  had  been  incis’d  behind  the  ear,  attended 
with  any  bad  fmell ;  but  the  fides  of  it  were  very  clean  ;  and  it  communicated 
with  the  bony  meatus  auditorius.  The  extent  of  the  caries,  both  internally 
and  externally,  being  examin’d,  I  had  not  time  lufficient  to  trace  the  fi  nudes 
that  lay  betwixt  both,  as  I  was  fo  much  taken  up  in  my  public  le&ures  of 
anatomy. 

But 


J» 


Letter  XIV.  Articles  4,  i1.  3 1  5 

But  as  to  what  relates  to  the  caufe  of  thatexquifite  fenfe,  which  was  always 
perceiv’d  in  a  certain  part  of  the  lips  of  the  tumour,  when  open’d  ;  I  obferv'd 
a  very  (lender  nerve,  which  proceeding  from  the  cervicals,  as  I  fuppofe, 
alcended  upon  that  part,  which  had  been  cut,  under  the  common  integu¬ 
ments,  and  ran  according  to  the  longitudinal  direction  of  the  head  :  fo  that 
it  was  very  natural  to  conjecture,  that  fome  part  of  it  being  prick’d  or  cut, 
at  the  time  of  opening  the  tumour,  this  punfture,  or  incifion,  had  given  rile 
to  the  pain  the  boy  had  fo  exquifitely  felt. 

4.  You  fee,  how  liable  furgeons  are  to  falfe  fufpicions,  among  the  common- 
people  :  whole  knife,  indeed,  cannot  poflibly  avoid  all  the  fubcutaneous 
nerves,  but  cannot  be  the  caufe  of  death  by  incifing  the  integuments  only,  as 
in  opening  this  tumour  ;  which  I  could  wifh  had  been  fooner  open’d,  or  rather 
had  fooner  appear’d,  to  wit,  before  the  caries  had  reach’d  the  cavity  of  the 
cranium.  And  my  conjecture  on  this  cafe  was  the  more  eafily  drawn  from 
the  confideration  of  the  whole  hiftory  •,  becaufe  Nicolaus  Mediavia  had  com¬ 
municated  to  me,  lcarcely  four  months  before  this  time,  an  obfervation  of 
his,  in  great  meafure  fimilar  to  this  •,  that  is,  of  a  caries  proceeding  from  a 
fiftula  above  the  maftoid  apophylis,  not  only  into  the  cavity  of  the  tympanum, 
but  of  the  cranium  alio.  But  as  the  very  experienc’d  Du  Verney  has  con- 
fefs’d,  that  the  propagation  of  a  caries,  from  a  fiftula  of  that  kind,  even 
into  the  cavity  of  the  tympanum  (£),  is  “  very  rare,”  and  that  he  had  “  only 
“  one  or  two  obfervations  of  that  kind  I  fuppofe,  it  will  not  be  lets  grate¬ 
ful  to  you,  than  it  was  to  me,  to  hear  what  Mediavia  related  to  me,  the  very 
fame  day  on  which  he  faw  the  cafe. 

5.  A  young  man  had,  as  it  feem’d,  an  old  fiftula,  above  the  right  maftoid 
procefs.  Injections  that  were  thrown  into  this  fiftula,  return’d  partly  by  the 
neighb’ring  ear,  with  which  he  neverthelefs  heard.  This  young  man  being 
receiv’d  into  the  hofpital,  not  on  account  of  the  fiftula,  but  for  a  fever,  yvith. 
which  he  had  been  attack’d,  and  growing  much  worfe  in  a  few  days,  be¬ 
came  delirious,  with  an  inclination  to  deep,  and  died. 

His  fkull  being  open’d,  all  the  veffels  of  the  brain  were  found  to  be  turgid 
with  blood.  There  was  much  greenifh  water  in  the  lateral  ventricles;  and 
in  this  kind  of  water,  that  was  in  the  right  ventricle,  pus  of  the  fame  colour 
fubfided.  But  a  much  greater  quantity  of  this  pus  was  effus’d  betwixt  the 
dura  mater,  and  that  furface  of  the  petrous  procefs  of  the  temporal  bone, 
which  was  particularly  pointed  out  in  the  former  obfervation  (c) ;  and  thus  it 
had  made  a  way  for  itfelf,  between  both,  from  thence  even  into  the  tube  of 
the  vertebrae.  The  cavity  of  the  tympanum,  alfo,  was  fill’d  with  the  fame 
kind  of  pus.  But  the  caries,  proceeding  behind  the  aqueduCt  of  Falloppius, 
and  the  femicircular  canals,  had  eroded  that  furface  of  the  petrous  procefs, 
after  the  manner  of  a  pretty  wide  cleft,  on  the  pofterior  fide  of  the  foramen, 
which  receives  both  portions  of  the  auditory  nerves.  And  this  cleft  was 
cover’d  by  the  dura  mater,  which  in  that  place  feem’d,  in  fa<5t,  to  be  eroded 
alfo  ;  yet  not  to  fo  great  a  length,  as  the  cleft  or  groove  of  the  bone.  But 
notwithftanding  the  brain  had  a  proper  firmnefs,  and  was  differed  the  day 
alter  death,  there  was  fo  ftrong  and  putrid  a  lfnell  in  the  head,  that  it  was 

'  .  *'(0  N.  3't 

S  f  2 


(i)  Parts  ead.  Tract,  cit.  fupra,  n.  2. 


t 


3 1  6  Book  I.  Of  Difeafes  of  the  Head. 

not  in  my  power  to  trace  the  paffage  of  the  pus  from  this  cleft  of  the  bone, 
to  the  right  ventricle  :  nor  yet  to  enquire,  whether  any  other  parts,  befide 
the  membrana  tympani,  were  hurt  in  the  ear,  and  what  parts  they  were. 

6.  This  very  great  difference,  in  the  degree  of  olfenfivenels  in  the  fmell, 
that  there  was  between  the  two  fubje£ts,  you  mult  refer  to  the  time  of  the 
year,  the  age  of  the  patients,  and  the  conftitution  of  the  humours,  which 
is  fo  different  in  different  perfons  ;  but  the  other  differences  muft  be  referr’d 
to  other  caufes,  as  that  of  fleepinefs,  to  the  greater  quantity  of  water  found 
in  both  the  ventricles  of  the  brain,  mix’d  with  pus  alfo  on  the  right  fide ; 
as  on  the  other  hand,  the  deafnefs  of  the  boy  in  the  former  hiflory,  muft  be 
accounted  for,  from  the  organs  of  hearing  being  much  more  injur’d,  and 
deftroy’d,  by  the  caries*,  and  the  convulfions  alio  of  the  fame,  from  the  nerve 
being  wounded  ;  and  finally  the  lofs  of  his  pulfe  and  ftrength,  from  the  ce¬ 
rebellum  being  much  affedted  with  difeafe.  But  the  fymptoms,  common  to 
both,  muft  be  referr’d  to  the  injuries  common  to  both,  as  the  unexpected 
acceffion  of  diforders  fo  violent,  to  the  fudden  irritation  of  the  meninges, 
from  the  pus  that  was  effus’d  upon  them  *,  and  the  delirium  alfo,  to  this  very 
fame  caufe,  which  delay’d  and  obftruCted  the  blood  in  the  veffels,  that  for 
this  reafon  became  turgid ;  and  in  fhort  death  itfelf,  to  the  erofion  of  the  me¬ 
ninges,  the  cerebrum,  and  cerebellum. 

But  that  in  particular  was  moil  common  to  both,  on  the  account  of  which 
I  defcrib’d  thefe  two  hiftories  to  you,  I  would  fay,  that  by  means  of  a  ca¬ 
ries,  a  paffage  was  laid  open  between  the  ears,  which  difcharg’d  a  purulent 
matter,  and  the  cavity  of  the  cranium;  nor  could  any  one  fufpeft,  that 
this  paffage  was  made  from  the  cavity  of  the  cranium,  to  the  ear,  notwith- 
ftanding  he  faw  a  pus  of  the  fame  nature  within  the  cranium :  but  on  the 
other  hand,  every  one  who  attended  to  the  order  of  the  preceding  fymp¬ 
toms  would  confefs,  that  its  paffage  had  been  from  the  ear  to  the  cavity  of 
the  cranium.  And  as  it  is  manifeft  that  the  ear  can  generate  pus,  and  bear 
it  without  any  detriment  to  life,  much  longer  than  the  brain ;  it  is  alfo  ma¬ 
nifeft,  what  judgment  we  ought  rather  to  form  in  cafes  of  that  kind,  which 
I  fpoke  of  to  you  in  the  beginning  (//).  Ulcers  of  the  ears,  therefore,  are 
not  to  be  haftily  clos’d  up,  not  fo  much  on  account  of  that  circum  fiance, 
which  is  more  rare,  I  mean  left  the  exit  of  lanies,  from  the  cavity  of  the 
cranium  to  the  ears,  be  obftrubted,  as  on  account,  of  that  which  is  far  more 
frequent,  left  the  exit  of  fanies,  from  the  ears  themfelves  being  obftrutfted, 
a  caries  be  either  generated  or  encreas’d,  and  fo  much  eafier  and  fooner  pe¬ 
netrate  into  the  cavity  of  the  fkull.  And  with  the  two  obfervations  that  I 
have  given  you,  you  may  join  two  more,  one  from  Moglingius  ( e ),  and  the 
other  from  Laubius  (/).  For  in  both  of  thefe  you  will  read,  that  after  a 
fanies  flowing  from  the  ear,  there  was  a  purulent  tumour  round  about  it, 
that  the  tympanum  was  confum’d,  that  a  caries  was  produc’d  through  the  os 
petrofum  to  the  cavity  of  the  cranium,  and  finally,  that  there  was  ichor,  or 
pus,  within  this  cavity,  attended  with  fatal  diforders  of  the  brain.  And 
though  you  may  believe,  that  in  the  lecond  cafe,  fomething,  from  the  very 
beginning,  was  u  fhut  up”  within  the  brain,  which  obfcur’d  the  fight;  yet 

f/)  n.  2.  (*)  Eph.  N.  C.  Cent.  6.  obf.  21.  (f)  Earund.  Cent.  7.  obf.  40. 


you 


Letter  XIV.  Article  7.  317 

you  will  underfland,  that  it  was  not  encreas’d,  and  brought  to  fuppuration, 
before  the  flux  of  purulent  matter  from  the  ear,  which  had  diminifh’d  the 
obfeuritv  of  the  fight,  being  flopp’d,  an  amaurofis  firff,  and  then  apopleftic 
fymptoms,  none  of  which  had  appear’d  before,  came  on  •,  which  would  cer¬ 
tainly  not  have  come  on,  if  the  very  great  quantity  of  pus  that  had  flow’d 
three  or  four  times  from  the  external  tumour,  communicating  with  the 
meatus  auditorius,  and  which  certainly  could  not  have  been  at  that  time 
within  the  cerebrum,  had  been  equal  to  the  talk  of  exhaufting  all  that 
putrid  matter,  which  was  generated  in  and  about  the  ear,  and  averting  it 
from  the  brain. 

7.  That  worms  are  generated  in  long  ulcers  of  the  ears  is  not  only  a  com¬ 
mon  oblervation  among  medical  writers,  but  is  alio  a  very  ancient  opinion, 
as  Dodonaeus  (g)  fhews,  from  Diofcorides,  Galen,  and  Aetius  ;  to  which 
you  may  alfo  add  the  more  ancient  authors,  from  whom  Pliny  took  reme¬ 
dies  (£),  that  were  to  be  dropp’d  into  “  ears  that  generated  worms,”  to  kill 
“  worms  therein.”  It  will  not,  however,  I  fuppofe,  be  difagreeable,  if  I 
fubjoin  an  account  of  much  greater  diforders  being  excited  by  worms  in  a 
young  matron,  than  have  been  obferv’d  by  Lanzonus  (z)  and  Behrius(£). 
I  was  by  chance  with  Valfalva  in  the  place  of  his  nativity,  when  fhe  came 
to  him,  and  related,  that  having,  when  a  virgin,  had  a  worm  come  out  of 
her  left  ear,  fhe  alfo  difeharg’d  another  from  the  fame  ear  fix  months  before 
the  prefent  time :  that  the  worm  was  of  the  fhape  of  a  fmall  filk-worm,  and 
was  difeharg’d,  together  with  pus,  after  a  violent  pain  of  the  ear,  which  had 
extended  to  the  forehead,  and  temple  that  border’d  upon  the  ear,  but  imme¬ 
diately  ceas’d  after  the  worm  was  ejected.  But  from  that  day,  at  various 
intervals,  fhe  was  feiz’d  frequently  with  the  fame  pain,  but  much  more 
violently,*  fo  that  fhe  fell  down  fuddenly,  being  depriv’d  of  all  her  fenfes  for 
two  hours  together,  till  the  pain  going  off,  fhe  came  to  herfelf  again,  and 
foon  after  dilcharg’d  a  worm  from  her  ear,  of  the  fame  form,  but  lefs,  the 
deafnefs  of  that  ear  remaining,  and  a  ftupor  of  the  neighbouring  parts,  join’d 
with  a  kind  of  itching.  Valfalva  did  not  doubt  but  the  tympanum  was  ul¬ 
cerated  :  and  to  drive  out,  or  deftroy  the  worms,  if  any  remain’d,  he  pro¬ 
pos’d  a  water  diftill’d  from  the  herb  hypericum,  or  St.  John’s  wort,  in  which 
qjuickfilver  had  for  fome  time  been  fhaken.  You  will  fee  other  remedies  re¬ 
commended  by  others,  particularly  by  du  Verney  (/).  To  me  there  certainly 
feems  no  fafer  remedy  againft  worms  of  this  kind  being  firft  generated,  or 
againft  their  being  regenerated,  when  they  have  once  been  driven  away, 
than  never  to  deep  in  the  day-time  of  the  fummeror  autumn,  without  having 
the  ear,  in  which  the  ulcer  is,  flopp’d  up.  For  then  the  flies,  allur’d  by  the 
fanies,  and  ulcerous  fleih,  enter  into  it,  without  the  patient  knowing  any 
thing  of  the  matter,  and  lay  eggs  therein,  from  whence,  afterwards,  worms 
arife,  or  if  they  happen  to  be  viviparous  infers,  leave  worms  themfelves  be¬ 
hind  them.  Nor  have  they  their  origin  from  any  thing  elfe  but  flies :  from 
which,  even  Homer  (; m )  formerly  accounted  for  them,  and  not  from  putre¬ 
fy  Medic.  Obf.  Exempl.  rar.  in  Annot.  ad  (&)  Eorund.  Aft.  T.  4.  obf  29. 

Valefc.  Tharant.  (/)  Parte  ead.  Traft.  cit.  fupra,  n.  2. 

(/j)  Nat.  Hilt.  1.  20.  c.  14.  &  23.  (;»)  Iliad.  19. 

(/')  Epb.  N.  C.  Cent.  5.  obf.  72. 

4 


fattion. 


3  i  8  Book  I.  Of  Difeafcs  of  the  Head. 

faction,  when  he  introduces  Achilles,  as  fearing  left  the  flies  “  ftiould  breed 

worms  in  the  wound  of  the  flain  Patroclus.  And  if  they  have  fufficient 
food  to  thrive  upon,  from  gnawing  in  the  ulcerated  meatus  auditorius  •,  fo 
they  might  have  a  proper  place  wherein  to  undergo  thofe  various  changes, 
-defcrib’d  by  the  very  ingenious  Reamur  (#),  the  laft  of  which  is,  that  they 
become  flies ;  and  for  this  reafon,  the  cafe  affirm’d  by  Klaunigius  (<?),  of 
very  violent  pains  of  the  ear,  and  difturbances  of  the  head,  immediately 
ceaflng,  when  a  fly  flew  out  of  that  ear,  though  they  had  been  conftant  for 
the  fpace  of  two  months  before,  is  lefs  difficult  to  be  explain’d,  than  what 
he  feems  to  have  believ’d,  to  wit,  that  this  fly  had  continued  all  that  time 
in  the  meatus  auditorius. 

But  in  order  to  drive  away  worms  from  the  penetralia,  or  interiors  of  the  ear* 
perhaps  the  frnoke  of  proper  things  drawn  in  by  the  mouth,  in  fuch  a  man¬ 
ner  as  to  be  forc’d  into  the  cavity  of  the  tympanum,  by  the  euftachian  tube, 
might  be  of  great  efifedt,  as  1  have  mention’d  in  a  former  work  (p) ;  although, 
indeed,  I  there  faid  nothing  of  removing  .worms  from  that  cavity,  through 
the  membrana  tympani  already  eroded  by  them,  inafmuch  as  what  I  there 
attempted  to  treat  of,  requir’d  the  membrane  to  be  fo  far  unhurt,  that  it 
could  refill  by  its  elafticity,  and  repel  even  the  medicated  air,  which  was 
forc’d  thither  by  the  way  of  the  euftachian  tube,  the  lips  and  noftrils  being 
at  the  fame  time  comprefs’d ;  I  fay,  repel  it  loon  after  by  the  fame  paflage, 
in  order  to  purge  away  the  noxious  matter,  gather’d  together  in  the  tympa¬ 
num.  And  when  you  read  this  over  again,  I  would  have  you  confider,  what 
there  can  be  that  is  new,  in  the  fame  method  of  cure,  as  it  actually  feems 
to  me,  which  was  propos’d  in  a  very  fhort  medical  and  chirurgical  writing, 
that  was  publifh’d  eight  years  after.  But  let  us  come  to  other  things. 

8.  The  obfervation  which  is  here  the  fecond  in  the  Sepulchretum,  and  to 
be  read  in  the  fecond  fedtion,  under  number  fifty-three,  is  the  fame  that  is 
commended  by  du  Verney  (q).  And  indeed  it  fhews,  that  from  a  fteatoma, 
growing  between  the  cerebrum  and  cerebellum,  the  optic  nerves  being  thereby 
firft  comprefs’d  at  their  origin,  then  the  acouftic  which  lie  under  them,  and 
at  length  others,  an  amaurofis  muft  firft  of  all  be  the  confequence,  then 
deafnefs,  and  in  the  laft  place  death.  But  du  Verney  teaches  us,  which 
ought  to  have  been  added  to  this  obfervation,  by  way  of  fcholium,  in  the 
new  edition  of  the  Sepulchretum,  by  what  marks,  although  the  internal  parts 
of  the  ear  do  not  come  under  the  notice  of  the  fenfes,  in  the  fame  manner 
as  the  eye,  fo  that  we  can  equally  determine  by  infpedlion,  how  far  either  of 
thefe  organs  is  hurt;  yet  he  teaches,  as  I  faid,  by  what  marks  we  may  con- 
jedlure,  even  in  the  ear,  that  the  diforder  entirely  confifts  in  the  nerve.  From 
which  it  is  certainly  very  probable,  that  thofe  diforders  were  in  a  woman  and 
a  man,  that  are  mention’d  by  me,  on  another  occalion  (r) ;  I  mean  deafnefs, 
and  heavinefs  of  hearing,  before  the  apoplexy  of  each. 

q.  To  the  third  obfervation,  many  things  are  added  in  the  fcholia,  con¬ 
cerning  the  caufes  of  a  tinnitus,  and  other  founds  of  that  kind,  in  the  place 

p?)  Memoir,  pour  1*  Hift.  des  Infeft.  T.  4.  (p)  Epift.  Anat.  7.  n.  14. 

Mem.  7..  &  8.  (7)  Tratt.  Sc  Parte  cit.  fupra  n.  2. 

(c)  Epb.  N.  C,  Cent.  8.  obf.  17.  (r)  Epift.  4.  n.  8.  &  u. 


of 


Letter  XIV.  Article  io,  3 1  9- 

of  which,  other  remarks  taken  from  du  Verney  (j),  in  like  manner,  would 
have  been  far  better  fubftitutes.  Yet  in  thefe  fcholia,  fome  things  are  con¬ 
tain’d,  that  are  not  contemptible  by  any  means,  as  that,  for  inltance,  con¬ 
cerning  a  heavinefs  of  hearing  in  fome  fevers,  not  being  always  a  bad  fign* 
and  even  fometrmes  a  good  one,  efpecially  if  it  be  join’d  with  thofe  fymp- 
toms,  which  indicate  that  peccant  matter  is  thrown  out,  from  the  internal 
ears,  by  the  euftachian  tube.  And  indeed,  Valfalva,  as  I  have  already  told 
you  (/),  in  deafnefs  which  came  on  in  acute  difeafes,  often  found  a  large 
quantity  of  water  in  the  tympanum.  But  how  far  it  is  allowable,  or  not,  to 
bring  this  water,  or  other  humours,  through  new  foramina,  from  the  cavity 
of  the  cranium,  into  the  tympanum,  as  he  did,  I  feem  to  myfeif  to  have 
made  a  pretty  large  difquifition  already,  on  a  former  occalion  («),  fo  that  I 
need  not  add  any  thing  elfe  here,  efpecially  as  they  who  have  written  fince 
me,  on  the  fubjedl  of  thefe  foramina,  do  not  feem  to  have  read  that  difqui¬ 
fition  of  mine.  For  the  fanguiferous  veffels  I  alfo  faw  pafs  through  them, 
but  at  the  fame  time  1  put  you  in  mind,  “  that  they  were  not  found  in  all,” 
in  fuch  a  manner,  “  as  entirely  to  obftruft  the  foramina:”  and  in  fa6t,  how 
can  very  fmall  arteries  fill  them  up,  even  when  they  do  occur,  where  the 
foramina  are  “  very  far,  indeed,  from  being  fmall  ?”  for  both  Valfalva  arid 
I  have  certainly  found  them,  more  than  once,  pretty  large.  But  I  will  not 
as  I  faid,  do  over  again,  what  I  have  already  done.  I  will  rather  return  to 
the  tinnitus.  On  which  fubjedt,  in  a  diflertation  of  a  certain  celebrated  man, 
I  read  what  follows :  “  It  is  a  very  rare  obfervation  which  Hieron.  Mercu- 
“  rialis,  in  his  Confultationes  Medics,  tome  the  fecond,  obfervation  the 
“  hundredth,  mentions  of  a  man,  and  Felix  Platerus,  in  his  Obfervationes, 
tc  book  the  fecond,  page  372,  of  a  woman,  in  whom  the  tinnitus  was  fo 
<c  vehement,  as  even  to  be  heard  by  the  perfons  who  were  about  the  pa- 
tc  tients.”  But  the  firft  of  thefe  authors  fays,  that  this  was  “  by  no  means 
“  certain.”  And  in  the  book  of  the  other  author,  whom  he  quotes,  I  can 
find  nothing  at  all  like  it;  only  in  page  371,  I  read  that  the  foetorof  the  pu¬ 
rulent  ear,  “  was  troublefome  to  the  bye-ftanders.”  But  if  you  fhould  chance 
to  find,  what  it  has  not  been  in  my  power  to  meet  with  •,  fee  if  you  are  not 
rather  to  underfland  it  of  the  found  of  the  artery,  pulfating  within  the  ear, 
as  du  Verney  remarks,  in  a  certain  matron  (x) :  or  if  it  was  really  a  hiding, 
believe  that  it  was  from  air,  which,  being  collected  in  the  cavity  of  the  tym¬ 
panum,  and  foon  after  fhut  up,  broke  forth  from  thence  on  a  fudden  with 
great  violence,  through  a  foramen,  which  it  might  have  open’d  for  itfelf,  in 
the  membrana  tympani,  or  at  its  upper  border  (y). 

10.  The  fourth  obfervation  propofes  a  caufe  of  deafnefs  from  the  birth,, 
in  the  incus  being  deficient,  or  in  all  the  ofiicula  auditus,  being  a  third  part 
lefs  than  is  natural.  But  in  another  fcholium,  and  the  appendix  fubjoin’d 
thereto,  I  fee  that  thefe  caufes  are  call’d  in  doubt,  becaufe  the  membrane  of 
the  tympanum,  and  the  ofiicula  being  broken,,  a  capacity  of  hearing  ftill  re¬ 
main’d.  And  this  is  alfo  confirm’d,  by  the  obfervation.  of  Valfalva  (2),  in  2 


(j)  Parte  modo  indicata.  (x)  Traft.  Parte  fsepe  indicata. 

(0  Epift.  6.  n.  5.  (y)  Vid.  Epift.  Anat.  5.  n.  16.  Si  feqq, 

C«)  Epift.  Anat.  7.  n.  5.  6.  7.  8.  (^)  Traft,  de  Aure  hum.  c.  5.  n.  5, 

6 


womans 


32o  Book  I.  Of  Difeafes  of  the  Head. 

woman,  who  had  the  membrana  tympani  eroded  on  both  fides,  either  alto¬ 
gether,  or  in  great  part,  and  on  one  fide  had  none  of  the  little  bones,  but 
the  bafis  of  the  ftapes,  remaining,  and  on  the  other  fide  the  incus  entirely 
disjoin’d  from  the  (tapes,  yet  had  never  been  deaf,  but  only  heavy  of  hearing 
for  a  long  time.  And  of  the  fame  nature,  certainly,  are  the  obfervations  of 
Vieuftens  (a)y  who  found  the  fame  appearance  in  the  fame  membrane,  in  the 
bodies  of  many  perfons,  who  neverthelefs  had  not  been  deaf,  but  had  only 
heard  with  difficulty  and  imperfectly  •,  and,  moreover,  he  found  the  mufcles 
of  the  officula  corrupted,  and  almoft  deftroy’d,  and  the  bones  themfelves 
quite  thrown  out  of  their  order  and  connexion :  and  we  muft  efteem  it  juft 
the  fame  thing,  as  if  they  were  wanting,  that  they  are  fo  plac’d,  as  not  to 
be  able  to  perform  their  functions.  However,  I  would  have  you  juft  attend 
to  thefe  circumftances,  both  in  relation  to  the  officula,  and  the  membrana 
tympani.  If,  in  the  rupture  of  this  membrane,  the  ftapes  fall  out,  not  only 
the  tympanum  itfelf,  but  the  very  foft  little  membranes  of  the  labyrinth,  lie 
open  to  injuries,  through  the  feneftra  ovalis,  which  is  by  this  means  unco¬ 
ver’d  :  wherefore,  I  have  never  read,  as  far  as  I  remember,  of  any  one 
who  preferv’d  his  hearing  long  after  the  ftapes  had  entirely  fallen  out  from 
his  ear.  And  though  Valfalva,  alfo,  has  exprefsly  affirm’d,  that  the  mem¬ 
brana  tympani  is  not  altogether  neceffary  to  the  Tenfe  of  hearing  (b)  •,  yet  I 
would  not  have  you  forget, .that  it  is  neceffary  to  proteCt  thofe  parts,  which 
are  fo  immediately  neceftary  to  hearing,  that,  if  they  are  injur’d,  we  cannot 
hear ;  I  mean,  the  labyrinth,  whofe  feneftras  it  preferves  from  external  in¬ 
juries  :  fo  that,  if  a  greater,  or  more  frequent,  violence  of  this  external  force 
urges  the  foft  and  tender  membranes,  in  particular,  which  are  very  weak, 
even  from  their  origin,  it  can  fcarcely  happen,  but  that,  in  a  pretty  long 
courle  of  time,  thefe  injuries  muft  prevail,  and  hearing  be  deftroy’d.  But  if 
this  happen’d,  neither  to  the  woman  whom  1  before  pointed  out  to  you,  nor 
yet  to  dogs  on  which  Valfalva  has  made  the  experiment,  that  Holder  (c) 
and  Willis  (d)  had  mention’d  *,  without  doubt,  it  was  becaufe,  before  this 
deftruCtion  of  hearing  could  come  on,  nature  had  fo  repair’d  the  membrane 
of  the  tympanum  in  the  woman,  which  had  been  in  part  eroded,  and  the 
fame  membrane  in  dogs,  which  had  been  broken  through,  as  Valfalva  found 
in  his  experiments  (<?). 

Nor  would  I  have  you  objeCt  to  me,  that  they  who  have  a  foramen  in  this 
membrane  are,  neverthelefs,  not  fubjeCt  to  thefe  external  injuries  in  their 
organs  of  hearing,  though  they  can  force  out  the  ffnoke  of  tobacco,  that 
they  draw  into  their  mouths,  through  this  aperture  :  for  I  would  wifh  you 
firft  to  read  over  the  examen,  which  I  have  made(/)  into  the  teftimonies  of 
moft  of  the  authors  who  have  mention’d  their  having  feen  it.  And  you  will 
find,  in  the  firft  place,  how  few  there  are  who,  you  can  be  certain,  have  feen 
it :  in  the  next  place,  that  there  is,  perhaps,  not  one  amongft  them  all,  who 
tells  us,  for  how  many  years  this  had  continu’d,  without  lofing  the  faculty  of 
hearing  :  finally,  you  will  obferve,  that  there  might  be  fuch  a  ftrufture  of 

[a)  Tr.  de  l’Oreille.  p.  2.  ch„  4.  (d)  De  Anima  Brutor.  c.  14. 

(£)  N.  5.  cit.  (<>)  N.  5.  cit. 

(<r)  Ad..  Philof.  Soc.  R.  in  Anglia,  a.  1668.  (f)  Epilh  Anat.  5.  n.  14. 

n.  1. 


this 


Letter  XIV.  Article  i  i ,  321 

this  foramen,  that  the  air  could  go  out,  and  not  enter  ;  and  that  the  paffage 
might  be  fo  ftraiten’d,  as  but  very  little  air,  and  no  duft,  nor  any  thing  elfe 
of  that  kind,  could  pals  through,  as  even  the  fmoke  itfelf  did  not  come 
forth  without  being  driven  with  iome  force. 

You  will,  therefore,  confider  thefe  things,  when  you  fh all  light  on  any 
cafes,  either  of  broken  officula,  or  of  erolion,  or  perforation,  in  the  membrane 
of  the  tympanum.  Now  let  us  return  to  the  reft  of  the  obfervations  pro¬ 
duc’d  in  the  Sepulchretum. 

11.  In  the  fifth,  is  propos’d  an  injury  of  the  hearing,  from  a  caufe  unknown 
to  the  ancients ;  I  mean,  from  the  lordes  of  the  ears  growing  ftony.  Galen, 
indeed,  had  written  ( g ),  “  that  in  the  number  of  thofe  things,  which  obftrudt 
tc  the  meatus  auditorius,  were  the  lordes  alfo,  which  are  generally  collected 
“  in  the  ears.”  Nor  did  he  hefitate  to  mention  the  remedy  of  Apollonius, 
“  againft  the  hordes  of  the  ears  ( h )  nor  his  own,  “  to  draw  out  the  fordes 
tc  from  the  ears  (i)  which  he  feems  to  have  taken  from  Apollonius,  from 
whom  I  fhall  alfo  fuppofe  that  Celfus  had  before  receiv’d  his  ( k ) :  and  thefe 
you  may  now  compare  with  thofe  which  Boerhaave  (/),  and  Dethardingius  ( m ), 
fay,  that  they  and  others  had  us’d  with  fuccefs.  But  although  Celfus  (n) 
propos’d  “  to  foften  the  hard  and  concreted  fordes,  and  to  take  them  out 
“  with  an  ear-probe,”  as  they  fometimes  became  much  harden’d  ;  yet  he, 
and  the  reft  of  the  ancients,  do  not  feem  to  have  taken  any  particular  notice 
of  calculi  generated  in  the  cerumen  aurium,  no  more  than  they  have  of  the 
calculi  in  the  veficula  fellis,  as  our  Cafferi  has  done  in  this  obfervation.  Nor, 
indeed,  are  the  inftances  frequent,  fince  from  the  times  of  Cafferi,  who  faid 
they  vjere  “  very  rare,”  I  fee  that  only  one  obfervation  of  this  kind,  which 
is  that  of  Carolus  Jofephus  Mullerus  (0),  which  is  commended,  and  which  he 
alfo  thought  “  extremely  rare.”  And  at  Padua,  at  leaft,  which  1  may  take 
upon  me  to  affirm,  it  is  hitherto  very  rare  to  find  the  cerumen  fo  concreted, 
that  you  may  draw  it  out  entire  from  the  meatus,  which  is  fill’d  with  it,  as 
you  would  draw  a  fword  from  its  fcabbard,  or  a  tent  from  a  fiftulous  ulcer ; 
unlefs  the  ears  happen  to  be  deaf  from  a  deeper-feated  caufe,  and  for  that 
reafon  negledted  ;  as  in  a  man  of  whom  I  fpoke  in  a  former  work  (/>),  and 
as  I  faw  again  in  an  old  woman,  in  whom  the  little  membrane,  which  con- 
nedts  the  bafis  of  the  ftapes  with  the  feneftra  ovalis,  was  become  bony. 
But  that  there  are  other  countries,  in  which  the  cerumen  aurium  becoming 
even  ftill  more  indurated,  is  fo  frequent  a  difeafe,  as  to  make  the  circulatory 
furgeons  undertake  the  cure  of  deafnefs  which  ariles  therefrom,  I  readily 
believe  :  for  even  in  France,  that  the  cerumen  is  often  “  infpifiated  like 
**  gypfum,  and  is  very  often  found  exadtly  filling  up  the  meatus,”  I  knew 
from  Du  Verney  (q),  and  from  Valfalva(r),  whom  I  commended  before, 
yet  that  this  cure  was  neverthelefs  there  adminifter’d  by  “  the  moft  fkilful 
“  furgeons but  in  Holland,  I  heard,  which  was  afterwards  confirm’d  by 


G)  De  Sympt.  Cauf.  1.  i.  c.  3. 

(£)  De  Compof.  Medic,  fee.  ioc.  1.  3.  c.  1. 
(,•)  De  Remed.  parat,  facil.  c.  10. 

(<£)  De  Medic.  1,  6.  c.  7.  n.  7. 

(/)  Praeled.  in  Inftit.  §  551,  698,  850. 

(»»)  Eph.  N.  C.  Cent.  5.  obf,  81. 

VOL.  I. 


(«)  N.  7.  cit. 

(c)  Eph.  N.  C.  Dec.  2.  a.  6.  obf.  162. 

(/>)  Epift.  Anat.  5.  n.  26. 

(p)  Parte  faepius  cit. 

(r)  Trad,  de  Aure  hum.  c.  1.  n.  12. 

T  t  reading 


322  Book  I.  Of  Difeafes  of  the  Head. 

reading  the  difiertation  of  the  celebrated  Du  Bois  (j),  that  this  kind  of 
deafnels  “  is  feldom  cur’d,  becaufe  it  is  well-known  to  few fo  that  I  did 
not  think  it  foreign  to  the  purpofe  of  this  method  of  cure  (/),  which  Val- 
falva  had  faid  (#)  was  us’d  alfo  by  him,  and  perhaps  the  firft  among  our 
countrymen,  to  relate  the  event,  and  to  add  the  example  of  another  deaf- 
nefs,  which  lafted  ten  months,  after  an  acute  difeafe,  whether  from  cerumen, 
or  from  any  other  matter,  cur’d  by  the  fame  hand,  and,  on  that  occafion,  to 
touch  nightly  upon  the  methods  of  cure  that  he  was  wont  to  make  ufe  of 
in  fuch  cafes ;  although,  as  I  there  exprefsly  affirm’d,  they  were  “  common 
“  with  others.” 

Whether  Du  Verney  has  quite  the  fame  methods,  you  yourfelf  will 
fee.  I,  at  leaft,  feem  to  myfelf  to  have  negledted  that  which  Du  Verney 
related,  “  from  the  forty-fifth  obfervation  of  the  firft  volume  of  the  works 
“  of  the  celebrated  Bartholin  to  wit,  that  his  wife  “  had  difcharg’d  fmail 
“  ftones  through  the  meatus  of  the  ear,  together  with  the  wax  who,  with¬ 
out  doubt,  I  would  acknowledge,  “  had  extradled  little  granules  of  fand 
“  with  the  wax,”  but  not  little  ftones.  As  to  what  remains,  and  relates  to 
the  obfervation  propos’d  in  the  Sepulchretum,  if  the  cerumen  has,  at  any 
time,  approach’d  to  the  nature  of  a  calculus,  it  certainly  had  in  the  cafe 
that  Valfalva  tells  us  he  cur’d  :  which  circumftance,  join’d  to  the  more  re¬ 
tir’d  fituation  of  the  meatus,  wherein  the  cerumen  had  been  indurated  for 
twelve  years  together,  gave  to  every  one  the  higheft  opinion  of  his  diligence,, 
and  fkill,  in  taking  it  out  at  different  times,  and  in  different  portions, ^as  he 
was  under  a  neceffity  of  doing.  Nor  yet  was  the  patient  “  oblig’d  to  learn. 
“  words,  and  fpeaking  over  again  although  “  he  had  recover’d  his  hearing, 
“  after  having  loft  it  many  years  together  for  he  had  continu’d  to  talk 
during  his  deafnefs,  as  deaf  perfons  generally  do:  fo  that  I  do  not  under- 
ftand,  how  that  could  poffibly  be  afferted,  by  a  moft  excellent  man,  which 
'certainly  never  happen’d  to  any  deaf  patient  of  ours  ;  except  he  there  fpoke 
of  fome  very  forgetful  perfon,  or  one  who  had  not  fufficiently  learn’d  to 
talk  before  he  became  deaf.  But  that  brute-animals,  inafmuch  as  they  are 
without  hands  to  cleanfe  their  ears  with,  “  frequently  rub  their  ears  againft 

pieces  of  wood,  trees,  or  ftones,  that  they  meet  with  in  their  way,”  and 
“  that  unlefs  they  do  this,  they  grow  deaf,”  he  has,  indeed,  rightly  affirm’d. 
Yet  to  this  we  may  add,  that  the  great  moveablenefs,  which  is  given  by  nature 
to  their  auriculae,  or  external  ears,  is  given  for  this  very  reafon,  “  that  by 
“  making  various  motions  on  all  fides,  the  acrid  recrementitious  matter,  and 
“  whatever  could  give  them  uneafinefs,  might  be  eafily  expell’d  from  their 
“  ears  as  Cafferi  has  admirably  well  judg’d,  in  that  very  chapter  from 
which  this  fifth  obfervation  is  taken  (x).  What  ?  if  I  fhould  add  to  the 
auriculae,  that  firft  part  of  the  meatus,  or  the  cartilaginous  tube,  “  in  which. 
“  the  fordes  of  the  ears  are  contain’d  (jy).”  I  do  not  doubt,  but  if  you  con- 
fider  this  tube,  even  in  the  figures  which  he  has  given  of  brutes,  and  at  the 
fame  time  attend  to  the  fituation  thereof,  its  ftrudture,  and  its  mufcles,  you 

(*)  Pentsefth.  1.  4.  f.  1.  c.  19. 

(y)  Dedar,  fig.  2.  tab.  1.  I.  ejufd.  ad  CC; 


will 


(/)  De  Auditu  §  15. 

(/)  Epifl.  Anat.  13.  n.  3. 
(u)  N.  12.  cit. 


Letter  XIV.  Article  12.  323 

•will  actually  perceive,  that  this  tube  being  agitated  in  many  different  ways, 
at  the  fame  time,  with  the  auriculae,  and  being  feparately  drawn  out,  and 
contracted,  the  difcharge  of  the  fordes  may,  at  that  time,  be  more  eafily 
promoted. 

12.  The  fixth  obfervation  being  pafs’d  over,  inafmuch  as  it  propofes  no 
peculiar  injury  of  the  auditory  nerve,  nor  any  vifible  one  of  the  ear  itfelf,  the 
added  obfervations  follow.  And  the  firft  of  thefe,  as  far  as  it  determines  the 
caufe  of  an  incurable  deafnefs  to  be  the  membrana  tympani,  which  was 
ie  very  thick  from  its  original  conformation,”  if  this  thicknefs  was  really 
very  great,  is  certainly  to  be  approv’d  :  but  it  is  uncertain,  whether  Lau¬ 
rentius  faw  it  thus  or  not.  It  is  certain,  however,  that  he  had  written  it, 
yet  not  in  “  book  the  fourth,  chapter  the  eighteenth,”  of  his  Hiftoria  Ana¬ 
tomica,  but  in  book  the  eleventh,  chapter  the  thirteenth  •,  and  that  the  fame 
was  feen  by  Lanzonus  (2),  in  another  perfon,  “  who  had  been  deaf  from  his 
“  birth.”  And  as  to  what  is  fubjoin’d  to  the  fame  obfervation,  from  Bauhin, 
of  a  great  quantity  of  thick  mucus  being  found  in  the  cavity  of  the  tym¬ 
panum,  and  frequently  oppofite  to  the  membrana  tympani,  efpecially  in 
children,  as  our  Fabricius  had  obferv’d,  whofe  teftimony  is  alfo  inculcated 
in  the  fecond  obfervation  •,  certainly,  this  caufe  is  of  fuch  a  kind,  that,  as 
long  as  ever  it  continues,  there  is  no  doubt  of  a  deafnefs,  or  a  great  injury 
of  hearing,  being  the  confequence.  But  how  far  fome  have  gone,  and  abus’d 
the  words  of  Fabricius,  I  have  already  fufficiently  fhewn  in  one  of  my 
Epiftolae  Anatomicae  ( a ),  without,  however,  for  that  reafon,  denying  what 
I  have  even  affirm’d  to  you  in  a  former  letter  (b)>  that  a  famous  matter  may 
be  found  in  the  tympanum  from  the  effeCt  of  difeafe  j  to  which  you  may 
alfo  refer  the  obfervation  of  Schulzius  ( c ). 

Moreover,  in  the  fifth  of  the  Epiftolae  Anatomies  (i),  thofe  queftions 
are  debated  at  large,  nor  altogether  without  accuracy,  which  relate  to  the- 
third  obfervation  taken  from  the  fame  Fabricius.  For  Fabricius  had,  in  fa<5t, 
found  “  twice,”  in  very  young  children,  “  a  very  thick  and  ftrong  mem- 
«  brane,”  added  externally  to  the  membrana  tympani  *,  and,  for  that  reafon, 
likely  to  prove  the  caufe  of  future  deafnefs.  But  others  have  not  doubted, 
that  this  was  the  fame,  which,  after  Kerckringius,  was  found  to  be  common 
to  all  infants,  by  Du  Verney,  Valfalva,  Cheffelden,  Waltherus,  Window,  and, 
in  like  manner,  by  Ruyfch,  Drake,  and  other  learned  men.  The  two.laft: 
of  thefe  anatomifts  have  fuppos’d  it  to  be  an  expanfion  of  the  cuticle ;  but 
the  five  former  have  deferib’d  it  as  a  thick,  mucilaginous,  whitiffi,  and 
almoft  fluid  fubftance  :  and,  indeed,  I  find,  that  all  of  them  have  attended 
to  the  truth,  but  in  different  ways  from  one  another  ;  for  not  only  the  thin 
expanfion  of  the  cuticle,  both  in  feetuffes,  and  in  adults,  makes  the  outer 
lamella  of  the  membrane  of  the  tympanum,  but  alfo,  in  feetuffes  peculiarly, 
and  in  children  recently  brought  forth,  a  foft  matter  is  laid  thereon,  which 
relembles  an  integument.  But  as  1  have  fhewn,  that  this  matter  is  of  the 
fame  febaceous  kind,  with  which  the  fkin  of  the  foetus  is  fmear’d  over,  you 

•  / 

(<■)  Aft.  N.  C.  tom.  1.  obf.  223. 

(d)  N.'I.  &  feqq.  ufq,  ad  n.  13. 


(z)  Eph.  N.  C.  Cent.  3.  obf.  62. 
(*)  VII.  n.  15,  &  16. 

{6)  Epift.  6.  n.  4. 


Tt  2 


fee 


324  Book  I.  Of  Difeafes  of  the  Head. 

lee  how  natural  it  is  to  conceive,  that  it  mull  be  rather  dried  up  and  fall  off, 
than  degenerate,  in  lome  children,  into  a  very  thick  and  ftrong  membrane, 
for  which  degeneracy  the  cuticle  itfelf  is  certainly  far  lels  urffit. 

And  tbefe  things  I  thought  it  neceflary  for  me  to  touch  flightly  upon,  in 
this  place,  that  you  might  fee  what  my  opinion  was,  concerning  this  laft  ob- 
fervation,  and  at  the  fame  time,  that  if  you  ever  fhould  read  me  number’d 
among  thofe  who  have  afierted,  that  the  kind  of  membrane  which  is  found 
lying  over  the  membrana  tympani,  in  new-born  infants,  is  nothing  elfe  but 
the  cuticle  •,  you  may  read  over  again,  the  paflfages  of  the  Epiftolse  Anato¬ 
micas,  which  I  have  pointed  out.  And  this  1  would  alfo  have  you  do,  where  - 
foever  you  fhall  perceive  that  I  am  compell’d  to  touch  upon  over  again,  any 
thing  that  I  had  treated  of  before,  as  I  did  above  at  obfervation  the  fifth  ( e ) ; 
not  fo  much  left  I  fhould  be  wanting  to  Vallalva  or  myfelf,  as  left  I  fhould  be 
wanting  in  juftice  to  the  obfervation  itfelf,  or  to  you. 

13.  As  to  the  fourth  obfervation  in  the  Additamenta,  of  a  double  mem¬ 
brana  tympani,  or  of  a  cruft  of  condens’d  wax  adhering  to  it,  after  what  has 
been  already  faid,  it  is  to  no  purpofe  to  add  any  thing  more  :  nor  yet  of  the 
fifth ;  for  it  is  very  evident,  that  if  an  excrefcence  of  flefh  ftops  up  the  mea* 
tus,  the  hearing  muft  be  intercepted,  unlefs  it  be  remov’d.  And  in  what 
manner  this  is  to  be  perform’d,  many  teach  us  •,  amongft  whom,  befide  our 
Marchetti  (/),  the  chevalier  who  gave  the  faculty  of  hearing  to  a  young 
man  thus  born,  in  the  firft  place  is  Du  Verney(^),  who  alfo  has  related  the 
manner  of  taking  out  other  things,  which  injure  the  hearing  and  the  ear,  by 
having  fall’n  deeply  into  the  meatus  auditorius,  the  incifion  of  the  ear,  where 
neceftity  compels,  not  being,  omitted.  Paulus,  indeed,  as  you  have  it  in  our 
Fabricius  (£),  and  Albucafis,  as  you  have  it  in  Marcellus  Donatus (/),  pro¬ 
pos’d  the  lame  operation  formerly,  but  in  a  different  place,  as  it  feems,  which 
perhaps  might  be  more  convenient  for  inlpedtion,  and  for  adlion  *,  but  that 
of  Du  Verney  is  more  fafe.  And  as  to  what  Donatus  has  fubjoin’d,  con¬ 
cerning  a  pea  Hipping  into  the  meatus  auditorius,  it  would  be  no  uncom- 
mon  cafe  here,  if  we  were  not  to  look  to  it  in  the  beginning.  But  as  it  hap¬ 
pens  very  often,  that  by  introducing  inftruments  to  extract  thefe  fubftances, 
they  are  pulh’d  ftill  farther  within  the  meatus ;  a  furgeon,  who  was  an  ac¬ 
quaintance  of  mine,  by  purfuing  quite  a  different  method,  in  many  perfons, 
very  happily  remov’d  them.  For  he  threw  with  force  into  the  meatus,  by 
means  of  a  fyringe,  oil  of  fweet  almonds,  or  milk  *,  and  by  this  means  the 
peas,  or  other  fuch  feeds,  were  brought  back  by  the  regurgitating  fluid,  and 
difcharg’d  from  the  auditory  tube.  And  when  I  faid,  that  the  rationale  of 
this  pradlice  was  before  led  to  by  Celfus  (/t),  who  at  that  time,  “  threw  water 
“  in  forcibly  with  a  fyringe,”  but  at  the  fame  time  objected  to  him  the  ad¬ 
monition  of  Scultetus  (/),  who  forbids  the  violence  of  injedtions  in  diforders 
of  the  ears,  “  left  the  membrana  tympani  be  ruptur’d;”  he  anfwer’d,  that 
he  had  never  yet  obferv’d,  in  any  one  of  thofe  children,  on  whom  he  had 
made  ufe  of  the  method  I  have  told  you,  of  getting  heterogeneous  fubftance-s 
out  of  the  ear  that  had  fall’n  in,  any  the  lealt  detriment  to  their  hearing  itn- 

(e)  n.  11.  (f)  Obf.  Med.  Chir.  28.  (/)  De  Medic.  Hift.  Mirab.  1.  2.  c.  is-.. 

(g)  Parte  fspius  cit.  ( k )  De  Medic.  1.  6.  c.  7.  in  fin. 

\b)  De  Chirurg.  Operat.  (/)  Armam.  Chir.  Tab.  36.  ad  Fig.  5. 

mediately* 


I 


Letter  XIV.  Article  14. 


325 


mediately,  or  at  any  time  after.  However,  that  no  one  may  be  compell’d 
to  delcend  to  injections,  that  are  thus  fufpe&ed,  or  to  incifion,  which  is  not 
at  all  approv’d  of  by  Fabricius  (*»),  unlefs  in  the  molt  rare  cafes,  not  only 
many  different  things  propos’d  by  furgeons,  fhould  be  previoufly  put  into 
practice,  but  efpecially,  that  whatever  fubftances  have  fall’n  in,  may  not  be 
forc’d  on  farther  by  introducing  inftruments,  but  may  be  more  eafily  laid 
hold  of,  and  taken  out,  it  will  be  of  much  advantage  to  ufe  that  eafy  me¬ 
thod  by  which  Fabricius  was  wont  to  ftraiten  and  dilate  the  meatus,  as  far 
as  it  was  poffible  for  him  to  do  it  ;  and  when  it  was  thus  ftraiten’d  and  di¬ 
lated,  to  examine  it  very  accurately,  by  admitting  the  light  of  the  fun  ;  at  the 
fame  time  transferring  hither,  from  the  nofirils,  the  cuftom  of  Julius  Caefar 
Arantius  (n)  ;  who,  “  when  the  heat  of  the  fun  was  troublefome  to  the  pa- 
“  tient,  the  phyfician,  and  the  attendants,  efpecially  in  a  very  hot  flate  of 
<c  weather,  for  that  reafon  invented,  in  a  clofe  wooden  window,  an  artificial 
“  foramen,  that  was  moft  proper  for  performing  that  office-,  fo  that  the 
ct  rays  of  the  fun,  infinuating  themfelves  by  this  foramen,  might  come  di- 
“  reClly  to  the  noflrils  of  the  patient.”  But  as  the  fun  does  not  always  ap¬ 
pear,  it  may  alfo  be  of  fervice,  if  a  better  apparatus  is  wanting,  to  make  ufe 
of  the  light  of  a  candle  by  night,  or  if  it  happen  in  the  day-time,  to  darken 
the  room,  and  to  let  the  light  pafs  through  a  globe  of  chryftal  fill’d  with 
water,  fo  that  the  greatefl  part  of  its  rays  may  fall  upon  the  meatus  audito¬ 
rius.  Therefore,  by  either  one  or  the  other  of  thefe  methods,  which  are 
fometimes  the  moft  convenient,  to  throw  a  light  upon  other  recedes  alfo,  as 
of  the  mouth  and  fauces,  efpecially  by  night,  one  of  the  parietes,  at  leaft,  . 
of  the  meatus  being  enlighten’d,  on  the  fide  of  the  furgeon ;  the  oppo- 
fite  paries  will,  confequently,  be  better  examin’d  into  by  means  of  the  re¬ 
flected  light the  fubftances  that  are  fall’n  in  will  be  better  perceiv’d,  and 
more  certainly  laid  hold  of;  and  thus  may  they  be  happily  drawn  out,  inftead 
of  being  haftily  driven  inwards. 

1 4.  Concerning  the  two  remaining  obfervations,  it  is  fufficientto  fay  a  few 
things.  In  the  fixth  a  reafon  is  propos’d,  why  more  perfons  ftiould  be  de¬ 
priv’d  of  their  hearing,  from  their  birth,  than  of  any  other  fenfe  whatever, 
difcover’d,  as  it  is  laid,  from  the  origin  of  the  nerves.  But  although  we 
ftiould  grant  to  Bauhin,  from  whom  thofe  things  are  taken,  which  we  ought 
by  no  means  to  grant,  that  the  portio  mollis,  of  the  auditory  nerve,  arifes 
from  the  cerebellum,  and  pafles  through  the  pons  Varolii,  or  the  annular 
protuberance ;  it  would,  neverthelefs,  by  no  means  follow  from  thence,  that, 
although  it  does  not  take  a  long  paffage,  “  it  is  eafily  fill’d  with  mucous 
“  excrements.”  But  as  to  what  Bauhin  immediately  adds,  “  that  hence  it 
“  alfo  happens,  that  both  ears  are  always  affeCted  from  the  birth,  as  Caffius 
“  has  taught,  whereas  it  happens,  for  the  moft  part,  that  one  only  is  affected 
“  from  difeafe-,”  neither  has  Caffius  ever  taught  this,  that  I  remember,  nor 
does  he  fo  much  as  in  the  leaft  fuppole  it,  in  the  feventeenth  problem,  which 
is  quoted  by  Bauhin  in  his  work,  but  even  quite  the  contrary ;  nor  indeed 
would  it  be  neceffary,  that  both  ears  fhould  be  ‘c  always”  affeCted  from  the 
birth,  notwithftanding  both  the  foft  portions  of  the  auditory  nerve  ffiauld 


(m)  Loco  indicato. 


(»)  1.  ds  Tumor,  prater  nat.  c,  21. 


arife 


2 


32  6  Book  I.  Of  Difeafes  of  the  Head. 

arife  from  the  annular  protuberance,  unlefs  it  were  certain,  that  both  of  them 
were  not  only  contiguous  one  to  another,  in  the  very  origin,  but  that  even 
the  diforder  was  always  in  that  very  fame  origin.  And  in  this  very  manner 
I  Ihould  anfwer,  if  any  perfon  who  now  attempted  to  explain  the  fame  thing, 
by  fubftituting  the  more  real  origin  of  the  nerves,  in  the  place  of  that,  which 
was  luppos’d  in  Bauhin’s  time,  ihould  lay,  that  it  feem’d  in  this  new  origin, 
which  was  at  length  known  to  the  more  modern  anatomifts,  that  both  of  the 
portions  were  contiguous  to  each  other,  to  wit,  in  the  middle  of  -the  calamus 
fcriptorius.  You  will  perhaps  wonder  here,  that  this  is  by  me  aicrib’d  to 
the  more  modern  anatomifts,  which  I  formerly  (0)  attributed  to  Piccolhomi- 
nus,  and  others  not  only  attribute  to  him  at  prefent,  but  alio  to  Varolius, 
and  even  to  Gabriel  Zerbus.  But  if  you  read  over  the  paffages  of  both  au¬ 
thors,  that  are  referr’d  to  by  them,  and  inipedfc  figure  the  firft,  in  the  firft 
author  (y),  you  will  lee  that  Varolius  deduces  the  auditory  nerves  from  his 
own  pons  (q) :  and  if  you  turn  to  Zerbus  (r),  you  will  find  him  writing,  in¬ 
deed,  that  thefe  nerves  44  run  together,  and  are  united  at  their  origin  ;”  and 
alfo,  44  that  the  optic  nerves  have  a  fimilar  union  at  their  origin  ;”  befide  that 
other  union,  44  about  the  middle  of  their  defcent  ;”  fo  that  you  muft  imme¬ 
diately  underftand  thefe  unions  in  the  origin,  not  to  have  been  defcrib’d  from 
the  fight,  but  ingenioufly  devis’d  :  and,  indeed,  when  he  was  fpeaking  above 
of  the  optic  nerves  (s),  he  affirm’d,  in  general,  44  that  all  the  pairs  of  thefe 
44  nerves  were  united  at  their  origin  ;”  and  when  he  was  fpeaking  of  the 
acouftic  nerves,  of  which  the  queftion  is  at  prefent,  he  affirm’d  (/),  44  that 
44  they  arife  from  the  anterior  ventricle.” 

But  if  I  had  compar’d  thefe  words  of  Piccolhominus,  in  which  I  faid  he 
44  feem’d  to  have  fhadow’d  out”  what  Willis  afterwards  ffiew’d,  with  thole 
things  which  he  had  written  (u)  on  the  origin  of  other  nerves  alfo,  and  had 
delineated  in  the  figure  join’d  thereto ;  I  Ihould  have  faid,  that  he  feem’d  to 
have  done  it  indeed,  but  had  not  really  done  it. 

Finally,  as  to  what  we  read  in  the  feventh  obfervation,  of  an  acutenefs  of 
hearing,  proceeding  from  the  auditory  nerve  being  threefold,  on  each  fide; 
1  Ihould  more  readily  believe  it,  if  either  fome  very  fkilful  anatomift  was 
nam’d,  who  had  feen  it,  or  I  myfelf  (x)  had  not  obftrv’d,  that  each  of  the 
portions  of  the  fame  nerve  were  frequently  diflolv’d  into  fibres,  by  the  very 
touch,  or  by  a  flight  motion  :  and  the  mollis  fometimes  44  very  eafilv  into 
44  two  or  three  thicker  nerves,”  while  the  brain  is  lifted  up,  and  theilr^por- 
tions  cut  through. 

15.  Although  I  have,  hitherto,  mention’d  many  caufes  of  injuries  in  the 
organ  of  hearing;  yet  take  care  how  you  fuppofe  that  I  have  touch’d  upon 
the  greater  part  of  them.  For  the  44  organ  of  hearing  is,”  as  Boerhaave 
excellently  fays  (y),  44  the  moft  compounded  among  all  the  organs  of  fenfe";’* 
for  which  reafon,  44  there  are  a  greater  number  of  parts  in  it,  than  in  any 
other ;  and  thefe  parts  may  be  injur’d,  and  hurt,  in  the  moft  different 

(0)  Adverf.  An  at.  6.  Anim.  27. 

:(p)  Ad  litt.  h.  &  i. 

(y)  De  nervis  Optic.  Epift.  1. 

(r)  Anat.  tot.  corp.  hum.  in  Anat.  Aut, 

(/)  in  Anat.  nerv.  Optic, 


(/)  in  Anat.  nervor.  quinti  Par. 
(a)  Anat.  Praeled.  1.  5.  Led.  5. 
(*)  Epift.  Anat.  12.  n.  28. 

(y)  Praied.  in  Inftit.  §  563. 


«< 


ways ; 


J» 


Letter  XIV.  Article  1  327 

“ways fo  that,  as  he  affirms  in  another  place  (z),  deafnefs  u  is  one  diforder, 
“  but  appears  in  a  thoufand  fhapes,”  which  the  great  number  of  caufes  that  he 
(a)  and  others  produce,  in  the  lift  of  thofe  that  injure  the  faculty  of  hearing, 
fufficiently  proves..  And  it  is  not  to  be  doubted,  but  this  number  may  be 
every  day  increas’d,  as  for  inftance,  when  innumerable  membranes,  drawn 
from  all  fides,  and  interfering  each  other  mutually,  occupy  the  whole  cavity 
of  the  tympanum-,  as  I  found  in'  that  ear  (£),  in  regard  to  which,  marks 
were  not  wanting,  that  the  man  had  not  heard  at  all,  or  at  leaft,  very  little 
and  in  like  manner,  when  any  mufcle  out  of  thofe,  which  ferve  to  the  motion 
of.  the  little  bones,  in  the  tympanum,  is  immoveable,  and  contracted,  as  I 
found  in  another  man  (c),  who  when  he  was  alive,  if  any  one  could  have  di¬ 
vin’d,  would  not,  I  believe,  have  been  interrogated  to  no  purpofe  at  all, 
concerning  the  certain, diforders  of  that  ear.  But  it  is  not  at  all  to  be  won¬ 
der’d  at,  that  among  fo  many  other  diforders,  common  to  all  mufcles,  which 
are  mention’d  by  a  few,  whom  I  have  before  commended,  Boerhaave  necef- 
farily  omitted  fome,  and  after  the  diforders  enumerated  by  him,  faid  that 
“  a  great  number”  ftill  remain’d.  You  will  alfo  fee,  that  many,  and  vari¬ 
ous,  caufes  of  deafnefs  are  confirm’d  in  other  writers,  by  examples  produc’d, 
the  greateft  part  of  which  are  either  the  fame,  or  of  the  fame  kind,  with 
thofe  I  have  mention’d  above.  But  I  could  wifh  that  they  had  had  oppor¬ 
tunity  of  examining,  by  means  of  that  fhrewd  judgment  which  they  are 
mafters  of,  all  thefe  examples,  and  enquiring,  whether  each  of  thefe  appear¬ 
ances  was  really  feen,  by  the  authors  whom  they  quote ;  and  if  they  were 
really  feen,  whether  they  were  really  the  caufes  of  deafnefs.  In  making  this 
enquiry,  they  would  have  obferv’d,  moreover,  that  fome  things  were  not 
fpoken  of  at  all,  in  fome  of  the  books  they  have  pointed  out,  or  not  fpoken 
of  in  the  manner  they  have  reprefented.  For  Valfalva,  to  fpeak  of  him 
alone,  for  example’s  lake,  did  not  deduce  deafnefs  from  the  injury  of  the 
mufcles  of  the  tube,  but  from  the  injury  of  the  falpingoftaphylini  mufcles 
he  deduc’d  “  a  heavinefs  of  hearing  5”  although  I  (which  relates  to  the  exa¬ 
mination  of  this  caufe)  did  not  even  find,  that  this  heavinefs  of  hearing  had 
been  in  him  (d)t  who  had  not  only  an  injury  of  thofe  mufcles,  but  had  alfo 
“  the  pallatum  molle  confum’d.” 

But  to  return  to  Boerhaave  j  he  excellently  well  judges  ( e)y  that  the  caufe 
of  deafnefs  is  often  from  the  lues  venerea,  by  bringing  on  a  concretion  of  the 
Euftachian  tube,  which  frequently  is  the  confequence  of  a  cicatrix,  that  re¬ 
mains  after  eroding  ulcers  of  the  fauces.  But  to  the  “  paralytic  diforders,” 
which  he  points  out  (/),  of  the  fmall  membranes,  or  nerves,  of  the  “  vefti- 
bulum,  labyrinth,  and  cochlea, ’’(inftead  of  which  this  expreffion  is  elfewhere 
(g)  made  ufe  of,  by  a  typographical  error,  “  the  fpiral  cavities  of  the  tym- 
“  panum”)  to  thefe  diforders,  I  fay,  or  to  diforders  of  that  kind,  may  be  re- 
ferr’d,  I  believe,  that  deafnefs,  with  which  an  old,  and  infirm  dog  had  been 
troubl’d,  for  the  fpace  of  three  years  together,  which  was  at  length  remov’d 


(z)  Ad  §  698.  850.  &  feqq, 

(а)  Epilt.  Anat.  5.  n.  26. 

(б)  pp.  Anat.  6,  n.  22. 

(<r)  Ep.  An.  7.  n.  15, 


(d)  Epift.  Anat.  9.  n.  9.  10. 
\e)  Prasled.  cit.  ad  §  852. 

(f) ,  ad  §  850. 

(g)  ad  §  563. 


7 


328  Book  L  Of  Difeafes  of  the  Head. 

by  the  transfufion  of  blood,  as  his  debility  was  at  the  fame  time  (b).  Thus 
far  of  the  dil'orders  of  the  ears. 

16.  Of  the  affections  of  the  nofe  in  the  next  and  twentieth  feCtion  of  theSe- 
pulchretum,  the  firft  is,  “  the  lofs  or  privation  of  the  fenfe  of  fmelling  :”  under 
which  head  fix  obfervations  are  produc’d:  although  in  the  third  and  fixth, 
which  feem  to  be  one  and  the  fame,  no  mention  is  made  of  this  afredtion ; 
nor  yet  in  the  foldier,  who  is  fpoken  of  in  the  fifth.  And  if  you  fhould, 
perhaps,  be  willing  to  compare  the  third  obfervation  with  its  original  author, 
you  will  not  find  any  more  of  it  there ;  but  you  mult  look  for  it  in  the  Dif- 
fertatio  Anatomica  of  Rolfinc,  book  the  fecond,  chapter  the  nineteenth,  not 
the  twentieth  ;  as  you  muft  alfo  look  for  the  fecond  in  the  book  of  Schneider 
De  ojfe  cribriformi,  not  page  one  hundred  and  eighteen,  but  five  hundred  and 
eighteen.  However,  if  thole  things  were  to  be  taken  for  granted,  without 
any  hefitation,  which  are  advanc’d  concerning  the  defedt  of  the  olfadtory 
nerves,  in  thofe  who  fuck  or  chew  tobacco,  upon  which  fubjedt  Schneider 
doubts,  in  page  five  hundred  and  three,'  it  would  be  natural  to  fuppofe,  that 
the  fenfe  of  fmelling  was  alfo  wanting:  which  fenfe,  I  firmly  believe,  was 
not  equally  ftrong  in  both  noftrils,  in  an  aflhmatic  perfon  whom  I  difiedted. 
For  he  had  the  procefs  of  the  os  ethmoides,  which  is  call’d  crifla  galli,  fo 
obliquely  fituated,  and  at  the  fame  time  fo  form’d,  that  it  render’d  the  feat 
of  the  little  foramina,  through  which  the  fibres  of  the  olfadtory  nerve  pafs 
into  the  nofe,  fo  much  the  narrower  on  one  fide,  as  it  was  broader  in  the 
other  ;  for  which  realbn,  there  was  a  lefs  number  of  thefe  kind  of  fmall  fo¬ 
ramina  on  one  fide,  than  on  the  other.  But  this  unequal  diflribution  of  the 
nervous  power  of  fmelling,  is  a  more  rare  caufe  •,  and  that  is  more  frequent, 
as  I  formerly  obferv’d  alfo  (z),  when  the  feptum  nafi  is  bent  very  confiderably 
to  one  fide,  in  fome  perfons ;  fo  that  it  prevents  the  odoriferous  particles  from 
penetrating  fo  high,  or  extending  fo  far,  on  the  fide  to  which  it  inclines.  And 
as  this  circumftance  does  not  rarely  occur,  in  the  difledtion  of  the  nofe  ;  let 
furgeons  take  care,  left  in  examining  into,  or  curing,  the  hidden  diforders  of 
the  nofe,  they  alfo  believe  that  to  be  always  from  the  prefent  dileafe,  which 
is  often  owing  to  another  caufe,  or,  perhaps,  is  fo  from  nature  itfelf;  and,  in 
like  manner,  let  them  not  always  expedt  to  find  an  equal  quantity  of  fpace 
in  one  cavity  of  the  nofe,  as  in  the  other ;  nor  be  deceiv’d  by  thofe,  who, 
not  having  attended  to  this  variety,  abfolutely  fay,  “  that  the  nofe  is  divided 
“  into  two  large  equal  cavities  by  a  feptum  lying  between.” 

Oppofite  to  this  is  another  error  •,  I  mean,  the  error  of  thofe  who  fay,  that 
the  feptum  “  is  always  inclin’d  to  one  fide  or  the  other,  except  in  children.” 
As  I  have  been  very  much  vers’d  in  this  part  of  anatomy,  1  have  happen’d 
to  fee  many  fepta  more  or  lefs  curv’d  ;  but  I  have  alfo  feen  many  without 
any  curvature,  or  inclination,  and  even  in  the  bodies  of  adults  :  fo  that, 
though  I  do  not  deny,  but  the  increafe  of  the  feptum  itfelf  being  much  falter 
than  that  of  all  the  other  bones  of  the  upper  jaw,  may  be  one  among  the 
caules  of  this  mal-conformation,  by  which  it  is  of  necelfity  curv’d  j  yet  that 
this  happens  in  all,  neither  reafon,  nor  obfervations,  fuffer  me  to  believe. 

1 

{f)  Aft.  Philof.  Soc.  R.  in  Angl.  a.  1668.  (/)  Adverf.  Anat.  6.  in  calce  Explic.  tab. 2. 

m,  Decembr.  n.  z. 


And 


Letter  XIV.  Article  17.  329 

And  I  find  alfo,  that  the  celebrated  Leipfic  profefior,  Quelmalzius  (£),  did 
not  believe  it  more  than  1  ;  fince,  when  he  was  recounting  fo  many  other 
caufes  of  thefe  incurvations,  which  he  had  conjectur’d,  or  obferv’d,  he  did 
not  fo  much  as  mention  a  fingle  word  of  this.  You  will  not  repent  of  your 
reading  them,  nor  yet  the  detriments,  troubles,  and  impediments,  which,  he 
thinks,  have  their  origin  from  this  conformation.  Many  of  thefe  caufes  I 
acknowledge,  as  well  as  he  •,  and  as  to  the  confequences  of  the  curvac'on,  I 
not  only  believe  that  they  may  happen,  but  that  even  other  diforders,  whether 
of  the  head  or  eye,  or  even  of  the  lachrymal  pafiages,  which  I  fee  are  pro¬ 
duc’d  by  others,  may  alfo  happen  therefrom,  provided  the  incurvation  of 
the  feptum  is  very  confiderable  :  and  I  moreover  believe,  that  from  thefe 
confequences,  without  any  apparent  caufe,  very  long  and  very  obflinately 
teazing  the  patient,  furgeons  may  be  at  length  induc’d  to  conjedure,  and 
enquire  into,  the  curvation  of  the  feptum,  in  a  patient  whom  they  have  un¬ 
dertaken  to  cure.  For  their  fakes,  1  fhould  believe  alfo,  it  ought  not  to  be 
entirely  omitted,  that  fometimes  this  variety  may  happen,  which  I  lately  ob¬ 
ferv’d,  while  I  was  demonflrating  the  interiors  of  the  nofe  of  a  certain  old 
woman,  to  my  auditors.  The  feptum  itfelf  was  inclin’d  neither  to  one  fide, 
nor  the  other:  but  below  the  middle  of  its  perpendicular  diameter,  fomevvhac 
nearer  to  the  poflerior  than  to  the  anterior  part,  a  fmall  portion  of  it  was 
hollow’d,  on  one  furface,  and  on  the  other  convex ;  and  that  fo  much  the 
more,  becaufe  in  this  part  a  kind  of  bony  ridge,  running  obliquely,  rais’d 
the  furface  of  the  feptum,  io  that  it  almofl  became  contiguous  to  the  os  tur¬ 
binatum,  that  was  oppofite  to  it.  This  was  a  fmall  portion,  as  I  have  faid  ; 
yet  not  k  dy  to  give,  for  that  reaton,  but  little  trouble  to  the  furgeons. 
The  anatomist,  certainly,  leads  them  into  danger  of  errors  and  miftakes,  who 
defcribes  every  thing  as  being  perpetual,  and  conflant,  in  thole  parts  that 
are  lefs  expos’d  to  the  eye  •,  and  he,  therefore,  is  more  ufeful,  who  fhews 
what  things  may  very  frequently,  or  fometimes,  vary. 

i  7.  But  now,  omitting  thole  queflions,  which  do  not  much  relate  to  our 
prefent  purpofe,  although  they  are  propos’d  in  the  feventh  obfervation,  and 
the  fcholium  added  thereto,  in  the  Sepulchretum,  whether  the  membrane  of 
the  frontal  finufifes  ferves  to  promote  the  fenle  of  fuelling,  and  whether 
odours  are  fometimes  inherent  therein  for  a  confiderable  length  of  time,  as 
in  that  example  which  you  read  in  the  book  of  Schneider,  already  com¬ 
mended,  not  in  page  one  hundred  and  twelve,  but  one  hundred  and  twenty- 
two,  and  the  following  pages,  the  more  certainly  to  fhew  you,  that  the  fmell 
of  a  morbid  body,  yet  not  “  a  mortal  difeafe,”  as  you  will  read  elfewhere, 
had  been  inherent  in  the  noflrils  of  a  merchant,  for  one  and  twenty  days ; 
thefe,  therefore,  being  omitted,  as  to  what  relates  to  the  polypi  of  the  noflrils, 
that  are  mention’d  in  the  next  obfervations,  it  were  to  be  wifh’d,  that  in  the 
fcholia,  which  are  fubjoin’d  to  the  ninth  obfervation,  their  nature  and  origin 
were  not  referr’d  to  thofe  polypous  concretions,  which  are  frequently  feen  in 
the  finufies  of  the  dura  mater  ;  although  this  is  at  length  added,  whether 
the  one  and  the  other  “  are  of  the  fame  nature,  muff  be  the  fubjefl  of  a 


Vol.  I. 


(A)  Progr.  de  Narium,  earumq.  fepti  incurvatione, 

U  u 


<c  farther 


330  Book  I.  Of  Difeafes  of  the  Head. 

“  farther  difquifition.”  But  the  polypi  of  the  noftrils  themfelves,  have  not 
only  a  different  nature,  but  a  different  fituation  from  each  other.  A  different 
nature,  certainly,  as  you  fee  in  the  celebrated  Palfin  (/),  in  regard  to  that, 
which,  being  form’d  of  a  condenfation  of  humours,  diftending  the  internal 
membrane  of  the  noftrils,  to  the  bignefs  of  a  pidgeon’s  egg,  was  laid  open 
from  the  upper  to  the  lower  part,  and  by  thefe  means  cur’d :  and  in  regard 
n  thofe  mention’d  by  Ruyfch  (?/?),  which,  “  being  wrapp’d  up  in  a  mem- 
t;  brane,  confift  of  a  filmy  and  pituitous  fubftance  but  above  all,  in  refpedl 
to  that  which  I  have  obferv’d  in  the  Sepulchretum  ;  not,  indeed,  in  this  fedtion, 
but  in  that  which  is  entitled  “  De  catarrho  («)”,  and  is  deferib’d  to  be  like 
“  an  oblong  bladder,  full  of  ferum,  membranous,  and  often  hanging  far 
“  out  of  the  nofe,  and  to  have  been  emptied  now  and  then  by  a  ferum  di- 
“  ftilling  therefrom.”  For  thefe  have  a  far  different  nature,  if  they  are,  in¬ 
deed,  to  be  reckon’d  among  the  true  polypi,  from  thofe  which  are'made  up  of 
a  fubftance,  of  a  middle  nature,  betwixt  a  glandular  and  a  flefhy  body.  I 
made  ufe  of  thefe  words,  ‘  If  they  are,  indeed,  to  be  reckon’d  among  the 
number  of  true  polypi,’  for  this  realbn,  becaufe  that  cenfure  of  Mauchartus(<?), 
“  The  pituitary  membrane  of  the  noftrils  has  been  obferv’d,  fometimes,  to 
“  have  fall’n  down”  (that  is,  to  have  fuffer’d  a  prolapfus)  “  in  phlegmatic 
“  fubjeefts,  fo  as  to  have  impos’d  upon  the  ignorant  and  unfkilful  for  a  po- 
“  lypus,”  falls  upon  fome,  if  not  of  thofe  that  are  juft  now  deferib’d,  yet, 
at  leaft,  of  thofe  that  are  not  unlike  them.  And  it  is  manifeft,  that  they 
which  are  mention’d  by  Slevogtius  (y>),  have  not  entirely  the  fame  nature 
with  the  true  polypi,  inafmuch  as  “  they  have  been  feen  cartilaginous,  or, 
“  in  procefs  of  time,  bony,  or  approaching  to  the  nature  of  a  ftone,  and, 
“  if  it  can  deferve  credit,  even  of  a  woody  nature,  by  Job  Van  Meekren.” 
But  if  you  read  over  the  chapter  of  this  author  (q),  referr’d  to  by  Slevogtius, 
you  will  perceive,  that  the  polypus  was  not  woody,  but  that  the  polypous 
excrefcence  contain’d  “  a  bit  of  wood  in  the  middle,”  thruft  privily  by  the 
patient,  who  was  a  boy  of  three  years  old,  into  the  noftrils,  which  had  been 
the  caufe  of  the  excrefcence,  and  of  the  fuppuration.  So  alfo,  in  regard  to 
that  polypus,  which  the  ancient  author  of  the  fecond  book  De  Morbis  (r), 
amongft  others,  thus  deferib’d  :  “  It  feems,  indeed,  to  be  flefti ;  but,  if 
“  you  touch  it,  it  gives  forth  a  found,  like  a  ftone  although  Salius 
thinks  (j),  that  it  was  a  cancerous  polypus ;  will  you  believe  that  it  was  a 
cancerous  polypus,  as  Slevogtius  feems  to  have  {hewn,  which  only  approach’d 
to  the  nature  of  a  ftone  ;  or  rather  a  polypous  excrefcence,  which  contain’d 
a  hard  calculus,  or  calculi,  by  embracing  them  loofely  ?  For  that  calculi  have 
been  difeharg’d  from  the  noftrils,  “  of  the  figure  and  bignefs  of  dates,” 
Thomas  Bartholin  has  afterted  (/) ;  to  omit  others,  of  a  lefs  fize,  obferv’d 
by  other  authors,  as  by  Khernius  («),  and  by  Riedlinus  (x)  •,  the  laft  of  which. 


(/)  Anat.  du  corps  hum.  p.  2.  tr.  4.  ch.  14. 
(m)  Obf.  Anat.  Chir.  6. 

(«)  L.  1.  f.  17.  append.  1.  ad  obf.  10. 

(o)  Diftert.  de  Hernia  incarcer.  c.  2. 

(/>)  Difp.  de  Polypis  capitis,  §  29. 

(y)  Obf.  Med.  Chir.  c.  14; 


(?)  N.  34.  apud  Marinell. 

(s)  Comment,  in  hunc  locum  qui  ipfi  eft 
text.  68. 

(/)  Cent.  i.  Hift.  Anat.  33. 

(a)  Eph.  N.  C.  Dec.  3.  a.  5.  &  6.  obf.  46. 
(*)  Dec.  ead.  a.  9,  &  10.  obf.  145. 


a  furgeon. 


Letter  XIV.  Article  17.  331 

a  furgeon,  having  introduc’d  into  the  noftrils  “  an  inftrument,  which  (truck 
“  againft  Tome  hard  body,”  laid  hold  of  with  the  forceps,  and  continu’d  to 
pull  at  them  fo  long,  till  he  extracted  them. 

Laft  of  all,  if  a  polypus  is  not  only  faid  to  have  been,  in  fome  meafure, 
cartilaginous,  but,  in  procefsof  time,  bony;  for  in  our  chevalier  Marchetti (y), 
and  others,  1  have  read,  that  polypi,  fometimes,  “  grow  callous,  almoft  to 
“  the  hardnefs  of  a  bone  ;  and  I  know,  that  when  Meekren  (z)  was  endea¬ 
vouring  to  extradt  a  polypus,  of  a  cartilaginous  hardnefs,  “  his  forceps  were 
“  broken,  although  they  were  otherwil'e  very  (trong  if,  therefore,  not 
what  approaches  in  hardnefs  to  a  bone,  but  what  really  is  a  bone,  is  to  be  call’d 
a  bony  polypus,  as  that  which  is  fpoken  of  by  Slevogtius  (#),  I  (hould  rather 
chufe,  with  him,  to  confider  it  as  an  excrefcence  of  the  bones  of  the  no fe  (£), 
than  as  a  polypus. 

And  it  is  very  evident,  that  different  polypi  have  different  fituations,  in 
refpedt  of  their  origins.  For  Ruyfch  (c)  faw  them  more  than  once  inherent 
in  the  maxillary  finus,  from  which  they  fometimes  proceeded,  through  the 
excretory  foramen  of  this  cavity,  into  the  nofe;  as  a  furgeon,  whom  Palfin 
mentions,  was  witnefs  to(^) :  and  this  author  very  juftly  imagines,  that  they 
may  be  produc’d  from  other  finuffes  of  the  nofe  alfo,  although  it  feems  much 
more  eaiy  to  me,  for  them  to  proceed  from  that  in  which  I  faid  they  have 
been  found,  I  mean,  the  maxillary,  for  this  reafon  •,  becaufe  the  exit  of  the 
mucus,  from  that  finus,  being  more  difficult,  on  account  of  the  fituation  of 
the  finus  itfelf,  and  its  excretory  foramen,  ftagnation  may  give  fuch  an  acri¬ 
mony  to  the  mucus,  particularly  in  fome  bodies,  that  it  may  erode  the  mem¬ 
brane  with  which  the  finus  is  internally  invefted,  and  from  thence  give  oc- 
cafion  to  the  beginnings  of  a  polypous  excrefcence.  Boerhaave  (£),  however, 
thought,  that  polypi^began  from  the  pituitary  finuffes,  in  a  far  different  manner; 
the  mucus  being,  as  it  were,  infpiffated,  fo  that  it  could  not  get  out,  “  at 
“  length  the  whole  finus  is  fill’d,  and  the  membrane  of  the  finus,  drawn  out 
“  through  the  orifice  into  a  pedicle,  hangs  forward  into  the  cavity  of  the 
“  noftrils.”  Which  manner  I  ffiouid  be  much  more  likely  to  underftand, 
if  it  were  faid,  that  the  mucus  had  intruded  itfelf,  and  been  colledted,  be¬ 
twixt  the  bony  parietes  of  the  finus,  and  that  membrane,  which  was  in  fome 
place  or  other  deftroy’d  by  erofion ;  that  fo  at  length,  by  the  preffure  and 
urging  from  behind,  the  membrane  might  be  forc’d  out  from  the  orifice. 

But  the  origins  of  polypi  are  much  larger,  and  much  more  frequent,  on 
the  outfide  of  the  finuffes,  where  the  pituitary  membrane  is  thicker,  and 
more  manifeftly  gland ulous.  For  that  they  arife  from  this  membrane,  you 
will  even  fufficiently  conceive  from  hence,  that  they  are  produc’d  therefrom, 
even  when  it  is  extended  on  the  outfide  of  the  noftrils.  Thus,  in  the  Acta 
Helvetica  (/),  you  will  read,  that  a  long  and  thick  polypus  proceeded,  not 
from  the  noftrils,  but  from  the  fauces.  Thus,  in  the  Commercium  Littera¬ 
rium  (£),  you  read,  that  a  polypus,  which  had  fuffocated  a  man,  was  found 


(y)  Obf.  Med.  Chir.  27. 

(z)  Obi.  cit.  c.  12. 

(«)  Dilp.  cit.  §  j. 

(£)  Ibid.  §  13.  (c)  Obf.  cit.  77. 


(A)  Tr.  cit.  ch.  15. 

(i?)  Prseleft.  cit.  ad  §.  498. 

(/)  Vol.  1. 

(g)  A'  173 *•  fpecim.  45.  n.  4. 


U  U  2 


.adhering 


332  Book  I.  Of  Difeafes  of  the  Head. 

adhering,  not  only  to  the  bone  of  the  vomer,  but  alio  to  the  neighb’ring  ad¬ 
ditamentum  of  the  os  occipitis,  that  is,  to  the  roof  of  the  pharynx.  But 
from  the  fame  membrane,  which  invefts  the  parts  juft  now  fpoken  of,  that 
polypi  much  more  frequently  proceed,  where  it  covers  over  the  internal  pa¬ 
rietes  of  the  noftrils,  or  the  protuberances  thereof,  I  faid  juft  now,  was  very 
well  known  ;  yet  I  will  fubjoin  fome  oblervations  thereupon,  not  fo  much  to 
confirm  this  opinion,  as  that  you  may  know  what  Valfalva  and  I  have  feen 
relating  thereto. 

i  8.  A  certain  man  had  polypi  growing  out  from  each  noftril.  The  cavity 
of  the  right  noftril  being  laid  quite  open  after  death,  two  polypi  were  found, 
one  hanging  from  each  of  the  fpongy,  or  turbinated  bones.  Their  origin 
was  from  the  glandular  membrane  of  thefe  bones,  fo  evidently,  that  the 
nearer  they  came  to  this  membrane,  fo  much  the  more  did  they  fhew  a  glan¬ 
dular  nature  ;  and  the  more  they  receded  therefrom,  the  more  did  they  de¬ 
generate  from  a  glandular  nature.  Nor  were  the  appearances  in  the  left  ca¬ 
vity  of  the  noftrils  much  unlike  to  thefe. 

19.  As  I  took  that  obfervation  from  the  papers  of  Valfalva,  fo  I  had  this 
from  his  own  mouth,  that  as  he  could  not  be  certain  by  any  other  means, 
that  the  whole  of  a  polypus  was  entirely  cut  out,  by  his  knife,  he  had  not 
hefitated  to  take  away,  at  the  fame  time,  a  lamella  of  the  part  to  which  it 
adher’d,  left  it  fhould  fhoot  out  again ;  for  that  nature  had  eaftly  cur’d  ir, 
and  the  operation  had  fucceeded  very  well.  I  am  not  ignorant,  that  when 
a  polypus  was  cut  out  in  the  prefence  of  Ruyfch(^),  and  44  a  cartilaginous 
44  portion  follow’d,  together  with  the  polypus,”  this  did  not  feem  to  him 
44  laudable,  but  that  it  was  better  to  extract  the  polypus,  with  a  portion  of 
44  the  interior  tegument.”  Neverthelefs,  what  Valfalva  had  feen,  and  what 
had  fucceeded  with  him,  I  did  not  think  proper  to  conceal.  But  it  is  to  be 
wifh’d,  that  it  were  rather  poflible  to  follow  the  method  which  was  practis’d 

,  by  the  celebrated  Heifter  (2),  with  good  iuccefs,  on  a  noble  woman  ;  or  when 
that  is  not  poflible,  at  leaft  to  beware  of  the  fatal  examples  of  the  lacerated 
trunk  of  the  nafal  artery,  the  principal  feat  of  which  Heifter  has,  for  that 
reafon,  pointed  out  (k) :  and  the  very  excellent  Haller  (/)  has  defcrib’d  this 
artery,  as  he  has  done  the  other  arteries,  with  the  greateft  preci fion  and  ex- 
abfnefs. 

20.  But  I,  in  order  to  return  to  the  promis’d  obfervations,  once  found 
the  beginnings  of  polypi,  and  thole  in  the  internal  noftrils  of  a  certain  infane 
man,  of  whole  brain  I  have  written  to  you  in  another  place  (m).  You  al¬ 
ready  know,  that  at  the  lower  border  of  the  turbinated  bones,  fome  pecu¬ 
liar  and  red  thicknefles  of  the  membrane  of  the  noftrils,  are  found  in  pretty 
great  number,  which  I  have  remark’d  in  a  former  work  (»),  and  consider’d 
as  glandular  parts.  But  in  this  infane  man  I  law  that  thefe  thicknefles,  where 
they  lay  on  the  lower  part  of  the  inferior  turbinated  bones,  had  grown  out 
into  very  lax  caruncles,  which  hung  one  from  each  of  thofe  bones.  And 

( b )  Thef.  Anat.  3.  n.  80.  (/)  Ad  Prceleft.  Boerhaav.  in  Inflit.  §.  494. 

(2)  In  flit.  Chir.  P.  2.  S.  2.  c.  71.  n.  7.  not.  e. 

(k)  Dlflsrt.  de  Anat.  maj.  in  Chir.  neceff.  (m)  Epifl.  8.  n.  11. 
c.  1.  n.  2.  («)  Adverf.  Anat.  6.  Anim.  88.  in  fin. 


upon 


Letter  XIV.  Article  21.  333 

upon  cutting  into  thefe  excrefcences,  in  any  part  whatever,  I  found  them  to 
be  fo  conftrudted,  that  between  a  white  net- work,  or,  if  you  pleafe,  betwixt 
white  cancelli,  red  areas  feem'd  to  be  contain’d  :  which  appearance  confirm’d 
the  glandular  nature  of  thefe  thicknefies,  and  at  the  fame  time  fhew’d  the  origin 
of  thefe  polypous  caruncles  to  be  glandular.  And  to  this  perhaps  mull  be 
referr’d,  what  1  obferv’d  in  two  other  men,  but  in  different  fituations,  and 
with  different  appearances.  For  in  one  of  them,  at  the  upper  part  of  the 
nofe,  three  or  four  flattiffi  verrucae,  bordering  one  upon  another,  occurr’d, 
the  fubftance  of  which,  as  far  as  1  could  judge  from  their  deprefs’d  fituation, 
feem’d  fungous.  Thefe  were,  if  I  remember  rightly,  in  one  cavity  of  the  nofe 
near  to  the  foraminulous  lamina  of  the  os  ethmoides,  and  in  the  feptum  itfelf. 
But  in  the  other  man,  who  was  the  dropfical  perfon,  in  whom  I  obferv’d 
that  the  right  lachrymal  du6t  had  coalefc’d  (0),  as  I  fearch’d  for  the  orifice 
thereof  in  vain ;  I  found  that  the  furface  of  the  inferior  turbinated  bone, 
which  us’d  to  lie  oppofite  to  the  orifice  of  this  lachrymal  du<5t,  was  almoft 
univerfally,  and  efpecially  towards  the  inferior  part,  befet  very  thickly  with 
tubercles,  of  the  form  and  magnitude  of  the  grains  of  millet-feed,  except 
that  fome  of  them  were  a  little  larger,  refembling  glands  by  their  cineritious 
colour,  and  by  the  humour,  which,  when  preis’d,  they  emitted  in  large 
quantity,  1  his  humour  was  thin  and  inodorous,  like  water  :  and  the  tuber¬ 
cles,  when  differed,  although  they  decreas’d  in  bulk,  yet  were  by  no  means 
obliterated  •,  but  in  great  meafure  preferv’d  their  own  fubftance,  which  was 
of  the  fame  colour  with,  and  bore  great  refemblance  to,  that  of  which  the 
pituitary  membrane  confifted.  Wherefore,  although  the  orifices  no  where 
appear’d  confpicuous  •,  yet  I  did  not  doubt,  but  thefe  tubercles  were  no  more 
than  encreas’d  glands,  fome  of  which,  as  they  were  naturally  bigger  than 
others,  might,  by  being  diffended  from  the  encreafe  of  their  contain’d 
humour,  eafily  degenerate  into  caruncles.  But  in  neither  of  thefe  men, 
although  I  examin’d  all  the  other  parts  of  the  interior  nofe,  accurately,  could 
I  find  tubercles,  or  verrucas,  in  any  place,  except  where  I  have  mention’d. 

21.  Before  I  quit  the  laft  fcholium  of  the  ninth  obfervation,  where  a  veil'd 
is  faid  to  have  been  found  out  by  Steno,  from  which  even  the  fluxes  of  the 
nofe  are  accounted  for  •,  I  could  wifh  that  others  could  find  it  in  the  human 
fubjefl,  of  a  bignefs  equal  to  that  of  which  he  found  it  in  fheep  (p)  ;  that  is 
to  fay,  “  capable  of  admitting  a  probe.”  Nor  indeed  do  I  fay  it,  for  this 
reafon  only,  becaufe,  by  that  means,  the  obfervation  of  Salmuthus  might 
be  more  fully  explain’d,  who  faw  the  noftrils  “  flow  with  a  thin  pituita,  for 
“  the  fpace  of  three  whole  days,  in  the  fame  manner,  as  in  other  perfons, 
“  they  flow  with  blood,  but  at  intervals,”  as  you  will  read  in  the  Sepulchre- 
turn  itfelf  (q).  But  I  fay  it  chiefly  on  account  of  a  much  more  rare  difcharge, 
which  happen’d  in  a  very  fine  Venetian  woman,  for  whom  I  was  confulted 
in  the  year  1745,  about  the  latter  end  of  June.  For  from  the  time  that  fhe 
had  been  troubl’d  in  the  winter  before,  with  a  coryza,  and  a  frequent  acrid 
jftiilicidium  from  the  left  noftril  only,  fhe  had  continu’d  ftill  to  be  harrafs’d 
with  the  fame  difcharge,  though  it  was  now  many  months  after  all  other 
fymptoms  of  difeafe  had  been  in  a  fhort  time  remov’d  ;  and  even  then  the 

F)  Epift.  13.  n.  27.  (/)  De  Glandul.  n.  8,  (j)  Se&.  17.  Append.  2.  ad  obf.  10, 

flux 


334  Book  I.  Of  Difeafes  of  the  Head. 

flux  {till  continu’d,  always  from  the  fame  noftril,  and  nearly  in  the  fame 
manner  as  at  firft,  except  that  the  marks  of  acrimony  having  left  her,  at  the 
fame  time  with  the  coryza,  afterwards  drops,  like  the  molt  pure  fountain 
water,  fell  from  the  noftrils  fo  fad  one  after  another,  that  they  amounted  to 
the  quantity  of  half  an  ounce  every  hour,  when  the  patient  did  not  lie  down  $ 
for  when  fhe  lay  down,  the  flux  was  diverted  to  the  polterior  foramina  of 
the  noftrils,  and  difcharg’d  by  them  into  the  fauces,  in  much  lefs  quantity, 
as  far  as  we  could  conjecture.  And  now  the  habit  of  the  patient,  which  was 
naturally  full,  began  to  be  extenuated,  the  remedies  which  had  been  applied, 
both  internally  and  externally,  in  order  to  diminifh  this  ftillicidium,  by  the 
molt  excellent  phyficians,  having  had  not  the  leaft  eftedt. 

However,  what  could  be  much  more  eafily  underftood,  by  means  of  one 
larger  canal,  whofe  orifice  was  relax’d,  was  explain’d  by  means  of  a  great 
number  of  1  mailer  vefiels,  whofe  mouths  were  fuppos’d  to  be  preternaturally 
open’d,  and  to  difcharge  their  contain’d  fluids,  before,  by  a  proper  remora, 
fome  of  the  aqueous  particles  flew  off,  and  others  return’d  back  into  the 
blood;  and  fuch  medicines  were  firft  recommended,  as  by  inviting  the  hu¬ 
mour  to  other  parts,  reliev’d  the  membrane  of  the  noftrils  ;  and  after  that 
fuch  regimens,  as  by  degrees  reftor’d  the  power  of  retaining  this  fluid,  both 
internally  and  externally,  efpecially  by  proper  fumigations  cautioufly  applied  j 
this  method  of  cure  being  concluded  upon,  and  drawn  by  analogy,  from 
thole  methods  which  are  of  the  moft  advantage  againft  other  fimilar  difor- 
ders  ;  as  for  inflance,  by  comparing  the  fluor  uterinus,  which  is  the  moft  fre¬ 
quent,  with  this,  which  is  very  rare. 

I  afterwards  heard  that  the  difcharge  diminifh’d  fo  gradually,  as  to  conti¬ 
nue  many  months,  till  at  length,  within  about  the  fpace  of  a  year,  it  was 
entirely  flopp’d.  A  much  more  confidepable  difcharge  than  this  you  will 
read  of  in  Bidloo  (r),  infomuch,  that  “  in  the  {pace  of  twenty-five  hours, 
“  about  twenty  ounces  of  the  moft  clear  water  diftill’d  from  the  right  noftril.’* 
But  this  happen’d  from  a  very  violent  and  external  caufe,  that  is,  an  injury 
of  the  fame  noftril,  from  whence  an  ulcer,  although  very  flight,  had  occu¬ 
pied  the  whole  internal  furface  *,  and  as  the  humour  foon  became  thick,  and 
turbid,  the  tents  that  wTere  introduc’d  were  found,  when  drawn  out,  to  be 
cover’d  over  with  pus.  And  after  this,  medicines  being  applied  to  the  in¬ 
ternal  furfaces  by  means  of  thefe  tents,  or  thrown  in  by  a  fyringe,  the  flux 
was  foon  reftrain’d  thereby  :  neverthelefs  the  patient,  after  fo  many  vehement 
fymptcms  in  the  beginning,  and  in  the  courfe  of  the  difeafe,  died  within  fe- 
■'ven  or  eight  months. 

22.  Next  in  order  come  four,  or  rather  three,  obfervations  of  fanious  or 
foetid  matter,  being  difcharg’d  from  the  noftrils.  For  the  tenth  and  thir¬ 
teenth  are  fo  evidently  the  fame,  that  it  is  amazing  the  famenels  Ihould  never 
have  been  regarded,  when  only  two  obfervations  are  interpos’d.  But  that 
the  fomes  of  excretions  of  this  kind  exifted  within  the  cranium,  though  it 
might  formerly  be  believ’d,  cannot  be  believ’d  now  However,  although 
it  is  evidently  fhewn  in  the  eleventh  obfervation,  that  the  pus  which  was 
difcharg’d  from  the  noftrils  of  a  dying  man,  had  flow’d  thither  from  the 


6 


(r)  Dec.  2.  Exercit.  Anat.  Chir.  y. 


lungs  j 


Letter  XIV.  Article  22.  33  $ 

lungs ;  yet  it  is  not  certain,  by  the  twelfth  obfervation,  that  what  proceeded 
from  the  nofe  of  a  lethargic  boy,  had  defcended  thither  from  an  abfcefs  ot 
the  brain  ;  which  is  already  fufficiently  hinted  to  you  in  my  fixth  letter  alio  (j), 
where  I  had  before  my  eyes,  even  the  hiftory  of  this  very  boy,  which  is 
given  you  above  in  the  Sepulchretum  (/ ),  and  compar’d  it  with  that  of  an¬ 
other  boy. 

But  if  you  fhould  require  ftill  more  •,  you  may  in  the  fifth  letter  (u)  read 
over  again,  that  I  faw  no  figns  of  pus  within  the  cavity  of  the  cranium,  in 
that  body,  from  the  noftrils  of  which  the  purulent  matter  had  flow’d.  And 
you  will  fee  that  Palfin  ( x )  is  of  the  fame  opinion,  and  that  he,  moreover, 
deduces  excretions  of  that  kind  immediately  from  the  pituitary  finufles. 
And  from  the  fame  fource,  or  rather  from  the  other  recedes  of  the  nofe, 
you  will  perceive  that  Fernelius  deduc’d  them,  in  that  paffage,  which  is 
quoted  in  the  fifth  obfervation  of  this  fedtion  :  “  About  thefe  parts  fometimes 
“  abfcefles  happen,  without  any  fever,  and  with  very  little  pain,  from  which, 
“  when  ruptur’d,  I  have  obferv’d  a  perfedt  pus  to  flow  down  plentifully, 
“  through  the  noftrils,  juft  as  frequently  happens  from  fuppurated  ears,  and 
tc  that  without  any  inconvenience  to  health.”  For  who  can  believe,  that 
fuch  a  man  had  laid  thefe  things  concerning  abfcefles  relating  to  thole  parts, 
which  he  had  laft  mention’d  ;  I  mean,  “  the  anterior  ventricles  of  the  brain, 
“  and  thofe  nervous  branches  in  which  is  the  fenfe  of  fmelling?”  At  lealt 
he  did  not  fay,  in  thefe  parts,  but  “  about  thefe  parts.”  But  if  Palfin  (y) 
fays,  that  by  a  fuppuration  happening  in  the  pituitary  fin u fifes,  “  an  intolerable 
“  pain  is  brought  on,”  which  is  alfo  confirm’d  by  the  obfervation  of  Henr. 
Alb.  Nicolaus  (2),  efpecially  as  he  fays,  that  he  twice  found  an  abfcefs  in 
the  frontal  finufles-,  how  much  more  would  Fernelius  have  judg’d,  that  the 
fame  mu  ft  happen  from  an  abfcefs  in  the  meninges,  with  one  of  which  thefe 
branches  are  inverted  within  the  fkull,  and  upon  the  other  of  which  they 
lie  *,  for  by  thefe  branches  he  meant  alfo  the  fame  {a),  that  we  now  firft  call 
the  conjunction  of  the  nerves  :  and  to  fay  nothing  of  pain,  how  could  there 
be  no  fever  at  fuch  a  time  ?  no  inconvenience  to  health  ?  Certainly  thefe 
things  could  hardly  be  fuppos’d  of  abfcefles  which  happen  in  any  part  of 
the  nofe,  that  has  only  a  more  dull  fenfation. 

And  that  the  fanies  of  ozenas,  not  only  proceeds  from  other  parts  of  the 
nofe,  but  alfo  from  the  finufles  themfelves,  fometimes,  and  efpecially  from 
the  maxillary,  Drake  (J?)  has  fhewn ;  but,  if  I  remember  rightly,  from  the 
obfervations  of  Cowper,  which  have  laid  open  the  very  diforder  itfelf,  and 
the  method  of  diftingtiirtiing  it  from  others,  and  in  how  eafy  a  manner  medi¬ 
cines  may  be  introduc’d  into  thefe  very  finufles  themfelves,  not  without  great 
praife  to  anatomy,  from  whence  all  thefe  advantages  are  drawn.  For  if  the 
antient  furgeons,  as  you  have  it  in  Celfus  (r),  taught  that  the  nofe  fhould  be 
cut  open,  that  their  remedies  might  be  able  to  reach  to  the  feat  of  a  far  lefs 
conceal’d  ozena,  and  afterwards  be  few’d  up -,  anatomy  has  now  taught  a 

(fl  n.  5.  (/)  Seft.  3.  obf.  34. 

(»)  n.  19. 

(*)  tr.  cit.  fupra  ad  n,  17.  ch.  ic. 

(y)  Ibid. 


(z)  Dec.  Obf.  III.  Anat.  Obf.  10. 
(a)  Vid.  Phyfiolog.  1.  i.  c.  9. 

(/)  Anthropol.  book  2.  ch.  ic. 

(<)  De  Medic.  1.  7.  c.  11. 


much 


33  6  Book  I.  Of  Oifeafes  of  the  Head. 

much  mtore  expeditious  and  defirable  method,  to  come  at  the  moil:  conceal’d 
and  internal  of  all.  But  whether  Jo.  Henr.  Meibomius  found  out  the  fame 
method  of  cure  (which  I  now  read  for  the  firft  time  in  a  certain  program¬ 
ma  (d)  of  the  molt  learned  Gunzius,  while  I  was  reviling  this  letter),  and 
Henry  his  fon  put  into  practice,  let  others  judge.  For  i  obferve,  that  be- 
fides  the  exit  given  to  the  matter,  from  the  maxillary  linus,  by  the  fockets 
of  the  teeth,  that  have  been  extracted,  none  of  the  other  things,  which  are 
from  Cowper,  are  produc’d,  as  if  equally  known  to  the  Meibomii  :  and,  in¬ 
deed,  Gunzius  partly  confelles  it,  by  whom  you  will  alfo  not  unwillingly 
acknowledge,  that  many  things  are  added,  which  tend  to  make  the  cure 
more  compleat.  But  how  thele  things  that  have  been  laid  may  be  transferr’d 
to  the  frontal  fmufles,  you  will  of  yourfelf  underftand,  if  you  attend  to  the 
fituation  of  them,  and  the  trepanning  upon  them,  which  is  propos’d  by 
Palfin  (<?),  in  the  cafe  of  fuppu ration  that  happens  there  ;  which  is  a  circu al¬ 
liance  not  much  to  be  delir’d,  and  might  have  its  own  inconveniences  join’d 
with  it,  as  Palfin  himfelf,  a  little  before,  fhews  :  but  yet  far  greater  incon¬ 
veniences,  and  even  death  itfelf,  have  oftentimes  been  brought  on  by  an 
uncur’d  ozena,  and  a  caries  confequent  thereon.  But  where  an  ulcer  of 
the  nol'e  was  on  the  out  fide  of  the  finufles,  and  it  was  not  certain  to  what 
parts  it  extended  at  all,  and  how  far  it  extended,  I  remember  that  Valfalva, 
whatever  innocent  remedies  he  injedted,  injected  them  always  by  a  pipe,  the 
head  and  the  upper  part  of  the  fides  of  which  were  every-where  pierc’d 
through  with  foramina ;  fo  that  no  part  was  without  being  fprinkl’d.  He 
alfo,  when  the  feptum  nafi  was  corroded  by  an  ulcer,  and  began  to  fubfide, 
endeavour’d  at  once  by  internal  and  external  remedies,  that  the  ulcer  might 
be  Hopp’d  in  its  progrefs  and,  at  the  fame  time,  introduc’d  thin  tubuli  into 
the  nollrils,  of  luch  a  fize  and  form,  that  the  ate  nafi,  when  they  began  to 
collaple,  might  be  fupported  thereby,  as  far  as  it  was  pofiiblc,  and  recede 
lefs  from  their  natural  figure. 

23.  The  obfervations  that  follow,  relate  to  the  haemorrhage  of  the  noftrils. 
Some  of  them  have  reference  to  the  cure,  nor  are  taken  from  the  dead  body: 
and  others  were  made  upon  the  dead  body,  but  not  where  they  ought  to  have 
been  chiefly  made  ;  I  mean,  in  the  nofe.  Wherefore,  I  fliall  fubjoin  only  a 
very  few  things,  which  relate  to  each  of  thele  kinds,  beginning  with  the 
fecond.  That  a  difeafe  of  the  vifcera,  and  efpecially  of  the  liver  and  fpleen, 
is  join’d  with  frequent  and  large  haemorrhages  of  the  noftrils,  the  fourteenth 
and  fixteenth  obfervations  confirm  ;  befides  others,  which  you  may  add,  and 
efpecially  one  of  Maurice  Hoffman  (/).  Nor  is  it  to  be  wonder’d  at*,  for 
whether  thefe  diforders  precede  the  effufion  of  blood,  and  thus  pervert  its 
nature,  and  diftribution  through  the  body,  fo  that,  as  it  is  carried  with  more 
difficulty  through  the  belly,  it  is  carried  more  eauly,  and  confequently  more 
copioufly,  through  the  upper  parts,  and  at  the  fame  time,  on  account  of  its 
watry  or  acrid  difpofition,  very  eaiily  finds  or  makes  an  exit  for  itfelf  in  the 
nofe  *,  or  whether  thefe  diforders  fucceed  to  the  effiifions  of  blood,  many 
things  will  flow  together  plentifully  into  the  channel  of  the  circulation,  by 

(d)  Edito,  a.  1753.  in  quo  obf.  ad  ozsenam.  (f)  Eph.  N.  C.  Cent.  9,  &  10.  in  append.  J. 
Maxillat.  pert.  (?)  Ch.  15.  cit.  obf.  5. 

2  reafon 


Letter  XIV.  Article  24«  337 

reafon  of  the  refinance  being  diminilh’d,  which,  on  that  account,  do  not  re¬ 
pair  the  lofs  of  blood  that  has  been  made,  but  injure  what  remains,  and 
render  it  more  inert  and  thick,  and  fo  much  the  more  eafily  prone  to  ob- 
ftrudtion,  becaufe  good  juices  cannot  be  fecreted  except  from  good  blood, 
in  order  to  prepare  a  good  chyle.  Wherefore,  the  taint  of  thefe  vifcera  is 
fometimes  the  caufe,  and  lometimes  the  efiedf,  of  thefe  haemorrhages ;  and 
although  what  was  before  the  effect  may  become  the  caufe,  yet  it  is  never 
the  proximate,  but  the  remote  caufe. 

The  proximate  caufe  would,  in  fa6t,  be  that  erofion  of  the  veffels,  which 
Bofcus  fays,  in  the  fifteenth  obfervation,  “  he  had  obferv’d  in  the  diffedtion 
“  of  perfons  who  died  of  the  hasmorrage  from  the  noftrils,”  if  it  were  cer¬ 
tain,  that  he  fpoke  of  the  veffels  in  the  cavity  of  the  noftrils  :  for,  as  to  what 
he  feems  to  fay  of  the  beginning  of  the  venal  finus,  which  is  call’d  the  fu- 
periorof  the  falx,  that  beginning  is  certainly  not  extended  within  the  noftrils; 
fo  that  although  the  fame  caufe,  by  which  the  veffels  within  the  noftrils  are 
eroded,  might  frequently  have  been  the  caufe  of  erofion  alfo  in  this  finus, 
yet  it  is  impoffible,  that  the  blood  extravafated  from  thence  can  defcend,  from 
the  cavity  of  the  cranium,  into  the  cavity  of  the  noftrils,  in  a  well-confti- 
tuted  head  ;  as  is  evidently  demonftrated  from  Schneider,  not  only  in  the 
fcholium  fubjoin’d  to  that  obfervation,  but  chiefly  in  that  which  goes  imme¬ 
diately  before,  in  the  fecond  appendix,  in  oppofition  to  many  otherwife  great 
men,  who  have  deduc’d  the  nafal  haemorrhage  from  this  finus.  Who  thefe 
were,  you  will  know,  by  infpedling  the  book  itfelf ;  and  you  will  alfo  fee, 
that  many  things  are  not  faithfully  rgprefented,  even  among  the  words  of 
Schneider,  and  others  omitted,  which  the  reader  Would  not  have  fufpefled. 

24.  But  although  the  obfervation  of  Valfalva,  which  is  lpoken  of  even  at 
this  day,  in  Bologna,  with  praife,  was  not  made  on  the  bodies  of  dead  per¬ 
fons  ;  I  think  it  ought,  neverthelefs,  not  to  be  omitted  here,  fince  even  in 
the  Sepulchretum,  as  I  faid  before,  obfervations  are  produc’d,  which  relate 
only  to  the  methodus  medendi ,  as  the  firft  in  the  appendix  does. 

A  nobleman,  who,  in  order  to  ftrengthen  his  joints,  had  made  too  free 
ufe  of  the  mud  of  the  baths  near  Verona,  began  to  be  fubjedl  to  a  nafal 
haemorrhage,  which  return’d  fo  often,  that  every  week  he  loft  a  greater  or 
lefier  quantity  of  blood  ;  and  fometimes  the  haemorrhage  was  fo  large,  that 
it  left  behind  it  a  great  dejedtion  of  fpirits  and  ftrength,  and  a  weaknefs  of 
the  head.  For  the  fpace  of  four  years,  or  more,  things  were  in  this  ftate  ; 
and  although  he  refided,  during  thefe  years,  as  his  office  requir’d  him  to  do, 
(for  he  was  one  of  the  firft  minifters  to  a  certain  great  court)  in  many  of  the 
chief  cities  in  Europe,  where  he  had  not  only  the  advice  of  the  phyficians 
who  were  prefent,  but  had  alfo  the  opinion  of  others  by  letters,  yet  all  were 
in  vain.  At  length,  having  return’d  into  his  native  country,  he  fent  for 
Valfalva,  at  the  time  when  a  very  great  quantity  of  blood  was  flowing  from  his 
noftrils.  What  had  happen’d  to  this  nobleman  was  already  known  to  Val¬ 
falva,  inafmuch  as  he  was  in  the  number  of  thofe  phyficians  who  had  been 
confulted  by  letters.  But  it  feldom  happens,  that  phyficians,  by  reading 
written  cafes,  fent  from  patients,  conceive  juft  in  the  fame  manner  of  them, 
as  they  would  from  feeing  them  ;  and  thus  it  happen’d  in  the  prefent  cafe. 
For  Valfalva  having  obferv’d,  that  as  often  as  ever  the  patient  wip’d  his 

Vol.  I.  X  x  nofe, 


3  3  8  Book  I.  Of  Difeafes  of  the  Head. 

nofe,  or  touch’d  it  with  his  hand,  the  flux  of  blood,  which  had  before  re¬ 
mitted,  was  again  encreas’d  ;  and  having  call’d  to  mind,  that  he  had  gene¬ 
rally  leen,  in  difledtions,  the  blood-vefiels  extremely  turgid  about  that^part 
where  the  alae  nafi  are  join’d  with  the  bone,  about  a  finger’s  breadth,  more 
or  lefs,  from  the  bottom  of  the  noftrils  ;  he  began  to  fufpeft  that  the  blood 
then  flow’d  from  thofe  vefiels.  Wherefore,  introducing  his  finger,  he  prefs’d 
that  part,  and  the  blood  immediately  ceas’d  to  flow  ;  l'o  that  it  was  not  even 
difeharg’d  by  the  pofterior  noftrils  into  the  fauces.  And  by  this  eafy  kind 
of  remedy,  which  always  anfwer’d  afterwards,  the  patient,  who  had  learn’d 
to  make  ufe  of  it  himfelf,  at  length  got  quite  rid  of  the  returns  of  the  he¬ 
morrhage,  within  a  few  months  (g), 

25.  This  fuccefsful  method  of  treatment,  which  Valfalva  made  ufe  of,, 
fhews,  that  tents,  or  doftils  of  lint,  introduc’d  into  -the  noftrils,  in  order  to 
reftrain  the  hemorrhage,  may  fometimes  be  not  lb  much  of  advantage,  from 
the  virtue  of  the  aftringent  remedies  with  which  they  are  moiften’d,°as  from 
comprefiion  itfelf ;  and  that,  either  when  the  blood  ifiues  out  of  thofe  vefiels, 
which  I  fpeak  of  at  prefent,  or  from  any  other  which  are  prefs’d  upon  by  the 
tents,  or  doffils,  introduc’d.  I  remember,  not  to  mention  other  cafes,  that 
a  certain  poor  widow  had  a  haemorrhage  from  her  nofe,  which  came  on  after 
fneezing.  It  began  with  violence,  and  continu’d  to  flow  for  nine  hours,  till 
at  length  I,  who  was  then  a  young  man,  going  by  chance  where  lhe  was, 
and  being  entreated  by  the  weeping  women  around  her,  I  approv’d  of  the 
remedies  which  had  been  made  ufe  of,  after  bleeding,  though  external!)'  ap¬ 
plied,  more  than  internally,  and  only  made  this  one  alteration,  that  tents  of 
linen,  bolfter’d  up  together  very  hard,  Ihould  be  applied  to  the  noftrils  in¬ 
ternally,  inftead  of  foft  ones  ;  which  being  done,  the  blood  immediately 
flopp’d.  Thefe  were,  indeed,  moiften’d  with  the  juice  of  nettles,  (by  which 
only,  when  fnuff’d  up  into  the  noftrils,  I  have  feen  a  hemorrhage,  fome¬ 
times,  reftrain’d)  and  that  mix’d  together  with  the  white  of  an  egg,  and  the 
foot,  which  is  ferap’d  from  the  bottom  of  a  brafs  kettle,  rubb’d  into  the  fineft. 
powder.  The  former  tents  were,  indeed,  daub’d  over  with  medicines,  that 
have  the  power  of  agglutinating  and  aftringing ;  but  by  reafon  of  their  fofe- 
nefs,  were  not  fit  for  comprefiion.  However  this  might  be,  the  poor  widow 
loft  fo  much  blood  from  her  nole,  that  fixteen  days  afterwards,  fhe  came  to 
me  to  afk  advice  on  the  fcore  of  a  new  diforder ;  I  mean,  a  bad  habit  of 
body,  attended  with  a  palpitation  of  the  heart,  and  a  difficulty  of  breathing, 
as  generally  happens.  She  at  the  fame  time  told  me,  that  fhe  had  felt  a 
kind  of  anxiety,  when  the  blood  was  ftopp’d,  which  had  afterwards  gone' 
off •,  and  that  after  fome  days,  the  menftrual  difeharge  had  come  on,  but  in 
lefs  quantity  than  ufual,  and  black  ;  and,  what  was  by  no  means  difaoreeable 
to  find,  that  ffie  made  a  great  quantity  of  urine.  Wherefore,  I  difmifs’d 
her,  with  hopes  of  recovering  her  former  health,  fo  that  fhe  would  but  ob- 
ferve  that  method  of  living  which  I  had  perfuaded  her  to  obferve,  and  ufe 
fome  few  medecines  that  I  recommended  to  her,  and  were  eafily  procur’d 
nor  were  her  hopes  difappointed. 

But  to  return  back  to  the  fubjedt  in  hand  :  As  the  vefiels  that  pour  out 

( g )  Vid.  Epift.  25.  n.  6. 


the 


Letter  XIV.  Article  2$.  339 

the  blood,  are  not  always  fituated  in  thofe  parts  of  the  nofe,  which  can  be 
comprefs’d  by  the  introduction  of  tents*,  or,  which  would  be  dill  more  cer¬ 
tain,  if  the  veffels  were  at  any  time  in  a  part  of  the  feptum,  that  might  be 
brought  into  fight,  by  an  inftrument,  not  far  unlike  that  which  the  celebrated 
Trew  invented  for  another  purpofe  (b) ;  we  muft  endeavour,  in  extreme 
cafes,  to  fee  if  we  may  be  happy  enough  to  comprefs  them  by  that  method, 
which  the  celebrated  H eider  mentions  (/),  as  taken  from  Le  Dran,  of  re¬ 
draining  the  blood,  after  the  excifion  of  a  polypus,  now  efpecially,  as  the 
very  ingenious  furgeon  Goulard  (£)  has  taken  great  pains  to  render  it  more 
eafy,  and  lefs  inconvenient.  But  the  lefs  room  there  may  be  for  remedies 
of  this  kind,  fo  much  the  more  care  mud  be  taken  about  others  :  among 
which,  if  at  any  time  the  extremity  of  the  cafe  compel  the  phyfician  to  try 
the  defeElio  animi ,  or  fwooning,  he  feems  to  be  lefs  commendable,  who  at¬ 
tempts  to  bring  on  a  fainting,  by  caufing  fudden  fear  in  the  patient,  than 
he  who  attempts  it  by  tying  bands  round  the  limbs,  and  raifing  the  patient 
up  to  fit;  for  in  this  way,  the  bands  being  immediately  unty’d,  and  the 
patient  again  lying  down,  and  having  luch  remedies  apply’d  as  were  pre- 
vioufly  prepar’d  for  that  purpofe,  he  can  more  eafily  remove  the  fyncope, 
than  if  it  had  been  the  confequence  of  terror.  But  as  to  what  it  may  be  ne- 
ceffary  to  give  in  obdinate  haemorrhages,  in  order  to  preferve  the  ftrength, 
we  mud  take  care,  that  they  may  not  be  of  fuch  a  kind,  as  either  to  excite 
the  motion  of  the  blood,  or  fuddenly  to  encreafe  its  quantity.  Thus  Val- 
falva  gave  broths  made  of  rice  or  barley,  and  even  thefe  fparingly,  and  in 
fmall  quantities,  at  different  times  :  notwithdanding  ralhnefs  has  had  fome- 
times  a  happy  effieft,  as  in  that  wounded  and  thirdy  youth  whom  Schneider 
mentions  (/),  and  another  young  man  of  whom  Lower  writes  (/»)  *,  the 
fird  of  whom,  in  an  immoderate  haemorrhage,  drank  fuch  a  quantity  of 
beer,  that  drops  of  blood  came  from  him,  “  chiefly  watry  ;**  and  the  other 
drank  fo  greedily  of  broths,  that  the  drops  of  his  blood  were  more  like  the 
broth  he  had  fo  often  drunk,  “  than  blood.”  Yet  you  will  find,  that  both 
of  them  were  fav’d,  and  that  the  young  man,  afterwards,  “  grew  up  into 
“  a  drong  and  well  built  man  fo  that  you  may  perceive  it  to  be  fometimes 
much  better,  where  neceflity  compels  you,  to  give  broths  in  a  fomewhat 
larger  quantity,  in  order  to  preferve  the  circulation  of  the  remaining  blood, 
as  far  as  it  can  be  done,  than  to  fuffer  the  circulation  to  languidi,  and  fail, 
at  once,  from  too  great  a  haemorrhage,  and  too  great  an  abdinence,  at  the 
fame  time.  * 

But  if  you,  perhaps,  afk  me  what  external  remedies  Valfalva  us’d  where 
compreflion  could  not  take  place,  I  will  readily  tell  you.  He  fird  order’d 
.  cold  water  to  be  thrown  into  the  nofe  by  a  fyringe,  which  he  had  often  feen 
have  more  effieft  thus  applied,  than  he  could  have  expedted.  But  where  this 
did  not  diffidently  anfwer  his  purpofe,  he  then  made  ufe  of  fpirit  of  wine, 
in  the  fame  manner.  Yet  he  could  not  have  read  the  very  experienc’d  Schli- 
tingius  («),  who  has  written,  “  that  alcohol  was  always  applied  by  him,  and 

(h)  Commere.  Litter,  a.  1741.  heb.  16.  n. 2.  (/)  De  Catarrh.  L  3.  c.  3. 

tc  tab.  1.  fig.  8,  9.  («)  Traft.  de  Corde,  c.  2. 

(?)  Inftit.  Chir.  p.  2.  f.  2.  c.  71.  n.  10.  (»)  Aft.  N.  C.  tom.  6.  obf.  20. 

(/£)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1740. 

X  x  2  "  “  another 


34°  Book  I.  Of  Difeafes  of  the  Head. 

“  another  phyfician,  at  Amfterdam,  by  way  of  fpecific,  with  fuccefs,”  and 
by  degrees  drawn  up  the  noftrils,  inafmuch  as  it  was  a  remedy,  not  lefs  effi¬ 
cacious  in  flopping  this  haemorrhage,  than  in  flopping  the  haemorrhages  of 
wounds.  And  I  fuppofe  that  Valialva  had  transferr’d  this  praftice  from  the 
bleeding  of  wounds  to  that  of  the  nofe,  having  known  by  experience,  how 
much  it  contributed  to  coagulate  the  blood,  but  efpecially  to  contradi  the 
mouths  of  the  fmaller  arteries ;  for  hence  it  feems  to  be,  that  it  is,  fome- 
times,  not  equal  to  the  talk  of  flopping  the  haemorrhage,  which  fucceeds  the 
extradlion  of  a  tooth,  becaufe  then,  doubtlefs,  the  orifice  of  the  little  artery, 
that  is  ruptur’d,  is  not  prominent  into  the  cavity  of  the  focket,  but  is  en¬ 
tirely  contradled,  and  lies  hid  within  the  fubflance  thereof,  in  the  fame  man¬ 
ner  as  that  artery  within  the  os  tibis,  from  which  Petit  obferv’d  a-  very 
troublefome  haemorrhage  ( o ).  You  fee  therefore  that  cafes  may  happen, 
fometimes,  in  which  you  cannot  reftrain  the  flux  of  blood  from  the  noftrils, 
even  by  this  remedy.  And  this  you  will  believe  fo'  much  the  more,  of 
other  both  internal  and  external  remedies,  when  you  have  read,  that  fo  many, 
of  both  kinds,  have  been  frequently  applied  by  phyficians  in  vain  j  and  in 
particular  by  Lentilius  (/>),  who  prudently  declares,  that  the  different  caufes 
of  hemorrhages,  in  different  cafes,  are  to  be  confider’d. 

Once  on  a  time,  when  I  was  turning  over  fome  old  records  of  my  coun¬ 
try  and  province-,  I  found  that  in  the  year  1200,  “  there  was  a  great  mor- 
“  tality  of  men,  in  the  lpace  of  twenty- four  hours,  in  Tufcany,  and  Roman- 

diola,  by  a  flux  of  blood  from  the  noftrils:”  and,  indeed,  in  the  fame 
year,  Clementini,  the  hiftorian  of  Rimini,  has  the  following  paffage,  to  the 
fame  purpofe,  although  he  does  not  fay,  from  what  part  the  blood  iffu’d  (q) : 
“  Many  died  at  Rimini  from  a  flux  of  blood,  within  twenty-four  hours, 
“  and  a  ftill  greater  number  at  Ravenna,  and  in  other  cities  of  our  province.” 
And  do  you  imagine  that  phyficians  did  not  then  apply  all  the  aftringents, 
in  particular,  and  ether  remedies  then  in  ufe  ?  Yet  you  fee  it  was  in  vain  j 
becaufe  the  epidemical  caufe  was  unknown.  And  in  regard  to  aftringent 
medicines,  attend  to  the  admonitions  of  Lentilius  (r),  and  this  befides,  whe¬ 
ther  it  is  probable,  that  when  they  are  taken,  they  can  fo  foon  come  to  the 
parts  where  their  force  is  requir’d,  and  aft  with  fo  great  efficacy  there,  as 
we  would  wifh  them  to  aft  with,  and  at  the  fame  time,  not  aftringe  the 
veflels  in  other  parts.  And  yet  you  will  now  fee  many  flying,  when  danger 
is  at  hand,  immediately  to  the  fcarlet  fungus  of  Malta,  which  perhaps  they 
cannot  get  true.  For  ever  fince  I  was  inform’d,  by  a  knight  of  Malta,  who 
was  my  fellow-citizen,  in  how  fmall  a  number  thefe  fungi  grew  every  year, 
as  they  were  confin’d  to  one  very  narrow  rock,  and  with  what  care  they  are 
wont  to  be  preferv’d,  that  they  may  be  fent,  as  prefents,  to  princes,  and 
great  men ;  I  am  much  afraid,  left  thofe  that  are  to  be  fold  are  brought  from 
another  rock,  near  Trapani,  or  from  Africa,  like  them  in  form  indeeo,  and, 
in  fome  meafure,  in  colour  alfo,  but  far  unequal  to  them,  as  this  knight 
of  Malta  inform’d  me,  in  efficacv. 

(0)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1732.  (f)  Racconto  Iftor.  della  Fond,  di  Rimino 

(/)  Eph.  N.  C.  Dec.  3.  A.  8.  Append,  n.  1.  3. 

10.  ad  obC  90.  (0  ad  cit.  obf.  90. 


26.  The 


Letter  XIV.  Articles  26,  27,  28.  341 

26.  The  two  obfervations  which  are  produc’d,  the  laft  of  all,  in  this  fec- 
tion,  and  both,  as  is  faid,  made  at  Rome,  are  of  fuch  a  kind,  that  one 
which  gives  the  relation  of  a  leech,  penetrating  from  the  noftrils  to  the  coats 
of  the  brain,  is  at  the  fame  time  that  it  is  propos’d,  jullly,  and  delervedly, 
rejected  ;  but  the  other  of  a  baker,  among  the  lower  clafs  of  people,  at 
Rome,  is  related  as  certain,  who  “  having  fneez’d  four  and  twenty  times 
“  fucceffively,  the  next  time  of  fneezing,  which  fucceeded,  and  which 
“  was  the  twenty-fifth,  was  fatal  to  him,  by  the  arteries  and  membranes, 
46  which  furround  the  brain,  being  ruptur’d  thereby.”  It  is  true,  that  I 
have  no  doubt  about  the  dangers  which  may  arife  from  fneezing,  as  they  are 
fufficiently  prov’d  by  medical  hiftories  :  and  moreover,  if  you  would  have  it 
that  the  veffeis  of  the  brain  were  ruptur’d  in  the  baker,  from  this  caufe,  as 
the  veffeis  of  the  nofe  were  in  the  widow  of  whom  I  fpoke  juft  now  (j)  ;  I 
fhall  not  be  much  againft  embracing  your  opinion.  But  this  is  doubtful, 
whether  the  veffeis  of  the  brain  and  membranes  were  really  ruptur’d  in  that 
baker.  For  Famianus  Strada,  who  is  brought  by  way  of  a  witnefs  to  the  ob- 
fervation,  in  that  prolujio ,  which  is  entitl’d  Pijior  Suburranus  (/),  has  nothing 
at  all  of  it,  as  far  as  I  could  find,  except  that  it  was  related  to  him,  “  that 
“  after  having  fneez’d  three  and  twenty  times  while  he  held  his  breath,  in 
44  the  twenty-fourth  effort  of  fneezing,  he  breath’d  out  his  laft but  of  the 
internal  caufe  of  his  death,  much  lei's  of  the  infpe<ftion  of  the  brain,  there 
is  not  the  leaft  word.  And  without  this  infpedlion,  how  eafy  it  is  to  be  de¬ 
ceiv’d,  the  following  obfervation,  which  was  made  by  two  phyficians,  Sala- 
no  and  Bigatti,  will  fhow :  thefe  two  phyficians  were  eminent  men  at  Bo¬ 
logna,  where  the  obfervation  was  taken,  about  the  end  of  the  year  1705, 
when  I  was  there. 

27.  A  nobleman,  about  forty  years  of  age,  very  fat,  and  given  to  drink* 
ing  freely,  as  was  reported,  had  been  troubl’d,  for  fome  time,  with  a  diffi¬ 
culty  of  breathing,  after  eating,  and  after  going  up  flairs.  This  gentleman 
being  accuftom’d  to  fneeze  frequently  and  violently,  at  length,  after  fneez-* 
ing  fome  times  together,  faid,  that  he  was  fuddenly  feiz’d  with  a  great  nar- 
rownefs  of  the  cheft,  and  a  difficulty  of  breathing :  and  as  he  faid  this,  he 
at  the  fame  time  fneez’d,  and  died,  his  mouth  being,  as  fome  faid,  diftorted. 
When  his  belly  was  open’d,  every  thing  appear’d  found,  if  you  except  a 
great  quantity  of  fat,  and  efpecially  in  the  omentum.  The  cavity  of  the 
thorax,  for  that  reafon  perhaps,  feetn’d  to  be  a  little  lefs  than  it  ought  to 
be  (a).  The  lungs  were  fomewhat  livid.  There  were  no  polypous  concre¬ 
tions  in  the  heart.  Finally,  there  was  fome  water  in  the  ventricles  of  the 
brain,  but  in  fmall  quantity-,  and  the  veffeis  thereof  were  diftended  and  tur¬ 
gid  j  but  whole. 

2S.  That  fneezing  which  is  a  kind  of  convulfion,  inftituted  by  nature, 
may,  if  at  any  time  it  exceed  its  natural  bounds,  degenerate  into  a  true  and 
preternatural  convulfion,  you  can  eafily  conceive  •,  and  that  by  this  means, 
an  apoplexy  may  be  brought  on,  you  have  heard  already  from  me,  on  an¬ 
other  occaffon  (a?) ;  but  this  happens  chiefly  in  thofe  bodies  in  which,  as  the 


(d  n.  25-. 

(/)  1.  3.  Proluf.  4. 


(«)  Vid,  Epift.  27.  n.  2. 
\x)  Epiit.  11.  n.  17. 


blood 


342  Book  I.  Of  Difeafes  of  the  Head. 

blood  from  their  manner  of  life  is  redundant,  it  neverthelefs  cannot,  by  rea- 
fon  of  the  refinance  it  meets  with  from  fat  in  other  parts,  di fiend  any  vdiels 
more  than  thofe  which  are  contain’d  in  the  cranium. 

But  by  what  means  the  membrane  of  the  nofe,  when  irritated,  can  draw 
the  diaphragm  into  content  with  it,  and  excite  it  to  the  motion  of  a  violent 
ilernutation,  I  fee  that  many  very  excellent  men  fo  much  wonder,  that  from 
this  well-known  fympathy  betwixt  the  noflrils  and  the  diaphragm,  they 
take  an  argument  againll  thofe  who  account  for  the  confect  of  parts,  one 
with  another,  from  the  correfpondence  of  the  nerves.  For  there  is  no  com¬ 
merce,  they  fay,  between  the  olfadtory  nerves,  which  belong  to  the  firft  pair 
of  the  brain,  and  the  nerves  of  the  diaphragm,  which  come  from  the  cervi¬ 
cal  ;  forgetting  truly  the  nerves  which  are  fent  from  the  fifth  pair  of  the 
brain  to  the  membrane  of  the  noflrils  ;  or  rather  taking  no  heed,  that  the 
fame  fifth  pair  belong  to  the  intercoftals,  which  have  fo  many  communica¬ 
tions  with  the  cervical,  and  pafs  through  the  diaphragm.  And  they  even 
belong  to  the  intercoftals,  if  not  by  thole  two  filaments,  which  were  fuppos’d 
by  moft  anatomifts  before,  and  which  had  given  occafion  to  a  long  contro- 
verfy,  yet  at  lead  by  a  little  branch,  which  Meckel  (y),  that  moft  diligent 
inveftigator  of  the  nerves,  trac’d  a  little  lower,  from  the  fifth  pair,  quite  to 
the  intercoftals,  on  each  fide  ;  fo  that  we  are  now  not  only  at  liberty  to  ex¬ 
plain  the  confent  between  the  noftrils,  and  the  feptum  tranfverfum,  from 
this  communication,  but  even  between  the  noftrils,  and  the  vifeera  of  the 
belly,  as  that  which  I  obferv’d  in  a  noble  lord,  for  whom  I  was  confulted  in 
former  years.  For  the  attacks  to  which  he  was  fubjedt,  and  which  were  of 
the  epileptic  kind,  beginning  from  the  hypochondria,  were  preceded  by  the 
fenfe  of  a  kind  of  foetid  fmell,  that  was  very  troublefome  to  himfelf,  though 
none  of  the  by-ftanders  could  ever  perceive  any  thing  of  it,  not  even  in  the 
breath  of  his  mouth  and  noftrils,  where  he  chiefly  complain’d  of  this  foetor, 
though  they  purpofely  receiv’d  his  breath  at  the  time  of  his  perceiving  it; 
fo  that  for  this  reafon  it  leem’d  to  me,  that  from  this  branch  of  the  inter- 
coftal  nerves  being  irritated  in  the  hypochondria,  a  motion  was  propagated 
into  the  membrane  of  the  nofe,  not  unlike  what  would  have  been  excited  by 
effluvia,  ifluing  from  a  foetid  fubftance  ;  till  at  length  the  irritation  of  the  in- 
tercoftal  nerves  increafing,  a  much  more  difturb’d  and  irregular  motion  feiz’d 
upon  the  brain,  and  the  nerves  in  general.  But  enough  on  the  difeafes  of 
the  nofe. 

29.  Three  fedtions  follow  upon  the  difeafes  of  the  mouth,  the  voice,  and  the 
fauces.  To  which,  if  I  fay,  that  you  cannot  much  expect  Vallalva’s  obler- 
vations,  or  mine,  to  be  added;  you  will  perhaps  wonder.  Yet  you  will 
ceafe  to  wonder,  when  you  fhall  obferve,  that  it  is  not  my  cuftom  to  repeat 
hiftories,  or  to  produce  thofe  in  one  place,  which  may  be  produc’d  with 
much  greater  propriety  in  another.  Wherefore  you  will  read  better  in  other 
letters,  thofe  which,  in  fome  mealure,  might  be  referr’d  hither.  In  the  mean 
while,  you  will  have  fome  animanverfions  upon  thele  fedtions,  which  may 
•either  tend  to  vindicate  to  you  this  refolution  of  mine,  or  fhew  fomething 
which  has  been  obferv’d  by  me.  And  as  all  thefe  things  may  be  compre- 

(y)  Hid.  de  1’Acad.  R.  des  Sc.  de  Berlin  A.  1751.  ClalT.  de  Philof.  Experim. 

4  hended 


Letter  XIV.  Articles  30,  31,  343 

Bended  here,  without  a  great  compafs  of  words •,  I  did  not  think  it  neceffary 
to  write  of  them  feparately  •,  but  rather  judg’d  it  proper  to  join  them  to  this 
letter. 

30.  The  twenty*  fir  ft  fe&ion,  indeed,  gives  you  more  than  five  and  thirty 
obiervations.  But  befides  that  the  fecond  obfervation  is  a  part  of  the  ninth  •, 
and  the  eleventh  a  part  of  the  fifth ;  and  the  fixth,  which  is  indeed  very  won¬ 
derful  that  it  fhould  pafs  unobferv’d,  nothing  but  a  compendium  of  that 
which  immediately  follows,  the  feventh  -,  if  you  read  over  the  whole  fetftion, 
vou  will  fcarcely  find  a  hiftory  which  does  not  relate  to  fome  other  more 
violent  dileafe,  and  is  not  repeated  amongft  others  under  the  head  of  fuch 
difeaie. 

And  the  fame  you  will  obferve,  even  in  the  twenty-fecond  fedtion.  Add 
to  this,,  in  order  to  finifti  what  I  have  to  fay  upon  the  twenty-firft  fedtion ; 
that  the  thirty-firft  obfervation,  and  others  which  are  propos’d  in  the  double 
appendix,  are  not  obfervations  made  on  thofe  who  died  of  the  dileafe,  but 
rather  conjedtures,  and  in  part  lefs  laudable  than  we  would  wifh.  But  what 
fliall  I  fay  of  l'ome  other  obfervations  ?  In  the  thirteenth,  the  patient  is  faid  » 
«  to  have  fpit  out  his  very  brain  from  his  mouth  5”  for  although  any  perfon, 
who  has  read  that  hiftory  in  Fernelius,  which  is  but  carelefsly  related  in  the 
fcholium,  will  not  deny,  but  that  it  might  in  fome  meafure  happen  •,  yet  he 
cannot  ealily  believe  it,  unlefs  the  bafis  of  the  cranium  be  defcrib’d  in  the 
obfervation,  to  be  perforated  from  a  caries ;  fo  that  it  is  very  certain  the  cor¬ 
rupted  part  of  the  fubftance  of  the  brain  itfelf,  had  really  pafs’d  from  thence 
into  the  fauces. 

The  twenty-ninth  and  thirtieth  obfervations  have  arguments  prefix’d  to 
them,  affirming  that  which  is  not  probable.  For  who  can  fuppole,  that  a 
pain  of  the  teeth,  which  had  formerly  preceded,  and  is  mention’d  in  the  fe¬ 
cond  obfervation,  was  “  from  yellow  ferum  contain’d  about  the  corpus  fal- 
“  ciforme,”  of  a  lethargic  perlon,  and  even  “  from  yellow  ferum  contain’d 
“  within  the  left  ventricle  ”  of  the  brain.  Or  who  can  believe,  that  the  pain 
of  the  teeth,  and  caries,  which  are  treated  of  in  the  firft,  were  “from  a 
“  humour  diddling  from  the  head,  by  a  peculiar  paflage,  into”  the  antrum 
of  Highmore  ?  For  that  was  the  blunder  of  Highmore  himfelf,  that  the  fo¬ 
ramen  of  the  antrum,  which  he  faw,  and  delineated  in  the  figure  that  is 
added  (2),  he  did  not  confider  as  the  emiffary  of  this  antrum,  as  it  really  is,, 
but  as  the  immiffary  foramen.  Finally,  not  to  take  up  your  time,  that  which 
is  propos’d  in  the  argument  of  the  thirty-fecond  obfervation,  “  from  a  tooth 
“  that  was  a  little  prominent  being  cut  off,  convulfions  and  death,”  is  not 
altogether  contrary  to  probability  ;  but  it  is  at  leaf!  doubtful*  whether  what 
Calpar  Bartholin  has  written  in  that  obfervation  (a),  Jiatim  convulfa  epilep¬ 
tica  decidit ,  fignifies  death,  or  only  an  epileptic  paroxyfm. 

31.  Enough  of  animadverfions  you  fay,  expecting,  perhaps,  the  obfer¬ 
vations  which  I  have  made  on  thofe  pains  of  the  teeth,  in  particular,  with» 
which  you  are  fo  often  troubl’d.  But  I  have  fcarcely  any  thing  to  add  to 
what  I  have  hinted  before,  on  this  fubjedt  (£).  As  far  as  I  have  been  able 

(z)  Corp.  hum.  Difqu.  Anat.  Tab.  1 6.  Fig.  (a)  Inflit.  Anat.  libell.  4.  c.  12. 

3.  ad  litt.  d..  (£)  Epift.  Anat.  13,  n.  6.  7. 


to> 


344  Book  !•  of  Difeafes  of  the  Head. 

to  obferve,  quite  different  remedies  are  nfeful  to  different  perfons ;  and  even 
different  things,  at  different  times,  to  the  lame  perfon,  in  proportion,  doubt- 
lefs,  to  the  various  caufes,  and  difpofitions  of  circumftances.  For,  in  rnyfelf, 
I  have  fometimes  found  warm  milk  of  fervice’to  me,  at  other  times  of  no 
fervice  at  all,  and  lpirit  of  wine  iaturated  with  camphor  more  ufeful,  and 
fometimes,  again,  neither  one  nor  *he  other  has  been  of  advantage.  And 
although  I  am  afraid  of  an  acid,  I  had,  neverthelefs,  determin’d  to  try  that 
among  other  things  ;  of  which  Jo.  Stephaniis  teftifies,  “  that  he  had  often 
“  made  the  experiment  (c),”  affirming  at  the  fame  time,  46  that  the  tooth- 
44  ach  was  eas’d  miraculoufly,  as  it  were,  if  the  mouth  were  vvafh’d  with 
<c  the  acid  of  a  deco&ion  of  tartar.”  But  it  was  much  better  to  have  had 
no  occafion  for  experiments  of  this  kind,  fince  it  is  now  a  long  time  that 
it  has  pleas’d  God  to  indulge  me  with  a  freedom  from  thefe  tortures.  For 
other  perfons,  as  well  as  Stephanus,  you  know,  had  promis’d  the  fame  things, 
by  applying  a  little  bone  from  the  foot  of  a  toad.  Yet  I  know  a  very  learn’d 
phyfician,  who  made  the  experiment  in  vain,  having  extracted  all  the  bones, 
both  of  a  living  and  dead  toad,  left,  perhaps,  on  account  of  the  difference 
of  authors,  in  defining  any  certain  little  bone,  he  fhould  take  one  for  the 
other,  and  applied  them  feparately  to  his  own  teeth  and  gums.  Perhaps 
fome  perfon  will  fay,  that  thefe  bones  were  not  taken  away  at  a  proper  time 
of  the  year :  or  not  rubb’d  fo  hard  upon  the  gum  as  was  neceffary.  I 
fhould  rather  believe  the  laft,  as  I  have  rnyfelf  fometimes  gain’d  a  little  eafe 
and  advantage  from  the  fridtion  of  my  gums  ;  yet  not  from  applying  a  bone 
of  that  kind,  but  from  my  fingers  only  :  for  which  reafon  it  is  natural  to 
believe,  that  thofe  miracles  are  to  be  let  down  to  the  account  of  fridtion 
only,  when  there  is  room  for  it  to  take  place,  rather  than  to  any  peculiar 
virtue,  or  property,  of  the  toad.  I  remember,  alfo,  that  a  man,  otherwife 
not  uniearn’d,  boafted  of  performing  the  fame  kind  of  miracle,  if  into  that 
noftril,  which  anfwer’d  to  the  tooth,  a  fluid  was  drawn  up,  diftill’d  from 
fpirit  of  wine,  in  which  a  warm  and  bitter  herb,  that  was  known  to  him,  (with 
the  powder  whereof  he  had  driven  away  fevers,  and  which  grew  equally  in 
mountainous  and  in  plain  places)  had  been  macerated  :  and  yet  he  afferted, 
that  the  Fluffing  up  of  this  liquor  was  not  follow’d  by  a  very  great  irritation 
of  the  noftrils.  I,  however,  with-held  my  affent,  not  fo  much  becaufe  he 
faid  the  name  of  the  herb  was  unknown  to  him,  but  rather  becaufe  he  af¬ 
ferted,  without  any  hefltation,  that  this  remedy  of  his  was  equally  efficacious 
and  inftantaneous,  whatfoever  fhould  be  the  caufe  of  the  pain. 

32.  But  in  regard  to  privation  of  tafte,  by  reafon  of  the  vitiated  fituation 
of  the  nerves,  1  never  read  that  in  Columbus,  which  the  thirty-fifth  obfer- 
vation,  in  the  twenty-firft  fedtion,  exhibits  ;  but  1  immediately  remark’d, 
that,  if  no  miftake  had  crept  in  at  the  time  of  the  obfervation,  all  future 
difquifition  was  fuperfluous,  in  order  to  determine  the  controverfy,  whether 
the  fifth,  or  the  ninth  pair,  of  nerves,  for  both  of  them  are  fubfervient  to 
the  tongue,  be  that  which  gives  the  faculty  of  tafting  thereto,  fince  in  a 
man  who  was  depriv’d  of  this  faculty,  it  was  the  fifth  pair  which  did  not  go 
to  the  tongue.  But  I  cannot  help  being  vex’d,  that  Rolfinc,  when  he  had 


(c)  Comment,  in  Hippocr.  de  horn,  ftrud. 


made 


7 


Letter  XIV.  Article  33.  345 

made  an  obfervation  fimilar  to  this,  in  refpetft  to  the  nerves  at  leaft,  as  you 
fee  in  the  lame  fedtion,  upon  another  man,  faid  fo  little  upon  a  fubjedl  of 
fuch  moment,  that  he  did  not  give  the  leaft  hint,  whether  the  taylor,  on 
whom  his  obfervation  was  made,  had  been  without  the  faculty  of  tailing, 
or  not.  And  I  had  a  much  greater  defire  to  know  this,  than  whether  he  de¬ 
vour’d  living  animals  alfo,  glafs,  ftones,  and  other  things,  as  the  man,  from 
whom  Columbus  took  his  obfervation,  had  done.  For,  as  others,  who  were 
not  deficient  in  the  fenfe  of  tailing,  have  devour’d  things,  not  altogether 
unlike  thefe,  or  even  ftill  more  injurious,  as  for  inftance,  the  fwallow-knife 
of  Bafil,  a  flight  defeription  of  whofe  belly,  as  confiderably  hurt  thereby, 
you  have  in  Felix  Platerus  (J),  which  Columbus  has  omitted  to  take  notice 
of,  in  his  lubjedt ;  and  as  other  branches  of  nerves  are  fubfervient  to  fwal- 
lowing,  and  preparing  the  ingefta,  as  you  very  well  know  5  Columbus  has 
by  no  means  fatisfied  thofe,  who  wonder  at  fo  great  a  voracity  in  the  man, 
by  propofing  this  one  caufe  only,  that  he  wanted  the  faculty  of  fading. 

But  do  not  let  it  furprife  you,  that  I  fhould  fay  it  was  the  fifth  pair  of 
nerves,  which  Columbus  and  Rolfinc  call’d  the  fourth  ;  as  anatomifts  were 
long  accuftom’d  to  do.  For  if  you  look  into  each  author,  where  they  de- 
feribe  the  fourth  (<?),  and  compare  them  with  Willis  (/) ;  you  will  plainly 
fee,  not  only  that  I  fay  the  truth,  but  that  fome  confiderable  errors  have 
crept  into  that  very  fhort  annotation,  which  is  fubjoin’d  to  this  obfervation 
in  the  Sepulchretum,  as  if  they  had  pointed  out  that  which  tc  is  the  fixth 
“  pair  of  Willis,”  and  he  had  taught  that  the  fixth  pair  “  went  to  the 
“  palate.” 

33.  But  now  fomething  muft  likewife  be  obferv’d  on  the  twenty-fecond 
feftion  alfo,  which  relates  to  diforders  of  the  voice.  The  firft  obfervation 
fets  forth  a  lofs  of  fpeech,  in  a  woman,  after  a  long  hoarfenefs,  in  which 
our  Spigelius  found  “  the  whole  afpera  arteria  inflam’d  on  its  internal  part, 
together  with  a  remarkable  blacknefs.”  Although  an  inflammation,  already  « 
degenerating  into  a  gangrene,  occupied  this  whole  tube  internally,  yet  it  is 
fufficient,  in  order  to  underftand  the  aphonia,  and  preceding  hoarfenefs,  to 
confider  the  larynx,  which  is  the  upper  part,  and,  as  far  as  it  relates  to  the 
voice,  the  principal  part  of  the  whole  tube  :  nay,  it  is  even  fufficient  to  exa¬ 
mine  the  glottis  only,  which  is  the  principal  part  of  the  larynx.  For  if  this 
alone  be  made  rough,  as  in  the  aperture  of  a  flute,  a  hoarfenefs  is  imme¬ 
diately  the  confequence,  as  Schelhammer  (g)  has  obferv’d  :  who  alfo  explains 
the  prognoftic  of  Gordonius,  “  That  a  hoarfenefs  of  the  voice,  which  has 
“  lalted  for  a  year,  does  not  admit  of  a  cure  and  this  alfo,  “  If  it  gees 
“  on  any  longer,  it  makes  the  voice  fmall,  and  at  length  entirely  takes  it 
“  away  which  happen’d  to  the  woman  on  whom  Spigelius  made  the  ob¬ 
fervation.  But  it  is  by  no  means  neceflary  for  us  to  follow  all  the  opinions 
and  explications  of  Schelhammer  on  thefe  things.  However,  we  except  fome 
of  them  befides,  efpecially  that  which  Dodart  {h)  very  much  approv’d,  that 
the  voice  was  then  generated,  when  the  air  ftruck  againft  the  glottis ;  but 

(</)  MantifT.  obf.  50.  (f)  Cerebr.  Anat.  c.  22. 

\e)  De  Re  Anat.  1.  8.  c.  3.  Diflert.  Anat.  ( g)  DifTert.  de  Voce,  p.  2.  c.  3. 

].  4.  c.  35.  ( h )  Mem.  de  l’Acad.  R.  des  Sc.  a.  1700. 

Vol.  I.  Y  y  that 


34 6  Book  I.  Of  Difeafes  of  the  Head. 

that  it  was  increas’d  and  modified,  by  the  other  refounding  parts,  againft 
which  the  fame  air  is  ftricken  prefently,  before  it  goes  out  from  the  mouth 
of  the  perfon  who  fpeaks.  For  as  to  what  has  been  advanc’d  by  fome  learned 
men  againft  Dodart,  “  That  the  difeafes  of  the  noftrils  not  only  deftroy  the 
“  fpeech  entirely,  but  the  voice  -,--and  that  when  the  palate  has  been  eroded, 
“  the  voice  was  not  only  injur’d,  but  entirely  deftroy’d,  as  you  read  in  Fo- 
“  refius,  book  the  thirty-fecond,  obfervation  the  twenty-fecond  ;  and  that 
“  the  fame  perfon  recover’d  his  voice,  by  having  a  plate  of  metal  fix’d  in 
“  the  place  of  the  bone  •,  and  that  the  fame  event  had  been  obferv’d  by 
“  Hildanus,  century  the  fecond,  obfervation  the  twenty-fecond  I  myfelf, 
indeed,  (and  I  would  have  you  believe,  that  I  fay  thefe  things  more  for  the 
fake  of  truth,  than  for  the  lake  of  Dodart,  or  myfelf)  I  myfelf,  I  fay,  have 
obferv’d  an  half-form’d,  or  inarticulate  voice,  and  one  that  had  its  force  di- 
minifh’d  in  fuch  cafes,  but  never  deftroy’d ;  unlefs,  perhaps,  the  fame  caufe 
which  had  injur’d  the  palate  and  the  noftrils,  had  injur’d  the  glottis  all'o,  or 
thofe  parts  which  are  necefiarily  requir’d  to  the  utilities  and  purpofes  of  the 
glottis.  Nor  is  the  teftimony  of  Hildanus  againft  us,  in  this  matter ;  who 
fays,  that  when  the  filver  plate  was  taken  away  from  the  hole  in  the  palate, 
which  was  “  very  large,  fcarcely  could  more  than  a  word  or  two  be  utter’d 
“  diftin&iy  and  articulately  for  this  relates  to  the  fpeech,  and  not  to  the 
voice  •,  as  the  obfervation  of  Foreftus  does  alfo,  who  fays,  that  without  a  like 
inftrument  to  the  former,  the  patient  “  could  fcarcely  be  underftood  when 
“  he  fpoke  but  when  this  was  replac’d,  “  that  he  fpoke  with  eafe.”  Yet 
if  the  cafe  which  Foreftus  has  fubjoin’d,  from  the  fifth  century  of  Amatus, 
cafe  the  fourteenth,  when  curforily  read  over,  feems  to  relate,  not  only  to  the 
fpeech,  but  to  the  voice  itfelf  *,  which  was  at  one  time  “  altogether  deficient,” 
and  at  another  time  “  was  recover’d  yet  if  you  compare  it  clofeiy  with  the 
obfervations  of  Foreftus,  and  Hildanus,  in  particular,  you  will  then  perceive, 
that  it  refers  to  the  ftrength  of  the  voice,  and  the  fpeech  ;  fince  it  is  not  pro¬ 
bable,  that  the  foramen,  which  was  (hut  up  with  an  inftrument,  made  like  a 
nail,  fhould  be  larger  than  that  which  Hildanus  call’d  “  very  large  nor, 
if  it  was  lets,  that  it  fihould  be  of  more  detriment  to  the  voice  than  a  very 
large  one. 

But  whether  the  too  great  fullnefs  of  moifture,  which  by  diftending  the 
fibres  of  the  glottis  very  unequally,  had  firft  only  exafperated,  or  made  them 
rough,  but  at  length,  by  its  long  continu’d  afflux,  fo  relaxes  them,  that 
they  lofe,  finally,  all  their  elaftic  force  ;  or,  on  the  other  hand,  an  internal 
drynefs  crifps  up,  and  exafperates  the  fibres,  and  at  the  fame  time  makes 
them  flirink,  fubfide,  and  be  lefs  tenfe,  and  confequently  lefs  obedient  to 
the  motions  of  the  mufcles  *,  the  cafe  may  at  length  come  to  this  point  fome- 
times,  that  the  hoarlenefs  degenerates  into  a  lofs  of  voice  :  which  feems  to 
have  happen’d  to  that  noble  orator,  Hortenfius,  if  we  give  credit  to  Sa- 
monicus(z),  when  he  writes  thus  : 

Vel  rabidus  clamor  f ratio  cum  forte  fonore 

Planum  radit  iter ,  fic  eji  Hortenfius  olim 

(/')  De  Medic,  c.  Uvae,  faucib.  &  c.  medend. 

Abjumftus  i 


347 


Letter  XIV.  Articles  34,  35. 

Abfumptus  :  caufis  etenim  confettus  agendis 
Obticuit ,  cum  vox  domino  vivente  periret , 

Et  nondum  ext  init  i  moreretur  lingua  diferti. 

And  in  order  to  convince  you,  that  Samonicus  had  hinted  a  foregoing 
hoarfenefs,  call  to  mind  what  Lucretius  (£),  whom  Samonicus  often  had  in 
his  eye,  as  I  have  formerly  (hewn  (/),  had  written  on  this  fubjedt : 

Pr^terradit  enim  vox  fauces  fepe ,  facitque 
Afperiora  foras  gr adiens  arteria  clamor  : 

Quippe  per  anguflum  turba  majore  coorta 
Ire  foras  ubi  coeperunt  primordia  vocum , 

Scilicet  expletis  quoque  janua  raditur  oris 
Rauca  viis ;  iter  ladit ,  qua  vox  it  in  auras. 


But  of  the  cafe  of  Hortenfius,  perhaps,  more  on  another  occafion  (m). 
Now  let  it  fuffice  to  have  faid  thus  far  on  the  fubjedt  of  hoarfenefs,  and  the 
lofs  of  fpeech,  which  fometimes  fucceeds  it. 

34.  But  as  to  the  aphonia,  when  the  term  is  us’d  m t  or  by  way 

of  eminence,  and  fignifies  a  diforder  fucceeding  to  an  injury  of  the  brain, 
let  me  add  a  few  things,  relative  thereto,  to  the  firft  appendix,  which  you 
will  fee  after  the  eighteenth  obfervation  (»).  You  will  read  in  this  appendix, 
that  it  is  an  affedlion  of  a  middle  nature,  betwixt  an  apoplexy  and  an  epi- 
lepfy,  becaufe  the  patient  is  without  fenfe,  and  without  voice,  yet  not  with¬ 
out  motion,  nor  attended  with  convulfive  agitations  •,  that  it  may  fometimes 
degenerate  into  an  apoplexy,  according  to  the  vehemence  of  the  caule  ;  and 
that  to  this  the  aphonia,  alfo,  may  be  referr’d,  of  which  the  aphorifm  of  Hip¬ 
pocrates  fpeaks  (0)  :  “  If  any  perfon,  who  is  drunk,  fuddenly  become  apcwof , 
“  or  fpeechlefs,  he  dies  convuls’d,  unlefs  he  is  feiz’d  with  a  fever,  or  re- 
“  cover  his  voice,  at  the  time  of  his  drunkennefs  going  off ;  that  it  arifes, 
“  generally,  from  a  confent  of  the  lower  parts,  and  a  narcotic  vapour, 
“  fuffocating,  or  difturbing  the  animal  fpirits  in  the  brain.”  But  that  this 
word  “  generally”  was  not  inferted  with  lels  propriety  here,  than  it  was  in 
the  tranllation  of  the  fame  aphorifm  by  Celfus,  my  obfervation,  which  fhall 
be  immediately  fubjoin’d,  will  fhevv  you.  The  tranllation  of  Celfus  runs 
thus(p):  “  Whoever  has  loft  his  fpeech  from  drunkennefs  is,  generally ,  carried 
ct  off  by  convulfions,  unlefs  either  a  fever  has  come  on,  or  he  has  begun  to 
“  fpeak,  at  the  time  in  which  the  drunkennefs  ought  to  go  off.”. 

35.  A  hufbandman,  of  a  middle  age,  but  of  a  lean  habit  of  body,  and 
having  his  Ikin  univerfally  brown,  was  feiz’d  with  an  aphonia,  when  he  was 
drunk.  He  was  brought  into  this  hofpital,  fcarcely  being  able  to  move  his 
head  :  and  there,  within  the  fourth  day  after  his  drunkennefs,  his  pulfe  being 
very  (lender  and  fault’ring,  but  without  being  convuls’d,  he  yielded  to  his 
fate. 

His  body  I  carefully  differed  at  the  college,  not  only  to  finilh  the  anato¬ 
mical  demonftrations,  before  the  end  of  February,  in  the  year  1737,  but 


(£)  De  Rer.  Nat.  !.  4.  v.  531.  &  feqq. 
(/)  Epifl.  in  Samonic.  I. 

(w)  Epift.  in  eu’nd.  II. 


(«)  Sedl.  22. 

(*)  5  fea-  5- 

(p)  De  Medic,  1.  2.  c.  6. 


Y  y  2 


alfo 


348  Book  I.  Of  Difeafes  of  the  Head. 

alfo  that  I  might  difcover,  by  examining  almoft  all  the  parts,  what  appear¬ 
ances  there  were  which  would  ferve  to  throw  light  upon  the  difeafe.  In  doing 
this,  I  obferv’d  the  following  preternatural  circumttances.  On  the  internal 
furface  of  the  ftomach,  at  the  fundus,  fome  black  points  occurr’d,  like  the 
larger  granules  of  tobacco :  which,  after  examining  a  little  more  attentively, 
I  perceiv’d,  were  fmall,  indeed,  but  certain,  marks  of  a  mortification  ;  after 
that  I  obferv’d,  a  little  higher,  two  black  fpots,  and  another,  near  thefe, 
that  was  red,  and  fomething  bigger,  and  which  was  in  effect  a  true,  though 
a  very  flight,  ulceration.  But  I  wonder’d  what  was  the  caufe,  that  I  found 
difeas’d  appearances  like  thefe,  and  even  greater  than  thefe,  in  the  flomach, 
cefophagus,  and  duodenum,  of  a  poor  woman,  with  the  difledtion  of  whofe 
body  I  had  begun  the  anatomy  of  this  year,  as  her  method  of  living,  and 
the  ficknefs  of  which  fhe  had  died,  were  quite  of  a  different  nature,  as  I 
fhall  tell  you  on  a  more  proper  occafion  {q). 

However,  1  found  the  gula  and  inteftines  of  this  man,  whom  I  then  de¬ 
fected,  to  be  entirely  without  injury  ;  except  that  in  the  firfi:  part  of  the  ileum 
internally,  one  or  two  fmall  prominences  appear’d,  like  the  point  of  a  little 
finger,  and  of  a  reddifh  fubftance,  as  I  perceiv’d  by  difledtion,  but  not  glan¬ 
dular  :  a  fmall  portion  of  the  coecum  was  red,  and  a  ftill  larger  of  the  redtum. 
The  fpleen  was  rather  thicker  than  it  ought  to  be  naturally,  the  liver  fome- 
what  hard,  and  of  a  palifh  colour ;  and  in  the  gall-bladder  was  a  fomewhat 
vifcid  bile,  which  was  of  a  dirty  green.  The  urinary  bladder  was  half-full, 
and  had  pretty  thickifh  coats.  In  the  bottom  of  the  abdominal  pelvis  was 
as  much  water  as  a  glafs  of  a  moderate  fize  would  contain ;  and  this  water 
was  bloody,  but  whether  from  the  difledtion  or  not,  is  perhaps  doubtful. 

In  each  of  the  thoracic  cavities  was  as  much  water  of  the  fame  kind.  The 
heart,  externally,  had  but  little  fat,  and  in  the  ventricles  were  polypous 
concretions.  The  valves  which  are  plac’d  at  both  the  venous  orifices  of  the 
heart,  were  here  and  there  pretty  much  thicken’d,  and  at  the  fame  time 
were  found  to  be  hard  and  whitifh.  In  like  manner,  the  aorta,  from  the 
heart  quite  to  that  part  where  it  begins  to  adhere  to  the  vertebras,  fhew’d, 
internally,  fome  white  fpots,  lying  at  a  diftance  from  each  other,  that  were 
the  firfi:  marks  of  a  future  oflification. 

The  upper  part  of  the  cranium,  which  was  pretty  thick,  and  the  dura 
mater,  in  whofe  finufles  fomething  of  a  polypous  concretion  was  obferv’d, 
being  remov’d  from  the  fubjedted  pia  mater,  the  vefiels,  in  this  membrane, 
appear’d  to  be  diftended  with  blood,  but  not  greatly ;  and  under  the  fame, 
about  the  fulci  of  the  cerebrum,  was  a  limpid  water,  and  in  it  were  contain’d 
many  bubbles  of  air  i  notwithftanding  it  was  at  the  time  of  the  year  l  men¬ 
tion’d  to  you,  and  fcarcely  the  fixth  day  after  death.  In  the  lateral  ventri¬ 
cles  alfo  was  a  pretty  large  quantity  of  limpid  water,  and  the  choroid  plex- 
ufles  were  pale.  And  while  I  rais’d  them  up  gently,  and  backwards,  I  per¬ 
ceiv’d  that  part  of  the  pineal  gland,  which  was  connected  to  them,  to  be 
cover’d  with  a  yellow  fubfiance,  which  indeed  feem’d  foft  in  itfelf ;  but  if 
you  rubb’d  it  between  your  fingers,  it  was  evidently  of  a  fandy  kind  of  fub¬ 
ftance.  The  brain  was  firm  under  the  knife,  but  all  the  medullary  fubftance 
that  was  beneath  the  fornix,  and  the  nerves  themfelves,  were  extremely  lax. 

(q)  Epift.  29.  n.  20. 


36.  You 


Letter  XIV.  Article  36,  37.  349 

3 6.  You  fee  therefore,  to  omit  here,  thofe  things  which  are  confider’d  in 
other  places ;  that  neither  by  confent  alone,  nor  from  vapour,  the  fpirits 
and  the  brain  were  here  affedted ;  nor  did  this  man  die  convuls’d,  notwith- 
ftanding  he  had  been  feiz’d  with  an  aphonia,  when  he  was  drunk  ;  and  his 
voice  had  not  return’d  at  the  time  when  his  drunkennefs  fhould  have  gone  off. 

But  what  time  fhall  we  fay  this  was  ?  I  know  that  in  the  books  of  Hip¬ 
pocrates,  fometimes  one  time,  and  fometimes  another,  is  pointed  out :  yet 
I  alfo  know,  that  in  the  fecond  book  De  Morbis,  which  generally  goes  along 
with  them,  it  is  laid  (r),  “  If  any  one  is  depriv’d  of  his  voice  from  drunken- 
“  nefs, — and  a  fever  does  not  immediately  attack  him,  he  dies  on  the  third 
“  day  fo  that  it  would  feem  to  follow,  that  the  drunkennefs  fhould  go  off, 
at  lead,  in  three  days.  Yet  it  is  natural  to  believe  Heurnius  ( s ),  when  he 
reminds  us,  “  that  Galen  indeed  fays,  drunkennefs  goes  off  on  the  fecond  or 
“  third  day,  for  the  Greeks  us’d  a  heavy  wine  ^  but  that,  in  other  places, 
“  drunkennefs  continued  only  fix  or  feven  hours-,  neverthelefs,  regard  was  to 
“  be  had  to  the  power  producing  the  effedt,  and  the  body  on  which  the  effedt 
“  was  produc’d  that  is,  as  he  had  juft  before  faid,  “  that  drunkennefs 
“  would  be  fooner  or  later  carried  off,  according  to  the  ftrength  or  quality 
“  of  the  wine,  the  peculiar  nature  of  the  patient,  the  time,  and  the  place  of 
“  the  debauch.”  You  will  find  the  celebrated  Ray  mannus  (/)  perfedtly 
agreeing  with  Heurnius,  as  that  author  relates  the  manner  in  which  he  had 
lav’d  a  patient  that  had  an  aphonia  from  drunkennefs,  and  was  already  at 
times  agitated  with  convulfions.  On  the  other  hand,  Littre  («)  diffedted  a. 
woman,  who  died,  within  twelve  hours,  of  drunkennefs,  not  without  a  flight 
fever,  and  convulfions  :  and  as  he  has  taken  notice  of  the  deprav’d  confti- 
tution  of  moft  other  parts,  even  in  fo  fhort  a  time,  fo  it  were  to  be  wifh’d, 
that  he  either  could,  or  would,  have  made  known,  what  wa3  the  condition 
of  the  brain  at  that  time  (x). 

37.  But  now  I  have  a  mind  to  give  you  fome  account  of  a  cafe  of  a  far 
lefs  violent,  and  very  fhort  aphonia,,  which,  when  I  was  a  young  man,  and 
refided  in  my  native  place,  I  had  the  care  of,  together  with  two  older  phy- 
ficians,  with  whom  that  nobleman,  count  Alexander  Monfignani,  would  have 
me  affociated,  in  the  treatment’of  the  diforder.  He,  being  more  than  fixty 
years  of  age,  {lender,  bilious,  and  us’d  to  fpeak  with  a  deep  voice,  as  the 
phrafe  is,  and  having  been  before  fubjedt  to  ftrangury,.  gout,  and  hasmor- 
rhoidal  fluxes,  and  then  being  entirely  free  from  all  thefe,  and  even  having 
been  feiz’d  with  no  rheum  in  the  lalt  winter,  which  had  us’d  to  affedt  his 
fauces,  frequently,  in  the  winter-time,  attended  with  much  fpitting began 
a  little  before  the  beginning  of  May,  without  any  previous  manifeft  caufe, 
to  be  feiz’d  with  an  interception  of  voice,  and  partly  of  refpiration  alfo  fo 
that  there  was  a  fenle  of  conftridtion  about  the  larynx,  and  no  where  elfe. 
This  diforder  fuddenly  came  on,  and  fuddenly  went  off,  without  any  ex¬ 
cretion  whatever.  The  time  of  its  attack,  and  the  time  of  its  continuance, 

(u)  Hift.  de  l’Acad.  R.  des  Sc.  a.  1706* 
Obf.  Anat.  5.* 

(x)  De  hoc  Aphonia:  genere  vid.  epift.  63. 
n.  x 3,  14. 


(r)  N.  22. 

(j)  In  cit.  Aphor.  n.  5. 

(/)  Ad.  N.  C.  tom.  6.  obf.  1. 


were 


350  Book  I.  Of  Difeafes  of  the  Head. 

were  various  :  for  its  continuance,  at  moft,  did  not  exceed  the  fpace  of  two 
minutes  ;  and  was  very  often  (till  fhorter.  And  although  almoft  every  night, 
about  the  feventh  hour,  this  diforder  came  on ;  yet  it  fometimes  came  on, 
likewife,  in  the  day-time,  from  gaping,  fneezing,  or  coughing,  not  always  in¬ 
deed,  but  perpetually  by  the  a&ion  of  drinking,  if  wine  only  was  drunk ; 
but  nor  if  water,  oil  of  almonds,  whey,  emulfions,  or  other  liquors,  recom¬ 
mended  by  us,  were  taken  down.  And,  indeed,  he  had  been  us’d  to  fuffer 
fomething  of  the  lame  kind  before  alfo,  when  he,  who  was  a  fober  man,  us’d 
wine  at  his  table,  as  the  cuftom  is,  although  it  was  a  much  fhorter  and  (lighter 
inconvenience.  But  now  the  diforder  was  as  I  have  delcrib’d  it ;  nor  could 
the  patient,  when  he  was  feiz’d  therewith,  take  any  thing  in  his  mouth,  nor 
(land  in  one  place,  but  was  compell’d  to  walk.  However,  his  head,  his 
thorax,  and  abdomen,  in  like  manner,  and.  his  neck,  if  you  felt  them  with 
your  hand,  as  the  pulfe  alio,  were  very  natural  and  well  The  tonfils  only, 
and  their  neighbourhood,  appear’d,  in  a  manner,  half-inflam’d  ;  and  there 
was  a  great  quantity  of  difcharge  by  fpitting,  the  tafte  of  which  was  mani- 
feftly  acid  to  the  perception  of  the  patient  :  and  the  more  eafy  expectoration 
of  this  matter,  occasion'd  by  fucking  barley- fugar,  as  it  is  commonly  call’d, 
l'eem’d  fometimes  to  prevent  the  invafion  of  the  diforder.  It  was  molt  pro¬ 
bable,  that  the  membrane,  with  which  the  upper  part  of  the  larynx,  and 
the  parts  bordering  thereon,  are  cover’d,  being  endow’d  with  fo  much  a  more 
exquilite  fenfe,  from  being  affeCled  with  a  kind  of  phlogofis,  when  it  was 
a  little  more  fharply  than  ufnal  irritated  by  the  acid  particles,  either  of  the 
wine,  or  of  the  moifture,  from  gaping,  fneezing,  coughing,  or  even  fome¬ 
times  by  the  quantity  itfelf,  which  was  prefs’d  out  plentifully  from  the  glands 
that  lay  about  thofe  parts,  and  which  was  greatly  vitiated  by  ftagnation  in 
them  ;  it  is  probable,  that  this  membrane,  I  fay,  was  by  thefe  means  con- 
traded,  and  crifp’d  up,  and  drew  the  nerves  and  mufcles  into  confent,  fo 
that  they  conftring’d  the  larynx  much  more  ftreightly  than  common  j  and 
that  fo  much  the  more  eafily,  as  they  were  by  nature  already  fomething  prone 
thereto  •,  and  perhaps  even  {till  more  prone  from  the  hypochondriac  affebtion, 
which  the  flux  of  blood,  by  the  haemorrhoids,  had  indicated.  And  this  fup- 
pofition  was  confirm’d  by  the  event.  For  having  gently  cleans’d  the  primae 
viae,  and  taken  away  blood  fparingly,  firft  from  the  arm,  and  then  from  the 
fundament,  whence  it  us’d  to  be  difcharg’d  by  nature,  formerly,  as  I  faid 
before,  and  at  the  fame  time  giving  fuch  medicines  internally,  as  might 
foften,  relax,  dilute,  and  in  the  mean  while  correCt,  the  acid  favour,  he  was 
entirely  free  from  the  attack  of  his  aphonia  many  nights  together,  and  it 
came  upon  him  much  more  fcldom  than  ufual  in  the  day-time  :  fo  that  we 
recommended  to  him  the  taking  of  a  fhort  journey,  after  which  his  fpittings  , 
were  much  diminifh’d  in  quantity,  and  became  leis  acid,  and  he  could  bear 
wine  diluted  with  water  and,  not  to  ufe  many  words,  within  the  fortieth 
or  fiftieth  day,  from  the  time  he  had  begun  the  regimen,  without  any  fear 
of  a  more  violent  or  longer  diforder,  or  at  lead  without  any  fear  of  this 
difordef  returning,  the  aftedtion  was  quite  overcome,  and  remov’d.  Give 
me  leave  juft  to  add  here,  and,  at  the  fame  time,  leave  you  to  judge  as  you 
may  think  proper,  of  what  this  very  patient,  who  was  a  grave  man,  aliened 
he  had  formerly  feen  in  a  nobleman  at  Rome,  who  was  ieiz’d  with  a  fimilar 

diforder  j 


Letter  XIV.  Article  38.  351 

diforder  ;  to  wit,  that  his  diforder  was  accuftom’d  to  be  remov’d,  if  any  body 
breath’d  into  his  ear.  But  it  muft,  at  leaft,  have  been  a  very  different  af¬ 
fection ;  nor  would  our  patient  have  fent  for  three  phyficians  to  attend  him, 
if  he  could  have  been  cur’d  by  fo  eafy  a  remedy. 

38.  1  muft  alfo  add  fomething  upon  Hammering.  For  in  the  twenty-firft 
obfervation  our  SanCtorius  is  quoted  as  faying  thefe  things  (y)  :  14  That  there 
44  are,  in  the  middle  region  of  the  palate,  that  is,  in  the  fourth  bone  of  the 
“  upper  jaw,  in  all  whom  he  had  feen  to  that  time,  who  could  not  exprefs 
“  the  letter  R,  two  foramina,  which  are  by  no  means  found  open  and  ob- 
44  vious  in  thofe  who  are  under  the  influence  of  this  difeafe  *,  therefore,  that 
44  the  immediate  caufe,  which  fuppofes  others  granted,  will  be  thofe  two 
44  paffages  being  open.”  Nay,  truly,  not  being  open,  any  one  would  lay, 
who  fhould  read  this  paffage  with  any  tolerable  care,  and  at  the  fame  time 
attend  to  the  argument  prefix’d  to  the  obfervation,  which  is  this,  14  That 
44  Hammering  depends,  fometimes,  on  the  defedt  of  the  foramina  of  the 
44  fourth  bone  of  the  upper  jaw.”  But  if  he  fhould  examine  the  palfage,  in 
SanClorius  himfelf,  he  would  find  that  he  has  written  the  very  contrary  to 
thefe  things :  for  he  fays,  that  he  had  feen,  in  perfons  who  Hammer’d,  thofe 
two  foramina,  44  which  are  by  no  means  found  fo  open  and  obvious  in  thofe 
44  who  are  free  from  this  diforder  *  wherefore,  the  immediate  caufe,  which 
44  fuppofes  others  granted,  will  be,”  fays  he,  4i  thefe  two  meatus,  or  foramina, 
44  more  open  than  they  ought  to  be.”  See,  I  befeech  you,  with  what  care- 
leflhefs  the  words  of  authors  are  fometimes  copied  :  yet  this  is  the  paffage 
of  the  Sepulchretum,  with  a  view  to  which  very  excellent  men  have  written, 
44  That  SanClorius  had  attributed  Hammering  to  the  defect  of  the  duCtus  in- 
44  cifivus,  in  the  Sepuichretum  of  Bonetus,  I.  p.  +73.”  But  if  they  had  chofen 
rather  to  look  into  the  chapter  of  SanCtorius,  which  is  quoted  in  the  fame 
place  (2),  without  doubt,  they  would  neither  have  believ’d  that,  nor  would 
have  underftood  the  duCtus  incifivus.  For  SanCtorius,  a  little  below,  adds 
thefe  words :  44  As  I  faid  that  in  t'he  middle  region  of  the  palate,  two  fora- 
44  mina  were  obferv’d,  which  are  the  caufes  of  Hammering,  fo,  in  like  man- 
44  ner,  I  oblerve  larger  foramina,  near  the  teeth,  (yet  in  all  thefe  perfons, 
44  congenial  with  their  original  formation)  through  which  a  pituita  diftilling 
44  and  moiftening  the  tongue,  on  its  anterior  part,  makes  an  impediment  in 
44  the  fpeech,  from  whence  they  become  lifping  and  fhort-tongu’d  fo  evi¬ 
dent  is  it,  that  from  the  meatus  being  very  open  behind  the  dentes  incifores, 
he  had  accounted  for  the  habit  of  lifping  only,  and  not  that  of  Hammering, 
of  which  the  queftion  is  in  this  obfervation  :  and  how  thefe  two  kinds  of  im¬ 
pediment  to  the  fpeech  differ  one  from  another,  the  learned  fcholia  to  the 
next  and  twenty- fourth  obfervation,  will  fhew. 

You  will  afk  here,  why  this  fecond  obfervation  of  Sandorius  is  omitted 
in  the  Sepulchretum,  whereas  the  firft  is  given  there,  though  erroneoufly  ? 
And  in  like  manner,  what  can  thefe  two  foramina  be  then,  in  that  fame 
fourth  bone,  and  in  the  middle  region  of  the  palate,  which  are  more  open 
in  perfons  who  Hammer  than  in  others  ?  And  at  length,  how  much  regard 

(yj  Se£t.  2.2.  (z)  Meth.  vitand.  error.  1. 3 .  c.  9. 


6 


15 


3  j  2  Book  I.  Of  Difeafes  of  the  Head. 

is  to  be  paid  to  thefe'  obfervations  of  Sanctorius  ?  I  do  not  doubt  but  it  was 
owing  to  the  fame  carelefihefs  which  perverted  the  firft,  that  the  fecond  was 
omitted. 

And  as  to  the  foramina  in  that  middle  region  of  the  palate,  I  do  not  re¬ 
member  to  have  feen  any  thing  of  them  in  the  many  dry  and  prepar’d  heads 
that  I  have  examin’d ;  nor  do  I  at  this  prefent  time  fee  any  fuch  thing  in  any 
of  thefe  heads  which  I  have  before  me  now,  while  I  write ;  nor  yet  fhould 
I  eafily  believe,  that  in  fo  great  a  number  of  heads,  as  have  come  into  my 
hands,  I  never  happen’d  to  light  on  one  that  had  belong’d  to  a  ftammerer, 
in  which,  doubtlefs,  I  fhould  have  feen  thefe  foramina  very  plainly,  inaf- 
much  as  they  were  very  open,  and  obvious  in  them,  though  in  others  very 
obfeure. 

But  although  it  is  natural  to  fufpect,  that  what  Sandtorius  had  by  chance 
obferv’d,  in  fome  Hammerers,  he  had  transferee!  to  ail ;  and  although  diffi¬ 
culties  are  not  wanting  to  prevent  our  aflenting  thereto,  from  reading  his 
words,  and  even  from  the  very  things  that  he  fays,  in  confirmation  of  what 
he  advances  for  he  confefles,  that  even  they  in  whom  the  mouth  naturally 
and  conftantly  overflows  with  pituita,  are  not,  for  that  reafon,  ftammerers, 
nor  lifpers ;  yet  on  account  of  his  well-known  excellence  in  other  matters,  it 
will  be  more  juft  and  fair,  I  think,  not  to  pronounce  any  thing  abfolutely 
on  the  point,  before  the  queftion  fhall  have  been  accurately  canvals’d  by 
fkilful  anatomifts,  who  have  examin’d  the  heads  of  many  ftammerers  and 
lifpers  to  this  purpofe. 

So  the  celebrated  Delius  (a),  having  found  a  double  uvula  in  a  certain 
perfon,  who  had  been  a  ftammerer,  very  prudently  admonifh’d  anatomifts, 
that  they  fhould  enquire,  whether  other  perfons  who  Hammer  have  any  fault 
or  diforder  about  the  uvula,  or  tonfils.  And  if  this  were  done,  .1  conjecture, 
being  induc’d  thereto  by  very  probable  arguments,  it  would  be  found,  that 
even  in  him  who  was  a  ftammerer,  the  impediment  could  not,  juftly,  have 
been  imputed  to  the  double  uvula.  For  there  are  many  examples  extant 
of  this  duplication,  which  you  know  1  have  pointed  out,  on  a  former  occa- 
fion(i>)  ;  nor  Zerbus;  nor  thofe  whom  Slevogtius  commends-,  nor  I  myfelf, 
at  leaft  in  that  perfon  whom  I  diflfedted  at  Bologna,  have  heard  any  thing 
of  an  impediment  of  this  kind,  in  the  fpeech,  notwithftanding  almoft  all  of 
us  enquir’d  diligently  what  inconveniences  had  attended  this  duplication  of 
the  uvula :  and  without  doubt  that  Lucretia  of  Zerbus,  if  fhe  had  pronounc’d 
vitioufly  in  this  way,  would  never  have  given  herfelf  up  to  the  art  of  flinging, 
nor  would  have  “  delighted  very  much,”  in  the  practice,  as  he  himfelf  tefti- 
fies  that  fhe  did. 

But  it  is  a  very  fuppofable  cafe,  that  ftammering  may  fometimes  arife 
from  confiderable  defeats  about  the  os  hyoides :  and  indeed  I  find  the  very- 
learned  Hahnius  has  advanc’d  this  doctrine  (r)  ;  that  from  the  figure  of  this 
bone  being  deprav’d,  “  perfons  become  ftammerers,  lifpers,  and  dumb.” 
Nor  indeed  does  it  feem  pofiible,  that  the  directions  of  the  mufcles  which 
move  the  tongue  can  be  chang’d,  without  making  the  motions  of  the  tongue, 

J 

(a)  A<5t.  N.  C.  Tom.  8.  obf,  106.  (c)  Commere.  Litter.  A.  1736.  Hebd.  31. 

{1)  Epift.  Anat.  10.  n.  21.  n.  1.  ad  $  25. 

4 


in 


Letter  XIV.  Article  38.  3  y  3 

in  Tome  meafure,  deviate  from  the  law  of  nature.  And  if  Kerch ringi us  (d) 
had  written  what  was  true,  concerning  the  os  hyoides,  when  he  fays,  “  that 
“  in  foetuffes,  not  fo  much  as  a  cartilage  of  it  appears  I  fhould  not  have 
doubted,  but  it  was  for  this  reafon,  that  little  children  begin  to  fpeak  very- 
late  after  their  birth ;  and  when  they  have  begun,  “  attempt  only  half-words,” 
or  “  fpeak  their  words  ftammeringly,”  as  Minucius  Felix  (?),  and  Albius  Ti¬ 
bullus  (/),  have  faid,  in  order  to  exprefs  their  manner  of  lpeaking.  But  the 
illuftrious  Albinus  (g)  fufficiently  fnews,  how  late  this  bone,  which  is  the 
fulcrum  of  the  tongue,  and  fome  of  its  mufcles,  becomes  perfc&ly  compleat 
on  all  fides,  and  entirely  bony. 

And  to  our  Molinetti  it  leem’d  (&),  “  that  the  infant  did  not  fpeak  imme- 
cc  diately  after  it  was  born,”  for  this  reafon,  becaufe  the  ftyliform  procefs, 
from  which  the  ftyloglofius,  and  ftylohyoideus  mufcles,  take  their  origin, 
<c  does  not  appear  in  a  foetus.”  Which  if  you  underftand,  fo  as  to  believe, 
that  he  denied  the  exiftence  of  this  procefs  in  a  foetus  •,  he  certainly  has  blun¬ 
der’d,  as  Cafiebohmius  teftifies  (i),  that  he  had  feen  it  in  a  foetus  of  four 
months,  and  Kerckringius  (k)  even  in  a  foetus  of  three  months.  But  if  you 
fo  underftand  it,  that  by  reafon  of  the  ftendernefs  and  flexibility  of  the  car¬ 
tilage,  he  did  not  confider  it  of  any  greater  advantage  in  its  prefent  condi¬ 
tion,  particularly  in  order  to  fix  fteadily,  the  origin  and  adtion  of  the  muf¬ 
cles,  than  if  there  had  been  none  at  all  ;  you  may  by  this  means  fufficiently 
protedl  his  afiertion,  from  what  I  faw,  when  I  read  over  this  letter  again, 
would  be  objected  to  his  opinion,  taken  from  a  very  Angular  obfervation  of 
that  moft  excellent  author  Haller  (/).  For  he,  in  a  man  who  was  about  fifty 
years  of  age,  and  who  had  never  labour’d  under  the  lead  impediment  in  his 
1’peech,  found  the  ftyliform  procefs  of  the  length  of  an  inch  and  half,  being 
bony  in  the  lower  half  of  it,  and  in  the  upper  part  of  it  cartilaginous.  But 
you,  to  omit  this  fuppofition,  that  in  the  man  whom  Haller  oblerv’d,  the 
mufcles  we  fpeak  of  might  poflibly  have  their  origin,  in  part,  from  the 
neighbouring  temple  bone,  as  both  Valfalva(w)  and  I  (»)  have  fometimes 
found  its  fellow,  the  ftylopharyngteus,  taking  its  origin  •,  you  certainly  un¬ 
derftand,  that  the  cartilage,  which  according  to  the  increafe  of  years,  was  fo 
much  thicker  and  ftronger,  ought  not  to  be  compar’d  with  that  which  Mo¬ 
linetti,  in  confequence  of  its  being  fo  (lender  and  foft,  confider’d  as  none  at 
all,  in  new-born  infants :  and  you  know’,  at  the  fame  time,  to  what,  and  to 
how  many  mufcles,  fome  of  the  cartilages  of  the  larynx  give  origin.  But  in 
regard  to  this  defence  of  Molinetti,  you  yourfclf  will  determine. 

I  indeed  think,  that  from  what  caufes  foever  the  Hammering  of  little  chil¬ 
dren  is  to  be  accounted  for,  it  may  be  imputed  to  many  more  caufes,  than 
thole  which  are  made  mention  of ;  and  I  believe  that  from  the  fame  caufes, 
the  Hammering  of  adults  arifes,  as  often  as  ever  it  happens,  that  the  increafing 
age  cannot  overcome  one,  or  more,  of  thefe  caufes.  And  it  will  certainly 


(A  Olleogen.  c.  i  x. 

(e)  in  Odlavio. 

(f)  1.  2.  Eleg.  5.  v.  94. 

(g)  Icon.  Off.  Feet,  ad  Fig.  152. 

(h)  Differt.  Anat.  Pathol.  1.  2.  c.  1, 
{ t )  De  Aure  Hum.  tr.  x.  §  43. 

VOL.  I. 

V. 


(A  OReogen.  c.  5. 

(/)  in  Differt.  Willigii  infeript.  obf.  Botan, 
&c.  §  2. 

(w,)  Vid.  Epift.  Anat.  11.  n.  4. 

(«)  Ibid.  n.  8* 


Z  z 


be 


354  Book  I.  Of  Difeafes  of  the  Head. 

be  of  advantage  to  enquire  into  thefe  caufes,  in  young  children,  fince,  from 
the  univerfal  Hammering  among  them,  it  will  be  more  eafy  to  obferve  the 
caufes  of  it,  fo  that  we  may  endeavour  to  diftinguifh  them  more  fagacioufiy, 
in  adults,  and,  as  far  as  it  can  be  done,  fometimes,  to  diminilh,  or  remove 
them. 

39.  Laftly,  as  to  what  relates  to  the  twenty-third  fedion,  which  is  on  the 
angina,  it  is  very  lurprifing,  that  no  obfervation  is  produc’d  in  this  whole  fec- 
tion,  of  that  molt  violent  and  frequent  diforder  of  the  larynx,  and  the  neigh¬ 
bouring  fauces,  from  which  it  may  appear,  what  has  been  found  in  thofe  who 
have  died  of  a  true  angina.  For  lome  of  thofe  obfervations  that  are  produc’d 
relate  to  the  lungs,  or  to  thefe,  and  the  gland  thymus,  being  huff’d  up  with 
blood  j  the  firft  of  which,  by  their  weight,  drew  the  afpera  arteria  down¬ 
wards,  and  the  latter,  by  its  encreas’d  bulk,  comprefs’d  it;  others  relate  to 
the  diforders  of  the  brain,  or  of  other  parts ;  fo  that  any  perfon,  who  was 
unexperienc’d,  might  fufped,  whether  this  diforder  ever  belongs  to  the  la¬ 
rynx  and  fauces.  But  certainly  in  the  angina,  an  external  tumour  often 
about  the  fauces,  or  an  internal  tumour,  as  I  have  more  than  once  feen, 
and  have  order’d  to  be  cautioufly  incis’d,  as  it  already  contain’d  pus,  and  in 
the  larynx  alfo,  that  which  was  the  firft  caufe  of  performing  the  operation 
of  laryngotomy,  as  it  is  call’d,  are  fufficient  proofs  of  an  angina  exifting, 
from  an  inflammation,  which  occupies  thofe  parts  above  mention’d  ;  and 
indeed,  topafs  over  the  mufcles,  by  which  the  arytenoid  cartilages  are  brought, 
dole  to  each  other,  unlefs  you  can  fuppofe,  that  the  glands,  which  moilten- 
the  larynx,  are  entirely  free  from  thofe  diforders,  which  happen  to  other 
glands  of  the  fame  kind  ;  it  will  plainly  appear  that  it  cannot  be  other wife^ 
but  that  inflammations,  fometimes,  and  thofe  of  the  moft  dangerous  kind, 
feize  upon  our  arytenoid  glands,  for  inftance,  by  the  fwelling  of  which  the 
air-pafiage,  that  is  there  naturally  narrow,  mull  be  fhut  up,,  or  of  courle 
much  obftruded. 

However,  I  do  not  fay  this,  becaufe  I  believe  that  you  think  otherwife  ;; 
but  for  this  reafon  only,  that  you  may  underftand  this  to  be  one  of  thofe  dif¬ 
orders,  the  feats  of  which  are  peculiar,  and  fometimes  more,  fometimes  lefs, 
dangerous  in  their  nature  and  effeds  and  though  every  one  of  thefe  cir- 
cumftances  ought  to  be  enquir’d  into  with  earneftnefs,  and  care,  yet  that  > 
they  do  not  feem  to  be  enquir’d  into  by  difiedion,  fo  much  as  the  feats, 
caufes,  nature,  and  efleds  o!  other  diforders  are(o).  And  this  has  not  been 
done  by  me  for  this  reafon,  becaufe  J  once  had  not  time  to  difled.  a  perfon 
who  died  of  the  true  angina  ;  and  ever  fince  that,  I  have  not  had  it  in  my 
power,  for  want  of  fubjeds  who  died  of  the  diforder  (p) :  but  with  the  fpu- 
rious,  perhaps,  who  certainly,  however,,  did  not  die  from  this  caufe,  I  dif- 
feded  one  or  tw.o.  What  I  obferv’d  in  the  fauces  and  larynx  of  thefe  patients, 
you  will  read  over  again  in  the  fourth  letter  I  fent  you  (q) ;  and  yon  may,  in 
fome  meafurc,  refer  to  the  true  angina,  thofe  things  of  which  I  made,  men-? 
tion  when  I  wrote  on  the  hydrophobia  (r).  Farewel. 

(q)  n,  24.  &  reqq-. 

(r)  Spilt.  8,  n.  1 9.  &  feqq. 


f 


(0)  Vid.  tamen  Epift.  63.  n.  16.  &  feq. 
(/)  Sed  vid.  Epift»  44.  n.  3, 


THE 


THE 


SEATS  and  CAUSES 

O  F 


DISEASES 


INVESTIGATED  BY  ANATOMY. 


BOOK  the  SECOND. 


Of  DISEASES  of  the  THORAX. 


'Z  z  a 


LETTER  the  FIFTEENTH 


Is  written  upon  the  Diforders  of  Refpiration,  particularly^ 
from  Caufes  plac’d  on  the  Outlide  of  the  Cheft  ;  and 
alfo  from  fuch  as  are  fituatecl  within  the  Lungs,  but 
efpecially  from  Calculi. 

I.  LTHOU GH  the  parts  in  the  thorax  are  much  fewer  in  number 

than  the  parts  of  the  head,  nor  is  there  any  of  thefe  parts,  whofe 
A.  jL  ftrudture  and  offices  are  fo  involv’d  in  darknefs  and  obfcurity,  as 
thofe  of  the  brain  are;  yet  among  thefe  few  parts,  there  is  fo  great  a  con- 
jundtion,  either  by  reafon  of  their  vicinity,  or  connexions,  or  offices,  that  if' 
one  is  injur’d  or  affedted,  the  others  alfo  are  injur’d  or  affedled  by  confent. 
And  this  circumflance  would  create  a  difficulty  to  me,  and  that  frequently 
infuperable,  not  only  in  feparating  the  principal  difeafe  from  the  others  that' 
are  join’d  with  it,  but  alfo  in  determining  the  firft  and  chief  feat  of  fuch 
difeafe,  if  I  were  not  writing  to  you,  who  will  require  nothing  more  of  me, 
on  this  fubjedt,  than  probable  conjedtures,  as  you  have  generally  done  on 
other  occafions.  This  will  appear  moft  evident  of  all,  in  the  cafe  of  injur’d 
refpiration,  upon  which  lubjedt  the  firft  fedtion  of  the  fecond  book  of  the 
Sepulchretum  Anatomicum  turns.  For  befides  that  the  difeafe  producing 
this,  may  exift  in  the  lungs,  and  at  the  fame  time  in  another  part  of  the 
cheft,  it  fometimes  happens,  that  it  may  exift  in  the  lungs,  and,  at  the  fame 
time,  in  another  part,  on  the  outfide  of  the  cheft,  as  in  the  head,  the  neck,, 
and  the  belly.  And,  indeed,  Boerhaave  went  fo  far  as  to  fay  (a),  “  that 
“  fcarcely  any  particle  remain’d  in  the  body,  which  was  not  more  or  lets 
“  concern’d  in  the  bufinefs  of  refpiration;”  and  he  fubjoins  with  great  juftice, , 
w  that  the  great  number  of  the  organs,  which  concur  to  the  performance  of 
this  adtion,  any  one  of  which  being  injur’d,  difturbs  the  whole  function, 
41  creates  the  higheft  difficulty  in  dileafes,  as  in  the  mean  while,  it  is  very 
u  difficult  to  know,  which,  cut  of  the  whole  number,  is  primarily,  and  par.— 
u  ticularly  injur’d.” 

(a)  Prseleft.  ad  Iuflit,  §  601. 

1  Zi  No ®r 


3  p  8  Book  II.  Of  Difeafes  of  the  Thorax. 

2.  Nor  could  any  other  caufe,  I  fuppofe,  induce  Bonetus  exprefsly  to  in- 
ferr,  up  and  down  in  this  fecftion,  not  only  lo  great  a  number  of  obfervations, 
which  belong,  m  like  manner,  to-  other  febtions,  but  even  the  fame  over 
again  and  again,  except  that  each. of  them  did  not  comprehend  the  diforder 
of  one  part ;  although  he  repeated  fo  many,  that  if  you  compare  them  one 
with  another,  he  feems  to  have  done  it  much  more  frequently  from  care- 
lefsnefs  than  from  defign :  for  compare  the  fixteenth  oblervation,  and  the 
hundred  and  fourth  i  the  appendix  to  obfervation  the  feventy-eighth,  and  ar¬ 
ticle  the  feeond  of  obfervation  feventy-feven  (and  left  you  fhould  doubt, 
whether  thefe  be,  in  fatft,  one  and  the  fame  obfervation,  turn  to  fedlion  the 
feventn  of  this  feeond  book,  obfervation  ninety-one)  j  the  feventy-feventh, 
article  the  laft,  and  the  hundred  and  fifteenth  ;  the  eighty- ninth,  article  the 
twelfth,  and  hundred  and  twelfth  ;  the  hundred  and  fortieth,  article  thirteen, 
and  the  hundred  and  forty-fifth,  article  three.  But  thefe  are  at  a  diftance 
from  each  other  j  fo  that  the  author’s  memory  might  much  more  eafily  fail 
him,  and  efpecially  in  fo  great  a  number.  But  you  may  alfo  fee  the.  repe¬ 
tition  of  thole  that  are  very  near  to  each  other.  Compare,  therefore,  the 
xorty-feventh,  and  the  forty-ninth  ;  the  fixty-fourth,  article  fix,  and  fixty- 
fifth  •,  the  feventh,  article  eight,  and  eighty-eighth  ;  the  hundred  and  thirty- 
ninth,  and  hundred  and  fortieth,  article  fix  ;  the  hundred  and  forty-third, 
and  the  hundred  and  forty-fixth,  both  of  which  relate  to  the  fame  woman, 
as  you  will  fee  in  the  twenty-firft  fection  of  the  third  book,  under  obfervation 
the  forty-eighth.  And  the  fame  feftion,  obfervation  the  fourth,  article  the 
ninth,  will  plainly  fhew,  that  it  is  not  another  woman,  whofe  cafe  is  here 
pointed  our,  obfervation  hundred  and  fifty-five,  article  four  and  article  ten. 
And  what  will  you  fay  to  this,  that  one  is  four  times  repeated,  not  only 
amongft  the  obfervations  which  are  diftant,  but  amongft  thole  that  are  near 
to  each  other  :  for  fee  article  four,  under  obfervation  the  forty-fixth,  (I  mean 
the  former,  for  foon  after,  through  careiefinels,  another  obfervation  is  mark’d 
with  the  fame  number)  and  immediately  read  obfervation  the  hundred  and 
twenty-eighth,  and  after  this,  in  obfervation  the  hundred  and  fortieth,  article 
the  feeond,  and  in  the  fame  obfervation,  article  the  twelfth,  and  you  will 
eafily  perceive  whether  I  have  faid  the  truth,  or  not. 

But  who  would  not  fuppofe,  that  repetitions  were,  at  leaft,  avoided  in  the  „ 
additamenta  which  are*  fubjoin’d  to  this  firft  fedtion  ?  Yet,  if  you  compare 
the  third  obfervation  with  the  fixth,  you  will  perceive,  that  both  of  them 
are  only  one  and  the  fame.  And  this  you  will  evidently  lee,  if,  when  you 
have  read  the  eighteenth  obfervation,  article  one,  two,  and  three,  and  the 
icholium  that  is  added,  you  return  to  the  obfervations  which  Bonetus  himfelf 
had  given  us  under  number  ninety-three,  and  ninety-two,  except  that  the  laft, 
which  is  the  obfervation  of  Willis,  he  feems  to  have  aferib’d  to  Ballonius. 
But  the  nineteenth  is  alfo  the  fame  with  that  which  follows  next  in  Bonetus, 
the  ninety- fourth  i  as  if  the  queftion  were  only  of  copying  over  again,  in 
order,  thofe  which  are  already  given  above,  and  not  of  adding  new  ones : 
and  fo  far  are  the  readers  from  being  put  in  mind,  at  obfervation  the  thirteenth, 
and  twenty- fixth,  that  the  former  hiftory  feems  to  be  of  one  and  the  fame 
man,  taken  here  from  Dominic  de  Marchettis  •,  and  in  Bonetus  under  number 
hundred  and  four,  from  Peter  the  father  of  Dominic ;  nor  that  Stephanus 

Blancardus, 


6 


Letter  XV.  Articles  3,  4.  3 ff9 

Blancardus,  who  at  other  times  profefs’d  44  to  have  mix’d  up,  from  the  re* 
44  lation  of  others,5*  what  he  himfelf  had  not  obferv’d  ( b ),  that  he,  1  lay, 
had  not  taken  the  twenty-fixth  obfervation  from  any  other  fource,  than  from 
the  obfervations  publifh’d  fo  many  years  before  by  Riverius,  and  was  there¬ 
fore  the  fame  which  Bonetus  had  produc’d  before  Blancardus  under  number 
hundred  and  twenty-three  ;  unlefs  that  Bonetus,  indeed,  mention’d  Ri- 
verius’s  name,  nor  interpolated  his  words,  but  omitted  many  things  in  the 
hiftory  of  the  difeafe,  and  both  of  them  fome  circumftances  in  the  diffedtion 
of  the  body. 

3.  But  if  all  the  obfervations  of  this  fedtion  had  been  more  accurately  di- 
flributed  under  certain  heads,  the  reading  of  them  would  not  only  have  been 
more  ufeful  to  others,  but  it  would  have  much  lefs  eafily  happen’d  to  the 
eolledlors,  that  any  thing  fhould  flip  their  memories.  Since,  therefore,  it  is 
my  fix’d  refolution  to  repeat  nothing,  a  certain  order  is  requifite  here,  whereby 
to  deferibe  the  obfervations  of  Valfalva,  and  mine,  which  relate  more  to  the 
fubjedts  at  prelent  treated  of,  than  to  others.  For  although  I  had  many  be- 
fides,  in  which,  among  other  difagreeable  fymptoms,  that  of  injur’d  refpi- 
ration  is  alfo  taken  notice  of-,  yet  all  thole,  which  feem’d  to  be  more  re¬ 
ferable  to  other  fedtions,  to  other  fedtions  I  referr’d,  and  the  remainder  I 
plac’d  by  themfelves  here.  And  not  to  depart  from  the  fcheme  I  hinted  at 
above,  I  believe  it  will  not  be  improper  to  divide  them  in  the  following 
manner  :  that  is,  firft  to  produce  thofe  in  which  the  principal  caufe  of  in¬ 
jur’d  refpiration  is  on  the  outfide  of  the  thorax  then  thofe,  in  which  the 
principal  caufe  is  within  the  thorax  ;  and  of  thefe  again,  thofe  firft,  in  which 
it  is  in  the  lungs  ;  then,  finally,  thofe  in  which  it  is  within  the  thorax,  in¬ 
deed,  but  on  the  outfide  of  the  lungs. 

And  as  when  the  caufe  is  on  the  oufide  of  the  thorax,  it  has  its  feat  chiefly 
either  in  the  head,  the  belly,  or  the  neck,  1  chufe  to  begin  from  the  head. 

4.  Willis,  indeed,  has  greatly  illuftrated  the  dodtrine  of  the  medical  fchools,, 
in  regard  to  the  convulflve  afthma,  and  has  confirm’d  it  by  his,  own  obfer¬ 
vations,  taken,  in  particular,  from  thofe,  w7ho,  unlefs  they  always  kept  their 
heads  eredt,  or  prone,  became  44  immediately  panting,  and  breath’d  as  if 
44  they  were  juft  at  the  point  of  death,”  whenever  they  mov’d  their  heads 
backwards,  or  lay  down  fupinely  ;  and  that  from  no  other  caufe,  but  from 
a  great  quantity  of  acrid  ferum,  which  was  found  by  diffedtion  within  their - 
heads,  falling  down  towards  the  origin  of  the  nerves  which  go  to  the  lungs, 
while  they  reclin’d  their  heads,  in  the  manner  I  have  faid,  and  prefling  vehe¬ 
mently  thereon ;  as  you  will  know  from  the  hundred  and  forty-fourth  obfer¬ 
vation  of  this  firft  fedtion. 

But  it  would  have  been  much  better  for  Willis  to  have  omitted  what  you 
will  read  in  the  fcholium  fubjoin’d  to  the  fame  obfervation  j  1  mean,,  44  that 
44  the  ancient  pbyficians  had  acknowledg’d  only  the  firft  fpecies  of  afthma,. 
44  which  proceeds  entirely  from  the  air-carrying  dudts  being  obftrudled,  or 
“  not  being  fufficiently  open  but  that  they  had  been  entirely  ignorant  of 
the  other  fpecies,  that  is,  the  convulfive,  inafmuch  as  they  were  accuftom’d, 
in  afthmas  of  this  kind,  44  to  aferibe  them  to  vapours  from  the  fpleen,  •uterus,, 

( b )  In  Piaffat,  ad  Anat.  Pra£t,  Rational. 

44  mefentery^, 


3  60  Book  II.  Of  Difeafes  of  the  Thorax. 

44  mefentcry,  or  fome  one  of  the  other  vifcera,  without  anyjuftice  whatever.” 
But  to  pais  over  the  paffages  of  Galen,  and  even  of  Hippocrates,  and  what 
his  interpreters  have  written  upon  the  fixty-eighth  aphorifm  of  the  fourth 
.ledion,  (for  the  words  of  Avicenna,  which  I  have  likewife  feen  produc’d  (c), 
relate  to  an  aithma,  indeed,  44  from  the  nerves,  and  the  beginning  of  the 
44  fpinal  marrow,  and  the  brain,”  but  to  an  afthma  brought  on  by  “  a  ca- 
M  tarrh,”  and  not  by  a  convulfion)  I  will  appeal  here  to  no  other  teftimony 
than  thole  which  you  may  fee  in  the  Sepulchretum  itfelf.  See,  therefore, 
the  fcholia  to  the  next  obfervation  under  number  hundred  and  fixty,  and  alfo 
under  number  hundred  and  fixty-five.  For  in  the  fcholium  to  the  firft:  of 
thefe  obfervations,  the  queftion  being  of  the  orthopnoea,  from  a  calculus  of 
the  kidney,  Ballonius  fays,  44  The  caufe  of  this  fecondary  diforder  they  will 
*'•  have  to  be,  that  there  is  a  little  nerve  from  the  fixth  pair,  which  goes 
44  through  the  diaphragm,  and  creeps  on  quite  to  the  kidnies •,  and  this  being 
44  oppreis’d,  not  only  brings  on  a  fenfe  of  ftupor  in  the  oppofite  thigh,  but 
44  may  alfo  bring  on  fome  difficulty  of  refpiration  in  the  upper  parts.”  And 
in  the  fcholium  to  the  other  obfervation,  Platerus  fays,  44  The  larger  nerves, 
44  and  efpecially  thole  of  the  diaphragm,  which  proceed  from  the  medulla 
44  fpinalis  of  the  back,  being  feparately  and  folitarily  infefted  with  defluxions, 
44  or  other  diforders,  bring  on  a  kind  of  dyfpnoea  :  fuch  as,  in  afthmatic 
44  complaints,  I  have  obferv’d  immediately  to  attack  the  patient,  when  no 
44  other  marks  of  the  lungs  being  affedted  appear’d.”  Now,  then,  do  thefe 
ancient  phyficians  lpeak  of  vapours  in  this  place,  or  of  diforders  of  the 
nerves  ?  Or  do  they  feem  to  be  entirely  ignorant  of  any  other  fpecies  of 
afthma,  but  that  firft,  which  arifes  from  the  bronchia  being  obftrudted,  or 
comprefs’d  ?  See,  I  befeech  you,  what  Willis  himfelf  fays  in  the  fame  fcho¬ 
lium,  a  little  below  the  words  of  Platerus :  44  In  proportion  as  the  nerves 
44  of  the  diaphragm  are  prevented  from  rightly  performing  their  offices,  or 
44  their  offices  are  perverted,  difficult  refpiration  of  different  kinds  is  pro- 
44  duc’d.”  Did  not  Platerus  fay  the  fame  ?  And  below :  44  The  reafon  that 
44  a  difficult  refpiration  lucceeds,  now  and  then,  to  a  perturbation  of  the 
44  fpleen,  in  hypochondriac  perlons,  is,  that  the  fplenic  nerves  communicate 
44  with  the  pulmonary.”  And  is  difficult  refpiration  deduc’d,  by  any  other 
kind  of  explication,  from  the  pertubation  of  the  kidney,  by  Ballonius  ? 

I  confefs  I  am  ignorant,  by  what  method  Vefalius  would  have  explain’d, 
that  which  he  obferv’d  in  a  hydrocephalous  little  girl,  mention’d  in  the  former 
book  of  the  Sepulchretum  (<i),  44  that  as  often  as  the  head  was  mov’d  by 
44  thofe  who  were  about  the  girl,  and  was  a  little  rais’d,  although  but  flightly, 
44  immediately  a  violent  cough  was  troublefome  to  the  patient,  join’d  with  a 
44  difficult  refpiration.”  Yet  I  believe,  neverthelefs,  that  he  would  not  have 
accounted  for  this  appearance  from  vapours,  nor  from  a  catarrh  running  down 
44  immediately,”  through  the  nerves  into  the  lungs ;  efpecially  as  he  had, 
indeed,  obferv’d  fome  difeas’d  appearance  in  the  brain,  and  fome  other  vif¬ 
cera,  but  no  diforder  at  all  in  the  lungs. 

5.  Plowever,  I  would  have  you  underftand  thefe  things  in  fuch  a  manner 
as  to  fuppofe,  that  I  intend  only  to  afcribe  to  every  one  his  due  praife;  and 

(c)  Canon.  1.  3.  Fen.  non  9.  fed  10.  tr.  i.  c.  38.  (d)  Sett,  1 6.  obf.  6. 

not 


Letter  XV.  Article  6.  361 

not  that  any  thing  is  detracted  from  Willis.  Before  whom  it  is  rather  fur- 
prifing,  that  the  phyficians  did  not  more  generally  conceive,  what  we  have 
all  very  well  understood  fince  his  time.  For,  as  fince  the  very  time  in  which 
men  firft  existed,  it  was  natural  to  obferve,  how  foon,  and  how  evidently, 
refpiration  may  be  chang’d  from  terror,  anger,  joy,  grief,  and  weeping ;  and 
as  the  very  ancient  author  of  the  book,  Be  Morbo  facro  (<?),  exprefsly,  and 
juSlly,  has  admonish’d  us,  6t  that  pleafnre,  gladnefs,  laughter,  and  fport,  and, 
“  in  like  manner,  griefs,  anxieties,  fadnefles,  howlings,  and  complaints, 
lt  happen  to  us,  from  no  other  part  than  the  brain;”  it  feems,  in  fa£t, 
that  from  thefe  things  it  Should  have  been  obvious  to  phyficians,  what  power 
the  brain  has  upon  refpiration,  when  fomewhat  mov’d  by  the  natural  work¬ 
ings  of  the  mind  only,  or  the  daily  paffions  with  which  it  is  affedted  ;  and, 
that  the  fame,  and  much  more,  it  muSt  consequently  have,  when  it  is  irri¬ 
tated,  and  prefs’d  by  the  more  vehement  force  of  a  difeafe.  The  effeft  of 
which  force  Willis  both  plainly  faw,  and  clearly  explain’d  ;  fometimes  attend¬ 
ing  to  it  in  the  brain,  fometimes  in  the  appendages  of  the  brain,  the  fpinai 
marrow,  and  nerves ;  fometimes  accounting  for  convulsions,  and  fometimes 
palfies,  therefrom  ;  and  fometimes  determining  one  or  the  other  of  thefe 
caufes  to  confift  in  the  internal  fibres  of  the  lungs,  and  fometimes  in  the 
diaphragm,  or  the  other  mufcles,  ferving  to  refpiration.  But  I  Shall  now 
give  you  two  observations,  the  one  Vallalva’s,  and  the  other  mine,  which  re¬ 
late  to  difficult  refpiration  in  general. 

6.  A  man  of  forty  years  of  age  had  efcap’d  from  an  acute  fever,  attended 
with  a  delirium,  and  a  Soporific  diforder,  when  a  little  after,  many  irregula¬ 
rities  being  committed  in  food,  drink,  and  continual  handling  of  hemp,  he 
was  again  oblig’d  to  take  to  his  bed,  having  his  refpiration  fo  much  injur’d, 
that  he  breath’d  with  his  neck  eredt,  and  that  with  a  wheezing,  'and  great 
tumefaction  of  the  abdomen.  He  lpoke  with  difficulty,  and  at  intervals, 
that  is,  during  the  time  of  expiration.  He  had  a  cough,  and  felt  a  great 
heat  in  his  fauces :  he  had  pain,  not  in  the  internal,  but  in  the  external  parts 
of  his  belly  and  thorax ;  and  he  was  tortur’d  with  continual  watchings.  At 
length,  four  or  five  hours  after  taking  a  bolus,  in  which  there  was  opium, 
not  being  able  to  continue  in  bed  any  longer,  he  got  up  and  walk’d  about ; 
but  foon  after  going  to  bed  again  he  Suddenly  died. 

His  abdomen  and  cheft  being  open’d,  the  other  vifeera  were  all  found, 
and  in  proper  condition,  except  the  lungs;  and  even  in  them,  nothing  elfe 
was  obferv’d,  but  that  they  were  very  turgid  with  air,  and  were  distinguish’d, 
here  and  there,  with  black  Spots.  The  blood  was,  in  general,  of  its  natural 
fluidity,  except  a  little  polypous  concretion,  that  was  contain’d  within  the 
right  ventricle  of  the  heart.  But  when  the  fkull  was  open’d,  firft,  a  gelati¬ 
nous  concretion  of  ferum  was  feen,  about  the  Sanguiferous  veffds,  that  crept 
through  the  pia  mater:  in  the  next  place,  a  limpid  ferum  filling  the  lateral 
ventricles  of  the  brain,  which  kind  of  ferum  was  alfo  found  within  the  firft 
vertebras,  about  the  fpinai  marrow  :  laft  of  all,  the  compages  of  the  brain 
itfelf  was  obferv’d  to  be  more  lax  than  it  naturally  is. 


Vol.  I. 


(<?)  N.  16. 
A  a  a 


7.  Although 


3  62  Book  II.  Of  Difeafes  of  the  Thorax. 

7.  Although  fome  perfons  might  certainly  fufpeffc,  according  to  what  I 
have  mention’d  to  you,  when  I  was  writing  on  another  occafion  (/),  that 
as  the  duft  of  the  hemp,  in  which  this  man  had  work’d,  by  irritating  the 
fauces,  had  excited  a  cough  and  fenfe  of  heat,  fo  alfo  by  infinuating  itfelf 
into  the  lungs,  and  irritating  them,  had,  in  great  meafure,  brought  on  the 
orthopnoea  ;  yet  the  diffedtion  fhew’d  the  contrary.  Nor  were  44  the  vehicles 
44  of  the  lungs”  found  here  46  quite  choak’d  up  with  fmall  cluft,”  as  in  that 
afthmatic  man,  who  had  made  it  his  buftnefs  to  drefs  and  cleanfe  feathers 
with  which  beds  are  Huff’d,  from  their  duft,  as  you  have  it  in  the  additamenta 
to  this  fedlion  (g)  ;  but  there  was  nothing,  befides  thole  black  fpots,  which 
though  Valfalva  took  into  confideration,  he  did  not  think  had  any  reference 
to  the  diforder,  inafmuch  as  he  found  it  fufficiently  inherent  in  the  brain. 
But  fhall  we  fay  that  this  caufe,  inhering  in  the  bra.n,  brought  on  fo  great  a 
difficulty  of  refpiration,  by  giving  rife  to  a  convulfion  of  the  mufcles,  or  to 
a  palfy  ?  Some  ligns  are  not  wanting,  which  might  make  us  believe,  that 
it  adled  by  inducing  a  palfy.  For  if  you  believe,  that  the  fibres  of  the  lungs 
were  refolv’d  ;  you  will  eafily  conceive,  that  they  could  not  have  been  able 
to  expel  the  air,  and  for  that  reafon,  were  found  to  be  very  turgid  ;  and  in 
like  manner,  why,  when  opium  was  given,  the  diforder  became  more  violent, 
and  death  follow’d,  the  fibres,  doubtlefs,  being  more  and  more  relax’d  there¬ 
by  :  and  it  would  feem,  that  if  they  had  been  diftended  by  a  convulfion,. 
they  muft  have  reap’d  advantage,  rather  than  injury,  from  the  adminiftration 
of  the  opium.  Nor  was  the  external  pain  of  his  belly,  and  thorax,  more 
the  proof  of  a  convulfion,  than  of  laxity;  the  mufcles  themfelves,  doubtlefs, 
and  the  neighbouring  parts,  being  relax’d  and  diftra&ed,  by  reafon  of  their 
conftant  and  violent  exertions  in  a  refpiration  of  this  kind.  But  whether  it 
feems  to  you,  that  this  queftion  ought  to  be  determin’d,  in  this,  or  in  any 
other  manner;  it  cannot  be  debated,  in  regard  to  my  obfervation,  by  reafon 
of  the  fame  difeas’d  appearances  being  wanting  :  the  obfervation  is  as  follows. 

8.  A  woman  about  forty  years  of  age,  the  mother  of  children,  whole  dis¬ 
orders  of  the  left  eye  I  have  defcrib’d  to  you,  in  a  former  letter  (£),  being 
fuppos’d,  (for  certain  reafons  which  I  could  not  learn,  though.  I  enquir’d) 
by  the  phyficians  who  had  attended  her,  to  labour  under  an  infardfion  of  the 
lungs,  hiving  at  length  died  in  the  hofpital ;  the  pulfe.  having,  been,  in  the 
laft  days  of  her  life,  low,  her  face  red,  and  having  been  attack’d  with  no 
delirium,  and  no  foporific  affection  ;.  was  very  accurately  differed  by  me,, 
about  the  beginning  of  April,  in  the  year  1741,  as  I  was  at  that  time,  ac¬ 
cording  to  my  cuftom,  making  many  and  various  anatomical  refearches. 

In  the  abdomen  we  found  nothing  which  was  preternatural,  if  you  except 
the  left  teftis,  and  the  fund  of  the  uterus  :  for  the  firft  was  diftended  with  ail 
internal  hydatid,  and  equall’d  the  bignefs  of  a  chefnut ;  and  the  latter,  in 
a  certain  part  of  its  internal  anterior  furface,  and  in  like  manner,  in  another 
part  of  its  posterior  furface,  grew  cut  into  a  fabftance,  of  a  brownifti  red 
colour,  unequal  on  its  fu  perficies,  of  a  roundifh  circumference,  and  of.  a 
moderate  height.  The  thorax  contain’d  lungs  that  were  entirely  healthy  and. 
found,  in  their  appearance,  and  the  heart  alfo.  But  the  brain,  if  ever  it  did 

(f)  Epift.  7.  n.  14.  (g)  Obf.  4.  3  2.  ( h )  Epift.  13.  n.  9. 

in 


Letter  XV.  Articles  9,  10.  363 

in  any  cafe,  ffiew’d  all  the  veffels  that  run  through  the  pia  mater  to  be  turgid 
with  blood  ;  and  a  great  quantity  of  blood  was  alfo  in  thofe  which  pals 
through  the  medullary  fubftance.  However,  notwithftanding  the  cerebellum 
was  very  lax,  the  cerebrum  itfelf  was  not  lax. 

9.  It  is  furprifing,  that  this  woman  was  neither  delirious,  nor  lethargic, 
as  1  faid,  in  the  laft  days  of  her  life.  Could  the  reafon  of  this  be,  that,  be¬ 
fore  the  laft  diforder,  the  veffels  of  the  brain  had  been  accuftom’d  to  be 
fomewhat  more  diftended  than  was  natural  ?  For  in  this  manner  you  might 
account  for  both  circum  fiances,  and  underftand  why  fhe  fuffer’d  lefs  than 
others  from  the  diftenfion  of  the  veffels  being  encreas’d  in  the  latter  part  of 
the  difeafe  ;  and  why  from  this  diftenfion,  in  the  former  part  of  her  diforder, 
which  perhaps  was  greater  at  the  origins  of  thofe  nerves  that  ferve  the  organs 
of  refpiration,  they,  being  more  comprefs’d  than  ufual,  difturb’d  the  fundions 
of  the  lungs,  juft  as  if  they  had  really  been  fluff’d  up  with  pituita. 

And  do  not  fay,  that,  if  it  had  been  thus,  the  woman  would  certainly 
have  complain’d  of  her  head  more  than  her  cheft,  or  at  leaft  equally  as 
much  ;  for  (lie  might,  or  fine  might  not  have  complain’d,  as  1  was  of  ne- 
ceffity  ignorant  what  complaints  fhe  had  been  previoufly  fubjed  to.  I  will 
tell  you  what  was  written  by  Valfalva,  in  a  confilium,  or  medical  opinion, 
for  a  certain  nobleman,  who  being  well  in  his  head,  was  firft  attack’d  with 
convulfions  in  his  teftes,  after  that  in  the  whole  belly,  as  it  were,  and  finally 
in  his  head.  He  affirm’d,  for  inftance,  that  he  had  frequently  found  in  thofe 
cafes,  by  diffedion,  that  the  origin  of  the  convulfions  was  in  the  brain  itfelf, 
although  there  had  been  no  mark  of  this  being  affeded,  even  at  the  time  of 
the  convulfions  ;  and  that  the  other  parts  which  had  been  convuls’d,  or  af¬ 
feded  with  pain,  he  had  found  without  the  leaft  mark  of  injury,  though  he 
had  examin’d  them  with  the  utmoft  care.  To  this  he  alfo  added,  that  in 
cafes  of  wounds,  threatening  convulfions  were  frequently  foretold,  not  by  a 
preceding  pain  in  them,  but  by  a  preceding  pain  in  the  pharynx  (i) ;  not¬ 
withftanding  it  is  very  certain,  that  the  caufe  of  the  pain,  and  convulfions, 
was  not  in  the  pharynx,  but  in  the  wounds:  on  which  fubjed  you  may  alfo 
fee  the  obftrvations  of  Wepfer(£),  even  in  the  Sepulchretum.  Wherefore, 
when  refpiration  becomes  difficult  from  a  diforder  of  the  nerves,  although  it 
is  then,  indeed,  more  eafily  diftinguifh’d,  if,  the  figns  of  other  caufes  being 
abfent,  the  head  is  affeded  ;  yet  it  fometimes  happens,  that  the  diforder  is 
originally  from  the  head,  when  that  feems  altogether  uninjur’d. 

jo.  However,  it  is  alfo  frequently  evident,  that  in  very  acute  pains  the  refpi¬ 
ration  may  be  difturb’d,  from  the  fault  of  the  nerves,  without  having  it  in  our 
power  to  lay  any  part  of  the  diforder  to  the  charge  of  the  brain.  For  we 
fee,  that  whatever  part  of  the  body  is  feiz’d  upon  by  thefe  pains,  the  refpi¬ 
ration  is  immediately  affeded.  Therefore,  whether  the  nerves,  which  con¬ 
tribute  to  the  bufinefs  of  refpiration,  or,  in  ffiert,  thofe  which  are  conneded 
with  them,  are  very  fharply  irritated,  or  prefs’d,  or  obftruded,  or  internally 
perverted  •,  it  is  plain,  that,  from  one  or  the  other  of  thefe  nerves,  refpiration 
may  be  injur’d.  And  the  firft,  indeed,  to  omit  the  ancient  experiments  or 

(2)  Vid.  E pift.  54.  n.  z.  Sc  feq.  (e)  L.  i.  f.  13.  in  Addit.  Obf.  2.  Sc  in  Schol. 


A  a  a  2 


Galen, 


3<$4  Book  II.  Of  Difeafes  of  the  Thorax. 

Galen,  upon  the  coftal  nerves  (/),  and  to  attend  only  to  the  late  experiments, 
•which  you  have  here  in  the  Sepulchretum  ( m ),  made  by  Lower,  on  the  phre- 
nics;  and  the  firft,  I  fay,  that  is,  thefe  phrenics,  being  incis’d,  the  fame  kind 
of  refpiration  is  immediately  brought  on,  which  we  fee  in  afthmatic  horfes : 
fo  that  Lower,  with  great  propriety,  accounted  for  this  diforder  in  horfes, 
from  thefe  nerves  being  diftradted  by  the  diaphragm’s  being  too  much  de- 
prefs’d,  and  fuffering  “  relaxation,”  or  “  extenfion,  beyond  their  proper  tone.” 
But  to  whatpurpofe  is  it  to  fay  any  thing  of  the  nerves  that  are  connedled  with 
thofe  which  ferve  to  refpiration  ?  fince  we  fee,  almoft  every  day,  that  when 
thefe  are  irritated,  they  hurt  refpiration,  as  in  hypochondriacal  men,  but  ftill 
more  in  hyfterical  women.  And  I  have  even  fhewn  above  («),  from  Ballo- 
nius,  that  he  had  explain’d  an  orthopnoea,  from  the  calculus  of  the  kidneys, 
in  the  fame  manner.  But  after  Willis  had  purfu’d  more  at  large  the  effedls 
of  convuls’d  nerves,  in  any  and  all  of  the  diftant  parts  of  the  body,  the 
greateft  part  of  phyficians  not  only  began  to  follow  this  dodtrine  of  his,  when 
it  was  neceffary  they  fhould,  but  frequently  even,  entic’d  by  the  facility  and 
convenience  of  it,  and  fometimes  deceiv’d  by  the  fallacious  appearance  of 
circumftances,  abus’d  it  to  fo  great  a  degree,  that  even  when  diforders  of 
the  organs  were  not  wanting,  they  accus’d  nothing  but  convulfions,  in  many 
diforders,  efpecially  thofe  in  which  refpiration  was  concern’d  ;  juft  in  the  fame 
manner  as  the  ancients,  for  the  moft  part,  accus’d  vapours.  And  how  eafy 
it  is  to  fall  into  this  abufe,  unlefs  we  are  very  cautious,  more  than  one  hiftcry, 
in  future  letters,  will  (hew  ( o ). 

i  j .  But  now,  in  regard  to  the  prefent  hiftory,  after  that  the  caufe  of  the 
difficult  refpiration  has  been  confider’d  in  the  head,  it  follows,  that  it  muft: 
be  equally  confider’d  in  the  belly ;  and  this  I  fhall  difpatch  in  a  few  words, 
as  it  is  a  iubjedt  that  has  been  much  fpoken  of,  even  from  the  earlieft  times. 
For  you  fee,  that  Galen  is  commended  here  in  the  Sepulchretum  (p),  as  ex- 
prefsly  teaching  it,  in  certain  affedtions  of  the  ftomach,  liver,  fpleen,  or  a 
part  of  the  belly,  which  is  connedled  with  the  organs  of  refpiration.  We 
let  afide  convulfions  here,  of  which,  and  even  thofe  that  have  their  origin 
from  a  vifcus  of  the  belly,  I  have  already  fpoken  fufficiently  above,  when 
opportunity  offer’d.  Let  there  be  no  convulfion  in  a  hypochondriac  man  ; 
only  let  the  ftomach,  or  the  inteftines  neareft  to  it,  be  turgid  with  flatus  ; 
they  will  certainly  be  in  the  way  of  the  defeending  diaphragm,  in  the  adtion 
of  infpiration.  So  in  that  afthmatic  matron,  concerning  whom  is  the  hun¬ 
dred  and  forty-feventh  obfervation  of  this  fedlion,  they  found  that  the  lungs 
“  were  in  very  good  condition;  but  that  all  the  inteftines,”  and  efpecially 
the  jejunum,  were  furprifingly  “  inflated  and  diftended.”  And  the  liver, 
being  preternatural!)’  increas’d,  will  not  only  be  in  the  way  of  the  defeending 
diaphragm  by  its  bulk,  but  alfo,  by  its  weight,  will  be  injurious  to  its  afeent ; 
wherefore,  it  will  be  injurious  both  to  infpiration  and  exfpiration.  Hence  you 
have  examples  of  a  dylpnoea,  from  the  increale  of  bulk  in  the  liver,  in  the 
fame  fedlion  (y) :  nor  are  examples  wanting  of  the  fame  diforder,  from  the 


(l)  De  Anatomic.  Adminiftr.  1.  8.  C.  4.  (0)  Epift.  17.  n.  26.  &  Epift.  18.  n.  17.  & 

(m)  Append,  ad  Gbf.  no.  fcq.  (f)  In  Schol.  ad  Ob.  138. 

N.  4.  (7)  Ut  in  A  Iditam.  ObCiz.  &  17. 

increas’d 

8 


Letter  XV.  Article  12.  365 

increas’d  bulk  of  other  vifeera  of  the  abdomen,  either  of  fuch  as  are  con¬ 
nected  with  the  diaphragm,  or  only  fubjeCted  thereto :  amongft  which  I  par¬ 
ticularly  remember  one,  that  Albertini  related  to  me,  when  I  was  a  young 
man. 

A  certain  perfon  at  Genoa  was  troubl’d  with  an  afehma,  in  regard  to  the 
caufe  of  which  his  phyfician  did  not  doubt,  but  it  was  contain’d  in  the  cavity 
of  the  thorax.  When  Albertini.  was  confulted,  he  fufpedted  that  the  caufe 
rather  lay  hid  in  the  abdomen,  nor  far  from  the  diaphragm,  by  reafon  of  a 
certain  fymptom  in  the  ftomach  while  he  took  food,  or  after  taking  it;  for 
I  do  not  certainly  remember  the  circumftance.  But  this  I  remember,  that 
the  patient  at  length  dying,  an  account  of  his  diffetftion  was  fent  by  his 
learn’d  and  ingenious  phyfician  to  Albertini,  which  prov’d  his  conjecture  ; 
for  there  was  a  difeafe  in  the  pancreas,  which  had  grown  out  into  many 
tumours,  refembling  fo  many  apples,  and  even  verging  to  the  nature  of 
a  cancer.  But  Valfalva’s  obfervations,  and  mine,  relative  hereto,  you  will 
have  on  another  occafion  •,  becaufe,  on  account  of  other  diforders,  befides 
thofe  of  refpiration,  it  is  better  to  referve  them  for  another  place ;  and  among 
them  you  will  have  fome,  to  which,  by  reafon  of  an  injury  of  the  ftomach, 
in  appearance  flight,  a  great  difficulty  of  refpiration  was  join’d. 

Ic  will  be  fufficient  here  to  put  you  in  mind  of  one  thing ;  that,  by  reafon 
of  the  common  boundaries  of  the  lower  part  of  the  thorax,  and  the  upper 
part  of  the  belly,  not  fufficiently  attended  to  by  many  phyficians,  fome  not 
rememb’ring,  and  others  not  being  acquainted  with  them,  they  are  frequently 
not  aware,  how  high  within  the  diaphragm,  which  is  the  lower  boundary  of 
the  cavity  of  the  thorax,  the  upper  part  of  the  cavity  of  the  abdomen,  with 
its  higheft  vifeera,  penetrates  ;  wherefore,  it  frequently  happens,  not  only 
in  other  diforders,  but  particularly  in  the  diforders  of  refpiration,  that  the 
caufe  which  really  belongs  to  the  belly,  is  wrongfully  aferib’d  to  the  thorax. 

12.  But  in  the  neck,  although  the  caufe  of  difficult  refpiration,  confifting 
in  the  femi-obftruCtion,  or  compreffion,  of  the  trunk  of  the  afpera  arteria, 
is  wont,  for  the  moft  part,  to  be  obvious,  as  when  fome  things  that  are 
taken  down  do  not  enter  the  pharynx,  but  perhaps  fall  into  the  lary  nx,. 
or  when  fome  hard  tumour  grows  near  that  tube,  hiftories  of  which  kind  are 
not  wanting,  in  the  Sepulchretum  ;  neverthelefs,  it  fometimes  happens,  that 
obftruCtion,  and  in  like  manner,  compreffion,  may  lie  hid,  fo  as  to  be  lefts  di- 
ftinguifh’d  from  the  relation  of  the  patient,  or  the  infpeCtion  of  the  phy¬ 
fician,  than  from  conjecture.  And  to  this  fpecies  belong  the  appearances 
formerly  obferv’d  by  the  celebrated  Fantonus(r),  “  in  the  body  of  a  man, 
“  where  the  arytenoid  cartilages  were  ulcerated  around,  and  their  thickncfs- 
‘c  fo  increas’d,  that  there  was  a  very  narrow  paffage  remaining  in  the  larynx, 
“  and  the  patient  breath’d  with  great  difficulty,  though  he  liv’d  a  long  time 
1‘  in  this  way.”  And  to  the  fame  purpofe  are  two  not  contemptible  obferva¬ 
tions  ;  the  one  common  to  Valfalva  and  me,  and  the  other  proper  to  our 
Mediavia.  1  he  firft  of  which  was  made  upon  that  virgin,  in  whom  I  firft 
faw  the  foramen  of  the  hymen  divided  into  two  parts,  by  a  kind  of  band, 
of  the  fame  fubftance  ;  fuch  a  one  as  I  know  l  have  deferib’d  in  the  Adver- 


(>)  Anat.  corp.  hum.  DifT.  13. 


faria, 


3  66  Book  II.  Of  Difeafes  of  the  Thorax. 

iaria,  from  other  obfervations  that  are  afterwards  added  (4),  and  again  taken 
notice  o f,  together  with  the  columnae  disjoin’d  from  the  hymen,  and  thole 
carunculae  which  fome  now  call  the  pifiform  caruncles ;  in  fuch  a  manner, 
however,  that  I  am  ignorant  of  having  propos’d  it  as  natural,  or  not  wanting 
the  affiftance  of  a  furgeon,  as  the  fame  perfons  affert,  and  fome  other  things 
all'o,  of  which  it  is  not  a  proper  place  to  treat  here. 

13.  The  virgin,  therefore,  of  whom  I  have  juft  fpoken,  being  forty  years 
of  age,  and  having  been  for  a  long  time  afthmatic,  and  having  her  voice, 
moreover,  much  diminilh’d,  was  fuppos’d  by  her  phyficians,  beyond  a  doubt, 
to  have  a  diforder  of  the  lungs,  when  the  ailhma  attacking  her  very  vehe¬ 
mently,  (lie  fuddenly  died,  and  was  brought  by  the  ftudents  into  the  ana¬ 
tomical  theatre  at  Bologna,  in  the  year  1  704.  The  vifcera  of  the  belly  had 
nothing  of  a  preternatural  appearance,  if  you  except  the  teftes  being  a  little 
larger  than  ufual,  hard,  white,  and  entirely  fchirrhous,  and  having  forne  hy¬ 
datids  lying  upon  them.  But  in  the  thorax,  and  the  lungs  themfelves,  was 
no  appearance  of  difeafe  ;  fo  that  no  body  doubted,  now,  but  the  caufe  of 
the  difeafe  would  be  found  entirely  within  the  cranium.  Yet  even  there  every 
thing  was  found  to  be  in  good  condition.  Every-one  was  aftonifh’d,  who 
had  diligently  infpeded  the  vifcera,  as  they  were  differed  in  their  order,  but 
Hill  more  we,  who  had  perform’d  the  diffedion  ;  when  I  faid  to  Valfalva,  let 
us  alfo  open  the  larynx,  that  we  may  fee  whether,  perhaps,  the  caufes  of  the 
voice  being  diminilh’d,  the  afthma,  and  death  itfelf,  might  not  lie  lurking 
there  :  for  at  that  time  the  larynx  was  not  open’d  in  the  public  demon- 
llrations,  to  fhew  the  horizontal  glottis,  the  ventricles,  or  finuffes  of  the  la¬ 
rynx,  the  arytenoid  glands,  and  the  joints  of  the  arytenoid  cartilages,  which 
1  had  not  yet  difcover’d,  or  reftor’d.  Valfalva  having  confented,  I  order’d 
.the  larynx  to  be  look’d  for  among  the  parts  that  were  not  yet  buried,  and  to 
be  brought  to  me.  And  having  cut  it  down,  on  the  poflerior  part,  in  a 
longitudinal  diredion,  and  laid  it  open  by  drawing  the  lips  afunder,  what 
we  enquir’d  after  was  immediately  manifeft.  B'or  a  pus  of  a  white,  degene¬ 
rating  into  a  cineritious,  colour,  and  of  a  pultice-like  confidence,  form’d  into 
the  fhape  of  a  cork,  entirely  Ihut  up  the  cavity  of  the  larynx,  that  lies  below 
the  glottis  •,  and  in  that  place  the  coat  inverting  the  larynx  was  ulcerated,  as 
it  was  in  like  manner,  where  it  cover’d  fome  of  the  neareft  annular  cartilages 
of  the  trachea  arteria,  although  here  more  (lightly.  And  thefe  things  being 
demonftrated  in  the  theatre,  on  the  lart  day  of  public  diffedion,  gave  great 
iatisfadion  to  all  who  were  prefen t. 

14.  As  I  was  afterwards  conrtdering  from  whence  fo  great  a  quantity  of 
pus  of  this  kind  could  have  been  colleded  in  that  place,  fo  as  entirely  to 
flop  up  the  paffage,  1  began  to  cut  into  many  larynxes,  and  accurately  examine 
them  ;  and  feeing,  not  only  the  glands  that  lie  thick  beneath  the  internal 
coat,  but  alfo  in  the  cavities  of  the  ventricles,  into  which  this  coat  is  pro¬ 
duc’d,  both  glands  of  the  fame  kind,  and  the  inferior  covering  crus  of  the 
arytenoid  glands,  I  readily  conjedur’d,  that  in  refped  to  the  ulceration  in 
the  virgin  I  fpoke  off,  as  it  was  manifert  beneath,  fo  it  might  perhaps  lie 
hid  in  the  ventricles  j  and  that  the  pus  in  thefe  might  grow  vifcid  from  ftag- 

[(;)  I.  n.  29.  Sc  IV.  Aninud.  23. 


nation, 


Letter  XV.  Article  i  j\  367 

nation,  efpecially  when  the  body  was  compos’d  to  deep,  and  at  length  be¬ 
come  very  denfe,  and  afterwards  be  difcharg’d  in  fpeaking,  and  be  added  to 
that  which  flow’d  down  from  the  neighb’ring  parietes  of  the  larynx,  and  af- 
pera  arteria ;  fo,  by  more  or  lets  obftrudting  the  air,  that  it  had  made  refpi¬ 
ration  more  or  lefs  difficult,  till  it  was  at  length  difcharg’d  on  both  Tides,  in 
fuch  a  quantity,  and  with  fuch  a  denflty,  from  the  ventricles,  that  it  could 
not  be  diverted  from  thence,  and  thrown  out  by  exfpiration  :  juft  as  Ment- 
zelius  law  it  happen  of  a  fudden  (/),  from  a  fmall  portion  of  very  thick  pi¬ 
tuita,  which  was  by  chance  harb’ring  itfelf  between  the  two  firft  rings  of  the 
afpera  arteria,  and  thereby  clofely  and  firmly  (hutting  it  up,  in  a  girl,  in 
other  refpects  healthy,  and  in  the  vigour  of  life.  But  in  the  virgin  at  prefent 
in  queftion,  who  was  neither  young  and  in  the  bloom  of  life,  nor  healthy, 
the  purulent  fpittings,  the  cough,  and  the  fenfe  of  erofion  in  the  larynx, 
which  I  believe  were  not  wanting,  and  the  difficulty  of  refpiration,  together 
with  the  diminution  of  voice,  which  certainly  were  not  wanting,  belied  an 
ulceration  of  the  lungs  :  nor  could  any  thing  but  an  accurate  enquiry  into 
the  other  fymptoms  which  fhew  the  lungs  to  be  afteCted,  as  for  inftance, 
whether  the  matter  which  was  thrown  up  was  perceiv’d  to  afcend  from  a 
pretty  deep  fituation  ;  whether  there  was  a  fenfe  of  weight,  or  compreffion, 
in  the  thorax;  whether  lying  on  the  back,  or  on  the  fide,  was  difficult 
whether  going  up  fteep  places  was  troublefome  ;  and  whatever  other  marks 
of  this  kind  there  may  be,  which- ought  to  be  attended  to  the  more,  the 
more  they  are  in  number  ;  nor  could  any  thing,  I  fay,  but  the  enquiry  into 
thefe  fymptoms,  and  the  abfence  of  them,  together  with  a  ccnftant  pain  in 
the  larynx,  which  had  continu’d  from  the  very  beginning  through  the  whole 
of  the  difeafe,  incline  the  phyfician  to  conje&ure  that  which  was  really  the 
cafe  ;  although  even  then  it  was  very  difficult  to  conjecture  what  there  had 
hitherto  been  no  example  of  extant. 

The  firft  advantage,  therefore,  you  will  draw  from  the  hiftory  I  have 
given  you,  is  to  fufpeCt,  that  what  has  been  once  obferv’d,  may,  perhaps,  once 
again,  and  even  frequently,  happen,  in  patients  of  this  kind;  and  in  the  fe- 
cond  place  you  will  draw  this  advantage,  not  to  be  over-hafty  in  pronouncing, 
from  the  difleCtions  of  dead  bodies,  that  there  was  no  caule  of  the  difeafe, 
which  came  under  the  notice  of  the  fenfes,  for  which  reafon  that  is  to  be  re> 
ferr’d  to  internal  convulfions,  or  other  affeCtions  of  that  kind,  which  may 
be  owing  to  invifible  corpufcles.  And  this  without  doubt  would  have  been 
done,  in  the  cafe  in  queftion,  if  it  had  not  by  accident  come  into  my  mind, 
after  having  examin’d  other  parts,  laft  of  all  to  examine  this  little  part,  the 
larynx:  and  I  would  have  you  always  take  care,  not  to  omit  the  infpeelion 
of  this  part,  when  you  would  wifh  to  explore  the  caufes  of  diforder’d  refpk- 
ration,  or  fudden  death,  which  feem’d  to  have  happen’d  from  fuffocation, 
Eut  now  let  us  come  to  the  other  obfervation. 

15.  A  woman  of  more  than  eighty  years  of  age,  -  had  complain’d,  already, 
for  many  days,  of  a  difficulty  of  breathing,  and  fwailowing,  join’d,  with  a 
heat  of  the  fauces,  when  fhe  was  at  length  receiv’d  into  the  holpital  at  Pa¬ 
dua.  There  fhe  was  ieiz’d  with  fo  violent  a  paroxyfm  of  difficult  refpiration, 

(/)  Eph.  N.  C.  Dec.  .2.  a.  4.  obf.[6z. 

4- 


that 


3  6  8  Book  II.  Of  Difeafes  of  the  Thorax. 

that  (he  was  almoft  kill’d  thereby.  -She  did,  however,  recover,  and  had  an 
ill-lmelling  pus  mix’d  with  blood,  difeharg’d  by  (pitting,  in  confequence  of 
the  paroxyirn.  As  the  woman  not  only  pointed  out  the  larynx,  for  the  (eat 
of  the  difeafe,  but  ajfo  drew  it  forwards,  by  laying  hold  of  it  with  her  fin¬ 
gers,  and  by  that  means  fetch’d  her  breath  fomewhat  more  eafily  ;  the  fauces 
were  infpe&ed  ;  and  the  uvula  indeed,  and  the  mulcular  arches  that  afeend 
up  to  it,  feem’d  to  be  driven  backwards,  fo  that  the  orifice  of  the  pharynx, 
which  opens  into  the  mouth,  feem’d  much  dilated,  and  thofe  parts  were  a 
little  more  red  than  ufual  *,  but  nothing  elfe  was  to  be  feen.  Thus  for  fifteen 
days,  or  more,  the  woman  went  on  with  thofe  fpittings,  and  difficulty  of 
breathing,  till  at  length  this  difficulty  encreafmg,  and  becoming  more  and 
more  violent,  fhe  was  conftrain’d,  in  fpite  of  all  remedies,  to  yield  to  her 
fate,  which  happen’d  about  the  beginning  of  September,  in  the  year  1725. 

The  neck,  in  which  it  was  evident,  that  the  caufe  of  the  diforder  lay  hid, 
was  difie&ed,  and  the  caufe  was  found  to  exift  after  this  manner.  On  the 
back  part  of  the  afpera  arteria,  at  the  diftance  of  a  finger’s  breadth  below  the 
cricoid  cartilage,  a  tumour  had  grown  out  to  the  bignefs  of  half  a  walnut, 
preffing  upon  the  gula  which  lay  behind  it  •,  but  fill  more  upon  the  trachea 
itielf,  fo  that  the  p adage  in  this  part,  was  made  extremely  narrow,  and  con¬ 
fided  only  of  a  kind  of  oblong  filTure.  When  this  was  dilated,  the  cavity 
of  the  tumour  was  found  to  be  fill’d  with  a  putrid  matter,  and  contain’d 
within  a  kind  of  involucrum,  internally  hard,  and  externally  made  up  of  cer¬ 
tain  granules  like  millet-feed,  and  of  a  yellowifh  colour.  And  of  this  fame 
kind  of  granules  confided  two  glands  alfo,  lituated  near  to  the  tumour  ex¬ 
ternally,  each  of  which  was  as  big  as  a  moderately-fiz’d  pea*,  fo  that  from 
one,  like  thefe,  but  more  encreas’d,  it  appear’d  that  the  tumour  was  brought 
on.  By  carrying  on  the  incifion,  from  the  oefophagus  to  the  pharynx,  this 
part  was  found  to  be  very  rugous  internally,  yet  not  fo  contracted,  but  that 
with  the  fingers  it  .might  be  all  laid  fmooth,  and  the  pharynx,  by  this  means, 
reduc’d  to  its  proper  lize  and  extenfion. 

16.  The  appearances  found  in  the  dead  body  very  readily  explain,  of 
themfelves,  what  had  been  before  oblerv’d  in  the  living  *,  as  for  indance, 
when  fhe  was  brought  almod  to  death’s  door,  by  the  tumour  which  was  ex¬ 
ceedingly  didended  with  pus,  being  juft  at  the  point  of  breaking*,  or  when 
by  drawing  the  afpera  arteria  forwards  with  her  fingers,  fhe  by  that  means 
drew  the  tumour  from  the  oefophagus,  and  even  from  the  vertebras,  that 
prefs’d  it  back  again  upon  the  trachea,  and  thus  caus’d  it  to  prefs  lefs  upon 
the  air-paflage. 

Yet  perhaps  you  will  afk  me  two  queftions  *,  one,  why  this  tumour,  al¬ 
though  previoufly  diminifh’d,  in  its  magnitude,  by  the  discharge  of  the  pus, 
fhould  be  the  occafion  of  the  woman’s  death  ?  and  the  other,  what  thefe 
glands  were,  three  of  which,  and  one  in  particular,  had  been  fo  much  en¬ 
larg’d  ?  And  the  lad  of  thefe  circumftances  you  will  very  well  conceive  of, 
if  by  taking  the  Adverfaria  into  your  hands  you  infpeCt  what  I  formerly  dc- 
ferib’d  («),  on  the  back  of  the  afpera  arteria,  and  what  I  obferv’d  (#),  in  re¬ 
gard  to  thofe  glands  fometimes  being  tumefied,  though  in  a  lefs  degree  than 

(«)  Adverf.  1.  Tab.  2.  Fig.  i.  (a-)  Adverf.  5.  Animad.  39. 

the 


Letter  XV.  Article  17.  3 69 

the  largeft  that  I  have  defcrib’d  in  the  prefent  hiftory.  And  the  firft  of  them 
you  wiil  aferibe,  partly  to  the  matter  at  that  time  coliedted  in  the  tumour,  a;  d 
partly  to  that  which  had  fall’n  down  from  thence  into  the  bronchia ;  for  the 
firft,  as  was  .evidently  feen,  left  a  very  narrow  pafi'age  for  the  air,  and  the 
laid,  perhaps,  being  carried  back  thither  by  the  expir’d  air,  made  it,  in  the 
mean  time,  more  narrow*,  fo  that  the  woman  by  age,  diieafe,  and  the  fma.l 
quantity  of  aliment,  which  by  reafon  of  the  difficulty  fhe  had  in  fwallowing, 
Ihe  was  able  to  take,  join’d  with  the  difficulty  of  refpiration,  was  brought 
gradually  to  her  end.  However,  from  this  very  difficulty  of  fwallowing, 
the  pharynx  having  been  for  2.  long  time  almoft  unemploy’d,  it  may  rea- 
fonably  feem,  that  it  had  contracted  itfelf,  internally,  into  wrinkles.  And 
with  this  hiftory  you  will  join  that,  which  Vitus  Riedlinus  ( y )  has  related, 
44  of  a  particle  of  grumous  blood,  that  had  acquir’d  almGft  the  hardnefs  of 
44  a  ftone,  found  near  the  afpera  arteria,  and  compreffing  it,”  in  an  old  man, 
who  having  had  a  terrible  fall,  a  few  years  before,  had  firft  a  pain  of  that 
part,  from  the  very  time  he  had  fall’n,  and  always  afterwards  a  difficult 
refpiration.  And  from  the  tenour  of  both  hiftorics,  you  will  very  eafily 
agree  with  Gabrielius  (2),  who  judg’d,  that  an  orthopnoea,  join’d  with  a 
fenfe  of  ftrangulating  matter,  in  the  fauces,  and  an  interception  of  the  voice, 
which  was  critically  folv’d,  by  the  difeharge  of  thirty  worms,  had  been 
owing  to  thofe  worms  diftending  the  oefophagus,  and  preffing  upon  the 
trachea  *,  efpecially  as  in  another,  who  had  died  luddenly  from  an  orthopnoea 
of  the  fame  kind,  he  had  feen  a  great  number  of  worms  occupying  the  gula, 
and  even  the  trachea  that  lay  clofe  to  it,  into  which  they  had  made  a  way 
for  themfelves  by  gnawing. 

But  although  a  preflure  from  behind  more  readily  and  more  effectually 
ftreightens  the  trachea,  inafmuch  as  it  is  not  defended  on  that  furface  by 
cartilages ;  yet,  if  any  very  ftrong  prelfure  happen  on  the  fore-part,  it  may 
fo  conftringe  this  tube,  as  to  bring  on  a  difficult  refpiration,  and  at  length 
death  itfelf ;  as  the  farcoma  obferv’d  by  Vorwaltner  (a),  and  44  the  gland 
44  thymus  enlarg’d  and  fill’d  with  chalky  concretions,”  remark’d  by  Chriftian 
Vater(^) :  fo  that  there  was  no  occafion  to  call  in  the  aid  of  polypi  of  the 
heart,  in  order  to  explain  the  death  of  the  child  *,  fince  the  upper  part 
of  the  fternum  did  not  fuffer  part  of  the  thymus,  nor  yet  that  farcoma, 
which  was  44  in  the  neck  under  the  Iternum,”  to  grow  out  forwards  *, 
and  fo  the  increafe  of  each  of  the  tumours  neceffarily  forc’d  the  trachea 
towards  the  vertebrse,  and  at  length  fhut  up  all  accefs  to  the  air. 

17.  Hitherto  I  have  written  of  the  caufes  producing  difficult  refpiration 
which  lie  in  the  head,  the  neck,  or  the  belly.  Now  let  me  add  fome  things 
upon  this  fubjeCt,  when  the  caufe  lies  within  the  thorax  itfelf :  although,  in¬ 
deed,  thofe  obfervations  which  I  juft  mention’d  relate,  in  part,  to  the  thorax, 
as  two  obfervations  of  Laubius  do  entirely  *,  the  one  of  a  vomica  adhering 
to  the  pofterior  part  of  the  afpera  arteria,  about  the  beginning  of  its  divifion, 
which  had  an  acute  and  rough  calculus  included  in  it ;  the  other  of  a  large 
fteatoma,  wherein  the  trachea  was  comprehended  :  which  obfervations,  as 

( y )  Eph.  N.  C.  Dec.  3.  a.  7.  obf.  120.  ( a )  Ibid.  Obf.  144. 

(z)  Ibid.  Obf.  188.  (6)  Dec.  ead.  3  a.  9.  Obf.  1 6 1 .  in  fin. 

Voi..  I.  B  b  b  they 


3  7°  Book  II.  Of  Difeafes  of  the  Thorax. 

they  contain  other  things  worthy  to  be  confider’d,  you  will  read  in  the  Cen¬ 
turia  ( c )  Ccefare N.  C.  Academia. \  For  I  am  now  in  hade  to  go  on  to  the 
enquiry  into  thefe  caufes,  which  are  inhaerent  in  the  lungs  themfelves.  And 
no- body  can,  in  the  lead,  doubt,  but  that  all  things,  which  either  too  much 
comprefs,  or  Huff-  up,  or  render  inflexible  and  rigid,  the  cells  of  the  lungs, 
and  the  (lender  and  irnall  canals,  through  which  the  air  pafles,  muft,  at  the 
fame  time,  be  injurious  to  reipiration.  And  they  are  too  much  comprefs’d, 
for  inftance,  when  the  blood  didends  the  veffels  that  lie  around  thefe  parts, 
either  by  being  in  too  great  a  quantity,  or  being  too  much  rarefied,  or,  from 
any  other  obftrudting  caufe  whatever,  pafles  with  difficulty  through  the  lungs: 
the  firft  of  which  happens  ir^plethoric  perfons,  efpecially  when  they  go  falter 
than  ufual,  and  increafe  the  motion  of  their  blood ;  the  fecond  in  ardent 
fevers  •,  and  the  third  feems  to  have  happen’d  ir.  a  princefs  (J),  who  being 
leiz’d  with  a  great  difficulty  of  refpiration,  had  the  veffels  of  her  lungs 
“  fwell’d  even  to  blacknefs.” 

And  as  to  infardtion,  belides  the  humours  which  are  fecreted  from  the 
bronchial  glands,  and  are  fometimes  too  vifcid,  or  in  too  great  a  quantity ; 
a  very  fine  dud,  which  is  continually  drawn  in  with  the  air,  as  in  the  feather- 
dreffer,  of  whom  I  fpoke  above  ( e ),  and  dill  more  in  cutters,  mafons,  and 
carvers  of  ftone,  whofe  lungs  being  very  hard,  when  they  were  cut  into,  the 
knife  feem’d  to  be  drawn,  “  as  it  were,  through  a  heap  of  fand,”  as  you 
■will  read  in  like  manner  in  the  Sepulchretum  (/)  ;  I  fay,  befides  the  hu¬ 
mours  of  the  part  being  vitiated,  or  increas’d,  thefe  or  fuch-like  caufes  will 
contribute  to  duff  up  the  lungs.  And  as  thefe  caufes  render  the  lungs  hard, 
fo  they  make  them  inflexible,  and  inexplicable,  that  is,  incapable  of  dila¬ 
tation  *,  the  fird  of  which  is  evidently  injurious  to  exfpiration,  and  the  other 
to  infpiration. 

18.  But  the  fame  may  alfo  happen  from  caufes  that  are  generated  within 
the  lungs,  as  from  thofe  that  are  generated  on  the  outfide,  and  taken  in 
with  the  air-,  and  thefe  may  be  of  fuch  a  kind,  as  to  duff  up  the  bronchia, 
at  the  fame  time,  or  not.  For  I  have  obferv’d,  as  I  purfu’d  the  bronchia 
in  diffedlions,  that  their  cartilages  fometimes  became  bony,  even  before 
the  perfon  was  far  advanc’d  in  age.  For  that  the  lungs  “  grow  hard. 
41  and  become  earthy,”  in  decrepid  age,  Aridotle  knew  (g)  ;  but  Littre  (£), 
and  Vieufiens  (<),  the  fird  in  a  man  of  eighty  years  old,  and  the  other  in  a 
matron  fome  years  older,  have  written,  that  fome,  or  all,  «the  annular  carti¬ 
lages  of  the  bronchia  were  become  bony  ;  although  neither  of  them  has  ex- 
prefsly  told  us,  whether  they  meant,  when  they  faid  annuli ,  to  have  it  un- 
derdood,  that  thefe  appearances  were  found  deep  within  the  lungs.  I,  how¬ 
ever,  have  feen  it,  and  can  dill  diew  it,  even  in  the  mod  internal  parts  of 
the  lungs,  where,  in  the  place  of  every  annulus,  many  little  bits  of  cartilage 
are  naturally  connedted  together ;  although  fome  of  thofe,  who  have  very 
learnedly  colledted  examples  of  all  the  parts  of  the  human  body  that  are 


(f)  IX.  Obf.  15.  &  VII.  Obf.  40. 
\d)  Rph.  earund.  Cent.  8.  Obf.  79. 

(4  N-  7- 

(f)  Addit,  ad  hanc  Sett.  Obi.  4. 


(g)  De  Juvent,  c.  14. 

\b)  Hift.  de  l’Acad.  R.  des  Sc.  a.  1706$ 
Obf.  Anat.  7. 

(/')  Traite  de  la  ftrutt.  du  coeur,  ch.  16. 


8 


fometimes 


Letter  XV.  Articles  19,  20.  371 

fometimes  found  to  become  bony,  have  not  only  omitted  to  mention  thefe, 
and  the  pleura,  and  the  internal  parts  of  the  eye,  which  I  have  feen  in  fome 
meafure  bony,  (£),  but  even  thofe  parts  that  are  much  more  frequently  to  be 
met  with  in  that  Hate  •,  I  mean,  the  cartilages  of  the  trunk  of  the  afpera  ar¬ 
teria.  However,  I  fliould  hardly  fuppofe,  that  what  is  quoted  from  our 
Columbus,  here,  in  the  Sepulchretum  (/),  is  referable  to  my  obfervation,  but 
rather  to  the  coats  of  the  veffels  ;  becaufe  he  lays,  that  he  had  feen  “  bones, 
“  of  no  inconfiderable  fize,  in  the  lungs.” 

19.  And  that  the  bronchia  may  be,  at  the  fame  time,  render’d  indexible, 
and  be  fluff’d  up,  from  caufes  generated  within  the  lungs,  you  will  very 
eafily  conceive,  if  you  do  but  recoiled,  that  calculi  are  generated  within 
the  bronchia.  I  am  not  ignorant,  indeed,  that  the  bronchial  glands  fome¬ 
times  grow  hard,  like  a  calx,  or  gypfum,  as  well  within  the  lungs,  as  with¬ 
out.  Yet  I  believe  that  the  fame  happens  much  more  frequently  from  a 
tough  humour,  or  pus,  too  long  retain’d  in  the  ceils  of  the  lungs  ;  and  in 
the  ramifications  of  the  bronchia,  I  know  it  for  certain.  And  if  you  do  but 
read,  as  I  did  lately,  the  greatefl  part  of  the  hiftories,  in  which  almoft  a 
hundred  authors  have  defcrib’d  calculi,  or  tophi,  that  have  been  brought 
up  by  coughing,  or  found  in  the  lungs,  without  doubt  you  will  agree  with 
me.  You  will  fee  many  pointed  out  by  Rhodius  (m),  others  by  Henry  Mei- 
bomius  (»),  others  by  Sachfius  (0),  the  laft  but  one  of  which,  that  you  may 
not  be  detain’d  by  a  typographical  error,  I  would  have  you  be  inform’d,  is 
one  of  Paavius’s :  but,  to  omit  others,  you  will  fee  a  great  number  in 
Scenck  (p),  who  not  only  pointed  out,  before  them,  what  he  could  at  that 
time,  but  alfo  defcrib’d  them.  And  although  even  fome  obfervations  from 
Crucius,  Blafius,  Saxonia,  and  Gendrotius,  are  transferr’d  into  this  firft  fedlion 
of  the  Sepulchretum,  which,  as  far  as  I  remember,  are  not  pointed  out  by 
others  j  yet  befides  thofe,  which,  as  they  are  giv’n  without  difiedtions,  do 
not  belong  to  the  prefent  purpofe,  I  have  obferv’d  fome*  both  in  that  a  d 
the  following  fedtions  of  the  Sepulchretum,  to  be  omitted,  which  might  have 
been  taken  from  the  writers  juft  now  commended,  or  from  fome  of  the  vo¬ 
lumes  of  the  Casfarean  Academy  (y),  at  that  time  publifh’d,  and  in  like 
manner  from  others,  as  from  Contulus  (r),  and  ftill  more  from  Morton  (s) 
not  to  fay  any  thing  of  thofe  books  which  had  not  yet  come  out  at  that  time, 
as  the  Centuria  (/),  and  the  AEta  («)  of  the  fame  academy,  the  Commercium 
Litterarium  (x),  and  others. 

20.  But  as  you  are  now,  perhaps,  without  the  greateft  part  of  them,  and 
as  the  whole  of  the  fubjedt  deferves  to  be  a  little  more  accurately  handl’d  ; 
I  will  give  you  the  chief  heads  of  the  hiftories  that  I  have  read  over,  the 
amount  of  which  is  as  follows : 


( k )  Vid.  Epift.  21.  n.  19.  &  22.  &  Epift. 
13.  n.  9,  10,  &  Epift.  52,  n.  30,  31. j 

(l)  Obf.  46.  primas  §  6. 

\m)  Cent.  2.  Obf.  Med.  3. 

(»)  Exercit.  Med.  de  Obferv.  rar.  &c.  n. 
20,  21. 

(c)  Eph.  N.  C.Doc.  1.  a.  2.  Obf.  181.  in 
•Schol. 


( 'p )  Obf.  Med.  rar.  1.  2.  ubi  de  Pulm.  Cal- 
cul.  cum  Strauffii.  Addit. 

(q)  Dec.  3.  a.  3.  Obf.  71,  72,  248.  &  a.  4. 
obf.  109. 

(r)  De  Lapidib.  Podagr.  &c.  c.  8. 

(f)  Phthifolog.  1.  3.  c.  6.  (r)  III.  Obf.  62. 

(a)  Tom.  4.  Obf.  49.  Sc  Tom.  5.  Obf.  68. 
(*)  A.  1743.  heb.  13.  n.  2. 


B  b  b  2 


Since 


372  Book  II.  Of  Difeafes  of  the  Thorax. 

Since  Ariftotle  (y)  Teem’d  to  have  pointed  out  calculi,  as  frequently  ob- 
ferv’d  in  the  lungs  of  vidlinis,  and  Aretasus  (2),  and  Galen  (a),  remark’d 
(mall  concretions,  like  hail-ftones,  cough’d  up  by  men  •,  Trallianus  (£),  and 
Paulus  (c),  were  the  firft,  as  far  as  l  know,  who  faw  them  thrown  up,  in¬ 
durated  into  true  calculi.  And  our  Curtius  was  the  firft,  as  far  as  I  re¬ 
member  at  prefent,  who  found  {d)  a  calculus  in  the  lungs  but  whether  three 
times,  as  fome  fay,  I  do  not  remember,  as  I  only  remember  to  have  read, 
“  that  he  had  feen,  in  a  differed  body,  many  little  Hones  generated  in  the 
“  lungs,  among  which  there  was  one  that  was  almoft  as  big  as  a  pea.” 

Moreover,  as  to  what  relates  to  their  number,  Fernelius  alfo  found  “  the 
“  lungs  (e)  fometimes  fluff’d  up  with  them  and  Gefner  (/)  has  taken  no¬ 
tice  of  “  a  great  number”  being  found  in  a  certain  youth,  Hildanus  (g) 
“  a  very  confiderable  number”  in  a  woman,  Huldenreichius (b)  “  fome 
“  hundreds”  in  a  ftudent,  and  Raygerus  (?)  found  them  “  innumerable”  in 
another  perfon  •,  not  to  fpeak  of  others,  and  thofe  even  who  have  fpoken  of 
them  being  thrown  up,  of  whom  it  is  fufficient  to  mention  two,  Hilda¬ 
nus  (£),  who  has  afferted,  that  an  “  infinite  number”  were  difcharg’d  from 
the  lungs  of  a  confumptive  patient ;  and  Boerhaave  (/),  who  has  afferted, 
that  “  four  hundred”  were  difcharg’d  by  Vaillant,  and  thofe,  to  fpeak  alfo 
of  magnitude,  all  very  fmall.  But,  from  the  magnitude  of  a  millet-feed, 
they  often  grow  to  the  fize  of  a  lentil,  a  pea,  a  vetch,  or  a  bean :  and  even 
Benivenius  (m),  and  our  Praevotius  (»),  faw  calculi,  that  had  been  cough’d 
up,  the  firft  of  which  was  as  big  as  a  filbert-nut,  and  the  other  ftill  bigger. 
And  thofe  mufl  have  been  very  large  which  Koehlerus  (<?)  faw,  and  wonder’d 
that  they  could  have  pafs’d  through  the  rimula  of  the  glottis,  without  caufing 
inflant  fuffocation  j  and  indeed  they  had  hurt  the  trachea  in  their  paffage. 
Nor  did  I  lefs  wonder  lately,  when  a  carman,  who  came  to  afk  my  advice 
for  a  dry  cough,  fhew’d  me  a  calculus,  which  was  fcarcely  lefs  than  the  ftone 
of  a  moderately-fiz’d  peach,  and  which  he  had  expectorated  with  great  pain 
and  difficulty  •,  and  two  others  of  the  bignefs  of  a  vetch,  that  he  had  dif¬ 
charg’d  fince  •,  and  all  of  them  from  the  right  lobe  of  the  lungs,  for  he  had 
perceiv’d  them  to  afeend  from  thence.  Yet  that  which  is  deferib’d  by 
Oethaeus  (p)  was  fo  much  bigger,  as  to  equal  the  fize  of  a  walnut  •,  and  what 
makes  it  ftill  more  admirable  is,  that  it  was  expedlorated  by  a  girl  of  four¬ 
teen  years  of  age,  and  without  any  evident  injury  being  the  confequence 
thereof,  if  the  phyficians,  however,  have  taken  fufficient  care  to  guard  them- 
felves  againfl  female  fraud.  But  I  can  eafily  believe,  that  a  calculus  of  the 
fame  magnitude,  was  found  within  the  lungs  by  Hildanus  (<7),  as  alfo  one  of 
the  bignels  of  a  pigeon’s  egg,  by  Contulus  (r),  although  he  has  fooliffily 
abus’d  Malpighi’s  figure  of  a  frog’s  lungs,  in  which  he  would  fain  reprefent 
to  us,  a  human  calculus. 


(y)  De  Partib.  Animal.  1.  3.  c,  4. 

(z)  Morb.  Diut.  1.  I.  c.  4. 

(a)  (1 b)  (c)  Apud  Shenck.  cit.fupra  ad  n.  19. 

(d)  Comment,  in  Mundin.  Anat.  c.  34.  in  fin. 

(e)  (f)  Apud  Shenck.  loc.  cit. 

(g)  Cent.  2.  obf.  29. 

\b )  Eph.  N.  C.  Dec.  1.  A.  6.  obf.  221. 

(«')  Earund.  Dec.  3.  A.  3.  obf.  248. 


{ k )  Cent.  6.  obf.  22. 

(/)  Praeleft.  in  Inftit.  §  835. 

(m)  Apud  Shenck.  1.  cit. 

(«)  Vid.  Rhodii  obf.  cit.  fupra  ad  n.  19. 

(0)  Commer.  Litter.  A.  1741.  Htbd.  8.  in  fin. 
(/>)  Apud  Shenck.  1.  cit. 

(7)  Obf.  cit.  fupra  29. 

(r)  c.  8.  cit.  fupra  ad  n.  19. 


21.  Yet 


Letter  XV.  Article  21.  373 

21,  Yet  he  has  fome  things  which  ought  not  to  be  pafs’d  over,  relating  to 
the  hardnefs  of  it,  the  marks,  and  method  of  cure,  in  an  incipient  calculus. 
For  as  thefe  calculi,  for  the  mod  part,  are  like  the  matter  whk  h  concretes 
in  the  joints  of  arthritic  patients,  friable,  light,  like  a  pumice  Fone,  chalky, 
and  tophaceous,  Fich  as  I  faw  from  the  carman  (j) ;  and  not  frequently  rather 
hard,  immoderately  hard,  extremely  hard,  and  [Scarcely  more  than  once  of 
the  hardnefs  of  a  flint,  and  of  the  weight  of  twenty  grains  ;  the  calculus  I 
fpeak  of,  is  faid  to  have  been  “  hard  and  Freaky  like  marble,  and  very 
“  heavy.”  And  as  an  afthma  and  orthopnoea  are  generally  found  to  attend 
this  difeafe,  but  Fill  more  often,  an  obftinate  and  long-continu’d  cough, 
and  that,  unlefs  an  hsemoptoe,  or  confumption,  be  join’d  to  it,  dry,  (for  it 
is  very  rarely,  that  there  is  no  cough,  as  happen’d  in  the  obfervation  of  Jo. 
Francus  (f),  when  the  lungs  were  fill’d  with  little  (tones ;  but  it  is  Fill  more 
extraordinary  that  a  cough  is  not  only  not  mention’d,  but  is  exprefsly  de¬ 
nied,  at  any  time;  not  to  fpeak  of  it  being  denied,  that  another  (a)  had 
ever  complain’d  of  any  pain  or  difficulty  of  the  lungs,  in  whom  they  were 
in  like  manner  fill’d  with  calculi  ;  however,  not  dried  up,  as  in  the  former 
cafe,  fo  that  they  may  be  fuppos’d  to  have  been  lefs  irritable )  as  the  afore- 
mention’d  fymptoms,  I  fay,  are  wont  not  feldom,4  or  indeed  generally  to  at¬ 
tend  ;  Contulus  relates,  that  this  young  man  of  his,  on  being  attack’d  with 
a  violent  cough,  had  a  great  quantity  of  the  moF  limpid,  water  difeharg’d 
from  his  fauces,  and  became  every  day  more  and  more  emaciated,  having  a 
moF  acute  pain  in  the  middle  of  his  cheF,  which  alfo  encreas’d  daily,  being 
obFinate  and  immoveable,  as  if  from  a  nail  which  had  been  driven  into  that 
part.  1  am  not  ignorant,  that  he  who  1  laid  juft  now  had  never  been  troubl’d 
with  any  cough,  had  however  labour’d  under  a  continual  pain  of  the  lungs, 
on  the  right  fide;  and  how  long,  and  how  great  pains  of  the  fides  he  bore,, 
whom  I  pointed  out  above  (x)  from  Benivenius :  and  Morton  (y)  has  even 
taught,  which  he  confirms  by  producing  hiftories  of  cafes,  that  when  with 
an  haemoptoe,  a  horrible  pain  of  the  cheft,  refembling  much  a  pleuritic,  or 
peripneumonic  complaint,  happens  about  the  beginning  of  a  confumption, 
we  may  with  juftice  fufpeCt,  that  this  diforder  is  of  the  calculous  kind.  But 
he  fays,  however,  that  the  calculi,  in  thefe  cafes,  are  form’d  with  angles, 
and  (harp  points ;  and  certainly  even  Paulus  (%),  in  an  hasmoptoic  patient, 
who  threw  them  up  in  a  rough  Fate,  and  (harp  like  the  tribuli,  (or  iron 
fpikes,  arm’d  with  prickles,  which  were  us’d  by  the-  ancients  to  annoy  the 
enemy’s  horfe  in  battle)  has  mention’d  a  pain :  but  where  the  calculi  are 
fmooth,  nor  apt  to  lacerate,  altho’  they  are  fometimes  pretty  large,  Morton  has 
aFur’d  us,  that  they  produce  no  inconvenience,  but  a  dry  cough,  and  fome 
heavinefs  in  the  cheF.  But  neither  Francus,  Benivenius,  nor  Contulus,  fay, 
that  the  calculi  they  had  feen  were  furnifh’d  with  angles,  and  fharp  points ; 
for  which  reafon  they  brought  on  no  fpitting  of  blood  ;  fo  that  it  is  natural 
to  imagine,  they  do  not  always  produce  the  pain,  by  pricking,  and  lace¬ 
rating  ;  but  fometimes  by  drawing  the  lungs,  by  their  weight,  afunder  from 

(s)  n.  20.  (*)  n.  20. 

(/)  Eph.  N.  C.  Dec.  3.  A.  3.  cbf.  72.  (y)  c.  cit.  fupra  ad  n.  19. 

[  (u)  Earund.  Dec.  1.  obf.  181.  ( z )  Apud  Shenck.  1.  cit.  fupra  ad  n.  19. 

the 


3  74  Book  II.  Of  Difeafes  of  the  Thorax. 

the  pleura,  or  mediadinum,  to  which  they  are  perhaps  conneded,  and  at  other 
times  not  even  in  this  way,  but  otherwife.  And  that  they  have  been  fometimes 
form’d  for  laceration,  but  in  fad  have  not  once  lacerated,  nor  yet  occafion’d 
any  pain,  you  will  underftand  from  what  1  fhall  prefently  fubjoin,  when  [ 
have  pointed  out  what  Contulus  and  others  have  remark’d  concerning  the 
method  of  cure. 

When  molt  of  the  phyficians  had  order’d,  that  milk  fhould  be  given  to 
that  young  man,  in  order  to  eafe  the  pain,  and  to  prevent  his  being  emaci¬ 
ated  ;  Albertus  Fabrius,  the  fame  whom  I  have  before,  with  great  juliice, 
commended  (<?),  very  refolutely  diffented  from  their  opinion,  inafmuch  as  he 
was  the  only  one,  who  guefs’d  at  the  real  caufe  of  the  diforder,^and  thought 
that  the  calculous  concretions,  in  the  lungs,  might  be  encreas’cl  by  the  ufe 
of  the  milk :  and  in  this  opinion  Morton  (b)  was  afterwards,  who,  we  fee, 
for  the  fame  reafon,  did  not  permit  a  milk  diet  in  a  phthifis,  from  calculous 
concretions  in  the  lungs,  unlel's  upon  the  mod  urgent  neceffity  :  and  indeed 
the  man  whofe  lungs  1  laid  were  found  fill’d  with  (mail  dones,  by  Francus, 
was  accudom’d  to  have  fuch  a  craving  appetite,  that  he  drank  it  even  in  the 
dead  of  water,  or  beer.  But  the  event  prov’d  the  judgment  of  Fabrius. 
For  the  ufe  of  milk  encreas’d  the  calculus,  or  at  lead  the  pain,  and  haden’d 
the  patient’s  death  :  whereas  in  another  young  man,  whofe  dilorder  Fabrius, 
from  the  very  fame  fymptoms,  attributed  to  the  lame  caule,  he  fucceeded 
fo  far  by  giving  oil  of  almonds,  and  other  remedies  of  that  kind,  even  by 
way  of  linitus,  indead  of  the  milky  diet,  that  the  done  was  cough’d  up, 
the  pain  by  degrees  went  away,  and  perfeit  health  was  redor’d.  So  alfo 
Benivenius,  by  giving  peitoral  lenients,  and  mollifying  the  throat  and  afpera 
arteria,  faw  that  the  calculus,  which  I  have  fpoken  of,  was  difeharg’d  j  and 
that  all  the  pain,  together  with  the  dry  cough,  was  remov’d. 

22.  Wherefore,  although  when  the  calculi  are  even  expedorated,  patients 
of  this  kind  perifh  much  more  frequently  than  they  recover,  either  becaufe 
they  have  not  thrown  up  all  of  them,  or  becaufe  they  again  generate  others, 
or  becaufe  they  receive  great  injuries  from  thence,  while  in  the  lungs, 
which  bring  them  into  confumptions,  or  fpittings  of  blood,  from  one  or  the 
other  of  which,  they  generally  perifh,  the  foft  lungs  being,  doubtlefs,  eafily 
injur’d,  even  from  the  very  nifus,  or  efforts,  made  by  them  to  get  rid  of  the 
calculus,  as  Boerhaave  has  rightly  taught  (r) ;  yet  examples  are  not  wanting, 
nor  thofe  very  rare,  of  perfons  who  have  not  only  liv’d  a  long  time,  after 
difeharging  the  calculi,  as  Petrus  Borellus  (d),  Richard  Morton  (*),  Sebadian 
Roth  (f),  and  Jo.  Francus  Hildefius  (£),  tedify ;  but  have  even  grown 
healthy  and  found,  as  fome  of  thefe  very  perfons  feem  to  have  done,  and 
others  certainly  did,  of  whom  I  fpoke  jud  now,  and  whom  Trallianus  (£), 
W^ierus  (/),  and  FlefTus  (£),  mention ;  and  he  in  particular  who  relates  of 
himfelf,  that  he  was  redor’d  to  health,  after  travelling,  without  the  ufe  of 
any  medicine,  Ofwald  Gabelchover  (/).  I  omit  others,  and  among  thefe 

(a)  Epift.  8.  n.  32.  &  Epift,  10.  n.  11.  («)  cit.  c.  fupra  ad  n.  21. 

(i>)  c.  indicato.  (f)  (g)  {h)  (/)  (t)  (/)  Apud  Schenck.  loc. 

(c)  ad  §  cit.  fupra  ad  n.  20.  cit.  fupra  ad  n.  19. 

(d)  Cent.  1.  obf.  67. 


Pechlinus 


Letter  XV.  Article  23.  37  5 

Pechlinus  (*»),  and  him  whom  I  have  mention’d  to  you  before  ( n ),  Cafp. 
Defid.  Martinettus  (0);  the  firft  of  whom  faw  three  calculi,  that  were  cough’d 
up  without  any  farther  inconvenience,  and  the  laft  two ;  by  which  dis¬ 
charge  the  patient  was  entirely  freed  from  the  afthmatic  affections  with  which 
he  had  before  been  troubled.  Yet  I  cannot  omit  Zacutus  (/>),  and  Georg. 
Wolfg.  Wedelius(^).  For  both  of  them  relate  examples  of  thofe  being  re- 
ftor’d  to  health,  who  had  even  difcharg’d  fharp  and  rough  calculi  from  the 
lungs  ;  one,  for  inftance,  that  was  heavy,  hard,  and  oblong,  like  the  bone 
of  the  finger,  and  rough  and  in  like  manner,  many,  fome  of  the  bignefs  of 
a  pea,  and  one  of  the  bignefs  of  a  bean,  and  all  of  them  with  acute  angles, 
and  arm’d  with  three  points :  and  they  mention  an  orthopnoea  indeed,  that 
was  brought  on  from  the  firft,  and  a  dry  cough  j  and  from  the  others,  a 
flight  haemoptoe,  and  cough,  that  had  preceded  the  difcharge  ;  but  do  not 
fay  a  word  of  any  pain.  Mention  of  which  you  will  not  even  find  made  by 
thofe  who  have  given  you  cafes,  where  death  was  brought  on  by  rough  cal¬ 
culi,  befides  the  other  fymptoms  that  had  preceded  the  patient’s  death.  For 
the  colleague  of  Wierus  (r)  faw  a  little  {tone  “  unequal  and  rough,”  Hil- 
danus,  that  great  one  which  I  fpoke  of  (j),  that  was  “  rough  on  all  fides,” 
Raygerus  (/)  one  “  here  and  there  fharp,”  Jo.  Seb.  Albrechtus  (a)  twenty, 
“  extremely  rough,”  Jo.  Phil.  Wolfius  (x)  many  more,  all  “  of  a  very  rough 
“  form,”  that  had  either  been  cough’d  up  from  the  lungs,  or  were  feen  in 
their  fubftance  after  death.  But  notwithftanding  every  one  of  thefe  authors 
mentions  fome  complaint  or  other  in  thefe  patients,  fuch  as  phthifis,  cough, 
dyfpnoea,  haemoptoe,  afthma,  and  heCtic  fever,  yet  no  one  of  them  makes 
the  leaft  mention  of  pain ;  fo  that  it  muft  have  been  flight,  and  not  horrible 
(as  Morton  has  defcrib’d  it  (y)  )  although  the  calculi  were  not  only  form’d 
for  laceration ;  but  had  even  lacerated,  in  fome,  as  the  fpitting  of  blood  de- 
monftrates. 

23.  And,  indeed,  the  blood  is  difcharg’d,  fotnetimes,  in  fo  great  'a  quan¬ 
tity,  as  to  kill  the  patient,  as  it  did  that  nobleman  of  whom  Dodon^us  (z) 
relates,  without  mentioning  any  cough,  or  even  pain,  that  he  had  often  dis¬ 
charg’d  a  calculus,  “  which,  being  generated  in  the  extreme  ramifications 
fi  of  the  afpera  arteria,  refembl’d  the  figure  of  the  place,  being  oblong  in 
tc  its  form,  round,  and  llender,  with  fhort  little  branches  here  and  there 
“  hanging  to  it.”  On  the  contrary,  another  man  ( a )  threw  up  no  blood  at 
all,  who  being  troubl’d  with  a  flight  dyfpnoea,  but  with  no  pain,  had  a  great 
number  of  tophaceous  concretions  in  each  lobe  of  the  lungs,  “  equal  in 
“  bignefs  to  pretty  large  filberts,  and  having  many  fharp  hooks,  which  had 
“  fix’d  themfelves  into  many  branches  of  the  bronchia that  is  to  fay, 
“  Being  foft  in  the  beginning,  they  had  taken  on,  by  degrees,  the  internal 
“  figure  of  the  canals  that  contain’d  them,  and  fo  had  form’d  hooks  here 


(m)  Aft.  Erud.  Lipf.  A.  1691.  M.  Maj. 
(;/)  Epift.  5.  n.  12. 

( 0 )  Litter,  ibid,,  cit. 

(/)  De  Praxi  Med.  Admir.  1.  1.  obf.  103. 
{q)  Eph.  N.  C.  Dec.  x.  A.  3.  obf.  16. 

(r)  Apud  Schcnck.  loco  indicato. 

(j)  n.  zo. 


( t )  Obf.  cit.  fupra  ad  eund.  n.  20. 

(a)  Aft.  N.  C.  Tom.  4.  obf.  49. 

\x)  Earund.  Tom.  5.  obf.  28. 

(  y)  c.  cit.  fupra  ad  n.  21. 

(z)  Apud  Schenck.  loc.  cit.  fupra  ad  n.  19; 
(a)  Commere.  Litter,  a.  1743.  hebd.  13. 
n;  2. 

“  and 


37  6  Book  II.  Of  Difeafes  of  the  Thorax. 

“  and  there,  where  a  paffage  open’d  from  one  canal  into  another.”  Thefe 
things  agree  very  well  with  the  obfervation  of  Flaterus  (£),  who  related, 

“  that  he  had  frequently  found,  by  diffeflion,  pulmonary  calculi,  at  one 
Xi  time  fmooth,  and  at  another  time  unequal,  and  form’d  like  tophaceous 
“  concretions,  into  the  fbape  of  the  veffels.” 

But  now  you  fee  at  length,  after  a  long,  but  perhaps  not  ufelefs,  difcourfe, 
on  the  fubjefl  of  thefe  calculi,  that  there  is  no  doubt  of  what  I  advanc’d  in 
the  beginning  of  it,  that  calculi  have  been  found,  which  have  concreted  in 
the  bronchia.  And  that  in  the  fame  bronchia,  and  in  like  manner  in  the 
cells,  in  which  the  laft  ramifications  of  the  bronchia  terminate,  the  greatefl 
part  of  thofe  I  have  mention’d  have  been  alfo  generated,  and  efpecially  of 
the  very  fmall  ones,  may  eafily  be  believ’d,  from  the  frequent  dilcharge  of 
them  from  the  lungs,  without  being  follow’d  with  blood  and  pus.  But  if 
the  fmall  branches  of  the  bronchia  are  befet,  here  and  there,  with  a  matter  * 
which  can  fo  harden,  you  underhand  in  what  manner  the  lungs  may  become 

lapidefcent,”  from  an  internal  and  inbred  caufe,  and  may  “  refemble  ftony 
<{  tophi,  or  a  hard  gypfeous  matter,”  fuch,  for  inflance,  as  are  fpoken  of 
in  the  Sepulchretum  (c). 

24.  Finally,  not  in  this  manner  only,  but  in  others  alfo,  the  lungs  may 
become  hard,  as  when  they  are  fchirrhous,  or,  what  is  more  rare,  when  they 
refemble  tendon  or  flefh  *,  the  latter  of  which  changes  in  the  lungs  you  have 
examples  of,  indeed,  befides  that  which  you  will  have  given  on  another  oc- 
cafion(^),  from  Valfalva,  in  Francifcus  Sylvius  (<?),  and  Jo.  Bapt.  Fanto- 
mis  (/)  and  examples  of  the  firfl  you  will  have  from  me  in  another  place  (£) ; 
or  when  they  refemble  the  very  fubflance  of  boil’d  liver  itfelf :  and  when  this 
is  the  cafe,  it  not  only  neceffarily  happens,  that  the  bronchia  are  fluff’d  up, 
and  render’d  lefs  flexible,  but  that  they  are  at  the  fame  time  greatly  com- 
prefs’d.  Yet,  as  this  flate  of  the  lungs  belongs  to  the  fedlion  Be  peftoris 
laterum  dolore ,  “  Of  pain  in  the  breaft  and  fides,”  1  will  put  off  my  obfer- 
vations  of  this  kind,  till  we  come  to  that  fedlion  ( h ).  And  as  it  would  take 
up  too  much  time  here  to  produce  obfervations  relative  to  the  other  kinds 
of  changes  I  have  fpoken  of,  it  will  be  fufficient  to  add  one  of  topha¬ 
ceous  lungs :  which  you  will  fo  much  the  more  willingly  receive,  as  it  is 
not  mine,  but  made  by  that  very  great  anatomifl  and  phyfician,  Malpighi. 
For  he,  when  Albertini,  from  whom  I  had  the  relation,  was  affiflant-phy- 
fician  to  the  hofpital  of  St.  Mary  de  Morte  at  Bologna,  which  office  he 
diligently  difcharg’d,  was  accuflom’d,  if  any  obfcure  difeafe  happened,  to 
go  and  fee  the  patient,  on  being  afk’d,  and  declare  to  Albertini  what  he 
thought  of  the  cafe  *,  as  was  done  in  that  which  I  fhall  immediately  fubjoin. 

25.  A  woman,  being  affedled  with  a  very  flight  fcabies,  but  a  great  con- 
fumption  of  flefh,  was  now  and  then  troubl’d  with  a  cough,  which  was  never 
follow’d  with  any  difcharge  of  thick  matter,  but  always  with  a  difficulty  of 
breathing  *  and  whether  fhe  lay  on  her  back,  or  on  her  right,  or  her  left 


(l)  Sedl.  hac  Sepulchr.  1.  in  Schol.  adObf. 
41. 

(0  S.-dE  ead.  Obf.  47.  §  1,  &  2,  Sc  in  Ad¬ 
dit.  Obf.  1. 

(d)  Epift  17.  n.  10. 


(e)  Sedt.  hac  Sepulchr.  Obf.  50. 

(f)  Obf.  Med.  15. 

(g)  Epift.  18.  n.  30.  &  Epift.  45.  n.  23. 
{h)  Vid.  Epift.  20.  &  21. 


fide. 


Letter  XV.  Article  26.  377 

fide,  it  was  not  for  that  reafon  either  increas’d,  or  diminifh’d.  With  her  neck 
ereCt,  indeed,  fhe  breath’d  a  little  more  eafily  ;  but  then  there  was  a  great 
fenfe  of  weight,  as  it  were,  hanging  from  the  fauces  into  the  cavity  of  the 
thorax,  and  rend’ring  the  fauces  narrow.  It  is  probable,  faid  Malpighi,  that 
this  woman  has  her  lungs,  to  life  his  own  words,  tartarizated.  She  having 
died  in  this  manner,  and  her  cheft  being  open’d,  as  foon  as  ever  the  knife 
was  imprefs’d  upon  her  lungs,  the  crafhing  of  them,  juft  as  if  any  one  had 
cut  into  fandy  concretions,  evinc’d  the  truth  of  Malpighi’s  diagnofis,  which 
the  continu’d  difieCtion  alfo  plainly  confirm’d. 

26.  It  is  not  eafy  to  fay,  with  what  admiration  this  diftedlion  was  receiv’d 
by  thofe,  who  had  before  heard  from  Albertini  the  conjecture  of  Malpighi: 
to  which  he  might  have  been  led  by  very  probable  realons,  when  he  atten¬ 
tively  confider’d  the  fymptoms,  being  at  the  fame  time  aftifted  by  his  own 
obfervations,  and  the  obfervations  of  others,  in  fome  meafure,  alfo.  For 
it  was  then  committed  to  print,  that  with  tophaceous  and  gypfeous  lungs, 
befides  a  difficulty  of  breathing,  cc  a  dry  cough  ”  had  been  join’d  (/) ;  as  alfo 
that  a  man,  who  had  frequently  cough’d  up  calculi,  “  had  perceiv’d,  in  the 
“  middle  of  his  cheft,  the  preflure  of  a  kind  of  weight  (k)  and  even  that 
in  many  who  were  us’d  to  complain  of  “  a  dry  cough,  and  fome  kind  of 
“  weight  preffing  upon  the  breaft,”  as  I  hinted  above  (/),  Morton  found  in 
their  lungs  “  fmooth  cretaceous  ftones,  in  great  number,  and  fome  of  them 
“  even  pretty  large.” 

I  have  borne  it  with  great  reluCtance,  when  I  have  happen’d  to  light  on 
lungs  of  this  kind,  that  I  could  not  know  for  certain,  what  fymptoms,  and 
of  what  kind,  they  had  labour’d  .under  when  living;  efpecially  in  a  man 
who  was  already  growing  old,  the  greateft  part  of  whofe  fanguiferous  veffels 
being  diligently  examin’d,  a  little  before  the  end  of  the  public  anatomical 
demonftrations  of  the  year  1729,  I  faw  the  left  vertebral  artery,  riling  from 
the  curvature  of  the  aorta  itfelf,  between  the  carotid  and  fubclavian  of  the 
fame  fide.  In  him,  one  lobe  of  the  lungs  was  tophaceous,  and  the  right 
ventricle  of  the  heart,  with  the  annex’d  auricle,  entirely  fill’d  with  poly- 
pous  concretions,  that  were  firm,  hard,  and  in  appearance  fleffiy ;  whereas 
the  left  auricle,  and  the  ventricle  ftill  more,  contain’d  nothing  but  a  black 
and  femi-concreted  blood  :  and  the  veins,  in  like  manner,  were  all  greatly 
diftended  with  blood ;  whereas  the  arteries,  in  proportion  to  the  ftature  of 
the  man,  feem’d  to  be  rather  contracted  ;  and  the  aorta,  at  its  divifion  into 
the  iliacs,  and  below  that,  ffiew’d,  here  and  there,  bony  lamellae ;  but  above 
this  divifion  was  not  the  leaft  appearance  of  that  kind  any-where.  But,  as  I 
faid,  I  was  entirely  ignorant  how  he  had  been  afreCted  when  living,  and  of 
what  diforder  he  had  died.  In  the  mean  while,  that  you  may  be  the  lefs 
difpleas’d  at  having  fewer  obfervations  of  Valfalva’s  and  mine,  than  you 
might  expeCI,  in  this  letter,  let  me  allure  you,  that  you  ffiall  have  many  in 
the  next.  Farewel. 

(/)  Vid.  €epulchret.  Sedt.  hac  I.  Obf.  47,  (&)  Sedt.  ead,  Obf.  46.  primae  §  11» 

&  1.  in  Addit.  ( l J  N.  21. 


VOL.  I. 


C  c  c 


LETTER 


378 


Book  II.  Of  Difeafes  of  the  Thorax. 


LETTER  the  SIXTEENTH 

Treats  of  Refpiration  being  injur’d  from  Caufes  within 
the  Thorax,  and  principally  from  the  Dropfy  of  the 
Thorax,  and  Pericardium. 

i.TT  follows  now,  according  to  the  method  I  have  laid  down,  that  we 
i  enquire,  what  caufes,  fituated  within  the  thorax,  indeed,  but  on  the 
outfide  of  the  lungs,  may  prove  injurious  to  refpiration.  The  chief  of  thele 
caufes  which  occur  relate,  and  that  much  more  frequently  than  moil  perfons 
imagine,  either  to  water  being  effus’d,  or  to  the  dilatation  of  the  heart  and 
the  great  veffels.  You  will  find  many  oblervations,  here  and  there,  in  this 
firft  fedtion  of  the  fecond  book  of  the  Sepulchretum  Anatomicum ,  relating  to 
each  fpecies  of  diforder  ;  but  a  particular  diffedtion  of  neither.  However,  - 
to  me  it  feems  to  be  more  convenient,  and  more  ufeful,  if,  by  dividing  our 
obfervations,  I  comprehend  in  this  letter  what  relate  to  the  dropfy  of  the 
thorax,  and  pericardium ;  but  referve  what  relate  to  the  an  eurum  of  the 
heart,  and  great  artery,  for  the  fubjedt  of  my  next  letter.  Wherefore,  as 
to  the  firft  divifion,  there  are  thefe  nine,  which  belong  to  it,  from  Valfalva. 

2.  A  woman,  about  two-and-twenty  years  of  age,  of  a  bad  habit  of  body, 
thirfty,  having  a  flight  cough,  and  fpitting  up  a  kind  of  catarrhous  matter* 
was  married.  Some  days  after  the  nuptials,  fhe  was  compell’d  to  take  to 
her  bed.  Her  pulfe  was  quick,  frequent,  and  low;  her  cough  tronblefome, 
with  but  little  expedl oration  ;  and  her  thirft  great.  Her  feet  fwell’d,  and 
became  cedematous ;  and  fo  much  the  more,  as  the  diforder  became  the  more 
violent :  and  even  now  her  face  alfo,  her  arms,  and  her  hands,  were  affedted 
with  the  fame  kind  of  fwelling.  There  was  a  fenfe  of  immoderate  heat  in  the. 
left  part  of  the  thorax  ;  fometimes  a  tightnels  of  the  praecordia,  and  a  diffi¬ 
cult  refpiration  ;  fo  that  fhe  was  oblig’d,  as  the  diforder  increas’d,  to  breathe 
with  her  neck  eredt.  Wherefore,  fhe  died  within  a  few  days. 

The  abdomen,  being  open’d,  was  found  to  contain  a  little  ferurn  ;  but  all 
the  vifcera  were  found,  except  that  the  fpleen  was  bigger  than  it  naturally 
fhould  be.  The  uterus,  alfo,  was  diffedted  ;  to  fee  if  any  mark  of  be¬ 
ginning  conception  might  appear  in  her,  as  fhe  had  been  lately  married.. 
And,  indeed,  there  were  in  the  uterus  two  vehicles,  and  a  kind  of  unform’d 
mafs.  But  this  confifted  of  a  mucous  fubftance,  to  which  another  was  join’d, 
of  fuch  a  colour,  that  it  was  not  much  unlike  coagulated  blood,  and  was 
entirely  free,  on  all  fides,  from  the  parietes  of  the  uterus.  On  the  contrary, 
the  vehicles,  one  of  which  was  of  a  magnitude  equal  to  that  of  a  fmall  lentil, 
and  the  other  to  that  of  a  fmall  vetch,  were  fo  fix’d  to  the  fides  of  the 

.  uterus. 


Letter  XVI.  Articles  3,  4,  5,  379 

uterus,  that  it  was  with  difficulty  they  were  pull’d  afunder.  But  they  were 
furniffi’d  with  no  fanguiferous  veffiels,  nor  did  the  included  humour  coagulate 
with  the  fire  ;  whereas  the  ova,  that  is,  the  veficles  of  the  ovaries,  confiding 
of  a  double  membrane,  not  only  have  manifeft  fanguiferous  veffiels,  but  their 
included  humour  will  coagulate  with  heat,  and  refembles  the  white  of  an 
egg  in  its  tafte,  as  was  even  obferv’d  in  this  very  woman.  Finally,  the  en¬ 
trance  of  both  the  Falloppian  tubes  into  the  uterus  was  entirely  (hut  up. 

The  thorax  being  open’d,  the  lungs,  indeed,  wTere  found  to  be  quite  free 
from  the  pleura  all  round,  but  hard  ;  fo  that  if  the  proper  figns  of  a  perip- 
neumony  had  preceded,  they  might  feem  to  have  labour’d  under  an  inflam¬ 
mation.  There  was  water  in  each  cavity  of  the  thorax,  in  fo  great  a  quan¬ 
tity,  that  a  portion  of  it  burft  forth  on  cutting  through  the  fternum.  And 
the  fame  kind  of  water  was  contain’d  in  the  pericardium,  to  the  quantity  of 
about  five  ounces :  but  with  this  difference,  however,  that  part  of  the  fluid 
in  the  thorax,  and  part  of  that  in  the  pericardium,  being  expos’d  to  the 
fire,  the  latter  did  not  coagulate,  though  the  former  did.  There  was  a  po¬ 
lypous  concretion  in  both  the  ventricles  of  the  heart;  but  that  in  the  right 
was  largeft,  which  not  only  was  produc’d  through  the  orifices  of  the  veflels, 
but  was,  particularly,  much  enlarg’d  in  the  auricle. 

3.  Whether  the  veficles  contain’d  in  the  uterus  were  ovula  of  the  ovaries, 
is  not  a  queftion  to  be  difputed  of  here  ;  and  ftill  lefs,  whether  that  unform’d 
mafs  was  the  beginning  of  conception,  when  both  the  tubes  were  entirely 
(hut  up.  The  water  is  what  I  principally  attend  to  in  this,  and  the  fol¬ 
lowing  obfervations,  inafmuch  as  it  prefs’d  all  round  upon  the  lungs,  and 
for  that  reafon  refilled  their  eafy  and  natural  dilatation  ;  though  I  fhall  not 
negledt  hereafter,  on  a  proper  occafion,  other  circumftances  which  relate  to 
the  fame  fubjedt. 

4.  A  woman,  about  twenty- fix  years  of  age,  who  had  been  more  than 
once  pregnant,  fwell’d  in  her  whole  body  flightly,  but  much  more  in  the 
abdomen,  after  great  uneafinefs  of  mind.  She  alfo  breath’d  with  great  dif¬ 
ficulty,  and  with  her  neck  eredt,  lay  down  on  either  fide  laborioufly,  and 
felt  a  great  weight  in  her  thorax ;  (he  thirfted  greatly  ;  till  at  length,  her 
difficulty  of  refpiration  growing  more  violent,  (he  died.  In  the  abdomen 
there  was  a  little  water ;  but  the  ftomach  being  very  turgid,  and  the  liver 
large,  had  driv’n  the  diaphragm  fo  far  upwards,  that  the  cavity  of  the 
thorax  was  much  leffien’d  thereby.  However,  the  lymphasdudts  in  the  belly 
were  turgid,  and  all  the  vifcera  of  that  cavity  were  found,  and  natural,  ex¬ 
cept  the  ovaries,  which  were  indurated.  The  thorax  was  entirely  full  of 
water ;  the  lungs  were  fomething  red,  in  fome  meafure  hard,  and  diftin- 
guifh’d  with  black  fpots,  but  in  other  refpedts  found.  The  right  ventricle 
of  the  heart  contain’d  a  polypous  concretion,  and  about  this  concretion  was 
grumous  blood  ;  yet  the  blood  in  the  left  ventricle,  and  in  all  the  veffiels, 
was  fluid. 

5.  As  to  what  Valfalva  left  written,  in  the  fame  manner  as  I  have  tranf- 
lated,  that  (he  who  breath’d  with  great  difficulty,  and  with  her  neck  eredt, 
lay  down  on  neither  fide  laborioufly  *,  he  either  [omitted  there  a  negative,  as 
fometimes  happens  through  hafte  and  careleffnefs,  by  which  we  (hould  un- 
derftand,  that  the  patient  could  lie  down  on  neither  fide  without  great  dif- 

C  c  c  2  ficulty 


3 Bo  Book  II.  Of  Difeafes  of  the  Thorax. 

ficulty  and  pain  ;  or  we  muft  underftand  him  in  this  manner,  as  if  he  would 
have  faid,  that  had  not  the  difficulty  of  breathing  forbidden  her,  ffie  could 
have  lain  down  on  either  fide  for  a  little  while,  as  perhaps  the  phyficians,  for 
experiment’s  fake,  had  order’d  her  to  do,  inafmuch  as  ffie  was  not  prevented 
on  one  fide,  or  on  the  other,  by  any  particular  anxiety  or  preflure,  the  tho¬ 
rax  being  equally  full  on  both  fides.  And  as  to  his  mentioning  in  this,  and 
in  forne  other  observations  of  this  kind,  that  the  lymphaedufts  were  turgid, 

I  muft  fuppofe  that  this  happen’d,  either  by  reafon  of  the  ferum  being  re¬ 
dundant  in  the  blood,  or  from  the  compreffion  of  thofe  du<5ts,  or  the  ob- 
ftruftions  thereof,  in  the  molt  remote  parts,  which  are  fometimes  fo  great, 
that  the  thin  coats  of  fome  of  them  burft  afunder,  and  the  water  overflows 
the  cavities  of  the  body.  You  have  in  the  Sepulchretum  ( a ),  the  cafe  of  a 
young  man  defcrib’d  to  you,  who  gave  himfelf  up  to  the  care  of  Willis  and 
Lower.  This  young  man,  after  immoderate  riding  on  horfeback,  and  other 
long-continu’d  exercifes  of  the  body,  having  had  fuch  a  fenfation,  for  fome 
time,  in  the  left  part  of  his  thorax,  that  could  not  have  happen’d  without 
an  internal  compreffion,  at  length  felt  that  fome  kind  of  vefiel  was  ruptur’d 
in  the  fame  place  where  he  felt  this  compreffion  :  “  and  from  thence,  for 
“  the  fpace  of  half  an  hour,  in  that  part  of  the  thorax,  not  only  a  dropping 
“  of  a  fluid  was  perceiv’d  by  himfelf,  as  if  it  fell  from  the  top  of  the  tho- 
“  rax  to  the  bottom,  but  even  could  be  heard  by  thofe  who  were  near  him,’* 
which  is  a  circumftance  not  very  eafy  to  be  explain’d  by  thofe  who  deny, 
that  any  fpace  lies  vacant  between  the  lungs  and  the  parietes  of  the  thorax; 
though  it  was  at  the  fame  time  certainly  true,  as  was  afterwards  prov’d,  not 
only  by  the  fiuftuation  of  water  collefted  in  that  fide,  perceiv’d  by  himfelf 
and  by  others,  “  very  evidently,”  during  the  agitation  of  the  body,  but 
alio  by  the  drawing  off  of  the  water  by  the  means  of  a  pipe,  firft,  which  was 
introduc’d  by  the  hands  of  the  furgeon,  and  ever  afterwards  by  the  means 
of  a  foramen,  that  was  open’d  by  nature,  and  kept  open  by  art. 

6.  A  man  who  was  near  forty  years  of  age,  had  labour’d  under  a  flow 
fever  for  many  weeks.  To  this  was  join’d  a  tumour  of  the  feet,  a  dry  cough, 
and  drynefs  of  the  fauces.  He  breath’d  very  ffiort  and  quick,  and  with  his 
neck  ereft  :  his  pulfe  was  fcarcely  perceptible.  He  died  fuddenly.  While 
the  integuments  of  the  abdomen  were  feparated  from  the  mufcles  beneath 
by  the  fcalpel,  a  watry  humour  iffu’d  out  from  the  left  part  of  the  umbilical 
region.  Yet  every  thing  was  found  in  the  belly,  except  the  fpleen,  which 
was  three  times  bigger  than  it  is  naturally.  In  both  cavities  of  the  thorax 
a  limpid  ferum  ftagnated;  which  being  preferv’d  in  a  glafs  veffel,  threw 
down  a  kind  of  fediment,  but  in  feparate  portions,  and  quite  to  the  bottom 
of  the  glafs,  yet  ffiew’d  nothing  of  the  appearance  that  ferum  found  in  the 
thorax  generally  does  ;  I  mean,  a  kind  of  condens’d  cloud  fwimming  in  the 
fluid  The  lungs  were  found,  and  altogether  free  and  unconnected,  unlefs 
that  the  inferior  lobule  of  the  left  lobe  was  tied  to  the  pleura,  by  a  ffiort  and 
flender  connexion.  The  pericardium  was  dilated,  and  contain’d  more  than 
half  a  pint  of  limpid  ferum.  The  heart  was  enlarg’d,  and  in  the  right  ven¬ 
tricle,  particularly,  was  a  lax  polypous  concretion  ;  which  certainly  is  a  cir- 

(a)  1.  2.S  .  i.  SchoJ.  ad  obf.  75. 


J 


cumftance 


Letter  XVI.  Articles  7,  8.  381 

cumftance  very  rare  in  the  heart  of  thofe  who  have  water  ftagnating  in  their 
cavities.  The  thoracic  du£t,  and  the  lymphaedu&s  alfo  in  the  belly,  were 
fo  far  become  empty,  that  not  the  leaft  veftige  of  them  appear’d  in  any  part. 

7.  Here  alfo,  when  Valfalva  fpeaks  of  the  polypous  concretion  in  the 
.heart,  he  may  perhaps  feem  to  have  omitted  a  negative  particle  by  accident, 
and  to  have  meant  to  fay,  that  it  was  a  circumftance  not  very  rare,  fince,  out 
of  thefe  nine  obfervations  on  the  hydrops  thoracis,  there  are  no  more  than 
two,  in  which  he  has  remark’d  it  to  be  wanting. 

But  as  to  his  obferving  the  lymphasdudts  to  be  empty  in  this  body,  per¬ 
haps  by  this  another  caufe  is  hinted  at,  which  had  produc’d  the  dropfy  in 
this  man,  different  from  what  had  produc’d  it  in  the  woman  laft  fpoken  of. 
Perhaps  you  will  alk  me  whether  this  caufe  was  the  rupture  of  thofe  dufts. 
For  you  are  induc’d  to  fufpedt  this  from  their  emptinefs,  and  from  the  effu- 
fion  of  a  limpid  humour,  which  had  but  little  fediment,  and  alfo  by  the  ob- 
fervation  of  the  younger  Du  Verney  (£),  on  patients  labouring  under  an 
afeites,  from  whom,  if  the  furgeon  does  not  draw  off  a  fluid  much  unlike 
this,  the  belly  begins  to  fwell  again  in  a  fhort  time,  and  fcarcely  any  hope 
of  life  remains.  But  whether  thefe  things  neceffarily,  or  only  probably,  in¬ 
dicate  a  rupture  of  thofe  dudts,  1  think,  can  hardly  be  determin’d  with  fafe- 
ty,  in  any  cafe :  for  in  this,  if  the  emptynefs  of  thefe  duffs  were  a  proof  of 
their  rupture,  it  would  alfo  prove,  that  wherever  they  are  obferv’d  to  be 
empty,  the  belly  there  muff  have  been  hydropic.  However,  the  dropfy  of 
the  pericardium,  join’d  with  this  dropfy  of  the  thorax,  befides  the  enlarg’d 
capacity  of  the  heart,  as  in  the  woman  who  had  been  lately  married  (r),  and 
the  hardnefs  of  the  lungs  in  the  fame,  from  which  the  fecond  was  not  en¬ 
tirely  free  (d),  and  whofe  diaphragm,  befides,  was  fo  greatly  forc’d  up  by 
the  vifeera  that  lay  under  it  into  the  cavity  of  the  thorax  j  all  thefe  circum- 
ftances,  I  fay,  will  probably  make  an  obfervation  more  agreeable  to  us, 
wherein  nothing  at  all  is  fet  forth  that  could  be  injurious  to  refpiration,  but 
the  dropfy  of  the  thorax,  whereof  we  principally  treat  j  and  of  this  kind 
will  the  obfervation  be  which  I  immediately  fubjoin. 

8.  An  old  woman  of  feventy  had  a  difficulty  of  breathing,  and  could 
lie  only  on  her  back:  ffie  had  a  flight  cough,  fpat  up  a  catarrhous  matter, 
and  was  very  thirfty :  her  pulfe  was  fometimes  fcarcely  perceptible:  the  right 
foot  had  an  cedematous  fwelling  upon  it.  Before  ffie  died,  ffie  threw  up. 
by  vomiting,  for  a  quarter  of  an  hour  together,  a  fluid  of  an  mruginous  co¬ 
lour.  Her  abdomen  being  open’d,  the  colon  was  found  to  infledt-  itfelf 
downwards,  quite  to  the  pubes,  from  the  arch  of  it  that  lies  under  the  fto- 
mach,  and  from  the  pubes  to  be  reflected  upwards  again,  till  it  return’d  to 
its  ufual  feat.  The  fiomach  contain’d  a  liquor,  of  the  fame  kind  with  that: 
which  had  been  thrown  up  by  vomiting-,  and  in  this  liquor  fvvam  a  concreted 
matter  of  the  fame  colour.  A  portion  of  this  fluid  being  fet  by,  ffiew’d  a. 
kind  of  matter  precipitated  to  the  bottom  on  the  day  following.  But  two 
other  portions  having  two  different  fluids  mix’d  with  them,  the  one  fpirit  of 
vitriol,  and  the  other  fpirit  of  fait  ammoniac,  as  they  are  call’d,  fliew’d  at 

(h)  Mem.,  de  l’Acad.  R.  des  Sc.  A.  1703.  fi)  n  2.  (d)  n.  4.. 


that 


382  Book  II.  Of  Difeafes  of  the  Thorax. 

that  time  no  change  indeed ;  foon  after,  however,  the  firft  had  a  kind  of 
fediment  in  the  bottom,  and  the  fecond  none.  In  each  cavity  of  the  thorax 
ferum  ftagnated  to  the  quantity  of  three  pints.  Each  lobe  of  the  lungs 
was  connected  anteriorly  to  the  pleura.  In  the  right  ventricle  of  the  heart 
there  was  a  fmall  polypous  concretion,  which  was  alfo  produc’d  through  the 
orifices  of  the  vefiels. 

9.  If  you  fet  afide  the  confideration  of  the  matter  thrown  up  by  vomiting, 
Inafmuch  as  it  belongs  to  another  place,  the  fituation  of  the  colon,  which  is 
lefs  frequent  indeed,  but  not  very  rare,  and  the  connexion  of  the  lungs,  and 
die  polypous  concretion,  which  are  both  of  them  very  innocent  here,  as  I 
think  ought  to  be  obferv’d,  and  are  beyond  doubt  to  be  frequently  met  with, 
in  thofe  who  have  had  no  difficulty  of  refpiration  ;  the  water,  which  was  ex- 
travafated  in  the  cavity  of  the  thorax,  will  then  remain,  and  be  the  only 
caufe  to  which  you  can  attribute  the  laborious  breathing.  And  as  you  ob- 
ferve  this  fymptom,  and  the  fwelling  of  the  feet,  the  third:,  and  the  drynels 
of  the  fauces,  in  the  three  former  hiftories  alfo  ;  and  in  two  of  them  a  low- 
nefs  of  the  pulfe,  with  a  dry,  or  almoft  a  dry  cough,  which  may  be  com¬ 
par’d  with  this,  that  difcharg’d  nothing  at  laft  but  a  catarrhous  matter;  you 
may,  I  think,  now  fufpect  what  fymptoms  might  relate  to  the  dropfy  of 
the  thorax,  in  thofe  three  alfo,  and  what  to  other  diforders  that  were  con¬ 
join’d  therewith.  Which  other  diforders,  however,  might  in  particular  en- 
creale  the  difficulty  of  refpiration  fo  much,  as  to  bring  it  to  a  perfedt  or¬ 
thopnoea.  And  for  this  reafon  you  will  not  wonder,  that  the  old  woman 
could  lie  on  her  back  ;  and  as  to  her  not  being  able  to  lie  on  either  fide,  this 
was  owing  to  the  water,  which  was  equally  collected  in  both  cavities,  but  not 
fo  as  to  fill  either.  And  that  you  may  the  better  underftand  this,  and  fome 
other  things  which  I  have  here  hinted  at,  attend  to  the  hiftories  that  follow,* 
and  compare  them  with  this  and  the  former  hiftories. 

10.  A  young  woman  having  been  long  troubl’d  with  a  cough,  thirft,  and 
difficulty  of  breathing,  was  particularly  opprefs’d  thereby,  in  the  nights  of 
the  laft  days  of  her  life.  When  (he  cough’d,  fhe  fometimes  brought  up  a 
catarrhous  matter :  fhe  could  not  lie  down  on  her  left  fide,  by  reafon  of  the 
ftreightnefs  of  the  praecordia  ;  for  which  reafon  fhe  lay  on  her  right.  Her 
feet  were  turgid  with  an  cedematous  tumour,  her  face  and  her  belly  were 
alfo  fwell’d,  but  the  latter  flightly  only.  About  three  days  before  death  fhe 
was  in  a  manner  lethargic,  and  had  a  hefitation  in  her  fpeech  ;  and  the  laft 
two  days  her  pulfe  was  entirely  imperceptible. 

In  the  abdomen  ferum  was  effus’d  to  the  quantity  of  three  or  four  pints. 
The  liver  was  palilh,  and  the  fpleen  fmall;  but  in  other  refpedts  both  of 
them  found,  bcarcely  any  traces  of  the  lymphatic  vefiels  appear’d  in  the 
abdomen.  In  both  the  cavities  of  the  thorax  the  lungs  were  found  ;  in  the 
left  loofe  and  free,  but  in  the  right  clofely  adhering  to  the  pleura :  again,  in 
the  left,  was  a  fmall  quantity  of  ferum ;  but  in  the  right,  whatever  fpace 
was  left  vacant  between  the  pleura  and  the  lungs,  was  fill’d  up  with  a  yellow 
ferum.  In  the  ventricles  of  the  heart,  was  a  fluid  blood,  without  any  fign 
of  a  polypous  concretion.  Finally,  in  the  head  was  a  found  brain,  except 
that  the  lateral  ventricles  contain’d  forne  ferum,  and  that  (lightly  ting’d  with 
blood.  This  ferum  being  put  upon  the  fire,  threw  down  a  thick  matter  to 

the 


Letter  XVI.  Article  1 1 .  383 

the  bottom  of  the  veflel,  and  itfelf  all  evaporated  into  the  air.  And  as  to 
the  ferum  which  I  laid  was  in  the  abdomen,  and  in  like  manner,  in  the 
right  cavity  of  the  thorax,  that  was  firfl:  made  turbid  from  the  fire,  then  by 
degrees  evaporated,  but  efpecially  what  had  been  contain’d  in  the  thorax, 
for  it  left  nothing  behind  it  but  a  fomewhat  glutinous  pellicle ;  the  fame  was 
alfo  left  by  the  other,  but  together  with  fome  remaining  fluid. 

11.  Omitting  what  relates  to  the  foporific  diforder,  which  I  have  treated 
of  elfewhere,  and  the  caufe  of  which,  in  this  cafe,  you  fee  was  ferum  alfo, 
that  had  been  lately  extravafated  in  the  brain  (nor  is  it  to  be  wonder’d  at  in 
fuch  a  body)  and  even  omitting  what  belongs  to  the  other  fymptoms,  which 
you  may  eafily  compare  with  the  preceding,  and  find  to  be  the  fame  ;  I  will 
not  omit  two  things,  which  relate  to  the  difficult  refpiration  :  one,  that  the 
woman  could  not  lie  on  the  left  fide,  inafmuch  as  Ihe  carried  on  refpiration 
chiefly  with  that  lobe  of  the  lungs,  in  confequence  of  the  right  fide  being 
quite  full  of  water ;  wherefore,  if  the  water  of  the  right  fide,  lying  upon 
the  mediaftinum,  prefs’d  it  in  upon  the  left  cavity  of  the  thorax,  which  was 
already,  of  itfelf,  not  altogether  free  from  ferum,  and  at  other  times  always 
lefs  than  the  right,  fhe  would  naturally  be  troubl’d  with  a  tightnefs  of  the 
praecordia  by  reafon  of  refpiration  being  more  impeded  :  and  the  other  is, 
that  her  refpiration  was,  particularly,  more  difficult  in  the  night.  But  if 
this  were  really  the  pathognomonic  fymptom,  as  we  commonly  fpeak,  of  the 
dropfy  in  the  thorax,  you  ought  to  wonder,  that  in  fo  many  other  obfer- 
vations  of  Valfalva’s,  and  of  mine,  it  was  wanting,  rather  than  that  it  is 
mention’d  here.  Yet  you  will  fee  many  phyficians  collectedly  mention’d  by 
the  celebrated  Reimannus  (*),  and  thofe  excellent  phyficians  too,  who  have 
afierted  this  doCtrine.  But  the  firfl:  of  them  was  Carolus  Pifo,  as  the  Sepul- 
chretum  itfelf  (/)  will  ffiew,  and  others  have  confirm’d  it  by  their  obfer- 
vations  fince  his  time,  as  related  in  the  fame  place  (g).  Nor,  indeed,  can 
it  be  denied,  if  to  other  fymptoms  this  is  added,  that  a  more  increas’d  dif¬ 
ficulty  of  breathing  awakes  the  patient  fuddenly  from  his  firfl:  fleep,  it  is 
often  a  true  conjecture,  that  the  patient  labours  under  a  dropfy  of  the  thorax,, 
either  be  caufe  the  blood,  being  rarefied  by  the  heat  of  the  bed,  does  not 
find  fufficient  room  to  pals  through  the  lungs  that  are  comprefs’d  by  the 
water,  as  Willis  ( h )  has  hinted,  or  rather  from  fome  other  caufe  j  for  it  is 
not  water  alone  that  can  comprels  the  lungs,  or  contract  the  fanguiferous 
velfels  that  pafs  through  them  :  although  it  is  probable,  if  you  take  the 
cafes  in  general,  that  Willis  had  well  explain’d  the  fubjeCt,  as  Reimannus, 
whom  i  fpoke  in  commendation  of  above,  has  obferv’d,  that  nearly  the  fame 
thing  happens  in  other  difeafes(z) :  in  which  difeafes,  I  obferve,  that  the  lungs 
may  be  prefs’d  upon,  and  the  pafl'ages  of  the  blood  through  them  conftring’d 
fo  that  this  fluid  being  rarefied  from  the  warmth  of  the  bed,,  in  the  fame 
manner  as  from  the  exercife  of  the  body,  it  is  not  able  to  find  its  pafiage 
through  the  lungs,  efpecially  in  that  lituation  of  body.  But  if  the  preffing 
or  conftripging  caufe,  or  if  the  ftreighten’d  pafl'ages  of  the  blood, ,  or,,  finally», 

(«)  A&.  N.  C.  Tom.  1.  Obf.  170.  ( b )  Ibid.  Schol.  ad  Obf.  76. 

(f)  L.  2.  S.  1.  Schol.  ad  Obf.  137.  (/)  Obf.  170.  cit. 

(g)  Ead.  S.  Obf.  81,  82. 


3$4  Book  II.  Of  Difcafes  of  the  Thorax. 

if  the  blood  that  is  about  to  pafs  through  them  ;  1  fay,  if  all  thefe  circum- 
ftances,  or  the  greatelt  part  of  them,  are  not  diipos’d  in  luch  a  manner  as 
to  have  thofe  confequences,  the  patient  will  not  only  not  be  rous’d,  in  the 
firfb  hours  of  his  deep,  by  the  inftant  danger  of  lu location  in  thofe  diforders 
merely,  but  not  even  in  the  dropfy  of  the  thorax.  Wherefore,  you  perceive, 
that  the  celebrated  Helwick  (k)  has  rightly  admonilh’d  us,  how  far  it  by  no 
means  follow’d,  that  the  patient  did  not  labour  under  a  dropfy  of  the  thorax, 
becaure  he  was  not  thus  rous’d.  And,  indeed,  to  the  obfervations  which  he 
points  out,  others  may  be  added,  and  efpecially  of  a  young  and,  noble  lady  (/), 
whole  “  deep  was  very  long,  and  continu’d  till  late  in  the  morning and 
of  a  Polilh  lenator  (;«),  who  “  had  no  interruption  of  his  deep,  with  a  dan- 
“  ger  of  fulfocation  and  yet  a  large  quantity  of  water  was  found  in  the 
thorax  of  each  of  them. 

You  perceive  alfo,  as  the  fame  Helwichius  did  not  doubt,  on  the  other 
hand  (»),  that  thofe  who  had  this  interruption  did  really  labour  under  a 
dropfy  of  the  thorax  •,  you  perceive,  I  fay,  that  he  feems  to  have  afcrib’d 
more  than  is  juft  to  a  great  number  of  obfervations,  as  I  hinted  above,  which 
he  alfo  confirms  by  his  own,  made  on  a  certain  matron,  and  one  likewife 
made  on  a  matron  by  others  ;  and  you  may  alfo  confirm  by  ftill  other  obfer- 
vations,  and  by  thofe  in  particular  which  were  made  by  the  uncle  of  our 
Valifneri  (o)  on  a  dyer,  and  by  the  illuftrious  Buchnerus  (/>)  on  a  certain 
man  :  but  thefe,  fuch  as,  though  they  are  true,  do  not  prevent  thofe  which 
Reimannus  has  oppos’d  to  them  from  being  equally  true,  and  efpecially  the 
obfervation  which  carried  that  moft  experienc’d  phyfician,  Jo.  Jacob.  Vi¬ 
carius  (q)  fo  far,  that  from  this  fymptom,  in  particular,  he  believ’d  he  could 
“  fwear,  that  the  patient  infallibly  labour’d  under  a  dropfy  of  the  thorax 
yet  in  the  thorax  of  this  very  patient,  when  open’d  after  death,  “  did  he 
“  find  not  the  lead  drachm  of  ferum,  or  water,”  either  in  the  left,  or  the 
right  cavity ;  upon  which  he  cried  out,  with  an  ingenuoufnefs  never  fuffi- 
ciently  to  be  commended,  and  full  of  wonder,  “  Oh  how  fallacious  fome- 
“  times  are  diagnoftics !”  It  does  not  however  efcape  me,  what  exception 
he  afterwards  thought  of,  to  wit,  that  this  fymptom  was  not  to  be  depended 
upon,  unlefs  the  feet  fwelfd  after  it,  and  not  before  it ;  nor  how  ingenioufly 
others  have  ftudied  to  invalidate  this  obfervation,  and  others  that  have  been 
objected  to  them,  by  Reimannus.  But  I  neither  fee  that  this  exception  is  at 
all  a  natural  confequence,  nor  is  it  my  intention,  nor  is  there  any  necdfity, 
to  make  the  controverfies  of  other  perfons  mine,  by  examining  that  excep¬ 
tion,  or  others,  and  others  after  that,  fince  the  very  number  of  thefe  excep¬ 
tions  fufficiently  (hews,  how  often,  and  how  eafily,  the  fymptom  we  fpeak 
of,  or  if  you  would  rather  have  it  fo,  the  fimilitude  of  that  fymptom,  can 
deceive  even  the  bell  phyficians  ;  fo  that  they  think  in  difeafes  of  the  lungs, 
heart,  aorta,  and  pericardium,  and  in  fpafmodic  fuffbcations,  which  I  have 
more  than  once  feen  return  exa&ly  at  the  fame  hour,  and  not  only  within 


(^)  Eph.  N.  C.  Cent.  io.  obf.  32.  (»)  cit.  obf.  32. 

(/)  Sepulchr.  1.  2.  S.  2.  obf.  3.  in  Schol.  ( 0 )  Eph.  N.  C.  Cent.  8.  obf.  74. 

C»z)  Commere.  Litter.  A.  1733.  Hebd,  11.  (/>)  Eorund.  Aft.  Tom.  6.  obf.  50. 

Du  2.  (?)  Eorund.  Cent.  1.  obf.  3.  in  Schol. 


the 


Letter  XVI.  Articles  12,  13.  385* 

the  pretty  long  fpace  of  one,  two,  or  three  hours,  after  the  fir  ft  fieep,  that 
they  are  not  thefe  diforders  in  reality,  but  that  there  is  water  in  one,  or  n 
both  the  cavities  of  the  thorax.  Wherefore,  neither  this  fymptom  wii|  be 
of  itfelf,  and  without  frequent  hefitacion,  the  moil  charafteriftic  mark  of  the 
difeafe,  fince  it  fometimes  appears  in  others  alfo,  and  fince  it  is  even  not  very 
leldom  wanting  in  thofe,  who  have  appear’d  after  death  to  have  lab  air’d  under 
this  difeafe,  as  the  obfervations  of  Valfalva,  and  mine,  teftify.  However, 
it  is  not  to  be  defpis’d,  if  it  be  join’d,  as  l  faid,  to  other  figns,  by  which  it 
is  generally  moll  evidently  indicated  that  water  is  coliebted  in  the  cavity  of 
the  thorax. 

12.  A  woman,  of  feventy  years  of  age,  of  a  fanguineous  temperament, 
and  fat,  while  fhe  was  conftandy  attending  upon  her  ion,  who  had  a  pleuritic 
fever,  being  feiz’d  with  a  pleurify  herfelf,  got  rid  of  it  after  many  days, 
without  any  expectoration  of  matter.  But  a  fenfe  of  great  oppreffion,  in  the 
left  part  of  the  thorax,  immediately  fucceeded  to  the  pleurify  ;  fo  that  fhe 
could  not  breathe  in  bed,  unlefs  fhe  lay  on  her  right  fide.  She  fpat  up  a 
catarrhous  matter,  was  extremely  thirfty,  and  had  a  fwelling  in  her  lower 
limbs.  To  thefe  diforders,  about  four  months  after,  was  added  a  violent 
diarrhea,  which  was  troublefome  to  her,  frequently,  every  day,  and  laded 
for  three  months.  In  all  this  fpace  of  time,  a  fever  return’d  at  a  certs' n 
period,  with  cold,  heat,  and  pain  of  the  head.  All  thefe  fymptoms  con¬ 
tinuing,  fhe  died  at  the  end  of  the  feventh  month  from  the  beginning  of 
the  d  iforder. 

The  belly  being  open’d,  the  liver  was  of  a  fomewhat  cineritious  colour, 
but  in  other  refpedts  found.  The  remaining  vifeera  were  alfo  found,  except 
that,  in  the  pancreas,  an  artery  was  found  to  have  acquir’d  a  bony  hardnefs, 
in  the  beginning  of  which  even  concreted  blood  itfelf  was  contain’d,  and 
after  that  the  fibrous  fubftance  of  the  blood  only  condens’d.  In  the  right 
cavity  of  the  thorax  was  no  diforder  at  all :  but  the  left  was  full  of  water, 
in  which  fome  kind  of  filaments,  as  it  were,  fwam.  Yet  the  lungs  in  that 
water  were  unhurt,  only  a  little  flaccid.  In  the  right  ventricle  of  the  heart 
was  a  large  polypous  concretion,  which  extended  itfelf  from  thence  into  the 
vena  cava. 

13.  That  an  empyema  did  not  fucceed  to  the  pleurify,  not  only  other 
things  fhew  you,  but  the  great  quantity  of  water,  with  filaments  of  that  kind, 
which  are  us’d  to  be  found  in  the  thorak,  after  great  inflammations  of  this 
cavity,  when  I  ftiall  treat  of  thofe  inflammations,  will  confirm.  And  that 
the  fibrous  fubftance  of  the  blood,  confin’d  in  any  artery,  as  it  was  in  that 
bony  one,  would  be  fo  condens’d,  as  at  length  to  fhuc  up  the  paflfage  of  the 
blood,  which  follows  from  behind,  is  what  was  taught  in  former  years,  by 
the,  celebrated  furgeon  Petit  (r).  But  why  the  woman  did  not  lie  on  that 
fide  which  was  full  of  water,  contrary  to  what  happen’d  in  the  woman  I 
fpoke  of  a  little  before  (s),  and  contrary  to  what  generally  happens,  may  per¬ 
haps  be  accounted  for,  from  the  mediaftinum  being  here  more  able  to  refill 
the  weight  of  incumbent  water,  or  at  leaft  from  the  oppofite  fide  being  able, 
as  it  was  entirely  free  from  ferum,  to  bear  the  diminution  of  its  cavity, 

•  (r)  Mem.  de  Is  Acad.  R,  des  Sc.  a.  1731.  (j)  N.  10. 

,  Vol,  1.  D  d  d  that 


3  86  Book  II.  Of  Difeafes  of  the  Thorax. 

that  was  made  by  the  incumbent  water •,  which  could  not  be  endur’d  in  the 
former  woman,  inafmuch  as  the  oppofite  cavity  was  itfelf,  in  fome  meafure, 
taken  up  by  water  of  its  own. 

14.  A  woman  of  fifty  years  of  age,  of  a  thin  habit,  and  a  pale  colour,  having 
labour’d  under  a  dyfpnoea,  for  a  year,  and  the  diforder  encreafing  upon  her, 
was  receiv’d,  at  length,  into  the  hofpital  of  St.  Mary  de  Vita,  at  Bologna.  Her 
refpiration  was  extremely  laborious,  her  third  great,  her  pulfe  moderately 
quick  and  fmall ;  which  faultering  more  and  more  every  day,  (he  died.  The 
vifcera  of  the  belly  were  all  extremely  natural  and  found.  In  the  left  cavity 
of  the  thorax  alfo  the  lungs  were  found,  and  every  where  free  from  the 
ribs  •,  but  fwam  in  a  pint  and  half  of  faltilh  water.  And  the  right  lobe  of 
the  lungs  adher’d  fo  clofely  to  the  pleura,  as  to  be  one  continu’d  body  with 
it :  wherefore,  no  water  was  feen  on  that  fide  ;  except  that  a  little  ferum 
flow’d  out  from  the  lower  part  of  the  lungs,  when  lacerated,  by  dividing  it 
with  the  knife  from  the  pleura.  In  the  heart  were  three  polypous  concretions, 
refembling  condens’d  mucus,  both  in  colour  and  confidence  ;  and  in  the 
veins  was  found  a  thick  and  vifcid  blood. 

1 5.  What  fhall  we  fay  was  the  caufe,  why  fo  little  ferum,  if  you  compare 
it  with  the  former  hiftories,  and  that  in  one  cavity  of  the  thorax  only,  fhould 
render  the  refpiration  fo  extremely  laborious  ?  Was  it  becaufe  the  ferum, 
being  impregnated  with  faline  particles,  did  not  fo  much  prefs  upon  the 
lungs  by  its  quantity,  as  it  conftring’d  by  irritating  them,  now  and  then, 
with  a  kind  of  fpiculre,  as  it  were  ?  You  know,  that  Albertini  (/)  taught: 
this  do&rine  in  dependance  upon  his  own  obfervations,  and  explain’d,  by  the 
irritation  of  falts  of  this  kind,  a  difficult  refpiration  from  extravafated  ferum, 
“  not  in  great  quantity,  but  turbid,  and  intenfely  yellow.”  Such  as  this, 
indeed,  is  not  defcrib’d  in  the  prefent  hiftory  j  but  it  is  faid  to  be  “  faltifh,” 
which  was  not  obferv’d  in  any  of  the  others. 

Perhaps  you  expert  I  fhould  here  add  that  very  clofe  cohefion  between 
one  lobe  of  the  lungs  and  the  pleura,  to  affift  in  accounting  for  the  difficult 
refpiration.  But  how  great  controverfies  there  are  about  the  noxioufnefs,  or 
innocence,  of  this  kind  of  cohefion,  you  may  even  know  from  looking  into 
the  Sepulchretum.  For  Hippocrates,  or,  if  you  pleafe,  the  author  of  the 
fecond  book  De  morbis  ( u ),  call’d  it,  as  interpreted  by  Salius,  “  a  prolapfus 
“  of  the  lungs  in  the  fide,”  and  from  thence  accounted  for  difficult  refpi¬ 
ration.  Nor  did  he  fuppofe  it  to  be  owing  to  a  wound  only,  inflated  by  the 
furgeon,  in  order  to  extradt  pus  ;  but  it  is  faid  to  arife  from  an  internal  caufe 
alfo,  both  there,  and  in  the  book  De  locis ,  where  it  is  exprefsly  written,  that 
the  lungs,  being  dried,  “  adhere  ”  to  the  moift  pleura,  and  make  a  dry 
pleurify  :  which  Boerhaave  ( x )  taught  nearly  in  the  fame  manner,  though  in 
fome  meafure  inverted,  when  he  fays,  where  “  the  feat  of  the  pleurify  was, 
“  there  the  pleura  was  render’d  imperfpirable,  and  adher’d  to  the  lungs  of 
“  the  fame  fide.”  Moreover,  others  have  follow’d  Hippocrates,  explaining 
this  adhefion,  indeed,  in  a  different  way,  that  is,  from  “  a  vifcid  ”  ferum 

(/)  Comment,  de  Bonon.  Sc.  Inft.  Tom.  x.  ( u )  Vid  Sepulchr.  1.  2.  S.  1.  in  Schol.  ad 

in  Opufc.  Obf,  67.  ( x )  Pieledt.  ad  Inflit.  §  606. 

“  tranfuding 


Letter  XVI.  Article  i  6.  387 

tc  tranfuding  ”  from  the  difeas’d  lungs,  “  and,  by  reafon  of  refpi ration 
44  being  impeded,  adting  the  part  of  a  gluten  in  the  cheft,  from  reft  and 
44  compreffion  (jy) or  44  when  the  lungs  grow  out  into  a  great  bulk,  by 
44  reafon  of  a  catarrhous  matter  being  imbib’d,  and  are  thus  fcarcely  mov’d(z):” 
but,  neverthelefs,  accounting  for  the  difficulty  of  refpiration,  with  which  they 
were  troubl’d,  when  living,  from  this  cohefion  found  in  their  bodies  after 
death.  On  the  contrary,  others  deny,  that  this  diforder  can  be  accounted  for 
from  thence,  and  produce  not  only  their  own  obfervations,  but  thofe  of  their 
adverfaries ;  fince  the  fame  perfon,  who  had  juft  faid,  that  he  found  the  caufe 
of  an  afthma,  of  many  years  continuance,  to  be  an  extenfive  adhefion  of  the 
lungs  to  the  ribs  (a),  immediately  confeffes,  44  that  the  lungs  were  con- 
44  nedled  in  the  fame  manner  ”  in  a  man,  who  44  had  been  neverthelefs  an  ex- 
44  cellent  runner,  and,  therefore,  that  an  adhefion  of  this  kind  did  not  of 
44  neceffity  bring  on  an  afthma.”  And  fimilar  to  this,  are  fo  many  obferva¬ 
tions,  both  of  others,  and  of  mine,  that  I  think  there  is  no  occafion  to  give 
many  inftances  of  what  is  commonly  known.  And,  indeed,  the  lungs  are 
found  to  be  fometimes  connected,  not  only  all  round  to  the  ribs  very  clofely, 
but  alfo  to  the  diaphragm,  and  mediaftinum,  without  any  previous  difficulty 
of  breathing  ;  as  the  observation  in  the  additamenta  to  the  Sepulchretum  (£), 
which  is  Diemerbroeck’s  (c),  and  under  number  twenty-four,  will  ffiew.  And 
lefs  large  cohefions,  fuch  as  inftances  are  produc’d  of,  in  the  fame  obfervation,, 
have  occurr’d  fo  often,  and  in  fo  great  a  number,  to  former  anatomifts,  that 
fome  of  them  have  thought  they  were  agreeable  to  the  intentions  of  nature, 
and  ufeful  to  man  {d). 

16.  Inth  is  fo  great  diflenfion  of  very  great  men,  it  is  not  an  eafy  matter 
to  reconcile  their  opinions.  For  what  you  fee  advanc’d  by  fome,  that  a  lax 
and  rare  adhefion  is  not  injurious  to  refpiration  (*),  but  that  it  is  injurious, 
if  it  be  very  clofe,  and  on  all  fides,  or  extended  to  great  tradts ;  this,  in  fact, 
by  no  means  anfwers  to  the  obfervations  that  were  a  little  before  pointed  out. 
Nor  becaufe  to  the  argument  of  thofe  who  deny,  that  they  are  injurious  to 
refpiration,  becaufe  the  lungs  certainly  mult  44  in  infpiration  ”  follow  44  the 
44  motion  of  the  dilated  cheft,  and  be  ftreighten’d  in  exfpiration  in  proportion 
44  thereto  (/),”  another  kind  of  argument  is  objected  by  a  great  man,  44  that, 
44  in  an  extenfive  adhefion  of  the  lungs  to  the  pleura,  the  lungs  cannot  de- 
44  feend,  and  follow  the  diaphragm,  when  the  cheft  is  dilated,”  can  any  one 
from  hence  bring  about  a  reconciliation,  by  affirming  that  refpiration  is  hurt 
only  from  the  adhefion  of  the  lungs  to  the  ribs,  but  not  from  the  adhefion  of 
them  to  the  ribs  and  diaphragm  at  the  fame  time.  I  fay,  can  the  difpute  be 
thus  compromis’d  ?  Certainly,  by  no  means.  For,  to  omit  other  things, 
you  have  leen,  in  one  of  the  obfervations  which  have  been  mention’d,  that 
there  was  a  cohefion  with  the  ribs  only,  and  yet  refpiration  was  unhurt :  to 
which  you  will  find  many  obfervations  fimilar,  and  in  particular  two  of  the 
celebrated  Hahnius  (£),  and  that,  in  like  manner,  which  was  made  formerly 


(y)  Sepulchr.  S.  cit.  Schol.  ad  Obf.  63. 

(z)  Seft.  ead.  Obf.  64.  §  9. 

( a )  Ibid.  §  8. 

( b )  Seft.  cit. 

(c)  Anat.  1.  2.  c.  non  12.  fed  13, 


(d)  Vid.  Schol.  ad  illam  Obf.  24.  &  ad  Ta¬ 
per.  Obf.  64.  §  ult.  &  ad  65. 

(*)  In  iifd.  Schol. 

(f)  Vid.  Schol.  3.  ad  Obf.  32.  in  Addit. 
\g)  Aft.  N.  C.  Tom.  7.  Obf.  13. 

by 


D  d  d  2 


3  £8  Book  II.  Of  Difeafes  of  the  Thorax. 

by  Piccolhominus  (£),  on  an  acquaintance  of  his*  44  of  the  whole  lobe  of 
44  the  lungs  very  tenacioufly  adhering  to  the  ribs  all  round,  although  in  him 
44  there  had  been  no  difficulty  of  refpiration.” 

How  is  ht  then  ?  I  certainly  cannot  deny  what  I,  for  the  mod  part,  find, 
promiicuoufly,  in  the  difiedions  both  of  men  and  women,  by  whatfoever 
difeale  they  have  been  taken  off,  and  what  every- body  fees  alrnoft  every  year, 
when  I  demonftrate  the  viicera  in  their  natural  fituations,  in  the  theatre  ;  l 
mean,  that  the  lungs  are  more  or  lei's  connected  to  the  parietes  of  the  thorax  : 
fo  that,  as  Diemerbroeck  (/)  has  alferted,  it  was  common  “  alrnoft  to  the 
third  part  of  mankind,”  and  Tulpius  (£),  44  that  the  lungs  were  quite  free 
4!  in  few  bodies,”  I  confels,  that  my  observations  come  nearer  to  thofe  of 
the  latter,  than  of  the  former,  when  taken  all  together.  Shall  we  then  fay, 
that  few  men  have  a  freedom  of  refpiration  ?  I,  perhaps,  fhall  not  even  fay 
that  which  fome  have  faid,  that  few  have  a  very  eafy  refpiration,  when  they 
have  acknowledg’d,  that  this  adhefion  is,  alrnoft  perpetually,  found  in  adults. 
And  yet  I  am  not,  for  that  realbn,  on  the  fide  of  the  queftion  with  thofe, 
who  have  iuppos’d  it  to  be  a  natural  connexion ;  as  I  well  remember,  that 
out  of  lb  many  foetulfes  which  I  have  diflfeded,  I  have  not  observ’d  in  more 
than  one  a  connexion  of  that  kind  (although  Diemerbroeck  (/)  does  not  feem 
to  have  believ’d,  that  44  any  one  was  born  with  it  ”  )  ;  nor  am  lefs  confcious, 
that  it  is  fo  rarely  found  in  animals  who  come  near  to  us  in  their  ftrudure, 
that  if  at  any  time  a  fome  what  large  adhefion  occurs,  they  44  are  fufpeded  of 
44  difeale.”  But  as  it  is  not  from  nature,  fo  neither  is  it  fcarcely  ever  but 
from  difeafe,  as  the  fame  Diemerbroeck  thought,  for  inftance,  44  from  the 
44  pleurify,  the  peripneumony,  or  any  other  fimilar  diforder,  attended  with 
44  ulceration.”  Nor  is  it  credible,  and  I  even  know  it  to  be  frequently 
not  true,  that,  if  you  except  a  few,  all  other  men  have  been  troubl’d  with 
diforders  of  this  kind  :  but  it  is  a  much  more  probable  conjedure,  which  I 
remember  the  celebrated  Vernoius  formerly  wrote  to  me,  that  this  appearance 
being  common  to  men  alone,  and  alrnoft  to  all  men,  but  not  to  their  feetufies, 
arifes,  perhaps,  from  the  adion  of  laughing,  which  is  common  to  them  alone, 
after  they  are  born.  But  from  what  caule  foever  that  is,  which,  (fetting  afide 
thofe,  in  whom  it  cannot  be  denied  but  it  may  have  happen’d  from  difeafe) 
I  fay,  from  whatfoever  caufe  that  is  in  others,  which,  it  is  certain,  generally 
does  happen,  though  it  is  uncertain  in  what  part  chiefly,  and  how  extenfively 
it  may  happen,  as  our  Columbus  has  rightly  admonifh’d  from  hence  ( m ),  that 
a  man  44  may  labour  under  a  wound  penetrating  into  the  thorax,  nor  yet  the 
44  wound  be  feen  to  breathe fo,  for  this  very  reafon,  thofe  furgeons  ad: 
prudently,,  who  perform  the  perforation  of  the  pleura  with  the  finger  rather 
than  with  the  knife. 

But  to  return  at  length  to  that  which  you  exped  :  When  the  foregoing 
injury  of  refpiration  is  accounted  for  from  the  adhefion  found  in  the  lungs, 
1  have  a  vehement  lufpicion,  either  that  fome  caufe,  out  of  lb  many  which  can 
really  injure  it,  was  not  properly  attended  to;  or,  if  there  was,  in  fad,  no 

(b)  L.  4.  Anat.  Pracl.  Left.  8.  (1)  Vid.  Schol.  ad  cit.  Obf,  24. 

(/)  Obf.  24.  cit.  in  fin.  n.  15.  (m)  Vid.  Schol.  ad  §  9.  Obf.  64.  cit.  ad  n. 

(/£)  Vid.  Schol.  ad  Obf,  65.  cit.  ad  eund,  n.  15. 


other 


Letter  XVI.  Articles  17,  18.  389' 

other  caufe  any  where  to  be  found,  that  it  might  have  lain  hid  in  that  very 
furface  of  the  lungs,  which  was  conne&ed  to  the  pleura  :  let  us  fuppofe,  for 
inftance,  forne  crifpature  that  refills  the  fpeedy  tranfit  of  the  humours,  lb 
that  the  nerves  may  be  thence  irritated,  and  difturb  the  internal  offices  of 
the  lungs:  which,  if  you  confider  the  different  nature  cf  the  humours,  and 
difpofition  of  the  nerves,  in  different  perfons,  will,  perhaps,  not  altogether 
dilpleafe  you,  or  will  {fir  you  up  to  think  of  fome  other  reafons,  which  may 
be  more  fatisfaftory  to  you,  and  of  confequence  to  me. 

17.  A  virgin  of  fifteen  years  of  age,  was  troubl’d  with  an  acute  fever,, 
and,  particularly,  with  a  dreadful  pain  of  her  head ;  for  all  her  other  fyrnp- 
toms  were  mild.  About  the  tenth  day  the  fever  leem’d  to  remit.  But  after 
a  few  days,  a  great  thirfb,  a  laborious  refpiration,  and  a  pain  in  the  left  part 
of  the  thorax,  were  added  to  the  fever.  The  two  laft-mention’d  fymptoms 
growing  more  violent  within  a  few  days,  being  perfectly  in  her  fenfes,  and 
having  the  free  ufe  of  her  fpeech,  (he  died,  contrary  to  the  expectation  of 
thofe  who  were  about  her.  The  thorax  being  open’d,  the  lungs  were  indeed 
found ;  but  the  left  cavity  of  the  thorax  w as  found  to  be  full  of  ferum,  not 
much  unlike  the  urine  of  horfes,  in  which  fome  concretions  fwam,  that  re- 
fembl’d  the  white  of  an  egg.  In  the  right  cavity  alfo  was  ferum,  though 
in  very  little  quantity.  But  in  the  pericardium  was  fuch  a  quantity,  that 
it  fill’d  the  whole  cavity,  and  was  more  thick,  than  that  which  had  been  feen 
in  the  thorax:  and  as  the  external  furface  of  the  heart  was  flightly  eroded*, 
it  might  perhaps  be  conjeftur’d,  that  this  had  happen’d  from  the  lame  ferum- 
The  polypous  concretions  in  the  ventricles  of  the  heart,  in  fome  meafure  re- 
fembl’d  a  condens’d  mucus :  but  that  was  the  greateft  which  was  in  the  left 
ventricle, 

18.  That  a  fever  of  this  kind  feem’d  to  remit,  without  any  excretion  of 
the  matter,  which  had  given  rife  to  it,  was  violently  to  be  fufpedted  •,  and 
indeed  this  had  pour’d  itfelf  out  into  the  cavities  of  the  thorax  and  pericar¬ 
dium,  endow’d  with  that  acrimony  which  a  dreadful  pain  of  the  head  firft, 
and  after  that  of  the  left  part  of  the  thorax,  had  indicated,  and  the  erefion 
of  the  heart  had  confirm’d.  But  as  this  caufe  of  the  fever  had  been  diverted 
from  the  head  to  the  thorax  and  the  heart,  it  is  not  to  be  wonder’d  at  if 
the  tongue  and  the  fenfes  were  free,  and  their  ufe  perfect  to  the  lad,  and  if 
death  came  on  fooner  than  it  generally  does  in  a  droofy,  and  fooner  than  the 
perfons  who  were  about  the  patient  expected  it;  although  dropfies  44  arifing 
44  after  acute  diforders,”  as  we  have  it  in  the  Pranotiones  (»),  44  are  all  bad. 
44  For  they  do  not  free  the  patient  from  the  fever,  and  are  very  painful  and 
44  mortal.”  But  as  to  thofe  concretions  in  the  extravaiated  ferum,  which 
Valfalva  liken’d  to  the  white  of  an  egg  ;  this  muft  be  underflood  of  the  white 
of  an  egg  condens’d,  and  harden’d  in  warm  water,  as  he  declares  in  another 
obfervation  ( 0 ).  Laft  of  all,  as  to  what  relates  to  the  dropfy  of  the  pericar¬ 
dium,  mention’d  above  alfo  in  fome  hiftories,  we  will  confider  it  prelently 
by  itfelf,  when  I  fhall  have  given  the  hiftory  of  the  difeafe  and  diffeeftion  of 
another  virgin. 


(0)  Epift.  20.  n.  j6. 


(«)  n.  8. 


19.  A  virgin* 


3  90  Book  II.  Of  Difeafes  of  the  Thorax. 

19.  A  virgin,  about  two-and-twenty  years  of  age,  was  not  able  to  breathe, 
unlefs  with  her  neck  eredt  ffie  had  a  great  third,  and  a  confiderable  cough, 
and  threw  up  a  kind  of  purulent  matter  from  the  lungs,  which  was  fome- 
ttmes  alfo  ting’d  with  blood  ;  ffie  had  a  fever,  her  face  was  fvvell’d,  and  at 
length  ffie  died.  In  the  belly  fome  pints  of  water  ftagnated  •,  yet  all  the 
vifcera  of  that  cavity  were  uninjur’d.  The  right  cavity  of  the  thorax  was 
full  of  ferum  ;  of  which  there  was  alfo  a  lei's  quantity  in  the  left.  The 
fubftance  of  the  lungs  difcover’d  not  the  lead  injury  ;  only  in  fome  places  it 
was  a  little  red,  and  in  others  white.  The  whole  pericardium  was  fill’d  with 
water.  In  the  ventricle  of  the  heart  was  nothing  but  a  fluid  blood. 

20.  I  have  already  faid  enough  upon  the  dropfy  of  the  thorax,  and  the 
greateft  part  of  its  fymptoms,  as  far  as  the  obfervations  of  Valfalva  relate 
thereto  •,  lb  that  I  think  there  is  Ids  occafion  to  enlarge  upon  thefe  heads  now, 
as  there  was  alfo  under  the  former  obfervation,  efpecially  as  other  difficulties, 
befide  this  diforder  itfelf,  were  join’d  with  it :  although  in  this  virgin,  the 
matter  fpit  up  does  not  feem  to  have  been  really  purulent ;  and  that  it  was 
fometimes  ting’d  with  blood,  it  is  eafy  to  fuppofe  was  the  accidental  effed 
of  the  violence  in  coughing.  Let  me  rather  add  fomething,  as  I  have  more 
than  once  promis’d,  upon  the  dropfy  of  the  pericardium. 

Freind(p),  amongft  thofe  things  which  are  proper  and  peculiar  to  Aven- 
zoar,  places  this  that  he  fpeaks  of  that  dropfy,  and  neverthelefs  adds,  that 
he  had  never  feen  it,  “  and  that  Galen  himlelf  does  not  fay  one  word  upon 
«  the  fubjeft.”  But  it  is  natural  to  underftand  what  he  fays,  in  fuch  a  man¬ 
ner,  as  if  Galen  had  never  feen  it  in  the  human  fubjett ;  lince  nothing  was 
more  commonly  known  among  his  followers,  than  what  he  faid  in  the  fifth 
book,  de  locis  affeffis  (q)  :  “  to  wit,  that  a  palpitation  of  the  heart  either 
“  happens  by  itfelf,  or  with  fome  indication  that  the  heart  is  mov’d  in  a 
“  fluid  :  nor  ought  it  to  feem  wonderful,  that  fo  great  a  quantity  of  water  is 
“  accumulated,  fometimes,  in  the  coat  furrounding  the  heart,  fo  as  to  pre- 
“  vent  the  heart  from  being  dilated  and  as  he  had  feen,  as  he  goes  on 
to  fay,  a  great  quantity  of  fluid  there,  in  difleded  animals,  and  an  hydatid 
in  an  ape,  and  a  fchirrhous  tumour  in  a  cock  ;  “  from  whence,”  he  concludes, 
“  a  probable  conjedure  may  be  drawn,  that  men  are  troubl’d,  alio,  with 
ct  fimilar  diforders.”  It  is  evident,  therefore,  that  Galen  was  not  only  not 
entirely  filent  upon  this  diforder,  but  that  he  even  very  fagacioufly  conjec¬ 
tur’d  it  •,  and  more  than  this,  feems  indeed  to  me  to  have  pointed  out  fome 
mark  to  diftinguiffi  it,  and  fome  manner  in  which  it  may  arife  ;  I  mean,  from 
hydatids  being  ruptur’d  within  the  pericardium,  as  I  fhall  hereafter  ffiew  (r). 
But  if  you  cannot  ule  equal  candour  with  a  modern  phyfician,  in  other  re- 
fpeds  learned,  who  let  this  fentence  I  know  not  how  efcape  him,  that  the 
dropfy  of  the  pericardium  “  was  to  be  fought  for  rather  among  the  inven- 
“  tions  of  artifts,  than  in  the  works  of  nature yet  you  will  at  leaft  agree 
with  another  great  man,  whom  I  have  commended  above,  who  only  pro¬ 
nounc’d,  that  “  the  dropfy  of  the  pericardium  was  a  very  rare  diforder.” 
For  by  this  I  fhall  fuppofe,  that  he  meant  to  fay  it  was  a  very  rare- diforder 
by  itfelf;  not  when  join’d  with  other  diforders  of  the  thorax.  For  l  my- 

(p )  Hilt  de  la  Medec.  P.  2,  (y)  c.  2.  (r)  n.  33. 

felf, 


Letter  XVL  Articles  21,  22.  391 

fclf,  as  well  as  many  others,  have  frequently  feen  it  join’d  with  thefe  dis¬ 
orders  *,  but,  as  far  as  I  remember,  never  alone.  Wherefore  it  is  very  dif¬ 
ficult  to  determine  upon  the  peculiar  fymptoms  of  it  •,  and  obfervations  made 
upon  this  diforder  alone,  if  it  be  at  any  time  found  to  be  folitary,  ought  to 
be  very  diligently  attended  to,  as  the  following  one  from  Valfalva. 

21.  A  certain  man,  whofe  feet  had  been  a  fie  died  for  fome  time,  with  an 
cedematous  tumour,  was  feiz’d  with  a  (light  fever:  his  refpiration  became 
difficult,  and  more  difficult  every  day,  fo  that  he  was  forc’d  to  breathe  with 
his  neck  ftrait  •,  he  cough’d,  and  fpat  up  a  catarrhous  matter  with  it  •,  he  had 
alio  a  great  third.  At  length  he  died.  The  body  being  differed,  the  pe¬ 
ricardium  was  found  to  be  full  of  water. 

22.  1  know  you  very  much  wonder  now,  that  you  read  of  no  fymptom  in 
the  dropfy  of  the  pericardium  alone,  which  you  did  not  read  above  in  the 
fame,  join’d  with  a  dropfy  of  the  thorax,  and  even  in  the  dropfy  of  the  tho¬ 
rax,  disjoin’d  from  that  of  the  pericardium.  For  which  reafon  you  will  the 
more  readily  believe,  that  Grastzius  wrote  the  truth,  in  the  difputation  (j) 
which  he  publifh’d  under  the  patronage  of  Hoffman,  when  he  exprefsly 
afferted,  “  that  he  could  find  fcarcely  any  figns,  by  which  even  the  mod  ex- 
“  perienc’d  phyfician  could  rightly  didinguifh  thefe  two  dropfies,  one  from 
tc  another.”  Yet  he  immediately  fubjoins,  “  Unlefs  any  one  fhould  perhaps 
“  fay,  that  the  faintings  were  more  frequent  in  the  dropfy  of  the  pericardi- 
“  urn,  than  that  of  the  thorax,  and  the  difficulty  of  breathing  more  mild  ;  and 
“  befides,  that  the  patient  affeCted  with  a  dropfy  of  the  pericardium,  does 
45  not  feel  the  fluctuation  of  the  water  fo  didinCtly,  in  turning  himfelf  from 
“  fide  to  fide,  as  he  has  obferv’d  they  are  accudom’d  to  do,  who  labour  un- 
“  der  a  dropfy  of  the  thorax.”  Yet  in  the  beginnings  of  the  dropfy  of  the 
pericardium,  “  they  are  wont,”  fays  he,  “  to  be  troubl’d  with  a  pituitous 
“  or  fcorbutic  cachexy,  attended  with  a  complexion  of  a  lead-colour,  with 
“  a  pale  and  vifcid  urine,  with  various  obdruCtions  of  the  vifcera,  with  a 
“  languor  of  all  the  bodily  functions,  and  a  decreafe  of  the  drength :”  and 
as  the  diforder  encreafes,  “  the  pulfe  grows  extremely  fmall,  the  urine  is 
“  pale,  thin,  and  in  little  quantity,  there  are  fomctimes  frequent  faintings, 
<c  and  a  weight  is  felt  opprefling  and  condringing  the  heart,  refpiration  be- 
“  comes  rather  more  difficult,  a  flow  fever,  with  third,  frequently  comes 
“  on,”  and  other  “  cruel  fymptoms,”  which  he  omits ;  fo  that  the  difeafe 
beginning,  in  a  manner,  by  dealth,  and  “  gradually  and  fuccefiively  attack- 
“  ing”  the  patient,  breaks  out,  at  length,  into  that  “violent  feverity  of 
“  fymptoms,”  which  1  have  mention’d.  All  which  things  I  have  related, 
that  you  may  compare  them,  not  only  with  the  hidories  that  I  have  produc’d, 
or  am  to  produce,  but  alfo  with  thole  that  are  defcrib’d  by  others,  and  even 
with  that  (/)  which  afforded  an  occafion  to  Grastzius  himfelf,  of  writing  this 
difputation.  Although  the  pericardium  had  been  fo  extended,  from  water 
of  fuch  a  kind,  as  to  corrode  the  external  furface  of  the  heart  univerfally; 
fo  extended,  I  fay,  that,  as  his  own  words  are,  “  it  fill’d  the  whole  cavity 
“  of  the  thorax,”  and  the  cavity  of  the  thorax  was,  for  that  reafon,  free 
from  any  extravafations  of  ferum  ;  yet  we  only  read  in  regard  to  the  fymp- 

(/)  in  Proeejnio,  &  §  3.  ejus  Difput. 


(/)  de  Hydr.  Pericard.  §  4. 


.7 


toms, 


3  9-  Bookll.  Of  Difeafes  of  the  Thorax. 

toms,  that  the  patient  4i  felt  an  oppreffive  weight  in  the  lower  part  of  the 
44  cheft,  and  being  long  troubl’d  with  other  fymptoms,  that  generally  indi- 
44  cate  a  dropfy  of  the  thorax,”  at  length  died,  as  if  fuffocated  64  by  a  dropfy 
44  of  [he  thorax,  as  had  been  fuppos’d.”  But  if  you  leave  that  oblervation, 
and  go  to  the  Sepulchretum,  in  which  there  are  many  more  hiftories  de- 
fcrib’d,  whether  you  turn  to  them,  in  which  other  diforders  alfo,  and  in  par¬ 
ticular  a  fimilar  corrofion  of  the  heart,  with  a  very  confiderable  dropfy  of 
the  pericardium  is  propos’d,  as  the  eighty- fix th  of  the  firft  fedtion,  in  this 
fecond  book;  you  will  read,  that  the  urine  was.  “in  fmall  quantity,”  in¬ 
deed,  but  44  turbid,  and  the  blood  fcorbutic  -,”  yet  omitting  lbrne  things, 
which  are  evidently  to  be  referr’d  to  other  caufes,  as  the  pain  of  the  left  hy¬ 
pochondrium,  44  the  very  violent  afthma”  alone,  will  remain  to  be  referr’d 
to  this  caufe,  which  itlelf  alfo  is  in  part  referrable  to  another ;  or  whether 
you  feek  for  thole  in  which  nothing  but  the  pericardium  is  mention’d  to  have 
been  “  full  of  water,”  or  44  fwell’d  out  into  a  vaft  tumour,  and  diihended  - 
44  with  tpany  pounds  of  water,”  you  will  find  thefe  are  all  the  fymptoms 
taken  notice  of,  44  that  the  heart  had  vehemently  palpitated,”  or  that  the  pa¬ 
tient  44  had  for  a  long  time  labour’d  under  a  palpitation  of  the  heart,  and  a 
44  difficulty  of  breathing,”  as  in  the  articles  ten  and  four  of  the  twenty-firft 
obfervation  of  the  eighth  fedtion  ;  into  which  fedtion,  as  it  relates  to  the  pal¬ 
pitation  of  the  heart,  even  more  hiftories  of  this  droply  are  transferr’d,  than 
into  that  firft  fedtion,  which  particularly  treats  of  this  diforder. 

23.  Since  we  are  come  to  the  fign  pointed  out  by  the  conjedture  of  Galen, 
as  I  faid  above  («),  which  was  deliver’d  at  the  fame  time,  on  account  of  this 
difeafe,  and  on  account  of  another,  I  mean  thefe  words,  44  with  fome  in- 
44  dication  that  the  heart  is  mov’d  in  a  fluid  we  muft  fee  whether  the 
event  often  anfwers  to  that  conjedture.  Our  Saxonia,  indeed,  as  you  will 
fee  in  the  Sepulchretum  (x),  faid,  that  the  figns  of  a  heart  palpitating  from 
this  diiorder,  were  a  foft  pulfe,  a  quick  refpiration,  no  thirft,  hollow  eyes, 
and  that  the  patient  at  the  fame  time,  particularly,  44  felt  that  the  heart  was 
44  lwimming,  as  it  were,  in  water-,”  and  that  a  noble  Venetian  was  us’d 
to  relate  this  to  him,  who  44  labour’d  under  a  great  quantity  of  water  in  the 
44  pericardium,  as  the  difiedtion  demonftrated.”  But  Reimannus  ( jy),  al¬ 
though  he  knew,  in  like  manner,  from  another  of  our  profefFors,  that  the 
fame  had  been  felt  in  a  certain  old  man,  fays,  that  there  were  few  men  of 
fo  exquifite  a  fenfe :  and,  indeed,  we  do  not  fee,  that  it  is  mention’d  in  fo 
many  other,  I  do  not  fay  ratiocinations  (2),  but  obfervations ;  and  he  fhews 
by  hiftories,  which  he  introduces,  that  a  palpitation  of  the  heart  has  fome- 
times  been  wanting  in  this  diforder.  To  which,  left  you  fhould  think  them 
very  rare,  do  not  forget,  that  thofe  I  have  defcrib’d  above,  and  thofe  I  fhall 
defcribe  hereafter,  will  be  to  be  added,  and  others  alfo,  but,  in  particular, 
thofe  that  are  transferr’d  into  the  Sepulchretum,  from  Diemerbroeck  ( a ) ; 
who  denies,  that,  in  any  of  thofe  he  difledted,  there  had  been  44  any  palpi- 
4*  tation  of  the  heart,”  though  they  had  been  confiderably  afFedted  with  a 

(z)  ut  Sepulchr.  cit.  S.  8.  in  Scliol.  ad  cbf. 
21.  §  4. 

(«)  Seft.  ead.  8.  obf.  22. 


(a)  n.  20. 

(*)  1.  2.  S.  8.  obf.  29. 

(y )  Aft.  N.  C.  Tom.  1.  obf.  iyo. 


I 


dropfy 


Letter  XVI.  Article  22.  393 

dropfy  of  the  pericardium  ;  and,  on  the  other  hand,  afierts,  that  “  he  had 
44  found  the  pulfes  very  languid  and  few,”  and  that  palpitation  44  was  excited, 
44  rather,  by  any  kind  of  liquor,  although  in  little  quantity,  fo  that  it  can 
44  but  irritate  the  heart  with  any  vellicating  quality.”  And,  indeed,  Diemer- 
broeck  has  many  followers  among  the  more  modern  obfervers  ;  all  of  whom 
prove  this  laft  affertion  ;  and,  moreover,  forne  of  them  confirm  the  former, 
for  this  reafon,  becaufe  they  do  not  doubt,  that  the  tone  and  ftrength  of  the 
heart,  and  its  fibres,  are  rather  broken  in  upon,  and  diminifh’d,  by  being 
wafh’d  fo  long  with  a  great  quantity  of  water.  But  there  are  even  obfer- 
vations,  not  only  of  the  heart  being  vellicated  in  this  dropfy,  but  alfo  of  its 
being  corroded,  in  which  no  mention  is  made  of  palpitation,  fuch  as  I  have 
produc’d  above  ( b )  ;  and  fuch  as  thofe  you  will  find  in  the  third  and  fourth 
Centuria  Cafarea  Academia  (c),  that  are  more  remarkable  ftill ;  and  in  the 
Sepulchretum  itfelf  ( d ),  befide  that  which  is  pointed  out  above  (<?) :  in  which, 
if  you  fufpedt  that  the  erofion  was,  perhaps,  more  in  appearance  than  in 
reality,  you  mull:  confefs,  at  lead,  that  vellication  and  uneafinefs  were  not 
wanting  from  the  matter  that  was  lying  about  the  heart.  And  there  are  innu¬ 
merable  obfervations,  which  no- body  is  ignorant  of,  in  which,  though  the 
pericardium  was  quite  free  from  water,  a  palpitation  of  the  heart  had  at¬ 
tended  on  other,  and  far  different,  diforders.  Which  it  is  necefiary  to  re¬ 
member,  whenever  you  read,  that  this  fymptom  was  join’d  with  a  dropfy 
of  the  heart.  And  we  do  read  this  very  often.  For,  not  to  make  ufe  of 
other  examples,  except  what  .are  extant  in  the  volumes  of  the  Caefarean  Aca¬ 
demy,  already  commended,  and  could  not  have  been  related  in  the  Sepul¬ 
chretum  *,  you  will  find  that  it  is  five  times  obferv’d  (/).  But  five  times,  in 
like  manner,  you  will  find,  that  at  the  fame  time,  the  aorta  near  the  heart, 
or  the  valves  of  the  vena  cava,  at  the  heart,  were  become  bony,  or  that 
even  the  heart  itfelf  was  much  bigger  than  its  natural  fize,  and  fometimes 
even  of  a  ftupendous  magnitude,  or  fo  loaded  with  fat,  befides  that  which  it 
is  fcarcely  ever  without,  that  the  auricles,  and  the  whole  heart  itfelf,  refembl’d 
nothing,  at  firft  fight,  but  one  great  heap  of  fat,  or  fchirrhous  and  corrupted 
lungs  •,  or  finally,  nor  that  feldom,  a  dropfy  of  the  thorax  join’d  with  a 
dropfy  of  the  pericardium  :  and  that  a  dropfy  of  the  thorax  may  not  only  be 
attended  with  thofe  other  diforders  which  have  been  mention’d,  but  may  even 
fometimes  have  a  palpitation  of  the  heart  join’d  with  it,  is  certain  from  other 
obfervations,  to  which  you  may  alfo  add  that  which  is  in  the  fame  volumes^). 
But  there  are,  you  will  fay,  examples  likewife,  from  whence  it  appears,  that 
palpitations  have  proceeded  from  the  dropfy  of  the  pericardium  ;  nor  are 
they  even  wanting  in  the  Sepulchretum,  in  which  thofe  are  mention’d  as  being 
join’d  with  this  one  difeafe  alone,  as  is  acknowledg’d  above  ( h ) :  and  that 
moll  judicious  phyfician,  Boerhaave,  who  certainly  wrote  after  thefe  contro- 
verfies  (z),  has  exprelsly  affirm’d,  44  that  from  a  dropfy  of  the  pericardium, 


{b)  N.  i7. 

(<•)  Obf.  141.1 

(d)  L.  2.  S.  2.  Obf.  3.  cum  Schol. 

(e)  N.  22. 


(f)  Dec.  3.  A.  5.  Obf.  154.  Cent.  6.  Obf. 
c i.  Aft.  Tom.  i.  Obf.  170.  Tom.  2.  Obf.  7. 
Tom.  6.  Obf.  143. 

(g)  Tomo  eod.  6.  Obf.  50. 

{b)  N.  22.  (0  Prse’.eft.  ad  Inflit.  §  71 1. 


VOL.  I. 


E  e  e 


44  wonderful 


394  Book  II.  Of  Difeafes  of  the  Thorax. 

“  wonderful  palpitations  of  the  heart  are  brought  on.”  How  is  it  then  ? 
We  mult  fuppofe  that  the  obiervations  of  all  thefe  gentlemen  are  true,  but 
that  they  were  made  upon  patients  of  different  temperatures,  and  at  different 
times  of  the  difeafe  :  wherefore,  although  this  fymptom  is  not,  indeed,  to  be 
confider’d  as  infeparable  from,  and  proper  to,  the  difeafe,  yet  it  is  by  no 
means  to  be  flighted  *,  and  fo  much  the  lefs,  as  it  has  been  more  frequently 
join’d  with  other  diforders,  that  have  often  been  obferv’d  to  attend  upon 
this  dropfy. 

24.  But  in  what  manner,  to  return  thither  again,  fhall  we  diflinguifh  this 
from  the  dropfy  of  the  thorax?  You  have  feen  what  Graetzius  has  pointed 
out  (&) ;  now  take  what  Reimannus  points  out  (/).  “  There  is  here  alfo,” 

lays  he,  “  a  difficulty  of  refpiration,  efpecially  after  ftronger  motion,  or  from 
“  the  alcent  of  fteep  places,  with  this  difference,  however,  that  the  oppref- 
tc  fion  of  refpiration  is  attended  with  anxiety,  rather  than  with  any  thing 
“  fonorous ;  frequent  faintings  alfo  attend  a  dry  fmall  cough,  and  rather 
“  more  than  in  the  dropfy  of  the  cheft,  a  flow  wafting  of  the  body,  without 
“  any  manifeft  caufe and  this  Carolus  Pifo  alfo  laid  down  for  granted* 
and  fome  other  things,  which  he  explains  by  reafons  that  he  brings,  as  you 
will  fee  in  the  Sepulchretum  (m).  But  if  you  require  obiervations  rather 
than  authorities  and  reafonings,  you  will  not  find  any  in  Reimannus,  that  re¬ 
late  to  the  diforder  whereof  we  treat,  when  it  is  disjoin’d  from  others,  as  it 
were  to  be  wifh’d  they  had  been.  Yet  there  were  fome  already  publifh’d  many 
years  before,  which  might  be  produc’d  from  Vieuffens,  and  one  long  be¬ 
fore  that  time,  made  by  Stalpart  (»).  For  he  tells,  us  of  a  girl  being  cur’d 
by  him,  who  had  her  face  pallid,  and  very  much  fwell’d,  and  had  never  un¬ 
dergone  any  menftrual  purgations,  in  whom  “  he  could  very  diftin&ly  hear 
<c  the  agitation  of  the  water  itfelf  in  the  pericardium,  when  the  heart  was 
<c  pulfating  (for  fhe  labour’d  under  a  palpitation  of  the  heart).”  And  Galen, 
indeed,  as  we  have  feen  above  (0),  had  written,  that  the  palpitation  of  the 
heart,  which  happens  from  the  dropfy  of  the  pericardium,  happens  “  with 
“  a  kind  of  indication  that  the  heart  moves  in  a  fluid,”  leaving  us  at  freedom 
to  determine,  by  our  interpretation,  whether  that  indication  can  be  perceiv’d 
by  the  patients,  as  was  faid  juft  now  (p)  to  have  happen’d  fometimes,  or  by 
phyficians,  who  applying  their  hands,  or  their  ears,  to  the  region  of  the  pe¬ 
ricardium,  obferve  fomewhat  of  a  fluctuation  there,  which  would  be  an  ex¬ 
cellent  fign  of  the  difeafe,  in  preference  to  all  others,  and  might  be  efteem’d 
pathognomonic,  if  it  could  really  exift  always,  and  in  thofe  alfo,  in  whom 
either  the  pericardium  does  not  contain,  as  yet,  much  water,  or  the  heart  is 
not  vehemently  agitated  therein,  but  fcarcely  trembles  with  a  languid  and 
obfeure  motion,  and  fo  no  fallacy  could  at  any  time  take  place,  either  from 
water  ftagnating  in  the  thorax,  or  from  the  very  motion  of  palpitation,  or 
from  any  other  caufe,  that  may  eafiiy  deceive  the  phyfician.  Which  de¬ 
ception,  perhaps,  they  have  fufpeCted,  who  have  pafs’d  over  the  obfervation 
of  Stalpart,  efpecially  as  it  was  not  only  not  confirm’d  by  diflfeCtion,  but 


(k)  N.  22.  ' 

(l)  Obf.  cit.  fupra  ad  n.  23. 

(/.»)  Li  ci:.  ibid.  Schol.  ai  Obf.  21.  §  4. 


(«)  Cent.  i.  Obf.  36* 

(0)  N.  20. 

(PJ  N.  23. 

7  even 


Letter  XVI.  Article  24.  395 

even,  perhaps,  render’d  fomething  doubtful,  by  reafon  of  the  entire  cure 
of  a  difeafe  of  that  kind. 

But  Vieuffens,  although  (q),  after  having  promis’d  four  obfervations  re¬ 
lating  to  the  dropfy  of  the  pericardium,  in  the  third,  which  relates  to  the 
dropl'y  of  the  lungs,  he  does  not  fay  a  word  of  the  pericardium,  and  in  the 
fecond  defcribcs  a  dropfy  of  the  pericardium,  join’d  with  other  diforders, 
yet,  in  the  fir  ft,  defcribes  it  disjoin’d  from  the  dropfy  of  the  cheft,  and  all 
other  diforders,  and  alfo  in  the  fourth  ;  uniefs,  perhaps,  you  alfo  believe, 
that  polypous  concretions  happen  long  before  death,  and  do  not  confider 
the  compreffion  of  the  lungs  as  an  effedt  of  the  diftended  pericardium,  which 
it  very  evidently  is.  The  firft,  therefore,  which  was  made  on  a  boy,  has 
thefe  fymptoms  :  In  the  beginning,  from  a  lively,  brifk,  and  well- colour’d 
youth,  he  became  fad,  flothful,  with  his  eyes  lefs  vivid  than  ufual,  pallid, 
and  his  lips  and  eye  brows  verging  to  a  leaden  colour.  If  he  walk’d  a  little 
fafter  than  ufual,  or  went  up  ftairs,  his  refpiration  became  difficult,  and  the 
palpitation  of  his  heart,  with  which  he  was  conftantly  troubl’d,  more  violent. 
The  diforder  then  greatly  increafing,  he  loft  his  appetite  for  food,  and  the 
Ilrength  of  his  body,  the  extremities  of  which  were  conftantly  fomewhat 
cold,  and  his  feet  very  much  fwell’d  ;  but  his  pulfe  was  always  very  foft,  weak, 
fmall,  frequent,  and  fomewhat  unequal.  Finally,  being  taken  with  a  flow 
fever,  he  died. 

But  the  fourth  obfervation,  in  which  there  was  much  the  moll  confiderable 
dropfy  of  the  pericardium,  defcribes  a  man  of  a  melancholy  temperament, 
who  had  always  been  extremely  well  in  health,  till  a  year  before  he  began 
to  labour  under  a  difficulty  of  breathing,  which  had  fo  increas’d  by  degrees, 
that  at  length,  for  three  or  four  months  together,  he  was  forc’d  to  fit  up  in 
bed  night  and  day,  for  fear  of  fuffocation.  He  was  at  that  time  lean,  with¬ 
out  any  fwelling  at  all,  fo  much  as  of  his  hands  or  his  legs  *,  but  both  of 
them,  for  the  mod  part,  were  chill.  His  eyes  were  very  dull,  and  heavy  ; 
but  his  face,  and  particularly  his  lips,  left;  by  tranfiating  the  words  of  the 
author  into  another  language,  I  render  them  obfcure,  or  ambiguous,  d’  un 
gris  de  fer  obfcur ,  which  we  may  render  in  Englifti,  of  a  dark  iron  grey. 
Being  bidden  to  lie  on  his  right  fide,  and,  in  like  manner,  on  his  left,  he 
lay  with  equal  uneafinefs  on  both  ;  but  he  lay  on  his  back  with  {till  greater 
uneafinefs ;  and  then  the  colour  of  his  face  became  more  dark,  his  pulfe 
more  fmall,  frequent,  and  unequal,  and  the  extreme  parts  of  his  body  feem’d 
ftill  more  cold.  This  man,  although  he  could  at  that  time  go  from  the  bed 
to  the  fire  by  himfelf,  yet  died  the  next  day,  at  dinner,  fuddenly  ;  Vieuffens 
having  both  forefeen,  and  foretold,  the  difeafe,  and  death.  And  from  com¬ 
paring  the  two  cafes  together,  you  will  perceive  what  indications  he  might 
have  follow’d,  taken  from  the  firft;  obfervation,  made  upon  that  boy.  At 
leaft,  he  confeffes,  in  the  fecond  obfervation  of  thefe  four,  that  he  was  led 
to  diftinguilh  the  fame  difeafe  foon  after  in  another  boy,  although  it  was 
join’d  with  others,  and  in  particular  with  the  dropfy  of  the  thorax,  from  thefe 
caufes  j  that  in  the  whole  progrefs  of  the  difeafe,  and  a  little  before  the  con- 


(7)  Traite  du  Coeur,  ch.  i. 


E  e  e  2 


clufion, 


396  Book  II.  Of  Difeafes  of  the  Thorax. 

clnfion,  there  had  been  a  palpitation  of  the  heart,  that  the  lower  eye-lids, 
and  the  nails,  were  of  a  lead-colour,  that  the  patient  was  very  fad,  and  from 
fome  other  marks  ot  that  kind  :  and  indeed  in  the  beginning,  he  had  ob- 
ferv’d  in  this  fecond  boy,  a  fomewhat  palifh  face,  the  extremities  of  the  body 
without  heat,  refpiration  not  altogether  free,  elpecially  when  he  went  up 
ftairs,  but  his  pulfe  very  foft,  and  too  frequent.  All  which  things  are  to  be 
confider’d  by  me  hereafter ;  in  the  mean  while,  if  you  compare  them  with 
the  figns  of  Grretzius  (r),  and  Reimannus  (s),  you  will  immediately  under- 
ftand,  which  of  them  are  different,  which  are  pretty  fimilar,  and,  finally, 
which  are  the  fame. 

25.  Perhaps  you  will  here  enquire,  what  marks  led  VieufTens  to  foreknow 
the  dropfy  of  the  thorax  in  the  fecond  boy,  befide  the  dropfy  of  the  pericar¬ 
dium.  Becaufe  the  boy  had  fwell’d  legs,  and  could  not  lie  with  his  head 
low,  and  as  often  as  he  turn’d  himfelf  on  his  right  fide,  breath’d  with  much 
more  difficulty ;  for  thefe  reafons,  fays  VieufTens,  I  fuppos’d,  that  water  was 
extravafated  in  the  left  cavity  of  the  thorax  :  and  indeed  the  cavity  was 
found  to  be  entirely  full  of  it.  Do  not  however  wonder,  that  in  a  man,  who 
in  like  manner,  as  he  faid,  could  not  lie  with  his  head  low  (/),  there  was  no 
dropfy  but  that  of  the  pericardium  *,  for  the  collection  of  water,  in  this  cafe, 
was  fo  great  beyond  all  bounds,  that  the  diftended  pericardium  cover’d  al- 
moft  all  the  lungs:  befides,  thofe  two  other  figns  were  wanting.  Finally,  the 
figns  of  a  dropfy  of  the  thorax  alfo,  are  none  of  them  fo  peculiar,  but  even 
the  mod  fkilful  phyficians  are  fometimes  deceiv’d  in  diftinguifhing  the  dif- 
eafe ;  which  VieufTens  (u)  himfelf  confefTes,  with  a  noble  example  of  inge- 
nuoufnefs,  to  have  happen’d  to  him,  and  another  great  man,  in  a  certain 
youth  :  and  Schreyus  has  alfo  imitated  VieufTens  in  this  ingenuous  manner  (x). 
For  which  reafon,  it  is  neceffary  you  fhould  the  more  clofely  attend,  not 
only  to  thofe  admonitions  1  have  given  you  above  (y),  in  relation  to  the  figns 
of  this  dropfy,  but  alfo  to  my  obfervations,  which  I  am  now  to  produce 
in  their  order ;  for  molt  of  them  will  be,  as  alfo  thofe  that  will  be  added 
upon  the  dropfy  of  the  pericardium,  of  fuch  a  nature,  that  they  unteach, 
rather  than  teach  •,  for  to  do  this  is  not  without  its  advantages ;  fo  that  it 
plainly  appears,  as  VieufTens  (z)  fays,  that  it  is  not  fo  eafy  to  know  the 
“  dropfy  of  the  thorax,  as  fome  phylicians  believe,  who  being  ignorant  of 
44  anatomy,  afcribe  too  much  to  themfelves,  and  who  never  imagin’d  that 
1,4  they  ought  to  have  differed  bodies,  or  infpedted  them,  when  they  were 
44  differed  by  others.”  For  thofe  who  have  difTefled  or  infpefted  many, 
have  at  lead  learn’d  to  doubt,  when  the  others,  who  are  ignorant  of  anato¬ 
my,  and  do  not  take  the  trouble  to  attend  to  it,  are  in  no  doubt  at  all. 

26.  A  man  of  Bologna  had  a  difficulty  of  refpiration,  nor  could  lie  on  the 
left  fide ;  on  the  right  he  not  only  could  lie,  but  even  lay  continually.  Al¬ 
though  he  neither  lay  with  his  head  rais’d,  nor  had  fwell’d  feet,  yet  I  en¬ 
quir’d,  whether  he  was  ever  wak’d  in  the  firfl  hours  of  his  fleep,  by  a  fudden 
fenfe  of  fuffocation  ?  which  he  anfwer’d  in  the  negative.  He  complain’d 
alfo  of  a  kind  of  hardnefs,  at  the  upper  part  of  his  belly  j  which  might  even 

( r )  n.  22.  (.r)  n.  24.  (#)  A£l\  N.  C.  Tom.  2.  obf.  34. 

\i)  Ibid.  («)  ch.  cit.  (y)  n.  9.  11.  15.  (ss)  ch.  cit. 

t  be 


Letter  XVI.  Articles  27,  28.  397 

be  perceiv’d,  by  applying  the  hand  to  that  part  where  the  pancreas  is  generally 
luppos’d  to  lie;  fo  that  any  one  might  have  taken  it  for  the  pancreas  indu¬ 
rated.  When  the  belly  was  open’d  after  death,  it  was  difcover’d  to  be  the 
liver,  found  indeed,  but  deprefs’d  on  the  right  fide,  by  the  diaphragm,  the 
nature  of  which  leem’d  to  be  no  longer  fiefhy  in  that  place,  where  1  have 
laid  it  was  driven.  But  the'  thorax,  when  open’d,  fhew’d  that  fo  great  a 
quantity  of  water  lay  on  that  part  of  the  diaphragm,  as  to  have  driven  the 
mediaftinum  much  to  the  left  fide,  though  become  thicker  in  its  coats. 

27.  That  the  diaphragm  has  been  fometimes  fo  deprefs’d  by  the  lungs, 
when  enlarg’d  from  a  certain  caufe,  that  the  liver  has  been  driven  down¬ 
wards,  though  in  other  refpedts  found,  and  taken  for  a  tumour  by  phylicians, 
I  have  heard :  and  that  from  a  quantity  of  water,  accumulated  in  the  left 
cavity  of  the  thorax,  the  diaphragm,  “  in  the  part  where  it  is  perforated  by 
“  the  cefophagus,  was  protruded  like  a  bag  towards  the  left  kidney,  fo  that 
“  the  ftomach  lay  over  the  liver,”  I  have  read  in  the  Sepulchretum  (a). 
However,  you  eafily  perceive,  what  fymptoms  of  the  dropfy  of  the  thorax 
were  wanting  in  this  man.  Yet  he  breath’d  with  difficulty,  and  lay  only  on 
one  fide.  But  what  if  even  thefe  are  wanting  ?  Perhaps  you  will  believe, 
that  I  am  going  to  produce,  here,  the  obfervations  of  Ruffius  in  a  virgin, 
and  of  Wepfer  in  a  young  man,  as  he  who  points  them  out  fays  of  the  vir¬ 
gin,  “  that  (he  had  the  whole  thorax  fill’d  with  a  foul  and  ill- favour’d  water, 
“  and  that  fhe  had  continu’d  quite  to  death,  without  any  difficulty  of 
tc  breathing;”  and  of  the  young  man,  “  although  in  the  right  cavity  of  the 
“  cheft  three  pints  of  ferum  were  found,  and  one  pint  in  the  cavity  of  the 
“  pericardium ;  yet  that  he  was  able,  to  the  laft  inftant  of  his  life,  to  lie 
“  down  with  his  head  in  a  low  pofture,  and  even  afcended  fteep  places  with- 
“  out  any  impediment,  and  went  to  the  top  of  them,  rather  by  running, 
“  than  by  walking  a  flow  pace.”  But  you,  when  you  review  them  in  the 
Sepulchretum,  for  there  it  is  that  both  one  and  the  other  obfervation  is  re¬ 
lated,  when  the  queftion  is  of  tabid  bodies  (£),  will  find,  that  the  young 
man  did  thefe  things  I  have  mention’d  laft,  when  as  yet  there  feem’d  to  be 
no  water  effus’d;  but  that  afterwards,  “  he  had  breath’d  with  difficulty ;” 
and  although  “  he  walk’d  with  a  flow  pace,  had  taken  breath  frequently, 
“  with  a  diftended  cheft;”  and  that  the  virgin  “  had  expanded  the  alas  nafi, 
“  at  the  time  of  expiration,  but  had  not  any  remarkable  dyfpncea.”  It  is 
enough,  therefore,  that  both'of  them  lay  down,  and  the  young  man,  with¬ 
out  doubt,  always  “  in  a  low  fituation.”  But  I  will  here  give  you  an  obfer¬ 
vation  from  our  Mediavia,  communicated  to  me  by  him,  according  to  his 
cuftom,  on  the  very  day  he  made  it,  that  is,  on  the  nineteenth  of  March 
1745  ;  from  which  you  will  perceive  it  fometimes  happens,  that  although  the 
thorax  is  full  of  water,  not  only  the  two  figns,  which  were  not  wanting  in 
the  man,  whofe  hiftory  is  now  in  queftion,  but  even  the  others,  which  are 
efteem’d  the  chief,  are  all  wanting. 

28.  A  wool-comber,  a  man  of  a  middle  age,  and  of  a  thin  habit  of  body, 
had  receiv’d  a  wound,  fome  days  before,  on  his  fcapula,  with  a  knife,  in 

(<a)  1.  2.  S.  7.  in  Schol.  ad  obf.  25.  in  Ad¬ 
ditam. 


(<5)  Seft.  ead.  cbf.  91 .  &  in  Additam,  obf. 


39  8  Book  II.  Of  Difeafes  of  the  Thorax. 

fuch  a  manner,  that  a  finger  might  be  thruft  through  the  very  bone,  in  its 
broad  and  thin  part.  It  was  manifeft  that  there  was  pus  betwixt  that  bone  and 
the  ribs,  which  was  difcharg’d  in  great  quantity,  by  an  artificial  opening 
that  was  made  in  a  more  depending  fituation  :  but  whether  pus  was  within 
the  cavity  of  the  thorax  alfo,  and  whether  the  wound  had  penetrated  into  this 
cavity,  or  not,  was  uncertain  *,  for  although  fomething  bloody  had  been  ob- 
ferv’d  in  what  he  expectorated,  it  was  not  fufficiently  clear,  whether  in  him, 
who  was  a  wool  comber,  and  a  thin  man,  this  ought  not  to  be  imputed  rather, 
perhaps,  to  fome  former  taint  than  to  the  wound  ;  efpecially,  as  all  other 
iymptoms  of  wounds  penetrating  into  the  cavity  of  the  thorax,  and  of  humours 
extravafated  there,  were  wanting.  ’Tis  certain,  however,  that  he  lay  with  his 
head  low,  and  on  either  fide  conftantly,  whenever  he  was  bidden  by  the  fur- 
geon,  or  whenever  he  chofe  it  himfelf ;  nor  was  he  ever  attack’d  with  any 
difficulty  of  breathing,  from  the  time  of  inflicting  the  wound,  to  the  very  end 
of  life.  About  the  latter  part  of  his  life,  his  pulfe  was  hard  and  fmall.  The 
thorax  of  the  body  was  accurately  inipeCted,  both  on  the  infide  and  the  out- 
fide  *,  and  on  the  outfide,  indeed,  there  was  a  large  finus  under  that  broad  bone 
univerfally,  from  whence  pus  was  wont  to  flow,  and  in  which,  even  at  that 
time,  a  very  foetid  matter  was  contain’d,  within  black  and  ftrong-fmelling 
parietes  ;  yet  there  was  no  where  any  communication  with  the  cavity  of  the 
thorax.  The  internal  infpeClion  confirm’d  the  external  ;  for  in  neither  of  the 
cavities  of  the  thorax  was  there  any  pus,  but  both  of  them  were  fill’d  with 
water,  and  that  of  a  yellow  colour,  which  being  at  laft  drawn  out,  not  the  leaft 
fign  or  mark  appear’d  of  any  paftage,  or  winding  aperture,  by  which  that 
finus  I  juft  now  defcrib’d,  could  have  communicated  with  the  cavity  of  the 
thorax.  The  lungs  adher’d  to  the  pleura  for  fome  confiderable  fpace,  and 
where  they  were  contiguous  to  the  diaphragm,  were  cover’d  with  a  kind  of 
jelly  :  this  jelly  being  wip’d  away,  they  were  infpeCted  and  cut  into  ;  but  al¬ 
though  they  did  notfeem  in  good  condition,  they  did  not  however  fhew  any 
appearance  of  difeafe  which  was  worth  much  attention,  or  which  might  feem 
to  be  recent. 

29.  As  to  the  wound,  I  fhould  be  clearly  in  opinion  that  it  was  inflifled 
obliquely,  and  not  directly,  and  that  the  broad  part  of  the  fcapula,  being  by 
chance  turn’d  away  from  that  part  of  the  ribs  towards  which  the  knife,  when 
pafs’d  through  this  bone,  tended,  the  wound  was  by  this  means  prevented 
from  penetrating  into  the  cavity  of  the  thorax.  And,  as  to  the  water,  1  fhould, 
without  doubt,  fuppofe,  that  the  collection  of  it  in  a  man  who,  after  the  wound 
he  had  receiv’d,  was  continually  in  a  recumbent  pofture,  and  therefore  in¬ 
active,  and  who  had  been  before  us’d  to  continual  exercife,  and  to  live  in  the 
heat,  had  rather  encreas’d  than  begun.  But  however  that  may  be,  this  you 
certainly  fee,  that  all  the  chief  figns  of  lb  confiderable  a  dropfy  were  wanting  ; 
fo  that  you  ought  to  be  lefs  furpriz’d  if  fome  of  them  were  wanting  in  thofe 
three  observations,  which  like  that  firft,  being  formerly  made  at  Bologna,  I 
fhall  immediately  produce. 

30.  A  young  man,  without  any  evident  caufe  to  which  he  could  attribute 
the  diforder,  fell  into  a  difficulty  of  breathing,  before  the  end  of  the  year  1704. 
Being  on  this  account  afterwards  receiv’d  into  the  hofpital  of  St.  Mary  de 
Morte  at  Bologna,  he  was  treated  in  various  methods  of  cure,  but  in  vain. 

Among 


Letter  XVI.  Article  30.  399 

Among  many  other  remedies,  I  know  that  venasfedtion  being  once  and  again 
order’d,  he  feem’d  once  and  again  to  have  a  little  immediate  relief  from  his 
difficulty,  but  that  this  relief  did  not  remain  :  and  that  fuch  medicines  as 
open’d  the  belly  did  not  afford  that  relief,  although  they  did  not  evidently  in¬ 
jure.  But  thefe  things  were  related  to  me  when  I  firftfaw  the  patient,  which 
was  not  quite  three  days  before  his  death,  at  which  time  he  was  very  pallid, 
and  breath’d  always  with  his  neck  upright.  When  he  infpir’d,  I  obferv’d  that 
the  lower  part  of  the  cheft  was  rais’d  very  high  :  he  had  no  third,  no  heat, 
nor  any  other  febrile  fymptom  of  that  kind  ;  yet  the  puliation  of  the  arteries 
was  frequent,  and  the  puliation  of  the  heart,  which,  when  we  applied  our  hands 
to  the  thorax,  feem’d  to  palpitate,  was  much  more  frequent  :  and  this  com- 
parifon  being  often  and  accurately  made,  always  anfwer’d  in  the  fame  manner, 
and  the  pulfations  of  the  heart  and  arteries  were  always  obferv’d  to  be  fur-, 
prifingly  unequal.  The  difficulty  of  breathing  being  much  encreas’d,  he  died 
about  the  hundredth  day  from  the  time  the  diforder  had  begun.  His  face, 
when  dying,  and  after  death,  was  very  much  fwell’d,  but  his  feet  were  not 
fwell’d  ;  about  the  eyes,  and  in  the  abdomen  of  the  carcafe  was  a  lividnefs  ; 
and  this  cavity  being  open’d,  the  omentum  appear’d  blackiffi,  and  cover’d,  as 
it  were,  with  glandular  globules,  on  both  furfaces  :  the  fpleen  was  found, but  the 
liver  was  externally  white,  and  internally  approach’d  nearly  to  the  colour  of  to¬ 
bacco  :  the  gall-bladder  was  white,  degenerating  into  yellow,  and  extremely 
contradted;  and  the  liver  itlelf  was  moreover  connedted  by  thin  cellular  mem¬ 
branes,  to  the  parts  that  lay  about  it,  and  efpecially  to  the  diaphragm,  even 
where  it  is  not  us’d  to  be  connedted  at  other  times.  The  peritonaeum  alfo, 
where  it  invefts  the  diaphragm,  was  rough,  as  it  were,  with  fome  kind  of  glo¬ 
bules,  of  various  magnitudes  and  forms.  Befides  all  thefe  appearances,  there 
was  alfo  a  yellow  and  green  water  in  the  general  cavity  of  the  abdomen  ;  but 
both  the  cavities  of  the  thorax  were  Ril’d  with  a  water  of  that  kind  j  and  while 
it  was  exhaufted  with  fponges,  you  might  have  feen  adhering  to  them  with  a 
kind  of  jelly,  various  pieces,  as  it  were,  of  thin  membranes.  The  right  lobe 
of  the  lungs  was  connedted  to  the  fide  of  the  cheft  by  many  membranes,  fuch 
as  I  have  defcrib’d  upon  the  liver-,  and  this  lobe  being  drawn  to  the  left  fide 
with  the  hand,  the  pleura,  which  anfwer’d  to  its  pofterior  part,  appear’d  as  if 
it  had  receiv’d  feveral  little  blows  here  and  there,  fo  that  it  ffiew’d  the  blood 
ftagnating  there,  of  a  high  florid  colour  :  but  the  left  lobe  of  the  lungs,  in  its 
whole  upper  and  lateral  furface,  adher’d  very  ftrongly  with  the  pleura,  which 
in  thofe  parts,  and  in  great  part  of  the  fubjedted  diaphragm  befides,  and  in  the 
anterior  furface  of  the  mediaftinum,  and  where  this  lies  contiguous  to  the 
pericardium,  was  not  only  rough  with  globules,  as  I  faid  the  part  of  the  peri¬ 
tonaeum  was,  but  was  moreover  of  fuch  a  hardnefs,  and  thicknefs,  that  it 
greatly  exceeded  the  coats  of  the  aorta,  where  it  rofe  from  the  heart,  in  its 
denfity,  confifting  internally  of  a  white  fubftance,  made  up  of  minute  par¬ 
ticles  :  and  if  you  comprefs’d  the  lungs  in  your  hand,  you  perceiv’d  them  to 
be  full  of  a  whitiffi  and  frothy  ichor  however,  they  had  no  appearance  of  in¬ 
jury,  nor  yet  the  heart  itfelf,  unlefs  you  ffiould  perhaps  imagine,  that  two  or 
three  polypous  concretions,  and  thofe  very  fmall,  and  almoft  mucous,  we<e  of 
any  great  importance  one  of  which  was  contain’d  in  the  right  auricle,  and 
the  other  two  belong’d  to  the  aorta,  and  pulmonary  artery.  Within  the  peri¬ 
cardium 


4oo  Book  II.  Of  Difeafes  of  the  Thorax. 

cardium  was  fome  water,  very  much  like  what  had  been  found  in  the  belly 
and  cheft,  but  fcarcely  in  a  larger  quantity  than  natural.  As  to  what  remains 
of  the  difiedtion,  I  ffiould  have  added  here,  what  diforder  was  oblerv’d  in  the 
left  lobe  of  the  thyroid  gland,  if  it  had  not  been  already  fufficiently  done  in  the 
ninth  of  the  EpiBolas  Anatomicae  (r),  as  this  is  the  young  man  of  whom  I 
there  told  you  that  he  had  died  of  a  dropfy  in  the  thorax. 

31.  Although  many  and  various  remarks  might  be  made  upon  this  hiftory, 
yet,  for  brevity’s  fake,  I  will  feledt  only  a  few.  And,  firft,  as  to  what  relates 
to  the  pleura,  it  is  very  difficult  to  afcertain  the  true  caufe,  why  it  ffiould  ap¬ 
pear  like  an  inflam’d  lurface,  with  the  blood  ftagnating  therein,  on  the  right 
poflerior  part  of  the  thorax.  For  if  you  ffiould,  perhaps,  be  willing  to  ac- 
cufe  the  yellow  and  greenifh  water,  as  the  caufe  of  this  appearance,  and  fup- 
pofe  that  it  had  been  eftedted  by  the  irritation  of  the  faline  fpiculae,  with 
which  this  water  was  impregnated ;  and  conjedture  alfo,  that  the  fame  pro¬ 
perty  inherent  in  the  water  of  the  pericardium  had,  by  vellicating  the  heart, 
been  the  occaflon  of  that  perverflon  in  the  pulfe ;  we  muft  then,  certainly, 
confider,  why,  as  the  fame  kind  of  water  was  in  the  belly,  and  the  left 
cavity  of  the  thorax  alfo,  it  produc’d,  neither  in  one  place,  nor  in  the  other, 
fimilar  effects  of  irritation  :  and  we  muft  even  enquire,  why  it  did  not  pro¬ 
duce  thofe  effedts  in  the  remaining,  and  greater,  part  of  the  right  fide  of 
the  thorax.  And.  indeed,  it  is  alfo  difficult  for  me  to  determine,  why,  as 
the  pleura  appear’d  inflam’d  in  that  particular  part,  there  was  no  pleuritic 
pain,  neverthelefs,  attending  it.  Finally,  for  what  reafon  can  we  fuppofe 
it  had  become  fo  thick  and  hard,  in  fo  many  parts,  and  to  fo  confiderable  an 
extent,  on  the  left  fide,  yet  was  not  thicken’d,  or  harden’d,  at  all,  on  the 
right  ?  For  if  you  fuppofe  this  to  be  owing  to  the  water  that  was  colledted 
there,  the  fame  water  was  alfo  collected  on  the  right  fide ;  fo  that  the  ex¬ 
planation  of  this  obfervation  of  mine,  is  much  more  difficult  than  that  of 
the  leventy-fifth,  which  in  the  firft  fedlion  of  the  fecond  book  of  the  Sepul- 
chretutn,  is  unjuftly  afcrib’d  to  Francifcus  Michinus  alone,  as  I  ffiall  pre- 
lently  fhew.  For  in  that  obfervation,  a  very  great  quantity  of  water  is  de- 
fcrib’d  “  in  the  left  cavity  of  the  thorax  only  and  in  that  cavity  only  was 
“  the  pleura  very  thick,  and  callous  ;  and,  in  like  manner,  the  lungs,  the 
tc  mediaftinum,  and  the  diaphragm,  were  almoft  callous.” 

32.  I  wiffi,  however,  I  could  as  readily,  and  as  clearly,  explain  all  thofe 
appearances  above-mention’d,  as  I  can  my  animadverfion  concerning  the 
principal  author  of  that  obfervation.  For  if  you  turn  to  thofe  feven  obfer- 
vations  of  our  Falloppius,  which  are  entitl’d,  Obf errationes  de  venis ,  you  will 
read,  juft  in  fo  many  words,  in  the  laft  and  feventh  obfervation,  that  very 
obfervation  which  is  attributed  to  Michinus ;  except  that  a  few  other  things, 
which  I  ffiall  produce  prefently,  are  thrown  in  between,  and  fubjoin’d.  But 
that  thofe  observations  belong  to  Falloppius,  not  only  his  Inftitutions,  and 
Anatomical  Remarks,  demonftrate,  whenever  his  difcourfe  happens  to  turn 
an  the  fame  fubjedts  that  are  fpoken  of  in  the  greater  part  of  thefe  feven  ob¬ 
fervations,  but  even  the  very  words  with  which  he  concludes  the  fourth  ob- 
fervation  confirm,  beyond  a  doubt :  “  A.nd  this  confent  of  the  veins,  I, 
“  .Falloppius,  oblerv’d  in  many  bodies  that  year.” 

(0  39- 

2 


But 


Letter  XVI.  Article  32.  401 

But  that  you  may  not  fuppofe  thefe  obfervations  to  have  been  made  by 
Michinus,  and  to  have  been  rafhly  adjudg’d  to  Falloppius,  by  the  editors  of 
all  his  works,  or  that  Michinus  had  claim’d  to  himfelf  what  was  proper  to 
Falloppius,  take  this  account  of  it.  When  Michinus  publifh’d  his  Expo- 
fition  on  Galen’s  Book  of  the  Bones,  at  Venice,  in  the  year  1570,  and  added 
to  it  thofe  feven  obfervations,  which,  in  like  manner,  44  were  firft  publifh’d 
44  at  that  time,”  he  ingenuouily  confefs’d,  in  the  beginning  of  the  book, 
44  that  they  all  belong’d  to  the  fame  author,”  that  is,  to  Falloppius  *,  but 
44  that  they  had  been  faithfully  copied  by  him,  as  a  difciple  of  the  author, 
44  and  taken  from  his  own  mouth,  as  he  publicly  taught.”  And,  in  like 
manner,  he  prefix’d  this  title  to  thofe  obfervations  in  its  proper  place :  44  Ana- 
44  tomical  Obfervations  of  Gabriel  Falloppius,  copied  by  Francefco  Michini 
41  dello  Santo  Archangelo,  while  he  dictated  them.”  This  is  alfo  added  by 
Michini,  which  betwixt  the  fifth  and  fixth  obfervation,  in  his  own  edition, 
indeed,  you  read  thus :  44  As  1  had  feen  and  obferv’d  all  thefe  things,  in  one 
44  and  in  another  body,  in  the  year  155+,  both  in  the  private  and  public 
44  difiedlions,  which  the  learn’d  Falloppius  made,  and  demonftrated ;  there- 
44  fore,  in  order  to  render  the  knowledge  of  this  truth  more  eafy  and  obvious, 
44  I  was  willing  to  add  the  figure  of  thefe  veins,  delineated  by  Moibanus, 
44  who  was  my  very  ingenious  fellow-difciple  and  friend  at  that  time.” 

I  fuppofe  this  was  that  Johannes  Moibanus,  the  learn’d  phyfician,  who  at 
that  time,  as  you  will  ealily  gather  from  Mercklinus  (d),  was  about  his  eight- 
and-twentieth  year  •,  fo  that  he  might  very  probably  have  been  prefent  at 
thofe  difieftions  of  Falloppius,  together  with  Michinus,  and  have  drawn 
that  figure,  at  the  defire  of  his  tutor,  which  we  have  among  thofe  obfervations 
in  the  works  of  Falloppius,  and  is  exa&ly  the  fame  with  that  added  by  Mi¬ 
chinus,  except  that  it  is  much  lefs.  But  Michini  himfelf,  you  will  fay,  faw 
and  obferv’d  thefe  things.  I  confefs  it  •,  but  no  more  than  the  reft  of  the 
difciples  did.  For  Falloppius  fays,  in  the  fourth  obfervation,  44  I  obferv’d 
44  thefe  things,  not  in  one  body  only,  but  in  many,  and  demonftrated  them 
44  to  the  ftudents  who  were  about  me.”  And  without  doubt,  he  who  de- 
monftrates,  is  the  author  of  the  obfervations  -,  they  who  aflift  at,  and  fee,  the 
demonftration,  are  witnefies  only.  Nor  does  Michini  arrogate  any  more  to 
himfelf  than  this,  where  you  read  thefe  things  in  the  latter  part  of  the  feventh 
obfervation  :  44  And  as  we  faw,  in  the  fame  year,  two  preternatural  diforders, 
*4  which  perhaps  rarely  happen,  and  are  more  rarely  feen  :  I  was  willing  for 
44  that  reafon  to  fubjoin  them,  for  the  fake  of  ftudents.”  xAmd  he  imme¬ 
diately  adds  what  44  they  had  feen  in  the  body  of  a  young  girl :  prefently  he 
lays,  44  But  in  the  body  of  an  adult,  we  faw  a  dropfy  of  the  lungs  and 
then  gives  the  obfervation  of  which  we  now  fpeak.  He  does  not  fay,  44  I 
44  found,”  but  44  we  faw  fo  that  you  may  eafily  perceive,  even  from  this, 
that  he  faw  thefe  appearances,  while  Falloppius  44  was  diflfe&ing,  demon - 
44  ftrating,  and  explaining  efpecially  as  he  throws  in  betwixt  the  obfer¬ 
vations  the  following  words:  44  And  my  very  learned  preceptor,  Falloppius, 
44  alferted,  that  this  diforder  might  be  call’d  the  empyema,  or  dropfy  of  the 
44  thorax.” 


1 

1  commend. 


Vol.  I. 


(d)  In  Linden.  Renov. 

F  f  f 


40  2  Book  II.  Of  Difeafes  of  the  Thorax. 

I  commend,  therefore,  the  ingenuous  temper  of  Michini ;  nor  yet,  like 
Marcellus  Donatus  (e),  do  I  attribute  the  obfervations  of  others  to  him. 
“  Francifcus  Michinus,”  fays  he,  “  who  has  publifh’d  fome  anatomical  ob- 
“  fervations  of  his  own,  fays,  in  the  fifth,  that  he,  &c.”  For  how  can 
that  poffibly  be  the  fifth  obfervation  of  Michinus,  which  Michinus  confeffes 
«  that  he  had  copied  from  the  mouth  of  Falloppius,”  as  he  had  done  the 
others  ?  I  fhould  rather  have  believ’d,  if  the  words  of  Donatus  had  not  fo 
evidently  referr’d  to  thefe  very  obfervations,  that  fome  other  “  anatomical 
“  obfervations”  were  pointed  out  by  him,  which  are  afcrib’d  to  Michinus, 
by  thole  who  revife  and  colled  the  writings  of  phyficians,  or  anatomifts, 
while  they  generally  copy  one  after  another,  publifh’d  at  Venice  in  the  year 
1554,  in  that  very  year,  to  wit,  which  he  fpent  here  among  the  difciples  of 
Falloppius,  not  by  way  of  afiifting  him  in  his  diffedions,  but  for  the  fake  of 
learning,  and  improving  himfelf  in  the  fcience  !  Yet  he  might  have  differed 
before.  Perhaps  he  might  •,  but  I  could  not  obferve  the  lead  word,  amongft 
what  he  publifh’d  of  the  works  of  Falloppius,  or  in  the  letter  prefix’d,  dated 
“  from  Fiorenzuola,  in  the  dutchy  of  Piacenza,  on  the  twenty  firft  day  of 
ct  Odober,”  1569,  where  he  perhaps  pradis’d  phyfic,  from  which  I  could 
fuppofe  that  he  was  an  anatomift.  But  notwithftanding  this  is  the  (late  of  the 
cafe,  and  notwithftanding  it  has  never  happen’d  to  me,  nor  to  the  very  learn’d 
Haller  indeed  (/),  as  1  found  when  I  was  revifing  this  letter,  to  have  feen 
any  other  obfervations  publifh’d  by  Michinus  than  thefe  of  Falloppius,  nor 
yet  to  have  lit  on  any  perfon  who  had  feen  them  •,  yet  I  fhall  not,  for  than 
reafon,  contend,  that  Inch  never  were  publifh’d.  It  is  enough  for  me,  that 
while,  with  the  confent  of  Michinus  himfelf,  I  afferted  to  our  Falloppius  his 
rights,  I  have  (lightly  touch’d  upon  fome  things  relative  to  the  firft  editions 
of  his  works,  and  to  the  hiftory  of  anatomy,  which  might  be  a  very  luitable 
recreation  to  you,  who  are  ftudious  of  both,  by  drawing  off  your  attention 
a  little  while  from  the  point  in  hand. 

33.  Falloppius,  therefore,  afferted,  that  the  difeafe  defcrib’d  in  that  fe- 
venty- fifth  obfervation  of  the  Sepulchrctum,  “  might  be  call’d  an  empyema, 
“  or  dropfy  of  the  thorax  j”  who  alfo,  a  little  below,  added  the  following 
paffage  upon  the  fame  diforder  :  “  Of  which  dropfy  of  the  thorax,  indeed, 
“  Hippocrates  fpeaks  in  the  fecond  chapter,  De  morbis ,  and  in  his  book  Ds 
“  affectionibus  internisy  about  the  middle,  where  he  treats  of  the  other  fpecies 
“  of  dropfy,  and  calls  this  the  dropfy  of  the  lungs.”  Wherefore  you  fee 
already,  why  that  obfervation  begins  thus,  In  the  body  of  an  adult  I  faw 
“  a  dropfy  of  the  lungs.”  For  fo  it  had  been  call’d  in  this  chapter,  with 
which  Falloppius  very  learnedly  join’d  the  paffage  of  that  other  book  ;  that 
we  may  by  this  means  perceive,  from  comparing  them  both  together,  and 
from  confidering  the  fymptoms,  and  the  cure,  that  it  is  the  fame  diforder 
which  is  fpoken  of  in  both  places,  that  is,  the  dropfy  of  the  thorax,  which  may 
be  cur’d  by  letting  out  the  water  by  incilion,  when  practicable.  But  as  to  the 
manner  in  which  water  may  be  extravafated  into  the  cavity  of  the  thorax,  the 
fecond  paffage  does  not  feem  to  me  to  hint  any  thing  differently  from  Galen’s 

(d  De  Med.  Hift.  Mirab.  1,  3  c.  9.  (f)  In  Boerh.  Meth.  Stud.  Med.  P.  7  S.  6. 

4 


fappofiuona 


Letter  XVI.  Article  33.  403 

fuppofition,  who  is  generally  wont  to  follow  Hippocrates :  this  fuppofition  I 
have  given  >ou  above  (^),  which  is,  that  water  is  pour’d  out  into  the  cavity 
of  the  pericardium,  from  ruptur’d  hydatids,  which  are  call’d  by  Hippocra¬ 
tes,  in  that  pafiage,  44  tubercles  :  if  tubercles  (hall  have  been  generated  in 
44  the  lungs,  and  fill’d  with  water,  and  burft  into  the  cavity  of  the  cheft.” 
For  that  it  happens  thus,  “  both  in  the  ox,  the  dog,  and  few.  And  it 
cc  fhould  feem,  that  fuch  things  mull  happen  more  frequently  in  men,  than 
ct  in  beads,  inafmuch  as  they  ufe  a  manner  of  living,  that  is  more  produc- 
44  tive  of  difeafes.” 

You  fee  how  thefe  very  ancient  phyficians,  who,  fome  think,  never  touch’d 
upon  thefe  fpecies  of  dropfies,  as  they  had  not  the  liberty  of  examining  into 
difeafes,  and  their  origins,  in  the  human  body,  difiedted  and  examin’d  the 
carcafes  of  beads,  and  carried  their  conjectures  from  what  they  faw  there, 
very  fagacioufly,  to  the  human  fpecies.  And  it  is  well  known,  that  fimilar 
appearances  to  thefe,  are  at  this  day  feen  in  oxen,  and  fheep  •,  and  Willius 
in  particular,  and  Willis,  confirm  it  by  their  obfervations  produc’d  in  the 
Sepulchretum  ( h ) :  and  in  a  fow,  to  omit  other  appearances  of  the  fame 
kind,  which  have  been  feen  by  me  in  beads,  and  in  men  ;  in  a  fow,  I  fay, 
that  was  in  other  refpedts  healthy,  I  remember  to  have  feen  an  hydatid,  which 
being  but  a  little  prominent  on  the  external  furface  of  the  lungs,  was  fo 
much  enlarg’d  internally,  as  to  contain  fome  ounces  of  limpid  water.  But 
in  men,  as  Falloppius,  in  particular,  faw  water  extravafated,  fo  his  difciple 
Coiterus  (1)  alfo,  found  hydatids  afterwards.  For  after  having  faid,  that  he 
had  found  44  one  or  both  the  cavities  of  the  thorax  full  of  water,  many 
“  times,  from  whence  he  could  afiert  with  Flippocrates,  that  a  dropfy  does 
“  happen  in  the  ched j”  he  fubjoins  two  examples  of  it,  one  in  the  body  of 
a  profeffor  at  Bologna,  whom  he  dififeded,  at  the  entreaties  of  Jerom.  Car- 
dani,  his  mod  affectionate  friend,  and  the  other  in  a  virgin  ;  in  the  fird  of 
which  he  found  hydatids  adhering  to  all  the  vifcera  of  the  abdomen,  and  in 
the  lad  one,  indeed,  at  the  fide  of  the  cervix  uteri,  but  fo  large,  that  it  was 
almod  twice  as  big  as  the  urinary  bladder,  and  quite  full  44  of  a  thin  and 
46  pellucid  water,”  as  he  fays  below-,  fo  that  it  is  natural  to  conjedure,  in  re¬ 
gard  to  the  water,  that  it  had  been  difeharg’d  from  fuch  ruptur’d  bladders, 
with  which  the  right  cavity  of  the  thorax  was  fill’d,  in  both  of  thefe  bodies ; 
efpecially  as  in  the  fird  l'edion  alfo  of  the  fecond  book  of  the  Sepulchretum  (&), 
we  read  that  the  lungs  of  a  man  were  found,  after  that,  by  others,  44  full  of 
44  bladders,  which  being  open’d,  either  water  iffu’d  out,”  or  a  pellucid  hu¬ 
mour,  which,  although  it  was  then  ropy,  44  like  the  white  of  an  egg,”  yet 
might  have  been  more  fluid,  in  thefe  very  bladders,  or  rather  in  the  others, 
which  had  been  ruptur’d,  and  thus  have  brought  on  the  dropfy,  that  was 
found  to  exid  on  one  fide  of  the  thorax. 

But  perhaps  you  will  here  afk  me  two  things ;  the  fird,  how  it  can  be 
call’d  a  dropfy  of  the  lungs,  when  the  hydatids  of  the  lungs  being  already 
burd,  the  water  is  pour’d  out  into  the  cavity  of  the  thorax  ?  The  fecond, 
whether  a  dropfy  of  the  thorax  is  generally  brought  about  in  this  way  ?  As 

(g)  n.  20.  (/)  Obf.  Anat. 

\b)  1.  2.  S.  1.  obf.  135.  &  Schol.  ad  obf  75.  (-6)  Obf  33.  &  36. 

F  f  f  2 


to 


404  Book  II.  Of  Difeafes  of  the  Thorax. 

to  the  fir  ft  then,  it  leems  to  be  properly  call’d  the  dropfy  of  the  lungs,  when 
the  ferum  is  inherent  in  the  lungs  themfelves,  as  Tozzius(/)  and  Albertini  (/»} 
defcribe  as  having  been  found  in  dead  bodies  by  them,  not  concealing,  at 
the  fame  time,  other  things  which  belong  to  that  difeafe  ;  to  the  fymptoms  of 
which  might  be  added,  according  to  what  Jo.  Maur.  Hoffman  (»)  has  hinted, 
complaints  “  of  a  fenfe  of  weight,  with  a  tightnefs  and  preffure,  proceeding 
44  from  the  throat  downwards,  through  the  middle  of  the  thorax.”  And 
although  oblervations  are  extant,  of  this  dropfy  being  join’d  with  the  dropfy 
of  the  thorax  (0)  j  yet  it  often  happens,  that  hydatids  being  ruptur’d,  when 
in  thefe  the  water  of  the  lungs  is  contain’d,  the  firft  diforder  goes  away,  and 
another  comes,  -which  many  continue  to  call  a  dropfy  of  the  lungs,  either  in 
reference  to  its  origin,  choofing  rather  to  mark  out  the  caufe,  than  the  effect, 
or  elfe  to  imitate  the  example  of  Hildanus  (y>),  who,  having  found  much 
44  ferous  water”  about  the  heart,  in  the  pericardium,  did  not  call  the  difeafe, 
a  dropfy  of  the  pericardium,  but  a  hydrocardia. 

Yet  as  to  the  dropfy  of  the  thorax,  whether  it  is  generally  brought  on  in 
this  way,  which  was  the  fecond  queftion  you  afk’d  me,  nobody  I  fancy  will, 
be  very  ready  to  affert  it,  in  fo  great  a  variety  of  caufes.  For  to  this  clafs 
belongs,  amongft  others,  that  alfo  which  you  will  hereafter  fee  confirm’d, 
both  by  Valfalva’s  obfervations,  and  mine  (<7),  and  which  Coiterus,  whom  I 
have  already  commended,  had  before  remark’d  alfo,  in  his  obfervations,  that 
you  have  in  the  Sepulchretum  ;  I  mean  (r),  44  that  there  are  feveral  difeafes, 
44  which  a  dropfy  of  the  thorax  may  attend  upon,  and  among  thefe  peripneu- 
44  monies,  pleurifies,  confumptions,  and  dropfies  :  for  which  reafon,  the 
44  caufe  of  this  collection  of  water,  in  the  cheft,  is  not  always  the  fame,  but 
44  they  feem  to  be  various,  and  in  great  number.”  And  thus  this  excellent 
anatomift,  by  diffecting  human  bodies,  after  his  matter,  not  only  illuftrated, 
but  moreover  enlarg’d  the  doctrine  of  the  moft  ancient  phy ficians.  To  which 
I  fhould  fuppofe,  that  Falloppius  alfo  had  his  eye,  when  he  aflerted  that  the 
diforder  delcrib’d  in  his  obfervation,  44  might  be  call’d  an  empyema,  or 
44  dropfy  of  the  thorax  (j)  that  is,  if  you  attend  to  the  ancient  fymptoms, 
very  much  like  to  the  empyema.  For  the  patient,  as  it  is  faid  in  that  paf- 
fage  of  the  fecond  book,  De  inorlis ,  pointed  out  by  Falloppius,  44  has  the 
44  fame  fymptoms,  as  one  who  has  an  empyema,”  but,  that  we  may  diftin- 
guifh  the  one  from  the  other,  44  more  nightly,  and  to  a  longer  extent  of 
44  time.”  Yet  that  thofe  who  have  water,  and  not  pus,  in  the  cavity  of  the 
thorax,  have  fometimes  very  violent,  and  quick-deftroying  fymptoms,  many 
of  the  obfervations  that  have  been  produc’d  fufficiently  (/)  fnew  :  and  on  the 
other  hand,  that  they  fometimes  are  without  all  the  fymptoms,  and  fre¬ 
quently  without  moft  of  them ;  as  certainly  that  young  man  (u),  from  whole 
cafe  I  took  occafion  to  write  thefe  things,  had  neither  44  fever,”  nor  44  cough,” 
nor  44  fwelling  of  the  feet,”  nor  44  contraction  of  the  nails,”  and  yet  there 
was  a  dropfy  of  the  thorax.  But  take  care  how  you  fuppofe,  that  I  fay 


(/)  Medic.  Part.  Pratt,  ubi  de  Morbis  Peft. 
( m )  Comment,  de  Bonon.  Sc.  Inft.  Tom.  1. 
in  Ooufc. 

(«)  Att.  N.  C.  Tom.  obf.  213. 

{c)  ut  cit.  Sepulchr.  Sett.  1.  obf.  73.  &  77. 


(/)  Cent.  1.  obf.  43. 

(7)  Epilt.  20.  &  21. 

(r)  1.  2.  S.  7.  obf.  40. 

(j)  n.  32.  (/)  Vid.  n.  2.  17. 

(«)  n-  3°' 


thefe 


Letter  XVI.  Article  34.  405' 

thefe  things,  becaufe  I  think  “  the  ancient  do&rine  ought  to  be  rejected,  by 
“  reafon,  that  it  has  not  an  exadt  certainty  about  all  things.”  I  fay  them 
rather,  becaufe  this  very  circumftance  being  ingenuoufly  acknowledg’d,  in 
the  book  de  Veteri  Medicina  (x),  thole  phyficians  whom  I  pointed  out  above, 
with  Vieuffens  (jy),  ftew  themfelves  to  be  the  moft  ignorant,  when  fearing 
nothing  lo  much  among  the  common  people,  as  to  feem  doubtful  of  the  na¬ 
ture  ot  any  hidden  difeafe,  they  often  do  that  which  Hippocrates  (2)  fo  juftly 
blam’d,  that  is,  they  pronounce  “  a  diforder  to  be  of  a  different  nature  from 
t£  what  it  really  is.”  But  let  us  go  on  to  the  other  oblervations  I  promis’d 
you. 

34.  A  virgin  of  Bologna,  about  eighteen  years  of  age,  having  repell’d 
an  eruption  of  the  fcabies  kind,  by  ointment,  was  feiz’d  with  a  moil  violent 
orthopnoea,  without  a  fever,  and  without  the  other  fymptoms  I  juft  now 
mention’d.  Blood  being  taken  from  her  arm,  to  the  quantity  of  fix  or  feven 
ounces,  fhe  became  much  worfe :  and  the  fame  quantity  being  taken  from 
her  foot,  fome  days  after,  fhe  funk  under  it  fo  much,  that  the  difficulty  of 
breathing  grew  more  violent,  and  fhe  died  on  the  following  day,  which,  if 
I  remember  rightly,  happen’d  in  the  year  1703.  The  body  after  death  was 
no  where  fwell’d,  but  had  in  every  part  its  proper  proportion  of  roundnefs 
and  plumpnefs,  and  not  the  leaft  veftige  of  the  fcabies.  In  the  abdomen 
was  a  very  livid  liver,  and  harder  than  ufual  :  the  other  vifcera  were  found, 
and  among  thefe  the  fpleen,  notwithftanding  its  upper  extremity  was  almoft 
entirely  disjoin’d  from  the  other  part  of  it-,  fo  that  if  there  had  not  been  a 
fmall  continuity  on  one  fide  of  it,  there  would  have  been  two  fpleens,  in- 
ftead  of  one.  What  obfervations  I  made  on  the  parts  of  generation  do  not 
belong  much  to  this  place.  Yet  one  or  two  things,  on  account  of  what  will 
be  faid  juft  now  on  the  breafts,  and  on  account  of  what  we  read  in  the  Apho- 
rifms  (tf),  mult  not  be  conceal’d.  The  uterus  was  perfectly  found,  the  hy¬ 
men  entire,  and  in  its  natural  ftate :  yet  in  the  cavity  of  the  uterus  was  con¬ 
tain’d  a  kind  of  glutinous  humour,  which  in  its  colour  refembl’d  water, 
wherein  frefh  meat  has  been  wafh’d.  This  being  wip’d  away,  fome  bloody 
points,  as  it  were,  appear’d  on  the  internal  furface  of  the  uterus,  principally 
in  the  middle  of  its  fundus,  when  the  fingers  were  prefs’d  underneath  •,  and 
thefe  being  a  little  encreas’d  by  prefiure,  became  real  little  drops  of  blood : 
but  certain  fin u fifes  that  were  fcatter’d  up  and  down,  throughout  the  uterus, 
feem’d,  in  a  manner,  ftufiF’d  up  with  blood ;  fo  that  1  by  no  means  doubted 
but  thefe  were  the  figns  of  the  menftruous  blood,  which,  if  this  virgin  had 
liv’d  longer,  would,  very  foon,  have  burft  forth. 

As  I  was  going  about  the  diflecftion  of  the  cheft,  I  made  incifions  into  the 
breafts,  that  were  juft  fwelling  into  maturity;  and  while  I  was  doing  this,  I 
was  furpris’d  to  find,  that  milk  burft  out  from  feveral  places,  and  even  with 
a  kind  of  impetus  or  jerk.  As  foon  as  ever  the  knife  made  a  deep  impref- 
fion  upon  the  cartilages  of  the  ribs,  a  bluifih  kind  of  water,  with  which  the 
whole  thorax  was  fill’d,  burft  forth.  And  this  being  all  exhaufted,  I  found 
the  left  lobe  of  the  lungs  connected  to  the  pleura,  only  on  a  part  of  its  pof- 


(x)  n.  21. 

O)  n‘  25- 


(z)  De  Morbis,  1.  i.  n.  5. 
(<?)  Seft.  5.  Aph.  39. 


tenor 


a.o6  Book  II.  Of  Difeafes  of  the  Thorax. 

terior  fnrface;  but  the  right  adher’d  very  clofely  to  that  membrane,  on  the 
whole  of  its  pofterior,  and  die  whole  of  its  lateral  furfaces.  The  pericardium 
was  alfo  diftended  with  water  to  fuch  a  degree,  that  before  I  cut  into  ir,  it  was 
very  hard  to  the  touch,  and  made  me  almoft  fuppofe  that  the  heart  muft  be 
extremely  enlarg’d.  Bur,  neverthelefs,  this  vifcus  was  found  to  be  of  its  pro¬ 
per  magnitude,  containing  fcarcely  any  blood  in  its  ventricles,  but  polypous 
concretions  in  each,  like  fat  that  is  of  a  white  and  yellowiffi  colour.  The 
head  was  not  open’d,  as  the  girl  had  always  told  me,  when  1  afk’d  her  in  the 
hofpital,  that  fhe  had  no  pain,  nor  any  complaint,  of  any  kind,  in  that  part. 

35.  Amongft  other  disorders  which  are  the  confequences  of  a  repell’d  lca- 
bies,  that  a  dropfy  of  the  thorax  may  juftly  be  number’d,  this  hiftory  of  mine 
confirms,  even  more  clearly  than  that  of  the  very  experienc’d  phylician 
Storch  (b).  Do  not,  however,  imagine  that  a  phylician,  by  no  means  tin- 
fkill’d  in  his  profeflion,  who  had  bled  the  patient  once  and  again,  fufpe&ed 
that  to  be  the  real  complaint,  and  yet  ftill  took  blood  away,  agreeably  to  the 
opinion  of  Vallefius  (c),  who  in  fome  meafure  approv’d  the  practice,  rather 
than  to  that  of  Galen,  who  does  not  commend  the  precept,  that  is  extant  al¬ 
moft  at  the  latter  end  of  the  book,  Be  Ratione  Vicius  in  morbis  acutis ,  which,  a3 
it  is  tranflated  by  Vallefius,  runs  thus  :  “If  a  dropfical  perfon  breathe  with 
“  difficulty,  and  the  time  of  the  year  be  hot,  and  the  patient  at  a  vigorous  time 
«  of  life,  and  have  ftrength  enough  ;  it  is  neceffiary  to  take  blood  from  the 
ec  arm.”  A  fufpicion  of  this  kind  had  never  enter’d  into  his  head,  nor  yet 
into  that  of  the  other  phyfician,  who  order’d  blood  to  be  taken  from  the 
young  man,  in  like  manner  as  I  have  faid  above  (d).  You  willobferve  what 
happen’d  to  each  patient  from  thence  •,  yet  you  will  pardon  both  of  the  phy- 
ficians,  as  neither  of  them  was  in  the  number  of  thofe  who  think  themfelves  in¬ 
fallible,  and  afcribe  all  merit  to  themfelves,  but  none  at  all  to  others:' nay  even 
both  of  them,  and  efpecially  the  fecond,  ingenuoufly  confefs’d  how  much  was 
ftill  wanting  to  the  art  and  to  himfelfj  in  order  to  diftinguiffi  the  nature  of 
hidden  difeaies,  as  in  this  dropfy,  and  that  of  the  pericardium,  which  in  this 

♦virgin,  and  alfo  in  the  other  three  examples  that  1  ffiall  immediately  produce, 
was  join’d  to  the  dropfy  of  the  thorax. 

36.  A  woman  in  the  fiftieth  year  of  her  age,  had  been,  for  many  days* 

troubl’d  with  a*clifficulty  of  breathing,  attended  with  a  wheezing  •,  yet  the 
difficulty  neither  made  her  incapable  of  lying  down,  nor  prevented  her  Deep. 
But  befides  that  one  arm,  which  was  painful,  had  a  fwelling  upon  it,  of  the 
cedematous  kind  (which  kind  of  tumour  Fantonus,  the  father  (e)y*\ and  Buch- 
nerus  (/),  and  fome  others,  among  whom  is  our  Vallaiva  {g)y  have  fometimes 
obferv’d  in  a  dropfy  of  the  thorax)  as  fhe  faid,  that  upon  the  motion  of  the 

thorax  fhe  felt  a  fluctuation  in  it,  and  a  weight,  even  without  motion  ;  it  did 

not  feem  at  all  to  be  doubted  of,  but  there  was  water  in  the  thorax.  Finally, 
an  cedematous  fwelling  of  the  feet  was  added  to  that  of  >he  arm,  three  or  four 
days  before  her  death,  without  the  difficulty  of  rcfpiration  being  encreas’d  •, 
yet  the  woman  was  carried  off  fuddenly,  as  ffie  happen’d  to  be  beginning  to 
take  food.  She  had  neither  been  liable  to  fainting  fits,  nor  had  ever  complain’d 

(£)  Aft.  N.  C.  Tom.  5.  Obf.  147.  (e)  Obf.  Anat.  Medic.  30.  &  %'S. 

(c)  Vid.  hujus  Comment,  in  Hippocr.  lo-  (f)  Aft.  N.  C.  Tom.6.  Obi'.  50. 

cum  indicatum.  (g)  Supra  n.  2. 

(dj  n.  30. 


Of 


Letter  XVI.  Article  37.  407 

of  any  flreightnefs,  or  conftrieflion,  at  her  heart,  nor  yet  of  a  pain  in  her  loins, 
nor  finally  of  any  inconvenience  that  related  to  the  ftomach ;  which  1  was  wil¬ 
ling  to  take  notice  of  here,  partly  on  account  of  thofe  things  which  will  be 
written  before  the  conclufion  of  this  letter,  and  partly  on  account  of  what  I 
fhall  immediately  fub'oin. 

The  abdomen  being  open’d,  the  ftomach  was  found  to  be  contracted  ;  and 
within  its  cavity,  near  the  very  mouth  of  the  pylorus,  as  I  have  alfo  related, 
in  the  third  of  the  Adverfaria  (£),  was  a  pretty  large  caruncle,  fix’d,  by  an  ob¬ 
long  ftalk,  to  the  internal  coats,  and  of  the  fame  colour  therewith,  if  look’d  at 
externally  ;  for  internally  it  was  made  up  of  a  foft  fub fiance,  that  was  red, 
but  degenerating  into  white,  fo  that  it  refembfd  nothing  more  than  one  of 
the  mefenteric  glands,  impregnated  with  chyle.  The  pancreas,  where  it  ad¬ 
heres  to  the  duodenum,  was  very  thick,  and  hard  ;  fo  that  I  wonder’d  the  lefs 
at  its  duct  being  wider  than  ufual  above. 

Both  cavities  of  the  thorax  contain’d  a  great  quantity  of  water,  which  was 
of  a  greenifh  colour.  The  pericardium  alfo  was  diftended  with  water,  per¬ 
haps  ting’d  with  the  fame  colour  ;  which  I  lay  for  this  reafon,  becaufe  having 
deferr’d  for  fome  days  to  cut  into  this  cavity,  as  the  method  of  demonftration, 
in  the  college  of  Bologna,  requir’d,  it  was,  at  that  time,  of  the  colour  of  water 
in  which  meat  has  been  wafn’d  ;  and,  indeed,  its  quantity  feem’d  to  be  di- 
minifli’d  by  this  delay,  yet  it  was  equal,  nearly,  to  the  quantity  of  two  pints. 
The  heart  being  almofl  wholly  cover’d  with  fat,  nor  that  thin  in  its  fubflance, 
had  polypous  concretions  in  the  ventricles.  Finally,  the  head  being  open’d, 
water  was  neither  wanting  betwixt  the  meninges,  nor  in  the  lateral  ventricles. 

37.  Although  it  was  eafy  to  perceive,  even  in  the  living  body,  that  there  was 
water  in  the  thorax,  yet  you  fee  what  fymptoms  were  wanting,  and  what  were, 
at  length,  added  to  the  firfl.  And  indeed  we  could  eafily  do  without  all  of 
them,  if  that  one  fenfation,of  a  fluid  fluctuating  in  the  thorax,  were  perpetual, 
without  any  caufe  of  fuppuration  having  preceded  :  for  fometimes,  indeed, 
that  this  fluctuation  is  not  only  perceiv’d  by  the  patients  themfelves,  but  even 
heard  by  others,  Hippocrates  has  evidently  aflerted,  in  thofe  paflages  wherein 
I  have  laid  above,  this  dropfy  was  treated  of  (z),  Vvhen  he  fays,  “  Lay  hold  of 
“  the  patient  by  his  fhoulders,  and  lhake  him,  and  then  liften  in  which  fide 
“  it  fluctuates  molt:”  and  again,  “  In  the  part  where  you  fhall  perceive  a 
“  noife,  there  cut  f ’  and  that  is  confirm’d  by  more  than  one  obfervation  of 
modern  phylicians,  fuch  as  I  have  mention’d  above  ( k ),  and  fuch  as  the  cele¬ 
brated  Fantonus  publifh’d  of  his  father’s  (/),  for  this  of  mine  depended  upon 
the  feeling  of  the  patienFonly,  and  thofe  of  the  celebrated  men,  Jo.  David 
Mauchartus  (»?),  and  Jo.  Philip  Wolflius  (;z).  But  this  fymptom  neither  is, 
nor  indeed  can  be  perpetual :  for  befldes  that  you  will  look  for  it  in  mine,  and 
Valfalva’s  obfervations,  in  vain,  the  fame  alfo  happens  in  rnofb  of  the  obler- 
vations  of  other  perfons  that  you  will  read,  who,  it  is  to  be  fuppos’d,  could 
not  have  pafs’d  over  this  clear  and  evident  mark  of  the  difeafe,  had  it  really 
exifled  ;  and  you  will  even  find  it  exprefsly  denied  by  fome,  that  it  ever  ex- 
ifled.  So  in  that  virgin,  and  in  that  Polifh  fenator,  whom  I  mention’d 
above  (<?),  to  omit  others  at  prefent,  notwithftanding  there  was  fuch  a  quantity 

(b)  Anim.  4.  (m)  Eph.  N.  C.  Cert.  7.  Obf.  100. 

(?)  n.  32.  &  33.  (k)  iu  5..  (n )  Eorund.  Aft.  Tom.  5.  Obf.  34, 

(l)  Obf.  Anat.  Med.  29.  (*)  n.  27.  &  11, 

-of 


40  8  Book  II.  Of  Difeafes  of  the  Thorax. 

of  water  in  the  thorax,  you  will  read  in  their  hiftories,  that  there  was  no  fluc¬ 
tuation,  while  they  were  living. 

Nor  indeed  fhould  I  fuppofe  you  can  fufpeCt  that  in  thefe,  and  all  the  for¬ 
mer  cafes,  the  water  was  juft  extravafated,  or  greatly  encreas’d  at  the  time  of 
heir  death:  for,  in  the  greater  part,  fome  figns  were  not  wanting,  of  water 
being  before  extravafated  ;  and  if  the  queftion  be,  in  particular,  of  thofe 
whom  I  juft  now  pointed  out,  in  the  virgin,  of  whom  particularly  I  think  I 
have  read  that  fufpicion  among  fome  *,  what  encreafe  of  the  extravafated  water, 

I  pray,  can  you  account  for  from  the  time  of  her  death,  and  efpecially  of 
“  greenilh  water,”  when  “  fhe  expir’d  placidly,  and  without  a  groan  ?”  Or 
in  the  fenator,  who,  when  “  he  feem’d  to  himfelf  to  be  extremely  well,  and 
“  was  at  play,  being  taken  with  a  natural  defire  of  going  to  ftool,  and  with- 
“  drawing  for  that  purpofe,  was  carried  off  by  an  inftant  death  ?  Fluctuation, 
therefore,  that  is  perceiv’d  by  the  patients,  is  not  a  perpetual  fign  of  this  dif- 
-eafe,  and  ftill  lefs  that  which  is  heard  by  others.  But  it  is  not  even  poffible, 
as  I  faid  before,  that  this  fymptom  fhould  be  perpetual  :  as  for  inftance,  if 
there  be  water,  which  even  others,  befides  Fantonus,  whom  I  have  already 
commended  (_p),  have  admonifh’d  ;  I  fay,  if  there  be  water  either  in  a  very 
fmall  quantity,  or  in  a  very  large  quantity,  fo  as  to  fill  the  cavity  of  the  thorax  ' 
entirely.  For  “  in  thofe  who  have  an  empyema,  and  in  whom,  while  they 
tc  are  fhaken,  there  is  no  noife  indeed,  but  a  ftrong  difficulty  of  breathing,  and 
<c  livid  nails ,  thefe,”  as  Hippocrates  himfelf  teaches  in  another  place  (y),  “  are 
“  full  of  pus.”  But  you  will  fay,  it  feems,  at  leaft,  that  this  fluctuation 
ought  to  be  perceiv’d  in  that  fpace  of  time,  when  the  water  is  growing  from  a 
fmall  quantity  to  a  large  one,  nor  is  yet  come  to  its  utmoft  increafe  :  and  in¬ 
deed  it  does  feem  fo  ;  but  fome  certainly  do  not  perceive  it,  as  the  fenator,  of 
whom  I  have  fpoken,  affirm’d,  that  he  neither  felt  at  that  time,  nor  had,  at 
any  time  before,  felt  a  fluctuation  of  fluid  in  his  cheft ;  fome  do  not  attend  to 
it  *,  others,  finally,  do  not  difcover  it  to  the  phyficians  ;  and  the  fymptoms 
may  be  at  the  fame  time  fo  few,  fo  flight,  and  fo  common  to  other  difeafes, 
that  if  any  one  inquires  into  this  fymptom,  he  may  be  thought  to  do  it  with¬ 
out  reafon  ;  but  to  lay  hold  of  patients  by  the  fhoulders,  and  fhake  them,  or 
agitate  them  in  any  other  way,  is  certainly  not  practicable  in  all  patients  ; 
which  you  will  fee  plainly  was  the  cafe  in  the  patient  whofe  hiftory  I  am  go¬ 
ing  to  relate. 

38.  A  country-woman,  not  much  older  than  twenty-five  years  of  age, 
and  of  a  very  pale  countenance,  having  been  married  four  months  before, 
was  already  paft  the  third  month  of  her  pregnancy,  when  fhe  was  receiv’d 
into  the  hofpital  at  Padua,  in  which  fhe  lay  a  month  or  more,  with  a  kind  of 
fmall  erratic  fever.  Her  pulfe  was  neither  fmall,  nor  intermitting.  There 
was  no  thirft ;  though  fhe  generally  ate  fruit,  which  they  did  not  wonder  at 
in  a  pregnant  woman.  She  had  no  fwelling  of  her  feet,  and  no  faintings. 
Nor  did  fhe  ever  complain  of  a  tightnefs,  or  oppreffion,  about  her  heart ;  nor 
yet  of  an  anxiety,  or  fenfe  of  weight,  nor,  indeed,  of  any  inconvenience, 
or  difficulty,  in  the  thorax,  whatever;  except  that,  now  and  then,  fhe  us’d 
to  be  attack’d  with  a  little  dry  cough,  to  which  fhe  had  been  for  a  long  time 
fubjeCt,  in  the  fame  degree,  that  is,  but  (lightly.  At  that  time,  alfo,  if  fhe 

(/)  Schol.  ad  Cit.  Obf,  29.  (f)  Coac.  Praenot. 


I 


took 


Letter  XVI.  Article  38.  409 

took  things  that  were  offer’d  to  her,  while  they  were  hot,  fhe  was  feiz’d 
with  a  difficult  refpiration  •,  for  which  real'on  fhe  was  us’d  to  beg  that  fhe 
might  have  them  cold.  But,  fetting  afide  this  accidental  circumftance,  fhe 
breath’d  pretty  freely ;  fo  far  was  fire  from  being  rous’d  in  the  night,  with 
any  fenfe  of  fuffocation,  or  being  forc’d  to  fit  up  in  bed.  She  lay  down, 
therefore,  as  I  have  faid,  but  it  was  on  her  right  fide  :  and  upon  this  lhe  lay 
when  fhe  died,  without  having  had  any  diforder  added  to  the  flight  fever, 
if  you  except  a  pain  in  the  loins,  of  which  fhe  complain’d  only  in  the  latter 
days  of  her  life. 

/  The  abdomen  was  open’d  within  half  an  hour 'after  the  deceafe  of  the 
mother,  fo  far  at  leaft,  that  if  the  foetus  were  living,  it  might  be  wafh’d 
with  the  holy  water ;  which  was  happily  perform’d.  For  the  infant,  when 
the  uterus  and  the  membranes  were  cautioufly  cut  into,  immediately  thruft 
itfelf  out,  as  it  were,  and  mov’d  its  hands  •,  nor  did  it  die  till  a  full  hour  after 
its  mother.  The  foetus  being  taken  out,  I  diligently  diftedted  the  uterus, 
with  the  adhering  placenta,  and  membranes,  and  the  remaining  'part  of  the 
woman’s  body,  on  the  fame,  and  on  the  following  days,  before  the  be¬ 
ginning  of  December,  in  the  year  1724.  But,  deferring  fome  things  to  other 
occafions,  I  fhall  fpeak  fcarcely  of  any  thing  here,  but  what  was  preter¬ 
natural.  Believe,  then,  that  all  the  other  parts  were  in  extremely  good  con¬ 
dition,  as  the  whole  habit  of  the  body  certainly  was,  the  mufcles  being  very 
ruddy,  and  well-colour’d,  and  having  a  proper  quantity  of  fat,  of  the  beft 
confidence,  to  cover  them,  and  betwixt  their  fibres  •,  fo  that  but  juft  a  little 
quantity  of  water  appear’d  to  be  lying  therein,  where  neither  in  the  living, 
nor  in  the  dead  body,  before  difledtion,  it  had  feem’d  to  be,  that  is,  in  the 
extreme  parts  of  the  feet :  but  it  does  not  efcape  me,  however,  that  this 
may  pofiibly  be  charg’d  to  the  account  of  her  pregnancy.  The  fpleen  was 
a  little  larger  than  it  ought  to  be ;  and  the  liver  much  more  fo,  as  it  extended 
itfelf  both  lower  than  it  us’d  to  be,  and  acrofs  quite  to  the  fpleen.  It  was 
externally  pale,  and  internally  a  little  variegated  with  its  own  colour  and  that 
of  tobacco,  but  not  hard.  The  ftomach  was  contradted  almoft  in  the  middle 
of  its  length,  and  fwell’d  out  on  both  fides,  but  lefs  on  the  right,  which  part 
defcended  obliquely  :  the  other,  being  plac’d  tranfverfely,  with  its  fundus 
turn’d  a  little  forwards,  was  half  full  of  fluid  and  air.  In  the  fmall  in- 
teftines  were  many  round  worms ;  and  where  they  were  lodg’d,  the  inteftines 
were  reddifh,  and  efpecially  in  one  certain  part,  and  in  that  place  they  alfo 
protuberated  in  their  coats,  as  if  they  had  been  dilated  by  force. 

Before  we  cut  into  the  cheft,  we  obferv’d  that  the  neck  was  tumid,  from 
the  fullnefs  of  the  thyroid  gland  •,  and  that  milk  was  eafily  prefs’d  out  from 
the  breafts.  The  thorax  being  laid  open,  behold  that  which  afforded  an  oc- 
cafion  of  enquiring  very  accurately  into  all  the  appearances  and  fymptoms 
that  had  preceded,  and  defcribing  them  ;  as  I  have  done  here.  In  the  right 
cavity  was  a  large  quantity  of  yellowifh  water,  and  in  it  were  a  thick, 
but  mucous  kind  of  membranes.  And  fome  water  of  this  kind  there  alfo 
was  in  the  left  cavity  •,  but  in  the  pericardium  fo  much,  that  it  was  almoft 
full,  nor  yet  without  fuch  a  kind  of  membranes,  or  webs,  fwimming  in  it,  as 
I  have  juft  mention’d.  Finally,  in  both  the  ventricles  of  the  heart  were 

Vol.  I.  G  g  g  polypous 


4 1  o  Book  II.  Of  Difeafes  of  the  Thorax. 

polypous  concretions,  as  if  of  a  kind  of  mucus  j  but  a  little  more  denfe 
in  the  left. 

39.  The  palenefs  of  the  face,  the  flight  fever,  the  dry  cough,  and  the  lying- 
down  on  one  fide  only,  had,  indeed,  been  obferv’d  in  this  woman  :  yet  the 
other  fymptoms,  and  thofe  in  particular  which  are  faid  to  be  proper  to  the 
dropfy  of  the  thorax,  had  not  exifted.  But  you  will  fay,  whatJwere  the  pe¬ 
culiar  marks  of  the  dropfy  of  the  pericardium,  in  this  woman,  and  the  two 

I  have  fpoken  of  juft  above  ?  Yet  before  I  anfwer  any  thing  to  this  queftion,  * 
fuffer  me  to  give  you  a  fourth  diflebtion,  which  I  made  at  Bologna,  with 
Valfalva,  about  the  end  of  the  year  1704. 

40.  A  man,  of  more  than  forty  years  of  age,  who  travell’d  on  foot,  fre¬ 
quently,  from  Imola  to  Bologna,  and  from  Bologna  to  Imola,  carrying 
goods  backwards  and  forwards,  from  one  place  to  the  other  ;  this  man,  I  fay, 
when  he  was  hot  from  his  journey,  was  us’d  to  drink,  and  efpeciaily  in  the 
latter  part  of  his  time,  when  he  had  a  continual  thirft  upon  him  ;  and,  be¬ 
ing  feiz’d  with  a  violent  fever,  and  a  defluxion  of  rheum  upon  his  fauces, 
was  taken  into  the  hofpital  at  Bologna.  Prefently  he  began  to  complain  no 
more  of  his  fauces,  and  faid  that  all  his  diforder  was  in  his  belly  ;  yet  com¬ 
plain’d  of  nothing  more  than  a  pain  in  the  fpine,  about  the  lumbar  region, 
by  which  that  feern’d  to  be  cutting,  as  it  were,  into  two  parts.  Some  of 
the  phyficians  fufpebted,  that  the  man  labour’d  under  an  inflammation  of  the 
bowels-,  but  Valfalva  fufpebted  the  diforder  to  be  in  the  thorax.  The  pulfe 
was  weak,  however,  and  low  ;  and  yet  feem’d-  to  be  opprefs’d,  as  we  fay. 
He  would  often  rife  up,  as  if  he  were  going  away.  And  in  this  manner 
he  died,  within  the  third  or  fourth  day  from  the  time  he  came  into  the 
hofpital. 

In  the  abdomen  every  thing  was  natural.  But  in  the  thorax,  and  parti¬ 
cularly  in  one  part,  a  humour  ftagnated,  in  which  pieces,  as  it  were,  of  the 
moft  white  and  thin  membranes  fwam  ;  fo  that  it  very  much  refembl’d 
the  whey  of  cow’s  milk,  having  the  fmall  particles  of  the  fecond  fort  of 
cheefe  mix’d  therein.  The  veffels  of  the  pleura  were  more  red  than  ufual, 
but  not  very  much.  Yet  the  pericardium  was  fo  diftended,  that  upon  the 
flighted:  prick,  it  threw  out  a  fmall  ftream  of  fluid,  like  a  fountain,  to  a 
very  considerable  height.  The  apex  of  the  heart  was  a  little  more  red  than 
ufual,  and  feem’d  to  have  been  flightly  inflam’d.  Finally,  when  I  differed 
the  head,  I  firft  obferv’d,  that  moft  of  the  teeth  were  wanting,  and  thofe 
that  remain’d  were  all  of  them  black  -,  fome  of  them  in  great  part  carious,  and 
others  almoft  altogether  fo.  Was  the  reafon  of  this,  do  you  think,  that  he  us’d 
to  drink  when  he  was  hot  ?  Or,  rather,  was  it  from  the  injuries  of  the  air, 
to  which  he  had  been  at  all  times  expos’d  ?  The  cranium  being  then  open’d, 
much  water  was  found  betwixt  the  dura  and  pia  mater.  And  the  former  of 
thefe  membranes  had  mufcular  fibres  apparent  about  the  proceflfes,  if  any 
one  ever  had.  But  the  veffels  that  crept  through  the  pia  mater,  where-ever 
it  invefted  the  brain,  were  all  very  turgid  with  blood  but  not  fo  thofe  which 
were  in  the  lateral  ventricles.  Finally,  the  bafis  of  the  cerebrum,  and  the 
fubftance  of  it,  that  was  neareft  to  the  bafis,  were  flaccid. 

41.  As  to  the  patient’s  rifing  up  often,  as  if  about  to  go  away,  it  was  evi¬ 

dent 


4 


Letter  XVI.  Article  41.  4 1 1 

dent  from  thence,  that  he  was,  in  fome  meafure,  delirious ;  and  the  caufe 
of  that  delirium  is  to  be  fought  for  in  the  veffels  of  the  brain  being  fo  di- 
ftended,  or  in  the  acrimony  of  the  water  which  lay  about  the  brain.  For 
in  the  thorax,  the  fame  kind  of  water  may  feem  to  have  inflam’d  both  the 
pleura,  and  the  apex  of  the  heart.  What  if  part  of  it,  alio,  having  fall’ll 
from  the  cavity  of  the  cranium,  into  the  tube  of  the  fpine,  was  the  caufe 
of  that  moil  violent  pain  in  the  loins  ?  For  nothing  is  more  natural  than, 
where  we  fee  water  effus’d  into  many  of  the  cavities  of  the  body,  to  fuppofe 
that  it  is  effus’d  into  fome  others  alfo.  And  this  I  fay,  left  you  fhould,  per¬ 
haps,  believe,  that  the  pain  is  fo  to  be  accounted  for  from  the  dropfy  of  the 
pericardium,  as  to  be  number’d  among  the  fymptoms  peculiar  to  that  difeafe, 
and  to  have  no  other  caufe  but  that ;  efpeciaily  as  in  the  woman  alfo,  of 
whom  we  fpoke  laft,  a  pain  of  the  loins  came  on  (r),  and  was  “  very  violent’* 
in  the  young  man,  whofe  hiftory  being  defcrib’d  by  Blaflus,  is  transferr’d 
into  the  Sepulchretum  (j).  Both  of  them,  certainly,  had  a  dropfy  of  the  pe¬ 
ricardium,  and  this  young  man  in  particular  ;  yet  in  neither  of  them  were 
other  fymptoms  wanting,  to  which  that  pain  might  have  been  imputed.  Val- 
ialva  himfelf,  in  regard  to  the  man  at  prefent  in  queftion,  drew  a  conjecture 
from  this  pain,  not  that  the  pericardium  in  particular,  but  in  general,  that 
fome  part  of  the  thorax  was  affeCted.  And  you  can  even  certainly  re¬ 
member,  what  I  have  written  to  you  on  another  occaflon  (/),  that  he  was 
wont  to  deduce  a  troublefome  fenfe  about  that  part  of  the  fpine,  from  the 
appendages  of  the  diaphragm,  that  were  irritated,  or  prels’d  upon,  being 
affeCted  thereby  ;  yet  in  fuch  a  manner,  that  he  fuppos’d,  from  thence,  water 
to  be  collefted  in  the  thorax,  rather  than  in  the  pericardium.  And  although 
in  the  body  which  I  was  fpeaking  of  at  that  time,  as  in  this  alfo,  water  was 
found  to  exift  in  both  places  ;  yet  in  another  man  (a),  who  “  had  a  moft 
“  excruciating  pain  in  that  part  of  the  back,  where  the  diaphragm  divides 
“  the  middle  and  lower  region  of  the  body,”  a  ferous  humour  was  found  in 
the  thorax,  and  not  in  the  pericardium.  But  the  pericardium,  you  will  fay, 
the  more  it  is  diftended,  fo  much  the  more  does  it  diftraCt  the  tendinous  part 
of  the  diaphragm,  to  which  it  is  very  clofely  connected  :  wherefore,  as  it 
afteCts  the  diaphragm,  not  only  by  oppreffing  it  with  weight,  but  alfo  by  di- 
ftraCting  its  fibres,  the  pain  fhould  feem  to  be  owing,  rather,  to  the  peri¬ 
cardium  being  fill’d  with  w'ater,  than  to  the  thorax.  But,  if  the  cafe  is  as 
you  conjecture  it  to  be,  what  is  the  reafon,  then,  that  in  lcarcely  any  of  the 
other  obfervations  made  by  Yalfalva  and  me,  and  comprehended  in  this 
letter,  the  patients  ever  complain’d  of  fuch  a  pain  ?  Was  it,  perhaps,  be- 
caule  the  pericardium  was  not  fo  much  diftended  ?  It  could  not  be  more 
diftended  than  it  was  found  to  be  by  GnEtzius  (x)  and  Vieuffens  ( y )  ;  nor  was 
the  pain,  for  this  reafon,  mention’d  by  them  among  the  other  marks  of  that 
diforder.  It  remains  to  fay,  that  in  their  patients  the  pericardium  was  gra¬ 
dually  diftended,  but  in  this  man  of  mine  very  fpeedily,  fo  that  the  fibres 
of  the  pericardium  and  diaphragm  could  not  be  gradually  relax’d.  Do  not, 

(r)  N.  38.  (*)  Aa.  N.  C.  Tom.  6.  Obf.  50. 

[s)  L.  2.  S,  I.  Obf.  60.  (at)  Vid.  fupra,  n.  21. 

(/)  Epift.  10.  n.  12.  (  y)  Vid.  n.  24,  &  25. 

G  g  g  2 


therefore, 


4 1  2  Book  II.  Of  Difeafes  of  the  Thorax. 

therefore  make  ufe  of  other  examples,  taken  from  us,  or  from  the  Sepul- 
chretum,  in  which  you  cannot  contend  that  it  was  dilated  in  a  fhort  time. 
But  on  the  other  hand,  read  over  again  the  obfervation  of  the  virgin  (z),  in 
whom,  within  a  few  days,  or  read  that  which  I  fhall  prefently  fubjoin,  of  an¬ 
other  virgin,  in  whom  luddenly,  a  great  quantity  of  water  was  colledted  in  the 
pericardium,  though  none  of  them  was  affetted  with  a  pain  of  the  loins.  And 
i  have  the  more  diligently  enquir’d  into  this  fymptom,  becaufe,  though  as  far 
as  1  know  it  has  been  propos’d  by  not  one,  as  a  mark  of  this  difeafe,  yet  it 
came  into  my  mind,  when  I  was  defcribing  the  laft  obfervation,  to  fee  if  it 
might  be  reckon’d  among  the  other  fymptoms,  which  are  not  perpetual  *,  and 
perhaps  it  may  fometimes  be  of  ufe,  join’d  with  other  fymptoms,  to  difcover 
the  nature  of  the  diforder,  when  the  pericardium  is  greatly  and  fpeedily  d in¬ 
tended,  which  I  confefs  did  not  happen  altogether  fo  in  thofe  two  virgins,  as 
the  diftenfion,  although  it  was  quick,  was  not  immoderate. 

42.  At  the  fame  time  you  fee,  that  even  this  is  not  conftant,  which  is  gene¬ 
rally  faid  (a),  and  indeed  is  very  often  true,  that  a  dropfy  of  the  pericardium 
comes  on  gradually  j  for  it  fometimes  happens  in  a  very  fhort  time,  juft  as 
the  dropfy  of  the  thorax  does  ;  and  this  you  will  know  much  better,  when  you 
fhall  have  read  over  the  obfervation  of  the  celebrated  Low  (£),  or  when  I  pro¬ 
duce  our  hiftories  of  inflammations  in  the  thorax  (c)  •,  and  to  thefe  I  would 
have  you  add  the  obfervation  which  I  fhall  give  you  by  itfelf  hereafter  (d). 

1  will  now  add  that  which  I  have  juft  promis’d,  and  which  you  ought  to  efteem 
fo  much  the  more,  as  it  is  one  of  thofe  very  rare  cafes  wherein  the  dropfy  of 
the  pericardium  was  the  only  diforder  that  was  found,  to  which  all  the  fymp¬ 
toms  the  patient  had  fuffer’d  might  be  afcrib’d  *,  and  alfo  becaufe  it  has  been 
related  and  confirm’d  to  me,  more  than  once,  by  a  phyflcian  who  was  ex¬ 
tremely  diligent  in  fearching-out  and  remarking  all  the  fymptoms,  I  mean 
Hippolyto  Francefco  Albertini.  I  have  referv’d  this  hiftory  on  purpofe  to 
this  latter  part  of  the  letter,  that  after  having  given  it,  I  may  more  certainly 
and  eafily  explain  what  we  ought  to  think  of  the  other  marks  of  this  diforder. 

43.  There  was  at  Bologna  a  nun,  -whofe  illustrious  family  and  convent  I 
might  mention  here,  if  I  chofe  it,  whom  a  phyflcian  had  cur’d  of  a  defluxion 
upon  her  gums  and  cheeks,  by  giving  her  Sudorific  decottions  of  the  woods  ; 
and  afterwards,  being  feiz’d  with  an  acute  fever,  had  reftor’d  to  health  with 
equal  fuccefs.  Though  he  might  have  been  content  with  one  and  the  other  of 
thefe  fuccefsful  cures,  yet,  as  fome  are  diligent  to  a  very  ill  purpofe,  when  the 
month  of  April  return’d,  he  began  to  urge  this  virgin,  that  fhe  Should  not  let 
flip  a  time  fo  opportune  for  the  taking  of  thofe  remedies  by  which  fhe  had 
preferv’d  herfelf  from  the  defluxions.  She  at  firft  refus’d  to  comply,  inafmuch 
as  fhe  was  in  very  good  health,  and  thought  her  conftitution  fufficiently  alter’d 
and  rettify’d  by  the  decottion  and  the  fever  together  ;  yet  as  the  man  very 
often  inculcated  the  neceflity  of  fuch  a  treatment,  fhe  at  length  confented,  but 
unwillingly,  as  if  her  mind  had,  in  fome  meafure,  prefag’d  what  would  hap¬ 
pen  *,  for  having  taken  as  much  of  the  fame  fyrupus  aureus,  as  it  is  call’d,  as 
others  in  the  convent  had  taken,  on  that  very  day,  with  every  one  of  whom  it 
had  fucceeded  extremely  well ;  with  her,  whatever  was  the  caufe  of  fo  unex- 

(ss)  n.  17.  ( a )  Vid.  n.  22.  (r)  Epift.  20.  Sc  21. 

{J})  Eph.  N.  C.  Dec.  3.  A.  5.  Obf.  154.  \d)  Epift.  45.  n.  i5. 


petted 


Letter  XVI.  Article  43.  413 

pefted  an  accident,  it  occafion’d  near  fifty  motions  to  (tool ;  by  which,  as  ge¬ 
nerally  happens  after  a  great  quantity  of  ferum  being  difeharg’d,  an  intolerable 
third:  was  brought  on,  that  did  not  remit  upon  drinking  a  very  large  quantity 
of  broths  •,  and,  for  this  reafon,  the  phyfician  order’d  her  to  drink  a  very  large 
quantity  of  dilute  emulfions  ;  nor  did  the  quantity  of  urine  that  ffie  made, 
anfwer  at  all  to  the  quantity  of  fluid  fhe  took  in.  The  day  afterwards,  having 
fat  up  in  bed,  with  an  intention  to  rife,  and  having  begun  to  put  on  her 
cloaths,fhe  was  fuddenly  feiz’d  with  a  kind  of  oppreffion  at  her  heart,  to  which  a 
fainting  fit  fucceeded ;  and  from  that  time,  this  oppreffion  never  fail’d  to  be  ex¬ 
acerbated  as  often  as  ever  fhe  fpoke  or  mov’d  too  much.  Many  phyficians  were 
lent  for,  whofe  opinions,  as  generally  happens  in  diforders  of  this  kind,  being 
very  different  from  one  another,  Albertini  was  added  to  their  number.  It  was 
now  the  month  of  July  :  when  they  came  together,  one  began  to  conjecture  a 
polypus,  another  an  aneurifm,  another  a  tubercle  of  the  lungs  ;  nor  were  they 
wanting  who  had  a  fufpicion  of  a  dropfy  of  the  lungs,  or  the  thorax.  When  it 
cameto  Albertini  to  give  his  opinion  (whofe  cautious  delay  in  this  cafe  I  was  al¬ 
ways  better  pleas’d  to  imitate,  rather  than  the  bold  haftinefs  of  fome)  he  affirm’d, 
that  it  did  not  become  his  modefty  to  undertake  to  determine  immediately,  from 
having  feen  the  patient  but  once,  what  fo  many  men,  excelling  in  years,  au¬ 
thority,  learning,  ingenuity  and  experience,  could  not  fufficiently  have  deter¬ 
min’d  upon  in  almoft  three  months  ;  and  begg’d,  therefore,  that  they  would 
permit  him,  by  vifiting  the  patient  once  or  twice  more,  to  endeavour  to  find 
out  the  nature  of  foobfeure  a  diforder,  which  he  fhould  perhaps  better  under- 
fland  from  what  he  might  fee  than  from  what  he  had  heard  ;  and  after  vifit¬ 
ing  the  patient  diligently  feveral  times,  and  confidering  not  only  the  fymp- 
toms  that  were  prefent,  but  what  were  abfent  alfo,  with  great  attention,  he 
call’d  together  again  the  council  of  phyficians,  and  firft  gave  them  his  reafons 
one  by  one,  why  it  feem’d  lefs  probable  to  him  that  the  diforder  was  of  the 
kind  any  of  them  had  mention’d,  than  that  it  was  a  dropfy,  and  that  of  the 
pericardium  :  a  dropfy  furely,  for  it  had  taken  its  origin  immediately  from 
the  time  of  fo  much  water  being  carried  into  the  conftitution,  which  had 
neither  been  difeharg’d  again  from  the  body,  nor  could  in  fo  ffiort  a  time  have 
been  mix’d  with  the  blood;  for  which  reafon,  a  portion  of  it  mud  be  fuppos’d 
to  have  falPn  upon  fome  part  or  other,  that  by  the  original  conftitution,  as 
frequently  happens,  was  more  difpos’d  to  fuffer  it  than  other  parts ;  and  that 
the  dropfy  was  of  the  pericardium,  becaufe  he  had  found  by  diffedion,  that 
fome  had  had  water  collected  in  that  cavity,  in  whom  he  had  obferv’d  the 
fame,  or  fimilar  fymptoms  while  living. 

Attend  now  to  thofe  difagreeable  fymptoms  that  did  not  exift  in  this  virgin. 
She  had  a  good  colour  in  her  face  ;  her  deep  was  undifturb’d  ;  llie  was  re¬ 
gular  in  her  bowels,  and  in  her  menftrua  ;  her  refpiration  was  equally  eafy, 
whether  ffie  flood  up  or  lay  on  her  back,  on  the  right  or  on  the  left  fide.  Her 
pulfe  was  neither  tenfe,  nor  hard,  nor  chord-like,  nor  in  the  lead  irregular  in 
any  way.  She  had  no  palpitation,  or  large  pulfation,  in  the  heart  ;  no  pain 
about  the  region  of  the  lungs  ;  no  cough  ;  there  was  not  the  lead  thing,  if 
you  except  what  I  have  faid  above,  and  what  1  fhall  fay  prefently,  there  v/as 
nothing,  I  fay,  that  you  could  find  fault  with,  or  that  fhe  could  complain  of. 
Albertini,  being  perfuaded  by  thefe  arguments,  did  not  fall  into  the  opinion 


4 1 4  Book  II.  Of  Difeafes  of  the  Thorax. 

of  others.  And  he  thought  that  thefe  figns  had  a  tendency  to  confirm  his 
opinion,  that  the  virgin  found  her  heart  opprefs’d,  as  if  with  a  ftone  be’ung 
laid  upon  it;  and  that  when  fhe  did  not  fpeak,  and  was  quiet,  and  tree 
from  motion,  fhe  was  not  troubl’d  with  that  oppreflion  of  the  heart,  as  I 
mention’d  in  the  beginning  ;  but  if  fhe  perform  d  any  motion,  or  ipoke  for 
any  little  time,  fhe  was  immediately  tortur’d  therewith,  the  ienfation  of 
which  fhe  us’d  to  exprefs  thus,  as  if  fhe  was  prels’d  and  iqueez’d  up,  with 
a  great  concourfe  of  people  all  round  her :  and  this  oppreffion  of  her  heart, 
a  flight  kind  of  fainting  always  accompanied  ;  and  her  pulfe,  even  when 
fhe  was  quiet,  was  always  weak.  Which  circumftances  certainly  render’d 
the  cure  very  difficult ;  for  befides  thatjft  by  medicines,  they  fhould  attempt 
to  difcharge  the  collected  ferum,  there  was  danger,  left  that  being  rather 
diminifh’d,  which  is  neeefiary  to  the  blood,  the  circulation  fhould  be  carried 
on  with  much  more  difficulty  through  the  heart,  which  was  comprefs’d  by 
the  water,  and  already  flaccid  by  its  long  ftagnation  ;  this  was  certainly  very 
evident,  that  whatever  remedies  were  very  efficacious,  would  without  doubt 
have  the  fame  effedt  upon  her,  as  the  motion  of  her  body  had ;  and  thofe 
that  were  lefs  efficacious,  would  be  of  no  ufe  at  all,  or  at  leaft  not  fuffici- 
ently  advantageous.  This  was  adlually  the  cafe ;  and  the  virgin  at  length 
died  of  the  diforder,  as  Albertini  had  predicted,  when  he  confider’d  thefe 
things.  For  when  fhe  had  dragg’d  on  life,  to  about  the  end  of  a  year,  from 
the  beginning  of  her  difeafe  ;  a  momentary  fenle  of  pricking  began  to  be 
added  to  the  other  fymproms,  which  return’d  every  now  and  then  in  the  part 
affedted,  attended  with  flight  convulfions  in  the  fame  place-,  the  pulfe  began 
gradually  to  be  more  and  more  weaken’d,  and  in  a  manner  obfcur’d  ;  which 
were  not  fallacious  fymptoms  of  death  being  now  at  hand. 

It  was  permitted  to  Albertini  to  open  the  thorax,  in  order  to  difcover  the 
nature  of  fo  abftrufe  a  difeafe,  Robert  Muratorio,  a  fenior  phyfician,  and  an 
eminent  man,  being  added  as  his  only  companion  in  the  difledfion.  Every 
thing  was  found  to  be  found,  and  in  proper  condition,  except  that  the  peri¬ 
cardium  was  tumid  w  th  water,  to  the  quantity  of  nine  ounces,  and  the 
membrane  of  the  heart  had  begun  to  be  evidently  eroded,  without  doubt 
from  the  fame  water,  which  was  at  length  become  very  acrid  from  its  flag- 
nation,  from  whence  that  fenfe  of  pricking  had  been  felt,  and  thofe  flight 
convulfions  had  happen’d. 

44.  You  have  the  hiftory  juft  as  I  wrote  it  down,  after  having  receiv’d  it 
from  Albertini,  containing  not  only  fuch  obfervations,  as  teach  us  what  we 
are  not  to  inculcate  upon  patients,  who  are  unwilling  to  obferve  it,  and 
what  we  are  upon  occafion  to  imitate;  bur,  in  particular,  fuch  remarks 
alfo  which  may  be  of  lervice  to  us  to  diftinguifh  the  difeafe  in  queftion. 
And  whereas  it  is  laid  in  this  hiftory,  that  Albertini  had  alfo  obferv’d 
the  flgns  of  it  in  others ;  you  may  read  what  he  has  in  genera!  advanc’d, 
in  the  Commentaries  of  the  Academy  of  Sciences  at  Bologna  (/),  in  rela¬ 
tion  thereto,  and  compare  it  with  the  obfervation  of  this  virgin,  which 
I  fuppofe  he  has  his  eye  to,  when  he  fays,  41  that  he  had  feen  the  furface  of 
“  the  heart  flightly  corroded,  in  the  carcafe  of  a  woman.”  Nor  would  I 


(e)  Tom.  1.  in  Opufc. 


have 


Letter  XVI.  Article  44.  415 

have  you  be  furpriz’d,  that  where  the  water  was  erofive,  he  fays  that 
fome  things  happen’d  otherwife,  than  they  are  related  in  the  foregoing 
hiftory  of  the  virgin ;  for  neither  was  the  water  in  her,  at  firft  of  a  cor- 
rofive  nature,  as  it  was  at  the  latter  end  of  the  difeafe,  when  the  very  in¬ 
firm  ftate  of  the  fibres  of  the  heart  was  no  more  able  to  produce  a  quick 
or  tenfe  pulie ;  and  yet  thofe  flight  convulfions  which  were  obferv’d  at  the 
heart,  were  a  proof  that  there  was  fomething  different  at  that  time,  from 
what  had  been  before,  although  the  patient  was  at  reft.  But  you  will  be¬ 
lieve  that  the  difficulty  of  breathing,  which  happen’d  from  motion,  41  or  ra- 
44  ther,”  as  he  calls  it,  the  “  apnoea,”  or  total  privation  of  breath,  which 
foon  became  evanid,  was  fcarcely  different  from  thofe  fhort  kinds  of  faint¬ 
ing,  or  fwooning,  which  though  he  had  certainly  obferv’d  in  the  virgin,  he 
did  not  however  particularly  exprefs  in  the  Commentaries.  The  other  things 
contain’d  in  thele  Commentaries,  in  general,  do  not  differ  from  the  hiftory, 
as  it  is  here,  or  at  leaft  only  in  the  different  quantity  or  quality  of  the  wa¬ 
ter.  And  the  quality  itfelf,  although  by  ftagnation,  as  I  have  laid,  it  may 
be  chang’d  in  the  manner  that  is  explain’d  by  Graetzius  (/) ;  yet  even  may 
in  the  beginning  be  very  different  from  a  watry  nature,  as  without  doubt, 
the  ferum  of  the  blood  is  very  different  itfelf  alfo.  For  I  have  frequently 
feen,  that  this  has  been  difcharg’d  from  morbid  bodies,  either  of  a  yellow 
colour,  or  verging  to  a  green,  a  blue,  or  a  white,  as  the  fluid  very  often  is* 
which  we  fee  extravafated  in  the  belly,  or  thorax,  or  finally  in  the  peri¬ 
cardium,  of  this  or  that  hydropic  patient  ;  from  whence  they  might  fetch 
an  argument,  who  do  not  doubt  but  the  water  of  the  pericardium  is  brought 
thither,  not  by  glands,  but  by  the  moft  flender  arteries  ;  although  where 
fome  certain  particles  are  too  prevalent  in  the  ferum  of  'the  blood,  the 
fame,  in  like  manner*  fo  predominate  in  the  humours  fecreted  by  the  glands,., 
that  the  faliva  of  thofe,  in  whom  the  kidnies  have  for  fome  time  ceas’d  from 
their  office,  has  feem’d  in  colour,  tafte,  and  odour,  not  to  be  different  from 
urine  (g).  But  of  what  kind  the  water  of  the  pericardium  is  naturally,  4s- 
not  juftly  argu’d  from  thofe  experiments  of  Vieuffens  (£),  in  which  he  faw 
the  water,  that  was  taken  from  thofe  who  had  long  labour’d  under  a  dropfy 
of  the  pericardium,  coagulate  either  at  the  fire,  or  even  of  itfelf,  and  when 
mix’d  with  the  tin&ure  of  the  flowers  of  mallows,  become  green,  and  finally, 
that  the  fait  drawn  out  from  that  water,  was  excited  into  fermentation  by 
what  they  call  acid  fpirits.  So  neither  fhould  I  rightly  argue  from  that  ex¬ 
periment  of  Valfalva  (*),  in  which,  having  taken  water  that  had  ftagnated  in 
the  thorax  and  pericardium  of  the  fame  body,  he  faw  a  portion  of  the  firft  co¬ 
agulate,  when  applied  to  the  fire,  but  the  latter  did  not  coagulate;  that  the 
fluid  with  which  we  find  the  one  and  the  other  cavity  to  be  more  or  lefts 
moiften’d,  is  of  a  different  nature  in  one  from  what  it  is  in  the  other :  for,  with¬ 
out  doubt,  that  thcfe  things  vary,  both  from  the  different  time  of  ftagnation, 
and  the  different  morbid  diathefis  of  the  blood  and  vifcera,  not  only  reafon  in¬ 
dicates,  but  many  other  things,  as  in  part,  alfo,  the  experiments  of  our  Val¬ 
falva  (i)  confirm.  But  as  to  the  quantity  of  water  in  the  pericardium  (which-; 

(f)  Difp.  cit.  fupra  ad  n.  22.  §  19.  (*)  Vid.  fupra  n.  2. 

C g )  Vid.  Epift.  41.  n.  5.  (;)  Vid.  fupra  n.  6.  8c  10. 

(1)  ch.  i.  cit*  fupra  ad  n.  24. 


that 


4 1  6  Book  II.  Of  Difeafes  of  the  Thorax. 

that  very  ancient  author  of  the  book  De  Corde  (£),  firft  after  ted,  as  far  as  I  can 
find,  to  be  found  in  fmall  quantity,  even  in  healthy  bodies)  that  it  is  not  only 
in  a  large  quantity  in  difeas’d  bodies,  and  efpecially  thole  who  are  afte&ed 
with  a  dropfy  of  the  part,  but  that  it  is  fometimes  in  almoft  an  incredible 
quantity,  is  even  evident  from  the  obfervations  above  mention’d,  or  delcrib’d, 
that  is  in  proportion  as  the  caufe  is  greater  or  lefs,  or  has  lafted  for  a  longer 
or  fhorter  lpace  of  time,  whether  it  confift  in  an  obftrudtion  to  the  reflux  of 
humours,  or  the  increas’d  afflux  thereof  ;  and  whether  this  happen  from  the 
quantity  of  ferum  being  redundant  in  the  blood,  or  from  its  motion  being  too 
long  retarded  about  the  praecordia,  either  by  reafon  of  fome  fault  in  the  organs, 
or  from  any  other  caufe  whatever;  or,  finally,  to  omit  other  things,  and 
amongft  ^hefe  the  lymphaedudts  of  the  heart  being  ruptur’d,  from  the  follicles 
of  hydatids  burfting  afunder.  For  after  Galen  had  obferv’d  thefe  in  an  ape, 
as  I  have  hinted  above  (/),  fome  faw  them  within  the  pericardium  of  beafts, 
and  molt  anatomifts  within  the  human  pericardium.  Wepfer,  for  inftance(flz), 
lound  many  fcatter’d  here  and  there  throughout  the  external  furface  of  a 
low’s  heart ;  and  Ballonius  (»),  and  Cordteus  (0),  have  related,  that  the  heart, 
in  two  women,  was  befet  with  hydatids.  Rolfinck  (p)  fays,  “  I  have  ob- 
“  ferv’d  hydatids  on  the  membrane  of  the  heart,  in  patients  who  were  fub- 
u  jetft  to  a  palpitation.”  Fantonus  the  father  fays  (j),  that  he  faw,  in  a  cer¬ 
tain  man,  “  the  heart  fwimming  in  a  very  copious  and,  faffron-colour’d  lymph, 
“  and  the  apex  of  it  ulcerated,  from  a  corrupt  hydatid;”  and  in  another (r), 
tc  a  great  number  of  hydatids  upon  the  furface  of  the  heart.”  The  cele¬ 
brated  Thebefius  (j),  in  a  merchant,  “  the  right  fide  of  whofe  thorax  being 
“  greatly  expanded,  together  with  the  pericardium,  was  full  of  water,  found 
44  the  external  membrane  of  the  heart  rough  with  hydatids.”  And  I  myfelf 
alfo,  as  1  have  written  to  you  before  (/)  faw  the  traces,  as  it  were,  of  a  rup¬ 
tur’d  hydatid,  on  the  fame  membrane,  and  am  to  tell  you  hereafter  («),  of  a 
large  hydatid,  which  was  hanging  in  the  fame  place.  All  which  circum¬ 
ftances  I  was  willing  to  take  notice  of  here,  that  you  might  the  more  rea- 
dily  conceive  how  far  this  dropfy  of  the  pericardium  may  vary  in  the  origin, 
quality,  and  quantity  of  the  water  ;  and  how  far  the  fymptoms  of  it  may  alfo 
vary,  as  is  particularly  written,  in  regard  to  the  pulfe,  by  Albertini  (#),  who 
always,  indeed,  found  it  to-be  fmall  and  rather  frequent,  but  more  fo  when 
there  was  the  greateft  quantity  of  water  ;  yet  he  found  it  foft  when 
the  water  was  pure  or  vifcid  ;  and,  finally,  tenfe  and  chord-like,  when  the 
water  was  fait  and  vellicating.  You  will  fee  in  Vieuftfens,  of  what  qua¬ 
lity,  and  in  what  quantity,  the  water  was  in  thefe  two  patients,  in  one  of 
whom,  as  1  have  related  above  (jy),  he  faid  the  pulfe  was  fmall,  frequent,  and 
unequal ;  but  in  the  other,  befides  thefe  circumftances,  always  very  foft  and 
weak.  And  Hoffman  (z)  has  remark’d,  that  in  a  certain  noble  widow,  who  had 
vifcid  ferum,  as  other  circumftances  (hew,  within  a  thicken’d  pericardium,  in 


(>£)  n.  1.  (/)  n.  20. 

(/«)  Sepuichret.  1.  4.  S.  3.  in  Schol.  ad  Obf. 
26.  n.  iv. 

(»)  Ibid.  1.  3.  S.  37.  Obf.  3.  §.  12. 

(c)  Ibid.  S.  21.  Obf.  21.  §.  14. 

(p)  Ibid.  1.  2.  S.  9.  Obf.  6. 

(2)  Obf.  Anat.  Med.  15.  ult.  edition. 


(r)  Ibid.  Obf.  12. 

(j)  Eph.  N.  C.  Cent.  4.  Obf.  1 1 5. 

(t)  Epift.  3.  n.  26. 

(«)  Epift.  25.  n.  13. 

(*)  in  Opufc.  cit. 

(y)  n.  24. 

(z)  Medic.  Rat.  T.  4.  P.  4.  c.  9.  Obf.  4. 

fuch 


8 


Letter  XVI.  Article  4^.  417 

fuch  a  quantity  as  to  exceed  a  pound  weight ;  the  pulfe  was  <£  fmall  and  lan¬ 
guid  and  when  he  fubjoins  what  had  been  obferv’d  in  another  widow,  by  Bal- 
lonius  ( a ),  you  would  eafily  perceive,  if  the  amanuenfes,  or  printers,  of  Hoff¬ 
man  had  more  carefully  copy’d  the  words  of  Ballonius,  that  the  woman’s 
pulfe,  which  was  “  large,  full.  How,  and  interrupted,  having  an  intermiflion  of 
“  one  or  two  pullations,”  and  other  circumftances  which  are  related  of  her, 
if  they  really  did  relate  to  the  dropfy  of  the  pericardium,  at  lealf  did  not 
relate  to  that  alone,  of  which  the  queftion  is  here,  but  to  that  when  join’d 
with  other  diforders.  Obfervations  of  this  kind,  therefore,  being  pafs’d  by 
here,  a  great  number  of  which  might  be  readily  quoted,  thofe  are  fo  much 
the  lefs  to  be  attended  to,  which  are  produc’d  afrer  this  manner  from  Zacutus, 
by  men  in  other  relpedts  learned  :  “  Zacutus  Lufitanus  law  this  diforder  ” 
(that  is,  the  dropfy  of  the  pericardium)  “  three  times,  where  the  patients 
“  dragg’d  on  life,  under  the  oppreflion  of  faintnefs,  palpitation  of  the  heart, 
<c  a  hard  fmall  pulfe,  and  a  lyncope,  without  any  preceding  caufe,  and  at 
“  length  were  conlum’d  by  a  flight  fever  coming  on  ;  and  on  account  of  this 
“  confumption  of  the  body,  fome  have  been  pleas’d  to  call  this  diforder  by 
“  the  name  of  a  tabes  pericardii .”  But  if  they  had  pointed  out  the  place 
where  he  wrote  thefe  things,  which  you  will  find  to  be  the  hundred  and 
thirty-feventh  obfervation  of  the  firft  book,  De  praxi  medica  admiranda ,  or  if 
they  themfelves  had  read  that  obfervation,  it  would  have  been  eafy  to  diftin- 
guifh,  that  thofe  things  are  not  faid  of  the  dropfy  of  the  pericardium,  or  of 
moifture  effus’d  into  its  cavity,  but  of  a  fmall  hardifh  tumour  growing  on 
the  coat  which  envelopes  that  cavity.  Thefe  obfervations,  therefore,  being 
defervedly  fet  afide,  if  we  look  to  what  is  written  on  the  pulfe,  in  the  few 
obfervations  relating  thereto ;  it  will  appear,  that  they  are  different  in  dif¬ 
ferent  perfons  •,  and  if  any  thing  has,  perhaps,  been  remark’d  more  frequently 
than  others,  that  it  feems  referable  to  the  fmallnefs,  weaknefs,  and  frequency 
of  its  pullations  :  and  how  far  thefe  cncumftances  may  vary,  not  only  ac¬ 
cording  to  the  different  time  of  the  difeafe,  but  even  to  how  many  other 
difeafes  they  are  common,  is  fufficiently  known  to  all. 

45.  But  if  now,  at  length,  we  compare  molt  of  the  other  figns,  or  fymp- 
toms,  of  this  diforder,  which  1  have  mention’d  above  (£),  from  the  obfer¬ 
vation  or  opinion,  of  celebrated  men,  with  the  hiftories  which  are  deferib’d 
or  pointed  out  by  me*,  it  will  alfo  be  manifefl,  that  fome  of  them  are  not 
perpetual,  and  fome,  indeed,  even  not  frequent;  as,  for  inftance,  the  fwoon- 
ings,  which  were  faid  to  happen  much  more  often  in  this  diforder  than  in 
the  dropfy  of  the  thorax,  but  you  will  find  to  be  mention’d  in  none  either  of 
Valfalva’s  obfervations,  or  thofe  of  Vieuffens,  or  mine,  whether  taken  from 
the  dropfy  of  the  thorax,  or  pericardium,  or  both  together  ;  and  you  will 
even  find,  that  in  fome  of  mine  they  are  exprelsly  denied  (c),  and  that  in 
the  lall,  which  is  Albertini’s,  they  are  but  juft:  (lightly  hinted  at  (d).  I  do 
,  not,  indeed,  deny,  that  they  were  obferv’d  in  thofe  patients  whofe  hiftories 
are  given  us  by  Fifcher(<?),  by  Reimannus(/),  by  Low  (g),  and  by  HofF- 

( a )  Ephem.  1.  i.  A.  1570.  Conftit.  Hyem.  ( e )  Aft.  N.  C.  T.  8.  Obf.  31. 

\b)  Vid.  n.  21,  23,  24.  (f)  Eorund.  Tom.  1.  Obf.  170. 

(c)  N.  36,  &  38.  (d)  N.  43.  (£)  Eph.  N.  C.  Dec.  3.  A.  5.  Obf.  154. 


VOL.  I. 


Hhh 


man. 


4i  8  Book  II.  Of  Difeafes  of  the  Thorax. 

man  (b).  But  if  the  dropfy  of  the  pericardium  was  join’d,  in  the  three 
former  patients,  with  a  very  great  languor  from  a  long  continu’d  hedtic  fever, 
if  it  was  join’d  with  a  difeafe  of  the  valves  of  the  heart,  and  with  a  dropfy 
of  the  thorax  ;  then  the  widow,  doubtlefs,  remains  almoft  alone  amongft 
thofe  from  whom  Hoffman  took  his  obfervations,  in  whom  I  know  that 
fwoonings,  or  faintings,  and  thofe  pretty  frequent  too,  did  really  accompany 
this  very  diforder  in  queftion.  How  then  could  I  fay,  that  thefe  fwoonings, 
even  if  they  were  not  common  to  fo  many  other  diforders,  are  very  fre¬ 
quently  wont  to  be  obferv’d  in  this  ? 

Moreover,  as  to  the  dry  fmall  cough,  which  was  fuppos’d  to  be,  in  ge¬ 
neral,  more  urgent  in  the  dropfy  of  the  pericardium,  than  in  that  of  the 
thorax,  have  you  read  of  it  being  more  troublefome  in  thofe  whom  I  have 
delcrib’d  as  being  affedted  with  both  ?  Certainly,  in  thofe  whom  I  have  feen, 
it  is  not  fo  much  as  mention’d,  except  in  one  woman  :  and  the  celebrated 
Kellner  (*)  has  obferv’d  exprefsly,  that  there  was  no  cough  in  a  man  who 
labour’d  under  both  of  thefe  diforders.  But  there  was,  you  will  fay,  in 
others  whom  Low  (£),  Bonetus  (/),  and  Wepfer  (w),  faw  equally  affedted. 
And  I  am  fo  far  from  difallowing  it,  that  I  rather  wonder  it  was  wanting  in 
fo  many  others,  whom  I  juft  now  fpoke  of.  For  water  in  the  cavity  of  the 
thorax,  is  contiguous  to  the  phrenic  nerves,  the  lungs,  and  the  whole  tradt 
of  the  pleura-,  fo  that,  if  it  be  of  an  irritating  nature,  it  cannot  but  vellicate, 
and  thus  excite  a  cough  :  whereas  in  the  dropfy  of  the  pericardium,  the 
water  touches  none  of  thefe  parts,  and  confequently  is  fo  far  from  being 
likely  to  excite  a  cough  more,  that  it  does  not  leem  poffible  for  it  to  excite  a 
cough  equally  with  the  other  j  although,  if  it  be  extremely  {Simulating,  it  may, 
perhaps,  by  vellicating  the  pericardium,  draw  the  annex’d  diaphragm  into 
confent  with  it  -,  which,  however,  the  water  of  the  thorax  will  be  able  to 
do  (till  more  by  means  of  the  pleura,  that  is  thinner,  and  connedted  to  the 
diaphragm  by  a  much  greater  fpace.  But  they  cough’d,  you  will  fay,  ac¬ 
cording  to  the  obfervations  of  Harderus  («),  Schrock  (0),  Erndlius  (/>),  and 
Reimannus  (j),  in  whom  there  was  even  not  a  dropfy  of  the  thorax,  but  of 
the  pericardium.  They  did  cough  indeed  ;  but  either  there  were  vomicae 
that  occupied  the  lungs,  or  lay  between  the  external  coat  of  the  lungs,  and 
the  pleura ;  or,  if  thefe  were  wanting,  other  difeafes  were  not  wanting,  from 
which  the  feptum  tranfverfum,  on  its  inferior  furface,  at  lead,  might  be  {Si¬ 
mulated.  But  if,  finally,  we  confider  thofe  in  whom  the  only  difeafe  was  the 
dropfy  of  the  pericardium,  the  man,  indeed,  whom  Vahalva  diffedted  (r), 
cough’d  j  but  neither  Vieuffens,  nor  Hoffman,  mention  a  cough  in  theirs, 
nor  did  Albertini  obferve  it  in  the  nun.  And  as  he  has  written  in  the  com¬ 
mentaries,  which  I  have  already  commended  (j),  that  this  diforder,  generally, 
“  has  either  no  cough,  or  very  little,  join’d  with  it,”  he  certainly  did  not 
mean  a  greater  than  in  the  dropfy  of  the  thorax. 


(h)  Obf.  4.  fupra  cit.  ad  n.  44.. 

(/)  Aft.  N.  C.  Tom.  5.  Obf.  1.  not.  1. 

( k )  Cit.  in  Eph.  Obf.  154. 

(/)  Sepulchr.  1.  2.  S.  2.  Obf.  3. 

(//2)  Ibid.  1.  4.  S.  3.  Obf.  26.  in  Additam. 


(«)  Ibid.  1.  2.  S.  7.  Obf.  24.  in  Additam. 
(0)  Eph.  N.  C.  Dec.  3.  A.  4.  Obf.  1 18. 
(p)  Earund,  Cent.  3,  &4  Obf.  141. 

\q)  Aft.  N.  C.  Tom.  1.  Obf.  cit.  170. 
(r)  Supra,  n.  21.  ( s )  Supra,  n.  44. 


But, 


Letter  XVI.  Article  45*.  419 

But,  cn  the  contrary,  as  to  what  mod  authors  fay,  that  the  difficulty  of 
refpiration  is  more  flight  in  the  dropfy  of  the  pericardium,  than  that  of 
the  thorax,  I  fhall  very  readily  acknowledge  that  it  is  true,  at  lead,  in  ge¬ 
neral,  from  the  judgment  both  ot  my  e<ms  and  my  eyes.  For  how  great 
that  difficulty  is  generally  wont  to  be  in  the  dropfy  of  the  thorax,  Du  Verney, 
the  younger  (/),  admirably  well  ffiews,  when  he  places  it  among  the  fymp- 
toms  of  this  diforder,  and  confiders  it  as  the  chief-,  or  when  he  teaches, 
that  if,  after  drawing  the  water  out  of  the  abdomen  of  a  perfon  who  labours 
under  an  afcites,  the  refpiration  is  not  at  all,  or  but  little  eas’d,  water  alfo 
ftagnates  in  the  cavity  of  the  thorax  ;  and  clearly  confirms  his  decifion  either 
by  drawing  out  the  water  from  the  thorax,  or  by  the  diffection  of  the  body 
after  death,  in  the  fame  manner  as  Jacobus  Oaethasus  ( u )  formerly  confirm’d 
his  fufpicion  of  a  humour  being  extravafated  into  the  thorax,  when,  although 
“  he  had  eas’d  ”  the  belly,  that  was  fomewhat  fwell’d,  “  of  its  bulk  of  hu- 
“  mours,”  by  the  help  of  purging  medicines,  yet  he  had  obferv’d  “  the  dif- 
“  ficult  breathing  not  to  be  diminiffi  d.”  And  even  read  over  the  obfer- 
vations  which  I  have  defcrib’d  to  you  in  this  letter,  and  obferve  once  more 
how  laborioufly  they  are  wont  to  breathe  who  are  affeCted  with  that  diforder, 
and  how  often  with  their  necks  quite  ftrait.  Nor  would  I  have  you  fuppofe, 
that  fo  great  a  difficulty  of  refpiration  is  rather  to  be  accounted  for  from  the 
dropfy  of  the  pericardium,  than  that  of  the  thorax,  becaule  you  will  read, 
that  in  moft  of  them  both  dropfies  exifted.  For  they  who  have  obferv’d  the 
firft  without  the  fecond,  and  without  the  other  caufes  of  a  dyfpnoea  (you  fee 
why  the  obfervations  of  Kellner,  Schrock,  Erndlius,  Reimannus,  Vicarius,  and 
others  of  that  kind,  which  I  purpofely  pafs  by,  are  to  be  fet  apart  from  this 
place  by  me) ;  I  fay,  they  who  have  obferv’d  the  dropfy  of  the  pericardium  alone, 
without  any  other  difeafe  that  could  be  injurious  to  refpiration,  as  Hoffman 
in  the  widow,  Vieuffens  in  the  boy,  and  Albertini  in  the  nun,  certainly  do 
not  make  any  mention  of  an  orthopnoea.  Nay,  even  Vieuffens,  as  I  before 
faid  (x),  conjectur’d,  that  the  dropfy  of  the  thorax  was  added  to  that  of  the 
pericardium,  in  another,  from  this  reafon,  becaufe  the  patient  could  lie  no 
more  with  his  head  low  :  and  Albertini  not  only  affirm’d,  in  the  cafe  of  the 
virgin,  that  whether  fhe  ftood  upright,  or  lay  on  her  back,  or  on  either  fide, 
her  refpiration  was  equally  eafy  ;  but  alfo  wrote  in  general,  in  dependance  on 
his  own  obfervations  (y),  that  in  this  difeafe  “  a  difficulty  in  lying  down,  and 
“  frequent  neceffity  of  fitting  upright  in  bed,  fcarcely  ever  happen’d.”  But 
Valfalva(2),  although  in  one  man  in  whom  this  dropfy,  as  it  hems,  had  al¬ 
ready  made  a  confiderable  p/ogrefs,  oblerv’d  an  orthopnoea-,  and  Vieuffens 
did  once  alfo,  (as  1  have  fa  d  above  (a)  from  his  fourth  obfervation,  and  ffiail 
fay  again  prefently)  in  the  laft  ftage  of  the  difeafe  j  yet  in  the  obfervations 
which  1  ffiail  give  you  the  copies  of,  upon  another  occafion(^),  made  upon  two 
young  men,  who  were  taken  off  by  a  peripneumony,  after  having  faid,  that 
the  firft  “  had  lain  down,  and  had  felt  no  inconvenience  from  hanging  down 
“  his  head,”  and  that  the  other  “  had  lain  fo  as  to  keep  his  head  down- 

(/)  Mem.  de  1’ Acad.  R.  des  Sc.  A.  1703.  (y)  Comment,  cit. 

[u)  Sepulchr.  1.  2.  S.  1.  Ob.  76.  (x)  Supra,  n.  21. 

{*)  N.  25.  («)  N.  24.  (^)  Epift.  20.  n.  35,  36. 

“  wards, 


H  h  h  2 


420  Book  II.  Of  Difeafes  of  the  Thorax. 

44  wards,”  he  immediately  fubjoin’d  this,  46  as  moft  of  thofe  perfons  are  wont 
“  to  do,  in  whom  the  pericardium  is  turgid  with  a  great  quantity  of  water  :** 
and,  indeed,  in  both  of  them,  that  cavity  was  fo  far  dilated  with  water,  that 
in  the  firft  44  it  might  be  with  judice  call’d  a  dropfy  of  the  pericardium,” 
and  in  the  other  “  it  occupied  a  great  lpace  in  the  thorax.”  But  Lancifi  (r), 
when  he  alfo  collected  the  figns  of  this  dropfy,  laid  the  fame  thing  as  I  have  juft 
faid,  yet  in  a  much  different  way.  For  when  he  had  written,  that  thofe  who 
labour’d  under  this  diforder  had  k4  a  difficult  and  fhort  refpiration,”  and  even 
“  from  the  beginning  could  not  breathe,  but  out  of  bed,”  he  fays,  at  length, 
44  near  death,  they  are  compell’d  to  lie  down  in  bed ;  that  is,  becaufe  the 
“  pericardium,  being  turgid  with  a  pint,  or  even  with  a  pint  and  half  of 
44  liquor,  makes  a  great  p  re  flu  re  upon  the  center  of  the  diaphragm,  nor 
44  fuffers  the  patients  to  ufe  any  other  pofture  than  the  horizontal,  which  is 
4t  the  leafl:  inconvenient  of  any,  inafmuch  as  the  pericardium,  then  afcending 
“  towards  the  throat,  prefles  no  more  upon  the  diaphragm.”  I  do  not  doubt 
but  this  celebrated  man  might  have  obierv'd  it  thus  in  forne  :  nor  do  I  deny 
that  which  is  confonant  to  reafon,  which  alfo  the  obfervation  of  Willis  (d)9 
on  that  young  man,  confirms,  who  having  begun  to  labour  under  a  dropfy 
of  the  thorax,  and  lying  upon  his  back  in  bed,  and  fuff’ring  his  head  to  be 
44  reclin’d,  from  the  margin  of  the  bed,  quite  down  to  the  floor,”  as  Willis, 
for  the  fake  of  the  experiment,  had  order’d,  44  immediately  felt,  very  plainly, 
44  the  courfe  of  the  water  downwards,  toward  the  clavicle,  and  at  the  lame 
4t  time  a  metaftafis,  or  tranflation  of  the  pain,  to  that  part.”  Nor  yet  do  I 
know,  whether  I  lufficiently  underftand,  why  they,  I  do  not  fo  much  fay, 
who  were  troubl’d  with  a  dropfy  of  the  thorax,  as  they  who  were  troubl’d 
with  a  dropfy  of  the  pericardium,  even  much  greater  than  that  which  was  re- 
ferr’d  to  by  Lancifi,  did  not  obtain  the  fame  eafe  by  lying  down.  Nay,  on 
the  contrary,  he  who  was  troubl’d  with  by  much  the  greateft,  as  the  obfer¬ 
vation  of  Vieuflens  a  little  bcfore-mention’d  fhews,  in  the  laft  months  of  his 
difeafe,  which  was  now  far  advanc’d,  was  oblig’d  to  fit  up  conftantly  in  bed; 
for  if  he  endeavour’d  to  lie  down,  which  it  had  been  in  his  power  to  do  in 
the  former  months,  an  evident  danger  of  fuffocation  and  death  was  imme¬ 
diately  at  hand.  Could  it  be,  perhaps,  owing,  to  fay  nothing  of  the  encreas’d 
prefiure  of  the  fanguiferous  velfels,  with  Vieuflens,  to  this  caufe,  that  the  pe¬ 
ricardium  being  diftended  with  fuch  a  quantity  of  water,  did  not  opprefs  the 
diaphragm  indeed,  but  grievoufly  overloaded  the  lungs,  upon  which  it  lay 
in  that  fltuation,  and  at  the  fame  time  fo  much  the  more  hinder’d  their  ex- 
panfion,  as  the  diaphragm  afcending  higher  at  that  time,  the  pericardium 
itfelf  was  alfo  thruft  up  with  it.  But  if  the  cafe  be  really  fo,  you  alfo  under¬ 
stand  that  this  lymptom,  either  as  it  is  defcrib’d  by  Lancifi,  or  by  others,  is 
varied  according  to  the  various  quantity  of  the  collefted  fluid  :  which,  how¬ 
ever,  in  molt  patients  (e),  feems,  notwithstanding  the  quantity  was  the  fame 
that  Lancifi  mentions,  or  even  fometimes  greater,  neither  to  have  compeil’d 
them  in  the  beginning  to  fit  up  out  of  bed,  for  the  fake  of  taking  their  breath,. 

(c)  De  Mot.  Cord.  1. 1.  S.  I.  c.  5  Prop.  23.  (*)  Vid.  n.  27,  Sc  36.  fupr3.  Sc  Sepulchr. 

in  Schol.  1.  I.  S.  2.  Obf.  3. 

(J)  Pharmac.  Rat.  P.  2.  S.  1,  c.  13.  in  fin. 


nor 


Letter  XVI.  Article  46.  421 

nor  yet  in  the  latter  part  of  their  difeafe,  that  they  fhould  lie  down  in  order  to 
breathe  with  more  freedom  *,  but  even  whichever  fituation  they  chole,  the  dif¬ 
ficulty  of  breathing  was,  for  that  reafon,  by  no  means  increas’d,  although  the 
droply  of  the  thorax  was  join’d  with  the  dropfv  of  the  pericardium.  Which 
circumftance  alfo  prevents  us  from  confidering  this  lymptom  of  lying  down 
eafily,  as  being  peculiar  to  the  dropfy  of  the  pericardium  ;  and  that  fo  much 
the  more,  as  in  thofe  who  labour’d  under  the  dropfy  of  the  thorax  alone, 
it  has  been  equally  obferv’d  fometimes  (/). 

46.  I  am  not  forry,  that  I  havejnlt  now  produc’d  the  obfervation  of  Lan- 
cifi,  although  it  differs  fo  much  from  that  of  Vieuffens.  For  behold,  while 
1  was  reading  this  letter  over  again,  I  receiv’d  from  the  Imperial  Academy 
at  Peterfburgh  their  new  commentaries  (g),  in  which  I  find,  among  other  cu¬ 
rious  obfervations,  that  of  the  celebrated  Schreiberus  {h)  likewife,  of  a  peri¬ 
cardium  which  was  fo  extended  by  about  four  pints  of  bloody  water,  that  the 
lungs  being  comprefs’d  together,  pofferiorly  and  laterally,  the  pericardium 
itfelf  “  fill’d  the  middle,  and  anterior  lateral  parts,  of  the  chert.”  Yet  in 
this  patient’s  cale,  when  “  the  greateft  increafe  of  difficulty  in  breathing  was 
“  come  on,-— it  was  impoffible  ior  him  to  lie  down  on  either  fide  of  his  chert, 
“  yet  to  lie  down  on  his  back  was  tolerable  for  him.”  In  this  man,  alfo, 
the  lungs  were  “  clofely  connected  ”  with  the  pleura  ;  and  even  at  laft,  “  a 
“  white  vilcid  matter,  mix’d  with  a  confiderable  quantity  of  blood,  was  thrown 
“  up  by  expectoration  befides,  the  furface  of  the  heart  was  all  over  rough 
with  villi,  form’d  from  the  ferum,  indeed,  but  by  which  the  left  ventricle  ad¬ 
her’d  very  firmly  to  the  pericardium.  Nor  yet  are  palpitations,  nor  faintings, 
mention’d  here,  but  “  an  oppreffion  on  the  breaft,  and  a  perpetual  dry  cough 
each  of  which  you  will  join  to  what  I  have  faid  above  of  the  figns  of  the 
dropfy  of  the  pericardium,  or  fhall  fay  below,  the  cough  only  being  excepted, 
becaufe  this  had  exifted  in  the  beginning,  when  an  internal  inflammation  of 
the  thorax,  according  to  appearances,  preceded  the  dropfy  •,  and  how  the  lungs 
were  after  that,  as  to  their  ftate,  you  underftand  from  what  has  been  faid, 
and  “  upon  the  diaphragm  a  little  portion  of  yellowifh  ferum  fluctuated.” 
But  I  would  have  you  attend  to  this,  above  all  things  in  the  hiftory,  that  not- 
withftanding  there  was  fo  great  a  collection  of  water  in  the  pericardium,  yet 
an  orthopnoea  was  wanting,  which  fituation  of  body,  from  what  caufe  foever 
it  might  happen,  was  fo  necefiary  to  the  patient  of  VieuflTens,  when  he  breath’d. 
Thus,  then,  I  think  I  have  faid  enough  of  faintings,  and  of  cough,  and  of 
the  difficulty  of  refpiration. 

Now  let  us  go  on  to  other  things.  And  third,  indeed,  fo  rarely  happens 
to  attend  a  dropfy  of  the  pericardium,  that  I  would  not  have  it  mention’d 
among  the  fymptoms  of  this  diforder,  efpecially  as  our  Saxonia  (7)  has  ex- 
prefsly  aflerted,  that  among  thefe  fymptoms  there  is  ce  no  third.”  Yet,  al¬ 
though  on  the  contrary,  you  will  find  in  the  obfervations,  which  I  have  co¬ 
pied  from  Valfalva,  that  there  was  either  a  thirft,  or  a  drynefs  of  the  fauces, 
always  attending  the  dropfy  of  the  thorax ;  it  fometimes  happens,  that  there 
is  none  alfo  in  this,  and  that  befides  others,  and  in  particular  befides  the  ob- 

(f)  Vid.  n.  26.  28.  ( b )  5.  inter  Phyfic. 

(g)  Tom.  3.  (/)  Vid.  fupra,  n.  23. 

fervation 


422  Book  II.  Of  Difeafes  of  the  Thorax. 

fervation  of  Rufius  (&),  more  than  one  of  my  hiftories  confirm  (/).  Where¬ 
fore  the  abfence  or  prefence  of  thirft,  will  not  certainly  diitinguifh  theie  two 
dtforders. 

But  Itill  lefs  the  tumour  of  the  feet,  as  one  which  you  will  read  number’d 
among  the  figns  of  the  dropfy  of  the  thorax  •,  and  yet  we  lee  that  the  fame, 
fomewhat  more  frequently  than  t  iirft,  attends  upon  the  dropiy  of  the  peri¬ 
cardium,  and  that  it  has  been  wanting,  and  not  very  fcldom  neither  in  the 
other  (/»),  and  fometimes  even  when  both  have  been  join’d  («),  as  our  ob- 
fervations  fufficiently  prove.  Fluctuation  is  almolt  the  only  mark  which 
fometimes  is  perceiv’d  in  that  other  dropfy  indeed,  as  I  faid  above  (e>)  ;  whereas 
in  the  dropfy  of  the  pericardium,  I  do  not  remember  to  have  read,  that  it 
has  even  been  perceiv’d  upon  the  concuffion  of  the  body  :  although  it  can 
only  fignify,  that  a  dropfy  of  the  thorax  is  prefent,  and  not  that  a  dropfy  of 
the  pericardium  is  abfent.  But  as  to  what  equally  relates  to  the  fluctuation 
in  the  pericardium  itfclf,  to  be  perceiv’d  by  the  pat  ent,  or  by  the  phyfician, 
in  this  manner,  or  in  any  other,  as  Graetzius  (p)  did  not  judge,  that  it  would 
be  fo  d:ftinCtly  fenfible,  as  in  the  dropfy  of  the  thorax,  lb  I,  in  like  manner, 
fince  it  may  be  lefs  perceptible  or  not  at  all,  or  perhaps  may  be  diflembl’d 
by  fome  accidental  fallacy,  did  not  fcruple  there  to  affirm,  that  I  acknow¬ 
ledg’d,  if  you  could  remove  all  thefe  objections,  it  would  be  before  all  others, 
the  belt  fign,  and  moft  to  be  depended  upon  (y). 

And  as  to  the  flow  fever,  the  wafting  of  fiefh,  the  fadnefs,  the  palenefs 
of  face,  the  eyes  being  become  lefs  lively,  the  extreme  parts  of  the  body 
being  almoft  cold,  and  every  thing  elfe  of  that  kind,  I  do  not  doubt  but 
they  may  be  oftentimes  common  to  both  thefe  dropfies  •,  and  I  even  know, 
for  certain,  from  the  other  obfervation  of  Vieuflens  himfelf  (r),  that  moft  of 
thefe  fymptoms  are  common  to  both.  Nor  if  I  find,  that  even  many  of 
thofe  figns,  which  have  been  before  examin’d,  have  exilted  in  any  one  perfon 
at  the  lame  time,  in  whom  the  dropfy  of  the  pericardium  is  found,  will  I 
for  that  reafon  immediately  depart  from  my  opinion;  but  will  firft  confider 
all  other  circumftances.  There  is  an  obfervation  of  Brunnerus  (j),  which  I 
will  produce  on  this  occafion,  in  particular,  for  the  fake  of  example,  though 
I  could,  at  the  fame  time,  produce  many  others,  becaufe  although  it  might 
have  been  added  to  the  Sepulchretum,  as  it  was  publiffi’d  in  the  year  1687, 
I  have  neverthelefs  fought  for  it  there  in  vain.  He  found  the  pericard.um 
turgid  with  water,  in  a  young  foldier,  who  had  complain’d  of  a  dyfpnoea, 
and  a  tightnefs  about  the  praecordia,  and  could  fcarcely  breathe  in  the 
night,  unlefs  in  an  ereCt  pofture  ;  he  had  thirfted  confiderably,  his  feet  had 
fwell’d  and  been  oedematous,  and  he  had  cough’d,  for  the  moft  part, 
“  without  any  expectoration.”  But  this  man  had  fometimes  had  a  kind 
of  turbid  expectoration,  he  had  the  abdomen  confiderably  fwell’d.  the  fcro- 
tum  very  tumid,  and  the  whole  habit  of  the  body  fomewhat  ftvell’d,  tfpe- 
cially  on  the  right  fide,  on  which  he  generally  lay  in  his  bed.  Belides 
thefe  and  other  things,  which  might  have  been  obferv’d,  even  before  death, 


ft)  Sepulchr.  1.  2.  S.  7.  obf.  91. 
(/)  n.  30.  38.  &  Epift.  10.  n.  j  1. 
ft»)  fupra,  n.  26.  28.  30. 

(«)  n.  34.  38. 


ft)  n.  37*  (/)  n.  22. 

(?)  n.  24. 

ft)  Traite  du  Coeur,  ch.  16.  obf.  1. 
ft)  Extrcit.  de  Gland,  in  Duodeno  §  5. 

amongft 


Letter  XVI.  Article  47.  423 

amongfl  which  neither  palpitations  of  the  heart,  nor  fwoonings,  nor  difor- 
ders  of  the  pulfe,  are  fpoken  of,  and  you  even  fee  that  mention  is  made  of 
its  regularity-,  by  difiedtion  of  the  belly,  the  liver  was  found  to  be  very 
large,  and  tight  pints  of  water  were  in  the  cavity  ;  and,  to  pafs  by  other 
things,  the  right  fide  of  the  thorax  was  fill’d  with  water  alfo ;  fo  that  if  even 
all  the  fymptoms  which  had  preceded,  had  been  in  the  number  of  thofe, 
which  are  faid  by  fome  to  be  proper  to  the  dropfy  of  the  thorax,  or  pericar¬ 
dium  yet  the  complication  of  diforders  would  have  prevented  us  from 
knowing,  which  they  particularly  were  fymptoms  of. 

4.7.  Since  then  thefe  two  dropfies  cannot  be  fufficiently  diftinguifh’d  by 
all  the  marks  which  have  been  hitherto  confider’d ;  it  remains  therefore  to 
fee,  whether  there  is  any  other  fign  fo  far  proper  to  the  dropfy  of  the  peri¬ 
cardium,  that  this  dropfy  cannot  exift  without  the  fign,  nor  the  fign  without 
this  dropfy.  And  1  do  not  fuppofe  you  can  believe,  that  the  mark  propos’d 
by  Vieuffens  (/),  is  what  we  at  prefent  are  in  fearch  of,  I  mean  the  eye-lids, 
and  lips  verging  to  a  leaden  colour,  fince  this  may  not  only  exift  in  other 
diforders,  but  it  may  be  abfent  even  in  this,  as  it  certainly  was  in  the  cafe 
of  the  nun  (#).  Muft  we  therefore  rather  depend  upon  thofe  fenfations 
which  Albertini  (x)  has  confirm’d,  that  is  to  fay,  of  a  weight  lying  upon  the 
heart,  and  of  oppreflion,  and,  in  a  manner,  of  conftriftion  of  the  heart  it- 
felf,  from  any  (light  motion:  confirm’d,  I  fay;  for  Grastzius  has  alfo (y) 
faid,  that  when  this  difeafe  began  to  encreafe,  “  a  w-eight  was  felt  to  overload, 
tc  and  conftringe  the  heart and  after  him,  indeed,  even  Lancifi  (z)  has 
written,  that  this  diforder  was  join’d  with  a  weight  of  the  heart,-— heavinefs, 
<c  -—and  anxiety  of  the  praecordia:”  Hoffman  alfo  has  told  us,  that  the 
widow,  whom  1  have  mention’d,  as  being  affiidted  with  the  fame  difeafe  (a), 
“  had  complain’d  exceedingly,  of  a  great  weight  opprefiing  the  heart,  and 
“  impeding  refpiration.”  And  among  thefe  you  may  reckon  the  man,  who 
told  the  elder  Fantonus  (£),  “  that  he  was  opprefs’d  with  a  very  great  weight 
“  of  his  cheft,”  unlefs  you,  perhaps,  fufpebt  that  this  ought  lefs  to  be  im¬ 
puted  to  the  ferum  of  the  pericardium  being  very  copious,  than  to  the  lungs 
being  hard  and  denfe,  fo  that,  as  Francifcus  Sylvius  (r)  had  frequently  found 
them,  “  they  might  feem  to  be  not  at  all  membranous,  but  entirely  flefhy.’* 
You  will  more  readily  believe,  however,  that  tc  the  preffure  in  the  cheft, 
“  and  thofe  great  oppreflions  of  the  heart,”  which  the  celebrated  men  Schrei- 
ber  (d),  and  Fifcher  (<?),  have  obferv’d  in  the  dropfy  of  the  pericardium,  may 
be  referr’d  to  this  place. 

But  although  thefe  things  are  even  confonant  to  reafon  alfo,  I  am  afraid 
neverthelefs  that  they  are  not  fuch  as  we  are  enquiring  after,  fince  I  fee  they 
are  taken  no  notice  of  in  the  accurate  obfervations  of  Vieuffens  (/),  and  in  the 
obfervation  of  Olaus  Borrichius  (g)  exprefsly  deny’d  ;  and,  to  omit  many  of 
Valfalva’s,  fince  the  fenator  of  Bologna  (£),  and  the  two  women  (f),  in  all  of 


(/)  Traite  cit.  ch.  i. 

(«)  fupra,  n.  43.  (at)  Ibid. 

(y)  Vid.  fupra,  n.  21. 

(z)  in  Schol.  cit.  fupra,  ad  n.  45. 

( a )  n.  44.  ( b )  Obf.  Anat.  Med.  15. 

(c)  Sepukhr.  1.  2.  S.  1.  obf.  50. 


(d)  Vid.  fupra,  n.  46. 

\e)  Aft.  N.  C.  Tom.  8.  obf.  31. 
(f)  Vid.  fupra,  n.  Z4.  &  25. 

\g)  Sepulchr.  Seft.  cit.  obf.  86. 
\ti)  Epift.  ic.  r.  11. 

\i)  fupra,  n.  36.  38. 


whom. 


424  Book  II.  Of  Difeafes  of  the  Thorax. 

whom  I  faw  a  dropfy  of  the  pericardium,  made  no  complaint,  at  any  time, 
of  a  fenfe  of  weight,  or  anxiety  of  this  kind  at  the  heart  •,  and  although  one  of 
the  women  felt  a  weight  in  the  thorax,  yet  in  both  the  right  and  left  cavity 
thereof  was  a  great  quantity  of  water  extravaiated  •,  and  from  this  it  hap¬ 
pen’d  that  I  did  not  produce  the  other  obfervation  of  Fantonus  the  father  (£), 
and  of  Gerbezius  (/),  Bonetus  (m),  Kellnerus  («),  Reimannus  (0)  and  others, 
a  little  time  ago.  In  thefe,  without  doubt,  l  read,  that  complaints  44  of  a 
44  great  load  lying  upon  the  breaft,  heavincfs  of  the  chelf,  an  opprdfive  pain 
44  at  the  bottom  of  the  fternum,  ftribtures  of  the  chelf,  anxieties  and  tight- 
44  neffes  of  the  praecordia,  and  of  the  heart  being  prefs’d  in,  as  it  were,  upon 
44  itfelf,  ”  were  join’d  with  a  dropfy  of  the  pericardium  :  but  I  read,  at  the 
fame  time,  that  this  dropfy  of  the  pericardium  was  join’d,  in  the  four  firffc 
obfervations,  with  a  dropfy  of  the  thorax,  and  in  the  fifth,  with  an  enlarg’d 
ftate  of  the  heart,  and  other  diforders  of  that  and  of  the  great  artery  ;  which 
enlarg’d  ftate  ot  the  heart,  nor  that,  as  the  very  A'ords  of  the  author  are,  44  in 
44  a  common  degree,”  was  alfo  in  the  fourth  ;  nor  were  other  things  want¬ 
ing  iivthe  fecond,  and  in  particular  14  a  fchirrhous  glandular  body,”  which, 
44  when  the  fternum  was  remov’d,  appear’d  to  be  fix’d  by  one  extremty  to 
44  the  inferior  lobule  of  the  right  lobe  of  the  lungs,  and  by  the  other  to  the 
44  mediaftinum  and  diaphragm.”  Wherefore,  although  I  would  willingly 
afcribe  the  cauie  of  thole  complaints  in  part  to  the  water  which  was  redun¬ 
dant  in  the  pericardium  ;  yet  what  I  did  in  regard  to  the  former  obfervation 
of  Fantonus,  that  I  was  alfo  conll  rain’d  to  do  in  regard  to  each  of  thefe  5  I  mean, 
to  doubt  whether  more  was  to  be  attributed  to  the  water,  or  to  other 
caufes,  which  either  by  their  own,  and  for  that  reafon,  greater  weight  over¬ 
loaded  the  diaphragm  ;  or  by  ftreight’ning  the  lungs,  and  the  heart  itfelf, 
or  the  vefiels  belonging  to  each,  or  in'  any  other  manner,  preventing  the 
quick  circulation  of  the  blood  through  the  heart,  might  bring  on  thole  other 
fenfations,  of  which  I  have  fpoken.  After  which  I  think  it  will  be  lefs  ne- 
cefiary,  efpecially  as  this  letter  is  already  drawn  out  to  a  greater  length  than  I 
intended,  to  enter  into  a  frefh  difquifition,  upon  thefe  feniations,  in  order  to 
determine  whether  they  may  happen  fometimes  from  another  caufe,  even 
without  any  dropfy  of  the  pericardium  ;  and  dill  lefs  to  treat  of  palpitations, 
pulies,  and  pain  of  the  loins,  of  which  I  have  faid  enough  already  (p). 

48.  And,  from  the  whole  reprefentation  I  have  made  to  you  of  this  diforder, 
you  will  eafily  fuppofe,  that  we  mull  ftill  wait  fome  time  longer  before  the 
trepanning  of  the  fternum,  and  the  perforation  of  the  pericardium  are  put 
into  pradtice,  in  order  to  cure  this  difeafe,  though  they  are  hinted  at  by  Rio- 
lanus,  in  his  Anthropographia  (y),  and  elfewbere  (r),  if,  according  to  the  ad¬ 
monitions  of  Schrockius  (j),  and  Grsetzius  (/),  44  We  ought  to  t  e  verv  certain 
44  before  fuch  an  attempt,  of  the  quantity  of  the  ferum  being  even  redundant 
44  in  the  pericard  urn,”  For  art  has  not  yet  carry’d  her  improvements  fo  far, 
as  to  what  I  can  lee  of  the  matter,  as  to  be  able  very  certainly,  and  evident- 


(6)  Obf.  cit.  37. 

(1)  Eph.  N.  C.  Dec.  3.  A.  7.  Obf,  186. 
(ot)  Sepulchr.  1.  2.  S.  2.  Obf.  3. 

(«)  A6t.  n.  c.  tom.  5.  Obf.  1. 

(0)  Eorund.  Tom.  1  Obf.  170. 


(p)  n-  23-  41.44. 

(q)  1.  3.  c.  7  m  fin. 

(r)  Encheirid.  Anat.  1.  3.  c.  4. 

ft)  Eph.  N.  C.  Dec.  3.  A.  4.  Obf.  1 1 8. 

(0  Difp.  fupra  ad  N.  22.  cit.  §.  25. 

iy. 


4 


« 


Letter  XVI.  Article  49.  42 £ 

ly  to  determine  this  queftion.  I  with  it  was  in  our  power,  by  frequent  and 
repeated  obfervations,  if  not  to  remark  other  figns,  yet  at  lead:  to  determine 
which,  out  of  all  thefe  that  have  been  propos’d,  occur  more  frequently,  or 
more  rarely,  in  the  courfe  of  this  dropfy,  and  at  what  time  of  the  difeale  they 
moft  rarely  or  mod;  frequently  happen  ;  whether  in  the  beginnings  of  it,  or 
near  its  end.  For  I  fee,  that  it  is  not  uncommon  for  perfons  affefted  there¬ 
with,  to  have  died  “  fuddenly,  contrary  to  the  expectation  of  thole  about 
“  them,  of  an  unexpected  death,  of  a  fudden  death  5”  which  various  ex- 
prefiions  you  will  find  in  their  various  places  (u). 

In  the  mean  while,  where  the  fymptoms  of  other  diforders  are  abfent,  and 
fame  of  the  fymptoms  of  that  diforder,  which  it  is  certain  is  near  akin  to  this,  I 
mean  the  dropfy  of  the  thorax,  are  alfo  abfent,  as  the  fenfe  of  fluctuation  efpe- 
cially  in  the  parts  of  the  thorax  more  remote  from  the  heart,  as  the  necefiity 
of  breathing  with  an  upright  neck,  efpecially  after  the  fil'd  hours  of  deep  ;  as 
the  lying  down  with  greater  difficulty  on  one  fide  or  the  other,  for  it  feldom 
happens  that  an  equal  quantity  of  water  is  collected  in  each  cavity  of  the  tho¬ 
rax  within  the  fame  time  j  and  the  other  fymptoms  of  that  dropfy  are  not 
met  with  at  ail,  or  are  much  flighter,  as  the  fwelling  of  the  limbs,  the  cough» 
and  third:-,  but  the  patient  feels,  as  it  were,  a  kind  of  weight,  in  the  very 
fituation  of  the  heart,  and  that  upon  the  motion  of  the  body  the  heart  is  op- 
prefs’d,  and,  as  it  were,  conftring’d,  the  breath  being  in  fome  meafure  de¬ 
ficient  and  that  thefe  fymptoms  are  prefently  remov’d  or  alleviated,  when 
he  has  reftor’d  himfelf  to  reft,  and  that  he  takes  his  red;  more  commodioufly 
when  he  lies  with  his  head  low  :  where,  I  fay,  all  thefe,  or  many  of  them,  at 
lead,  ffiall  be  found  together-,  I  indeed,  on  account  of  the  greateft  part  of 
thofe  hidories  which  have  been  above  defcrib’d,  or  taken  notice  of,  although 
I  will  not  for  certain  pronounce,  that  the  diforder  is  a  dropfy  of  the  pericar¬ 
dium,  yet  ffiall  fay  that  it  is  extremely  probable.  But  I  ffi  dl  fay  it  the 
more  readily  if,  befides  thefe,  the  patient  is  in  the  number  of  thofe  who  feel 
as  if  their  hearts  fwam  in  water ;  or  in  whom  there  is  fome  mark  of  water  fluc¬ 
tuating  in  the  didended  pericardium,  and  not  elfewhere  Nor,  where  there 
are  many  of  thofe  figns  which  I  have  mention’d,  will  I  defpife  fome  other 
figns,  as  efpecially  the  palpitation  of  the  heart,  notwithdanding  there  was  no 
more  than  one,  among  all  the  obfervations  I  have  defcrib’d,  in  which  this 
fymptom  was  obferv’d  -,  as  alfo  the  extremities  being  almod  cold,  the  pale- 
nefs  of  the  face,  and  particularly  of  the  lips  and  eye  lids,  verging  to  a  leaden 
colour,  and  other  fymptoms  of  that  kind,  which,  as  pnyficians  fomedmes 
either  negleCt  to  attend  to  or  enquire  after,  or  the  patients  neglect  to  tell,  in- 
afmuch  as  they  are  very  often  un [earn’d  and  ignorant  perfons,  and  labour 
under  more  violent  diforders,  it  would  not  have  been  furprizing  if  they  were 
pafs’d  over  in  fome  hiftories,  notwithdanding  they  did  really  exid.  Thus 
much  I  had  to  fay  on  the  dropfy  of  the  thorax,  and  on  this  occafion  of  the 
dropfy  of  the  pericardium  alfo.  Farewel. 

49.  Scarcely  had  I  revis’d  this  letter,  in  order  to  fend  it  you,  when  John 
Baptid  Molinari,  a  mod  learn’d  phyfician,  and  a  very  humane  man,  knowing 
that  I  had  been  without  the  excellent  treatife  of  Peter  Senac,  who,  befides  his 

(?<)  Vid.  fupra.  n.  6.  17.  24.  36.  38.  &  Att.  N.  C.  Tom.  5.  Obf.  121.  &  Tom  6.  Obf.  143. 

Vol.  I.  Iii  being 


4  26  Book  II.  Of  Difeafes  of  the  Thorax. 

being  phyfician  to  a  moil  potent  monarch,  the  king  of  France,  is  a  very  great 
man  •,  I  fay,  knowing  that  1  had  wanted,  for  thefe  five  years  together,  that  it 
has  been  publiffi’d,  this  Treatife  upon  the  ftru&ure  of  the  heart,  its  aflion,. 
and  difeales,  very  generoufly  took  care  that  it  ffiould  be  brought  to  me  quite 
from  Vienna.  Nothing  has  given  me  fo  much  pain,  for  a  long  time  palt,  as 
my  not  being  able  to  get  this  work  into  my  hands  fooner,  elpecially  as  it  was 
on  this  particular  fubjedt,  and  has  inform’d  me  of  many  things  •,  but  I  could 
not  help  being  affe&ed  with  an  ingenuous  ffiame,  and  great  admiration,  when 
1  found,  that  this  very  excellent  man  has  aferib’d  fo  much  to  my  poor  merits, 
as  neither  I  can  by  any  means  acknowledge,  nor  any  one  could  aferibe,  unlefs,. 
perhaps,  the  moft  intimate  and  benevolent  friend  who  was  very  familiar  with 
me,  and  attach’d  to  me  by  every  inftance  ofkindnefs.  However,  though  it 
was  fo  long  out  of  my  power  to  return  at  lead  fome  grateful  refpedl:  for  fo 
much  humanity  fhewn  to  me,  I  do  at  prefent  gratefully  and  iincerely  acknow¬ 
ledge  it,  and  will  never  ceafe  to  do  it  as  long  as  I  live. 

But  now,  as  to  the  fubjebt  of  this  letter,  I  would  not  have  you  be  ignorant, 
that  among  other  diforders,  this  illuftrious  author  has  written  on  the  dropfy 
of  the  pericardium  (x)  with  fuch  copioufnefs  and  accuracy,  with  fuch  ingenuity 
and  judgment,  as  a  difeafe  “  that  is  frequent,  difficult  to  be  known,  and  more 
“  difficult  to  be  cur’d,”  as  he  juftly  fays,  requires.  He  examines  the  caufes, 
nature,  figns,  and  cure  thereof,  feparately  and  clearly  •,  and,  as  to  what  re¬ 
lates  to  the  cure,  he  fo  far  changes  the  place  of  that  remedy  propos’d  by 
Riolanus  (y),  that  neither  the  mammary  artery,  nor  the  heart  could  be 
wounded,  but  water  might  be  drawn  out  of  the  thorax  very  advantageoufly, 
if,  perhaps,  the  dropfy  of  that  cavity  ffiould  have  impos’d  itfelf  upon  us,  at 
any  time,  for  a  dropfy  of  the  pericardium  ;  the  figns  of  which  he  has,  how¬ 
ever,  previoufly  confider’d  with  fo  much  care,  and  even  encreas’d,  in  depen- 
dance  both  upon  the  obfervations  of  others,  fome  of  whofe  writings  are  not  in 
my  hands,  and  upon  his  own,  that  he  teaches  how  far  it  is  poffible  to  diftin- 
guifh  this  dropfy  from  that  of  the  thorax,  and  from  other  difeafes.  How  far 
it  is  poffible,  I  fay,  for  he  does  not  think  that  he  has  remov’d  all  difficulties  ; 
and  if  I  did  think  fo,  fays  he  fhrewdly,  I  fhould  fhew  that  I  did  not  Efficient¬ 
ly  underhand  them.  But  why  ffiould  I  fay  more  upon  this  head  ?  fince  I 
fhall  let  you  have  the  perufal  of  this  excellent  work,  as  foon  as  ever  I  have 
made  ufe  of  his  dottrine  and  authority  in  revifing  fome  other  letters,  which  I 
wiffi  it  had  been  in  my  power  to  do  in  this.  You  however,  when  you  come 
to  read  this  treatife,  will  find  many  paffages  by  which  you  may  confirm  v/hat 
I  have  faid  to  you  in  this  letter  :  but  if  you  ffiould  happen  to  light  on  any* 
where  our  opinions  are  fomewhat  different,  take  it  for  granted  it  will  be  very 
agreeable  to  me,  thai  you  fhould  chufe  rather  to  be  of  the  fame  opinion  with 
fo  great  a  man,  than  with  me.  Again  farewel. 

(*)  1.  4.  ch.  5.  ( y )  fupra,n.  48. 


LETTER 


Letter  XVII.  Article  i. 


427 


LETTER  the  SEVENTEENTH 


Treats  of  Refpiration  being  injur’d  from  Aneurifms  of  the 
Heart,  or  the  Aorta,  within  the  Thorax. 


1.  T^TOW  t^ie  *nternal  aneurifms  of  the  thorax  are  to  be  treated  of,  which 
not  only  comprefs  the  lungs  by  their  bulk,  and  pervert  the  motion 
of  the  blood  through  them,  but  even  often  overload  the  diaphragm  by  their 
weight,  fo  that  they  are  injurious  to  refpiration  in  many  ways.  The  prin¬ 
cipal  and  more  frequent  of  thefe  are  the  dilatations  of  the  heart  and  the  aorta. 
But  before  I  proceed  to  give  you  any  obfervations  re'ative  thereto,  I  muft  en¬ 
deavour  to  give  an  anfwer  to  a  kind  of  tacit  interrogation  that  you  have  made, 
1  mean,  whence  it  could  happen,  fince  thefe  diforders  are  fo  frequent  as  1  fay 
they  are,  that  no  certain  or  particular  mention  is  m.  de  of  them  among  the 
more  ancient  phyficians  ;  for  as  to  the  paffage  that  we  read  in  the  fir  ft  book 
De  Morbis  (a),  which  perhaps  fomebody  might  fuppofe  to  have  relation  to 
thefe  diforders,  where  it  is  faid,  that  fometimes  4  a  kind  of  varix”  happens 
of  a  vein  in  the  lungs,  and  might  fay,  at  the  lame  time  alfo.  that  by  the  term 
of  a  vein,  an  artery  is  to  be  underdo  d  -,  as  they  were  wont,  in  ancient  time, 
to  comprehend  both  under  one  name;  this  perfon,  whoever  he  may  be,  if 
he  reads  over  all  which  is  faid  there,  will  acknowledge,  that  thofe  dilatations, 
referred  to  in  that  book,  are  meant  for  dilatations  ot  the  veins,  and  thole  of 
fuch  a  kind  too,  that  when  they  are  at  length  ruptur’d,  they  do  not  bring  on  a 
ipeedy  death  by  pouring  out  a  great  quantity  of  blood,  but  a  (low  ling  ring 
death,  by  leaving  ulcers  behind  them,  and  making  the  lungs  purulent  Nor 
did  Martianus  (£),  nor  before  him  Salius  (r),  underhand  it  in  any  other  light. 
Moreover,  as  we  read  foon  after,  in  the  fame  place,  that  the  veins  of  the 
fide  alfo,  44  become  varicole,  and  are  internally  elevated  ;”  Salius  puts  us  in 
mind,  when  upon  this  paffage  (J),  that  thofe  are  pointed  out  in  this  manner  by 
Hippocrates,  44  which  are  feated  internally  upon  the  furface,”  left  any  one 
fhould  perhaps  fuppofe  that  he  meant  thofe  44  which  creep  through  the  inter- 
44  mediate  fpaces  of  the  ribs,  and  other  internal  fpaces,”  where,  without 
doubt,  it  has  been  obferv’d  by  fucceeding  phyficians,  that  dilatations  of  the 
intercoftal  arteries  are  fometimes  brought  on  :  and  indeed,  patients  are  faid, 
by  that  molt  ancient  phyfician,  to  become  44  luppurated  ”  from  a  rupture  of 
thefe  varicofe  veins.  But  in  the  book  alfo  De  Affefticnibus  internis  (e),  where 
“  a  varix  in  the  lungs,”  its  fymptoms  and  cure  are  fet  forth,  if  the  difeafe  does 
not  remit  after  the  firft  fourteen  days,  44  the  fame  remedies”  are  indicated  to 

(<-)  Comment-,  in  ejufd.  1.  S.  3.  t.  19.  &  feqq. 
(d)  Ibid,  ad  t.  22.  (e)  n.  5. 


(a)  n.  10.  apud  Markiell. 

(/’)  Annor,  ad  ci t.  1,  verf.  219. 


1  i  i  2 


be 


428  Book  II.  Of  Difeafes  of  the  Thorax. 

be  made  ufe  of,  which  are  made  ufe  of  44  in  him  who  has  a  fuppuration  in  the 
“  lungs.”  But  if,  neverthelels,  any  one  would  diftorr  all  thefe  paffages,  fo 
as  to  make  them  fignify  aneurifms ;  yet  this  will  be  not  fufficiently  certain, 
though  fome  are  of  a  contrary  opinion  ;  or  if  we  fuppofe  it  certain,  it  is  ftill 
uncertain,  whether  it  was  put  down  from  conjecture  rather,  or  from  dif- 
feCtions,  efpecially  as  beads,  which  us’d  at  that  time  generally  to  be  cut 
open,  and  examin’d,  inftead  of  human  fubjects,  are  very  ieldom  taken  with 
fuch  diforders  as  thele  :  and  finally,  thofe  diforders  which  I  laid  were  pretty 
frequent,  and  of  which  you  enquire  at  prefent,  relate  to  dilatations  of  the 
heart,  and  great  artery,  and  not  to  others.  And  the  chief  reafon  that  thefe 
were  not  mention’d  by  thofe  ancient  phyficians,  I  fuppofe,  was  the  very  reafon 
which  I  touch’d  upon  juft  now. 

2.  For  after  that,  in  order  to  renovate  anatomy,  human  bodies  began,  at 
length,  to  be  more  frequently  differed,  mention  alfo  began  to  be  made  of 
thofe  diforders.  At  leaft,  I  fee  that  one  is  pointed  out,  as  being  differed,  in 
the  year  1534,  by  Nicolaus  Mafia  (/),  44  which  had  the  heart  enlarg’d  to  fo 
“  great  a  magnitude,  that  he  had  never  feen  the  like  in  another  man  and 
by  Vefalius  (g),  tc  the  heart  of  a  very  learn’d  man,  in  whofe  left  ventricle  he 
11  found  almoft  two  pounds  of  glandular,  but  at  the  fame  time  black ifh  fiefh, 
“  the  heart  being  like  the  uterus  extended  to  the  bulk  of  that  fiefh.”  And 
I  alfo  find,  that  Carolus  Stephanus  (b)  faw,  44  in  the  carcafe  of  a  patient,. 
44  part  of  whole  lungs,  on  the  right  fide,  by  reafon  of  fome  injury  or  other, 
44  was  altogether  confum’d  and  corroded,  the  auricle  of  the  heart  on  the 
44  fame  fide,  which  had  grown  out  into  fo  large  a  magnitude,  that  it  feem’d 
44  to  be  three  times  larger  than  the  other.”  After  thefe  I  find  others  alfo, 
and  in  particular  Ballonius,  who  has  fpoken  of  the  heart  (/),  44  as  being 
“  equal  to  the  magnitude  of  a  pretty  large  head  and  another,  as  you 
have  it  in  the  Sepulchretum  (, k ),  fo  diftended  with  its  valves,  44  and  great 
4i  artery,  that  it  feem’d  to  be  triply,  or,  at  leaft,  doubly  greater  than  it  us’d 
44  to  be.”  Andreas  Laurentius  (/)  found,  in  the  chevalier  Guicciardini, 
44  that  the  heart  had  grown  to  fuch  a  vaft  bulk,  as  to  become  almoft  a  pro- 
44  digy,  and  to  take  up  nearly  the  whole  cavity  of  the  thorax,  both  the 
44  finufies  of  the  heart  being  diftended  with  blood,  to  almoft  the  quantity  of 
44  three  or  four  pounds.”  But  this  cafe,  and  after  that  others,  fo  much  the 
more  frequently,  as  bodies  were  more  frequently  differed,  have  been  taken 
notice  of  by  others,  in  different  places,  who  have  added  with  fo  much  the 
greater  accuracy  what  had  preceded  in  the  living  body,  as  the  knowledge 
thereof  is  more  ufeful  to  be  join’d  with  the  difiedlion,  and  yet  more,  if  you 
except  Vefalius  and  Ballonius,  negletted  by  thofe  who  had  gone  before 
them. 

3.  Nor  did  the  certain  knowledge  of  the  dilatation  of  the  aorta  come  to 
phyficians  in  any  other  way.  Thus  Vefalius,  for  example’s  fake,  having  ob- 
lerv’d  a  certain  pulfating  tumour  about  the  vertebras  in  the  back,  in  conle- 
quence  of  thofe  things  which  he  had  obferv’d  before,  in  external  aneurifms, 

(/)  Epid.  1.  2.  in  Conflit.  Autumn.  A.  1575. 

(k)  L.  2.  S.  8.  Obf.  26.  §  2. 

(l)  Hill.  Anat.  hum.  to  p.  1.  9.  qu.  18. 

faid, 


(f)  Lib.  Introd.  Anat.  c.  28. 

(o)  De  corp.  hum.  fabr.  1.  1.  c.  5. 

(/?)  De  difT.  part.  corp.  hum.  1.  2.  c.  33. 


Letter  XVII.  Article  3.  429 

laid,  that  there  was  an  aneurifm  “  from  a  dilatation  of  the  aorta.”  But  the 
phyficians,  neverthelefs,  did  not,  beyond  a  doubt,  know,  that  Vefalius  had 
pronounc’d  the  truth,  till,  when  the  patient  was  dead,  they  found  this  ar¬ 
tery  io  dilated,  that  “  it  was  almoft  as  big  as  an  oftrich’s  egg,”  as  you  will 
know  even  from  the  Sepulchretum  itfelf  (w),  from  which  you  will  alfo  un¬ 
derhand  what  that  aneurifm  contained,  and  how  far  it  had  vitiated  the  neigh- 
b’ring  vertebras,  and  ribs.  This  was  feen  in  the  year  1557  :  and  thus  weight 
was  added  to  what  Fernelius  had  written,  where  he  taught  (#),  that  the  pal¬ 
pitation  of  the  heart  “  had  often  dilated  the  artery  outwards,  into  an  aneu- 
“  rifm  of  the  bignefs  of  a  clench’d  fill,  in  which,  both  to  the  fight  and  to 
“  the  touch,  there  was  a  puliation  confpicuous  f  ’  and  alfo,  where  lpeaking  of 
external  aneurifms,  he  fubjoins  thefe  words  (0)  :  “  An  aneurifm  likewife 
“  happens,  fometimes,  in  the  internal  arteries,  efpecially  under  the  breaft, 
“  about  the  fpleen  and  mefentery,  where  a  vehement  pulfation  is  often  ob* 
“  ferv’d.”  For  he  might  have  laid  thefe  things  merely  from  conjecture  :  nor 
is  every  pulfation,  certainly,  though  vehement,  owing  to  an  aneurifm,  as 
will  be  fhewn  hereafter  by  our  oblervations  alfo(y>).  If  it  had  been  other- 
wife,  that  excellent  phyfician,  Ballonius,  who  “  never  in  his  remembrance 
“  had  laid  his  hand  upon  fo  highly  a  palpitating,  and  pulfating  hypochon- 
“  drium,”  as  in  Joannes  Formageus,  would  never  have  fufrer’d  himfelf  to 
be  fo  far  deceiv’d,  as  not  to  have  acknowledg’d,  that  an  aneurifm  lay  be¬ 
neath,  except  from  the  fudden  death  and  diffeCtion  of  the  patient,  as  he 
candidly  confeffes  in  his  Confilium  (<y),  written  in  the  year  1575.  I  fuppofe  he 
had  attended  to  the  great  number  of  paffages  in  Hippocrates,  more  than  to 
any  thing  elfe,  that  are  quoted  in  that  Confilium ,  and  in  th z  Annotationes  {r)^ 
or  are  at  ieall  pointed  out,  in  which  the  pulfation  of  the  hypochondrium,  or 
the  other  parts  of  the  belly,  are  treated  of,  that  are  fometimes  fo  great  as 
“  not  to  be  generated  either  from  running,  or  from  fear  affeCting  the 
“  heart  (/).”  All  which  paffages,  if  you  will  attentively  read  them  over, 
you  will  find,  belong  either  to  the  fymptoms  of  acute  difeafes,  or,  if  they 
relate  to  other  difeafes  (/),  that  they  do  not,  certainly,  relate  to  aneurifms. 

But  after  that  diffeCtion,  in  which  the  aneurifm  was  found  according  to  the 
prediction  of  Vefalius,  fome  other  obfervations  were  made,  in  that  very  age, 
which  relate  to  the  fame  diforder.  Among  thefe,  however,  be  cautious  how 
you  reckon  up,  without  any  hefitation  (a),  as  Freind  feems  to  do(x),  that 
of  Parey  (jy) :  for  Parey  fays,  that  he  had  Found  a  dilatation  of  the  pulmo* 
nary  vein,  to  which  if  he  did  not  give  the  name  of  varix,  but  that  of 
“  aneurifm,”  he  might  doubtlefs  do  it  for  the  very  fame  reafon  that  he,  ac¬ 
cording  to  the  cuftom  of  thofe  times,  call’d  that  vein  bv  the  name  of  the 
arteria  vencfa.  But  bcfides  that  of  Ballonius,  which  I  havefpoken  of  above(^), 
and  ethers  of  the  fame  Ballonius,  on  a  merchant  (<3),  and  on  a  cook  (£),  and 


(m)  L.  4.  S.  2  Obf.  21.  §  7. 

(n)  Patholog.  1.  5.  c.  12. 

(0)  Ibid.  1.  7.  c.  3. 

(/)  Epift.  24.  n.  34.  &  feqq. 

(?)  io7  •  h  f- 
(?  )  5,  Sc  6. 

(.<)  Epidem.  Hippocr.  1.  7.  in  Eratclai  iilio. 


(/)  Vid.  etiam  Valltfii  Comment,  in  cit  lo¬ 
cum.  n.  4.  Sc  in  1.  5.  Epid.  n.  1 1. 

(u)  Vid.  Epift.  24.  n  35. 

(V)  Hift.  de  la  Medec.  P.  I. 

(y)  Optr.  1.  6.  c.  32. 

(2)  N.  2. 

[a)  Paradigm.  »3. 


of 


43°  Eook  II.  Of  Difeafes  of  the  Thorax. 

of  others  who  liv’d  in  that  age,  you  will  do  very  well  in  reckoning  up  with 
Freind  (c),  who  follows  Lancifi  (d),  that  very  fame  obfervation  of  Laurentius 
on  the  chevalier  Guicciardini,  which  I  have  in  like  manner  mention’d  above(^), 
who,  as  he  had  the  heart  fo  dilated,  fo  he  alfo  had  “  the  mouth  of  the  great 
«  artery  fo  much  enlarg’d,  as  to  be  equal  in  bignefs  to  the  arm.”  This  is 
that  obfervation,  which,  in  the  French  tranflation  of  Freind’s  hiftory,  “  is 
“  faid  to  be  a  cafe  that  is  to  be  found  in  Laurentius,  publifh’d  by  Guicciar- 
“  dini  j”  which  is  a  new  information  to  us,  how  carefully  every  learn’d 
author,  a  little  before  our  memory,  confulted  his  own  fafety,  by  writing  in 
the  Latin  idiom,  which  is  well  known  to  other  learn’d  men. 

4.  However,  in  that  fixteenth  century,  and  great  part  of  the  feventeenth, 
which  follow’d,  the  dodtrine  of  the  dilatation  of  the  aorta  made  fo  flow  a 
progrefs,  that  in  the  year  1595,  when  Johannes  Baptifta  Sylvaticus  publifti’d 
his  “  Treatife  of  the  aneurifm,”  he  mention’d  nothing  of  them,  though  he 
treated  the  fubjedt  of  aneurifms  at  large,  and  in  a  general  way  •,  and  many 
years  after  Jo.  Riolanus(/)  aflerted,  “  that  an  aneurifm  happen’d  but  fel- 
“  dom  in  the  trunk  of  the  aorta,  by  reafon  of  the  thicknefs  of  the  coats:” 
and  moreover,  in  the  year  »670,  Joach.  Georg.  Elfnerus,  in  other  refpedls  a 
learn’d  phyfician,  when  he  defcrib’d  an  aneurifm  of  the  aorta,  found  by 
Gulielmus  Riva,  prefix’d  by  way  of  title  to  his  obfervation,  De  Paradoxico 
Aneurifmate  Aortico ,  and  made  no  fcruple  to  affirm,  that  an  aneurifm  happens 
“  feldom  or  never  in  the  larger  arteries,  and  that  it  feem’d  wonderful  fuch 
“  a  thing  could  be  excited  even  in  the  aorta  itfelf  alfo.”  And  this  is  the 
obfervation  which  Lancifi  meant  to  point  out  (g),  when  he  faid,  that  the 
aneurifm,  obferv’d  by  Riva,  “  was  exprefs’d  in  a  table,  and  inlerted  in  the 
sc  eighteenth  obfervation,  under  the  care  and  infpeddon  of  a  German.”  For 
the  name  of  Ephemerides  Germanic a  Natura  cur  to  forum,  is  either  omitted  in 
that  place  through  the  fault  of  the  printers,  or  is  fo  far  corrupted,  as  I  have 
defcrib’d  to  you,  juft  as  we  fee  many  other  corruptions  of  that  kind,  in  the 
pofthumous  writings  of  this  great  man. 

But  from  that  year  1670,  quite  down  to  our  times,  the  anatomifts  taking 
more  and  more  pains,  fo  many  obfervations  were  added  to  the  former,  that 
dilatations  of  the  aorta  began  to  be  efteetn’d  no  longer  rare,  or  wonderful. 
And  we  are  at  the  fatue  time  come  to  luch  a  point,  that  the  caufes,  occalions, 
and  figns  of  thefe  dilatations,  being  frequently  animadverted  upon,  and  at¬ 
tended  to,  this  difeafe,  of  which  the  ancient  phyficians,  as  you  fee,  had  not 
the  lead  knowledge,  and  which  firft  began  to  be  known  in  the  fixteenth 
century,  and  then  not  till  it  began  to  appear  by  elevating  thepaiietes  of  the 
thorax,  and  to  betray  itfelf  by  tumour  and  pulfation,  we  now  believe  we 
can  diftinguifh,  and  indeed  often  do  diftinguifh,  when  it  is  as  yet  very 
fmall,  and  entirely  hidden,  within  the  recedes  of  the  thorax.  For  which 
reafon,  Malpighi  was  by  no  means  to  be  blam’d  (h)  for  recounting  among 
“  the  improvements  of  his  age,”  which  was  alfo  in  part  mine,  “  the  know- 


(£)  Ibid.  26. 

(<r)  P.  cit. 

(d)  De  Subit.  Mort.  Schol.  ad  Obf.  ult. 
n.  8. 


(e)  N.  2. 

(J)  Encheir.  Anat.  1.  5.  c.  46. 

(g)  De  Aneur.  1.  2.  c.  2.  Prop.  21. 

\h)  Refp.  ad  Epift.  de  Rec.  Med.  S  ud. 


“  ledge 


4 


4 


Letter  XVII.  Article  $•  :  431 

ledge  of  dilatation  of  the  aorta much  lefs  was  it  to  be  objedled  to  him, 
“  that,  in  the  ancient  Greek,  Latin,  and  Arabic  fchools,  aneurifms  were 
“  known,  and  all  the  books  of  the  ancients  fpoke  of  aneurifms.”  For  the 
queftion  was  not  of  external  aneurifms,  but  of  internal  ones,  and  particu¬ 
larly  thofe  of  the  aorta  itfelf.  Concerning  which,  if  any  one  out  of  any  of 
thefe  three  fchools  had  left  any  writing,  it  certainly  would  not  have  efcap’d 
Sylvaticus,  who  in  that  treatile  of  his  fhews  himfelf  fo  well  vers’d  in  the 
reading  of  each  of  them.  For  as  to  what  Act: us  ( 1 )  has  written,  that  an 
aneurifm  “  may  happen  in  any  part  of  the  body,”  there  is  no  doubt  but 
“  external  ”  (hould  be  there  underftood  ;  as  is  evident,  not  only  from  his 
treating  of  external  tumours  in  that  difcourfe,  but  alfo  from  his  perpetual 
filence  of  internal,  and  fo  much  more  dangerous,  aneurifms  j  whereas  even 
he  gives  the  figns  of  external  aneurifms,  and  the  method  of  cure. 

5.  Lancifi  (£),  therefore,  has  with  juftice  written,  whereas  Hippocrates 
“  made  no  mention  of  aneurifms  of  the  arteries,”  and  whereas  “  in  Galen, 
“  Paulus,  Oribafius,  Aetius,  Adtuarius,  and  Avicenna,  many  examples  of 
“  this  diforder  in  the  arteries  are  read  of 5  yet  in  thefe  very  writers,  as  far 
“  as  he  could  fee,  there  was  a  total  filence  upon  aneurifms  of  the  heart,  and 
“  the  great  vefiels  thereof,  which  fince  that  time  have  been  known  to  the 
u  more  modern  furgeons  and  phyficians,  by  the  frequent  difiedtion  of  dead 
“  bodies.”  Some  obfervations  of  which,  he  himfelf  has  mention’d,  as  I 
faid  he  had  done  in  regard  to  the  oblervations  of  Laurentius,  and  Riva  (/) ; 
and  that  he  did  the  fame  in  relation  to  the  obfervations  of  Harvey,  and  Mar- 
chetti,  and  others  in  like  manner,  you  will  fee  of  yourfelf,  by  infpedting  his 
books  (m).  For  he  certainly  never  pretended  to  conceal,  that  the  dilatations 
of  the  heart,  as  well  as  thofe  of  the  aorta,  were  known  before  his  time. 
He  only  complain’d  (»),  that  the  hiftories  which  he  had  read  among  medical 
oblervations,  of  the  dilatations  of  the  heart,  were  lefs  fully  and  accurately 
deferib’d,  than  was  requir’d  for  others,  and  for  himfelf  in  particular,  who 
was  about  to  propol'e  the  dodtrine  of  them  as  abfolute,  as  far  as  it  was  pof- 
fible  for  any  dodtrine  to  be  fo.  But  he  call’d  thefe  dilatations  aneurifms  of 
the  heart  •,  which  names  I  fhall  alfo  ufe  promifeuoufly  with  each  other,  not 
only  becaufe  I  would  not  here  willingly  be  drawn  into  that  difpute,  what 
the  Greek  phyficians  ftridtly  meant  by  the  word  aneurifm,  but  alfo  becaufe 
it  is  but  juft  and  natural  to  attribute  fometbing  to  a  man  who  was  extremely 
meritorious,  if  any  other  perfon  was,  in  regard  to  the  dodtrine  of  aneurifms  1 
efpecially  as  we  fee  that  the  molt  eminent  and  learn’d  phyficians  have  fol¬ 
low’d  his  cuftom  *,  unlefs  you  perhaps  fuppofe  that  Ballonius,  in  the  firft 
book  of  his  Confilia,  not  as  it  is  in  the  Sepulchretum  (0),  “  chapter  the  fif- 
“  teenth,”  but  in  the  hundred  and  ninth  of  the  Confilia,  had  formerly  hinted 
the  fame,  when  he  wrote,  that  “  if  there  be  an  aneurifm  in  the  heart  itfelf,” 
the  diforder  is  mortal. 

I  (hall  give  you  firft,  according  to  cuftom,  the  obfervations  of  Valfalva 
upon  aneurifms,  and  then  my  own,  and  diftribute  them  in  fuch  order,  that- 

(/')  Medic.  Tetrab.  4.  Serm.  3.  c  10.  ( m )  Schol.  ad  obf.  2.  Repent.  Mort.  n.  ii. 

(<£)  De  Aneur.  1.  1.  Prop.  2.  Sc  de  Aneur.  1.  2.  c.  6.  Prop.  48. 

(/j  n.  3.  &  4.  ( n )  Ibid. 

(0)  1.  2.  S.  8.  in  SchcJ,  ad  obf.  27. 

in 


i 


43-  Book  IT.  Of  Difeafes  of  the  Thorax. 

in  the  firft  place,  I  (hall  produce  the  aneurifms  of  the  hearc ;  in  the  fecond 
place,  thofe  of  the  great  artery,  and  in  the  third  place,  the  aneurifms  of 
both,  and  yet  not  all  that  we  have;  lor  many  of  them  it  will  be  more  con¬ 
venient  to  defer  to  other  letters,  and  to  thoie  in  particular,  in  which  I  fla.aU 
fpeak  of  fudden  death  (p).  But  here  I  fhali  deicribe  thofe,  which  relate  to 
injur’d  refpiration,  illu  It  rating  this  new  doctrine,  as  tar  as  lies  in  my  power. 
44  Amongft  us,  fays  Albertini  (q)>  who  was  very  deferving  in  regard  to  this 
fame  do&rine,  44  formerly,  in  the  cafe  or  injur’d  refpiration,  the  names  of 
44  a  vitiated  ftruCture  of  the  heart,  and  praecordia,  were  unheard  of.  But 
44  after  obfervations  being  feveral  times  repeated  in  dead  bodies,  the  fame 
44  names  are  too  much  heard  of,  and  too  much  dreaded  in  the  living.” 
That  thefe  dilatations  therefore  may  not  ra(hly  be  concluded  to  exift  in  thofe 
where  they  are  not;  and  on  the  contrary,  that  they  may  be  more  readily  ac¬ 
knowledg’d  in  thole  where  they  are,  it  will  be  of  ufe  to  compare  the  obfer¬ 
vations,  which  l  have  comprehended  in  the  two  lalt  letters,  with  thofe  which 
1  fhali  produce  in  this,  and  the  following. 

6.  An  old  man,  about  fifty  years  of  age,  of  an  athletic  body,  but  of  a 
palifh  complexion,  began  to  complain  of  a  pain  opprefling  the  thorax,  par¬ 
ticularly  on  the  left  fide,  on  which  he  could  not  lie.  He  cough  d  ircquently, 
but  not  vehemently,  and  fpat  up  a  kind  of  ferous  matter.  He  was  in  like 
manner,  troubl’d  with  opprefiions  of  his  cheft,  with  difficulty  of  r-  fpiration, 
.and  with  anxieties  of  the  heart.  The  pulfe  was  at  firft,  indeed,  flow,  and 
hard,  vehement  and  chord-like,  but  afterwards  became  more  quick,  and  un¬ 
equal,  the  hardnefs  Hill  remaining.  The  abdomen  was  not  tumid,  but  yet 
tenfe.  He  died.  The  belly  contain’d  water.  But  although  the  fpleen  was 
fo  clofely  connected  to  the  liver,  that  it  could  fcarcely  be  feparated  without  la¬ 
ceration  ;  yet  thefe  two  vifeera,  and  the  neighbouring  vifeera  alfo,  were  found. 
Through  the  inteftines  and  mefentery  were  no  lymphaeduCts  obferv’d  ;  thro* 
the  emulgent  vefiels  a  few  were  confpicuous;  but  throughout  the  great  trunks 
of  the  vefiels,  in  the  region  of  the  loins,  many  appear’d,  and  thole  very  tur¬ 
gid.  In  the  thorax  was  a  ferous  humour,  efpecially  in  the  left  cavity,  which 
was  entirely  fill’d  therewith.  The  lungs  were  ting’d  with  a  black  colour, 
and  every  where  diftinguifh’d  with  blackiffi  fpots,  yet  preferv’d  their  natural 
ioftnefs.  The  heart  was  immoderately  large  ;  but  the  right  auricle  itfelf  was 
equal  in  bignefs  to  half  the  heart.  And  this  being  wounded,  the  blood  burft 
forth  in  a  . fluid  ftate,  as  if  from  the  living  body.  Yet  a  great  part  of  the 
auricle  was  occupied  by  a  fofc  polypous  concretion,  which  had  been  pro¬ 
duc’d  from  the  neighbouring  ventricle,  in  which  was  alfo  a  portion  of  con¬ 
creted  blood.  The  left  ventricle  alfo  contain’d  concreted  blood,  but  more 
{lightly  condens’d.  The  great  artery,  where  it  delcended  in  the  courfe  of 
the  vertebra;  of  the  back,  was  remov’d  from  its  fituation,  to  the  fpace  of 
about  two  fingers  breadth,  in  its  longitudinal  direction. 

7.  Whether  this  feparation  was  an  original  disjunction,  or  whether,  as 
there  was  only  a  lefs  drift  connexion  in  that  part,  the  vehemence  and  vibra¬ 
tion  of  the  pulfe,  being  added  to  this  native  difpolition,  the  artery  was  dif- 
join’d  thereby,  is  not  eafy  to  determine. 

(•/)  Epift,  26.  &  27.  (?)  Comment,  de  Eonon.  Sc.  Acad.  Tom.  i.  in  Opufc. 


But 


Letter  XVII.  Articles  8,  9.  433 

But  although  it  may  be  doubtful,  whether  the  dilatation  of  the  heart,  and 
right  auricle,  preceded  the  dropfy  of  the  thorax,  or  the  dropfy  of  the  thorax 
preceded  that  i  yet,  to  me  it  is  more  probable,  that  the  diforders  of  the 
heart  were  prior  to  the  other,  whether  I  confider  what  the  firfl:  pulfes  were, 
or  how  much  more  eafy  it  is  for  a  dropfy  to  happen,  from  thefe  diforders, 
than  for  thefe  to  happen  from  a  dropfy.  Turn  to  Lancifi  (r),  and  fee  what 
things  he  lays  upon  the  aneurifms  of  the  veifels  near  to  the  heart,  and  tranf- 
fer  them  to  the  aneurifms  of  the  heart  itfelf,  efpecially  in  thofe,  in  whom, 
as  in  this  pallid  old  man,  there  was  a  difpofition  to  a  dropfy.  Nor  would  I 
have  you  aferibe  fo  much  to  the  pain  opprefTing  the  thorax,  efpecially  in  the 
left  fide,  on  which  he  could  not  lie,  that,  forgetful  of  the  heart  being  im¬ 
moderately  increas’d,  and  efpecially  of  its  right  auricle,  you  judge  that  thofe 
things  are  to  be  accounted  for,  entirely,  from  the  fluid  occupying  the  thorax, 
and  more  on  the  left  fide  than  on  the  other ;  for  that  would  rather  have 
hinder’d  the  patient,  as  it  generally  does,  from  lying  on  the  right  fide,  than 
on  the  left. 

8.  A  man,  of  fixty  years  of  age,  was  feiz’d  with  an  orthopnoea.  Scarcely 
could  he  complain  of  an  opprefiion  of  the  thorax.  The  pulfe  did  not  vary 
from  the  law  of  its  natural  motions.  At  length  the  difficulty  of  refpiration 
growing  more  and  more  grievous,  every  day,  he  died  on  the  fixth  day. 
The  thorax  being  open’d,  the  lungs  were  found  to  be  fomevvhat  hard,  on  the 
back-part,  and  ting’d  of  a  black  colour.  The  heart  was  very  large,  and 
contain’d  a  large  polypous  concretion,  in  the  right  ventricle ;  which  being 
expanded  into  the  neighb’ring  auricle,  had  fo  dilated  this  cavity,  that  it 
was  equal  in  fize  to  a  large  purfe :  and  fent  long  produftions  into  the  neigh¬ 
b’ring  vefiels,  fo  that  a  proper  quantity  of  blood  could  not  readily  be  con¬ 
tain’d  therein. 

In  the  belly,  above  the  left  kidney,  a  round  tumour  appear’d,  which  was 
indeed  tied  to  the  other  neighb’ring  parts  firmly,  by  membranes,  and  ad¬ 
her’d  fo  clolely  to  the  ren  fuccenturiatus,  as  in  one  part  to  make  a  continu’d 
body  therewith.  It  confided  of  a  glandular  fubftance,  which  in  its  centre  had 
two  finufles,  diftindt  from  each  other,  and  containing  a  kind  of  ferous  hu¬ 
mour.  A  portion  of  which,  being  fet  upon  the  fire,  coagulated  :  another 
portion  having  fome  fpirit  of  fulphur,  as  it  is  call’d,  added  to  it,  by  de¬ 
grees  became  of  a  black  colour,  and  let  fall  a  fediment,  and  in  the  fpace  of 
many  hours  was  entirely  concreted  ;  a  third  portion,  having  fpirit  of  fait  am¬ 
moniac  mix’d  with  it,  continu’d  Fill  fluid  as  before. 

9.  Whether  this  tumour  was  part  of  the  ren  fuccenturiatus  only,  is  of  lefs 
confequence,  perhaps,  to  enquire  here,  where  we  are  ignorant  of  what  had 
preceded,  relating  to  that  part,  than  to  conjedlure,  what  was  the  opinion  of 
Vall'alva,  in  regard  to  fome  parts  of  this  hifiory.  For  as  in  defcribing  it,  I 
have  taken  great  care,  as  ufual,  not  to  add  any  thing  to  his  opinion,  or  take 
away  any  thing  from  it,  fo  after  I  have  faithfully  done  this,  now  I  think  it 
is  free  for  me  to  underftand  the  thing  fo,  that  when  he  fays  the  patient  died 
on  the  fixth  day,  1  luppofe  he  means  on  the  fixth  day  from  the  time  that  he 
began  to  breathe  with  his  neck  upright,  or  was  receiv’d  into  fome  hofpital: 


VOL.  I. 


(r)  De  Aneur.  J.  z.  in  fin. 

Kkk 


and 


4  34  Book  II.  Of  Difeafes  of  the  Thorax. 

and  as  to  what  he  fays,  that  he  could  fcarcely  complain  of  any  opprefiion  at 
his  breaft,  1  Pnall  underhand  it  in  this  manner  i  not  that  he  had  no  opprefiion 
at  all,  but  rather  fuppofe  it  to  have  been  lb  great,  that  by  reafon  of  the  diffi¬ 
culty  of  breathing,  he  could  fcarce  fpeak  fo  as  to  complain  of  it.  But  as  to 
the  pulfe,  which  was  not  vehement,  and  chord  like,  as  in  the  former,  or  in 
regard  to  the  dropfy,  which  did  not  equally  follow,  I  would  not  have  you 
wonder  greatly  ;  for  either  difpofition  or  time  might  be  wanting  for  the  latter 
to  take  place  •,  and  the  heart,  either  by  reafon  of  the  right  auricle  being  ener¬ 
vated,  inafmuch  as  it  was  expanded  into  the  form  of  a  great  purfe,  receiv’d 
lefs  blood,  or  the  magnitude  of  the  fame  heart  was  owing  rather  to  the  ven¬ 
tricle  being  enlarg’d,  than  to  the  parietes  being  at  the  fame  time  made  thick¬ 
er  *,  not  to  fay  any  thing  here  of  the  more  large  and  certainly  lefs  mucous 
concretions,  which  not  only  occupied  the  heart,  but  the  vefiels  alfo  :  and  al¬ 
though  they  had  not  begun  to  be  form’d  before  thofe  laft  days  of  the  man’s 
life,  yet  Valfalva  could  not  have  examin’d  the  pulfe,  except  on  thefe  very 
days. 

10.  A  girl  of  thirteen  years  of  age,  who  from  her  birth  had  been  almofi: 
always  a  valetudinarian,  began  in  the  lafi;  months  to  complain  of  a  laborious 
refpiration,  attended  with  a  confiderable  cough,  a  fpitting  of  thick  matter, 
and  a  fwelling  of  the  abdomen.  Befides  all  this,  on  the  lafi;  days  of  her  life, 
fhe  became  much  more  thirfty,  and  very  hungry  •,  but  after  food,  a  great 
tenfion  of  the  abdomen  came  on  ;  her  pulfe  was  quick,  hard,  and  fmall  *,  and 
the  tightnefs  and  opprefiion  of  her  cheft  were  fo  very  violent  at  times,  that 
more  than  once  (he  rofe  up  fuddenly  from  her  bed,  fighing  and  groaning. 
At  length,  being  feiz’d  with  one  of  thefe  paroxyfms,  fhe  died  fuddenly  with  a 
great  clamour  and  impetuofity.  In  her  belly  was  a  great  quantity  of  yellow 
ferum  extravafated  •,  the  ftomach  and  the  inteftines  were  very  much- difiended 
with  air ;  the  fpleen  was  very  hard,  and  of  a  black  colour  ;  the  left  kidney, 
internally,  was  in  fome  meafure  inflam’d  •,  the  thorax  contain’d  fo  much  fe¬ 
rum,  that  while  the  cartilages  were  cut  through  at  the  fternum,  it  burft  forth. 
There  was  a  large  thymus  ;  the  lungs  were  found,  except  that  the  fubftance 
of  the  left  lobe  had  grown  fo  hard,  near  the  larger  bronchia,  as  to  referable 
folid  flefh  ;  the  pericardium  contain’d  four  or  five  ounces  of  yellowifh  ferum ; 
and  the  right  auricle  of  the  heart  had  fuch  a  quantity  of  blood  within  it,  that 
it  was  difiended  fo  as  to  equal  almofi  the  bignefs  of  the  heart.  Both  of  the 
ventricles  contain’d  a  polypous  concretion,  extremely  fimilar  to  a  condens’d 
mucus ;  but  that  in  the  right  was  the  largeft.  As  to  what  remains,  the  fe¬ 
rum  both  of  the  pericardium  and  the  belly,  when  put  upon  the  fire,  evapo¬ 
rated,  leaving  only  a  cruft  behind  it,  which  adher’d  to  the  fides  and  the  bot¬ 
tom  of  the  vefifil  ;  but  the  other  left  a  thinner  cruft  immediately,  and  this 
cruft  was  diftinguifh’d  here  and  there  with  fome  ftriae  difpos’d  in  the  manner 
of  chryftailiz’d  nitre. 

11.  It  is  probable  that  this  girl  had,  from  her  original  formation,  not  only 
humours  but  little  falubrious  and  mild,  but  alfo  a  lax  and  weak  ftru&ure  of 
the  parts,  and  efpecially  of  the  right  auricle  from  which  caufes  (lie  was  almofi 
always  a  valetudinarian,  till  that  auricle  being  relax’d  into  an  aneurifmatic 
date,  a  dropfy  of  the  pericardium,  thorax,  and  belly  eafily  came  on,  in  fuch  a 
conftitution  of  body  ;  fo  that  (fie  was  carry’d  off,  not  by  one  difeafe  only,  but 

by 


Letter  XVII.  Articles  12,  13.  435 

by  many  complicated  together,  and  efpecially  in  the  thorax,  which  brought 
on  the  moft  violent  kind  of  death. 

12.  A  virgin  who,  from  the  very  time  of  her  birth,  had  always  lain  Tick,  efpe¬ 
cially  on  account  of  her  very  great  debility,  breath’d  fhort,  and  had  her  fkin 
ting’d  all  over  with  a  kind  of  livid  colour  :  at  length,  when  the  came  to  bo 
about  fixteen  years  of  age,  fhe  died.  She  had  a  heart  that  was  very  fmall, 
and,  towards  the  apex,  in  a  manner  roundilb.  The  right  ventricle  was  of  the 
form  that  the  left  generally  us’d  to  be,  and  the  left  of  the  fame  form  that 
the  right  us’d  to  be  •,  and  although  the  right  was  wider  than  the  left,  yet  it 
had  thicker  parietes.  The  right  auricle,  in  like  manner,  was  univerfally  en¬ 
larg’d,  and  twice  as  big  as  the  left,  and  twice  as  thick  •,  betwixt  the  two,  even 
then,  the  foramen  ovale  was  open,  fo  as  to  admit  the  little  finger.  Of  the 
three  triangular  valves,  one  had  a  proper  bignefs,  the  two  others  were  lei's 
than  ufual.  The  iigmoid,  which  lie  at  the  mouth  of  the  pulmonary  artery, 
were  at  their  bafis  indeed  natural,  but  in  their  upper  part  feem’d  cartilaginous, 
nay  indeed  they  had  already  a  fmall  offification  •,  and  were  fo  connected  to¬ 
gether  in  this  part,  that  they  did  but  juft  leave  a  little  foramen,  not  bigger 
than  a  barley-corn,  through  which  the  blood  was  fent  out.  And  at  this  fo¬ 
ramen  alfo  were  fome  fmall,  flefliy,  and  membranous  productions,  plac’d  in 
fuch  a  manner,  that  they  might  fupply  the  places  of  valves,  by  yielding  to  the 
blood  that  was  going  out,  and  by  refilling  that  which  was  about  to  return. 

13.  I  fhould  iuppofe  that  this  virgin  had  the  beginnings  of  that  diforder 
at  the  mouth  of  the  pulmonary  artery,  from  her  original  formation ;  to  which 
diforder,  being  gradually  more  and  more  encreas’d,  every  thing  ihe  fuffer’d 
when  living,  and  what  were  found  in  the  dead  body,  are  without  doubt  to  be 
referr’d  :  that  is  to  fay,  the  lei's  quick,  and  lefs  ready  entrance  of  the  blood  in¬ 
to  that  artery,  from  this  caufe,  was  a  reafon  why,  on  the  one  hand,  a  lei's  quan¬ 
tity  of  it  fhould  be  tranfmitted  through  that  artery  and  its  correfponding  vein, 
to  the  left  auricle  and  left  ventricle,  and  from  this  fhould  be  fent  to  the  whole 
body  *,  and,  on  the  other  hand,  that  a  greater  quantity  of  blood  than  is  na¬ 
tural  fhould  remain  in  the  right  ventricle,  right  auricle,  and  all  the  veins. 
From  whence  the  colour  of  the  whole  fkin,  in  a  manner  livid,  and  the  dilata¬ 
tion  of  the  right  ventricle  and  right  auricle,  and  the  continu’d  communica¬ 
tion  by  the  foramen  ovale,  by  realon  of  its  valve  being  urg’d  towards  the  left 
fide,  by  the  great  quantity  of  blood  from  the  right,  whereas  but  little  urg’d 
it  on  the  left  fide,  and  applied  it  to  the  edge  of  the  foramen.  But,  for  con¬ 
trary  reafons,  the  left  auricle  and  left  ventricle  were  neither  fufHciently 
open’d  out  and  dilated,  nor  fufficiently  ftrong  •,  and  the  proper  influx  of  blood 
to  the  brain,  and  to  all  other  parts,  being  deficient,  that  very  great  debility, 
and  difficult  refpiration  were  the  confequences ;  and  thefe  even  for  that  very 
reafon,  becaul'e  from  the  fmall  portion  of  blood  entering  into  fo  large  and 
firm  a  vefiel  as  the  pulmonary  artery,  it  could  neither  be  fufficiently  ex¬ 
panded  and  dilated,  nor  confequently  contract  and  refiore  itfelf,  as  it  ought 
to  do,  in  order  to  carry  the  blood  properly  through  the  lungs. 

And  as  to  this  diforder  having  begun  in  the  virgin  gradually,  and  with  her 
original  conftitution,  when  the  parts  were  all  extremely  lax,  you  will  fee  that 
the  fame  thing  happen’d,  and  even  much  more,  within  a  few  months,  from  a 
nearly  fimilar  impediment,  though  in  a  different  lituation,  in  a  man  about 

K  k  k  2  .  thirty 


43^  '  Book  II.  Of  Difeafes  of  the  Thorax. 

thirty  years  of  age,  whofe  hiftory  is  deferib’d  by  Vieuflens  (j) ;  for  the  val¬ 
vulas  mitrales  being  become  bony,  and  greatly  diminifhing  the  orifice  by 
which  the  blood  goes  to  the  left  ventricle,  both  the  capacity  of  this,  and 
the  thicknefs  of  its  parietes,  as  figure  the  fecond,  table  the  thirteenth,  com¬ 
par’d  with  figure  the  fecond,  table  the  eleventh,  fufficiently  (hews,  had  been 
diminifh’d :  but,  on  the  other  hand,  both  the  auricles,  with  their  adjoining 
trunks,  for  fo  he  calls  the  trunks  of  the  pulmonary  vein,  and  the  two  cavas, 
(which  Valfalva  comprehends  under  the  general  name  of  auricles)  and  the 
trunk  of  the  pulmonary  artery,  and  the  right  ventricle,  were  much  diftended, 
and  the  columnas,  and  fibres  of  the  fame  ventricle,  were  become  very  thick; 
which  might  either  happen  from  a  caufe  that  will  be  pointed  out  hereafter  (/), 
or  becaufe  a  greater  thicknefs  of  the  mufcles  is  the  confequence  of  their  more 
frequent  and  ffronger  actions.  Without  doubt,  thefe  parts  of  the  heart  muff 
have  been  conffantly  and  vehemently  contracted,  and  exercis’d,  in  their  en¬ 
deavours  to  thruft  on  fo  great  a  quantity  of  ffagnating  blood  into  the  pulmo¬ 
nary  veffcls,  which,  by  re  alb  n  of  the  difficult  entrance  into  the  left  ventricle, 
did  not  eafily  admit  it :  but  this  ventricle  had  need  fcarcely  of  any  nifus  what¬ 
ever,  to  throw  its  fmall  portion  of  blood  into  the  great  artery,  for  which 
reafon  the  fmall  and  weak  pull'e  here  alfo  teftified  the  weaknefs  of  the  nerves, 
and  languor  of  the  whole  body.  With  this  hiffory,  and  explication,  I  would 
have  you  compare  an  obfervation  pretty  much  of  the  fame  kind,  which  I  lit 
on  by  chance,  as  I  was  turning  over  the  Sepulchretum,  in  the  fecond  book, 
after  I  had  written  thefe  things  (#).  Thus  far  I  have  produc’d  (ome  aneu- 
riims  of  the  ventricles  of  the  heart,  and  of  the  auricles,  found  by  Valfalva. 
1  will  now  fubjoin  others,  that  he  found  in  the  aorta. 

14.  An  old  man,  aged  feventy  five  years,  of  a  ready  wit,  and  a  fangui- 
neous  temperament,  a  tall  flature,  and  endow’d  with  a  good  conftitution  of 
body,  in  general,  grew  very  much  emaciated  fome  years  before  his  death, 
and  efpecially  in  his  lall  years.  At  the  fame  time  he  perceiv’d  an  op- 
preflive  kind  of  pains,  which  he  had  been  a  long  time  fubjedt  to,  in  the  left 
part  of  his  thorax,  and  which  were  alleviated  only  by  the  eruption  of  flatus, 
to  become  more  violent,  and  particularly  upon  the  entrance  of  his  laft 
winter.  Me  was  alfo  affliCled  with  a  troublefome  cough,  with  which  he  very 
frequently  brought  up  a  kind  of  ferous  matter,  and  frequently  a  matter 
globol'e  and  compadt.  At  the  time  of  a  more  quick  motion,  he  was  feiz’d 
with  a  difficult  refpiration,  and  that  pain  in  the  thorax  or  which  I  fpoke,  fome- 
times  alfo  with  a  palpitation  of  the  heart,  which  oblig’d  him  to  Hand  ftill. 
At  length,  about  the  third  day  of  January,  a  little  before  the  latter  end  of 
the  day,  he  was  taken  with  a  kind  of  deliquium  animi ,  or  fwooning,  with  a 
copious  fpitting  of  blood,  and  a  very  difficult  refpiration,  with  a  ffertor. 
About  the  firft  hour  of  the  night,  thofe  fymptoms  became  more  mild  from 
blood  letting,  a  kind  of  pricking  pain  of  the  left  fide  only  remaining,  upon 
which  he  could  not  lie  without  much  uneafinefs :  his  pulfe  was  weak,  rare, 
hard,  and  chord-like,  but  not  often  unequal.  At  the  fifth  hour,  all  the 
former  fymptoms  came  on  afrefli,  the  ffertor  being  extremely  fonorous,  and 

(j)  Traite  du  Coeur  ch.  16.  (/)  Epift.  i8._n.  35.  (//)  In  Additam,  ad  Scd.  8.  Obf.  3. 


7 


a  white 


Letter  XVII.  Article  15.  4 37 

a  white  matter  being  mix’d  with  the  blood  that  he  fpat  up.  After  this  they 
became  a  little  more  mild,  till  the  ftertor  and  hoemoptoe  going  off  about 
the  tenth  hour,  he  died  with  his  mouth  gaping  quite  wide,  as  if  he  had  taken 
breath  every  now  and  then  in  this  manner. 

While  the  thorax  was  open’d,  ferum  burff  forth  from  its  left  cavity,  with 
which,  and  with  coagulated  blood,  the  whole  cavity  was  fill’d,  the  right 
being  entirely  uninjur’d.  The  lungs  were  not  much  different  from  their  na¬ 
tural  ftate  •,  only  about  the  bronchia,  fome  black  bodies  were  obferv’d,  like 
glands.  In  the  pericardium  were  three  ounces  of  ferum  :  in  the  ventricles 
of  the  heart,  only  a  grumous  blood,  nor  that  in  great  quantity.  But  the 
aorta,  in  that  whole  trail  of  it  which  reaches  from  the  heart  to  the  dia¬ 
phragm,  was  dilated  into  an  enormous  aneurifm,  yet  not  every-where  equally 
broad,  but  in  fome  places  lels  lo,  and  in  others,  on  the  contrary,  more.  It 
adher’d  very  tenacioufly  to  the  fourth  and  fifth  thoracic  vertebrae,  which 
feem’d  to  be  a  little  incurvated  to  the  right  fide  :  and  near  to  thefe  vertebrae 
it  was  ruptur’d,  and  had  dilcharg’d  its  blood,  by  a  large  hiatus,  into  the  left 
cavity  of  the  thorax.  About  this  foramen  there  was  a  polypous  concretion, 
hollow’d  out  into  the  form  of  a  little  tube  ;  and  the  foramen  itfelf  was  fur- 
rounded  with  an  ulcer  :  fo  that  the  fide  of  the  artery,  having  been  firft  ex- 
ulcerated  by  fome  corroding  juice,  and  after  that  the  ulcer  being  made  more 
and  more  deep,  it  feem’d  to  have  been  reduc’d  to  fuch  a  thinnefs  in  its  coats, 
that  it  could  no  longer  fupport  the  impetus  of  the  blood  againfl  them. 

in  the  belly,  the  right  kidney  was  worthy  of  obi'ervation,  the  lower  half 
of  which  was  in  its  natural  ftate  ;  but  the  remaining  half  was  entirely  chang’d 
into  a  large  bladder,  made  only  of  a  thin  membrane,  through  which  an 
elegant  network  of  veffels  was  drawn,  although  of  unequal  areas,  which  came 
to  be  very  confpicuous  by  injecting  a  colour’d  fluid  into  the  emulgent  artery. 
This  bladder  was  turgid  with  ferum  to  about  the  quantity  of  three  ounces, 
which  being  fet  upon  the  fire  exhal’d  a  kind  of  urinous  odour,  and  by 
boiling,  and  foaming,  evaporated  away.  Another  thing  all'o  occurr’d  to 
Valfalva,  that  is  more  worthy  to  be  obferv’d.  As  the  chyliferous  veffels  rofe. 
frequent  from  the  Lm all  inteftines,  from  eight  inches  below  the  pylorus,  to 
about  two  ells,  and  went  to  the  center  of  the  mefentery,  that  trabl  of  the 
inteftines,  which  I  juft  now  pointed  out,  was  diftinguifh’d  with  certain  whitifh 
fpots,  and,  as  he  himlelf  lays,  “  irregular  with  caverns  fome  of  them 
being  of  different  figures  and  magnitudes,  fo  that  fome  were  equal  to  a 
lentil,  others  were  twice  as  big,  and  fome  lefs  :  out  of  which  although  he 
could  not  lee  thofe  veffels  proceeding,  yet  he  believ’d  that  they  communi¬ 
cated  with  thofe  fame  “  little  cifterns,”  inafmuch  as  they  were  certainly 
turgid  with  chyle,  the  tafte  of  which,  when  examin’d,  he  found  to  be  like 
that  of  milk,  except  that  it  verg’d  more  to  the  favour  of  fait. 

15.  1  hat  we  may  omit  to  enquire,  whether  thofe  black  bodies  about  the 
bronchia  were  really  bronchial  glands,  accidentally  enlarg’d  beyond  their  na¬ 
tural  fize,  do  r.or  wonder,  that,  among  other  appearances  which  are  without 
doubt  morbid,  we  at  lait  defcrib’d  fome  things  which  feem  to  belong,  rather, 
to  a  natural  ftate.  For  thofe  little  cifterns  may  be  fuppos’d  to  refer  much 
more  to  a  natural  ftate,  than  that  change  of  a  great  part  of  the  kidney 


43^  Book  IT.  Of  Difeafes  of  the  Thorax. 

into  a  bladder ;  of  which  I  have  written  before,  and  fhall  write  again  (*). 
For  there  is  reafon  to  fufpeft,  that  the  appearance  of  thefe  “  little  citterns'” 
was  owing  to  the  comprellion  of  the  thoracic  du6t,  by  fo  great  an  aneurifni 
of  the  aorta  within  the  thorax,  which  left  a  very  narrow  pattage  for  the 
chyle  ;  fo  that  it  was  oblig’d  to  ftagnate  for  a  while  in  its  way  through  the 
parietes  of  the  intettines,  and  dilate  the  veflels  which  carried  it  into  that 
kind  of  varices  or,  if  you  would  rather  have  it  lb,  extend  certain  lacunte, 
or  refervoirs,  in  this  manner,  which  were  not  confpicuous  by  nature.  And, 
certainly,  Santorini  (jy),  who  afterwards  law  “  little  citterns  ”  of  the  fame 
kind,  except  that  they  were  of  the  bignefs  of  a  panic,  law  them  once  alfo, 
as  Vallalva  did,  in  a  perfon  who  died  of  an  aneurifm.  The  feat  of  which, 
although  he  does  not  make  it  known,  yet  moft  probably  was  in  the  place 
where  it  would  be  able  to  obttruft  the  motion  of  the  chyle  :  and,  indeed, 
I  myfelf,  who  never  obferv’d  any  thing  of  that  kind  but  once,  remember 
to  have  obferv’d  it  in  a  bitch,  who  was  pregnant;  lo  that  fome  compreffion 
of  the  pafiages  of  the  chyle  was  by  no  means  wanting.  However  it  is, 
Santorini  and  I  have  evidently  prov’d  the  opinion  of  Valfalva;  fince  Santorini 
faw  the  chyliferous  veflels  emerge  from  thole  “  little  citterns  and  I  not 
that  only,  but  other  letter  ones  alfo,  which  went  to  them.  But  let  us  o-q 
on  to  the  more  certain  and  more  confiderable  effects  of  the  aneurifm  de- 
fcrib’d. 

1 6.  That  this  aneurifm  had  begun  a  long  time  before,  is  evidently 
demonftrated  by  thofe  pains,  which  opprefs’d  the  left  part  of  the  thorax  fo 
long  before.  As  to  their  being  eas’d  from  the  eruption  of  flatus  that  might 
have  impos’d  upon  the  patient,  as  I  have  feen  in  many  others,  who  for  this 
yeafon  believ’d  they  were  only  troubl’d  with  a  flatulent  diforder:  that  is  to 
fay,  the  part  of  the  thorax,  occupied  by  the  aneurifm,  fo  prefles,  frequently, 
upon  the  oefophagus,  that  the  pattage  for  flatus  to  break  forth  is  by  no  means 
free  and  open.  The  flatus,  therefore,  diftends  the  ftomach,  and  that  part 
of  the  celbphagus  which  is  neareft  thereto,  and  encreafes  the  uneafinefs,  by 
ftill  more  diminilhing  the  fpace  of  the  thorax,  and  comprefling  the  aneu- 
rilm.  Thefe  uneafinefies  mutt  of  courle,  then,  decreafe,  when  the  flatus 
has  at  length  got  free.  Yet  they  are  not  remov’d  entirely  ;  which  circurn- 
Aance,  together  with  the  fenle  of  weight,  or  any  other  inconvenience,  that 
cannot  be  afcrib’d  to  flatus,  ought  to  admonifh  thephyfician  not  to  fuffer  him- 
felf  to  be  deceiv’d,  as  the  patient  is.  But  thefe  circumftances,  and  others 
alfo,  which  are  to  be  explain’d  in  another  place,  are  the  moft  eafy  in  this 
hiftory. 

Yet  fome  are  far  from  being  eafy  to  be  explain’d,  among  which  are  thefe 
two :  the  firft,  how  this  old  man  could  poffibly  live  ten  hours,  or  more,  after 
the  fymptoms  of  a  ruptur’d  aneurifm  •,  and  the  fecond,  by  what  means  that 
copious  fpitting  of  blood  was  brought  on.  As  to  the  firft,  that  celebrated 
man,  Paulus  Valcarengus  (2),  in  a  cafe  which  you  may  in  fome  meafure 
compare  with  the  prefenr,  explains  it,  by  fuppofing,  that  the  blood  was  not 

(#)  Vid,  Epift.  38.  n.  39.  &  feqq.  (z)  De  Aortze  Aneur.  Obf.  2. 

(y)  Obf.  Anat.  c.  9.  §  10. 

difeharg’d. 


Letter  XVII.  Article  17.  439 

difeharg'd  “  altogether,  and  immediately,”  from  the  rupture  of  the  aneu- 
rilm,  “  but  had  flow’d  out  by  degrees.”  Yet  becaufe  his  patient  liv’d  only 
about  four  hours,  and  he  whom  I  have  giv’n  the  hiftory  of  here  liv’d  fo  long 
as  ten,  there  is  room  to  fufpeft,  that  the  polypous  concretion,  which  was  found 
hollow’d  out  into  the  form  of  a  little  tube,  about  the  large  hiatus  of  the 
aneurifm,  had  been  once  and  again,  as  the  twice  returning  mitigation  of  the 
moft  violent  fymptoms  feems  to  prove,  flopp’d  up,  as  it  were,  by  fome  por¬ 
tion  of  a  fimilar  concretion,  or  by  coagulations  of  blood,  which  the  remaining 
fluid  had  carried  thither,  out  of  the  cavity  of  the  large  aneurifm,  till  once 
and  again  a  part  of  them  being  thruft  out  from  the  little  tube,  left  a  paffage 
half  open  for  the  alternately-repeated  effufion,  till  at  length  it  was  left  en¬ 
tirely  open. 

But  as  to  what  relates  to  the  fpitting  of  blood,  you  may,  perhaps,  be 

ready  to  conceive,  that  from  an  aneurifm  of  this  kind,  fome  winding  fi- 

nuflfes  were  hollow’d  out,  either  into  the  neighb’ring  canal  of  the  cefopha- 
gus,  or  afpera  arteria  \  and  that  thefe  finuffes,  by  reafon  of  their  oblique 
courfe,  within  that  polypous  concretion,  were  lefs  obferv’d  by  Valfalva,  ef- 

pecially  as  he  does  not  l'eem  to  have  look’d  after  them.  But  in  whatever 

manner  it  is  to  be  explain’d,  this  however  is  certain,  that  others  alfo,  while 
an  aneurifm  was  ruptur’d  within  the  cavity  of  the  thorax,  had  blood  likewife 
coming  out  from  their  mouths.  So  he  whom  Valcarengus,  above  com¬ 
mended,  deferibes,  “  threw  up,  at  the  fame  time,  a  fmall  quantity  of  blood,. 
“  by  fpitting.” 

17.  A  man  of  fifty-five  years  of  age,  of  a  fmall  ftature,  but  robuft,  and 
very  falacious,  who  fometimes  earn’d  his  livelihood  as  a  waggoner,  and  at 
other  times  by  riding  poft,  as  a  guide  to  travellers,  began,  about  ten  years  before 
his  death,  to  be  fubjedt  to  many  and  various  diforders,  at  firft  to  fevers,  af¬ 
ter  that  to  diforders  of  the  fpleen,  afterwards  to  a  cachexy,  and  laft  of  all 
to  a  dropfy.  From  which  though  he  had  been  freed,  a  year  before  he  was 
taken  off,  he  neverthelefs  retain’d  a  yellow  colour  of  his  fkin,  and  a  difficulty 
of  breathing.  Thefe  fymptoms  were  more  violent  from  motion,  and  were 
attended  with  a  kind  of  anguifh  at  his  heart  In  the  neck,  and  the  tem¬ 
ples,  the  arteries  had  evidently  a  leaping  motion  *,  the  pulfe  was  hard,  rather 
flow,  and  chord-like,  but  never  intermitting,  never  unequal.  He  could  lie 
on  either  fide.  Fie  often  cough’d  and  fpat  up  fomething,  but  it  was  in 
fmall  quantity  only,  and  ferous.  Having  a  vein  open’d,  the  blood,  after 
concretion  (very  little  ferum  being  feparated,  and  that  of  a  yellow  colour) 
fhew’d,  on  the  furface,  a  white  crufl,  as  in  thofe  who  labour  under  a  perip- 
neumony,  which  cruft  was  three  inches  in  depth,  whereas  the  red  part  be¬ 
neath  it  did  not  exceed  two  inches.  After  this  he  began,  fometimes,  to  be 
feiz’d  with  faintings,  and  to  grow  worfe  gradually,  his  face  being  much 
fweli’d,  on  the  laft  days  of  his  life.  At  length,  while  he  was  carried  from 
one  bed  into  another,  he  fuddenly  died. 

His  belly  being  open’d,  the  inteftines  were  connected  on  their  anterior  fur- 
face,  with  the  omentum,  and  on  their  lateral  furface  with  one  another:  the 
other  vifeera  alfo,  were  ftrongly  and  unufually  connected  to  the  parts  that 
were  neareft  to  them.  So,  in  like  manner,  when  the  thorax  came  to  be 
open’d,  the  lungs  were  found  cohering  with  the  pleura,  the  right  lobe,  in- 
4  deed* 


44°  Book  II.  Of  Difeafes  of  the  Thorax. 

deed,  in  mod  places,  where  the  pleura  covers  the  ribs  internally,  but  the 
left  almod  every  where,  fo  that  it  was  free  neither  from  the  mediadinum, 
nor  from  the  diaphragm,  and  fcarcely  from  any  part.  About  the  bronchia 
were  a  great  number  of  black  and  hard  glands,  fome  of  the  bignefs  of  a 
bean,  others  of  the  bignefs  of  a  barley-corn.  But  the  aorta  was  indurated, 
internally  bcfet  with  bony  fcales,  and  dilated  to  fuch  a  degree,  that  it  made 
an  aneurifm  of  three  fingers  breadth,  and  of  the  length  of  a  fpan:  and  more¬ 
over,  about  the  fourth  vertebra  cf  the  thorax,  it  was  more  dilated,  fo  that  the 
body  of  this  vertebra  being  hollow’d  out,  the  place  of  it  was  occupied  by  the 
aneurifm,  and  there  it  was  fo  clofdy  conne&ed,  that  it  could  not  be  puli’d 
away  without  laceration.  A  polypous  concretion,  which  took  its  origin  from 
the  left  ventricle  of  the  heart,  was  contain’d  in  this  aneurifm.  In  the  left  ca¬ 
vity  of  the  thorax,  forne  ferum  dagnated,  and  befides  that  a  large  coagulum 
of  blood,  which  perhaps  had  flow’d  out  from  the  ruptur’d  aneurifm,  although 
no  evident  trace  of  rupture  any  where  appear’d. 

1 8.  Perhaps  in  no  clafs  of  men,  have  I  and  my  friends  feen  aneurifms  of 
the  aorta  more  frequently,  than  in  guides,  pod-boys,  and  other  perfons  who 
fit  almod  continually  on  horfeback.  Nor  is  it  to  be  wonder’d  at  ;  for  even, 
to  omit  the  other  accidents  and  injuries  of  air,  to  which  they  are  expos’d,' 
it  mud  of  courfe  follow,  that  the  great  concudion  and  agitation  on  the  one 
hand,  by  exciting  the  motion  of  the  blood,  and  by  urging  the  fides  of  the 
artery ;  on  the  other  hand,  by  compelling  thefe  parietes,  mafrnuch  as  they 
are  fliaken,  to  counteract  the  drokes  of  the  excited  blood,  will  relax,  finally, 
the  druCture  of  their  parietes,  and  make  inroads  upon  their  drength.  Which 
fo  much  the  more  eafily  happens,  where  falacity  and  difeafes  are  added  to  it, 
as  in  this  hifiory.  To  thole  difeafes,  and  efpecially  to  the  foregoing  drop- 
fy  (a),  I  fhould  make  no  fcruple  to  attribute  the  cohefions  of  the  vifeera, 
which  were  found  in  the  carcafe.  But  as  to  the  bronchial  glands,  they,  in 
fa£t,  were  not  fo  much  known  at  that  time  to  every  body,  yet  I  fhould  not 
fuppofe,  that  on  this  account  in  particular,  as  alfo  in  the  former  old  man  (£), 
thefe  glands  were  taken  notice  of,  but  becaufe  they  occurr’d  to  him,  in  a 
more  enlarg’d  date,  or  in  greater  number,  or  more  hard,  than  is  ufually  in 
others.  As  to  the  bony  lamellae  within  the  dilated  artery,  1  fhall  write  of 
them  on  another  occafion  (c),  as  alfo,  of  the  neighbouring  bones,  and  thofe 
that  lye  near  it,  being  hollow’d  out.  It  is  diffident  here  to  admonifh,  that 
even  from  the  fird  internal  aneurifm,  which  was  difeover’d  by  dififeCtion,  as 
far  as  I  know,  the  vertebrae  that  were  connected  to  it,  were  hollow’d  our, 
as  1  have  faid  above  (d).  When  you  read  that  hidory  in  the  Sepulchretum, 
you  will  alio  obferve  another  cireumdance  relating  to  the  prefent  quedion  •,  I 
mean,  that  this  fird  aneurifm  “  had  taken  its  origin  from  the  leap  and  con- 

cufiion  of  a  fierce  and  unruly  horfe.” 

19.  A  man  of  forty  years  of  age,  endow’d  with  a  good  habit  of  body, 
began  to  complain  of  a  difficult  refpiration,  three  or  four  years  before,  efpe- 

'  daily  after  pretty  violent  motion.  This  man,  about  three  months  before, 
had  a  tumour  begin  to  appear  in  the  left  part  of  his  neck,  hard,  and  vvith- 

(a  Vid.  Epift,  39.  n.  30.  (r)  Epifl.  27.  n.  20.  Sc  feqq. 

(£/n.  14*  (<0  M-  3- 

out 


Letter  XVII.  Article  20.  441 

out  pain,  and  as  far  as  could  be  difcover’d  externally,  to  be  referr’d  to  the 
i'pecies  of  farcomata :  this  being  encreas’d  by  degrees,  came  to  the  magni¬ 
tude  of  a  very  large  fill ;  and  even  feem’d,  now,  to  refemble  two  fills,  plac’d 
one  over  the  other.  The  man  was  receiv’d  into  the  hofpital  of  St.  Mary 
de  Morte,  at  Bologna,  when  his  ftrength,  by  degrees,  failing  him,  he  was  at¬ 
tack’d  with  a  flight  fever.  His  pulle  was  fometimes  quick,  and  hard,  and 
fometimes  unequal,  both  as  to  the  order  and  force  of  its  ftrokes.  His  head 
was  troubl’d  with  a  violent  pain,  and  alfo  with  a  flight  delirium.  His  ref- 
piration  was  more  vitiated,  and  attended  with  a  flertor;  and  his  voice  fo  di- 
minifh’d,  that  it  was  almofl  like  that  of  a  woman.  He  had  l'ome  pain  in 
his  thorax.  To  thefe  fymptoms  was  prefently  added,  a  difficult,  and  even 
altogether  obftruded  deglutition  :  and  at  length  his  face,  and  even  his  whole 
head,  being  very  red,  he  died  on  the  feventeenth  of  December,  1688. 

The  tumour,  which  had  been  hard  while  the  man  was  living,  was  now  be¬ 
come  foft  when  he  was  dead.  As  foon  as  ever  it  was  cut  into,  a  great  quan¬ 
tity  of  blood  immediately  flow’d  out*,  and  when  it  was  differed  down,  quite 
to  the  root,  it  was  found  to  be  full  of  blood,  partly  concreted  into  grumi, 
and  partly  fluid.  The  glands  which  us’d  to  be  plac’d  at  that  part,  being 
greatly  indurated,  fome  of  them  prefs’d  upon  the  celophagus,  “  others 
<c  upon  the  jugular  vein  itfelf,  both  which  parts  were  much  thicken’d  in 
tc  their  membranes.  And  the  latter  ffiew’d  a  laceration  in  its  larger  trunk, 
<s  as  the  aorta  alfo  did.  The  tumour  being  examin’d,  the  thorax  was  cut 
i{  into.”  The  lungs  were  diftinguifh’d,  externally,  with  black  fpots  here 
and  there;  but  internally,  they  were  fill’d  with  globules  of  tartareous  mat¬ 
ter,  in  many  places,  and  every  where  with  a  great  quantity  of  ferum.  The 
right  lobe  was  tied  by  many  fibres  to  the  pleura :  the  left  was  entirely  free ; 
but  very  much  inflam’d.  The  right  ventricle  of  the  heart  contain’d  a  poly¬ 
pous  concretion,  which  occupied  alfo  the  orifices  of  the  vena  cava,  and  the 
pulmonary  artery.  Finally,  the  belly  being  open’d,  ail  the  contents  of  that 
cavity  appear’d  found,  except  the  extremity  of  the  inteftine  ileum,  which 
was  affiedted  with  an  inflammation. 

20.  I  was  in  doubt  whether  I  fhould  defcribe  this  obfervation  of  Valfalva, 
and  if  I  did  defcribe  it,  to  what  clafs  I  fhould  refer  it ;  whether  to  that  kind 
of  tumours  which  are  turgid  with  blood,  fuch  as  I  have  more  than  once 
found  in  the  thyroid  gland  (e) ;  or  to  others,  that  communicate  with  the 
trunk  of  fome  ruptur’d  vein,  which  Valfalva  (/),  and  I  (£•),  have  both  of  us 
fpoken  of,  on  former  occafions,  or  rather  to  thofe  dilatations  of  the  aorta, 
which  are  the  diforders  now  treated  of.  At  length,  my  mind  inclin’d  rather 
to  place  it  here,  when  I  attended  to  the  difficulty  of  refpiration,  which  had 
begun  fo  long  before,  and  efpecially  after  any  violent  motion.  For  as  to  no 
pulfation  being  obferv’d  in  the  tumour,  there  are  fo  many  caufes  which  may 
render  this  obfcure,  in  the  progrefs  of  the  diftenfion,  that  we  need  not  won¬ 
der,  if  in  thefe  laft  days,  on  which  the  patient  being  admitted  into  the  hof¬ 
pital,  the  tumour  was  taken  notice  of,  it  was  no  longer  poffible  to  obferve 
it.  Thefe  caufes  I  have  touch’d  upon  heretofore  (£),  and  in  the  next  letter  (/) 

I  will  mention  another.  In  this  manner  it  is  I  conceive  of  the  affair,  th^n : 


(1?)  Epift.  Anat.  9.  n.  39. 

(f)  Traft.  dc  Aure  Hum.  c.  4,  n,  8. 

VOL.  I, 


( g )  Epift.  Anat.  13.  n.  4.  (£)  Ibid. 

(?)  Epift.  18.  n.  20. 

to 


Lll 


44-  Book  II.  Of  Difeafes  of  the  Thorax* 

to  wit,  that  the  aorta,  in  the  place  where  it  is  faid  to  have  fhown  a  lacera¬ 
tion,  when  the  tumour  was  diffe&ed,  had  by  degrees  dilated  itfelf  upwards 
into  the  fac  which  conftituted  the  tumour  ;  and  this  tumour,  by  prcffing  upon 
all  the  parts  which  lay  about  it,  was  the  caufeof  moil;  of  the  fymptoms  which 
had  been  obferv’d  in  the  living  body  •,  for  the  afpera  arteria  and  larynx  being 
prefs’d  upon,  and  confequently  being  made  narrower  than  ufual,  render’d  the 
voice  lefs  deep  and  iirong  •,  the  gula  and  pharynx  being  prefs’d  upon  firft, 
render’d  deglutition  very  difficult,  and  at  length  totally  obftrudted  the  canal., 
fo  as  to  allow  no  palTage  for  the  aliment.  Finally,  the  larger  trunk  of  the  ju¬ 
gular  vein,  that  is  to  fay,  of  the  internal,  being  prefs’d  upon,  the  return  of  the 
blood  from  the  upper  parts,  and  efpecially  from  the  brain,  was  obftrubired ; 
whence  pain,  rednefs  of  face,  and  flight  delirium.  Yet  becaufe  the  lacera¬ 
tion  of  the  fame  jugular  vein  is  hinted  at,  and  fome  things  in  that  part  of  the 
diffeclion  are  fo  written  by  Yalfalva,  that,  perhaps,  they  may  leem  to  you  to  be 
intended  in  a  different  light  from  that  in  which  they  leem  to  me,  I  chofe  rather 
to  ufe  the  very  words  of  the  author,  fuch  as  I  found  them,  upon  that  paffage, 
and  only  to  make  this  one  cbfervation,  that  when  he  wrote  this  hiftory,  he 
was  not  as  yet  three  and  twenty  years  of  age  j  notwithftanding  he  made  an¬ 
other  obfervation  about  the  fame  time  alfo,  in  which  there  is  no  room  for 
hefitation.  This  will  be  the  firft  of  the  three  next  following,  in  which  he  ob¬ 
ferv’d,  at  the  fame  time,  an  aneurifm  of  the  heart  and  aorta. 

21.  A  poor  man,  in  the  fixty- fifth  year  of  his  age,  being  of  a  fanguineous 
temperament,  and  a  pretty  good  conflitution  of  body,  began,  fome  years  be¬ 
fore,  to  be  attack’d  at  intervals,  with  a  kind  of  oppreffion  of  the  chetf,  with  a 
flow,  tenie,  and  chord-like  pulfe,  and  a  confequent  failure  of  breath  and 
ltrength  r  but  in  the  month  of  December,  in  the  year  1687,  being  admitted 
into  the  hofpital  of  St.  Mary  de  Morte  at  Bologna,  on  account  of  a  tertian 
fever,  and  the  fever  now  feeming  to  remit,  by  the  help  of  remedies,  the 
tightnefs  and  oppreffion  of  his  breaft,  together  with  palpitation  of  the  heart, 
were  fo  ftrong,  that  about  the  eleventh  day,  he  feem’d  to  himfelf  and  others,  to 
be  juft  at  the  point  of  death  •,  yet  the  fame  fymptoms  continu’d  to  the  twen¬ 
tieth  day,  with  fo  great  vehemence,  that  they  left  him  fpeechlefs,  and  almoft 
defperate.  But  about  the  twenty-feventh  day  he  complain’d,  in  the  belt  man¬ 
ner  he  could,  of  a  very  great  fuilnefs  in  the  cheft,  and  about  the  thirtieth  day 
thefe  paroxylms  remitting,  and  his  pulfe  becoming  almoft  natural,  he  fpat 
up  a  great  quantity  of  a  gelatinous  kind  of  matter,  with  which  a  palifh 
brown  fubftance  was  mix’d.  The  patient,  in  the  mean  while,  though  he  ate 
nothing,  drank  freely  of  wine,  which  was  brought  to  him  privately,  from 
whence  he  had  firft  an  inflammation  of  the  right  eye,  then  of  the  left,  and 
from  that  blindnefs.  At  length,  from  continual  lying  on  his  back,  and  from 
the  erofion  of  the  excrements  and  urine,  being  feiz’d  with  a  gangrene  upon 
the  os  facrum,  he  died  about  the  fortieth  day. 

The  thorax  was  differed  with  the  affiftance  of  Hippolyto  Francefco  Al- 
bertini,  who  at  that  time  perform’d  the  office  of  affiftant  phyfician  to  this 
hofpital,  with  great  diligence.  The  lungs  adher’d  clofely  to  the  pleura,  which 
is  a  circumftance,  however,  frequently  met  with  in  differed  bodies  ;  being 
cut  into,  they  fhew’d  a  matter  very  much  like  to  that  which  had  been  fpit  up, 
except  that  it  was  thinner  •,  and  the  fubftance  of  the  lungs  itfelf  was  ting’d  of 
a  black  colour.  In  the  pericardium  was  ferum  to  the  quantity  of  a  pint  and 
'  i  half 


Letter  XVII.  Articles  22 ,  23.  443 

half  nearly,  partly  yellowifh,  partly  black,  and  infipid  ;  and  the  heart  was  of 
fuch  a  magnitude  as  to  equal  that  of  an  ox.  The  right  ventricle,  indeed, 
had  its  cavity  in  a  natural  ftate,  but  the  parietes  of  it  were  thicken’d  very 
much  ;  and  the  cavity  of  the  left  was  fo  much  enlarg’d,  that  it  might  have 
contain’d  another  heart,  not  larger  than  in  the  natural  ftate  ;  but  the  parietes 
of  it,  on  the  other  hand,  were  fo  thin,  that  they  feem’d  fcarcely  to  have  been 
able  to  fuftain  the  motion  of  the  heart.  With  all  this  great  capacity  of  the 
ventricle,  the  capacity  of  the  great  artery  was  not  much  lefs,  fo  that  this  alfo 
might  feem  to  belong  to  an  ox  rather  than  to  the  human  body  ;  but  internal¬ 
ly  its  membranous  fubftance  had  degenerated  into  a  cartilaginous  one. 

22.  Intemperance  in  wine,  even  at  that  time,  is  an  evident  proof  what 
courfe  he  us’d  to  follow  before  ;  and,  without  doubt,  from  thence  had  been 
the  firft  caufe  of  the  difeafe  :  and  indeed  that  very  experienc’d  phyfician  Lan- 
cifi  (&)  teftifies,  that  out  of  a  hundred  aneurifms  which  arofe  fpontaneoufly, 
without  any  accident,  more  than  fifty  “  had  happen’d  in  gluttons  and  drunk- 
“  ards.”.  But  which  of  thofe  difeafes  preceded,  and  which  follow’d,  is  difficult 
certainly  to  determine  :  yet  it  is  probable,  that  the  dilatation  of  the  aorta  was 
brought  on  before  that  of  the  ventricle,  from  whence  it  rifes;  for  when  the  ven¬ 
tricle  was  itfelf  dilated  with  fo  great  an  extenuation  of  its  coats,  it  does  not  feem 
poffible  that  it  fhould  have  driven  the  blood  on  with  fo  much  force  into  the 
artery  as  to  dilate  that  ;  and  the  artery,  when  dilated,  and  at  the  fame  time 
cartilaginous,  feems  certainly  to  be  fo  far  incapable  of  propelling  the  blood 
quite  into  the  veins,  that  it  could,  for  this  reafon,  admit  only  a  part  of  the 
blood,  brought  thither  by  the  ventricle,  and  conlequently  the  remaining  part 
muft  be  left  behind  to  ftagnate  in  that  cavity  and  dilate  it,  and  from  thence 
it  would  follow,  that  the  blood  muft  be  obftrudted  in  the  lungs  alfo  •,  from 
whence  thofe  oppreffions  and  tightnefles  of  the  bread,  and  hence  the  encreas’d 
fecretions  and  dilcharges,  from  the  glands  opening  into  the  bronchia,  as  alfo 
by  reafon  of  the  remora  of  the  blood,  in  the  membrane  lying  about  the  heart, 
and  the  frequent  flrokes  of  the  heart,  which  had  long  palpitated,  a  dropfy  of 
the  fame  membrane  or  pericardium  arofe. 

23.  A  man  of  fifty  years  of  age,  whofe  daily  bufinefs  was  to  drefs  wool,  in 
order  to  make  beds  of,  began  to  complain  of  a  difficult  refpiration,  which  was 
attended  with  a  kind  of  whittling  or  wheezing  •,  fometimes  he  was  feiz’d  with 
ftricttures  of  the  pnecordia,  and  tightnefles  of  refpiration,  which  were  fucceeded 
now  and  then  by  a  violent  pain  in  the  loins  •,  the  arteries  in  the  neck  had  a 
violent  pulfation  :  befides  all  this,  a  lpitting  of  blood  coming  on,  fome  days 
before  death,  with  an  extremely  difficult  and  difturb’d  refpiratory  motion,  he 
at  length  died.  In  both  the  cavities  of  the  thorax,  ferum  was  extravafated, 
of  the  colour  of  diluted  blood  ;  the  inferior  part  of  the  left  lobe  of  the  lungs, 
and  one  lobule  of  the  right  lobe,  were  quite  black,  from  the  quantity  of  blood 
extravafated  within  their  fubftance  ;  the  heart  was  encreas’d  in  its  bulk,  but 
fhew’d  no  figns  of  any  polypous  concretion  in  its  cavities ;  the  aorta,  near  the 
heart,  was  dilated  into  an  aneurifm,  the  internal  parietes  of  which  were  co¬ 
ver’d  here  and  there  with  bony  fcales  ;  while  a  very  flaccid  cerebrum  was 
taken  out  from  the  cranium,  a  fmall  quantity  of  ferum  was  difcharg’d  from 

(4)  De  Aneurifm.  propof.  41. 

Lll2 


thence, 


444  Book  II.  Of  Difeafes  of  the  Thorax. 

thence,  but  a  much  greater  quantity  lay  about  the  beginning  of  the  fpinal 
marrow  ;  yet  in  the  ventricles  only  a  little.  The  extremely  bad  putrefcency, 
and  fmell  of  the  body,  prevented  us  from  opening  the  belly,  in  order  to  en¬ 
quire  into  the  caufe  of  the  pain  in  the  loins  ;  although  Valfalva,  even  then, 
imagin’d  that  the  enquiry  would  be  in  vain,  inafmuch  as  he  rather  fup- 
pos’d  it  was  to  be  accounted  for  from  nerves,  that  were,  perhaps,  elfewhere 
irritated. 

24.  If  this  pain  had  not  been  accuftom’d  to  fucceed  the  ftriftures  of  the 
prascordia  and  the  tightnefles  of  refpiration,  at  fome  times,  we  might  perhaps 
be  at  liberty  to  fufpeft  the  caule  of  it  to  lie  in  that  water,  which,  as 
it  occupy’d  the  upper  part  of  the  vertebral  tube  in  fo  large  a  quantity,  muft 
needs  be  fuppos’d  to  have  fill’d  the  lower  part  ftill  more,  or,  at  lead  as  much. 
But  now  it  feems  rather,  that  it  ought  to  be  afcrib’d  to  the  more  vehement 
a&ions  of  the  diaphragm,  in  endeavouring  to  carry  on  refpiration,  as  this 
mufcle  is  fix’d  by  one  of  its  extremities  to  the  vertebrae  of  the  loins.  But  the 
dilatation  of  the  aorta,  in  this  cafe,  I  ffiould  chufe  rather  to  afcribe  to  the  very 
great  force  with  which  the  heart,  being  encreas’d  in  bulk,  drove  the  blood 
forwards  into  it  ;  and  to  the  fame  caufe  the  production  of  the  bony  fcales . 
feems  to  be  owing,  fince  Boerhaave(Z)  aflerts,  that  thofe  flags  only  have  the 
beginning  of  this  artery  bony,  who  have  exercis’d  themfelves  with  long  and 
frequent  running,  and  not  thofe  which  are  kept  in  the  parks  of  gentlemen, 
and  nourifh'd  at  their  eafe.  But  as  thefe  things  are  to  be  afcrib’d  to  the  very 
great  force  of  the  left  ventricle  of  the  heart,  fo  this  is  to  be  imputed  to  the 
very  great  force  of  the  right  ventricle  ;  I  mean,  that  the  blood  having  at 
length  broken  through  its  vefifels,  was  effus’d  into  the  fubftance  of  the  lungs, 
that  is  among  the  veficles,  from  whence  it  was  difcharg’d  by  fpitting  •,  and 
this  effuficn  was  fo  much  the  moreeafily  made,  becaule  that  vifcus  could  not 
be  quite  found  and  firm,  by  reafon  of  the  duft  of  the  wool  continually  flying  in 
with  the  air  ;  and  the  dilatation  of  the  aorta  being  fuppos’d  for  fome  time,  it 
is  probable  that  the  ventricles  alfo  of  the  heart  were  fomewhat  dilated  from 
the  ftagnating  blood  •,  fo  that  the  encreafe  of  bulk  was  owing  not  only  to  the 
thicknefs  of  the  parietes,  but  likewife  to  the  enlarg’d  ftate  of  the  ventricles. 
And  the  fame  you  will  ftippofe  laid  of  the  next  obfervation  that  follows. 

25.  A  woman,  of  about  fixty  years  of  age,  had  labour’d  a  long  time 
under  a  cough,  and  a  difficulty  of  refpiration,  which  was  not  continual,  but 
moft  obfervable  after  violent  motion.  At  length  a  pulfating  tumour  began 
to  appear,  under  the  right  clavicle  at  the  fternum  ;  which,  in  the  fpace  of 
two  or  three  months,  increas’d  to  fuch  a  degree,  that  one  head  of  it 
feem’d  to  have  rifen,  as  it  were,  out  of  the  middle  of  the  fternum  •,  for 
it  was  extended  from  thence,  almoft  in  a  globular  form,  to  the  neck. 
In  the  tumour  was  a  fenfe  of  heat,  and  burning  pain.  In  the  mean 
while,  thofe  former  inconveniences  were  much  increas’d,  and  others  were 
added  over  and  above.  For  from  the  middle  of  the  upper  arms  to  the 
hands,  and  from  the  upper  part  of  the  legs,  almoft  quite  to  the  feet,  her 
limbs  were  all  over  cedematous,  which  was  fo  much  the  more  remarkable, 
becaufe,  as  the  upper  arms  were  much  extenuated,  from  the  upper  part  quite 

(/)  Pisleft.  in  inftit.  §.  478. 


7 


to 


Letter  XVII.  Article  2  $.  44^ 

to  the  middle,  at  that  part,  of  a  fudden,  began  this  immoderate  thicknefs ; 
which  circumftance  might  alfo  be  obferv’d  in  the  legs,  though  not  fo  evF 
dently,  when  the  upper  parts  of  them  were  compar'd  with  the  neighb’ring 
parts.  The  face  alfo  had  1  well’d  a  little.  She  had  a  frequent  fpitting,  and 
on  the  laft  days  it  was  almoft  purulent.  The  pulfe  was  weak,  and  fmall. 
She  had  no  reft,  unlefs  when  {he  fat  up  :  for  any  even  flight  motion,  and 
not  only  lying  down  on  her  back,  threw  her  into  inftant  danger  of  fuf- 
focation.  The  fame  effedt  was  produc’d  from  the  taking  of  food,  or  drink  j 
fo  that  flie  was  at  length  conftrain’d  to  abftain  entirely  from  both.*  Wherefore, 
having  abftain’d  fix  days,  fhe  was  carried  off,  rather  from  being  ftarv’d  with 
hunger,  and  from  flight  convuifive  motions,  than  from  the  difeafe. 

In  the  belly,  a  limpid  ferum  ftagnated.  The  liver  and  the  ftomach  were 
found  to  be  plac’d  lower  than  ufual.  The  colon  did  not  go  from  the  right 
fide  to  the  left,  but  when  it  had  touch’d  upon  the  bottom  of  the  ftomach,, 
it  went  from  thence  immediately,  through  the  middle  of  the  belly,  to  the 
redtum.  The  feces  of  the  belly,  not  having  been  dilcharg’d  of  a  long  time 
before  death,  were  almoft  all  contain’d  within  the  beginning  of  the  colon. 
A  gland  lay  upon  the  left  kidney,  externally,  of  the  bignefs  of  a  chefnut, 
and  internally  of  a  yellowifh  colour.  In  the  thorax  ferum  ftagnated,  which, 
was  drawn  out  with  fponges.  The  left  lobe  of  the  lungs  was  very  much 
contradled,  and  in  a  manner  inflam’d,  and  in  the  middle  contain’d  a  famous 
ichor,  and  here  and  there  little  tubercles,  fome  of  which  were  fuppurated. 
The  pericardium  abounded  with  ferum.  The  heart,  being  plac’d  fomewhat 
lower  than  ufual,  and  almoft  wholly  in  the  left  fide,  was  twice  as  big  as  it 
naturally  is,  nor  yet  contain’d  any  polypous  concretions.  But  the  aorta  had 
a  large  and  oblong  aneurifmal  fac  produc’d  from  it.  The  orifice  of  this  fac 
communicated  with  the  artery,  at  the  fuperior,  and  fomewhat  anterior  part 
of  its  curvature,  in  fuch  a  manner,  that  the  common  trunk,  alfo,  of  the 
right  carotid,  and  fubclavian,  being  dilated  into  that  fac,  thefe  two  arteries 
came  forth  from  the  pofterior  furface  of  its  beginning.  And  as  the  fac  be¬ 
came  more  wide,  the  more  diftant  it  was  from  the  orifice.  Firft,  indeed,  it 
comprefs’d  very  much  the  interior  parts  of  the  thorax,  and  among  thefe  the 
afpera  arteria,  and  cefophagus  :  but  after  that,  having  con  fum’d  away  the 
anterior  bones  of  the  thorax,  and  efpecially  the  right  clavicle,  and  fuch  of 
the  ribs  as  were  neareft  to  it,  a*nd  the  parts  of  the  fternum,  by  its  continual 
pulfation,  arid  by  an  eroding  humour  that  was  diicharg’d  therefrom,  it  had 
prepar’d  a  way  for  itfelf  to  the  external  parts,  and  railing  up  the  mufcles  and 
integuments,  had  made  that  figure,  as  I  call’d  it,  of  another  head.  But 
thefe  parts,  which  it  had  carried  out  with  it,  had,  by  lying  round  the  fac, 
prevented  the  blood  from  being  eafily  pour’d  out  from  the  ruptur’d  aneurifm. 
For  the  exernal  coat  of  the  artery,  the  more  it  receded  from  the  trunk,  being 
fo  much  the  more  extenuated,  could  fcarcely  be  any  more  known,  or  per¬ 
ceiv’d,  when  you  came  on  the  outfide  of  the  thorax.  And  the  internal  coat 
itfelf  alfo,  in  the  trunk,  preferv’d  its  natural  ftate  ;  yet  prefently  feem’d  to 
confift  even  of  three  membranes,  each  of  which  feem’d  to  be  fubdivided 
into  others,  but  pretty  thick  ones,  and  in  a  manner  flefhy,  and  which,  if 
they  had  been  more  firm,  would  have  almoft  reprefented  a  mufcular  body, 
the  tendon  of  which  was  to  be  fuppos’d  in  this  internal  coat,  where  it  came 

out 


44 6  Book  II.  Of  Difeafes  of  the  Thorax. 

out  from  the  trunk.  Never; helefs,  t’nefe  fiefhy  kinds  of  membranes,  which 
made  up  the  internal  coat  of  the  fac,  and  which,  in  fome  places,  were  equal 
in  thicknefs  to  a  finger’s  breadth,  in  other  places  were  lacerated,  and  eroded  ; 
fo  that  tinlcfs  either  the  external  coat,  or  the  parietes  of  the  parts  that  lay 
round  about,  had  prevented  it,  the  blood  muft  have  burft  forth  from  thence. 
As  to  what  remains  on  this  fubjedt,  a  grumous  blood  was  contain’d  in  the 
cavity  of  the  fac. 

The  limbs,  alfo,  that  were  cedematous,  were  differed  ;  and  no  ferum  was 
found  betwixt  the  mufcular  fibres  :  but  the  whole  of  it  feesn’d  to  be  fhut 
up  betwixt  the  fkin  and  the  mufcles,  in  the  dilated  cells  of  the  adipofe  mem¬ 
brane.  And  it  was  eafily  fuppos’d,  that  in  thofe  parts  of  the  limbs,  which 
I  fpoke  of,  this  ferum  had  ftagnated,  by  reafon  of  the  impulfe  of  the  blood 
through  the  arteries  being  debilitated,  and  for  that  reafon  not  able  to  carry 
it  upwards-,  for,  certainly,  thofe  parts  of  the  limbs  that  were  nearer  to  the 
heart,  by  no  means  fwell’d,  as  I  have  already  faid.  This  ferum  being  prefs’d 
out  from  the  arm,  in  many  places,  by  the  incifion  of  the  fkin,  refembl’d 
water  in  its  colour  ;  and  when  put  upon  the  fire,  did  not  at  all  become  turbid, 
but  evaporated  away  wholly.  But  that  which  had  been  taken  from  the  tho¬ 
racic  cavities,  approaching  in  its  colour  to  a  faturated  yellow,  not  only  became 
turbid,  but  a  little  after  had  a  pellicle  upon  its  furface,  which,  as  the  eva¬ 
poration  conftantly  went  on,  it  at  length  left  in  the  bottom  of  the  veflel. 

As  to  the  ferum  that  was  drawn  out  from  the  belly,  although  it  was  like 
the  firfb  in  colour,  and  although  it  evaporated  away  in  the  fame  manner  as 
the  fecond,  yet  it  by  no  means  became  turbid.  Moreover,  as  a  portion  of 
each  was  not  commuted  to  the  fire,  but  kept  feparately  in  glafs-veflels,  and 
although  the  fecond,  in  a  fhort  time,  fhew’d  many  concretions  of  a  mem¬ 
branous  form,  fwimming  in  the  middle  of  it,  like  thofe  which  frequently 
appear  in  wine,  yet  the  firft  and  third  exhibited  very  few  only.  <r> 

26.  Many  things  in  this  hiftory  are  worthy  of  remark,  whether  we  con- 
fider  the  woman  as  living,  or  as  dead.  And  this,  in  particular,  in  the  living 
body,  that  not  only  from  violent  motion  fhe  fell  into  danger  of  fuffocation, 
as  moft  other  perfons  who  labour  under  aneurifms  do,  but  even  from  any 
flight  motion,  and  from  the  taking  of  food  and  drink.  I  never  remember 
to  have  feen  fymptoms  more  like  thefe,  and  others,  that  are  defcrib’d  in  this 
woman,  than  in  the  month  of  Odlober,  in  the  year  1705,  when  I  attended 
as  phyfician  upon  the  moft  excellent  marquis  Aloyfio  Palucci,  who  was  com¬ 
mander  in  chief  of  the  pontifical  forces,  and  related  to  three  moft  eminent 
cardinajs  of  the  holy  church  of  Rome,  of  the  fame  name,  that  is,  to  one 
as  his  brother’s  fon,  to  another  as  his  brother,  and  to  a  third  as  his  uncle  ; 
a  man  who  deferv’d  a  much  longer  and  happier  life.  For  by  reafon  of  a 
difeafe  of  this  kind,  he  could  neither  lie  down,  nor  go  to  ftool,  nor  make 
water,  nor  even  fwallow  nourifhment,  but  almoft  immediately  a  paroxyfm 
was  brought  on,  which  threaten’d  inftant  fuffocation,  and  fometimes  almoft 
death  itfelf.  For  he  us’d,  fometimes,  to  leap  fuddenly  out  of  the  feat,  on 
which,  to  avoid  all  motion,  he  continually  fat,  and  run  to  the  window  with 
hopes  of  breathing  better  there;  yet,  neverthelefs,  he  us’d  to  draw  his  breath 
with  a  ftertor,  to  be  livid  in  his  whole  face,  to  difcharge  his  urine  and  feces 
involuntarily,  which  circumftances,  and  others  of  the  fame  kind,  very  fre¬ 
quently 


Letter  XVII.  Article  27.  447 

quently  happen’d.  But  fometimes  the  ftricture  upon  his  bread  was  fo  great, 
that  his  breath  being  quite  intercepted,  he  could  no  more  even  fnore,  but 
fell  forwards,  juft  like  one  that  was  dying,  upon  the  arms  of  the  fervants, 
that  fupported  him  on  each  fide  •,  and  when  at  length  he  began  to  recover 
from  fo  great  a  danger,  and  fometimes  perhaps  afk’d  for  the  chamber-pot, 
in  vain  would  he  then  attempt  to  make  water,  by  reafon  of  the  penis  being 
drawn  inwards  in  an  almoft  incredible  manner.  I  was  much  chagrin’d,  that, 
before  he  funk  under  his  inevitable  fate,  I  was  under  a  neceffity  of  returning 
out  of  my  native  place  into  Bologna,  in  order  to  prefide,  in  virtue  of  my 
office,  at  the  fir  ft  meeting  of  the  illuftrious  academy,  now  call’d  Academia 
Jnfiituli  Scientiarum.  For  owing  to  this  neceffity,  it  was  not  in  my  power  to 
examine  thoroughly,  by  diffedtion,  the  difeafe,  which  I  had  diftinguiffi’d  from 
a  few  others,  that  had  fomewhar.  fimilar  fymptems,  by  thinking,  and  com¬ 
paring  them  together-,  though,  indeed,  there  was  no  doubt,  but  that  an 
aneurifm,  of  the  bignefs  of  a  kid’s  head,  was  found  at  the  curvature  of 
the  aorta,  on  diffedtion,  by  which  the  cefophagus,  and  (till  more  the  canals 
of  the  afpera  arteria,  were  comprels’d  :  for  that  even  the  phyfician  of  this 
nobleman  exprefsly  confefs’d,  who,  though  in  other  relpecfts  learn’d,  had 
before  referr’d,  in  conjundtion  with  moft  others,  whatever  the  patient  fuf- 
fer’d,  to  convulfions  ;  for  this  reafon  particularly,  which,  as  is  demonftrated 
by  the  celebrated  Pafta  (»2),  has  oftentimes  impos’d  upon  others,  or  might 
have  impos’d  upon  them,  that  it  does  not  feem  poffible,  but  the  effedts  muft 
be  perpetual  from  fuch  a  perpetual  caule  as  an  aneurifm  is.  Bur  as  to 
pointing  out  more  clearly  the  fituation  of  this  aneurifm,  and  whether  it  con- 
fifted  in  a  fimple  dilatation  of  the  aorta,  or  in  a  fac,  and  other  circumftances 
of  that  kind,  1  ffiould  have  been  able  to  have  done  this  with  certainty  from 
the  difledlion,  but  I  am  not  able  to  do  it  at  prefent. 

27.  For  I  do  not  doubt  but  you  will  remember,  that  aneurifms  were  for¬ 
merly  divided  by  me  (»)  into  thefe,  which  a  veffel  equally  expanded  on  all 
fides  forms,  and  thofe  which  grow  out  from  the  fide  of  the  veffel,  like  a 
bag,  and  that  my  divifion  was  approv’d  by  thofe  very  learned  men  Schrei- 
berus  (0)  and  Valcarenghus  (p) :  and  that  from  the  fac,  being  plac’d  after 
this  or  that  manner,  a  reafon  was  eafily  given  by  Littre  (<7),  and  by  Boer- 
haave(r),  why  fwoonings,  or  fuffocations,  ffiould  frequently  attack  the  pa¬ 
tients,  from  a  change  in  the  fituation  of  the  body,  the  blood,  for  inftance, 
fometimes  falling  clown  in  fo  large  a  quantity,  into  the  fundus  of  the  fac, 
which  has  a  great  declivity,  that  there  does  not  remain  enough  in  the  ar¬ 
teries  to  carry  on  the  circulation,  and  fometimes  falling  back  into  the  oppo- 
fite  part  of  the  fac,  in  fuch  a  manner,  that  the  bronchia,  if  they  are  near 
at  hand,  are  very  confiderably  comprefs’d,  which  happen’d  in  the  woman, 
whofe  hiftory  I  have  juft  given  you.  Flowever,  whether  there  was,  or  was 
not,  a  fac  of  the  aorta  in  Palucci  -,  there  certainly  was  fuch  a  dilatation,  that 
when  it  lay  on  the  afpera  arteria,  as  it  did  in  the  Lupine  pofture  of  body, 

that  tube  was  greatly  comprefs’d  by  it,  and  fo  much  the  more,  as  the  more 

(m)  Epift.  de  Cord.  Polyp,  n.  V.  (p)  De  Acr  se  Aneur.  Obf.  i. 

(«)  Adverf.  2.  Animadv.  39.  (q)  Mem.  de  i’ Acad.  R.  des  Sc.  A.  1707. 

(o)  Ad.  Erud.  Lipf.  A.  1731.  M,  Aug.  (r)  Prasled.  in  Inftit.  §  826. 

blood 


448  Book  II.  Of  Difeafes  of  the  Thorax. 

blood  was  obftru&ed  there,  which  would  of  courfe  encreafe  both  the  expan- 
fion,  and  the  weight.  And  that  the  blood  was  accuftom’d,  even  on  the 
flighted  motion,  to  ftagnate  there,  both  in  him,  and  in  the  woman,  was 
prov’d  from  the  fwallowing  of  nouriffiment;  by  which  aftion  the  aneurifm, 
that  was  near  to  the  gula,  could  be  but  very  little  prefs’d  upon,  or  agitated. 

In  this  manner,  fome  effects  of  an  aneurifm  may  not  be  perpetual,  though 
the  aneurifm  is  itfelf  indeed  perpetual,  but  not  always  equally  dilated,  or 
grievous.  And  from  this  you  underftand,  that  if  any  (light  internal  caufe 
happen,  or  any  other  that  is  but  little  attended  to,  as  for  inftance,  flatuffes 
endeavouring  to  elcape  by  the  cefophagus,  or  accidental  compreffions  of  the 
limbs,  and  confequently,  fome  of  the  veffels,  relifting  the  blood,  and  for 
that  reafon  fomewhat  retarding  its  motion  in  the  aorta  and  aneurifm  ;  they 
may  certainly,  in  patients  of  that  kind,  give  occafion  to  the  moft  violent 
paroxyfm  ;  and  on  the  other  hand,  if  the  veffels  of  the  limbs  are  oppor¬ 
tunely  relax’d,  when  the  blood  begins  to  ftagnate  in  the  aneurifm,  its  motion 
may  fometimes  be  fo  expedited,  that  the  paroxyfm  may  be  intercepted  in 
the  very  beginning.  And  both  thefe  circumftances  happen’d  in  Palucci. 
For  fometimes  no  reafon  appear’d,  why  he  was  taken  with  a  paroxyfm. 
And  at  other  times,  thofe  that  were  now  threat’ning,  and  even  begun,  were  - 
artificially  fupprefs’d  in  this  manner.  From  the  very  beginning,  when  the 
dileafe,  being  yet  obfcure,  lay  under  the  deceitful  ma(k  of  periodical  pains, 
that  wander’d  through  the  left  (houlder,  and  the  adjacent  parts,  the  patient 
experienc'd  great  eafe,  from  the  immerfion  of  the  arm  and  hand  on  the  fame 
fide,  into  water  that  was  pretty  hot. 

Put  from  the  time  that  the  dileafe  began  to  difcover  itfelf,  by  other  lefs 
ambiguous  marks,  and  thole  fuffocating  paroxylms,  which  1  fpoke  of,  in  par¬ 
ticular,  he  call’d  now  and  then,  in  the  progrefs,  or  declenfion,  of  thefe  pa- 
roxyfms,  for  the  fame  kind  of  water,  that  he  might  only  waffi  his  hands 
and  forehead  with  it;  and  he  affirm’d,  that  he  was  always  fomewhat  eas’d 
from  thence,  even  more  than  by  any  other  kind  of  remedy  whatever.  Then 
I,  who  faw  the  patient  in  thofe  firft  days,  and  heard  thefe  things,  laid  to  the 
ether  phyficians,  why  do  we  not  rather  prevent  the  paroxyfm,  when  it  is 
coming  on,  by  this  very  fame  method?  yet  not  only  by  walking  the  hands, 
but  bathing  both  them  and  the  arms  in  warm  water,  quite  up  to  the  elbow; 
and  if  the  event  fucceeds  according  to  our  wiffies,  by  holding  them  fo  long 
in  the  water,  till  all  figns  of  an  approaching  paroxyfm  entirely  vaniffi  away. 
As  the  other  phyficians  did  not  diffent,  and  the  patient,  in  particular,  was 
willing  to  try  it,  the  experiment  w;as  made  with  fuch  fuccefs.  that  notwith- 
ftanding  his  paroxyfms,  fome  (lighter,  and  fome  more  violent,  had  been  very 
frequent  on  the  three  foregoing  days ;  yet  on  the  day  in  which  we  made  this 
experiment  firft,  which  was  the  feventh  of  October,  and  on  the  four  follow¬ 
ing  days,  no  attack  could  appear  openly ;  for  although  many  began  on  the 
feventh  day,  in  particular,  yet  all  of  them  were  immediately  reprefs’d  by 
this  method.  And  notwithftanding  there  happen’d  two  on  the  following 
days  which  could  not  be  check’d  by  this  method,  yet  fome  others,  and 
amongft  thefe,  one  very  violent  paroxyfm,  which  began  on  the  fourteenth 
day,  were  reprefs’d  thereby  ;  and  you  may  take  my  word  ;  for  as  long  as  I 
attended  the  patient,  1  very  attentively  and  accurately  obferv’d  whatever 

happen’d 


Letter  XVII.  Article  28.  449 

happen’d,  and  on  what  day  it  happen’d.  And  I  with  this  method  had  been 
fufficient  to  have  prevented  them  all,  as  it  certainly  did  prevent  thofe  I  have 
mention’d,  and  that  not  with  lefs  joy  to  the  patient,  than  if  you  had  lb 
many  times  freed  him  from  initant  death. 

The  fame  kind  of  remedy  I  afterwards  us’d,  adding  frictions  of  the  arms, 
while  they  were  immers’d  in  the  hot  water,  with  great  advantage  in  two 
virgins,  whom  a  vehement  anxiety  at  the  praecordia  in  one,  with  a  fenfe  of 
fuffocation,  and  in  the  other,  with  a  total  fufpenfion  of  all  the  fenfes,  had 
feiz’d  at  different  times.  For  the  latter  of  them  I  rous’d  in  this  manner,  and 
foon  put  a  Hop  to  the  attack,  which  otherwife,  according  to  cuftom,  would 
not  have  been  fhort ;  and  the  former  found,  at  lead,  feme  alleviation  there¬ 
from.  And  not  to  digrefs  from  thofe,  ip  whom  it  was  certain,  that  there  was 
an  organical  injury,  about  the  praecordia,  and  for  thatreafon,  frequent  anxie¬ 
ties,  with  a  difficulty  of  breathing,  though  it  was  in  no  perfon’s  power  to 
remove  the  diforder,  yet  I  have  render’d  the  fymptoms  of  it,  at  lead,  fo 
flight,  by  the  fame  eafy  remedy,  and  that  in  fo  fhort  a  time,  efpecially  in  a 
noble  Venetian,  that  all  who  were  prefent  were  adoniffi’d.  But  even  in  the 
cafe  of  a  mod  ferene  prince,  to  whom,  when  lab’ring  under  a  like  didemper, 
I  was  call’d,  for  the  fake  of  confulting  with  other  phyficians,  I  did  not  doubt 
to  propofe  the  fame  remedy,  with  the  fame  hope :  although  the  phyficians, 
who,  as  I  return’d  immediately  to  Padua,  to  continue  my  office  of  teaching, 
prefently  pronounc’d  that  death  was  at  hand,  negledted  to  make  ufe  of  this 
remedy,  being  fo  much  deceiv’d  in  their  prognodic,  that  this  excellent 
prince  furviv’d  many  months,  under  the  care  of  other  phyficians,  as  I  had 
laid  might  happen.  And  fince  internal  convulflons  frequently  bring  on 
anxieties  of  that  kind,  as  in  thofe  virgins,  and  frequently  alfo,  as  in  the 
others  who  have  been  taken  notice  of,  may  be  join’d  to  an  organical  injury, 
and  thus  accelerate  the  coming  on  of  the  attacks,  and  encreafe  their  force; 
therefore,  if  you  would  refer  the  utility  of  fridtions,  in  warm  water  alfo,  to 
fome  revulfion  of  the  motions,  and  that  of  the  irnmerfion  therein,  to  the 
relaxation,  which  is  propagated  from  the  limbs  to  the  vifeera,  jud  as  cold, 
by  a  contrary  adlion,  extends  itfelf  from  the  feet  inwardly,  in  fuch  a  man¬ 
ner,  as  frequently  to  bring  on  cholic  pains ;  I  ffiall  not  only  not  be  againft  it, 
but  even  very  much  approve  it,  if  you  transfer  hither  what  the  illuftrious 
Archiater  Senac  (j)  has  taught,  relating  to  the  manner  in  which  fridtions, 
and  in  like  manner  warm  baths  to  the  feet,  have  often  alleviated  palpita¬ 
tions  of  the  heart.  But  let  us  return  to  the  woman  dilfedled  by  Valfalva(7). 

28,  As  to  the  fituation  of  fome  vilcera  being  chang’d,  which  he  obferv’d 
in  her  body,  there  is  no  occafion  to  fay  much  upon  this  head  here.  For 
that  the  colon  does  obtain  the  fituation  which  he  has  deferib’d,  and  not  very 
feldom  neither,  from  the  very  original  formation,  I  have  not  only  admo- 
niffi’d  in  a  former  work  (u) ;  but  you  may  alfo  gather,  from  fome  of  the 
foregoing  letters,  and  from  fome  of  the  future.  But  the  liver  and  the  fto- 
mach  were  puffi’d  lower  than  ufual  by  the  heart,  itfelf  being  alfo  thrufr 
downwards,  not  only  by  its  own  weight  and  bulk,  but  alfo  by  an  aneurifm 


(s)  Traits  du  Coeur  1.  4.  ch.  11.  n.  19.  (/)  fupra,  n.  25.  '(«)  Adverf.  2.  Animad.  z. 

Vol.  I.  M  m  m  of 


45°  Book  II.  Of  Difeafes  of  the  Thorax. 

of  the  aorta,  by  which  it  was  driv’n  even  to  the  left  fide  :  nor  could  the  heart 
have  thruft  down  thofe  two  vifcera,  without,  at  the  fame  time,  driving  the  dia¬ 
phragm  downwards,  which  lay  betwixt  them.  And  that  this  might  juftly  and 
defervedly  be  call’d  the  prolapfus  of  the  heart,  I  have  already  laid  in  the  Fpiftolas 
Anatomicae  (x)  •,  and  by  this  name  I  would  alfo  willingly  call  that  which  is  de- 
fcrib’d  by  Pacchioni,  in  the  firft  and  in  the  fecond  hiftory  (y) ;  for  I  have, 
without  injuftice,  rejected  fome  others,  which  have  been  propos’d  by  other  per- 
fons  frequently,  for  this  reafon  only,  becaufe  they  do  not  feem  to  have  obferv’d, 
that  the  heart  naturally  lies  upon  the  diaphragm :  nor  indeed  do  1  fee,  that  Val- 
falva  has  ever  fall’n  into  an  error  of  this  kind.  But  in  the  true  prolapfus  of  the 
heart,  the  diaphragm  is  fometimes  fo  far  depress’d,  that  it  extends  itfelf  down¬ 
wards,  into  a  kind  of  a  hood,  in  which  the  heart  is  embrac’d,  as  the  French- 
king’s  phyfician,  whom  I  have  already  commended,  faw  in  the  Marquis  dir 
Palais  (z).  But  as  the  diaphragm  and  heart  defcend  more  or  lefs,  fo  the 
inconveniences  of  a  comprefs’d  ftomach,  and  the  pulfations  of  the  heart, 
in  the  left  hypochondrium,  are  more  or  lefs  obferv’d,  as  the  hiltories  of 
Pacchioni  confirm  :  wherefore,  not  the  patients  only,  but  the  phyficians, 
who  do  not  confider  all  the  fymptoms  accurately,  may  take  a  diforder  of  the 
heart,  and  the  pulfations  thereof,  for  a  diforder  of  the  ftomach,  and  the  pul¬ 
fations  of  the  cceliac  artery.  And  it  has  frequently  happen’d,  that  from  a 
like  compreftion  of  the  diaphragm,  thofe  who  are  aftedted  with  a  dropfy  of 
the  pericardium,  have  complain’d  of  pain,  and  weight,  opprefiing  the  re¬ 
gion  of  the  ftomach.  You  muft  not,  however,  wonder  that  Vallalva  has 
not  made  mention  of  any  complaints  in  the  ftomach,  or  pulfations  about 
that  region,  in  this  woman.  For  the  heart  had  defcended  only  a  little  lower 
than  ufual  in  its  fituation  :  and  befides,  on  the  laft  days  that  he  feems  to 
have  feen  her,  the  patient  had  fo  many  other  more  violent  fymptoms  to  com¬ 
plain  of,  that  flie  might  eafily  have  pafs’d  them  over,  as  the  more  (light, 
which  generally  happens ;  not  to  fay  any  thing  of  the  pulfes  of  the  heart, 
which  at  that  time  were  certainly  fmall,  and  weak  alfo,  as  is  generally  the 
cafe  in  a  long  and  very  troublefome  difeafe,  and  in  this,  that  brought  the 
patient  to  the  laft  neceffities  of  hunger,  might  eafily  happen. 

29.  However,  we  muft  allow  to  Vallalva  what  is  to  be  allow’d  to  many 
others,  to  wit,  that  at  the  time  he  made  this  obfervation,  what  were  in  fadt 
poHpous  concretions  adhering  internally  to  the  membrane  of  the  aorta,  and' 
refembling  flefh,  might  feem  to  him  to  be  the  real  fubftance  of  the  coats  of 
the  artery,  although  Harvey  (a)  had  admonifh’d,  that  fiefli  of  this  kind  did 
not  belong  to  the  coats  of  the  artery  •,  and  fome  believe  him  to  have  been  the 
firft  who  mention’d  this  in  his  writings.  But  you  will  find  in  that  very  obfer¬ 
vation  which  I  have  more  than  once  commended  above  (£),  as  the  firft  which  was 
made  by  difiedtion,  on  the  aneurifm  in  the  trunk  of  the  aorta,  that  the  blood 
“  was  contain’d  in  a  kind  of  concreted  cruor  or  fiefh-like  matter,  deftitute  of 
tc  fibres,  which  was  again  furrounded  by  a  kind  of  whitifh  and  hard  fubftance, 
*  of  the  thicknefs  of  a  finger’s  breadth,  in  colour  and  appearance  not  unlike 

(*)  XV.  n.  53.  (a)  De  Circulat.  Sanguin.  Exerc.  3.  five.ad 

(y)  Oper.  Edit.  4.  verf.  fin,  Riolan.  2. 

(2)  1.  cit.  ch.  8.  n.  4.  (£)  n.  3.  &  18. 

hog9s 


4 


Letter  XVII.  Article  2y.  4^1 

4t  hog’s  lard  that  has  been  melted.”  And  when  you  read  this,  I  would  have 
you  attend  not  only  to  what  was  evident,  that  this  concretion  was  double,  but 
alfo  whether  it  Teem’d  to  be  continu’d  all  round  *,  and  I  would  have  you  at¬ 
tend  to  the  fame  things,  not  only  in  that  delineation  which  was,  without 
doubt,  the  firft  of  a  differed  aneurifm  of  the  aorta,  and  which  is  from  Riva  (c), 
but  alfo  in  that  more  full  defcription  which  Ruyfch  gave  (d)  of  the  innumerable 
“  fleihy  ”  coats,  or  rather  concretions,  that  being  dilpos’d  “  in  lamellae,  as  it 
“  were,”  made  up  the  aneurifm.  I  pafs  by  other  obfervations  that  were 
publifh’d  afterwards,  in  fome  of  which,  as  in  that  of  Valfalva,  both  of  thofe 
circumftances  I  have  mention’d,  you  will  eafily  find  did  exift.  And  if  this  is 
fo,  as  certainly  it  frequently  is  from  my  obfervations,  efpecially  in  thefe  aneu- 
rilms  which  hang  like  a  bag  from  the  artery,  1  hope  it  will  be  by  no  means 
difplealing  to  a  very  learn’d  man  who  is  much  my  friend,  if  I  perfift  in  my 
opinion  of  confidering  thefe  concretions,  at  leaf!:,  which  were  formerly  de- 
fcrib’d  alfo  by  me  (<?),  as  a  polypus  form’d  before  death.  Nor  indeed  am  1 
us’d  to  find  them  fometimes  in  this  region,  and  fometimes  in  that  region  of 
the  body,  according  to  the  different  pofture  thereof  after  death,  but  even 
plac’d  every  where  all  round  in  an  unmov’d  carcafe,  and  adhering  to  all  fides, 
and  thofe  of  a  certain  lurid  colour,  not  yet  entirely  deprav’d,  and  of  a  Tub- 
fiance  immoderately  dry  •,  fo  that,  inafmuch  as  they  differ  greatly  from  all 
thofe  which  I  ever  law  in  the  ventricles  of  the  heart,  fo  much  the  more  do 
they  fhew  that  they  were  not  recently  produc’d,  as  thefe  were,  nor  yet  finiilar, 
as  thefe  are,  in  all  at  leaft  that  have  ever  occurr’d  to  me,  to  blood,  that  is  ex¬ 
amin’d  after  having  flood  in  a  glafs  veffel  a  day  or  two  to  coagulate,  but  far 
differing  from  this,  both  to  the  touch  and  to  the  eye.  They  do  not  how¬ 
ever,  occur  in  all  aneurifms,  notwithftanding  the  blood  be  thick  and  vifcid, 
and  the  furface  of  the  artery  unequal,  the  breadth  much  greater,  the  parietes 
weak,  and,  finally,  every  thing  fo  difpos’d,  that  from  the  motion  of  the  blood 
being  doubtlefs  diminifh’d,  it  leems  that  thefe  depofitions  and  adhefions  muft 
of  courfe  eafily  take  place ;  and  even  putting  the  aneurifm  quite  out  of  the 
queftion,  when  the  artery  has  been  very  clolely  tied  up  in  living  dogs,  yet  a 
polypous  concretion  did  by  no  means  appear  above  the  part  that  was  tied,  as 
it  had  appear’d  to  Lancifi  (/).  Yet  1  do  not  only  readily  give  credit  to  this 
gentleman,  who  by  real'on  of  his  ingenuity,  his  diligence,  his  doflrine,  and  his 
friendfhip  towards  me,  is  very  dear  to  me  *,  but,  moreover,  what  he  contends 
for,  in  regard  to  fome  kinds  of  aneurifms,  I  even  confirm  by  fome  of  my  ob¬ 
fervations,  and  by  a  great  number  of  Valfalva’s.  However,  as  I  confefs  that 
innumerable  other  polypi,  which  mod  phyficians  have  fuppos’d,  with  too  great 
readinefs,  to  have  exiiled  in  the  living  body,  werejuflly  call’d  intodifpute  by 
him  ;  and  as  I  do  not  know  any  perfon  who  has  re  a  Ton’d  more  nervoufly  on 
the  whole  of  this  fubjedl,  and  deferv’d  better  of  the  medical  faculty  in 
this  refpedl,  fo  I  fhould  believe  that  fome  very  few  polypi,  out  of  fo  great  a 
number,  may  be  excepted,  and  efpecially  thofe  which  are  found  where  the 
motion  of  the  blood  has  either  been  wholly  defiroy’d,  or  very  much  impeded. 
For  what  has  been  found  by  Lancifi  in  dogs,  has  alfo  been  found  by  others  in 

(<■)  Eph.  N.  C.  Dec.  i.  A.  i.  Obf.  18.  ( e )  Adverf.  2.  Anim.  41. 

(d)  Obf.  Anat.  Chir.  38.  (f)  De  Aneur.  Propof.  38. 


M  m  m  2 


men, 


4  5  2  Book  II.  Of  Difeafes  of  the  Thorax. 

men,  as  by  the  very  experienc’d  furgeon  Petit  (g),  who  defcribes  and  gives  a 
figure  of  a  polypus  in  the  artery  of  thofe  who  had  their  limbs  amputated, 
form’d  above  the  ligature  ;  and  he  lays,  that  this  was  not  only  found  perfect,  in 
general,  after  the  twentieth  or  thirtieth  day,  but  even  after  the  fecond  day 
from  amputation.  But  if  the  motion  of  the  blood  be  not,  as  in  that  cafe,  al¬ 
together  obftrucled,  but  only  very  much  retarded  as  in  a  large  aneurilfn,  it 
feems  to  me  very  difficult  to  luppofe,  in  many  cafes,  that  no  part  of  the  blood, 
at  leaft  in  a  long  (pace  of  time,  ffiould  at  length  ieparate,  concrete,  and  ad¬ 
here,  as  it  certainly  flows  on  very  llowly  in  that  part,  or  even  as  in  thofe  aneu- 
rifms  which  have  the  form  of  a  bag,  almoft  hands  hill  :  for  through  the  fame 
orifice  of  the  fac  into  which  it  is  eafiiy  impell’d,  or  falls,  it  cannot  fo  eafily 
and  totally  return  ;  which  circumftanee  is  plac’d  by  Littre  ( b )  amons  the 
caufes  retarding  the  motion  of  the  blood  ;  but  I  do  not  know  whether^it  be 
the  chief  of  them  ail  or  not.  What  if  with  this,  befides  the  other  general 
caufes,  almoft  perpetual  quiet  is  join’d,  by  reafon  of  the  patient  fearing  either 
a  fyncope  or  fuffocation,  as  is  for  the  moft  part  the  cafe,  in  the  latter  part  of 
the  difeafe  ?  And  if,  even  in  this  manner,  no  polypi  were,  perhaps,  gene¬ 
rated  before  death,  in  any  particular  inftance,  1  fhould  think  that  a  peculiar 
caufe  lay  latent  in  that  man,  by  reafon  of  which  they  could  not  even  be  ge¬ 
nerated  after  death,  or,  at  leaft,  could  fcarcely  be  generated.  But  thefe  things 
I  will  leave  to  the  determination  of  others,  and  particularly  to  the  judgment 
and  decifion  of  that  very  celebrated  man,  whom  I  defervedly  love  and 
commend. 

30.  Before  I  make  an  end  of  writing  upon  aneurifms,  which  were  found 
from  difiedlion  in  the  aorta,  much  more  frequently  by  Valfalva  than  he  could 
have  believ’d,  1  do  not  think  that  I  am  at  liberty  to  pafs  over,  entirely,  in 
filence,  that  being  mov’d  by  the  very  great  frequency  of  fo  fatal  a  difeafe!  he 
began  to  think  how  it  would  be  poffible,  by  counter-adling  it  in  the  begin¬ 
ning,  to  prevent  its  increafe  and  progrefs.  This  method  of  prevention^  or 
cure,  is  made  public  by  Hippolyto  Francefco  Albertini  (z),  the  companion  of 
his  ftudies,  which  if  you  read  over,  you  will  immediately  think  with  me, 
that  no  other  perfcn  certainly  ever  exifted  who  executed  with  fo  fevere  a 
diligence,  what  Plippocrates  (&),  in  regard  to  the  internal  varices  of  the  veins 
which  I  fpoke  of  above  (/),  had  commanded  formerly  after  this  manner  :  “  But 
“  it  is  of  ufe  in  fuch  perfons,  if  you  undertake  to  cure  them  in  the  beo-in- 
“  ning,  that  blood  be  taken  from  the  veins  in  the  hand,  and  that  the  diet  be 
“  as  dry  as  poffible,  and  as  little  apt  to  generate  blood.”  But  the  advantage 
was  equal  to  the  feventy  of  the  regimen  ;  for  as  to  what  Hippocrates  fubjoins, 
“  if  they  are  cur’d  in  the  beginning  of  the  difeafe,  the  veins  in  the  fide  ao-ain 
“  lubfide  into  their  places,  and  become  low,”  the  very  fame  thing  happen’d  in 
the  arteries,  from  the  fame  method  of  cure  being  timely  apply’d.  b?or  did 
Valfalva  know  this  from  the  departure  of  the  puliation,  and  the  other  figns 
only  which  attend  upon  an  incipient  aneurifm,  but  he  alfo  made  ufe  of  his 
own  eyes*,  for  a  nobleman  whom  he  had  cur’d  in  this  manner,  havino-  died 
afterwards  of  another  difeafe,  he  found  the  artery,  in  which  the  aneurifm  had 

(0  Opufc.  cit.  fupra,  sd  n.  r. 

(/6)  De  Morbis  1.  1,  n.  xo. 


(g)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1531. 
(/->)  Mem.  A.  1707. 


8 


(/)  n.  1; 

been 


Letter  XVII.  Article  31.  453 

been  beginning,  contracted  again  to  its  natural  fize,  but  in  a  manner  callous 
in  that  place.  This  cafe,  indeed,  Valfalva  omitted  to  write  down,  as  he  did 
many  others  in  the  latter  years  of  his  life  ;  yet  he  communicated  it  to  feveral 
perfons,  and  in  particular,  to  that  excellent  phyfician  Anthony  Stancario,  a 
man,  if  there  is  one  in  the  world,  of  undoubted  credit,  from  whom  I  myfelf 
receiv’d  that  which  I  have  related  and  what  I  {hall  fubjoin,  when  I  came 
from  Bologna  in  the  year  1728. 

When  Valfalva  had  taken  away  as  much  blood  as  was  requifite,  and  had 
done  the  other  neceffary  things  which  Albertini  has  fince  deferib’d,  he  made 
it  a  cuftom  to  diminifh  the  quantity  of  meat  and  drink  more  and  more  every 
day,  till  he  came  fo  far  as  to  allow  only  half  a  pound  of  pudding  in  the  morn¬ 
ing,  and  in  the  evening  half  that  quantity,  and  nothing  elfe  except  water  (and 
this  alio  within  a  certain  weight)  which  he  medicated  with  what  they  call  the 
ice  of  quinces,  or  the  lapis  ofteo  colla  ground  down  into  a  very  fine  powder. 
After  he  had  fufficiently  reduc’d  the  patient  by  this  method,  fo  that  he  could, 
by  reafon  of  weaknefs,  fcarcely  raife  his  hand  from  the  bed,  in  which  he  lay 
by  Valfalva’s  order,  from  the  very  beginning  of  thedifeafe,  he  encreas’d  by  de¬ 
grees,  every  day,  the  quantity  of  aliment,  till  the  necelfary  ftrength  return’d, 
in  order  to  rife.  And  Stancario  added  this  alfo,  that  he  himfelf  having  fuc- 
cefsfully  cur’d  a  young  nun  in  the  fame  manner,  on  the  firft  days  that  {he 
rofe  from  her  bed,  according  to  the  regimen  given  ns  by  Albertini,  the  pul- 
fation  return’d  *,  but  that  we  ought  not  to  be  terrify’d  at  this,  for  it  did  not 
continue,  but  at  length  vanifh’d  away  entirely,  nor  did  any  more  return  ;  nor 
will  it  in  general  return,  unlefs,  perhaps,  the  patients  will  not  reftrain  them- 
felves  within  moderate  bounds  of  living  :  for  a  young  doflor  who  would  not 
live  regularly,  had  the  pulfation  taken  away  by  Valfalva,  by  this  method  of 
cure,  in  vain  j  for  the  puliation  return’d  again,  and  with  that>  the  difeafe, 
which  at  length  carry’d  off  the  patient. 

Thefe  things,  if  you  pleafe,  you  may  add  to  what  Albertini  has  faid  on  the 
fame  fubjedt,  and  in  the  mean  while  obferve  with  me,  how  far  from  the 
method  of  Valfalva,  who  luffer’d  water  to  be  given,  only  under  proper  re- 
flraint,  is  the  advice  of  thofe  who  have  recommended  the  drinking  of  warm 
water  from  baths  to  thofe  who  are  affedted  with  this  difeafe  •,  and,  on  the 
other  hand,  how  near  that  method  of  cure  approaches  to  Valfalva’s,  which 
was  happily  made  ufe  of  by  Bernardin  Genga(w),  and  John  Maria  Lan- 
cifi  (#),  with  juftice  confirm’d,  in  order  to  reftrain  external  aneurifms  in  the 
very  beginning  ;  fo  that  if  Hippocrates,  as  is  hinted  at  above,  had  not,  in 
fomc  meafure,  pointed  out  the  way,  this  might  feem  to  have  been  transferr’d 
by  Valfalva,  from  external  to  internal  aneurifms. 

31.  I  am  not  ignorant,  that  there  will  be  many  to  whom  the  method 
of  cure  which  Valfalva  us’d  may  feem  much  more  infufferable  than  the 
aneurifm  itfelf,  efpecially  at  that  only  time  when  it  could  be  of  ufe  ;  for 
the  flight  inconveniences  in  the  beginning,  and  the  danger  Which  is  not 
yet  at  hand,  and  is  unfeen  to  the  patients,  fuffer  them  to  flatter  thern- 
felves,  though  they  mu  ft  of  courfe  feel  far  otherwife,  when  the  dflorder 
(hall  come-  to  fuch  a  height,  that  neither  the  moft  grievous,  and  continual 

(m)  Anat.  Chirurg.  1,  2.  c.  24.  (»)  De  Mot.  Cord.  &  Aneur.  1,  2.  c.  1.  Prop.  11.  in  fin. 

uneafi- 


454  Book  II.  Of  Difeafes  of  the  Thorax. 

uneafi nefies,  nor  death  itfelf,  which  is  every  hour  impending,  can  any  longer 
be  avoided,  by  any  kind  of  remedy  whatever.  They  who  would  not  endure 
that  parfimony  in  their  food,  while  it  could  be  a  cure  to  them,  are  fometimes 
oblig’d  to  fuller  the  molt  extreme  hunger,  as  the  woman  1  fpeak  of  (0)  did, 
which  does  not  bring  health,  but  rather  death,  inafmuch  as  it  really  accelerates 
it,  to  a  very  weak  and  exhaufted  body.  And  by  reafon  of  the  fame  infir¬ 
mity,  and  the  little  quantity  of  blood,  venaefedlions,  which,  if  timely  made 
ufe  of,  would  have  been  advantageous,  are  now  prejudicial.  On  the  other 
hand,  how  much  thofe  remedies,  and  that  parfimony,  can  do  in  the  be¬ 
ginning,  nothing  better  demonftrates  than  the  utility  of  both,  which  is  well 
known  to  phyficians,  if  they  are  even  moderately  made  ufe  of,  to  retard  the 
progrefs  of  an  aneurifm  that  is  already  form’d,  yet  not  too  far  advanc’d. 
But  1  faw  an  old  woman  at  Bologna,  who  had  been  taken  into  the  hofpital 
for  a  violent  inflammation  of  her  eyes.  As  I  perceiv’d  that  her  pulfe  was 
full,  tenfe,  and  chord-like,  and  faw  that  the  arteries  in  her  neck  leap’d  to 
a  confiderable  degree,  efpecially  the  left,  which  was  fwoll’n  into  an  aneurifm, 
rot  far  from  the  larynx,  equal  in  fize  to  a  walnut ;  I  enquir’d  whether  this 
was  a  recent,  or  an  old  complaint,  and  had  this  relation  made  to  me,  which 
I  make  to  you  :  That  this  tumour,  which  I  obferv’d  in  the  neck,  had  come 
upon  her  about  nine  years  ago,  after  fhe  had  wearied  herfelf  for  two  days 
together  by  continual  fatigues.  And  having  fhewn  it  to  two  eminent  phy¬ 
ficians,  they  both  of  them  pronounc’d  it  to  be,  what  it  evidently  was,  an 
aneurifm  ;  but  that  each  of  them  had  given  a  different  advice  :  for  that  one 
had  order’d  her  to  lofe  blood  every  two  months  :  the  other  not  to  lofe  blood, 
but  rather  to  ufe  a  fpare  diet,  and  other  things  of  that  kind  ;  adding  this 
reaion  in  confirmation  of  his  opinion,  that  he  had  known  a  man,  who,  while 
blood  was  flowing  out  of  the  vein  that  had  been  open’d,  had  his  aneurifm 
burft  at  the  very  inflant;  which,  whether  it  happen’d  by  accident,  the  pa¬ 
rietes  of  the  aneurifm,  for  inftance,  being  already  extenuated,  and  half  la¬ 
cerated,  and  a  rupture  of  itfelf  being  at  hand,  or  whether  the  rupture  waq 
perhaps,  fomewhat  accelerated  by  the  impetus  of  the  blood  being  a  little  in¬ 
creas’d  upon  the  very  thin  parietes  of  the  aneurifm,  while  the  blood  flow’d 
out  from  the  vein,  may  certainly  be  added  here  to  the  other  caufes,  as  a 
reafon  why,  in  the  latter  part  of  the  difeafe,  or  when  there  are  already  figns 
of  a  rupture  being  at  hand,  no  tumult  is  to  be  excited  by  thephyfician,  efpe¬ 
cially  as,  befides  Ballonius  (p),  I  am  not  ignorant  of  another  example,  which 
will  prefently  be  fubjoin’d  :  yet  it  ought  not  to  prevent  that  moft  ufeful  re¬ 
medy  of  blood-letting  in  the  incipient  and  progrdTive  ftate  of  the  aneurifm. 
For  this  remedy  was  very  ufeful  to  the  woman  I  have  been  fpeaking  of,  al¬ 
though  fhe  was  too  fond  of  the  praftice.  For  having  follow’d  the  advice  of 
the  former  phyfician  entirely,  but  having  detefted  to  fuch  a  degree  the  advice 
of  the  latter,  which  the  former  would  certainly  have  approv’d,  fo  that  fhe 
committed  all  kinds  of  errors  and  irregularities  in  her  diet,  fuch  as  either 
occafion  threw  in  her  way,  or  appetite  fuggefted  to  her ;  yet  for  thofe  nine 
years  together,  fhe  bore  what  I  have  deferib’d  in  her  neck,  without  the  leafl 
increafe,  although  palpitations  of  the  heart  were,  indeed,  fometimes  brought 

(0)  Supra,  n.  25.  (/)  Vid.  n.  feq.  in  fin. 

©n. 


Letter  XVII.  Article  32.  4 55 

on.  But  it  is  dangerous  to  imitate  this  woman,  unlefs  any  one  fhould,  per¬ 
haps,  generate  fo  much  blood  as  the  generated.  For  befides  that  quantity 
which  (lie  loft  every  two  months  alfo,  a  year  before  I  law  her  fhe  had 
brought  up  from  her  lungs  fuch  a  quantity  of  blood  that  fhe  was  reduc’d  to 
the  laft  extremity,  yet  did  not  fall  into  a  cachexy,  but  even,  as  I  faid,  la¬ 
bour’d,  at  length,  under  an  inflammation  of  the  eyes. 

32.  Now  take  the  other  example,  which  I  promis’d  juft  now  ;  an  example 
not  very  much  unlike  that  which  the  phyfician  related  to  the  old  woman, 
if  I  am  not  deceiv’d.  A  nobleman,  aged  more  than  fifty  years,  about  the 
begmning  of  May,  in  the  year  1730,  came  to  Padua,  to  confult  me,  and 
at  the  fame  time,  to  confult  another  fenior  phyfician.  He  told  11s,  that  from 
the  very  time  he  had  repell’d  an  eruption  of  the  fcabies  kind,  that  had 
come  upon  him  for  the  fecond  time,  by  a  fulphureous  ointment  j  from  that 
very  time,  1  fay,  and  it  was  now  ten  years  fince,  he  had  been,  by  degrees, 
fubjedft  to  a  certain  troublefome  fenfe  of  weight,  and  conftriCtiop,  juft  as  if 
a  large  bolus  ftuck  in  its  paflage  through  the  cefophagus  :  that  this  fenfation 
feem’d  to  be  fituated  in  the  internal  part  of  the  thorax,  oppofite  to  the: 
middle  region  of  the  fternum,  except  that  fometimes,  though  but  leldom,.. 
it  was  extended  fo  far  as  to  correfpond  with  the  lower  part  of  the  fternum ; 
and  at  that  time  his  refpiration  was  alfo  fomewhat  injur’d,  and  a  very  heavy 
kind  of  ftupor  was  diffus’d  through  each  of  his  luperior  limbs  :  and  that  in 
the  beginning,  indeed,  he  had  felt  this  fenfation  only  when  he  walk’d, 
efpecially  up  fteep  places,  but  afterwards  when  he  bent  himfelf  forwards 
alfo,  and  remain’d  in  that  fituation  :  that  it  very  feldom  attack’d  him  in  the 
fummer,  or  before  dinner,  but  much  more  often  in  the  winter,  and  after 
dinner,  and  when  he  was  going  to  bed  :  that,  for  the  moft  part,  it  vanifh’d 
foon,  if  he  ftood  upright ;  but  in  the  laft  winter,  when  it  had  awak’d  him 
out  of  his  fleep,  which  never  had  happen’d  before,  that  it  continu’d  two  or 
three  hours,  although  he  had  rifen  out  of  bed.  However,  he  neither  per¬ 
ceiv’d  any  pulfation,  nor  had  an  intermitting  pulfe  *,  yet  his  pulfe  was  very 
frequent  and  chord-like,  that  uneafy  fenfation  not  being  entirely  gone  off, 
when  I  enquir’d  into  their  ftate  ;  at  which  time  alfo,  by  preffmg  the  hand 
clofely  to  the  left  nipple,  the  heart  feem’d  to  beat  a  little  ftronger  than  was 
natural.  And  as  we  found  no  diforder  in  any  place,  but  thole  which  are 
ipoken  of,  and  efpecially  that  there  was  not  the  leaft  trace  of  a  cephalic,  or 
hypochondriac  affection,  we  both  of  us  began  to  fufpetft,  that  the  irritating 
and  corrofive  particles  of  the  fcabies,  which  had  been  repell’d,  had  not  fo 
much  fall’n  upon  a  ganglion,  or  any  plexus  of  nerves,  which  go  to  the  prae¬ 
cordia,  as  perhaps  upon  the  coats  of  the  aorta,  and  brought  on  a  tendency' 
to  dilatation. 

Notwithftanding  we  here  gave  our  opinion  in  a  cafe  that  was  not  quite 
clear,  yet  we  did  not  think  venrefcdtion  fhould  be  omitted,  becaufe  we  be¬ 
liev’d,  that,  if  it  were  of  no  advantage,  it  could  be  of  no  injury,  inafmuch 
as  he  was  a  man  of  firm  ftrength,  of  a  good  habit  of  body,  and  had  a  florid 
complexion  from  his  youth  •,  that  it  could  be  in  no  refpedt  injurious,  even 
whether  the  difeafe  was  from  contractions  of  the  nerves,  or  from  a  dilatation 
of  the  artery,  but  certainly,  as  it  was  then  the  fpring-time,  would  be  par¬ 
ticularly  ufeful.  And  I  remember  I  inculcated  this  upon  him,  when  he. 

was 


456  '  Book  IT.  Of  Difeafcs  of  the  Thorax. 

was  going  away,  that  if  he  found  the  lofs  of  blood  of  fervice  to  him,  he 
fhould  take  care  to  have  it  repeated,  before  the  end  of  the  fpring;  but  if  he 
obferv’d  himfelf  to  be  difturb’d,  or  weaken’d  by  the  firft,  he  Ihould  omit  it, 
and  that  he  fhould  do  the  fame  allb  in  regard  to  other  remedies,  one  indif- 
penfable  remedy  only  excepted,  which  we  earneftly  recommended  a  compli¬ 
ance  with ;  I  mean,  a  proper  ufe  or  what  the  phyficians  call  the  non-natu¬ 
rals.  Wherefore  this  nobleman  having  reach’d  his  home  very  happily,  which 
was  not  at  a  great  diftance,  and  having  begun  to  ufe  the  firft  and  moft  inno¬ 
cent  remedies,  and  at  the  fame  time  having  loft  eight  ounces  of  blood  from 
his  right  arm,  his  phyfician  thought  proper  that  he  fliould  lofe  blood  again, 
for  this  reafon,  becaufe  it  was,  as  he  laid,  hot  and  inflam’d,  at  leaft  black, 
and  very  vifeid. 

But  when  the  fourth  day  was  come,  on  which  the  phyfician  had  order’d 
the  blood  to  be  taken  away,  the  patient  was  not  willing  to  comply,  perhaps, 
in  confequence  of  the  admonitions  1  had  given  him,  and  objected  to  it  on 
account  of  the  debility  which  he  faid  he  perceiv’d;  and  indeed,  on  the  two 
preceding  nights,  he  had  been  a  little  troubl’d  with  his  diforder.  Yet  as 
this  weaknefs  had  not  deftroy’d  his  ufual  chearfulnefs,  nor  taken  away  the 
power  of  walking,  nor,  as  the  furgeon  affirm’d,  the  vigour  and  ftrength  of- 
his  pulfe,  at  length,  overcome  by  his  perluafions,  he  gave  his  foot  to  him, 
in  compliance  with  the  phyfician’s  order,  from  which  fix  ounces  of  blood, 
and  no  more,  were  taken.  No  fooner  was  this  done,  but  the  nobleman  cried 
out,  that  the  furgeon  had  kill’d  him,  and  was  feiz’d  with  a  fainting-fit,  and 
prelently,  when  he  recover’d  from  that,  with  another,  and  at  length,  having 
of  himfelf  got  out  of  bed,  for  the  fake  of  going  to  ftool,  with  a  third,  and 
being  at  the  fame  time  taken  with  his  former  diforder,  he  could  be  no  more 
recover’d,  wherefore  he  died,  in  an  ealy  placid  manner,  on  that  very  day ; 
that  is,  about  the  twentieth  day  after  his  departure  from  Padua. 

As  moft  perlbns  of  the  city,  where  this  nobleman  refided,  inveigh’d 
againft  the  phyfician  and  furgeon,  according  to  cuftom,  as  having  injudicioufly, 
and  without  reafon,  taken  blood  away  on  that  day,  and  thereby  brought 
on  the  immediate  death  of  their  noble  patient,  and  as  I  was  confulted  on 
this  fubject  by  letters,  I  inform’d  them,  what  frequently  happen’d  in  a  dif¬ 
order  of  that  kind,  which  we  fufpetfted  this  nobleman’s  to  be,  even  without 
any  blood-letting  being  adminifter’d ;  and  by  this  means  we  appeas’d  their 
refentments  againft  them.  And  this  they  themfelves  would  have  done  much 
fooner,  in  my  opinion,  if  they  had  been  at  liberty  to  open  the  body  after 
death,  by  fhowing  that  the  caufe  of  death  did  not  arile  from  the  blood  that 
had  been  taken  from  the  vein  externally,  but  from  that  which  had  certainly 
flow’d  from  a  vefiel  that  had  been  ruptur’d  internally:  notwithftanding  Bal- 
lonius,  to  whom  an  almoft  flmilar  circumftance  happen’d  ;  to  wit,  that  For- 
mageus,  whole  aneurifm  I  have  mention’d  above  (^),  “  died  fuddenly  from 
“  the  rupture  of  it,  three  hours  after  ven^feblion,”  did  not  deny  that  this 
had  happen’d  to  him,  “  to  the  great  reproach  of  our  art,  which  is  fo  ufeful 
“  to  many,”  and  even  acknowledg’d,  “  that  it  was  a  fhameful  calamity.” 
But  he  who  had  taken  the  difeafe  for  another,  could  not  have  prevented  the 


(?)  n-  3* 


reproach : 


Letter  XVIII.  Articles  i,  2.  457 

reproach :  yet  the  phyfician  and  furgeon  of  the  noble  patient  I  have  been 
fpeaking  of,  might  have  confulted  their  own  reputation  better,  before¬ 
hand,  both  from  our  fufpicion,  and  from  hearing  what  1  had  inculcated  on 
the  patient. 

However,  the  cafe  which  I  have  here  defcrib’d,  ought  to  be  a  caution  to 
all  pradlitioners,  not  to  compel  patients  to  admit  of  any  remedy,  to  which 
they  are  utterly  averfe,  efpecially  in  obfcure  difeafes,  whether  the  remedy  is 
cf  great  importance,  or  has  the  appearance  of  being  fo.  In  the  mean  time 
farewel,  and  expert  my  obfervations  upon  aneurifms,  confirm’d  by  anatomy, 
in  the  next  letter. 


LETTER  the  EIGHTEENTH, 

Which  concludes  the  Difcourfe  upon  injur’d  Refpiration, 
from  Aneurifms  of  the  Heart,  or  great  Artery,  within 
the  Thorax. 

1.  "j\T O W  take  alfo  my  obfervations  of  internal  aneurifms  in  the  thorax, 
l/N  digefted  in  the  fame  order  which  I  purlu’d  in  the  laft  letter,  in  re¬ 
gard  to  the  obfervations  of  Vali'alva  ;  fo  that  whether  they  have  place  in  the 
heart,  or  in  the  great  artery,  or,  finally,  in  both  places  at  once,  you  may 
equally  underftand  from  thence,  that  a  lefion  of  refpiration,  which  is  the 
fubjedt  I  treat  of,  had  exifted. 

2.  A  Ihoemaker,  of  three- and- thirty  years  of  age,  having  been  liable  to 
a  d  fficulty  of  breathing,  for  a  few  years  paft,  which  us’d  even  to  trouble 
him,  when  he  was  fitting  down,  as  fhoemakers  generally  do,  and  to  a  kind 
of  flight  faintings,  his  pulle  being  at  that  time  unequal,  but  not  afterwards, 
lometimes  alfo  to  vertigoes,  but  chiefly  to  the  other  fymptoms,  which  I 
mention’d  juft  now,  as  I  heard  from  the  phyfician,  who  had  attended  him  a 
twelvemonth  before;  finally,  about  the  middle  of  January,  in  the  year  1739, 
after  having,  in  the  morning,  gone  up  all  the  flairs  into  the  hofpital,  which 
are  in  great  number,  by  himfeif,  and  being  taken  immediately  into  bed,  he 
pointed  out  both  by  his  words,  and  by  his  hand,  a  pain  in  the  region  of 
the  diaphragm  ;  he  cough’d,  he  had  a  languid  and  fomewhat  frequent  pulle, 
but  it  neither  intermitted,  nor  was  in  any  refpeft  unequal.  When  death  did 
not  feem  to  be  very  near  at  hand,  he  threw  up,  from  his  ftomach,  a  green- 
ifh  kind  of  matter,  and  within  half  an  hour,  from  the  time  that  he  came 
into  the  hofpital,  died.  Examining  the  carcafe,  when  it  was  brought  into 
the  theatre,  in  order  to  begin  my  anatomical  demonftrations  from  it,  I  found 
that  it  fo  far  feem’d  of  a  laudable  habit,  as  not  to  have  any  oedematous 
fwelling  upon  the  legs  and  feet,  notwithftanding  it  was  a  little  blotch’d  with 
Vol.  I.  Nnn  a  kind- 


45  8  Book  II.  Of  Difeafes  of  the  Thorax. 

a  kind  of  fcabies,  and  defac’d,  as  it  were,  with  the  colour  of  a  cacheCtic 
perfon. 

The  abdomen  being  open’d,  in  which  a  little  bloody  ferum  was  extrava- 
fated,  a  great  part  of  the  fmall  inteftines  was  found  to  be  of  a  reddifh 
colour,  degenerating  into  brown  •,  and  the  colon,  to  a  very  confiderable  ex¬ 
tent,  and  particularly  where  it  paffes  over  from  the  right  to  the  left  hypo¬ 
chondrium,  was  fo  contracted,  that  it  did  not  greatly  exceed  the  thicknefs  of 
a  thumb.  The  ftomach  was  alfo  contracted,  and  internally  mark’d  here 
and  there,  with  inflammatory  ftrise,  and  efpecially  in  the  rugae,  the  upper 
orifice  being  already  livid,  and  almoft  black;  it  contain’d  alfo  a  little  quan¬ 
tity  of  yellow  bile,  which,  notwithftanding  it  appear’d  in  its  veficle  to  be 
almoft  black,  had  neverthelefs  ting’d  the  external  coats  of  the  gall-bladder, 
and  the  neighbourhood  thereof,  with  a  deep  yellow  colour.  The  fpleen  was 
thicker  than  is  natural,  but  found,  and  was  connected  very  ftrongly,  by  its 
whole  convex  furface,  to  the  diaphragm.  What  ftruck  our  eyes,  above  other 
things,  was  the  fmallnefs  of  the  aorta,  which,  from  the  diaphragm,  quite  to 
its  divifion,  was  more  fuitable  to  a  little  woman,  than  to  a  man,  who  was, 
like  him,  rather  of  a  large  ftature :  and  this  fmallnefs  I  fhould  perhaps  have 
accounted  for  from  this  reafon,  that  the  aorta  did  not  here,  as  ufual,  pals 
under  the  arch  of  the  appendages  of  the  diaphragm,  where  they  are  united 
into  one  ;  that  is  to  fay,  they  did  not  pafs  through  a  large  interftice,  but 
only  through  a  foramen  to  the  belly ;  if  this  foramen  had  not  been  of  its  ac- 
cuftom’d  breadth,  and  of  the  length  of  two  inches.  But  that  I  may  not 
feem  to  be  obfcure,  in  a  circumftance  which  I  do  not  remember  ever  to  have 
met  with,  among  other  authors,  take  this  account  of  it :  that  interval,  which 
I  juft  now  pointed  out,  being  left  from  the  upper  part  of  the  arch,  down¬ 
wards  and  backwards,  a  tendon  was  drawn  from  the  internal  fide  of  the  right 
appendix,  into  the  internal  fide  of  the  left,  to  the  length  of  nine  lines  of 
Bologna  {a),  and  the  thicknefs  of  one  :  and  fo  between  this  tendon,  and  that 
arch,  the  aorta  pafs’d  through  to  the  belly.  Thefe  things,  and  others,  which 
it  is  of  lefs  confequence  to  take  notice  of  here,  being  confider’d,  when  the 
vena  cava  was  cut  into,  where  it  goes  out  from  the  liver  to  the  diaphragm, 
a  great  quantity  of  blood  iflfu’d  out,  in  fo  black  and  thick  a  ftate,  that  it  ad¬ 
her’d  to  the  fponge,  rather  than  was  abforb’d  by  it,  and  ting’d  the  fponge 
like  ink.  Nor  did  I  find  that  a  lefs  quantity  of  the  fame  kind  of  blood,  had 
ififu’d  out  from  the  fame  vein  afterwards,  when  on  the  tenth  day,  which  from 
the  time  of  his  death,  was  the  thirteenth,  having  demonftrated  all  the  vif- 
cera  of  the  belly  feparately,  and  in  order,  I  return’d  to  the  body  in  general, 
which  in  that  cold  leafon,  had  not  contracted  the  leaft  putrefcency. 

The  thorax  being  open’d,  we  found,  in  both  of  its  cavities,  a  limpid 
water,  yet  not  in  great  quantity ;  and  the  right  lobe  of  the  lungs  was  con¬ 
nected  to  the  pleura,  almoft  in  every  part,  but  the  left  only  in  one  part. 
Both  of  them  were  turgid,  but  neither  of  them  heavy,  nor  yet  in  the  bron¬ 
chia,  nor  the  other  veffels,  nor  in  the  fubftance  of  the  lungs  itfelf,  in  any 
refpeCt  morbid.  This  only  was  obferv’d,  that  the  fubftance  of  this  vifcus 
could  not  be  torn  afunder,  or  broken  from  the  bronchia,  and  the  other  vef- 

(«)  Vid.  Valfalvse  de  Aure  Hum.  Tab.  9.  ad  * 

fels,  • 


Letter  XVIII.  Article  3.  459 

fels,  without  much  more  difficulty  than  ufual.  So  alfo,  Toon  after,  in  pull¬ 
ing  away  the  external  coat  of  the  aorta,  a  greater  refiftance,  than  ufual,  was 
found.  But  at  the  divifion  of  the  afpera  arteria,  into  the  firfb  bronchia, 
the  bronchial  glands  not  only  appear’d  in  great  number,  but  were  fo  thick, 
as  to  equal  the  magnitude  of  fmall  grapes. 

In  the  pericardium  was  a  fmall  quantity  of  reddiffi  water;  and  the  heart 
was  more  large  than  if  you  ffiould  even  join  two  hearts  into  one  ;  and  both 
the  auricles,  and  the  finus  of  the  pulmonary  vein,  as  it  is  call’d,  were  larger 
than  ufual  ;  but  the  ventricles,  and  efpecially  the  left,  were  much  larger  than 
ufual ;  for  this  latter  cavity  was  fo  extended  in  breadth  on  all  fides,  that  the  di- 
miniffi’d  thicknefs  of  all  its  parietes  was  fcarcely  equal  to  the  thicknefs  of  that 
paries  which  is  proper  to  the  right  ventricle  ;  yet  thofe  mufcular  chords  which 
are  interwoven  within  the  right  ventricle  in  a  reticular  manner,  were  not 
broken  afunder  for  that  reafon,  nor  yet  wafted  ;  nor  was  there  any  evident 
diforder  in  the  valves,  except  in  thofe  which  are  plac’d  at  the  mouth  of 
the  aorta,  for  thefe  we  faw  very  lank,  and  contracted  into  themfelves,  fome- 
what  rigid  alfo,  and  a  little  hard,  and  that  particularly  in  the  upper  border  of 
each  ;  but  as  there  was  only  a  fmall  quantity  of  the  blood  which  I  defcrib’d 
above,  in  the  beginning  of  the  aorta,  there  was  more  in  the  left  ventricle ;  and 
the  fame  had  fo  fill’d  the  branches  of  the  coronary  vefiels,  which  pafs  through 
the  heart,  that  a  greater  number  of  their  lateral  anaftomofes  appear’d  to  the 
naked  eye  than  ufual  ;  and  though  the  aorta,  as  well  as  the  vena  cava,  was 
not  particularly  dilated  in  any  part,  yet  it  fhew’d  no  flight  diforders  in  its 
whole  trunk,  and  thofe  the  greater,  as  it  approach’d  nearer  to  the  heart. 
For  as  it  was  fo  variegated  internally  with  large  whitifh  fpots,  or,  in  other 
words,  with  the  beginnings  of  future  offification,  that  it  had  a  natural  ap¬ 
pearance  only  in  few,  and  thofe  fmall,  places  ;  the  farther  it  afcended  into  the 
thorax,  the  more  this  appearance  of  dileafe  encreas’d,  fo  that  before  we  came 
to  the  left  fubclavian  artery  thefe  fpots  more  evidently  approach’d,  up  and 
down  in  its  fubftance,  to  the  nature  of  bony  fcales.  However,  there  was  no¬ 
where  any  bone,  not  fo  much  even  as  betwixt  the  heart  and  that  orifice  which 
is  common  to  the  right  fubclavian  and  carotid;  in  the  whole  of  which  ex¬ 
tent,  the  artery  was  internally  pale,  and  in  many  places  of  an  unequal  furface; 
which  appearances  it  alfo  fhew’d  even  behind  the  femilunar  valves.  But  in 
the  whole  of  this  traCt,  which  I  juft  now  mention’d,  there  was  fuch  a  hard- 
nefs  of  the  parietes,  that  they  could  fcarcely  be  cut  afunder  by  the  knife, 
when  apply’d  with  great  force ;  and  in  thefe  fe&ions,  the  fubftance  appear’d 
of  a  middle  nature,  between  cartilage  and  ligament. 

At  length  the  cranium  was  open’d  ;  but  if  we  except  the  veins  of  the  dura 
and  pia  mater  being  turgid  with  black  blood,  with  which  kind  of  blood  molt 
of  the  finuftes  alfo,  that  thofe  vefiels  open  into,  were  diftended,  there  was  no¬ 
thing  at  all  worthy  of  remark,  as  in  the  ventricles  of  the  cerebrum  itfelf  no 
ferum  was  extravafated,  nor  yet  any  other  morbid  appearance  was  feen. 

3.  I  have  told  you  at  large  what  I  faw,  and  would  have  told  you  other 
things  in  like  manner,  it  l  had  feen  or  had  known  them  for  certain  ;  1  mean 
thofe  fymptoms  v/hich  had  preceded  in  the  laft  months,  or  at  leaft  in  the  laft 
days  :  and  there  had  preceded  probably  fuch  caufes  as  could  irritate  the  fto- 
mach  and  fmall  inteftines,  as  the  appearances  in  both  of  thefe  parts,  and  the 

M  n  n  2  vomiting 


460  Book  Ik  Of  Difeafes  of  the  Thorax. 

vomiting  of  green  matter,  may  indicate,  whether  the  patient  had  taken  in  fuch 
things  as  were  capable  of  exciting  irritation,  or  whether  he  had  collected 
them  by  degrees  ;  fuppofe,  for  inftance,  the  bile,  fuch  as  I  have  defcrib’d  it, 
and  acid  humours.  Or  even  fuppofe,  from  whatever  caufe  it  might  be,  that 
the  ftomach  was  now  feiz’d  with  an  inflammation,  as  thofe  reddifh  ftrias,  and 
even  the  ftill  more  inflam’d  frate  of  the  upper  orifice,  which  was  evident  from 
the  livor  and  blacknefs  of  this  part,  fufficiently  demonftrated.  And  from 
hence  yon  will  readily  underftand  why  vomitings,  a  languid  pulfe,  and  a  pain 
in  the  region  of  the  diaphragm,  immediately  preceded  death,  efpecially  as  the 
diaphragm,  at  that  time,  labour’d  more  and  more  under  the  weight  of  the 
heart  that  lay  upon  it,  which  was  encreas’d  by  a  very  thick  blood  of  that  kind  ; 
and  this  blood  ftagnated  the  more,  as  the  force  of  the  heart,  in  expulfion, 
was  more  debilitated,  as  was  evident  from  the  debility  of  the  pulfe  •,  to 
which  if  you  alfo  add  the  compreffion  of  the  cerebrum  from  blood,  by  reafon 
of  the  languid  circulation,  ftagnating  in  the  veflfels  of  the  meninges,  and  con- 
fequently  the  very  fmall  afflux  of  fpirits  to  the  heart  at  the  time  when  there 
was  the  greateft  need  of  them,  it  will  be  very  eafy  to  determine  upon  the 
caufes  that  confpir’d  to  fo  fudden  a  death  which  is  not  however  to  be  won¬ 
der’d  at,  if,  as  Lancifi  obferves  (£),  we  attend  to  more  examples  of  the  fame 
kind,  in  thofe  perfons,  where  the  heart,  being  affedted  with  dilatation,  the 
more  eafily  ceas’d  to  move,  inafmuch  as  it  was  overburthen’d,  and  prefently, 
upon  any  flight  accident  in  the  conftitution,  opprefs’d  by  the  load  of  the 
ftagnating  blood  :  examples  of  which  kind,  that  you  need  not  go  about  to 
feek  them  in  other  authors,  or  turn  back  to  the  former  letter  (c),  you  will 
find  in  fome  of  the  next  obfervations  (d). 

4.  But  from  what  caufe  fhall  we  fay  the  heart  was  dilated  in  this  man? 
One  part  of  the  aorta  was  in  him,  as  I  have  faid,  immoderately  narrow  *  and 
how  far  this  circumftance  can  avail  to  bring  on  a  dilatation  of  the  heart,  will 
appear  prefently,  and  the  obfervation  of  that  molt  fkilful  anatomift  Meckel  (e)9 
taken  from  a  virgin,  will  confirm.  Befides  this  deviation  from  the  ufual 
courfe  of  nature^  which  doubtlefs  was  a  fault  in  the  original  formation,  the 
man  afterwards  apply’d  himfelf  to  fuch  a  kind  of  life  as  had  a  natural  tendency 
to  render  the  progrefs  of  the  blood  more  difficult  through  that  artery  •,  for 
fhoemakers  not  only,  like  other  fedentary  artificers,  bend  thofe  lower  large 
branches  of  the  artery  to  angles,  in  more  than  one  place,  and  keep  them 
bent ;  but  moreover,  the  more  they  bend  themfelves  forwards,  the  more  do 
they  comprefs  the  vifcera  of  the  belly,  which  in  mod  of  them  are  generally 
full  of  meat  and  drink,  and  by  this  means  alfo  comprefs  the  diaphragm,  fo 
that  the  motion  of  the  blood  is  lefs  quicken’d  through  the  belly  and  thorax  ; 
the  branches  of  the  aorta,  and  the  trunk  itfelf,  being  conftridted  and  reduc’d 
to  a  greater  degree  of  narrownefs  *,  and  an  obftrudtion  being,  by  this  means, 
put  to  the  progrefs  of  the  blood  through  the  aorta,  and,  in  like  manner,  to 
its  egrefs  from  the  heart,  the  heart  mult  confequently  impel  the  blood  with 
greater  efforts  through  this  artery,  and  the  artery  alfo  mull  refill:  and  contradt 
itfelf  with  greater  force,  till,  for  thefe  very  reafons,  the  ftrudture  of  it  was  fo 

ft)  De  Subit,  Mort.  Schol.  11.  ad  Obf.  ft)  n.  10.  (d)  n.  8.  &  14. 

Pbyf.  Anat.  2.  ft)  Memoir,  de  l’Acad.  R.de  Berlin  A.  1750. 

vitiated, 


Letter  XVIII.  Article  5.  461 

vitiated,  that  it  contracted  the  hardnefs  which  I  have  defcrib’d,  efpecially  near 
the  heart  •,  and  in  the  valves,  moreover,  contracted  that  lanknels  and  con- 
ftriCled  ftate.  And  then  neither  could  this  artery  yield  properly  to  receive 
the  blood,  nor  yet  contract  itielf  properly  in  order  to  propel  it.  Some  por¬ 
tion  of  blood,  therefore,  muft  neceftarily  remain  in  the  heart,  and  that  fo  much 
the  greater,  as  the  valves,  by  reafon  of  their  rigidity,  could  neither  fuffi- 
ciently  recline  themfelves  to  the  parietes  of  the  artery,  in  order  to  permit  a 
free  egrefs,  nor  yet,  by  reafon  of  the  fame  rigidity,  and  the  lank  and  con- 
ftriCbd  ftate,  being  added  thereto,  could  they  fufficiently  open  and  expand 
themfelves,  in  order  to  prevent  a  return  of  the  blood.  Wherefore  you  plain¬ 
ly  fee  in  my  obfervation,  as  alfo  in  the  obfervations  of  others,  for  inftance, 
that  of  Verdrieftus  (/),  and  Zwingerus  (^),  the  firft  of  whom  faw  the  aorta 
internally  bony,  near  the  heart,  and  the  laft  found  the  valves  of  the  aorta  hard 
and  “  cartilaginous  ”,  what  caufes,  by  refilling  the  heart,  and  by  retaining  the 
blood  therein,  (which,  as  it  was  in  the  greater  quantity,  would  more  irritate 
the  fibres,  and  at  the  fame  time  give  more  refinance  to  the  encreas’d  efforts 
of  the  heart)  could  by  degrees  more  and  more  diftraCt,  and  dilate  the  heart ; 
and  that  fo  much  the  more  eafily  here,  as  both  kinds  of  difeafe  were  join’d 
together  in  the  aorta,  and  the  blood  not  only  gave  more  refiftance  from  its 
thicknefs,  but  by  the  eroding  falts  with  which,  as  this  fcabies  demonftrated, 
it  was  pregnant,  might  have  broken  afunder  thofe  fmall  bands,  whatever 
they  may  be,  that  connected  the  fibres  of  the  heart.  But  if  this  vifeus,  or 
any  part  of  it,  was,  perhaps,  fomewhat  lax,  or  infirm,  from  its  original 
formation,  fo  much  the  more  eafily  could  the  whole,  or  a  part  of  it,  be 
dilated. 

5.  And  it  feems  neceffary  to  acknowledge  this  laft  caufe,  in  fome  cafes  at 
leaft,  if  not  in  this,  as  when  the  obftruCtion  is  at  the  aorta,  but  the  right, 
and  not  the  left  ventricle  of  the  heart  is  dilated ;  which  happen’d  in  that, 
choirifter,  whofe  difleCtion  is  giv’n  by  Lancifi  (b).  For  in  general,  and  at 
other  times,  when  an  obftruCtion  is  made  to  the  emiflary  of  either  ventricle, 
that  ventricle  is  wont  to  be  more  dilated ;  fuppofe,  for  inftance,  the  left, 
when  the  impediment  is  in  the  aorta.  For  which  reafon,  I  doubt,  if  Lancifi  had 
put  the  finifhing  hand  to  his  own  writings,  whether  he  would  have  fubjoin’d 
the  following  things  :  when  there  is  an  obftacle  in  the  aorta,  that  the  dila¬ 
tation  “  is  wont,  for  the  moft  part,  to  happen  in  the  right  cavities  of  the 
“  heart ;  but  when  it  happens  on  the  left  fide,  it  is  almoft  always  obferv’d 
*c  in  the  auricle,  and  not  in  the  ventricle  ;  and  that  this  was  evident  in  the 
“  cafe  related  in  the  fecond  book  of  the  Sepulchretum,  feCtion  the  feventh,, 
“  obfervation  the  forty-ninth,  from  the  obfervation  of  Daniel  Horftius,”  by 
Bonetus  himlelf.  For  if  he  had  read  over  that  cafe,  he  would  certainly  have 
feen,  “  that  the  left  auricle  had  appear’d  bigger  than  the  right,”  but  nothing 
in  particular  of  the  fize  of  the  ventricles  •,  only  this  hin  general  obferv’d, 
“  that  the  heart  was  fo  much  encreas’d  in  its  proportion,  that  all  who  were 
“  prefent  greatly  wonder’d  at  its  magnitude.”  And  if  he  had  look’d  back,, 
not  only  upon  the  obfervations  of  others,  but  upon  his  own,  he  would  have 

(f)  Eph.  N.  C.  Cent.  6.  Obf.  51.  ( h )  De  Aneur.  Obf.  53. 

(g)  Eorund*  Aft.  Tom.  1.  Obf.  18. 

immediately^ 


462  Book  II.  Of  Difeaies  of  the  Thorax. 

immediately  obferv’d,  that  he  ought  to  judge  otherwife ;  unlefs,  perhaps, 
we  fuppofe,  that  another  very  celebrated  man  would  not  have  publilh’d  this 
himfelf,  «  That  the  right  fide  of  the  heart  is  but  rarely  fubjedt  to  aneurifms, 
“  and  the  left  more  frequently,  appears  from  the  experiments  of  Lancifi.” 

I,  however,  whether  1  confider  my  own  obfervanons,  or  thofe  of  others, 
feem  to  remember  to  have  found,  and  to  have  read  of,  more  aneurifms  of 
the  left  ventricle,  than  of  the  right ;  but  not  many  ot  the  left  auricle  :  and, 
in  like  manner,  that  the  aneurifms  of  the  left  ventricle  were  join’d  with  a 
diforder  of  the  neighb’ring  aorta,  or  its  valves  j  but  thofe  of  the  right  ven¬ 
tricle,  generally,  with  fome  impediment,  either  in  the  valves,  which  are 
plac’d  at  the  orifice  of  its  emiffary,  or  in  the  very  paffages  of  the  blood 
through  the  lungs,  or,  finally,  at  the  emiffary  of  the  left  ventricle  ;  fome 
aneurifms  excepted,  in  the  obfervation  of  which,  either  thofe  things  that  1 
mention’d  juft  now  do  not  feem  to  have  been  enquir’d  into,  or  an  hereditary 
laxity  of  the  fibres,  on  the  right  fide,  according  to  Lancifi  himfelf,  ought, 
certainly,  to  be  granted  (/).  Is  not  then,  you  will  fay,  the  mufcular  paries 
proper  to  the  right  ventricle  thinner,  and  confequently  weaker,  than  the 
other,  and  for  thefe  reafons  more  liable  to  dilatations  ?  I  grant  it  is,  if 
equal  caufes,  and  applied  in  the  lame  manner,  contend  with  equal  force  to 
bring  on  a  dilatation  of  the  ventricles.  But  it  is  not  my  bufinefs  to  difpute 
in  this  place  concerning  this  propofition.  Wherefore,  when  there  is  an  ob- 
ftacle  at  the  emiffary  of  the  left  ventricle,  nor  yet  this  ventricle,  but  the 
right,  or,  if  both  of  them,  the  right  is  the  moft  dilated  of  the  two,  it 
feems  that  more  ftrength  than  uiual  mult  have  happen’d  to  the  left  ventricle, 
and  lefs  to  the  right,  whether  this  was  from  the  original  conftitution  of  the 
body,  or  from  any  other  caufe  afterwards,  as  in  that  man,  the  fhort  hiftory 
of  whole  difeafe,  and  diffedtion,  was  formerly  communicated  to  me,  by  a 
man,  even  at  that  time,  particularly  confpicuous  for  his  humanity,  not  lefs 
than  for  his  learning,  and  his  virtue,  and  lately  very  defervedly  taken  into 
the  number  of  the  pontifical  archiaters,  Marc  Anthony  Laurentio.  This  was 
his  account  of  it : 

6.  A  certain  man,  being  often  troubl’d  with  a  diforder  fimilar  to  the  night¬ 
mare,  and  in  like  manner  with  a  difficult  refpiration,  to  which  a  flight  fever 
had  been  join’d,  feem’d  to  recover,  almoft  entirely,  by  the  lofs  of  fome 
blood.  His  diforder,  however,  coming  on  a-freffi,  and  his  face  and  neck 
being  livid,  he  died.  The  thorax  being  open’d,  and  water  being  found 
therein,  fo  great  a  dilatation  of  the  heart  was  obferv’d,  as  had  never  been 
feen  before,  efpecially  on  account  of  the  enlarg’d  ftate  of  the  right  ventricle, 
and  its  annex’d  auricle.  And  the  aorta  was  contradted  to  an  amazing  nar- 
rownefs,  near  to  the  heart. 

7.  It  alfo  fometimes  happens,  that  a  dilatation  of  the  left  ventricle,  and, 
at  the  fame  time,  of  the  right  auricle,  is  found,  as  in  that  obfervation  which 
was  made  by  the  moft  excellent  Santorini,  at  Venice,  in  the  middle  of 
autumn,  in  the  year  1708,  and  related  to  me  foon  after  by  himfelf,  in  the 
following  manner.  And  I  would  have  you  compare  this  hiftory  with  one 
of  Valfalva’s  (*). 


(/)  Ibid,  propof.  47. 


4 


(£)  Epift.  1 7.  n.  10; 


8.  A  man. 


Letter  XVIII.  Articles  8,  9.  463 

8.  A  man,  who  had  labour’d,  before,  under  a  difficulty  of  breathing,  at 
intervals,  at  length  crying  out  that  he  was  dying,  began  to  walk  vehemently 
acrofs  the  chamber,  and  loon  after  falling  down  on  the  bed,  died  imme¬ 
diately.  The  thorax  contain’d  many  pounds  of  bloody  ferum,  but  not  in 
equal  quantity  on  both  fides :  the  great  artery  was  found  internally  rough, 
with  bony  fcales,  and  among  thefe  were  fome  tubercles.  The  left  ventricle 
of  the  heart,  and  the  right  auricle,  were  dilated.  To  open  the  head  after 
thefe  appearances  feem’d  fuperfluous. 

9.  I  do  not  doubt  but  you  will  be  able,  yourfelf,  to  explain  the  greater 
part  of  the  remarks  that  are  contain’d  in  the  two  lait  obfervations,  even  by 
the  help  of  thofe  things  that  I  have  faid  above.  As  to  one  thing,  rather, 
which  is  contain’d  in  neither  of  them,  you  will  perhaps  nfk  of  me,  whether 
it  was  wanting;  and  if  it  was  wanting,  and  particularly  in  the  firft,  what  are 
we  then  to  think  of  the  dogma  of  Lancifi  (/),  in  which  he  has  afferted,  that 
from  the  dilatation  of  the  right  auricle,  and  ventricle  of  the  heart,  it  follows, 
that  the  orifice  which  lies  between  both,  and  is  furnifh’d  with  triangular 
valves,  mufl  alfo  be  dilated  in  fuch  a  manner,  that,  as  the  blood  can  no 
longer  be  entirely  precluded  by  thefe  valves,  a  portion  thereof,  during  the 
conftriftion  of  the  ventricle,  is  of  courfe  driv’n  back  into  the  vena  cava, 
through  the  apertures  that  are  neceflarily  form’d  between  their  edges,  from 
whence  a  dilatation  of  the  jugular  veins  is  brought  on,  which,  as  they  are  ex¬ 
ternal,  and  expos’d  to  the  eyes  of  every  body,  in  the  neck,  muff  be  con- 
fpicuous,  and  the  ventricle  prefently  dilating  itfelf,  an  equal  and  alternate 
conftriftion  takes  place  :  and  thefe  appearances  fometimes  impofe  upon  un¬ 
wary  phyficians  for  a  pulfation,  and  contraction,  of  the  carotid  arteries.  You 
will  afk,  therefore,  whether  this  pulfation,  or  fluctuation,  of  the  jugular  veins, 
was  in  thofe  patients  whom  I  fpoke  of  juft  now  ?  Or,  if  it  was  not,  how 
can  it  “  with  juftice  be  call’d  the  pathognomonic  fign”  of  a  dilatation  in 
the  right  cavities  of  the  heart  ? 

I,  however,  cannot  certainly  fay,  whether  that  pulfation  was  wanting  in 
thefe  patients  or  not ;  as  I  only  receiv’d,  briefly  and  in  general,  the  prin¬ 
cipal  heads  of  thofe  obfervations  which  relate  to  their  hiftories,  by  way  of 
common  difcourfe,  from  very  eminent  and  credible  men.  Yet  I  am  not  ig¬ 
norant,  as  Lancifi  was  not  ignorant  neither,  that  in  a  noble  matron  who  was 
liable  to  afthmatic  paroxylms,  in  whom  there  was  a  frequent  pulfation  of 
the  jugular  veins,  and  of  the  brachial  alfo,  Homberg  (m)  judg’d,  that  a  very 
violent  palpitation  of  the  heart,  without  which  thefe  circumftances  never 
happen’d,  had,  if  I  underftand  him  rightly,  not  drawn  afunder  thofe  valves, 
but  had  only  forc’d  them  outwards  alternately,  with  fuch  an  impetus,  as  to 
transfer  each  concuffion  to  the  venous  blood  ;  which  concuffions  were  fo 
much  the  greater,  as  the  blood,  having  dilated  the  ventricles  to  a  great 
degree,  could  not,  without  difficulty,  be  fent  into  the  arteries,  which  were 
now  obftruCted  with  polypi :  although,  as  that  heart  is  faid  to  have  been 
flaccid,  like  a  bag  that  was  made  of  loft  leather,  it  is  natural  to  fufpeCt,  that 
the  orifice  leading  to  the  veins  was  enlarg’d,  fo  that  it  could  not  be  clofely 
ihut  up  by  the  valves.  But  you  may  make  ufe  of  which-ever  explication 

( m )  Mem.  de  1’  Acad.  R.  des  Sc.  A.  1704. 

you 


(l)  De  Aneur.  propof.  57,  &  60, 


4^4  Book  II.  Of  Difeafes  of  the  Thorax. 

you  pleafe,  if,  perhaps,  by  realon  of  fome  of  the  valves  of  the  veins  them- 
felves,  the  reflux  of  the  blood,  through  them,  feem  to  you  lefs  eafy  :  for 
either  the  veins  are  dilated,  and  fo  cannot  be  fliut  up  byfthe  valves  •,  or  they 
are  not,  and  fo  the  concuffions,  efpecially  the  large  ones,  are  alfo  commu¬ 
nicated  through  the  valves.  u 

But  at  the  fame  time,  other  things  alfo  do  not  efcape  me,  which  Lancifl 
could  not  poflibly  know,  as  they  were  publiffi’d  after  his  death.  For  the 
celebrated  Morand(«),  having  obferv’d  in  another  woman,  befldes  palpi¬ 
tation  and  faintings,  a  continual  pulfation  of  the  jugular  veins,  the  thicknefs 
of  which  was  equal  to  that  of  a  man’s  thumb  ;  and  in  the  carcafe  of  the 
fame  woman,  as  he  had  foretold,  having  found  the  right  auricle  of  the  heart 
almoft  fill’d  with  a  polypous  concretion,  the  branches  of  which  reach’d  throuoh 
the  neighb’ring  veins  quite  to  the  jugular,  concluded  that  a  portion  of  the 
blood  which  was  obftrudted  by  the  polypous  concretion,  and  prevented  from 
defcending  into  the  ventricle,  that  this  portion,  I  fay,  as  often  as  the  auricle 
contracted  itfelf  was  repell’d,  by  the  conftriCtion  thereof,  into  thofe  veins, 
according  to  the  direction  of  the  ramifications  of  the  polypi,  and  therefore 
had  alternately  dilated  them.  But  after  this,  the  very  experienc’d  man 
Andreas  Pafta  (<?),  in  that  epiflle  where,  fupported  by  reafonings,  and  by 
obfervations,  he  fo  call’d  into  queflion  the  polypi  in  the  heart,  and  other 
receptacles  of  the  blood,  in  the  living  fubjeCt,  that  it  feems  by  no  means 
eafy  to  give  a  clear,  firm,  and  full  anlwer  to  his  objections,  particularly  de- 
fcrib’d  what  he  found  in  three  patients,  who,  “  for  iome  months  before  their 
“  death,  had  labour’d  under  this  puliation  of  the  veins  in  the  neck,  a  palpi- 
“  tation  of  the  heart  coming  on  at  intervals,  and  difficulty  of  breathino-  alfo 
tc  with  fwoonings,  not  without  a  pulfe  continually  unequal,  and  intermitting.” 
He  therefore  fays,  that  he  had  found  no  polypus  any-where,  no  expanfion  of 
the  right  auricle-,  but  the  ventricle  join’d  to  it,  twice  as  big  as  it  naturally 
is  in  one,  and  in  the  other  even  much  larger  but  in  a  third  he  had  not 
found  even  this,  which  I  fuppofe  was  prevented,  partly,  by  a  kind  of  laroe 
bony  ring  of  the  pericardium,  that  adher’d  very  clofely  to  the  heart,  by  the 
conftriCtion  of  which  ring,  doubtlefs,  the  left  ventricle  was  made  three  times 
lefs  than  when  in  its  natural  ftate,  and  fcarcely  any  traces  of  the  right  auricle 
appear’d  whereas  the  left,  which  was  not  comprefs’d  by  the  bone,  was  di¬ 
lated  to  a  furprifing  extent.  And  taking  all  thefe  things  together,  we  mu/t 
confider  how  far  it  is  proper  to  make  ule  of  the  fign  which  the  celebrated 
phyfician  Lancifi  propos’d. 

10.  As  I  was  therefore  obferving,  that  out  of  the  five  obfervations  juft 
now  pointed  out,  there  were  at  leaft  three,  in  which,  if  not  a  dilatation  of 
the  right  auricle  alfo,  yet  at  leaft  a  dilatation  of  the  right  ventricle,  was  found- 
and  as  I  was  joining  thefe  together  with  the  obfervations  of  Lancifi,  it  feem’d 
to  me,  that  he  had  indeed  propos’d  a  true  fign,  as  it  really  happens  in  many, 
but  that  it  was  to  be  explain’d,  fometimes,  in  the  way  that  he  himfelf  plann’ci 
out,  and  fometimes  in  the  other  manner,  thatHomberg  has  tauo-ht;  althouoh 
it  is  eafy,  as  I  granted  above  (yj),  that  the  orifice  of  the  ventricle  ffiould  be 

\n)  Mem.  de  la  meme,  A.  1732.  ( 0 )  Epift.  de  Cord.  Polyp,  n.  9,  &  13.  (p)  N.  9. 


dilated 


Letter  XVIII.  Article  11.  4  65 

dilated  in  the  fame  manner  as  the  ventricle  itfelf,  or  if  the  parietes  of  the 
Ventricle  are  too  much  expanded,  that  thofe  parts  to  which  the  little  chordae 
tendineae  of  the  valves  are  tied,  may  be  now  too  aiftant  from  that  orifice  to 
be  able  to  perform  their  ufual  office  to  the  valves,  lb  that  they  may  have  it 
in  their  power  to  fhut  up  the  orifice  fpeedily,  and  entirely  :  unlefs,  perhaps, 
the  valves  (which  will  generally  be  obferv’d  in  this  kind  of  hearts)  are  al¬ 
ways  enlarg’d  alfo,  and  the  little  chords  produc’d. 

But  in  the  obfervation  of  JMorand,  and  in  that  of  Pafta,  which  is  produc’d  in 
the  third  place,  1  confels,  no  dilatation  of  the  cavities  on  the  right  fide  of  the 
heart  occurs.  Yet  in  each  of  them  it  is  to  be  acknowledg’d,  that  there  was  an 
impediment  to  the  blood,  as  it  was  about  to  enter  the  right  ventricle:  for 
in  the  firft,  it  is  indicated  by  a  very  great  dilatation  or  the  jugular  veins, 
join’d  with  a  palpitation  of  the"  heart,  and  fwoonings ;  and  in  the  laft,  by 
the  decreafe  of  the  left  ventricle,  and  the  furprifing  expanfion  of  the  auricle 
on  the  fame  fide  ;  forafmuch  as  thele  retarded  the  paflage  of  the  blood  from 
the  left,  lb  much  more,  it  feems,  ought  to  be  accumulated  in  the  right  ven¬ 
tricle,  and  refill  that  which  is  brought  thereto,  which  as  it  has  no  auricle  to 
be  diverted  into  alternately,  it  feems  that  it  mull  have  diftended  the  neareft 
veins  by  its  fo  much  greater  quantity,  and  have  remov’d  their  parietes,  and 
the  valves  that  are  affix’d  to  them,  very  far  from  their  axis  j  and  that  by  this 
means  the  concuffions,  which  the  valvul?e  tricufpides,  when  driven  upwards 
by  the  heart,  that  palpitated  vehemently,  communicated  to  the  blood,  might 
have  been  more  eafily  carried  on,  and  continu’d  :  as  in  the  obfervation  of 
Morand,  when  the  veins  were  evidently  difpos’d  in  the  fame  manner,  they 
were  communicated  by  that  portion  of  blood  which,  not  being  able  to  enter 
into  the  right  ventricle,  (whatever  was  the  real  caufe  of  that  impediment) 
was  repeli’d  upwards  by  the  auricle  when  it  contracted. 

Befides  thele,  other  cafes  may  happen,  in  which  neither  the  right  ventricle, 
nor  its  auricle,  being  dilated,  the  blood,  neverthelefs,  returns  into  the  veins 
by  the  intermediate  or  auricular  orifice,  when  the  ventricle  is  in  contraction, 
and  for  that  reafon  alternately  raifes  them  up.  For  inftance,  if  any  trian¬ 
gular  valve  is  become  contracted,  or  inflexible,  and  from  thence  unfit  to 
perform  its  office  ;  or  if  any  of  thofe  little  chords,  which  I  fpoke  of  juft 
now,  being  eroded,  ruptur’d,  or  relax’d,  are  no  longer  able  to  retain  the 
valve  in  its  place,  fo  as  to  (hut  up  the  orifice,  but  fuffer  it  to  be  inverted 
outwards,  and  by  this  means  leave^  a  paflage  open  for  the  return  of  the 
blood. 

To  any  one,  therefore,  who  fhall  duly  weigh  all  thefe  circumftanccs,  I 
think  it  will  feem,  that  the  fign  propos’d  by  Lancifi  very  often,  indeed,  in-  „ 
dicates  a  dilatation  of  the  right  ventricle  ;  but  fometimes  does  not  indicate 
this,  yet  always  fome  diforder  or  other,  the  feat  of  which  is  either  in  the 
right  cavities  of  the  heart,  or  the  effects  of  which  relate  fo  far  to  thefe  ca¬ 
vities,  that  the  circulation  of  the  blood  is  not  naturally  perform’d  in  the 
right  fide  of  the  heart. 

1 1.  But  that  we  may  make  the  belt  ufe  of  this  fign,  we  rnuft  firft  of  all 
take  care,  left,  perhaps,  fometimes,  inftead  of  a  palpitation,  there  is  a  kind 
of  alternate  turgefcency  of  the  jugular  veins,  aniwering  to  a  violent  infpi- 
ration,  or  exfpiration  j  as  in  that  experiment  which  I  fhall  deferibe  to  you 

Vol.  I.  O  o  o  hereafter. 


4  6  6  Book  II.  Of  Difeafes  of  the  Thorax. 

hereafter,  in  another  letter  (q)  ;  but  it  will  be  eafy  to  diftinguifti,  whether 
the  dilatation  agrees  more  with  the  number  of  inipirations,  or  the  number 
of  pulfes.  After  that,  if  we  are  convinc’d,  that  there  is  in  reality  a  pul- 
fation,  we  mult  not  fuffer  ourfelves  .to  be  fo  deceiv’d,  as  to  believe  that  to 
be  a  pulfation  of  the  jugular  veins,  .which  is,  in  fa£t,  the  pulfation  of  the 
carotid  arteries.  And  to  this  I  find  a  pafiage  of  Galen  refers  (r).  In  violent 
pains  of  the  head,  “  the  veins  of  the  temples,”  fays  he,  “  and  efpecially 
“  where  thefe  pains  are  attended  with  much  heat,  feem  to  beat,  and  to  vi- 
“  brate,  as  it  were.  But  I  have  more  frequently  feen  the  jugulars  of  the 
“  neck,  that  is  to  fay,  thofe  which  are  plac’d  fuperficially,  agitated  with  a 
“  certain  motion  not  unlike  a  pulfe.  The  motion  in  the  temples  feems  alio 
“  to  happen  from  the  lubjacent  arteries,  at  the  time  that  they  pulfate  molt.” 
I  faid,  that  the  pafiage  of  Galen  referr’d  to  this,  if  we  conjecture  from  the 
Jail  words  of  his,  in  what  manner  he  himfelf  would  have  explain’d  that 
which  he  had  written  in  the  foregoing.  But  if  we  would  rather  chufe  to 
fuppofe,  as  perhaps  we  ought,  that  he  intended  quite  different  things  in  the 
former  and  the  latter  words,,  we  fhall  confefs,  that  the  pulfation  both  of  the 
temporal  and  jugular  veins,  was  alfo  formerly  obferv’d.  For  that  “  vehe- 
“  ment  pulfation  of  the  jugular  veins,”  mention’d  by  Hippocrates,  is  un- 
derftood  by  Jacotius  (j),  and  Duretus  (/),  of  the  arteries  :  which  we  are 
not  at  liberty  to  do  in  this  of  Galen,  where  the  arteries  are  exprefsly  diftin- 
guifh’d  from  the  veins,  and  the  external  jugular  veins  are  moft  clearly  in¬ 
tended.  But  when  the  large  pulfation  of  the  fubjedled  arteries  alternately 
raifes  up  thefe  veins,  it  will  not  be  difficult  to  obferve,  that  not  only  the 
veins  themfelves,  but  the  furrounding  parts  of  the  neck,  are  at  the  fame 
time  rais’d  up,  and  thofe  parts  even  more,  which  are  more  immediately  op- 
pofite  to  the  carotids. 

But  if  thefe  pulfating  vefiels  in  the  neck,  being  dilated,  are  prominent 
and  turgid,  then,  indeed,  we  may  diftinguilh  the  veins  I  am  fpeaking  of 
from  the  carotid  arteries,  if  we  attend  to  their  external  fituation,  and  the 
foftnefs  of  their  parietes  ;  and  efpecially  if  with  Morand  (#)  we  obferve.  that 
upon  prefling  the  finger  on  them,  that  part  of  the  vefifel  which  is  below  the 
finger  fhall,  according  to  the  laws  of  the  circulation,  fubfide  ;  and  that  part 
which  is  above  is  increas’d,  or  at  lead  preferves  its  former  diftenfion.  And 
I  would  not  have  you  be  furpriz’d,  that,  in  diftinguifhing  the  pulfations  of 
the  veins  from  the  pulfations  of  the  arteries,  I  have  not  taken  notice  that 
it  ought  to  be  attended  to,  whether  the  pulfations  happen  at  the  fame  time 
with  the  pulfation  of  the  heart ;  for  you  will  lee  hereafter,  that  hence  we 
may  be  fometimes  deceiv’d  (x).  We  muft,  befides,  obferve,  whether  there 
can  be  any  other  caufe  of  the  fign  propos’d,  which  does  not  confift  in  an  or- 
ganical  diforder  of  the  heart ;  for  inftance,  in  virgins  affeded  with  the  chlo- 
rofis.  For  although  Lancifi  (y)  does  not  doubt,  but  a  pulfation  of  the  ju¬ 
gular  veins  happens  in  the  fame  manner,  in  thefe  patients,  and  in  particular 

(7)  Epift.  19.  n.  33,  34.  ( u )  Loc.  cit.  fupra,  ad  n.  9. 

(r)  In  I.  Prorrhet.  Hipp.  Comm.  3.  n.  9.  (x)  N.  12. 

(s)  L.  2.  Comm.  In  Coae.  S.  2,  n.  42.  (j)  Propof.  57.  ibid  cit. 

(/)  In  Coac.  1.  2.  c.  10.  n.  1. 

when 


» 


Letter  XVIII.  Article  it.  4S7 

when  they  go  up  deep  places,  and  by  that  motion  accelerate  the  reflux  of  the 
thicker  blood,  towards  the  right  fide  of  the  heart,  out  of  which  it  cannot 
be  tranfmitted  with  equal  difpatch,  through  the  vefiels  of  the  lungs  that  are 
obftru&ed,  comprefs’d,  or  convuls’d ;  and  although  he  alfo  adds,  that  if  this 
pulfation  does  not  yield  to  remedies,  but  continues  long,  even  in  thefe  vir¬ 
gins,  as  he  himlelf  has  fometimes  obferv’d,  a  dilatation  of  that  part  of  the 
heart  is  at  length  brought  on  ;  yet  this  is  no  reafon  why  we  fhould  fuppofe 
it  before;  fince  nothing  more  frequently  happens,  than  that,  together  with 
the  chlorofis,  all  the  inconveniences  which  attend  thereon  vanifh. 

But  when  neither  this  difeafe,  nor  any  other  of  the  fame  kind,  is  join’d 
with  that  pulfation  ;  he  then  fays,  that  a  dilatation  of  the  right  cavities  of 
the  heart  is  fo  much  the  more  fignify’d  (z),  if  other  marks  are  obferv’d  which 
jointly  prove  it,  among  which  he  places  anguifh  of  the  heart,  and  palpita¬ 
tion,  a  pulfe  for  the  molt  part  large  and  equal,  this,  and  oppreftions  of  the 
heart,  being  confirm’d  by  Albertini  (a),  to  which  he  alfo  adds  fwoonings. 
And  you  will  find,  that  the  other  marks  often  anfwer,  even  from  reading 
over  again,  either  thofe  hiftories  which  are  juft  now  taken  notice  of  (£),  or 
thofe  which  are  hitherto  deferib’d  in  the  prefent  letter,  or  at  length  from 
thofe  that  are  given  in  the  beginning  of  the  laft  letter  (c).  But  perhaps  you 
will  be  in  doubt  as  to  the  pulfes,  fince  you  will  remember,  that  out  of  three 
perfons,  who  were  di  fie  died  by  the  celebrated  Pafta  [d)9  there  was  not  fo 
much  as  one,  who  had  not  continually  an  unequal,  and  intermitting  pulfe, 
although  two  of  them,  without  doubt,  had  the  right  ventricle  of  the  heart 
dilated.  I  would  therefore  have  you  obferve,  that  the  fign  taken  from  the 
pulfe,  is  not  neceflarily  a  true  one,  when  other  diforders  are  added  to  the 
dilatation  of  the  right  cavities  of  the  heart,  which  you  will  find,  from  read¬ 
ing  Pafta  himfelf,  did  really  exift  in  thole  two,  juft  as  in  the  choirifter  whom 
I  mention’d  above,  from  the  obfervation  of  Lancifi  (e),  in  whom  an  inequa¬ 
lity,  and  intermifiion  of  pulfe,  were  not  wanting.  But  on  the  other  hand 
fee,  whether  in  thofe  where  Valfalva  (/),  at  the  fame  time,  remark’d  the 
dilatation  of  thofe  cavities,  and  attended  to  the  pulfe,  the  pulfe,  un lels  per¬ 
haps  in  the  latter  part  of  the  difeafe,  was  unequal.  Nticher  had  the  lhoe- 
maker,  whole  hiftory  I  have  deferib’d  to  you  (g),  any  inequality  in  his  pulfe, 
when  free  from  his  faintings,  not  even  when  death  was  near  at  hand.  And 
that  you  may  perceive  the  fame  thing  to  have  happen’d  to  others  alfo, 
which  happen’d  to  Lancifi,  Albertini,  Valfalva,  and  myfelf;  look,  in  par¬ 
ticular,  upon  that  vaft  dilatation  of  the  right  auricle,  the  figure  and  deferip- 
tion  of  which  are  publi  fil'd  by  Peter  Dionis,  in  the  latter  part  of  his  anato¬ 
my  ( h ).  The  auricle,  indeed,  you  will  fee  was  bigger  than  the  head  of  a 
new-born  infant;  yet  will  find  not  the  leafl  mention  of  any  inequality  in  the 
pulfe.  But  there  is  another,  who  after  a  difficulty  of  refpiration,  and  inter¬ 
mifiion  of  the  pulfe,  being  obferv’d  in  a  patient,  writes,  “  that  the  magni- 
“  tude  of  the  right  ventricle  of  the  heart,  and  its  right  auricle,  were  fo  en- 


(z)  Propof.  ead.  &  60. 

(a)  Comm,  de  Bonon.  Acad.  Tom.  i.  in 
Opufc. 

(J>)  n.  9.  (c)  n.  6.  8.  10. 


(^)  fupra,  ad  n.  9. 

( e )  n.  5.  (f)  n.  cit.  6.  8.  10. 

(?)  fupra,  n.  2. 

(%)  L’Anatom.  de  l’homme. 


O  O  0  2 


“  creas’d. 


/l6S  Book  II.  Of  Difeafes  of  the  Thorax. 

“  creas’d,  that  one  very  large  cavity  appear’d.”  I  grant  it ;  but  it  is  not 
added,  what  diforder  there  was  in  the  left  cavities,  nor  in  the  aorta,  nor  in 
the  lungs,  nor  what  diforder  there  was  not ;  nor  yet,  whether  this  intermiffion 
was  of  long  continuance,  or  only  on  the  laft  days  of  the  patient’s  life:  al¬ 
though  it  is  fufficient  for  my  purpofe  here,  that  there  often  is  an  equality  of 
the  pulfe,  when  there  are  dilatations  in  the  right  fide  of  the  heart. 

12.  I  obferve,  however,  that  this  obfervation,  and  that  publifh’d  by  Di¬ 
onis,  agree  very  well  in  two  circumftances.  For  firft,  if  in  this  one  very 
large  cavity  was  found  to  be  form’d,  from  the  right  auricle  and  ventricle  ; 
in  the  other,  the  orifice  that  is  interpos’d  betwixt  the  two  cavities,  was  en¬ 
larg’d  in  a  furprifing  manner.  Again,  if  in  this,  “  the  parietes  of  the  au- 
“  ricle  were  thick,  hard,  callous,  and  internally  cartilaginous  in  the  other, 
the  internal  membrane  of  the  auricle  was  cover’d  over  with  a  bony,  fcaly 
fubftance,  like  to  a  very  hard  egg-fhell.  And  this  being  the  ftate  of  both 
cafes,  doubtlefs  there  was  a  puliation  of  the  jugular  veins  in  both  patients, 
by  reafon  of  that  very  enlarg’d  condition  of  the  orifice,  which  has  been  fo 
often  mention’d  •,  but  in  neither  of  them,  certainly,  was  it  owing  to  the  al¬ 
ternate  contradions  of  the  right  auricle,  -as  this  being  prevented  by  the  in¬ 
ternal  cruft,  whether  cartilaginous,  or  bony,  and  even  by  the  very  hardnefs 
of  this,  or  the  other  parietes,  could  not  contrad  itfelf ;  but  remain’d  rigid,, 
and  inflexible,  in  perpetual  dilatation.  Wherefore,  as  in  thefe,  and  in  many 
other  cafes,  and  in  that,  particularly,  in  which  (/)  fcarce  any  veftige  of  the 
right  auricle  remain’d,  this  pulfation  is  to  be  accounted  for  from  the  ventri* 
cle,  which  in  fome  others  may  be  from  the  auricle :  and  if  you  fhould,  per¬ 
haps,  enquire,  by  what  method  it  is  poflible  to  diftinguifh  from  which  of  thefe 
cavities  it  happens,  I  fhould  fay  it  was  poflible  to  diftinguifh,  when  both  the 
arteries,  and  jugular  veins,  vibrate  with  fomewhat  lefs  frequent  ftrokes.  For 
if  by  fixing  your  eyes  upon  the  veins,  and  at  the  fame  time  applying  your 
fingers  to  the  artery  of  the  temples,  or  the  wrift,  you  evidently  perceive, 
that  the  veins  are  lifted  up  at  the  very  fame  point  of  time,  in  which  you 
feel  the  pulfation  of  the  artery ;  you  will  then  underftand,  that  they  are  ele¬ 
vated  from  the  contradion  of  the  right  ventricle :  but  if  on  the  contrary, 
then  you  will  underftand  that  the  pulfation  of  the  veins  is  not  owing  to  the 
contradion  of  this  ventricle,  but  of  the  annex’d  auricle.  For  you  know 
that  the  arteries  do  not  pulfate,  when  the  auricles,  but  when  the  ventricles, 
are  contraded  ;  and  on  the  other  hand,  that  they  do  not  fubfide  when  the 
ventricles,  but  when  the  auricles,  are  contraded.  Wherefore,  if  the  jugular 
veins  are  elevated,  when  the  arteries  are  fubfiding  •,  the  pulfation  of  thefe 
veins  cannot  be  owing  to  the  right  ventricle,  which  is  at  this  time  inadive : 
but  on  the  contrary,  if  the  arteries,  and  thefe  veins,  pulfate  at  the  fame 
time;  the  pulfation  of  the  veins  muft  then  of  neceflity  be  from  the  ventri¬ 
cle,  which  is  at  that  time  in  adion,  and  not  from  the  auricle,  which  is  in¬ 
adive  ;  the  force  of  contradion  in  the  ventricle,  at  that  time,  forcing  the  valves 
vehemently  upwards,  if  they  fhut  up  the  orifice  ;  and  giving  a  concuftion  to  the 
blood  in  the  veins,  or  driving  back  a  portion  of  its  own  blood  into  the  veins, 
if  the  orifice  between  the  two  cavities,  is  not  clofely  fhut  up  by  the  valves, 
according  to  the  intention  of  nature;  the  probable  mark  of  which  is  to  be 


(/)  fupra,  n.  9. 


taken 


Letter  XVIII.  Articles  13,  14,  13*.  469 

taken  from  thofe  fymptoms  that  are  pointed  out  above  (£),  of  the  cavities 
being  dilated  in  the  right  fide  of  the  heart. 

And  thus  far  I  had  to  fay  at  prefent  of  the  pulfation  in  the  jugular  veins. 
From  which  fign,  and  from  my  examination  into  it  here,  it  you  fee  that 
any  advantage  can  be  drawn,  in  order  to  diftinguifh  the  moft  hidden  difor- 
ders  of  the  heart ;  you  fee  at  the  fame  time,  whether  it  is  with  juftice,  or 
with  injuftice,  written  againft  the  more  modern  phyficians,  as  follows :  “  Of 
“  what  advantage  is  the  exadt  knowledge  of  the  life  of  the  valves  of  the 
<c  heart,  to  a  phyfician  who  has  the  care  of  fuch  diforders,  in  order  to  afcer- 
“  tain  the  diforder  ?” 

13.  But  left  you  fhould,  perhaps,  believe,  that  I  am,  in  the  mean  while, 

forgetful  of  my  promis’d  obfervations  (/),  thofe,  for  inftance,  from  which 
you  might  underhand  it  frequently  to  have  happen’d,  that  where  the  heart 
was  dilated,  thefe  patients  were  carried  off  by  a  fudden  death,  more  quick 
than  thought  ;  although  I  have  many  of  my  own  obfervations,  which  I  re¬ 
fer  to  other  letters,  and  many  of  my  friends,  I  choofe  rather  to  add  another 
obfervation,  to  that  which  I  produc’d  from  the  narration  of  the  celebrated 
Santorini,  by  which  I  pay  a  tribute  to  the  memory  of  my  auditor  Angelo 
Nicolao  Villi,  who  was  very  remarkable  both  for  his  probity  and  diligence, 
and  whofe  progrefs  in  the  very  beginning  of  his  medical  practice  was  inter¬ 
cepted  by  death.  Thus  it  was  that  he  wrote  to  me,  about  the  end  of  the  year 
1727.  •- 

14.  A  huntfman,  who  was  almoft  continually  fhort- breath’d  (for  this  word 
he  chofe  to  make  ufe  of)  having  complain’d  eight  days  together,  that  he  was 
not  very  well,  but  only  complain’d  of  his  ftomach  in  particular  ;  at  length, 
when  he  was  performing  fome  religious  ceremonies,  having  taken  a  little 
food  about  noon,  he  was  forc’d  to  recline  himfelf  on  the  bed,  and  before  he 
could  well  call  his  wife  to  him,  he  died.  The  fkin  of  the  carcafe,  which 
was  of  the  colour  of  cacheCtic  bodies  in  general,  and  the  very  thin  adipofe 
membrane  being  incis’d,  the  belly  and  thorax  were  prefently  open’d.  In  the 
belly  every  thing  was  found.  But  in  the  thorax,  the  lungs  were  very  turgid 
with  air,  and  every  where  connected  with  the  neighb’ring  parts,  the  upper 
only  excepted,  and  indeed  almoft  grown  into  one  fubftance  with  them  ;  fo 
that  great  force  wras  requir’d,  in  order  to  feparate  them  from  the  ribs,  the 
diaphragm,  and  the  mediaftinum.  Within  the  pericardium  was  fcarcely  any 
moifture,  and  the  heart  was  flaccid,  but  extremely  large. 

15.  It  feem’d  to  Villi,  that  the  caufe  of  all  this  man’s  fymptoms,  and 
even  of  his  death,  was  to  be  referr’d  to  that  very  great  cohefion  of  the  lungs, 
with  the  neighb’ring  parts.  But  I  took  notice  to  him  of  the  obfervation  of 
Diemerbroeck  (//2),  who  found  the  lungs  not  only  connected  to  all  thofe  parts, 
but  alfo  to  the  uppermoft  parts,  and  this  fo  firmly,  that  they  could  not  be  pull’d 
afunder  without  a  great  laceration ;  yet  the  man  in  whofe  body  he  found  thefe 
appearances,  had  liv’d  very  healthy,  and  free  from  any  difficulty  of  breathing, 
till  he  died  by  being  hang’d,  But  altho’  I  fhould  even  attribute  fomething  to  this 
adhefion,  according  to  what  I  conjectur’d  in  a  former  letter (»)  on  this  fubjeCt, 


(/&)  fupra,  n.  u, 
(/)  fupra,,  iv.  3.. 


(tn)  Anat.  I.  2.  c.  13, 

(»)  Epift.  16.  n.  15.  &  16. 


after; 


47°  Book  II.  Of  Difeafes  of  the  Thorax. 

after  having  pointed  out  that  fame  obfervation  of  Diemerbroeck,  and  others  j 
yet  I  fhould  not  doubt,  at  the  lame  t;me,  but  much  more  was  to.  be  im¬ 
puted  to  the  very  great  and  increas’d  magnitude  of  the  heart,  efpecially  as  ic 
was  flaccid,  and  that  for  the  chief  of  thofe  reafons  which  are  fpoken  of 
above  (<?),  on  occafion  of  the  death  of  the  fhoemaker.  Moreover,  the  ef¬ 
fects  of  the  heart  being  diftended,  and  for  that  reafon  urging  and  prefling 
the  meduftinum  to  the  lungs,  and  the  lungs  to  the  ribs,  may  in  part  alio, 
fometimes,  be  this  very  adhefion  of  the  lungs,  which  was  obferv’d  in  the 
cafe  of  the  fhoemaker,  as  the  effect  thereof,  on  account  of  the  prefiure  and 
force  applied  to  the  lungs,  is  certainly  a  difficulty  of  refpiration.  For  which 
reafon,  I  wonder  the  more,  that  the  increas’d  bulk  of  the  heart  is  not  at¬ 
tended  to  in  the  hiftories  of  afthmatic  perfons,  fince  it  is  frequently  found 
to  be  enlarg’d  to  a  confiderable  degree  ;  as  you  may  read  in  that  which  is 
giv’n  in  the  firft  feblion  of  the  fecond  book  of  the  Sepulchretum  (p),  and 
is  without  doubt  frequently  the  caufe  of  many  of  their  fymptoms.  For  al¬ 
though  fanies,  indeed,  was  not  wanting  in  the  bronchia  of  the  lungs,  where 
they  adher’d  to  the  pleura  and  pericardium  •,  nor  yet  other  appearances  very 
remote  from  the  natural  conftitution,  among  which  was  the  fubftance  of  the 
left  lobe  of  the  lungs  “  being  compact  and  denfe,  and  reprefenting  the  pa- 

renchymatous  fubftance  of  the  liver,  and  of  the  fame  palifh  red  colour,” 
that  is,  being  feiz’d  with  a  mortal  inflammation,  though  it  is  not  there  ac¬ 
knowledg’d  ;  yet  the  heart  ought  by  no  means  to  have  been  omitted  among 
the  caufes  of  that  afthma,  by  the  very  enlarg’d  ftate  of  which,  the  circulation 
of  the  blood,  and  confequently  its  paflfage  through  the  lungs,  muff,  with¬ 
out  doubt,  of  courfe  have  been  greatly  retarded.  For  “  the  heart  was  itn- 
<c  menfely  large,  and  anfwer’d  to  the  increas’d  fize  of  the  pericardium;”  and 
the  pericardium  was  fo  large,  that  it  might  be  laid  “  to  have  lin’d  the  whole 
“  cavity  of  the  thorax.” 

How  different  was  the  opinion  of  that  great  phyfician  Ballonius,  as  you 
will  read  in  the  fame  fedlion  (q).  “  A  certain  man,”  fays  he,  “  breath’d 

“  fhort,  and  with  difficulty,  and  became  lean  and  thin.  The  lungs  were 
“  univerfally  accus’d  as  the  feat  of  the  diforder.  The  body  being  open’d 
“  after  death,  nothing  was  found  worthy  of  notice  in  the  lungs.  But,  what 
“  was  very  furprifing,  the  heart  was  equal,  in  magnitude,  to  the  fize  of  a 
“  pretty  large  head  ;  and  doubtlefs,  in  conlequence  of  its  great  increafe,  all 
“  the  eryppow  &  ffuvJ'f opti,  the  conflux  and  concourfe,  of  the  blood  and  fpirits, 
“  was  made  to  that  part.”  And  thus  he  exprefs’d  himfelf,  according  to  the 
cuftom  of  his  times.  And  Marcus  Gerbezius  (r),  in  a  monk,  “  who  had 
“  his  heart  fo  much  increas’d  in  its  bulk,  that  being  weigh’d  in  the  fcales, 
“  it  was  found  equal  to  thirty  ounces,”  but  had  the  lungs  very  fmall,  exte¬ 
nuated,  flaccid,  and  corrupt,  openly  declar’d,  in  regard  to  the  cafe  of  this 
patient,  that  he  conjeftur’d  the  enlarg’d  ftate  of  the  heart  to  have  been  “  the 
“  foie  caufe”  of  the  long  difficulty  of  breathing,  and  its  increafe  within  the 
laft  year,  and  finally  of  the  corruption  of  the  lungs,  “  inafmuch  as,  by  its 

bulk,  it  was  a  caufe  of  compreffion  to  the  lungs,  and  confequently  re¬ 

ft)  N.  3.  (q)  Obf.  91. 

(/)  In  Additam.  Vid.  Schol.  ad  Obf.  34.  (r)  Eph.  N.  C.  Dec.  3.  A.  9.  Obf.  2Z3. 

“  tarded 


4 


Letter  XVIII.  Article  1 471 

“  tarded  the  progrefs  of  the  blood  through  them.”  This  caufe  you  will, 
therefore,  add  to  the  others,  on  account  of  which,  the  heart,  when  enlarg’d, 
is  injurious  to  the  motion  of  the  blood  through  the  lungs,  and  for  that  reafon 
renders  breathing  difficult :  which  fymptom,  you  will  read,  here  and  there, 
was  join’d  with  that  difeafe,  not  only  in  our  hiftories,  but  alfo  in  the  hiftories 
of  others,  as  in  that  of  Hottinger  (j),  of  a  man  whofe  heart  was  larger  than 
the  heart  of  an  ox,  the  auricles  being  in  proportion  to  that  bignefs ;  and  in 
that  of  Zwinger  (/)  of  another  man,  who  had  the  bulk  of  his  heart  very 
much  increas’d,  together  with  a  remarkable  magnitude  of  the  right  auricle, 
on  the  fame  fide  -3  and  alfo  that  of  Fraundorffer  («),  from  an  infant  of  nine 
months  of  age,  in  whom  the  fame  auricle  was  fo  much  enlarg’d,  that  it  not 
only  cover’d  over  the  whole  right  fide  of  the  heart,  but  was  even  extended 
beyond  the  apex.  And  to  thefe  we  may  add,  to  take  no  notice  of  others, 
the  obfervations  alfo  of  Riedlinus  (x),  who  faw  the  heart  far  greater  than 
ufual;  and  of  Budceus  (j),  and  Laubjus(z),  the  firft  of  whom  found  the 
heart  enlarg’d  to  an  extraordinary  fize,  and  the  laft  found  it  three  times  larger 
than  ufual ;  and  that  of  Graffius  the  fon  (a),  who  met  with  the  right  au¬ 
ricle  of  the  heart,  when  exceeding  its  ufual  bulk,  even  in  a  double  pro¬ 
portion. 

But  if  in  all  thefe  cafes,  you  perhaps  afk  me,  what  fymptoms  were  ob- 
ferv’d  in  the  living  body  relative  to  the  diforder  in  queftion,  befides  the  dif¬ 
ficulty  of  breathing  ;  you  will  find,  that  in  the  laft,  together  with  a  palpi¬ 
tation  of  the  heart,  which  is  alfo  mention’d  by  Hottinger,  there  were  fre¬ 
quent  fwoonings,  and  finally  unexpected  death.  But  in  the  remaining  cafes, 
there  is  hardly  any  thing  taken  notice  of,  which  can  be  referr’d  to  this  caufe, 
if  you  except  the  hiftory  of  Zwinger,  in  which  the  pulfe  was  fmall,  languid, 
and  unequal ;  and  that  of  Riedlinus,  in  which  the  pulfe  was  remark’d  to  be 
unequally  intermitting  :  yet  there  were,  in  both  of  the  patients,  diforders  of 
the  lungs  alfo,  and  water  extravafated  in  the  thorax  •,  as  alfo  in  that  man 
whofe  hiftory  is  given  by  Hottinger.  But  I  do  not  wonder,  that  other 
fymptoms  of  this  kind  are  not  mention’d  by  other  authors  ;  the  age  of  the 
patient,  or  the  fhortnefs  of  the  time  in  which  he  could  be  examin’d,  or  the 
negligence  of  thofe  who  reported  them,  or  the  number  and  variety  of  things 
which  were  to  be  written,  fometimes  forbidding,  or,  finally,  other  caufes  of 
different  kinds  being  obftacles  thereto.  For  you  will  fcarcely  believe,  that' 
in  the  moft  renown’d  man  Alexander  Marchetti  (b),  though  there  was  an  en¬ 
larg’d  bulk  of  the  heart,  and  a  very  remarkable  dilatation  of  this  right  au¬ 
ricle,  there  was  no  diforder  of  refpiration,  and  much  lefs  other  fymptoms, 
peculiarly  referable  thereto.  Yet  1  would  have  you  believe  nearly  the  fame 
of  a  woman  (c),  in  whofe  hiftory-*  in  like  manner,  you  will  find  nothing  of 
that  kind,  notwithftanding  the  fame  auricle  “  was  fo  far  dilated,  that  it  was 
“  not  only  equal  in  fize  with  the  ventricle  to  which  it  was  connected,  but 
“  even  exceeded  it  in  magnitude.”  But  in  the  merchant  (d),  whofe  heart,, 


(j)  Ibid.  Obf.  89. 

(/)  Dec.  ead.  A.  5.  Obf.  8. 

(«)  Ibid.  Obf.  124. 

(*)  Earund.  Cent.  3.  Obf.  45. 
(y)  Cent.  2.  Obf.  106. 


(z)  Cent  10.  Obf.  84. 

(a)  Cent.  5.  Obf.  24. 

(£)  Cent.  7.  Append,  n.  4. 

(c)  Cent.  4.  Obf.  1 20. 

(A  Ibid.  Obf.  1 15. 

being 


47  2  Book  II.  Of  Difeafes  of  the  Thorax. 

being  large  and  tumid,  had  the  right  auricle,  in  like  manner,  much  ex¬ 
panded,  the  fame  celebrated  author  of  the  obfervacion,  Thebefius,  had,  at 
leaf!',  obferv’d  for  many  years  paft,  a  difficulty  of  breathing,  and  “  other 
“  fymptoms  at  times,”  which  were  perhaps  owing  to  the  fame  caufe. 

And  that  we  may  mention  fomething  of  the  left  auricle  alfo,  of  the  dila¬ 
tation  in  which  there  are  fewer  examples  extant,  than  in  the  right  j  befides 
what  I  have  pointed  out  from  the  celebrated  Pafta  above  (<?),  and  what  you 
will  find  in  this  letter,  and  in  others  of  mine,  Schreyus(/),  an  ingenuous 
man,  obferv’d,  in  a  boy  of  feven  years  old,  a  palpitation  of  the  heart,  with 
a  quick  and  feeble  pull'e  ;  whereas  the  heart  of  this  very  boy,  “  beino-  of  a 
“  ftupendous  magnitude,  exceeded  that  of  an  adult  in  its  form,  the  left 
“  auricle  being  equal  to  the  fize  of  an  egg  but  there  was  a  great  quantity 
of  water  both  in  the  thorax  of  this  boy,  and  in  that  of  the  merchant.  And 
if  you  chufe  to  confider  other  examples  of  a  dilated  heart,  you  have  many 
mention’d  up  and  down  in  thefe  letters  :  and  befides  thofe  which  the  cele¬ 
brated  Van  Swieten  will  point  out  (£•),  you  find  a  great  many  of  other  au¬ 
thors,  and  of  his  own,  in  the  writings  of  that  great  man  Senac  (£),  in  the 
chapter  where  he  particularly  treats  of  that  fubjedt,  'with  fuch  copioufnefs' 
and  (kill,  that  when  you  have  read  this  chapter  through,  you  will  not  be 
much  at  a  lofs,  either  in  regard  to  the  caufes  which  dilate  the  heart,  or  in 
regard  to  the  milchiefs  that  proceed  from  the  heart  when  dilated,  or  in  regard 
to  the  remedies  which  may  be  ufeful  to  diminifh  them,  or,  finally,  in  reo-ard 
to  the  figns  that  indicate  not  only  a  dilatation  of  the  heart,  but  alfo  of  the 
particular  parts  of  it,  efpecially  if  you  attend,  at  the  fame  time,  to  thofe 
things  which  he  has  either  before  remark’d,  or  excepted,  in  reo-ard  to  the 
fame  diforders  (/),  as  far  as  they  are  referable  thereto. 

1 6.  Thus  far  of  aneurifms  of  the  heart.  Now  the  next  thing  is  to  give 

you  inftances  of  aneurifms  in  the  aorta.  And  I  will  begin  with  one  whofe 
hiftory,  I  think,  by  no  means  deferves  to  be  forgotten,  whether  on  account  of 
the  man  who  was  taken  off  by  the  difeafe,  or,  particularly,  on  account  of  thofe 
who  have  written  of  his  difeafe.  The  patient  was  Anthony  Ferrarini,  one  of 
the  firft  phylicians  at  Modena-,  and  the  phyficians  who  wrote  of  his  difeafe 
were  Bernardino  Ramazzini,  and  Marcello  Malpighi.  For  as  1  read  over 
all  the  medical  conlultations  of  Malpighi,  written  with  his  own  hand,  (neither 
the  number  of  which,  nor  the  method  of  fome  in  particular,  are  eafily  to 
be  judg’d  of,  from  thofe  confultations  of  the  fame  man,  which  are  publiffi’d 
by  fome  perfons)  and  all  the  medical  letters  that  had  been  fent  to  him  from 
all  quarters,  by  the  means  of  Albertini,  1  by  chance  lit  on  thefe,  which 
Ramazzini  fent  to  Malpighi,  from  the  beginning  to  the  very  end  of  the 
difeafe  I  have  fpoken,  for  the  fake  of  confulting  him.  From  all  which 
letters,  and  other  loofe  papers,  1  carefully  collected  and  digefted  the  hiftory 
which  I  fhall  give  you  in  the  following  manner:  }  * 

17.  Anthony  Ferrarini,  being  of  a  melancholic  temperament,  as  it  is 
call’d,  and  of  a  habit  inclining  to  the  cache&ic  kind,  was  wont,  continually. 


(e)  N.  9. 

(f)  A£t.  N.  C.  Tom.  2.  Obf.  34. 

(g)  Comment,  in  Boerh.  Aphor.  §  176. 


F>)  Traite  du  Coeur,  1.  4.  ch.  8. 

(0  L.  4.  ch.  4.  n.  4.  ch.  9.  n.  7.  &  ch.  1 1. 

n.  9. 

to 


Letter  XVIII.  Article  i  8.  473 

to  be  fpitting  up  much  faliva,  and  this  pregnant  with  many  corrofive  fairs ; 
and  having  been  now,  for  a  year,  troubl’d  with  a  very  violent,  and  almoft 
continual  cough,  to  which  was  at  length  added  fome  difficulty  of  breathing, 
efpecially  when  he  went  up  deep  places ;  about  the  end  of  Auguft,  in  the 
year  1689,  he  was  feiz’d  fuddenly,  in  the  middle  of  the  night,  with  fuch  an 
oppreffive  torture  at  his  bread:,  that  he  was  afraid  of  immediate  fuffocation. 
Yet  by  expectorating  a  confiderable  quantity  of  catarrhous  matter,  that  op¬ 
preffive  torture  was  remov’d.  But  after  an  interval  of  two  days,  when  he 
had  a  motion  to  (tool,  in  confequence  of  a  glvfter,  being  feiz’d  with  the 
fame  oppreffion,  although  lels  violent,  and  being  afterwards  compell’d  to 
draw  his  breath  with  his  neck  ftretch’d  out,  he  found  confiderable  eafe  from 
the  lofs  of  blood ;  but  this  eafe  did  not  continue.  For  very  often,  watch¬ 
ings,  and  fometimes  a  molt  troublefome  cough,  and  generally  dry,  but  chiefly 
a  lenfation,  as  it  were  of  a  cord  binding  the  alpsra  arteria,  ftill  afflicted 
him  greatly  ;  notwithftanding  he  could  again  lie  down  a  little  fometimes.  Ia 
the  mean  while  he  became  emaciated,  and  the  paroxyfms  became  more  fre¬ 
quent,  and  more  violent.  Yet  his  pulfe  never  difcover’d  any  thing  fever- 
iffi.  It  feem’d  proper  to  the  other  phyficians  who  were  there,  that  blood 
fhould  be  taken  away  from  the  foot,  contrary  to  the  opinion  of  Ramazzini : 
and  by  this  evacuation,  his  ftrength,  which  had  kept  up  pretty  well  till  then, 
became  much  decreas’d,  and  his  difeafe  more  violent.  For  he  was  now  at¬ 
tack’d,  every  day,  with  that  oppreffive  torture,  attended  with  the  fenfe  of 
conftriCtion  in  the  afpera  arteria,  and  fauces,  fometimes  three  or  four  times, 
and  that  for  two  hours  together,  with  fo  much  violence,  that  there  was  no¬ 
body  who  did  not  think  he  was  about  to  be  inflantly  fuffocated.  Fie  did 
efcape  however,  not  by  difcharging  any  thing  from  his  mouth,  but  by  falling 
into  a  univerfal  and  plentiful  fweat.  Yet  whether  he  endeavour’d  to  fwallow 
food,  or  any  thing  elfe,  or  whether  a  glyfter  was  given  him  of  milk,  and 
not  only  of  any  other  fluid  ;  that  oppreffion,  and  particularly  that  conftriCtion, 
immediately  return’d.  When  he  was  free  from  thefe  fymptoms,  he  perceiv’d 
no  pain  or  uneafinefs  in  any  part,  if  you  except  the  accuftom’d  difficulty  of 
breathing  which  was  moderate,  and  a  fenfe,  as  he  call’d  it,  of  a  kind  of  air 
afcending  from  the  hypochondria,  to  the  fauces,  which  circumftance,  toge¬ 
ther  with  the  fudden  invafion  and  departure  of  the  fit,  and  the  relief  that  he 
frequently  found  from  the  eruption  of  flatus,  and  the  melancholic  tempera¬ 
ment  which  I  mention’d  before,  induc’d  not  only  the  fick  phyfician  him- 
felf,  but  mofl  others,  to  think  that  the  paroxifms  were  to  be  accounted  for, 
almoft  as  in  hyfterical  women,  only  from  irritated  and  convuls’d  nerves. 

For  although  in  the  beginning,  fome  conjectur’d  that  a  vifcid  matter  was 
collected  in  the  lungs;  and  others,  that  a  thin  defluxion  was  diftill’d  upon 
them,  from  the  glands  of  the  fauces  yet  afterwards,  moft  of  them,  as  I 
have  faid,  thought  that  the  diforder  was  a  convulfion,  from  the  nerves  being 
now  and  then  irritated,  by  the  hypochondriac  juices,  which  fome  exprefsly 
deduc’d  from  the  ipleen  :  although  others  fuppos’d  the  irritation  to  arife  even 
from  the  brain  itfelf,  by  reafon  they  had  obferv’d  fomething  epileptic  in  the 
paroxilms.  Yet  fome  were  not  wanting,  who,  as  they  could  by  no  means 
•underhand,  how  he  could  poffibly  furvive  fo  many,  and  fo  violent  paroxilms, 
and  not  only  furvive,  even  in  fpite  of  fo  much  abftmence,  but  not  have  his. 

Yol.  I.  P  p  p  ftrength 


474  Book  II.  Of  Difeafes  of  the  Thorax. 

.ftrength  entirely  pull’d  down,  fufpefted  that  there  was  fome  witchcraft  in  the 
cafe.  Malpighi  alone,  as  almoft  all  his  letters  to  Ramazzini  clearly  fhew, 
fear’d,  left  befide  irritations  of  the  nerves,  “  fome  great  obftacle  fhould 
“  lie  conceal’d  in  the  conftitution,  fome  organical  injury,  which  had  been 
brought  on  by  the  humours  that  were  loaded  with  corrofive  falts  it  was, 
therefore,  with  great  caution,  that  he  approv’d  of  the  ufe  of  narcotics, 
which  had  been  fometimes  giv’n  to  the  patient,  or  of  baths  which  had  been 
propos’d,  but  rather  approv’d  of  other  things,  that  were  lefs  to  be  fufpefted, 
or,  according  to  his  modeft  manner,  recommended.  At  length,  within  the 
leventieth  day  from  the  firft  attack,  the  patient  was  conftrain’d  to  yield  to 
the  violence  of  his  difeafe,  having  been  under  a  necefiity,  for  all  that  long 
fpace  of  time,  to  fit  up  in  bed  almoft  always,  or  on  a  chair,  in  order  to 
draw  his  breath  more  eafily,  as  he  did  particularly,  if  he  fat  with  his  head 
inclin’d,  or  rather  with  his  body  bent  forwards  in  the  manner  of  a  bow  j  and 
for  this  reafon  he  almoft  continually  fat  in  that  pofture. 

The  abdomen  being  open’d,  neither  the  fpleen,  nor  any  other  of  the  vif- 
cera,  had  the  leaft  morbid  appearance.  In  the  thorax  alfo,  the  lungs  were 
found  to  be  found,  and  unhurt.  But  in  the  aorta,  where  it  rofe  above  the 
heart,  a  great  aneurifm  was  feen,  from  which  they  took  out  a  pound,  and 
more  than  that,  of  blood,  in  the  middle  of  which  was  a  polypous  concretion, 
of  the  length  and  thicknefs  of  the  fore-finger. 

1 8.  As  there  had  been  other  fymptoms  in  Ferrarini,  which  we  afterwards 
obferv’d  in  the  marquis  Paulucci  ( k ),  from  the  fame  caufe ;  fo  there  were  alfo 
thele  in  particular,  which  you  will  now  add  to  what  I  have  formerly  faid  of 
Paulucci,  that  he  felt  a  kind  of  air  afcending  from  the  hypochondria,  and 
that  he  fat  in  no  pofture  more  conveniently  than  with  his  head  and  body  in¬ 
clin’d  forwards.  Of  which  circumftances,  as  the  one  might  have  led  us  into 
an  error,  fo  the  other  fhould  have  averted  us  from  it.  For  if  you  would 
have  underftood  the  firft  as  a  fign  of  a  hypochondriac  convullion,  by 
which  alone  you  would  explain  thofe  horrible  paroxifms  ;  the  fecond  was 
flatly  againft  this  conclufion,  inafmuch  as  it  was  rather  a  fymptom  of  quite 
an  oppofite  caufe  ;  I  mean,  that  there  was  fome  obftacle  in  the  thorax,  which 
prefs’d  more  upon  the  afpera  arteria,  unlefs  it  was  drawn  to  fome  diftance  from 
that  tube  by  the  inclination  of  the  body  forwards.  Thus  did  Ramazzini 
explain  the  cafe,  when  he  related  the  diftebtion  I  have  juft  giv’n  the  detail 
of,  to  Malpighi,  in  like  manner  as  you  will  fee  that  Reifelius,  in  an  obfer- 
vation,  publifh’d  that  very  year,  and  afterwards  transferr’d  into  the  Sepul- 
chretum  (/),  explain’d  the  cafe  of  a  boy,  who  tc  perceiv’d,  that  he  was  re- 
liev’d  from  the  very  great  ftrifture  of  his  afthma,  when  he  lean’d  his  head 
“  and  cheft  forwards  upon  a  bench  as  he  flood,  without  doubt,  becaufe  the 
heart  being  extremely  enlarg’d,  he  was  more  at  eafe  if  it  lay  upon  the 
*c  fternum,  than  when  it  prefs’d  upon  the  lungs  in  a  fupine  ftate.”  So 
Vieuflens  ( m )  afterwards  brought  as  a  reafon,  why  a  foldier  made  his  ref- 
piration  lefs  difficult,  by  fitting  in  the  fame  pofture  in  bed,  that  which  I 
Rave  defcrib’d  in  Ferrarini ;  1  mean,  that  the  heart  being  greatly  dilated, 
■with  a  kind  of  polypous  concretion,  fo  comprefs’d  the  afpera  arteria,  in  a 

{k)  Epifl.  17.  n.  26.  U)  in  Addit,  ad  Sed.  1.  1*  2.  obf.  29.  (/»)  Traite  du  Coeur  ch.  1. 

8  fupine 


Letter  XVIII.  Article  19.  475 

fupine  pofture,  as  to  bring  on  danger  of  fuffocation.  Nor,  perhaps,  was  there 
any  other  caufe,  why  he  alfo,  whom  I  have  mention’d  from  Dionis  (n),  as 
having  the  right  auricle  of  the  heart  only  dilated,  kept  himfelf  almoft  in  the 
fame  pofture,  except  that  the  lungs  fuffer’d  lefs  from  the  bulk  and  weight 
thereof  But  Freind  law,  that  the  fame  pofture  was  more  convenient  to 
another,  who  labour’d  under  an  aneurifm  of  the  aorta  in  the  thorax  (0)5  and 
Albertini  (p)  recounts  this  very  circumftance,  among  the  figns  which  do  by  no 
means  (lightly  indicate  to  us  the  dilatations  of  thefe  receptacles  of  blood  within 
the  thorax.  Nor  did  what  Pacchioni  obferv’d  (q),  in  a  certain  patient  of  his,, 
tend  much  lefs  to  prove  the  fame  thing  •,  for  “  as  often  as  a  great  danger 
“  of  luftdcation  came  on,  fo  often  was  it  an  eafe  and  alleviation  to  him,  to 
“  incline  his  head,  and  to  raife  his  hips  high  ;  and  thus  the  diaphragm  was 
“  at  leaft  reliev’d  of  forne  part  of  its  burthen,  that  is  the  heart,”  which  was 
twice  as  big  as  is  natural :  I  fay  the  diaphragm  ;  for  the  fame  inclination  was 
a  relief  to  that,  “  whether  the  patient  was  in  a  prone  or  fupine  pofture.” 
But  another  patient,  in  whom  the  heart  was  alfo  “  enlarg’d  in  its  bulk,”  that 
is  defcrib’d  by  Beggius  (r),  efcap’d  from  the  danger  of  fuffocation,  if  “  his 
“  cheft  was  inclin’d  towards  his  knees,  or  he  fat  a  little  prone.”  But  I  fhall 
alfo  take  notice  of  other  examples  of  this  kind  below. 

19.  Yet  you  will,  perhaps,  fay,  that  it  appears  in  the  firft  feflion  of  the 
fecond  book  of  the  Sepulchretum  (j),  and  in  like  manner  in  the  thirteenth 
of  the  former  book  (/),  from  the  obfervations  of  Willis,  that  there  were 
patients,  who,  except  they  kept  their  head  always  eredt,  or  inclin’d  for¬ 
wards,  fome  immediately  fell  into  tremors  of  the  hearts,  and  deliquia  of  the 
fpirits,  and  others,  which  is  more  to  the  prefent  purpofe,  became  imme¬ 
diately  fhort  of  breath,  and  breath’d  with  great  difficulty,  like  a  perfon 
who  was  dying  ;  whereas,  notwithftanding  all  this,  neither  of  them  had  aneu^- 
rifms  in  the  thorax,  but  both  had  a  large  collection  of  ferum  in  the  ventricles 
of  the  brain,  that  was  fait  and  acrid  *  and  this  ferum,  when  the  head  was 
not  ereCt,  or  not  inclin’d,  falling  back  towards  the  origins  of  thole  nerves 
that  go  to  the  praecordia,  had  excited  very  great  convulfions  thereof. 

But  I  do  not  fpeak  here  of  the  head  being  eredt,  fo  much  as  of  the  thorax, 
in  particular,  being  inclin’d  forwards  :  and  this  I  moreover  fay,  that  the 
patients,  in  whole  brain  fuch  a  great  quantity  of  ferum  of  this  kind  was  ex- 
travafated,  could  not  be  without  other  fymptoms  of  diforder  in  the  head, 
which  thofe  whom  I  have  fpoken  of  were  in  general  free  from,  when,  at  the 
fame  time,  they  had  many  fymptoms,  which  fhew’d  that  the  principal  feat 
of  the  diforder  was  in  the  thorax,  if  you  would  be  at  the  pains  to  compare 
the  prefent  fymptoms  with  the  paft.  For  fome  fell  into  the  diforder  from 
very  violent  paflions  of  the  mind  ;  as  Paulucci,  and  he  whom  we  have  men¬ 
tion’d  from  Dionis  •,  and  others,  as  Ferrarini,  from  being  agitated  with  a 
long  and  violent  cough. 

And  that  from  a  cough  of  this  kind,  the  natural  motion  of  refpiration  is 
very  frequently  and  violently  chang’d,  and  consequently  alfo  the  motion  of 

(q)  Oper.  Edit.  .4..  verf.  fin.  Hilt.  2. 

(r)  Ibid.  Hift.  feq. 

(s)  Obf.164.  (/)  Obf.  4. 

P  p  p  2 


(«)  Supra,  n.  1 1 .  &  12. 

(0)  Hilt,  de  la  Medec.  I. 

(/)  Opufc.  cit.  lupra,  ad  n,  11. 


the 


476  Book  II.  Of  Difeafes  of  the  Thorax. 

the  blood,  and  that  fudden  repercuffions  thereof  are  made  upon  the  receptacles 
of  the  blood  in  the  thorax,  is  evident ;  fo  it  is  no  lefs  evident,  that  in  the 
paffions  of  the  mind,  the  courfe  of  the  blood  through  thefe  fame  pafiages  is, 
fometimes,  for  a  long  while,  var ioully  and  vehemently  excited,  and,  fome- 
times,  as  varioufly  and  vehemently  retarded,  as  the  face,  the  refpiration,  and 
the  pulle,  do,  at  fuch  times,  certainly  and  jointly  demonftrate:  fo  that  it  is 
not  to  be  wonder’d  at,  if,  from  a  violent  effort  to  fupprefs,  or  dilfemble,  in¬ 
dignation,  that  great  aneurifm  Ihould  happen  in  the  right  auricle,  as  related 
by  Dionis,  no  more  than  it  is  to  be  wonder’d  at,  that  fo  great  a  dilatation  of 
the  heart,  and  aorta,  had  happen’d  from  the  lame  caufe,  as  related  by  Har¬ 
vey  (u)  •,  fo  that  the  friends  of  the  patient,  juft  as  was  faid  of  Ferrarini,  before 
the  difteCtion  of  the  body,  believ’d,  from  the  unheard-of  violence  of  the 
difeafe,  that  the  man  “  was  under  the  malicious  influence  of  a  witch,  or 
“  befet  by  fome  evil  fpirit.”  And  fuch  is  the  force  of  human  paffions,  in 
dilating  the  channels  and  receptacles  of  blood  in  the  thorax,  that  Alber- 
tini  with  juftice  deduc’d  a  reafon  from  hence  (x),  why  thefe  dilatations  are 
fo  feldom  found  in  beafts,  and  fo  often  in  men. 

When,  therefore,  thefe  or  other  caufes  have  preceded,  from  whence  aneu- 
rifms  may  take  their  origin,  I  (hall  conjecture,  fays  the  fame  author,  fo  ac¬ 
curately,  that  I  can  add  nothing  thereto,  that  fuch  aneurifms  are  already 
form’d,  not  only  when  I  perceive  that  molt  of  the  figns,  by  which  thefe 
diforders  are  wont  to  fhew  themfelves,  are  prefent,  but  alfo  when  I  perceive, 
that  there  is  no  other  hidden  diforder  in  the  thorax,  by  comparing  the  caufes 
and  figns  of  other  difeafes,  and  the  effects  of  remedies  one  with  another. 
For  he  would  form  a  very  ill  conjecture  about  an  aneurifm,  who  fhould  not 
attend  to  thefe  things.  So  one  of  the  two  men,  whom  the  celebrated  Cap- 
perus(jy)  has  defcrib’d,  breath’d  with  great  difficulty  indeed,  and  “  was 
“  under  a  neceffity  of  fitting  with  his  body  fo  infleCted,  that  he  feem’d,  as 
“  it  were,  to  conceal  his  head  between  his  knees yet  this  man  had  no 
aneurifm,  and  even  “  his  heart  was  very  fmall.”  But  other  figns  of  an 
aneurifm  were  wanting,  and  he  was  evidently  phthifical.  So  the  boy  fpok’n 
of  in  the  Sepulchretum  ( z ),  whofe  death  was  not  brought  on  by  an  aneu- 
xifm,  but  by  a  kind  of  flefhy  mafs,  which  adher’d  clofely  to  the  pleura  and 
the  ribs,  complain’d  of  an  obtufe  pain  in  the  cheft,  and  a  difficulty  of 
breathing-,  fo  that  in  an  obfcure  difeafe,  which  had  taken  its  beginning  from 
a  blow  of  one  fide,  receiv’d  from  a  very  violent  fall,  any  one  might  have 
been  led  to  fufpeCt  an  aneurifm,  efpecially  as  that  fymptom  had  at  length 
been  added,  which  1  have  told  you  was  obferv’d  in  Paulucci  and  Ferrarini  ; 
for  the  boy  could  not  now  go  to  deep,  tc  except  with  his  head  inclin’d  on  a 
table  that  had  a  great  declivity.”  Yet  other  marks  of  an  aneurifm,  and 
thofe  fuch  as  might  be  depended  upon  better,  were  wanting  in  this  boy, 
that  were  prefent  in  them.  And  I  have  put  you  in  mind,  that  not  fome 
fymptoms  only,  but  the  greateft  part,  ought  to  be  attended  to,  for  this  reafon, 
becaufe  as  they  do  not  all,  at  all  times,  occur,  nor  certainly  did  all  occur  in 

(y)  Aft.  N.  C.  Tom.  4.  Obf.  47. 

(z)  L.  z.  S.  2.  Obf.  4.  in  Addit. 


(«)  De  Circ.  Sangu.  Exerc.  Anat.  3. 
i  (*)  Opufc.  cit.  ftipra,  ad  n.  11. 


thofe 


Letter  XVIII.  Article  10.  477 

thofe  two  patients  mention’d  above  j  fo  if  you  confider  fome  only,  you  will 
often  be  deceiv’d. 

20.  You  will,  perhaps,  afk,  how  it  can  happen,  that  although  there  was 
in  both  of  thefe  cafes  a  dilatation  of  the  aorta,  yet  there  was  in  neither  of 
them  any  pulfation  ?  The  abfence  of  this  fymptom,  doubtlels,  drew  moft 
of  the  phyficians  of  both  patients  into  an  error :  although,  as  there  may  be 
a  pulfation  without  an  aneurifm  of  the  artery  ( a ),  fo  there  may  be  an  aneu- 
rifm  of  the  aorta  without  a  pulfation,  whether  becaufe  this  is  only  to  be 
flightly  obferv’d  by  the  patients  themfelves,  rather  than  by  the  phyficians, 
and  only  before  the  difeafe  begins  to  grow  violent,  as  it  was  perhaps  in  Fer- 
rarini  ;  or  becaufe,  in  others,  it  occurs  in  the  beginning  of  the  diforder, 
when  it  firft  difcovers  itfelf  to  the  phyficians,  as  certainly  happen’d  in  Pau- 
lucci,  before  he  return’d  into  his  native  country,  and  after  that  becomes  fo 
obfcure  in  both,  that  there  feems  to  be  none.  But  as  I  formerly  mention’d 
three  caufes  of  this  obfcurity  (£),  I  will  not  repeat  them  here.  In  regard  ter 
the  firft  of  them,  only,  as  it  relates  moft  to  thefe  twro  cafes,  it  is  fufficient  to 
add  at  prefent,  that  it  often  takes  place  even  in  external  aneurifms,  as  I  have 
alfo  feen,  and  Parey  formerly  rightly  admonifh’d  (c),  when  he  had  propos’d 
pulfation  among  the  figns  of  aneurifms.  His  words  are,  “  Do  not  let  us 
“  be  deceiv’d  by  the  figns  above-mention’d :  for  fometimes,  in  very  confi- 
“  derable  aneurifms,  we  cannot  perceive  even  the  leaft  pulfe,  becaufe  the 
“  blood  is  colledted  into  thrombi,  and  coagulates.”  And  if  fome  furgeons, 
afterwards,  had  not  been  forgetful  of  this  very  juft  admonition,  or  had  be¬ 
liev’d,  that  this  could  not  happen  in  fmall  aneurifms  *,  doubtlefs,  neither  that 
friend  of  Ruyfch  ( d )  would  have  dar’d  to  open  a  fmall  tumour  about  the 
ankle,  of  the  bignefs  of  a  walnut,  notwithftanding  “  all  pulfation  was  wanting, 
“  by  reafon  of  the  coagulated  blood  ;”  nor  Ruyfch  ( e )  would  have  again  ad¬ 
monifh’d  us,  “  That  not  in  every  aneurifm  a  pulfation  was  ftridtly  felt,  al- 
“  though  authors,  in  general,  confider’d  that  as  a  pathognomonic  fign.  For 
«  if  the  blood  is  coagulated  in  the  aneurifm,  no  pulfation  is  perceiv’d.” 

And  he  added,  that  he  had  had  experience  of  the  fame  in  large  aneurifms, 
and  produc’d  an  example  of  that  large  aneurifm,  which  beginning  from  the 
trunk  of  the  aorta,  about  three  inches  above  the  heart,  occupied  the  exterior 
parts  of  the  thorax,  like  a  pillow  ;  an  aneurifm  very  much  fimilar  to  which, 
Tittre  (/)  defcrib’d  afterwards  :  but  both  of  them  obferv’d,  that,  for  fome 
fpace  of  time  before  death,  the  pulfation  was  entirely  obfcur’d,  and  that  this 
obfcurity  was  to  be  accounted  for  from  the  quantity  of  lamellae,  which  I 
have  fpok’n  of  before  ( g ),  or  rather  of  polypous  concretions,  which  the 
blood  that  ftagnated  internally  ftill  more  and  more  increas’d.  So,  therefore,  the 
obfervation  of  the  pulfation  being  obfcur’d,  is  transferr’d  from  external  aneu¬ 
rifms  to  them  alfo,  which,  although  they  had  made  way  for  themfelves  out¬ 
wards,  yet  belong’d  to  the  internal  trunk  of  the  aorta  ;  and  after  that  to  thofe 
alfo,  which  are  altogether  conceal’d  3  for  Lancifi  fpeaks  in  general,  in  the 

(«)  Vid.  Epift.  39.  n.  19,  2c.  (e)  Ibid. 

(£)  Epift.  Anat.  13.  n.  4.  (f)  Mem.  de  1’  Acad.  R.  des  Sc.  A.  1707. 

(c)  Oper.  1.6.  c.  32.  (^)  Epift.  17.  n.  29. 

\d)  Vid.  Anat.  Chir.  Obf.  38. 


fifty- 


47  8  Book  II.  Of  Difeafes  of  the  Thorax. 

fifty-eighth  propofition  (A),  and  Albertini  alfo  (*),  where  he  takes  occafion  to 
fpeak  of  the  pulfation  of  aneurifms,  if  not  as  entirely  deficient,  yet  at  lead: 
as  being  become  much  lefs,  and  languid.  But  although  each  of  them  are 
then  fpeaking  of  the  difeafe,  when  it  is  already  inveterate,  and  touch  upon 
other  caufes,  moreover,  befides  that  which  I  have  fpoken  of-,  yet  nothing, 
perhaps,  is  a  fufficient  obje&ion  againft  the  fame  caufe,  very  foon  inter¬ 
cepting  the  puliation  in  fome,  that  is  the  blood,  which  was  at  length  found 
to  be  concreted  all  round,  in  the  aneurifms  of  Paulucci,  and  Ferrarini,  and 
which  began  to  coagulate  very  early,  and  thereby  interpofe  a  pretty  thick 
obftrudtion,  or  bar,  betwixt  the  hands  of  the  phyficians  when  laid  upon  the 
thorax,  and  the  pulfation,  which  was  certainly  more  diftant  from  them  at 
that  time.  You,  therefore,  readily  perceive,  how  it  could  be,  that  although 
there  was  in  each  of  them  an  aneurifm,  yet  no  pulfation  occurr’d  in  either. 

But  how  it  could  happen,  that  though  the  difeafe  was  always  prefent,  there 
were  not  always  paroxifms,  is  already  explain’d  in  the  former  letter  (£). 
You  muft  not,  therefore,  immediately  imagine,  that  becaufe  a  puliation  is 
wanting,  or  becaufe  the  more  violent  effedts  of  the  difeafe  do  not  appear, 
through  longer  or  fhorter  fpaces  of  time,  the  patient  has  not  an  aneurifm. 
I  would  not  have  you  even  truft  longer  intervals,  unlefs  all  the  marks  of  an 
aneurifm  go  away  at  the  fame  time  with  the  paroxifms,  nor  thofe  paroxifms 
now  return  any  more,  if  the  caufes  by  which  they  were  excited  return  as, 
for  inftance,  motion  of  the  body,  deglutition,  and  other  things  of  that  kind, 
which  were  wont  in  the  two  patients  in  queftion,  and  are  wont  in  other  pa¬ 
tients  like  them,  to  renew  the  attacks  of  the  diforder. 

21.  If  you  have,  perhaps,  hitherto  wonder’d,  that  I,  who  had  promis’d 
my  own  obfervations  in  this  letter,  fhould  rather  have  produc’d  remarks, 
and  animadverfions,  than  obfervations  ;  fince  out  of  five  of  thofe  which  I 
have  defcrib’d,  one  only  is  mine,  and  the  remaining  obfervations  from  others  ; 
you  will  immediately  ceafe  to  wonder,  when  you  fhall  oblerve,  that  I  choofe 
rather  after  that  (/),  to  defer  the  greateft  part  of  mine,  to  other  letters,  and 
to  communicate  here  thofe  of  others,  indeed,  but  fuch  as  were  unpublifh’d, 
left  they  fhould  happen  to  remain  in  obfcurity.  But  to  prevent  you  being 
difpleas’d  with  what  you  ought  rather  to  receive  kindly,  thofe  that  I  fhall 
fubjoin,  you  will  have  one  and  all  from  me.  And  I  fhall  firft  give  you  one, 
which,  when  explain’d,  will  agree  with  the  laft,  whether  you  would  attend  to 
the  nature  of  the  caufe,  or  confider  the  great  uneafinefs  in  deglutition,  or, 
finally,  the  feat  of  the  aneurifm  itfelf. 

22.  I  faw  a  trumpeter  at  Padua,  as  far  as  I  can  remember,  in  the  year 
1723,  whom  his  art  had,  long  before,  thrown  into  an  incurable  aneurifm, 
which  occupy’d  the  internal,  and  upper  parts  of  the  cheft.  The  more  this 
increas’d,  the  more  it  increas’d  the  uneafinefs  in  deglutition,  and  the  difficulty 
of  breathing;  till,  at  length,  the  power  of  fwallowing,  being  at  firft  wholly 
intercepted,  and  then  the  power  of  breathing,  the  patient  was  of  courfe  car- 
ry’d  off.  Thofe  parts  of  the  body  where  the  feat  of  the  diforder  was,  being 
brought  into  the  hall  of  the  anatomical  theatre,  I  faw  the  arch  of  the  aorta, 

(£)  De  Aneur.  (i)  n.  27. 

(/)  Opufc.  cit.  fupra,  ad  n.  n.  (/)  fupra,  n.  13, 

together 


Letter  XVII.  Articles  23,  24.  47 9 

together  with  that  large  branch  which  gives  origin  to  the  right  fubclavian  and 
carotid,  fo  dilated,  that  it  comprefs’d  the  afpera  arteria,  and  cefophagus.  And 
when  the  celebrated  Vulpius  there  differed  this  aneurifm,  1  law  that  its  in¬ 
ternal  furface  was  occupy’d  with  a  very  thick  polypous  concretion,  the  ft  ruc¬ 
tu  re  of -which,  in  this  man,  was  like  the  ftrudture  of  the  others  that  I  had  feen 
before ;  fo  that,  like  an  onion,  it  might  have  been  refolv’d  into  curv’d  laminm, 
fome  of  which  were  contain’d  within  others  ;  but  a  great  part  of  the  lubftance 
thereof  was  hard,  and  of  a  yellowiftv  white,  fo  that  it  refembl’d  nothing  more 
than  harden’d  fuet. 

23.  Freind  (, m )  aflerts,  that  a  matter,  “  refembling  fuet,”  was  fometimes 
found  by  Vefalius,  within  aneurifms,  from  the  teftimony,  as  it  feems,  of 
Adolphus  Occon.  Which  I  do  not  find  in  his  narration,  either  as  it  is  related 
in  the  Sepulchretum  (»),  or  as  it  is  read,  fomewhat  more  at  large,  in  the  oh- 
fervations  of  Schenck  ( 0 ) :  although  nothing  is  more  common,  than  to  find 
polypous  concretions  like  fuet,  lard,  or  fat  ;  fo  that  obfervators  have  often, 
both  before  and  fince,  pointed  out  thofe  concretions,  either  by  the  name,  or 
by  the  refemblance,  of  thele  things :  nor  in  the  heart  alone,  but  alfo,  fome¬ 
times,  even  in  aneurifms.  So  in  that,  which  is  fuppos’d  to  be  the  very 
firft  that  was  differed,  I  have  taken  notice,  that  the  external  part  of  the 
concretion  was  found  to  be,  “  in  colour  and  appearance,  not  unlike  hog’s 
lard  (p).  So  Lancifi  (j)  defcrib’d  “  a  polypous  fubftance,  like  lard,”  dif- 
pos’d  into  the  form  of  an  arch,  “  in  that  aneurifm,  the  length  whereof  did 
“  not  exceed  half  the  length  of  the  aorta,  where  it  is  curv’d  fo  that  I  do 
not  fee  why  Freind  relates  it  in  fuch  a  manner  (r),  as  if  “  in  the  whole  curva- 
**  ture  of  the  aorta,  fomething  like  lard  included  in  a  cyft,”  had  appear’d  to 
Lancifi:  neither  do  I  fee  why  he  fays,  that  the  large  aneurifm  defcrib’d  by 
Ruyfch  (j),  which  may,  in  a  great  meafure,  be  compar’d  with  another  that 
Littre  has  defcrib’d  (/),  “  had  fill’d  up  the  whole  cavity  of  the  thorax,  with- 
“  out  any  external  tumour.”  I  confels  thefe  things  are  of  little  confequence, 
if  you  attend  to  the  defign  of  Freind,  and  perhaps  are  not  all  to  be  imputed 
to  him  ;  neverthelefs,  thefe,  and  other  circumftances  moreover  (#),  which  I 
remark’d  in  a  few  pages,  while  I  was  upon  another  enquiry,  give  me  a  fufpi- 
cion,  that  he  trufted  too  much  to  his  own  memory,  in  writing,  and  fhould 
make  you  more  cautious  in  reading  him. 

24.  But  as  we  have  deduc’d  the  caufe  of  the  aneurifm  inFerrarini,  from  a 
long,  obftinate,  and  violent  cough  (x)  •,  fo  in  the  trumpeter,  I  think  the 
fame  diforder  ought  to  be  attributed  to  the  frequent  and  ftrong  inflation  of 
that  inftrument.  For  whatever  violently,  and  for  a  long  time,  changes  the 
natural  motion  of  refpiration,  changes  alfo  the  motion  of  the  blood  ;  fo  that 
being  fometimes  obftrufted,  and  fometimes  excited,  if  any  part  of  a  veftel  be 
accidentally  lefs  ftrong  than  others,  this  part  will  at  length  be  dilated,  by  its 
fibres  being  ftrOngly  prefs’d  upon,  and  drawn  afunder.  For  which  reafon 


(m)  Hift.  Med.  ad  A.  1 640.  ubi  de  aneuryfm. 

(n)  1.  4.  f.  2.  obf.  21.  §  7.  partic.  2. 

(c)  1.  5.  obf.  medic.  5. 

ip)  Epift.  17.  n.  29.  vid.  Sepulchr.  §  cit. 
partic.  1. 

(q)  De  Subit,  Mort.  obf.  ultimu 


(r)  loco  indicato. 

(1)  Obf.  38.  cit.  fupra,  ad  n.  zo. 
(0  Ibid. 

(a)  Vid.  epift.  17.  n.  3. 

( x )  fupra,  n.  19. 


Lancifi 


480  Book  II.  Of  Difcafes  of  the  Thorax. 

Lancifi  has  obferv’d,  that  others,  in  like  manner,  who  play  on  a  trumpet, 
flute,  or  fife,  and  blow  hard  into  them,  are  often  fubjebt  to  aneurifms  (y) ; 
and  Albertini  has  taken  a  mark  from  an  art  of  that  kind  (2),  by  which,  join’d 
together  with  other  fymptoms,  we  may  conjecture  at  aneurifms  while  they 
are  yet  latent.  And  the  reafon  why  all  trumpeters,  and  all  that  are  troubl’d 
with  a  violent  cough,  do  not  fall  into  thefe  difeafes,  is  either  becaufe  a  firmer 
ftruCture  of  veflels,  about  the  praecordia,  or  a  (lighter  and  lefs  afiiduous  appli¬ 
cation,  and  agitation,  or,  finally,  a  lefs  quantity,  and  a  better  condition,  of 
blood,  prevent  the  other  diftending  or  eroding  caufes,  from  being  added 
thereto.  So  neither  in  all  who  are  troubl’d  with  a  violent  cough,  or  who  play 
on  a  flute,  or  trumpet,  is  an  ulcer  of  the  lungs  brought  on,  or  a  clofe  adhe- 
fion  of  them  to  the  pleura,  although  both  of  thefe  diforders  were  found,  in 
two  patients  who  had  been  accuftom’d  to  ufe  inftruments  of  that  kind,  by 
thofe  celebrated  men  Duifingius  (a),  and  Fabricius  (3),  who  thought  that  this 
obfervation  would  ferve  to  encreafe  the  number  of  thofe  difeafes,  to  which 
our  Ramazzini  has  taught,  that  this  kind  of  artifts  are  liable  (c),  and  indeed 
juftly ;  but  fo  that  we  mud  acknowledge  fome  of  thefe  to  be  more  expos’d  to 
diforders  of  this  kind,  than  others,  according  to  their  various  dilpofition,  and 
conftitution. 

But  as  to  the  deglutition  being  troublefome,  and  at  length  entirely  obftruft- 
ed,  in  the  trumpeter,  which  is  to  be  accounted  for,  from  the  bulk,  pofition, 
and  feat,  of  the  aneurifm,  comprefling  the  cefophagus,  in  this  manner ;  the 
circumftance  is  not  only  manifeft  of  itlelf,  but  is  alfo  confirm’d  by  other  ex¬ 
amples,  that  are  produc’d  above  (d). 

Laft  of  all,  as  to  the  feat  of  the  aneurifm,  in  the  very  curvature  of  the 
aorta,  it  fo  frequently  happens,  that  aneurifms  are  found  either  in  that  place, 
or  near  to  it ;  fo  that  if  you  begin  with  that  which  was  delineated  by  Riva  (e), 
and  certainly  was  the  firft:  that  was  delineated,  as  I  have  already  faid,  and 
even  with  thefe,  which  you  fee  are  taken  notice  of  in  the  Sepulchretum  (/), 
from  Lazarus  Riverius,  and  Otto  Heurnius,  and  go  on  to  thofe  that  are  de- 
fcrib’d  by  Ruyfch  (g),  by  Littre  (b),  and  by  others  afterwards,  which,  for 
brevity’s  fake,  I  purpofely  omit,  and  then  come  down  to  mine,  and  compare 
them  with  all  thofe  others,  that  have  been  found  in,  or  about  that  place 
which  I  have  mention’d,  how  many  foever  you  may  read  of,  as  having  their 
origin  from  an  internal  caufe,  in  other  authors,  you  will  wonder,  without 
doubt,  that  all  the  parts  of  the  aorta  have  fo  feldom  grown  out  into  an  aneu¬ 
rifm,  into  which,  that  one  part  has  fo  frequently  been  form’d.  The  caufe  of 
which  difference,  as  I  have  treated  flightly  of  it  heretofore,  in  the  Adverfa- 
ria  (/),  I  will  not  repeat  here ;  efpecially  as  I  fee  that  it  was  afterwards  ap¬ 
prov’d  of  by  learn’d  men,  and  among  thefe  by  Valcarengus  (£),  who  (hews 


(j>)  De  Aneur.  propof.  39.  &  53. 

(2)  Opufc.  cit.  fupra,  ad  n.  11. 

(rf)  Commere.  Litter.  A.  1741.  Hebd.  44. 

n.  1. 

(£)  in  Propempt.  edito  Helmfl.  A.  1751. 

( c )  Diatrib.  de  morb.  artif.  c.  37.  verf.  (in. 

(d)  n.  17.  &  epift.  17.  n.  25,  &  26. 

(<■)  Ibid.  n.  29. 


(f)  1.  4.  f.  3.  obf.  21.  §  10.  &  1.  2.  f.  c. 
obf.  8. 

(^)  Anat.  chir.  obf.  37.  &  38. 

(' b )  Mem.  de  l’acad.  R.  des  Sc.  A.  1707. 
&  1712. 

(i)  II.  animad.  41. 

(£)  de  Aort.  Aneur.  obf. 

that 


Letter  XVIII.  Articles*.  481 

that  it  is  confirm’d  by  Frefnd,  and  by  Michellottus.  I  will  rather  add  two 
things.  The  fird,  that  with  how  much  the  greater  force  the  blood  is  im- 
pell’d  by  the  left  ventricle  of  the  heart,  into  the  curvature  of  the  aorta,  that 
lies  near  to  it,  with  fo  much  the  greater  force,  is  the  blood  repell’d  into  both 
the  neared  parts  of  the  aorta,  by  the  curvature,  when,  foon  after,  it  con¬ 
tracts.  But  as  it  is  more  eafily  receiv’d  into  that  part  which  defcends,  than 
into  that  which  afcends  from  the  heart,  inafmuch  as  it  is  far  fhorter,  nor 
opens  into  branches,  and  is  alfo  fhut  up  by  the  femilunar  valves  •,  it  follows 
hence,  that  if  an  impetus  is  to  be  made  upon  one  part  or  other  of  the  artery, 
it  will  rather  happen  on  that  part,  and  confequently  aneurifms  are  wont  to 
be  found  in  much  greater  number,  betwixt  the  upper  part  of  the  curvature 
and  the  heart,  than  in  any  other  part  that  is  near  to  it. 

The  fecond,  that  although  the  end  of  the  trunk  of  the  pulmonary  artery  is 
not  more  didant  from  the  right  ventricle  of  the  heart,  than  the  curvature  of 
the  aorta  from  the  left,  and  although  that  trunk  feems  to  be  no  more  able, 
in  proportion,  to  refill  the  drength  of  the  right  ventricle,  than  the  trunk  of 
the  aorta  does  the  left ;  yet  much  fewer  aneurifms  are  found  in  that  trunk  of 
the  pulmonary  artery,  than  in  the  arch  of  the  aorta,  doubtlefs  by  reafon  of 
the  different  pofition  of  the  trunk  of  the  pulmonary  artery,  which  does  not 
lie  fo  diredlly  in  the  way  of  the  flream  of  the  blood,  when  driv’n  againd  it, 
nor  yet  fo  violently  and  fuddenly  infiedts  that  flream  into  a  different  diredlion. 
But  let  us  go  on  to  other  obfervations. 

25.  A  native  of  Beluna,  in  the  territories  of  Venice,  who  was  about  fifty 
years  of  age,  and  whole  bufinefs  was  to  fhear  woollen  cloth,  with  fhears  that 
were  pretty  large,  indeed,  but  not  the  larged,  and  mod  heavy,  began  a  year 
before  to  have  a  tumour  arife  in  the  right  and  upper  part  of  the  ched,  whe¬ 
ther  drinking,  to  w'hich  he  was  much  addidted,  gave  occafion  to  it.  or  the 
venereal  difeafe,  or  rather  both  of  them  together,  being  added  to  the  bufi- 
nefs  in  which,  as  I  have  (aid,  he  continually  exercis’d  himfelf.  For  what 
inconveniences  had  preceded,  or  what  had  afterwards  fucceeded,  it  was  not 
in  my  power  to  know,  except  that  at  lead,  from  the  time  he  return’d  to 
Venice,  which  was  about  the  beginning  of  Odlober,  in  the  year  1707,  he 
was  troubl’d  with  a  difficulty  of  breathing,  whether  he  walk’d  or  fpoke  ; 
which,  however,  neither  attack’d  him  by  paroxifms,  nor  threaten’d  fuffoca- 
tion,  nor  broke  his  deep:  and  this  would  have  been  readily  referr’d  to  the 
man’s  trade  all'o,  elpecially  by  thofe  to  whom  the  experiment  made  by  Kerck- 
ringius  (/),  in  the  fhop  of  forne  artids  of  this  kind,  was  known  and  approv’d. 
But  befides  this,  he  could  now  eat  and  drink  but  little.  His  face  was  tumid, 
and  of  a  brownifn  red ;  his  voice  obfcure  and  hoarl'e ;  his  fpitting  thick  j 
and  the  pulfation  of  the  tumour  was  fometimes  feen,  or  at  lead  before  the 
lad  twenty  days,  was  very  evident,  even  at  a  didance.  This  man,  about 
the  beginning  of  the  December  following,  having  fpent  the  former  part  of 
the  night  among  his  fellow-lervants,  according  to  cudom,  and  having  talk’d 
with  them,  went  at  length  to  bed,  faying  that  he  Ihould  foon  go  to  deep ; 
but  a  little  after,  he  was  found  in  a  dying  condition,  with  a  dertor,  and  a  foam 
21  his  mouth  and  nodrils*,  and  thus  within  about  about  four  hours  he  died, 

(/)  Vid.  in  Adi.  N.  C.  Tom.  5.  Schol.  ad  obf.  85. 

Q.q  q 


VOL,  I. 


The 


482  Book  II.  Of  Difeafes  of  the  Thorax. 

The  face  of  the  body  was  turgid  and  livid  •,  the  hands  and  feet  not  tumid; 
but  the  praeputium  and  the  glands  were  fwell’d,  livid,  and  had  a  putrid  fmell, 
as  if  they  were  inclin’d  to  a  gangrene;  but  when  Santorini  and  1  would  fain 
have  examin’d  the  urethra,  neither  time,  nor  place,  nor,  perhaps,  the  per- 
lbns  who  were  prefent  permitted  us.  Wherefore  the  belly  being  open’d,  and 
the  liver,  and  fpleen,  being  obferv’d  to  be  pretty  hard,  and  the  latter  of  thefe 
vifcera  alfo  to  be  larger  than  the  natural  fize,  our  whole  attention  was  turn’d 
towards  the  thorax.  And,  externally  indeed,  in  that  part  of  the  chert  which 
lies  between  the  right  axilla  and  the  fternum,  a  tumour  was  prominent,  of  a 
hemifpherical  figure,  but  deprefs’d,  reaching  from  the  fourth  rib,  to  the  cla¬ 
vicle,  but  nearer  to  the  fternum  than  to  the  axilla  ;  if  you  prefs’d  upon  it,  it 
yielded,  fo  as  immediately  to  fhow  you  that  fcarcely  any  bones,  or  cartilages, 
now  remain’d ;  which,  in  that  part,  naturally  lie  betwixt  the  mufcles,  and 
the  cavity  of  the  thorax.  And,  indeed,  we  found  the  clavicle  to  be  dif- 
plac’d,  and  corroded,  internally,  with  a  caries  ;  and  that  part  of  the  four  up¬ 
per  ribs,  in  particular,  which  us’d  to  continue  long  cartilaginous,  we  found 
to  be  corrupted,  or  confum’d  by  the  aneurifm,  the  magnitude  of  which  ex¬ 
ceeded  that  of  a  kid’s  head  :  the  figure  of  the  tumour  was  nearly  oval,  and 
the  feat  of  it  was  extended  from  the  bafis  of  the  heart,  to  the  upper  part  of  the 
thorax.  But  the  aneurifm  was  like  a  fac,  the  left  fide  of  which,  by  a  foramen 
that  admitted  two  fingers,  communicated  with  the  right  fide  of  the  aorta,  be¬ 
fore  it  gave  off  the  common  beginning  of  the  right  fubclavian,  and  carotid 
arteries.  This  fac  feem’d  to  be  form’d  of  the  produc’d  fubftance  of  the  aorta, 
but  was  more  white,  tenacious,  and  denfe,  and  not  lefs  thick.  This  fub¬ 
ftance  was  internally  inverted  with  many  curv’d  laminas,  folded  one  within 
another,  feemingly  fibrous,  and  really  polypous,  but  without  moifture :  and 
thefe  laminas  contain’d  fuch  a  quantity  of  blood,  within  their  circumference, 
and  this  almoft  concreted,  that  being  taken  out  from  the  cavity,  together 
with  thofe  polypous  laminas,  and  put  into  the  fcales,  it  weigh’d  forty  ounces. 
The  aneurifm,  by  its  bulk,  had  driv’n  the  right  lobe  of  the  lungs  back¬ 
wards,  and  more  downwards  than  ufual ;  fo  that  it  feem’d  to  be  made  lefs  by 
the  comprefiion.  This  lobe  being  cut  into,  a  white  pus  was  feen  to  come 
forth,  here  and  there,  from  the  bronchias  that  were  cut  afunder.  The  left, 
lobe  was  found.  Yet  in  each  cavity  of  the  thorax,  but  more  in  the  right, 
was  a  quantity  of  yellowifh  ferum,  which  had  a  kind  of  mucous  pellicles 
mix’d  with  it. 

The  pericardium  alfo  adher’d  to  the  heart,  on  all  fides,  by  a  mucous,  and 
yellowilh  fubftance  of  that  kind.  In  the  right  auricle  of  the  heart,  and  its 
annex’d  ventricle,  was  a  polypous  concretion  :  in  the  pulmonary  artery  was 
blood  :  but  in  the  left  ventricle,  neither  one  nor  the  other.  Finally,  the  aorta 
defcendens  was  internally  unequal  in  fome  places,  and  had  marks  of  oflifica- 
tion,  beginning,  as  it  were,  by  a  kind  of  tendinous  hardnefs. 

26.  Although  many  things  were  found  in  the  thorax  of  this  man,  which 
as  they  made  his  breathing  difficult,  whether  he  walk’d,  or  even  only  fpoke, 
fo  by  the  addition  of  any  little  circumftance,  they  might  entirely  intercept 
refpiration,  that  is,  might  fuffocate ;  yet  if  you  choofe  rather  to  fuppofe, 
that  by  an  obftrudtion  lying  in  the  way  of  the  blood,  as  it  return’d  from  the 
brain,  fomething  of  an  apoplectic  diforder  had  moreover  come  on ,  from  con- 

fidering; 


Letter  XVIII.  Article  27.  4S3 

iidering  the  feat  of  the  aneurifm  deferib’d,  I  fhall  not  be  very  repugnant  to 
your  opinion.  For  it  was  feated  in  fuch  a  manner,  that  it  might  prefs  upon 
the  trunk  of  the  fuperior  vena  cava,  efpecially  when  the  patient  lay  down, 
and  perhaps  on  the  right  fide :  in  which  fituation,  without  doubt,  it  prefs’d 
upon  that  trunk,  not  only  by  its  bulk,  but  alfo  overloaded  it  by  its  weight  ; 
and  both  thefe  properties  were  encreas’d  fo  much  the  more,  as  the  aneurifm, 
at  that  time,  admitted  more  blood ;  inafmuch  as  being  carried  down  through 
the  trunk  of  the  aorta,  from  the  anterior,  into  the  pofterior  part,  not  the  al~ 
cending  trunk  in  a  recumbent  pofture,  but  rather  the  defcending,  fo  that  it 
enter’d  the  orifice  of  the  fac  itfelf,  and  diftended  it,  perhaps,  fo  as  it  had 
never  been  before  diftended,  either  becaufe  the  parietes  of  the  fac  were  at 
length  reduc’d  to  fuch  a  ftate,  as  to  yield  more  *  or  rather,  becaufe  there  was 
either  a  greater  turgefcency  of  blood  that  night,  or  a  greater  quantity,  by 
reafon  of  a  greater  quantity  of  wine  being  taken  in,  than  ufual,  or  by  reafon 
of  infenfible  perfpiration  being  fupprels’d,  as  it  was  then  a  cold  feafon.  Thefe 
circumftances,  therefore,  you  will  fuppole  in  any  manner  you  pleafe,  fince 
the  ftertor,  the  foam  at  the  mouth,  the  turgid,  and  livid  face,  agree  very 
well  with  both  kinds  of  diforders. 

27.  But  as  to  the  confumption,  or  corruption,  of  the  bones  and  cartilages, 
neareft  to  the  aneurifm,  fuch  as  I  found  in  the  man,  whofe  hiftory  I  at  pre- 
fent  treat  of,  and  in  others,  this  appearance  frequently  occurs  in  dilTedtion, 
whether  an  aneurifm  had  fucceeded  to  a  violent  contufion,  as  in  the  lieute¬ 
nant,  of  whom  the  celebrated  Chriftian  Vater  (m)  fpeaks  ;  or,  to  omit  other, 
and  more  ancient  examples,  and  to  produce  one  more  fimilar  to  mine,  in  a 
man  whom  the  celebrated  Schreiberus  (n)  defcribes,  where  the  ribs  and  car* 
tilages  were  confum’d  with  a  caries,  and  the  mufcles  cover’d  the  aneurifm, 
which  was  ruptur’d  beneath  them  ♦,  or  without  any  previous  blow,  as  in  a 
young  man,  of  whom  the  celebrated  Fackius  (0)  gives  a  hiftory,  the  dilata¬ 
tion  of  the  artery  had  taken  its  rife  from  too  acrid  a  ftate  of  the  blood,  and 
its  increafe,  from  too  great  a  motion  of  the  body  and  arms,  in  playing  at 
tennis,  and  had  brought  on  a  corrupt  ftate,  in  the  neighb’ring  clavicle.  You, 
however,  will  account  for  the  caries,  and  confumption,  that  I  law  in  the  ribs 
and  clavicle,  either  from  the  puliation  of  the  contiguous  aneurifm,  or  itscor- 
rofive  ichor,  as  you  (hall  think  moft  proper ;  although  even  the  pulfation, 
where  it  hollows  out  the  parts  into  a  caries,  does  not  aft  without  an  ichor  of 
that  kind.  For  the  fmall  veflels  of  the  periofteum,  and  perichondrium,  and 
other  veftels  of  any  kind,  as,  for  inftance,  of  the  pleura,  that  is  ftretch’d  out 
upon  thefe  parts,  being  plac’d  between  thofe  refilling  bodies,  and  the  aneu¬ 
rifm,  which  is  continually  and  vehemently  pulfating  j  and  being,  for  that 
reafon,  contus’d,  and  extenuated,  are  at  length  eafily  ruptur’d  here  and  there, 
and  produce  a  kind  of  little  ulcers,  very  fmall  indeed,  and  almoft  efcaping 
the  fenfes,  yet  pouring  out  a  moifture,  betwixt  the  lamellte  of  thefe  mem¬ 
branes,  which,  by  ftagnation,  contradis  an  acrimony,  and  a  power  of  eroding, 
and  that  very  confiderable  too,  efpecially  in  fome  particular  conftitutions  : 
and  this  I  would  have  you  believe  all'o,  of  the  veflels  which  creep  through 

(m)  Eph.  N.  C.  Dec.  3.  A.  9.  obf.  162.  (»)  Nov.  Comm.  Acad,  Sc.  Imp.  Petropol. 

tom.  3.  inter  phyf.  n.  4.  (0)  Eph.  N.  C.  cent.  5.  obf.  74. 

Qjqq  2 


that 


484  Book  II.  Of  Dtfeafes  of  the  Thorax. 

that  part  of  the  parietes  of  the  aneurifm,  which  is  urg’d  againft  the  refilling 
bodies.  But  the  eroding  ichor  is  not  always  the  effedt  of  the  aneurifm,  as^I 
have  row  explain’d,  but  even  iometimcs  a  caule,  as  I  have  hinted  in  a  for¬ 
mer  work  (/>),  and  the  very  ingenious  Lancifi  afterwards  explain’d,  in  many 
different  ways ;  to  wit,  either  from  acrid  humours,  being  obftrufled  betwixt 
the  coats  of  any  artery,  in  a  part  where  it  has  been  ftruck,  as  in  thofe  aneu- 
rifms  which,  as  I  mention’d  before,  fucceed  to  blows  and  contufions  (q) ;  or 
from  a  corrofive  ichor,  flagnating  in  the  fame  part,  without  any  previous  exter¬ 
nal  caufe,  as  in  thofe  which  anle  in  hypochondriac,  fcorbutic,  and  hyfteric1 
bodies  (r)  ;  or  even  from  an  ichor  diftilling  out  of  the  neighb’ring  parts, 
that  are  eroded,  upon  the  parietes  of  the  artery,  as  in  thofe  which  happen1 
near  the  bones,  that  are  already  affefled  with  a  venereal  caries  ( s ).  Yet  I  do  > 
not  doubt,  but  the  corrofive  particles  that  contaminate  the  humours  of  thofe 
who  are  infedted  with  a  venereal  lues,  as  they  difcover  themfelves  by  ftagna- 
ting  in  other  parts,  that  are  by  no  means  bony,  fo  I  do  not  doubt,  I  fay, 
but  they  frequently  flagnate,  in  the  coats  of  the  arteries  alfo,  in  the  fame 
manner  nearly  as  Lancifi  has  faid  in  hypochondriac,  hyfteric,  and  fcorbutic 
conftitutions,  and  weaken  thefe  coats  by  corroding  them  here  and  there,  and 
in  that  manner,  render  them  more  liable  to  dilatations.  And  indeed,  I  have 
often  found  manifeft  marks  of  erofion,  in  the  coats  of  the  aorta,  efpecially 
where  this  lues  exifted,  as  I  have  faid  in  a  former  work  (/) ;  for  fometimes, 
even  where  it  w’as  not,  I  have  found  the  coats  cover’d  over  internally,  here 
and  there,  with  bony  fcales.  But  thefe  obfervations  I  put  off  toother  occa- 
fions  (ft),  when  it  will  be  more  proper  to  produce  them.  And  thofe  which  T 
lhall  produce  now,  although  they  will  not  be  without  thefe  fcales  ;  yet  they 
will  relate  to  that  fubjedt  which  our  order  requires,  to  the  aneurifms  of  the- 
heart,  for  inftance,  and  of  the  aorta,  at  the  fame  time. 

28.  When  I  refided  at  Bologna,  in  the  year  17 02,  I  had  often  heard  an 
old  woman,  who  was  almoft  eighty,  complaining  of  her  ftomach  ;  for  it  is 
thus  that  the  common-people  are  wont,  in  that  place,  to  mark  out  the  lower 
part  of  the  thorax.  Her  pulfe  was  extremely  tenfe  and  chord-like  ;  and  the 
difficulty  cf  breathing  fo  great,  that  fhe  was  oblig’d  to  fit  up  in  her  bed; 
which,  however,  grew  lefs  violent,  fometimes,  by  taking  freffi-drawn  oil  of 
almonds.  At  length,  it  increas’d  fo  much,  that  the  woman  was  fuffocated. 
The  thorax  being  open’d,  a  large  quantity  of  water  w7as  found  in  its  cavities ; 
and  in  the  pericardium  was  dill  more,  in  proportion  to  the  cavity,  fo  that  this 
bag  was  greatly  diftended.  The  heart  was  of  fuch  a  bulk,  fo  thick  in  its 
parietes,  and  had  its  cavities  fo  much  enlarg’d,  that  it  feem’d  like  the  heart 
of  an  ox.  In  each  of  thefe  cavities  were  large  polypous  concretions,  that 
reach’d  into  the  veffels.  The  aorta  was  greatly  dilated,  quite  from  the  heart 
even  to  the  firft  orifice  of  the  fuperior  branches,  and,  in  almoft  that  whole 
trafl,  cover’d  internally  with  bony  fcales,  which  refembl’d  nothing  more  than 
thickly-ftrown  drops  of  white  wax,  after  they  have  grown  cool  upon  the  floor. 
The  left  lobe  of  the  lungs,  efpecially  in  its  inferior  part,  was  very  lax,  and 

(p)  Adverf.  2.  Anim.  41.  (r)  Animad.  indicata  41. 

( q )  De  Aneur.  Propof.  20.  Si  feqq.  («)  Epift.  26..  n.  17.  &  Epift.  27.  n.  2,  22, 

(rj  Ibid.  Propof.  30  &  feq.  Si  ieqq.. 

(j)  Ibid.  Prop.  32.  k  feq. 

half- 

*4 


3 


Letter  XVIII.  Article  25).  485- 

lialf-corrupted,  juft  as  if  it  had  been,  for  a  long  time,  macerated  in  water, 
as  anatomifts  fometimes  do. 

29.  Yon  will  read  a  hiftory  in  Malpighi  (x),  much  like  this  in  many  re- 
fpedts,  whether  you  attend  to  the  ftate  of  the  pulfe,  or  the  quantity  of  water 
in  the  pericardium,  or  the  dilatation  of  the  chief  cavity  of  the  heart,  and 
the  aorta,  and  the  bony  feales  that  had  been  form’d  upon  it  internally. 
Which  three  laft  circumftances  you  will  alfo  find  in  the  two  following  obser¬ 
vations  that  I  (hall  give  you,  But  before  I  produce  thefe,  thofe  three  cir¬ 
cumftances,  and  the  two  others,  likewife,  that  are  before-mer.tion’d,  afford 
me  an  occafion  of  throwing  in  Something  in  regard  to  the  opinion  of  a  cele¬ 
brated  man  on.  the  caufe  of  aneurifms,  and  of  bony  feales  therein.  He  thinks, 
that  the  caufe  of  both  thefe  accidents  may  confilt  in  the  caries  of  the  bones  ; 
but  it  is  explain’d  in 'a  manner  far  different  from  that  in  which  1  explain’d  ir 
juft  now  (y).  That  is  to  lay,  as  many  arteries  are  contiguous  to  bones  as 
to  fulchra,  if  a  caries  happen  to  hollow  out  the  bone,  the  refiftance  of  the 
fiikhrtrm  being  there  wanting,  that  the  artery  becomes  prone  to  dilatation,' 
and  to  conglutination  with  the  carious  bone,  and  by  real'on  of  the  bony  juice 
diftilling  from  this  bone,  even  to  the  production  of  little  bony  concretions/ 
It  is  eaiy  to  fuppofe,  that,  if  what  happen’d  to  the  celebrated  Targioni  (z)' 
had  alfo  happen’d  to  this  writer,  that-  is,  if  he  had  feen  a  great  cavity  hol¬ 
low’d  out  in  the  vertebrae  of  the  thorax,  and  the  vena  fine  pari  lying  clofe- 
to  it,  in  a  very  varicous  ftate;  it  is  eafy  to  fuppofe,  1  fay,  that  he  would 
have  rather  confider’d  the  cavity  in  the  vertebrae  as  the  caufe  of  the  varix,' 
contrary  to  what  Targioni  Suppos’d,  whofe  opinion  you  would  much  more 
readily  give  into,  if  the  varix  had  begun  at  a  time  when  the  vertebrae,  on 
account  of  the  patient’s  age,  had  not  as  yet  ceas’d  to  be  capable  of  impreflion. 
However,  I  willingly  allow,  that  the  opinion  I  have  mention’d;  as  far  as 
it  relates  to  Some  peculiar  dilatations  of  the  arteries,  may  fometimes  poffibly 
take  place,  in  Some  meafure  at  leaft,  as  in  the  carman,  whofe  hiftory  is  giv’n- 
in  the  former  letter  (a),  and  ftill  more  in  that  cafe,  on  occafion  of  which  that 
opinion  took  its  origin  *,  for  there  were,  in  the  pofterior  furface  of  the  aorta, 
a  kind  of  hemifperical  tuberofities,  anfwering  to  the  pits  or  cavities,  which 
being  hollow’d  out,  in  the  contiguous  bodies  of  the  thoracic  vertebrm,  re¬ 
ceiv’d,  each  of  them,  one  of  thefe  hemifpherical  dilatations.  Vet  the  aorta 
was  alfo  dilated  on  its  anterior  furface,  nor  was  this  furface  without  thefe  he¬ 
mifpherical  dilatations  ;  neither  of  which  circumftances  could  be  the  effedl  of 
theie  pits,  or  cavities,  in  the  vertebrae.  Thus  I  have  at  prefent  by  me,  in 
a  dried  ftate,  the  aorta,  from  a  certain  man,  with  an  oblong  aneurifmal  fac, 
which  began  to  arife  before  the  fuperior  branches  emerg’d  therefrom ;  and 
from  that  beginning  of  the  fac,  a  peculiar  hemifpherical  dilatation  was  pro¬ 
minent,  which  had  fufficient  capacity  to  admit  the  lower  part  of  the  thickeft 
thumb  :  and  this  tuberofity,  as  the  feat  of  it,  that  is  pointed  out,  ihews, 
was  certainly  in  the  neighbourhood  of  no  bone.  But  as  to  the  fac,  which 
I  have  deferib’d  in  the  native  ot  Beluna  (£),  contiguous  to  the  corrupted 
clavicle  and  the  ribs,  (hall  we  fay,  that  it  had  its  oiigin  from  the  caufe  of 

(x)  Epift.  de  Struct.  Glandul.  .  (z)  Prima  Raccolta  di  Oflerv.  Med.  pag.  22. 

(y)  N,  27..  (*)  17.  n.  17.  (£)  Supra,  n.  25. 


this 


4  S6  Book  II.  Of  Difeafes  of  *the  Thorax. 

this  corruption,  notwithftanding  its  firft  origin  was,  in  like  manner,  from 
that  part  of  the  artery,  which  is  fo  very  diftant  from  thofe,  and  from  other 
bones  ?  Befides,  you  have  read  in  the  hiftory  of  the  old  woman  above,  and 
in  others,  alfo,  you  have  read,  and  will  read,  that  there  have  been  aneurifms 
in  the  fame  part  of  the  aorta ;  and  that  there  have  been,  to  fpeak  of  thefe 
alfo,  bony  lamella.  Shall  we,  then,  account  for  thefe  from  the  bones  that 
are  diftant  and  found  ?  to  fay  nothing  of  the  bony  juice,  which  is  alfo  call’d 
into  queftion,  by  the  late  experiments  of  Du  Hamel  (r),  even  where  it  was 
believ’d  to  flow  from  broken  bones ;  fo  that  if  you  are  of  his  opinion,  it 
feems,  that  it  ought  ftill  lefs  to  be  accounted  for  from  carious  bones.  But 
in  regard  to  the  origin  of  bony  lamellae  in  the  arteries,  I  will  prelently  take 
into  confideration  fome  other  circumftances,  after  having  given  you  another 
oblervation,  which  I  made,  as  I  did  the  laft,  at  Bologna,  two  years  after 
that. 

30.  A  man,  whofe  uncle  had  been  carried  off  by  a  hidden  diforder  in  the 
thorax,  join’d  with  a  great  puliation,  being  immoderately  given  to  venery, 
and  to  feafting,  efpccially  when  he  was  young,  and,  when  he  was  more  ad¬ 
vanc’d  in  life,  being  troubl’d  with  heavy  cares,  and  violent  affections  of 
mind,  began,  firft,  to  feel  a  like  pulfation,  and  in  the  intermediate  time, 
began,  moreover,  to  draw  his  breath  with  difficulty,  when  he  walk’d  through 
even  places,  but  ftill  much  more  when  he  went  up  fteep  places.  This  dif¬ 
ficulty  of  breathing  was  fo  very  ftrong,  almoft  every  month,  in  the  manner 
of  a  peculiar  paroxifm,  that  the  man  feem’d  to  be  in  inftant  danger  of  fuf- 
focation,  if  blood  was  not  fpeedily  taken  away;  for  by  this  means  he  wa3 
eas’d.  At  length,  he  was  feiz’d  with  a  flight  fever,  on  which  occafion  his 
phyfician  particularly  obferv’d,  that  his  pulle  was  extremely  different  from  a 
natural  ftate ;  nor  yet  did  it  even  agree  with  that  fever,  inafmuch  as  it  was 
vehement,  and  very  chord-like,  efpecially  on  the  left  fide.  He  immediately 
afk’d,  whether  he  felt  any  pulfation  in  his  cheft  ?  for  the  patient  had  been 
filent  upon  this  head,  notwithftanding  it  had  been  of  long  continuance,  as 
I  have  faid,  and  was  lo  great,  that  if  the  hand  were  applied  to  the  left 
nipple,  it  was  often  violently  urg’d,  and  in  a  manner  repell’d.  And  now 
he  could  not  breathe  except  with  his  neck  ftrait :  a  bloody  kind  of  expedio* 
ration  was  difeharg’d  alfo,  but  in  a  very  fmall  degree.  Blood  being  taken 
away,  to  the  quantity  of  two  ounces,  and  no  more,  that  fluid  feem’d  to  be 
in  a  very  good  ftate.  In  the  mean  while,  the  patient  became  gradually  very 
lean,  like  a  hedlic  perfon ;  and  yet  not  in  a  very  great  degree.  His  feet 
were  cedematous,  his  ftrength  was  decreas’d,  his  pulfe  became  lower,  but 
did  not  lofe  that  chord-like  vibration,  and  the  pulfation,  alfo,  under  the 
bread,  continu’d.  And  even  about  the  fortieth  day  from  the  time  the 
fever  had  attack’d  him,  and  an  hour  before  his  death,  this  pulfation  was,  to 
the  full,  as  confiderable  as  ever  it  had  been. 

The  abdomen  had  fcarcely  any  appearance  which  was  not  natural,  except 
that  the  fpleen,  though  of  its  proper  magnitude,  was  hard,  and  very  black. 
In  the  thorax  no  water  was  collected,  nor  yet  in  the  abdomen,  or  pericardium. 
But  the  heart  was  extremely  large,  and  the  veins  that  crept  through  its  fur- 

(r)  Mem.  de  1’  Acad.  R.  des  Sc.  A.  1741. 

face. 


4 


Letter  XVIII.  Article  31.  487 

face  were  dilated,  and  in  a  manner  varicofe.  The  right  ventricle  being  cut 
open,  in  which  was  a  fmall  polypous  concretion,  and  the  left  ventricle,  in 
which  there  was  no  fueh  appearance,  all  the  parietes  of  the  heart  were  found, 
in  general,  to  be  thicken’d,  and  both  the  ventricles  to  be  much  dilated,  but 
the  left  Hill  more  than  the  right,  in  which  I  obferv’d  the  valvulm  mitrales 
to  be  almoft  three  times  as  large  as  ufual,  and  the  columnar,  to  which  they 
are  tied,  to  be  much  enlarg’d.  The  aorta,  alfo,  from  the  heart  quite  to  the 
neighbourhood  of  the  emulgents,  was  much  broader  than  natural,  and,  through 
the  whole  of  this  trad,  was  rigid  and  inflexible,  by  reafon  of  bony  lamelim, 
w'hich  were  form’d  on  its  internal  furface.  While  thefe  appearances,  that  I 
have  mention’d,  were  examin’d  into,  and  the  heart  was  feparated  from  its 
veflels,  a  great  quantity  of  black  and  half-concreted  blood  fell  out  of  them, 
an  oblong  cylinder  of  which  was  drawn  out  of  one  of  thole  veflels,  that  is, 
from  the  fuperior  vena  cava,  juft  like  a  lword  from  a  fcabbard.  The  lungs, 
upon  cutting  into  them,  appear’d  to  be  variegated,  and  overflow’d  with  a 
kind  of  frothy  humour,  and  were  found  to  be,  when  you  touch’d  them,  al¬ 
moft  of  a  tendinous  hardnefs. 

31.  As  the  blood  was  driv’n  very  violently,  by  the  ftrong  parietes  of  the  ' 
heart,  into  the  aorta,  which  was,  perhaps,  more  eafily  dilated  therefrom,  by 
reafon  of  its  being  fomewhat  weak ;  for  that  difurder  in  his  uncle  feems  to 
prove  fomething  of  an  hereditary  tendency  ;  and  as  the  blood  could  not  be 
driv’n  forwards,  as  it  ought  to  have  been,  by  the  aorta,  that  was  already 
dilated,  and  afterwards  become  rigid  j  there  is  no  doubt,  but  the  blood  muft 
neceflfarily,  in  part,  ftagnate  in  the  neighb’ring  ventricle,  as  I  have  alfo  faid 
elfewhere,  and  of  courfe  diftend  it  conflderably  5  although  the  right  ventricle 
muft,  alfo,  have  been  diftended  in  like  manner,  but  in  a  lei's  degree,  by  the 
blood  being  “  fucceflively  and  mediately  ”  retarded  therein,  and  in  the  veflels. 
of  the  lungs,  from  the  fame  caufe,  notwithftanding  it  aded  with  lefs  violence. 
From  thefe  circumftances,  therefore,  and  from  the  increas’d  weight  of  the 
heart  overloading  the  diaphragm,  you  can  account  for  that  difficulty  of 
breathing,  and  thofe  bloody  expedorations :  and  from  the  efforts  of  both 
the  ventricles,  which  were  lo  much  the  greater,  as  the  more  blood  was  to  be 
expeli’d  into  paffages  already  obftruded  with  ftagnating  blood,  you  will,  per¬ 
haps,  account  for  the  hardnefs  and  rigidity  of  thefe  paflages,  the  firft  of 
which  difeover’d  itfelf  in  the  difledion  of  the  lungs,  and  the  other  in  that 
of  the  aorta.  If  you  chufe  to  account  for  them  thus,  you  will  then  adopt 
the  dodrine  of  Boerhaave  ( d)r  which  has  already  been  adopted  by  many,, 
who  fuppofes  it  to  be  owing  to  perpetual,  and  too  ftrong  motion,  that  the 
parts  become  not  only  more  hard,  but  even  bony,  through  old  age,  and  a 
laborious  life.  For  whether,  through  a  very  long  fpace  of  life,  the  fmalleft 
particles  of  the  veflels  are  ftrongly  impell’d,  and  comprefs’d,  fo  that  the 
veflels  are  render’d  impervious,  and  at  length  entirely  deftroy’d  j  or  whether 
the  fpace  of  life  be  more  fliort,  and  the  veflels  are  more  ftrongly  urg’d  ;  you 
will  very  eafily  conceive  of  their  hardnefs,  and  in  fine  their  bony  rigidity. 
But  as  I  know  that  many  eminent  men  have,  neverthelefs,  diflented  from- 
this  dodrine,  and  that  one  of  them,  whofe  deputation  is  now  in  my  hands* 


has. 


(d)  Prselett.  ad  In  (lit.  §  415, 


488  Book  II.  Of  Difeafes  of  the  Thorax. 

has  giv’n  us  the  reafons,  and,  in  particular,  the  obfervations,  which  have 
induc’d  him  to  difient,  and  which,  as  I  (hall  ffiew  hereafter  (e),  a»ree  in  fome 
meafure  with  mine  ;  it  becomes  you,  I  think,  to  proceed  here  with  fome 
caution  and  diftinCtion. 

32.  In  the  firft  place  then,  it  cannot  be  denied,  that  the  parts  of  the  old 
are  harder  than  the  parts  of  the  young,  fince  it  is  not  only  confirm’d  by  ana¬ 
tomies,  that  even  the  brain  of  old  perlons  is  more  hard  and  firm  (/)  than 
that  of  young  perfons  ;  but  no  one  is  ignorant,  with  how  much  difficulty  the 
fleffi  of  animals,  when  old,  is  made  tender  by  the  fire,  mafticated  with  the 
teeth,  or  digefted  by  the  ftomach.  And  it  feems  to  me  not  ridiculous,  to 
account  for  this  hardneis,  in  the  manner  that  Boerhaave  thought  it  was  to  be 
accounted  for.  Nor  is  there  any  great  reafon,  in  my  opinion?  why  we  ffiould 
not  afcribe,  chiefly,  to  the  fame  caufe,  that  fome  of  the  ligaments,  mem¬ 
branes,  and  tendons,  in  old  fubje&s,  and  even  part  of  the  mufcular  lubftance 
of  the  heart,  as  has  been  found  by  others  (g),  and  even  fometimes  by  myfclf 
alfo  (£),  have  become,  in  like  manner,  rigid  and  bony.  Now  it  is  very  evi¬ 
dent,  that  the  arteries  confift  of  membranes,  and  mufcular  fibres.  It  feems 
therefore,  that  the.fame.reafoning  might  take  place  in  regard  to  thefe  alfo* 
if  they. do,  at, any  time,  become  bony  in  this  manner:  but"  we  muff;  account 
for  it  in  another  way,  if  they  have  degenerated  in  a  different  manner.  And 
that  this  degeneracy  does  more  frequently  happen,  in  a  different  manner  I 
cannot  deny,  when  I  confider  the  disjunction  of  thofe  little  fcales  that  the 
queftion  turns  upon  at  prefent,  and  the  other  appearances,  which  I  obferv’d 
together  with  them.  But  though  I  readily  make  this  confeffion,  I  (till  as 
readily  believe  that  offification  does  fometimes  really  happen,,  in  the  manner 
before  mention’d.  For  I  cannot  fee  any  reafon  utterly  to  deny,  that  what 
we  acknowledge  to  have  happen’d  in  the  other  coats  and  membranes  of  the 
body,  did  ever  happen  at  all  in  the  arterial  coats.  Nor  is  it  any  objection 
that  the  middle  coat  is  mufcular,  and  conftantly  employ’d  in  alternate  con¬ 
traction,  and  relaxation,  fince,  as  I  have  juft  now  laid,  we  know  .that  the 
fleffiy  lubftance  of  the  hearc  itfelf  has  become  bony.  Nor  do  the  web-like 
cellular  membranes,  that. are  every  where  interpos’d  betwixt  thefe  coats  af¬ 
ford  any  argument  contrary  to  this  doCtrine j  for  they  being  naturally  com- 
prefs’d,  between  thele  coats,  do  not  appear  in  the  form  of  a  cellular  texture 
unlefs,  in  confequence  of  diftraClion,  or  by  the  help  of  inje&ed  air-  for 
which  reafon,  they  do  not  fufficiently  preferve  the  veffels  that  pafs  through 
them  to  go  into  thefe  coats  from  compreffion  ;  and  indeed  we  frequently  fte 
that  membranes  in  other  parts  of  the  body,  notwithftanding  they  are^  fur’ 
rounded  with  cellular  texture  of  the  fame  kind,  do,  neverthefeis,  deonerate" 
and  become  bony  :  although  I  do  not  fo  much  confider  here  the  veffels  cr0in? 
to  thefe  coats,  as  the  ultimate  ramifications  difpers’d  through  their  internal 
fubftance.  But  that  the  veffels  alfo,  which  go  to  the  coat? of  the  arteries' 
may,  even  in  this  very  cellular  texture,  be  fqueez’d  together  through  acre* 
and  coalefce,  Boerhaave  has  pointed  out  from  Ruyfch  (/),  by  confidenno-  on 


(/)  .Epilt.  27.  n.  21.  22. 

(f)  Vhd.  apud  Haller  in  extrema  ad  cit. 
Boerh.  §  Adnar. 


(id  ibid.  . 

(/.>)  Kpift.  indicata,  n.  18. 
(0  PraclcCt.  cit.  ad  §  47J. 


one 


Letter  XVIII.  Article  33.  489 

one  hand,  the  arteries  of  feetufles  after  injection,  and  on  the  other,  thofe  of 
adults,  and  by  comparing  the  veflels  of  both  :  and  the  fame  has  alfo  been  con¬ 
firm’d  by  the  illuftrious  Haller  {k).  Nor,  indeed,  is  the  very  loft  and  cel¬ 
lular  texture  of  the  lungs,  capable  of  exempting  the  veflels  of  that  part 
from  diforders  of  this  kind,  fince  an  example  is  on  record  (/),  where  “  the 
“  arteries  in  the  lungs,  and  their  branches,  were  entirely  bony.” 

For  that  the  veins  alfo  become  bony,  againft  whofe  parietes  the  blood  does 
not  bound  with  fo  much  impetus,  as  againft  the  parietes  of  the  arteries,  or 
that  thefe  do  not  always  begin  to  become  bony  near  the  heart,  where  they 
are  urg’d  more  forcibly  by  the  blood,  doubtlefs  happens  much  more  feldom  ; 
nor  is  it  to  be  wonder’d  at,  if  from  other  caufes,  the  fame  thing  fometimes 
happens  to  the  veins,  which  happens  alfo  to  other  membranes  of  the  body  ; 
or  if  certain  tratts  of  the  arteries,  either  from  a  natural  tendency  in  them- 
felves,  or  from  a  peculiar  habit  of  living,  or  from  fome  more  frequent  fitu- 
ation  of  the  body  or  limbs,  have  their  internal  veflels  more  difpos’d  to  re¬ 
ceive  compreflion  from  the  blood  which  diftends  the  arteries.  And  as  this 
difpofition  may  have  exifted  from  the  very  birth,  even  in  the  fmall  particles 
of  the  arteries  here  and  there,  or  in  the  external  lamella?  of  the  internal 
coat,  more  than  in  the  internal  lamellae ;  fo  it  may,  in  like  manner,  happen 
from  this  caufe,  that  there  may  not  be  a  continuity  of  oflification,  or  that 
the  inner  furface  of  the  internal  coat,  although  more  expos’d  to  the  impetus 
of  the  blood,  may  itfelf  not  become  bony,  when  that  which  this  internal 
coat  covers  is  already  become  fo. 

33.  But  if  you  fiiould  not  be  fufficiently  fatisfied  with  fome  of  thefe  argu¬ 
ments,  which  I  have  produc’d,  rather  that  you  may  be  excited  to  produce 
better,  than  becaufe  I  am  well  pleas’d  with  them  mylelf  (and  indeed  you 
will  perceive  elfewhere  (m),  that  I  do  not  aferibe  much  to  the  greater  part  of 
them)  yet  I  do  not  think  that  we  mult  immediately  give  up  the  point,  and 
confefs  that  the  arteries  do  never  degenerate  into  a  bony  nature,  in  the  fame 
manner  that  tendons,  and  fome  other  parts  do.  For  what  if,  fometimes, 
even  the  whole  internal  coat  itfelf,  what  if  the  whole  artery  (hould  be  chang’d 
into  that  ftate  ?  Falloppius  (»),  for  the  ancient  anatomifls  were  not  ignorant 
of  this  kind  of  degeneracy,  having  obferv’d,  long  before  Steno,  “  that  old 
“  birds  have  their  mufcular  chords  become  bony,  by  reafon  of  too  great 
“  exercife  and  labour,  but  that  the  chords  of  younger  birds  are  foft;”  ex- 
prefsly  aflerted  at  the  fame  time  (0),  “  that  he  had  feen,  in  a  certain  old  wo¬ 
man,  all  the  arteries  on  the  left  fide  degenerated  into  bone.”  And  Coite- 
rus  (/>),  moreover,  has  written  thus  of  F'alloppius,  “  that  men  worthy  of 
“  credit  had  related  to  him,  at  Bologna,  that  they  had  feen,  in  a  body  dif- 
tc  letted  by  Falloppius,  at  Padua,  the  aorta,  or  great  artery,  univerfally 
“  bony.”  And,  without  doubt,  that  portion  of  the  deicending  aorta  muft  have 
been  altogether  bony,  which  was  taken  by  Flarvey  from  the  carcafe  of  a  no¬ 
bleman,  together  with  the  two  “  crural  branches,  to  the  length  of  a  fpan(^);” 
for  he  fays,  “  that  the  coats  of  the  artery  were  totally  converted  into  a  bony 


(^)  ad  earund.  §.  467.  not.  2. 

(1)  Eph.  N.  C.  Dec.  2.  A.  3.  obf.  38. 
(»)  Epift.  27.  n.  21.  22. 

VOL.  I. 


(>/)  De  Partib.  Similar,  c.  10. 

(0)  Ibid.  c.  14.  (/>)  Obf.  Anat. 

(7)  Exercit.  Anat.  3.  de  Circ.  Sangu. 

“  tube. 


R  r  r 


49°  Book  II.  Of  Difcafes  of  the  Thorax. 

“  tube,  or  pipef’  nor,  indeed,  if  any  of  the  original  coat  had  remain’d,, 
would  his  argument  have  had  its  force  •,  1  mean,  “  that  by  reafon  of  the  fo- 
“  lidity  of  the  bone,  the  pulfihc  faculty  could  not  be  carried  through  the 
“  artery.”  I  omit  other  obfervations,  fince  in  this  Harvey  has  laid  as  much, 
as  is  fuffi  cient,  to  prevent  us  from  eafily  conjecturing  otherwile,  by  reafon  of 
his  filence,  and  ftill  more,  to  prevent  us  from  arguing  or  demonitrating  the 
contrary.  Thus  much  have  I  faid  on  this  fubjett,  not  for  the  fake  of  dif- 
fenfion,  but  only  that  we  may  for  a  while  with-hold  our  aflfent,  till  the  truth,, 
at  length,  more  clearly  difcover  itfelf  to  our  refearches.  Now  let  us  go  on 
to  the  remaining  oblervation  of  the  dilated  heart  and  great  artery. 

34.  A  woman,  feemingly  about  forty  years  of  age,  rather  of  a  fat  habit, 
who  had  been  accuftom’d  to  earn  her  bread  by  walking  linen,  having  been 
frequently  brought  into  the  hofpital,  within  her  laft  fix  years,  on  account  of 
a  difficulty  of  breathing,  that  had  the  appearance  of  a  convulfive  afthma, 
at  which  time,  not  the  leaf!:  puliation  could  ever  be  perceiv’d  in  the  wrifts ; 
return’d  to  the  hofpital,  on  the  fame  occafion,  and  died  within  fifteen  days, 
having  fpit  up,  in  the  laft  moments  of. her  life,  as  was  related  to  me,  a  thick 
and  purulent  matter. 

The  body  of  this  woman  being  brought  into  the-  theatre,  for  public  de- 
monftration,  I  examin’d  into  its  appearances,  There  was  no  tumour  on  the 
external  furface,  not  even  at  the  feet,  nor  any  other  mark  of  diforder.  But 
the  day  after  her  death,  when  the  integuments  were  remov’d  from  the  abdo¬ 
men,  the  mufcles  began  to  look  green  •,  the  next  day  Bill  more,  and  even  to 
have  a  molt  filthy  odour :  yet  the  vifcera  of  the  belly,  when  foon  after  laid 
open,  did  not  appear  livid,  or  with  any  marks  of  difeafe,  Yet  a  little  after 
the  ftomach,  the  omentum,  the  mefentery,.  and  fome  other  vifcera  were 
taken  out,  they  all  began  to  be  livid,  and  to  have  a  very  ill  fmell :  and  the 
next  day  the  pancreas  was  ting’d  of  a  dirty  green  colour,  fo  as  to  refemble 
any  thing  more  than  the  pancreas,  when  in  its  natural  ftate.  And  in  the 
mean  while,  not  only  the  theatre,,  but  almoft  the  whole  college,  was  fill’d 
with  a  vehement,  and  almoft  intolerable  ftench,  notwithftanding  the  weather 
was  cold,  and  very  lhowy  in  thole  days,  which  immediately  preceded  that 
very  great  vehemence  of  cold,  which  began  on  the  tenth  of  February,  in 
the  year  1740.  Although,  for  thefe  reafons,  it  was  necefifary  the  body  lhoulcl 
be  foon  taken  away  and  buried,  yet  I  was  refolv’d  that  the  integuments 
fhould  be  previoufiy  incis’d,  in  both  wrifts,  to  fee  whether  there  was  any  ar¬ 
tery  in  the  place  where  phyficians  generally  are  wont  to  look  for  it,  or  whe¬ 
ther  it  was  only  fmall,  or  by  any  means  obftructed,  and  that  the  thorax 
ihould  be  laid  open,  to  enquire  into  the  feat  of  the  difeafe. 

And  an  artery  there  was  in  each  wrift,  fuch  as  is  generally  found.  Nor 
had  the  thorax  any  effus’d  humour  contain’d  in  it-,  nor  was  the  pleura  any 
where  conne&ed  with  the  lungs  :  though  thefe  laft-mention’d  vifcera  were, 
indeed,  turgid  with  a  frothy  fluid  in  every  part  yet  fhew’d  no  other  morbid 
appearance,  either  internally,  or  externally.  But  within  the  pericardium, 
the  heart  was  found  to  be  pretty  hard  and  thick,  being,  in  a  manner,  ten¬ 
dinous,  and  much  enlarg’d.  Upon  difle&ing  the  heart,  I  obferv’d  that  this 
enlarg’d  ftate  of  it,  and  the  great  capacity  of  the  ventricles,  was  not  join’d 
with  an  extenuation  of  the  parietes,  which  were  rather  thicker  than  natural. 

In 


Letter  XVIII.  Article  3j*.  491 

lh  both  of  the  ventricles,  were  thick  and  whitifh  polypous  concretions,  but 
efpecially  in  the  right,  from  whence  a  very  long  one  extended  itlelf,  through 
the  pulmonary  artery  :  yet  thefe  polypi  were  not  harder  than  the  cruft  which 
forms  itlelf  on  the  furface  of  blood,  when  congealing  in  a  bafon  after  its  ernif- 
fion,  and  were  eafily  pull’d  into  pieces.  Thefe  being  remov’d,  I  examin’d  the 
internal  furface  of  the  ventricles  with  diligence,  together  with  the  valves,  the 
auricles,  and  great  veffels,  and  found  that  every  thing  had  the  appearance  of 
health,  except  what  I  am  going  to  relate.  The  finus  added  to  the  left  auri¬ 
cle  was  larger  than  ufual,  and  more  unequal,  on  its  internal  furface.  The 
aggeres,  as  Valfalva  calls  them  (r),  of  the  valves  of  the  aorta,  were  here  and 
there  thicken’d,  efpecially  in  two  ;  as  they  alfo  were  in  one  of  thole,  which 
are  plac’d  at  the  beginning  of  the  pulmonary  artery.  When  I  look’d  upon 
the  valves  of  the  aorta,  it  was  eafy  to  perceive,  that  befides  the  two  orifices, 
from  whence  begin  the  two  coronary  arteries,  there  was  a  third  over  and 
above  ;  nor  that  at  the  fide  of  the  right,  but  of  the  left  orifice,  and  of  fuch  a 
fize,  that  I  do  not  remember  ever  to  have  feen  that  which  I  have  defcrib’d  in 
another  place  (j),  at  the  fide  of  the  right,  of  fo  great  a  magnitude.  But  it 
was  much  more  eafy  to  perceive,  that  the  great  artery  was  dilated  from  thofe 
valves,  even  almoft  to  that  very  part,  whence  the  inferior  intercoftals  arife. 
Which  was  not  lefs  manifeft,  than  that  the  coats  of  it  were,  in  that  whole 
trad,  thicken’d  and  grown  hard,  being  on  its  internal  furface,  in  many 
places,  yellow,  and  fhewing  figns  of  its  approaching  change  into  bone, 
fuch  as  the  beginning  of  one  of  the  fubclavians,  in  like  manner,  exhibited. 
And  as  foon  as  ever  the  aorta  could  be  call’d  defcending*  it  had,  internally, 
fome  fmall,  but  truly  bony  laminae;  and  in  the  fame  part,  its  fibres 
feem’d  as  if  they  had  been  drawn  afunder,  and  that  to  a  confiderable  diftance 
from  each  other.  Laft  of  all,  where  it  approach’d  to  the  diaphragm,  it  feem’d 
to  be  mark’d  with  a  kind  of  furrows,  drawn  in  the  longitudinal  diredion  of 
the  artery. 

35.  But  as  to  thefe  furrows,  I  fhall  fpeak  of  them  elfewhere  (7) ;  for  I  have 
obferv’d  them  in  other  fubjeds.  And  in  regard  to  that  una'ccuftom’d  difpo- 
fition  to  putrefadion,  which  the  vifcera,  and  efpecially  thofe  of  the  belly* 
had  acquir’d  j  or  in  regard  to  the  pull'e*  which  could  not  be  felt  in  the  wrifts, 
I  have  nothing  to  fay,  unlefs  you  will,  perhaps,  attribute  this  latter  efted  to 
convulfion  («),  and  the  former,  to  that  very  malignant  fever,  which  had 
lately  been  join’d  to  the  other  diforders.  But  whether  the  expedorated  mat¬ 
ter  that  was  difcharg’d  juft  before  death,  was  alfo  purulent,  or  only  had  the 
appearance  of  purulency,  I  will  not  take  upon  me  to  determined 

One  thing,  however,  I  will  endeavour  to  explain,  which  I  have  not  yet 
thrown  any  light  upon,  notwithftanding  it  is  mention’d  in  the  two  former 
hiftories  (x),  as  well  as  in  this :  I  mean,  how  it  could  happen,  that  although 
the  ventricles  of  the  heart  were  fo  much  dilated,  yet  the  parietes  of  them 
were  not  diminifh’d,  but  rather  encreas’d  in  thicknefs ;  which  a  celebrated 
man,  when  he  denies  the  preternatural  augmentation  of  mufcular  flefh,  even 
in  aneurifms  of  the  heart,  l'eems  either  not  to  have  feen,  or  not  fufficiently  to 
have  attended  to. 

(r)  D.'fT.  anat.  I.  n.  io.  («)  Ibid.  n.  7.  in  fin. 

(/)  Epift.  anat.  15.  n.  8.  (*)  n.  28.  &  30. 

(0  Epilh  24.  n.  34,  37. 


Rrr  2 


When 


49-  Book  II.  Of  Difeafes  of  the  Thorax. 

When  the  ventricles  of  the  heart  are  affe&ed  with  an  aneurifm,  they  do 
not  expel  all  the  blood  into  the  arteries,  and  confequently,  that  portion  which 
has  remain’d  in  them,  mull:  be  added  to  that  which  they  receive  from  the 
veins.  A  greater  portion  of  blood,  therefore,  will  more  refill  that  quan¬ 
tity  of  it,  which  is  about  to  return  from  the  fubftance  of  the  heart  itl'elf, 
through  many,  but  narrow  pafiages,  into  the  ventricles  :  for  which  reafon, 
this  part  of  the  blood,  ftagnating  within  the  parietes  of  the  heart,  will  ren¬ 
der  them  thicker.  But  if  an  aneurifm  of  the  ventricles  be  join’d  with  an 
aneurifm  of  the  aorta,  as  in  thefe  three,  of  which  I  fpoke  laft ;  this  circum- 
ftance  will  moreover  be  added,  that  as  the  aorta  cannot  then  carry  on  the  cir¬ 
culation,  in  the  manner  it  ought,  fo  as  to  take  off  the  load  of  blood  from 
the  heart,  a  g!  eater  quantity  thereof  will  prefently  be  repeli’d  into  the  mouths 
of  both  the  coronary  arteries,  when  the  aorta  contracts  itlelf:  and  for  that 
realon  the  parietes  of  the  heart  will,  at  the  fame  time,  receive  more  blood 
than  ufual,  and  expel  lels,  fo  that  the  thicknels  of  their  fubftance  muft  of 
coniequence  encreafe,  from  a  double  caule:  and  that  fo  much  the  more,  if 
either  the  p<dfages  through  which  they  throw  out  the  blood,  are  naturally 
narrower,  or  fewer,  or  the  orifices  through  which  they  receive  it  are  greater  $ 
or,  as  in  this  woman,  fometimes  in  greater  number. 

Nor  yet  will  the  parietes  of  thele  cavities  grow  thicker,  in  all,  whofe  ven- 
tr  cles  are  dilated,  but  in  fome  will  even  be  extenuated,  either  becaufe  the 
diameters  of  thofe  emiftaries,  and  immiflaries,  are  not  quite  the  fame  as,  or 
are  quite  contrary  to,  the  original  formation  ;  or  even,  becaufe  the  ftrublure 
of  the  fibres  is  fometimes  naturally  more  lax,  and  for  that  reafon,  more 
prone  to  yield,  and  at  other  times,  from  eroding  juices,  a  great  quantity  of 
which  will  diffolve  the  tender  fibrillas,  whereof  the  larger  fibres  are  compos’d, 
or  whereby  they  are  connefled  one  with  another. 

36.  It  is  long  fince,  as  you  very  well  know,  that  I  fent  you  this  explana¬ 
tion.  In  which,  I  now  fee  there  are  fome  things,  that  do  not  very  well 
agree  with  the  obfervations  of  that  illuftrious  man,  Senac,  efpecially  where 
he  enquires  (j),  whether  orifices  do  really  open  on  the  internal  iurface  of  the 
ventricles  of  the  heart,  and  difcharge  blood  into  thofe  cavities,  as  fo  many 
celebrared  men  might  feem  to  have  demonftrated,  who  have  been,  in  general, 
follow’d  by  others.  1  would  have  you,  therefore,  confider  the  fubjett  well  ; 
and  whatever  parts  of  my  explication  you  may  think  ought  to  be  chang’d, 
or  rejected,  I  would  have  you  freely  change,  or  rejebl.  But  when  you  ffiail 
penile  the  writings  of  Senac,  you  will  frequently  light  on  other  things,  relat¬ 
ing  to  this  point.  For  they  wiil  confirm  what  the  laft-propos’d  hiftory  has 
taught,  that  not  all  the  aneurifms  of  the  heart,  and  ltill  lefs  of  the  aorta,  are 
attended  with  more  vehement  pulfes,  as  fome  feem  to  imagine,  and  will  give 
you  more  than  one  reafon,  why  they  may  not  be  fo  attended  { z ),  and  confe¬ 
quently,  why  all  aneurifms  of  the  heart  do  not  dilate  the  aorta  {a) ;  and  when 
there  is  an  aneurifm  both  of  the  heart,  and  great  artery,  which  of  them  feems 
to  be  the  caufe  of  the  other  ( b )  \  and  by  what  figns  each  of  them  may  be 
known,  notwithftanding  the  puliations  are  cbfcure  (c) :  belides  other  ques¬ 
tions  of  this  kind ;  which  although  they  have  no  lels  difficulty  than  utility, 
in  their  folutions,  you  will  nevertheless  find  excellently  folv’d,  nor  with  lefs 


(y)  Traite  dn  Coeur.  I.  2.  c.  5.  n.  11.  (a)  c h.  8.  n  6. 


(b)  Ibid. 


Letter  XVIII.  Article  37.  493 

lkill  than  ingenuity,  as  far  as  the  nature  of  the  question  admits.  Nor  will 
many  admonitions,  and  animadverfions,  be  wanting,  which  may  be  very 
ufefui  ;  as  tor  inftance,  when  you  fnall  read  (4),  that  the  heart  is  fometimes 
dilated,  and  this  dilatation  is  not  feen,  unlefs  the  cavities  be  fill’d:  and  that  the 
fame  thing  ft),  unlefs  you  diligently  attend  to  it,  happens,  fometimes,  in  the 
grert  artery,  which  is  not  dilated,  laterally,  into  the  form  of  a  fac,  but  equally 
on  all  fides  :  and  (/)  that  the  dilatations  of  the  auricles  are  an  obftrudion  to 
the  blood,  as  it  i flues  from  the  ventricles,  by  comprefling,  either  the  aorta,  or 
the  pu  monary  artery.  To  which  you  may  alfo  add,  that  an  aneurifm  in  either 
of  thtfe  arteries,  by  prefling  on  the  contiguous  trunk  of  the  other,  will  (till 
more  obftrud  the  exit  of  the  blood  ;  but  by  prefling  on  either  of  the  auricles, 
or  the  veins  that  go  into  them,  it  will  refill:  the  return  of  the  blood. 

But  to  return  to  Senac,  befide  thefe  few  things  which  I  have  taken  notice 
of  among  many,  he  has  his  own  obfervations  of  aneurifms  of  the  heart  and 
aorta  exifling  together  at  the  fame  time;  and  thefe  not  as  Lentilius  (g)  has 
them,  without  any  peculiar  fymptoms,  but  even  attended  with  almoft  all  the 
fymptoms  that  are  peculiar,  efpecially  in  the  Marquis  du  Palais  (h),  amongft 
which  alio  is  the  fymptom  that  we  confider’d  above  ft),  as  being  join’d  with 
other  figns  of  the  aneurifm  ;  I  mean,  that  the  patient  could  not  lie  down, 
but  was  compell’d  to  fit  with  his  body  bent  forwards. 

And  you  will  read  of  this  fituation  giving  fome  eale  in  an  old  man  alfo, 
join’d  together  with  other  figns  of  a  long  continu’d  diforder  of  the  heart  ft), 
in  whom  the  heart  was  “  almoft  of  a  ftupendous  magnitude,”  and  the  great 
artery,  immediately  as  it  came  below  the  diaphragm,  was  “  ex. ended  to  the 
“  fize  of  a  fift and  this  I  fhould  iuppofe  was  an  aneurifm,  to  which  a 
polypous  matter  adher’d  internally  ;  for  if  it  had  been  a  membranous  follicle, 
or  apoftem,  that  had  open’d  itfelf  into  the  aorta,  rather  than  this  fhould  have 
difcharg’d  its  pus  into  the  aorta,  as  is  luppos’d,  the  aorta  rnuft  have  impeli’d 
its  blood  into  this  follicle,  or  apoftem,  by  realon  of  the  ftronger  force  with 
which  that  fluid  is  driv’n. 

37.  Although  I  have  produc’d  many  examples  to  you  of  aneurifms  in  the 
aorta  and  fhall  yet  produce  others  in  other  places,  and  not  only  of  them 
which  confilt  in  an  almoft  equal  dilatation  of  the  artery,  in  every  part,  but 
of  thofe  alio  which  grow  out  like  a  bag  on  the  fide  of  it ;  left  you  fhould 
poflibly  believe,  that  thefe  are  very  rarely  met  with,  fince  it  has  happen’d, 
that  no  more  than  one  example  of  this  kind  has  been  produc’d  among  all 
the  obfervations  both  from  Valialva’s  papers,  and  mine,  l  have  by  me,  at  leaft, 
on  the  other  hand,  four  aneurilms  that  were  formerly  ftuflf’d,  and  dried,  by 
the  celebrated  Vulpi  us,  all  o‘  which  were  either  in  the  arch  of  the  aorta,  or 
in  that  trad:  which  lies  betwixt  this  arch  and  the  heart;  and  one  of  them 
only  is  of  the  firft  kind,  and  three  of  the  lecond.  And  thefe  preparations  I 
will  fhew  you,  if  at  any  time  you  fhall  come  to  Padua,  according  to  my 
wifhes.  In  the  mean  while,  farewel ;  and  continue  your  prelent  affection 
for  me. 

(d)  Ch.  8.  n.  2.  ft)  Supplem.  ch.  3. 

(f)  L.  4.  ch.  11.  n  2. 

(£)  Eph.  N.  C.  Dec.  3.  A.  3.  in  Append, 
n.  3.  ad  Obf.  31. 


( h )  L.  4.  ch.  8.  n.  4,  6,  7. 
ft)  N.  18,  19. 

ft)  Aft.  N.  C.  Tom.  3.  Obf.  31. 


LETTER 


494 


Book  II.  Of  Difeafes  of  the  Thorax. 


\ 


LETTER  the  NINETEENTH 


Treats  largely  of  Suffocation,  and  flightly  of  Coughs. 

i.  TJAVIN  G  fent  you  four  letters  oh  the  fubjefl  of  injur’d  refpiration* 
and  moft  of  them  very  long,  I  will  fend  only  this  one  on  fuffocation, 
and  coughs.  For  as  difficulty  of  breathing  has  a  cough  often  join’d  with 
it,  and  very  often  terminates  in  fuffocation  ;  I  could  not  write  on  tfat  fub- 
je£t  without  making  mention  of  both  thefe  fymptoms  frequently,  the  one 
exprefsly,  and  the  other  obfcurely.  Arid  the  fame  muft  of  courfe  happen 
in  other  diforders  of  the  thorax,  to  be  treated  of  hereafter.  You  will  there¬ 
fore  look  for,  in  other  places,  what  may  feem  to  be  omitted  here. 

Neither,  indeed,  are  there  a  great  number  of  obfervations,  if  thofe  which 
are  given  in  this  fecond  feftion  of  the  Sepulchretum,  of  fuffocation,  and  in 
the  following  fedtion,  of  coughs,  are  compar’d  with  thofe  contain’d  in  the 
foregoing  fedtion  ( a ) ;  for  you  will  find  that  many  are  intentionally  repeated, 
and  forne  through  careleffnefsi  So  that  obfervation,  which  had  been  given 
under  number  twenty-one,  is  given  over  again,  loon  after,  under  number 
twenty-nine  :  and  that  which  Bonetus  himfeif  had  delcrib’d  under  number 
fifteen  ( b ),  is  read  again,  in  like  manner,  under  number  three,  in  the  addi¬ 
tamenta.  And  in  the  next  fedtion,  number  three,  and  the  fourth  article 
under  number  eighteen,  are  the  fame  *,  number  twelve  and  fifteen  ;  the  ar¬ 
ticles  one  and  feven,  under  number  feventeen  •,  the  third  under  eighteen,  and 
the  fecond  under  nineteen  •,  number  thirty,  and  article  fix,  under  thirty-feven  •, 
thirty-one,  and  eight,  under  eighteen ;  and,  what  would  be  fcarce  credible 
to  any  one,  the  two  articles  four  and  five*  which  lie  immediately  together, 

under  number  twenty. 

¥ 

2.  But,  as  fuffocation  happens,  not  only  from  internal  caufes,  but  alfo 
from  external,  and  adventitious  ones,  which  I  have  not  hitherto  touch’d 
upon,  I  ffiall  begin  with  this  kind  :  and  in  the  firft  place,  according  to  my 
cuftom,  I  ffiall  give  you  fome  obfervations  of  Valfalva’s-,  to  which,  after  a 
few  of  my  own,  fuch  as  they  are,  I  will  alfo  fubjoin  fome  experiments  made 
by  him  and  by  me.  And  then,  paffing  over  from  this  fpecies  to  the  other* 
which  arifes  from  internal  caufes*  if  I  have  any  obfervations  to  communicate, 
I  will  firft  give  you  thofe  that  relate  to  fuffocation,  and  afterwards  thofe  alio 
which  relate  particularly  to  coughs. 

3.  A  woman,  of  one-and-twemy  years  of  age,  was  publicly  executed  at 
the  gallows.  The  carcafe  about  the  back,  loins,  and  buttocks,  had  the  fkin 
in  fome  places  reddifh,  and  in  others  livid.  The  mouth  was  diftorted,  the 

(^)  1 . 1«  1.  (^)  §  1. 


4 


eyes 


Letter  XIX.  Articles  4,  i*,  6,7,8.  495 

cyes  half-open,  and  the  face  altogether  livid  ;  but  this  was  prefently  chang’d 
into  a  pale  colour,  from  opening  the  external  jugular  veins.  For  the  blood 
had  almoft  preferv’d  its  natural  fluidity.  The  cheft  being  open’d,  it  was  ne- 
ceflary  to  loofen  the  lungs  from  the  pleura,  to  which  they  adher’d  in  many 
places,  on  both  fides  ^  and  the  lower  edge  of  the  right  lobe  adher’d  to  the 
diaphragm  alio.  The  furface  of  the  lungs  that  was  turn’d  to  the  back,, 
Teem’d  to  have  been  affeCted  with  a  flight  inflammation. 

4.  That  the  lividrrefs  of  the  face  was  owing  to  the  ftagnation  of  the  blood 
in  its  veins,  is  confirm’d  by  the  feCticn  of  the  jugular  veins,  which  alfo 
fhew’d,  that  the  natural  fluidity  of  the  blood  was  preferv’d.  And  this  being 
Tuppos’d,  whatever  was  obferv’d  by  Valfalva,  both  in  the  pofterior  parts  of 
the  body,  and  in  the  pofterior  parts  of  the  lungs,  is  eafily  underftood  to  have 
happen’d,  from  the  time  that  the  carcafe  being  taken  down  from  the  gallows, 
was  laid  in  a  fupine  pofture. 

5.  A  highwayman,  not  more  than  two  years  older  than  that  woman,  was 
executed  in  the  fame  public  manner.  In  the  carcale,  that  was  given  for 
public  difledtion,  the  face,  in  which  the  eyes  were  half-open,  the  arms,  the 
back,  and  the  buttocks,  were  in  Tome  places  reddifh,  and  in  others  appear’d 
livid.  But  internally,  nothing  was  feen  worthy  of  notice,  except  that  the 
lungs  appear’d  in  a  manner  red  from  inflammation. 

6.  But  here,  although  the  other  appearances  muft  be  explain’d  in  the 
fame  manner,  yet  that  which  relates  to  the  lungs,  as  it  was  not  only  feen  on 
the  back- part,  fhould  feem  to  be  accountable  for  from  fuflocation,  if  the 
former,  and  the  two  following  obfervations  fhould  admit  of  it.  But  the  eyes 
being  half-open  in  thofe  two  that  are  fpoken  of,  and  even  in  that  which  will 
be  next  fpoken  of  quite  open,  do  not  much  help  forwards  this  remark  of 
Garmannus  (. c ):  That  almoft  all,  who  are  deftroy’d  by  a  violent  death,  have 
“  their  eyes  cover’d  with  their  eye-lids.” 

7.  The  eyes  of  a  man,  who  was  publicly  hang’d,  were  open  and  turgid, 
and  his  face  a  little  livid.  In  the  abdomen,  fome  chyliferous  veflels  were 
feen  about  the  lumbar  glands,  in  which  they  Teem’d  to  terminate.  In  the 
thorax,  the  lungs,  which  adher’d  to  the  pleura  in  both  their  lobes,  but  efpe- 
cially  in  the  right,  fo  that  they  could  not  be  feparated  without  great  difficulty, 
were  fome  what  red  on  the  pofterior  part.  There  were  no  polypous  con¬ 
cretions  in  the  heart.  In  the  head,  the  fanguiferous  veflels  of  the  dura  mater 
were  fomewhat  turgid. 

8.  A  (lender,  and  middle-ag’d  man  was  hang’d  for  many  and  great  thefts. 
He  had  been  fubjeCt  at  intervals,  and  efpecially  in  walking,  to  a  difficulty 
of  breathing,  and  a  troublefome  cough.  The  abdomen  being  open’d  for 
public  demonftration,  fome  lacteal  veflels  were  feen  in  the  mefentery.  And 
in  the  thorax,  the  lungs  were  mark’d  with  a  kind  of  blackifh  fpots,  yet  were 
unconnected  with  the  pleura,  except  at  the  upper  part  of  the  right  lobe ; 
which  was  indurated  to  the  bignefs  of  an  apple,  and  ting’d  with  a  peculiar 
rednefs,  juft  as  if  it  had  been  inflam’d  •,  for  this  part  was  ftrongly  connected 
to  the  pleura,  about  the  ribs,  and  oppofite  to  the  clavicle.  In  the  pericardium, 
was  fcarcely  half  an  ounce  of  ferum,  and  in  the  heart  no  grumous  concretion 


(?)  De  mirae,  mortuor.  1.  i.  tit.  5.  §7. 


of 


49^  Book  II.  Of  Difeafes  of  the  Thorax. 

of  blood  was  found  In  the  neck,  the  compreffion  of  the  halter  had  broken 
thro’  the  mufcles  which  conned  the  os  hyoides  with  the  larynx,  and  the  neigh- 
b’ring  parts ;  fo  that  this  bone  was,  of  courfe,  feparated  from  the  larynx. 
At  length  we  came  to  the  head.  And  the  fkin  which  cover’d  the  cranium 
was  turgid  with  b.ood  veffeB,  on  its  internal  iurface.  The  brain,  as  far  as 
could  be  obvious  to  the  judgment  of  the  fenfes,  did  not  at  ail  differ  from 
the  natural  conftitution.  The  mufcles,  and  the  other  parts  that  lie  about 
the  eyes,  feem’d  to  be  in  a  manner  inflam’d,  from  the  ftagnating  blood  ;  and 
the  retina  was,  in  both  eyes,  fuffus’d  with  a  fanguineous  colour.  The  mem¬ 
brana  tympani  of  one  ear,  with  the  annex’d  little  bones,  was  tindur’d  with 
blood  ;  the  tympanum  of  the  other  ear  was  more  (lightly  ting’d  indeed,  yet 
fhew’d  a  greater  rednels  than  ufual. 

9.  The  diforder  in  the  lungs,  which  was  the  moft  confiderable,  ought  not, 
doubtlefs,  to  be  accounted  for  from  the  recent  punifhment,  but  from  fome 
other  caufe  of  a  more  ancient  date;  and  feems  to  be  that  which  had  render’d 
the  man  liable  to  a  difficulty  of  refpiration,  and  a  troublefome  cough,  efpe- 
cially  when  the  blood,  being  excited  by  walking,  came  to  the  part  where  its 
paffage  was  obftruded  in  that  vifcus,  through  which  it  muff  pafs  at  that  time 
in  greater  quantity,  and  with  greater  velocity  :  and  at  the  fame  time,  the 
blood  might  eafily  prefs  out,  from  that  vitiated  part  whereon  its  impetus 
was  made,  fomething  into  the  air-pafiages,  which,  by  its  irritation,  would 
give  rife  to  a  cough. 

But  though  I  would  not  deny,  that  the  blackifn  kind  of  fpots,  with  which 
the  lungs  were  diltinguifh’d,  might,  polfibly,  with  juftice,  be  referr’d  to 
fuffocation  ;  yet  I  do  not,  on  the  other  hand,  affirm  it  for  certain  ;  and  in 
this,  and  the  preceding  obfervations,  I  do  not  by  any  means  find  the  fame 
appearances,  which  were  found  by  Bartholin  in  two  perfons  who  died  of  the 
fame  kind  of  death,  as  you  will  read  in  this  fecond  fedtion  of  the  Sepul- 
chretum  (d).  For  he  faw,  in  one  of  thefe  fubjedts,  the  lungs  “  not  only 
“  very  large,  variegated,  and  blue,  with  a  rednels  interfpers’d  like  marble,’* 
to  which  we  might  rtTemble  thofe  fpots,  but  alfo  “  fo  full  of  a  frothy  blood, 
“  that  not  only  the  external  veins  were  tumid  on  every  part  of  the  enve- 
“  loping  membrane,  but  were  an  obftrudtion  to  him  in  demonftrating  the 
<£  diffedtion  of  the  heart :  and  in  the  other,  “  the  air  pipe  of  the  lungs  fill’d 
“  with  a  copious  froth.”  Littre,  alfo,  in  a  woman  (<?),  whom  two  men  had 
fuffocated,  by  fqueezing  her  neck  with  their  hands,  found  the  lungs  ex¬ 
tremely  tenfe,  from  the  included  air,  and  their  external  membrane  univer- 
fally  diftinguifh'd  by  a  dilatation,  and  fwelling,  of  the  fanguiferous  veflels. 
Pacchioni  (/)  alfo,  “  in  thofe  who  die  by  the  halter,”  mentions,  that  the 
lungs  “  were  fuffus’d  with  black  blood  and  mucus.”  And  in  regard  to 
froth,  or  foam,  it  is  lufficient  to  turn  to  the  aphorifm  of  Hippocrates  (g), 
efpecially  as  it  is  tranflated  into  Latin  by  Celfus  (£),  in  the  laft  and  eighth 
chapter  of  the  fecond  book.  The  words  are,  “  Nor  does  that  perfon  ever 

return  to  life,  who  is  taken  from  the  gibbet  with  a  foam  at  his  mouth  :” 

v  (d)  Obf.  23,  &  24.  (f)  Oper.  Edit.  4.  in  ProlapC  Cord,  hift.i. 

(e)  Hilt,  de  1’ Acad.  R.  des  Sc.  A.  1704.  ( g )  43.  Sedt.  2. 

Obf.  Anat.  2.  ( ’/> )  De  Medic. 

although 


Letter  XIX.  Article  io.  -  497 

although  I  {hall  make  fome  remarks  upon  this  aphorifm  below  (7),  and  you 
will  alio  fee  other  things  remark’d,  in  like  manner,  by  the  celebrated  Lang- 
guthus  (k)  ;  in  whofe  differtation  you  will  find,  among  other  things,  which 
he  law  in  the  diffe<5tion  of  perfons  who  had  been  hang’d  7),  that  the  lungs 
were  turgid  with  a  great  quantity  of  blood.  Why  did  not  Vallalva,  then, 
oblerve  fuch  things  ?  Was  it  becaufe  he  came  fo  late  to  the  examination  of 
the  lungs,  as  the  order  of  public  demonftration  requires  ?  The  obfervation 
of  Harvey  (»;),  which,  as  well  as  the  others  that  are  near  it,  and  belong  to 
the  foregoing  fedtion,  are,  to  my  great  furprize,  omitted  in  the  Sepulchretum, 
may  illultrate  this  fubjedt  in  fome  meafure.  His  words  are,  44  1  have  fome- 
44  times,  in  a  human  body  recently  llrangl’d,  that  is,  within  two  hours  after 
44  hanging,  when  the  cheft  and  pericardium  were  open’d,  before  the  rednefs 
*4  of  the  face  was  gone  off,  demonftrated  to  many  witneffes,  that  the  right 
44  auricle  of  the  heart,  and  the  lungs,  were  very  much  diftended,  and  fluff’d 
44  up  with  blood,  but  chiefly  the  auricle,  to  the  bignefs  of  a  large  man’s  fifl, 
44  and  fo  very  turgid,  that  you  would  fuppofe  it  was  ready  to  burff.  Yet 
44  all  this  quantity  of  blood  on  the  following  day,  when  the  body  was  quite 
44  cool  had  entirely  difappear’d,  having  flow’d  down  into  other  paffages.” 
That  is  to  fay,  the  blood  being  fluid,  as  I  have  already  laid  it  has  been  ob- 
ferv’d  to  be  in  bodies  of  this  kind,  eafily  Aides  down  to  the  parts  of  the 
veffels  that  are,  from  their  fituation,  inferior :  and,  indeed,  it  is  driven 
thither  by  the  fibres  being  every-where  cool’d,  and  for  that  reafon  contradled ; 
fo  that  the  anterior  veffels  of  the  lungs  cannot  be  equally  tumid  with  the 
pofterior  veffels,  in  bodies  which  are  plac’d  in  a  fupine  pofture.  And  the 
foam,  by  the  efcape  of  the  air-bubbles,  will  fubfide  into  a  very  fmall  quan¬ 
tity  of  moifture,  and,  on  the  body  being  mov’d,  eafily  flow  out. 

io.  But  what  fhall  we  fay  is  the  reafon,  why  Vallalva  remark’d,  that  the 
blood  was  fluid,  as  I  have  related,  and  made  this  obfervation  alfo  exprefsly, 
befides,  that  there  were  no  polypous  concretions  in  the  heart,  nor  any  gru- 
mous  blood  found  there,  when  in  that  very  fedtion  of  the  Sepulchretum  (#), 
it  is  copied  from  Befierus,  that  in  a  virgin,  44  who  died  of  fuffocation,  the 
44  body  of  the  heart  was  fill’d  with  a  grumous  blood,  which  was  common 
44  in  fuffocated  perfons  ?”  Without  doubt,  I  fhall  fay,  that  in  this  part  of 
the  epiftle  of  Beflerus,  which,  in  the  book  of  Zacutus,  quoted  in  the  fame 
place,  makes  the  fixty- fourth,  and  not  the  fixty-third  obfervation;  as  the 
queftion  is  of  a  virgin,  who,  after  an  illnefs  of  fix  years  continuance,  was  at 
length  carried  off'  by  the  laft  of  all  difeafes,  fuffocation  ;  fo  it  is  very  probable 
that  Beflerus  intended  rather  to  fpeak  of  this  kind  of  fuffocated  perfons, 
than  thofe,  who,  being  in  good  health,  were  fuddenly  ftrangl’d  by  external 
force,  of  which  kind  thefe  in  general  are,  that  are  propos’d  by  Valfalva.  For 
it  is  manifeft,  that  the  dilpofition,  or  conftitution  of  the  vifeera,  and  of  the 
blood  alfo,  is  quite  different  in  the  one  and  the  other,  no  lefs  than  that  thick 
and  grumous  blood,  as  it  is  the  more  unfit  to  be  carried  through  the  fmail 
veffels  of  the  lungs,  is  fo  much  the  more  apt  to  ftagnate  therein,  and  bring 

{/)  N.  36.  (1)  Ibid.  §  10. 

(/f)  Difp.  de  redd.  rec.  praefocatis  ademta  ( m )  De  Circui.  Sang.  Exerc.  3. 

anima  §  11«  («)  Obf.  32. 

Vol.  I  S  f  f 


on 


49  8  Book  II.  Of  Difeafes  of  the  Thorax. 

on  fuffocation.  And  I  do  not  doubt,  but  even  they  who  are  fuffocated  with 
a  halter,  if  they  happen  to  have  blood  very  prone  to  concretion,  will  not  only 
have  grumous,  but  even  polypous  concretions  alfo,  in  the  refervoirs  of  blood.; 
fuch  as,  to  omit  others,  I  find  were  drawn  out  by  Coiterus(^),  “  in  the  bo- 
“  dies  of  perfons  who  had  been  hang’d,”  from  the  finufles  of  the  dura  mater. 

ii.  Moreover,  the  fame  fluidity  of  the  blood,  which  was  in  thofe  who; 
when  in  perfect  health,  were  ftrangFd,  lefiens  my  furprize,  that  Valfalva 
found  the  brain,  in  the  fame  perfons,  nothing  alter’d  from  its  natural  ftate, 
or  at  leaft  the  vefiels  of  the  dura  mater  only,  fomething  turgid  with  blood  ; 
whereas,  in  the  mean  while,  the  internal  vefiels  of  the  fkin,  that  covers  the 
cranium,  and  thofe  which  lie  about  the  eyes,  or  are  difpos’d  through  their 
retiform  coat,  or  through  the  tympanum  of  the  ears,  were  fo  turgid,  that 
fome  of  thefe  parts  appear’d  to  be  inflam’d,  and  others,  as  the  membrana 
tympani,  and  the  annex’d  little  bones,  feem’d  to  be  even  dy’d  with  blood. 
For  the  halter  being  loos’d,  and  thofe  very  large  paflages  of  the  internal  ju¬ 
gular  veins,  being  fet  at  liberty,  for  the  return  of  the  blood,  the  much, 
greater  part  of  this  blood,  inafmuch  as  it  was  fluid,  eafily  flow’d  out  of  the 
finufles,  and  the  great  veins  that  open  into  them  ;  whereas  that,  which,  by 
reafon  of  the  windings,  and  narrow  paflages  of  the  more  diftant  and  fmaller 
veins,  had  a  lefs  fpeedy  return,  ftagnated  therein,  fome  of  them  only  ex¬ 
cepted,  which,  in  confequence  either  of  being  more  full,  or  having  lefs  re¬ 
finance,  had  been  previoufly  broken  through  by  the  halter,  or  other  exter¬ 
nal  violence  ;  for  Littre,  in  that  woman  ipoken  of  above  (p),  found  the 
membrana  tympani,  on  one  fide,  not  only  bloody,  as  Valfalva  did,  but  rup¬ 
tur’d,  fo  as  to  have  emitted  about  half  an  ounce  of  blood  ;  although  in  pro¬ 
portion  to  the  various  degree  of  ftrangulation,  the  violence  of  the  caule  of 
rupture  in  the  vefiels,  may  be  greater  or  lefs,  as  I  fhall  Ihew  below  (q) ;  not 
to  mention  the  different  laxity  in  different  perfons,  both  of  the  fmall  veins 
and  membranes  of  thofe  parts,  and  their  different  difpofitions,  from  whence 
it  feems  to  have  happen’d  at  other  times,  that  the  famous  anaromift,  Philip 
Conrade  Fabricius  (r),  “  in  perfons  who  had  been  ftrangl’d  with  a  halter 
44  fometimes,”  but  not  always,  14  found  the  anterior  lamella”  of  the  tunica 
cornea  of  the  eye  44  receding  from  the  internal,  or  pofterior  part  •”  and  from 
hence  that  the  excellent  Peter  Chriftopher  Burgmann  (j)  faw  the  coats  of  the 
eyes  forming  themfelves  into  two  little  horns,  almoft  like  fingers,  and  coming 
down  by  degrees,  to  the  very  cheeks  of  one,  out  of  three,  who  were  hano-’d 
upon  a  gibbet,  which  is,  indeed,  a  very  rare  infiance ;  yet  you  will  not  fay 
that  it  is  44  without  example,”  as  Garmannus  (/)  could,  perhaps,  formerly 
fay,  when  he  produc’d  an  inftance,  not  unlike  this,  from  Kornmannus,  mak¬ 
ing  ufe  of  his  own  words :  44  a  certain  chymift  being  hang’d  upon  the  gal- 
44  lows,  had  two  horns  fprouting  from  his  eyes,  of  the  length  and  bi^nefs  of  a 
“  finger and  thefe  words  1  have  copy’d,  that  you  may  not  afk  with  Bura- 
mann,  but  may  know,  that  they  are  no  other  than  what  Bertramus  had  be¬ 
fore  us’d,  in  the  writings  of  Bartholin  («)., 

(0  obf-  anat-  (P)  n-  9‘  (?)  n‘  38-  (0  h  I.  cit.  fupra,  ad  n.  6.  tit.  io.  §  iQi 

(r)  Idas. anatom.  Praft.  fedt.  4.  &  u. 

(/)  Differ 4  epiftol..  de  fingulari  tunicar,  (*)  Cent.  2,  epift.  med.  u*. 
utrlufq.  oculi  expanf. 

7 


12;  Finally, 


Letter  XIX.  Articles  13,  14.  499 

12.  Finally,  this  difference,  in  the  neck,  is  to  be  accounted  for,  equally, 
from  the  different  mode  of  ftrangulation,  and  from  the  different  conftitution 
of  the  perfons  flrangl’d  ;  I  mean,  that  in  fome,  this  or  that  mufcle  is  broken 
through,  and  in  others  alfo,  fome  cartilages  of  the  larynx,  in  others  the  up¬ 
per  vertebras  are  luxated,  or  rather  broken,  and  in  fome,  nothing  of  this 
kind  is  found.  Valfalva  has  mention’d  the  mufcles  being  broken  through, 
in  the  laft  hiftory  (x).  And  in  that,  which  will  be  immediately  fubjoin’d, 
he  has  mention’d  a  cartilage  of  the  larynx  being  broken,  together  with  thefe 
mufcles. 

13.  A  hang’d  man  had  the  llernothyroidasi,  and  hyothyroidasi  mufcles 
torn,  fo  that  only  a  membranous  fubftance  remain’d  in  their  place,  about  the 
annular  cartilage.  And  this  very  cartilage  was  alfo  broken  afunder.  In  the 
left  cavity  of  the  thorax,  the  pleura  was,  here  and  there,  unequal,  with  ma¬ 
ny,  and  hard,  tubercles  j  fome  of  which  were  equal  in  fize  to  a  lentil,  fome 
to  a  vetch,  and  others  to  a  bean. 

14.  Thefe  tubercles  were  owing  to  a  difeafe,  which  was  eafily  contracted 
by  the  noifomenefs  of  a  dungeon.  For  I  have  made  a  remark,  relative  to  this 
very  man,  whole  body  I  dififedted,  together  with  Valfalva,  in  the  college  at 
Bologna,  in  the  year  1703,  that  he  was  almofl!  a  year  in  prifon,  and  that, 
befides  thefe  tubercles,  almofl:  of  a  cartilaginous  hardnefs,  which  befet,  nearly, 
the  whole  pleura,  on  that  fide  ;  he  had  the  left  lobe  of  the  lungs  alfo,  in 
fome  places,  pretty  hard,  and  in  the  fame  cavity  of  the  thorax,  a  fmall  quan¬ 
tity  of  reddifh  humour.  And  from  what  caufe  it  happens,  that  fcarcely  any 
of  thofe  who  are  long  detain’d  in  a  prifon,  ever  come  out  healthy  from,  thence, 
the  Sepulchretum  itfelf  (j y)  takes  notice,  that  is  to  fay,  from  the  conftant  bad 
air,  and  often,  even  the  provifion,  continual  grief,  and  an  inactive  life,  which 
although  it  renders  fome  of  them  fat,  yet  1  cannot  approve  of  the  ule  of 
fuch  fat,  but  of  that  which  is  prepar’d  from  a  man,  who  is  accidentally  kill’d, 
when  in  good  health. 

But  to  return  to  what  relates  to  the  violent  lefion  of  the  parts,  which  are  in 
the  neck  j  that  was  the  greateft,  as  far  as  relates  to  the  cartilages,  which  the 
celebrated  profeflfor  Weiffius  ( z ),  found  in  a  foldier,  who  had  been  hang’d.' 
For  the  annular  cartilage  “  was  broken  afunder,  into  many  pieces,  and  the 
“■  inferior  part  of  the  trachea  entirely  torn  away  from  the  larynx  j”  fo  that 
blood,  and  this  in  a  confiderable  quantity  too,  flow’d  out  both  by  the  nof- 
trils  and  the  mouth,  and  defcended  into  the  bronchia.  And  that  the  carti¬ 
lages  are  not  only  broken  fometimes,  but  fometimes  alfo,  even  fome  of  the 
vertebrae,  Columbus  (a)  may  feem  to  have  hinted,  when  he  denies  that  the 
head  is  luxated  in  hang’d  perfons,  according  to  the  obfervations  he  had  made 
“  frequently,  at  Padua,  at  Pifa,  and  at  Rome  ;”  and  he  even  affirms,  that 
fo  great  is  the  ftrength  of  this  ligament,  to  prevent  luxation,  “  that  the  fe- 
“  cond  vertebra  may  be  more  eafily  broken,  than  luxated ;  and  not  the  fe« 
“  cond  only,  but  the  firfl:  alfo.”  If  we  acknowlege  that  this  may  be  fo,  we 
fhall  then  confefs  that  the  Latins  fpoke  properly,  when  they  call’d  this  kind 
of  punilhment,  which  we  now  ipeak  of,  cervices  frangere ,  or,  to  break  the 

( x )  n.  8.  ( z )  Commere.  Litter.  A.  1745.  Hebd.  24. 

(jJ  1.  hoc.  2.  S.  7.  in  ad  not.  ad  obf.  12.  I.  Tub  n,  7.  (a)  De  re  anat,  I.  3.  c.  2. 

Sff  2  neck, 


5oo  Book  II,  Of  Difcafes  of  the  Thorax. 

neck,  as  you  have  it  in  Cicero  (jb).  But  if  we  do  not  allow  of  it,  we  (hall 
then  fuppofe,  that  they  fpoke  with  greater  juftnefs,  and  propriety,  when  they 
laid,  laqueo  gulam  frangere,  or,  to  break  the  gullet  with  a  halter,  as  you 
find  it  literally  exprefs’d  in  Salluft  (c),  fo  we  do  but  take  it  for  granted,  that 
they  meant  the  throat,  when  they  fpoke  of  the  gullet,  tor  that  the  larynx 
is  fometimes  broken,  from  that  caule,  I  have  feen,  together  with  Valfalva  ; 
but  have  never  feen  the  vertebrae  broken,  nor  yet  even  luxated.  But  when 
I  fay  this,  I  do  not  fay  it  by  way  of  pronouncing  any  thing,  in  regard  to  the 
diflenfion,  which  I  obferve  amongft  very  experienc’d  men.  For  fome,  as 
you  will  even  read  in  the  writings  of  Palfin  (d),  fay,  that  they  had  found,  in 
almoft  all  the  perfons,  who  had  been  executed  in  this  manner,  that  the  firlt 
vertebra  of  the  neck  was  entirely  feparated  from  the  fecond.  On  the  con¬ 
trary,  others  deny  what  Columbus  had  denied  of  thele  vertebras,  and  not 
only  of  thefe,  but  even  of  all  the  remaining,  vertebras.  Yet  am  I  not  igno¬ 
rant,  that  it  is  written  by  Panarolus,  for  example’s  fake*,  for  I  will  ufe  the 
obfervation  which  you  have  in  the  Sepulchretum  (e)  j  that  he,  by  difledtion, 
had  found  the  fecond  vertebra  of  the  neck  luxated.  But,  at  the  fame  time,  I 
am  not  ignoranr,  that  he  found  this  in  the  difiedtion  of  a  perfon  who  had 
fall’n  from  a  tree,  fo  that  the  vertebra  might  have  been  luxated,  and  broken, 
at  the  fame  time  (/).  For  thefe  reafons,  then,  ’till  1  have  an  opportunity  of 
again  enquiring  more  diligently  into  thefe  things,  I  fhall  be  not  a  little  cha¬ 
grin’d,  that  it  did  not  come  into  my  mind  to  do  it  formerly,  when  I  had  op¬ 
portunities  at  Bologna  ;  which  I  negledted  to  do,  partly  becaufe  there  was  lefs 
difpute,  at  that  time,  about  thefe  things,  and  alfo,  becaufe  bodies  of  this 
kind  are  generally  thofe  of  men  in  good  health  (criminals  being  there  de¬ 
tain’d  but  a  little  time  in  prifon)  and  thereby  give  fo  great  an  opportunity  of 
enquiring  what  is  natural,  which  took  up  fo  much  of  my  time,  that  fcarcely 
any  remain’d,  even  for  a  flight  enquiry,  into  the  peculiar  effedts  of  ftrangu- 
lation.  Wherefore,  of  what  I  then  noted  down  in  papers,  nothing  relates  to 
the  prefent  queftion,  except  fome  few  things,  which  l  ihall  immediately  fub- 
join. 

15.  A  young  man  of  four  and  twenty  years  of  age,  having  been  publicly 
hang’d,  his  body  was  given  to  the  anatomical  theatre  at  Bologna,  for  public 
demonftration,  in  the  year  1705.  The  fcrotum  feem’d  to  be  bruis’d,  as  it 
were,  and  was  of  a  reddifli  colour.  The  larynx  was  quite  whole;  nor  were 
the  muffles  about  it  broken  through,  but  even  little,  or  not  all  injur’d :  nor 
was  there  any  thing  elfe  to  be  met  with,  in  the  difledtion  of  the  neck,  which 
feem’d  preternatural.  The  fmalleft  blood- veflels  appear’d  in  great  quantity, 
and  with  great  elegance,  efpecially  in  the  head ;  as  if  they  had  been  fill’d  by 
injection.  Yet  I,  neverthelefs,  found  no  injury  within  the  cranium  :  nor  did  I 
wonder  that  the  finuffes  of  the  dura  mater  were  empty,  as  I  had  obferv’d, 
that  a  great  quantity  of  blood  had  before  flow’d  out  from  the  jugular  veins, 
which  had  been  cutoff  with  the  head. 

16.  Is  the  larynx  of  young  perfons,  by  giving  v/ay  to  the  halter,  lefs  liable 
to  rupture  ?  Valfalva,  as  you  have  feen,  has,  certainly,  not  mention’d  its 

(£)  In  Verrem.  1.  5.  &  in  Vatin.  (*)  1.  4.  S.  6.  obf.  1. 

(0  De  Conjur.  Catii.  (f)  Vid.  etiam  epift.  56.  r.35. &37- 

(JJ  Anat.  du  corp.  hum.tr.  5.  ch.  8. 

being 


Letter  XIX.  Articles  17,  18,  10.  501 

being  broken  in  young  perfons,  nor  do  I  remember  to  have  teen  it  (g).  The 
appearance  of  a  bruil'e,  and  extravafation  in  the  ferotum,  was  owing  to  the 
quantity  of  blood,  flowing  down  from  the  fufpended  body,  into  the  vefiels, 
that  were  the  leaft  comprefs’d.  Thus  out  of  t tie  two,  I  fhail  fpeak  of  next, 
you  will  fee,  that  not  only  the  ferotum  of  one  was  aftebted,  in  the  fame 
manner,  but  the  penis  was  moreover  tenle  alio. 

1  7.  Two  thieves,  a  middle-ag’d  man,  and  a  young  man,  were  executed  in 
the  fame  manner,  in  the  year  1  706.  The  body  of  each  of  them,  being  taken 
down  from  the  gallows,  (boner  than  ufual,  that  is,  within  four  hours  after 
being  dead,  and  being  brought  to  a  place  convenient  for  difiebtion  imme¬ 
diately,  was  (till  warm  on  the  external  parts,  though  the  feafon  was  extremely 
cold.  When  the  body  of  the  firft  was  open’d,  and  the  trunk  of  the  great  ar¬ 
tery  cut  into  longitudinally,  under  the  emulgents  ;  it  was  obferv’d,  that  fluid 
blood  flow’d  out  both  from  the  upper,  and  lower,  part  of  the  trunk,  and  that 
not  in  fmall  quantity  :  and  the  concomitant  trunk  of  the  vena  cava  was  ex¬ 
tremely  diflended  with  blood.  Before  we  faw  thefe  things,  it  had  been  ob¬ 
ferv’d,  that  the  intefline  ileum  was,  for  fome  confiderable  trabt.  of  a  kind 
of  livid  rednefs,  and  that,  in  this  place,  it  contain’d  round  worms. 

18.  I  was  not  willing  to  pal's  by  this  laft  circumftance,  becaule  even  in  fuf- 
focated  dogs,  I  have  alfo  obferv’d,  that  the  inteftines  were  affebted  with  a 
kind  of  inflammation,  in  that  place  where  the  worms  form’d  a  nidus  for  them- 
felves  ;  fo  that  the  phlogiftic  colour,  join’d  with  fome  protuberance  of  the  in¬ 
teftines,  pointed  out  to  me  their  fituation.  But  this  man  had  certainly  com¬ 
plain’d  of  no  inconvenience  of  his  inteftines ;  fo  that  fome  motion,  or  agita¬ 
tion  of  the  worms,  which  had  follow’d  his  death,  feems  to  have  excited  the 
courfe  of  the  blood,  which  was  fluid,  that  way.  From  whence  it  follows, 
that  when,  in  the  opening  of  bodies,  we  fee  any  part  of  the  inteftines  ting’d 
with  a  colour  of  that  kind,  we  muft  not  immediately  have  recourfe  to  inflam¬ 
mation,  or  gangrene,  and  pronounce  that  it  had  been  affebted  with  thefe  dif- 
orders,  in  the  living  body  :  except  either  ^lie  fymptoms  which  had  preceded 
death,  or  the  appearances  that  accompany  this  colour,  in  the  dead  body, 
jointly  demonftrate  it  to  us  ;  fince  this  colour  may  be  brought  on,  even  after 
death  fometimes,  efpecially  when  the  blood  is  diflblv’d,  and  fluid. 

19.  But  the  carcafe  of  the  young  man,  befides  the  ferotum  being  affebted 
with  a  kind  of  ecchymofis,  as  it  were,  had  alfo  the  penis  ftill  tenfe.  Being 
di  fie  bled  about  fix  hours  after  death,  it  was  quite  warm  internally  •,  and  even 
feven  hours  after,  ftill  retain’d  fome  warmth  externally.  The  blood  was  fluid. 
The  remaining  circumftances,  which  I  have  minuted  down,  in  relation  to 
this  body,  and  that  above  fpoken  of,  do  not  ail  relate  to  the  prefent  queftion, 
and  fome  of  them  are  taken  notice  of  in  other  places  ;  as,  tor  inftance,  that 
the  arch  of  the  colon,  which  generally  lies  under  the  ftomach,  and  which 
was  itfelf  alfo,  in  this  young  man,  plac’d  much  lower  than  ufual,  was  fituated 
below  the  navel ;  but  above  all,  what  relates  to  the  lacteal  vefiels  being  full 
of  chyle,  almoft  half  concreted,  and  for  that  reafon  ftagnating  more,  and 
diftinguifh’d  with  frequent  valves,  in  the  appearance  of  little  knots :  for  you  j 

(£)  Sed  vid.  epift,  56.  n.  37, 

.  ’  O 

0 


have  ■** 


50  2  Book  II.  Of  Difeafes  of  the  Thorax. 

have  the  other  circumftances  deicrib’d  in  the  fiftieth  animadverfion  of  the  fe- 
cond  of  the  Adverfaria,  from  this  very  young  man. 

20.  You  know  very  well,  how  Ruyfch  (h)  explains  the  ereftion  of  the 
penis  in  dead  bodies,  when,  in  the  fummer  time,  they  are  difpos’d  to  putre¬ 
faction.  But  the  carcafe  of  this  young  man  was,  at  that  time,  very  far  from 
putrefaction,  nor  were  the  other  parts  of  it  inflated ;  and  the  feafon,  as  I 
have  already  faid,  was  extremely  cold.  Paulus  Zacchias(/),  obferving  in  his 
writings,  that  the  fame  thing  had  been  found  in  other  hang’d  perfons  as  in 
this  young  man,  afligns  a  reafon  for  it,  which  is  very  fuitable  to  the  time 
wherein  he  wrote  But  Lancifi  ( k ),  being  about  to  affign  the  caufe  of  the 
fame  circumftance,  in  him  whom  a  convulfion  of  the  whoie  body  had  carried 
off,  after  a  previous  fuffocative  afthma,  affirms  at  the  fame  time(/),  44  that 
‘4  a  continu’d  ereCtion  of  the  penis,  after  death,  was  generally  met  with  in 
41  ftrangulated  men,”  and  fays,  that  it  arifes  from  the  fibres  being  convuls’d, 
and  intercepting  the  return  of  the  blood  through  the  veins  of  the  part.  And 
if  you  fhould  be  willing  to  follow  this  opinion,  inafmuch  as  you  readily  al¬ 
low  of  convulfions  in  ftrangl’d  perfons,  even  from  that  diftortion  of  the 
mouth,  which  I  obferv’d  above  (m),  together  with  Valfalva ;  add  alfo,  that 
a  quantity  of  blood  eafily  flow’d  downwards,  in  the  fufpended  flate  of  body, 
and  that  in  fo  much  the  greater  proportion,  as,  in  the  lafl  pulfations  of  the 
heart,  fo  much  a  greater  quantity  is  difpatch’d  into  the  lower  arteries,  fince, 
by  reafon  of  the  conftriClion  from  the  halter,  the  lefs  can  be  fent  upwards  to 
the  fuperior  From  which  caufe,  that  was  eafily  to  be  accounted  for  alfo, 
which  Columbus(w),  in  a  woman  who  had  been  hang’d,  accounted  for  from 
the  menftrua  being  at  hand,  to  wit,  that  the  veins  going  to  the  vagina  were 
44  very  large  and  very  black  j”  and  from  this  caufe  alfo,  what  l  have  feen 
in  a  man,  who  had  hang’d  himfelf  in  prifon.  For  as  the  whole  body  was 
fuffus’d  with  a  livid  rednefs,  the  internal  furface  of  the  urethra  was  much 
more  fo,  and  far  beyond  its  ufual  appearance  :  but  I  fcarcely  examin’d  anv 
other  part  in  that  foetid  body,  being  taken  up  with  the  public  demon  fixations 
of  the  year  1718,  and  much  indifpos’d  in  my  health.  Yet  I  extremely  well 
remember,  that  from  the  very  fame  caufe,  Vallalva  did,  in  like  manner,  de¬ 
duce  this  circumllance,  that  when  both  the  carotid  arteries  were  tied  up  in 
living  dogs,  there  was  a  tenfion  in  the  penis. 

And  1  am  glad  that  I  happen  to  remember  this  narration  of  Valfalva’s, 
fince  I  find  it  is  accidentally  omitted  in  the  papers,  where  he  minuted  down 
the  other  circumftances,  that  took  place  upon  the  conftridtion  of  the  arteries 
in  the  neck.  But  it  feems  to  me,  that  I  have,  at  prefent,  fo  convenient  an 
occafion  of  communicating  the  experiments  of  Valfalva,  relative  to  this 
fubjedt,  which,  in  the  Epiflolae  Anatomicas(o),  I  promis’d  to  let  forth  at  fome 
other  time,  with  preciflon  and  order,  nor  omit  the  experiment  of  Galen  re¬ 
lating  to  the  fame  queflion,  that  unlefs  I  make  ufe  of  it,  I  fear  I  fhall  fcarcely 
find  an  equal  opportunity  of  difcharging  my  promife.  For  they  fo  far  relate 
to  the  fubjedl  in  hand,  that  they  help  us  to  form  a  judgment  in  regard  to 

(b)  Thef.  Anat.  ic.  n.  95.  (/)  Ibid,  in  Schol.  n.  8. 

{>)  Qaseft.  Med.  Legal.  1.  5.  tit.  2.  qu.  II.  ( m )  N.  3. 
n.  5.  (»)  De  Re  Anat.  1.  6. 

(/£)  De  Subit.  Mort.  Obf.  har.  4.  (0)  XIII.  n.  30. 

thole 


Letter  XIX.  Article  21.  503 

thofe  catrfes  that  are  generally  aftign’d  for  the  death  of  fuch  as  are  publicly 
bang’d.  But  as  thefe  experiments  have  fucceeded  differently  with  different 
men,  even  from  the  molt  ancient  times,  we  muft  begin  very  far  back,  and 
from  the  defire  we  have  of  finding  out  the  truth,  we  muft  well  confider,  and 
compare  one  with  another,  the  ancient  and  modern  experiments. 

21.  The  firft  of  all  who  mention’d  the  experiment  of  tying  up  both  the 
carotid  arteries,  feems  to  many  to  have  been  Ariftotle,  that  is  to  fay,  to  Co¬ 
lumbus  (p),  to  Salius  (q),  to  Sandtorius  (r),  and  to  others.  But  to  me,  if 
I  am  allow’d  todiffent,  with  fubmiflion,  from  fuch  very  learn’d  men,  Ariftotle 
does  not  feem  to  have  mention’d  the  experiment  of  tying  up  the  carotid  ar¬ 
teries,  but  quite  another  thing,  that  is,  the  experiment  of  tying  up  both  the 
internal  jugular  veins.  Nor  is  my  opinion  fhaken  by  that  paffage  (j),  which 
alone  I  fee  is  pointed  out  by  them,  and  by  Csefalpinus  (t),  where  Ariftotle 
coming  more  clolely  to  the  point,  fays,  that  “  they  who  have  the  veins  in 
“  their  neck  conftridted,  become  infenfible  nor  does  it  efcape  me,  that 
the  ancients,  by  the  term  veins,  did  frequently  alfo  intend  the  arteries.  But 
I  pay  regard  to  that  other  paffage  (#),  where,  after  he  has  diftinguifh’d  the 
greater  vein,  or  the  cava,  from  the  aorta,  and  undertaken  the  defcription  of 
the  fuperior  cava,  and  come  on  to  the  jugulars,  thefe,  fays  he,  “  when  they 
“  enter  the  neck,  dividing  into  two  branches,  go  towards  the  artery  of  the 
<c  lungs  •,  and  thefe  veins  being  at  any  time  conftricfted  from  without,  the 
ci  perfons  fall  down  bereav’d  of  their  fenfes  having  their  eye-lids  clos’d  ; 
ct  and  being  thus  ftretch’d  out,  and  embracing  the  artery,  they. are  continu’d 
<c  to  that  fpace,  on  the  fide  of  the  ears,,  where  the  jaw-bones  are  join’d  with 
«  the  fauces.”  I  do  not  here,  with  Riolanus(x),  who  otherwife  underftands 
the  jugular  veins  with  me,  confirm  my  opinion  from  this  circumftance,  that 
they  are  faid  to  receive  betwixt  them,  or  embrace,  the  artery  ;  for  it  is  not 
the  carotid  artery,  and  much  lefs,  as  Niphus  ( jy)  explains  it,  the  aorta,  but 
«  the  artery  of  the  lungs,”  as  Ariftotle  juft  now  call’d  it,  that  is  the  afpera 
arteria,  near  to  which  they  are  faid  to  afcend  in  the  lower  part  of  the  neck, 
and  bending  themfelves,  moreover,  this  way  and  that,  are  faid  to  receive  it 
between  themfelves.  For  that  the  jugular  veins,  and  not  the  carotid  arteries, 
are  here  defcrib’d,  is  manifeft,  not  only  from  the  defcription  of  the  fuperior 
cava,  that  he  had  undertaken,  as  I  before  afferted,  but  alfo  from  this  cir¬ 
cumftance,  that  when  he  has  finifh’d  that  defcription,  he  immediately  goes, 
on  to  fpeak  of  the  part  of  the  aorta  correfponding  to  it,  in  this  manner  (2)  : 
«  The  lefier  vein  alfo,  which  I  have  faid  is  nam’d  aorta,  is  difpers’d  in  the 
“  fame  manner,  in  branches,  and  thefe  follow  the  branches  of  the  greater 
«  vein.”  And  that  Ariftotle  fpoke  of  the  internal,  not  of  the  external  ju¬ 
gulars,  their  afcent  near  to  the  afpera  arteria,  fufficiently  proves ;  which  I 
mention,  left  you  fhould,  perhaps,  imagine,  that  this  expreftion,  “  being 
«  eonftridted  from  without,”  relates  to  the  external  jugulars, 

( p )  De  Re  Anat.  1.  14.'.  (/)  L.  2.  Med.  Quseft.  15. 

( q )  De  Affeft.  Fartic.  c.  2.  (z/)  Hift.  Animal.  1.  3.  c.  3, 

(r)  Commen.  in  Art.  Med.  Gal.  qu.  35.  &  (#)  Anthropogr.  1.  3.  c.  9, 

in  I.  Fen.  I.  Avic.qu.  108.  (y)  Expof.  in  hunc  loe. 

p)  De  Somno,  &•  Vigil,  c,  2.  (.«J  Initio  c.  4, 

22.  But 


504  Book  II.  Of  Difeafes  of  the  Thorax. 

22.  But  if  you  alls;  me,  by  what  means  this  could  be  done,  I  ftAll  give 
nearly  the  fame  aniwer  that  was  formerly  giv’n  by  Cafpar  Floffmane  (a)  : 
44  Did  Ariftotle  lee  any  fuch  thing,  as  Coftseus,  in  the  fixth  book,  and  fixth 
44  chapter,  of  his  Difquifuiones  Phyjiologica  relates,”  of  circumforaneous  moun¬ 
tebanks,  who  by  means  of  a  firing  being  thrown  round  the  veffels,  and  jugular 
veins  of  a  fhe-goat,  which  they  could  relax,  or  tighten,  privately,  and  ac¬ 
cording  to  their  plcafure,  fo  as  now  to  force  the  animal  to  fall  down,  deftitute 
of  all  lenfe  and  motion,  and  prefently  to  fuffer  it  to  leap  up  again.  And  as 
Ariftotle  has  fpoken  exprefsly  of  “  men,”  the  fame  Hoffman  adds,  in  another 
place  (£),  that  Benedic  I.  Praff.  34,  writes,  41  that  it  is  cuftomary  in  Affyria 
44  to  tie  up  the  veins  of  the  neck,  in  thole  young  men,  whofe  praeputia  they 
44  want  to  cutoff.  For  by  this  means  they  lofe  all  fenfe  and  motion.”  To 
this  we  will  add  the  paffage  of  Valverdus  (c) :  The  carotid  arteries,  fays  he, 
44  being  obftrufted,  or  from  any  caufe  whatever  fhut  up,  we  immediately 
44  grow  ftupid,  and  fall  afleep.  And  this  experiment  I  faw  made  by  Co- 
44  lumbus,  at  Pila,  in  the  year  1554,  on  a  young  man,  in  a  large  circle  of 
44  gentlemen,  not  witli  lefs  terror  to  them  than  laughter  to  us,  who  perfuaded 
44  them  that  this  was  done  by  the  force  of  incantation.”  It  feems  that  there 
muff  have  been  an  eafy  method  of  (hutting  up  thele  veffels,  which  this  young 
man  would  fuffer  by  way  of  fport,  and  the  by-handers  thought  to  be  an  in¬ 
cantation.  For  which  reafon  it  were  to  be  wifh’d,  that  Valverdus,  or  Co¬ 
lumbus,  had  explain’d  it.  But  this  the  firft  did  not  do,  as  Riolanus  ob- 
ferves  (d)9  and  Columbus  hill  lefs,  as  when  he  had  the  faireft  opportunity,  in 
many  places,  to  do  it  (?),  he  was  not  only  filent  upon  the  fubjedf,  but  attri¬ 
buted  the  lofs  of  the  voice,  in  dogs,  entirely  to  the  nerves  being  tied  up  with 
the  arteries,  which  frequently  happens,  and  not  to  the  arteries  themlelves 
being  tied  up.  And  if  Hieronymus  Rubeus  (/)  had  read  this  paffage,  I  do 
not  doubt  but  he  would  have  laid,  that  he  was  at  a  lofs  what  to  think  of  the 
narration  of  Valverdus,  in  regard  to  which,  he  denied  44  it  to  be  probable, 
44  that  the  very  learn’d  anatomift  Columbus  (hould  have  incautioufly  tied  up 
44  the  nerves  together  with  the  arteries  although  you  will  think,  that  Ari- 
ftotle’s  book  Be  fomno  &  vigilia  was  not  attentively  read  by  Rubeus  ( g ), 
whom  the  words  of  this  author,  pointed  out  by  me  in  the  firft  place(£),  feem 
to  have  efcap’d  •,  words  which  are  call’d  by  a  certain  perfon,  as  undoubt¬ 
edly  they  are,  44  the  very  weighty  and  memorable  authority  of  a  philofopher,” 
when  he  had  read  it  by  chance  in  Csefalpinus  *,  yet  abus’d  thefe  very  words, 
by  contending,  that  what  Steno  had  taught,  44  that  a  mufcular  fibre  was 
44  actuated,  and  put  in  motion,  by  the  blood,”  he  had  learn’d  44  from  Hip- 
44  pocrates,  and  the  reft  of  the  ancients,  and  alfo  from  Caefalpinus  himfelf, 
44  in  the  third  of  the  Queftiones  Peripatetic towards  the  latter  part,  where 
44  the  argument  from  ligatures  is  exprefsly  propos’d,”  and  that  paffage  of 
Ariftotle,  which  we  have  fpoken  of,  44  is  related.”  What  ?  if  he  had  read 
that  other  paffage,  in  which  the  men  are  faid  44  to  fall  down,”  or  thofe  things 


(а)  Comment,  in  c.  io.  1.  8.  Gal.  deUf. 
Part 

(б)  De  Thorace,  1.  2.  c.  2 9. 

{()  Arat.  toip.  hum.  1.  6.  c,  11. 


(d)  C.  9.  cit.  ad  n.  21. 

(e)  L.  ibid.  cit.  &  1.  7. 

(f)  Annot,  in  Celf.  1.  4.  C.  1. 

(g)  Ibid.  (£)  N.  21. 


which 


Letter  XIX.  Article  23.  50$ 

which  were  Laid  juft  now  of  other  men,  and  of  the  Ihe-goats  of  mounte¬ 
banks.  But  all  thefe  things,  though  they  were  evidently  true,  and  were 
what  Cfel'alpinus  touch’d  upon,  in  that  laft  queftion  of  the  fifth  book,  which 
fhould  have  been  added,  did  not,  however,  bring  on  this  conclufion,  that 
we  fhould  fuppofe,  when  the  arteries  were  tied  up  which  went  to  the  mufcles, 
that  the  motion  of  thefe  mufcles  was,  in  confequence,  immediately  fufpended, 
efpecially  as  Galen  (/)  fays,  14  That  the  obftruCtion  of  an  artery  by  a  liga- 
‘4  ture,  is  the  caufe  of  no  prelent  injury  to  the  part  whereto  it  goes-,”  but 
only  tended  to  prove  this  propofition,  that  when  the  vefTels  in  the  neck  were 
conftri&ed,  the  fluid  did  no  longer  flow  into  the  brain  and  nerves,  which 
was  neceflary  to  their  functions.  Nor  would  the  paflfage  of  Hippocrates  (k) 
convey  any  other  fignification  •,  I  mean,  44  that  the  obftrudions  of  the  veins 
44  caufe  any  one  to  be  feiz’d  with  a  fudden  privation  of  voice if  others 
like  Hoffman  (7),  whom  we  have  already  commended,  could  fuppofe,  that 
this  interception  of  the  veins  of  Hippocrates  44  was  the  fame  with  the  in- 
“  terception  of  the  veins,  in  the  neck,”  of  Ariftotle.  But  whereas  Galen  (m) 
fays,  that  Hippocrates  44  calls  repletions,  which  arife  from  fulnefs,  inter- 
44  ceptions  of  the  veins  and  Hippocrates  himfelf,  when  he  explains  thefe 
interceptions,  which  44  happen  to  a  healthy  perfon,  without  any  manifeft 
44  caufe,”  mentions  the  heart,  indeed,  or  the  liver,  but  not  a  word  of  the 
brain  ;  I,  for  thefe  reafons,  dare  not  venture  to  fay,  that  this  experiment  we 
fpeak  of  was  known  to  Hippocrates,  as'if  he  had  alluded  to  it,  and  chofe 
rather  to  begin  with  Ariftotle.  And  I  hope  you  will  not  be  difpleas’d,  that 
I  fhould  prove  the  experiment  mention’d  by  him,  not  to  relate  to  the  arteries, 
but  to  the  veins  of  the  neck.  For  you  will  fee  afterwards  alfo,  in  regard 
to  this  experiment,  of  how  much  confequence  it  has  been  to  difeourfe  of  it 
here. 

23.  As  to  that  experiment,  however,  which  relates  to  the  arteries  of  the 
neck,  it  evidently  appears  from  Ruffus  Ephefius  (»),  that  this  was  known 
alfo  to  the  ancients,  as  he  fays,  44  that  the  ancients  had  nam’d  the  arteries 
“  which  go  to  the  neck,  the  carotids,  or  fomniferous  arteries,  becaufe  when 
44  they  were  comprefs’d,  they  affedted  the  man  with  fleepinefs,  and  took  away 
44  the  voice.”  He  then  lubjoins  this,  which  led  Daniel  Le  Clerc,  otherwife 
a  very  learn’d  man,  into  an  error:  44  But  in  our  age,  it  is  found  that  this  is 
44  an  attention  of  the  fenfitive  nerves,  which  lie  near  to  the  arteries,  and  not 

44  of  the  arteries  themfelves.”  Hence  learn,  fays  Le  Clerc  lo)>  44  that  the 

“  nerves,  which  are  flnee  call’d  recurrent  nerves,  were  then  lately  found 
44  out*,”  and  confequently,  fays  he,  in  another  place (p),  44  it  is  to  be  obferv’d, 
44  that  Galen  attributes  to  himfelf  the  difeovery  of  thefe  nerves;  although 
44  Ruffus  Ephefius,  who  liv’d  before  his  time,  had  already  made  mention  of 
44  them.”  For  Le  Clerc  did  not  attend  to  this  circumftance,  that  as  the 
trunks  of  the  par  vagum,  from  whence  thefe  little  branches  arife  below,  are 
nearer  to  thofe  arteries,  than  the  recurrents,  Ruffus  certainly  meant  to  lpeak 

(?)  DePulf.  Ufu,  c.  2.  .  («)  De  corp.  hnm.  part,  appell.  !.  I,  c.  34.; 

(/$)  De  Vifr.  rat.  in  Acut.  n.  37.  (9)  Hift.  de  !a  Medec.  3.  part.  1.  3.  ch.  3. 

(l)  Comment  in  r.  12  1.  16.  de  Uf.  Part.  (p)  L.  3,  ch.  7. 

(m)  Comment.  4.  in  cit.  Hippocr.  1.  n.  23. 

Vol.  I.  T  1 1 


of 


50&  Book  II.  Of  Difeafcs  of  the  Thorax. 

of  thefe  trunks,  which  he  certainly  does  not  lay  were  found  out  in  his  age  j, 
but  he  lays  it  was  found  out  in  his  age,  that  from  the  comprefiion  of  thefe 
nerves  (which  may  be  eafily  tied  up  with  the  arteries)  thole  affections  were 
brought  on,  which  had  been  before  attributed  to  the  comprefiion  of  the  ar¬ 
teries. 

And  to  this  queftion  relate  many  paflages  in  Galen,,  but  efpecially  thefe 
which  I  am  furpris’d  that  Le  Clerc  fhould  have  overlook’d.  He  fays  [q)r 
u  l  was  accuftom’d  to  call  thofe  nerves,  which  I  found  out  m.yfelf,  the  vocal 
nerves  :  for  my  preceptors  knew  only  thofe  which  lie  near  the  arteries. — 
“  And  the  rnulcles  of  the  throat  are  injur’d  in  the  fame  manner,  whether 
“  theie  recurrent  nerves,  or  thofe  which  lie  near  the  arteries,  are  hurt that 
is  to  fay,  as  he  fa i d  a  little  before,  44  either  incis’d  or  comprefs’d  with  a. 
4;  halter.”  And  in  another  place  (r),  in  like  manner,  when  he  had  men¬ 
tion’d  44  the  nerves  that  are  annex’d  to,  and  affociated  with,  the  carotid  ar- 
“  teries,”  and  in  confluence  of  experiments,  he  had  admonifh’d,  44  that 
44  the  animal  was  immediately  render’d  mute,”  from  the  conftriCtion  of 
thofe  nerves,  and  not  from  the  conftriCtion  of  the  arteries,  he  at  length  fays 
thefe  things:  44  But  the  greater  part  both  of  phyficians  and  philofophers  tied 
44  up  the  nerves  alfo,  in  their  ligatures,  together  with  the  arteries  ;  and  as 
41  they  law  that  the  animal  immediately  loft  its  voice  from  thence,  they 
44  fuppos’d  that  this  injury  was  to  be  afcrib’d  to  the  arteries;  and  call’d  it 
44  deep,  though  not  with  propriety,  unlels  they  would  have  filence  be  call’d 
44  fieep for  befides  the  vocal  faculty,  as  he  had  faid  above,  44  no  other 
44  function  contracts  any  injury,  neither  at  that  inftant,  nor  after  fome  little 
44  time,  not  even,  if  the  nerves  annex’d  to  the  arteries  are  cut  through.” 

But  you,  in  the  mean  while,  plainly  fee,  in  what  circumftance  he  differs 
from  Ruffus,  and  from  thofe  phyficians  and  philofophers  who  liv’d  in  his 
age.  You  fee,  in  like  manner,  how  far  he  agrees,  or  difagrees,  with  thole 
who  have  repeated  the  experiment  afterwards,  the  obfervations  of  whom, 
and  efpecially  thofe  of  Valfalva,  need  not  to  be  repeated  here;  as  I  have 
related  them  at  large  in  a  former  work  (j),  either  as  far  as  relates  to  the 
nerves,  which  lie  near  to  the  cardtids,  being  tied  up  without  the  arteries,  or 
cut  aftinder;  or  as  far  as  relates  to  the  lame  nerves,  being  tied  up,  together 
with  thefe  arteries  (/).  Nor  fhould  we  wonder  greatly,  becaufe,  fince  thofe 
obfervations  were  publifh’d,  it  happen’d  to  the  celebrated  Abraham  Enfius(»j, 
that  in  a  very  young  whelp  he  law,  upon  the  tying  of  thefe  nerves,.  44  all 
44  fenfe  loft  in  a  moment ;”  fince  it  has  happen’d  to  others  fometimes,  what¬ 
ever  might  be  the  caule  of  it,  that  the  experiment  had  the  fame  confequenees, 
and  even  as  I  have  related  in  that  anatomical  epiftle  (.v),  that  death  has  im¬ 
mediately  taken  plape  thereupon  :  but  that  which  much  more  frequently  hap¬ 
pens,  and  indeed  .that  which  almoft  always  is  obferv’d,  it  becomes  us  parti¬ 
cularly  to  take  notice  of.  And  indeed,  when  Jofeph  Henry  Brunnerus  (jy), 
who  was  worthy  of  his  iiluftrious  grandfather,  repeated  thefe  experiments 

($0  De  lee.  afF.  1.  i.  c.  6.  (uj  DifT.de  CaufTa  vices  cord,  altera  produc. 

(r)  De  Hippocr.  &  Plat.  Deer.  1.  2.  c.  6.  n.  4, 

(•>)  Epift.  Anat.  13.  n.  27.  &  feq.  ufcp  ad  40.  (x)  n.  30. 

(/)  Ibid.  n.  30.  &  31.  (yj  Exper.  circa  ligat,  nervor.  §  25.  &feq. 


not 


Letter  XIX.  Article  24.  co; 

not  long  ago  on  a  dog,  and  on  rabbits,  he  never  obferv’d  any  thing  of  that 
kind,  but  rather  the  contrary  ;  which  I  would  have  you  compare  with  the 
obfervations  of  the  greater  part  of  thole  who  have  made  the  experiments,  and  in 
particular  with  the  obfervations  of  Valfalva,  and  with  the  remarks  I  have  made 
upon  them,  either  when  I  have  admonilh’d,  that  the  ligatures  with  which  the 
nerves  are  conftrifted  do  not  all  produce  the  fame  effedt,  or  when  I  have  ob¬ 
ferv’d  that  the  animal  which  had  thele  nerves  cut  afunder,  had  liv’d  longer  than 
that  whofe  nerves  were  tied.  I  alfo  had  demonftrated  this,  that  they  were  every 
now  and  then  deceiv’d,  who  fuppofe  the  par  vagum,  in  brute  animals,  to 
defcend  through  the  neck,  disjoin’d  from  the  intercoftals,  as  in  men,  fo  that 
the  one  may  be  tied  up,  or  cut  afunder,  without  the  other:  and  if  I  may 
be  allow’d  to  fpeak  the  truth,  the  greater  part  of  thole  who  have  fince  that, 
either  explain’d,  or  taken  notice  of  experiments,  and  difquifnions  of  this 
kind,  do  not  feem  to  have  been  very  mindful  of  this  admonition. 

But  let  us  difmifs  thefe  things.  For  it  is  enough  at  prefent,  if,  not  un¬ 
mindful  of  my  defign,  I  conlider  the  experiments  of  Galen,  and  others, 
which  relate  to  the' fanguiferous  veffels  in  the  neck  being  tied  up,  with¬ 
out  the  nerves.  And  I  mention  Galen,  as  ufual,  becaufe  if  any  perfons  be¬ 
fore  him  did  tie  up  the  velfels  without  any  nerves,  though  the  error  may  be 
now  dilcover’d,  thefe  obfervations  have  not  reach’d  me. 

24.  Galen  then,  after  having  written  what  we  juft  now  related,  in  regard 
to  the  nerves,  has  in  like  manner  told  us,  at  the  fame  time  (2),  what  he  had 
obferv’d,  when  the  arteries  were  tied  up  feparately,  or  the  veins  which  run 
betwixt  the  heart  and  the  brain  ;  that  is  to  fay.  the  carotids,  and  internal 
jugulars.  And  when  the  arteries  were  tied,  “  that  the  animal  neither  became 
“  mute,  nor  fleepy,  which  moft  of  thofe  fince  Hippocrates,  who  were  but 

little  fkill’d  in  diftedlion,  have  teftified  but  when  the  veins  were  tied  up, 
“  that  no  function  was,  to  appearance,  loft and  he  concludes  in  fuch  a 
manner,  as  to  fay,  “  that  the  animal  was  not  lull’d  to  fleep,  when  the  nerves 
44  were  even  cut,  and  ftill  lefs  when  the  arteries  were;”  (the  flux  of  blood, 
however,  being  entirely  prevented)  44  but  if  the  nerves  are  injur’d,  that  he 
44  then  is  dumb ;  if  the  arteries  are  hurt,  that  this  by  no  means  happens  ; 
44  and  if  the  veins,  ftill  lefs.” 

Moreover,  he  affirms,  in  another  place  (*),  4t  that  he  had  often  made  the 
44  experiment”  of  tying  up  the  carotid  arteries,  “  and  that  the  animal  had 
44  fuffer’d  nothing  from  it,  neither  immediately,  nor  afterwards,  and  that  he 
44  had  even  watch’d  the  creature  the  whole  day  ;  and  at  the  middle  of  the 
44  night,  had  at  length  kill’d  it;  as  he  judg’d,  that  fo  long  an  experiment 
44  was  no  more  to  be  depended  upon  :  for  that  in  fo  great  a  fpace  of  time,  in 
«•  which  the  cords  were  ty’d  round  the  arteries,  forne  of  the  principal  parts 
44  might  be  injur’d  by  confent. 

Finally,  in  another  place  (£),  after  afterting,  44  that  in  this  manner,  the 
44  animal  continu’d  a  whole  day  without  injury,”  as  he  had  often  experienc’d, 
he  added  this  one  obfervation,  that  having  compell’d  him  to  run,  44  he  had 
44  feen  him  run  very  well  for  fome  time,  but  after  that  very  languidly,  and 
44  at  length  not  able  to  run  at  all moreover,  having  again  forc’d  him, 

(£)  De  Pulf.  Ufu.  c.  2,- 


(z)  c.  6.  1.  2.  fuprs,  ad  n.  23,  cit. 
(a)  De  utilit.  Refp.  c.  5. 


T  t  t  a 


«  that 


8  Book  II.  Of  Difeafes  of  the  Thorax. 

“  that  he  did  not  continue  his  race  fo  long  as  before,  but  was  inftantly  di£ 

“  abled.”  And  this  is  the  fum  of  thofe  things,  which  Galen  fays  he  had 
obfervjd  on  the  tying  up  of  the  carotid  arteries,  as  they  appear’d  to  me/ 
upon  turning  to  thofe  three  paflages,  that  I  have  pointed  out  in  the  bottom 
of  the  pages  *,  for  as  to  the  book,  that  is  the  eighth.  Be  Adminiftratione , 
which  I  fee  is  referr’d  to  upon  this  queftion,  by  learned  men,  I  could  never 
yet  find  any  thing  in  it,  that  relates  thereto. 

Galen  had  many  who  agreed  with  him,  and  among  thefe,  of  thofe  who 
repeated  the  experiments,  Columbus,  as  may  be  gather’d  from  what  has 
been  laid  above  (c),  and  Sandtorius  (J),  who  fays,  “  I  law  a  dog  which  had 
t;  his  carotid  arteries  tied,  able  to  move  himfelf,  and  preferve  his  fenles,  for 
“  the  fpace  of  an  hour:  yet  after  many  hours,  it  is  not  to  be  doubted,  but 
“  by  reafon  of  the  wonderful  confent  betwixt  the  heart  and  the  brain,  he 
“  mu  ft  at  length  die:”  and  left  you  fliould  certainly  believe,  that  after  the 
fpace  of  an  hour,  the  dog  had  entirely  loft  all  fenfe  and  motion  ;  you  will  per¬ 
haps  fee  the  reafon,  why  he  wrote  thus,  from  another  p adage  of  the  fame 
Sandlorius  (*),  where  he  fays,  “  I  law  a  dog  whofe  carotid  arteries  were  tied,. 

“  and  after  that  cut  entirely  afunder :  for  fome  fpace  of  time  he  could  (till 
“  move,  and  then,  by  reafon  of  the  great  lofs  of  arterial  blood,  he  died:” 
and  if  you  believe  this  to  be  the  fame  dog,  you  plainly  fee  why  he  did  r.o 
longer  retain  his  fenfe  and  motion  :  but  if  you  fuppole  it  to  be  another,  you 
then  perceive  that  the  experiment  anfwer’d  twice,  according  to  Galen.  And 
amongft  thofe  who  have  written  in  our  age,  the  excellent  Archiater  Van 
Swieten  (/)  fays,  “  I  tied  up  both  the  carotid  arteries  of  a  dog,  nor  could 
“  1  obferve,  that  he  differ’d  any  injury  from  thence:  for  I  found  this  ani— 
“  mal,  eight  days  after,  brifk  and  fprightly.”  And  the  celebrated  Emet- 
tus  (g)  writes,  that  a  dog,  on  whom  he  had  perform’d  a  like  operation,  and 
had  even  tied  up  the  jugular  veins,  at  the  fame  time,  which  Van  Swieten 
had  not  done  in  his  dog,  except  he  did  it  after  thofe  eight  days,  had  alfo  en-  ' 
joy’d  “  the  moft  perfect  health  and  vivacity  for  fome  weeks.”  Yet  he  adds  (/•?), 
that  on  repeating  the  experiment  often,  though  none  of  them  was  feiz’d 
with  an  apoplexy,  nor  any  of  the  dogs  died,  it  happen’d,  “  fometimes,  that 
“  for  the  fpace  of  two  hours,  the  animals  feem’d  fleepy.”  But  you  will  fee  im 
Dionis  (/)  that  the  dog  in  whom  he  tied  up  both  the  carotids,  was  fleepy' 
for  a  much  longer  fpace,  even  for  fome  days  after  the  conftrifition  notwith- 
ftanding  that,  after  thefe  days,  he  recover'd  his  former  vigour,  and  his  ala¬ 
crity  to  adlion.  And  you  may  alfo  join  the  obfervations  of  thefe  perfons 
with  thofe  of  Galen,  -if  you  except,  in  fome  meafure,  the  two  laft. 

But  on  the  other  hand,  the  greater  part  have  by  no  means  follow’d  Galen,, 
as  Avicenna,  for  inftance,  who,  as  you  have,  it  in  Salius  (£),  fays,  that  “  the 
“  a  pople  ft  ic  veins”  (for  thus  the  Arabians  call’d  the  carotids)  “  befog  tied 
“  up,  fenfe  and  motion  is  inftantly  loft:”  and  with  him  Carolus  Stephaniis 
fee  ms  to  have  agreed  in  opinion  (/)  j  and,  among  the  more  modern,  Baglivi, 

( c )  n.  22.  .  ( b )  not.  a  ad  n.  33, 

\d)  quatt.  35.  cit.  fupra,  ad  n.  21.  (/)  L’Anat.  de  1’HommeEd.  5.  Demonft,  7. 

(f)  qu.  108.  ibid.  cit.  (^)  De  AfFeft.  Panic,  c.  2. 

(f)  Comm,  in  Boerh.  Aphor.  §  170.  n.  3,  (/)  De  diJTed.  part.  corp.  hum.  1.  n  c.  88. 

(g)  Teotam.  de  Morb,  Cap.  n.  30, 


in 


Letter  XIX.  Article  25.  5 09 

in  that  paflage,  which  I  have  quoted  in  <a  former  work  (*»).  And  among 
thole  who  have  made  the  experiment,  I  ip'e  that  Drelifhcurt  i.:s  commended  (;/), 
whole  experiment,  though  only  Angle,  and  continu'd  but  for  a  little  time, 
neverthelefs  fufficiently  contradifls  that  of  Galen  It  runs  thus  :  “  The  caro- 
“  tid  arteries  being  tied,  but  not  yet  quite  obftrudted,  and  the  head  of  the  maf- 
46  tiff  hanging  over  the  edge  of  the  table,  he  was  opprefs’d  with  a  veternus 
44  or  lethargy  ;  but  when  his  head  was  rais’d,  and  the  left  carotid  open’d,  he 
44  was  rous’d,  and  fhook  himfelf.”  Nor  mud  it  be  entirely  pafs’d  over  in 
filence,  that  the  very  experienc’d  man  L’A  mur  (<?),  although  he  was  not  in 
particular  upon  this  enquiry,  and  faw  it  only  for  a  very  (hurt  time  •,  having 
tied  up  the  trunks  of  the  fame  arteries,  in  a  drong  dog,  the  animal  immedi¬ 
ately  fell  into  a  deep. 

25.  Amongft  experiments  that  differ  fo  much  from  each  other,  take  what 
Valfalva,  who  made  it  his  bufinefs  to  confider  this  one  thing  only,  and  to 
afeertain  the  event,  did  not  make  once,  but  three  times  •,  nor  for  a  fhort 
fpace  of  time  only,  but  for  a  much  longer  than  any  other  perfon,  as  far 
as  I  know,  had  done,  making  obfervations  not  only  in  liying  dogs,  but,  af¬ 
ter  that,,  in  dead  animals  alfo,  which  I  have  never  read  of  being  done  by 
any  one  who  had  undertaken  this  experiment  alone:  for  Drelincurt  {p)  had 
made  the  experiment-lb  many  times  together,  on  the  fame  maftiff,  that  the 
few  things  he  defer  ib’d  from  the  dead  animal,  feem  to  belong  more  to  ano¬ 
ther  place  than  to  this. 

Vallalv?.,  therefore,  having  tied  up  both  the  carotid  arteries  of  a  dog,  in 
the  lower  part  of  the  neck  ;  he  receiv’d  no  detriment  as 'to  the  motion  of  his 
limbs,  yet  his  head  remain’d  hanging  down,  and  feem’d  to  be,  in  a  manner, 
dull  and  ftupid.  But  on  the  following  night,  a  great  quantity  of  faliva  being 
difcharg’d  from  his  mouth,  in  the  morning  that  dullnefs  and  ftupidity  were 
ihaken  off,  and  the  dog  feem’d  to  have  a  cheerful  afpefl,  and  ate  with  greedi- 
nefs  what  was  offer’d  him,  notwithflanding  he  had  fome  difficulty  in  fwallow- 
ing.  In  this  manner  he  liv’d  tolerably  well,  for  five  days,  moving  all  the 
parts  of  his  body  with  eafe,  and  according  to  his  occafions,  and  walking  up 
and  down  the  houfe.  In  the  mean  while,  however,  the  lips  and  the  head, 
and  the  interior  parts  of  the  neck,  began  to  fwell :  and  notwithflanding  he 
ilill  difcharg’d  a  great  quantity  of  ferum  from  his  mouth,  yet  the  tumour  flill 
more  and  more  encreafing  continually,  and  his  flrength  by  degrees  failing 
him,  he  died  on  the  fixth  day. 

In  differing  the  neck,  it  appear’d  that  fome  of  the  lacerated  parts  had  be¬ 
gun  to  be  attack’d  with  a  gangrene  :  and  that  there  was  not  the  leafl  paffage, 
for  any  thing  to  flow,  through  the  conflridled  arteries. .  The  internal  jugular 
veins  contain’d  a  little  grumous  blood  only,  whereas  the  other  veins,  what¬ 
ever  they  were,,  that  go  through  the  head,  on  the  outfide  of  the  cranium, 
were  tumid  with  a  large  quantity  of  blood.  But  there  was  a  little  only  in  the 
veffels  of  the  brain,  which,  in  other  refpefls,  had  a  very  natural  appearance. 
In  the  right  Ventricle  of  the  heart,  was  the  beginning  of  a  polfpous  concre¬ 
tion.  Finally,  the  tumour  that  occupy’d  all  the  external  parts  of  the  neck, 

(tf)  Mem.  de  1’  Acad.  R.  des  Sc.  A.  1749. 
Exp.  2.  (p)  loco  modo  cit. 

"and 


(m)  Epift.  anat.13.  n.  30. 

(«)  Experim.  anat.  canicid.  1.  n.  id. 


£  i  o  '  Book  II.  Of  Difeafes  of  the  Thorax. 

and  head,  was  made  up  of  ftagnant  ferum,  which,  in  its  colour,  and  con¬ 
fidence,  refembl’d  a  jelly. 

Valfalva  having,  by  letters,  inform’d'Malpighi  of  thefe  things,  which  he 
had  lately  obferv’d  •,  Malpighi  return’d  thanks,  by  letter,  a  little  after  he 
came  to  Rome  :  this  letter  bore  date  the  twelfth  of  December,  in  the  year 
1691,  and  he,  at  the  lame  time,  exhorted  him  to  repeat  the  experiment  again, 
and  not  once  only,  but  frequently,  that  he  might  fee,  whether  that  kind  of 
jelly  always  occurr’d,  and.  the  other  things  anlwcfd  in  the  fame  manner. 

26.  He  therefore  tied  up  the  fame  arteries  in  another  dog:  and  faw  the 
fame  drooping  pofture  of  the- head,  on  the  firft  days  :  his  neck  alfo  was  fome- 
thing  fwcll’d  •,  he  had  the  fame  greedinefs  in  taking  his  food  •,  and  the  fame 
difficulty  in  fwallowing:  befides  thefe  things,  he  obferv’d  a  manifeft  weaknefs 
of  his  mufcies.  But  it  often  happen’d  that  blood  flow’d  from  the  wound : 
and  when  this  did  happen,  the  dog,  on  that  day,  entirely  loath’d  food,  which 
on  the  day  after,  when  the  blood  was  at  reft,  being  grown  more  brifk,  he 
very  eagerly  deflr’d.  Many  days  being  pal's’d  in  this  manner,  and  the  blood 
having  entirely  ceas’d  flowing,  the  dog  was  nearly  as  well  as  he  had  been 
before  the  arteries  were  tied  •,  but  on  the  twenty-third  day  from  the  opera¬ 
tion,  he  was  kill’d,  and  difieded,  by  Valialva. 

One  of  the  carotids,  below  the  ligature,  having  fuffer’d  a  flight  laceration, 
had  pour’d  out  the  blood  frequently  that  way,  till  a  few  days  before  death, 
it  was  Efficiently  agglutinated.  But  where  the  arteries  had  been  comprei's’d 
by  the  ligature,  the  parietes  were  connected  together,  in  both  of  them,  and 
theyjwere  harden’d  into  a  ligament,  in  the  fame  manner  with  the  umbilical 
veffels,  fo  as  to  tranfmit  not  the  lead  moifture,  nor  the  lead  air  (what  Van 
Swieten  (q),  and  what  Emettus  (r)  found,  you  will  fee  in  their  writings). 
And  yet  none  of  the  arteries,  and  in  particular  the  vertebral,  were  become 
in  the  leaft  wider  than  ufual.  In  the  brain  was  nothing  worthy  of  remark, 
except  that  about  the  beginning  of  the  fpinal  marrow,  a  humour  was  found, 
which  was  equal,  in  its  weight,  to  about  the  third  part  of  an  ounce,  and 
feem’d,  in  its  nature,  very  much  like  that  humour  which  is  found  in  the 
cavity  of  the  joints. 

27.  In  a  little  bitch  alfo,  whofe  carotid  arteries  were  tied  up,  he  obferv’d 
thefe  things.  She  was  much  more  brifk  than  the  former  dogs  ;  but  liv’d 
no  longer  than  three  days,  having  an  utter  averfion  to  food,  and  being  ex¬ 
cited  by  a  kind  of  madnefs,  as  it  were,  to  bark  at  every  body.  Being  difle<5t- 
ed,  nothing  occurr’d  that  was  worthy  of  obfervation  :  although  the  carotids, 
in  this  animal,  were  likewife  found  to  be  clofely  tied  up. 

2§.  It  is  of  no  fmall  importance  in  refpedt  to  Galen,  that  of  the  three  dogs, 
on  which  Valfalva  repeated  his  experiment,  not  fo  much  as  one  of  them  was 
feiz’d  with  a  fleepinds,  nor  loft  the  faculty  of  the  voice.  For  as  to  his  not 
mentioning  barking  in  the  two  firft,  1  would  not  have  you  for  this  reafon 
fup pole,  that  they  did  not  bark  •,  fince  you  fee,  that  he  would  not  have  men¬ 
tion’d  it  in  this  little  bitch,  unlefs  to  fignify  her  being  ftirr’d  up  with  a  kind 
of  madnefs  j  and  that  in  the  two  former  he  had  even  taken  notice  of  a  little 
difficulty  of  deglutition,  which,  as  far  as  I  know,  had  not  been  obferv’d  by 


(9)  (r)  Ecis  indicatis  fupra  ad  n.  24 


any 


Letter  XIX.  Article  29.  51  1 

any  other  :  an  evident  proof,  that  he  would  not  have  pafs*d  over,  by  any 
means,  fo  confiderable  an  effeft  as  the  diminution  of  the  voice,  which  is  easy 
to  be  obferv’d,  by  every  body,  in  a  dog,  not  to  mention  the  total  abolition 
of  it. 

Of  thofe  things,  however,  which  he  obferv’d,  fome  feem  to  belong  chiefly 
to  the  peculiar  difpofitions  of  the  feveral  dogs  •,  as,  for  inftance,  that  the 
bitch  refus’d  food,  and  was  in  lbrne  meafure  mad  ;  or  that  the  firft  dog,  be- 
fides  the  great  quantity  of  fluid' difcharg’d  from  his  mouth,  had  his  head  and 
neck  fo  much  fwell’d  with  ftagnant  ferum  •,  un'efs  you  will,  perhaps,  fay, 
that  before  this  could  have  happen’d,  the  bitch  was  dead  •,  and  in  the  other 
dog,  that  the  redundancy  of  ferum  had  flow’d  out  of  the  wound  at  the  fe¬ 
veral  times  that  the  wound  bled;  fo  that  the  tumour,  which  began  alfo  to 
rife  in  this  dog,  of  courfe  did  not  increafe,  but  rather  decreafe.  And,  in¬ 
deed,  either  fomething  of  that  kind,  or  fome  different  difpofition  in  the  dif¬ 
ferent  veflels,  feems  to  have  been  the  caufe,  that  all  of  them  were  not  af- 
fc6ted  with  the  fame  tumour,  if  the  true  caufe  of  it  be  fuch  as  was  imagin’d 
by  Valfalva  in  the  former  dog  ( s ).  -For  he  luppos’d,  that  the  impulfe  of  the 
blood  through  the  arteries  being  taken  away,  that  which  was  brought  by  the 
correfponding  veins  had  ftagnated  in  them,  from  whence  lb  great  a  tur- 
gefcency  of  thofe  veflels,  and,  confequently,  the  feparation  of  ferum,  and 
Itagnation,  efpecially  as  the  ftrength  of  the  fibres,  by  reafon  of  the  influx  of 
blood  being  deficient,  was  weaken’d,  and  the  blood  could  not  be  lufficiently 
propell’d.  But  if  you  objedt  to  this  theory,  that  there  was  no  ferum  effus’d 
in  the  brain,  and  that  neither  the  veins  thereof,  nor  the  finuffes,  nor  the  in¬ 
ternal  jugular  veins,  had  fwell’d  with  the  ffagnating  blood,  all  which  veflels 
correfpond  to  the  carotid  arteries ;  only  call  to  mind  the  vertebral  arteries ; 
for  although  Valfalva  did  not  perceive  them  to  be  at  all  widen’d  (/),  yet  it 
cannot  be  denied,  that  they  muff  have  receiv’d  fo  much  the  more  blood,  in 
proportion  as  the  carotids  admitted  lefs,  and  carried  it  to  the  brain,  and  into 
the  branches  of  the  carotid  arteries ;  and  not  only  into  the  two  pofferior 
branches,  which  are  found  to  be  larger  in  beaffs  than  in  men,  but  alfo  into 
many  other  leffer  ones,  that  are  neareft  to  its  lmall  branches,  and  commu¬ 
nicate  with  them,  and  by  this  means,  in  fome  meafure,  have  kept  up  the 
proper  circulation  in  the  brain,  and  confequently  have  help’d  forwards  the 
return  of  the  blood  from  thence  by  the  veins. 

2 9.  And  this  is  the  very  reafon,  though  differently  explain’d  by  different 
perfons,  why  Andreas  Vefalius  [u]  formerly,  and  Chriffopher  a  Vega  (x),  and 
not  only  the  more  modern  obfervers,  did  not  think,  that  the  experiment  of 
Galen  was  to  be  denied,  but  the  confequence  which  he  deduc’d  therefrom. 
And  if  you  enquire  of  the  fame  more  modern  gentlemen,  why  Drelincurt  OO» 
when  he  repeated  the  fame  experiment,  faw  an  apoplexy  follow  it,  or  at  leaft 
a  lethargy  ?  perhaps  they  can  no  otherwife  account  for  this  difference,  than 
by  fuppoflng  a  different  difpofition  of  the  arteries  in  the  different  dogs. 

But  if  you  afk,  from  what  caufe,  then,  a  fpeedy  death  is  the  confequence 

1 

(c)  Vid.  enim  infra,  n.  32.  -  (x)  Vid.  apud  Cafp.  Hofman  Comment,  in 

(/)  n.  26.  c.  10.  cit.  fupra,  ad  n.  22. 

(u)  De  corp.  hum.  fabr.  1.  7.  c.  19.  (y)  Vid.  fupra,  n.  24. 

of 


3 


5 i  2  Book  II.  Of  Difeafes  of  the  Thorax. 

of  ftrangulation  ?  They  fay,  that  it  is  the  confequence  of  a  conftrl&ion  on 
the  jugular  veins,  inafmuch  as  they  do  not  return  the  blood  that  is  carried 
into  the  brain  by  the  vertebral  arteries,  which  cannot  be  conftring’d  by  the 
halter.  And  left  you  ffiould,  perhaps,  reply,  that  the  vertebral  veins  can 
not  be  conftring’d  by  the  halter,  and  that  for  this  reafon  the  blood  may  be 
brought  back  by  them;  they  obferve  in  another  place,  that  fome  blood. alfo 
is  carried  to  the  brain  at  that  time  by  the  carotid  arteries  ;  for  that  thefe  are 
fufficiently  defended  from  the  compreffion  of  the  halter,  by  the  protuberance 
of  the  afpera  arteria,  whereas  the  jugular  veins  “  lie  almoft  naked  under  the 
“  fkin.”  1  confefs,  indeed,  that  the  carotids  are  more  internal  than  even 
the  internal  jugular  veins  are  :  I  add  alfo,  that  they  refill;  compreftion  more 
by  reafon  of  the  thicknels  of  the  coats,  and  the  impetus  of  the  blood  with 
which  they  are  diftended.  Yet  the  internal  jugular  veins  are  certainly,  alfo 
fomewhat  defended  by  the  jutting  out  of  the  afpera  arteria,  and  doubtleii 
cannot  be  faid  to  lie  almoft  naked  under  the  fkin,  though  the  external  ju¬ 
gulars  undoubtedly  do.  And  it  is  certainly  proper,  in  this  place,  to  con- 
fider  the  internal  chiefly,  where  the  queftion  is  of  bringing  back  the  blood 
from  the  brain,  and  not  the  external.  And,  indeed,  I  have  fhewn  above (2), 
that  in  the  experiment  of  Ariftotle,  it  was  not  the  'external,  .but  the  internal 
which  were  conftricted,  as  they  follow  the  courfe  of  the  afpera  arteria:  and 
this  may  alfo  be  confirm’d  from  what  Harderus  ( a )  found  to  be  the  con¬ 
fequence  of  tying  up  the  external  jugulars,  in  a  maftiff ;  for  when  he  expedted 
a  fleepinefs  from  thence,  with  an  epileptic  ftroke,  nothing  at  all  of  this  kind 
appear’d.  Yet  there  are  fome  who  refer  to  this  place  that  other  experiment 
of  Galen,  which  I  mention’d  before,  together  with  the  firft 

But  as  the  delign  of  Galen,  in  that  experiment  alfo,  was  to  tie  up  the  veffels 
“  which  join  the  heart  to  the  brain,”  I  cannot  beinduc’d  to  believe  that 
the  external  jugulars,  and  not  the  internal,  were  conftridted  by  him.  Yet 
you  will  here  readily  reply,  how  could  it  be,  that,  if  he  had  tied  up  the 
internal  veins,  he  from  thence  found  “  no  function  to  be  evidently  loft?” 
efpecially  as  Ariftotle  has  affirm’d,  that  the  fenfes  were  by  this  means  taken 
away.  Shall  we  believe  both,  or  ffiall  we  believe  neither  of  them  ?  for 
Rolfinc  gave  credit  to  neither  (c).  And  Harvey  ( d )  has  pronounc’d  that 
another  experiment  of  Galen’s,  which  in  like  manner  related  to  the  fano-ui- 
ferous  veffels,  was  never  adludly  made.  But  foftly,  I  befeech  you,  espe¬ 
cially  when  the  queftion  is  of  fuch  great  men,  left,  through  incautioufnefs 
we  devife  more  or  lefs  for  them,  than  they  have  intended  to  fay.  As  to 
Rolfinc,  he  did  not  only  fay,  that  he  diftrufted  the  experiment  of  Galen 
but  even  all  the  other  experiments.  Yet  he  denied  none  of  them,  but  onlv 
weaken’d  the  force  of  fome,  by  the  fame  plea  which  I  mention’d  a  little 
before,  that  whether  the  arteries  or  the  veins  be  tied  up,  the  vertebral  veins 
always  remain,  which  cannot  be  tied.  And  if  Caefalpinus  had  obferv’d  this 
he  certainly  would  not,  in  behalf  of  Ariftotle,  have  objected  to  the  former 
experiment  of  Galen  (e),  “  that  the  ancients  had  not  only  call’d  the  arteries 

(A  n.  21.  (c)  Differt.  Anat,  1.  6.  c.  44. 

(a)  Eph.  N.  C.  Dec.  2.  A.  3.  obf.  115.  in  (</)  De  Circ.  fangu.  Exerc.  3. 

Sc  ol.  fine.  (e)  quseft.  15.  cit.  fupra,  ad  n.  2f. 

(£)  n.  24. 


carotids. 


Letter  XIX.  Article  30.  3-13 

**  carotids,  but  likewife,  all  the  veins  that  go  to  the  head as  if,  truly, 
Ariftotle  could  have  been  able  to  conftringe  them  all  in  the  fame  manner. 
But  let  us  confider  Harvey  by  himfelf.  *3 

30.  I  with  he  had,  in  regard  to  that  experiment,  in  which  a  pipe  being 
introduc’d  into  the  artery,  and  no  ligature  being  previoufly  made  round  the 
veffel,  Galen  (/)  has  affirm’d,  that  the  artery  pullated  below  the  pipe,  but 
that  a  ligature  being  applied,  it  did  not  pulfate;  I  wiffi,  I  fay,  he  had  only 
broken  the  force  of  it,  by  (hewing  the  caufe  of  the  fallacy  not  being  obferv’d 
by  Galen,  and  had  not  written,  that  Galen,  and  Vefalius,  “  not  thinking  of, 
“  or  not  underftanding,  the  difficulty  ”  of  that  experiment,  which  they  do  not 
fay  was  tried  by  them,  had  propos’d  it  to  be  tried  by  others,  and  in  that 
circumftance,  had  not  undertaken  to  demonftrate  <s  the  error  of  Vefalius,  and 
cc  the  inexperience  of  others.”  For  if  you  read  Vefalius  (g)  attentively,  and 
(till  more  if  you  read  Galen,  you  will  perceive,  that  both  of  them  have 
fpoken  with  fuch  affirmation,  that  it  is  cuftomary  for  no  man  in  his  fenfes  to 
do,  except  who  has  made  the  trial  of  the  matter,  and  is  prepar’d  to  demon¬ 
ftrate  that  experiment  to  every-body  who  chufes  to  afk  it.  Nor  was  it  ne- 
ceffary  to  accufe  others  of  “  inexperience  ”  in  this  manner,  as  if  the  propos’d 
adminiftration  was  almoft  impofiible  ;  and  befides,  if  you  made  the  ligature 
tight,  the  artery  would  be  dilated  above,  and  the  flux  of  blood  being,  for 
that  reafon,  reftrain’d,  the  artery  would  pulfate  very  obfcurely  below  :  but,  if 
you  loos’d  the  ligature,  the  whole  of  the  operation  would  be  thrown  into 
confufion  by  the  effufion  of  blood  fpringing  forth  from  the  wound.  For,  to 
pafs  by  Sandtorius  (£),  who,  before  Harvey  wrote,  teflifled,  that  he  had,  alfo, 
made  trial  of”  this  experiment  of  Galen,  on  brutes-,  at  leaft,  Vieuflens  (i) 
perform’d  it  afterwards  with  fuccefs  -,  nor  when  he  had  tied  the  ligature,  did 
he  fee,  that  the 'flowing  of  the  blood  was  prevented,  but  even  that  the  ar¬ 
tery  pulfated  below  the  tube,  with  almoft  equal  ftrength,  to  what  it  did 
above  ;  nor  when  he  had  foon  after  applied  no  ligature,  was  the  other  expe¬ 
riment  confounded,  by  the  effufion  of  blood,  which  experiment  San£torius(£) 
fays,  was  alfo  propos’d  by  Galen,  in  the  fame  chapter  as  the  firft,  in  which 
chapter  I  do  not  find  any  fuch  thing.* 

But  both  of  them,  you  will  fay,  turn’d  out  contrary  to  the  opinion  of 
Galen.  I  confels  it:  nor  was  it  ever  my  intention  to  defend  him.  This  one 
thing  only  I  intended  to  (hew,  that  there  was  no  occafion  to  call  the  credit 
of  Galen  into  queftion,  as  if  he  could  not  have  perform’d  that  experiment, 
which  others  could  perform.  For  that  he,  and  Sandtorius,  might  have  been 
deceiv’d  in  the  operation,  becaufe  the  ligature  being  tight,  for  the  reafon 
taken  notice  of  by  Harvey,  or  any  other  of  that  kind,  the  artery  would 
pulfate  fo  obfcurely,  that  it  would  not  feem  to  pulfate  at  all,  1  fliould  fo 
much  the  more  readily  grant,  as  I  the  more  plainly  fee,  that  Harvey  himfelf 
alfo,  not  having  obferv’d  all  the  cautions  which  Vieuflens  lince  inculcated, 
had  feen  it  pulfate  much  lefs  than  he.  One  caution,  however,  which  has 
been  omitted,  is  the  reafon  why  the  experiments  do  not  anfwer  fo  well,  as  I 

(f)  An  fanguis  in  arter.  Sec.  c.  8.  (b)  Comment,  in  I.  Fen.  I.  Can.  Avic. 

(j-)  c.  9.  cit.  fupra,  ad  n.  29.  Dodr.  1.  c.  2.  &  quasft.  121. 

(?)  Neurogr.  1.  1.  c.  4.  (b)  locis  modo  cit. 

U  u  u  have 


V OL.  I. 


514  Book  II.  Of  Difeafes  of  the  Thorax. 

have  formerly'  experienc’d  in  that  of  Pecquet  (/) ;  not  to  digrefs  too  far  from 
the  Object  of  the  fanguiferous  veilels,  and  the  blood  that  is  mov’d  in  them 
in  which  he  wrote,  that  the  crural  artery  being  tied  up,  the  blood  that 
flow’d  from  the  turgid  cavity  of  its  correfpondent  vein,  when  incis’d,  “  firft 

flow’d  out  by  drops,  its  impetus  being  greatly  diminifh’d,  and  at  length 
“  entirely  flopp’d  ;”  but  when  the  artery  was  relax’d,  “  that  it  burft  out 
<c  again  from  the  vein  with  equal  vigour.”  Yet  as  the  greater  part  of  thofe 
things,  which  I  then  obferv'd  in  two  dogs,  together  with  Homob.  Pifo,  a 
celebrated  phyfician  and  proteffor,  and  a  man  of  great  condefcenflon  and  kind- 
nefs  towards  me,  are  publifh’d  by  him,  and  fet  forth  in  a  clear  light (m)  it 
will  be  fufficient  here  to  take  notice,  that  neither  part  of  the  experiment  an- 
fwer’d  in  ihofe  animals.  For  the  blood,  indeed,  fprang  forth  from  the  vein, 
when  the  artery  was  untied,  with  greater  vigour  than  juft  before,  when  it 
was  tied  ;  and  yet  not  with  equal  force,  to  what  it  had  before  it  was  tied  : 
but  when  the  artery  was  tied  (which  Pifo  attended  to  chiefly)  the- impetus 
of  the  blood  was  broken,  indeed,  in  its  motion ;  yet  it  did  not  ceafe  to  flow 
in  the  firft  dog,  who  was  more  fprightly  and  ftrong,  copioufly,  and  with  a  kind 
of  jerk,  and  in  neither  of  them  did  it  diftil  in  drops,  and  ftill  lefs  not  at  all: 
nor  could  the  flux  be  entirely  flopp’d,  in  one  of  them,  before  a  ligature 
being  drawn  under  the  artery  and  vein,  which  were  rais’d,  as  you  fee  in 
the  figure  of  Walseus  («),  I  order’d  it  to  be  drawn  tight  about  the  thigh. 
For  as  1  obferv’d,  that  in  this  dog  alfo,  the  experiment  had  the  fame  fuccefs ; 
I  did  not  doubt  but  Pecquet  had  by  chance  lit  on  a  dog,  in  whom  as  the 
other  branches,  which  arife  from  the  artery  above  the  ligature,  and  commu- 
cate  with  the  crural  vein,  were  fmaller  and  fewer  than  in  ours,  it  happen’d 
to  him,  that  he  law  fomething  different  from  what  we  faw,  for  that  reafon  : 
or  even,  perhaps,  that  he  nude  the  ligature  higher  than  we  made.- it,  as 
the  place  of  applying  it,  with  us,  was  a  little  below  the  groin.  Wherefore 
you  underftand,  that  Pecquet  ought  not  to  have  omitted,  in  what  place  the 
artery,  or  the  thigh,  were  to  be  bound,  4f  he  would  have  others  fee  the  fame 
things,  which  he  had  feen  ;  although  indeed,  fometimes,  the  author  of.  any 
experiment,  fuppofe,  for  inftance,  Valfalva,  has  omitted  no  circumftance  in 
deferibing  it;  yet  without  any  advantage;  for  they  who  repeat. it,  evidently 
change  fomething,  and  then,  as  if  they  had  made  no  change  at  all,  wonder 
that  their  experiment  does  not  anfvver !  But  of  thefe.  things  in  another  place, 
or  rather,  in  no  place  at  all. 

31.  Perhaps  you  think  that  I  have  digrefs’d  farther  from  my  defign,  than 
there  was  occaffon.  And  yet  I  have  not  digrefs’d.  For  my  defign  was,  that 
after  I  had  weigh’d  well  the  experiment  of  Galen,  concerning  the  ligature  of 
the  carotid  arteries,  I  ftiould  fee  alfo  about  that  other  experiment  of  his, 
which  confifts  in  the  conftri&ion  of  the  internal  jugular  veins,  without  any 
funftion  being  evidently  loft  therefrom.  And  although  this  might  feem  dif* 
ficult  to  be  believ’d  ;  I  have,  neverthelefs,  taken  pains  to  fhew*  that  the  cre¬ 
dit  of  his  experiment  was  not  to  be  call’d  in  queftion  too  haftily  ;  but  we 
ought  rather  to  fee,  whether  by  the  omiffion  of  any  caution,  he  admitted  any 

(/)  Differt,  de  Circul.  fangu.  c.  1.  (w)  I.  in  Epift.  1.  de  met.  chyl, 

(z«)  Nov.  in  fangu.  Circul.  Inquif.  c.  7. 


mot 


Letter  XIX.  Article  31.  5  r  .$■ 

r error  common  to  humanity  *  as  for  inftance,  if,  perhaps,  thofe  veins  being 
icarcely  tied,  he  had  prefently  taken  off  the  ligatures,  or  had  kill’d  the  ani¬ 
mal,  without  regarding  the  appearances,  which  might  have  follow’d,  it  the 
experiment  had  been  a  little  longer  protracted,  inafmuch  as  he  fought  againft 
the  force  of  the  heart,  which,  if  it  had  been  fent  from  thence  into  the  brain 
by  the  veins,  certainly  would  have  been,  as  he  contended  in  a  fimilar  circum- 
ftance  (0),  44  tranfmitted  in  a  moment  of  time.”  And  this  1  fay  the  more 
confidently,  becaufe  when  he  fpoke  of  tying  up  the  nerves  ( p ),  or  arteries  (q), 
in  the  neck  of  an  animal,  he  exprefsly  faid  that  he  protracted  the  experiment  *, 
yet,  in  regard  to  the  veins,  as  far  as  I  know,  he  wrote  nothing  of  that 
kind.  But,  if  he  had  mention’d  this  experiment,  made  upon  the  veins,  fre¬ 
quently,  as  he  did  thofe  on  the  arteries,  and  nerves,  it  would  have  been 
more  eafy  to  judge  of  this  matter.  As  far  as  I  remember,  at  prefent,  how¬ 
ever,  he  fpoke  of  it  once  (r)  only  ;  and  I  am  fure  he  has  not  mention’d  it 
again,  in  the  twenty-third  chapter  of  the  book  De  Pulfuum  Ufa,  although 
Salius  (j)  hints  at  it. 

But  he  has  neither  faid,  in  what  kind  of  animals,  nor  in  what  part  of  the 
neck,  he  tied  up  the  veins.  Both  of  which  circumftances  were  proper  to  be 
confider’d,  by  thole  who  would  call  his  experiment  into  queftion.  For  as  to 
what  relates  to  the  firft,  the  more  modern  authors  have  generally  made  the 
experiment  on  dogs  -,  and  how  feldom  he  diffe&ed  thefe,  even  when  dead,  no 
one  can  be  ignorant,  who  is  vers’d  in  his  writings :  but  what  living  animals 
he  made  ufe  of,  for  thefe  experiments,  as  far  as  relates  to  the  nerves,  we 
know  (/) ;  as  to  the  fanguiferous  velfels,  however,  if  I  remember  rightly, 
we  are  ignorant:  and  yet,  who  can  deny  that  there  may  be  a  different  difpo- 
fition,  or  communication  of  the  velfels,  in  different  fpecies  of  animals  ?  fince 
it  is  not  uncommon  in  the  fame  fpecies,  and  even  in  one  and  the  lame  animal, 
by  comparing  the  velfels  that  lie  on  the  right  fide,  with  thofe  of  the  left,  to 
find  a  variation  in  their  difpofition.  Wherefore,  it  is  proper  to  confider, 
alfo,  the  other  circumftance,  that  is,  in  what  part  of  the  neck,  the  jugular 
veins  have  been  tied.  And  that  there  is  a  difference  even  in  dogs,  betwixt 
an  inferior,  and  a  fuperior  fituation,  either  from  the  caufe  juft  pointed  out, 
or  from  fome  conftant  caufe,  you  may  conjecture  from  the  experiments  of 
the  celebrated  L’Amur  («). 

For  this  gentleman,  while  he  was  enquiring  into  other  things,  happen’d  to 
confider  the  internal  jugular  veins  of  many  dogs,  and  had  them  tied  up,  in 
two  of  thefe  animals,  for  a  Ihort  fpace  of  time  :  in  the  firft  of  them  (#),  after 
the  ligature  had  been  made  below  their  bifurcations,  he  oblerv’d  nofleepinefs 
at  all ;  but  in  the  fecond  (jy),  when  the  ligature  was  made  as  near  to  the  thorax, 
as  it  could  pofiibly  be,  the  dog,  fays  he,  44  fell  into  a  profound  fleep.”  I 
with  we  had  more  of  thefe  oblervations,  and  continu’d  for  a  longer  time  •,  fo 
that  we  might,  by  comparing  the  old  ones  of  Galen,  and  the  new  ones,  with 
each  other,  as  we  did  in  thole  above,  draw  fome  more  liable  conjecture,  in 
relation  to  this  experiment,  from  thence.  But  none  occur,  at  prelent,  except 

(0)  An  fangu.  in  arter.  &c.  c.  8.  (/)  Vid.  de  Anat.  Admin.  1.  8.  c.  8.  &  1. 

(/)  De  Hippccr,  &  Plat.  Decret.  1.  z.  c.  6.  de  Prsecogn.  ad  Poiih.  c.  5. 

(q)  Vid.  fupra,  n.  24.  (r)  cit.  c.  6.  («)  loc.  cit.  fupra,  ad  n.  24. 

(j)  De  Aff.  particul.  c.  2.  (*)  Exp.  3.  *  (y)  Exp.  4. 

U  u  u  2 


one 


5  i  6  Book  II.  Of  Difeafes  of  the  Thorax. 

one  or  two,  which  I  ffiall  produce  below  (z),  and  which  are  rather  favour¬ 
able,  than  repugnant,  to  Galen.  And  indeed,  thole  are  favourable  to  him,., 
which  I  pointed  out  above  from  Emettus,  and  in  particular,  from  the  cele¬ 
brated  Van  Swieten  (a).  For  the  laft  of  thefe  gentlemen  certifies,.  “  that  he 
“  tied  up  the  jugular  veins,  without  any  obfervable  evil and  moreover, 
“  that  after  four  days,  he  found  the  dog  entirely  healthy,  and  found.”  Me- 
verthelels,  as  in  thefe  very  dogs,  the  carotid  arteries  were  tied  at  the  fame 
time,  or  had  been  tied  before  j  you  fee  plainly,  that  thefe  experiments  were 
not  quite  the  fame  as  Galen’s.  The  other  experiments  that  occur,  evidently 
relate  to  the  external  jugulars :  and  although  i  know  that  thefe  communicate 
with  the  internal,  and  lor  that  reafon,  as  well  as  by  their  own  office,  do,  not 
a  little,  contribute  to  the  more  expeditious  return  of  the  blood,  from  the  in¬ 
teriors  of  the  cranium  ;  yet  I  do  not  think  that  they  are  at  all  to  be  put  in 
competition  with  the  internal,  in  this  office  •,  and  indeed,  Harderus  having 
tied  up  the  external  veins,  in  a  dog,  not  only  did  not  fee  the  fymptoms 
of  the  brain  being  injur’d,  or  opprefs’d,  as  I  have  faid  above  (£),  but  alfo 
found  in  the  brain,  upon  diffedtion,  “  only  a  fmall  quantity  of  extravafated 
“  blood,  nor  yet  any  traces  of  grumous  concretions  in  the  finuffes,  which',. 
“  fays  he,  is  a  very  firong  argument,  that  when  this  paffiage  was  (hut  up, . 
“  nature  prepar’d  itfelf  anothei  way,  efpecially  through  the  internal  jugular 
“  veins.” 

The  lectures  of  Boerhaave,  indeed  (c),  mention  the  experiments  of  Drelin- 
curt,  from  whence  it  appears,  that  the  external  jugulars  being  tied  up,  the 
dog  has  a  ftertor,  tumour,  and  fuffocation  come  on.  But  if  they  refer  to  the 
fourth  experiment  (d),  in  this  we  read,  that  four  other  veins,  to  wit,  the  cru¬ 
ral,  and  the  axillary,  were  tied  up  at  the  fame  time,  and  in  a  dog,  which  had 
been,  already,  tortur’d  for  three  days  together,  by  one  experiment  or  other. 
Bur,  perhaps,  other  experiments  are  alluded  to,  which  efcape  me  •,  or,  per¬ 
haps,  thole  might  even  be  intended,  which  Drelincurt  had  by  him  in  writing, . 
as  is  hinted  at  the  latter  end  of  thofe  which  he  has  publiffi’d.  For  in  that 
place,  and  elfewhere  (e),  thefe  fame  lectures  fuppofe  other  experiments  of 
Drelincurt,  in  which,  befides  the  carotids,  the  vertebral  arteries  were  alfo 
tied,  which  I  do  not  remember  to  have  read,  among  thofe  he  has  publiffi’d  j 
nor  do  I  remember  the  experiment  of  Steno,  fpoken  of  in  another  place  (/), . 
“  in  which  it  feem’d  that  the  animal  was  made  apopledlic,  from  the  conftric- 
“  tion  of  the  jugular  veins unlefs  we,  perhaps,  fuppofe,  that  the  author 
of  thefe  ledtures,  though  a  very  great  man,  by  giving  them  extempore,  de¬ 
pended  on  his  memory  ;  which,  as  generally  happens  in  things  of  this  kind, 
muft  fometimes  fail  him. 

32.  Yet  there  are  fome,  who  may  feem  to  refer  the  experiment  of  Lower  (g) 
to  the  internal  jugular  veins-,  whereas  Lower  by  no  means  fays  that-,  and 
what  he  oblerv’d  in  the  living  dog,  and  fought  for  in  the  dead,  fhow’d  no  in¬ 
jury  of  the  brain.  For  at  length,  c-  after  fome  hours,  all  the  parts  above  the. 
“  ligature  were  wonderfully  iwell’d,  and,  within  two  days,  the  dog  dy’d  fuf- 

( z )  n.  32.  (</)  n.  2. 

(a)  n.  24.  (*)  §  695. 

F)  n.  29.  (f)  %  286. 

F)  in  Inflit.  §  8(0,  (g)  Traft.  de  Co.de,  c.  2. 


“  focated, 


Letter  XIX.  Article  32.  517 

44  focated,  as  it  were,  with  an  angina,  while  not  only  the  tears  flow’d 
44  very  copioufly,  through  the  whole  time,  but  alfo,  a  great  quantity 
“  of  l'aliva  from  the  mouth and  after  death,  the  parts  under  the  fkin 
were  found  fweli’d,  that  is  to  fay,  44  all  the  mufcles  and  glands  were 
greatly  diftended  with  limpid  ferum ;”  fo  that  there  feems  to  be  a  con- 
liderable  fimilitude,  in  moll  circumftances,  betwixt  this  dog,  and  the  firft  of 
them,  in  which  I  have  Laid  (*),  that  the  carotid  arteries  were  tied  up  by 
Valfalva;  nor  is  this  obfervation,  perhaps,  to  be  explain’d  otherwife,  than  as 
will  be  hinted  at  prefently,  for  many  reafons,  but  elpecially  by  reafon  of  a 
certain  experiment  of  Jo.  Bohnius  ( h ).  It  were  to  be  wifh’d  that  Peyerus  (i), 
(for  he  alfo,  in  like  manner  with  Lower,  faw  44  a  great  quantity  of  water 
44  colledted  here  and  there,  under  the  fkin  of  the  head,  in  the  adipofe  mem- 
44  brane,  and  the  interdices  of  the  mufcles”)  had  particularly  faid,  which  of 
the  veins  he  had  tied  up  in  the  dog ;  for  he  has  only  faid,  that  he  tied  up  the 
44  jugular  veins.” 

Nor  has  Harderus  (£),  the  intimate  friend  of  Peyerus,  fpoken  more  clearly, 
where  he  has  affirm’d,  almoft  in  the  fame  words,  4-  that  others  had  remark’d 
44  the  fame  with  him  although  it  is  mod  natural  to  luppofe,  that  he  did 
not  mean  any  other  than  the  external  veins,  as  he  had  exprefsly  mention’d, 
fome  years  before,  in  the  paflage  I  pointed  out  above  (/).  But  Pechlinus 
feems  to  have  underdood  Lower  otherwife.  For  as  you  have  it  in  the  Seoul  - 
chretum  itfelf  (m),  he  lays,  44  I  have  known  for  a  long  time,  by  a  common 
44  experiment,  that  when  the  internal  jugular  veins  are  tied  up,  in  a  calf  that 
44  is  half  dead,  the  brain  is  copioufly  inundated  with  dagnating  ferum.” 

finally,  the  celebrated  Oederus  («),  having  tied  up  the  external  veins  in  a 
dog,  tells  us,  that  he  made  thefe  obfervations  :  44  That  the  veins  above  the 
44  ligature  did  not  fwell  much,  nor  did  the  dog  fufier  much  apparent  injury 
44  from  the  operation,  nor  did  he  become  dupid,  but  through  almod  the 
44  whole  day  was  brifk,  and  continually  barking,  and  fnrviv’d  to  be  the  fub- 
44  jedt  of  another  experiment.  A  portion  below  the  ligature,  which  difap- 
44  pear’d  upon  every  refpiration,  was  at  length  fill’d  again.”  Whether  he 
did  not,  probably,  write  44  infpiration,”  you  will  perhaps  determine  from 
what  will  be  produc’d  below  ( 0 ).  However,  he  alfo  complains  much  of  the 
want  of  perfpicuity,  in  the  narration  of  Lower  his  words  are,  44  When  he 
44  fays  that  he  tied  up  the  jugular  veins,  it  is  uncertain  whether  he  meant 
44  the  external  only,  or  not.”  And,  indeed,  Noveflus  feem’d,  formerly,  to 
have  underdood  both  (y>),  as  he  put  ligatures  round  both  the  internal  and 
external.  And  having  done  this  in  one  dog,  and  even  in  a  fecond,  in  like 
manner,  he  obferv’d  (which  I  do  not  find  in  Lower)  figns  of  the  head  being 
made  more  pond’rous,  and  fome  tears  ;  but  the  dogs  dying  after  fome  time, 
he  found  no  extravafated  ferum,  either  on  the  infide,  or  on  theoutfide,  of  the 
cranium  :  and  he  judg’d,  that  if  all  the  jugular  veins,  and  their  branches, 
were  tied  up,  the  circulation  of  the  blood  would  be  continu’d,  though  more 


(*)  fupra  n.  25. 

(/j)  Circ.  Anat.  Prog.  6.  in  cane  quarto. 
(/)  IVIeth.  hift.  anat.  med.  c.  6. 

(if)  Apiar.  in  fchol.  ad  obf.  72... 

(/)  n.  29. 

3 


(m)  1.  1.  S.  16.  obf.  5.  in  Additam. 

(;;)  Differt.  de  Derivat.  &c.  §  33. 

(0)  n.  33.  &  feq. 

(/)  Lettr.  de  G.  Defnoves  IV- 

flowly, 


—  l  8  Book  II.  Of  Difcafes  of  the  Thorax. 

(lowly,  inafmuch,  fays  he,  as  it  returns  by  the  finus  of  the  medulla  fpinalis. 
And  I  very  well  remember,  that  when  Novefius  related  thefe  things  to  me, 
and  Valialva,  at  Bologna,  which  he  foon  after  publifh’d,  he  fubjoin’d,  that 
when  he  tied  up  thole  veins,  he  took  great  care  not  to  tie  up  any  thing  but 
the  naked  veins  themfelves  :  and  he  therefore  fulpe&ed,  that  Lower  had  tied 
up  the  adhering  lymphasdu£ts  together  with  thofe  veins,  and  that-  thefe  being 
ruptur’d  from  too  great  a  plenitude,  had  giv’n  rife  to  that  quantity -of  limpid 
ferum.  And  this  fufpicion  was  not  difapprov’d  by  Valfalva,  and  might  even 
be  confirm’d  by  a  certain  oblervaticn  of  Drelincurt  (q).  However  this  is,  at 
lead  the  obfervations  of  Novefius  fhew,  that  Galen  might  have  feen  no  in¬ 
jury  worthy  notice,  a  little  after  he  had  tied  up  the  internal  jugular  veins,  fince 
Novefius  obferv’d  no  more,  when  the  internal  and  external  were  both  con- 
ftri&ed. 

3j.  You  will,  perhaps,  afk,  what  the  experienc’d  man  Valfalva  obferv’d 
when  the  fame  veins  were  conflrifted.  And  as  1  lately  examin’d  all  his 
papers  with  care,  for  this  very  reafon,  though  I  found  nothing  relating  to 
the  tying  up  of  thefe  veins,  I  found  other  things,  nevertnelefs,  which,  as 
they  relate  to  the  fame  veins,  and  to  the  carotid  arteries,  that  were  open’d, 
or  laid  bare,  in  living  dogs,  I  fhall  not  think  it  any  trouble  to  defcribe,  in  this 
place,  to  you,  as  I  promis’d  in  the  former  letter(r),  and  to  tell  you  alfo,  at  the 
lame  time,  in  a  few  words,  what  has  appear’d  to  me  from  repeating  the  fame 
obfervations.  Valfalva,  therefore,  having  cut  open  the  (kin  in  the  neck,  and 
laid  bare  the  jugular  veins,  obferv’d  that  thefe  vefiels,  which  were  turgid 
with  blood,  became  lefs  tumid,  when  the  dog  infpir’d  ;  but  in  exfpiration, 
that  they  again  became  turgid,  efpecially  when  the  refpiration  approach’d 
more  nearly  to  its  natural  Hate :  and  he  law'  the  fame  afterwards,  alfo,  in 
other  do^s,  and  a  kind  of  fyftole  and  diaftole  in  thofe  veins.  Befides,  by 
comprefifng  them,  he  fiw  the  blood,  which  was  below  the  comprefs’d  part, 
flow  back  towards  the  heart,  though  it  was  not  urg’d  from  above. 

In  another  dog,  he  cut  afunder  the  carotid  artery,  and  faw  what  he  ex¬ 
pected,  from  the  higher  communications  of  the  branches  of  both  carotids, 
one  with  another,  that  blood  flow’d  alfo  from  the  uppper  part  of  the  dif¬ 
fered  artery,  and  that  not  in  a  fmall  quantity,  but  with  lefs  impetus  from 

the  lower  part. 

Thefe  things,  however,  which  he  obferv’d  of  the  carotid  artery,  and  thofe 
which,  in  theTecond  place,  he  remark’d  of  the  jugular  veins,  were  in  ge¬ 
neral  known,  indeed,  at  that  time  to  all,  bur,  i  believe,  not  in  that  very 
manner  which  he  obferv’d  them  equally  known  to  all.  But  as  to  thole  which 
he  obferv’d,  in  the  .fir It  place,  of  the  jugular  veins,  they  would,  perhaps, 
have  been  known  to  no-body,  even  at  this  time,  if  the  obfervations  of  the 
celebrated  Schlidingius  (j),  which  were  publifh’d  in  the  year  1750,  had  not 
put  feveral  perfons  upon  enquiring,  why  the  brain  is  rais’d  up  in  every  exfpi¬ 
ration,  and  fubfides  in  every  inlpiration.  For  when  men  of  great  fagacity 
enquir’d  into  this  caufe,  at  Gottingen,  and  Montpelier,  they  lit  on  the  fame 
observation  as  Valfalva  did  formerly,  and  extended  the  fame  motions  of  the 

(j)  Memoir,  prefent.  a  l’Acad.  R.  des  Sc. 
Tom.  1. 


(y)  Experim.  Anat.  Canici'd.  6.  n.  4,  -5* 
p)  N.  11. 


veins, 


Letter  XIX.  Article  34.  5  r  9  - 

reins,  which,  as  far  as  I  know,  had  b  en  feen  by  nobody  till  that  time, 
betides  Valfalva,  to  other  larger  veins,  by  the  diligence  of  their  own  expe¬ 
riments.  Which  one  thing  1  was  willing  to  add,  as  I  revis’d  this  letter,  to 
the  others  that  1  had  written  to  you  fo  long  before  •,  and  yet  not,  for  that 
reafon,  omit  any  thing  of  thofe  which  will  immediately  follow.  At  firft, 
indeed,  they  will  not  leem  to  correfpond  with  the  great  number  of  continu’d 
experiments,  which  were  made  by  Valfalva,  and  by  other  very  excellent 
men,  whom  I  have  mention’d,  and  whofe  experiments  I  efteem,  as  faithful 
and  true.  But  they  are  not  for  this  reafon  to  be  pafs’d  over;  and  I  even 
think  it  ought  not  to  be  conceal’d,  in  the  firft  place,  that  among  fo  many 
anatomical  experiments  of  this  kind,  one  may  be  extant,  which  is  not  re¬ 
pugnant  to  thofe  things  which  reafon,  and  even  the  eyes  themfelves,  fhew  to 
exilt  in  the  bodies  of  living  men  fometimes,  that  is  to  fay,  when  the  veins 
fwell  at  the  time  of  infpiration,  and  are  depleted  at  the  time  of  exfpiration  : 
and  fecondly,  that  the  very  ingenious  writers  of  thefe  experiments  may  be 
able,  if  they  pleale,  to  determine  properly,  every  one  from  their  own  ex¬ 
plications,  what  is  the  caufe  of  fo  great  a  difference  between  their  experi¬ 
ments  and  mine;  whether  it  is  the  lame,  which  I  fee  is  mention’d  (/). to 
explain  what  I  faid  was  feen  in  living  men  ?  or  another  caufe,  which,  if  you 
read  attentively  what  1  faw  immediately  from  the  beginning  of  every  infpi¬ 
ration,  may  better  agree  with  thefe  obfervations  ? 

34.  For  when  I  repeated  the  experiments  of  Valfalva,  which  I  have  a 
little  before  deferib’d,  about  the  end  of  the  year  1723,  I  made  thefe  re¬ 
marks.  The  integuments,  on  the  right  fide  of  the  neck,  being  fo  feparated, 
and  drawn  back,  in  a  dog,  that  the  whole  of  the  external  jugular  vein,  which 
had  been  cover’d  by  them,  lay  quite  bare,  a  tremulous  kind  of  motion  was 
feen  in  it,  .as  there  was  alfo  in  the  neighb’ring  part  of  the  neck,  as  much  of 
it  as  was  la  d  bare.  Soon  after,  fixing  my  eyes  attentively  on  the  vein,  and 
applying  my  hand  to  the  abdomen,  1  very  evidently  perceiv’d,  that  as  often  ' 
as  the  mufcles  of  this  part  were  rais’d  by  infpiration,  that  vein,  at  the  fame 
time,  immediately  became  tumid,  nor  did  its  tumour  decreafe  before  the  ab¬ 
do  nen  fubfiued  in  exfpiration  ;  for  at  that  time,  alfo,  the  turgefcency  of  the  : 
vein  manifeffly  decreas’d.  And  as  thefe  things  were  contrary  to  the  obfer- 
vation  of  Valfalva,  1  obferv’d  them  fo  much  the  more  diligently  again  and  . 
again,  and  took  care  that  they  (hould  be  obferv’d  by  thofe  who  were  prefent,  , 
among  whom  were  thofe  accurate  and  fkilful  anatomifts,  Vulpius  and  Me- 
diavia,  and  other  very  learned  men,  befides  a  number  of  ftudents  :  and 
the  experiment  alwavs  iucceeded  as  I  have  declar’d  to  you:  and  there  feem’d 
the  lefs  danger  of  falling  into  error,  in  proportion  as  refpiration,  in  both  its 
parts,  or  infpiration,  at  lead,  was  great,  and  of  long  continuance,  and,  in  ■ 
alternate  o.der,  always  fimilar  to  itlclf ;  fo  that  there  was  no  difference  in  its 
ftate,  through  the  whole  of  the  oblervation.  And  I  wifh’d,  indeed,  at  that 
time,  refpirat  on  might  at  length  return  to  its  natural  ffate,  that  I  might 
more  certainly  compare  my  oblervation  with  the  oblervation  of  Valfalva.  But 
now  thole  reafons,  for  which  I  have  not  conceal’d  this  experiment,  make  me 

(/)  Vid.  Walftorff  Differt,  fid.  Experim.  circa  mot.  cerebri  &c.  §  28. 


the  e 


\ 

j  2o  Book  IT.  Of  Difeafes  of  the  Thorax. 

the  more  difappointed,  that  the  natural  ftate  of  refpiration  did  not  return- 
Nor  indeed  could  1  fee  any  other  fyftole,  or  diaftole,  of  the  jugular  vein, 
befides  thefe;  and  perhaps  Valfalva,  under  thefe  names,  fignified  that  fubfid- 
ing  and  turgefcency  of  the  jugular  vein,  correfponding  with  the  alternate 
parts  of  refpiration.  But  in  the  remaining  obfervations,  there  was  nothing 
at  all  repugnant  to  the  obfervations  of  Valfalva.  For  having  conftring’d 
the  neareft  and  upper  part  of  the  vein,  by  prefling  my  finger  upon  it,  in  » 
fu’ch  a  manner,  that  I  divided  the  upper  column  of  blood  from  the  lower  en¬ 
tirely  ;  the  blood,  neverthelels,  which  was  below  my  finger,  flow’d  down 
within  a  fliort  fpace  of  time,  and  left  the  vein  empty,  or  almoft  empty. 

Finally,  thefe  things  which  I  have  faid,  being  feen  again,  and  often,  one  ' 
of  the  carotid  arteries  on  the  fame  fide  was  laid  bare,  and  disjoin’d  from  the 
neighb’ring  parts ;  after  that  it  was  a  little  rais’d,  and  cut  afunder  tranf- 
verfly,  at  about  the  middle  of  the  neck  longitudinally.  As  we  were  in  doubt, 
whether  blood  flow’d  from  the  upper  part  immediately  after  di.ffeCtion,  as  it 
certainly  did  from  the  lower ;  we  thought  proper,  in  order  to  remove  this 
doubt,  through  the  reft  of  the  oblervation,  that  the  celebrated  Vulpius,  who 
flood  by  as  an  affiftant,  fhould  hold  both  parts  of  the  artery,  which  was  cut 
afunder,  between  his  fingers,  but  one  in  one  hand,  and  the  other  in  the 
other,  that  they  might  not  fall  together,  and  at  the  fame  time,  fhould  incline 
one  a  little  to  this  fide,  and  the  other  a  little  to  that,  to  prevent  the  blood 
of  one  part  meeting  the  blood  of  the  other,  and  fo  confounding  our  obfer¬ 
vations,  but  that  it  might  be  very  eafy  to  obferve  the  difference  between  the 
upper  and  the  lower  part.  And  this  he  having  done  almoft  fooner  than  it 
was  faid,  it  was  very  evident,  that  the  blood  fprang  forth  from  both  parts,  to 
a  great  diftance,  although  in  a  fmaller  thread,  and  with  lefs  impetus  from  the 
upper  part,  than  the  lower ;  and  this  we  continu’d  long,  and  according  to 
our  pleafure.  Yet  the  upper  ftream  was  not  of  fo  remarkable  a  fmallnefs, 
that  the  reafon  did  not  lufficiently  appear,  why  Galen  had  admonifh’d  us 
even  of  old  (»),  in.  thofe  experiments,  in  which  the  fanguiferous  veffels  are 
cut  afunder  in  the  neck,  “  that  to  prevent  the  animal  from  immediately  pe- 
“  riffling,  in  confequence  of  the  immoderate  profufion  of  blood,”  had  ad- 
moniffl’d,  I  fay,  that  “  we  fhould  previoufly  tie  up  the  neck,  both  in  the 
“  upper  and  the  lower  part,  with  very  tight  ligatures;”  that  is  to  fay,  they 
being  drawn  acrofs,  behind  the  afpera  arteria,  “  and  then  cut  through  that 
“  part  of  the  veffels,  which  is  intercepted  betwixt  the  ligatures.”  And  this 
circumftance  being  fufficiently  attended  to,  it  was  found  that  the  inferior 
part  of  the  artery  contracted  itfelf,  in  fuch  a  manner,  where  it  was  cut,  that 
fcarce  any  thing  flow’d  out  of  it.  But  a  little  of  the  fame  extreme  part  be¬ 
ing  laid  hold  of,  with  the  forceps,  the  blood  immediately  return’d  to  its 
former  manner  of  dreaming  forth:  whereas,  in  the  mean  while,  the  maftoid 
mufcle,  which  we  had  before  cut  acrofs,  in  the  middle  of  the  neck,  had 
not  contra-fled  the  differed  parts  towards  its  extremities ;  fo  that,  without 
applying  any  force,  you  might  bring  one  part  clofe  to  the  other,  by  laying 
hold  of  them  with  the  hands,  and  they  lay  contiguous  to  one  another,  as 
they  had  done  before ;  the  dog  at  that  time  being  fo  ftrong  and  vigorous, 


(«)  Cap.  i l:o  6.  cit.  fupra,  ad  n  31. 


that 


* 


I 


Letter  XIX.  Article  35.  3*21 

that,  all  thefe  things  being  fufficiently  infpedted,  the  abdomen  open’d, 
many  parts  in  the  belly  examin’d,  and  fome  ligatures  made  round  the  vefiels, 
when  the  thorax  was  at  length  laid  open,  the  heart  even  at  this  time 
beat  ftrongly,  and  regularly.  But  tl^efe  things  belong  to  other  places. 

35.  Now  let  us  return  to  our  firft  defign  (x)  :  from  which  I  am  pleas’d  to 
have  withdrawn  you,  by  a  prolix  recital  and  examination  of  experiments ; 
for  it  is  far  lefs  melancholy  and  dreadful  to  be  detain’d  long  in  the  con- 
fideration  of  dogs,  which  are  tortur’d  by  experiments,  than  in  the  confi- 
deration  of  ftrangulated  men.  But  we  mult  now  return  to  this  fubjedt, 
being  about  to  judge  of  the  caufes  which  are  generally  afiign’d  for  their 
deaths,  fince  we  have  now  gone  through  the  confideration  of  all  the  expe¬ 
riments,  both  of  the  ancients  and  moderns,  that  are  neceflfary  hereto. 

To  the  nerves  therefore,  which  accompany  the  blood-vefiels  in  the  neck, 
being  conftridted  with  the  halter,  I  do  not  fee  that  any  one,  at  this  day,  re¬ 
fers  the  fudden  death  of  thefe  ftrangl’d  perfons :  and  if  any  did,  I  fhould 
recommend  to  them  the  confideration  of  thofe  ancient  and  late  experiments, 
which  are  pointed  out  above  (jy). 

Nor,  indeed,  do  I  think  there  are  many,  who  account  for  it  from  the 
compreflion  of  the  carotid  arteries ;  and  yet  I  think  that  if  thofe  things  were 
confider’d,  which  are  juft  now  propos’d  (2),  and  explain’d  at  large,  thefe 
gentlemen  would  be  greatly  in  doubt  how  to  determine. 

But  on  the  contrary,  I  know  that  the  greater  part  agree  with  that  very 
learned  man,  who,  after  Wepfer  ( a ),  taught,  in  more  than  one  place,  that 
the  return  of  the  blood  was  prevented  by  the  aftridtion  of  the  jugular  veins, 
as  the  blood  is  ftill  carried  to  the  brain,  by  the  carotid  arteries,  which  are 
not  entirely  comprefs’d,  and  ftill  more  by  the  vertebral  arteries ;  and  that, 
for  this  reafon,  a  fatal  apoplexy  is  immediately  brought  on,  “  nor  is  there 
**  any  other  reafon  for  the  death  of  perfons  who  are  hang’d for  the  blood, 
they  fay,  being  thus  congefted  in  the  brain,  confequently  brings  on  a  violent 
compreflion,  and  perhaps  even  the  tender  vefiels  are  ruptur’d,  and  the  blood 
is  effus’d  into  the  ventricles,  and  the  convolutions  of  the  brain. 

But  can  there  be  more  blood  carried  into  the  brain,  than  when  no  com¬ 
preflion  is  applied  to  the  carotid  arteries,  or  its  return  be  more  hinder’d, 
than  when  ligatures  are  feparately  applied  round  each  jugular  vein,  and  not 
only  about  the  internal  or  external  only,  as  was  done  in  the  experiments  of 
Galen,  or  Harderus,  Oederus,  and  perhaps  even  of  Lower,  but  about  the 
internal  and  external  both  at  one  time,  as  I  have  told  you  that  Novefius 
did  ?  And  did  any  one  of  thefe  gentlemen  fee,  any  apoplexy  I  will  not  fay, 
but  any  fleepy  diforder,  which  immediately,  or  foon  after,  follow’d  ?  Read 
their  experiments  over  again,  I  befeech  you,  that  I  have  pointed  out  above  (b). 
You  will  certainly  find,  that  nothing  of  that  kind  was  feen :  or  if  it  has 
happen’d  fometimes,  to  fome  other  perfons,  that  they  have  feen  otherwife, 
from  a  conftridtion  of  the  veins,  nerves,  or  arteries  in  the  neck  I  would 
have  you  call  to  mind,  that  when  I  fpeak  here  of  the  death  of  hang’d  per- 


( x )  Supra,  n.  20. 

(y)  n<  23- 

(ss)  n.  24.  Sc  quinque  feqq. 

Voi.  I. 


(a)  Exercrt.  de  loco  all',  in  apopl. 
(J)  n.  29.  31.  32. 


fons,» 


X  xx 


_$*  2  2  Book  II.  Of  Difeafes  of  the  Thorax. 

fons,  I  enquire  into  the  caufes,  not  that  fometimes  only,  but  that  always,  or 
almoft  always,  and  fpeedily,  kill.  What  is  then  the  cafe  ?  Are  there  other 
caufes  befide  thole  we  have  juft  examin’d,  which  we  ftiould  rather  accufe  ? 
as,  for  inftance,  the  luxation  of  the  upper  vertebrae,  which  fome  now  fup- 
pofe  (c),  and  Wepfer  (d),  at  his  time,  leem’d  to  fufpeft,  when  the  execu¬ 
tioner  leaps  upon  the  fhoulders  of  the  perfons  who  are  hang’d,  and  with  his 
foot  pufhes  the  head  in  a  tranfverle  diredtion.  But  this  method  is  not  in 
practice  every  where,  and  where  it  is,  there  Columbus  fo  far  denied  ( e )  his 
having  found  a  luxation,  that  he  afferted  a  fradture  of  the  vertebrae  to  be 
much  eafier  than  a  luxation  ;  and  at  length,  whether  you  would  choofe  rather 
to  fuppofe  a  luxation,  or  a  fradture,  from  either  of  thefe,  a  compreflion  of 
the  fpinal  marrow  muft  happen  at  its  beginning  •,  and  from  this  caufe,  im¬ 
mediate  death,  rather  than  an  apoplexy,  would  follow.  And  left  you  fhould 
reply,  that  an  apoplexy  muft  then  follow,  fince  the  vertebral  veffels  are  alfo 
comprefs’d,  either  by  the  luxation,  or  fradture,  of  the  vertebrae,  or  fo  injur’d* 
that  the  blood  cannot  be  carried  into  the  brain,  and  brought  back  from  it, 
even  by  thefe  channels ;  let  us  then  omit  the  confideration  of  fuch  cafes, 
which  I  have  faid  are  not  common  to  all  hang’d  perfons,  and  certainly  were 
not  to  thofe,  who  had  recover’d  from  their  apoplexy,  or  rather  from  that 
fleep  with  which  they  had  been  feiz’d,  after  hanging,  and  let  us  at  leaft  fee, 
by  what  means  we  may  fay,  that  fleep  which  is  common  to  all  is  brought 
on  ;  for  there  is  no  doubt  but  the  fame  caufe  which  brings  on  this  fleep,  if 
it  be  fuddenly  and  violently  applied,  will  foon  kill  the  man. 

36.  Casfalpinus  (/)  fays,  44  they  who  have  not  died  in  confequence  of  being 
44  hang’d,  relate,  that  as  foon  as  ever  the  halter  was  tied,  they  were  feiz’d 
44  with  a  ftupor,  fo  that  they,  at  length,  felt  nothing.”  Wepfer  alfo(^), 
fpeaking  of  a  man  and  woman  who  furviv’d  hanging,  tells  you,  that  the 
woman  lay  like  an  44  apopledtic  perfon,”  forgetful  of  every  thing ;  and  that 
the  man  44  had  not  luffer’d  the  leaft  pain,  after  the  conftridtion  of  the  hal- 
44  ter, — and  had  pafs’d  fome  hours,  buried,  as  it  were,  in  a  profound  fleep.” 
And  I  myfelf  have  heard,  from  a  grave  and  credible  man,  that  a  certain 
criminal,  who,  as  was  fuppos’d,  for  the  fame  caufe  with  thofe,  of  whom 
Cardanus  fpeaks  in  the  Sepulchretum  (£),  could  not  be  entirely  put  to  death 
by  the  executioner,  related  to  thofe  who  queftion’d  him  upon  the  fubjedt, 
that  at  firft  he  found  a  kind  of  fparks  flying  about  before  his  eyes,  and  1000. 
after  that  he  felt  nothing,  or  at  leaft  nothing  but  as  if  he  was  afleep.  And 
this  cafe  is  much  like  that  related  by  Bacon  (*),  except  that  he  who  had 
hang’d  himfelf,  after  44  an  appearance  of  fire,  now  began  to  fee  44  darknefs,” 
that  is,  nothing  at  all,  when  being  immediately  taken  down  from  this  very 
fhort  fufpended  ftate  by  a  friend,  he  began  to  fee  a  fomewhat  pale  colour  j. 
yet  felt  no  pain.  Finally,  I  faw  a  woman  whom  thieves,  that  they  might, 
rob  the  houfe  fafely  in  the  night,  had  bound  about  the  neck  with  a  twilled; 
handkerchief,  in  fuch  a  manner,  that  they  did  not  doubt  but  fhe  was  dead.. 


(r)  Vid.  fupra,  n.  14. 

(d)  Exercit.  cit. 

( e )  n.  14.  cit. 

'(f)  1.  2.  Quajft.  Medi  1$. 


4 


(g)  Exercit.  paulo  ante  cit-,. 
{h)  1.  4.  S.  12.  obf.  ii. 

(>),  Hift.  Vit..&  Mort. 


Letter  XIX.  Article  37.  523 

This  woman  was  found  with  her  face  fwell’d,  and  livid,  and  her  mouth  very 
frothy ;  which  I  take  notice  of  for  this  reafon,  that  you  may  underhand  in 
regard  to  the  aphorifm  which  mention  is  made  of  above  (£),  that  it  is,  as 
many  others  frequently  are,  to  be  admitted  with  fome  exception  ;  for  (he  was 
lav’d  by  the  induftry  and  care  of  the  phyficians,  blood  being  taken  from  her 
arm  and  foot,  and  fuch  medicines  as  are  call’d  cardiacs  being  adminifter’d,  as 
foon  as  it  was  polfible  to  get  them  down  ;  by  which  method  of  cure,  you  will 
find  in  Riolanus  (/),  and  Bacon  ( m ),  that  other  ftrangulated  perfons  generally 
efcap’d,  fomentations  and  warm  baths  being  added  ;  this  woman,  therefore* 
after  (he  began  to  be  a  little  reliev’d,  by  taking  off  the  handkerchief,  lay 
many  hours,  even  then,  before  (he  return’d  entirely  to  herfelf.  You  fee,  1 
mention  many  examples,  that  you  may  not  be  in  any  doubt,  what  is  com¬ 
mon  to  ftrangulated  perfons,  and  may,  at  the  fame  time,  obferve,  by  confi- 
dering  over  again  the  experiments  made  upon  dogs,  which  I  have  let  before 
you,  whether  any  thing  of  that  kind  has  happen’d  when  the  nerves,  the  arte¬ 
ries,  or  the  veins,  have  been  tied  up  in  the  neck  of  thefe  animals.  And  if 
this  has  not  happen’d  in  any  of  them,  or  even  if  it  has  not  happen’d  in  the 
greateft  part  of  them,  the  caufe  of  fuffocation  muft  be  fought  for  elfewhere. 

37.  And  to  me,  indeed,  it  feems,  when  I  confider  all  thefe  circumftances, 
that  fomething  (till  remains,  which  might  be  enquir’d  into  by  experiment; 
that  is,  whether  it  would  happen  otherwife  to  dogs,  if  not  any  velfels  fingly, 
but  all  the  velfels  in  general,  were  tied  up  by  putting  ligatures  on  them. 
For,  that  different  circumftances  may  take  place,  when  any  particular  vef- 
fels  only  are  conftring’d,  from  what  muft  happen  when  they  are  all  tied  up, 
is  not  only  confirm’d  by  reafon,  but  by  experience.  And  as  you  may  fee 
what  happens,  when  the  nerves,  or  arteries,  fingly  are  tied,  not  only  from 
the  prefent  letter,  but,  alfo,  from  the  thirteenth  of  myEpiftoke  Anatomic®, 
you  will  alfo  fee  in  the  fame  place  ( n ),  how  dilfimilar  the  fymptoms  are,  and 
how  much  more  violent  alfo,  that  have  happen’d  from  both  being  tied  up  at 
once.  Call  to  mind,  likewife,  thofe  circumftances  which  I  have  mention’d 
above  (0),  in  relation  to  the  Ihe-goat  of  the  mountebanks,  and  of  the  young 
men  of  Alfyria  and  Pifa,  that  both  the  one  and  the  other  fell  down,  hav¬ 
ing  their  fenfes  and  power  of  motion  fulpended  into  a  profound  deep.  But 
the  goat  certainly  fell  down  in  this  manner,  when  the  bandages,  which  were 
thrown  round  the  velfels  and  nerves,  that  pafs  together  through  the  neck, 
were  drawn  tight ;  and  it  is  not  to  be  fuppos’d,  that  it  was  in  the  power  of 
mountebanks,  to  diftinguifh  veins  and  arteries  from  each  other  ;  fo  that  it  is 
molt  probable  they  were  all  comprefs’d  together.  Nor  indeed  is  it  in  the 
power  of  anatomifts  themfelves,  in  fo  great  a  vicinity  of  nerves,  and  velfels 
of  both  kinds,  and  I  may  even  fay,  in  fo  great  a  cohefion,  to  comprefs  the 
one  rather  than  the  other,  without  wounding  the  fkin:  nor  does  Columbus 
feem  to  have  done  otherwife  (/>).  And  we  muft  fuppofe  the  fame,  finally, 
of  the  experiments  of  Ariftotle  (*),  who,  though  by  his  words  he  means  the 
jugular  veins,  and  thofe  the  internal,  yet  fays,  “  that  they  were  laid  hold  of, 

( l )  n.  9.  («)  n.  31. 

(/)  Anthropogr.  1.  1.  c.  18.  (0)  n.  22.  (p)  ibid. 

\tn)  Hift.  modo  cit.  (*)  Vid.  fupra,  n.  21. 

X  x  x  2  ‘‘or 


5  2  4  Book  II.  Of  Difeafes  of  the  Thorax. 

u  or  conftridled,  on  the  outfide,  while  the  perfons,  fo  laid  hold  of,  fell  down, 
“  bereft  of  their  fenfes,  and  having  their  eyelids  comprefs’d.”  And,  indeed, 
Salius  (j),  fpeaking  of  thefe  very  things,  does  not  doubt  but  the  veins,  ar¬ 
teries,  and  nerves,  were  comprefs’d  altogether.  And  Riolanus  (r)  having 
quoted  that  paffage  of  Ariftotle,  fays,  “  that  it  is  not  certain  amongft  antient 
“  authors,  in  regard  to  the  veffels,  which  of  them,  by  being  obftrudled  by 
<c  ligatures,  bring  on  fleep  ;  becaufe  thofe  veffels,. veins,,  arteries,  and  nerves, 
“  are  fo  contiguous  one  to  another,  as  to  have  been  miftaken  fur  each 
“  other.” 

38,  Befides,  as  it  is  obvious  that  in  ftrangl’d  perfons,  of  whom  the  qiref- 
tion  is  chiefly  at  this  time,  not  only  thefe  veffels  in  general,  but  the  afpera 
arteria,  at  the  fame  time,  is  conftring’d  ;  why  may  we  not  fuppofe,  that  this 
caufe,  in  particular,  is  to  be  added  to  the  others  ?  Nor,  indeed,  is  there 
any  occafion  to  make  experiments,  in  order  to  prove,  that  the  effeci  proper 
to  the  total  obftru&ion  of  this  canal,  is  fpeedy  death.  The  cafe  itfelf  has 
happen’d  frequently :  as  when  Drufus,  the  fon  of  Claudius  Caefar,  who  was 
not  arriv’d  at  the  age  of  puberty,  was  fuffocated  “  by  a  pear,  which  had 
“  been  thrown  up  to  fome  height  in  play,  being  receiv’d  in  his  open  mouth,” 
as  Suetonius  (s)  records  it;  or  when  a  robuft  young  man,  of  whom  you  read 
in  the  Sepulchretum  (/),  “  was  fuffocated,  by  refpiration  being  fuddenly 
“  loft,”  from  a  bit  of  meat  having  fall’n  into  the  larynx,  and  totally  flopp’d 
it  up  :  and  this  was  fo  Hidden,  that  there  was  no  time  to  have  the  afftftance  of 
a  furgeon.  1  would  to  God,  fuch  accidents  might  very  feldom,  or  never, 
happen,  and  that  Petit  the  furgeon  (#),  and  lately,  alfo,  the  illuftrious  Hal¬ 
ler  (x),  to  pafs  over  others,  had  not  had  fo  many  fudden  deaths  to  relate,  from 
a  caufe  of  this  kind.  Wherefore,  it  is  not  to  be  wonder’d  at,  that  many, 
even  among  the  more  modern  writers,  as  Dionis  (j y),  Langguthus  (z),  and 
others,  have  fuppos’d,  that  the  death  of  hang’d  perfons  is  owing  to  this  one 
caufe  only,  that  refpiration  is  intercepted  ;  and  that  many  celebrated  men 
have  at  length  pafs’d  over  into  that  opinion,  to  whom  it  feem’d  before,  that 
this  was  to  be  accounted  for,  rather,  from  the  jugular  veins  being  obftrudled, 
than  from  the  ufe  of  the  air  being  impeded. 

And  left  you  fhould  objedt  to  me  with  Wepfer  (*),  that  men  who  dive, 
and  hyfterical  women,  live  without  refpiration ;  although  he  does  not  deny 
that  the  laft  breathe  at  all,  but  to  outward  appearance  only  ;  know,  that  I 
am  not  willing  to  dwell  on  thefe  points  at  prelent,  nor  to  difpute  about  the 
particular  utility  of  the  air,  which  we  inlpire ;  but  only  am  willing  to  fay 
this,  that  if  a  compreflion  made  on  the  nerves,  and  veffels,  at  the  fame  time, 
be  not  thought  fufficient,  of  itfelf,  to  produce  that  effedt,  whofe  caufe  we.are 
now  enquiring  into,  yet  it  is  certainly  iufficient  to  produce  this  effedl,  when 
a  conftridtion  of  the  afpera  arteria  is  added.  For  that  circulation  of  the  blood 
through  the  brain,  which,  when  the  carotid  arteries,  and  jugular  veins,  are 
comprefs’d,  can  but  juft  be  preferv’d,  in  fome  mealure,  by  the  vertebral  ar- 


(q)  De  Aff.  Partic.  c.  2. 

(r)  Anthropogr.  1.  3.  c.  9. 

(j)  De  duodec.  Caefarib.  1.  5.  c.  27. 

(/)  Sedt.  hac  2.  obf  6. 

(«)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1742. 


(a-)  Opufc.  Pathol,  obf.  7. 

(y)  (z)  locis  fupra  iodic,  ad  n.  2 Si  ad 
n.  9.  Vid.  §  5. 

(a)  Exercit.  cit.  fupra  ad  n.  35. 

terieSj, 


Letter  XIX.  Article  38.  523' 

tkries,  and  veins ;  and  if  refpiration  be  totally  impeded,  this  alfo  is  certainly 
prevented.  For  the  air,  that  was  lately  drawn  in  by  the  lungs,  dilates  itleif, 
and,  becaufe  it  cannot  now  return  from  that  warm  place,  as  it  us’d  to  do, 
more  ftrongly  comprefles  the  fmall  vefleis,  which  carry  the  blood  through  the 
lungs,  fo  that  it  mull  of  confequence  ftagnate  in  a  large  quantity,  in  the 
lungs  •,  the  right  ventricle  of  the  heart,  and  the  vena  cava,  as  Thomas  Corne¬ 
lius  (£),  in  fa£t,  found,  in  animals  who  dy’d  with  the  air  confin’d  in  their 
lungs.  And  this  having  happen’d,  the  blood  is  at  the  fame  time  withdrawn 
from  the  vertebral  arteries,  which  they  carry  to  the  brain,  and  at  the  fame 
time  the  return  of  that  blood,  which  had  flow’d  into  the  brain,  from  the 
veins  that  correfpond  to  thefe  arteries,  into  the  fub-clavians,  is  more  diffi¬ 
cult,  inafmuch  as  the  cava,  into  which  thefe  veins  open,  is  fo  diftended,  in 
ftrangl’d  animals,  with  the  blood  which,  as  I  have  faid,  ftagnates  there,  that, 
according  to  the  oblervation  of  the  fame  Cornelius  (c),  it  is  fometimes  rup¬ 
tur’d. 

But  I  do  not  now  fay,  that  no  blood  pafles  through  the  lungs,  immediately 
on  refpiration  being  impeded  •,  but  that  it  pafles  in  lefs  quantity,  and  after 
that  in  Id's,  and  lefs,  fo  that  what  does  pal's,  cannot  be  fuflkgent  to  preferve 
the  circulation  ;  nor  is  there  time  in  this  cafe,  as  in  haemorrhages,  for  the  ar¬ 
teries  to  contradi'  themfelves  more,  and  more,  to  accommodate  themfelves 
to  that  fmall  quantity  of  blood  ;  but  in  the  mean  while,  the  right  ventricle  of 
the  heart  is  fo  dilated  with  blood,  that  it  cannot  prcfently  conflringe  itfelf, 
nor  drive  on  even  a  fmall  quantity  of  blood,  through  the  lungs,  to  the  left 
ventricle,  and  the  arteries.  And  if  impeded  refpiration,  therefore,  of  itfelf, 
and  in  a  fhort  time,  prevents  the  circulation  of  the  blood,  it  muft  of  courfe 
be  prevented,  in  a  much  lfioi  ter  time,  through  the  brain  of  thofe,  in  whom, 
by  reafon  of  the  carotid  arteries,  and  the  jugular  veins,  being,  at  the  fame 
time^conflridted  with  the  halter,  fo  little  blood  is  carry’d  to  the  brain,  as  to 
be  barely  fufficient  to  keep  up,  in  fome  mealure,  the  circulation  of  the  verte¬ 
bral  arteries  and  veins.  But  if  it  happen,  at  any  time,  before  the  tranfit  of 
the  blood  through  the  lungs  be  altogether  impeded,  that  for  thofe  reafons 
which  are  above  mention’d  (d),  fome  blood  may  fiill  continue  to  flow  through 
the  carotids,  which  are  lefs  comprefs’d,  than  the  jugulars  are  •,  not  only  the 
circulation  through  the  brain  will  ftand  (till,  but  the  blood  itfelf  will  be  ac¬ 
cumulated  in  fuch  a  quantity,  as  loon  to  occafion  a  rupture  of  the  vefleis, 
which  happen’d  in  that  woman,  whom,  as  is  before  related  (>),  two  men  had 
ftrangl’d,  by  grafping  her  neck  with  their  hands.  For  in  her,  Littre  found 
blood  extravafated  upon  the  balls  of  the  cranium,  and  in  the  ventricles  :  and 
his  explication  does  not  much  differ  from  this  of  mine.  And  according  to 
this  explication  it  may,  in  like  manner,  be  underftood,  why,  in  a  thief  who 
was  hang’d,  and  whom  Peter  Nanni  differed,  when  I  was  at  Bologna,  the 
longitudinal  finus  of  the  dura  mater  was  rupiur’d:  and  ftill  more,  why  Lan- 
cifi  (/,)  faw,  in  perfons  who  had  been  ftrangl’d,  “  bloody  points  which  ap- 
“  pjear’d  in  great  number,  and  variegated  the  white  fubftance  of  the  medulla. 

(d  n.  9. 

(/)  De  Subit.  Mort.  obf,  4.  in  fin.  a!  n.  8. 

“  of 


(£)  Progymn.  7. 
(c)  ibid. 

(4)  29. 


$z6  Book  II.  Of  Difeafes  of  the  Thorax. 

«  of  the  brain and  why  I  myfelf  faw  all  thofe  appearances,  which  I  have 
before  (^)  defcrib’d  to  you,  in  the  brain  and  lungs  of  a  certain  maniac,  who, 
from  the  univerfal  teftimony  of  thefe  appearances,  was  deftroy’d  by  the  fame 
kind  of  death. 

39.  This  would  be  a  proper  place,  alfo,  to  fpeak  of  thofe  perfons,  whofe 
iudden  deaths  moft  people  account  for  from  a  more  denfe,  or  more  rare  air 
being  taken  into  the  lungs  •,  that  is  to  fay,  from  the  firft  conftringing,  in  the 
fame  manner  as  I  explain’d  before,  the  fmall  veflels  of  the  lungs,  and  the 
latter  not  explicating  or  unfolding  them  •,  fo  that  being  collaps’d,  and  corru¬ 
gated,  they  are  by  no  means  in  a  proper  ftate  to  tranfmit  the  blood :  al¬ 
though,  by  the  experiments  of  the  celebrated  Greenwood  (£),  the  air  of  a 
well,  in  which  the  men  who  went  down  were  deftroy’d,  or  a  lighted  torch  let 
down  was  extinguilh’d  immediately,  was  found  to  differ  from  the  common 
air,  neither  in  denfity  nor  gravity,  neither  in  humidity  nor  elafticity.  But 
notwithftanding  deaths  of  this  kind  happen  frequently,  and  I  myfelf,  in  the 
year  1731,  anlwer’d  for  the  facred  college  of  phyficians  at  Padua,  what  was 
.to  be  done,  left  that  fhould  happen  again  to  thofe  who  go  down  into  a  certain 
fepulchre  at  Efte,  in  the  republic  of  Venice,  which  had  lately  happen’d  to 
three  men,  I  mean,  that  they  were  immediately  fuffocated  •,  yet,  as  no  car- 
cafe  of  a  perfon,  who  was  taken  oft’  by  a  death  of  this  kind,  has  been 
brought  to  Vallalva  or  me,  in  which  we  might  examine  the  ftate  of  the 
vifcera  and  blood,  1  pafs  over  this  difquifttion  at  prefent.  But  if  you  fhould 
afk  me,  why  1  take  upon  me  to  fay,  that  thofe  three  perfons  were  fuffocated, 
I  fhould  anfwer,  that  I  take  upon  me  partly  for  this  reafon,  becaufe  a  bearer 
who  went  down  into  this  vault  five  or  fix  months  before,  was  immediately 
feiz’d  with  a  tightnefs  of  refpiration,  and  alfo  becaufe  one  of  thofe  three 
perfons  lent  forth  a  kind  of  howling,  as  he  died,  and  the  reft  were  writh’d 
with  certain  motions,  like  thofe  who  are  fuffocated,  and  one  of  them  had 
even  a  livid  and  black  body. 

Nor  did  it  happen  very  differently  with  thofe  ten,  who  went,  one  after 
another,  into  a  wine-cellar  at  Verona,  that  was  full  of  the  fteam  of  the  fer¬ 
menting  grape  :  for  every  one  of  thefe  perfons  underwent  the  fame  fate,  fome 
of  them  making  a  noife,  like  howling,  or  bellowing,  and  moft  of  them 
throwing  themlelves  upon  the  ground  l'uddenly,  and  agitating  themfelves 
like  perlons  who  are  fuffocated.  And  in  the  cave,  which,  among  the  Nea¬ 
politans,  goes  by  the  name  of  the  Dog’s  Grotto,  the  learned  Leonard  Ca- 
puano  (7)  teftifies  by  his  experiments,  that  the  beafts  fall  down  immediately 
juft  as  if  they  were  dtal,  except  that  moft  of  them  agitate  their  limbs,  and 
writhe  themfelves,  in  a  miferable  manner.  And  that  you  may  not  fuppofe 
thefe  agitations  of  the  limbs  rather  to  be  convulfive  motions,  by  reafon  of 
the  brain  being  primarily  affedted,  than  fuch  as  are  cuftomary  in  thofe  who 
perceive  themfelves  to  be  fuffocated^  obferve  what  follows  in  the  work  of 
Leonard  -,  I  mean,  that  the  animals  being  taken  from  thence,  half- alive,  into 
the  wholefome  air,  are  reftor’d  in  fuch  a  manner,  that  they  do  not  feem  to 
have  fuffer’d  any  diforder :  that  thofe  animals,  which  do  not  naturally  breathe, 

(g)  Epift.  8.  n.  4.  (/')  Delle  Mofete  Lez.,  1, 

(b)  Saggio  delle  Tranfaz.  Tom.  5.  n.  2, 

are 


Letter  XIX.  Article  40. 

are  deftroy’d  very  flowly,  and  with  great  difficulty  :  that  a  dog,  which  died 
in  this  grotto,  had  his  lungs  fomewhat  contracted  •,  and  frogs,  that  died  there, 
had  their  lungs  collaps’d,  and  empty  of  air.  All  which  I  was  willing  to  take 
notice  of  here,  left  you  ffiould  readily  believe  what  you  will  read  in  the  Se- 
pulchretum  (£),  that  thofe  who  are  deftroy’d  by  the  vapours  of  new  wine,, 
or  with  the  fume  of  charcoal,  “  die  very  placidly  ;  which  alfo  happens  to 
“  dogs  that  die  in  the  cave  which  is  call’d  la  grotta  de'  caniy  or  the  Dog’s 
“  Grotto for  if  all  thefe  animals  died  of  an  affe&ion  of  the  lungs,  rather 
than  of  an  afre&ion  of  the  brain,  “  they  certainly  would  be  troubl’d  with 
“  a  tolling  of  the  arms,  a  drawing  up  of  the  legs,  and  finally  with  an  agi- 
“  tation  and  ftruggling  of  the  whole  body.”  Thus  far  the  Sepulchretum. 
But  in  this  grotto,  alio,  the  height  of  the  mercury  in  the  barometers  is  not 
alter’d  by  the  deadly  vapours  (/) :  nor  in  this  only,  for  the  barometer  dif- 
covers  no  change  in  the  cavern  of  Pyrmont  (*»),  the  phenomena  of  which; 
are  very  fimilar  to  thofe  of  the  Neapolitan  grotto.  And  what  has  been  ob- 
ferv’d  without  difledlion,  or  by  diffedtion,  in  the  bodies  of  thofe  who  have 
been  kill’d  by  the  fteam  of  charcoal,  or  any  well,  the  Commercium  Litte¬ 
rarium  ( n )  will  teach  you,  and  ftill  more  the  Hiftory  of  the  Academy  of 
Sciences  at  Paris  ( 0 ). 

40.  But  although  neither  I,  nor  Valfalva,  have  had  any  opportunity  of 
differing  the  bodies  of  perlons  who  had  been  drown’d  ;  yet  as  I  have  for¬ 
merly  differed  various  kinds  of  animals,  which  I  had  taken  care  to  have 
drown’d,  I  will  not  conceal  what  obfervations  I  have  made.  For  following 
the  example  of  Galen  (/>),  who  “  was  accuftom’d  to  take  ”  for  dilfedlion  an 
ape  that  had  been  “  fuffocated  in  water,”  I  was  not  afraid,  left,  for  that 
reafon,  they  fhould  fwell  too  much,  or  grow  putrid  too  foon  :  for  they  who 
are  afraid  of  thefe  things,  mean,  I  believe,  thofe  carcafes  which  have  been 
long  in  water ;  fo  that  fome  caufes  ceafing,  which  kept  the  internal  air  com- 
prefs’d,  it  difengages,  and  expands  itfelf,  as  I  chufe  rather  to  fuppofe  with 
the  celebrated  Senac  {q),  than  to  account  for  that  enlargement  of  bulk  from- 
water  entering  the  pores  of  the  fkin,  on  which  account  the  bodies  of  drown’d 
perfons  rife  from  the  bottom  of  the  water,  and  fwim  on  the  top.  Nor  did 
Jacobus  Sylvius  (r),  I  fuppofe,  who  preferr’d,  the  bodies  of  men  that  had; 
been  drown’d  to  others,  wilh  for  any  but  frefti  bodies  ;  for  the  reafon  he 
gives  is,  that  in  thefe  bodies  every  thing  is  found,  “  if  you  difcharge  a  great 
“  quantity  of  water,  through  the  cefophagus,  from  the  ftomach,  by  com- 

preffing  it  with  your  hands although  this  very  exception  of  Sylvius  will 
often  feem  to  you  but  little  neceflary,  as  the  obfervations  of  many  perfons. 
are  againft  it.  For  Platerus,  as  you  have  it  in  the  Sepulchretum  (r),  having 
fometimes  experienc’d  it,  found  only  a  little  water  in  the  ftomach  of  thefe 
bodies  *,  fo  that  he  rather  thought  their  death  had  been  owing  to  water,  in- 
ftead  of  air,  falling  into  the  afpera  arteria.  But  Wepfer(/),  in  a  drown’d! 


(/£)  Sefl.  hac  2.  in  Schol.  ad  Obf.  15.. 

(1)  Vid.  Mead  de  Venen.  Tent.  6. 

(jw)  Commere.  Litter.  A.  173.7.' Hebd.  8. 

(,«)  Ibid.  A.  1736.  Hebd.  14.  n.  z. 

(0)  A.  de  Phyf.  n.  5.  &  A.  1701.. 


(p)  De  Anat.  Admin.  I.  1.  c.  3. 

( q )  Hitt,  de  1’  Acad.  R.  des  Sc..  A.  1 723. 

(r)  Ifag.  Anat.  1.  3.  c.  23. 

(A  Seft.  hac  2.  Obf.  44. 

(/)  Eph.  N.  C./Dec,  1.  A.  2.  Obf.  251, 


528  Book  II.  Of  Difeafes  of  the  Thorax. 

beaver,  found  none  at  all  in  the  lungs  ;  and  Waldfchmid  (#)  at  length  con¬ 
firm’d,  “  that  not  the  lead  drop  of  water  was  ever  to  be  found  in  the  fto- 
“  mach,  or  thorax,  of  drown’d  perfons,”  many  other  obfervers  afterwards 
aflenting  thereto,  with  Beckerus  (#),  either  in  men,  or  in  beads,  till  Littre(_>’) 
aflerted,  that  he  had  found  a  little  water  in  the  lungs  of  drown’d  men,  and  a 
great  quantity  in  the  domach. 

41.  It  happen’d  to  me  to  obferve  the  following  things  in  the  creatures  that 
I  (hall  tell  you  of.  Two  guinea-pigs,  male  and  female,  the  fird  of  which, 
that  was  alfo  the  bigged,  liv’d  longed  in  the  water,  had  no  water  either  in 
the  domach,  cefophagus,  or  afpera  arteria  ;  only  a  frothy  humour  was  prefs’d 
out  from  the  lungs  with  the  hand.  As  a  perfon  who  was  prefent  doubted 
whether  the  water  had  not  flow’d  out,  unobferv’d,  fiom  the  cefophagus,  and 
particularly  from  the  larynx,  while  the  pigs  were  taken  out  of  the  water, 
1  order’d  a  third  to  be  fuffocated,  in  like  manner,  and  to  be  taken  out  of 
the  water,  by  being  laid  hold  of  by  the  head,  fo  that  nothing  could  flow 
out  •,  yet  the  appearances  were  the  fame  as  in  the  two  fird,  nor  did  any 
thing  come  out  from  the  lungs,  when  comprefs’d,  unlefs  a  white  watery  froth, 
nor  that  in  great  quantity.  I  did  not  find  the  epiglottis,  which  is  in  thefe 
animals  very  fliort,  deprefs’d,  fo  that  the  entrance  into  the  larynx  lay  quite 
open. 

Hedge-hogs,  alfo,  had  this  part  fliort  and  open.  In  three  of  which  ani¬ 
mals  I  enquir’d  after  the  fame  things  that  I  did  in  the  pigs.  The  fird  of 
them,  being  taken  out  of  the  water  with  the  caution  before-mention’d,  had 
a  fmall  portion  of  frothy  and  watry  humour  in  the  domach,  but  fcarcely  any 
in  the  lungs,  which  were  flaccid.  As  this,  which  had  feem’d  to  be  dead  be¬ 
fore,  fhew’d  itfelf  alive  under  the  knife,  I  would  have  the  others,  which 
were  male  and  female,  be  detain’d  longer  under  water;  for  they  endeavour’d 
to  get  from  under  water  with  great  violence,  and  efpecially  the  female,  though 
the  lead,  jufl  as  the  former  did.  And  while  they  were  under  water,  I  ob- 
ferv’d  that  all  of  them,  but  the  female  mod  of  all,  fent  forth,  every  now 
and  then,  aerial  bubbles  out  of  their  mouths,  which  reach’d  to  the  top  of 
the  water.  In  the  domachs  of  thefe  creatures,  when  dead,  was  no  water: 
but  a  little  froth  could  be  drawn  out,  by  preflfure,  from  the  lungs,  which 
were  of  a  whitifli  colour.  Thefe  hedge-hogs  were,  as  the  former  was  alfo, 
of  that  fpecies,  which  are  mod  like  to  dogs  in  the  nofe ;  and  for  this  reafon 
1  wonder’d  the  lefs,  that  the  hairs,  which  cover’d  the  neck,  chin,  bread,  and 
the  part  of  the  abdomen  that  lay  beneath  it,  befides  the  arm-pits,  and  the 
groins,  were  fill’d  with  fleas,  jud  as  in  any  dog:  and  thefe  two  I  difledted 
about  the  end  of  May.  But  in  the  fird,  which  1  difiedted  in  the  latter  end 
of  October,  I  wonder’d  a  little  to  find  a  living  worm  within  one  of  the 
bronchia,  which  was  oblong,  (lender,  and  white;  whereas  in  that  part,  or 
in  the  other  parts  of  the  lungs,  the  afpera  arteria,  thorax,  cefophagus,  do¬ 
mach,  and  intedines,  all  which  1  open’d,  and  diligently  examin’d,  I  could 
.  neither  find  any  morbid  appearance,  nor  any  other  worm  ;  and  the  hedge¬ 
hog  itfelf  was  ftrong  and  lively,  as  it  was  poflible  to  be.  Thefe  circum- 

(u)  Earund.  Dec.  2.  A.  6.  Obf.  153.  (y)  Hitf.  de  1’  Acad.  R.  des  Sc.  A.  1719. 

( x )  Trad,  de  Submerf.  morte  fine  pota  aqua. 

dances, 


3 


Letter  XIX.  Article  42.  5*9 

fiances,  though  they  do  not  much  belong  to  the  prefent  defign,  yet  as  I  lit 
on  them  at  the  fame  time,  I  was  not  willing  to  pafs  over;  that  you  may 
compare  this  with  the  worms,  which  our  anceftors  (z)  have  aiTerted  to  be 
cough’d  up  from  the  lungs,  whether  you  fuppofe  them  to  have  been  gene¬ 
rated  there,  or  rather  to  have  come  thither  from  fome  other  parts. 

In  a  mole,  with  which  great  pains  had  been  taken,  in  order  to  fuffocate  it 
in  water,  and  which  I,  notwithftanding,  differed  half-alive,  the  ftomach 
contain’d  but  little  water ;  and  from  the  lungs,  which  were  in  other  refpedt* 
turgid,  not  water,  but  a  frothy-  humour,  was  exprels’d.  In  a  domeftic 
moufe,  neither  the  ftomach,  nor  the  lungs,  had  any  part  of  the  water  within 
them,  in  which  the  creature  had  been  fuffocated.  Nor  did  I  find  it  other- 
wife  in  the  dormoufe  of  our  country,  who  died  the  fame  death  ;  for  although 
the  ftomach,  which  was  fomewhat  flaccid,  contain’d  a  fluid,  yet  this  cer¬ 
tainly  was  not  water.  I  alfo  found  the  larynx  of  this  creature  not  fhut  up, 
and  the  epiglottis  fo  low,  that  it  fcarce  appear’d.  And  although  I  do  not 
mention,  in  regard  to  each  drown’d  animal  which  I  differed,  that  the  epi¬ 
glottis  was  not  deprefs’d,  and  the  larynx  not  fhut  up  ;  yet  1  would  have  you 
underftand,  that  there  was  not  one  of  all  thefe  animals,  in  which  I  examin’d 
it,  wherein  I  did  not  find  it  in  the  fame  ftate. 

42.  And  as  I  remember’d,  that,  at  another  time,  when,  for  other  reafons, 

I  was  about  to  difiect  a  young  whelp,  and  two  cats,  which  had  been  born  the 
night  before,  the  firft  had  liv’d  a  long  time  in  the  water,  but  that  the  two 
laft,  after  great  pains-  had  been  taken,  for  a  long  time,  to  fuffocate  them 
under  the  water,  had  begun  to  creep  about  the  anatomical  table,  after  they 
were  brought  to  me  ;  I  refolv’d  to  try,  in  new-born  kittens,  how  long  they 
would  live  in  water,  but  efpecially  to  fee,  when  they  were  at  length  dead, 
what  water  they  contain’d  in  the  ftomach  and  lungs.  Having  feen,  therefore, 
that  two,  which  had  been  born  twelve  hours  before,  were  alive,  and  fwim- 
ming  in  the  water,  for  about  half  a  quarter  of  an  hour,  I  was  tir’d  of  the 
delay,  and  order’d  them  to  be  plung’d  under  water,  and  held  there.  And 
after  this  was  done  for  fome  little  time,  I  prefently  faw  them  floating  on  the 
furface  of  the  water  without  any  motion  ;  fo  that  they  were  fuppos’d  to  be 
quite  dead.  But  having  left  one  there,  I  differed  the  other,  and  obferv’d 
motions  in  its  whole  body,  and  efpecially  in  the  heart.  Yet  neither  in  the 
ftomach  of  this,  nor  of  the  other,  which  died  a  little  after,  did  1  find  any 
thing  but  milk  half-coagulated,  fo  as  to  refemble  the  fecond  fort  of  cheefe. 
But  the  lungs  of  each  were  quite  fill’d  with  bubbles,  which  fhone  through 
the  external  membrane  :  and  I  fuppos’d,  that  the  water  had  enter’d  by  the 
larynx,  which  I  had  found  not  to  be  fhut  up  by  the  epiglottis,  and  confirm’d 
the  fame  by  difieftion  :  for  a  great  quantity  of  moifture  came  forth,  in  a 
frothy  ftate,  from  the  feveral  fe&ions  which  I  made,  and  with  this  the  lungs 
had  been  diftended. 

Having  begun  to  d'.fieft,  at  another  time,  as  many  cats,  that  had  been 
born  forty  hou^s  before,  and  were  not  drown’d  with  the  hand,  but  left  fo 
long  in  water  as  till  they  feem’d  to  be  entirely  dead,  which  happen’d  in  a 


VOL.  I. 


(2)  Vid.  apud  Schenk.  Obf.  Med.  1.  2.  ubi  de  Pulmonib. 

Yyy 


fhort 


5%o  Book  II.  Of  Difeafes  of  the  Thorax. 

fhort  time,  although  I  in  faft  found  one  only  to  be  dead,  that  had  been  the 
longefl  time  in  the  water  *,  yet  I  faw  thofe  bubbles  through  the  whole  lungs* 
in  both  of  them ;  but  found  thefe  vifcera  to  be  full  of  air,  rather  than  of 
moifture.  And  the  ftomach  of  that  which  was  half-alive  when  difleded, 
contain’d  a  little  water*,  but  the  ftomach  of  the  other  was  greatly  diftended 
with  it,  which  it  certainly  had  not  drunk,  before  I  order’d  it  to  be  kill’d  : 
and  both  of  them  were  brought  to  me,  in  order  to  be  difleded,  with  the 
head  upwards,  and  laid  hold  of*,  that  you  may  not  fufped,  as  is  the  cuftotn 
with  moil  perfons,  that  any  thing  had  flow’d  back  from  the  ftomach  of  the 
firft. 

I  alfo  difleded  two  other  cats,  which  had  been  kill’d  in  the  fame  manner* 
after  being  only  a  few  days  old,  and  had  been  taken  out  of  the  water,  in 
the  fame  manner  as  the  others  -r  I  found  a  watry  humour  in  the  ftomach  of 
both,  not  in  a  very  inconfiderable  quantity,  and  prefs’d  out  much  white  and 
watry  foam  from  the  lungs. 

Finally,  I  difleded  four  cats,  which  had  been  brought  forth  the  night  be¬ 
fore  ;  and  although  I  had  order’d,  with  a  view  to  fome  particular  experiments, 
that  they  ftiould  rather  be  vehemently  fatigu’d  in  the  water,  than  fuffocated ; 
yet  I  was  willing  you  fhould  know,  that  the  ftomach,  in  all  of  them,  was 
1  well’d,  to  a  very  great  proportion,  in  its  magnitude,  partly  indeed  with  milk, 
that  was  half-concreted,  but  with  a  great  quantity  of  water  alfo. 

43.  From  all  the  obfervations  advanc’d,  when  compar’d  one  with  another, 
it  appears,  in  the  firft  place,  that  not  much  afliftance  is  to  be  expeded,  in 
order  to  avoid  fuffocation,  from  the  foramen  ovale  being  open,  nor  yet  from 
the  canalis  arteriofus  being  in  the  fame  ftate :  in  the  fecond  place  alfo,  that 
in  cats  newly-born,  no  fmall  quantity  of  water  has  gone  down  into  the  lungs, 
and  often  a  great  quantity  into  the  ftomach  ;  whereas,  to  the  greater  part  of 
adult  animals,  neither  of  thefe  circumftances  has  generally  happen’d.  And 
Littre  (a),  having  kill’d  a  number  of  both  cats  and  dogs,,  fometimes  found 
nothing  at  all  in  their  ftomach,  but  always  much  lefs  water,  than  in  the  fto¬ 
mach  of  drown’d  men  *,  for  he  had  been  accuftom’d  to  find  a  great  quantity 
of  water,  in  human  bodies,  which  I  alfo  faid  above  (b)  fo  that  it  does  not 
feem,  that  he  ought  to  have  been  reckon’d,  by  a  very  learned  man,  among 
thofe  who  have  taught  the  contrary  :  for  he  even  plac’d  the  obfervations  of 
Beckerus,  who  had  found  no  water  in  the  ftomach,  or  in  the  lungs,  among 
the  more  rare  cafes  *,  in  which  circumftance,  however,  I  fear  I  fball  not  be 
able  to  agree  with  Littre.  For  if  to  Beckerus,  we  join  thofe  whom  Chari- 
fius  (r)  has  commended,  and  thofe  whom  I  have  commended  above  (d),  Pla- 
terus,  and  Wepfer,  and  thofe  that  Charifius  might  have  added,  Kulmus  ( e ), 
and  Leprotti  (/)  *,  we  have  from  thefe,  doubtleis,  and  others,  fuch  a  num¬ 
ber  of  obfervations,  that  they  cannot  be  call’d  fo  rare ;  efpecially  after  the 
Royal  Parifian  Academy  of  Sciences  itfelf,  in  that  excellent  admonition, 
which  it  took  care  to  make  puttie,  in  the  year  1740,  upon  the  method  of 


{a)  Hilt.  cit.  fupra,  ad  n.  40.  A.  1719. 

(<£)  cod.  n. 

(c)  Specira.  de  Morte  Submerf.  §  ic,  ad  e 
prim.  &  e  ftcund. 


(A  rr.  40. 

[c)  Obf.  adjed.  Defcrip.  Feet,  monfir.  §  2.  5. 
(f)  In  Epift.  poll  Comment.  De  Bonon, 
Acad.  Tom.  1. 

afliftijis; 


Letter  XIX.  Article  43.  531 

affifting  fuch  perfons,  as  are  fuppos’d  to  be  drown’d,  exprefsly  acknowledg’d 
it  to  have  been  found  from  the  diffedions  of  drown’d  perfons,  by  fkilful 
anatomifts,  that  but  little  water  was,  for  the  mod  part,  contain’d  in  their 
flomachs.  And  to  thefe  you  will,  moreover,  add  the  obfervations  of  others, 
to  fay  nothing  over  again  of  my  own.  Among  which,  we  muft  by  no  means 
omit  thole  that  were  made  by  very  celebrated  phyficians  (£),  in  order  to 
examine  the  affertions  of  Beckerus.  And  as  he  had  advanc’d,  “  fo  they 
“  found  the  thing  to  be,  and  met  with  no  water  in  the  ftomach  of  drown’d 
“  whelps and  although  they  do  not  deny  that  water,  “  under  fome  certain 
“  circumftances,  may  fometimes  enter  into  the  canals  and  veficles  of  the 
“  lungs,”  yet  they  affirm,  “  that  in  general,  drown’d  bodies  are  wont  to 
“  die,  without  drinking  the  water.”  Nor  are  thefe  words  of  the  very  expe¬ 
rienc’d  Haller  (b)  to  be  pafs’d  over:  for  after  having  himfelf  plung’d  under 
water,  fome  whelps,  he  fays,  “It  will  not  be  foreign  to  the  pur  pole  to  take 
ct  notice,  that  in  living  whelps,  which  had  been  thus  plung’d,  both  the 
lungs,  and  the  ftomach,  were  free  from  water,  even  when  they  had  gap’d 
“  under  water,  and  put  out  their  tongues.  So  far  Beckerus  is  to  be  de- 
M  pended  upon.” 

But  as  I  quoted  thefe  paflages,  that  you  might  underftand  how  far  it  does 
not  feem,  that  obfervations  of  this  kind  can  be  number’d  among  the  more 
rare  cafes  ;  fo,  on  the  other  hand,  1  would  not  only  have  you  not  forget  thole 
obfervations,  which  are  of  an  oppofite  nature  to  thefe,  but  would  have  you 
know,  that  other  obfervations  are,  moreover,  extant,  befides  what  I  have 
mention’d  ;  as,  for  inftance,  fome  that  are  very  accurately  pointed  out  by 
Charifius  (/'),  and  others  that  you  may  add  thereto,  from  Genfelius  (£),  who 
-neverthelefs  excepted  the  lungs,  as  alfo  fome  that  are  propos’d  by  Olaus  Bor- 
richius  (/).  For  as  to  what  he  had  formerly  written,  that  a  boy,  who,  when 
fwimming,  was  carried  away  by  the  waves  of  the  fea,  and  funk  in  the  very 
deep,  fo  as  to  be  found  with  difficulty,  was  prefently  fnatch’d  from  fud- 
-den  death,  by  being  roll’d  about  by  a  great  number  of  perfons ;  you 
will  perceive  that  it  relates  to  the  preient  fubjeft,  for  this  reafon,  becaufe 
by  a  vomiting,  which  took  him  in  the  midft  of  thefe  rotations,  “  he  threw 
4‘  up  a  great  quantity  of  the  fait  water.” 

And  indeed,  the  fame  Haller,  whom  I  juft  now  commended,  found  in  a 
woman,  whom  he  difiefted  in  the  year  1 747  («?),  and  in  one  dilfedted  in  the 
year  1748  (»),  (both  of  whom  had  been  very  long  under  water)  by  com- 
preffing  the  ftomach,  and  the  lungs,  that  the  water  had  defeended  into  the 
ftomach,  in  both  of  them,  and  in  one,  faw  the  water  regurgitate  from  the 
Jungs.  And  although,  where  he  purpofely  treats  of  this  fubjeft  (0),  he  does 
not  mention  the  former,  fo  that  from  the  error  of  the  printer,  in  marking 
the  year,  two  may  feem  to  be  made  out  of  one ;  yet  he  adds  new  experi¬ 
ments  of  his  own,  on  four  drown’d  dogs,  and  one  cat,  by  which,  if  you  ex- 

(g)  Vid.  Commere.  Litter.  A  1737.  Hebd.  (/)  In  Bartholin.  Adi.  Med.  Hafn.  A,  1671. 
37.  n.  1 .  ad  2.  &  1672.  obf.  ^5. 

(b)  DeRefpir.  Exper.  P.  2.  ad  n.  39.  not.  1.  (/»)  not.  i  cit. 

(0  cit.  §  10.  ad  /  prim.  (>/)  Opufc.  Pathol,  obf.  62. 

(i)  Eph.  N,  C.  Cent.  6.  obf  85.  (0)  Ibid. 

Y  y  y  2 


cept 


5  3  2  Book  II.  Of  Difeafes  of  the  Thorax. 

cept  the  cat,  he  found  water  in  the  ftomach  of  all  thele  animals ;  and  in 
the  lungs  of  all,  the  cat  not  excepted,  he  found  much  watry  foam.  He 
then  adds  other  experiments,  which  I  fhall  take  notice  of  below,  that  are 
frequently  confirm’d,  in  the  fame  manner  as  the  former,  by  his  celebrated 
auditor  Evers  (/>).  Whofe  writings  on  thefe  matters,  I  would  willingly  have 
had  publifii’d,  long  before  I  could  have  revis’d  this  letter.  For  1  find  the 
experiments  made  with  fuch  care  and  (kill,  that  you  might  perceive  whether 
the  animals  breath’d  under  water,  and  fwallow’d  ;  nor  could  it  be  doubted, 
whether  they  had  taken  down  the  water  into  their  (tomachs,  and  lungs,  as 
it  was  purpofely  ting’d  with  a  certain  colour.  And  it  was  found  by  diffec- 
tion,  that  they  had  taken  the  water  down  into  both.  Had  all  of  them  ?  you 
will  alk.  Yes,  one  and  all.  Which  I  know  you  will  be  furpriz’d  at,  el'pe- 
cially  in  fo  great  a  number  of  experiments-,  you,  who  efteem  as  true  and 
faithful,  fo  many  and  various  obfervations  of  others,  which  do  not  afifent 
thereto,  no  lefs  than  thefe  lateft  of  all,  who  do  not  eafily,  as  I  fuppofe,  ima¬ 
gine  that  the  force  of  thefe  contradictory  experiments  can  be  fufficiently 
evaded,  by  fuppofingit  to  have  happen’d  fo,  at  that  time,  becaufe  the  water,, 
being  then  very  cold,  had  prevented  deglutition  and  infpiration.  Nor,  in¬ 
deed,  did  the  experiments,  on  occafion  of  which,  Haller  found  no  water  any 
where  in  the  whelps,  that  had  been  plung’d  thereinto,  mention  that  the  wa¬ 
ter  was  very  cold  :  nor  did  I  ever  ufe  any  for  this  purpofe  but  what  was  luke¬ 
warm  :  nor  was  the  young  man  of  Leprotti  to  omit  others,  who  have  been 
fnatch’d  away  by  the  fame  kind  of  death,  in  Italy  and  France  -,  drown’d  at 
the  time  of  year,  when  the  waters  are  very  cold  with  us  ;  yet  in  the  ftomach 
was  fcarcely  any  moifture  found,  and  in  the  lungs  “  not  the  leaft  drop,”  in¬ 
to  which  it  might  have  •  delceneied  by  the  noftrils  at  leaft,  if  not  by  the 
mouth. 

44.  But  how  muft  we  account  for  thefe  differences,  that  are  to  be  found,, 
not  only  among  the  different  obfervations  of  different  authors,  but  even  among 
my  own  ?  Flave  they,  who  had  no  water  in  the  lungs,  and  the  ftomach, 
Ihut  up  the  entrance  of  the  larynx,  and  cefophagus  ?  and  have  they  who 
had  a  little,  or  large  quantity,  not  (hut  up  the  entrance  of  thefe  paffages  ? 
for  there  are  forne,  I  fee,  who  have  explain’d  it  from  the  different  refolutions 
of  perfons,  when  they  w'e re  plung’d  under  the  water-,  and  in  this  manner, 
that  they  who  have  heard  of  drown’d  perfons  dying  from  the  great  quantity  of 
water  that  is  fwallow’d,  clofely  (hut  up  the  entrance  ;  and  they  who  have 
heard  that  their  death  is  owing  to  the  want  of  refpiration,  open  it.  But  al¬ 
though  thefe  different  contrivances  cannot  obtain  in  beafts ;  we  neverthelefs 
find  that  the  circumftances  are  different,  in  different  animals  alfo.  And  even 
fuppofe,  that  different  men  would  have  different  devices  :  yet  how  can  they 
fhut  up  the  larynx,  who  intend  to  do  it  ?  Is  it  by  conftringing  the  glottis  ? 
But  how  fhall  they  keep  it  conftring’d,  as,  when  refpiration  ceafes,  the  influx 
of  fpirits,  into  the  conftringing  mufcles,  ceafes  alfo?  And  1  make  the  fame 
obje.Clion,  if  you  fay  that  thefe  men  depress  the  epiglottis,  fo  as  to  cover  the 
larynx  entirely  -,  although  I  do  not  fufficiently  allow  of  fuch  mufcles,  that  are 
able  ftrongly  to  deprels  this  valve. 


It 


(£)  DifT.  fid.  experim.  circa  Submerfos^ 


Letter  XIX.  Article  44.  533 

It  remains,  therefore,  for  you  to  have  recourfe  to  convulfion,  by  the  force 
of  which,  thefe  mufcles,  and  thofe  that  fhut  up  the  oefophagus,  remain  con- 
traded,  even  after  death,  juft  as  the  mufcles,  which  bring  the  lower  jaw  clofe 
to  the  upper,  were  actually  contracted,  in  the  cafe  of  that  young  man,  whom 
Plancus  difteCted  with  Leprotti  (q) :  for  the  mouth,  as  this  celebrated  man 
wrote  to  me,  about  the  fortieth  day  afterwards,  that  is,  on  the  feventeenth 
of  May,  in  the  year  1722,  the  mouth,  I  lay,  was,  after  death,  kept  very 
clofely  Ihut.  But  I  found  neither  the  larynx  fhut  up,  nor  the  epiglottis  de- 
prefs’d  (r),  in  thofe  animals  into  whofe  lungs  the  water  had  not  fall’n,  even 
after  death  :  nor  did  Littre  find  it  otherwife,  in  any  of  his  drown’d  crea¬ 
tures  (j),  he,  who,  in  other  refpeCts,  thought  that  the  epiglottis  was  de- 
prefs’d,  not  only  in  thofe  of  whom  we  fpeak,  but  even  in  thofe  who  were 
thrown  into  the  water,  after  death,  advancing,  in  this  manner,  a  fuppofi- 
tion,  that  was  neither  credible,  nor  coherent,  with  the  things  he  had  laid 
down  ;  for  how  could  the  tongue,  which  he  had  fuppos’d  to  be  at  length  re¬ 
lax’d,  in  living  perfons,  and  to  fall  forwards,  raife  itfelf  up  in  dead  perfons,  in 
order  to  deprels  the  epiglottis  backwards,  or  be  kept  in  that  pofition  ?  To 
this  alfo  may  be  added,  that  the  tongues  of  the  guinea-pigs,  in  whofe  lungs 
1  have  faid  (7),  that  I  found  no  water,  are  oblong  indeed  ;  but,  if  you  ex¬ 
cept  the  firft  part,  it  is  fo  fix’d  to  the  bafis  of  the  mouth,  that  it  cannot  raife 
itfelf,  and  deprels  the  epiglottis,  which  is,  in  other  refpeCts,  very  fhort,  fo 
that  it  can  fcarcely  cover  the  whole  hiatus  of  the  larynx.  And  what  will  you 
fay  to  this?  that  amongft  “  thofe  things  which  are  commonly  feen  and  ob- 
ferv’d,”  in  the  bodies  of  drown’d  perfons,  is  plac’d  by  Charilius  ( u ),  “  the 
44  tongue  thruft  out for  the  epiglottis,  by  reafion  of  the  connecting  liga¬ 
ments,  44  neceffarily  follows”  the  tongue,  when  thruft  out,  to  ufe,  in  a  well 
.  known  circumftance,  the  equally  well-known  words  of  Palfin  (x).  And 
moft  of  thefe  things,  you  may  think,  are  faid  by  me,  not  fo  much  from  the 
opinion  of  Littre,  as  on  account  of  that  of  Dethardingius  (7),  and  his  fol¬ 
lowers.  For  they  do  not  doubt,  but  that  refpiration  is  intercepted,  and  the 
water  excluded,  by  the  ftriCture  of  the  epiglottis,  to  the  orifice  of  the  larynx; 
as  if  it  did  really  happen,  that  the  air  and  water  were  excluded  in  all :  and 
yet  there  is  not  one  of  them  all,  who  fays  that  the  epiglottis  has  been  found 
deprels’d,  in  the  diffeCtion  of  drown’d  perfons,  by  themfelves,  or  by  others : 
but  on  the  other  hand,  even  Evers  (2),  in  all  his  experiments,  always  faw  the 
glottis  open,  and  the  epiglottis  rais’d,  juft  in  the  fame  manner  as  I  did,  and 
as  he  did  likewife  in  a  boy  (*),  whofe  lungs  and  ftomach  the  water  had  en¬ 
ter’d  into.^p 

Yet  Dethardingius,  taking  for  granted  what  I  have  mention’d,  has  pro¬ 
nounc’d  that  the  chief  affiftances,  which  can  be  giv’n  to  perfons  that  have 
been  drown’d,  are  thofe  whereby  the  epiglottis  may  be  rais’d,  or  if  that  can¬ 
not  be  done,  to  open  another  paffage  for  the  air,  inftead  of  that  which  this 
cartilage  fhuts  up.  That  this  cartilage,  therefore,  is  to  be  irritated,  by  im- 


(j)  Epift.  cit.  fupra,  ad  n.  43. 

(r)  n.  41. 

(s)  Hi  ft.  cit.  ad  n.  43. 

(On.  41.  .  .  , 

(u)  §  8.  Specim.  cit.  fupra,  ad  n  43- 


( x )  Anat.  du  corps  hum.  tr.  3.  ch.  8. 

(y)  Sched.  de  fubven.  fubmerfis  per  laryn— 
gotom. 

(z)  Differt,  cit.  fupra,  ad  n.  43. 
bd  §  7* 

-  mediately 


534 


Book  IF.  Of  Difeafcs  of  the  Thorax. 


mediately  putting  the  finger  into  the  throat,  or  rather  a  feather,  or  pencil 
made  of  briftles,  and  that  it  is  to  be  excited,  even  after  the  afpera  arteria  has 
been  open’d,  under  the  larynx,  the  finger  being  now  and  then  apply’d  to  the 
wound,  or  a  cough  excited,  that  by  one  method,  or  other,  the  epiglottis 
may  be  rais’d  by  the  impell’d  air.  The  greateft  part  of  which,  if  what  he 
iuppos’d  were  lo  in  fa£t,  1  fhould  certainly  approve  as  much  as  he  ;  did  not 
a  more  fpeedy,  and,  at  the  fame  time,  a  more  certain,  method  appear,  from 
what  has  been  juft  now  laid,  of  raifing  this  cartilage  when  depfefs’d,  I  mean, 
immediately  to  draw  the  tongue  forwards,  by  laying  hold  of  it  with  your  fin¬ 
gers. 

But  although  the  epiglottis  is  not  deprefs’d,  there  may  neverthelefs  be  room 
for  the  operation  of  bronchotomy,  propos’d  by  Dethardingius,  when  other 
remedies  are  of  no  efiedt,  which  are  mention’d  in  great  number,  in  the  Mo¬ 
nitum  I  have  commended  (5),  either  for  that  caufe  which  is  pointed  out  in 
that  very  Monitum,  of  opening  a  nearer  paflage  for  warm  air  into  the  lungs, 
by  means  of  a  pipe  ;  or  if  you  choole  rather  to  think  with  the  more  modern 
authors,  that  the  water,  which  has  fall’n  into  the  lungs,  may  have  a  more 
fpeedy  paflage  to  go  out :  although  they  fo  far  confefs,  that  they  have  us’d 
not  only  this,  and  other  methods  which  are  not  common,  but  even  the  moft 
curious  that  have  been  propos’d  by  any  one,  upon  a  great  number  of  dogs, 
but  in  vain ;  for  notwithftanding  thefe  animals  had  not  been  detain’d  more 
than  eight  minutes  under  water,  yet  they  could  not  be  recall’d  to  life  ;  fo 
that  they  take  away  from  us  alrpoft  all  hope  of  relieving  human  creatures 
that  have  been  drown’d.  If,  as  they  have  treated  their  fubjedt  methodically, 
nervoufiy,  learnedly,  and  ingenioufly,  fo  they  had  had  time,  a  great  degree 
of  which  was  certainly  neceflary,  to  weigh  leparately  every  example  of  thofe 
drown’d  perfons  who  have  been  recall’d  into  life,  as  they  fay,  they  would, 
perhaps,  have  found  a  greater  number  of  methods  than  they  feem  to  believe, 
which  give  us  hopes  of  afliftance  even  by  remedies,  fometimes,  not  very 
curious,  and  that  where  fubmerfion  does  not  happen  in  cold  water,  or  that 
which  is  mix’d  with  ice,  from  whence  both  deglutition  of  the  water,  and  in- 
Ipiration,  might  be  laid  to  be  hinder’d. 

You  will  read,  for  example’s  fake,  in  the  epiftle  of  the  celebrated  Lang- 
hanfius(c),  publifh’d  at  Gottingen,  in  the  year  1748,  that  a  man,  who  lay 
under  water  “  for  about  half  a  day,”  fo  that  not  the  leaft  fign  of  life  re¬ 
main’d,  “  had  recover’d  his  life  again,  in  a  fhort  time,  merely  by  having 
“  the  fpirit  of  fait  armoniac  applied  to  his  noftrils.”  You  will  read  alfo, 
in  the  feventh  volume  of  the  Atta  Cafarea  Natur.  Curiof.  Academia  (d),  from 
the  obfervation  of  a  cautious  phyfician  of  Breflau,  nam’d  Kundmann,  that 
two  perfons,  whofe  heads  had  been  held  down  under  water,  the  one  almoft  a 
quarter  of  an  hour,  the  other  almoft  half  an  hour,  in  a  river,  were  excited 
in  a  fhort  time,  by  remedies  that  were  not  very  violent  or  exquifite.  And, 
not  to  collect  more  together.  I  would  have  you  juft  read  over  again,  how 
eafily  that  young  man  was  fnatch’d  from  death,  whom  I  have  mention’d 
above  from  Bornchius  (<■).  Shall  we  fay,  then,  that  they  were  all  drown’d 


( d)  Obf.  124. 
(')  N.  43. 


7 


m 


Letter  XIX.  Article  4 53  5 

in  cold  water,  and  that  for  this  reafon  they  did  not  take  it  into  their  ftomach, 
or  lungs  ?  Certainly,  we  cannot  fay  that  this  boy  of  Borrichius  was,  who, 
although  he  liv’d  in  a  cold  country,  <c  would  not  have  indulg’d  himfelf  in 
<c  fwimming,”  with  his  companions,  unlefs  the  time  of  the  year  had  been  fuch, 
-that  the  water  was  lukewarm  ;  nor  could  he,  when  funk  therein,  have  taken 
it  down  plentifully  into  his  ftomach,  upon  their  fuppofition.  As  to  the  other 
three,  I  do  not  lee,  that  particular  notice  is  taken  of  the  time  of  year  in 
which  they  were  drown’d,  except  that  Kundmann  writes,  in  relation  to  one, 
that  it  was  “  on  the  eve  of  Eafter  5”  and  of  another,  that  a  troublefome 
cough  having  attack’d  him  foon  after,  “  he  often  threw  up  grumous  blood 
“  from  his  lungs,”  which  you  may  confider  as  a  proof  of  his  having  taken 
in  water,  that  had  injur’d  the  very  tender  veffels  of  the  lungs.  You  fee  that 
I  do  not  mention  examples  which  are  lefs  credible,  nor  in  great  number,  nor 
little  known  ;  but  a  few  only,  and  thofe  fuch  as  are  obvious  to  every  one, 
and  that  none  of  them  are  taken  from  the  warmer  or  more  temperate  regions, 
in  which,  as  the  cultom  of  fwimming  is  much  more  frequent  in  thefe  coun¬ 
tries,  and  efpecially  in  fummer,  fo  I  do  not  doubt,  but  you  will  find  a  great 
number  of  examples,  if  you  enquire  after  them.  For  hence  it  feems  to  have 
been,  that  the  Roman  phyfician  Zachia  (/)  was  the  more  eafily  induc’d,  in 
regard  to  the  recovery  of  a  young  man,  who  was  drown’d,  and  taken  out  of 
the  river  an  hour  after,  confidently  to  affert,  “  that  it  was  certain,  not  only 
“  of  this  reftitution,  that  it  ought  not  to  be  confider’d  as  a  miraculous  effedt, 
“  but  that  it  ought  not  even  to  be  enumerated  among  thofe  events  which  are 
“  wont  to  excite  the  wonder  of  the  hearers.” 

But  to  return  to  our  former  fubjedt,  from  thofe  things  which  have  been 
produc’d  by  a  defire  of  enquiring  out  the  truth  in  a  matter  of  the  moft 
ferious  confequence,  and  not  by  a  defire  of  contradidting,  why  then,  you 
will  at  length  fay,  if  in  all  drown’d  perfons  a  paffage  lies  free,  through  the 
open,  and  in-no-wife-protedted,  glottis,  into  the  lungs,  does  not  the  luke¬ 
warm  water,  at  leaft,  enter  the  lungs  equally  in  all  ?  The  celebrated  Se¬ 
nae  (g)  will  explain  this  to  you,  to  whom  I  willingly  refer  you,  as  I  am 
haft’ning  on  to  other  fubjedts.  He  will,  at  the  fame  time,  inform  you,  which 
is  indeed  a  confequence  of  the  other,  that  the  mark  which  is  commended 
alfo  by  Littre  (b),  in  order  to  diftinguifh  thofe  perfons,  who  are  thrown  into 
the  water  alive,  from  thofe  who  are  thrown  in  dead,  by  the  water  being 
fall’n  inwards,  or  not  fall’n  inwards,  which  is  in  other  refpedts  eafy,  and  in 
medical  queftions,  relating  to  judicial  affairs,  not  without  its  advantage,  is 
is  not  to  be  confider’d  altogether  as  perpetual. 

45.  But  I  know  that  you  are  here  going  to  interrupt  me,  though  I  am  in 
hafte  in  regard  to  that  other  mark,  which  relates,  at  the  fame  time,  to  thefe 
queftions,  and  at  the  fame  time  to  fuffocation,  which  is  our  prefent  fubjedt  ; 
1  mean  that  mark,  which  is  taken  from  the  lungs  of  an  infant,  being  thrown 
into  water  :  fo  that,  from  thefe  falling  to  the  bottom,  or  fwimming  at  the 
top,  it  may  be  diftinguifh’d,  whether  the  child  was  born  dead  or  alive.  What 
would  you  have  me  fay  ?  I  am  of  opinion  with  thofe,  who  make  ufe  of  this 

(f)  Quaeft.  Med.  Legal.  Tom.  3.  Confll.  7 9.  (g)  Hift.  cit.  fupra,  ad  n.  40. 

n.  n.  (b)  Hiit.  hoc  n.  cit. 


5  3  6  Book  II.  Of  Difcafes  of  the  Thorax. 

fign,  indeed,  but  cautioufly,  and  prudently.  For  I  know,  how  many  ex¬ 
ceptions  have  been  obferv’d,  within  a  fhort  feries  of  years.  And  although 
Galen  (V)  pointed  out,  that  the  fubftance  of  the  lungs  in  fee  tu  fifes  was  not 
only  red  and  denfe,  but  alfo  “  heavy,”  contrary  to  what  it  was  in  thole  who 
had  breath’d  ;  and  tho*  others  obferv’d  the  fame  afterwards,  and  among  thefe 
our  Spigelius  (k)  repeated  it  ;  yet  I  do  not  know,  whether  any  one,  for 
that  reafon,  ever  thought  of  making  the  experiment  on  this  account,  ex¬ 
cept  a  few  1  ultra  before  my  age.  At  lead,  no  mention  is  made  of  it  in 
Zacchia,  much  lefs  in  Fidelis,  and  Parey,  even  in  thole  places  where  it  was 
natural  to  expeCt  it. 

1  fee  it  therefore  objected,  that  the  lungs  of  an  infant  who  was  born  alive 
may,  neverthelefs,  fubfide  in  water,  if  they  have  either  been  not  fufficiently 
diltendeds  from  a  want  of  ftrength  in  the  infant,  or  have  been  made  heavy 
from  difeafe,  or  from  iuffocation  itfelf :  and  that  on  the  other  hand,  the 
lungs  of  the  infant,  who  was  born  dead,  may  fwim  on  the  furface,  if  they 
are  diftended  with  air,  which  either  putrefaction  may  have  difeharg’d,  or  it¬ 
felf  may  have  drawn  in,  before  it  came  into  the  world,  or  fome  perfon  af¬ 
terwards,  in  order  to  excite  refpiration,  has  blown  in,  through  the  mouth. 
And  thefe,  and  any  other  dangers  of  deception  whatever,  it  is  neceifary  to 
know,  and  to  be  cautious  of,  in  the  manner  which  will  be  immediately 
pointed  out. 

46.  And  fir  ft,  there  is  no  reafon  to  doubt  of  what  that  very  grave  man, 
Laurence  Heifter(/),  teftifies  his  having  feen  (for  as  to  fome  other  observa¬ 
tions,  not  much  unlike  this  in  other  reipeds,  as  far  as  belongs  to  the  crying 
of  the  infant,  I  fee  that  they  depend  upon  a  forc’d  teftimony  of  contempti¬ 
ble  women)  that  an  infant,  after  living  nine  hours,  weakly  indeed,  and  con¬ 
tinually  fending  forth  feeble  lamentations,  the  lungs,  which  were  in  other 
refpeds  found,  appear’d  juft  in  the  fame  manner,  as  in  thole  who  never 
breath’d,  and  fubfided  in  water,  as  they  are  wont  to  do  in  this  kind  of  in¬ 
fants  :  which  ought  not  to  feem  very  wonderful,  if  you  obferve  with  this 
author,  whom  I  have  already  commended  (7»),  that  air  fent  by  us,  into  the 
lungs  of  a  foetus,  in  fmall  quantity,  and  with  little  impetus,  is  unequal,  as 
he  has  often  found  by  experiment,  to  the  talk  of  expanding  fo  many  veficles 
of  the  lungs,  as  is  neceifary,  in  order  to  render  them  fpecifically  lighter  than 
water.  And  this  being  the  Hate  of  the  cafe,  before  we  argue,  from  their  fub- 
fiding,  that  the  infant  was  born  dead,  we  muft  enquire  into  the  marks  of  its 
weaknefs,  from  the  foregoing  or  prefent  diforders  of  the  mother,  from  the 
difficulty  of  the  birth,  from  the  ftate  of  the  child’s  body,  after  death,  and 
other  things  of  that  kind  :  and  if  there  be  none  of  thefe  things,  and  no  other 
argument,  to  the  contrary  ;  we  (hall  not  doubt  but  the  child  was  born  dead. 

Yet  on  the  other  hand  it  will  be  evident,  that  we  cannot  truft  to  the  fio-n 
in  queftion,  if  at  any  time  we  fhould  obferve,  that  the  lungs  are  not  endow’d 
with  that  gravity  which  is  natural  and  peculiar  to  a  foetus,  but  with  a  mor¬ 
bid  gravity;  either  becaufe  they  are  fchirrhous,  or  becaufe  they  are  inflam’d, 
or  becaufe  they  are  fo  far  affedted,  with  fome  kind  of  infarction  or  other, 

(:')  De  Ufu  Part.  1.  15.  c.  6.  (/)  Diflert.  de  fall.  pulm.  infant,  exper.  n. 

(*)  De  form.  Fretu  c.  18.  10.  &  feqq.  (»/)  ibid.  n.  16. 

that 


/ 


1 


Letter  XIX.  Article  47.  537 

that  if  they  were  even  the  lungs  of  an  adult  man,  they  neverthelefs  could 
not  fwim,  on  the  top  of  the  water,  which  mod  anatomifts,  and  I  alfo,  l'ome- 
times,  have  experienc’d.  For  that  in  fcetufies,  there  may  be  fometimes  in¬ 
farctions  of  this  kind,  is  not  only  indicated  by  reafon,  but  confirm’d  by  ex¬ 
perience,  as,  for  inftance,  in  the  obfervation  made  by  Zeller  (»),  on  a  calf, 
which  had  liv’d  half  an  hour. 

But  finally,  if  fuffocation  itfelf  can,  fometimes,  fill  the  lungs  with  fo  great 
a  quantity  of  blood,  in  an  infant,  as  I  have  mention’d  that  they  have  been 
overwhelm’d  with  in  ftrangl’d  adults,  from  the  obfervation  of  others,  and 
particularly  of  Harvey  (<?)  •,  yet  fuffocation  will  not  be  able  to  hide  itfelf, 
tinder  the  fign  in  queftion.  For  although  all  the  external  marks  thereof 
fhould  be  wanting,  yet  certainly  a  different  hate  of  the  lungs  from  that  which 
is  ufual  in  the  foetus,  and  the  enlarg’d  bulk  befides,  would  admoniffi  us, 
that  although  they  did  not  happen  to  fwim  in  water,  we  fhould  not  be  too 
hafty  in  milling  to  this  fign.  Befides,  it  can  fcarcely  happen,  in  thofe  who 
have  drawn  in  air,  but  that  fome  fmall  parts  of  the  lungs  lhall  retain  fo 
much  of  it,  as  to  make  them  fwim,  though  the  other  parts  defcend  ;  fo  that 
thefe  parts  are  to  be  examin’d  into,  by  cutting  the  lungs  piece-meal,  and 
throwing  them  feparately  into  water,  as  well  as  by  other  means,  and  thefe 
both  in  this  and  the  two  former  cafes,  that  we  may  not  be  eafily  drawn  into 
error,  from  the  fubfiding  of  the  lungs. 

4 7.  But  on  the  other  hand,  that  we  may  not  be  impos’d  upon,  by  the 
fwimming  of  this  vifcus  ;  we  muft,  particularly,  attend  to  this,  that  although 
learned  men  have  not  been  wanting,  who  have  feen  the  lungs  of  foetuffes  fall 
to  the  bottom  in  water,  even  after  the  highefb  putrefaction  has  taken  place, 
we  cannot,  neverthelefs,  deny  the  truth  of  the  affertions  of  thofe  perfons, 
who  affirm  that  they  have  feen  the  contrary amongft  whom  is  the  celebrated 
profeffior  Weiffius,  whofe  obfervation  if  you  read  (p),  you  will  readily  con- 
fels,  that  the  lungs  of  a  (Unking  foetus,  who  was  never  able  to  draw  in  air, 
cc  were  fpongy  ”  to  the  touch,  and  “  fwam  on  the  top  ”  of  the  water,  for 
no  other  reafon  but  becaufe  they  were  already  “  infeCled  with  putrefaction,” 
which  difcharg’d  the  air.  And  I  fhould  fuppofe  that  Frederic  Ruyfch(^) 
had  a  view  to  the  fame  thing,  when  he  wrote,  “  that  the  lungs,  when  pro- 
c<  perly  form’d,  would  never  fwim  upon  the  furface  of  water,  if  the  foetus 
“  fhould  die  in  the  womb  of  its  mother,”  where  he  complain’d  of  them 
who  difputed  this  circumftance  with  him  formerly,  which  controverfy  is,  per¬ 
haps,  the  fame  with  what  Boerhaave  has  made  mention  of,  in  fome  part  of 
.his  lectures  (r).  When  therefore  we  find,  that  the  lungs  are  not  “  in  a  good 
**  date,”  but  tainted  with  putrefaction  j  we  muft  not,  although  they  fwim  in 
water,  for  that  reafon,  pronounce  the  child  to  have  been  born  alive. 

And  much  lefs  (till,  whenever  there  may  be  a  probable  fufpicion,  that 
amidft  the  throws  of  a  very  difficult  birth,  the  foetus  might  have  drawn  in 
the  air  by  means  of  a  rupture  of  the  membranes,  before  it  could  be  poffi- 
bly  extruded,  by  reafon  of  that  delay,  and  by  this  means  have  died  in  the 

(»)  Difput.  quod  pulm.  infant,  in  aq.  &c.  (p)  In  Med  it.  BehJing.  fup,  caf.  rupti  in  ' 

Vid.  Hift.  partu  uteri.  ( q )  Thcf.  Anat.  V..  n.  40. 

( 0 )  n.  9.  (r)  Pracleft.  ad  Inttit.  §  691. 


VOL.  I 


birth, 


Z  z  z 


£3S  Book  II.  Of  Difeafes  of  the  Thorax. 

birth,  as  Pal  Bn  (j)  alio,  among  the  reft,  has  ad moni fil’d :  although  It  can 
Scarcely  happen,  that  '.n  this  cafe,  and  the  laft  preceding,  we  fhall  be  deceiv’d 
by  the  craft  of  an  old  woman,  fince  both  of  them  require  helping  hands, 
nor  the  circumftances  which  precede,  or  accompany,  or  are  the  confequence 
of  them,  can  be  eafily  either  diffidently  conceal’d  or  difiembl’d. 

But  on  the  contrary,  it  would  be  very  eaiy  for  the  woman  to  call  to  mind 
that* laft  circumftance,  that  fhe,  when  her  child  was  born  dead,  thinking  it 
half-alive,  had  blown  air  into  the  mouth  very  ftrongly,  that  it  might  be  ex¬ 
cited  to  refpiration  :  and  that  for  this  realon,  the  lungs  were  diftended  witli 
air,  and  lwam  on  the  furface  of  the  water.  And  indeed,  as  the  minds  of 
fome  men  are  prone  to  all  kinds  of  wickednefs,  feme  man  or  woman,  into 
whofe  hands  the  child  was  receiv’d  in  a  ftate  of  death,  might,  with  a  mali¬ 
cious  intention  againft  the  woman,  have  done  it,  privily  to  all  perfons  pre¬ 
lent,  in  order  to  fcandalize  the  poor  mother,  as  if  Ihe  had  deftroy’d  the  child, 
when  it  was  breathing.  But  if  there  are  no  marks  of  internal  or  external 
force  having  been  applied  to  the  child,  when  yet  alive  •,  for  the  marks  of 
force  applied  to  the  dead  infant,  and  efpecially  not  immediately  after  death, 
are  very  different;  we  may  from  thence  difprove  the  calumny,  and  fo  much 
the  more  readily  give  credit  to  the  mother,  who  fays  that  fhe  blew  air  into 
the  lungs,  if  none  of  the  other  circumltances  argues  the  contrary,  nor  the  di- 
ftenfion  of  the  lungs  is  greater,  than  can  really  be  brought  about  in  that  me¬ 
thod,  in  a  foetus  recently  dead,  or  that  has  not  been  dead  long,  as  will  appear 
by  experiments  carefully  inftituted  for  that  purpofe :  although  I  think  thefe 
things  ought  to  be  touch’d  upon  by  ns,  rather  that  they  may  not  be  en¬ 
tirely  unknown  to  phyficians  and  judges,  than  that  they  fhould  come  to  the 
knowledge  of  the  common  people,  as  nearly  the  fame  prudence  and  caution 
is  requir’d  in  regard  to  this  fubjeft,  as  in  regard  to  what  it  is  neceflary  to 
fay  upon  poifons. 

48.  Here  you  have  a  method  of  ufing  the  experiment  in  queftion,  cau- 
tioufly  and  prudently.  But  if  I  feem  to  you  to  have  explain’d  thefe  circum¬ 
ftances  too  little  at  large,  you  may  compare  them  with  what  has  been  writ¬ 
ten  more  at  large  by  the  celebrated  Michael  Alberti  (/),  who,  in  like  man¬ 
ner,  as  Heifter  («)  did  alfo,  thought  that  the  experiment  was  not  to  be  re¬ 
jected,  but  made  ufe  of  with  circumfpedtion.  And  you  will  fee  that  the 
opinion  of  thofe  prudent  phyficians  Beherenfius  (#),  and  Trew  (y),  and  of 
others,  was  the  fame,  and  that  we  may  not  feem  to  have  entirely  omitted  the 
Lawyers,  of  Schoepfter  (%)  alfo,  in  turning  over  whofe  works,  you  will  not 
only  know  what  authors  have  treated  of  this  fubjeCt,  befides  him,  but  will 
particularly  know  what  relates  to  the  circumftances  of  the  affair,  whenever 
you  have  regard  to  the  other  figns  of  infanticide,  and  by  what  means  thefe 
are  alfo  to  be  examin’d,  that  we  may  not  be  deceiv’d.  For  whether  they 
are  abfent,  or  prefenr,  they  add  to,  or  take  from,  the  force  of  the  expe¬ 
riment  :  which,  at  other  times,  for  the  molt  part,  anfwers,  as  it  did  even 

(j)  Tr.  3.  fupra  ad  n.  44.  cit.  c.  9  (ji)  Aft.  N.  C.  Tom.  2.  Obf.  28. 

(0  Differt.  de  pulm.  fubfid.  exprim.  prud.  (y)  Eorund.  Tom.  8.  in  Schol.  ad  Ap- 

applic.  .  pend.  n.  3. 

(«)  Diflert.  fupra,  ad  n.  46.  cit.  n.  22.  («)  Differt.  Jurid.de  pulm.  infant,  natant. &c. 

with 


Letter  XIX.  Articles  49,  50.  439 

with  me  lately,  In  a  cow-calf,  that  had  double  lungs,  as  it  had  alfo  two  heads, 
two  necks,  and  two  hearts.  The  lungs  of  this  calf  were  contrafted,  denle, 
and  of  a  red  colour  inclining  to  black  ;  and  when  they  were  even  cut  into 
pieces,  and  thrown  into  a  proper  quantity  of  water,  for  a  fmall  quantity  may 
deceive  us  fometimes,  I  found,  from  their  immediately  going  to  the  bottom, 
that  the  calf  had  been  born  dead,  though  fome  had  aflerted  in  writing,  that 
it  had  flood  up  when  it  was  born,  and  had  liv’d  fome  hours.  The  truth  of 
the  ftory  being  diligently  enquir’d  into,  according  to  my  defire,  from  one 
who  had  been  prefent  at  the  birth,  I  was  certainly  inform’d,  by  other  letters, 
that  it  had  really  been  born  dead.  But  of  the  other  circumltances  which  L 
faw  in  the  difiecftion  of  this  animal,  I  fhall  have  a  proper  opportunity  of 
fpeaking  hereafter  (a).  But  now  1  fhall,  at  length,  pafs  on  to  the  other  fpecies 
of  fuffocation  (£),  I  mean,  that  which  is  from  internal  caufes  ;  and  fhall  be 
fo  much  the  fhorter  on  this  fubjedt,  as  I  have  been  the  more  prolix  on  the 
other. 

49.  An  old  woman,  who  had  a  cancer,  that  had  crept  from  the  left  angle 
of  the  mouth,  which  it  had  confum’d,  farther  into  the  mouth,  and  under 
the  tongue,  being  fubjedl  to  diforders  of  the  thorax,  which  fhe  call’d  of  the 
catarrhous  kind,  died  of  fuffocation.  On  difie&ing  the  body,  I  found  the 
larynx  and  its  neighbourhood  found,  and  yet  there  was  a  purulent  ichor 
Under  the  glottis,  and  in  the  neareft  part  of  the  afpera  arteria ;  and  the  fame 
within  the  upper  part  of  the  left  fuperior  lobe  of  the  lungs,  and  in  other 
parts  thereof.  But  the  inferior  lobes  were  vehemently  inflated.  Where- 
ever  I  cut  into  the  lungs,  1  found  them  of  a  cineritious  colour,  which  was 
here  and  there  diftinguifh’d  by  black  lines,  and  ramifications  of  the  fmall 
vefiels,  wherein  the  blood  ftagnated.  The  heart,  alfo,  was  full  of  black 
blood,  which  was  not,  indeed,  altogether  coagulated,  not  yet  without  po¬ 
lypous  concretions  ;  and  one  of  thefe,  being  in  its  form  and  whitenefs  like 
a  worm,  reach’d  into  the  pulmonary  veflel.  The  coronary  veins,  and  all 
the  jugulars,  and  the  branches  of  thofe  that  ran  through  the  neck,  were 
alfo  greatly  diftended  with  blood.  I  found  one  valve  of  the  great  artery 
beginning  to  oflify  ;  and  I  faw  the  fame  degeneracy  in  feveral  places  on  the 
internal  furface  of  the  fame  artery,  as  far  even  as  to  the  iliacs. 

50.  This  woman  brings  back  to  my  memory,  the  man  whofe  body  I  dif¬ 
fered,  about  the  fame  time,  in  the  fame  place,  that  is,  in  the  hofpital  of  In¬ 
curables  at  Bologna.  For  he  alfo  had  an  ulcer  in  the  mouth,  but  in  the 
more  internal  parts,  and  the  larynx  and  the  afpera  arteria  were  in  like  man¬ 
ner  uninjur’d,  and  the  fame  part  of  the  lungs  as  in  this  woman  was  to  the  lad 
degree  diforder’d  :  and  he  alfo  died  in  the  manner  of  a  fuffocated  perfon.  But 
what  remains  of  his  hiftory  I  referve,  till  I  come  to  treat  of  deglutition  being 
injur’d ;  for  as  to  the  other  circumftances,  which  I  juft  now  took  notice  of, 
and  by  what  means  his  lungs,  as  well  as  the  lungs  of  this  woman,  might 
have  been  diforder’d,  I  have  pointed  out  in  a  former  work  (*).  Thefe  per- 
lons,  therefore,  were  fuffocated  from  a  diforder  of  the  lungs,  as  others  have 
been  from  a  diforder  of  the  larynx,  and  afpera  arteria,  concerning  which,  be- 

(rt)  Vid.  Epiil.  48,  n.  57.  (£)  Supra,  n.  2.  (*)  Epift.  Anat.  9.  n.  9,  &  10. 


Z  Z  Z  2 


fldes 


3*4°  Book  II.  Of  Difeafes  of  the  Thorax. 

fides  what  you  will  read  from  Platerus  (c),  and  Kerckringius  (</),  I  fhall 
write  to  you  more  properly  on  another  occafion  (e),  and  indeed  have  already 
written  (/).  But  I  ffiall  here  add  no  other  obfervation  befides  this,  except 
that  which  I  receiv’d  from  the  very  experienc’d  Santorini,  on  the  fame  day 
that  he  had  made  it.  And  it  relates  to  fuffocation  from  a  diforder  of  the 
great  artery. 

51.  A  virgin,  who,  for  fome  time  before,  had  but  little  difcharge  of 
blood  from  the  uterus,  at  the  time  of  her  monthly  evacuations,  was  troubl’d 
with  a  difficulty  of  refpiration,  and  at  length  was  fuffocated,  as  if  by  convul- 
fions.  The  abdomen  being  open’d,  a  tubercle  was  obferv’d  externally,  in 
the  fubftance  of  the  uterus  itfelf,  like  to  that  kind  of  foft  tumour,  which,  in 
the  Italian  language,  is  call’d  natla ,  or  a  foft  tumour  of  the  wenny  kind. 
But  when  the  thorax  was  open’d,  the  beginning  of  the  great  artery  was  found 
to  be  of  fuch  a  thicknefs,  in  its  parietes,  that  the  capacity  of  the  veffel  was 
greatly  diminiffi’d  thereby.  In  this  artery  was  a  great  quantity  of  blood  ; 
but  a  (till  greater  in  the  lungs,  which  were  quite  over-loaded  with  it. 

52.  Whatever  was  the  caufe  of  this  thicknefs  in  the  parietes  of  the  artery, 
that  diminiffi’d,  in  fuch  a  manner,  the  capacity  of  the  veffiel,  an  example  of 
which,  in  other  arteries,  you  have  from  Littre  ( g ) ;  it  is  evident,  that  by  rea- 
fon  of  the  artery  being  made  narrower  than  its  natural  ftate  was,  the  blood 
could  not  be  fent  out  from,  and  circulated  through,  this  artery,  in  fo  lame  a 
quantity,  or  with  fo  much  force,  as  naturally  it  is.  For  which  reafon  the 
blood  was  found  here,  but  in  far  greater  quantity  in  the  lungs,  in  the  veffels 
whereof,  fo  much  more  was  of  neceffity  collected,  as  fo  much  a  iefs  quan¬ 
tity  could  be  fent  into  the  aorta.  From  the  narrownefs,  therefore,  of  this  ar¬ 
tery,  not  only  the  difficult  refpiration,  elpecially  in  the  motion  of  the  body, 
but  at  length  the  fuffocation,  arofe.  But  of  this  fubjedt  enough.  It  remains, 
that  inftead  of  writing  a  particular  letter,  on  account  of  thefe  few  things 
which  I  have  to  fay  on  the  fubjedt  of  coughs,  I  rather  add  them  to  this,  as  I 
promis’d  in  the  beginning. 

53.  Some  caufes  of  a  cough,  like  thofe  of  loft  refpiration  (F),  are  without, 
and  fome  within,  the  lungs.  And  of  the  firft  clafs,  fome  are  on  the  outfide 
of  the  thorax,  and  fome  within.  And  again,  of  thofe  that  are  on  the  outfide 
of  the  thorax,  fome  are  in  the  head,  and  others  in  the  belly,  and  ftill  others 
in  the  neck.  And  as  a  cough  may  arife  from  caufes  that  arefo  different,  and 
have  their  fituations  fo  different  ^  it  is,  at  fome  times,  to  be  compar’d  with 
thofe  fevers  which  they  call  corruptive  fevers,  and  then  only,  with  lalubrious 
and  depurative  fevers,  when  it  has  its  origin  from  matter,  which  may  be  dif- 
charg’d  by  the  force  of  the  cough  itfelf.  For  although  a  fever  and  couoh 
are  both  of  them,  by  themfelves,  evils,  yet  both  of  them  are  then  caufes  'of 
good :  wherefore  both  of  them  arife  from  the  very  nature,  and  conftitution 
of  the  body,  which  we  call,  in  general,  nature,  and  are  never  fupprefs’d, 
but  with  the  worft  of  confequences,  as  they  were  both  much  to  be  defir’d 
fuppofmg  them,  to  have  been  abfent.  For  there  is  fometimes,  in  the  lungs, 

(c)  Se£h  hac  2.  Sepulch.  Obf.  4*  (f)  Epift.  15.  n.  13.  &  feqq. 

(d)  Ibid.  Obf.  9.  (g)  Mem.  del’Acad.  R.  des  Sc.  A.  1712. 

(f)  Epift.  2S.  n.  9,-  &  10.  f»)  Yid.  Epift.  15.  n.  3, 

a  pec- 


Letter  XIX.  Articles  $ 4,  $5.  541 

a  peccant  matter,  and  that  in  great  quantity,  which  may  be  expell’d;  but 
there  is  no  cough,  by  reafon  of  the  fenfation,  in  the  internal  coat  of  the  bron¬ 
chia,  being  dull,  and  deficient :  to  which,  perhaps,  relate  two  obfervations 
in  the  Sepulchretum,  I  mean  the  twenty-fifth,  and  twenty-feventn,  of  the 
firfi  fe&ion  of  this  fecond  book.  But  on  the  other  hand,  fometimes  the 
lungs  are  befet  with  matter,  which  cannot  be  difcharg’d  by  the  moll  violent 
cough,  as,  for  inftance,  in  the  twelfth  obfervation  of  this  third  fedtion,  or 
that  which  I  have  defcrib’d  in  another  letter  (7),  of  tophaceous  lungs. 

Nor  ought  you  to  believe  otherwife,  of  the  caufes  of  a  cough,  which  the 
cough  itfelf  is  able,  or  not  able,  to  difcharge,  from  the  upper  air-paflage, 
or  eliewhere :  although  it  is  almoft  impoffible  for  the  cough  to  difcharge 
thole  caufes,  which  lie  on  the  out-fide  of  the  airpafifages,  whether  they  are 
feated  within  the  thorax,  as  when  in  the  dropfy  of  this  cavity  (&),  a  cough  is 
fometimes  excited,  but  fuch  as  I  have  laid  is  fruitlefs,  or  at  lead:  brings  our 
none  of  that  water,  or  whether  they  are  fituated  on  the  outfide  of  the  thorax. 
For  they  are  fometimes  feated  in  the  head,  the  neck,  and  the  belly,  as  I  have, 
already  laid,  inftances  of  which  I  (hall  give  you  feparately. 

54.  And  firft,  that  the  caufe  of  the  cough  may  be  in  the  head,  is  manifeft 
to  ail,  even  from  this  circumftance,  that  a  cough  frequently  follows  the 
flight  irritation  which  is  occafion’d  by  picking  the  ears ;  whether  the  irri¬ 
tation  be  propagated  through  the  internal  membranes  of  the  ear,  and  the 
euftachian  tube,  and,  finally,  through  the  tube  of  the  pharynx,  quite  into  the 
larynx;  or  whether  it  is  the  occafion  of  fomething  being  immediately  dil- 
charg’d,  from  that  tube,  into  the  pharynx,  which  will  ftimulate  this,  and  the 
larynx;  or,  at  length,  whether  it  draw  fome  certain  nerves  into  confent,  as,, 
for  inftance,  thofe  which  go  to  the  membranes,  that  are  in  near  continuity 
with  the  internal  coat  of  the  larynx.  And,  as  I  have  already  faid*  the  excit¬ 
ing  of  a  cough  of  this  kind  is  well  known  to  every  body.  But  to  anatomifts, 
that  alfo  is  known,  which  depends  upon  an  irritation,  at  the  beginnings  of 
the  nerves,  as  fometimes  happens  in  hydrocephali.  You  may  read  in  the 
foregoing  book  of  the  Sepulchretum  (/),  the  obfervation  of  Vefalius  relating 
to  thatdifeafe;  and  you  will  find,  that  upon  the  flighted:  motion  of  the  head,, 
a  violent  cough  was  immediately  excited,  when  no  diforder  was  fpoken  of  in, 
the  lungs.  So  alfo,  in  the  obfervation  of  Lechelius  (/7?),  you  will  read  of  a 
cough,  whereas  no  other  vifcus  but  the  brain  was  diforder’d,  and  even  the 
lungs  in  particular,  were  in  a  very  natural,  and  found  ftate,  and  are  laid  to< 
be  without  any  fault  whatever. 

55.  But  nobody  is  ignorant,  that  the  caufes  of  coughs  frequently  lie  in- 
the  neck,  that  is  to  fay,  in  the  afpera  arteria ;  but  efpecially  in  the  larynx, 
and  that  thefe  may,  fometimes,  be  difcharg’d,  even  without  the  afliftance  of 
medicines,  when  the  larynx  is  fo  vitiated,  as,  after  a  cough  of  a  year’s  con¬ 
tinuance,  and  the  fpitting  of  various  kinds  of  matter,  is  defcrib’d  by  the  ce¬ 
lebrated  Fantonus  (»).  And  Lancifi,  in  a  letter  which  he  wrote  to  me,  told 
me,  that  when  Malpighi,  and  he,  were  converfing  together,  of  certain  very 


(/)  Epift.  15.  n.  21. 
(£)  Epift.  16. 

Qj  1  Se£t.  16.  obf.  6. 

6 


(*) 
(«) 
n.  8. 


Ibid,  in  Additam,  obf.  4. 

De  Ohfervat.  Med. .  &  Anat.  epill.  8. 

violent;: 


54 2  Book  II.  Of  Difeafes  of  the  Thorax. 

violent  coughs,  which  others  improperly  afcrib’d  to  the  clafs  of  convulfive 
coughs,  it  ieem’d  to  them-,  that  they  ftiould  rather  be  number’d  among  thofc 
which  have  their  origin  from  a  fmall  quantity  of  humour,  but,  in  its  nature, 
fait  and  acrid,  fuch  as  thofe  patients  expectorated,  and  was  preternaturally 
lecreted  from  the  glands  of  the  larynx  :  in  the  number  of  which  glands  he 
afterwards  would  have  reckon’d  our  arytaenoidm,  and  that  fo  much  the  more 
readily,  becaufe  he  had  found  them,  in  a  body  he  had  diftetfted,  44  fome- 
44  what  monftrous  in  their  fize.”  And  I  call  them  mine,  not  only  becaufe 
this  very  learned  man  himfelf,  firft  attributed  them  to  me  (0),  but  becaufe  it 
has  never  l'eem’d  to  me,  as  it  did  lately  to  a  gentleman,  in  other  refpedts  very 
learned,  that  theie  glands  had  been  before  pointed  out  by  Carpus,  and 
Schelhammer.  Do  not  take  it  ill,  I  befeech  you,  if  1  examine  into  this  af¬ 
fair  a  little  more  deeply  *,  for  it  ought  to  be  done  the  more  carefully,  in  pro¬ 
portion  as  we  both  of  us  owe  the  more  to  the  authority  of  an  illuftrious  man. 

44  Carpus  had  afterted,”  fays  he,  44  page  three  hundred  and  ninety  three, 
44  that  a  glandular  flefh  was  feated  on  the  glottis.  And  Schelhammer  had 
44  added,  1.  c.  p.  11.  that  a  glandular  fubftance  lay  upon  the  arytaenoid.” 
And  I  would  have  you  turn  to  both  of  thefe  authors  :  I  myfelf  will  readily 
point  out  the  pafiages  to  you,  that  you  may  not  have  the  trouble  of  looking 
backwards  and  forwards  through  many  pages,  and  that  you  may  not  happen, 
by  this  means,  to  light  on  another  opufculum  of  Schelhammer,  which  is  lefs 
relative  to  this  fubjeCl.  You  muft  turn  to  that  difiertation  of  his,  entitl’d, 
De  Voce ,  in  the  firft  part  of  which,  and  chapter  the  third,  fpeaking  of  the 
arytenoid  cartilages,  he  fays,  44  Thefe  are  the  fupport  of  a  peculiar  kind  of 
■“  fubftance,  which  is  found  no-where  elfe  in  the  body,  and  which  Galen  has 
44  aptly  exprefs’d,  by  calling  it  an  adipofe,  cartilaginous,  and  membranous 
“  fubftance:”  and  having  interpos’d  fome  things  relative  to  this  fubftance, 
that  he  may  drew  it  to  be  fimilar  to  thofe  fubftances  which  Galen  has  men¬ 
tion’d,  and  to  be  in  a  kind  of  middle  ftate  betwixt  the  three,  he  immediately 
concludes  thus,  in  the  eleventh  page,  which  is  pointed  out:  44  This  fubftance, 
44  then,  adheres  to  the  double  arytenoid  cartilage,  like  a  double  crift,  foft, 
44  lax,  and  fmooth,  more  diftant  from  each  other  when  we  breathe,  and  ap« 
k44  proaching  mutually  to  each  other  when  we  fpeak,  and  when  we  hold  in 
44  our  breath,  entirely  fhut  up.  The  fpace,  which  is  intermediate  to  both 
44  of  thefe  fubftances,  is  fometimes  call’d  the  rimula  vocalis,  or  glottis.  In- 
44  terpreters  have  tranftated  it  lingula  Galeni .”  Does  he  fay,  then,  44  that  a 
44  glandular  fubftance  is  plac’d  upon  the  arytenoid  cartilage  ?”  It  cannot  be 
fuppos’d  fo  in  the  leaft,  fince  he  fays,  that  it  is  a  fubftance  of  fuch  a  kind, 
as  44  is  to  be  found  no  where  elfe  in  the  body,”  and  confirms  it  alfo  in  the 
end  of  the  fifth  chapter  (p).  Let  us,  therefore,  leave  to  Schelhammer  44  thefe 
44  crifts,  fpines,  or  eminences,  of  the  arytenoid  cartilages,”  for  fo  he  calls 
them  in  another  place  (q),  from  whencefoever  he  has  taken  his  idea  thereof, 
and  the  glottis,  which  is  nowhere  fufficiently  explain’d,  in  whatfoever  manner 
he  has  undtrftood  it  to  be  form’d  ;  for  he  44  fuppos’d  that  the  arytenoidasus 
44  proprius  mufde,  as  it  is  call’d,  was  the  fubftance  of  the  glottis  itfelf  (r).” 

(c)  De  Subit.  Mort.  edit.  Venet.  1.  1.  c.  18.  (?)  Ibid.  c.  4. 

ad  n.  3.  lr ]  Ibid.  c.  3, 

(p)  Pan.  I. 

For 


3 


Letter  XIX.  Article  56.  543 

For  it  is  fufneient  with  me,  that  it  plainly  enough  appears,  that  u  glandular 
u  fubitance  ”  was  not  “  add  d  ”  by  him. 

56.  Nor  will  you  be  lefs  clea  ly  convinc’d,  in  my  opinion,  that  when  it  is 
faid  by  Carpus,  “  that  a  glandular  flefh  is  fituated  upon  the  glottis,”  he  meant 
nothing  elie  at  all,  than  that  the  epiglottis  had  its  own  proper  gland  fuuated 
upon  it;  as  I  formerly  admonifh'd  in  thole  very  firft  Adverfaria  (s).  For 
the  words  of  Carpus,  which  you  have  in  his  “  Commentaries  upon  the  ana- 
<c  tomy  of  Mundinus  (/),”  and  which  are  on  the  pofterior  furface  of  page 
three  hundred  and  ninety-three,  that  is,  of  the  page  referr’d  to,  are  in  fadt 
thefe  :  “  Nature  has  ordain’d,  as  will  be  feen  below,  a  certain  glandular 
flefh,  above  or  below  the  lingua,  or  tongue,  which  adheres  to  that  air- 
tc  pipe,  in  order  to  mollify  the  epiglottis,  or  larynx.”  But  that  “  lingua,” 
or  tongue,  “  of  the  pipe,”  is  not,  with  Carpus,  what,  with  the  interpreters 
of  Galen,  is  the  lingula ,  or  rima,  of  the  glottis,  as  I  have  mention’d  juft 
now,  in  the  words  of  Schelhammer.  For  this  lingula  is  entirely  the  fame 
with  that,  which  Celfus  («),  who  is  quoted  by  Carpus,  in  the  preceding 
page,  had  thus  deferib’d  :  “  There  is  a  very  imall  part  in  the  afpera  arteria, 
which  has  the  Shape  of  a  little  tongue,  lying  immediately  under  the  fauces  : 
“  and  this,  when  we  breathe,  is  lifted  up;  and  when  we  take  down  meat 
“  and  drink,  it  (huts  up  the  afpera  arteria.”  That  is  to  fay,  it  is  the  car¬ 
tilage  call’d  epiglottis,  as  Carpus  Shews  in  that  very  fame  page  three  hun¬ 
dred  and  ninety-three,  and  a  few  lines  before,  where  he  fays,  “  Yet  the 
“  proper  epiglottis,  by  the  force  of  the  word,  fignifies  epiglottida,  which  is 
ts  the  tongue  of  a  pipe,  plac’d  upon  the  cimbalar  cartilage.”  And  this  he 
not  only  confirms  in  Several  places,  in  the  whole  remainder  of  that  twenty- 
ninth  commentary,  but  he  there,  above  all,  plainly  declares  it,  where (x)  he 
deferibes  the  epiglottis,  properly  fo  call’d,  “  by  the  figure  of  a  human 
“  tongue,  or  or  the  tongue  of  a  pipe,”  made  by  art,  and  in  fuch  a  fituation, 
that  “  with  its  molt  acute  part,  it  goes  toward  the  cefophagus,  and  (huts  up 
“  the  upper  part  of  the  cimbalar  cartilage,”  that  is  the  arytenoid ;  in  the 
description  of  which,  having  loon  after  Shewn  that  it  was  double,  he  has 
thus  pointed  out  the  feparate  cartilages  of*  the  larynx  (y)  :  “  Befides  thefe 
“  two  cimbalar  cartilages,  there  are  three  others,  to  wit,  the  clipealis,  or 
sc  Shield  like  cartilage,  and  a  cartilage  that  has  no  name,  and  the  cartilage 
“  call’d  the  tongue  of  the  pipe:”  which  being  added,  he  immediately  con¬ 
cludes,  that  the  cartilages  of  the  larynx  are  five  in  number,  inftead  of  three, 
wh;ch  others  had  fuppos’d  before. 

But  notwithstanding  thefe  things  are  fo  clear,  that  nothing  can  be  more 
evident,  yet,  moreover,  add  this.  Carpus  had  faid,  as  I  related  a  little 
above,  “  that  he  Should  enquire  below  ”  into  that  glandular  flefh  plac’d 
upon  the  tongue  of  the  pipe,  and  its  ufe.  Where,  then,  is  this  done  ?  In 
no  other  place,  but  where,  in  deferibing  the  epiglottis,  properly  fo  call’d  (z), 
he  has  acknowledg’d  “  a  fat  flelh  in  it,”  the  ufes  of  which  were,  as  he  fup- 
pofes,  to  moiiten  the  epiglottis,”  that  is,  the  larynx,  and  epiglottis  pro- 
peily  lo  call’d.  And  as  even  that  very  learn’d  man  has,  a  little  beiow, 

( s )  N.  3  (d  Comm.  29.  (*)  Pag.  396.  (y)  Pag.  397. 

(«)  De  Medic.  1.  4,  c.  1.  (z)  Pag.  396. 

jightly 


544  Book  II.  Of  Difeafes  of  the  Thorax. 

rightly  underftood  this  pafiage  of  the  gland  of  the  epiglottis,  although  he 
thought  that  the  former  related  to  the  arytenoid  glands  ;  fo  when  he  (hall 
obferve,  that  this  other  paflfage  is  to  be  referr’d  to  that  firft,  I  do  not  doubt, 
but,  according  to  his  known  ingenuity,  he  will  now  fay,  that  the  arytenoid 
glands  are  rather  to  be  fought  for  among  other  antient  authors,  than  in 
Carpus,  if  any  footfteps  of  them  did  really  exift :  and  yet  not  in  Galen,  or 
Fabricius,  although  they  “  had  faid  formerly,  that  the  glottis  was  vifcous 
the  former,  in  his  treatife  Be  Utilit.  Part.  1.  vii.  c.  13.  and  the  latter,  /.  c.  9. 
that  is.  Be  Larynge,  parte  i.  cap.  9.  for  thefe  are  indeed  “  obfcure  traces.’* 
But  if  you  fhould  fuppofe,  that  what  Galen  has  written  in  the  fame  book, 
in  the  eleventh  chapter,  and  Fabricius  in  the  fecond,  relate  more  to  the 
prefent  lubjefl,  you  might  at  leaft  produce  the  words  of  the  firft,  which  ex¬ 
prefly  affirm,  that  the  body  of  the  glottis  “  is  membranous,  adipofe,  and 
44  glandular,”  and  the  words  of  Fabricius,  which  affirm  nearly  the  fame  thing 
in  hogs.  For  he  fays,  that  Galen  had  affirm’d  this,  “  becaufe  he  exactly 
44  defcrib’d  the  glottis  of  pigs,  which  is  adipofe,  the  adeps,  however, 
“  being  very  hard,  and  denfe,  lb  as  to  refemble  even  the  fubftance  of  a 
<c  gland.”  But  how  far  there  are  arytenoid  glands  in  pigs,  and  where  they 
are  fituated,  ’tis  not  a  place  to  enquire  here,  nor  yet  whether  Galen  meant 
to  point  them  out.  Fabricius,  however,  affirms,  at  leaft,  “  that  moft  other 
“  animals  are,  generally,  deftitute  of  that  adipofe,  and  glandular,”  body, 
which  he  acknowledges  in  a  low*,  nor  finally,  does  he  hint,  that  in  any  of 
them  it  is  fituated  in  that  part,  where  the  human  arytenoid  glands  are  fituated, 
but  quite  more  anteriorly,  and  inferiorly,  as  you  will  readily  perceive,  by 
reading  that  part  of  the  chapter  quoted,  where  he  defcribes  the  glottis. 

And  whether  thefe  things  are  faid  for  my  own  fake,  or  rather  for  the  fake 
of  a  truth,  which  we  both  of  us  ftudy  to  illuftrate,  in  the  hiftory  of  ana- 
romy,  let  this  truly  learn’d  man  himfelf,  whom  I  very  highly  efteem  on  the 
fcore  of  his  great  merits,  be  the  judge. 

57.  Now  let  us  return  to  the  lituations  of  the  caufes  of  coughs.  For  there 
remain’d  of  thefe,  thofe  which  lie  in  the  belly.  And  they  are  the  moft  ob¬ 
vious,  which  lie  neareft  to  the  diaphragm,  efpecially  in  the  liver,  and  the 
ftomach  ;  for  you  will  find,  that  caufes  of  this  diforder  have  been  obferv’d 
in  the  pancreas  alfo,  and  partly  in  the  fpleen,  and  indeed  in  the  kidneys 
iikewile,  in  the  Sepulchretum  ( a ).  For  whether  the  leptum  tranfverfum  is 
irritated  by  mere  contact  itfelf,  or  the  peritonaeum,  which  you  know  is  com¬ 
mon  to  thofe  vifcera,  and  to  the  lower  furface  of  the  feptum,  is  diftrafted, 
and  hurt;  or  finally,  whether  the  lungs  themfelves  are  drawn  into  confent,  by 
the  nerves  being  affecfted,  which  go  both  to  thofe  vifcera,  and  to  the  luno-s, 
coughs,  that  are  in  themfelves  dry  and  fruitlefs,  follow  affedlions  of  the  fame 
vifcera.  The  laft  of  this  kind  of  caufes  feems  to  be  chiefly  applicable  to 
the  ftomach,  from  the  infpedtion  of  thofe  nerves,  juft  now  fpoken  of,  that 
go  to  this  vifcus,  which  is  the  firft  of  all  of  the  vifcera  of  the  belly,  in  a 
very  great  quantity  ;  although  there  may  be  fome  who  believe  that  the  irri¬ 
tation  is  propagated  from  the  ftomach,  through  the  oefophagus,  either  to 
the  adhering  trunk  of  the  afpera  arteria,  or  to  the  larynx  itfelf  alfo ;  into 

(a)  Seft,  hac  3.  1.  2,  obf.  27.  §  7.  obf.  22.  §  2.  obf.  30. 

which. 


Letter  XIX.  Article  58.  545 

which,  the  internal  membrane  of  the  cefophagus  is,  at  length,  continu’d. 
However  this  is,  I  will  give  you  an  inftance  of  a  dry  cough  arifing,  according 
to  appearances,  from  a  tumour  annex’d  to  the  ftomach :  and  then  I  will  im¬ 
mediately  put  an  end  to  this  very  long  letter. 

58.  An  old  woman  of  feventy,  who  had  formerly  been  a  drunken  nurfe, 
and  always  coveted  wine,  had  been  render’d,  for  at  lead:  eighteen  months, 
unfit  for  fervice,  by  reafon  of  the  following  indifpofitions  in  her  health,  and 
chiefly  a  cough  which  was  dry,  a  difficulty  of  breathing,  and  a  continual 
pain  in  the  head,  although  fometimes  encreafing,  and  fometimes  remitting, 
together  with  the  natural  confequences  of  thefe  complaints,  watchings,  and 
lofs  of  appetite,  to  a  great  degree.  Thefe  things  1  learn’d  from  the  women 
who  liv’d  with  her,  when,  on  account  of  fome  things,  which  were  found  in 
her  body,  I  took  care  that  other  circumftances  fhould  be  enquir’d  into,  but 
particularly,  whether  flie  complain’d  of  any  hardnefs  in  the  belly,  dwelling, 
or  fenfe  of  weight;  which  they  affirm’d  Ihe  did  not.  At  length,  after  hav¬ 
ing  labour’d  under  a  kind  of  peripneumony,  for  a  few  days,  ihe  died. 

Her  body  was  emaciated  •,  which  made  the  globe  of  fat,  that  was  found 
under  the  fkin  to  the  bignefs  of  a  fift,  upon  the  enfiform  cartilage,  fo  much 
the  more  remarkable  (b).  The  belly  being  open’d,  nothing  appear’d  more 
worthy  of  obfervation,  than  a  roundifli  tumour  of  the  weight  of  a  pound  at 
leaft,  which  was  annex’d  to  the  pofterior  furface  of  the  ftomach,  at  about  the 
middle  of  it.  This  tumour  was  externally  unequal,  with  little,  and  perfect¬ 
ly  hemifpherical,  tubercles  upon  it,  and  internally  variegated  with  a  white  and 
brownifh  colour,  and  alfo  with  a  blood-colour,  from  the  tinCture  of  the  veffels. 
And  although  it  was  every  where  fo  hard,  that  you  would  not  have  hefitated 
to  take  it  for  a  fchirrhus ;  it  was  internally,  in  fome  parts,  endow’d  with  a 
bony  hardnefs.  Being  cut  afunder  in  two  parts,  the  fedtions  were  equal  to 
three  inches  breadth,  in  one  diameter,  and  four  in  another  diameter.  It  had 
no  communication  with  the  cavity  of  the  ftomach  :  and  when  this  cavity  was 
open’d,  it  appear’d  rugous,  and  juft  as  it  does  in  healthy  perfons,  even  in 
that  part  which  anfwer’d  to  the  tumour,  that  is,  to  the  fpace  of  about  two 
inches.  And,  indeed,  the  coats  which  cover’d  the  internal  coat  to  that  fpace, 
were  found,  and  not  annex’d  to  the  tumour :  which  was  tied  to  the  ftomach 
only  by  the  external  coat.  This  feem’d  to  be  produc’d  over  the  tumour, 
and  make  the  external  furface  of  it,  and  carry  with  it  its  fanguiferous  veffels, 
one  of  which,  in  appearance  venous,  proceeding  from  the  tumour,  crept 
through  the  inferior  furface  of  the  ftomach,  being  almoft  equal  in  thicknefs 
to  a  goofe-quill.  it  was  very  eafy  to  conjecture,  that  any  the  leaft  gland 
of  the  clafs  of  the  conglobated  glands,  adhering  to  the  external  coat,  or  the 
cellular  membrane,  which  lay  under  it,  or  even  fome  cells  of  the  cellular 
membrane,  if  you  choofe  rather  to  fuppofe  fo,  had  grown  out  into  this 
great  bulk,  the  matter  being,  by  degrees,  collected,  and  drawing  thefe 
coats  from  the  others  by  its  weight.  The  fpleen,  however,  being  fomewhat 
larger  than  was  natural,  and  internally  pale,  was  of  fuch  a  laxity,  that  it 
feem’d  rather  to  contain  a  .kind  of  pultice,  than  what  it  is  wont  to  contain. 
The  liver  was  very  long  tranfverfly  ;  in  its  internal  fubftance  palifh,  and  aL 
moft  variegated,  but  not  hard.  The  great  artery  was’ in  a  manner  winding, 


VO L.  I. 


{b)  Vid.  Epift.  50.  n.  24. 

4  A 


and 


546  Book  II.  Of  Difeafes  of  the  Thorax. 

and  the  iliac  ftill  more,  inafmuch  as  they  feem’d,  in  Tome  places,  almoft  to 
l'well  out  into  diverticula,  or  little  refervoirs.  The  internal  furface  of  the 
one,  and  of  the  others,  was,  here  and  there,  white,  and  cover’d  with  bony 
fcales,  which  were  fmall  however,  and  only  in  few  places.  Thefe  were  the 
appearances  in  the  belly.  In  the  thorax,  and  head,  I  could  not  make  ufe  of 
equal  diligence,  being  taken  up  with  the  public  anatomy  of  the  year  1745, 
for  which  the  other  bodies  that  I  was  fupply’d  with,  were  lefs  unfit,  as  the 
mufcles  of  this  body  were  very  lax.  This,  however,  I  know,  that  the  heart 
was  not  affefted  with  any  difeafe,  which  was  obvious :  and  that  the  lungs  were 
annex’d  to  the  pleura,  and  hardifh,  but  had  no  appearance  that  ffiew’d  a  true 
inflammation,  and  ftill  lefs  any  that  fhew’d  an  inveterate  difeafe.  However, 
of  what  nature  that  true  inflammation  is,  which  occurs  in  the  lungs,  the  next 
letters  will  demonftrate.  Farewel. 


LETTER  the  TWENTIETH 

Treats  of  pain  in  the  Breaft,  Sides,  and  Back. 

THERE  are  fo  many  obfervations  both  of  Valfalva’s  and  of  mine,  rela¬ 
tive  to  pains  of  the  breaft,  fides,  and  back,  but  efpecially  of  the  breaft, 
that  although  I  have  fent  fome  of  them  to  you,  in  other  letters  (*),  to  which 
alfo  they  related,  and  am  to  fend  others  hereafter,  I  am,  neverthelefs,  under 
a  neceflity  of  dividing  the  remaining  obfervations  into  two  letters,  the  firft  of 
which  contains  thofe  of  Valfalva,  and  the  other  mine. 

2.  He  faw,  then,  a  carman,  about  forty  years  of  age,  who,  although  he 
had  been  troubl’d,  for  a  whole  year,  with  fevers,  and  even  at  laft  with  a  pe- 
ripneumony  alfo,  with  a  dry  cough,  and  a  difficult  refpiration,  attended  with 
fome  flight  delirious  fymptoms,  yet  never  would  go  to  bed,  but  went  about 
his  ordinary  bufinefs,  in  whatever  manner  it  was.  Wherefore  he  did  not 
come  to  the  hofpital,  till  the  fifth,  or  fixth  day  from  the  beginning  of  the 
peripneumony.  and  then  came  by  himfelf,  and  on  foot:  where  being  ex¬ 
tremely  troubl’d  with  the  fame  fymptoms,  he  died  within  twenty-four  hours. 
In  the  belly  was  found  a  fmall  quantity  of  limpid  ferurn  :  and  the  fpleen 
■  was  three  times  as  large  as  is  natural.  In  the  right  cavity  of  the  thorax  were 
fome  ounces  of  turbid  ferurn  :  and  the  fuperior  lobe  of  the  lungs,  efpecially 
towards  the  back,  was  entirely  inflam’d  •,  and  this  being  cut  into,  very  fmall 
abfceffes,  containing  a  fanious  matter,  were  every  where  found.  The  pleura 
was  unhurt.  The  cavity  of  the  pericardium  was  half  fiTll  of  its  own  natural 
fluid.  In  the  heart  were  polypous  concretions,  being  greater  in  the  auricles 

(*)  VI.  n.  10,  12,  14.  VII.  4-  XXII.  10,  16,  22.  XXXVI.  2 3.  XXXVII.  29. 
XLV.  16.  XLVJII.  32.  LI1.  15. 

and 


4 


Letter  XX.  Articles  3,  4,  5.  3*47 

and  lefs  in  the  ventricles  at  the  mouths  of  the  arteries,  and  out  of  thefe  laid 
mention’d,  thoCe  were  the  greateft,  which  were  in  the  right  ventricle. 

3.  A  man  of  forty  years  of  age,  who  had  long  been  in  the  hofpital  of  St. 
Mary  de  Vita,  at  Bologna,  in  order  to  be  cur’d  of  a  flight  wound  in  his  leg, 
and  had  lain  near  another  man,  who  had  been,  at  length,  taken  off  by  a  large 
abfcefs  of  his  leg,  was  feiz’d  with  a  cough,  and  an  acute  fever ;  the  matter  he 
fpat  up  was  ting’d  with  blood,  and  afterwards  inclin’d  to  a  green  colour,  with 
a  difficult  refpiration,  and  a  pain  in  the  right  fide:  and  while  thefe  fymp- 
toms  were  violent,  and  he  lay  on  his  right  fide,  on  which  he  could  lie  eafily, 
he  died,  about  the  fourth  day  from  the  beginning  of  the  acute  difeafe. 

The  left  lobe  of  the  lungs  was  found,  and  unconnected.  The  upper  lo¬ 
bule  of  the  right  lobe,  and  the  upper  part  of  the  next  lobule,  both  of  them 
on  that  fide,  towards  the  back,  were  turgid  with  an  inflam’d,  and  very  hard 
tumour,  and  clofely  adher’d  to  the  pleura  by  membranous  connexions.  Yet 
the  pleura  bore  not  the  lead  mark  of  inflammation.  Each  ventricle  of  the 
heart  contain’d  a  fingle  polypous  concretion,  which  was  of  a  large  fize  :  yet 
the  right  contain’d  the  larged :  and  although  they  were  produc’d  not  only 
into  the  auricles,  and  veins,  but  into  the  arteries  alfo,  yet  they  were  lefs  pro¬ 
duc’d  into  the  arteries,  than  the  veins. 

4.  Both  of  thefe  hiftories  teach  fomething  of  themfelves,  which  is  known 
indeed  to  every  body,  but  never  fufficiently  inculcated :  the  firft,  that  unlefs 
we  endeavour  to  overcome  great  diforders  in  time,  even  the  ftrongeft  men, 
and  for  that  reafon  trufting  too  much  in  themfelves,  among  whom  that  car* 
man  certainly  was,  are  carry’d  off  more  haftily  than  we  fhould  imagine :  the 
fecond,  that  thofe  perfons  are  very  carelefs  of  themfelves,  who  lie  long  in 
hofpitals,  on  the  fcore  of  flight  diforders,  efpecially  if  they  lie  near  patients, 
who  infeCt  the  air  with  unwholefome  vapours:  for  they  are,  by  this  means, 
difpos’d  to  much  more  violent  diforders,  than  that  was,  which  they  went  thi¬ 
ther  to  get  rid  of,  as  happen’d  to  this  very  man,  who,  by  this  means,  was 
feiz’d  with  a  moft  acute  inflammation,  and  that  of  a  malignant  kind,  if  you 
attend  to  Fantonus  (a),  who  pronounc’d  that  the  caufe  of  an  inflammation  of 
this  kind,  confifted  in  a  thin  and  greenifh  humour,  which  colour  was  obferv’d 
in  the  matter  expectorated  by  the  patient  in  queftion.  But  as  to  the  pain, 
the  caufe,  and  feat  thereof,  I  fhall  have  a  better  opportunity  of  writing  on 
thefe  fubjedts  below.  In  the  mean  while,  do  not  wonder,  that  Valfalva  men¬ 
tion’d  no  pain  in  the  firft  hiftory.  For  when  he  lpoke  of  a  peripneumony, 
he  underftood  a  dull  heavy  pain,  juft  as  he  did  a  fever,  though  he  exprefsly 
afterted  neither.  I  am  not  ignorant,  however,  that  in  this  diforder,  the  pain 
lometimes  feems  to  be  nothing,  as  1  fhall  fhew  on  a  future  occafion  (£),  and 
the  fever  but  flight  (c).  Yet  when  this  circumftance  does  happen,  it  ought 
not  to  be  omitted  ;  nay,  it  ought  to  be  diligently  remark’d,  which  Valfalva 
would  certainly  have  done.  But  now  he  omits  to  mention  the  fever  in  more 
than  one  hiftory  (rf),  being  a  thing  which  may  be  eafily  fub-underftood,  as 
particularly  in  the  two  which  1  fhall  immediately  fubjoin. 

5.  An  old  man,  who  was  fixty-five  years  of  age,  having  been  feiz’d  two 
years  before  with  a  palfy  of  the  right  arm,  and  being  freed  therefrom,  was 

(а)  in  hac  1.  2.  Sepulchr.  fedl.  4.  obf.  28.  (<r)  Vid.  infra,  n.  26. 

(б)  Epifb  21.  n.  5.  Si  feqq.  (d)  Vid.  infra,  n.  20. 


4  A  2 


accu  dom’d, 


54 8  Book  II.  Of  Difeafcs  of  the  Thorax. 

accuftom’d  to  complain  frequently,  afterwards,  of  a  pain  in  his  head,  and 
was,  laft  of  all,  receiv’d  into  the  hofpital,  which  I  mention’d  above,  for  an 
inflammation  of  the  lungs,  where  he  was  much  troubl’d  with  a  pain,  and 
fenfe  of  weight,  in  the  left  part_  of  his  cheft,  and  expedforated  a  purulent 
matter:  but  this  discharge  being  deficient  for  many  hours,  he  died  fuddenly, 
which  was  about  the  twenty-third  day. 

The  left  lobe  of  the  lungs  was  entirely  tumid,  and  hard,  and  fill’d  up 
the  whole  cavity,  containing  an  ulcer,  which  abounded  with  much  lanies, 
that  was  diffus’d  even  through  the  greater  part  of  the  lungs,  on  that  fide. 
But  the  pleura  was  altogether  found.  The  right  fide  of  the  heart  contain’d 
a  polypous  concretion,  which  extending  itfelf  through  the  vena  cava,  as  it 
were,  to  the  length  of  a  cubit,  imitated  its  various  partitions.  There  was 
another  in  the  left  fide  of  the  heart ;  but  this  fcarcely  reach’d  to  the  great 
artery.  In  the  ventricles  of  the  brain  was  found  water,  to  the  quantity  of 
half  a  pint  :  nor  was  there  any  other  preternatural  appearance  in  the  whole 
brain,  if  you  except  the  glandules  of  the  plexus  choroides,  which  were  very 
turgid. 

6.  Nothing  more  accelerates  death,  in  diforders  of  this  kind,  than  a  fup- 
preffion  of  the  matter  that  ought  to  be  expedforated.  And  this  fo  much  the 
more  eafily  happens,  as  the  ftrength,  by  reafon  of  long- continu’d  ficknefs, 
age,  and  a  taint  of  the  nervous  kind,  is  proportionably  decreas’d  :  all  which, 
you  fee,  were  join’d  together  in  the  old  man  here  lpoken  of.  But  as  to 
that  which  was  feen  in  his  brain,  it  may  point  out  to  you,  what  was  the 
caufe  of  the  pally  which  had  preceded,  and  of  the  pain  which  often  affedfed 
the  head,  if  you  turn  back  to  what  I  have  before  ( e )  written  to  you  in  re¬ 
gard  to  both  thele  affedtions. 

7.  A  woman,  about  twenty-feven  years  of  age,  who,  though  fhe  had 
been  married  four  years  before,  had  never  conceiv’d,  was  affedfed  with  a 
pain  in  the  left  fide  of  the  cheft,  with  a  difficulty  of  breathing,  and  a  violent 
.cough,  by  which  fhe  had  fome  expectoration.  She  died.  Upon  opening 
the  thorax,  not  only  ferum  was  found  in  its  left  cavity,  ting’d  with  a  white 
colour,  but  the  lungs  alfo  were  inflam’d  on  the  pofterior  part  :  from  the 
fedtion  of  which,  although  no  abfcefs  appear’d,  a  lanies  mingl’d  with  blood 
flow’d  out,  and  black  fpots  were  feen  here  and  there  through  its  fubftance. 
The  belly  being  open’d,  in  the  ovaria,  the  fluid  of  the  vehicles  was  found  to 
be  wholly  concreted,  juft  as  if  it  had  been  boil’d  over  the  fire  :  from  which, 
it  is  probable,  that  the  caufe  of  barrennefs  had  arifen. 

8.  This  you  will  alfo  add  to  the  other  caufes  of  barrennefs.  But  as  it  is 
not  a  proper  occafion  to  fpeak  of  this  here,  we  will  pafs  on  to  the  hiftory 
of  another  woman,  who  had  often  conceiv’d,  and  who,  when  fhe  approach’d 
near  to  the  time  of  her  delivery,  was  taken  off  by  an  inflammation  of  the 
lungs. 

9.  A  noble  matron,  aged  five  and-forty,  of  a  very  fat  habit  of  body,  and 
abounding  with  ferum,  in  whom,  when  in  health,  refpiration  was  always 
lbmewhat  difficult,  efpecially  after  motion,  and  a  flight  cough  and  frequent 
fpitting  very  often  return’d,  and  who  had  almoft  every  day,  after  a  difturb’d 
and  reftlefs  night,  vomitings  of  thick  and  vifcid  matter  in  the  morning,  by 


(<?)  Epift.  XL  &  I. 


which 


I  o. 


Letter  XX.  Articles  9, 


449 


which  {lie  feem’d  to  be  reliev’d,  having  already  brought  forth  many  children, 
and  having  fuffer’d  many  mifearriages  alfo,  when,  at  length,  in  the  year  1689, 
fhe  had  enter’d  upon  the  ninth  month  of  her  pregnancy,  and  had  long  ex¬ 
pos’d  herfelf  to  a  very  cold  air,  was  leiz’d  with  a  great  rigor  in  her  whole 
body,  which  was  follow’d  by  an  equal  heat,  attended  with  violent  third,  and 
difficulty  of  breathing,  a  very  troublefome  cough,  an  oppreffive  pain  in  the 
right  part  of  the  thorax,  verging  to  the  fcapula,  a  quick  and  hard  pulfe,  a 
bilious  vomiting,  (from  which  there  feem’d  to  be  fome  alleviation)  and  with, 
that  inquietude  and  toning  of  the  whole  body,  which  was  very  troublefome, 
even  on  the  following  days.  A  vein  was  open’d  in  the  right  arm  ■,  nor  were 
the  other  affiftances  of  art  omitted.  Neverthelels,  a  more  vehement  attack 
of  the  difeafe  coming  on,  to  thofe  firft  diforders  of  the  pulfe,  an  intermiffion 
alfo  was  added  on  the  fecond  day,  and  a  neceffity  of  breathing  with  the  neck 
ereCt,  together  with  a  difeharge  of  watry  and  livid  matter  by  fpitting,  and 
of  a  bilious  matter  by  ftool. 

On  the  third  day,  the  difficulty  of  breathing  was  increas’d,  and  a  ftertor 
came  on  :  the  expectorated  matter  was  lefs  in  quantity,  very  thick,  denfe, 
and  whiciffi,  and  fometimes  alfo  yellow  :  fhe  had  a  confiderable  number  of 
ftools :  her  pulfe  was  (till  more  unequal.  Blood  was  again  taken  away,  and 
other  remedies  made  ufe  of,  but  in  vain,. 

For  on  the  fourth  day  all  the  fymptoms  became  worfe :  and  that  pain  of 
the  cheft,  which,  as  I  have  Laid,  had  been  of  a  heavy  kind,  began  now  to 
be  very  pungent  and  acute,  efpecially  when  the  patient  cough’d,  or  mov’d 
her  body  :  and  to  this  was  afterwards  added  a  pain  in  the  lower  part  of  the 
belly,  not  much  unlike  the  other,  which  caus’d  fome  fufpicion  of  delivery 
coming  on.  But  on  the  following  night,  amidft  frequent  inequalities,  and 
intermiffions,  the  pulfe  began  to  faulter,  and  the  pains  being  alleviated,  the 
continual  tolling  of  the  whole  body  being  remitted,  the  fpitting  being  fup- 
prefs’d,  and  the  ftrength  being  wearied  out,  the  beginning  of  the  fifth  day 
put  an  end  to  her  life. 

The  abdomen  being  immediately  open’d,  the  uterus  was  fomewhat  inflam’d, 
and  a  female  child  was  found  to  be  already  dead  therein  ;  yet  the  vilceraof  the 
child,  as  well  as  the  remainder  of  thofe  in  the  belly  of  the  mother,  were  in 
a  natural  date.  But  when  the  thorax  of  the  mother  was  laid  open,  the  right 
lobe  of  the  lungs  ffiew’d  a  very  great  inflammation,  and  hardnefs,  and  an 
abfeefs  already  begun  under  them. 

10.  Although  you  will,  perhaps,  wilh  at  firft,  that  Valfalva  had  deferib’d 
the  anatomy  of  the  thorax  of  this  matron,  with  the  fame  accuracy  that  he 
did  the  difeafe  ;  yet  neither  the  hardnefs  of  the  pulfe,  nor  the  pain  which 
from  a  heavy  one  became  pungent,  neceffarily  indicate,  that  befides  an  in¬ 
flammation  of  the  lungs,  which  he  has  mention’d,  there  was  alfo  an  inflam¬ 
mation  of  the  pleura,  of  which  he  makes  no  mention. 

But  as  I  ffiall  have  occaflon  to  fpeak  of  both  thefe  figns  again  below, 
when  I  fpeak,  once  more,  in  behalf  of  the  fame  opinion  (/),  1  ffiall  fpeak 
but  flightly  here  of  each.  For  that  the  pulfe  has  been  hard  in  thofe  who 
were  aflfefted  with  a  peripneumony,  and  yet  the  pleura  has  been  found  with- 


(f)  N.  38. 


out 


SSo  Book  1L  Of  Difeafes  of  the  Thorax. 

out  any  inflammation,  you  will  fee  hereafter  (g) :  nor  did  Galen,  on  whofe 
authority  they  chiefly  depend,  who  deny  that  the  pulfe  is  hard  in  a  peripneu- 
mony,  deny  this  himfelf  (b) ;  but  even  confefs’d  exprelsly,  as  Schneider  has 
admonifh’d  us  (<),  that  this  does  happen  “  now  and  then,”  and  abounds  with 
bilious  matter,  as  in  the  cafe  before  us.  Nor  is  it  to  be  wonder’d  at,  if  in 
fo  great  an  inflammation  of  the  lungs  which  this  matron  labour’d  under,  its 
external  membrane  was,  at  length,  alfo  inflam’d  :  and  when  this  happens, 
Schneider  (£),  whom  I  have  already  commended,  did  not  doubt,  but  by 
reafon  of  the  fmall  nerves  which  go  into  this  membrane,  the  pain  might  be¬ 
come  pungent,  which  was  afterwards  confirm’d  by  Vieuffens  (/),  who  aflerts, 
“  that  a  great  number  of  nervous  fibrillas  terminate  there.”  Nor  had  San- 
nertus  (m)  doubted  upon  this  point  before  ;  nor  did  the  author  of  the  fcho- 
lium  which  is  added  to  the  obfervation,  in  this  fourth  fedtion  of  the  Sepul- 
chretum  (#),  doubt  afterwards,  (which  paffage  is  wrongly  pointed  out  by 
Tulpius)  efpecially  if  “  either  the  tenfion  be  ftrong,  or  the  inflammation 
“  great,”  as  in  this  matron. 

See  how  many  circumftances  confpir’d  to  the  death  of  this  matron,  and  of 
what  kind  they  were.  In  the  firft  place,  fhe  was  very  fat :  which  fhews  the 
caufe  of  the  diforder  to  have  been  very  violent  *,  for  bodies  of  a  fat  habit  are 
lefs  liable  than  others,  to  pleurifies  and  peripneumonies,  as  is  obferv’d  by  that 
equally  learn’d  and  diligent  phyfician  Triller  (o) :  which,  upon  calling  to  mir*d 
all  the  pleuritic,  or  peripneutnonic  patients,  that  1  have  feen,  or  taken  care 
of,  I  find  to  be  true  ;  and  you  may  eafily  perceive  the  lame,  from  reading  all 
the  hiftories  of  thofe,  who  have  been  differed  byValfalva,  and,  in  like  manner, 
by  me,  this,  and  another  of  Valfalva’s  (/>),  excepted. 

Befides,  it  is  fufficiently  manifefl,  how  much  room  is  taken  up  by  too 
great  a  quantity  of  fat  ;  fo  that  the  lungs,  efpecially  in  a  recumbent  pofture, 
are  much  prefs’d  up,  and  confin’d,  by  which  reipiration  and  expectoration 
are  render’d  much  more  difficult.  To  thefe  was  added  the  great  diflenfion 
of  the  uterus,  which  in  the  ninth  month  is  very  confiderable.  Nor  was  an 
inflammation  of  the  uterus  entirely  wanting,  which  I  fuppofe  began  at  the 
time,  when  the  pungent  pain  in  the  lower  part  of  the  belly  brought  on  a 
falfe  fufpicion  of  the  delivery  being  at  hand. 

But  you  will  eafily  underftand,  how  much  even  the  utero-geftation  itfelf, 
when  a  peripneumony  comes  on,  makes  the  diforder  more  dangerous,  whether 
you  confider  the  fymptoms  of  the  difeafe,  or  the  principal  remedies  that  are 
apply’d  :  for  there  are,  I  fay,  on  one  hand,  frequent  concuffions  of  the 
cough,  pain,  and  watching  and  on  the  other,  blood-lettings,  together  with 
a  flender  diet ;  whereas  we  mufl  neither  take  from  the  foetus  what  ferves  to 
its  nourifhment,  nor  yet  fuffer  the  ftrength  of  the  child,  or  the  mother,  to 
be  fo  pull’d  down,  as  not  to  be  fufficient  for  delivery,  efpecially  when  the 
birth  is  at  hand,  as  in  the  prefent  cafe.  Yet,  neverthelefs,  the  opinion  of 


(g)  Epift.  21.  n.  1 6,  &  feq. 

(^>)  De  Cauf.  Pulf.  1.  4.  c.  12. 

(0  Differt,  de  Peripneumonia,  c.  2.  §  26. 
\k)  Ibid.  c.  1.  §  10. 

.(/)  Neurogr.  1.  3.  c.  4. 


( m )  Medic.  Pratt.  1.2.  P.  2.  c.  3. 

(«)  20.  §  3. 

( 0 )  Vid.  Commere,  Littej.  A.  1741.  Hebd. 
2.  n.  2.  ad  Aph.  14. 

(p)  Infra,  n.  61. 


Hippocrates* 


Letter  XX.  Article  i  o.  551 

Hippocrates  (q),  “  That  an  acute  diforder,  when  it  feizes  on  a  pregnant 
“  woman,  becomes  mortal,”  is  not  to  be  taken  in  any  other  fenfe  than  as 
Celfus  tranflates  it  (r),  acuto  morbo  facile  confumi ,  “  that  a  pregnant  woman 
“  is  eafily  deftroy’d  by  an  acute  difeafe;”  for  he  has  not  always  put  facile 
for  certe ^  by  which  it  would  be  underftood,  “  that  a  pregnant  woman  is 
“  certainly  deftroy’d  by  an  acute  difeafe  ;”  or  if  he  did  ufe  it  there  in  this 
fenfe,  he  had  an  eye  to  thofe  ancient  methods  of  cure,  which  were  intolerable 
to  pregnant  women  :  for  it  has  fince,  by  the  blefllng  of  God,  happen’d  to 
me,  and  to  many  others  who  pra&ife  phyfic,  nor  yet  fo  feldom  as  fome 
think,  that,  by  means  of  a  diet  moderately  thin,  and  by  making  ufe  even 
of  blood-letting,  fometimes,  cauiioufly,  where  the  cafe  requir’d  it,  the  mo¬ 
ther  and  the  child  have  been  fav’d  both  together,  even  more  than  once  in  a 
diforder  like  an  angina,  as  in  Jacoba  Severia,  manifeftly  join’d  with  an  in¬ 
ternal  inflammation  of  the  thorax :  yet  thefe  patients  were  not  fat,  nor  had 
weak  and  lax  lungs,  like  the  matron  we  fpeak  of.  For  as  fhe  had  been  long 
fubjedl  to  a  cough,  and  frequent  expectorations,  fhe  was,  without  doubt,  fo 
difpos’d  to  a  peripneumony,  that  fhe  could  not  be  equal  to  the  overwhelming 
force  of  it;  nor  was  it  of  the  light  kinds  of  diforder,  as  an  ancient  author 
fays,  or  if  you  chufe  rather,  as  Hippocrates  fays  (f),  of  the  kind  “  of  thofe 
“  that  are  not  pernicious  and  foft,”  fince  it  had  not  “  a  few,”  but  a  great 
number  “  of  thofe  figns,”  which  the  fame  author  enumerates.  For  there 
was  “  an  acute  fever,  a  frequent  and  warm  breath,  an  anxiety,  and  tolling, 
“  a  pain  under  the  fcapulas,  a  heavinefs  in  the  bread,  and  a  violent  cough 
and  befides  thefe,  others  ftill,  as  for  inftance,  the  neceffity  of  breathing  with 
the  neck  upright,  a  great  thirft,  great  diforders  of  the  pulfe,  livid  fpittings, 
the  belly  frequently  loofe,  more  frequently,  I  believe,  and  more  plentifully, 
than  it  ought  to  have  been;  fo  that  “  the  humour  being  fecreted  below;” 
as  the  fame  Hippocrates  fays  (/),  “  the  purgation  by  fpitting  was  not  carried 
“  on  above ;  ”  and  indeed  this  difcharge  was  from  thence  made  lefs  in  its 
quantity,  and  very  thick.  For  which  reafon,  he  pronounc’d  in  another 
place  («),  “  that  a  diarrhoea  coming  on  after  a  pleurify,  or  inflammation  of 
“  the  lungs,  was  bad.”  It  does  not  efcape  me,  what  phyficians  have  feen 
to  the  contrary,  and  that  not  very  feldom,  and  what  exceptions  they  make 
for  this  reafon,  at  the  fame  time  that  they  commend  fome  of  the  obfervations 
and  opinions  of  Hippocrates  himfelf.  Neverthelefs,  a  diarrhoea  is,  for  the 
molt  part,  noxious,  in  diforders  of  this  kind,  unlefs  it  fhould  be  accidentally 
proper  on  the  firfl:  days,  or  critically  fucceed,  in  the  progrefs.  And  this  fo 
far,  that  I  can  mention  two  men  of  illuftrious  birth,  who  were  my  fellow- 
citizens,  not  to  fpeak  of  many  others,  who  were  inftances  of  this  dodtrine  :  I 
mean,  the  Marquis  Thomas  Auguftini,  a  nephew  of  Stephen,  of  the  fame 
name,  who  was  a  cardinal  of  the  holy  Roman  church,  and  Count  John  Gad- 
dio,  the  one  at  that  time  aged  fixty-five  years,  and  the  other  older  by  eight 
years.  In  the  firft,  indeed,  when  leiz’d  with  a  peripneumony,  I  obferv’d  that 
a  diarrhoea  was  very  ufeful  in  the  end  of  the  difeafe,  and  gave  the  finifhing 


( q )  Sett.  5.  Aph.  30. 

(r)  De  Medic.  1.  2.  c.  6. 

(j)  De  Morbis.  1.  3.  n.  16. 


(/)  Ibid.  n.  17. 

(«)  Sett.  6.  Aph.  1 6. 


hand 


5  S 2  Book  II.  Of  Difeafes  of  the  Thorax. 

hand  to  the  cure  :  but  in  the  other,  who  was  feiz’d  with  the  fame  difeafe, 
the  fame  flux  coming  on  about  the  third  day,  at  firft  render’d  the  expedtorated 
matter  little  in  quantity,  tough,  and,  in  a  manner,  dry,  but  afterwards  de- 
ftroy’d  the  ftrength,  and  wholly  fupprefs’d  the  fpitting  ;  fo  that  having  en¬ 
deavour’d  in  vain  to  moderate  the  diarrhoea,  and  to  preferve  the  difcharge 
from  the  lungs,  I  could  fcarcely  fucceed  fo  far,  that  his  life  fhould  be  pro¬ 
long’d  even  to  the  ninth  day.  And  that  the  fame  happen’d  to  a  virgin, 
eighteen  years  younger  than  this  nobleman,  you  will  learn  from  the  next 
hiflory  of  Valfalva. 

j  n.  A  virgin,  about  fifty-five  years  of  age,  was  feiz’d  with  a  pain  in  the 
thorax,  elpecially  about  the  fternum  ;  (he  had  alfo  a  fever,  a  pain  in  the  head, 
and  a  difficult  breathing,  and  expectorated  a  great  quantity  of  matter.  A 
diarrhoea  coming  on,  all  the  fymptoms  became  more  violent,  and  the  difficul¬ 
ty  of  breathing  fo  great,  that  fhe  could  not  breathe  but  with  her  neck  eredt : 
fhe  died  about  the  ninth  day. 

In  the  abdomen  the  gall-bladder  was  obferv’d  to  be  turgid  with  bile,  and 
both  the  ovaries  to  be  much  indurated,  fhe  thorax  being  open’d,  the  left 
lobe  of  the  lungs  was  found  to  adhere  fo  much  to  the  pleura,  wherever  it  in¬ 
verted  the  ribs,  that  it  could  not  be  leparated  without  laceration.  But  the 
right  lobe,  adhering  cloiely  to  the  whole  mediaftinum,  and  in  like  manner 
to  the  pleura,  where  it  inverts  the  upper  ribs,  was,  by  realbn  of  its  rotten- 
,nefs,  torn  into  pieces,  by  attempting  to  feparate  it  from  the  pleura  with  the 
hand,  and  at  the  fame  time,  it  difcharg’d  from  an  abfcefs  which  it  contain’d, 
a  great  quantity  of  famous  matter,  of  a  palifh  red  colour.  The  pericardium 
was  full  of  ferum.  In  the  right  ventricle  of  the  heart  was  a  large  polypous 
concretion,  which  particularly  occupied  the  neighbouring  auricle,  and  was 
produc’d  through  the  orifices  of  the  communicating  veins.  There  was  none 
in  the  left  ventricle  •,  and  only  a  flight  beginning  of  one  in  the  entrance  of  the 
aorta,  and  pulmonary  vein.  But  the  blood  in  this  body  had  loft  its  fluidity. 

12.  The  other  circumftances,  which  you  have  read  in  this  obfervation, 
will  be  fpoken  of  on  a  more  convenient  occafion.  It  is  proper  here,  to  attend 
to  this  one  in  particular,  that  as  the  pain  was  principally  about  the  fternum, 
the  lungs  adher’d  clofely  to  the  whole  mediaftinum,  which  is  connected  with 
the  fternum.  But  it  is  connedted  alfo,  you  will  fay,  to  the  vertebras  of  the 
thorax,  about  which  parts  no  pain  is  fpoken  of.  I  grant  it  you  :  but  you 
muft  in  return  grant  me  this,  that,  in  a  violent  refpiration,  which  this  virgin 
was  under  a  neceffity  of  ufing,  the  fternum  is  mov’d,  and  not  the  vertebras  ; 
for  which  reafon,  thofe  parts  of  the  mediaftinum  were  more  affedted,  that 
are  annex’d  to  the  fternum.  But  be  this  as  it  will,  if  you  will  read  the  fe- 
cond  obfervation,  in  this  fourth  fediion  of  the  Sepulchretum  (#),  and  the 
fchol  um,  not  only  that  is  lubjoin’d  to  it,  but  alfo  that  which  is,  by  miftake, 
fubjoin’d  to  the  third  obfervation,  as  it  ought  to  have  been  plac’d  under  the 
iecond,  and  in  like  manner,  the  twenty-ninth  obfervation  •,  you  will  imme¬ 
diately  obferve,  that  when  there  v/as  an  inflammation  in  the  mediaftinum  it- 
felf,  or  in  the  pericardium,  which  you  know  is  annex’d  to  it,  and,  in  a  man¬ 
ner,  part  of  it,  the  fenfe  of  pain  and  uneafinefs  was  not  perceiv’d  about  the 


8 


(a*)  1 .  2, 


vertebrae, 


Letter  XX.  Articles  13,  14,  15,  16.  553 

vertebrae,  but  about  the  fternum.  And  to  thefe  things  which  I  have  been 
laying,  the  next  hiftory  may  in  part  alio  be  referr’d. 

13.  A  butcher,  about  fifty  years  of  age,  was  feiz’d  with  a  pain  in  the 
right  fide  of  his  thorax,  and  even  in  the  middle  of  his  fternum  •,  he  lay  on  his 
back,  he  cough’d  very  much,  and  fpat  up  but  little.  He  was  forc’d  to 
breathe  with  his  neck  upright.  At  length  he  died  on  the  feventh  day. 

The  right  lobe  of  the  lungs  had  grown  hard,  in  its  whole  upper  part,  and 
adher’d  a  little  to  the  fternum,  but  much  more  clofely  to  the  mediaftinum. 
The  left  lobe  was  ting’d,  on  the  pofterior  part,  with  a  black  colour.  On 
the  left  fide  alfo,  the  thoracic  cavity  contain’d  a  little  ferum  ;  with  which  the 
pericardium  was  full.  In  the  right  ventricle  of  the  heart,  was  obferv’d  a  po¬ 
lypous  concretion.  But  the  blood,  in  this  body,  was  more  inclin’d  to  flui¬ 
dity,  than  concretion. 

14.  In  diforders  of  this  kind,  the  blood  generally  verges  to  concretion  *, 
and  from  this  tendency  they  generally  account  for  polypi,  that  is,  polypous 
concretions,  which  you  will  find  are  generally  obferv’d  in  Valfalva’s  diflections 
of  peripneumonic  patients,  and  mine.  Though,  indeed,  the  matter  fome- 
times  proceeds  fo  far,  that  the  blood  lofes  its  fluidity,  which  was  obferv’d  in 
the  body  of  the  virgin  fpoken  of  above  (y).  But  in  the  living  body,  it  fre¬ 
quently  happens,  when  the  inflammation  is  very  dangerous,  that  the  blood 
approaches  fo  near  to  concretion,  that  a  vein  being  open’d,  it  fcarcely  comes 
out  from  a  large  orifice,  and  drips  down  very  flowly :  and  this  I  remember 
was  the  cafe  in  many  others,  but  particularly  in  Maria  Varania,  who  was 
taken  off  by  an  infuperable  peripneumony,  every  artifice  to  make  the  blood 
flow  out,  being  applied  in  vain.  But  on  the  other  hand,  it  fometimes  hap¬ 
pens,  that  the  blood,  in  peripneumonic  patients,  tends  to  a  fluid  ftate,  whe¬ 
ther  there  be  any  polypous  concretion,  as  in  the  butcher  in  queftion,  or  none, 
as  in  the  three  obfervations  that  follow.  The  firft  of  thefe  is  fo  much  the 
more  rare,  as  children,  and  efpecially  thofe  that  are  newly- born,  are  laid  to 
be  lefs  liable  than  others,  to  diforders  of  this  kind,  by  Aretasus  (z),  which  is 
alfo  confirm’d  by  the  celebrated  Triller  (a). 

15.  A  young  girl,  fourteen  days  old,  was  affefled  with  aftertor,  and  a  red- 
nefs  of  the  face :  fhe  refus’d  to  luck  the  breaft,  fo  that  it  was  neceflary  to 
make  ufe  of  art,  in  order  to  give  her  that  nourilhment.  Thefe  fymptoms 
continuing  eight  days,  fhe  died.  The  lungs  were  inflam’d,  and  particularly 
on  the  back-part,  and  were  diftinguifh’d  with  fome  black  fpots  in  their  fub- 
ftance.  In  the  ftomach  was  a  great  quantity  of  bile.  But  in  the  veflels,  the 
blood  preferv’d  its  natural  fluidity. 

16.  A  virgin  of  twenty  years  of  age,  was  firft  feiz’d  with  a  pain  in  the  left 
fide  of  the  thorax,  and  after  that  in  the  right.  She  could  not  lie  on  the  right 
fide  *,  fhe  cough’d :  fhe  was  delirious  in  the  night :  fhe  was  fo  far  affedted 
with  convulfions,  that  fome  of  her  limbs  remain’d  drawn  up.  At  length  fhe 
died.  The  right  lobe  of  the  lungs  was  fomewhat  inflam’d,  efpecially  on  the 
pofterior  part.  And  the  left  lobe,  which  adher’d  every  where  clofely  to  the, 
pleura  that  inverted  the  ribs,  and  diaphragm,  fo  that  it  could  not  be  taken 
away  without  laceration,  was  extremely  red.  In  the  heart  was  no  polypous 

00  n.  11.  («)  loco  fupra  ad  n.  10.  indic.  Aph.  1 6. 

( js )  De  caufis  Acut.morb.  1.  i.  c.  io.  in  fin. 

Vol.  I.  4  B 


concretion  ; 


554  Book  II.  Of  Difeafcs  of  the  Thorax. 

concretion  :  only  in  both  the  ventricles,  the  blood  was  black,  and  coagulated. 
It  was  alfo  black  in  the  veflels,  and  very  thick  •,  but  {till  fluid.  The  head, 
likewife,  and  the  belly  were  open’d.  In  the  former,  the  brain  was  very 
found  :  only  there  was  a  little  ferum  at  its  bafis.  But  in  the  belly,  which 
before  diffedtion  had  been  obferv’d  to  be  fomewhat  tumid,  the  caufe  of  this 
circumftance  was  found  to  be,  that  the  colon  was  very  much  diftended  with 
air.  In  other  refpebts,  the  colon  itfelf,  and  all  the  other  vifcera  were  found : 
although  that  inteftine,  when  it  came  to  the  ftomach,  immediately  bent  its 
courfe  downwards,  below  the  middle  of  the  belly,  and  was  reflected  from  thence 
immediately,  to  the  upper  part  of  that  cavity,  and  then  continu’d  in  its  natural 
courfe.  But  the  appendicula  vermiformis  was  equal  in  thicknefs  to  a  goofe-quill, 
and  in  length  to  about  eight  fingers  breadth,  being  obliquely  ftretch’d  out  to¬ 
wards  the  kidney. 

17.  A  young  man,  almoft  thirty  years  of  age,  after  a  long  courfe  of  labour, 
was  feiz’d  with  a  fmall,  and  obtufe  pain,  in  the  left  part  of  his  thorax  •„  he  was 
feverifh,  and  breath’d  with  difficulty,  but  expedlorated  nothing.  Thefe  fymp- 
toms  lalted  even  to  the  fourteenth  day,  in  which  time,  the  diforder  fcem’d 
to  remit  foinething.  But  on  a  fudden,  a  great  difficulty  of  breathing  came 
on,  with  a  ftertor,  and  a  {pitting  of  a  frothy  matter,  of  a  rofy  colour,  which 
he  threw  up  in*great  quantities,  without  a  cough,  and  without  any  difficulty. 
Notwithftanding,  through  the  whole  courfe  of  this  dileafe,  he  had  lain  on  the 
right  fide,  and  fometimes  alfo  on  the  back,  he  died  on  the  feventeenth  day,, 
while  he  was  turning  himfelf  from  his  back  to  the  right  fide. 

The  thorax  being  open’d,  the  pleura  was  found  to  be  unhurt,  and  the 
lungs  altogether  free  from  it.  But  the  left  lobejvas  every  where  inflam’d, 
except  at  the  fuperior  part :  from  which,  although  found,  the  blood  burft 
forth  by  drops,  in  two  places ;  fo  that  more  than  four  pounds  of  this  fluid, 
were  found  ftagnating  in  the  fame  left  cavity  of  the  thorax.  In  the  heart 
were  no  polypous  concretions. 

18.  In  none  of  thefe  three  obfervations  were  there  any  polypous  concre¬ 
tions,  as  you  fee.  But  if  in  a  tender  infant  (£),  in  which  early  age  they  are 
very  rarely  faid  to  be  found  (r),  it  is  lefs  to  be  wonder’d  at ;  and  if  in  the 
virgin,  the  blood,  although  fluid  ( d ),  was  neverthelefs  very  thick  and  coagu¬ 
lated,  in  the  ventricles  of  the  heart ;  at  lead:  none  of  thefe  circumftances  occur 
in  the  lafb  hiftory.  And  indeed,  the  effufion  of  blood  into  the  left  cavity  of 
the  thorax,  in  fuch  a  quantity,  and  its  burfting  forth  even  in  the  dead  body, 
lufficiently  fhew  its  fluidity.  But  it  feems,  that  fo  much  the  greater  quantity 
of  it  had  flow’d  into  the  upper  part  of  that  lobe  of  the  lungs,  which  was  found, 
in  proportion  as  lefs  could  be  admitted  into  the  lower  part,  that  was  entirely 
obftrudted  by  inflammation :  wherefore  more  and  more  blood  ftill  flowing-, 
and  the  column  preffing  on  from  behind,  it  feems  that  the  veflels  were  at 
length  raptur’d,  fomeof  the  fmalleft  of  which  would  burft  into  the  air-pafiages, 
and  give  that  rofy  colour  to  the  expedtorated  matter ;  and  others,  fomewhat 
lefs  (lender,  would  burft  on  the  external  membrane  of  the  lungs,  from  whence 
io  great  a  quantity  of  blood  in  that  cavity  of  the  thorax  :  and  whereas  by  rup¬ 
ture,  and  extravafation  of  blood  into  both  thefe  places,  all  the  fymptoms  be¬ 
came  more  violent,  it  feems  that  death  did  then  at  length  come  on,  after  that 

( f> )  n.  15.  .  Hebd.  42.  n.  i.  ad  art.  15. 

V)  Vide  tamen  Commere.  Litter.  A.  1744,;  f  (</)  n.  16. 


the 


Letter  XX,  Articles  19,  20.  SSS 

the  found  part  of  the  left  lobe  of  the  lungs,  being  render’d  altogether  incapable 
of  refpiration,  from  the  blood  being  more  and  more  extravafated,  both  on 
the  infide,  and  on  the  outfide  of  the  furface,  he  turn’d  himfelf  on  the 
right  fide,  and  by  this  means  comprefs’d  the  only  lobe  of  the  lungs,  with 
which  he  could  breathe,  by  overwhelming  it  with  the  bloody  humour,  which 
mull  fall  down  from  the  lefc  bronchia  to  the  right,  the  mediaftinum  at  the 
fame  time  giving  way,  from  the  weight  of  blood,  which  was  extravafated 
about  the  left  lobe  of  the  lungs,  being  added  to  the  weight  of  the  lobe  itlelf, 
which  was  fo  much  encreas’d  by  inflammation.  For  the  right  lobe  could  not 
bear  up  under  fo  many  oppreffive  circtimftances  at  the  fame  time,  as  it  before 
bore  only  this  one  weight  of  the  left  lobe. 

19.  But  perhaps  there  will  be  fomething  which  you  will  interrogate  me 
upon,  in  regard  to  this  laft  obfervation  of  the  young  man,  and  upon  that 
other  of  the  virgin  ( e ).  And  firft,  why  could  the  young  man  lie  on  his 
healthy  fide,  whereas  the  virgin  was  forc’d  rather  to  lie  on  the  difeas’d  fide, 
in  like  manner  as  the  man,  whom  I  fpoke  of  as  having  come  into  the  hof- 
pital  for  a  flight  dileafe,  and  having  perifh’a  of  a  violent  one  (/),  could  lie 
very  ealily  on  the  difeas’d  fide? 

It  is  very  fuppofable,  that  the  caufe  of  the  difference  is  to  be  taken 
from  this  circumftance,  that  in  the  young  man  the  difeas’d  lobe  of  the 
lungs  was  loofe  and  free  •,  .but  in  the  man,  and  the  virgin,  annex’d  to  the 
pleura,  in  iuch  a  manner,  that  if  they  attempted  to  lie  on  the  found  fide,  the 
weight  of  the  lungs  immediately  diflraded  the  pleura,  and  created  uneafinefs. 

The  other  circumfiances  relative  to  the  virgin,  are  partly  not  altogether 
without  the  bounds  of  a  natural  conftitution,  as  thefe,  which  are  delcrib’d  in 
the  belly,  partly  belong  to  what  I  have  treated  of  in  other  places,  as  what 
was  met  with  in  the  head,  and  are  partly  very  eafy  to  be  explain’d,  as,  for 
inftance,  an  attack  of  the  pain,  firft:  on  the  left  fide,  and  after  that  on  the 
right.  For  as  the  matter  which  caus’d  the  inflammation,  had  firfl:  ftagnated 
in  that  left  lobe,  which,  as  it  was  fo  clofely  connected  to  the  pleura  of  the 
ribs,  and  diaphragm,  was  lefs  able  to  diflodge  it  from  thence,  this  matter 
continu’d  to  overload  it  •,  but  the  remaining  part  of  the  matter  fell,  in 
i'ome  meafure,  on  the  other  lobe,  that  was  loofe,  and  brought  on  a  flight 
inflammation  there.  And  it  is  not  at  ail  to  be  wonder’d  at,  that  the 
lobe  which  was  firfl:  attack’d,  had  the  much  greater  inflammation,  either  be- 
caufe  it  was  weaker  than  the  other  naturally,  or  was  render’d  fo  by  the  attack 
of  the  difeafe  :  which  happen’d,  as  you  will  fee,  in  the  following  cafe  likewife. 

20.  A  prieft:  of  almoi't  thirty  years  of  age,  was  feiz’d  with  a  difficult  re¬ 
fpiration,  and  fpat  up  a  great  quantity  of  matter :  in  the  beginning  he  com¬ 
plain’d  of  pain  in  the  right  part  of  the  thorax,  and  after  that  in  the  left.  He 
died  on  the  tenth  day.  In  both  the  cavities  of  the  thorax  was  ferum,  but 
not  a  great  quantity  :  a  portion  of  which  had  concreted  every  where  upon  tile 
lungs,  like  a  palifh  coat.  And  the  right  lobe,  in  that  part  where  it  look’d 
towards  the  back,  was  extremely  red  :  and  had  grown  hard  alfo ;  yet  lefs  fo 
than  it  is  wont  to  do  in  other  peripneumonies :  but  about  the  middle  a  puru¬ 
lent  matter  began  to  be  generated  internally.  The  left  lobe  of  the  lungs,  in 
like  manner,  ftiew’d  a  flight  inflammation  on  the  back  part.  The  pericardium 
was  thicker  than  it  naturally  is,  and  was  turgid  with  a  yellowifh  lerum  :  and 


(.")  n.  1 6. 

4  B  2 


(f)  n-  3- 


from 


5  5  6  Book  II.  Of  Difeafes  of  the  Thorax, 

from  a  concreted  portion  of  this  ferum,  a  kind  of  reticular  body,  as  it  were,, 
was  form’d,  both  on  the  external  i'urface  of  the  heart,  and  the  internal  furface 
of  the  pericardium  :  which  being  prefs’d  upon,  lome  fmall  drops  of  ferum 
burft  forth.  The  right  ventricle  of  the  heart  contain’d  a  polypous  con¬ 
cretion. 

21.  This  hiftory,  where  it  defcribes  the  right  lobe  of  the  lungs,  gives 
mean  opportunity  of  fubjoining  another*,  and  where  it  defcribes.  ferum  in 
the  thorax  and  pericardium,  it  gives  me  an  opportunity  of  fubjoining  many 
more. 

To  begin  with  the  lirft,  thefe  words  are  to  be  attended  to,  that  the  lungs- 
had  indeed  grown  hard,  but  lefs  than  is  ufual  in  other  peripneumonies.  For 
moft  perfons  feem  to  fuppofe,  that  inflammation  of  the  lungs  confifts,  almoft 
wholly,  in  rednel's:  and  that  this  may  fometimes  happen  is  not  to  be  denied  ; 
as  when,  for  inflance,  the  inflammation  happens  to  be  of  the  true  eryfipeta- 
lous  kind.  But  in  moft  inflammations  the  lungs  become  hard  and  denfe. 
Which,  amongft  others,  after  Coiterus,  whole  words  I  (hall  produce  on  ano¬ 
ther  occafion  (g),  Guarinoni,  as  you  have  it  in  the  Sepulchrcrum  ( h ),  for¬ 
merly  obferv’d.  His  words  are,  “  You  will  feldom  find,  in  bodies  which 
“  have  died  of  a  pieurify,  that  the  lungs  are  not  full  and  hard.”  And  Wep- 
fer,  after  having  faid  of  the  lungs  of  a  certain  perfon,  as  you  will  read  in  the 
fame  place  (*),  “  Yet  that  rednefs  was  not  the  index  of  a  confiderable 
«  inflammation,  for  in  that  part  the  lungs  continu’d  foft  *,”  went  fo  far,  as 
exprefly  to  add  this,  “  For  the  lungs,  when  inflam’d,  are  always  found  to 
**  be  harden’d.”  And  the  hardnefs  and  denfity  are  of  fuch  a  nature,  for  the 
moft  part,  that  being  then  cut  into,  they  feem  to  be  any  thing  elfe,  rather 
than  the  lungs  (k).  Thus  to  Valfalva,  in  many  bodies,  have  they  feem’d 
like  very  lolid  flefti  :  and  this,  in  a  certain  writing  of  his,  he  thought  might 
be  accounted  for,  in  a  probable  manner,  from  a  vitriolic  acid  coagulating 
the  blood  in  the  pulmonary  veficles,  fince  the  flefti  of  the  mufcles  alfo,  is 
nothing  elle  but  white  membranous  filaments,  which,  as  they  retain  the 
blood  in  their  extremities,  acquire  the  name  of  flefli.  But  however  this  might 
be,  he  affirm’d  that  he  had  certainly  found  it  fo,  in  the  lungs  of  men,  whom  a 
peripneumony  had  taken  off,  within  four  or  five  days;  fo  that  we  cannot 
doubt,  in  what  manner  he  found  them  to  be  affedted,  in  thofe  whom  1  have 
defcrib’d  (/),  as  being  taken  off  within  fuch  a  fliort  time,  by  this  difeafe. 
But  although  in  the  writing  I  have  fpoken  of,  he  only  endeavour’d  to  ftiew, 
that  this  might  happen  to  the  lungs,  within  a  few  days,  it  does  not  therefore 
follow,  that  he  did  not  find  the  fame  thing  in  thole  who  liv’d  longer ;  and 
that  he  did  really  find  this  appearance,  is  not  only  obfcurely  fliewn  in  feveral 
places,  but  exprefly  confirm’d  by  the  following  hiftory. 

22.  An  old  man,  about  fixty  years  of  age,  was  feiz’d  with  a  pain  in  the 
right  fide  of  his  thorax  :  he  had  a  fever,  he  cough’d,  he  fpat  up  mat¬ 
ter,  he  lay  moft  eafily  on  his  back.  The  quantity  of  expectorated  matter 
became  greater*,  but  by  opening  a  vein,  on  the  tenth  day,  it  was  fupprefs’cL 

(g)  Epift.  2i.  n.  38.  (k)  Vid,  Epift.  21.  n.  20.  28. 

(6)  Sedt  hac.  4.  in  Additam.  Obf.  2.  (/)  fupra,  n.  3.  9.  &fortalTe  etiam  2. 

(/)  1.  4.  S.  3.  in  Addit.  Vid.  Schol,  ad 
Obi'.  26.  n.  8. 


Where* 


Letter  XX.  Article  23.  557 

Wherefore  he  died  on  the  eleventh  day.  The  left  lobe  of  the  lungs  was 
found,  although  it  adher’d  on  all  fides  to  the  pleura.  On  the  contrary,  the 
right  lobe,  although  free  from  the  pleura,  was  found  to  be  greatly  inflam’d 
towards  the  back-part,  fo  as  to  refemble  the  more  folid  lubftance  of  flefh. 
Two  very  fmail  feparate  polypous  concretions,  and  in  a  manner  equal  one 
with  another,  were  found  in  the  feparate  ventricles  of  the  heart. 

2  j.  This  obfervation  gives  a  handle,  as  it  were,  for  adding  many  more, 
before  1  deferibe  to  you  thofe  which  I  promis’d  you,  on  account  of  ferum 
being  found  in  the  thorax,  and  pericardium.  Let  me  omit  to  mention,  as 
it  is  already  ment  on’d  above  (»?),  that  by  no  circumftance  whatever  is  death 
accelerated  more,  in  a  peripneumony,  than  by  the  fupprefilon  of  the  fpitting. 
And  that  this  often  happens  from  unfeafonabie  blood-lettings,  efpecially  in 
old  men,  I  alio  omit  ;  although  there  are  many  phyfleians  who  kill  their 
patients,  for  that  reafon,  becaufe  they  do  not  know  when  to  be  quiet. 
Amongit  whom  I  formerly  knew  an  elderly  phyfician,  who  indeed  by  blood¬ 
lettings,  repeated  again  and  again,  broke  the  violence  of  the  peripneumony, 
but  fo  took  away  the  ftrength  of  the  patient,  that  moil  of  them,  not  being 
able  to  expectorate,  were  fuffocated  in  the  very  decline  of  the  difeafe  ;  whereas* 
another  phyfician,  in  the  fame  place,  and  the  fame  conftitution,  who  let 
blood  indeed,  but  not  beyond  bounds,  fav’d  alrnoft  all  his  patients.  And 
yet  even  old  men,  to  whom  the  fuccefsful  cafe  cf  Marfhal  de  Botzhtim,  who 
was  more  than  ninety  years  of  age  («),  may  give  hope  and  courage  *,  I  fay, 
even  old  men  may  have  blood  taken  from  them,  and  I  myfelf  have  taken  it, 
when  the  circumftances  of  the  patient  fuffer’d  it,  and  that  even  on  two  days 
fuccefftvely,  as  in  a  very  aged  woman,  to  whom  I  had  not  been  call’d  till 
the  fifth  day  of  the  peripneumony,  Anna  Mazon'a  by  name,  whofe  blood, 
together  with  the  water  into  which  it  was  dilcharg’d,  for  the  blood  was  taken 
from  the  hand,  coagulated  into  a  perfect  jelly  :  but  I  did  not  take  away 
more,  in  thofe  two  days,  than  five  ounces  at  a  time,  that  is  to  lay,  as  much 
as  the  ftrength  of  the  patient  permitted  ;  and  not  only  what  the  prefent  ftrength 
permitted,  but  alfo  what  it  was  necefiary  to  preferve,  for  the  fake  of  con¬ 
tinuing  expectoration,  by  means  of  which  the  old  woman  happily  recover’d, 
though  the  diforder  was  carried  out  fo  far  as  to  the  twenty-third  day.  But 
left  I  fhould  feem  to  do  the  contrary  to  what  I  have  promis’d,  let  us  pafs  by 
thefe  things  alfo,  and  have  regard  only  to  this  circumftance,  in  the  old  man 
fpoken  of.  that  he  lay  very  eafily  on  his  back. 

The  caufe  of  this  circumftance  is  not  always  fo  evident,  as  it  feems  in  that 
cafe  to  be.  For  although  the  right  lobe  of  the  lungs,  towards  the  back,  was 
fo  inflam’d  and  heavy,  yet  as  it  was  quite  free  from  the  pleura,  it  could 
neither  caule  any  diffraction  of  the  parts,  nor  opprefs  the  found  part  of  itfelr, 
or  the  other  lobe,  in  that  lupine  ftate  of  body.  But  how  did  it  happen,  that 
the  butcher  fpoken  of  above  (0),  could  lie  on  his  back,  though  he  had  his 
lungs  in  a  ftate  of  induration,  and  adhering  to  the  fternum  ?  Was  it  be¬ 
caufe,  in  the  beginning,  as  feems  confonant  to  reafon,  the  lungs  were  lefs 
heavy,  in  confequence  of  not  having  collected  together  fo  great  a  quantity 

(«0  N.  6.  (0)  Vid.  Commere.  Litter.  A.  1744.  Hebd.  3,  n.  1.  (0)  N.  13. 

l 


of 


55  8  Book  II.  Of  Difeafes  of  the  Thorax. 

of  matter  ?  And  after  this  matter  was  increas’d,  then,  at  length,  could  he 
no  longer  bear  to  lie  on  his  back,  but  was  oblig’d  to  draw  his  breath  with 
his  neck  ftretch’d  out,  as  I  have  faid.  But  what  explanation  fhall  we  give 
of  the  cafe  that  follows  ? 

24.  A  man,  who  was  about  forty  years  of  age,  and  labour’d  under  two 
hernias,  was  feiz’d  with  a  pain  of  the  thorax,  and  a  difficult  refpiration.  In 
the  beginning  of  the  difeaie,  indeed,  he  lay  very  eafily  on  the  right  fide,  after 
that  on  the  left-,  but  on  his  back  he  could  by  no  means  lie.  He  fpat  up 
much  matter.  He  was  compell’d  to  breathe  with  his  neck  upright.  On  the 
tenth  day  he  died. 

Both  lobes  of  the  lungs  adher’d  to  the  pleura,  yet  fo  that  they  could  be 
feparated  without  laceration,  and  towards  the  back  they  were  very  much  in¬ 
flam’d,  and  very  hard.  There  was  no  water  in  the  pericardium.  In  the 
heart  were  three  polypous  concretions:  one  in  the  left  ventricle ;  and  two 
thicker  and  more  firm  concretions  occupied  the  right  ventricle,  and  the  whole 
of  its  annex’d  auricle.  As  to  what  relates  to  the  hernias,  cirfocele,  and  hy¬ 
drocele  the  latter  was  caus’d  by  ferum  filling  the  cavity  of  the  tunica  vagi¬ 
nalis,  which,  when  comprefs’d,  emitted  fome  drops  of  an  aqueous  fluid  * 
and  the  former,  by  a  varicofe  production  of  the  veins  of  the  fcrotum,  which, 
not  inelegantly,  reprefented  the  figure  of  a  chain. 

25.  Why  this  man  ffiould  lie  more  eafily  on  his  right  fide,  and  after  that 
on  his  left,  and  not  at  all  on  his  back,  is  Indeed  difficult  to  be  explain’d,  if 
we  have  regard  to  nothing,  but  thole  appearances  which  were  at  length  found 
in  the  body  after  death.  But  as  thefe  things  happen’d  in  the  beginning,  and 
before  he  was  oblig’d  to  breathe  with  his  neck  upright,  reafon  requires  that 
we  ffiould  reconfider,  in  what  ftate  things  might  be,  at  that  time,  in  the 
thorax.  And  nothing  forbids  us  to  fuppofe,  that  the  collection  of  morbific 
matter  was,  at  firft,  greateft  in  the  right  lobe  of  the  lungs,  and  after  that 
in  the  left,  till  being  become  equal  on  both  fides,  the  man  v/as  oblig’d  to  fit 
upright.  But  before  that  time,  although  he  could  lie  with  lefs  difficulty  on 
the  right  fide,  and  foon  after  that  on  the  left,  yet  he  could  not  lie  down  on 
his  back,  in  my  opinion,  for  this  reafon,  becaufe  although  the  lungs,  like 
the  right  lobe  of  the  old  man  laft  fpoken  of  (p),  were  inflam’d  and  heavy, 
yet  they  were  not,  like  his,  free  from  the  pleura.  Wherefore,  this  man 
could  not  lie  fupine,  but  the  pleura,  to  which  the  lungs  were  conneCled, 
being  dragg’d  away  from  the  anterior  part,  caus’d  an  'uneafinefs,  and  jiid  not 
permit  this  fituation.  But  what  relates  to  the  hernias  belongs  to  another 
place.  However,  they  recal  to  my  mind  an  obfervation  of  another  man  who 
had  a  hernia,  in  whofe  peripneumony  there  is  fometing  relative  to  lying 
down,  as  you  will  immediately  perceive. 

26.  A  man,  of  fifty  years  of  age,  having  had  from  his  birth,  a  brown 
complexion,  an  atrabilious  conftitution,  and  a  great  propenfity  to  venery, 
was  feiz’d,  on  the  twenty-firft  of  December,  with  a  difficult  refpiration,  as 
if  it  had  been  from  a  catarrh.  The  diforder  grew  gradually  more  violent, 
fo  that  on  the  19th  of  January,  in  the  year  i6uO,  he  was  oblig’d  to  take 
to  his  bed.  His  voice  was  very  hoarfe  and  hollow ;  he  had  a  plentiful 


(p)  N.  22,  23. 


fpitting 


Letter  XX.  Article  27.  ^ S9 

fpitting  of  watry  matter;  his  refpiration  was  very  difficult,  with  a  fenfe  of 
ftrangulation,  as  it  were,  about  the  fauces  :  he  could  not  lie  on  either  fide 
without  difficulty,  but  he  had  more  difficulty  to  lie  on  the  left,  which  made 
his  breathing  more  oppreffive.  At  length,  it  became  fufpirious,  or  panting, 
nor  could  he  breathe  but  with  his  neck  upright.  In  the  progrefs  of  the 
difeafe,  however,  the  great  quantity  of  that  watry  difcharge  was  fomewhat 
chang’d  into  a  little  quantity  of  vifcid,  tough  m.atter,  which  had,  in  fome 
meafure,  a  ftrong  fmell,  and  his  refpiration  became  eafier,  though  the  fenfe 
of  fuffocation  Hill  remain’d.  The  fever  was  always  flight.  Neverthelefs, 
on  the  twelfth  of  February,  he  died. 

His  cheft  being  open’d,  the  right  lobe  of  the  lungs  was  found  to  be  little 
different  from  its  natural  Hate  :  but  the  left  adher’d  univerfally  to  the  pleura, 
without  any  fpace  interpos’d,  and  its  fubftance  was  very  hard,  and  inflam’d. 
In  each  of  the  ventricles  of  the  heart  were  dift'ndt  polypous  concretions, 
what  Valfalva  had  -not  yet  feen  ;  that  in  the  left  was  the  greateft.  The 
fauces,  where,  perhaps,  the  greateft  diforder  was,  it  was  not  permitted  to 
examine. 

When  the  belly  was  open’d,  the  fpleen  was,  on  all  fides,  found  tied  to  the 
neighb’ring  parts,  by  membranes  that  were  interpos’d  ;  and  in  this  vifcus,  the 
arterious  veffels  were  cartilaginous.  As  a  hydrocele  was  obferv’d  in  the 
right  fide  of  the  fcrotum,  in  the  fecond  place,  an  aqueous  humour  was  alfo 
oblerv’d  to  be  comprefs’d,  betwixt  the  tunica  albuginea  and  teftis  :  and  fome 
limpid  drops  of  this  water  diftill’d  from  that  membrane,  efpecially  where  it 
was  comprefs’d,  at  the  fide  of  the  larger  finall  veffels.  This  humour,  over 
a  ftrong  fire,  coagulated  into  a  very  white  fubftance  ;  but  over  a  more  gentle 
heat,  was  gradually  diffipated  by  evaporation,  and  left  marks  of  lymph 
behind. 

27.  As  to  the  hernia,  although  under  the  tunica  albuginea  I  have  feen 
another  very  thin  membrane,  which  immediately  embrac’d  the  fubftance  of 
the  tefticle,  fo  that  the  water  might  be  {hut  up  betwixt  thefe  two  mem¬ 
branes  ;  yet,  confidering  what  is  immediately  fubjoin’d,  I  fhould  rather  fup- 
pofe,  that  Valfalva  did  not  mean  to  write  what  he  has  written,  and  what 
I  have  faithfully  copied,  but  between  the  tunica  vaginalis  and  albu¬ 
ginea. 

Yet  be  this  as  it  will,  it  is  not  one  circumftance  only,  that  keeps  my  mind 
fufpended  in  regard  to  this  hiftory.  Whence  did  that  fenfe  of  ftrangulation 
arife  ?  For  it  could  not  here,  as  in  fome  peripneumonic  patients,  whom 
Gagliardi  (q)  mentions,  whole  cafe  was  miftaken  for  an  angina,  be  accounted 
for  from  the  quantity  of  pus  which  was  in  the  lungs.  Why  ffiould  the  dif¬ 
ficulty  of  breathing  be  made  lefs,  from  the  time  that  the  expectorated 
matter,  inftead  of  being  in  great  quantity,  became  much  diminiffi’d  ? 

And  why  was  a  flight  fever,  only,  join’d  with  a  peripneumony  ?  for  that 
this  patient  did  labour  under  that  diforder,  Valfalva,  who  faw  him  when 
living,  and  differed  his  body  when  dead,  did  not  hefitate  to  fuppofe  ;  for 
he  had  prefix’d  to  this  obfervation,  by  way  of  title,  Be  Pulmcnia.  At  length, 
to  omit  other  things,  why  was  it  difficult  for  him  to  lie  on  either  fide,  when 

(?)  Relaz;  de’  Mali  di  Petto. 


4 


the 


5^o  Book  II.  Of  Difcafes  of  the  Thorax. 

the  lungs  of  one  fide  only  were  affecfted  ?  And  even  why  was  It  mere  dif¬ 
ficult  tor  him  to  lie  on  the  left  fide  than  the  right,  when  it  was  the  left 
lobe  that  was  affedted  ?  If  any  thing  of  fuch  a  nature  had  preceded,  that 
we  could  refer  the  caufe  of  an  impediment  not  fufficiently  underflood,  to  an 
injury  of  any  latent  part,  as  in  the  cafe  which  I  (hall  immediately  lubjoin,  it 
would  be  more  allowable  for  us  to  take  liberties  in  forming  conjectures 

2b.  A  young  man,  of  fifteen  years  of  age,  had  a  fail  in  quarrelling,  and 
dafh’d  his  back  againft  a  ltone,  about  the  lafb  vertebra  of  the  thorax,  and 
the  firft  of  the  loins.  The  young  man,  who  was  his  adverfary,  leap’d  upon 
him  as  he  lay,  and  prefs’d  his  cheft  with  his  knees.  He  who  had  fall’n, 
complain’d  very  much  of  pain  about  the  part  where  he  receiv’d  the  blow  •, 
yet  there  did  not  appear  any  mark  of  injury  that  was  worthy  of  notice.  'He 
had  much  pain  in  his  head  ;  and  while  he  endeavour’d  to  go  about  his  ufual 
bufinels  at  home,  was  leiz’d  with  a  fyncope.  On  that  firft  day,  he  was  im¬ 
mediately  obferv’d  to  have  a  great  lofs  of  appetite  ;  and  after  a  day  or  tv/o 
more,  a  fever  came  on,  There  was,  before  this,  a  continual  pain  in  the 
cheft.  To  the  pain  was  added  a  difficulty  of  refpiration,  and  a  cough,  which 
two  fymptoms  were  afterwards  made  more  violent,  and,  at  the  fame  time, 
his  expectoration  was  bloody,  and  he  difeharg’d  a  reddifh  matter  by  Itool. 
A  delirium  alfo  came  on,  attended  with  convulfions,  fo  that  all  his  body 
remain’d  immoveable :  and  at  length  he  died,  about  the  tenth  day  from  his 
fall  :  in  all  which  time,  the  patient  was  never  able  to  bend  his  back,  but 
was  under  a  neceffity  of  keeping  it  extended.  When  the  body  was  open’d, 
no  greater  mark  of  injury  was  found  about  the  internal  furface,  than  was 
feen  on  the  external,  where  the  blow  was  receiv’d.  But  perhaps  the  hurt, 
that  caus’d*  the  mifchief,  was  upon  the  fpinal  marrow,  and  the  nerves,  as 
they  lay  in  the  interior  parts  of  the  vertebrae,  which  we  were  not  permitted 
to  examine.  However,  the  upper  part  of  the  lungs  was  inflam’d  on  the 
fight  fide  ;  and  on  the  left  was  found  to  be  a  little  hard,  the  right  lobe  ad¬ 
hering  ftrongly  to  the  pleura,  and  the  left  being  quite  free. 

29.  I  have  interpos’d  fo  many  obfervations  relating  to  lying  down,  and 
the  fituation  of  the  body,  that  I  luppofe  you  have  almoft  forgotten  thofe 
which  i  had  promis’d  (r),  relative  to  lerum  being  collected  in  the  thorax, 
and  pericardium,  of  peripneumonic  patients.  The  firft  of  thefe  will  relate 
at  once  to  that,  and  to  lying  down,  and  will  moreover  fhew,  how  far  the 
inflammation  of  the  lungs  fometimes  belies  the  inflammation  of  the  liver. 

30.  A  clergyman,  who  had  juft  enter’d  into  his  twenty-third  year,  had, 
three  years  before,  labour’d  under  an  acute  fever,  with  a  fwelling  of  the  pa¬ 
rotid  glands  :  and  when  he  had  got  rid  of  this,  he  fell  into  a  double  tertian, 
which,  after  troubling  him  long,  went  off  indeed,  but  left  a  pallid  colour  of 
the  face  behind  it,  and  a  wafted  habit  of  body  in  fome  meafure ;  befides  that, 
his  refpiration  was  at  times  difficult,  his  nights  frequently  difturb’d,  and  his 
urine  almoft  always  red.  To  thefe  fymptoms,  at  length,  an  acute  fever  was 
added,  which,  on  the  lecond  day,  was  attended  with  a  pain  below  the  falfe 
ribs,  on  the  left  fide,  and  below  the  enfiform  cartilage  ;  and  this  pain  was 
exafperated  by  the  touch.  On  the  firft  days  there  was  a  vomiting  and  diar- 


(r)  N.  2  1. 


rhcea. 


Letter  XX.  Article  31.  $61 

rhcea,  alio  a  cough,  that  was  fomewhat  moift,  but  this  became  dry  and  fruit- 
lefs,  after  a  very  few  days.  It  was  difficult  for  him  to  lie  on  either  fide, 
fo  that  he  could  not  lie  down  at  all,  but  on  his  back  •,  and  he  felt  a  violent 
heat  in  his  back,  towards  the  right  kidney  :  his  pulfe  was  quick,  frequent, 
unequal,  and  intermitting.  Vallalva  was  much  wavering  in  his  own  mind, 
in  regard  to  the  fituation  of  the  difeafe.  Yet  as  the  patient  difcover’d  no 
fign  of  pain  in  the  thorax,  but  always  pointed  with  his  own  hands  to  the 
place  I  have  mention’d,  that  is,  to  the  region  of  the  liver,  he  at  length  fup- 
pos’d  it  to  be  an  inflammation  of  the  liver.  In  the  mean  while,  the  difeafe 
growing  more  violent  every  day,  and  the  difficulty  of  breathing  increafing 
continually,  as  well  as  the  weaknefs  of  the  pulfe,  he  died  upon  the  con- 
clufion  of  the  feventh  day. 

The  difledlion  of  the  body,  fays  Vallalva,  with  an  ingenuoufnefs  worthy 
of  him,  “  detected  the  error  of  my  judgment.”  For  all  the  vifcera  in  the 
belly  were  found,  except  that  the  fpleen  was  four  times  as  big  as  it  ought 
naturally  to  be.  But  in  the  left  cavity  of  the  thorax,  limpid  ferum  ftag- 
nated,  to  the  quantity  of  two  pounds  or  more :  the  right  was  full  of  a 
thicker  ferum,  fome  parts  of  which  had  in  a  meafure  concreted,  fo  as  to  re- 
femble  a  kind  of  membranous  bodies,  fwimming  in  that  liquor.  The  lungs, 
indeed,  were  free  from  the  pleura  •,  but  the  right,  although  its  bulk  w  s  not 
much  increas’d,  was,  neverthelefs,  entirely  indurated,  from  inflammation. 
The  pericardium  was  much  larger  than  ufual,  being  thus  dilated  by  the  ferum 
it  contain’d.  The  right  ventricle  of  the  heart,  belides  a  fmall  polypous  con¬ 
cretion,  was  full  of  coagulated  blood,  with  which  the  neighb’ring  auricle 
was  extremely  turgid.  Blood  of  the  fame  kind  alfo,  but  in  lefs  quantity, 
was  found  in  the  left  ventricle. 

31.  What  happen’d  to  Valfalva,  might  much  more  eaflly  have  happen’d 
to  molt  other  perfons,  I  mean,  to  believe  that,  which  was  in  fa<5t  an  inflam¬ 
mation  of  the  lungs,  to  be  an  inflammation  of  the  liver,  as,  on  the  ocher 
hand,  I  know  it  has  happen’d  to  fome,  that  they  have  taken  an  inflammation 
of  the  liver  for  an  inflammation  of  the  lungs ;  examples  of  which  you  have 
in  the  Sepulchretum,  in  the  thirty-fixth  obfervation  :  and  I  point  out  this  in 
particular,  in  order  to  ffiew  you,  that  what  figns  are  enumerated,  as  being 
peculiar  to  the  liver,  were,  neverthelefs,  in  great  meafure,  not  wanting  in 
the  clergyman.  So  eafy  is  it,  fometimes,  to  be  deceiv’d  in  the  practice  of 
phyfic,  by  thole  very  appearances  which  feem  to  prevent  us  from  falling  into 
deceptions  !  This  clergyman  had  fymptoms,  alfo,  which  were  the  eflfeCts  of 
remaining  foregoing  diforders :  fo  that  if  any  one  confider’d  them  in- con¬ 
junction  with  thofe  which  had  lately  attack’d  him,  he  was  much  more  liable 
to  be  deceiv’d.  And,  indeed,  as  to  other  fymptoms,  which  you  may,  per¬ 
haps,  require,  to  mark  out  an  inflammation  of  the  liver,  either  even  they 
were  not  wanting,  although  they  might  poffibly  be  omitted  by  Valfalva,  in 
fuch  a  number  of  circumftances,  or  if  they  were  wanting,  yet  they  might 
have  exifted,  thofe  morbid  appearances  only  being  fuppos’d,  which  were 
found  in  the  body  after  death  •,  or,  finally,  if  you  do  not  readily  grant  this, 
at  leaft  you  muft  grant,  that  moft  of  the  figns  of  an  inflam’d  liver  were  here 
prefent  •,  and  that  it  is  very  rare,  in  the  praClice  of  phyfic,  to  find  that  all 
the  figns  of  any  one  difeafe,  whatever,  concur  in  the  fame  body.  And  for 
Vol.  I  4  C  this 


$6 2  Book  II.  Of  Difeafes  of  the  Thorax. 

this  reafon,  it  becomes  phyficians  to  be  more  cautious  in  that  part  of  their 
profeflion,  which  by  Hippocrates  (j)  is  juftly  call’d  “  difficult I  mean,  in 
forming  a  judgment  of  difeafes,  but  efpecially  where,  in  the  fame  region  of 
the  body  that  is  affe&ed,  many  parts  lie  conceal’d,  as  in  the  prefent  cafe. 
For  behind  the  liver,  the  right  lobe  of  the  lungs  was  inflam’d,  to  which  alfo 
was  owing  the  fenfe  of  heat  at  the  back,  towards  the  kidney  of  the  fame 
fide  :  and  although  that  lobe  was  not  fo  much  increas’d  in  bulk  as  might 
have  been  expected,  yet  {till  it  was  increas’d,  and  the  ferum  was  moreover 
very  thick,  with  which  the  right  cavity  of  the  thorax  was  fill’d  :  and  this 
ferum  urging  the  feptum  tranfverfum  downwards,  and  forwards,  prefs’d  upon 
the  liver,  and  that  vifcus  being  again  prefs’d  back  by  the  falfe  ribs,  or  their 
cartilages,  and  by  the  abdominal  mufcles,  efpecially  at  the  time  of  refpiration,. 
and  ftill  more  if  you  applied  your  hand  thereto,  comprefs’d  the  inflam’d 
lungs,  and  caus’d  an  uneafy  fenfation. 

To  this  add  the  bulk  of  the  fpleen,  which  was  increas’d  in  a  quadruple 
proportion,  and  which,  without  doubt,  confin’d  the  liver  into  a  more  narrow 
compafs,  laterally.  And  from  hence  you  will  alfo  account  for  the  difficulty 
that  he  had  in  lying  on  his  right  fide  •,  for  you  fee  that  it  ought  to  have  been 
on  the  left  fide,  from  the  lungs  of  the  oppofite  fide  being  heavy,  and  from 
fo  great  a  quantity  of  ferum  being  in  that  cavity,  which  urg’d  the  mediafti- 
num  into  the  left  cavity  of  the  thorax,  and  by  that  means  fo  much  the  more 
opprefs’d  the  other  lobe,  with  which  only  the  patient  breath’d,  in  proportion 
as  this  lobe  was  already  more  impeded  in  its  motions,  whether  on  account  of 
the  ferum,  which  was  alfo  effus’d  into  its  cavity,  or  on  account  of  the  bulk 
of  the  fpleen,  lying  upon  that  part  of  the  diaphragm  which  was  neareft  to> 
itfelf.  And  thefe  things  feem  to  have  exifted,  even  from  the  time  of  the  long 
foregoing  fevers,  in  this  clergyman,  juft  as  it  did  in  that  carman,  of  whom, 
we  fpoke  in  the  beginning  (/).  But  thefe  marks,  which  we  have  faid  pre¬ 
ceded,  create  no  flight  fufpicion,  whether,  before  this  inflammatory  fever  came 
on,  ferum  was  not  colledled  in  the  cavity  of  the  thorax  of  this  clergyman. 
And  as  this  fufpicion  arifes,  alfo,  in  the  two  hiftories  which  I  fhall  imme¬ 
diately  fubjoin,  I  chtife  rather  to  add  after  thefe  what  I  think  of  this  queftion 
in  each  of  them. 

32.  A  virgin,  of  fixteen  years  of  age,  whofe  menfes  had  been  fupprefs’d; 
for  eight  months  paft,  being  in  a  bad  habit  of  body,  and  fpitting  up  a  ca- 
tarrhous  matter,  having  alfo  fome  difficulty  in  the  motion  of  refpiration,  and 
being  accuftom’d  to  complain  of  a  certain  heat  and  irritation  in  the  left  part 
of  the  thorax,  was  fuddenly  feiz’d  with  a  laborious  orthopnoea,  fo  that  fhe 
could  not  by  any  means  lie  down,  having  an  expeftoration  of  catarrhous 
matter  mix’d  with  blood,  and  a  fenfe  of  an  oppreffive  weight  in  the  fame  left 
part  of  the  thorax,  together  with  a  hard  pulfe,  a  coldnefs  of  the  extremities* 
and  at  length  with  death  itfelf,  on  the  fourth  day,  from  the  beginning  of 
the  orthopnoea. 

In  both  cavities  of  the  thorax,  was  found  a  limpid  ferum,  which,  when 
fet  afide,  in  like  manner,  as  the  blood  (hews,  by  ftanding,  a  red  coagulated 
part,  feparate  from  the  ferous,  Ihew’d  a  concreted  fubftance  in  the  middle 


7 


(i)  S.  i.  Aph,  i. 


(/)  N.  z. 


Of 

•  -i- 


Letter  XX.  Articles  33,  34.  563 

of  it,  like  a  jelly,  and  feparated  from  the  reft  of  the  ferum.  This  ferum 
alfo,  when  fet  over  the  fire,  concreted  in  the  fame  manner  as  the  ferum  of 
the  blood.  However,  the  whole  left  lobe  of  the  lungs  was  extremely  hard. 
In  the  right  ventricle  of  the  heart  was  a  very  large  polypous  concretion  *  in 
the  left  was  another,  but  lefs.  And  in  the  belly,  the  gall-bladder  was  ob- 
ferv’d  to  be  very  fmall,  having  its  coats  much  thicken’d,  and  preferving  but 
flight  traces  of  the  bile. 

33.  An  old  man,  of  feventy-four  years  of  age,  was  feiz’d  with  a  pain  of 
the  right  fide,  which  was  troublefome,  rather  by  a  fenfe  of  weight,  than  in 
any  other  way,  but  was  more  uneafy,  if  he  lay  on  the  oppofite  fide,  where¬ 
fore  he  lay  on  the  right  fide  only.  The  pain  was  accompanied  by  a  trouble¬ 
fome  cough,  a  bloody  expectoration,  a  pain  of  the  head,  watching,  and 
efpecially  a  violent  fever,  with  a  pulfe,  hard,  and  frequent,  but  not  very 
turgid.  He  died  on  the  third  day. 

While  the  thorax  was  open’d,  ferum  burft  forth  from  its  cavity,  with 
which  it  was  entirely  filled.  Was  it  fecreted  by  the  force  of  fo  fhort  a  difeafe  ? 
or  had  it  been  previoufiy  colle&ed  ?  The  lungs  which  were  in  that  cavity  be¬ 
ing  black,  and  affected  with  inflammation,  and  befldes  that  hard,  very  com- 
pa<t,  and  eafily  feparable  from  their  external  membrane,  adher’d  to  the 
pleura,  towards  the  fcapula,  by  little  membranes.  The  left  lobe  had  fcarcely 
receiv’d  any  injury.  In  the  right  ventricle  of  the  heart  was  a  fmall  polypous 
concretion,  extending,  in  great  meafure,  to  the  right  auricle-,  and  another 
more  {lender  in  the  left :  the  former  was  produc’d  into  the  vena  cava  and 
pulmonary  artery and  the  latter  into  the  pulmonary  vein  to  a  fhort  tra6f, 
but  into  the  great  artery  to  a  long  extent :  both  of  them  were  attended  with 
coagulated  blood. 

34.  What  Valfalva  doubted  of  in  this  old  man,  whether  the  ferum  had  not 
been  already  effus’d  into  the  thorax,  before  the  inflammation  of  the  lungs,  it 
would  have  been  more  eafy  to  believe,  if  any  fign  of  fuch  extravafation  had 
preceded,  as  I  have  obferv’d  that  in  the  virgin,  and  the  clergyman,  more 
than  one  did  precede.  Both  of  them  were  previoufiy  cachetic,  and  the  vir¬ 
gin  fo  far,  that  no  trace  of  bile  was  preferv’d  in  the  cift,  from  which  any 
one,  who  was  pleas’d  with  that  very  improbable  opinion  of  Drake  (#),  that 
the  bile  is  the  caufe  of  the  menftrua,  might  perhaps  draw  an  argument  in 
favour  of  his  hypothefis,  in  confideration  of  the  long  fuppreffion  fhe  had  la¬ 
bour’d  under.  And  the  clergyman  had  red  urine,  and  difturb’d  fleep  by 
night.  Finally,  to  omit  other  things,  the  refpiration  of  neither  of  them  had 
been  entirely  healthy.  And  alfo  this  is  cuftomary  in  a  bad  habit  of  body, 
yet  the  blood  alfo,  is  wont  in  fuch  a  ftate  to  abound  with  much  ferum,  and 
eafily  to  depofit  it  here  and  there.  Wherefore,  if  you  think  that  in  thefe 
two,  a  part  of  the  ferum  had  before  ftagnated  in  the  thorax,  the  remainder 
of  which  was  added  by  a  new  difeafe,  I  fhall  readily  afient  to  it.  Nor  would 
I  even  obftinately  deny  it  in  the  old  man,  as  the  foregoing  fymptoms  might 
have  been  unknown  to  Vallalva,  for  this  reafon  among  others,  that  decrepid 
old  people  are  us’d  to  afcribe  moft  of  their  indifpofitions  to  age,  rather  than 
to  difeafe,  and  for  that  reafon  neglect  them  :  and  as  it  feems  furprizing,  that 


{u)  Anthropol.  book  i-  ch.  23. 

4  C  2 


fo 


5  6  4  Book  II.  Of  Difeafes  of  the  Thorax. 

lb  great  a  quantity  of  water  could  have  been  collected,  in  the  cavity  of  the 
thorax,  in  the  fpace  of  three  days.  Do  not,  however,  imagine,  that  what  I 
do  not  difallow  here,  in  thefe  three  perfons,  takes  place  in  the  other  perip- 
neumonic  patients,  who  had  a  ferum  extravafated  in  the  cavity  of  the  thorax. 
For  Coiterus,  as  I  have  told  you  before  (x),  has  obferv’d,  that  “peripneu- 
“  monies”  are  in  the  number  of  thefe  difeafes,  “  which  a  dropfy  of  the  tho- 
“  rax  attends^”  and  in  the  obfervations  of  Valfalva,  and  mine,  you  will  alfo. 
find  fo  many  in  which  both  thefe  difeafes  were  join’d,  that  it  is  not  probable 
they  had  all  previoufiy  labour’d  under  a  dropfy  of  the  thorax,  and  pericar¬ 
dium  ;  for  this  laft  likewife,  is  very  frequently  join’d.  And  it  is  even  cer¬ 
tain,  that  molt  of  them  were  in  very  good  health,  before  they  were  feiz’d 
with  an  inflammation  of  the  lungs  :  as  when  a  perfon,  in  the  highefh  habit  of 
health,  has  expos’d  himfelf,  when  hot  from  exercife,  to  a  very  cold  air.  For 
if  the  circulation  of  the  blood,  through  the  fmall  veflfels  of  the  lungs,  be  re¬ 
tarded  in  this  man  from  that  caufe,  and  the  innumerable,  but  invifible  par¬ 
ticles,  which  are  continually  going  out  from  the  internal  membrane  of  the 
lungs,  and  the  external  furface  of  the  body,  are  obftrudted  ;  thefe  particles 
will  endeavour  to  procure  themfelves  an  exit,  through  other  fmall  foramina 
of  membranes,  and  efpecially  of  thole,  which,  being  at  that  time  more  hot, 
have  their  pores  more  open,  that  is,  thofe  which  inveft  the  thorax  internally, 
and  its  vifcera  :  and  this  exit  will  be  fo  much  the  more  ealy,  as  the  tranfit  of 
the  blood,  through  the  lungs,  is  more  difficult,  and  approaches  nearer  to 
ftagnation,  and  as  the  exertions  of  the  chefl,  in  order  to  expedite  its  motion, 
either  in  refpiration,  or  in  coughing,  are  more  frequent  and  flrong.  For,  by 
thefe  means,  the  humour  will  be  the  more  plentifully  prefs’d  out,  from  the 
pores  of  the  membranes  :  which,  when  once  they  have  been  relax’d  and  dila¬ 
ted,  will  continue,  even  of  themfelves,  to  afford  a  very  eafy  egrefs  to  the 
ferurn.  And  all  thefe  things  will  be  the  more  readily  brought  about,  in  thofe 
perfons,  whofe  membranes  are  at  that  time  moft  prepar’d,  and  difpos’d  there¬ 
to/ and  the  blood,  at  the  fame  time,  moft  impregnated  with  aqueous  par¬ 
ticles.  But,  if  either  of  thefe  circumftances,  or  any  of  thofe  juft  now  men¬ 
tion’d,  (hall  be  difpos’d  in  a  contrary  manner,  then  the  extravafation  of  fe¬ 
rum  into  the  thorax,  and  pericardium,  will  be  very  flight,  or  there  will  be 
none  at  all.  For  even  in  the  obfervations  hitherto  propos’d,  as  they  are  partly 
thofe,  in  which  water  is  defcrib’d  to  be  found  in  the  thorax,  and  pericardium, 
fo  they  are  partly  thofe,  in  which  it  is  not  mention’d  ;  and  there  is  even  one 
where  it  is  exprelsly  remark’d  (jy ),  that  there  was  no  water  in  the  pericar¬ 
dium. 

But  I  will  here  give  the  hiftories  of  two  young  men,  in  whom  there  v/as  a 
great  quantity  ;  which  hiftories  I  remember  to  have  promis’d  you  before  (z), 

35.  A  young  man,  of  almoft  four  and  twenty  years  of  age,  was  feiz’d  with 
a  pungent  pain  in  the  left  part  of  his  thorax  :  he  breath’d  with  difficulty,  he 
had  a  great  thirft,  and  a  violent  cough  ;  but  expe&orated  nothing.  He  lay 
only  on  his  affecled  fide,  and  was  more  free  from  uneafinefs,  when  he  hung 
down  his  head.  At  length,  his  refpiration  growing  more  and  more  difficult 
every  day,  on  the  fixteenth  day  he  died,. 

{•*)  Epift.  16.  n.  33.  (ji)  fupra,  n.  zp  (z)  Epift.  16.  n.  45. 

A.  .  '  -  ...  The 


Letter  XX.  Articles  3  <5,  37-  565 

The  left  lobe  of  the  lungs  was  connected  all  round,  very  clofely,  to  the 
neighb’ring  parts,  and  was  inflam’d  ;  and  indeed,  about  the  clavicle,  al¬ 
ready  fuppurated.  The  pericardium  was  dilated  with  a  very  great  quantity 
of  water,  fo  that  this  might  be  defervedly  call’d  a  dropfy  of  the  pericardium. 
It  was  alfo  much  thicken’d  in  its  coats,  and  to  thefe  coats  internally,  as  well 
as  to  the  outfide  of  the  heart,  fome  concretions  of  a  whitifh  fubdance  adher’d, 
in  feveral  places.  The  heart  was  alfo  encreas’d  in  its  bulk :  and  while  it  was 
cut  open,  a  fluid  blood  flow’d  out  from  its  ventricles.  Yet  in  thefe  cavities, 
notwithdanding,  were  polypous  concretions  alfo,  that  in  the  right  being  pretty 
large,  and  that  in  the  left  of  a  fmaller  fize. 

36.  Another,  who  was  about  two  years  younger  than  him  fpoken  of  above, 
having  complain’d  fird  of  a  pain  in  his  belly,  and  this  going  off,  was  at 
length  feiz’d  with  a  pain  in  the  thorax,  a  difficult  refpiration,  and  a  trouble- 
fome  third.  He  lay  continually  in  a  prone  podure,  yet  fo  as  to  incline  to  the 
right  fide  ;  and  held  his  head  dooping  downwards,  as  mod  of  thofe  patients 
generally  do,  who  have  water  in  the  pericardium  in  great  quantity.  Finally, 
all  the  fymptoms  growing  more  violent,  he  died  about  the  fame  time  of  the 
difeafe  as  the  former,  that  is,  about  the  fixteenth  day. 

In  the  left  cavity  of  the  thorax  a  limpid  water  dagnated,  in  which  the 
lungs  of  this  fide  was  in  every  refpedt  found  and  free.  But  the  lungs  on  the 
right  fide  were  indurated,  and  adher’d  to  the  parts  around  them,  and  efpe- 
cially  towards  the  fcapula ;  where  there  was  a  humour,  like  the  whey  of 
cow’s  milk,  and  in  it  fome  concretions,  refembling  the  white  of  an  egg  con- 
denfated,  in  hot  water.  In  the  pericardium  was  jud  the  fame  kind  of  hu¬ 
mour,  having  the  like  concretions  in  it,  and  adhering  to  the  internal  furface 
of  it,  and  the  external  of  the  heart,  in  fuch  a  quantity,  that  the  pericardium 
being  didended  from  thefe  caufes,  took  up  a  great  fpace  in  the  cavity  of  thq 
thorax.  The  ventricles  of  the  heart  contain’d  polypous  concretions,  the 
right  a  larger  one,  and  the  lefc  a  fmaller. 

37.  What  relates  to  the  dropfy  of  the  pericardium,  I  have  already  taken 
out  from  thefe  two  obfervations  (a),  and  confider’d.  And  as  to  the  concre¬ 
tions,  adhering  internally  to  the  pericardium,  and  externally  to  the  heart,  or 
fwimming  in  the  ferum,  which  was  extravafated  in  the  cavity  of  the  thorax, 
and  refembling  the  white  of  an  egg  condens’d,  we  are  to  fuppofe  jud  the 
fame,  as  of  the  other  concretions,  that  are  found  fwimming  elfewhere,  in  the 
form  of  a  jelly,  or  of  little  membranes,  or  like  a  reticular  body,  or  the  coat 
of  fome  vefifel,  lying  upon  the  furface  of  the  parts  fpoken  of,  and  often  even 
of  the  lungs,  or  the  pleura,  as  I  have  already  deferib’d  in  this  letter  (£),  and 
in  others  (r};  and  ffiall  hereafter  deferibe.  That  is  to  lay,  as  I  have  already 
taken  notice,  and  as  Valfalva  has  mention’d  above  (^),  in  exprefs  terms,  that 
they  are  form’d  from  a  portion  of  the  extravafated  ferum,  being  concreted. 
For  as  the  pores  of  the  membranes  are  more  or  lets  dilated,  from  the  caufes 
above  mention’d  (<?),  fo  more  or  lefs  particles,  of  a  thicker  or  thinner  confid¬ 
ence,  are  extravafated  together  with  the  ferum,  that  are  capable  of  concreting, 

(a)  Ibid.  ( b )  n.  32,  30,  20.  (d)  n.  30. 

(?)  Epift,  16.  n.  17,  30,  38.  &  epift..  feq.  (?)  n.  34. 

&  aliis, 

and, 

£  ,i. 


$66  Book  II.  Of  Difeafes  of  the  Thorax. 

and,  for  this  reafon,  form  thofe  various  concretions,  efpecially  at  that  time, 
as  I  fuppofe,  when  the  motion  of  the  heart,  lungs,  and  even  of  the  heat  it- 
felf,  is  become  very  languid  j  and  finally,  when,  after  death,  it  ceafes  en¬ 
tirely  ;  fo  that  the  ferum  being  agitated  but  little,  or  not  at  all,  fufters  thefe 
particles  to  combine  one  with  another,  or  be  depofited. 

And  thus  far  I  had  written,  when  1  lit,  by  chance,  on  the  trad  of  a  learn’d 
man,  who  having  made  many  obfervations  about  concretions  of  that  kind, 
thinks  them  to  be  of  the  fame  nature  that  Valfalva  and  I  have  thought  them  ; 
but  as,  in  his  explication,  there  are  fome  things  in  which  we  agree,  fo  there 
are  fome  again  in  which  we  differ:  yet  I  am  not  accufiom’d  to  difpute,  wil¬ 
lingly,  on  luch  fubjedts  as  thefe.  I  will  rather  fay  this,  that  nothing  occurs 
more  frequently,  contrary  to  what  he  feems  to  believe,  than  concretions  of 
that  nature,  when  we  find  much  ferum  in  the  thorax,  or  pericardium,  as  this 
letter,  and  other  of  ours,  fhew,  efpecially,  when  the  lungs  “  are  very  hard, 
“  in  an  equal  proportion,  larger  than  ulual,  and  more  heavy,”  that  is,  as  I 
underftand  it,  inflam’d.  But  befides  our  obfervations,  there  are  the  obfer- 
vations  of  others,  and  thofe  not  a  few,  even  in  this  fourth  fedtion  of  the 
Sepulchretum,  to  go  no  farther-,  as  that  of  Panarolus  (/),  who  found  the 
heart  entirely  whitifh  on  its  furface,  and  cover’d  with  floating  filaments,  or, 
to  ufe  his  own  words,  “  towy”  in  its  appearance,  by  reafon  of  the  matter  ad¬ 
hering  to  its  coat  and  that  of  Harderus  ( g ),  who  deferib’d  the  pericardium 
“  as  internally  rough  and  hairy,  and  cover’d  over,  as  it  were,  with  velvet,” 
and  the  heart  “  furrounded  with  a  thick  lymph,  which  could  be  taken  off, 
“  like  a  bark,  that  encompafs’d  it-,”  and,  to  comprehend  many  obfervations 
in  one,  as  that  of  Guarinoni  (i>),  who  affirms,  “  that  he  had  feen  in  mod  of 
“  thofe  who  had  died  from  the  oppreffion  of  pain  in  the  fide,  and  peripneu- 
“  mony,  that  the  heart  was  cover’d  with  a  white  cruft,  or  that  the  heart  was 
“  cover’d  with  a  kind  of  down,  or  fediment”  (/),  as  he  had  faid  above  ( k ), 
where  he  alfo  teftifies,  that  in  bodies  of  this  kind,  he  had  not  only  “  very  of- 
“  ten  fecn  the  cavity  of  the  thorax  full  of  a  watry  fluid,  but  of  a  white  fluid, 
“  and  alfo  the  lungs  full  and  hard,”  as  was  before  pointed  out  (/) ;  ‘‘and 
“  when  the  very  thick  coat  which  had  been  form’d  upon  them,  was  wip’d 
u  off,  they  appear’d  as  if  they  had  been  affedled  with  an  eryfipelas.”  And  I 
feem,  to  myfelf,  in  this  place,  as  I  confider  what  more  frequently,  or  more 
rarely  occurs,  according  to  my  manifold  obfervations,  to  be  more  capable  of 
believing,  that  a  thick  concretion  of  a  membranous  form,  was  feen  by  Gua¬ 
rinoni,  to  be  lying  upon  the  lungs :  nor  am  I  quite  free  from  lufpicion,  that 
the  concretion  was  probably  of  the  fame  kind,  but  thinner,  which  is,  above 
by  Valfalva  (w),  call’d  an  external  membrane,  eafily  feparable  from  the  Jungs 
of  the  old  man,  which  were  hard. 

38.  But  you,  perhaps,  rather  wifh  to  know,  why  in  fome  of  the  hiftories 
iaft  produc’d,  together  with  a  peripneumony,  there  were  fome  fymptoms  of 
a  pleuriiy,  as  in  the  firft  young  man,  a  pungent  pain,  and  in  the  old  man, 
whole  hiitory  precedes  his,  a  hard  pulfe  ?  Firft,  then,  as  to  what  relates  to 

(f)  Obf.  20.  §  7.  (/')  Vid.  epift.  45.  n.  16. 

(g)  In  Additam,  obf.  11.  .  (^)  Obf.  modo  dt.  §  1. 

\h)  Ibid.  obf.  2.  §2.  (/)  n.  zi.  (m)  n.  33.. 

the 


Letter  XX.  Article  38.  567 

the  pungent  pain,  take  this ;  that  they  who,  among  the  more  modern  phy^ 
ftcians,  have  flood  up  learnedly,  and  ingenioufly,  for  the  antient  feat  of  the 
pleurify,  even  they,  I  fay,  readily  allow  more  than  oneway,  in  which,  when 
the  lungs  are  inflam’d,  a  troublefome,  and  even  an  acute  pain  may  be  per¬ 
ceiv’d  :  and  that  the  fame  perfons  by  no  means  difallow,  that  a  pleurify,  ab- 
folutely  fpeaking,  may  exift:  without  this  acute  pricking  pain,  or,  at  leaft, 
be  only  accompany’d  with  a  flight  one:  all  which  circumftances  I  would  have 
you  call  to  mind  ;  for  they  are  true,  and  you  will  fee  that  they  perfectly 
agree  with  both  Vaifalva’s  obfervations,  and  mine  (»).  And  as  I  have  readily 
perceiv’d  this,  in  reading  thefe  letters  over  again,  fo,  alfo,  I  have  readily 
ieen,  in  what  manner  other  very  excellent  men  do  not  doubt,  but  the  pulfe 
in  a  peripneumony  may  be  fometimes  foft,  and  fometimes  hard. 

For  although  the  arteries  of  the  lungs,  if  you  except  the  bronchials,  are 
not,  like  all  the  reft,  and  among  thefe  the  intercoftals,  continuous  with  the 
aorta,  fo  that  they  can  communicate  all  their  irritations  to  the  whole  of  this 
artery  ;  yet  the  veflels  of  the  lungs,  being  irritated  with  that  vehemence,  may 
urge  the  blood  into  the  left  ventricle  of  the  heart :  fo  that  this,  being  irri¬ 
tated,  may  vehemently  compel  the  blood  into  the  aorta,  and  fo  irritate  that 
vefiel,  till,  the  veflels  of  the  lungs  being  comprefs’d,  and  ob  ft  rubied,  from 
the  inflammation  being  encreas’d  there,  lefs  vehemently  impel  the  blood,, 
and  in  lefs  quantity,  into  that  ventricle,  and  this  ventricle  into  the  aorta,  and 
by  this  means,  the  aorta  being  lefs  and  lefs  irritated,  the  pulfe  become  lefs 
hard,  and  even  foft.  All  which  circumftances,  in  relation  both  to  the  pun¬ 
gent  pain,  and  the  hardnefs  of  the  pulfe  in  peripneumonies,  I  was  willing  to- 
take  notice  of  to  you  here,  that  you  may  add  what  is  to  be  gather’d  from 
hence,  to  thofe  things,  by  which  I  have  endeavour’d  to  explain  both  the  one 
and  the  other,  in  the  matron  whofe  cafe  I  defcrib’d  above  in  this  letter  ( 0 ), 
and  in  like  manner  to  thofe  things,  by  which  I  fliall  now  explain  each  of  thefe 
fymptoms  alfo,  in  a  different  manner,  in  the  old  and  the  young  man  at  pre- 
fent  fpoken  of.  For  the  hardnefs  of  the  pulfe,  in  the  old  man,  already  more 
perhaps,  than  feventy-four  years  of  age,  may  feem  to  be  rather  the  effedt  of 
age,  by  which  all  the  parts  grow  rigid,  than  of  difeafe.  And  if  in  the  young 
man  I  fhould  refer  that  pungent  pain  to  the  ftrong  connexion  of  the  inflam’d 
lungs  with  the  pleura,  fhould  I  not  be  able  to  explain  the  thing  in  fuch  a 
manner,  as  to  make  you  underftand,  that^the  pleura,  although  not  inflam’d, 
fuffer’d  diftradtion,  as  often  as  the  lungs,  which  were  already  diftended, 
though  not  entirely  by  inflammation,  were  ftill  more  diftended  by  the  air 
they  took  in  :  and  that  by  this  very  adlion  all  the  points  of  the  furface  of  that, 
vifcus,  are  drawn  afunder  from  each  other,  and  there  is  confequently  an  at¬ 
tempt,  as  it  were,  to  tear  afunder  the  annex’d  pleura?  And  in  this  manner 
nearly,  you  will  fee  a  cafe,  almoft  fimilar  to  ours,  explain’d  in  the  Sepulchre- 
turn  ( p ).  Are  they  all  then,  you  will  fay,  affedled  with  a  pungent  pain, 
whofe  inflam’d  lungs  adhere  to  the  pleura  ?  Not  all,  certainly,  as  even  many 
obfervations  in  this  letter  fhew ;  for  although  Valfalva  may,  perhaps,  have 
forgotten  to  fpeak  of  a  pungent  pain,  in  fome  one  of  them,  yet  it  is  not  to, 

(«)  Vid.  hiftor.  feqq.  &  epifb  2L.  n.  17.  ( 0 )  n.  9.  &  ic. 

&  hiftor.  feqcp  (gj  Sed.hac4.  in  fchol.  ad  §  10.  obf.  20. 

be 


5  6  8  Book  II.  Of  Difeafes  of  the  Thorax. 

be  fuppos’d,  that  he  had  forgotten  it  in  fo  many  others.  How  is  it  then  ? 
In  fome,  perhaps,  the  connexion  of  the  lungs  with  the  pleura  is  lets  dole  ; 
and  in  fome  the  lungs,  towards  the  furface,  may  be  fo  obftrufted  by  the  in¬ 
flammation,  and  be  grown  fo  hard,  that  they  cannot  be  diftended  in  that  part 
by  the  infpir’d  air,  ;  and  in  others,  finally,  there  might  be  fome  other  caufe, 
why,  though  we  fhould  fuppofe  this  connexion,  yet  there  might  not  be  a 
pungent  pain.  And  the  reafon  why  this  does,  or  does  not,  happen,  is  fome- 
times  very  evident  ;  but,  to  confefs  the  truth,  is  alfo  fometimes  very  obfcure, 
or  at  leaft  does  not  ealily  occur  to  the  mind.  Both  of  which  you  may  con¬ 
ceive  of  from  the  following  obfervations. 

39.  A  man,  about  threefcore  and  fix  years  of  age,  having  long  fpit  up  a 
catarrhous  matter,  was,  at  length,  by  being  expos’d  to  the  injuries  of  a  very 
cold  air,  feiz’d  with  a  pungent  pain  of  the  left  fide  :  he  cough’d  very  much, 
and  was  feverifh.  Having,  from  the  very  beginning  of  the  pain,  fpit  up 
continually,  a  great  quantity  of  thick  and  yellow  matter,  ftreak’d  with  bloody 
lines,  he  at  length  died,  on  the  feventh  day  of  the  difeafe,  in  confequence 
of  his  expectoration  being  wholly  lupprefs’d. 

In  the  left  cavity  of  the  thorax  was  water,  like  the  whey  of  cow’s  milk  : 
and  the  lungs  of  that  fide,  which  were  in  a  very  hard  ftate,  adher’d  ftrongly 
to  the  mediaftinum,  and  pleura,  that  inverted  the  ribs.  And  in  the  fame 
manner,  the  lungs  of  the  right  fide  were  attach’d  to  the  mediaftinum  and 
pleura,  where  it  inverted  the  diaphragm,  and  efpecialiy  where  it  inverted  the 
upper  ribs,  anteriorly.  At  this  laft  place,  a  cancerous  ulcer  lay  hid  in  the 
lungs,  the  feat,  perhaps,  of  an  inveterate  difeafe.  In  the  left  ventricle  of 
the  heart  was  a  imali  polypous  concretion,  arid  in  the  right  a  pretty  large 
one,  to  which  a  quantity  of  coagulated  blood  adher’d.  In  the  belly,  the 
colour  of  the  fpleen  was  obferv’d  to  be  inclining  to  a  red. 

4.0.  If  you  jurtly  approve  the  conjecture  of  Valfalva,  in  regard  to  the  feat 
of  an  ancient  difeafe,  you  underftand,  then,  how  patients  are  fometimes  im¬ 
pos’d  upon  by  the  name  of  catarrhous  matter ;  and  I  wiih  I  could  fuppofe 
phyficians  to  be  wholly  free  from  fuch  impofitions.  But  this  only  by  the 
way.  I  would  here  have  you  principally  attend  to  this  circumftance,  that 
on  the  fame  fide  where  the  pungent  pain  was,  in  that  fide  alfo  the  inflam’d 
lungs  adher’d  to  the  pleura  ;  inflam’d,  I  fay,  although  Valfalva  has  negleCted 
to  mention  that  difficulty  of  breathing,  which,  in  diforders  of  this  kind,  is 
fuppos’d  not  to  be  entirely  wanting;  juft  as  in  the  following,  and  other  ob¬ 
fervations,  he  has  omitted  to  mention  fever,  notwithftanding  thole  obferva¬ 
tions,  as  wrell  as  the  prefenr,  are  lliperfcrib’d  by  his  own  hand,  with  the 
title  of  De  Pulmonia . 

41.  A  woman,  of  fixty  years  of  age,  was  feiz’d  with  a  pungent  pain  in 
the  right  part  of  the  thorax,  fo  that  the  could  by  no  means  lie  down  upon 
it.  She  was  troubl’d  with  a  cough  ;  fhe  lpat  up  but  little  :  fhe  breath’d  with 
home  difficulty,  but  that  not  very  great  :  her  ftrength  was  entirely  gone. 
Her  pain,  however,  remitted  afterwards  fo  much,  that  fhe  could  new  lie 
down  on  the  right  fide  again,  with  eafe,  But  in  the  mean  while,  the  pulfe 
failing  more  and  more  every  day,  at  length  life  fail’d  alfo. 

1  he  thorax  being  open’d,  both  lobes  of  the  lungs  wrere  found  to  adhere 
to  the  pleura,  but  the-  right  moft  clofely.  This  laft  mention’d  lobe,  alfo; 

had 


Letter  XX.  Article  42.  569 

had  grown  univerfally  hard,  efpecially  in  its  upper  part ;  where  there  was 
an  abfcefs,  which,  when  cut  into,  difcharg’d  a  great  quantity  of  brownilh 
ferum.  With  this  very  colour,  the  neighboring  fubftance  of  the  lungs,  alfo, 
was  infedted,  which  in  feme  meafure  had  been  l'eiz’d  with  a  fphacelus.  The 
left  lobe  of  the  lungs,  confilting,  not,  like  the  right,  of  one  lobe,  but  of 
many  fmaller  lobes,  was,  on  its  pofterior  part,  nightly  inflam’d,  and  on  the 
whole  of  its  remaining  external  furface,  was  diftinguilh’d  here  and  there  with 
black  fpots.  In  the  pericardium  was  much  water.  In  both  the  ventricles 
of  the  heart  was  a  large  polypous  concretion  *,  but  that  in  the  right  was 
larged.  The  belly  alfo  being  cut  afunder,  within  the  external  part  of  the 
fpleen  was  found  a  certain  bony  body,  which  was  altogether  of  a  fpherical 
figure.  And  in  the  vefiels  of  this  woman,  the  blood  was  almod  univerfally 
concreted. 

42.  The  bone  in  the  fpleen,  and  the  greater  number  of  lobes  found  in  the  • 
lungs  on  the  left  fide,  contrary  to  what  is  generally  found,  being  here 
omitted,  as  belonging  to  another  place  ;  unlefs  you  may,  perhaps,  fuppofe, 
that  from  the  effedt  of  inflammation,  the  three  lobules  of  the  lungs  on  the 
right  fide,  had  coalefc’d  into  one ;  you  eafily  conceive  why,  when  this  inflam¬ 
mation  began  to  degenerate  into  fphacelus,  that  remiffion  of  the  pain  necef- 
farily  follow’d,  which  has  too  often  impos’d  upon  fome  phyficians,  in  a 
manner  that  refledts  much  upon  their  judgment,  in  not  attending  to  other 
fymptoms,  as  you  fee  alfo  in  this  fedbion  of  the  Sepulchretum  (q).  But  be¬ 
fore  the  fibres  were  in  fome  meafure  relax’d  by  the  approaching  fphacelus, 
that  inflam’d  lobe  which  adher’d  to  the  pleura  clofely,  fo  diftradted  this 
membrane,  that  the  woman,  by  reafon  of  the  great  pain,  could  not  bear  the 
predlire,  which  this  fide  mud  fuffer  in  lying  upon  it  •,  though  other  peripneu- 
monic  patients,  when  the  vehemence  of  the  pain  is  not  fo  great,  are  ac- 
cudom’d  to  lie  upon  the  affedted  fide,  and  efpecially  thofe  in  whom  the  lungs 
are,  in  like  manner,  connedted  with  the  pleura.  And  even  they,  who  in 
ancient,  and  in  modern  times,  did  not  doubt  that  an  indammation  of  the 
pleura  very  often  happen’d  without  an  indammation  of  the  lungs,  have 
taught,  that,  in  pleuritic  patients,  “  lying  down  on  the  indam’d  fide  is 
“  ealy,  for  the  pleura  was  then  plac’d  in  its  proper  place,  and  natural  fitua- 
“  tion  :  but  that  lying  on  the  oppofite  fide  excited  the  pain,  for  from  the 
“  weight,  phlegmon,  and  fufpenfion  upon  all  the  contiguous  parts  of  this 
“  membrane,  the  pain  is  greatly  increas’d.”  Thefe  are  the  words  and  ex¬ 
plication  of  Aretaeus(r).  To  which  has  alfo  been  added  this  other  expli¬ 
cation,  that,  as  it  is  certain,  that  the  fide  which  is  comprefs’d  in  lying  down, 
is  much  lefs  agitated  in  refpiration,  than  the  oppofite,  which  is  quite  free 
and  unreftrain’d  in  its  motion  ;  fo  it  feems  that  the  pleura  is  lefs  agitated  and 
extended,  where  it  adheres  to  the  comprefs’d,  than  where  it  adheres  to  the 
free,  fide.  And  you  fee  how  far  it  is  allowable  to  transfer  thefe  explications 
to  the  pleura,  to  which  the  inflam’d  lungs  are  connedted. 

Yet,  neverthelefs,  thefe  very  fame  perfons  have  obferv’d,  that  it  fome- 
times  happens  otherwife  in  regard  to  lying  down  *,  as  is  evident  from  Cselius 

«  '  \ 

(?)  Obf.  22.  ( r )  Mod).  Acut.  1.  1.  c.  io- 

Vol.  L  4  D 


Aurelianus, 


5  7°  Book  II.  Of  Difeafes  of  the  Thorax. 

Aurelianus  (j),  who  has  advanc’d  ftill  another  explication.  And  if  you  con- 
fider  this,  you  will  perceive,  that  it  agrees  with  thofe  who  lie  molt  eafily 
upon  the  affected  fide,  and  not  with  thofe  “  certain  perfons,  who  are  pre- 
“  vented  from  lying  on  the  affefted  fide  ;**  fo  that  it  appears,  even  from 
hence,  that  thefe  perfons  are  rarely  met  with,  and  the  firft  very  frequently. 
Nor  ought  it  to  be  any  objedtion  to  this  fuppofition,  that  we  read,  before 
thefe,  the  following  words  in  Caelius  (/) :  «  A  difficulty  of  lying  on  that  fide 
“  attends  this  kind  of  patients,  and  when  they  turn  themfelves  on  the  con- 
“  trary  fide,  a  pain.”  For  although  by  “  that  fide,”  I  cannot  underftand 
with  others,  the  fide  which  is  found,  not  only  becaufe  Caelius  had  not  men¬ 
tion’d  the  found  fide,  but  the  difeas’d  *,  but  alfo  becaufe,  by  this  means,  I 
muft  underftand  “  the  contrary  fide,”  which  he  immediately  mentions,  to 
refer  to  the  difeas’d  fide,  contrary  to  the  molt  frequent  obfervation  •,  yet  I 
iufpedt,  that  at  this  palfage,  either  there  is  fome  fault  in  the  copies,  which 
are  in  many  other  refpedb  very  falfe,  as,  for  inftance,  if  the  laft  fyllable  of 
jacendi,  being  repeated  by  the  carelefs  copyifts,  the  word  difficultas  had  arifen 
therefrom,  inftead  of  facilitas^  or  facultas:  or  if  we  muft  read  difficult  as^  I 
underftand  it  thus,  fo  as  to  fuppofe,  that  there  is,  indeed,  an  uneafinefs  in 
lying  down  even  on  the  pain’d  fide,  yet  that  this  is  by  no  means  to  be  com¬ 
par’d  with  what  is  occafion’d  by  lying  on  the  contrary  fide.  So  I  fee,  that 
in  the  woman  in  queftion,  Valfalva  has,  indeed,  mention’d  her  incapacity 
of  lying  down  on  the  aftedted  fide  ;  but  I  ffiould  not,  for  this  reafon,  believe, 
that  there  was  not  a  much  greater,  and  more  excruciating  pain,  when  ffie 
endeavour’d  to  lie  down  on  the  found  fide;  nor  does  he  deny  this  :  or  if  it 
was  not  fo,  I  am  then  compell’d  to  return  to  what  I  have  already  confefs’d 
above  («)  ;  I  mean,  that  the  caufe  of  lying  down  with  difficulty,  is  not 
always  evident :  as,  for  example’s  fake,  if  not  only  the  pleura,  but  the  pe- 
riofteum,  which  lines  the  ribs  in  every  part,  by  reafon  of  the  very  clofe 
connexion  of  the  lungs  in  this  woman,  and  of  the  lungs  being  diftended, 
both  by  inflammation,  and  by  abfcefs,  had  been  fo  diftradted,  that  it  could 
not  have  been  prefs’d  upon  by  the  weight  of  the  incumbent  body,  without 
very  great  pain. 

But  be  this  as  it  will,  although  I  remember  to  hear  Albertini  fay,  that  in 
a  peripneumony,  it  was  fometimes  eafier  for  the  patient  to  lie  down  on  the 
pain’d  fide,  and  fometimes  on  the  oppoflte ;  neverthelefs,  I  alfo  remember, 
that  Valfalva,  when  he  allow’d  this,  made  the  following  diftindtion  :  I  mean, 
he  afierted,  that  the  firft  happen’d  to  a  very  great  number  of  patients,  and. 
the  laft  only  to  a  few :  and  the  obfervations  he  has  left  behind  him  in 
writing,  if  compar’d  one  with  another,  Efficiently  confirm  it. 

43.  A  virgin,  aged  two-and-twenty  years,  was  feiz’d  with  a  fix’d  and 
pungent  pain  of  the  right  fide,  together  with  a  cough,  fpitting,  difficult  re- 
ipiration,  and  fever.  She  could  lie  down  in  no  manner,  except  on  the  right 
fide.  In  the  progrefs  of  the  difeafe,  the  fpitting  was  ting’d  with  blood,  which 
was  difcharg’d  to  a  confiderable  quantity  in  one  day.  Some  days  before 

fi)  Acut.  Morb.  1.  2.  c.  16.  n.  98.  edit.  Al-  (/)  L.  eod.  c.  14.  n.  91. 
aielov.  (u)  N.  23. 


deatha. 


Letter  XX.  Articles  44,  45,  46.  57  1 

death,  the  was  troubl’d  with  pains  about  the  ilia.  And  on  the  ninth  day, 
convulfive  motions  coming  on,  fhe  expir’d,  as  fhe  lay  on  the  left  fide. 

In  the  cavity  of  the  abdomen  ferum  was  obferv’d;  the  fpleen  was  very  large* 
and  the  greater  part  of  the  fmall  inteftines  inflam’d.  The  thorax  being  open’d, 
the  right  lobe  of  the  lungs  was  found  to  adhere  clofely  to  the  pleura,  and  the 
whole  fubftance  of  it  to  be  greatly  affeCted  with  inflammation,  and  moreover 
with  an  ulcer  on  the  fide  towards  the  pleura,  in  a  certain  place,  betwixt  which 
ulcer  and  the  pleura  was  a  ferous  matter.  And  the  left  lobe  of  the  lungs, 
befldes  that  its  colour  inclin’d  to  black,  was  diflinguifli’d  alfo  here  and  there, 
with  black  fpots.  There  were  home  ounces  of  ferum  in  the  left  cavity  of  the 
thorax,  in  like  manner.  In  the  heart  were  two  polypous  concretions :  the 
lead  of  which  lay  hid  in  the  left  ventricle  *  and  the  largeft  fill’d  up  the  whole 
cavity  of  the  right  auricle,  which  was  much  dilated. 

44.  In  thofe  perfons  whofe  blood  is  difpos’d  to  create  inflammations,  it  hap¬ 
pens  not  unfrequently,  that  many  parts  are  inflam’d  at  the  fame  time,  or  at 
le-aft,  one  after  another,  and  efpecially  the  parts  of  the  thorax.  Other  inftan- 
ces  of  which,  feem  to  be  in  fome  meafure  pointed  out,  in  this  letter,  befides 
the  example  of  this  virgin;  for  in  the  man  fpoken  of  a  little  above  (x),  the 
colour  of  the  fpleen  inclin’d  to  red  under  the  inflam’d  lungs :  and  in  the  young 
man  (j),  before  the  lungs  were  inflam’d,  the  pain  in  the  belly  had  fignified 
what  diforder  fome  one  of  the  vifcera  was  threaten’d  with. 

However,  the  pungent  pain  in  this  virgin  feems  to  have  been  milder,  than 
in  the  woman  whofe  hiftory  I  laft  of  all  (2)  related.  For  the  virgin  lay 
down  on  the  affeCted  fide,  which  the  woman  could  not  do ;  although  fhe,  at 
length,  lay  upon  the  other,  after  that  the  ferous  matter  of  the  ulcer  had  re¬ 
lax’d  the  fibres  of  the  pleura,  whereby  it  more  eafily  bore  the  diftradtion  from 
the  lungs,  that  were  attach’d  to  it. 

From  the  connexion  therefore,  of  the  lungs  with  the  pleura,  it  was  lawful 
for  us  to  account  for  the  caufe  of  the  pungent  pain,  in  the  method  which 
is  pointed  out  above  ( a ),  in  thefe  three  obfervations.  But  in  as  many  that 
follow,  it  will  not  be  lawful  to  account  for  it  from  the  fame  caufe,  unlefs 
we,  perhaps,  do  it  by  way  of  conjecture. 

45.  A  man  of  fifty  years  of  age,  was,  on  the  fecond  of  March,  feiz’d 
with  an  acute  fever,  and  laborious  refpiration,  attended  with  a  pain,  which 
reach’d  from  the  fternum,  quite  to  the  middle  of  the  abdominal  mufcles,  and 
a  very  troublefome  cough,  inalfnuch  as  it  caus’d  a  great  pain  at  the  right 
nipple,  and  the  falfe  ribs.  He  could  lie  down  on  neither  fide :  he  did  not 
fpit  any  thing  :  he  died  on  the  fifth  day  of  the  difeafe. 

In  cutting  out  the  fternum,  a  little  quantity  of  brown  ferum  flow’d  out  of 
the  cavity  of  the  thorax,  on  the  left  fide.  The  lungs,  which  were  in  this 
cavity,  had  become  much  indurated,  being  inclin’d  to  a  greenifh  colour,  and 
diftinguifh’d  with  black  fpots ;  and  when  they  were  cut  into,  a  ferous  and 
putrid  colluvies  burft  forth,  having  blood  mix’d  with  it.  In  the  ventricles  of 
the  heart  were  polypous  concretions. 

46.  In  this  cafe  indeed,  it  appears  into  what  fatal  difeafe,  the  inflammation 
of  the  lungs  had  degenerated.  But  it  does  not  appear,  why  he  could  not 

(*)  **•  39*  (y)  n*  36.  (z)  n.  41,  42.  (*)  n*  38* 

4  D  2  kea* 


SJ2  Book  II.  Of  Difeafes  of  the  Thorax. 

bear  to  lie  down  on  either  fide,  nor  yet  why  the  pain  fiiould  reach  from  the 
fternum,  quite  to  the  middle  of  the  abdominal  mufcles  ;  unlefs  you  lay  it  to  the 
charge  of  that  very  troublefome  and  dry  cough,  from  which,  at  leaft,  that 
pain  at  the  left  nipple,  and  the  falfe  ribs,  was  believ’d  to  be  brought  on. 
And  if  this  pain  was  pungent,  as  it  leems  to  have  been,  and  as  it  generally 
is,  the  caule  of  it  is  not  lufficiently  underftood,  unlefs  you  conjecture  that 
the  adhefion  of  the  inflam’d  lungs  to  the  pleura,  in  thefe  places,  was  perhaps 
omitted  by  Valfalva:  and  this  being  luppos’d,  it  will  more  eafily  appear, 
how,  in  the  cutting  out  of  the  fternum,  notwithftanding  neither  of  the  tho¬ 
racic  cavities  was  full  of  ferum,  that  fmall  quantity  of  brown  ferum  might 
iffue  forth  from  the  left  cavity,  that  is  to  fay,  from  the  furface  of  the  annex’d 
lungs,  which  overflow’d  with  putrid  and  ferous  colluvies  in  confequence  of 
being  lacerated.  But  this  is  conjecture  only.  Yet  if  we  had  read,  that  with 
this  peripneumony,  an  inflammation  of  the  pleura  was  join’d  ;  we  could  then 
more  eafily  underftand  molt  of  the  circumftances,  which  really  happen  in 
fome  pleuritic  patients,  and  are  obferv’d  by  Caelius  Aurelianus  alfo  (£),  as  a 
pain  at  the  “  bread,  &  ilium,  an  incapacity  of  lying  down,  and  an  anxiety 
“  in  any  pofture.” 

47.  A  young  man,  of  about  twenty- fix  years  of  age,  was  feiz’d  with  a 
pungent  pain  in  the  right  fide  of  his  thorax,  with  a  fever,  and  cough.  He 
fpat  up  but  little.  About  the  eighth  day  a  delirium  came  on,  and  particu¬ 
larly  in  the  night.  The  pain  went  off  j  but  the  difficulty  of  refpiration  al¬ 
ways  became  more  violent.  He  could  lie  down  eafily  on  either  fide.  At 
length,  he  died  on  the  tenth  day. 

Both  lobes  of  the  lungs  had  grown  entirely  hard  :  both  of  them  were  con¬ 
nected  to  the  pleura,  towards  the  back,  and  the  left  laterally.  Befides,  as  a 
certain  white  fubftance,  of  a  membranous  nature,  was  laid,  as  it  were,  upon 
the  pleura,  univerfally,  and  upon  the  lungs,  though  almoft  like  fome  foft, 
and  lax,  reticular  body ;  yet  by  means  of  their  fubftance,  the  lungs  and  the 
pleura  were,  in  fome  places,  firmly  tied  one  to  another.  In  both  the  cavi¬ 
ties  of  the  thorax,  but  more  in  the  right,  there  was  a  great  quantity  of  moif- 
ture,  in  colour  like  the  whey  of  cow’s  milk :  which,  although  when  fet  by, 
it  fiiew’d  no  reparation,  as  has  been  obferv’d  on  a  previous  and  fimilar  oc- 
cafion,  yet  when  put  on  the  fire,  coagulated,  neverthelefs,  like  a  bloody  fe¬ 
rum.  The  pericardium  was  turgid  with  ferum.  In  the  heart  were  polypous 
concretions,  that  which  was  in  the  right  ventricle  being  largeft,  and  that  in 
the  left  fmalleft. 

48.  As  the  brain  was  not  examin’d,  it  is  not  poffible  to  know,  whether 
any  inflammation  was  there  alfo,  to  which,  agreeably  to  what  has  been  faid 
a  little  above  (c),  the  delirium  ought  to  be  imputed.  Yet  to  this  I  impute 
the  ceflation  of  the  pain,  without  any  juft  caufe*,  for  which  reafon,  it 
became  eafy  for  him  to  lie  down  on  which  fide  he  pleas’d.  For,  after  Hip¬ 
pocrates  (d),  Celfus  (e),  as  you  very  well  know,  has  admonifh’d,  “  that  they 
“  in  whom  the  caufe  of  pain  exifts,  without  the  fenfation  of  it,  are  diforder’d 
“  in  their  fenfes.” 

•  »  ■  »  • 

(l)  Acur.  PalT.  1.  2.  c.  14.  (<•)  n,  44.  (d)  S.  2.  Aph.  6.  (t)  De  Mel'c.  1.  2.  c.  7. 


But 


Letter  XX.  Articles  49,  50,  51.  573 

But  why  was  the  pungent  pain  in  the  right  fide  of  the  thorax,  when  the 
lungs  attach’d  laterally  to  the  pleura  indeed,  were  attach’d,  not  on  the  right 
fide,  but  on  the  left  ?  For  as  to  the  connexion  on  the  back-part,  that  is  quite 
out  of  the  queftion,  becaufe  there  was  neither  any  pain  in  that  part,  nor  was 
there  any  thing  particular  in  this  connexion,  as  it  was  common  to  both 
fides.  Are  therefore  the  attachments  which  lay  hid,  as  it  were,  under  a  cer¬ 
tain  membrane  of  a  loft  fubftance,  on  whofe  nature,  and  origin,  1  have  fuffi- 
ciently  fpoken  before  (/) ;  I  fay,  are  thefe  attachments,  which  were  pretty  firm, 
and  flrong,  to  be  more  attended  to  by  us,  on  this  occafion  ?  But  thefe  are 
pointed  out  in  fome  places  only,  and  as  it  feems  on  both  (ides.  It  remains 
therefore  to  conjecture,  that  thole  larger  ones  which  were  in  the  right  cavity 
were  more  firm,  and  prior  to  the  delirium,  in  which  cavity  alfo,  the  greatest 
quantity  of  extravafated  humour  was  found. 

49.  A  woman  of  fixty  years  of  age,  of  a  (lender  habit,  and  a  fanguineous 
temperament,  was  feiz’d  with  a  violent  fever,  a  dry  cough,  and  a  pungent 
pain  of  the  left  fide  ;  yet  if  Fie  lay  down  on  the  dii'eas’d  fide,  fhe  felt  but  little 
pain.  The  pain  remitted  fo  much  from  blood-letting,  that  fhe  could  now  lie 
down  on  any  part  fhe  pleas’d,  Only  a  fever  and  third:  were  troublefome.  She 
fometimes  expectorated  a  thick  matter.  Her  refpiration  became  more  violent. 
At  length,  on  the  thirteenth  day  fhe  died. 

The  left  lobe  of  the  lungs  was  entirely  unconnected  with  the  pleura,  and 
this  membrane  was  without  the  lead  injury;  yet  the  lungs  themlelves  were 
\vhitifh  in  their  colour,  diftinguifh’d  with  black  points,  pretty  hard  in  their 
flefh,  and  fhew’d  fome  tubercles  that  abounded  with  lanies.  The  left  lobe 
indeed,  at  its  upper  part,  adher’d  to  the  pleura,  but  was  far  lefs  difeas’d  than 
the  right,  as  it  was  only  fprinkl’d  over  with  black  fpots,  and  towards  the 
throat  was  pretty  hard,  and  contain’d  a  fmall  abfeefs.  In  the  pericardium 
was  an  ounce  of  ferum.  In  the  right  ventricle  of  the  heart  was  a  large  poly¬ 
pous  concretion,  which  however  was,  as  to  the  greater  part  of  it,  contain’d 
in  the  auricle,  the  cavity  whereof  it  wholly  occupied,  extending  itfelf  from 
thence  into  the  vefiels.  In  the  left  ventricle  was  another,  but  fmaller. 

50.  But  what  conjeClure  fhall  we  make  ufe  of  here  ?  Why  that  which  the 
evident,  but  eafily  pardonable  error  of  Valfalva,  or  rather  of  his  pen,  fup- 
plies  us  with.  For  when  he  deferibes  the  lungs,  he  in  neither  place  mentions 
the  right  lobe,  but  the  left  in  both  places  :  and  for  this  realon  it  is,  I  think, 
allowable  for  us  to  fufpeCt  that  the  lobe  which  he  firft  deferib’d,  was  the 
right,  and  that  he  deferib’d  fecondly,  the  left.  In  this  manner  every  cir- 
cumftance  will  be  eafily  explain’d.  Hitherto  I  have  endeavour’d,  in  the  way 
of  conjeClure,  to  deduce  the  caufe  of  the  pungent  pain  from  the  connexion 
of  the  pleura  and  lungs.  But  there  are  fome  hiftories,  in  which,  befides  that 
connexion,  there  was  alfo  a  flight  inflammation  of  the  pleura,  but  no  pun¬ 
gent  pain,  which,  neverthelefs,  mod  perfons  have  aferib’d  to  an  inflamma¬ 
tion  of  this  membrane.  Of  that  kind,  befides  another  which  I  fhall  pro¬ 
duce  in  another  place  (g),  are  thofe  two  that  follow. 

51.  A  young  man,  of  more  than  twenty  years  of  age,  who  had  previoufly 
labour’d  under  a  chronic  fever,  was  feiz’d  with  an  acute  one,  with  a  pain  of 

(f)  n.  37.  (g)  Epift.  45.  n.  16. 

the 


574  Book  II.  Of  Difeafes  of  the  Thorax. 

the  bread,  a  difficulty  of  refpiration,  a  cough,  and  a  flight  expe&oration  of 
matter,  which  was  ting’d  of  a  bloody  hue.  This  man,  on  the  firft:  days  of 
the  difeafe,  for  the  mod  part,  lay  on  his  left  fide,  and  in  the  laft:  days  con¬ 
tinually.  About  the  fixteenth  day  he  died.  In  the  abdomen,  the  fpleen 
was  three  times  larger  than  its  natural  fize.  The  left  cavity  of  the  thorax  was 
entirely  fill’d  up  by  the  bulk  of  its  own  lungs ;  fo  much  were  they  fwell’d  ; 
univerfally  hard,  and  inflam’d,  and  every  where  annex’d  to  the  pleura:  which 
being  only  fuffus’d  with  a  flight  rednels,  fhew’d  the  beginning  of  an  inflam¬ 
mation.  The  pericardium  was  not  only  fill’d  with  a  humour,  like  the  whey 
of  cows  milk,  but  was  alfo  vaftly  diftended,  and  fome  concretions  of  this  hu¬ 
mour  were  ftrew’d  here  and  there,  over  the  furface  of  the  heart.  In  each  of  the 
ventricles  of  the  heart  was  a  polypous  concretion,  of  a  very  fmall  fize,  and 
flaccid  •,  yet  that  in  the  right  was  rather  the  larged ;  and  larger  productions 
were  carry’d  from  each,  into  the  auricle,  and  veins,  than  were  carry’d  into 
the  arteries. 

52.  You  fee  this  is  already  the  third  perfon,  in  this  one  letter  (£),  who  had 
the  fpleen  much  enlarg’d  after  a  long  fever*,  and  I  {hall  add  others  alfo  here¬ 
after  (/).  So  likewife,  you  will  read  in  Kramer  (£),  that  an  infarction  of  the 
fpleen  l<  is  conftantly  obferv’d  in  Hungary,  after  every  chronic  fever,  and 
“  efpecially  a  quartan  and  not  only  lee  that  in  the  bodies  of  fome,  “  who 
«  died  of  intermitting  fevers,  fchirrhous  fpleens”  were  obferv’d  by  the  cele¬ 
brated  Hoyer(/).  Moreover,  it  is  pointed  out  by  the  learn’d  Fantonus  (wj, 
how  much  more  eafy  it  is  for  patients  to  fall  into  a  peripneumony,  after  be¬ 
ing  attack’d  with  diforders  of  that  kind  in  the  fpleen.  Which,  as  it  hap¬ 
pen’d  to  that  carman  (»),  and  the  clergyman  happen’d  alfo  to  this  young 
man. 

In  him,  indeed,  you  fee  that  there  was  a  connexion  of  the  inflam’d  lungs 
with  the  pleura,  and  that  this  membrane,  moreover,  was  not  entirely  free 
from  inflammation  *,  yet  no  mentionis  made  of  any  pungent  pain.  But  if 
you  fhould  fet  light  by  the  inflammation  of  the  pleura,  as  being  here  very 
flight,  at  leaft  you  will  attend  to  the  connexion  of  the  pleura  with  the  lungs, 
being  very  confiderable.  How  then  is  it  ?  The  magnitude  of  this  fame 
lobe  being  fa  much  encreas’d,  as  to  fill  up  the  whole  cavity  entirely,  and  be¬ 
ing  alfo  join’d  with  a  hardnefs  of  the  furface  (p),  was,  perhaps,  the  reafon 
why  neither  the  weight  of  the  lungs,  inafmuch  as  they  were  fupported  on  all 
fides,  nor  the  diftenfion  from  the  infpir’d  air,  inafmuch  as  the  furface  did  not 
give  way,  could  caufe  any  uneafmefs  or  pain  *,  and  that  fo  much  the  lefs,  as 
the  magnitude,  and  hardnefs  of  this  lobe  were  ftill  augmented  by  the  pro- 
grefs  of  the  difeafe.  For  which  reafon,  the  patient  lay  on  the  affeCled  fide,  on 
the  firft  days  of  the  difeafe,  for  the  moft  part,  and  on  the  laft  days,  continually. 

53.  The  man-fervant  of  a  certain  knight,  who  was  five-and-fifty  years  of 
age,  complain’d  of  a  pain  in  the  middle  of  his  cheft  :  he  could  only  lie  upon 
his  back,  and  a  little  on  the  left  fide.  He  was  oblig’d  to  breathe  with  his 
neck  upright.  He  died  bn  the  flxth  day. 


(h)  Vid.  fupra,  n.  2.  &  30. 

(i)  Epift.  31.  n.  2.  &r  epift.  36.  n.  17,  18. 
{k)  Vid.  Commere.  Litter.  A.  1738.  Hebd. 

15.  n.  2. 


(1)  A£L  N.  C.  Tom.  5.  obf.  68. 

(»;)  Schol.  ad  Patris  obf.  Anat.  Med.  27. 
(«)  ( 0 )  n.  fupra  indie.  2.  &  30. 

(p)  Vid.  fupra,  n.  38. 


6 


The 


Letter  XX.  Articles  34,  3 s,  36-  S7S 

The  left  lobe  of  the  lungs,  towards  the  back,  had  grown  univerfally  in¬ 
durated,  to  a  confiderable  degree,  and  adher’d  rtrongly  to  the  pleura,  which 
was  a  little  red,  even  where  it  inverted  the  diaphragm.  The  right  lobe  of  the 
lungs  was  found ;  notwithftanding  a  little  ferous  matter  was  obferv’d  in  that 
cavity  of  the  thorax,  like  pus.  In  the  pericardium  was  a  turbid  water.  In 
the  right  ventricle  of  the  heart,  together  with  a  polypous  concretion,  there 
was  coagulated  and  grumous  blood :  yet  in  other  parts,  the  blood  prefcrv’d 
lome  fluidity. 

54.  This  hiftory,  as  far  as  relates  to  our  prefent  purpofe,  is  pretty  much 
like  the  former ;  and  if  it  is  underftood  by  you  in  a  fimilar  manner,  both  in 
regard  to  the  obfervation  itfelf,  and  the  explication  of  it,  I  have  no  occafion 
to  add  any  thing  more. 

But,  perhaps,  you  defire  to  know,  whether  a  pungent  pain  is  troublefome 
only  at  that  time,  when  the  inflammation  of  the  pleura  is  complete.  I  will 
fubjoin  two  cafes  of  this  kind,  from  the  firft  of  which,  you  will  perceive, 
that  this  was  the  cafe,  and  from  the  other  that  it  was  not. 

55.  That  man  whom  I  have  already  fufficiently  fpoken  of,  in  the  third  of 
the  Epiftolae  Anatomies  (j),  as  lab’ring  under  long  and  various  diforders, 
which  related,  in  general,  to  the  abdomen,  and  in  whom  I  found  the  liver 
much  difeas’d,  was  at  length  feiz’d  with  a  pungent  pain  in  the  left  part  of 
the  thorax,  and  a  difficulty  of  lying  down  upon  that  rtde,  though  he  could* 
lie  with  eafe  on  the  other :  he  had  in  the  beginning  alfo  a  cough,  and  expec¬ 
torated  fomething.  But  on  the  tenth  day,  or  thereabout,  from  the  beginning; 
of  that  pain,  the  expedoration  being  fupprefs’d,  he  died. 

The  upper  part  of  the  left  lobe  of  the  lungs  had  grown,  univerfally,  into 
a  hard  tumour,  which  comprefs’d  the  neighb’ring  parts,  on  all  lides,  being, 
conneded  alfo  to  the  pleura,  in  fome  places,  by  (lender  filaments  :  and  the 
pleura  itfelf  was  alfo  inflam’d.  But  the  right  lobe  of  the  lungs,  although  con- 
neded  ftrongly  to  the  pleura,  in  fuch  a  manner,  that  it  could  be  IcarCely 
feparated  without  laceration,  was  found  to  be  quite  free  from  difeafe.  In  the 
pericardium  was  a  fmall  quantity  of  water,  in  the  ventricles  of  the  heart 
were  polypous  concretions,  in  the  left  a  very  fmall  one,  ftretch’d  out  to  the 
great  artery,  in  the  right  a  larger,,  which  reach’d  to  the  vena  cava,  and  the 
pulmonary  artery. 

56.  A  man  of  about  fifty  years  of  age,  who  had  already,  for  many  years,, 
labour’d  under  a  leprofy  in  the  thigh,  was  feiz’d  with  an  angina.  And  this; 
lading  two  days,,  terminated  in  a  kind  of  pain  in  the  back:  to  which  was  af¬ 
terwards  added,  a  dry  cough,  a  great  third,  and  a  difficulty  of  lying  down 
on  the  right  fide,,  though  he  could  lie  eafily  on  the  left  •,  alfo  an  opprefliee 
kind  of  pain,  which  feem’d  to  bind  the  lower  part  of  the  thorax,  like  a  gir¬ 
dle.  Although  the  fever  fi-em’d  mild  on  the  laft  days  of  the  difeafe,  and 
there  were  no  figns  befide  thofe  I  have  mention’d,  which  indicated  an  inflam¬ 
mation  of  the  thorax,  yet  the  patient  died  on  the  ninth  day,  from  the  time  he 
had  taken  to  his  bed. 

The  left  cavity  of  the  thorax  was  found  to  be  full  of  a  purulent  ferum  : 
and  from  this  ferurn,  being  concreted,  a  kind  of  membranous  expanfion  was^ 


form’d. 


(?)  n.  5, 


576  Book  II.  Gf  Difeafcs  of  the  Thorax. 

form’d,  which  adhering  to  the  pleura,  look’d  like  a  corruption  of  this  mem¬ 
brane.  Yet  the  pleura,  which  lay  under  this  ftratum  ot  concreted  ferum, 
was  inflam’d  :  and  the  lungs  had  differ’d,  in  fome  meafure,  the  fame  incon¬ 
venience,  though  very  (lightly.  But  very  (mail  polypous  concretions  lay  hid 
in  the  great  veffels,  near  the  heart. 

57.  You  do  not  fee  that  any  pungent  pain  is  taken  notice  of  in  this  hi  (lory, 
as  in  the  former,  although  you  read  that  the  pleura  was  alio  inflam’d  in  this : 
and  even  if  you  compare  it  with  the  lungs,  it  will  appear,  that  it  was  affefted 
with  an  inflammation  of  fuch  a  kind,  that  the  man  may  feem  to  have  died 
principally  on  the  fcore  of  this  inflammation.  And  the  oblervation  is  fo  far 
extraordinary,  on  this  very  account,  that  I  do  not  remember  to  have  met 
with  any-thing  fimilar  to  it,  in  the  hiftories  that  Valfalva  has  left  in  writing, 
or  that  1  have  collefted.  And  even  Nanni  (r),  having  diffefted  many  WI19 
died  of  an  inflammation  of  the  thorax,  and  difcover’d  the  chief  injury 
to  have  been  in  the  lungs  of  the  reft,  found  but  juft  one  or  two,  in  whom 
the  pleura  only  was  affefted  with  inflammation  ;  and  thefe  were  taken  off 
within  the  fpace  of  two  days,  by  the  violence  of  the  difeafe,  without  any 
fpitting  of  blood.  But  by  reafon  of  the  rarenefs  of  this  circumftance,  and 
the  difficulty  of  underftanding  how  death  could  happen  from  this  caule  alone, 
1  then  doubted,  and  do  dill  doubt,  whether  a  fever  of  the  mod  malignant 
kind,  join’d  with  that  inflammation,  had  not  deftroy’d  thefe  patients,  rather 
than  the  inflammation  itfelf;  efpecially  as  Nanni  lays,  that  he  had  found 
only  a  certain  part  of  the  pleura  to  be  inflam’d.  For  if  he  had  feen  tlie 
whole  pleura  to  be  univerfally  inflam’d,  from  the  axillae  quite  to  the  dia¬ 
phragm,  in  the  manner  which  happen’d,  in  one,  or  two  cafes,  at  mod,  that 
you  fee  related  in  the  Sepulchretum,  from  Diemerbroeck  (4),  I  ffiould  have 
been  fomewhat  lefs  in  doubt  on  this  fubjeft ;  although  in  the  former  of  his 
cafes,  there  was  a  fuppuration  of  the  pleura  befides,  and  an  extravafation  of 
pus  into  the  cavity  of  the  thorax,  from  an  abfcefs  of  this  membrane  ; 
and  in  the  other,  fuch  a  caufe  had  preceded,  which  even  of  itfelf  is  capable 
of  bringing-on  fpeedy  death,  that  is,  a  great  draught  of  cold  fmail  beer  in 
a  very  hot  (late  of  body.  But  if  the  obfervations  of  Willis,  and  Riverius, 
were  all  read,  in  any  place  where  they  were  equally  well  defcrib’d,  and  not 
pointed  out  in  a  word,  as  they  are  in  the  Sepulchretum  (/),  we  might  then 
judge  how  many  cafes  of  this  kind  there  are,  and  know  of  what  nature  they 
are.  In  our  country,  without  doubt,  it  would  very  feldom  happen,  if  any 
body  fhould  at  all  find,  that  in  thofe  whom  an  internal  inflammation  of  the 
thorax  has  carried  off,  “  the  feat  of  it  confided  in  the  pleura,”  or  that  this 
membrane  “  was  corrupted,  and  putrefied.” 

58.  But  even  pleurifies,  of  fuch  a  kind  as  occurr’d  to  Diemerbroeck  fo 
frequently,  mud  needs  be  very  rare  amongft  us ;  for  he  writes,  “  That  in 
“  the  di  deft  ion  of  many  pleuritic  patients  ( u ),  he  had  never  found  a  pleurify 
“  brought  on  without  the  pleura  being  injur’d  and  that  in  thofe  ^hole 
“  lungs  adher’d  to  the  pleura,  he  had  alfo  feen  the  lungs  themfelves  to  be 
6‘  affefted,  at  the  fame  time,  in  the  part  which  was  connected  to  the  pleura; 

(r)  Vid.  Comment,  de  Bonon.  Sc.  Acad.  (s)  Se£t.  hac  4.  Obf.  14.  §  8,  &  9. 

Turn.  1.  inter  Medica,  (/)  Ibid.  §  1,  &  4.  Ibid.  §  10. 

“  but 


Letter  XX.  Article  58.  57^ 

44  but  in  -others,  in  whom  the  lungs  were  free  from  the  pleura,  that  the  lungs 
“  were  not  at  all  affected and  that  it  happens  to  a  third,  or  fourth  part, 

44  only,  of  mankind,”  (and  not  to  a  third,  or  fourth  part  of  pleuritic  pa¬ 
tients,  as  fome  have  underftood)  that  the  lungs  adhere  to  the  pleura.  For 
read  all  the  obfervations  of  Valfaiva,  that  I  have  given  you  hitherto,  which 
are  nine-and  twenty  in  number ;  read  alfo  mine,  which  I  fhall  fend  to  you  in 
a  fhort  time,  eighteen  in  number.  I  open’d  the  bodies  of  thole  perfons,  who 
had  died  of  an  internal  inflammation  of  the  thorax,  promifeuoufly,  as  they 
offer’d.  What  appearances  I  met  with  you  will  fee  (x).  Valfaiva,  cer-  * 
tainly,  in  five-and-twenty  of  his  cafes,  as  well  as  in  two  others  befides,  which 
will  be  prefently  lubjoin’d  (jy),  never  mention’d  any  injury  of  the  pleura*,  and 
even  in  fome,  in  whom  you  might  have  fufpedted  otherwife,  exprefsly  ad- 
monifh’d  us,  that  the  pleura  was  without  any  difeafe.  He  found  an  inflam  ¬ 
mation  of  the  pleura,  indeed,  in  four  of  thofe  whom  I  laft  wrote  of,  but  in 
thefe  only.  And  in  two  of  thefe  (2),  it  was  fo  flight,  when  compar’d  with 
the  inflammation  of  the  lungs,  which  were  annex’d  to  it,  that  you  would 
luppofe  the  difeafe  had  been  propagated  from  the  lungs  to  the  pleura,  rather 
than  from  the  pleura  to  the  lungs.  In  the  third,  indeed  (a),  as  likewife  in 
the  fourth  (£),  the  inflammation  was  not  very  flight.  But  in  the  Hrft  of  thefe 
two,  it  was  molt  violent  in  the  lungs,  although  connected  only  in  fome  places 
to  the  pleura,  and  that  by  tender  filaments :  yet  in  this  man  I  am  at  prefent 
fpeaking  of,  no  connexion  between  the  lungs  and  pleura  is  mention’d,  though 
the  lungs  were  not  altogether  free  from  inflammation.  And  if  y^>u  afk  to 
what  caufe  I  then  attribute  his  death,  I  fhall  accufe  neither  the  lungs  nor  the 
pleura,  but  the  purulent  ferum,  with  which  one  cavity  of  the  thorax  was 
fill’d,  and  that  part  alfo,  whatever  it  was,  from  whence  this  pus  had  pro¬ 
ceeded.  For,  as  Hippocrates  (c)  teaches  us,  that  44  whofoever  is  freed  from 
“  an  angina,  (that  is  to  fay,  44  fuddenly,”  as  Celfus  has  tranflated  it  (d), 
which  feems  to  have  happen’d  to  this  patient)  44  in  thefe  the  diforder  is 
“  thrown  upon  the  lungs,  and  they  perifh  in  feven  days :  but  if  they  get 
«  over  thefe  feven  days,  they  then  have  a  fuppuration,”  and  that,  as  Celfus 
fays,  44  in  fome  part  *”  I,  who  fee  that  in  a  patient  who  furviv’d  the  feven 
days,  pus  has  been  found,  and  do  not  fee  from  what  part  this  pus  proceeded, 
although  I  fhould  willingly  accufe  the  lungs,  if  the  hillory  would  permit,, 
give  you  free  leave  to  interpret  Hippocrates  in  fuch  a  manner,  that  when  he 
mention’d  the  lungs,  you  may  fuppofe  he  meant  to  point  out  the  neighb’ring 
parts  alfo,  as  he  was  very  ftudious  of  brevity.  But  that  pain  of  the  back, 
which  immediately  fucceeded  to  the  angina,  and  the  other  heavy  pain,  which 
feem’d  to  bind  the  lower  part  of  the  thorax,  like  a  girdle,  unlefs  you  chufe 
to  refer  the  latter  to  the  purulent  ferum,  with  which  the  diaphragm  was  op- 
prefs’d,  will  perhaps  fupply  you  with  fome  fufpicion,  if  not  fome  conje&ure. 
But  leaving  thefe  matters  quite  at  large,  I  will  admonifh  you  of  this  one 
thing,  in  the  mean  while,  that  in  the  defeription  fet  before  you  (<?),  you  at- 

(*)'  Epift.  21.  ^  N.  59,  &61.  (r)  S.  5.  Aph.  io. 

(z)  N.  51,  &  53.  (<?)  N.  55.  (d)  De  Medic.  1.  z.  c,  7, 

(b)  N.  56.  p)  N.  56. 


4  E 


Voi.  I, 

L  - 


tend 


578  Book  II.  Of  Difeafes  of  the  Thorax. 

tend  to  the  falfe  membrane,  which,  adhering  to  the  pleura,  refembl’d  a 
corruption  thereof.  For  the  next  obfervation  is  of  the  fame  nature. 

59.  A  woman,  in  the  fixty-fourth  year  of  her  age,  was  feiz’d  with  a  pain 

in  the  right  part  of  her  thorax,  fo  that  fhe  could  not  lie  upon  it,  but  with 
difficulty,  nor  touch  it,  but  with  pain.  Her  refpiration  was  frequent,  her 
cough  dry,  her  pulfe  quick,  frequent,  fmall,  and  weak.  On  the  feventh 
day,  a  fweat  came  on  about  her  head.  Her  ftrength  failing,  ffie  died  about 
the  ninth  day.  m 

The  thorax  being  open’d,  the  lungs,  in  the  right  cavity,  appear’d  to  be 
very  turgid,  fo  as  to  fill  it  up  entirely,  and  to  adhere  (lightly  to  the  pleura, 
by  means  of  a  kind  of  membrane,  as  it  were,  betwixt  that  and  the  pleura. 
But  this  membrane  was,  in  fa6t,  nothing  elle  but  ferum,  which,  after  it  had 
ifiu’d  out  from  the  pores  of  both  thefe  parts,  had  fo  concreted,  and  extended 
itfelf,  that  at  firft  fight  it  refembl’d  a  membrane  turgid  with  fanies,  and  even 
a  corrupted  pleura.  An  appearance  of  which  kind,  fays  he,  feems  to  have 
impos’d  upon  Riverius  (/),  when  he  affirms,  that  he  had  found  the  pleura 
corrupted  in  a  pleurify.  But  in  this  cafe,  by  diligent  enquiry,  the  pleura 
was  at  length  found  to  be  found  •,  yet  the  lungs,  on  their  back  part,  were 
inflam’d  with  great  hardnefs.  However,  the  other  lobe  was,  in  many  places, 
conne&ed  to  the  pleura,  yet,  neverthelefs,  uninjur’d.  In  the  pericardium 
was  much  water.  In  the  cavities  of  the  heart  many  polypous  concretions  lay 
hid,  a  pretty  large  one  in  the  right  auricle,  and  a  lefier  one  in  the  adjoin’d 
ventricle,  the  firft  of  which  was  produc’d  into  the  venae  cavse,  and  the  other 
into  the  pulmonary  artery.  There  were,  alfo,  two  lefs  than  the  laft,  in  the  left 
ventricle,  unequal  to  one  another  in  magnitude  :  the  larger  of  thefe  extended 
itfelf  into  the  great  artery,  and  the  lefier  into  the  left  auricle. 

60.  Whether  Riverius  has  blunder’d,  or  not,  and  if  he  has,  whether  in 
this  way  only,  I  fhall  not  take  upon  me  to  determine.  For  I  know,  that 
there  may  fometimes  be  another  caufe  of  error:  and  this,  when  you  (hall 
have  read  the  next  hiftory,  I  will  declare. 

61.  A  woman,  who  was  more  than  fixty  years  of  age,  of  a  plethoric  habit 
and  fat,  was  feiz’d,  on  the  firft  of  December,  with  a  pain  in  the  thorax* 
particularly  on  the  right  fide,  with  a  violent  fever,  great  third,  and  a  fore- 
nefs  and  laffitude  of  the  whole  body :  nor  could  fhe  breathe  without  pain. 
Blood  was  taken  from  her,  and  other  afliftances  of  art  were  made  ufe  of,  but 
in  vain.  That  laffitude  was  even  increas’d,  the  fenfes  became  torpid,  and 
fhe  was  in  fome  meafure  delirious.  At  length,  the  fpitting,  which  was  be¬ 
fore  in  fmall  quantity,  and  not  glutinous,  was  thrown  up  in  a  round  form 
and  in  a  date  of  purulency ;  refpiration  became  more  laborious ;  a  delirium 
came  on  ^  and  on  the  eighteenth  day  of  the  difeafe  death  itfelf  took  place. 

The  thorax  being  open’d,  while  the  right  lobe  of  the  lungs  was  feparated 
from  the  pleura,  to  which  it  adher’d,  much  purulent  matter  burft  forth,  that 
is  to  fay,  from  an  abfcefs  in  the  fubftance  of  the  lungs,  round  which*there 
was  a  great  inflammation  5  yet  the  pleura  was  without  injury.  The  left  lobe 
of  the  lungs  was  found.  The  right  ventricle  of  the  heart  contain’d  a  fmall 

(/)  Vid.  fupra,  n.  57. 

polypous. 


Letter  XX.  Article  6  2.  579 

polypous  concretion  ;  but  the  other  contain’d  only  a  beginning  concretion, 
of  that  kind. 

62.  Now,  if  you  will  read  over  again  that  which  was  even  written  by  me 
on  the  difledlion  of  a  certain  virgin  fpoken  of  above  (g),  I  mean,  that  while 
the  reparation  of  the  lungs  from  the  pleura,  to  which  they  adher’d  ftrongly, 
was  attempted  with  the  hand,  the  lungs  were  torn  afunder,  by  reafon  of  their 
rottennefs,  and  that,  at  the  fame  time,  they  threw  out,  from  an  abfeefs,  a 
great  quantity  of  famous  matter  j  you  will  then  eafily  underftand,  how  liable 
that  is  to  happen,  which  I  gave  an  admonition  in  relation  to,  fifty  years  ago, 
in  the  Academy  of  Sciences  at  Bologna  (b) ;  and  my  prince  and  mailer,  that 
moll  beneficent  patron  of  letters,  which  he  himfelf  greatly  adorn’d,  Benedidt 
the  Fourteenth,  Pontifex  Maximus,  did  not  think  this  admonition  unworthy 
to  be  made  a  favorable  mention  of,  in  his  immortal  books  (z).  For  fuppoie 
that  fome,  as  I  have  more  than  once  feen,  even  celebrated  phyficians  among 
the  populace,  who  were  much  pradlis’d  in  vifiting  patients,  and  but  little, 
or  not  at  all,  exercis’d  in  infpedting  bodies  after  death,  were  prefent  at  the 
diflfedlion  of  a  man,  who  died  not  without  figns  of  a  pleurify,  which  was  per¬ 
form’d,  as  frequently  happens,  by  an  inexperienc’d  furgeon  ;  and  as  he  endea¬ 
vours  to  remove  the  lungs  from  the  pleura,  the  fame  thing  happens  which  hap¬ 
pen’d  in  this  woman  (k\  or  in  that  virgin  (/),  that  from  an  abfeefs,  fuddenly 
burlling  in  that  part  of  the  lungs  which  adheres  clofely  to  the  pleura,  pus  is 
effus’d,  but  that  the  remainder  of  the  pus,  and  the  lacerated  remains  of  the 
lungs,  which  are  annex’d  to  the  pleura,  continue  ftill  to  adhere,  as  they  ge¬ 
nerally  do,  while  the  other  part  of  the  lungs,  immediately  collapfing  on  the 
difeharge  of  the  pus,  contradi  the  cavity  of  the  abfeefs,  and  almoll  conceal 
it,  or  if  it  fhew  it  at  all,  feems  rather  to  fhew  the  effedl,  and  a  part  of  a  cer¬ 
tain  neighb’ring  tumour,  fuppurated  in  the  pleura  ;  I  would  not  have  you 
doubt,  but  it  would  immediately  be  pronounc’d,  that  they  had  enquir’d  fuf- 
ficiently,  that  they  had  evidently  feen  the  pleura  putrefied,  and  corrupted, 
flowing  with  collected  pus,  and  leaving  no  fufpicion  of  an  error  from  the 
pre-judg’d  opinion.  But  this  error  might  have  been  very  eafily  avoided,  where 
thofe  remaining  parts  being  clear’d  away,  by  the  hand  of  a  cautious  and  di¬ 
ligent  difiedtor,  the  pleura  had  been  found,  underneath  them,  to  be  but 
(lightly  affedted,  or  even,  as  happen’d  to  Valfalva  (z/z),  entirely  found,'  and 
altogether  without  injury,  when  laid  bare. 

I  do  not,  however,  for  thefe  reafons,  deny,*  but  a  great  injury  of  the 
pleura  itfe-lf  may  fometimes  have  been  met  with,  by  fkilful  and  practical 
anatomilts,  after  internal  inflammations  of  the  thorax.  I  only  take  the  li¬ 
berty  to  declare,  what  I  fufpedt  of  the  obfervations,  fo  much  boalted  of  among 
the  lefs  expert. 

Nov^,  becaufe  I  have  obferv’d,  that  by  moll  of  them  who  labour  to  afiert 
the  feat  of  thefe  inflammations  to  be  the  pleura,  and  to  take  it  away  from 
the  lungs,  almoll  all  fenfation  is  denied  to  this  vifeus,  I  will  fubjoin  one  ob- 
fervation,  and  no  more,  from  Valfalva,  and  that  a  very  Ihort  one  too,  by 
which  the  contrary  may  be  affirm’d. 

(g)  N.  11.  10  De  Servor.  Bei  Beatific.  1  4.  P.  1.  c.  18. 

( b )  Vid.  ejus  Comment,  loco  cit.  fupra,  ad  (,£)  N.  61.  (/)  N.  11* 

n.  57.  \m)  N.  61. 


63.  An 


8  o  Book  II.  Of  Difeafes  of  the  Thorax. 

63.  An  old  woman,  of  feventy  years  of  age,  complain’d  about  two  months 
of  an  internal  pain  of  the  thorax.  She  had  no  cough  :  lhe  expectorated  no¬ 
thing  :  fhe  could  lie  down  on  neither  fide.  At  length,  lhe  died. 

Both  lobes  of  the  lungs  were  diftinguifti’d  with  black  fpots :  and  the  right, 
befides  this,  was  on  its  back-part,  towards  the  vertebrae,  hard  and  ulcerated, 
although  no  famous  matter  appear’d.  A  polypus,  of  a  confiderable  fize,  was 
found  in  the  right  ventricle  of  the  heart,  which  was  produc’d  from  thence, 
through  both  the  orifices  of  that  cavity,  into  the  veffels,  and  the  branches  of 
the  veffels,  and  by  its  bulk  had  much  dilated  the  right  auricle. 

64.  If  you  conceive  how  the  polypus,  or  rather  the  polypous  concretion  ; 
fince  even  thole  were  not  the  marks  of  a  polypus,  which  are  commonly  pro¬ 
duc’d,  nor  yet  of  the  dilated  auricle  •,  or  rather,  I  fay,  the  polypous  concre¬ 
tion,  which  Valfalva  was  accuftom’d,  at  that  time,  to  ufe  the  name  of  poly¬ 
pus  for  ;  was  form’d  in  the  laft  moments  of  life,  in  the  fame  manner  as  you  do 
thole  black  fpots  of  the  lungs  (#),  and  that  the  auricle  was  of  itfelf  lax,  and 
for  that  reafon,  eafily  dilated  by  the  polypous  concretion,  inafmuch  as  it  was 
too  infirm  in  its  coats,  to  refill  the  diltenfion ;  it  then  remains  only,  that  the 
internal  pain  of  the  thorax  mull  have  had  its  feat,  for  two  months,  in  no 
other  part  but  in  the  ulcerated  lungs. 

65.  Now,  as  you  have  a  very  long  ferifcs  of Valfalva’s  obfervations;  fori 
have  given  you  one  and  thirty,  before  this  laft;  if  you  fhould  happen  to  en¬ 
quire,  in  which  fide  of  the  thorax,  the  inflammation  happens  moft  frequent¬ 
ly,  you  will  find  that  it  happen’d  quite  differently  with  him,  from  what  it 
did  to  thole  very  learned  men,  who  have  faid  that  the  right  fide  was,  for  the 
moft  part,  affeCted  therewith,  and  the  left  more  feldom.  For  fetting  afide 
the  bodies,  in  which  Valfalva  found  both  fides  inflam’d,  you  will  fee,  that 
out  of  the  remaining  cafes,  almoft  as  many  had  an  inflammation  on  the  left, 
as  on  the  right  fide :  and  you  will  learn  nearly  the  fame  alfo,  from  my  two 
and  twenty  obfervations,  which  I  lhall  fend  to  you  fpeedily. 

But  you  will  fay,  that  this  affertion  has  been  made  in  regard  to  the  inflam¬ 
mation  of  the  lungs  only,  and  not  of  the  conjoin’d  inflammation  of  the  lungs 
and  pleura.  Yet  you  will  not  find,  that  the  obfervations  of  Valfalva  agree 
with  them,  even  on  this  fuppofition.  And  as  four  of  thefe,  and  no  more, 
give  a  hiftory  of  both  inflammations  being  join’d  together  (0),  fo  in  every 
one  of  thefe,  the  diforder  was  on  the  left  fide.  But  if  one  of  mine  agrees 
with  them  (p)>  another  does  not  agree  very  well  ( q ).  It  feems,  therefore, 
that  a  greater  feries  of  obfervations  is  requir’d,  in  order  to  determine  any 
thing  certainly  on  this  head,  or  in  order  to  undertake  to  explain  from  anato¬ 
my,  why  a  pleurify  is  more  frequent  on  the  right  fide,  but  more  mild.  And 
yoy  will  then  judge,  whether  the  illuftration  of  this  problem,  which  has  been 
giv’n  by  excellent  men,  with  no  lefs  modefty,  than  ingenuity,  may  be  far¬ 
ther  carry’d  on,  and  perfected  by  anatomy,  when  it  lhall  feem  lefs  prema¬ 
ture.  In  the  mean  while  farewel, 

(k)  Vid.  epift.  24.  (p)  Epift.  21.  n.  33, 

00  n.  51,  53.  55.  56,  (?)  Ibid.  n.  34. 


LETTER 


Letter  XXI.  Articles  i  ,  2,  3* 


>8  r 


LETTER  the  TWENTY-FIRST 

Finifhes  the  Difcourfe  of  pain  in  the  Breaft,  Sides,  and 

Back. 

AS  I  am  about  to  write  my  obfervations  to  you,  nearly  in  the  fame  order 
that  I  wrote  Valfalva’s,  I  will  begin  with  thofe,  in  which  the  internal 
inflammation  of  the  thorax  had  its  feat  in  the  lungs,  without  the  pleura  being 
at  all  affe&ed. 

2.  A  woman  died  of  a  peripneumony,  not  without  inequalities  of  the 
pulfe,  in  the  hofpital  of  St.  Mary  de  Morte,  at  Bologna,  in  the  month  of 
March,  and  in  the  year  1706  :  at  which  time,  Valfalva  being  fent  for  to  Par¬ 
ma,  I  differed  the  bodies  in  the  anatomical  theatre,  in  his  dead. 

The  lungs  had  a  compaCt  fubftance,  like  that  of  the  liver:  and  the  peri¬ 
cardium  contain’d  a  great  quantity  of  water.  The  external  lurface  of  the 
heart  feem’d,  at  firft  fight,  to  be  corroded  in  a  great  part  of  it :  and  yet  was 
not  fo  •,  but  unequal  concretions  adhering  to  it  gave  it  this  falfe  appearance  : 
and  thefe  concretions,  being  eafily  remov’d,  the  external  membrane  of  the 
heart  appear’d  fmooth  and  entire  (a).  Other  concretions  alfo,  adher’d  to 
the  internal  furface  of  the  pericardium,  which  were  entirely  disjoin’d  from 
the  former,  yet  of  the  fame  kind ;  fo  that  you  would  readily  conjecture  both 
of  them  to  have  been  form’d  in  the  fame  manner,  of  the  grofler  particles, 
which  had  feparated  from  that  water,  and  coalefc’d.  In  the  ventricles  of  the 
heart,  and  the  right  auricle,  were  large,  white,  polypous  concretions,  but 
they  had  not  any  very  firm  confidence.  In  the  veficula  fellis  were  two  black 
calculi,  of  a  pretty  hard  texture,  approaching  to  the  form  of  a  cube,  and  of 
an  unequal  magnitude  ;  but  neither  of  them  fmall. 

3.  A  flout  mufcular  young  man,  of  eighteen  years  of  age,  being  taken 
off,  at  Venice,  by  a  peripneumony,  within  eight  days-,  fome  learn’d  men, 
among  my  friends,  requefted  of  me,  that  I  would  go  through  the  difieCtion 
of  his  body,  it  being  now  the  month  of  December,  in  the  year  1708  :  and 
that  more  for  the  fake  of  knowing  the  natural  ftate  of  things,  and  examining 
them  with  care,  than  thofe  appearances  which  related  to  the  difeafe.  How¬ 
ever,  I  demonftrated  the  following  things  in  relation  thereto. 

The  right  lobe  of  the  lungs  adher’d,  all  round,  to  the  neighb’ring  parts, 
by  a  kind  of  thin  membrane.  The  upper  lobule  of  the  fame  lobe  was  ex¬ 
tremely  hard,  and  heavy,  that  is,  of  a  fubftance  refembling  the  liver,  which 
appearance  the  remaining  part  of  the  lobe  alfo,  had,  in  fome  meafure,  and 
the  greater  part  of  the  left.  In  the  left  cavity  of  the  thorax,  was  a  great 


(a)  Vid.  epift.  25.  n.  24. 


quantity 


j-Ba  Book  II.  Of  Difeafcs  of  the  Thorax. 

quantity  of  water,  and  that  bloody,  and  of  a  blackifh  kind  of  hue  :  and  the 
lame  kind  of  water  was  alfo  in  the  pericardium,  in  confiderable  quantity. 
The  right  auricle  of  the  heart  was  extremely  dilated,  with  a  great  quantity  of 
blood,  by  eafily  yielding,  as  I  fuppos’d,  to  the  quantities  thrown  into  it,  in 
the  laft  moments  of  life,  and  ftagnating  there.  This  blood  was  black  and 
grumous,  and  contain’d  a  tough  polypous  concretion,  of  a  large  fize,  part 
of  which  reach’d  into  the  ventricle  beneath :  there  was  another  in  the  pul¬ 
monary  artery,  of  a  fubftance  not  unlike  the  former,  but  round.  Yet  there 
was  ndne  in  the  left  ventricle,  and  its  adjoining  auricle,  for  in  thefe  cavities, 
there  was  not  even  the  leaft  blood  of  any  kind,  unlefs  it  had  flow’d  out  in 
difie&ion.  in  the  abdomen  was  fome  quantity  of  water  ;  the  liver  was  livid 
at  its  edge:  and  the  inteltines,  being  in  l'ome  places  reddifh,  had  a  very  ftrong 
fmell. 

4.  An  old  man  of  feventy-four  years  of  age,  of  a  low  ftature,  and  us’d 
to  frequent  vidtualling-houfes,  having  been  liable,  for  fome  years  paft,  to  an 
inflammation  of  the  lungs,  was  at  length  carried  off  by  it  in  the  holpital  at 
Padua.  There  was  nobody,  at  that  time,  who  could  accurately  relate  the 
peculiar  fymptoms,  that  had  been  obferv’d  in  him  :  wherefore  I  do  not  enu¬ 
merate  them,  as  I  did  not  likewife,  in  the  two  former  hiftories,  for  the  fame 
reafon.  I  will  not,  however,  conceal  this  one  thing,  which  I  could  learn  for 
a  certainty.  He  had  labour’d  under  no  fymptom  at  all,  that  particularly  re¬ 
lated  to  any  diforder  of  the  heart,  no  deliquke,-  no  palpitations,  no  inequali¬ 
ties  of  the  pulfe,  which  was  in  other  refpedts  fmall,  nor  any  other  fymptoms 
Gf  that  kind.  For  I  enquir’d  diligently  into  thefe  things,  after  having  made 
ufe  of  the  body,  for  public  demonftration,  in  the  year  1730. 

The  lungs  were  univerfaily  annex’d  to  the  pleura.  The  upper  part  of  the 
right  lobe  was  hard,  and  blackilh  :  and  the  fanguiferous  veflels,  of  the  fame 
lobe,  were  very  clofely  connedted  with  the  bronchia  *  and  among  thefe  veflels, 
was  obferv’d  one,  which  was  dilated  to  the  extent  of  fome  inches  $  but  when 
this  tradt  was  meafur’d  over,  it  then  return’d  to  its  juft  diameter.  I  alfo 
faw  the  trunk  of  the  bronchial  artery  arife  from  the  aorta,  of  an  unufual 
bignefs,  fo  as  to  be,  nearly  by  three  times  the  diameter,  larger  than  it  gene¬ 
rally  is.  And  on  the  pofterior  furface  of  the  left  ventricle  of  the  heart,  at 
about  the  fpace  of  two  fingers  breadth  above  the  apex,  a  tubercle  was  pro¬ 
minent  outwards,  of  the  bignefs  and  ftiape  of  a  fmall  cherry,  one  half  of 
which  rofe  above  the  furface,  and  the  other  half  buried  itfelf  within  the  fub¬ 
ftance  of  the  heart.  It  was  pretty  much  like  one  of  thofe  hydatids,  which 
are  form’d  within  the  other  vifeera,  the  lungs  for  inftance,  or  the  kidnies,  in 
fuch  a  manner,  that  they  are  ftill  prominent  in  fome  meafure.  When  it  was 
prick’d  with  the  knife,  it  emitted  a  little  water ;  yet  ftill  retain’d  a  more  tur¬ 
bid  humour.  But  this  turbid  humour  was  alfo  difeharg’d  from  the  cavity, 
when  laid  quite  open,  together  with  a  fmall  membrane,  in  which  were  fome 
white  and  mucous  particles  as  it  were,  and  alfo  a  particle  of  a  tendineous 
hardnefs.  This  little  membrane  feem’d  to  obtain  the  place  of  inner  coat  in 
the  tubercle  ;  for  the  external  was  another  membrane  of  a  denfe  nature,  and 
v/hitifh,  internally  rough  and  unequal,  girt  round  the  whole  tubercle ;  fo  that 
it  feem’d  to  be  in  fome  meafure  referable  to  thofe  tumours,  which,  as  Celfus 

{b)  fay 3* 


^Letter  XXI.  Article  3.  -5 S3 

(b)  fays,  “  arife  from  fmall  beginnings,  increafe  for  a  long  time,  and  gra- 
“  dually,  and  are  included  in  a  proper  coat”.  And  while  I  was  feparating  this 
coat  from  the  flefli  that  lay  about  it,  I  found  it  found,  and  that  not  only  round 
about,  but  where  it  pafs’d  between  the  tubercle  and  the  cavity  of  the  ven¬ 
tricle  ;  for  the  tubercle  did  not  extend  itfelf  much  beyond  half  the  thicknefs 
of  the  flelhy  paries,  in  which  it  had  been  form’d.  Finally,  the  left  auricle 
of  the  heart  was  much  longer  than  it  us’d  to  be,  and  on  the  internal  furface 
of  the  aorta,  frequent  bony  fcales  were  feen,  efpecially  at  the  curvature,  and 
near  the  heart,  with  this  exception  however,  that  behind  the  femilunar  valves 
beginnings  of  them  only  appear’d.  Yet  fome  of  them  were  not  wanting, 
even  in  other  places,  and  particularly  at  the  orifice  of  the  cceliac  artery. 

5.  In  regard  to  the  tubercle  of  the  heart,  I  will  here  firft  fay,  what  I  faid, 
when  I  demonftrated  it  to  my  auditors,  that  it  might  be  perceiv’d  from  this 
obfervation,  that  the  following  words  of  Pliny  (r)  do  not  fufiiciently  agree 
with  the  truth  :  “  This  alone  of  all  the  vifcera”  (that  is,  the  heart)  “  is  not  con- 
“  fum’d  by  difeafes,  nor  lingers  under  the  afflictions  of  life  :  for  when  it  is 
“  once  injur’d,  death  is  immediately  the  confequence.”  I  now  add  :  Neither 
does  the  general  opinion,  that  the  heart  cannot  be  injur’d,  without  fome  or 
many  of  thofe  fymptoms,  which  I  have  faid  did  not  take  place  in  this  old 
man,  fufficiently  coincide  with  the  truth.  And  what  the  fymptoms  were  in 
the  obfervation  of  our  Veflingius,  which  was  more  rare  indeed,  on  account 
of  its  fituation,  and  yet  belong’d  to  the  fame  fpecies  as  mine,  Rhodius,  who 
defcrib’d  the  obfervation  (J),  has  negleCted  particularly  to  inform  us.  For 
as  far  as  it  is  certain,  that  what  was  taken  out  of  the  right  auricle  of  the  heart, 
was  not  any  thing  polypous  (although  in  regard  to  fome  other  obfervations  I 
doubt)  but  a  true  “  follicle,  in  which  there  was  no  pus”,  inafmuch  as  “  it 
“  had  fmall  veins  annex’d  to  it,  for  nutrition  fo  far  alfo,  it  is  evident, 
that  the  dropfy,  and  the  pus  dilcharg’d  in  the  beginning  of  the  diforder, 
could  not  be  efteem’d  as  peculiar  fymptoms  of  this  degeneracy  in  the  heart. 

But,  to  return  to  what  relates  to  the  prefent  purpofe,  is  the  beginning,  and 
encreafe,  of  that  tubercle  to  be  imputed  to  the  inflammations  of  the  lungs, 
which  our  old  man  had  been  fubjeCt  to  ?  For  you  have  feen  in  the  former 
letter,  and  even  from  the  difieCtion  produc’d  in  this  alfo,  how  frequently  fe¬ 
rum  is  accumulated  in  the  pericardium,  at  the  time  of  a  peripneumony,  and 
that  very  thick,  and  loaded  with  heterogeneous  particles,  which,  by  being 
feparated,  may  adhere  to  the  heart,  or  be  injurious  in  fome  other  way,  even 
after  the  inflammation  is  at  an  end.  And  you  will  even  fee  what  I  fhali 
flightly  obferve  below  (e),  in  regard  to  feveral  perfons  who  have  had  their 
hearts  dilated,  from  an  inflammation  of  the  lungs :  and  from  thence  may  con¬ 
jecture,  that  as  an  impetus  had,  in  this  cafe,  been  very  evidently  made  upon 
the  left  auricle,  fo  alfo,  that  an  impetus  might  have  been  made  upon 
the  fubftance  of  the  fubjeCted  ventricle,  though  not  in  fo  evident  a  manner. 
But  thefe  circumftances,  at  leaft,  may  be  afcrib’d  to  the  foregoing  peripneu¬ 
mony;  that  the  bronchial  artery  was  much  thicker,  that  fome  one  of  the 
veflels  that  attend  upon  the  bronchia  was  varicofe,  that  thefe  veflels 
coher’d,  much  more  clofely  than  ufual,  to  the  bronchia,  and  perhaps  even 
that  the  lungs  had  every  where  coalefc’d  with  the  pleura.  For  the  cir- 

(£)  De  Medic.  1.  7.  c.  3.  (rf)  Cent.  3.  Obf.  Med.  4. 

(c)  Nat.  Hilt.  1.  11.  c.  37.  ( e }  n.  34. 

culation 


Book  II.  Of  Difeafes  of  the  Thorax. 


culation  of  the  blood  being  retarded  through  the  lungs,  by  frequent  inflam* 
mations,  and  indeed  in  part  obftrubted,  it  muft  of  courfe  happen,  that  the 
veflels,  and  the  lungs  themfelves,  would  be  diftended  ;  and  tor  this  reafon, 
that  the  firft  would  apply  themfelves,  very  clofely,  to  the  bronchia,  and  the 
laft  to  the  pleura  •,  and  that  the  particles,  which  were  prefs’d  out  from  the 
blood,  that  was  then  of  itfelf  vilcid,  and  made  ftill  more  fo  by  ftagnation, 
would  join  one  part  to  another  like  glue.  But  why  more  humours  ftill,  and 
more  vifcid  humours,  are  prefs’d  out  at  fuch  a  time,  fo  that  befides  the  lungs, 
other  parts  in  like  manner,  even  thofe  of  the  belly,  are  often  feiz’d  with  in¬ 
flammation,  and  other  circumftances  of  the  like  kind,  as  they  have  been 
fufficiently  explain’d  in  the  foregoing  letter  (/)  •,  do  not  expedi  me  to  repeat 
the  explanations  here :  and  for  the  fame  reafon  it  was,  that  to  the  two  hifto- 
ries  defcrib’d  before  this,  I  lubjoin’d  no  remark  at  all.  But  that  jn  thefe 
three  obfervations  I  have  not  related  the  fymptoms  particularly,  which  had 
accompanied  the  peripneumony,  is  not  owing  to  my  carelefsnels  in  enquiring 
or  defcribing,  but  to  the  neglebt  of  thofe  who  had  leen  the  patients  :  although 
there  are  fometimes  caufes,  on  the  account  of  which,  even  they  themfelves 
who  vifit  the  patients,  cannot  be  fufficient  judges  of  the  greater  part,  or  at 
leaft  of  fome,  of  the  flgns,  that  attend  upon  diforders.  I  will  here  give  you 
a  particular  hiftory,  in  order  to  elucidate  each  of  thefe  canfes,  as  I  produce 
them,  beginning  with  a  diflediion  which  I  perform’d  at  Bologna,  in  the  fame 
days,  and  on  the  fame  occafion,  in  which  I  perform’d  the  firft  (g). 

6.  A  builder,  or,  as  they  are  commonly  call’d,  a  mafon,  of  about  thirty 
years  of  age,  was  feiz’d  with  a  fever  after  great  labour.  To  this  were  added 
daily  periodical  rigors,  at  the  time  of  which  he  at  length  began  to  be  delirious. 
But  when  the  delirium,  which  us’d  to  be  foon  over  every  day,  at  laft  became 
continual,  the  patient  immediately  grew  worfe  and  worfe.  It  was  a  melan¬ 
choly  and  plaintive  delirium:  the  pulfe  was  equal:  blood  fometimes  came 
forth  from  the  noftrils.  Although  a  vein  had  been  open’d  once  and  again, 
and  other  things,  which  were  fuppos’d  to  be  advantageous  to  the  patient, 
were  not  omitted,  yet  he  grew  continually  worfe,  though  gradually,  till  at 
length  he  died.  The  vifcera  of  the  body,  when  differed,  though  at  the  dis¬ 
tance  of  nine  hours  after  death,  were  even  then  warm  and  fmoking  :  and  the 
blood  iflu’d  from  their  veins,  when  incis’d,  in  a  fluid  and  warm  ftate ;  not- 
withftanding  polypous  concretions  were  afterwards  drawn  out,  not  only  from 
the  crural  veins,  but  alfo  from  the  heart,  from  whence  they  were  produc’d 
into  the  pulmonary  veflels,  on  one  fide  at  leaft.  The  lungs,  if  you  except  the 
anterior  part,  which  was  whitifh  and  found,  were  almoft  every  where  harder 
than  the  natural  ftate ;  but  on  the  right  fide,  and  efpecially  in  the  fuperior 
lobe,  were  very  hard,  very  heavy,  diftended,  red,  and  made  up  of  a  denfe 
and  compared  fubftance.  In  the  belly  was  a  large  fpleen. 

7.  What  fymptoms  of  a  peripneumony  can  you  properly  learn  from  a  pa¬ 
tient,  when  it  has  fucceeded  a  delirium,  efpecially  thofe  that  relate  to  the  na¬ 
ture,  and  fituation  of  the  pain  ?  And  both  thefe  diforders  may  be  eafily  join’d 
together,  as  the  great  number  of  examples  pointed  out,  and  produc’d,  in  the 
feventh,  and  the  former  letters,  demonftrate,  not  only  on  account  of  the 


(/)  34»  37»  44*  te)  n.  z. 


6 


polypous 


Letter  XXL  Articles  8,  9,  5 8 jr 

polypous  particles  of  the  blood  being  ptane  to  ftagnation,  but  alfo  becaufe 
the  delirious  patient  forgets  frequently,  and  for  a  long  time,  to  draw  his 
breath,  and  for  that  reafon  to  propel  the  blood  through  the  lungs  :  and  the 
peripneumonic  patient,  having  the  circulation  of  the  blood  through  the 
lungs  not  fo  free  as  ufual,  muft  of  courfe  have  an  oblfruftion  to  the 
quick  return  of  it  from  other  parts  ;  I  add,  from  the  upper  parts  in  parti¬ 
cular,  when  the  luperier  vena  cava  is  prefs’d  by  the  diftended  lungs,  as  in 
the  prHent  cafe  of  the  mafon.  For  which  reafon,  we  fee  that  the  upper 
parts  >ften  grow  externally  red,  and  turgid  in  this  difeafe  •,  fo  that  it  is  eafy, 
from  thence,  to  conceive  what  may  happen  to  the  internal  parts  alfo,  or,  at 
leaft,  may  be  in  danger  of  happening.  From  being  appriz’d  of  thefe  cir- 
cumftances,  it  was  that  I  was  lefs  furpriz’d,.  when,  upon  teaching  the  ana¬ 
tomy  of  the  brain  publicly.,  at  different  times,  but  elpecially  in  the  year  1730, 
there  was  not  one  of  the  heads  that  I  had  open’d,  in  which  the  veffels  of  the 
brain  were  not  diftended  with  blood ;  for  it  had  accidentally  happen’d,  that  all  of 
them  had  been  taken  from  bodies  of  perfons  who  had  died  of  a  peripneu- 
mony,  which  was  frequent  at  that  time  :  nor  was  extravafated  water  wanting 
in  the  brain  of  each  of  them,  juft  as  we  often  fee  it  extravafated  in  the 
thorax  of  peripneumonic  patients,  in  like  manner.  But  on  this  fubjedt 
you  will  read  over  again  the  feventh  letter  •,  for  I  will  not  repeat  here 
what  has  been  Laid  relative  thereto  in  that  epiftle,  and  efpecially  under  number 
eleven  and  twelve. 

8.  There  is,  alfo,  another  caufe,  why  patients  fometimes  perceive  no  un- 
eafinefs  from  the  inflam’d  lungs ;  I  mean,  a  dullnefs  of  fenfation,  either  by 
reafon  of  the  laxity  of  the  brain,  or  of  the  nerves,  the  lungs,  or  the  annex’d 
pleura.  And  you  have  an  example  of  its  being  from  the  brain  and  nerves, 
in  two  old  men,  one  of  whofe  hiftories  I  defcrib’d  in  the  fixth  (h)y  and  the 
other  in  the  eleventh  letter  (*).  Both  of  them  had  an  inflammation  of  the 
lungs.  But  one  of  them,  being  half  afleep,  and  flow  of  underftanding, 
denied  his  having  any  uneafinefs  in  the  thorax,  even  at  the  time  when  he 
ought  moft  to  have  perceiv’d  it.  And  the  other  being  hemipledic  from  an 
apoplexy,  and  having  no  fenfation  in  the  whole  right  fide  of  his  body,  it  is 
not  to  be  wonder’d  at,  if  he  had  no  fenfe  of  the  lungs  being  inflam’d  on  that 
fame  fide.  It  remains,  then,  only  to  Ihew,  by  example,  that  the  fame  thing 
may  happen  from  the  laxity  of  the  lungs,  or  the  annex’d  pleura. 

9.  A  hufbandman,  who  was  thirty-five  years  of  age,  having  fall’n  from  a 
great  height,  and  bruis’d  his  right  lide,  was  receiv’d  into  the  hofpital  of  St. 
Mary  de  Morte  at  Bologna.  This  man,  after  having  recover’d  by  a  proper 
method  of  cure,  and  being  quite  well  in  regard  to  his  refpiration,  and  other 
circumftances,  fo  that  he  was  about  to  be  difmifs’d  from  the  hofpital,  began 
to  cram  himfelf,  privately,  with  bread,  and  other  vifcid  aliments,  to  fuch  a 
degree,  that  he  fell  into  an  ardent  fever,  and  foon  after  into  a  difficulty  of 
breathing,  which  was,  however,  attended  with  no  pain  in  the  cheft.  Such 
remedies  were  adminifter’d,  as  the  diforder  feem’d  to  require,  among  which 
was  blood-letting,  once  or  twice.  But  all  were  to  no  purpofe.  For  lying  on 
his  back,  as  his  cuftom  was,  and  having  a  ftcrtor,  and  his  pulfe  being  chord- 


4  F 


VoL.  I. 


(b)  N.  12. 


(l)  N.  13* 


5B6  Book  II.  Of  Difeafes  of  the  Thotax. 

like,  and  very  frequent,  which  had  been  before  large,  he  died  within  eight 
days  after  the  ardent  fever  had  attack’d  him,  having  dragg’d  on  the  laft  days 
of  his  exiftence,  under  the  oppreffion  of  fuch  fymptoms.  This  happen’d 
about  the  middle  of  April,  in  the  year  1706. 

I  differed  the  body  on  the  day  following,  in  which  I  firft  faw  a  laudable 
habit  j  but  the  face  and  neck  were  livid,  as  in  hang’d  perfons.  The  abdo¬ 
men  was  alfo  livid,  not  only  at  the  ilia,  but  alfo  very  far  about  the  middle 
of  it.  The  lungs  every-where  adher’d  to  the  pleura,  not  only  by  means  of 
membranes,  but  immediately,  and  by  themfelves,  as  it  feem’d  at  firft.  Yet 
if  you  attended  to  it  more  nicely,  betwixt  the  membrane  of  the  lungs,  which 
was  found,  and  the  pleura,  a  thin  concretion  was  interpos’d,  in  fuch  a  manner, 
as  to  refemble  another  membrane.  With  this,  when  you  pull’d  away  the 
lungs,  the  pleura  itfelf  follow’d  readily.  The  inferior  lobe  of  the  lungs  was 
very  large,  and  heavy,  in  its  whole  fubftance  much  harden’d,  and  refembling 
the  fubftance  of  the  liver.  The  remaining  parts  of  the  lungs  were  not  to 
be  found  fault  with.  In  the  pericardium  was  a  large  quantity  of  yellowiftx 
and  turbid  water.  In  each  of  the  orifices  of  the  heart,  and  its  auricles,  were 
polypous  concretions  *,  and  among  thefe,  the  greateft  was  in  the  right  auricle, 
which  fent  branches  from  thence  quite  into  the  jugular  veins.  In  the  belly, 
the  large  inteftines  appear’d  more  confpicuous  than  the  reft,  being  turgid 
with  air.  But  the  lower  parts  of  the  ileum  deferv’d  our  attention  more,  which 
were,  to  a  confiderable  extent,  every-where  of  a  blackilh  red  colour,  the 
fanguiferous  veffels  being  very  manifeft,  juft  as  if  they  had  been  injedted 
with  a  colour’d  wax  :  and  there  was  a  ftrong  fmell,  fuch  as  is  common  to  in¬ 
flam’d  inteftines.  The  liver  was  whitilh,  except  that  it  was  livid  at  its  border, 
and  internally  variegated  like  marble.  The  gall-bladder  had  but  little  bile, 
nor  was  it  altogether  natural.  The  fpleen  was  large,  whitilh,  and  very  lax. 

10.  If  you  acknowledge  the  pleura,  which  eafily,  follow’d  the  adhering 
lungs,  when  feparated  from  them,  to  have  been  lax,  you  may,  I  think,  from 
thence  learn,  why  the  weight  of  the  inflam’d  lungs  was  not  felt  thereby. 

However,  notwithftanding  I  think  that  this,  and  other  caules  befides, 
may  be  fometimes  produc’d,  and  not  without  probability  neither,  why  fome 
peripneumonic  patients  do  not  perceive  the  weight  of  the  lungs,  when  it  is 
fo  greatly  increas’d  ;  yet  I  confefs,  that  in  fome  of  them,  I  do  not  fee  the 
caufe  of  this  circumftance,  which  can  fufficiently  fatisfy  me,  and  ftill  lefs 
why  the  other  figns  of  this  difeafe  are  alfo  wanting  in  part  j  and  in  part  fo 
flight  and  obfcure,  that  when  inevitable  death  is  now  at  hand,  the  difeafe  is 
with  difficulty  known  by  the  phyficians,  and  fometimes  not  at  all  even  then^ 
but  only  after  diffedlion. 

You  perceive  that  I  fpeak  of  a  thing  of  the  greateft  moment,  the  figns- 
and  marks  of  which  ought  to  be  inquir’d  into,  and  trac’d  out  with  the  greateft 
exadtnefs  and  care  j  fo  that  whenever  it  happens,  we  may  have  it  in  our  power 
to  know  it,  and  obviate  it  fufficiently  in  time.  And  I  wilh  Valfalva,  from 
whom  I  heard  the  firft  mention  of  this  circumftance,  had  taken  notice  of  it, 
alfo,  in  his  papers,  and  had  mark’d  it  out  by  fome  figns.  But  whether,  on  ac¬ 
count  of  the  rarity  of  the  caies,  he  had  not  opportunity  of  obferving  ir, 
unlefs  in  patients  who  were  already  defperate,  or  whether  he  did  really  make 
©bfervations,  but  in  the  laft  part  of  his  life,  when  he  was  fo-continuaUy  taken 

up, 


Letter  XXL  Articles  n,  12,  13.  y8 7 

\!p  in  his  profeffion,  that  he  had  no  time  to  commit  any  thing  of  that  kind 
to  writing ;  be  this  as  it  will,  I  could,  at  leaft,  find  nothing  at  all  in  his 
papers  relative  thereto.  For  which  reafon,  I  fhall  communicate  what  I  have 
heard  from  him,  and  what  I  have  myfelf  feen,  beginning  with  a  Ihort  hiftory, 
part  of  which,  as  far  as  it  relates  to  the  difeafe,  was  told  me  by  Valfalva  s 
but  as  to  what  relates  to  the  diffeCtion,  that  I  faw  myfelf,  as  I  afiifted  him  in 
the  examination  of  the  body. 

1 1.  Francefco  Coralli,  a  native  of  Bologna,  being  an  old  man,  was  troubl’d 
with  a  catarrhous  diforder,  as  men  of  his  age  generally  are,  but  fo  flight  in 
appearance,  that  he  did  not  think  it  worth  while  to  fend  for  a  phyfician  to 
take  care  of  it.  It,  therefore,  happen’d  accidentally,  that,  as  he  intended 
going  out  of  his  houfe,  on  the  day  following,  and  this  feem’d  too  early  to 
his  domeftics,  Valfalva  wasdefir’d  by  them  to  call,  as  it  lay  in  his  way,  upon 
their  mailer,  who  was  familiarly  known  to  him,  that  he  might  dilfuade  him 
from  fo  ralli  a  defign.  He  came,  therefore,  on  that  day  in  the  morning,  and 
obferv’d  thofe  fymptoms,  which,  when  obferv’d,  had  figfrified  to  him,  in 
other  cafes  of  the  fame  kind,  that  death  was  near  at  hand,  contrary  to  the 
opinion  of  thofe  who  were  about  the  patient.  Wherefore,  calling  afide  his 
domeftics,  who  fufpeCted  no  filch  thing,  he  immediately  told  them  what  was 
at  hand,  and  affirm’d,  that  although  the  patient  felt  no  heavy  fpain  in  his 
chelt,  nor  yet  any  of  the  pungent  kind,  and  even  feem’d  to  himfelf  to  be 
pretty  well,  he  had,  neverthelefs,  an  inflammation  of  the  lungs,  which  was 
already  defperate.  The  event  confirm’d  the  prediction  j  for  within  twelve 
hours,  or  fooner  than  that,  death  came  on.  And  the  knowledge  of  the 
difeafe  was  confirm’d  by  the  diffeCtion  of  the  body.  For  when  the  thorax 
was  open’d,  we  found  the  upper  lobe  of  the  lungs,  on  the  right  fide,  tumid, 
hard,  and  (luff’d  up  with  blood. 

12.  I  do  not  doubt  but  you  will  here  alk  two  things ;  one,  in  what  manner 
Valfalva  explain’d  the  circumltance  ?  and  the  other,  by  what  figns  he  was 
influenc’d  to  make  this  diagnoltic  and  prediction  ?  As  to  what  relates  to 
the  firlt,  when  I  exprefs’d  my  furprize,  how  it  could  happen,  that  the  weight 
of  the  infarCted  lungs  was  not  felt,  I  do  not  remember  that  he  made  any 
other  anfwer,  except  what  gave  me  equal  furprize,  to  wit,  that  he  had  known, 
that  a  leaden  bullet,  weighing  two  ounces,  difcharg’d  from  a  mufquet,  had 
lluck  in  the  lungs,  and  had  occafion’d  no  fenfe  of  its  weight. 

But  in  regard  to  thofe  figns,  or  marks,  as  I  have  mention’d  what  were 
abfent  in  the  hiftory,  fo  I  Ihould  not  have  omitted  thofe  which  were  prefent, 
if  Valfalva  had,  in  like  manner,  related  them.  But  as  he  was  filent  on  this 
head,  and  I  hop’d  that  he  would  publiffi  them  of  his  own  accord,  I  did  not 
care  to  feem  troublefome  at  that  time,  by  repeated  interrogations.  However, 
chance  has,  I  believe,  given  me  occafion  to  conjecture  what  thefe  figns  were, 
from  what  I  obferv’d  here  in  the  celebrated  profeffor  Anthony  Vallifneri,  in 
the  year  1730,  who,  to  my  very  great  grief  and  affliction,  was,  I  think, 
fnatch’d  away  by  the  fame  kind  of  difeafe. 

13.  In  that  epidemic  conftitution  of  catarrhous  fevers,  which  I  defcrib’d 
to  you  in  the  thirteenth  letter  (&),  he  was  feiz’d  with  the  common  difeafe,  on 


th? 


(i)  N.  4. 
4  F  2 


SSS  Book  II.  Of  Difeafes  of  the  Thorax. 

the  twelfth  of  January,  a  fever  which  had  been  to  all  flight  and  falutary  ;  and 
to  him  in  appearance  flight  alfo,  but  mortal,  either  becaufe  his  lungs  were 
more  lax,  or  becaufe  vifcid  matter  then  abounded  in  great  quantity,  or,  finally,, 
becaule,  although  he  was  fixty-nine  years  of  age,  yet  of  a  robuft  confti- 
tution,  and  unus’d  to  illnefs,  he  fomewhat  defpis’d  the  diforder  in  the  be¬ 
ginning,  and  even  more  than  once,  in  the  advanc’d  ftate  of  it,  likewife. 
And,  indeed,  it  was  fuch  a  diforder  feemingly,  as  might  be  defpis’d.  For 
to  omit  other  things,  which  I  heard  from  two  phyflcians  who  had  feen  him 
on  the  feeond  day,  the  one  a  little  before  noon,  and  the  other  in  the  evening, 
that  there  was  fcarcely  any  fymptom  of  fever  in  the  pulfe,  and  even  that  they 
were  lefs  quick  in  the  evening  than  in  the  morning,  I  will  relate  nothing  elfe 
to  you,  but  what  I  faw  and  found  myfelf.  When  I  came,  on  the  fourth  day, 
to  congratulate  him,  as  one  that  was  recovering,  and  found  him  fitting  up 
in  bed,  after  taking  food,  I  perceiv’d  that  his  face,  refpiration,  ftrength  of 
voice,  and  other  circumftances  of  that  kind,  which  may  have  a  judgment 
form’d  of  them  by  feeing  and  hearing,  were  all  juft  as  they  are  us’d  to  appear 
in  health.  Then  faid  he  to  me  with  his  ufual  complaifance,  you  fee  what 
kind  of  a  diforder  mine  was ;  fo  that  I  need  not  make  any  apology  to  you 
for  not  calling  you  in  to  my  affiftance  on  this  account.  While  I  fat  by  him, 
he  cough’d  fometimes.  I  examin’d  the  matter  he  fpat  up,  and  found  that 
it  was  well  conceded,  and  faw  that  he  brought  it  up  with  eafe.  He  fhew’d 
me  his  tongue :  it  was  fomewhat  vifcid  and  white.  He  ftretch’d  out  his  arms:, 
the  mufcles  were  like  thole  of  a  healthy  man,  his  pulfe  equal,  and  of  a  mo¬ 
derate  fullnefs,  and  ftrength,  having  a  proper  interval  betwixt  each  ftroke,, 
except  that  it  was  rather  fomewhat  longer,  fo  as  to  incline  to  flownefs.  This 
was,  as  1  faid,  on  the  fourth  day  of  the  difeafe.  The  day  after,  1  fent  a 
perfon  to  falute  him  in  my  name  j  and  word  was  brought  me  that  he  was- 
ftill  more  chearful,  fo  that  he  was  didating  a  letter  to  a  friend,  as  he  fat  up 
in  bed.  On  the  flxth  day,  though  I  was  extremely  taken  up  with  the  public 
bufinels  of  the  college,  yet  in  the  morning  I  was  determined  to  go  and  fee 
my  friend,  as  I  pafs’d  by  him.  But  I  found  him  in  a  far  different  ftate,  on. 
this  viflt,  from  that  in  which  he  had  been  three  days  before.  His  face  was 
difcolour’d,  melancholy,  and  down-caft ;  his  refpiration  difficult ;  his  voice 
was  low,  and  languid,  and  feem’d  to  afeend,  as  it  were,  from  a  deep 
and  hollow  place  j  his  expedorated  matter  was  altogether  very  little  in  quan¬ 
tity,  fomewhat  crude,  and  ting’d  here  and  there  with  blood,  which  was  of 
a  dirty  colour. 

So  great  a  change  immediately  ftruck  me,  and  that  fo  much  the  more,, 
when  upon  afking  him  how  he  found  himfelf,  and  why  he  fat  up  thus  in  bed, 
at  thofe  hours ;  for  it  was  two  hours  before  noon,  and  the  weather  was  very 
cold,  he  anlwer’d,  that  he  was  much  as  he  had  been  two  days  before,  when 
I  faw  him,  or  even  rather  better.  I  then  afk’d  him,  if  he  felt  any  fenfe  of 
weight,  or  any  pain,  or  heat  rn  his  breaft :  but  he  exprefsly  deny’d  that  he 
felt  any.  He  only  added  this,  that  he  felt  fuch  an  uneafmefs  in  the  left  fide 
of  his  breaft  externally,  which  all  are  wont  to  feel  from  a  cough,  and  for 
this  reafon  he  paid  no  regard  to  it:  that  he  was  troubl’d  with  thirft,  as  he 
had  alfo  often  been  on  the  former  days  ;  but  left  I  ftiould  fufped  that  any 
internal  heat  was  perceiv’d  by  him,  for  that  reafon,  he  faid  that  the  feat  of 

his 


Letter  XXL  Article  14.  589 

Ms  tfhirft  was  fo  far  from  being  in  the  vifcera,  that  whatever  watry  fluids  he 
forc’d  himfelf  to  drink,  he  found  were  reje&ed  by  the  ftomach  :  that  the 
feat  of  it  was  not  below  the  fauces  ;  for  that  thefe  were  befet  with  a  vifcid  mat¬ 
ter,  by  which  the  tafte  of  whatever  food  he  took  was  obtunded,  and  of  the 
wine  alfo,  of  which  he  faid  he  had  taken  a  little  quantity  the  day  before,  as 
being  fuitable  to  a  diforder  arifing  from  a  vifcid  matter.  Although  his  fenfes, 
as  you  perceive  from  this  difcourfe,  which,  however,  he  did  not  fpeak  juft 
in  the  chain  I  have  related  it,  and  without  intermiffion,  were  in  perfedt  vi¬ 
gour  ;  although  his  tongue,  flelh,  pulfe,  except  that  this  was  lefs  ftrong  than 
it  had  been,  were  juft  the  fame  as  on  the  fourth  day ;  and  though  he  affirm’d 
his  urine,  which  I  did  not  fee,  to  have  been  always  good,  and  to  be  (till  fo ; 
yet  I  was  fo  far  more  and  more  difpleas’d,  almoft  every  moment,  with  his 
refpiration,  voice  and  countenance,  not  to  mention  the  quality  of  the  expec¬ 
torated  matter,  and  the  diminution  of  it,  that  I  could  not  help  betraying  my 
grief  in  my  countenance,  though  I  ftudy’d  to  conceal  it.  Then  faid  he  to 
me.  Why  do  you  hefltate  ?  we  muft  confide  in  this  pulfe •,  and  touch’d  his 
wrift  with  his  fingers.  But  as  I  was  not  ignorant  of  the  deceitful  nature  of 
fome  difeafes,  and  as  I  bore  in  mind  the  cale  of  Coralli  (/),  thefe  very  things 
made  my  fears  more  certain,  becaufe  he  was  not  fenfible  of  fo  great  a  difor¬ 
der,  and  becaufe  other  circum ftances  did  not  agree  with  fo  many  bad  fymp- 
toms,  as,  among  the  reft,  the  pulfe,  and  the  urine,  in  particular :  for  why 
was  the  pulfe,  in  this  cafe,  not  quick,  but  rather  fluggiffi  ?  I  afk’d  him, 
therefore,  whether,  when  he  was  in  health,  he  us’d  to  have  rather  a  flow 
pulfe  ?  To  which  he  anfwer’d  no ;  and  added,  that  from  the  age  of  fixty,  as 
generally  happens  to  old  men,  he  had  begun  to  have  an  intermitting  pulfe,; 
but  that  thole  intermiffions  had  ceas’d  for  fome  days  paft,  which,  without 
doubt,  was  a  proof  of  fome  greater  impetus  being  excited.  This  one  circum- 
ftance,  and  the  thirft,  were  the  only  marks  of  any  fever,  that  I  found  in  the- 
difeafej  when  it  had  proceeded  fo  far,  that  within  twenty-four  hours,  from 
the  time  I  refer  to,  it  took  off  this  worthy  man,  who  deferv’d  to  have  liv’d 
to  a  much  longer  period. 

14.  Do  not  be  furpriz’d  if  you  have  any  thing  related  by  me,  here,  a  little 
differently  from  what  it  is  related  in  his  life.  For  his  mod  familiar  friends, 
and  phyficians,  befides  his  moft  tender  wife,  and  belov’d  children,  were 
feiz’d  in  the  mean  while,  one  after  another,  with  the  epidemical  fever,  fo 
that  being  all  confin’d  to  their  beds,  on  thofe  laft  days,  they  could  not  fend 
a  fufficiently  compleat  account  of  what  I  faw,  and  obferv’d,  at  that  time,  to 
the  very  ingenuous  and  learn’d  writer.  In  this  ftate  of  things,  I  took  pains 
that  other  phyficians,  and  thofe  the  moft  experienc’d,  ffiould  be  call’d  to 
him  immediately,  if  they  Ihould,  perhaps,  think  differently  from  me,  and 
this  moft  deferving  patient  might  yet  be  fav’d  by  any  affiftance  of  art.  And 
I  would  to  God  I  had  been  deceiv’d.  But  the  cataftrophe  was  now  coming 
on,  and  every  fymptom  continu’d  to  grow  worfe  and  worfe,  very  evidently,, 
and  very  haftily,  his  countenance  being  grown  entirely  cadaverous,  his  refpi¬ 
ration  more  difficult,  and  expectoration  being  at  length  entirely  fupprefs’d. 
Yet  he  himfelf,  fuch  was  the  deceitful  nature  of  the  difeafe,  anfwer’d  to  one 


of 


(/)  fupra,  n.  1 1, 


Book  II.  Of  Difeafes  of  the  Thorax. 

of  his  phyficians,  who  return’d  in  the  evening,  and  afk’d  him  how  he  did, 
that  he  was  better.  And  although  he  was  troubl’d  all  the  night  with  a  (ter- 
tor,  and  a  great  difficulty  of  breathing,  yet  it  was  not  till  the  morning* 
and  a  very  few  hours  before  his  death,  when  his  pulfe  was  become  low 
and  quick,  that  he,  at  length,  found  his  own  diforder  had  impos’d  upon 
him,  and,  according  to  his  cuftom,  ingenuoufly  confefs’d  it,  to  thofe  who 
were  prefent.  And  from  thofe  perfons  it  was  that  I  learn’d  thefe  circum- 
(lances :  for,  from  the  time  that  I  forefaw  the  inevitable,  and  even  almoft 
immediate,  lofs  of  my  mod  friendly  collegue,  my  grief  would  not  fuffer  me 
to  be  prefent.  And  much  lefs  fhould  I  have  been  prefent  at  the  opening  of 
the  body,  if  it  had  been  open’d  ;  although,  indeed,  there  was  no  doubt  with 
me,  and  with  the  other  moll  learn’d  phyficians,  who  vifited  him  after  me,  but 
that  he  was  taken  off  by  an  inflammation  of  the  lungs,  which  was  fo  much 
the  more  dangerous,  as  it  crept  on  the  more  latently,  and  infidioufly  ;  fo  that 
when  it,  at  length,  difcover’d  itfelf  to  us,  it  was  out  of  our  power  to  cure  it. 

And  for  thefe  reafons,  the  figns  of  this  moft  treacherous  difeafe,  as  often  as 
ever  it  fhall  happen,  ought  to  be  more  accurately  remark’d,  if  any  one 
iymptom  could  be  poffibly  found  to  attend  conftantly,  or  at  lead  frequently, 
upon  this  difeafe,  at  the  very  time  when  it  begins  in  the  mod  occult  date. 
For  although  thole  fymptoms,  which  accompany  it  after  it  is  quite  confirm’d, 
are  not  without  their  advantage,  and  that  not  only  to  prevent  us  from  being 
deceiv’d  by  the  confidence  of  the  patient,  and  fome  figns  that  are  not  bad, 
but  alfo  to  enable  us  to  predid  the  danger  when  at  hand  •,  yet  it  is  much 
more  advantageous  to  didinguilh  the  latent  mifchief,  which  mud  be  deftruc- 
tive  unlefs  immediately  overcome,  and  counterad  the  very  beginnings  of  the 
difeafe. 

But  perhaps  it  may  now  come  into  your  head  to  fufped,  that  the  very 
fymptoms  which  I  enquire  after,  have  been  already  obferv’d,  and  propos’d 
by  Sydenham  (>»),  and  Boerhaave  (»),  where  they  have  defcrib’d  that  diforder, 
which  both  of  them  call  the  peripneumonia  notha. 

But  if  you  compare,  with  a  little  more  attention,  the  defcription  of  thefe 
things  which  they  have  feen,  and  what  I  faw  in  Valiifneri,  you  will  doubt 
very  much,  whether  they  belong  to  one  and  the  fame  difeafe  :  although,  in¬ 
deed,  they  do  not  quite  agree  with  one  another.  For  as  to  the  vomiting  of 
all  fluids,  the  turbid,  ?and  intenfely  red  urine,  the  pain  of  the  head,  ex¬ 
cited  by  the  cough  to  fuch  a  degree  that  the  head  feems  ready  to  fly  into 
pieces,  and  in  like  manner,  a  pain  in  the  whole  thorax,  and  fome  other  fymp¬ 
toms,  which  Sydenham  propofes,  they  are  not  once  mention’d  by  Boerhaave  : 
and  he  even  hints  that  there  is  fcarcely  any  thing  to  be  feen  in  the  urine, 
that  can  give  us  any  apprehenfions.  On  the  other  hand  he  teaches,  that  from 
the  very  beginning  of  tfie  difeafe  almoft  all  motions,  or  adls  of  the  mind,  are 
at  a  (land,  that  is,  as  it  is  interpreted  by  a  very  celebrated  man,  who  was 
acquainted  with  Boerhaave’s  meaning,  that  there  was  an  unufual  dullnefs,  or 
flupidity,  while  patients  of  this  kind  feel  fcarcely  any  influence  of  the  paf- 
iions,  and  that  the  internal  and  external  fenfes  were  torpid :  which  you  find 

(ra)  Obf.  circa  raorb.  Aeut.  hill,  f.  6.  c.  4.  (»)  Aphor.  de  cogn,  &  cur.  morb.  §  867.  &  feqq; 

nothing 


Letter  XXL  Article  14^  5^1 

nothing  of  in  Sydenham.  But  it  is  agreed  betwixt  both  of  them,  that  if 
thofe  who  are  of  a  pretty  full  habit,  and  grofs,  or  if  pituitous,  cold,  and  ca- 
tarrhous  perfons  are  improperly  addicted  to  the  ufe  of  fpirituous  liquors,  and 
efpecially  of  fpirit  of  wine,  or  to  drunkennefs,  efpecially  with  liquors  that 
are  ftrongly  heating,  thefe  perfons  are  feiz’d  with  this  diforder,  more  readily 
than  others :  that  they  are  fometimes  hot,  and  fometimes  cold,  or  affeCted 
with  wand’ring  fhiverings :  that  they  are  ffiort  of  breath,  or  draw  it  frequently, 
and  fpeedily :  that  an  oppreffion  of  the  bread,  or  coardlation  of  the  lungs, 
is  not  wanting :  nor  another  fymptom  or  two,  which  I  fhall  confider  pre- 
fently. 

Now  if  you  compare  thofe  things,  in  which  thefe  two  very  fkilful  phyfi- 
cians  agree,  and  in  which  they  differ  from  one  another,  with  thofe  that  I  have 
defcrib’d,  and  know,  moreover,  that  Vallifneri  was  of  a  good  complexion,  by 
no  means  of  a  lax  habit,  and  had  us’d  a  very  proper  medium  in  regard  to 
meats,  and  drinks ;  you  will  eafily  perceive,  how  much  his  diforder  mult  be 
different  from  what  they  have  defcrib’d. 

But  you  will  fay,,  that  it  agreed  in  this  circumftance,  I  mean,  that  the 
fymptoms  of  heat,  or  fever,  fcarcely  admonifh’d  us  of  the  danger,  as  in  his 
pulfe,  and  urine,  there  was  fcarcely  any  prefage.  And  I  confels  it  did  agree : 
although  Sydenham  fays  nothing  at  all  of  the  danger  of  unexpected  death : 
and  confeffes  befides-,  that  there  are  almoft  no  fymptoms  of  a  fever,  efpecially 
in  thofe  who  are  of  a  pretty  full  habit  of  body,  and  affeCted  with  this  dif- 
eafe  ;  yet  in  that  place  where  he  teaches  how  to  diftinguifh  the  peripneumonia 
notha  from  the  dry  afthma,  he  fays,  that  in  this  fpurious  difeafe,  manifeft 
figns  of  a  fever,  and  inflammation,  difcover  themfelves,  notwithftanding  they 
are  far  lefs,  and  more  obfcure,  than  in  a  true  peripneumony.  But  fuppofe 
that  both  of  the  writers  agree  entirely  one  with  another,  in  thefe  circumftam 
ces  alfo  ;  yet  we  laid  that  marks  were  to  be  fought  for,  by  which,  if  the  fame 
diforder  that  carried  off  Vallifneri  in  fo  infidious  a  manner,  Ihould  again  fall 
under  our  notice,  we  might  very  early,  or  at  leaft  in  the  middle  of  its 
courfe,  forefee  the  pernicious  exit  of  it:  and  whether  we  can  forefee  this,  by 
what  they  have  deliver’d  as  figns,  mull:  now  fufficiently  appear  to  you.  For 
there  are  many  diforders  that  are  deceitful  from  the  beginning  •,  but  different 
diforders  are  known  by  different  tokens.  Thus,  not  to  recede  from  inflam¬ 
mation  of  the  lungs,  you  may  fee  from  what  is  defcrib’d  by  the  celebrated 
Jo.  Gefner  (<?)>  with  how  fallacious  an  appearance  it  has  begun,  and  with  how 
fatal  an  event  it  has  terminated.  But  peculiar  marks  were  not  wanting, 
which  fufficiently  ffiew’d  the  deceitfulnefs  of  thefe  appearances.  And  if  the 
defcription  of  the  difeafe,  which  fuddenly  fnatch’d  away  Wilh.  Huld, 
Waldfchmid  (/>),  after  fome  flight  uneafineffes  of  the  catarrhous  kind,  from 
the  republic  of  phyfic,  almoft  at  the  fame  time  of  year,  that  Vallifneri  was 
taken  off,  but  in  the  following  year,  was  not  unknown  to  us ;  we  fhould 
certainly  read  of  fome  other  fymptoms  than  what  we  have  feen  in  Vallifneri. 
For  the  difeafe  was  even  in  the  judgment,  and  fenfation  of  the  patient  alfo, 
fo  flight,  that  he  continu’d  to  vifit  his  patients  even  to  the  laft  day  :  on  which 

(0)  Commere.  Litter.  A.  174.3.  Hebd.  8.  (/)  Eod.  Commere.  A.  1731.  Specim.  2$. 


<  9-  Book  II.  Of  Difeafes  of  the  Thorax. 

very  day,  having  rifen  from  bed,  very  brifk  and  full  of  fpirits,  he  was  fooft 
after  forc’d  to  lie  down,  on  account  of  a  great  languor,  and  debility,  which, 
to  that  time,  had  neither  been  perceiv’d  by  him,  nor  obferv’d  by  his  domeftics; 
and  not  many  hours  after,  the  phyficians  in  vain  acknowledging  the  greatnefs 
of  the  danger,  he  clos’d  his  eyes  in  death. 

However,  when  I  confider  by  what  fymptoms  the  diforder  of  Vallifneri, 
or  another  much  of  the  fame  nature  with  that,  might  be  known  in  the  begin¬ 
ning,  it  feems  to  me  that  this  queftion,  for  example’s  fake,  might  be  afk’d, 
from  what  I  obferv’d  in  him  on  the  fourth  day,  and  what  I  faid  had  been  ob- 
ierv’d,  even  on  the  fecond  day  •,  I  mean,  whether  if  any  one,  together  with  the 
other  fymptoms  of  a  catarrhous  fever,  have  not  the  pulfe  more,  or  lefs  fre¬ 
quent,  but  rather  more  rare  than  he  is  us’d  to  have  in  health-,  I  fay,  whether 
in  him,  an  inflammation  of  the  lungs  of  that  kind,  may  not  prefently  difcover 
itfelf.  It  is  certainly  worthy  of  oblervation,  that  even  after  the  diforder  had 
difcover’d  itfelf,  the  pulfe  was  even  then  more  rare.  Add  to  this,  that  in 
the  fuffocating  catarrh,  alfo,  defcrib’d  by  Schneider  (y),  and  Etmuller  (r), 
a  flow  pulfe  is  propos’d  as  one  of  the  fymptoms  :  and  although  this  catarrh 
is  not  to  be  confounded  with  the  diforder  that  I  have  defcrib’d,  as  even  the 
reft  of  its  marks  fufliciently  fhew  yet  it  is  faid  by  each  author,  that  the 
diforder  is  brought  on,  when  the  blood,  efpecially  if  it  is  pituitous,  or 
lomewhat  vifcid,  or  by  any  means  render’d  thicker  than  ufual,  ftagnates  in 
the  lungs.  But  you  will  judge  better  of  thefe  things,  for  as  yet  I  determine 
nothing.  I  only  fay  this,  that  according  to  the  various  dilpofition  of  the 
blood,  the  body,  and  of  the  lungs  in  particular,  and  the  different  manner, 
in  which  a  congeftion  of  blood  happens  therein,  it  is  probable,  the  fymptoms 
are  varied  ;  fo  that  fometimes,  all  the  chief  fymptoms  of  an  inflammation,  or 
at  lead  mod  of  them  occur,  and  that  this  happens  for  the  mod  part ;  but 
that  fometimes  fcarcely  any  of  the  genuine  figns  appear,  and  thofe  that  do 
appear  are  contrary,  as  when  the  pulfe  is  flow ;  and  finally,  that  fometimes 
no  marks  appear  at  all,  yet  the  pulfe  is  more  or  lefs  quick,  as  in  that  hidory 
which  I  fhall  immediately  fubjoin. 

15.  An  old  man  of  ninety,  who  had  lain  in  this  hofpital  fome  time,  on 
account  of  a  contus’d  thigh,  being  at  length  feiz’d  with  a  flight  fever,  no 
external  caufe,  and  no  remarkable  fymptoms  of  which  appear’d,  died  within 
a  tew  days,  having  gone  off  gradually,  and  flowly,  his  pulfe  having  been 
pretty  quick,  and  weak,  but  without  any  intermiflion.  And  this  happen’d 
about  the  end  of  November,  in  the  year  1741. 

In  both  the  cavities  of  the  thorax  was  a  reddifh  water,  but  not  in  great 
quantity.  The  left  lobe  of  the  lungs  adher’d,  in  fome  places,  to  the  pleura, 
which  was  in  every  part  entirely  without  injury ;  but  the  right  lobe  adher’d 
fcarcely  in  any  place.  Yet  this  lobe,  in  its  lower  lobule,  was  tumid,  and 
hard,  from  inflammation.  The  heart  was  almod  univerfally  cover’d  with 
fat,  on  its  anterior  furface,  in  this  old  man,  who  was  in  other  refpedts 
very  lean.  Though  in  the  difle&ion,  I  had  found  all  the  valves,  belonging 
to  the  orifices  of  the  right  ventricle,  not  only  not  rigid,  nor  thicken’d,  but  even, 
like  thofe  which  belong  to  the  pulmonary  artery,  they  had  feem’d,  rather,  to 


(?)  De  Catarrh.  &c.  1.  5.  S.  2.  c.  4. 

6 


(r)  Prax.  1.  i.  S.  14.  c.  3.  art.  4. 


be 


Letter  XXL  Articles  16,  17.  593 

be  form’d  of  a  thinner  membrane  than  ufual ;  neverthelefs.  when  I  came  to 
the  other  ventricle,  the  mitral  valves  were  found  to  be  thicker  than  they 
ought  to  be,  and  the  femilunar  valves  were,  moreover,  all  bony  in  the  lame 
manner,  inflexible,  and  protuberating  internally,  fo  as  to  be  dillant  from  the 
parietes  of  the  artery,  on  its  internal  furface,  and  to  grow  out  in  the  middle 
of  the  border,  into  a  thick  little  tubercle,  as  if  that  which  I  delineated  there, 
as  the  largeft  of  all,  in  the  lirft  of  my  Adverfaria  (j),  had  not  been  only  made 
bony,  but  even  much  increas’d  in  its  bulk.  Yec  the  great  artery,  from  the 
heart  even  to  that  part  where  it  adheres  to  the  vertebrm,  the  carotids  alfo, 
and  fubclavians,  had  no  bony  fcales  ;  which  were  leen  in  the  remaining  trad 
of  the  aorta  through  the  thorax. 

In  the  belly  alfo,  the  fame  artery,  and  the  iliacs,  were  not  without  thofe 
fcales.  The  orifice  of  the  pylorus  was  furnifh’d  with  that  valve,  which  is 
call’d  by  its  own  name,  only  on  one  fide ;  and  on  the  other  fide,  which  was 
the  larger  extent,  nothing  like  it  exifted,  nor  feem’d  ever  to  have  exifted  : 
moreover,  the  orifice  of  itfelf  feem’d  to  be  much  larger  than  it  us’d  to  be. 

The  fubftance  of  the  right  kidney  was,  in  two  places,  hollow’d  out,  in  the 
one  more,  in  the  other  lefs :  and  thefe  cavities  contain’d  a  kind  of  aqueous 
humour,  included,  on  the  upper  part,  in  the  proper  coat  of  the  kidney. 
The  urinary  bladder,  which  was  in  other  refpeds  found,  had  grown  cut  into 
a  hernia,  of  the  fame  kind  with  that  which  I  have  defcrib’d  in  another  place(7), 
of  a  hemifpherical  figure,  and  a  moderate  fize,  into  which,  when  the  coats 
of  the  bladder  were  relax’d,  it  open’d  by  a  fmall  orifice  above  the  terminating 
aperture  of  the  left  ureter.  But  another  true  hernia,  which  feem’d  formerly 
to  have  contain’d  a  part  of  fome  inteftine,  or  a  greater  part  of  the  omentum 
than  at  prefent,  occurr’d  in  the  fcrotum.  It  was  a  facculus,  not  very  fmall, 
reaching  from  the  right  ring,  as  it  is  commonly  call’d,  of  the  abdomen,  al- 
moft  quite  to  the  tefticle,  betwixt  that  coat  which  is  taken. away  with  the 
cremafter  mufcle,  and  the  membrane  that  covers  the  fpermatic  veflels,  which 
feem’d  to  be  unhurt,  and  with  the  internal  fide  of  thefe  vefiels  the  facculus 
lay  contiguous.  For  on  the  fame  fide  that  I  have  already  mention’d,  the  pe¬ 
ritonaeum  defcended  through  an  orifice,  capable  of  admitting  a  finger,  being, 
after  that,  dilated  into  a  facculus,  and  become  much  thicken’d  in  its  fubftance. 
Alfo,  a  fmall  and  thin  flap,  or  fold,  of  the  omentum,  having  fall’n  down 
through  that  orifice  into  the  facculus,  had  grown  very  clofely  to  the  furface 
of  it. 

16.  In  regard  to  this  diffedtion,  it  is  fufficient,  at  prefent,  to  attend  to  what 
relates  to  the  lungs,  as  the  other  parts  of  it  are  relative  to  other  fubjedts,  and 
will  be  mention’d  by  me  in  their  proper  places.  And  having  produc’d  examples 
of  an  inflammation  in  this  vifcus,  that  was  not  attended  by  its  proper  figns ; 
I  now  go  on  to  thofe  cafes,  in  which  you  may  fee  that  inflammation  accom¬ 
panied  with  the  marks  of  a  pleurify,  at  leaf!:,  which  did  not  exift. 

1 7.  An  old  man,  more  than  fixty  years  of  age,  was  feiz’d  at  once  with  a 
fever,  and  pungent  pain  in  the  anterior  part  of  the  right  fide.  He  lay  on  his 
back.  His  tongue  was  dry  j  his  pulfe  large  and  frequent.  After  fome  days 

(j)  Tab.  4.  Fig.  3.  {/)  Adverf,  3.  Aniraad,  36. 

4G 


VOL.  I. 


being 


5  94  Book  II.  Of  Difeafes  of  the  Thorax. 

being  elaps’d,  and  the  common  methods  of  cure,  us’d  in  the  hofpital  of  Sc. 
Mary  de  Morte  at  Bologna,  being  made  ufe  of,  he  feem’d  to  be  io  far  freed 
from  his  fever  and  pain,  that  the  fenior  phyfician  gave  him  leave  to  eat 
freely,  of  the  common  provifion  of  the  houfe  •,  and  after  three  days  gave 
him  a  purge,  as  his  cultom  was,  to  carry  off  the  reliques  of  the  difeafe. 
The  man  having  eaten  freely  after  thefe  evacuations,  on  one  of  the  following 
nicrhts,  the  fever,  and  pain  in  the  fame  part,  return’d.  Thepulfe  was  hard, 
quick,  large,  and  tenfe,  even  to  the  laft  day,  and  even  to  a  few  hours 
before  death  •,  for  at  a  time,  when  his  refpiration  was  indeed  quick,  but  not 
very  bad,  and  when  he  had  rais’d  himfelf  up  in  bed  to  fit,  of  his  own  ac¬ 
cord,  fo  that  he  feem’d  likely  to  live  forne  days,  he  was  almoft  immediately 
feiz’d  with  a  ffertor,  and  died,  which  was  about  the  middle  of  April,  in  the 
year  1706. 

His  body,  which  was  differed  the  fame  day,  had  a  fqualid  appearance, 
being  lean,  having  a  fcahies  on  the  thighs,  and  the  abdomen  funk  in. 

When  the  thorax  was  open’d,  the  upper  lobule  of  the  lungs,  on  the  right 
fide,  was  enlarg’d,  and  appear’d  to  be  very  hard.  And  upon  cutting  into 
it,  I  faw  that  the  fubftance  of  it  was  become  like  the  fubftance  of  the  liver, 
and  that  pus,  or  at  leaft  a  matter  not  unlike  pus,  flow’d  out,  together  with  a 
frothy  humour.  In  the  left  cavity  of  the  thorax,  was  water  of  a  yellowifh 
colour,  degenerating  into  green,  but  in  lmall  quantity.  The  lungs,  where 
they  lay  towards  the  diaphragm,  and  in  like  manner  on  the  upper  fide,  and 
more  clofely  in  that  place,  adher’d  to  the  pleura,  a  kind  of  yellow,  and  thin 
membrane,  as  it  were,  being  interpos’d.  Yet  the  pleura,  in  all  this  thorax, 
appear’d  to  be  no  where  injur’d.  But  to  return  to  the  left  lobe  of  the  lungs; 
the  inferior  lobule  thereof  was  black,  and  hard,  on  the  pofferior  part,  and 
made  up  of  the  fame  kind  of  fubftance  that  was  leen  on  the  right  fide  ;  nor 
was  it  without  pus,  which  I  faw  flow  from  it,  of  a  white  colour,  when  the 
lungs  were  taken  out  of  the  thorax. 

In  the  pericardium  was  much  water,  of  the  fame  kind  I  juft  now  defcrib’d. 
At  each  of  the  orifices  of  the  heart,  were  diftintft  polypous  concretions :  the 
leaft  of  which  was  what  went  to  the  left  auricle,  and  the  largeft,  that  which 
went  into  the  aorta.  This  great  artery  I  alfo  obferv’d  to  be  very  wide,  yet 
equally  fo,  and  to  have  fome  marks  of  a  beginning  offification  about  the 
valves. 

When  the  belly  was  open’d,  that  heavy  kind  of  fmell  was  perceiv’d,  which 
is  generally  the  confequence  of  inflam’d  inteftines.  And,  indeed,  the  fmall 
inteftines  were  red,  to  confiderable  tracfts,  round  about.  The  liver;  the 
bladder  of  which  had  ting’d  the  fubjetfted  pylorus,  and  the  duodenum,  to  a 
very  great  degree,  though  the  tincture  had  not  pervaded  to  its  inner  coats ; 
had  a  livid  appearance  on  its  edge,  and  the  fame  to  fome  fmall  extent  on  its 
hollow  furface.  The  flat  furface  of  the  fpleen  was  very  black  ;  and  the 
pancreas  a  little  hard. 

iS.  You  fee,  then,  that  there  were  the  figns  of  a  pleurify,  in  a  peripneu- 
mony;  And,  without  doubt,  when  Hippocrates  defcrib’d  this  dilorder,  in 
his  book  Be  internis  affectionibus  (#),  he  laid  that  there  is  a  pain  “  fome- 


(*)  n'  4- 


**  times. 


Letter- XXI.  Article  19.  595 

ct  times,  even  in  the  fide.”  Which  pafiage  is  not  only  taken  notice  of  by 
Ballonius,  as  you  fee  in  the  Sepulchretum  itfelf  (x),  but  alfo  confirm’d  by 
his  own  obfervations,  and  “  particularly”  in  thofe  who  “  have  either  a  dropfy 
“  of  the  thorax,  or  in  whom  the  lungs,  being  fomewhat  hard,  abound  with 
<c  a  quantity  of  fanies.”  And  that  he  has  lpoken  wifely,  by  faying  not  in 
thofe  only,  but  in  thofe  “  particularly,”  even  my  two  next  obfervations  will 
fhew,  which  were  taken  a  few  weeks  before  the  former,  and  in  the  fame  hoi- 
pital. 

19.  A  butcher,  of  feventy-eight  years  of  age,  of  a  tall  flature,  and  a  pal¬ 
lid  and  brown  complexion,  who  had  been  before  troubl’d  with  a  fpitting  of 
blood,  had  begun  to  feel  an  internal,  and  pungent  pain,  a  little  below  the 
left  nippie,  four  days  before  the  time  he  was  admitted  into  the  hofpital. 

His  pulfe  was  not  only  unequal,  but  alfo  frequently  intermitting,  and 
quick,  and  gave  very  little  refiftance  to  the  finger  that  felt  it :  he  had  a  fre¬ 
quent  cough,  attended  with  that  kind  of  found  which  is  almofl  like  the  bark¬ 
ing  of  a  dog  :  his  expectorated  matter  was  thick,  and  had  in  it  a  kind  of  po¬ 
lypous  particles,  of  a  white  colour:  his  refpiration  was  difficult:  he  could  lie 
only  on  his  back.  The  blood  which  he  lofl  on  the  day  he  came  into  the  hof¬ 
pital,  that  is  on  the  fifth  day  of  the  difeafe,  to  the  quantity  of  eight  ounces, 
had  no  more  ferum  than  could  be  contain’d  in  one  fpoon  :  and  this  ferum 
was  turbid :  but  on  the  top  of  the  blood  was  a  yellow  cruft,  mark’d  with  li¬ 
vid  points  on  the  upper  furface,  which  was  hollow,  and  two  inches  deep, 
fo  that  it  greatly  refilled  the  knife ;  and  the  craftamentum  below,  was  fepa- 
rated  into  a  number  of  diftindl  grumous  concretions,  as  it  were.  Blood  after¬ 
wards  appear’d  in  the  expectorated  matter.  As  the  difeafe  did  not  at  all  re¬ 
mit,  a  vein  was  again  open’d  on  the  feventh  day.  The  cruft  then  appear’d 
thin  ;  the  ferum,  which  was  of  a  golden  colour,  was  in  a  proper  quantity, 
and  the  craffamentum  of  a  natural  firmnefs.  The  fpitting  being  diminifh’d, 
and  all  other  circumftances  continuing,  the  patient  being  no  longer  able  to 
fpeak,  turn’d  himlelf  upon  his  right  fide,  and  while  he  lay  thereon,  died 
placidly,  and  without  any  ftertor ;  which  happen’d  on  the  eighth  day. 

When  we  open’d  the  thorax  the  day  after,  we  found  the  right  lobe  of  the 
lungs  adhering  to  the  pleura,  almofl  in  every  part,  yet  in  fuch  a  manner 
that  it  might  be  eafily  leparated  without  injuring  its  membrane,  except  the 
upper  part  of  the  fuperior  lobule.  For  this  part  was  grown  together  with 
the  pleura,  and,  within  its  fubftance,  which  was  of  a  black  and  livid  hue, 
contain’d  many  fmall  round  cells,  each  of  them  being,  every  where,  com¬ 
prehended  in  their  proper  follicle  ;  fo  that,  as  far  as  I  could  obferve,  there  was 
no  opening  outwards,  being  fmooth  internally,  and  quite  empty  :  which  I 
judg’d  to  be  the  veftiges  of  an  old  difeafe,  that  I  have  already  hinted  at.  The 
odour  that  proceeded  from  this  part  of  the  lungs,  was  like  that  of  four 
whey,  or  like  what  comes  from  the  mouths  of  children,  who  are  very  ill  from 
worms. 

But  the  upper  lobule  of  the  left  lobe  of  the  lungs  had  no  diforder  at  all : 
only  that  it  abounded  with  a  great  quantity  of  a  ferous  moiflure.  Yet  the 
lower  was  heavy  and  red,  and  appear’d  to  have  its  whole  fubftance  chang’d 


(at)  Schol,  ad  §  4.  obf.  20.  fe£t.  hujus. 

4G  2 


into 


59  6  Book  II.  Of  Di  (cafes  of  the  Thorax. 

into  a  fubftance  like  that  of  the  liver.  This  lobule  adher’d,  in  fome  places, 
to  the  pleura,  and  was  cover’d,  here  and  there,  with  broad  and  white  por¬ 
tions  of  a  kind  of  mucous  membrane  :  with  which  kind  of  membrane,  only 
red,  under  a  little  turbid  ferum,  that  furface  of  the  diaphragm  alfo  was  co¬ 
ver’d,  which  correfponded  to  this  lobe.  But  it  was  eafy  to  remove  mem¬ 
branes  of  this  kind,  from  the  furface  of  that  lobule,  or  of  the  diaphragm, 
which  were  uninjur’d  ;  and  efpecially  from  the  laft  mention’d  furface,  as  the 
pleura  that  inverted  the  parietes  of  the  thorax,  and  even  the  diaphragm  itfelf, 
was  not  only,  which  is  a  very  rare  inrtance,  of  a  cartilaginous,  or  bony 
hardnefs,  but  was,  in  fadt,  made  up  of  thin  laminae  of  bony  matter;  and 
from  the  furface  of  it,  that  was  turn’d  toward  the  thorax,  very  frequent  bony 
tubercles  protuberated,  efpecially  where  the  bony  laminae  were ;  being  of  a 
hemifpherical  figure,  and  of  the  bignefs  of  a  vetch.  And  notwithftanding 
all  thefe  appearances  were  feen  much  more  on  the  right  fide  of  the  thorax, 
than  on  the  left;  yet,  in  this  alfo,  the  pleura,  in  many  places,  came  up 
to  the  defeription  above,  and,  in  fome  places,  came  up  quite  to  it ;  but  in 
no  part  whatever  was  it  at  all  red,  or  had  the  leaft  appearance  of  inflam¬ 
mation.  The  pericardium  contain’d  a  fmall  quantity  of  water,  of  a  reddilh 
colour  :  and  the  right  ventricle  of  the  heart  contain’d  a  polypous  concretion, 
of  a  flelhy  colour,  flat  and  large,  and  extending  itfelf  into  the  neighb’ring 
auricle,  befides  another  that  was  round,  and  more  denfe,  which  reach’d  into 
the  pulmonary  artery.  And  another,  like  the  laft,  enter’d  the  aorta  from 
the  left  ventricle:  the  leaft  of  all,  and  not  unlike  an  inflam’d  cruft,  was  at 
the  left  auricle.  There  was  alfo  black,  and  half-concreted  blood  in  both 
ventricles  of  the  heart,  and  in  the  great  artery. 

At  length  we  turn’d  our  eyes  towards  the  belly,  and  efpecially  the  lower 
part  of  it.  For  at  the  right  flank,  the  abdomen  was  rais’d  up  into  a  flaccid, 
and  fomewhat  livid  tumour.  But  when  we  found,  by, opening  this  tumour, 
that  it  was  owing  to  the  colon  being  diftended  with  air,  in  that  part,  we  im¬ 
mediately  went  on  to  examine  other  tumours.  A  fmall  one,  which  was  in 
the  left  groin,  we  faw  to  confift  of  an  inguinal  gland,  one  inch  in  thick- 
nels,  two  inches  in  length,  and  one  and  a  half  in  breadth  :  and  upon 
cutting  into  it,  I  found  that  it  had,  in  great  meafure,  as  to  colour,  and  the 
modification  of  its  fubftance,  the  appearance  it  naturally  has ;  but  in  one  lit¬ 
tle  part  it  was  white,  and  feem’d  to  confift  of  a  kind  of  fmall  and  globular 
particles.  1  then  found  the  ferotum  to  be  tumid  in  both  fides,  but  particu¬ 
larly  on  the  left,  the  right  fide  being  red  at  the  bottom,  and  on  cutting  into 
it  I  found  three  hernias.  On  the  left  fide  was  the  firft,  which  was  a  facculus, 
going  from  the  cavity  of  the  belly,  quite  to  the  upper  part  of  the  tefticle ; 
this  facculus  was,  at  that  time,  rugous,  and  contain’d  nothing  but  a  long 
fold  of  the  omentum,  that  could  be  eafily  drawn  out:  but  that  it  had,  at 
other  times,  been  diftended  by  the  admifiion  of  an  inteftine,  was  not  only 
indicated  by  thefe  rugae,  but  particularly  by  the  unufual  turns,  and  compli¬ 
cated  folds,  of  the  ileum,  in  the  abdomen,  and,  in  fome  meafure  alfo,  by 
thofe  of  the  colon.  But  the  two  other  herniae  were  of  another  kind,  and 
were  made  up  of  a  yellowifh  water,  which  was  contain’d  in  the  tunica  vagi¬ 
nalis,  on  each  fide,  both  of  which  coats  were  become  thicker  than  ufual  in 
their  fubftance  ;  and  this  water  I  readily  fuppos’d  to  have  been  effus’d  from 
a  ruptur’d  hydatid,  as  I  feem’d,  to  myfelf,  to  find  out  fome  remains  thereof, 
i  in 


Letter  XXL  Article  20.  597 

in  a  very  fmall  kind  of  veficle,  made  up  of  thick  parietes,  as  if  they  had 
been  contracted  into  themielves,  and,  for  that  reafon,  already  almoft  folid, 
and  of  a  flefhy  colour  :  this  veficle  hung  by  a  peduncle  from  the  tunica  al¬ 
buginea,  where  it  inverts  the  belly  of  the  tefticle,  near  the  greater  globe  of 
the  epididymis,  and  this  very  fituation  had  the  veficle  that  grew  to  the  tellis 
on  the  left  fide,  as  well  as  that  on  the  right  (y).  The  fmall  canals,  which 
lerve  to  elaborate  the  femen,  but  fcill  more  thole  vertfels  that  ferve  to  carry 
out  the  blood,  were  unufually  large  fo  that  there  feem’d  to  be  a  kind  of 
beginning,  as  it  were,  of  a  varicofe  hernia,  on  each  fide,  which  was  to  be 
accounted  for  from  the  other  herniae,  rather  than  from  the  falacious  difpo- 
fition  of  the  man,  inafmuch  as,  without  any  traces  of  diforder  having  ever 
preceded,  the  preputium  was  contracted  beyond  the  glans,  juft  as  it  is  found 
in  thofe  young  men,  who  have  not  as  yet  had  any  knowledge  of  venery. 

20.  All  the  circumftances  which  you  have  read  in  this  prolix  hiftory  do  not, 
as  you  fee,  relate  to  our  prefent  purpofe  ;  yet  I  have  written  them  all  down 
together,  as  my  general  method  is,  left  I  Ihould  render  obfeure,  by  a  di¬ 
vided  narration,  what  were  join’d  together  by  obfervation  Among  the 
circumftances  to  be  taken  notice  of  here,  were  thofe  white  kind  of  po¬ 
lypous  particles,  in  the  living  body,  which  were  thrown  up  with  the  ex¬ 
pectorated  matter.  And,  certainly,  they  might  be  really  pol  pous.  For 
as  polypous  concretions  are  fometimes  made  up,  in  the  uterus  and  intertines, 
out  of  feveral  vifeid  corpufcles,  condens’d  into  one,  why  may  not  the  fame 
thing  happen  in  the  afpera  arteria  ?  And,  indeed,  as  I  have  feen  thofe  bearing 
the  form  of  the  uterus,  and  inteftines,  fo,  in  like  manner,  have  1  feen  thefe 
bearing  the  form  of  the  afpera  arteria,  and  efpecially  in  a  young  man,  who 
lay  ill  of  a  peripneumony,  in  the  year  1704,  in  the  hofpital  ox  St.  Mary  de 
Vita,  at  Bologna,  of  which  he  alfo  died  in  a  few  days,  as  I  remember,  but 
was  not  difieCted,  whatever  the  caufe  of  it  might  be.  For  as  he  had  fpit 
up  fuch  matter  by  expectoration,  that  the  attendants,  who  had  long  been 
accuftom’d  to  fuch  patients  as  thefe,  and  even  the  phylician  himfelf,  who 
was  in  other  refpeCts  a  man  of  great  experience,  never  remember’d  to  have 
feen,  confifting  of  white  portions,  fprinkl’d  over  with  blood  and  froth  ;  fome 
of  us  thought  proper,  that  part  of  this  expectorated  matter  fhould  be  thrown 
into  water,  and  agitated  there,  for  the  fake  of  examining  into  it  better  ;  and 
while  this  was  done,  we  faw  one  of  thefe  portions  divide  itfelf  into  three 
branches,  and  each  of  thefe,  again,  into  many  fmaller  branches,  which  at 
length  dwindl’d  into  the  flendemefs  of  a  hair. 

But  I  afterwards  faw,  that  a  concretion  of  this  kind,  thrown  up  from  the 
afpera  arteria,  had  been  reprefented  in  a  figure  by  Chefifelden  (z),  fo  as  to 
fhew  the  manner  of  its  divifion  And  then  it  came  into  my  mind,  in  whofe 
writings  1  had  before  feen  reprefentations  of  other  concretions  of  this  kind  : 
and  firft,  for  inftance,  in  the  writings  of  Ruyfch(^),  who  exprefs’d  even 
the  fmall  capillary  branches  ;  but  when  he  admonifh’d,  that  vafiform  polypi 
of  this  kind  “  differ  in  r.o  circumftance,  as  to  the  appearance,  from  arteries 
“  and  veins,  but  by  the  want  of  a  cavity  alone,  as  they  are  everv-where 

(y)  Vid.  Epilt.  43.  n.  i6.'&  feqq.  («)  Refp.  ad  Epift.  Pxobl.  6.  Fig.  4* 

(z)  Anat.  of  the  human  body,  Tab.  19. 

“  hard 


598  Book  II.  Of  Difeafes  of  the  Thorax. 

“  hard  and  folid,”  he  has,  contrary  to  his  intention,  confirm’d  in  an  error, 
which  heendeavour’d  to  remove,  fome  perfons  whofe  names  mud  be  fpar’d, 
who  without  doubt  lit  on  polypi  of  that  kind  which  were  hollow.  For 
Buflierus,  whole  delineation  1  had  alfo  feen  in  the  Ada  Eruditorum,  which 
were  publilh’d  at  Leipiic  (£),  has  not  only  taught  how  they  might  be  form’d 
hollow,  but  alfo  took  one  out  from  the  whole  afpera  arteria  of  a  boy,  that 
was  hollow,  which  boy  was  foolifhly  fuppos’d,  when  living,  to  have  cough’d  up 
a  venous  velfel  of  th.e  lungs.  And  even  the  celebrated  Nichollius  (c)  law 
two  of  thefe  concretions,  expeftorated  by  an  afthmatic  man,  both  of  which 
were  ramified  and  hollow,  and  thefe  he  afterwards  alfo  gave  a  reprefentation 
of.  Nor  do  I  doubt,  but  that  was  of  the  lame  kind,  although  it  was  not 
ramified,  which  is  defcrib’d  as  “  a  red  flefiiy  mafs,  like  meat  frefla  kill’d, 
“  without  any  ill  fmell,  equal  in  length  to  an  internode  of  the  little  finger, 
“  and  in  breadth  to  the  thicknefs  of  it,  but  form’d,  internally,  like  any 
cc  venous  vefifel,”  which  being  thrown  up  by  coughing,  from  a  boy  of  eight 
years  old  (</),  who  had  cough’d  violently  every  winter,  and  fpit  up  vtfcid 
matter,  he  was  immediately  freed  from  his  diforder. 

However,  many  perfons  have  feen  ramified  concretions  cough’d  up,  and 
among  thefe  the  illuftrious  Senac  (<?).  And  our  Palta,  a  very  experienc’d 
man(/),  having  produc’d  three  examples  of  this  kind,  which  were  feen  by 
himfelf,  was  at  the  fame  time,  and  that  not  without  the  greateft  reafon,  of 
opinion  with  thole,  who  referr’d  to  the  fame  clafs,  thole  two  which  had  been 
defcrib’d  by  Tulpius  (£),  as  if  they  had  been  examples  of  a  real  pulmonary 
vefifel  being  thrown  up  by  coughing.  And  to  this  clafs,  you  will  eafily  be¬ 
lieve  are  to  be  referr’d,  not  only  that  fpoken  of  by  Bartholin  (/;),  who,  like 
Tulpius,  added  a  figure  to  his  defcription,  but  alfo  others,  that  are  taken 
notice  of  by  Moellenbroccius  (7),  and  Mackius  (£),  and  perhaps  by  others, 
and  that  “  little  piece  of  a  vein,  expectorated  by  coughing,  from  the  lungs,” 
which  Marcellus  Donatus  (/)  mentions,  from  Nicolaus  Florentinus,  fo  much 
the  more  in  proportion  as  thofe  things  were  lefs  known  at  that  time  which  are 
known  in  ours  :  although  I  cannot  help  wond’ring  that  Donatus,  who  fays, 
“  he  was  not  willing  to  omit  it,  as  a  circumftance  which  very  rarely  hap- 
“  pen’d,”  did  not  make  mention  of  Galen,  in  the  reading  of  whofe  works  he 
was  very  well  vers’d,  as  faying  (*»),  “  That  he  had  feen  a  certain  portion  of 
“  a  velfel,  not  very  fmall,  thrown  up  by  coughing,  which  was  clearly  un- 
derftood,  by  thofe  who  were  not  unlkilful  profdfors  of  the  art  of  dilfedlion, 
“  to  have  been  drawn  out  from  the  lungs  :  for  all  the  velfels  that  come  to 
“  the  afpera  arteria,  in  the  neck,  are,  in  general,  to  be  referr’d  to  the  fpecies 
“  of  capillaries.”  But  whether  Hippocrates,  in  that  hiftory  of  the  epi¬ 
demics  (»),  which  begins  thus :  “  Pherecida  was  feiz’d  in  the  night,  after 
“  the  winter  folftice,  with  a  pain  of  the  right  fide and  ends,  as  Valefius 


(6)  A.  1701.  Tab.  4.  Fig.  5. 

(c)  Vid.  Commere.  Litt.  A.  1733.  Hebd. 
37.  &  Tab  2.  Fig  1. 

(d)  Aft.  N.  C.  Tom.  1.  Obf.  196. 

(t)  Traite  du  Coeur,  1.  4.  ch.  3.  n.  2. 

( fj  Epift.  de  Cord.  Polyp,  n.  11. 

{£)  Obf.  Med.  1.  2.  c.  12,  13. 


(b)  Cent.  3.  Hid.  Anat.  98. 
f/j  Eph.  N.  C.  Dec.  1.  A.  2.  Obf.  91. 
(i)  Earund.  Dec.  2.  A.  10.  Obf.  102. 
(1)  De  Medic.  Hi  ft  Mirab.  1.  3.  c.  10. 
(«)  De  loc.  aff.  1.  1.  c.  7. 

(«)  7* 


has 


Letter  XXL  Article  2  i .  599 

hasjuftly  acknowledg’d  (c),  in  thefe  words,  “  Before  death  fhe  threw  up,  by 
“  coughing,  fome  fungi,  as  it  were,  made  up  of  mucus,  and  had  alio  ex- 
“  creted  before  little  white  milky  particles  I  fay,  whether  Hippocrates, 
in  thefe  words,  points  out  concretions  of  that  kind,  I  leave  undetermin’d, 
becaufe  the  fame  very  fkilful  interpreter  does  not  doubt,  but  that  this  hiftory 
“  has  been  vitiated  in  a  thoufand  ways,”  and  that  “  not  only  on  account  of 
“  the  antiquity,  but  of  the  corruption  of  the  copies.”  It  may,  however, 
be  fufficiently  underftood,  from  what  I  have  laid,  that  either  from  polypous 
blood,  as  in  the  uterus,  or  even  from  ferum,  as  in  the  inteftines,  thrown  out 
into  the  bronchia,  and  ftagnating  there,  concretions  of  that  kind  may  be 
brought  on  in  their  cavities.  And  this  being  granted,  I  think  another  cir- 
cumftance  may  alfo  be  underftood,  that  is,  how  it  happens  that  the  fub- 
ftance  of  the  lungs,  when  inflam’d,  entirely  refembles  the  fubftance  of  the 
liver.  That  is  to  fay,  where  not  only  the  languiferous  veflels,  but  alfo  the 
branches  of  the  bronchia,  and  all  the  fmall  branches  going  to  any  particular 
part  of  the  lungs,  and  the  veficles  communicating  therewith,  are  all  fill'd 
and  fluff’d  up  with  polypous  concretions,  there  mult  of  courle  happen  to 
the  lungs,  what  we  read  of  in  the  book  De  Veteri  Medicina  (p),  in  this 
manner:  “  When  the  lungs  themfelves  have  taken  a  humour  into  their  own 
“  fubftance,  the  empty,  the  rare,  and  the  fmall  parts  of  them,  are  entirely 
“  fill’d  up  *,  and  inftead  of  a  rare  and  foft  body,  the  lungs  become  hard  and 
“  denfe,  and  neither  concod,  nor  difeharge,  any  part  of  the  tumour  they 
“  have  taken  in.” 

You  very  well  underftand,  then,  how  that  new  hardnefs  is  brought  about, 
inftead  of  the  foftnefs  and  rarity  of  texture,  and  alfo  that  liver-like  kind  of 
denfity,  from  all  the  very  flender  pipes  and  veficles  being  fill’d  up,  which 
are  naturally  empty,  and,  confequently,  how  it  happens,  that,  inftead  of  their 
ulual  lightnefs,  the  lungs  have  alfo  a  weight  luitable  to  the  fubftance  of 
the  liver  But  the  colour  is  at  one  time  more  red,  or  black,  and  at  another 
time  more  pale,  as  the  red  part  of  the  blood,  being  at  one  time  more  or 
lefs  condens’d,  and  at  another  much  lefs,  or  not  at  all,  ftagnates  with  the 
polypous  part  of  it,  in  both  the  fpecies  of  veflels  •,  nor  yet  is  there  always 
blood,  which,  by  making  an  impetus  on  the  fmall  veflels,  may  diftil  into 
the  afpera  arteria  •,  but  even  frequently  only  a  ferum,  ftrongly  impregnated 
with  polypous  particles,  diftils  from  the  glands  of  the  trachea,  inafinuch  as 
thefe  particles,'  in  diforders  of  that  kind,  circulate  with  the  blood  in  a  great 
quantity,  as  is  fnewn  by  the  thick  polypous  cruft  generally  to  be  feen  on  the 
upper  part  of  peripneumonic  blood,  when  let  out  from  the  vein,  and  coagu¬ 
lated  :  luch  as  was  feen  in  this  old  man  alfo,  of  whom  I  fpeak,  when  blood 
was  firft  taken  from  him. 

21.  But  as  the  cruft  on  that  blood,  which  was  taken  away  two  days  after, 
was  but  thin,  muft  we  fuppofe  the  caufe  of  it  to  have  been,  that  a  great 
part  of  the  polypous  matter  had,  in  the  mean  while,  ftagnated  in  the  lungs, 
and  increas’d  their  infardtion  ?  For  if  you  do  not  difapprove  of  this  caufe, 
you  certainly  underftand  from  thence,  how  little  opportunely  fome  phyficians 
rejoice,  who,  without  attending  to  other  circumftances,  conflder  this  one 

(0)  Comment,  in  eund.  1.  n.  82.  (j>)  N.  40.  ^ 

thing 


6oo  Book  IL  Of  Difeafes  of  the  Thorax. 

thing  only,  that  the  cruft  on  the  blood,  which  had  been  before  thick,  is  now 
become  thinner,  or,  perhaps,  is  none  at  all.  Yet  be  cautious,  on  the  other 
hand,  how  you  agree  with  thofe  entirely,  whom  I  have  lbmetimes  heard  pro¬ 
nouncing,  that  if,  in  dilorders  of  this  kind,  the  blood,  which  is  taken  away 
at  the  fccond  time,  be  without  a  cruft,  it  is  fo  bad  a  fign,  that,  if  blood  be 
let  a  third  time,  the  patient  mult  die  ;  becaufe  there  are  many  circum- 
ftances,  which  may,  by  mere  chance,  prevent  the  exiftence  of  this  cruft, 
that  would  otherwife  have  exifted,  which  circumftanees  are  frequently  not 
attended  to.  Sydenham  (q\  who  flouriffi’d  in  England,  at  a  far  different  time 
from  that  in  which  he  liv’d,  who,  according  to  Marcellus  Donatus  (r),  and 
Vincentius  Baronius  (j),  affirm’d,  “  that  the  difeafe  call’d  pleurify,  was  feen 
“  very  rarely  among  the  Englifh,  fo  as  to  be  almoft  a  new  diforder  to  them,’* 
as  he  certainly  found  no  diforder  more  frequent  than  this,  has  obferv’d  many 
things  in  relation  to  it,  as  you  know  ;  fome  of  which  although  the  phyficians 
of  our  country  do  not  imitate,  as  this,  for  inftance,  “  that  during  the  difeafe, 
“  the  patient  Ihould  be  taken  out  of  bed  every  day,  and  that  for  fome 
“  hours,”  yet  there  are  fome  other  things  which  are  very  good  ;  and  among 
thefe,  what  relate  to  the  cruft  upon  the  blood,  which,  if  not  always,  as  fpme 
have  remark’d  (/),  yet,  at  leaft,  anfwer  fo  often,  that  Boerhaave  receiv’d  them 
as  true  maxims  (#).  And  when  you  have  attended  to  thefe  obfervations,  you 
will  readily  conceive  how  eafy  it  is  to  be  deceiv’d,  when  that  cruft  is  thin,  or 
there  is  no  cruft  at  all,  unlefs  the  phyfician,  when  he  looks  at  the  coagulated 
blood,  knows,  whether  at  the  time  it  was  taken  away,  it  firft  crept  down  the 
arm,  or  came  forth  in  but  a  fmall  ftream,  and  at  length  whether  it  was  fhaken 
while  it  was  yet  warm.  And  yet,  how  few  phyficians,  efpecially  in  fome 
places,  enquire  into  thefe  circumftanees,  when  they  look  upon  the  blood  ! 
or  whether  it  coagulated  in  an  air  immoderately  cold,  or  warm  !  tho’  the 
very  learn’d  Senac  (x)  has  mention’d,  that  by  either  the  one,  or  the  other,  of 
thefe  circumftanees,  the  feparation  of  the  ferum  is  prevented.  On  thefe 
accounts,  therefore,  I  was  not  willing,  juft  now,  to  determine  any  thing  in 
regard  to  the  blood  of  this  old  man,  deferib’d  by  me,  as  to  the  caufe  of 
its  change,  although  I  do  not  doubt,  but  I  -made  many  enquiries  at  that 
time  which  are  not  noted  down  in  my  papers,  efpecially  as  it  was  not  chang’d 
in  that  one  particular  only  •,  and  1  know  very  well,  that  of  what  relates  to  obfer¬ 
vations  on  blood,  that  has  been  taken  from  a  vein,  and  the  inquifitions  into  the 
caufes  of  all  the  appearances,  which  are  feen  therein,  in  fo  great  a  number 
and  variety,  many  things  are  ftill  wanting  among  phyficians,  and  certainly 
may  ftill  be  long  wanting. 

22.  But  as  to  what  relates  to  the  pleura  being  found  bony,  after  death, 
the  circumftance  is  certainly  of  too  rare  a  nature,  to  be  attributed  merely  to 
old-age.  I  have  differed  many  older  men  than  this,  and  among  thefe  one 
who  was  fpoken  of  above (y),  about  twelve  years  older  than  this  man  was; 
and  yet  I  never  lit  on  a  like  appearance.  It  is  true,  that  in  the  year  1741, 

(?)  Seft.  6.  cit.  fupra,  ad  a.  14.  c.  3.  («)  Aph.  §  314,  &  901. 

(r)  De  Hilt.  cit.  fupra,  ad  n  20.  i.  6.  c.  4.  (*)  Tr.  cit.  fupra,  ad  n.  20.  1.  3.  ch.  4.  n.  S. 

(j)  De  Pleuripneurn.  1.  1.  c.  2.  (y)  N.  15. 

(/)  Vid.  apud  Swieten  Comm,  ia  Boerh. 

Aph.  §  890. 

in 


Letter  XXI.  Article  23.  6qi 

in  an  old  man,  of  a  moderate  habit  of  body,  who  died  of  a  diarrhoea,  and 
whofe  body  I  made  ufe  of  for  the  demonftration  of  many  things,  in  the  na¬ 
tural  way,  to  my  pupils,  when  it  was  hardly  poffible  to  puli  away  one  lobe 
of  the  lungs  from  the  back  without  laceration,  we  obferv’d  ihat  betwixt  the 
ribs  and  the  lungs,  a  bony  lamina  was  interpos’d,  part  of  which  1  ftiii  pre- 
ferve.  This  lamina  adher’d  to  fome  of  the  ribs,  and  to  the  ipaces  that  lay 
betwixt  them,  near  to  the  vertebrae,  yet  in  luch  a  manner  that  it  could  be 
eafily  drawn  away  :  and  this  vicinity  you  will  alfo  obferve  in  the  following 
hiftory.  But  befides  that  I  doubted,  whether  this  lamina  belong’d  fo  much 
to  the  pleura,  as  to  the  membrane  of  the  lungs,  it  was  not  much  more  than 
an  inch  in  width,  and  ten  lingers  breadth  in  length  j  nor  did  any  thing  of 
that  kind  occur  in  any  other  place  but  in  this. 

However,  the  moft  excellent  Haller  (a)  has  fometimes  feen  a  44  callofity” 
of  the  pleura,  but  efpecially  in  a  thief,  who  was  publicly  hang’d,  fo  that  44  it 
“  took  up  a  large  fpace,  equal  to  the  extent  of  a  man’s  hand.”  The  fame 
appearance  was,  likewife,  in  this  man,  where  the  pleura  touch’d  44  the  ribs 
“  behind  yet  in  that  part  neither  44  was  it  a  bone,  but  a  callus.” 

And  the  celebrated  Hottinger(^)  found  44  the  lungs  grown  to  the  left 
“  fide,  and  the  pleura  inverted  with  a  kind  of  matter,  not  unlike  to  a  carti- 
44  lage  and  this  he  judg’d  to  arife  from  a  pleurify,  under  which  the  woman 
had  labour’d  fome  years  before.  Perhaps  alfo,  this  thief,  and  the  old  man 
I  have  fpoken  of,  had  that  membrane  made  callous,  and  bony,  from  an  in¬ 
flammation  which  had  formerly  preceded. 

But  to  omit  thefe  things,  and  revert  to  our  firft  propofition  (c)  ;  the  pleura 
was  not  inflam’d  in  that  hiftory  of  which  1  have  hitherto  fpoken,  nor  did  the 
lungs  abound  with  any  great  quantity  of  fanies,  nor  did  the  thorax  labour  un¬ 
der  a  dropfy  *,  and  yet  a  pungent  pain  was  perceiv’d  below  the  nipple. 
Now  let  us  go  on  to  the  other  hiftory,  which  is  very  ftmilar  in  all  thefe  cir- 
cumftances. 

23.  A  man  about  forty  years  of  age,  was  feiz’d  with  a  pungent  pain  on 
the  right  fide,  with  a  fever,  and  great  heat.  When  he  was  brought  into  the 
hofpital  from  home,  where  he  had  been  let  blood,  which  was  on  the  begin¬ 
ning  of  the  fourth  day  of  the  difeafe,  he  had  a  fmall,  quick,  and  femewhat 
unequal  pulfe  •,  and  his  refpiration  was  alfo  quick,  and  weak.  He  lay  on  his 
back.  His  countenance  was  fleepy.  He  was  a  little  delirious.  He  fpent 
the  night  in  a  very  difturb’d  manner,  his  refpiration  being  difficult.  But  in 
the  morning,  it  was  ftill  much  more  fo ;  fo  that  a  ftertor  coming  on,  he 
died  about  the  end  of  the  fame  fourth  day. 

The  thorax  being  difiedted,  on  the  following  night,  vve  faw  nothing  in 
the  pleura,  that  was  preternatural,  except  that  near  the  left  fide  of  the  fpine, 
it  was  made  rough  with  three  or  four  tubercles,  the  colour  of  which  was 
white,  and  the  hardnefs  like  that  of  a  bone.  On  that  fide,  the  lungs  were  al- 
moft  found  •,  but,  neverthelefs,  were  impregnated  with  a  yellow  humour, 
wherever  we  cut  into  them,  which  even  proceeded,  in  a  very  conflderable 
quantity,  from  the  right  lobe.  For  this  being  grown  more  large,  heavy, 
and  hard,  refembl’d  the  fubftance  of  the  liver,  in  every  part,  fame  pretty 

(«)  Progr.  de  indur.  corp.  hum. partibus  §  2.  ( b )  Eph.  N.  C.  Dec.  2.  A.  10.  obf.  231. 

(c)  n.  18. 

4  H  large 


VOL.  I. 


6 02  Book  II.  Of  Difeafes  of  the  Thorax. 

large  traCls  being  excepted,  in  which  it  was  of  a  whitifh  fubftance,  and 
verging,  as  it  were,  to  putrefaction. 

In  all  the  orifices  of  the  heart  was  fomewhat  of  a  polypous  concretion,  the 
leaft  of  which  was  at  the  left  auricle,  and  the  largelt  at  the  right,  being,  in 
both  places,  accompany’d  with  grumous  blood  •,  and  betwixt  the  fize  of  thefe 
two,  were  the  two  others,  which  reach’d  to  the  pulmonary  artery,  and  aorta. 

When  the  cranium  was  open’d,  I  found  the  veflfels  of  the  pia  mater  to  be 
fomewhat  turgid  :  and  under  this  was  a  water  •,  forne  portion  of  which  was 
alfo  in  the  lateral  ventricles,  but  of  a  reddifh  colour.  The  plexus  choroides 
were  not  pale,  and  yet  not  without  hydatids. 

At  leng.h  we  open’d  the  abdomen,  and  the  fmall  inteftines  feem’d,  in  fome 
places,  but  in  very  few,  to  have  the  beginning  of  a  flight  inflammation. 
The  liver  feem’d  to  be  fomewhat  hardifh  :  and  was  livid,  both  on  the  edge, 
and  through  a  large  extent  of  the  hollow  furface  ;  but  here  it  was  fuperficial 
only,  not  lb  in  the  former  place.  Finally,  the  fpleen  was  fo  lax,  that  by 
applying  the  fingers  to  it,  it  was  torn  to  pieces  without  any  difficulty. 

24.  A  woman  of  a  middle  age,  died  in  the  fame  year,  1706,  and  in  the 
fame  hofpital,  as  the  three  of  whom  I  fpoke  laft,  and  not  long  before  them  : 
her  diforder  was  as  follows.  Being  now  in  the  third  month  of  her  pregnancy, 
fhe  mifcarry’d.  Although,  after  this,  as  much  blood  was  difcharg’d  from 
the  uterus,  as  feem’d  to  her  to  be  fufficient,  and  although  a  vein  had  been 
open’d  over  and  above  ;  yet  on  the  eighth  or  tenth  day  after  her  mifcarriage, 
without  any  previous  caufe  that  fhe  knew  of,  fhe  was  feiz’d  with  an  internal 
inflammation  of  the  thorax:  on  account  of  which,  fhe  lay  ill  firft  at  home, 
and  after  that,  in  the  hofpital,  till  the  very  laft  day  of  her  life,  which  was  about 
the  thirtieth  after  her  mifcarriage.  There,  while  fhe  lay  always  on  her  right 
fide,  for  on  her  left  fide,  or  back,  fine  could  not  lie,  fhe  complain’d  of  a  pain  in 
her  thorax,  befidesa  fever,  and  difficulty  of  breathing;  which  pain  was  inter¬ 
nal  indeed,  fo  as  not  to  be  exafperated  by  the  touch,  but  the  fituation  of  it 
fhe  could  not  accurately  define.  She  cough’d,  but  either  expectorated  no¬ 
thing,  or,  at  leaft,  nothing  which  related  to  the  difeafe.  A  deafnefs  came 
on,  and  a  pain  in  the  ears :  for  which  reafon,  1  fuppofe,  as  they  had  taken 
blood  from  the  arm  before,  they  took  fome  alfo  from  the  foot.  But  all  was 
in  vain. 

The  thorax,  the  head,  and  the  belly,  we  could  not  difieCl  till  three  days 
after.  In  the  firft  of  thefe  cavities,  I  found  a  little  turbid  water  on  both 
fides,  but  the  leaft  on  the  right  fide.  The  lungs  being  every  where  con¬ 
nected  with  the  pleura,  when  we  endeavour’d  to  pull  them  away,  a  kind  of 
whitifh  pellicle  follow’d,  which  was  eafily  ruptur’d,  and  certainly  was  not 
the  membrane  of  the  lungs,  as  this  was  entirely  found  beneath,  and  unin¬ 
jur’d  :  but  whether  it  was  from  the  pleura,  could  neither  be  fufficiently  de¬ 
termin’d  at  that  time,  nor  fhould  1  now,  fora  certainty,  decide,  when  I  call 
to  mind  thofe  membrane-like  concretions,  of  which  I  have  often  fpoken  : 
which  it  was  evident  to  me,  did  neither  belong  to  the  pleura,  nor  to  the 
lungs,  not  only  frequently,  when  they  were,  as  yet,  frefh,  and  foft,  but 
even  after  they  had  been  dry'd  by  lying  a  long  time  ;  and  this  in  the  bodies 
of  lome  perfons,  who  had  formerly  eicap’d  from  diforders  of  this  kind,  as 
in  that  which  I  difieCted,  when  I  wrote  this  letter.  For  upon  pulling  away 
the  right  lobe  of  the  lungs,  w  hich  adher’d  almoft  to  the  whole  fide,  and  the 

neareft; 


Letter  XXL  Article  24.  603 

neared  part  of  the  back,  without  leaving  any  interval  betwixt,  and  feeing  a 
dry,  denfe  membrane  remain  continu’d  through  that  whole  fpace,  which 
certainly  did  not  belong  to  the  lungs,  as  they  were  inverted  with  their  own 
proper  membrane,  which  was  in  a  found  date  *,  I  alfo  obferv’d,  that,  in  like 
manner,  it  did  not  belong  to  the  pleura,  becaufe  I  faw  that  this  membrane 
lay  under  the  other  quite  uninjur’d,  and  I  took  away  the  former  membrane 
with  eafe,  by  drawing  it  oft”,  at  one  pull. 

But  to  return  to  the  woman ;  her  lungs  were  inflam’d,  particularly  at  the 
poderior  part  •,  for  they  fhew’d  a  more  denfe  lubdance,  were  fomewhat  hard, 
and,  in  feveral  places,  even  of  a  blackifh  colour.  In  the  pericardium  was 
forne  quantity  of  a  turbid,  and  reddidi  water.  In  both  the  ventricles  of  the 
heart,  were  polypous  concretions,  made  of  a  kind  of  mucus,  of  a  middle 
colour  betwixt  white  and  yellow. 

The  top  of  the  cranium  being  taken  off,  and  other  things  of  that  kind  be* 
ing  premis’d,  there  was  leen  a  fmall  concretion  in  the  upper  finus  of  the 
falx,  and  a  fmall  quantity  of  water  under  the  pia  mater  ;  but  in  the  ventricles 
fcarcely  any.  Nor  yet  was  the  cerebrum  altogether  lax  :  and  the  plexus 
choroides  were  in  a  very  natural  date.  Yet  the  pineal  gland  was  of  fuch  a 
bignefs,  as  to  equal  the  fize  of  a  fmall  grape,  and  was  no  fooner  touch’d 
gently  with  the  knife,  but  it  difcharg’d  a  turbid  water,  and  a  little  yellow- 
ifh  and  mucous  matter,  and  immediately  fubfided  in  its  magnitude.  We 
then  look’d  within  the  cavities  of  the  ears,  and  found  the  membrana  tympani, 
on  each  fide,  to  be  blackifli,  and  very  flaccid,  and  the  madoid  cells  that  lay 
the  neared  to  this  membrane,  on  each  fide,  to  be  more  moid  than  ufual : 
and  indeed,  in  one  of  the  tympana  was  a  purulent  kind  of  matter :  and  ex¬ 
ternally  in  the  neighb’ring  part  of  the  head  behind,  efpecially  at  the  left 
fide,  all  the  cellular  part  of  the  common  integuments  was  didended  with 
a  kind  of  mucous  water.  Yet  on  both  fides,  the  meatus  auditorius  and 
the  parotid  gland  were  found. 

At  length,  we  thought  proper  to  open  the  belly,  becaufe  it  fwell’d  down¬ 
wards  from  the  epigadrium  i  and  if  you  prefs’d  upon  the  tumour,  flatus  im¬ 
mediately  came  out,  through  the  mouth.  And  this  was  owing  to  the  liver, 
which  was  the  biggefl  I  had  ever  feen,  at  that  time,  having  driv’n  down  the 
domach,  into  the  umbilical  region.  The  domach  was  tumid  with  air.  And 
the  liver  was  every  where  hard  ;  yet  in  its  colour,  although  it  inclin’d  to  a 
white,  was  not  greatly  alter’d  from  what  it  naturally  is.  In  the  veficula  fellis 
the  bile  was  almod  black.  The  fpleen  was  large,  but  not  to  compare  with 
the  liver. 

The  parietes  of  the  uterus  feem’d  to  be  a  little  thicker  than  ufual,  but 
without  blood,  whether  I  cut  into  them  tranfverfely,  or  by  prefling  my  fin¬ 
gers  underneath,  I  endeavour’d  to  fqueeze  out  the  blood  from  the  internal 
fur  race  of  its  fund,  which  was  livid.  One  of  the  Falloppian  tubes  had  hy¬ 
datids  hanging-  to  its  fimbriae,  in  fuch  a  manner,  that  the  greater  orifice 
thereof  might  feem  to  be  fhut  up.  But  each  of  them  fo  far  abounded  with 
a  great  quantity  of  its  white  puriform  humour,  that  if  you  comprefs’d  the 
thicker  part  of  the  tubes,  towards  the  orifice,  that  humour  would  iflue 
forth,  and  demondrate  the  orifice.  But  in  the  middle  of  one  of  thefe-tubes 
infernally,  was  a  fmall  body  refembling,  in  its  flaape,  that  of  a  grape,  and 
had  the  appearance  of  a  kind  of  dalk,  which  body  feem’d  to  be  a  grumous 

4  H  2  concretion 


6  0  4  Book  II.  Of  Difcafes  of  the  Thorax, 

concretion  of  blood,  and  perhaps  was  really  fo.  The  ovaries  were  unequal 
in  their  furface,  and  both  of  them  were  mark’d  with  a  black  fpot.  Under 
thefe  fpots  was  a  kind  of  peculiar  cy It,  fill’d  up  with  a  black  globule.  And  in 
the  middle  of  one  globule  was  another  lefier  kind  of  cavity,  which,  in  regard 
to  its  colour,  was  of  a  mixture  of  black  and  yellow.  However,  the  uterus, 
and  the  parts  annex’d  to  it,  had  the  odour  of  a  violent  fphacelus,  as  it  were : 
and  in  the  pelvis  of  the  belly,  was  a  little  reddifh  and  turbid  water. 

25.  Thefe  la(t  circumftances  we  obferv’d  when  we  made  our  enquiries  in 
regard  to  the  foregoing  abortion.  What  was  obferv’d  in  the  pineal  gland, 
confirms  that  home  of  the  ules  afcrib’d  to  it  are  not  juftly  afcrib’d.  As  to 
what  I  remark’d  in  the  ears,  they  are  to  be  referr’d  to  thofe  things  which  I 
have  hinted  elfewere(d),  in  regard  to  the  caufe  of  deafnefs  in  acute  diforders. 

What  were  obferv’d  in  the  lungs  relate  to  our  prefent  purpofe.  And  yet 
you  will  fcarcely  account  for  the  inability  of  lying  down  on  the  left  fide  from 
thence  *,  but  rather  from  that  great  bulk  of  the  liver,  which  overloaded  the 
ftomach  lels  when  the  woman  lay  on  her  right  fide.  For  how  much  the 
ftomach  may  be  thruft  downwards,  fometimes,  by  an  over  grown  liver,  the 
Sepulchretum  will,  in  other  places,  fhew  ( e ). 

26.  Now  I  will  pafs  over  from  this  kind  of  epidemic  inflammation  of  the 
lungs,  which  rag’d  at  that  time  among  the  poor  at  Bologna,  to  another  at 
Padua,  which  lpread  about  in  the  winter  of  the  year  1738  ;  and  no  where 
more  than  in  fome  convents  of  nuns,  and  efpecially  in  one,  to  fuch  a  degree, 
that  all  who  were  leiz’d  with  it  died,  and  fome  even  within  four  days.  Which 
was  the  reafon,  without  doubt,  that,  as  nine  had  already  died,  I  was  pub¬ 
licly  commanded  to  enquire  into  the  nature  of  the  difeafe,  even  by  diffeCtion. 
It  was  not  difficult  to  conceive,  that  there  was  nothing  contagious  in  it,  as 
none  of  thofe  who  had  attended  upon  the  fick  had  contracted  the  difeafe,  and 
even  they,  who  had  taken  the  molt  care  to  keep  themfelves  from  them,  were 
feiz’d  with  it  •,  but  not  without  a  peculiar  caufe,  and  difpofition,  in  almoft 
every  one.  One  of  them,  for  inftance,  had  had  an  ulcer  of  long  Handing 
in  her  leg,  which  was  now  healed  up  *,  another  had  had  a  previous  fall  upon 
her  cheft,  and  had  fpit  a  great  quantity  of  blood  in  this  laft  ficknefs ;  another 
had  been  long  inclined  to  a  pulmonary  phthifis ;  and  in  fine,  others  had  other 
caufes  to  render  the  powers  of  the  thorax  and  lungs  infirm,  as  they  who  were 
of  a  decrepid  age. 

But  neverthelefs,  although  out  of  thofe  who  had  been  ill  at  that  time, 
notwitnftanding  three  different  phyficians  had  been  employ’d,  fome  having 
been  attended  by  one,  and  fome  by  another,  not  one  could  be'  fav’d,  as  I 
have  faid ;  yet  by  many  this  was  not  afcrib’d  fo  much  to  the  violence  of  the 
diforder,  as  to  its  nature  not  being  well  known,  and  efpecially  by  the  inha¬ 
bitants  of  the  convent.  And  by  what  means  I  extorted  this  judgment  from 
them,  you  will  know  from  the  fubjoin’d  hiftory.  For  when  the  tenth  was 
now  dead,  and  thofe  phyficians  and  1  came  together  to  the  diffeClion  of  her, 
{  begg’d  of  them,  before  the  diffeCtion  was  begun,  that  they  would  relate 
what  had  been  obferv’d,  and  what  had  been  done,  in  the  diforder.  Which 
the  fenior  phyfician  who  had  attended  upon  her,  did  very  accurately  in  the 

(dj  Epifl.  6.  n.  5.  \e)  Vid.  1.  2.  S.  7.  Obf.  61. 


manner 


Letter  XXL  Article  27.  6 05 

manner  I  fhall  relate  prefently  ;  the  others  at  the  fame  time  affirming,  that 
they  alfo  had  feen,  and  done,  almoft  the  fame  things,  in  the  others,  except 
that  one,  who  had  given  frelh-drawn  oil  of  almonds,  ingennoufly  added, 
that  the  patient  had  been  worfe  from  it.  But  let  us  come  to  her  who  was 
then  to  be  dilfedted. 

27.  A  virgin,  of  two-and-forty  years  of  age,  who  had,  every  winter,  been 
fubjedt  to  a  violent  cough,  of  a  very  good  habit  of  body,  and  abounding  in 
blood,  being  employ’d  in  great  and  continual  labours,  for  the  fervice  of  the 
convent,  was  feiz’d,  in  the  night,  with  a  fever,  with  which  fhe  firft  fhivered, 
and  was  cold  through  her  whole  body,  and  after  that  grew  hot.  After  an 
interval  of  twenty-four  hours,  a  pain  on  one  fide  of  the  bread  was  added  to 
the  fever,  together  with  a  difficulty  of  breathing,  a  cough  quite  dry,  and  a 
rather  hard  pulfe,  which  refilled  the  prelfure  of  the  fingers,  even  almoft  to 
the  very  time  of  the  patient’s  death.  In  the  progrefs  of  the  difeafe,  the  pain 
fhifted  from  one  fide  of  the  bread  to  the  oppolite  part.  There  was  a  lenfe 
of  weight  within  the  thorax.  She  could  lie  down  upon  neither  fide.  In  the 
blood  that  was  taken  from  her  the  ferum  was  of  a  greenilh  colour,  there 
was  a  polypous  cruft,  and  the  other  part  of  it,  that  lay  under  this,  had  a 
very  great  blacknefs  and  hardnefs.  And  blood  was  taken  away  immediately 
as  the  pain  came  on,  and  after  that  once,  and  even  twice,  in  a  proper  quan¬ 
tity,  for  a  body  of  that  kind  ;  and  not  only  from  the  arms,  but  from  the  feet 
alfo,  within  the  fame  day,  as  the  cuftom  always  is  here,  in  regard  to  women. 
Nor  was  any  thing  omitted  befides,  of  all  the  remedies  cuftomary  in  diforders 
of  this  kind.  NevertheleCs,  on  the  beginning  of  the  feventh  day  Ihe  died. 
When  I  had  heard  this  relation,  I  faid,  in  dependance  upon  thole  appear¬ 
ances,  that  I  had  always  found  after  the  chief  of  luch  kind  of  fymptoms, 
“  Come,  let  the  body  be  difiedted  ;  this  will  be  certainly  found  to  be  the 
“  nature  of  the  difeafe,  that  the  lungs  lhall  appear  to  have  the  lubftance  of 
“  the  liver.” 

In  the  thorax,  then,  when  open’d  by  the  furgeon,  there  was  no  extrava- 
fated  humour,  and  no  connexion  of  the  lungs  with  the  pleura,  except  at  the 
left  fide ;  and  this  was  neither  very  clofe,  nor  to  any  confiderable  extent! 
While  this  connexion  was  disjoin’d,  and  the  lungs,  on  that  account,  prefs’d, 
a  turbid  ferum  flow’d  out,  in  fome  confiderable  quantity  ;  but  whether  from 
the  lungs,  as  it  feem’d  to  us,  or  from  the  interftice  left  between  this  and  the 
pleura,  within  the  borders  of  the  connexion,  was  the  more  uncertain,  as 
neither  the  lungs,  nor  the  pleura,  in  that  place,  lhew’d  any  particular  in  ¬ 
jury;  but  the  lungs  were  cover’d  with  a  whitilh  and  thickifh  kind  of  mem¬ 
brane,  fuch  as  I  have  often  defcrib’d  in  the  foregoing  hiftories,  even  where 
the  lungs  were  quite  free  ;  and  to  the  correfponding  pleura,  quite  upon  the 
furface,  adher’d  a  reddifh  kind  of  fediment,  fuch  as  would  fubfide  in  water 
wherein  frelh  meat  had  been  wafh’d.  In  another  place,  where  there  had  been 
no  adhefion,  the  furface  of  the  lungs  was  prominent  into  a  kind  of  tubercle, 
which  being  cut  into,  difcharged  a  whitilh  kind  of  ferum  like  pus.  We 
then  ordered  the  lungs  to  be  taken  out  :  and  they  were  not  only  heavy,  but, 
in  more  than  one  place,  hard.  When  they  were  cut  into,  they  appeared  to 
have  a  denfe  and  compact  fubftance,  like  that  of  the  liver,  as  I  had  pre¬ 
dicted,  and  not  only  on  the  furface,  but  to  great  depths  internally,  being 
in  other  parts,  in  general,  of  a  redder  complexion,  and  abounding  with  that 

whitilh 


606  Book  II.  Of  Difeafes  of  the  Thorax. 

whitifli  ferum  which  was  found  in  the  tubercle  :  and  from  hence  it  was  very- 
evident,  that  the  inflammation  of  both  lobes  of  the  lungs,  which  already  de¬ 
generated  into  fuppuration,  had  been  the  caufe  of  her  death.  However,  in 
the  pericardium  was  fcarcely  any  ferum  ;  and  in  the  heart  no  polypous  con¬ 
cretion  was  found  ;  becaufe  the  left  ventricle  contain’d  fcarcely  any  blood, 
and  the  right  only  a  little  more,  which  was  black,  and  not  at  all  fluid. 

28.  Having  found  thefe  appearances,  I  return’d,  together  with  the  other 
phyficians,  to  the  place  where  we  were  expefted  by  the  abbefs,  and  faid  to 
her,  It  is  not  an  unknown  and  a  rare  diforder,  as  you  was  afraid,  which  has 
carried  off  fo  many  virgins ;  but  the  vehemence  of  one  that  is  very  common, 
and  very  well  known.  And  to  convince  you  that  it  is  really  fo,  I  foretold, 
previoufly  to  the  difle&ion  of  the  body,  that  the  lungs  would  be  found  to 
be  in  fuch  a  ftate,  as  they  were  really  found  to  be  in  ;  and  this  it  would  have 
been  impoflible  for  me  to  have  done,  if  I  had  not  very  frequently  difledted 
thofe,  who  died  of  this  diforder  :  and  I  did  it  on  purpofe,  that  you  your- 
felves  might  readily  underftand  that  to  be  true,  which  1  juft  now  pronounc’d. 
By  this  means  they  were  freed  from  their  fears,  and  their  opinions  of  the 
difeafe  being  unknown  •,  and  our  difcourfe  was  turn’d  to  propole  that  method, 
which  has  turn’d  out  moft  fuccefsfully,  by  which  the  other  nuns,  and  efpe- 
cialiy  thofe  who  had  their  lungs  very  lax,  and  weak,  might  beware  of  the 
difeafe  ;  for  it  did  not  feem  at  all  doubtful  to  us,  but  that  the  peripneumony 
could  not  be  overcome  in  thofe  who  had  died,  chiefly  for  this  caufe. 

You  will  perhaps  here  afk  me  two  things :  one,  who  firft  obferv’d  for¬ 
merly,  that  in  thofe  who  were  carried  off  by  an  inflammation  of  this  kind, 
the  lungs  refembl’d  the  fubftance  of  the  liver?  and  the  other,  whether,  after 
mortal  inflammations  of  the  thorax,  I  have  never  found  great  injuries  of  the 
pleura  alfo,  juft  as  I  have  found  the  lungs  affedted,  in  the  manner  I  have 
been  defcribing. 

As  to  the  firft,  I  do  not  now  readily  call  to  mind,  whether  any  one  men¬ 
tion’d  this  circumftance  very  exprefsly,  before  Laelius  a  fonte.  But  you 
muft  turn  to  his  book.  For  although  his  obfervation  is  put  down,  at  leaft 
three  times,  in  the  firft  volume  of  the  Sepulchretum  ;  once  where  the  queftion 
is  of  injur’d  refpiration  (/),  and  a  fecond,  and  a  third  time,  in  this  fedtion 
on  pain  in  the  breaft  (g) ;  yet  that,  which  I  fpeak  of,  is  always  omitted.  In 
fbort,  you  will  but  juft  find  it,  at  laft,  in  the  fourth  book  of  the  third  volume, 
under  the  title  De  Febribus ,  to  which  the  readers  are  referr’d,  if  by  diligently 
examining  into  that  prolix  firft  fedtion,  you  light  on  the  fixth  article,  under 
obfervation  forty-five.  And  there,  indeed,  you  will  read  this :  “  The  flefh 
“  of  the  lungs  was  found  to  be  denfe,  hard,  and  red,  as  the  flefh  of  the 
“  liver  is  us’d  to  be;”  but  ftill  you  will  not  read  that  the  diforder,  after 
which  this  appearance  was  found,  had  been  judg’d  by  Laelius  to  be,  be¬ 
yond  all  doubt,  a  peripneumony,  as  the  fymptoms  really  fhew’d.  You  are 
under  a  neceffity,  therefore,  of  looking  to  this  confukation,  which  either  is 
not  mark’d  out  in  the  Sepulchretum,  or  is  fo  mark’d  out,  that  you  would 
fuppofe  the  mark  to  be  a  hundred,  when  it  is  really  ninety-eight.  And  al¬ 
though  I  am  not  ignorant  that  others  after  him,  and  forne  even  in  this  our 


age, 


{/)  1.  2.  S.  i.  Obf.  24. 


(£)  Obf  9.  §.  10.  &  Obf.  i 6. 


Letter  XXI.  Article  29.  6  07 

age,  and  among  thefe  Jo.  Bapt,  Fantonus  (/6),  Dominic  Gagliardi  (/),  and 
Frederic  Hoffman  (£),  have  found  them  in  th-  fame  ftate,  as  will  be  (hewn 
more  at  large  below  (/)  •,  yet  to  whom  it  happen’d,  as  it  feems  to  have  hap¬ 
pen’d  to  Valfalva,  and  as,  one  difledtion  excepted,  it  certainly  has  happen’d 
to  me,  that  the  lungs  were  always  found  in  this  ftate,  I  do  not  readily  call 
to  mind. 

But  in  regard  to  the  other,  that  is,  the  remarkable  injury  of  the  pleura, 
and  which  may  be  compar’d  wi;h  what  I  have  deferib’d  in  the  lungs,  if  you 
read  over  all  Valfalva’s  obfervarions,  and  mine,  that  relate  to  mortal  inflam¬ 
mations  of  the  thorax,  you  will  evidently  perceive,  not  only  that  it  never 
happen’d  to  either  of  us  to  fee  any  great  injury  of  the  pleura,  without  that 
of  the  lungs,  but  even  not  in  conjundtion  with  it.  And  my  obfervations  of 
this  kind  are  not  only  fuch  as  are  hitherto  propofed  in  the  prefent  letter,  or 
have  been  already  produc’d  in  others  ( m ),  but  alfo  fuch  as  will  be  produc’d 
immediately,  in  the  fequel  of  this  letter.  You  will  find,  indeed,  in  fome 
of  the  foregoing  hiftories,  and  in  all  of  thofe  which  follow,  that  an  injury  of 
the  pleura  was  join’d  with  an  injury  of  the  lungs ;  but  whether  to  fo  great 
a  degree,  that  of  itfelf  it  could  prove  mortal,  or  at  leaft  more  fo  than  the 
injury  of  the  lungs,  you  yourfelf  will  judge. 

29.  A  fervant-maid,  of  nineteen  years  of  age,  a  virgin  of  a  full  habit, 
and  plethoric,  having  had  her  menfes  flow  lefs  freely  than  ufual  for  three 
months  paft,  was  feiz’d  with  a  pungent  pain  in  her  bread:,  and  a  difficult 
refpiration,  in  confequence  of  being  expos’d  to  a  cold  air,  at  the  time  of 
her  menftruation.  This  pain  remain’d  fix’d  below  her  left  bread,  and  was 

encreas’d  by  the  touch  ;  fo  that  fhe  could  not  lie  on  that  fide.  She  was 

brought  into  the  hofpital  of  St.  Mary  de  Morte  at  Bologna,  after  having 
had  a  vein  open’d  in  the  arm,  on  the  (train’d  fide.  The  fymptoms  I  have 
mention’d  continu’d.  She  lay  upon  her  back.  Her  pulfe  was  quick  and 
fmall,  and,  if  you  prefs’d  it,  gave  but  little  refiftance  to  the  fingers ;  yet  was 
not  unequal :  there  was  a  found  in  the  afpera  arteria  like  that  of  boiling 
water :  fhe  had  a  deep,  hollow,  and  dry  cough :  her  tongue  was  parch’d  : 
her  belly  was  lax  •,  but  moderately  fo.  At  intervals  a  flight  degree  of  de¬ 
lirium  came  on.  Blood  being  taken  from  the  right  arm,  and  examin’d, 

after  Handing  fix  hours,  fhew’d  a  little  ferum,  of  a  golden  colour,  and  fome- 
thing  turbid,  and  a  cruft  of  the  thicknefs  of  two  inches,  of  a  yellow  colour, 
fo  as  to  relemble  rancid  fat,  the  circle,  into  which  it  had  form’d  itfelf, 
touching  the  fides  of  the  vefiel  round  about.  This  cruft,  when  the  veflel 
was  inclin’d,  disjoin’d  itfelf  into  many  laminae,  and  that  part  of  the  blood 
which  lay  below  it,  into  many  grumous  concretions,  not  much  unlike  fome 
kind  of  foup,  with  pieces  of  meat  ftew’d  in  it.  On  the  fame  day,  after  this 
venasfedtion,  a  little  blood,  or  rather  ferum  flightly  ting’d  with  blood, 
flow’d  from  the  uterus.  All  the  fymptoms  growing  worfe  and  worfe,  the 
pulfe  being  made  much  deeper,  as  if  the  artery  had  been  drawn  in¬ 
wards,  and  a  humour  flowing  out  of  her  mouth  like  frothy  water,  in 

(/$)  Medic.  Rat.  Syft.  Tom.  4.  P.  1.  S.  2. 
c.  6.  thef.  path.  §.  12.  (/)  n.  4°* 

(»)  VI.  n.  12.  &  VII.  n,  11.  S{  13. 

vhich 


(£)  Obf.  Anat.  Med.  27. 

(/)  Relaz.  de’  Mali  di  petto. 


6  o8  Book  II.  Of  Difeafes  of  the  Thorax. 

which  frefh  meat  has  been  wafti’d,  fhe  died  about  the  beginning  of  the  fe- 
venth  day. 

I  differed  her  body  on  the  following  day,  which  was  on  the  eighteenth 
of  March,  in  the  year  1706.  The  lungs  every  where  adher’d  to  the  parietes 
of  the  thorax,  even  thole  that  are  made  up  of  the  feptum  tranfverlum,  in  * 
fome  few  places,  by  means  of  membranes,  but  in  many  more,  and  efpeci- 
ally  at  the  fides  and  back,  by  themfelves,  where  their  membrane,  being  un¬ 
injur’d,  join’d  itfclf  to  the  pleura,  which  was  only  a  little  thicker  than  it 
us’d  to  be,  and  eafiiy  divifible  into  two  laminae.  The  fuperior  lobe  of  the 
lungs,  on  the  left  fide,  was  univerfally  compos’d  of  a  hard  and  compact 
fubitance,  like  that  of  the  liver,  and  inclin’d,  in  its  colour,  to  that  of  a 
darkifh  white.  All  the  other  lobes  of  the  lungs,  although  entirely  diftended 
with  a  frothy  humour,  preferv’d  their  natural  modification  of  fubftance : 
from  which,  when  cut  into,  that  humour  iffu’d  forth,  and  at  the  fame  time, 
a  white  matter  flow’d  out  from  feveral  of  the  fmall  branches  of  the  bronchia, 
in  every  refpeft  like  pus ;  yet  from  one,  unlels  perhaps  it  was  a  fmall  fan- 
guiferous  veflfel,  a  white,  but  not  fluid,  matter  iflu’d  forth,  which  I  look’d 
upon  to  be  a  polypous  concretion.  In  the  very  trunk  of  the  afpera  arteria, 
and  in  the  larger  bronchia,  into  which  that  tube  firft  divides  itfelf,  I  faw 
a  matter  collected  here  and  there,  and  forming  itfelf  into  concretions,  of  a 
white  and  cineritious  colour  mix’d,  with  which  the  tongue  alfo  was  cover’d 
over :  and  1  prefs’d  out  a  whitifh  and  fomewhat  thick  matter  from  the 
mouths  of  the  glands,  which  lie  on  the  back  part  of  thefe  tubes.  But  the 
larger  glands,  which  are  found  at  that  firft  divifion,  and  are  call’d  bronchial 
glands,  did  not  all  feem  found.  Moreover,  in  the  lungs,  betwixt  one  lobule 
and  another,  in  fome  places,  were  interpos’d  thofe  white  membranes,  which 
are  frequently  deferib’d  above,  in  this  body  pretty  hard,  and  fomewhat  thick, 
but  ftill  falfe.  In  the  pericardium  was  fome  quantity  of  reddilh  water.  In 
the  ventricles  of  the  heart  was  no  blood,  but  polypous  concretions,  in  great 
part  folid,  and  confifting,  as  it  were,  of  flelhy  membranes;  yet  in  fome 
meafure  alfo  mucous.  One  of  thofe  that  were  in  the  right  ventricle,  was 
extended  within  the  neighb’ring  auricle,  and  went  on  into  the  venae  cavae ; 
and  another,  which  was  round,  was  carried  into  the  pulmonary  artery,  and 
the  branches  of  it.  But  through  the  left  ventricle  only  one  pafs’d,  which 
was  in  like  manner  round,  and  infledled,  on  one  fide,  into  the  aorta,  and 
on  the  other  into  the  left  auricle,  and  the  pulmonary  vein :  and  the  cellular 
membranes  which  furround  the  trunks  of  the  great  vefiels  that  1  have  men¬ 
tion’d,  as  they  go  out  from  the  pericardium,  feem’d  to  be  of  a  mucous  con¬ 
fluence,  by  reafon  of  the  water  that  was  colle&ed  in  them. 

When  the  abdomen  was  open’d,  a  ftrong  finell  iflfu’d  from  its  cavity, 
fuch  as  proceeds  from  inflam’d  vifeera,  already  verging  into  a  ftate  of  gan¬ 
grene.  But  the  liver  was  of  a  whitilh  colour ;  though  the  fpleen  was  in- 
fe&ed  with  a  gangrenous  blacknefs,  yet  not  -very  deep,  and  to  a  moderate 
extent,  and  this  on  the  inferior  part,  fo  that  it  did  not  lie  in  contaft  with 
the  diaphragm,  on  that  part ;  and  the  diaphragm  was  found.  But  a  ftill 
more  ftrong  and  difagreeable  fmell  iflu’d  from  the  uterus,  and  the  parts  that 
were  annex’d  to  it,  on  each  fide,  and  behind.  About  thefe  parts  was  a  fmall 
quantity  of  water,  and  that  a  little  reddilh  :  and  all  of  them  were  externally 

livid. 


1 


Letter  XXL  Article  30.  6 09 

livid,  from  the  foregoing  inflammation,  which  flill  difeover’d  itfelf  in  the 
-lower  part  of  the  re&um,  and  the  pudendum  alfo,  by  its  redoefs,  the  very 
(mailed  veffels  being  as  confpicuous  as  if  they  had  been  injected  with  red 
wax.  Upon  cutting  out  all  thefe  parts  together,  in  order  to  examine  each 
of  them  more  accurately,  I  was  (truck  with  the  appearance  on  the  infide  of 
the  thighs,  which  were  mod.  dilagreeably  variegated  from  the  fire  that 
this  virgin  had  been  accuftom'd  to  put  under  her  clothes,  in  the  winter  time, 
frequently,  and  in  great  quantity :  and  this  I  take  notice  of  by  the  way,  be- 
caufe,  according  to  the  opinion  of  fome,  it  might  feem  that  fhe  ought  to 
have  had  her  menfes  flow  more  freely,  in  the  lad  winter  months,  for  this 
reafon,  indead  of  being  lefs  in  quantity.  The  tedes  were  not  let's  than 
thofe  of  a  moderate  fize  in  men,  foft,  and,  among  a  very  great  number  of 
veficles  larger  and  fmaller,  full,  as  they  generally  are,  of  a  fluid,  and  amply 
furndh’d  with  fmall  twigs  of  blood  veflels,  which  in  thefe  tedes  were  to  be 
met  with  in  great  quantity,  had  each  of  them  two  cells,  one  of  which  con¬ 
tain’d  a  black  little  body,  perfectly  fpherical,  very  much  like  a  coagulum  of 
biood  that  is  dried ;  but  the  other  contain’d  nothing,  being  made  up  of  the 
little  membrane  itfelf  corrugated,  which,  from  a  yellow  and  white  colour, 
degenerated  into  green,  and  was,  at  lead  in  one  teflis,  very  near  to  the  fur- 
face,  which,  if  it  did  not  open  in  that  place,  was  certainly,  however,  not 
without  marks  of  a  foregoing  injury. 

The  uterus  and  vagina  being  open’d ;  in  the  latter,  about  the  mouth  of 
it,  were  dill  two  little  coagula  of  blood,  which  could  be  prefs’d  out,  with 
great  eafe,  from  the  inner  lurface  of  its  neck,  but  particularly  from  its  fund  : 
the  furface  of  which,  as  it  was  not  tenle  in  this  body,  had,  at  fird  fight, 
reprefented  a  kind  of  mucus,  with  which  it  was  cover’d  over.  But  this  does 
not  belong  to  the  prefent  occafion,  nor  yet  the  fituation  of  the  tubes,  nor 
the  nature  and  fituation  of  the  rugae  of  the  vagina,  nor  the  globular  carun¬ 
cles  plac’d  behind  the  hymen,  which  was  here  quite  entire,  nor  other  things 
of  the  like  kind,  which  although  I  have  obferv’d  in  this,  and  in  other  vir¬ 
gins,  yet  fome  learned  men  feem,  in  part,  not  to  have  feen,  and,  in  part,  not 
to  remember,  that  they  were  formerly  deferib’d  by  me.  Nor  does  it  relate 
much  to  the  prefent  purpofe  to  remark,  that  we  found  a  defedt  of  thole  pi¬ 
tuitary  finufies,  that  are  call’d  maxillary,  and  fphenoid,  as  the  ufe  of  them 
was  fupply’d  by  the  encreas’d  magnitude,  and  number  of  the  others. 

But  the  other  circumdances  which  I  fhall  fubjoin,  do  relate  to  our  prefent 
fubjedt.  For  in  the  head,  the  fauces,  and  the  neighb’ring  parts  began  to 
fineil  drong,  as  if  from  inflammation.  And  from  the  cranium,  when 
open’d,  fuch  an  acid  fmell  proceeded,  if  I  may  be  allow’d  to  fpeak  fo,  as 
comes  from  the  mouth  of  a  child  who  has  worms.  In  the  upper  part  of  the 
falciform  finus,  were  white  polypous  concretions.  The  veflels  that  creep 
through  the  dura  mater,  were  a  little  more  turgid  than  ufual.  Betwixt  that 
and  the  brain  was  water,  yet  in  but  fmall  quantity,  as  alfo  in  the  lateral  ven¬ 
tricles,  where  it  was  of  a  reddifh  colour.  The  plexus  choroides  werefome- 
what  pale,  and  contain’d  a  few  hydatids  only,  but  fuch  as  were  of  a  large 
fize.  Finally,  the  cerebrum  was  a  little  fofter  than  ufual,  and  the  cerebellum 
much  more  fo. 

30.  A  man,  aged  fix  and  fifty  years,  of  a  moderate  habit  of  body,  a  tall 
Vol.  I.  4  I  dature. 


6  i  o  Book  II.  Of  Difeafes  of  the  Thorax. 

flature,  and  a  manner  of  life,  in  many  circumftances,  very  irregular,  having, 
not  long  before,  undergone  great  fatigue  in  ringing  of  the  bells  in  churches, 
which  was  the  means  of  his  fupport,  had  now,  for  fome  days,  fuffer’d  a 
(lightly  pungent  pain,  at  the  internal  and  lower  part  of  the  fternum,  when 
at  length  this  pain  was  greatly  encreas’d,  a  fever  coming  on  the  fame  day, 
not  long  after,  join’d  with  a  difficult  refpiration.  In  the  mean  while,  two 
or  three  fpontaneous  flools  came  on,  which  confided  of  a  bilious  and  warm 
humour.  At  length  he  was  brought  into  the  fame  hofpital,  in  which  the 
virgin  had  died  two  weeks  before  •,  but  fo  much  too  late,  that  blood  could 
not  be  taken  from  the  arm,  till  the  latter  part  of  the  fourth  day,  after  the 
fever  had  begun.  The  blood  had  but  little  ferum,  and  a  cruft  two  inches  in 
thicknefs,  of  a  white  colour  changing  to  yellow.  On  the  fifth  day,  the 
pulfe  was  full  and  hard :  he  fpent  the  night  almoft  without  reft,  and  could 
fcarcely  breathe  at  all.  The  urine,  being  examin’d  before  the  end  of  that 
day,  was  of  a  faturated  colour,  and  not  very  pellucid  ;  the  pulfe  was  fre¬ 
quent,  equal,  and  not  hard:  his  refpiration  was  difficult,  and  attended  wi  h 
a  groan  :  the  pain  continu’d  in  the  fame  place  :  he  could  lie  on  which  fide 
he  pleas’d :  his  expedorated  matter  was  thick,  frothy,  and  of  a  variegated 
yellow.  On  the  night  following  he  was  troubl’d  with  a  pain  and  cough. 
In  the  morning  his  pain  was  more  mild  :  his  fpitting  and  pulfe  were  the  fame; 
his  urine  alfo  was  nearly  the  fame,  except  that  it  was  fomewhat  red,  in  fmail 
quantity,  and  a  little  turbid.  Near  the  end  of  this  day,  which  was  the 
fixth,  blood  was  taken  from  the  right  hand  :  but  as  all  of  it  was  effus’d  from 
the  vein  into  water,  it  could  not  be  examin’d  as  it  ought  to  have  been. 
On  the  beginning  of  the  feventh  day,  the  patient  feem’d  to  be  a  little  better, 
Neverthelefs,  about  the  end  of  that  day,  the  pain  was  become  more  confi- 
derable,  the  pulfe  much  lefs,  and  more  quick,  as  the  refpiration  was  alfo; 
and  the  tongue  dry.  In  the  beginning  of  the  eighth  day  he  had  profufe 
fweats :  and  this  difpofition  was  encourag’d,  as  much  as  poffible,  with, 
gentle  provocatives,  by  the  phyfician,  who  had  all  this  time  been  applying, 
both  internally  and  externally,  the  remedies  ufual  on  fuch  occafions  ;  but  all 
were  to  no  efted.  The  fucceeding  night  was  very  much  difturb’d,  and  at 
the  end  of  the  day  the  breathing  was  very  quick,  the  pulfe  fmail,  and  gave 
but  little  refiftance  to  the  preffure  of  the  fingers  :  he  fpat  up  a  crude  yellow 
matter,  which  was  fluid,  and  without  froth  :  the  urine  continu’d  to  have 
the  fame  appearances.  On  the  beginning  of  the  ninth  day,  being  able  to 
pus  his  arms  out  from  under  the  clothes,  as  he  pleas’d,  and  to  fpeak,  though 
with  fome  difficulty,  the  attendants  fuppos’d,  for  thefe  reafons,  that  he  would 
not  die  ;  but,  contrary  to  their  opinion,  he  died  loon  after. 

The  thorax  contain’d  water  on  both  fides,  and  on  the  right  fide,  at  leaft, 
it  was  yellow  and  turbid.  Both  lobes  of  the  lungs  were  conneded,  on  the 
upper  part,  to  the  pleura,  which,  in  that  part,  and  in  other  places,  alfo,  of 
the  right  fide  of  the  thorax,  was  fomewhat  thicken’d.  And  in  this  cavity 
pieces  of  that  membrane,  as  it  were,  lay  upon  the  furface  of  the  lungs, 
which  was,  in  other  refpeds,  uninjur’d.  The  lungs  themfelves,  on  this  fide, 
were  very  heavy,  and  confided  entirely  of  that  fubftance  like  the  liver,  very 
hard,  but  whitiffi,  and  were  lefs  than  they  generally  are  when  fo  denfe;  fo 
that  it  feem’d  to  be  half-corrupted,  efpecially  as  from  the  orifices  of  the 

bronchia, 


Letter  XXL  Article  31,  6  it 

bronchia,  when  cur,  a  vvhitifh  and  turbid  humour  i (Til’d  out  in  many  places. 
Over  the  furface  both  of  the  lungs,  which  was  contiguous  to  the  me- 
diadinum,  where  it  contains  the  pericardium,  and  of  the  rnediaftinum  itlelf 
at  that  part,  was  extended  a  thickifh  kind  of  net,  as  it  were,  of  a  yellowifh 
colour,  elegant  in  its  appearance,  and  eafily  to  be  drawn  off,  as  was  another 
alfo,  which  you  might  have  feen  in  the  fame  part,  over  the  rnediaftinum,  of 
a  bloody  colour.  There  was  no  appearance  of  this  kind  on  the  left  fide  ; 
and  the  lungs  there  were  even  found,  or  almoft  found.  In  the  pericardium 
was  a  large  quantity  of  water,  of  the  fame  kind  with  that  I  mention’d  in 
the  thorax,  on  the  right  fide.  The  heart  was  very  large,  even  in  proportion 
to  the  daiu  re  of  the  man  ;  but  very  lax,  and  contain’d  polypous  concretions, 
one  of  which,  beginning  in  the  right  auricle,  was  produc’d  from  thence,  thro’ 
the  annex’d  ventricle,  into  the  pulmonary  artery  ;  and  the  other,  which  was 
a  little  more  denfe,  and  much  larger,  inafmuch  as  it  occupied  almod  the  whole 
left  ventricle,  went  on  from  this  cavity  into  the  aorta.  From  the  cavity  of 
which  artery,  when  I  drew  out  the  polypous  concretion,  a  cylinder  of  blood 
follow’d,  very  much  coagulated,  to  the  length  of  a  fpan.  Nor  was  the  blood 
lefs  coagulated  which  was  contain’d  in  the  upper  veffels,  at  lead,  as  I  per¬ 
ceiv’d,  by  differing  the  neck.  Thofe  of  the  larynx,  and  pharynx,  were 
turgid.  The  face  was  of  a  livid  red.  In  the  left  external  ear  was  blood 
half-concreted.  I  did  not,  however,  difiedt  the  head,  being  taken  up  with 
other  things  *,  fo  that  I  could  lcarcely  open  the  ched,  and  the  belly,  the  fe- 
cond  day  after  death. 

The  belly  was  externally  livid  about  the  flanks.  Yet,  internally,  nothing 
correfponded  thereto,  but  the  colon,  which  was  in  every  refpedt  found,  ex¬ 
cept  that  it  was  didended  with  air.  The  liver  was  fo  far  ftretch’d  acrofs  the 
body,  as  to  cover  the  whole  upper  part  of  the  fpleen,  to  which  it  was  clofely 
connected,  and  had  its  edge  livid  to  a  confiderable  extent.  This  lividnefs, 
which  did  not  penetrate  to  any  great  depth,  in  the  fubftance  of  the  liver, 
had  alfo  ting’d  the  hollow  furface  of  this  vifeus,  to  about  the  fpace  of  three 
inches.  However,  the  liver  was  not  very  hard,  but  only  a  little  whiter  than 
ufual,  in  its  general  appearance.  The  gall-bladder  contain’d  but  little  bile, 
yet,  neverthelefs,  had  ting’d  the  external  furface  of  the  antrum  pylori,  which 
lay  beneath  it :  and  with  this  bile  it  alfo  contain’d  twenty  calculi,  of  dif¬ 
ferent  flzes,  but  mod  of  them  fmall :  one  of  them,  however,  was  very 
large,  and,  like  all  the  others,  internally  and  externally  black,  juft  as  if  it 
had  been  a  piece  of  charcoal,  which  its  rare  and  friable  fubdance  alfo  re- 
fembl’d.  None  of  thefe  concretions,  when  applied  to  the  flame,  took  fire, 
or  emitted  fparks ;  only  they  fometimes  gave  a  kind  of  crack.  The  fpleen 
was  large,  although  compar’d  with  the  dature  of  the  man  j  it  was  lax  alfo, 
and  externally  white.  Finally,  the  domach,  on  its  whole  left  fide  exter¬ 
nally,  had  both  of  its  furfaces  mark’d  with  certain  large,  and,  as  it  were, 
ramifying  fpots,  of  a  black  and  livid  colour.  Thefe  alfo  appear’d  internally, 
and  were  produc’d  quite  to  the  oefophagus,  and  had  little  drops  of  blood 
adhering  around  them  betwixt  the  coats:  fo  that,  confidering  all  thefe  things, 
you  would  have  no  doubt  about  the  inflammation  of  the  domach  having  been 
at  length  added. 

21.  If  to  thefe  two  long  hidories,  I  fhould  alfo  add  long  animadverfions 

4  I  2  relating 


6  i  2  Book  II.  Of  Difcafes  of  the  Thorax. 

relating  either  to  the  difeafe,  or  the  method  of  curing  ir,  or  to  thofe  ap¬ 
pearances  found  by  difle&ion,  what  would  the  bulk  of  this  letter  be  ?  efpe- 
cially  as  many  things  ftill  remain  that  ought  not  to  be  omitted.  It  is  iuffr- 
cient,  however,  if  in  each  of  the  hiftories  you  attend  to  two  things,  the 
one  relative  to  the  difeafe,  the  other  to  the  difledlion. 

Relative  to  the  difeafe  is  the  yellow  colour  on  that  cruft  of  the  blood  ; 
which,  as  I  remember  Albertini  has  faid  to  me,  was  the  fign  of  the  inflam¬ 
mation  being  worfe,  and  more  dangerous,  according  to  his  obfervations. 
Which  remark  anfwers  alfo  in  my  obfervations,  as  far  as  I  can  call  to  mind. 
Yet  not  only  in  thefe  two,  but  likewife  in  that  of  the  butcher,  which  is  dc- 
fcrib’d  above  (»),  and  in  others  befides,  have  I  obferv’d  it,  even  when  I 
could  not  join  the  difledtion  to  the  obfervation,  as  particularly  in  a  drunken 
man,  who,  in  that  epidemic  ftate  of  the  air  at  Bologna,  being  feiz’d,  at  the 
fame  time,  with  a  pungent  pain  in  the  breaft,  and  an  acute  fever,  and  having 
us’d  wine  inftead  of  blood-letting,  till  the  fifth  day  of  the  difeafe,  when  he 
came  into  the  fame  hofpital,  had  blood  taken  from  him  immediately,  on  than 
day,  and  again  on  the  fifth.  That  which  was  taken  away  on  the  fourth  day 
greatly  refilled  the  knife,  and  was  cover’d  with  a  thin  cruft  of  a  livid  colour, 
variegated  in  its  appearance,  and  difficult  to  be  cut  through.  But  that  which 
was  taken  away  on  the  fifth  day,  being  cover’d  over  with  a  cruft  equally 
tough,  but  an  inch  in  thicknefs,  and  yellow,  was  diflolv’d  into  grumous  con¬ 
cretions,  while  it  was  turn’d  up  in  the  bafon  :  fo  much  did  things  appear  to 
be  chang’d  in  one  day’s  time  !  This  fame  eafy  difiolution  of  the  crafiamen- 
tum  of  the  blood  into  grumous  coagula,  I  mention’d  alfo  in  the  fervant- 
maid  (0),  and  in  that  butcher,  in  whom  you  will  obferve  there  was  a  change 
likewife,  within  the  fpace  of  two  days,  but  in  a  contrary  order.  All  thefe 
perfons  died,  as  that  drunken  man  alfo,  of  whom  I  began  to  fpeak,  who 
died  at  the  evening  of  the  fame  day,  on  which  blood  had  been  again  taken 
away  in  the  morning.  He  always  lay  on  his  back,  and  was,  even  from  the 
fourth  day,  troubl’d  with  a  vertigo  and  delirium,  his  tongue  being  black, 
his  pulfe  frequent,  and  intermitting,  although,  thefe  circumffances  confider’d, 
it  gave  a  pretty  ftrong  refiftance  to  the  fingers :  and  to  thefe  fymptoms,  a 
few  hours  before  death,  a  ftertor,  and  a  deep  refpiration,  were  added. 

But  now  for  what  relates  to  the  difledtion  :  You  fee,  doubtlefs,  by  reading 
over  thefe  laft  hiftories  alfo,  that  the  injuries  of  the  pleura,  which  it  has 
happen’d  to  me  to  meet  with  in  bodies  of  this  kind,  were  very  far  from  being 
of  iuch  a  nature,  that  you  could  fuppofe  them  to  be  the  caul'e  of  death.  For 
inftance,  I  have  found  the  pleura  fomewhat  thicken’d  5  but  not  to  fuch  a 
degree  as  is  mention’d  here  in  the  Sepulchretum  (/>),  from  Riolanus,  fo 
“  that  it  was  ten  times  thicker  than  ufual nor  have  I  found  it  livid,  nor 
flirivell’d,  nor  yet  red  from  inflammation.  But  he,  you  will  fay,  and  others, 
have  found  it  fo:  and  he  has  even  added,  “  that  for  this  reafon  Hippocrates 
“  had  written,  that  the  carcafes  of  pleuritic  perfons  feem  as  if  they  had  been 
u  ftricken  with  lightning,  which  is  to  be  underftood  of  the  internal  parts  of 

the  thorax.”  And  I  do  not  deny  the  obfervations  of  other  perfons  j  but 

{»)  N.  19.  (<?)  N.  29.  (p)  L.  2.  S.  4.  Obf.  14.  §  2  &  3. 


will 


Letter  XXL  Article  31.  6 13 

tyill  even  willingly  confirm  them,  as  far  as  I  fhall  be  able,  from  my  own, 
which  I  fhall  immediately  fubjoin.  I  only  at  prefent  recite  thole  that  I  have 
already  written  to  you.  Yet,  if  Riolanus,  trufting  lefs  to  his  memory,  had 
read  over  again,  the  paffage  of  Hippocrates,  which,  I  fuppofe,  is  in  the 
book  De  viSius  rations  in  morbis  acutis  (q),  he  would  have  perceiv’d,  that  there 
is  no  mention,  or  hint,  of  difleCtion  in  it,  as  the  ancients  are  Laid  to  have 
fuppos’d,  that  feme  pleuritic  perfons  4t  were  thunder-ftricken,”  for  this 
realon,  “  becaufe  after  death,  one  fide  is  found  to  be  livid,  as  if  they  had 
“  receiv’d  a  blow  !  ”  but  would  even  have  acknowledg’d,  with  Galen  (r), 
in  his  expofition  of  that  paffage,  that  this  “  blacknefs  ”  appear’d  “  in  the  fkin,” 
juft  as  it  did  “  in  thofe  who  have  been  thus  afteCted  from  a  blow.”  Yet  I 
will  quote  the  paffage  of  Cmlius  Aurelianus  (j),  which  it  would  have  been 
better  for  Riolanus  himfelf  to  do,  as  it  makes  very  evidently  for  his  opinion. 
For  when  that  author  fpeaks  of  pleuritic  patients,  and  of  the  pleura,  he  fays 
this,  “  In  patients  who  have  died,  it  is  often  found  black.”  Nor  would  I 
have  you  fuppofe,  that  he  faid  this  in  reliance  upon  conjecture,  taken  from 
the  livid  appearance  of  the  external  parts  of  the  fide,  in  confequence  of  tha 
patient’s  having  lain  upon  it  fo  long  ;  efpecially  if  it  had  happen’d,  that  as 
they  generally  lie  upon  that  fide,  in  the  courfe  of  the  difeafe,  fo  they  lay 
upon  the  fame  fide  at  the  time  of  their  death.  Nor  would  I  have  you  add 
to  this  opinion,  that  he  did  not  fay  it  of  all  thefe  patients  ;  and  that  he  im¬ 
mediately  fubjoin’d  thefe  words,  which  indicate  an  external  lividnefs :  “  In 
“  fine,  fome  have  believ’d  thefe  perfons  to  be  poifon’d.”  And  even  if  you 
fhould  fuppofe,  that  you  could,  perhaps,  confirm  your  opinion'  from  this 
circumftance,  that  in  the  age  of  Caelius  human  bodies  were  not  differed  ; 
firft  fee,  whether  in  the  age  of  Hippocrates,  which  you  juft  now  objected 
with  Riolanus,  they  were  really  begun  to  be  diffeCted  ?  then  turn  to  Caelius, 
and  you  will  perceive,  that  in  the  chapter,  where  he  has  faid  this,  he  has  alfo 
produc’d  arguments  for  the  pleura  from  Erafiftratus,  who,  it  is  certain,  did 
diffeCt  human  bodies  :  at  length,  read  over  again  thofe  very  words  of  Qelius, 
which  I  have  quoted  firft,  and  you  will  fee  that  they  do  not  depend  upon 
conjecture,  but  agree  with  oblervation.  To  wh;ch  if  you  fuppofe  that  this 
one  thing  may  be  objected,  I  mean,  the  lying  down,  of  which  I  fpoke,  of 
dying  perfons,  as  if  the  falling  down  of  the  blood  into  the  lower  parts,  by 
diftending,  not  only  the  external,  but  the  internal  vefiels  of  the  fide  alfo,  and 
their  fmaller  brandies,  had  at  that  time  brought  on  a  livid  appearance  of  the 
pleura,  which  was  not  before-,  I  fay,  if  you  fhould  chance  to  be  of  this 
opinion,  firft  fee  whether  pleuritic  patients  are  us’d  to  lie  down  on  the  fide 
which  is  pain’d  j  then  fee  to  this  alfo,  that  the  cafes  of  pleuritic  patients  are 
not  objeCfed  to  you,  who,  like  the  duke  of  Rochefoucault  (/),  being  com- 
pell’d  to  breathe,  even  to  the  very  moment  of  his  death,  with  his  neck  ftrait, 
had  neverthelefs  both  the  fkin  and  the  pleura  livid  on  one  fide.  But  you  will 
fee  to  thefe  things.  Nor  is  it  neceflary  for  me  to  explain  the  fubjeCt  in  this 
manner  ;  becaufe,  if  I  had  even  feen  that  lividnefs,  and  the  other  appearances 
which  Riolanus  has  fpoken  of^  in  the  pleura  of  thofe  whom  I  am  fpeaking  of 


(q)  N.  8. 

(r)  Comm.  i.  ad  t.  35^.  1.  cit. 


p)  Acut.  PafT.  1.  2.  c.  1 6. 

(?)  Sepulchret.  S.  4.  cit.  Obf.  ult* 


6 1  4  Book  Ii.  Of  Difeafcs  of  the  Thorax. 

at  prefent,  yet,  neverthelefs,  I  fnould  not  have  accounted  for  the  death  of 
the  patients  from  that  caufe,  rather  than  from  the  very  great  diforder  of  the 
lungs :  nor,  indeed,  do  I  believe,  that  you  will  think  otherwife,  in  regard 
to  the  hiftories  that  follow,  in  which  I  found  the  pleura  red,  and  fometimes 
alfo  livid,  and  very  much  thicken’d,  and  at  other  times  even  half-corrupted. 
^  32.  A  woman,  of  five-and- forty  years  of  age,  was  very  ill  with  an  old 
ulcer  of  one  leg,  and  a  dry  fcabies  over  her  whole  body,  a  flow  fever  being 
added  to  the  fcabies.  The  fcabies  going  off,  but  the  ulcer  being  (till  more 
violent,  fhe  got  herfelf  admitted  into  the  hofpital  of  Incurables  at  Bologna. 
But  before  fhe  came  into  this  houfe,  forefeeing,  probably,  what  fhe  fliould  be 
under  a  neceflity  of  doing  without  there,  fhe  till’d  herfelf  fo  full  of  generous 
wine,  that  fine  took  fcarcely  any  thing  but  that  for  the  fpace  of  three  days 
together.  For  which  reafon,  on  the  firft  night  that  fhe  lay  in  the  hofpital, 
fhe  had  but  little  reft,  and  was  very  hot.  In  the  morning  fhe  was  better. 
Yet  her  pulfe  was  very  quick,  hard,  and  tenfe,  but  did  not  greatly  refift  the 
preffureof  the  fingers,  nor  was  very  large.  The  heat  return’d  at  the  fame 
hour  ;  a  pungent  pain  came  on,  at  the  lowed:  true  rib  of  the  left  fide,  which, 
although  it  was  not  increas’d  by  the  touch,  nor  by  lying  down  on  that  fide, 
yet  it  was  more  eafy  for  her  to  lie  down  on  the  right  fide,  for  this  reafon, 
becaufe  when  fhe  lay  down  on  the  left,  a  cough  was  excited,  which  was 
conftantly  obierv’d  to  happen  during  the  continuance  of  this  fhort  diforder. 
The  pain  went  off  afterwards,  nor  return’d  any  more  ;  fo  that  the  patient 
feem’d  to  be  fomething  better,  eipecially  as  the  pulfe,  although  it  retain’d 
its  other  irregularities,  was,  neverthelefs,  become  more  flow.  But,  on  the 
fourth  day,  fhe  grew  hot  after  a  fhivering  fit,  was  much  worfe,  and  with  her 
cough,  which  had  been  hitherto  dry,  fine  brought  up  a  pus  of  a  cineritious, 
and  livid  colour,  foetid,  and  bloody.  She  could  not  breathe  but  with  her 
neck  ftretch’d  out.  Her  pulfe  became  lefs,  and  weaker ;  and  the  expecto¬ 
rated  matter  was  of  a  blackifh  colour.  A  flight  delirium  came  on.  The 
fever,  in  the  laft  days  of  the  difeafe,  came  on  later  than  it  us’d  to  do.  In 
the  middle  of  the  fixth  day  fhe  died,  from  a  fudden  fuft'ocation,  as  it  were  : 
and  this  was  in  the  autumn  of  the  year  1705. 

The  thorax,  on  each  fide,  contain’d  a  little  foetid  and  cineritious  ferum  : 
but  the  lungs  adher’d  flighdy,  and  loofely,  to  the  pleura.  This  membrane, 
on  the  iefc  fide,  where  the  lungs  had  adher’d,  was  rough  here  and  there, 
-and  unequal  from  a  fmall  and  red  kind  of  tubercles.  Under  the  lungs  of 
the  fame  fide  (for  the  right  lobe,  being  found,  had  none  of  thefe  appearances 
that  the  left  had)  where  it  was  contiguous  to  the  diaphragm,  were  two  falfe 
membranes,  one  of  which  adher’d  to  the  lungs  themfelves,  and  the  other  to 
the  diaphragm.  That  lobe  was  not  red,  but  livid,  and  harder  than  the  liver. 
Being  cut  into,  it  fhew’d,  in  its  internal  fubftance,  a  pus  'of  the  fame  kind 
with  that  which  had  been  expectorated,  eipecially  in  certain  finufies,  as  it 
were,  which  alfo  contain’d  a  little  yellow  pus.  Thefe  finufies  were  fur- 
rounded  with  no  very  hard,  or  peculiar  coat  ;  nor  was  there  any  thing  in 
the  afpera  arteria.  In  the  vena  cava,  and  the  pulmonary  artery,  were  poly¬ 
pous  concretions  of  a  fmall  fize  •,  and  a  pretty  large  concretion  was  found  in 
the  left  auricle.  In  the  abdomen  every  thing  was  found.  I  did  not  difleCt 
the  head. 


7 


S3-  A 


Letter  XXI.  Article  33.  61$ 

33.  A  foldier,  of  a  middle  age,  and  of  a  moderate  habit  of  body,  ex- 
cepc  that  he  inclin’d  to  leanncfs,  died  in  the  hofpital  at  Padua,  about  the 
beginning  of  March,  in  the  year  1743;  and  as,  at  that  time,  I  was  ex¬ 
plaining  1'ome  things  in  anatomy  to  the  ftudents,  his  body  was  brought  to 
me.  Before  the  beginning  of  the  difiedtion,  I  enquir’d,  according  to  cuftom, 
of  what  diforders  the  patient  had  complain’d  ?  Being  anfwer’d,  that,  on 
the  firft  days  of  the  difeafe,  he  had  complain’d  of  a  pungent  pain  of  one 
fide,  join’d  with  a  fever,  cough,  and  difficulty  of  refpiration,  till  being  be¬ 
come  almoft  lethargic,  and  (lightly  delirious,  his  fingers  trembling,  and,  on 
the  laft  days,  being  without  pulfe,  he  died  *,  I  made  no  fcruple  to  predict,  to 
a  very  crowded  circle  of  pupils,  and  learned  men,  that  the  fubftance  of  the 
lungs  would  be  like  that  of  the  liver,  that  we  ftiould  find  polypous  concre¬ 
tions  in  the  heart,  that  the  veffels  about  the  brain  would  be  turgid,  and  that 
an  aqueous  humour  would  certainly  be  found  there. 

The  thorax  being  then  immediately  open’d  there,  and  the  head  boon  after, 
every  one  faw  that  the  two  lobes  of  the  lungs,  (which  adher’d  almoft  every¬ 
where  to  the  pleura  very  clofely,  except  on  the  anterior  furface,  which  alio 
was  nearly  of  its  natural  colour)  when  they  were  taken  out  from  the  body, 
differ’d  one  from  another  confiderably.  For  the  right  lobe  was  greatly  en¬ 
larg’d,  heavy,  and  univerfally  hard,  if  you  except  a  little  portion  of  the 
upper  part,  and  that  furface  of  it,  which  I  mention’d  before :  it  was  like- 
wife  ffnooth,  and  equal,  fo  as  to  reprefent  the  furface  of  the  liver ;  nor  did 
any  net-work  of  veffels  appear  thereupon ;  and,  internally,  it  was  of  that 
compadt  fubftance,  which  refembl’d  the  liver  when  boil’d,  and  cut  into. 
But  the  left  lobe  differ’d  from  its  natural  ftate,  only  in  thefe  circumftances, 
that  when  it  was  cut  into,  it  feem’d  to  be  a  little  harder  and  redder  than 
ufual,  with  a  mixture  of  black.  But  the  pleura  being  difcolour’d,  on  the 
left  fide,  or  rather  whitifh,  on  the  right  fide  appear’d  to  be  red,  almoft  uni¬ 
verfally,  from  a  manifeft  inflammation.  There  was  no  extravafated  water  in 
the  thorax  :  but  when  the  lungs  were  cut  off  from  the  afpera  arteria,  (which 
happen’d  to  be  very  w'ide  in  this  man,  and  was  furnifh’d  with  many  bronchial 
glands,  larger  than  ufual,  about  the  divifion)  a  large  quantity  of  bloody  and 
frothy  water  foon  after  flow’d  out,  gradually,  from  the  right  fide,  and  a  fmall 
quantity  from  the  left.  In  the  pericardium  was  no  very  fmall  quantity  of 
water,  of  a  yellow  colour,  with  a  flight  tinge  of  red.  In  both  the  ventricles 
of  the  heart  were  white  polypous  concretions,  which  were  produc’d,  from 
thence,  into  the  large  veffels,  with  black  and  grumous  blood  every-where- 
adhering  to  them  :  and,  afterwards,  I  even  found  fome  like  the  taeniae,  or 
tape-worms,  in  the  iliac  veffels  themfelves,  and  others  like  the  afearides,  in 
the  beginning  of  the  longitudinal  finus.  But  I  will  add  feparately,  as  my 
cuftom  is,  what  I  found  preternatural  in  the  head,  and  the  belly,  befides. 
thefe  appearances. 

While  the  fkull  was  cut  into,  no  fmall  quantity  of  water  flow’d  down  from, 
it.  Soon  after,  we  faw  the  greater  part  of  the  veffels  which  creep  through 
the  pia  mater,  turgid  with  blood  •,  and  in  the  medullary  fubftance,  here  and 
there,  by  cutting  into  it,  I  faw  drops,  of  blood  very  frequent  in  their  ap¬ 
pearance,  fome  of  a  larger,  and  fome  of  a  fmaller  fize  •,  and  in  the  lateral 
ventricles  was  a  great  quantity  of  a  fonTewhat  turbid  water,  the  choroid 

plexufies. 


6  1 6  Book  II.  Of  Difeafes  of  the  Thorax. 

*  •  *  . 

plexnfies  not  being  pale  indeed,  yet  not  without  many  veficles  i  and  among 
thefe  fome  pretty  large,  and  full  of  water.  The  fornix  was  lax,  and  the 
medulla  oblongata  was  lax. 

The  abdomen  being  open’d,  and  the  omentum,  which  had  become  ad¬ 
hering,  by  inflammation,  to  the  beginning  of  the  colon,  being  freed  from 
thence,  and  drawn  upwards,  an  unufual  fituation  of  that  inteftine  appear’d, 
which,  for  this  reafon,  ought  not  to  be  omitted  here.  For  fcarcely  had  it 
touch’d  the  liver,  but  it  immediately  pais’d  downwards,  below  the  umbilical 
region,  from  whence  it  was  carried,  obliquely  upwards,  to  the  left  hypo¬ 
chondrium.  This  whole  part  of  it  only  was  dilated  with  air,  and  that  to  a 
very  great  degree. 

Finally,  the  liver,  the  fpleen,  and  the  pancreas,  were  not  natural.  For 
the  laft- mention’d  vifcus  was  pretty  hard:  and  the  fpleen  not  a  little  bigger 
than  ufual,  and  for  that  reafon  lower:  the  liver  was  alfo  large,  and,  in  the 
greater  part  of  it,  of  a  whitifh  colour ;  nor  was  it  altogether  found,  if  you 
cut  into  it,  efpecially  on  the  right  fide  :  and  the  biliary  du£l  thereof,  in  that 
part  where  it  is  call’d  duftus  communis ,  was  wider  than  it  ought  to  be. 

34,  The  body  of  another  man  was  brought  to  me,  alfo,  in  the  fame  place, 
before  the  end  of  March,  in  the  year  1744.  He  had  earn’d  his  living  by 
lifting  of  wheat,  which  is  very  pernicious  to  the  lungs.  Wherefore,  having 
had  a  pleurify  before,  he  died  from  a  relapfe,  on  the  eleventh  day.  In  this 
diforder,  he  complain’d  of  a  heavy  pain  in  the  thorax,  efpecially  on  the  right 
fide,  being  conftrain’d  to  fit  up  in  bed,  in  order  to  take  his  breath:  he 
cough’d  very  much,  but  expe&orated  only  little  ;  and  what  he  did  fpit,  was 
vifcid,  and  bloody  :  his  face  was  red :  his  pulfe  was  hard,  very  confus’d  in 
its  ftrokes,  unequal,  and  intermittent ;  nor  without  fome  convulfive  tremors, 
at  fome  times.  Blood  had  been  taken  away  two  or  three  times,  and  on  this 
blood  a  thick  polypous  cruft  form’d  itfelf.  Having  heard  this  relation  from 
thofe  who  had  frequently  feen  the  man  in  his  laft  difeafe,  and  feeing  the  belly  of 
the  carcafe  to  be  fome  what  tumid,  and  the  feet,  and  the  lower  part  of  the  legs, 
-to  be  aftefted  with  an  cedematous  diforder ;  I  immediately  faid  to  thofe  who 
gave  me  this  relation,  and  to  the  reft  of  the  circle  of  auditors,  that  we 
lliould  certainly  fee  water  extravafated  here,  not  only  in  the  belly,  but  alfo 
in  the  thorax  and  pericardium  :  perhaps  alfo  polypous  concretions  about  the 
heart,  and  rednefs,  or  fome  other  diforder  of  the  pleura,  or  a  connexion 
thereof  with  the  lungs :  but  that  beyond  a  doubt  we  ftiould  find  a  turgefcency 
4n  that  vifcus,  and  a  hardnefs  and  clenfity  in  its  fubftance. 

They  began  to  open  the  cheft  immediately^  and  while  this  was  doing, 
water  .flow’d  out  at  the  incifions  of  the  cartilages,  that  join’d  the  ribs  with 
the  fternum :  and  this  water  was  found  to  be  turbid,  and  yellowifh,  and  in 
confiderable  quantity,  on  both  fides,  but  efpecially  on  the  right,  and  had  in 
it  a  kind  of  concretions,  like  thofe  that  generally  fwim  at  the  bottom  of  a 
cafk  of  wine.  This  water  being  dried  up,  neither  lobe  of  the  lungs  was 
feen  to  adhere  to  the  pleura  •,  but  this  membrane  appear’d  to  be  fomewhat 
redder  than  ufual  on  the  fides,  and  efpecially  on  the  left,  where,  probably, 
the  former  pleurify  had  been.  The  lungs,  being  in  other  parts,  in  general, 
foft,  had  the  lower  part,  on  the  right  fide,  hard  and  turgid ;  which  being 
cut  into,  Ihew’d  a  mo-e  denfc  fubftance,  of  a  brown  colour,  degenerating 

into 


Letter  XXI.  Article  34.  617 

into  purple.  From  both  of  the  larger  bronchia,  a  bloody  humour  was 
prefs’d  out,  into  the  afpera  arteria.  The  pericardium  feem’d  to  be  very  large 
before  it  was  cut  into.  But  when  it  was  cut  into,  it  was  evident  that  this 
enlarg’d  date  was  not  owing  fo  much  to  water,  although  the  quantity  of  that 
was  confiderable,  and  of  the  fame  kind  with  what  was  found  in  the  thorax ; 
as  it  was  owing  to  the  bignefs  of  the  heart,  the  parietes  of  which,  indeed, 
were  not  much  thicken’d,  but  the  ventricles,  and  efpecially  the  right,  were 
dilated,  and  contain’d  a  great  quantity  of  black  blood.  This  blood  was  cer¬ 
tainly  not  very  fluid,  yet  did  not  fliow  any  polypous  concretion  here,  or  in 
any  other  place,  one  thin  cruft  excepted,  and  that  in  the  right  ventricle ;  fo 
that  I  was  not  forry  to  have  predicted  polypous  concretions,  and  the  adheflon 
of  the  pleura  to  the  lungs,  with  no  great  degree  of  aflurance ;  notwithdand- 
ing  I  was  not  ignorant,  that  thefe  concretions  had  always  been  feen  upon 
the  blood  of  this  man,  when  difcharg’d,  and  thofe  very  thick  and  vilcid  ; 
and  that  this  adheflon  was  fuppos’d,  by  moft  perfons,  where  there  had  been 
a  pleurify,  as  I  had  very  often  found  it.  But  if  any  one  had  been  able  to 
tell  for  certain,  what  fymptoms  there  had  been  before  this  lad  difeafe,  or  at 
lead  after  the  fird  pleurify,  of  a  dilated  heart,  and  an  incipient  dropfy  in  the 
thorax,  without  doubt  I  fhould  have  referr’d  a  part  of  thofe  fymptoms, 
which  had  troubl’d  the  man  fo  vehemently,  in  his  lad  inflammation,  to  an¬ 
other  caufe  than  the  diforder  of  the  lungs,  which  was,  in  faff,  found  by 
me,  to  be  in  the  date  I  had  foretold,  but  not  to  fo  great  a  degree  as  the 
fymptoms  requir’d.  I  faid,  that  after  the  fird  pleurify,  there  might  have 
been  fymptoms  of  a  dilated  heart.  For  that  it  might  happen  to  this  man 
from  a  pleurify,  that  is,  from  an  inflammation  of  the  lungs,  and  not  very 
rarely  to  others,  may  be  argu’d  from  more  than  one  diffedtion  propos’d 
above.  So  the  man,  whom  I  wrote  of  lad  before  this  («)  •,  fo  alfo  the  old 
man,  whom  we  fpoke  of  in  the  beginning  (x) ;  had,  both  of  them,  an  affec¬ 
tion  of  this  kind  :  for  the  fird  had  his  heart  even  bigger  than  his  tall  dature 
requir’d,  and  the  lad  had  the  left  auricle  of  the  heart  much  longer  than  it 
us’d  to  be.  So  that  young  man,  the  fecond  of  thofe  whom  I  defcrib’d 
among  the  obfervations  of  Valfalva  (jy),  fhow’d  the  heart  much  encreas’d  in 
its  bulk.  Nor  indeed  is  it  to  be  wonder’d  at,  if  the  paffages  of  the  blood 
through  the  inflam’d  lungs  being  comprefs’d,  and  dreighten’d,  this  blood, 
either  by  too  much  didending,  or  too  much  irritating  the  heart,  and  the 
veffels  proper  to  it,  fhould  adt  with  violence  upon  the  parietes  of  the  heart, 
or  the  internal  fubdance  of  the  veffels.  And  although  the  diflenfion  mud 
be  the  greater  in  the  cavities  on  the  right  fide,  inafmuch  as  the  obdacle  is 
then  oppos’d  to  their  unloading  themfelves  into  the  lungs ;  yet  the  veins  in 
the  internal  fubdance  of  the  left  cavities,  mud  of  courfe  alfo  be  didended, 
the  blood,  with  which  the  right  cavities  are  fill’d,  and  dretch’d,  being  an 
obdrudtion  to  the  blood  likewife,  which  is  about  to  return  thro’  the  mouth 
of  the  coronary  vein,  from  the  left  fide.  And  the  irritation,  which  is  brought 
on  from  the  blood  being  vehemently  compell’d,  mud  have  been  greater  on 
the  left  fide,  as  long  as,  the  inflammation  being  not  yet  compleat,  the  paf¬ 
fages  through  the  irritated  lungs  are  more  open.  Befides,  in  fome  perfons, 

(a)  n.  30.  (x)  n.  4.  (y)  Epift.  20.  n.  3^. 

Vol.  L  4  K  one 


6 1  8  Book  IL  Of  Difeafes  of  the  Thorax. 

one  part  of  the  heart  may  be  more  firm,  and  ftrong,  than  the  others,  in 
proportion,  and  that  either  originally  from  the  birth,  or  after  the  birth  ;  fo 
as  to  make  it  lefs  able  than  the  other  parts  of  the  heart,  to  refift  an  equal 
caufe,  which  may  injure  that  vifcus  by  irritating,  or  diftending  it.  For 
which  reafon  it  is  not  to  be  wonder’d  at,  that  in  fome,  the  whole  heart,  and 
in  others,  fome  particular  part  of  it,  but  efpecially  on  the  right  fide,  is 
found  to  be  very  much  enlarg’d,  after  violent  and  repeated  inflammations  of 
the  lungs.  And  although  it  is  in  my  power  to  confirm  thefe  circumftances 
by  the  obfervations  of  others,  yet  1  chufe  rather  to  point  out  thofe  which 
I  happen’d  to  read  at  the  time  of  revifing  this  letter,  in  a  work  of  the  illuf- 
trious  Senac  (2),  who,  as  you  will  fee  in  his  treatife,  explains  the  fubjedt  in 
the  fame  manner,  and  affirms,  that  he  had  often  feen  the  heart  enlarg’d, 
after  inflammations  of  this  kind,  and  particularly  on  the  right  fide,  as  it 
happen’d  to  me,  in  the  man  in  queflion. 

And,  that  we  may  omit  nothing  that  was  preternatural,  and  occurr’d  to 
ns  in  diffedlion ;  this  man  had  water  in  the  abdomen  alfo,  in  confiderable 
quantity,  like  that  which  has  been  defcrib’d  in  the  thorax,  and  pericardium. 
The  liver  was  hard,  externally  livid,  and  pale,  and  internally  variegated  with 
frequent  white  particles.  I  was  fo  much  taken  up  with  other  affairs,  that  I 
could  not  diffedt  the  head. 

35.  In  the  following  year,  but  in  the  fame  month,  and  the  fame  place,  I 
diffedted  the  body  of  a  man  of  a  middle  age,  and  a  healthy  habit  of  body, 
but  inclining  rather  to  be  lean  than  fat,  at  the  time  in  which  I  demonftrated 
and  explain’d  the  parts  in  their  natural  ftate,  according  to  my  ulual  cuftom, 
and  to  a  crowded  audience.  Among  the  reft  was  prefent  the  affiftant  phy- 
fician  to  the  hofpital.  He  being  afk’d  about  the  patient,  and  his  diforder, 
anfwer’d,  that  he  had  been  by  trade  a  ftone-cutter:  and  how  liable  to  difor¬ 
der  the  lungs  of  fuch  artificers  are,  from  the  duft  flying  into  them,  is  not 
only  argu’d  from  reafon,  but  confirm’d  by  obfervation  {a).  This  man  firft 
had  a  fever,  foon  after  that  a  pungent  pain  in  the  left  fide,  and  foon  after 
this,  a  diarrhea  to  fuch  a  degree,  that  he  had  eight  loofe  ftools  within  the 
four  and  twenty  hours,  which  were  not  yellow,  nor  attended  with  any  unea- 
finefs ;  and  not  long  after  this,  a  heavy  pain  in  the  thorax  came  on.  He  alfo 
faid,  that  the  patient  was  brought  very  late  into  the  hofpital,  as  the  common 
people  generally  are,  and  that  he  had  not  been  kept  up  at  all  in  any  houfe ; 
that  it  was  the  fifth  day  of  the  difeafe  when  he  came  thither ;  and  that  he 
already  labour’d  under  all  the  fymptoms  I  have  mention’d,  which  lafted  even 
to  the  very  period  of  his  life.  That  the  blood  which  had  been  taken  away 
was,  by  reafon  of  the  particular  nature  of  the  difeafe,  and  the  violence  of 
it,  become  very  denfe,  but  had  no  polypous  cruft.  That  a  fpitting  of  mat¬ 
ter  had  appear’d,  with  fome  flight  tin&ure  of  blood  mix’d  with  it,  but  had 
not  continu’d  long.  At  length,  that  his  mind  growing  confus’d,  and  fome- 
what  delirious,  and  his  pulfe  foon  after  failing,  which  had  been  before  tenfe, 
and  without  intermiffion,  he  died  on  the  beginning  of  the  eleventh  day. 
And  all  of  us  having  heard  this  account*,  Now,  faid  I,  you  very  well  know, 
what  appearances  you  have  been  accuftom’d  to  fee  with  me  in  the  lungs, 

(z)  Traite  du  Coeur,  1.  4.  ch.  8.  n.  3.  [a)  Vid.  Ad.  N.  C.  Tom.  5.  Obf,  85. 

after 


tetter  XXI.  Article  3^.  619 

after  diforders  of  this  kind.  You  have  alfo  feen  a  little  injury  in  the  pleura  : 
in  the  diaphragm,  likewifc,  I  have  fometimes  feen  marks  of  diforder  (<£), 
when  a  peripneumomc  patient  had  been  delirious :  and  often  water  in  the 
thorax:  but  much  more  frequently,  polypous  concretions  in  the  heart,  and 
adjoining  veflels.  Yet  one  and  the  other  of  thefe  may  certainly  be  wanting 
in  this  cafe;  as  fo  great  a  quantity  of  ferum  has  been  difcharg’d  by  ftool, 
and  as  there  was  no  polypous  cruft  on  the  blood,  that  had  been  taken  from 
the  patient,  when  living. 

The  thorax,  after  having  faid  thefe  things,  was  immediately  open’d  be¬ 
fore  them  all,  and  contain’d  no  water.  Both  lobes  of  the  lungs  were  turgid 
on  their  anterior  furface,  and  had,  alfo,  their  natural  foftnefs,  and  colour, 
in  that  place  :  but  on  their  pofterior  and  inferior  furface,  and  in  the  left  fide, 
on  almcft  the  whole  lateral  furface,  adher’d  clofely  to  the  parietes  of  the 
thorax.  Wherever  the  lungs  had  adher’d,  there  the  pleura  was  unequal, 
and  at  the  back  was  blackiih,  and  in  the  left  fide  was  much  thicken’d,  and 
not  of  a  natural  colour.  The  diaphragm  alfo,  both  in  the  fieflby  and  tendi¬ 
nous  parts  of  it,  to  which  the  lungs  had  been  connected,  was  of  a  brown 
colour,  intermix’d  with  rednefs,  and  had  its  blood  veflels  much  more  diftindfc 
than  ufual.  The  lungs,  being  taken  out,  were  very  heavy,  and  in  their 
whole  pofterior  and  lower  furface,  of  a  black  colour,  the  blacknefs  penetrat¬ 
ing  deeply  into  the  hard  and  compadt  fubftance,  which  was  found,  on  the 
left  fide,  to  be  more  hard,  compadt,  and  denfe,  to  a  confiderable  extent ; 
whereas,  on  the  anterior  part,  particularly  on  the  right  fide,  a  foft  and  rare 
fubftance  occurr’d,  and  that  was  of  a  rofy  colour,  when  cut  into  with  the 
knife.  In  the  pericardium  was  a  little  more  water  than  ufual.  The  veflels 
proper  to  the  heart,  efpecially  on  its  flat  furface,  were  turgid  with  blood. 
So  alfo  both  the  venas  cavas,  and  the  right  auricle,  were  diftended  with  blood. 
And  this  blood  was  extremely  black;  but  without  any  polypous  concretions: 
which  were  neither  found  in  the  ventricles  of  the  heart,  nor  any  where  in 
the  veflels :  yet  in  this  blood  there  was  a  kind  of  a  femicoagulum,  but  this 
in  fmall  quantity. 

The  belly  alfo  being  open’d,  on  account  of  the  diarrhea,  ftiow’d  Tome 
parts  of  the  fmall  inteftines  to  be,  in  a  manner,  inflam’d.  But  the  colon, 
which  immediately  came  into  fight,  in  confequence  of  its  being  fomewhat 
tumid  with  air,  was  in  its  proper  fituation,  except  that  from  the  middle  of 
that  tradt,  through  which  it  is  generally  carried  tranfverfely,  it  was  infledted 
downwards  to  the  navel,  from  whence  it  mounted  upwards  again,  buc  not  to 
any  confiderable  height.  The  liver  was  internally  and  externally  pallid,  and 
its  bladder  was  empty,  or  at  leaft  contain’d  but  a  very  few  drops  of  bile, 
which  being  daub’d  upon  paper,  ting’d  it  with  a  kind  of  yellow,  brown,  and 
dirty  colour.  The  fpleen  was  both  bigger,  and  more  lax,  than  it  us’d  to  be. 

The  difledtion  of  the  cranium,  by  reafon  of  other  obfervations  coming  in 
between,  was  deferr’d  to  the  fifth  day :  fo  that  for  this  reafon,  perhaps,  I 
found  all  the  parts  of  it  more  lax.  In  one  furface  of  the  falciform  procefs 
of  the  dura  mater,  was  a  bone  of  an  irregular  figure,  but  fmooth  rather  than 
rough,  not  very  thin,  and  in  its  fize  not  equal  to  that  of  the  nail  of  the  little 


( b )  Epift.  7.  n.  13. 
4  K  2 


finger. 


6  2  0  Book  II.  Of  Difeafes  of  the  Thorax. 

finger.  Under  the  pia  mater,  in  the  convolutions  of  the  cerebrum,  was 
fomething  like  jelly  :  and  in  this  membrane,  the  greater  part  of  the  larger 
blood-veffels,  and  the  lmaller  branches  of  thefe  veflels,  were  very  turgid 
with  blood,  and  extremely  diftind,  in  feveral  places.  Thofe,  alfo,  of  the 
plexus  choroides  abounded  with  blood,  as  did  thofe  which  creep  through  the 
medulla  oblongata  :  nor  were  frequent  bloody  points  wanting,  wherever  you 
cut  into  the  medulla  of  the  brain. 

36.  A  young  man,  of  twenty-five  years  of  age,  and  of  a  palifh  com¬ 
plexion,  having  been  before  troubl’d  with  ftrumous  complaints,  and,  as  was 
laid,  having  labour’d  under  a  previous  lues  venerea,  was,  after  being  very 
hot  from  violent  exercife,  for  he  was  a  fervant,  feiz’d  with  a  fhiv’ring,  and 
fever,  attended  with  a  pungent  pain,  whch  he  laid  he  felt  in  almoft  his 
whole  bread,  properly  fo  call’d,  but  more  at  the  inferior  part.  He  had  pain 
alfo  in  his  back,  and  even  in  the  whole  circumference  of  his  body  ;  fo  that 
wherefoever  you  touch’d  it,  there,  he  would  fay,  the  pain  was  confiderably 
encreas’d  by  your  touch.  Pie  could  lie  down  in  no  pofture  but  on  his  back. 
His  pulfe  was  quick,  and  fmall  :  he  had  no  third  :  he  had  an  internal  heat : 
his  refpiration  was  difficult :  his  expectorated  matter  was  yellow  and  red. 
On  the  fourth  day,  he  had  fome  bilious  ftools  :  and  on  the  eighth  day,  after 
having  made  a  great  quantity  of  water,  and  been  moift  with  the  fweat  of 
death,  he  died  about  the  end  of  the  fame  day,  in  the  hofpital  at  Bologna, 
which  I  have  fo  often  mention’d,  in  the  middle  of  January,  in  the  year  1706. 

In  the  right  cavity  of  the  thorax  was  a  turbid  and  fnanious  ferum.  And 
in  both  of  them,  the  lungs  adher’d,  almoft  univerfally,  to  the  parietes,  even 
thofe  which  are  made  up  of  the  diaphragm  •,  but  the  left  lobe,  on  its  anterior 
l'urface,  by  filaments  only  *,  yet  this  lobe,  and  the  right  alfo,  in  almoft  their 
whole  circumference,  were  not  only  very  clofely  connected,  but,  in  fome 
meafure,  grown  into  one  fubftance,  as  it  were,  with  the  furrounding  fur- 
faces,  by  means  of  a  thick  kind  of  membrane  being  interpos’d.  This  mem¬ 
brane  was  white,  tenacious,  and  in  iome  places,  on  the  right  fide,  fcarcely 
lefs  than  half  the  thicknefs  of  the  ring  finger  ;  for  on  the  left,  it  was  much 
lefs  thick  and  white ;  and  follow’d  the  lungs,  which  we  were  oblig’d  to  pull 
away  with  violence.  Yet  if  you  feparated  this  very  membrane  from  the 
lungs,  which  was  eafy  to  do,  you  plainly  perceiv’d  that  their  membrane  lay 
beneath,  in  its  entire  and  uninjur’d  ftate.  For  which  reafon,  you  would  have 
faid  jt  was  the  pleura,  if  you  had  not  obferv’d  that  this  membrane  remain’d 
in  its  natural  fituation,  on  the  right  fide,  found  and  whole,  through  which 
the  neighb’ring  intercoftal  mufcles  were  feen,  and  they  rather  of  a  red  colour. 
Yet  on  the  right  fide,  in  the  place  of  the  pleura,  another  membrane  appear’d, 
fimilar  to  that  which  had  been  drawn  away  with  the  lungs  already,  except  that 
it  was  not  quite  fo  thick  ;  and  if  you  drew  away  this  other  membrane,  you 
then  faw  that  the  intercoftal  mufcles  appear’d  white  under  it  *,  fo  that  the 
pleura  might  feem  here,  indeed,  to  be  made  thicker  from  the  violence  of 
the  difeafe. 

But  be  this  as  it  will,  the  pleura,  where  it  cover’d  the  triangular  mufcle  of 
the  breaft,  on  the  right  fide,  was  certainly  half-corrupted,  and  was  torn  by  a 
flight  fn&ion  of  the  fingers.  This  mufcle  was  inflam’d  :  and  the  fleffiy  part 
of  the  diaphragm,  which  was  very  near,  on  each  fide,  to  its  center,  where  the 

lungs 


Letter  XXL  Article  37.  621 

lungs  had  adher’d,  feem’d  like  an  inflam’d  furface,  in  Tome  places.  But  the 
lungs  had  the  following  appearances :  the  left  lobe,  in  one  place,  fhevv’d  a 
white  fubftance,  confiding,  as  it  were,  of  tartarizated  granules,  but  in  all 
the  other  parts  of  it  almoft,  was  only  hard,  denfe,  and  heavy  *,  yet  the  lead 
fo,  on  its  anterior  furface.  But  the  right  lobe  was  even  more  hard,  denfe, 
and  heavy,  than  the  left. 

In  the  pericardium  was  water,  in  a  fomewhat  larger  quantity  than  ufual, 
and  turbid.  A  polypous  concretion  of  a  white,  and  yellowifli  colour,  but 
lax  in  its  confidence,  was  produc’d  from  the  right  ventricle  of  the  heart, 
through  both  the  orifices  of  that  cavity.  Nor  were  the  concretions  much 
unlike  this,  which  pafled  through  both  the  orifices  of  the  left  ventricle. 
Thofe  which  went,  from  hence,  into  the  pulmonary  vein,  and  from  the  right 
ventricle,  into  the  pulmonary  artery,  being  divided  into  branches,  imitated 
the  divifions  of  thefe  veflfels. 

The  belly  being  open’d,  the  domach  and  the  inteflines,  efpecially  the 
colon,  appear’d  to  be  much  didended  with  air.  The  lower  part  of  the 
fpleen  was  ting’d  with  a  peculiar  blacknefs,  jud  as  if  it  had  begun  to  dege¬ 
nerate  into  a  gangrene,  from  inflammation  :  and  this  blacknefs  continu’d  to 
the  depth  of  an  inch  and  a  half.  On  the  other  hand,  the  liver  was  whitilh, 
and  at  the  fame  time  very  large :  and  in  the  gall-bladder,  together  with  a 
little  bile,  which  was  of  a  white  colour,  degenerating  into  yellow,  I  found 
more  than  threefcore  and  ten  calculi,  the  larger  ones  of  which,  being  in. 
number  very  few,  did  not  exceed  a  bean  in  magnitude,  whereas  the  lead' 
were  not  lefs  than  a  pepper  corn :  the  former,  in  fome  meafure,  approach’d 
to  the  figure  of  an  oval,  but  deprefs’d  in  one  part  •,  and  the  others,  in  great' 
meafure,  refembl’d  a  cubical  figure.  Internally,  they  were  moifl  with  bile, 
and  feem’d  to  be  made  up  of  a  kind  of  granules.  This  conftrudtion  wasj 
Ihut  up,  on  all  fides,  by  a  double  cruft  at  leaft,  which  was,  in  moft  places,- 
greenifh,  but,  in  fome,  partly  white.  All  of  them  preferv’d  the  flame  which 
they  had  once  caught,  and  lparkl’d  now  and  then,  with  a  kind  of  flight 
crackling  noife.  The  right  kidney  was  very  lax.  The  trunk  of  the  great- 
artery,  both  in  the  belly,  and  from  thence,  through  the  thorax,  quite  to  the? 
curvature,  feem’d  to  be  narrow,  in  proportion  to  the  fize  of  the  body,^ 
which  was  in  other  refpedts  pretty  large,  and  of  the  greater  part  of  the* 
vifcera.  The  head  I  did  not  touch. 

37.  It  has  never  happen’d  to  me,  to  fee  a  greater  injury  of  the  pleura* 
in  inflammations  of  the  thorax,  than  is  related  to  you  in  this  hiftory,  which 
I  purpofely  referv’d  to  the  laft  place.  Now,  which  do  you  believe,  that 
this  young  man  died  of  the  injury  of  the  pleura,  or  the  inflammation  of  the 
lungs  that  was  join’d  with  it?  If  you  read  over  again  all  the  obfervatio’ns 
both  of  Valfajva  and  mine,  and  compare  them  with  thofe  of  other,  not 
only  ancient,  but  modern  phyficians,  whom  I  (hall  mention  below,  you  will 
readily  perceive,  that  it  is  far  more  ealy  for  us  (if  it  was  abfolutely  necef- 
fary  to  follow  one  or  the  other)  to  agree  with  the  opinion  of  thofe,  who  teach 
that  a  mortal  pleurily  confifts  in  the  inflammation  of  the  lungs  only,  which 
I  have  often  feen,  than  with  the  opinion  of  thofe,  who  fay  that  it  confifts  of 
the  inflammation  of  the  pleura  only,  which  I  never  found.  And,  indeed, 
Hippocrates,  to  pafs  over  Praxagoras,  Herophilus,  and  Euriphontes  Gnidius, 

who* 


622  Book  IT.  Of  Difeafes  of  the  Thorax. 

who  was,  perhaps,  older  than  Hippocrates,  and  others,  who,  according  to 
the  teftimony  of  Cselius  Aurelianus (r),  as  he  alfo  produces  their  arguments, 
taught,  44  that  in  pleuritic  patients  the  part  affiedted  was  the  lungs ;”  Hip¬ 
pocrates,  I  fay,  in  the  book  entitled  De  locis  in  homine  (d)9  not  only  exprefsly 
places  the  feat  of  a  peripneumony  in  the  lungs,  but  of  a  pleurily  alio ;  that 
is,  of  the  latter,  when  one  part  of  this  vifcus  is  tumefied,  from  a  quantity 
of  hot  humour  flowing  into  it;  and  of  the  former,  when  both  parts  of  it  are 
affedted  in  this  manner.  I  do  not,  however,  contend  that  this  diftindtion 
fhould  be  recall’d  into  ufe  :  I  only  fay  this,  that  it  was  better  (as  Demetrius 
Herophilus  (e)  had  done)  to  make  ufe  of  it,  than  to  make  obfcure  what 
truth  there  was  in  this  paffage,  on  account  of  other  paffages  in  Hippocrates. 
Yet  whether  Martianus  has  done  this,  I  (hall  not  enquire  here.  But  you  may 
fee,  even  in  the  Sepulchretum  itfelf  (/),  when  he  difputed  of  this  fame  paf¬ 
fage  of  Hippocrates,  whether  he  with  juftice  affirm’d,  contrary  to  Jouber- 
tus(g),  in  dependance  upon  44  his  having  open’d  an  infinite  number  of  bodies, 
44  that  it  rarely  happens  for  one  part  of  the  lungs  to,  be  inflam’d,  while  the 
44  other  remains  unhurt,”  or  44  that  the  pain  does  not  arife  on  account  of 
44  the  lungs  being  inflam’d,”  but  of  the  fide  :  and  although  he  has  objedted 
to  the  obfervations  of  thofe,  who  afferted  their  44  having  always  found  the  lungs 
44  to  be  injur’d  in  a  pleurify although  he  has  objedted,  I  fay,  that  it  was 
not  to  be  wonder’d  at,  if  they  oblerv’d  this  at  44  Rome,”  where  44  the  pleu- 
44  rifles  and  peripneumonies  are  almoft  all  of  the  number  of  thofe  of  which 
44  mention  is  made  in  this  paffage  of  Hippocrates ;”  he,  neverthelefs,  imme¬ 
diately  fubjoins,  44  that  carcafes  of  pleuritic  patients  are  obferv’d  every  day 
44  at  Rome,”  in  the  hofpital  of  the  Holy  Ghoft,  that  is  to  fay,  of  fuch  per- 
fons  as  are  brought  in  thither  44  from  the  country  about  Rome,  in  whom  the 
44  fide  is  found  to  be  injur’d,  and  corrupted,”  without  making  any  mention 
of  the  lungs.  But  I  would  have  you  call  to  mind  thofe  obfervations  which 
Hoffman  (h)  fpeaks  of,  about  thele  times,  as  being  made  by  Petrus  Servius, 
in  the  fame  hofpital  of  the  Holy  Gholt,  44  even  in  three  hundred  bodies  of 
44  pleuritic  patients,”  in  which  he  44  always  faw  a  lobe  of  the  lungs  to  be 
44  affedted,  and  fill’d  with  matter;  and  the  pleura  either  not  at  all  injur’d, 
44  to  the  appearance  of  the  fenfes,  or  only  (lightly  afledted  in  fome  meafure.” 
Then  fee  how  much  more  all  our  obfervations  agree  with  thefe,  than  with 
the  former  ;  which  certainly,  left  Martianus  excite  any  fcruple  in  your  mind, 
were  made  in  different  places,  and  at  different  times.  The  fame  will  fhew, 
feparately,  and  not  as  Joubertus  does,  in  general,  whether  it  be  more  rare, 
that  one  only,  or  that  both  lobes  of  the  lungs,  are  inflam’d;  and,  in  like 
manner,  whether  the  pungent  pain  be  always  owing  to  the  inflammation  of 
the  fide.  Which  is  not  only  found  not  to  be  inflam’d,  at  fome  times,  but 
even  is  then  found  not  to  have  any  connedtion  with  the  inflam’d  lungs  :  a 
circurnftanee  that  differs,  in  many  refpedts,  from  the  obfervations  of  Die- 
merbroeck  (/),  and  but  little  agrees  with  the  determinations  of  fome  more 

(<r)  Acut.  PafT.  1.  2.  c.  1 6.  (g)  Se£t.  each  Obf.  24. 

( d)  N.  24.  {b)  Medic.  Rat.  Tom.  4.  P.  1.  S.  2.  c.  6. 

{  )  Apud  eund.  Ccelium,  I.  cit.  c.  25.  §  2. 

(f)  Schol.  ad  §  5.  Obf.  14  hujus  Sed:.  (/)  Vid.  Epift.  20.  n.  58. 


modern 


Letter  XXL  Article  38.  623 

modern  writers,  as  you  are  not  ignorant.  And  if  you  look  to  fome  of  our 
observations,  defcrib’d  to  you  in  the  Sixteenth  letter  (£),  you  will  find,  that 
the  pleura  was,  fometimes,  not  quite  free  from  inflammation,  and  yet  there 
was  no  pain  in  the  fide  ;  to  omit  enquiring  here,  whether  the  pleurifies 
“  without  a  pundorious  pain  of  the  fide,”  obierv’d,  according  toEtmuller(/)) 
by  more  than  one  author,  are  evidently  to  be  referr’d  to  this  clafs. 

38.  But  now,  if  you  attend  to  all  our  observations,  and  thofe  of  Servius, 
at  the  fame  time,  you  will  immediately  underhand  how  eafily  you  may  affent 
to  the  opinion  of  thofe,  who  think,  that,  in  a  mortal  pleurify,  “  the  pleura 
“  alone  is  frequently  inflam’d,”  the  lungs  themfeives  being  unhurt;  although 
Sydenham  Seems  to  be  of  their  opinion  (m),  as  he  thinks,  “  that  the  peccant 
“  matter  is  depoflted  upon  the  pleura,  and  fometimes  alfo  on  the  lungs.’*' 
But  how  differently  have  thofe  phyficians  judg’d,  who  have,  even  formerly, 
invefligated  by  anatomy,  what  happens  raoft  frequently  ;  as  Coiterus  («),  for 
inflance,  whole  whole  words  I  lhall  copy  here,  not  only  becaufe  they  agree 
with  our  observations,  but  alfo  becaufe  I  have  look’d  for  them  in  this  fedion 
of  the  Sepulchretum  without  effed.  “  In  the  autumn  of  the  year  of  our 
“  Lord  1 563,  coughs,  peripneumonies,  and  malignant  pleurifles,  Spread  all 
<c  over  Italy,  like  epidemical  difeafes,  and  deftroy’d  great  numbers ;  and  in 
“  the  bodies  that  I  diffeded,  I  found  the  lungs,  as  it  were,  univerfally  turgid 
“  with  blood  half-putrefied,  and  indurated  to  a  Surprizing  degree.  That 

Space  of  the  thorax  which  was  not  fill’d  up  by  the  lungs,  was  full  of  a 
tc  water  not  unlike  that  which  has  been  us’d  to  wafli  away  blood  :  and  the 
“  heads  were  fill’d  with  a  great  quantity  of  limpid  water.”  You  fee,  that, 
although  he  mentions  other  things,  he  does  not  mention  the  pleura.  But 
you  may,  in  return,  objedt  Vefalius  (0)  to  me,  who  is,  in  like  manner,  taken 
no  notice  of  in  the  Sepulchretum,  and  who,  when  Speaking  of  two  women, 
one  of  whom,  he  conjedur’d,  “  had  died  of  a  pain  in  her  fide,”  and  the 
other  “  of  an  inflammation,  on  the  third  day,”  makes  mention  of  the 
pleura,  but  not  of  the  lungs.  For  he  writes,  that,  in  the  former,  “  the  in- 
«  flammation  had  occupied  almoft  the  whole  left  fide  of  the  membrane  which. 
«  Surrounds  the  ribs  internally,  but  particularly  at  the  root  of  the  ribs.’* 
And  in  the  latter,  <c  that  it  had  occupied  the  whole  pofterior  part  of  the 
u  thorax,  at  the  entrance  of  the  vena  fine  pari,  and  according  to  the  diftri- 
“  bution  of  its  branches,  and  had  afforded  him  an  excellent  Specimen,  in 
“  order  to  diftinguilh  the  effential  properties  of  a  difeafe  of  this  kind  in  the 
«  fide.”  I  will  not,  however,  on  this  occafion,  Say,  that  Vefalius,  who  was 
then  engag’d  about  another  fubjed,  and  mention’d  thefe  things  only  by  the 
way,  might  have  So  much  the  more  eafily  omitted  to  mention  the  injury  of 
the  lungs,  as  at  that  time  this  controversy  was  leSs  agitated  :  but  if  you  will 
have  it,  that  the  lungs,  in  thefe  two  women,  were  unhurt,  I  will  grant  it 
you,  provided  you  at  the  fame  time  grant  me  alfo,  that  in  all  thofe  whom 
Coiterus  points  out,  and  certainly  in  much  greater  number,  the  pleura  was 
without  injury,  or,  at  leaft,  had  only  Such  a  one  as  might  be  eafily  negleded,, 


(*)  N.  30,  31,  40. 

(/)  Prax.  I.  1.  S.  18.  art.  9. 

(m J  Obf.  Med.  circa  Morb.  acut  S.  6.  c.  3. 

6 


©r 


(«)  Obf.  Anat. 

(0)  Epift  de  Rad.  Chy  n. 


6  2  4  Book  II.  Of  Difeafes  of  the  Thorax. 

or  overlook’d.  And  here  we  enquire  what  happens  in  general ;  not  what 
Sometimes  happens.  Nor  indeed  have  I  denied  in  the  former  letter  (/>),  that 
fome  obfervations  now  and  then  happen,  which  are  fimilar  to  thofe  of  Vefa- 
lius.  And  even  fo  far  from  this,  that  I  would  have  added  another  obferva- 
tion,  of  Harderus  (y),  for  inftance,  which  is,  in  like  manner,  omitted  in  this 
fedtion  of  the  Sepulchretum,  if,  befides  that  there  was  another  caufeof  death, 
in  the  cortical  part  of  the  brain,  which  was  purulent,  he  had  not  fhown  a 
want  of  clearnels,  and  precifion,  in  making  out  the  firuation  of  a  quantity 
of  pus,  which  he  found  extravafated  into  the  cavity  of  the  thorax ;  for  fitu- 
ations  of  this  kind  ought  to  be  accurately  defin’d,  nor  is  the  fame  purfe,  or 
bag,  in  which  pus  is,  or  has  been,  contain’d,  to  be  at  one  time  referr’d  to 
the  pleura,  and  at  another  time  to  the  lungs,  according  to  the  pleafure,  as  it 
were,  of  the  obferver  j  though  we  fee  this  to  be  fometimes  done.  The  ob¬ 
fervations,  therefore,  upon  which  no  doubt  falls,  of  very  confiderable  and 
grievous  injuries  of  the  pleura  in  a  pleurify,  without  the  lungs,  being  affeft- 
ed,  1  do  not  deny  -,  but  I  fay  that  they  are,  without  doubt,  very  rare,  if  they 
are  compar’d  with  the  immenfe  number  of  thofe,  which  Coiterus  and  Ser¬ 
vius  have  made,  and  Barthol.  Vicarius  (r),  who  obferv’d  the  fame  thing  as 
Servius,  in  twenty  pleuritic  bodies,  and  Gagliardi  (j),  who  took  care  to  have 
bodies  of  pleuritic  patients  difledted,  to  about  the  number  of  thirty,  and 
Nannius(/),  and,  to  fay  nothing  here  of  myfelf,  or  of  others,  whom  I  fliall 
mention  below,  in  fine,  Valfalva,  who  difledted  a  great  number.  Nor  did 
2ny  one  of  thefe  ever  light  on  a  very  confiderable  injury  of  the  pleura,  or  to 
any  great  extent,  at  the  fame  time  that  they  found  the  lungs  to  be  unhurt, 
r.otwithftanding  they  made  fo  great  a  number  of  difiedtions. 

39.  And  indeed,  the  inflammation  of  the  pleura,  join’d  with  an  inflam¬ 
mation  of  the  lungs,  is  not  fo  frequently  found  in  difledted  bodies,  as  fome 
gentlemen,  in  other  refpedts  very  learned,  feem  to  imagine.  But  whether 
this  be  true,  or  not,  can  be  only  properly  determin’d,  when  a  great  feries  of 
obfervations  is  taken  into  confideration.  And  if  you  well  weigh  what  has 
been  faid  by  Coiterus,  Servius,  and  Vicarius ;  you  will  have  a  great  number 
of  obfervations  to  add  to  thofe  of  Valfalva,  and  to  mine.  To  which  you 
v/ill  alfo  add,  befides  others,  thefe  that  are  read  in  the  Sepulchretum.  Zwin- 
ger  («)  and  Dilenius  (x)  faw  the  lungs  pretty  hard,  and  already  afledled  with 
a  gangrene  ;  and  when  they  defcrib’d  the  other  parts,  which  were  difeas’d  in 
thofe  bodies,  do  not  fo  much  as  mention  the  pleura ;  and  the  firfi:  exprefsly 
adds,  that  the  lungs,  in  a  patient,  who,  with  an  intolerable  pungent  pain  in 
the  fide,  had  cough’d  up  a  great  quantity  of  blood,  “  were,  neverthelefs,  no 
“  where  connected  to  the  pleura  and  another  had  been  carried  off  by  an 
exquifite  pleurify,  which  degenerated  into  a  peripneumony.  Lanzonus  alfo  {y) 
found,  in  the  body  of  a  perfon  who  died  of  a  violent  pleurify,  an  abfcefs  of 
the  lungs  “  which  had  been  the  caufe  of  the  difeafe,  and  death  of  the  pa- 
“  tient  j”  but  not  one  word  of  the  pleura.  And,  indeed,  in  the  epidemical 

(/)  n*  57*  5^-  (/)  Vid.  Epift.  20.  n.  57. 

(7)  Apiar.  Obf.  53.  (a)  Eph.  N.  C.  Dec.  3.  A.  5.  Obfi  S. 

(r)  Vid.  in  Obf.  87.  Cent.  1.  N.  C.  (x)  Ead.  Dec.  A.  10.  Obf.  241. 

(s)  cit.  fupra,  ad  n.  28.  (y)  Ibid.  A.  5.  Obf.  122. 


conftitution 


Letter  XXI.  Article  39.  625 

cfonftitution  of  the  fame  year,  as  from  the  fymptoms  of  a  pleurify,  the  greater 
part  of  the  phyficians  judg’d  the  pleura  to  be  inflam’d,  others  difputing 
againft  it;  he  having  open’d  a  body,  “  in  order  to  determine  this  great  dif- 
“  pute(2),”  found  one  lobe  of  the  lungs  affected  with  an  eryfipetalous  inflam¬ 
mation,  tumefied,  and  of  a  yellow  colour,  with  fpots,  but  “  without  any  in- 
tc  jury  of  the  pleura.” 

The  celebrated  Fifcher  alfo  (a),  in  another  epidemic  ftate  of  air,  having 
open’d  a  body,  that  he  might  lee  “  what  was  to  be  determin’d  in  regard 
“  to  the  controverfy,  fo  warmly  agitated  by  fome  perfons,  concerning  the 
“  feat  of  inflammation,”  lays,  that  he  found  no  other  appearance  than  the 
inflammation  of  the  right  lobe  of  the  lungs,  and  polypous  concretions  in 
the  larger  pulmonary  veflfels.  Nor  does  the  molt  excellent  Gefner,  in  that 
conftitution  I  mention’d  above  (b)9  which  was  fallacious  indeed,  but  not 
without  a  puntftorious  pain  in  the  fides,  or  under  the  fcapula,  after  having 
difledted  feveral  bodies,  relate,  that  he  found  any  injury  of  the  pleura  ;  not- 
withftanding  he  fays,  that  he  found  the  lungs  to  be  inflam’d,  and  otherwife 
difeas’d,  both  internally  and  externally.  Finally,  to  omit  others,  I  cannot 
pafs  by  the  illuftrious  Haller  (c),  who,  although  he  has  given  us  four  obfer- 
vations  of  his  own,  made  upon  the  pleurify,  and  peripneumony,  yet  in  one 
only  of  them,  he  has  faid,  “  that  there  were  marks  of  inflammation  in  the 
“  pleura but  in  all  of  them,  he  fays,  that  the  lungs  were  either  difeas’d 
with  a  great  abfeefs,  or  had  their  weight  and  bulk  much  encreas’d,  from 
blood,  that  had  diftill’d  into  their  vehicles,  and  cells,  or  from  a  white  hu¬ 
mour,  that  was  forc’d  into  their  *fub fiance  ;  and  that  they  were  partly  hard 
and  folid,  which,  as  I  have  fhown  you  above  (d)>  frequently  happens  in  the 
inflammations  of  this  vifeus.  And  this  ftate  of  the  controverfy  being  con- 
fider’d,  you  very  weli  perceive,  that  the  inflammation  of  the  pleura,  join’d 
with  an  inflammation  of  the  lungs,  is  lefs  frequently  to  be  found,  than  a 
phyfician  of  our  age,  who  was  defervedly  very  eminent,  feem’d  to  believe, 
when  he  faid,  “  that  a  peripneumony  rarely  began  alone,  but  that  it  fuc- 
“  ceeded  to  a  pleurify,  and  paraphrenitis.”  Which  words  call  to  mind  the 
paflage  of  Hippocrates,  that  is  thus  render’d  into  Latin  by  Duretus  (<?) : 
Peripneumonia  pleuritidis  fuccedanea ,  tutior  eft  primiginia  ;  “  A  peripneumony 
“  that  comes  after  a  pleurify,  is  lefs  dangerous  than  when  it  is  the  original 
“  dileafe which  paflage  has  much  tortur’d  the  wits  of  the  interpreters, 
and  phyficians,  not  only  for  other  caufes  mention’d  by  Caelius  Aurelianus (/), 
and  Ballonius  (g),  but  particularly,  becaufe  it  is  written  in  the  aphorifms  (h) : 
A pleuritide peripneumonia  malum :  “  A  peripneumony  after  a  pleurify  is  bad.’* 
And  Martianus,  indeed  (/),  and  Senertus(l),  to  whom  others  perhaps  might 
feem  to  be  too  bold  in  their  alterations,  and  emendations  of  the  text,  have 
thought  of  a  method  by  which,  without  making  any  change  in  the  words, 
they  fuppos’d  that  the  paflage  might  be  very  properly  underftood,  if,  aa 


(«}  Ibid.  Obf.  1  zo. 

{a)  Cent.  9.  N.  C.  Obf.  80. 

(£)  n.  14. 

(c)  Opufc.  Pathol.  Obf.  13.  St  feqq. 

(d)  n.  20. 

(<?)  Coacar.  Pr<enot.  1,  2.  c.  16,  n.  28. 

Vgl.  I. 


(f)  Acut.  Morb.  1.  2.  c  25. 

(g)  Annot.  6.  ad  Confil.  27.  I.  1. 

(h)  Se£l.  7.  Aph,  1 1. 

(/)  Ad  Coac.  Sed.  2.  n.  277. 

F)  Medic.  Prad.  1.  2.  P.  2.  c.  16. 


4 


Sencrtus 


6 1 6  Book  XL  Of  Difeafes  of  the  Thorax, 

Senerlus  fays,  we  confider,  that  when  a  part  of  the  peccant  matter  having 
been  previoufly  depofited  upon  the  pleura  and  parietes  of  the  thorax,  the 
remainder  is  not  only  of  confequence,  lefs  in  its  quantity,  but  is  alfo  carried 
with  lefs  impetus  into  the  lungs ;  or  if,  as  Martianus  fuppofes,  the  word 
be  not  underftood  in  fuch  a  fenfe,  as  to  fignify  that  the  peripneu- 
monies  are  more  fafe,  or  lefs  dangerous,  which  is  generally'  fuppos’d  by  the 
commentators,  but  that  they  are  more  fiable ,  that  is,  lefs  mutable  into 
any  other  diforder.  But  I  am  prevented  from  following  the  firft  of  thefe  in¬ 
terpretations,  by  the  aphorifm  juft  now  mention’d,  becaufe  I  do  not  fee, 
how  I  can  fufficiently  reconcile  the  one  with  the  other :  and  1  am  prevented 
from  following  the  other,  by  the  conftant  ufe  of  this  word,  and  thofe  of  a 
fimilar  kind,  in  the  Coaca  Praenotiones^  where  they  do  never,  as  far  as  I  have 
been  able  to  fee,  fignify  a  greater  liability,  but  a  greater  fecurity,  that  is  lefs 
danger  (/).  And,  thefe  things  being  fo,  it  came  into  my  mind  fome  time 
ago,  to  enquire  whether  it  might,  perhaps,  be  allow’d  us  to  caft  off  from 
the  word  in  queftion,  that  firft  letter,  which  has  the  force  of  a  privative,  as 
if  it  had  been  added  by  the  carelefsnefs  of  copyifts  or  librarians ;  fo  that  by 
means  of  a  change,  which  is  the  leaft  that  is  poffible,  as  the  cafe  feems  to 
require,  we  fhould  not  read,  as  we  do  at  prefent,  that  thofe  peripneumonies 
which  fucceed  to  a  pleurify,  are  more  fafe,  but  that  they  are  more  dange¬ 
rous  :  or  if  this  could  not  be  allow’d  us,  whether  we  might  not  follow  the 
reconciliation  propos’d  by  Petit  (/»),  or  at  leaft  approv’d  by  him ;  I  mean,  to 
underftand  the  aphorifm,  of  the  peripneumony  which  is  added  to  a  perfifting 
pleurify ;  and  the  paffage  of  the  Coaca  Praenotiones ,  of  the  peripneumony  into 
which  a  pleurify  is  chang’d.  But  you  will  fee,  whether  thofe  two  peripneu¬ 
monies  are  compar’d  together,  in  that  paffage,  or  whether  this  other,  into 
which  a  pleurify  is  chang’d,  is  compar’d  with  that,  which  is  the  original  dif¬ 
order.  And  if  it  be  fo,  as  it  evidently  is,  we  then  revert,  without  doubt, 
to  this  enquiry,  what  can  be  the  reafon,  that  Hippocrates  pronounces  thofe 
peripneumonies  which  happen  to  patients  that  are  already  debilitated  by 
a  pleurify,  and  the  cure  of  it,  to  be  more  fafe  than  thofe  which  attack  ftrong, 
robuft,  and  healthy  men,  without  any  preceding  pleurify  ?  For  you  will 
fee  in  Ballonius  (#),  that  the  former  are  judg’d  to  be  “  mortal and  that 
not  from  reafoning  only,  or  the  authority  of  Galen,  but  alfo  from  examples, 
which  he  produces,  of  the  death  of  “  the  queen  of  Navarre,”  from  that 
caufe,  and  of  “  Madame  Dupuy to  which,  phyficians  have  fince  added 
many,  and  many  other,  fatal  examples,  and  not  long  ago,  our  celebrated 
Gianella  (o) :  fo  far  am  I  from  being  able  to  believe,  that  thofe  peripneumo¬ 
nies,  if  we  take  into  confideration  what  more  frequently  happens,  are,  uni- 
verfally,  “  more  fafe  than  thefe  diforders  when  original.” 

40.  But  to  return  from  thefe  peripneumonies  which  fucceed  to  a  pleurify, 
to  thofe  which  are  join’d  together  with  it,  although  thefe  do  not  happen  very 
often,  as  you  have  already  fufficiently  feen,  yet  that  they  do  now  and  then 

I 

( l )  Vid.  apud  Duret,  cit.  cap.  n.  17.  cui  (/»)  Comment,  in  Aret,  de  Morb.  Acut.  1. 
adde  n.  16.  &  cap,  17.  n.  1.  Adde  cap.  15.  n.  1.  c.  10. 

4.  &  1.  1.  n.  149.  (»)  Annot.  6.  cit. 

(0)  De  Succeff,  Morb.  1.  2.  c.  6. 


occur, 


Letter  XXI.  Article  40,  6  27 

occur,  not  only  my  obfervations,  but  the  obfervations  of  others,  demonftrate. 
At  kali:,  it  is  very  certain,  that  thofe  very  rarely  occur,  with  which  a  violent 
inflammation  of  the  pleura  is  join’d.  Even  that  fellow-citizen  of  mine,  Vin¬ 
cent  Baronius,  is  a  witnefs,  in  preference  to  others,  who  wrote  a  volume  ex- 
prefsly  on  the  fubjedt  of  thefe  two  diforders  being  join’d  together,  and  firfl: 
gave  the  name  of  pleuripneumony  to  both,  or  at  leaft  fo  confirm’d  it,  that 
it  is  now  confider’d  as  the  moll  proper,  by  fome  of  the  1110ft  modern  phy- 
ficians  :  and  I  do  not  know,  why  his  obfervations,  which  have  been  printed 
ever  fince  the  year  1636,  have  not  been  copied  into  this  fedtion  of  the  Se- 
pulchretum,  especially  as  fome  other  obfervations,  befides  what  I  pointed  out 
above  (/>),  are  not  only  fet  down  once,  but  twice ;  as,  for  inftance,  thofe 
which  are  found  to  be  the  lame,  both  in  article  the  feventh,  obfervation  the 
ninth,  and  article  the  fecond,  obfervation  the  fortieth  ;  and  thofe  all'o  which 
you  have  in  the  laft  fcholium  to  obfervation  the  thirty-third,  and  in  the  ninth 
article  of  the  appendix  to  obfervation  the  twenty-fifth  •,  and  thofe  which  are 
in  the  fourth  article  of  this  appendix,  and  in  the  fecond  of  the  fcholium  to 
obfervation  the  thirty-eighth.  Baronius,  then  (q),  having,  at  a  time  when  the 
pleuripneumony  was  fpread  about  epidemically  in  our  regions,  difledled  three 
bodies  that  died  of  this  difeafe,  in  the  hofpital  of  his  native  place,  could 
“  find  no  traces  of  inflammation,  or  tumour,  in  the  membrane  that  covers 
“  the  ribs,  internally,  or  any  abfcefs  in  their  fide,  except  in  one  woman,” 
in  whom,  however,  he  did  not  find  this  membrane  inflam’d,  but  “  tabid 
fo  that  it  follow’d  the  clolely- adhering  lungs,  when  they  were  pull’d  away. 
And  from  the  defcription  of  the  difeafe  of  each  feparate  perfon,  which  he 
premifes  to  the  difledtion,  it  appears,  that  all  of  them  had  been  tormented 
with  an  acute  and  pungent  pain  of  the  fide :  and,  indeed,  he  has  fubjoin’d 
to  thefe  the  obfervations  of  Platerus,  and  Zecchius,  as  being  fimilar  to  his ; 
the  firfl:  of  whom  found  “  only  a  livid  fpot  ”  in  the  pleura  of  two  pleuritic 
patients,  and  the  lungs  themfelves,  which  were  affix’d  to  it,  to  be  rather  af~ 
fedted  with  difeafe ;  and  Zecchius  found,  in  many  bodies,  that  the  lungs,  and 
not  the  pleura,  were  injur’d,  as  you  will  even  find  obferv’d  in  the  Sepulchre- 
turn  (r);  although  in  his  laft  treadle  Pe  Lateris  Dolore ,  which,  as  it  is  fubjoin’d 
to  the  Methodus  de  Urinis ,  fo  alfo  is  prefix’d  to  that  Ccnfultatio  which  was  laft 
publiffi’d  at  Venice,  the  fame  Zecchius  writes,  that  in  pleuritic  bodies,  with 
a  great  diforder  of  the  lungs,  the  pleura  was  found  “  to  be  entirely  unin- 
“  jur’d,  at  fome  times,  but  fometimes  a  little  chang’d.”  To  this  add  Ja- 
cotius  (5),  whofe  words  are  thefe :  “  By  experience,  in  the  difledtion  of  pleu- 
“  ritic  bodies,  I  find  that  the  pleura  is  rarely  tumefied  and,  not  to  infift 
too  often  upon  the  difledftions  of  Valfalva,  and  mine,  add  thofe  three  hundred 
of  Servius  (/),  in  which  he  found  the  pleura  either  not  at  all  affedted  with 
difeafe,  or  “  only  flightly,  as  it  were,  tainted.”  But  as  you  will  believe, 
when  I  ffiew’d  above  (u)  the  rarity  of  extenfive  and  violent  injuries  of  the 
pleura,  where  the  lungs  are  found,  or  of  the  inflammation  of  that  membrane, 
join’d  with  the  inflammation  of  this  vifeus,  that  I  am,  at  leaft,  not  in  the 

(p)  N.  28.  (/)  Comment,  in  Hipp.  Coac:  Sett.  2. 1.  1. 

(q)  De  Pleuripneum.  1.  1 .  c.  1.  aphor.  1. 

(r)  Sett,  hac  Obf.  20.  §  29,  &  i.  (0  Supra  n  57,  («  N.  38,  39. 

4  L  2  number 


()  2  8  Book  II.  Of  Difeafes  of  the  Thorax. 

number  of  thofe  who  have  contended,  “  that  no  pleurify  is  excited  from  the 
“  membrane  which  covers  the  ribs,  internally,  being  inflam’d,”  moft  of 
whom  are  mention’d  by  the  celebrated  Titmannus  ( x ) ;  fo  here,  in  like  man¬ 
ner,  you  will  believe,  notwithftanding  I  demonftrate,  that,  in  the  difledlion 
of  a  great  number  of  bodies,  no  confiderable  inflammations  of  the  pleura 
were  join’d  with  an  inflammation  of  the  lungs,  that  I  do  not,  for  this  reafon, 
neceffarily  deny  this  cafe  ever  to  happen.  For  I  am  not  unmindful  of  thofe 
cafes  that  are  related  in  the  Sepulchretum :  and  to  them  I  can  add  others ; 
as  thofe,  for  inftance,  which  are  pointed  out  by  Gagliardi  (y),  and  that  in 
a  great  number  too,  where  the  inflammation  was  extended  from  the  lungs 
to  the  pleura  *,  or  when  Hoffman  (2)  fays,  that  he  had  feen  “  the  pleura  in- 
“  flam’d,  and  lphacelated,”  adhering  to  the  difeas’d  lungs  by  fmall  abfceffes. 
But  Hoffman  has  added  the  word  etiam  (as  if  he  had  feen  this  appearance 
fometimes  only)  after  having  faid,  in  general,  what  he  had  moft  frequently 
feen,  in  the  following  words  :  “  In  difiedtion  the  lungs  are  found  to  be  in- 
“  flated,  and  hard,  like  the  liver,  and  fall  to  the  bottom  in  water which 
he  alfo  confirm’d  by  a  very  clear  obfervation  (<2),  in  defcribing  their  vaft: 
weight,  diftenfion,  and  hardnefs,  becaufe  they  had  “  their  veficles  fluff’d  up, 
as  it  were,  with  a  thick,  red,  flefhy  fubftance :  and  though  he  omitted  no 
other  of  the  internal  parts  of  the  thorax,  he  did  not  fo  much  as  mention  the 
pleura.  And  Gagliardi,  having  differed  to  the  number  of  thirty,  as  is  faid 
above  (£),  in  fome,  found  the  fubftance  of  the  lungs  to  be  fo  chang’d  into 
the  likenefs  of  the  liver,  that  in  a  certain  chirurgical  Undent,  when  cut  in 
pieces,  they  could  not  be  diftinguifh’d  from  the  liver  of  the  fame  body  :  in 
others,  he  found  it  black  *,  and  in  fome,  promifcuoufly  affedted  with  both 
thofe  diforders,  the  Hrft  of  which  he  call’d  phlegmonofus ,  and  the  other  gan - 
gr<enofus.  The  moft  excellent  Senac  (c),  alfo,  though  he  fays,  in  general, 
that  the  fubftance  of  the  lungs  <c  was  indurated  in  pleurifies,  and  form’d  a 
“  mafs  like  to  the  fubftance  of  the  liver,”  yet,  in  another  place  (i),  excepts 
the  pleurifies  of  a  particular  conftitution  of  air,  in  which  he  accufes  “  a 
“  gangrenous  principle,”  and  relates  what  he  had  obferv’d  in  the  patients 
when  living,  and  in  their  bodies  after  death.  By  comparing  the  two  writers 
together,  you  will  fee  what  difference  there  was  betwixt  the  ftate  of  the 
difeafe  at  Paris,  and  at  Rome.  For  Gagliardi  afcribes  to  each  of  thofe  three 
diforders  their  peculiar  figns,  and  remedies.  But  as  he  pretty  clearly  (hews 
the  progrefs  of  the  phlegmonofe  kind  to  fuppuration,  in  thofe  who  had  died 
fomewhat  late  in  the  difeafe ;  fo  you  will  find,  that  perfpicuity  is  wanting  in 
the  defcription  of  the  gangrenous  kind,  and  of  that  which  is  compounded 
of  both  •,  for  it  is  not  poflible  to  conceive  from  thence,  whether  thofe  parts 
of  the  lungs,  which  were  feiz’d  by  a  gangrene,  had  been  afledted  with  a 
phlegmon,  or  with  an  eryfipelas,  or  with  neither  kind  of  inflammation.  And 
the  progrefs  of  that  liver  like  fubftance  into  fuppuration,  you  will  fee,  is 
alfo  remark’d  by  me,  both  in  this  ( e )  and  in  other  letters  (/)  •,  and,  in  like 


(x)  In  Procem.  Mechanifmi  venae  Azyg. 
Pleurit.  caufae. 

(y)  Cit.  fupra,  ad  n.  28. 

(«)  Cit.  ibid. 

(rz)  1.  in  Enarr.  Morb.  cap.  ibid,  cit» 


(l>)  N.  38. 

(c)  Traite  du  Coeur,  I.  4.  ch.  3.  n.  Zi. 

(d)  L.  3.  ch.  8.  n.  9. 

(e)  N.  17. 

(f)  Epift.6.  n.  11. 

manner* 


Letter  XXI.  Article  40.  62$ 

manner,  the  blacknefs  in  that  fame  hard  and  denfe  part(g)  :  and  that  Val- 
falva  had  feen  it  in  this  very  part,  when  he  defcrib’d  the  lungs  of  an  old 
man  (£),  as  being  “  black,  and  afieded  with  inflammation,  hard,  and  very 
44  compad,”  who  died  on  the  third  day  ;  and  when  he  defcribes  a  part  of 
the  lungs  of  a  woman  (/),  who,  during  the  time  of  her  diforder,  had  loft  all 
her  ftrength,  and  whofe  pain  afterwards  remitted,  44  as  being  brown  in  the 
44  indurated  lobe,  and  feiz’d,  in  fome  meafure,  with  a  fphacelus  $”  and  alfo 
when  he  defcribes  the  lungs  of  a  man  (£),  who  died  on  the  fifth  day,  as 
44  very  much  indurated,  verging  to  a  greenifh  colour,  and  diftinguifh’d  with 
44  black  fpots.”  But  Valfalva  never  found  the  lungs  of  peripneumonic  pa¬ 
tients,  as  far  as  I  know,  to  be  black,  except  where  they  were  indurated ; 
nor  I,  except  in  one  man,  of  whom  notice  is  taken  in  the  thirteenth  of  the 
Epiflolse  Anatomicae  (/)  *,  although  I  examin’d  them  in  a  curfory  manner,  as 
I  was  chiefly  attentive  to  the  head,  and  I  remember  that  they  were  exceedingly 
injur’d  :  but,  neverthelefs,  whether  this  blacknefs  was  from  a  gangrene,  or 
from  blood,  which  had  not  fo  thoroughly  ftagnated  in  their  veflels  as  is  re¬ 
quir’d  to  conflitute  a  gangrene,  I  have  no  remark  to  determine  :  nor  do  I 
underftand,  whether  they  were  hard,  or  relax’d  by  a  fphacelus,  and  foft, 
when  Lancifi,  in  that  epidemic  peripneumony,  at  Rome,  wrote  (m),  44  That 
44  the  precordia  were  red,  quite  to  the  diaphragm,  and  black  from  blood 
44  that  was  colleded  in  them  that  is,  as  he  fpeaks  below  (»),  44  red,  and 
44  attack’d  with  the  beginning  of  a  fphacelus.”  But  however  this  might  be ; 
do  all  thefe  diforders  of  the  lungs,  in  making  mention  of  which,  you  will 
perhaps  think  that  I  have  digrefs’d  from  my  purpofe,  feem  to  you  to  be  of 
fuch  a  kind,  that  if  they  be  fometimes  join’d,  even  with  violent  injuries  of 
the  pleura,  you  ought  to  impute  the  death  of  the  patients  to  the  latter,  ra¬ 
ther  than  to  the  former?  Certainly  it  did  not  feem  fo  to  Lancifi,  who  wrote 
to  me  (<?),  that  even  thofe,  in  whom  the  branches  of  the  vena  fine  pari,  on  the 
fide  that  was  firft  inflam’d,  44  had  form’d  themfelves  into  varices,  had  died 
44  from  a  violent  pleurify  ;  but  fuch  a  one,  as  degenerated  into  a  peripneu- 
44  mony,  and  an  inflammation  of  the  diaphragm.”  And  indeed  the  truth 
forc’d  thefe  words  from  Riverius  himfelf,  at  the  fame  time  that  he  defended 
a  contrary  opinion,  which  you  may  alfo  find  in  the  Sepulchretum  (y>),  and 
ought  to  be  fufficient  for  us :  I  mean,  44  that  very  violent  pleurifies,  which 
44  are  accuftom’d  to  bring  on  death,  for  the  molt  part  degenerate  into  a  perip- 
44  neumony.”  But  that*  very  excellent  phyfician  Trillerus  (q)  univerfally 
afierts,  that  in  a  true  pleurify,  44  not  only  the  pleura  is  affeded,  which  has 
44  been  hitherto  wrongfully  fuppos’d ;  but  that  the  fubftance  of  the  lungs 
44  themfelves  is  at  the  fame  time  infefted,  which  anatomy,  the  only  eye  of 
44  medicine,  has  very  clearly  prov’d  •,  and  that  there  is  no  fuch  thing  as  a 
44  true  acute  pleurify,  without  a  peripneumony.”  In  fine,  to  omit  others,  in. 
this  place,  it  will  be  fufficient  that  the  moft  experienc’d  anatomift,  Haller  (r)f. 


(g)  Supra,  n.  4,  &  24. 

(b)  Epift.  20.  n.  3,3;. 

(i)  Ibid.  n.  41. 

(k)  Ibid.  n.  45. 

(l)  N.  23. 

(m)  Epidenu  Rheum,  A.  1709.  c.  2.  n.  6. 


(»)  C.  4.  S.  1.  n.  7. 

(0)  Difi'ert.  de  Vena  fine  pari. 

(/>)  Se£t.  hac  Obf.  14.  §.  4. 

(^)  Vid.  Commere.  Litter.  A.  1741.  Hebd, 
2.  n.  2. 

(r)  Opufc,  Pathol.  Obf.  13. 


denies* 


S  3  ©  Boole  II.  Of  Difeafes  of  the  Thorax. 

denies,  “  that  it  ever  feem’d  to  him,  that  the  pleura  alone,  by  its  inflamma- 
.  “  tion,  had  deftroy’d  any  perfon.” 

41.  Nor  am  1  afraid,  left  while  I  am  detain’d  thus  long,  in  this  contro- 
verfy,  about  the  true  feat  of  pleurifies,  you  fhould,  perhaps,  in  imitation  of 
the  empirics,  with  whom  Galen  (j),  in  regard  to  this  queftion,  a&ed  very 
mildly,  think  that  I  make  all  this  parade  of  words  about  a  very  ufelefs  en¬ 
quiry.  For  if  the  dogmatifts,  at  that  time,  “  defended  themfelves  againft 
the  empirics  by  a  very  improper  anfwer  at  lead;  in  our  times,  if  you 
fhould  confult  two  very  celebrated  phyficians  among  the  dogmatifts,  Boer- 
haave  (/)  and  Hoffmann  (#),  you  would  not  eafily  fuppofe,  that  thofe  em¬ 
pirics  had  known  by  experience  alone  fo  clearly,  diftindtly,  and  accurately, 
the  fame  diftin&ions  of  cure,  as  thele  two  gentlemen,  and  particularly  Boer- 
have,  led  on  by  reafon  and  anatomy,  have  propos’d.  And  you  will  be  cha¬ 
grin’d  to  find,  that  there  was  in  our  age,  a  fenior  phyfician,  who  afferted, 
that  every  one  made  ufe  of  the  fame  method  of  cure,  whether  the  pleura  is 
occupied  by  the  difeafe,  or  the  lungs  are  affected  by  it ;  that  is  to  fay,  for¬ 
getting  even  the  very  diftindtion,  which  they  themfelves  do  not  attempt  to 
deny,  who  endeavour’d  to  extenuate  other  circumftances ;  I  mean,  that  one 
method  of  cure  is  requir’d,  at  leaft,  if  the  diforder  verges  to  fuppuration, 
when  the  pus  is  in  the  pleura,  and  the  mufcles  that  lie  upon  it;  and  another, 
if  it  is  in  the  lungs  ;  and  that  it  is  to  be  drawn  out  from  one,  and  from  the 
ocher,  by  quite  different  methods.  Yet  it  does  not  efcape  me,  that  there 
have  been  other  phyficians,  in  our  age,  and  thofe  much  more  fkilful  than  this 
gentleman,  who  have  taught,  that  almoft  the  fame,  and  indeed  in  every  re- 
fpedt,  a  fimilar  method  of  cure  is  fuitable  to  both  difeafes.  Thefe,  however, 
either  judg’d  that  the  feat  of  both  difeafes  was  in  the  lungs,  or  that  both 
of  them  were  join’d  together,  from  which  it  is  eafy  to  conceive,  what  reme¬ 
dies  they  pronounc’d  to  be  common  to  both  difeafes,  and  with  juftice.  But 
the  other,  in  order  to  have  it  to  fay,  that  all  the  labour  of  anatomifts,  in 
this  difquifition,  was  to  no  purpofe,  affirm’d  the  fame  thing  of  the  whole 
method  of  cure  ;  as  if  this,  at  leaft,  were  not  true,  that  the  phyfician  is 
more  folicitous  about  the  difeafe,  and  the  fpeedy  adminiftration  of  the  moft 
important  remedies,  who  knows,  that  its  much  more  frequent  feat  is  in  the 
lungs,  and  its  more  rare  fituation  in  the  pleura.  You,  however,  if  I  rightly 
conceive  of  you,  as  having  a  mind  defirous  of  knowledge,  and  preferring 
the  finding  out  that  which  is  true,  to  other  things,  will  not  only  not  be  fa- 
tisfied  with  thofe  things,  which,  I  faid,  I  had  hitherto  feen  in  regard  to  this 
difeafe,  but  will  perhaps  wiffi  moreover,  that  as  I  have  fo  often  obferv’d  the 
membrane  of  the  lungs  to  be  found,  and  entire,  fo  I  had,  in  like  manner, 
found  it  to  be  fometimes  affedted  with  a  kind  of  eryfipelas,  the  deeper  fub- 
ftance  of  it  being  quite  unhurt,  and  by  no  means  fluff’d  up,  that  you  might 
have  all  the  feats  of  thefe  inflammations  of  the  thorax  afeertain’d  by  me, 
from  anatomy. 

But  do  not  be  difpleas’d  that  I  have  left  fomething  to  others,  who  are 
more  diligent,  or  more  fuccefsful,  than  I  am  :  and  in  the  mean  while,  from 

(s)  De  Loc.  all*.  1.  3.0.  2.  fi)  Aphor.  de  cogn.  &  cur.  Morb.  turn.  §.  849.  Sc  feqq.  turn, 

886.  feqq.  («)  c.  6.  cit.  fupra,  ad  n.  28.  §.  2.  &  feqq. 

that 

6 


Letter  XXL  Article  42*  6  31s 

that  feat  which  I  have  confirm’d  to  you,  to  be  the  moil  frequent  of  all,  let  it 
be  fufiicient  for  you  to  underftand  many  things,  but  thefe  in  particular, 
much  more  eafily.  Firft,  why  an  empyema  is  not  fo  frequently  the  confe- 
quence,  as  it  muft  have  been,  if  the  pus  were  collected  in  the  pleura,  from 
which  there  is  naturally  no  exit  outwards.  Secondly,  how  it  happens  that 
fo  great  a  quantity  of  pus  is  expectorated  by  fome  pleuritic  patients,  or  is 
pour’d  out  into  the  cavity  of  their  chefts,  which,  if  it  proceeded  from  the 
pleura,  a  (lender,  and  thin  membrane,  might  well  feem  to  be  “  a  great  ml- 
“  racle  indeed,”  to  others,  as  it  did  to  Aretasus  (x).  For  that  it  becomes 
fo  th.ck  from  inflammation,  as  to  contain  a  very  great  quantity  of  matter, 
has  never  happen’d  either  to  me,  or  to  Valfalva,  or  to  any  of  the  anatomifts, 
to  fee  for  a  certainty,  who,  as  1  have  faid  above  (y),  have  made  far  the 
greateft  number  of  obfervations.  And  confider  now,  whether  it  be  juft  to 
add  the  fat  to  the  pleura,  that  we  may  fuppofe  fuch  a  quantity  of  matter  not 
to  be  wanting.  For  the  external  fat  relates  to  the  baftard-pleurify,  and  not 
to  the  true  and  latent  one,  of  which  we  fpeak.  And  how  little  in  quantity 
the  internal  fat  is,  in  perfons  who  are  not  of  a  fat  habit  of  body,  you  are  by 
no  meajis  ignorant ;  lor  I  have  acknowledg’d  already,  in  another  place  (z),. 
in  concert  with  that  very  diligent  phyfician  Trillerus,  that  perfons  of  a  fat 
habit  of  body  are  not  fo  liable  as  others,  to  a  pleurify.  Finally,  in  the  third- 
place,  if  it  be  taken  for  granted,  that  I  have  prov’d  which  is  the  moft  fre¬ 
quent  feat  of  this  difeafe,  it  alfo  may  be  eafily  conceiv’d  by  you,  how  a 
fpitting  of  blood  fhows  itfelf  fo  often,  even  in  the  very  beginning  of  this  dif- 
order. 

42.  I  am  not  ignorant  how  many  methods  of  explaining  this  matter  have 
been  invented  by  ingenious  men,  although  even  the  inflammation  lhould  be 
fuppos’d  to  be  confin’d  to  the  pleura  alone.  The  moft  ancient  of  which, 
is  that  of  Erafiftratus,  whofe  words  are  handed  down  to  11s  by  Galen  (*),, 
when  he  difputes  againft  it.  Which  mode  of  explication,  although  follow’d 
by  Sennertus  (£),  without  acknowledging  the  author,  yet  moft  would  now 
be  ftrangers  to,  if  a  learned  man  among  the  Italians,  and,  at  the  fame  time,, 
much  to  be  commended  for  his  treatment  of  the  pleurify,  had  not  plac’d  it 
in  a  proper  point  of  view,  and  even  render’d  it  probable ;  the  words  of 
Erafiftratus  being  not  only  accommodated  to  the  circulation  of  the  blood,  as 
it  is  now  known,  but  alfo  particularly  explain’d  by  the  bronchial  artery,  which, 
was  known  to  Erafiftratus  and  Galen,  in  like  manner  with  the  vein  correfpond- 
ing  to  it,  as  the  words  of  both  fufficiendy  (hew  (r) :  in  which  explanation, 
neverthelefs,  you  may  have  room  to  with  for  this  one  thing,  at  lead,  if  not 
many  others,  that  by  the  u  concave  artery,”  the  bronchial  (hould  not  be 
underftood,  but  the  aorta;  for  the  vein  alfo  “  is  call’d  cava  for  this  very 
<c  reafon,”  becaufe  it  is  “  very  large,”  as  is  aflerted  by  Galen  (d),  in  ano¬ 
ther  place.  And  among  the  modern  methods  of  explaining  this  bloody  ex¬ 
pectoration,  to  pafs  over  the  other  ancient  ones,  which  Schneider  (e)  has 

(*)  De  Cauf.  diuturn.  Affett.  1.  1.  C.  9,.  (/>)  cap.  16.  cit.  fupra,  ad  n.  39,  qu.  3.  in- 

(y)  n.  38.  &  feqq.  fin. 

(z)  Epift.  20.  n.  10.  (r)  cap.  3.  modo  cit.  infra  medium. 

(a)  De  Loc.  aff.  1.  5.  c.  3.  (d)  De  Venar.  &c.  diffect.  c.  2. 

(A  Differt,  de  PleuripEeum.  c.  1.  §  33»  34. 

already 


6  $  z  Book  II.  Of  Difeafes  of  the  Thorax. 

already  diffidently  refuted,  and  to  take  no  notice  of  the  ramifying  veins, 
that  go  from  the  pleura  into  the  ramifying  veins  of  the  lungs,  which  are 
pointed  out  by  fome  perfons,  in  relation  to  this  queftion ;  1  fay,  to  take  no 
notice  of  thefe  branches,  except  that  if  they  were  even  condant,  whatever 
they  might  carry  in  would  by  no  means  ftagnate  in  the  lungs,  inafmuch  as 
it  mud  always  be  carried  to  other  parts,  proceeding  from  the  more  narrow, 
perpetually,  to  the  . wider  veins,  together  with  the  other  part  of  the  blood ; 

I  cannot,  however,  omit  to  commend  that  mode  of  explication,  which  was 
formerly  related  to  me  by  Lancifi  (/),  by  means  of  tubuli  difcover’d  by  in¬ 
jections,  betwixt  the  vena  fine  pari  and  the  afpera  arteria,  as  it  may  proba¬ 
bly  fometimes  take  place. 

But  although  I  approve  the  ingenuity  and  diligence  of  this  excellent  man, 
-yet  certainly  as  often  as  ever  1  know,  that  the  lungs  themfelves  are  affeCted 
with  inflammation,  I  fhall  not  eafily  leek  for  the  caufe  of  the  expectorated 
blood  in  the  pleura*,  nor  fhall  I  leave  the  broad  and  drait  way,  to  purfue 
narrow  and  oblique  paths,  efpecially  as  long  as  I  (hall  call  to  mind  thole  ob- 
iervations,  which  were  formerly  propos’d  by  Nanni,  in  a  difpute  that  he  had 
with  me,  in  a  friendly  manner,  as  he  was  wont  to  do,  in  the  Academy  of  Sci¬ 
ences  at  Bologna,  which  are  related,  with  too  little  fulnels,  in  that  antient 
writing,  from  which  alone,  the  no  lels  diligent,  in  other  refpeCts,  than  learned 
man,  who  now  is  delervedly  one  of  the  feleCt  body  of  that  Academy,  could 
copy  them  into  the  Commentaries  thereof  (g).  For  Nanni  related  them  thus, 
as  1,  for  the  fake  of  my  memory,  took  them  down  on  the  fame  day  :  In  that 
epidemic  date  of  pleurifies,  he  found  but  one  or  two,  who  had  the  pleura 
only  difeas’d,  and  thefe  died  without  any  ipitting  of  blood,  as  you  will  read 
in  the  Commentaries  ;  but  that  the  others  (which  you  will  not  find  there),  in 
whom  he  found  the  lungs  to  be  principally  difeas’d,  which  were  in  great 
number,  had  all  died  with  previous  fpittings  of  blood.  Now  therefore  you 
fee,  both  why  he  thought  it  neceflary  it  (hould  not  be  omitted  by  him,  that 
in  the  two  former  bloody  expectorations  were  wanting,  and  at  the  fame 
time,  what  fcems  to  be  pointed  out  by  me,  from  his  obfervations,  in  regard 
to  the  prelent  iubjeCt  of  difpute. 

43.  I  remember  that  on  the  fame  day,  I  communicated  to  the  Academy 
what  I  had  leen  in  two  young  men,  in  the  hofpital  of  St.  Mary  de  Vita,  but 
in  each  at  different  times.  Or.e  of  them  had  been  feiz’d  with  a  piercing  pain 
about  the  middle  of  the  right  fide,  from  external  cold,  that  leem’d  to  be 
mov’d,  and  carried  about,  in  the  (pace  it  occupied,  which  was  but  veryfmall : 
warm  cloths  being  applied  to  the  part,  the  pain  did  not  remit,  but  increas’d 
by  the  touch,  fo  that  the  patient  could  not  lie  down  on  that  fide.  In  the 
night  a  fever  came  on,  which  began  with  cold,  and  went  off  with  a  fweat* 
And  although  this  fever  was  intermitting,  yet,  as  it  return’d  every  night, 
and  the  pain  continu’d  juft  the  fame,  the  young  man  came  into  the  hofpital; 
where  blood  being  taken  from  his  arm,  and  his  fide  being  anointed  well  with 
warm  linfeed  oil,  the  pain  chang’d  its  fituation  indeed,  and  its  nature  fo  far 
that  it  troubl’d  him,  rather,  by  being  heavy,  and  opprefllve,  than  by  piercing 
as  before ;  however,  the  enfiforai  cartilage,  for  to  that  part  it  had  Ihifted 

(/)  Differ t.  de  Vena  fine  pari.  (g)  Tom.  1.  inter  Medica. 

its 


letter  XXI.  Article  43.  <533 

its  (ituation,  could  not  endure  the  touch,  when  applied  to  it.  This  being 
the  ftate  of  things,  now  that  it  was  the  ninth  day  from  the  beginning  of  the 
pain,  a  cough  fuddenly  came  on,  by  means  of  which  the  patient  threw  up  a 
foetid  coagulum  of  blood,  equal  in  bignels  to  a  pretty  large  chefnut.  And 
this  being  difeharg’d,  ail  the  fymptoms  I  have  mention’d  vanifh’d  ;  fo  that 
the  fever  did  not  return  on  the  following  night,  but  rather  fweats,  and  foon 
after,  not  even  thefe. 

I  enquir’d,  therefore,  from  whence  came  this  coagulum  ?  for  it  was  of 
fuch  a  magnitude,  that  it  did  not  feem  to  have  come  from  the  afpera  arteria  : 
and  that  it  came  from  the  internal  noftrils,  notwithftanding  blood  had  pro¬ 
ceeded,  not  long  before,  from  the  external,  the  patient  conftantly  denied  ; 
and  I  was  difpos’d  to  give  credit  to  him,  not  only  by  what  had  preceded,  but 
by  the  fudden  folution  of  the  fymptoms,  and  by  other  corroborating  circum- 
ftances  befides.  Jt  remain’d,  therefore,  that  it  proceeded  from  the  ltomach; 
although  no  uneafinefs  had  difeover’d  itfelf  about  the  region  of  this  vifeus, 
particularly  on  the  Hrft  days  of  the  difeafe  •,  nor  any  naufea,  nor  any  propen¬ 
sity  to  vomit,  had  preceded  the  dilcharge  of  that  coagulum. 

And  there,  is  no  doubt,  but  what  had  happen’d  in  the  other  young  man 
had  a  reference  to  the  ftomach.  For  he  being  affedled  with  a  pain  of  the 
fide,  cough,  and  other  marks  of  the  pleurify,  and  complaining  only  of  thefe, 
except  that  he  was,  neverthelefs,  attack’d,  at  the  fame  time,  with  a  naufea, 
and  being  made  worfe  by  fuch  remedies  as  are  generally  of  advantage  in 
pleuritic  patients,  at  length,  threw  up,  by  vomiting,  a  round  worm,  toge¬ 
ther  with  blood,  and  was  immediately  freed  from  all  thofe  fymptoms  which 
I  have  related. 

Nor  yet  did  I  mention  this  obfervation  on  that  day,  becaufe  I  confider’d 
it  as  a  very  rare  one  :  for  it  did  not  efcape  me,  how  many  of  the  fame  kind 
had  been  publilh’d,  fince  the  time  that  one  had  been  propos’d  by  Gabucinus(T), 
which  feem’d  fo  wonderful  to’Donatus  (i)  ;  and  that  not  only  by  thofe  whom 
Etmuller  fpeaks  of  (£),  but  alfo  by  others,  who  are  mention’d  in  the  Sepul- 
chretum  (/).  To  which  there  are  Hill  others  that  may  be  added,  as  you  are 
not  ignorant,  and  in  particular  from  Harderus  (m),  Raygerus  (»),  and  other 
very  famous  men  ;  as  efpecially  from  John  Baptift  Verna  (<j),  and  Jofeph  An¬ 
thony  Pujati  (/>),  formerly  my  auditor,  and  now  my  very  deferving  collegue, 
by  whom  alone  many  oblervations  of  this  kind  are,  according  to  his  cuftom, 
learnedly  and  accurately  propos’d.  But  I  mention’d  it  for  this  reafon,  becaufe 
a  difeourfe  was  made  that  day,  in  the  Academy,  upon  the  pleurify,  on  account 
of  fome  letters  that  were  fent  to  me  by  a  late  very  experienc’d  phyfician  of 
Cremona,  Ignatius  Pedratti  by  name,  in  which  he  deferib’d,  with  great  exa£t- 
nefs,  the  pleurifies  from  worms,  which  went  about  in  the  winter  of  the  year 
1705,  at  Farnefe,  and  in  the  neighbourhood,  where  he  practis’d  phyfic  at 
that  time.  Therefore,  in  order  to  Ihew,  firft,  that  the  fimilitude  of  a  pleu- 


(h)  Comment  de  Lumbric.  c.  13. 

(/)  De  Medic.  Hift.  Mirab.  1.  4.  c.  6. 

(k)  Prax.  1.  1.  S.  1 8.  art.  9. 

(l)  Schol.  ad  Obf.  38.  hujus  Sed. 

(m)  Apiar.  Obf.  96. 

(a)  Vid.  Ad.  Lipf  A.  1691.  M.  Janu.  in 
fin.  ad  Obf  26. 

(0)  Prine,  morb.  acut.  Pleurit.  P.  3.  c.  it. 
n.  19.  &  feqq. 

(p)  Dec.  rar.  Medic.  Obf  7. 

Vol.  L 

4  M  ril % 

C  34  Book  II.  Of  Difeafes  of  the  Thorax. 

rify  is  fometimes  brought  on  by  worms,  which  would  immediately  vanifti  upon 
the  worms  being  thrown  up  ;  and,  fecondly,  that  the  true  pleuropneumony 
mi<dit  fometimes  happen,  if  thefe  creatures  continu’d  to  irritate,  and  by  this 
means,  not  I  know  not  what  vapours,  but  conftant  fpalmodic  ftridtures  of 
the  membrane,  being  communicated,  which  at  length  would  detain  the  blood, 
efpecialiy  if  vifcid,  in  the  narrow  parts  of  the  fmaller  vefiels ;  I  thought 
proper  to  confirm  the  former  by  my  recent  oblervation,  as  the  latter  might 
be  argu’d  from  the  recent  obfervations  of  Pedratti. 

44r  But  becaufe  I  find  no  diflfedtion  in  the  Sepulchretum,  which  fhews, 
that,  in  a  pleurify  from  worms,  the  interior  parts  of  the  thorax  can  really  be 
inflam’d,  as  thole  which  are  produc’d  from  Quercetanus  (q)  only  exhibit 
heaps  of  worms,  that  were  found  in  the  ftomach  and  inteftines  i  I  will  add 
what  Pedratti  then  obferv’d  in  the  thorax  tof  thofe  who  died  of  it,  after 
having  firft,  however,  fignified,  in  a  fummary  manner,  what  fymptoms  he 
obferv’d  in  the  living  patients,  not  only  from  that  which  he  had  then  written, 
but  all'o  from  what  he  added  before  us,  as  he  had  made  many  obfervations 
after  writing  his  epiftle.  For  it  is  of  advantage  to  have  read  and  compar’d 
one  with  another  the  many  conftitutions  of  deceitful  difeafes,  which  have  been 
cbferv’d  at  different  times,  and  in  different  places.  Firft  of  all,  there  was 
a  pain  in  the  fide,  that  was  rather  obtufe  than  pungent,  which,  befides  that 
it  fometimes  had  intermiflions,  was  in  the  beginning  tolerable.  But,  in  the 
mean  while,  fymptoms  appear’d  of  worms  harb’ring  themfelves  in  the  belly: 
and,  indeed,  fome  of  thefe  creatures  were,  for  the  moft  part,  feen  to  be 
thrown  out  from  the  mouth,  or  with  the  flools.  At  the  fame  time  there  were 
white  unconcodted  fpittings,  not  without  a  very  violent  cough,  and  thefe 
already  tindtur’d  with  a  kind  of  bloody  filaments.  The  fever,  which  had 
beo-un  with  a  fnivering,  continu’d  on,  with  almoft  the  fame  courfe  and  tenor. 
The  pulfe  was  not,  as  it  generally  is  in  a  pleurify,  hard  or  tenfe,  but  low', 
fmall,  and  unequal.  From  the  beginning  quite  to  the  fifth  day,  or  after 
that,  to  the  feventh,  the  diforder  not  only  feem’d  not  to  increafe,  but  rather 
to  decreafe,  and  even  to  be  now  almoft  quite  fubdu’d,  the  pain  and  the 
cou*h  <yoing  off,  and  the  fever  itfelf  being  much  diminifh’d  But  after¬ 
wards,  all  thefe  fymptoms  were  made  l'o  much  more  confiderable  than  before, 
and  fo  m-eat  a  difficulty  of  breathing,  and  dejedtion  of  fpirits,  were  join’d  to 
them,  That  within  forty  hours,  the  patients,  being  miferably  reftlels,  inter¬ 
nally  hot,  but  in  the  whole  external  part  of  the  body  extremely  cold,  and, 
what  was  a  very  certain  fign  of  death,  livid  like  a  carcafe,  died,  no  remedies 
beino-  then  of  any  effedt.  But  in  the  beginning  of  the  difeaie,  as  it  was  af¬ 
terwards  obferv’d,  it  was  of  fervice  to  thofe  who  had  a  ftrong  conftitution, 
to  give  fuch  things  as  excited  vomitings,  and,  in  particular,  that  which  they 
call’d  the  aqua  Rulandi  •,  in  regard  to  which  I  would  have  you  confider,  what 
was  the  opinion  of  Quercetanus  in  pleurifies  of  that  kind  ;  for  you  have  it 
in  the  Sepulchretum  (r).  But  it  was  not  of  fo  much  fervice,  in  this  difeafe, 
to  open  the  belly,  even  by  frefh-drawn  oil  of  almonds,  or  fweet  mercury, 
as  it  is  call’d,  join’d  with  a  little  myrrh  and  corraline,  in  order  more  cer- 

(j)  Obf.  38,  paulo  ante  cit.  &  Schol.  ad  eand.  in  fin.  (r)  In  eod.  Schol.’ 

tainly 

6 


Letter  XXL  Articles  45,  46.  6 35 

t-ainly  to  drive  away  the  worms.  For  although  they  were  furprifingly  ex¬ 
pend  by  this  medicine,  yet  the  pain  was  foon  after  exacerbated  by  the  ffools, 
and  the  inflammation  increas’d.  And  the  oil,  though  it  feem’d  at  firft  to 
render  the  expectoration  more  eafy,  yet  foon  after,  as  if  it  had  relax’d  the 
lungs,  the  difficulty  of  breathing  being  encreas’d,  it  accelerated  death ;  fo 
that  it  was  necefiary  to  difufe  this  remedy  entirely. 

And  it  was  necefiary  to  abftain  from  blood- letting,  as  it  lefien’d  the  ftrength ; 
fothat  it  was  fcarcely  ever  made  ufe  of,  only  when  the  inflammation  ran  high, 
and  then  but  in  fmall  quantity  at  a  time,  and  cautioufly.  Whether,  there¬ 
fore,  this  difeafe  is  to  be  fo  explain’d,  as  was  a  little  while  ago  hinted  (r), 
the  explanation  being  confirm’d  by  the  advantage  from  the  aqua  Rulandi 
throwing  out  immediately,  and  in  the  beginning  of  the  difeafe,  that  which 
would  have  made  the  blood  more  vifcid  j  or  even  whether  this  water  being 
confider’d  to  a<5t  like  an  antidote,  as  it  was  by  Quercetanus,  and  others,  you 
chuie  rather  to  fuppofe  that  the  diforder  had  fomething  peftiferous  in  it,  which 
the  worms  rather  accompanied,  than  brought  on  ;  for  even  peftilential  pleu- 
rifies  are  fometimes  obferv’d,  to  which  fpecies  thofe  that  you  read  of  in 
Ballonius  (/),  in  the  firft  annotation,  are  referr’d,  and  that  are  defcrib’d  by 
him  in  the  beginning  of  the  vernal  conftitution  of  the  year  1571,  though 
but  (lightly  taken  notice  of  in  the  Sepulchretum  (u)  ;  this,  however,  is  cer¬ 
tain,  that  many  bodies  which  had  died  of  the  difeafe  before  defcrib’d,  being 
differed,  both  at  Farnefe,  and  in  the  neighb’ring  villages,  the  vifcera  of  the 
belly,  indeed,  appear’d  to  be  differently  affedted  in  different  bodies,  juft  as 
the  particular  conftitution,  and  the  diforders  proper  to  each,  had  inclin’d 
them  to ;  that  is  to  fay,  fome  were  fchirrhous,  obftrudted,  or  in  other  ways 
difeas’d,  and  that  the  ftomach  was  very  much  affedted  above  all  the  others, 
inflated  after  the  manner  of  a  tympany,  and  loaded  with  a  putrid  and  ftrong- 
lmelling  faburra  of  humours ;  but  that  the  principal  injury  in  all,  within  the 
penetralia  of  the  thorax,  was  found  to  be  nearly  the  fame  with  that,  which, 
for  this  reafon,  is  added  below  from  one  only. 

45.  The  lungs  of  a  man,  who  had  been  taken  off,  in  a  violent  and  fpeedy 
manner,  by  the  diforder  juft  now  mention’d,  were  fwell’d  to  fuch  a  degree, 
as  to  fill  the  whole  cavity  of  the  thorax.  And  the  left  lobe,  in  which  fide 
the  pain  had  been,  feem’d  to  be  quite  inflam’d,  and  blackifh,  and  was,  be- 
fides  this,  towards  the  lower  part,  fluff’d  up  with  a  white  ichor,  like  an 
abfcefs.  The  pleura  was  every-where  inflam’d  and  livid,  and  diftinguifh’d, 
as  it  were,  with  fome  bloody  points.  The  intercoftal  mufcles,  and  particu¬ 
larly  the  internal  on  the  left  fide,  had  contracted  fo  confiderable  an  inflam¬ 
mation,  that  they  appear’d  to  be  black,  like  a  bruifed  part.  At  length,  in 
the  ventricles  of  the  heart,  and  the  large  veffels  of  both  kinds  that  are  an¬ 
nex’d  to  it,  were  coagula  of  black  blood,  which  were  not  much  unlike  po¬ 
lypous  concretions. 

46.  From  thefe  circumftances  which  I  have  related,  of  the  pleurify  from 
worms,  join’d,  however,  with  thofe  which  the  authors  above  commended  (x) 

( u )  Schol.  ad  Obf.  28  hujus  4  Sed. 

(*)  N.  43,  Si  feq. 


(s)  N.  43.  in  fin. 
(/)  Epidem.  1.  1. 


4  M  2 


have 


6 $6  Book  II.  Of  Difeafes  of  the  Thorax. 

have  written  on  the  fame  fubjeft,  it  will  already  appear  very  clearly  to  you, 
that  there  are  no  true  figns  of  a  pleurify,  which  have  not  been  fometimes 
alfo  obferv’d  in  this  •,  and  not  only  when  it  had  already  degenerated  into  a 
true  pleurify,  but  even  at  the  time  when  it  only  bore  the  fimilitude  of  it. 
For  which  reafon,  phyficians  ought  to  take  care,  efpecially  in  children,  and 
in  like  manner  in  others,  who  are  wont  to  be  fubjedt  to  worms,  and  in  thofe 
conftitutions  alfo  that  are  produdtive  of  them,  left  they  take  any  diforder  for 
a  true  pleurify,  in  which  there  is  nothing  but  this  fimilitude  of  it,  and  which 
will  yield  only  to  anthelmintics. 

But  in  regard  to  the  inflammation  of  the  diaphragm,  mediaftinum,  and 
pericardium,  as  whatever  of  this  kind  I  have  feen  has  been  flight,  and  join’d 
with  the  inflammation  of  the  lungs,  it  is  hinted  at  in  conjunction  therewith, 
already,  in  this  letter  (j),  and  even  in  another  (z).  You  may  therefore  fee, 
who  have  not  only  met  with  particular  inflammations  of  thefe  membranes,  but 
have  alfo  remark’d  their  figns :  for  neither  is  fufficient  alone.  Thus,  for¬ 
merly,  Avenzoar  (from  whom  a  pretty  long  paflfage  is  produc’d  by  Zacutus(^), 
and  confider’d  much  at  large  before  Freind  ( b ))  had  propos’d  figns  of  the 
inflammation  of  the  mediaftinum,  which  he  made  no  fcruple  to  believe  he 
himfelf  had  fufter’d.  So  likewife  Jacotius  (r)  related  the  marks  which  he  be¬ 
liev’d  to  agree  with  the  fame  diforder,  alfo,  from  the  opinion  of  Avicenna. 
So,  finally,  you  will  read,  by  what  fymptoms  Heurnius  the  elder  ( d )  con¬ 
jectur’d,  that  a  certain  young  man  had  died  from  this  caufe.  On  the  other- 
hand.  Nicolaus  Mafia  (*),  who  fays  that  he  has  even  feen  apoftems  in  the 
mediaftinum,  added  nothing  in  regard  to  their  figns,  notwithftanding  he  had 
diligently  related  thofe  which  had  accompanied  a  pleuritic  apoftem,  in  a 
noble  Florentine  ;  which  dileafe,  and  difiedtion,  I  do  not  fee  that  any  men¬ 
tion  is  made  of  in  the  Sepulchretum.  And  although  he  fays,  “  that  he  had 
“  feen  many  who  died  from  a  pleuritic  apoftem,  in  whom  the  abfeefles  were 
w  large  yet  I  have  not  taken  notice  of  thefe  above,  as  l  was  uncertain 
whether  large  apoftems  of  that  kind  related  to  thofe  I  was  then  treating  of, 
or  rather,  as  in  that  Florentine,  of  whom  he  fpoke,  to  fuch  cold  humours 
as  occupied  even  the  neighboring  mufcles,  had  been  of  long  ftanding,  and 
very  troublefome,  by  creating  a  heavy  pain,  and  a  conftant  little  cough,  for 
many  years. 

There  is  a  neceffity,  therefore,  of  having  marks  confirm’d  by  diflections, 
in  order  to  make  a  proper  diagnofis  of  the  difeafe,  and  cure  it  by  a  proper 
and  fpeedy  adminiftration  of  remedies ;  or  if  this  be  not  in  our  power  to 
perform,  at  leaft,  that  we  may  be  able  to  admonifh  the  friends  of  the  pa¬ 
tient  of  the  great  danger  of  the  difeafe,  and,  that  we  may  not  feem  to  be 
deceiv’d,  foretel  what  appearances  will  be  found  in  the  body,  after  death. 
And  both  of  thefe  things,  which  I  fay  are  equally  requir’d,  that  very  ex¬ 
cellent  phyfician  my  neighbour  Salius,  will  (hew  (/).  For  he,  when  he 
was  a  very  young  man,  having  feen,  for  the  firft  time,  an  inflammatory 

(y)  N.  35,  36.  ( c )  Comment  in  Coac.  Se&.  2.  1.  5.  aph.65. 

(z)  Epift.  7.  n.  II.  (d)  Enarrat.  Hippocr.  1.  5.  aphor.  24. 

( a )  De  Medic.  Princ.  Hid.  1.  2.  hi ft.  23.  (<?.)  L.  Introdufl.  Anat.  c.  27. 

\b)  Ffilt.  Medic,  ad  A.  980.  (f)  De  Affed.  Particular,  c.  6. 


tumour 

7 


Letter  XXL  Article  46.  6  3^ 

tumour  in  the  mediaftinum,  of  a  confiderable  fize,  and  having  accurately 
obl'erv’d  what  fymptoms  had  exifted  in  the  patient ;  never  ceas’d  afterwards 
diligently  to  compare  them  with  thofe  of  a  fimilar  kind,  which  occurr’d  in 
other  patients ;  for  which  reafon,  he  not  only  determin’d  what  were  the 
fymptoms  of  the  difcafe,  but  alfo  publifh’d  an  entire  treatife,  written  learn* 
edly,  and  fkilfully,  on  that  head,  which  is  the  firft  that  phyficians  ever  have 
had.  The  obfervation  which  gave  rife  to  that  treatife,  you  have  in  this 
fourth  fedtion  of  the  Sepulchretum  (g)  :  and  in  the  firft  fedtion  of  this  fe- 
cond  book,  you  will  read  another  (b),  which  was  publilh’d  in  the  age  fol¬ 
lowing,  by  Panarolus,  which  is  taken  no  notice  of  by  thofe  whofe  writings 
I  have  feen  upon  this  diforder :  in  regard  to  which,  1  heartily  wifh  the  other 
fymptoms,  that  I  fuppofe  were  not  wanting,  had  been  alfo  fpecified ;  and 
that  the  feat  of  the  inflammation,  which  perhaps  touch’d,  in  fome  meafure, 
upon  the  pericardium,  had  been  clearly  pointed  out*  The  fecond  of  thefe 
circumftances  you  will  find  is  not  wanting,  in  the  obfervation  of  Heurnius 
the  younger,  which  is,  in  like  manner,  transferr’d  into  the  Sepulchretum  (/) ; 
but  you  will  find  no  remark  made  what  fymptoms  were  peculiar  to  this  in¬ 
flammation,  before  it  pafs’d  into  vomicae,  or  even  after  it  had  undergone 
that  change. 

So  that  I  fhail  point  out  to  you  all  the  examples  of  inflammation  and 
abfcefs  of  the  mediaftinum,  in  the  Sepulchretum,  and  in  like  manner,  of 
the  pericardium,  that  you  may  be  able  to  read  them  over  the  fooner.  Firft 
then,  you  will  fee  the  fame  obfervation,  which  I  faid  was  that  of  Salius,  as. 
it  defcribes  an  inflammatory  tumour,  belonging  in  part  alfo  to  the  pericar¬ 
dium  *,  for  which  reafon  Salius  has  treated  of  the  inflammation  of  both  thefe 
membranes,  at  leaft  before  he  could  have  feen  the  obfervation  of  Rondele¬ 
tius  (£),  as  it  was  publifh’d  at  Lions,  in  the  year  1583,  being  the  very  fame 
year  in  which  Salius,  on  the  15th  of  March,  wrote  his  preface  at  Faenza,. 
to  be  prefix’d  to  his  work.  And  as  to  the  hiftories  that  were  written  in  the 
next  age,  which  you  will  fee  quoted  from  Plildanus,  and  in  like  manner 
from  Zacutus,  know  that  two  are  quoted  from  each  of  them,  in  order  to 
prevent  your  being  deceiv’d.  For  you  will  find  the  firft  of  Hildanus  in  the 
Sepulchretum  (/),  not  far  from  that  of  Rondeletius,  which  was  juft  now 
mention’d,  and  the  other  in  this  fourth  fedtion  (m).  And  there  that  which, 
is  proper  to  Zacutus  (»),  is  alfo  to  be  found,  but  muft  not  be  look’d  for  in 
the  fecond  book  of  his  work,  which  you  will  fee  there  referr’d  to  by  the 
printer ;  but  if  you  fhould  wifh  to  compare  them  together,  and  indeed  it  is 
not  related  exadtly  in  the  fame  manner  by  the  author,  you  muft  turn  to  his 
firft  book.  But  the  fecond  of  Zacutus,  certainly,  has  no  relation  to  the  pe¬ 
ricardium,  and  is  even  Avenzoar’s  defcription  of  his  own  difeafe.  And  as, 
according  to  Freind’s  admonition  (0),  inflammation  and  abfcefs  of  the  peri¬ 
cardium  alfo,  as  well  as  of  the  mediaftinum,  are  taken  notice  of  by  him,, 
how  ihall  we  excufe  Salius  and  Rondeletius,  for  making  no  mention  of  it  ? 

(g)  Obf.  2.  (/)  Obf.  ead.  §  5. 

(/?)  Obf.  125.  ( m )  Obf.  4. 

(/)  Sett.  4.  Obf  27.  (n)  Obf  2 9. 

Sett.  8.  1.  hujus  2.  Obf.  4.  §  \i,  (c)  Hhh  &  A.  cit.. 


efpeciallj 


6  3  8  Book  II.  Of  Difeafes  of  the  Thorax. 

efpecially  as  the  latter  has  written,  “  that  this  diforder  had,  as  far  as  he 
“  knew,  been  obferv’d  by  nobody  and  Salius,  “  that  it  is  furprizing,  by 
“  what  means  thole  who  teach  the  practice  of  phyfic,  have  fo  far  ncgledted 
“  both  the  di (orders,  as  not  to  mention  the  leaft  word  of  them  :**  although 
he  has  here  fufficiently  declar’d  in  his  preface,  whom  he  meant,  that  is, 
“  the  mod  modern  phyficians,”  and  has  fhown  alfo,  in  his  preface,  why,  as 
Jacotius  has  judg’d,  not  while  he  was  teaching  the  method  of  cure  in  all 
difeafes,  as  practical  profeffor  in  ordinary,  but  while  he  was  interpreting  the 
Coaca  Pranotioms,  he  himfelf  could  not  attribute  the  knowledge  of  the  in¬ 
flammation  of  the  mediaftinum  to  Avicenna,  though  he  would  have  fo  much 
the  more  readily  alcrib’d  it  to  Avenzoar,  becaule,  by  this  means,  he  would 
have  confirm’d  the  greater  part  of  his  figns,  by  the  authority  of  an  ancient 
phyfician,  as  the  cultom  then  was.  And  as  to  what  I  would  have  faid  for 
Rondeletius  alfo,  fo  great  was  the  fame  of  Avicenna,  before  the  other  phy- 
iicians  of  the  Arabian  l'chool,  that  what  was  not  extant  in  his  large  work, 
it  feem’d  to  be  in  vain  to  look  for  in  any  other  of  his  writings.  But  it  is 
far  from  being  fo  eafy  to  excule  Ludovicus  Mercatus,  whofe  writings  upon 
thefe  diforders  (/>),  if  you  compare  them  with  the  treatife  of  Salius,  whom 
he  does  not  fo  much  as  mention  by  name,  you  will  immediately  perceive, 
were  all  taken  from  Salius.  But  in  proportion  as  fome  who  liv’d  in  the  fame 
age,  were  lefs  grateful  to  Salius,  as  frequently  happens,  fo  much  the  more 
grateful,  and  more  juft,  has  been  an  eminent  writer  in  this  our  age,  Freind  (q) ; 
and  in  like  manner  the  two  very  eminent  Archiaters,  whom  I  very  lately 
read,  in  that  part  where  they  treated  of  thefe  diforders,  at  the  time  I  was 
reviling  this  letter:  one  of  them  has  even  exprefsly  confirm’d  the  obfervation 
of  Salius,  by  his  own  ;  and  the  other  has  fhown  how,  and  when,  by  the  in- 
fpiration  of  very  cold  air,  or  by  drinking  of  very  cold  water,  the  mediafti¬ 
num,  inafmuch  as  it  is  intercepted  by  the  lungs,  and  intercepts  the  cefopha- 
gus,  may  be,  without  great  difficulty,  inflam’d.  Yet  I  fhould  not  believe 
that  he,  in  other  refpects  a  learned  man,  was  ungrateful  to  Salius,  who,  al¬ 
though  he  publilh’d  his  work  in  the  tenth  year  after  the  Hiftory  of  Phyfic, 
by  Freind,  had  come  out,  yet  complain’d,  that  the  inflammation  of  the  me¬ 
diaftinum  had  been  pals’d  Over  by  all,  unto  that  time,  fome  figns  of  which 
he  produc’d  in  the  mean  while,  that  are  to  be  met  with  among  thofe  before 
propos’d  by  Salius :  for  he  has  not  fo  much  as  omitted  the  fyncope,  where 
the  inflammation  touch’d  upon  the  pericardium.  That  complaint,  therefore, 
I  fhould  rather  think  arole  from  this  caufe,  that  all  of  us  can  neither  read 
all  things,  nor  yet  remember  ail  that  we  do  read. 

Plowever,  in  reading  over  again  the  figns  obferv’d  by  Salius,  you  will 
perhaps  wonder  at  this,  that,  as  he  remark’d  the  uneafinefs  at  the  fternum, 
he  did  not  alfo  remark  that  uneafinefs  at  the  vertebras  of  the  back ;  or  when 
he  gave  as  a  reafon  for  the  former,  the  circumftance  of  the  mediaftinum 
being  tied  to  the  fternum,  that  he  did  not  attend  to  the  circumftance  of  its 
being  tied  to  the  vertebrae  alfo:  or  at  leaft,  that  he  did  not  admonifh  (which 
was  perhaps  the  cafe)  that  thofe  inflammations  had  been  feated  nearer  to  the 
fternum  than  to  the  vertebrae ;  which  diftindtion,  in  fome  pafiages  of  Hip- 

(/>)  De  Intern.  Morb.  Curat.  1.  2.  c.  6.  (^)  loco  modo  indicato. 

pocrates. 


Letter  XXI.  Article  47.  639 

pocrates,  “  of  the  pleurify  at  the  back,”  that  are  differently  explain’d  in  the 
Sepulchretum  (r),  is  touch’d  upon  by  the  celebrated  Verna  (s) :  although,  in 
the  preceding  letter  (/),  another  reafon  is  alfo  pointed  out  by  me,  why,  when 
the  mediaftinum  is  affedted,  it  may  fometimes  happen,  that  the  fternum, 
rather  than  the  vertebras,  fhall  fympathize  with  it. 

But  now  mention  is  made  of  the  vertebras,  I  cannot  help  wond’ring,  that 
fince  the  pains  of  the  head  are  fo  often  accounted  for  from  the  impetus,  or 
delay,  of  the  blood  in  the  meninges  of  the  brain,  or  from  fome  other  in¬ 
jury,  or  irritation,  of  thefe  membranes,  why,  in  order  to  explain  pains  of 
the  back,  of  which  this  fedtion  of  the  Sepulchretum  exprefsly  treats,  the 
meninges  that  inveft  the  fpinal  marrow,  are  fo  very  leldom  taken  notice  of, 
as  they  are,  in  effedt,  nothing  more  than  thofe  fuperior  meninges  produc’d 
into  the  cavity  of  the  vertebras. 

In  this  very  fedtion,  examples  are  alfo  produc’d  of  pains  in  the  thorax 
proceeding  from  an  aneurifm.  Of  which,  notwithstanding  I  have  written 
many  things  upon  aneurifms,  in  a  preceding  letter,  and  am  to  write  more 
hereafter  in  another,  I  will  here  produce  two  examples ;  the  firft  for  this  rea¬ 
fon,  becaufe  I  could  fcarcely  find  out  any  other  mark  of  an  aneurifm,  be- 
fides  the  pain  within  the  thorax ;  and  the  fecond,  becaufe  in  that  the  pain 
of  the  thorax  feems  to  be  accountable  for,  not  only  from  the  aneurifm,  but 
alfo  from  the  weight  of  the  liver. 

47.  A  woman,  of  a  middle  age,  who  had  been  in  the  hofpital  at  Padua 
before,  on  account  of  a  pain  in  the  internal  part  of  the  thorax,  on  the  left 
fide,  return’d  into  the  fame  hofpital,  before  the  middle  of  January,  in  the 
year  1717,  complaining  of  the  fame  pain,  which  was  now  join’d  with  a  vio¬ 
lent  fever.  Her  pulfe  was  very  tenfe,  and  chord-like  :  and  the  diforder 
feem’d  to  be  extremely  violent,  but  not  fo  as  to  make  us  fuppofe  death  to  be 
near  at  hand.  Neverthelefs  it  was ;  for  the  woman  died  fuddenly,  on  the 
very  day  after  (he  came  into  the  hofpital. 

The  thorax  being  open’d,  there  appear’d,  at  firft  fight,  to  be  a  kind  of 
dropfy  in  this  cavity.  But  as  a  great  quantity  of  coagulated  blood  was  found 
below  the  water,  it  was  clearly  underftood,  that  the  ferum  of  this  blood  had 
refembl’d  a  fpecies  of  dropfy.  As  we  enquir’d  whence  this  blood  had  pro¬ 
ceeded,  a  great  aneurifm  of  the  aorta  discover’d  itfelf,  which  was  already 
ruptur’d.  And  examining  this  artery  with  fome  accuracy,  I  made  the  fol¬ 
lowing  obfervations.  From  the  very  beginning  it  was  wider  than  is  natural, 
and  internally  unequal.  Nor  had  it  dilated  itfelf  into  an  aneurifm  fovery  ma- 
nifeftly,  before  it  had  fent  off  the  fubclavian  artery.  From  thence,  not  a 
lateral  fac  was  form’d,  but  the  trunk  expanded  itfelf,  equally,  on  all  fides, 
fo  as  to  form  a  large  cavity,  approaching  in  its  figure  to  a  fpheroid :  at  the 
lower  part  of  which,  it  again  contradted  itfelf  into  the  bounds  of  an.  artery, 
and  defcended  according  to  cuftom,  upon  the  lower  vertebrae  of  the  thorax. 
But  above,  where  1  faid  it  was  dilated,  I  found  that  it  prefs’d  upon  the 
higher  part  of  the  left  lobe  of  the  lungs,  on  one  fide ;  and  that,  on  the  other 
iide,  it  urg’d  fome.  of  the  bodies  of  the  vertebrae,  and  the  lateral  procdfes. 


** 


(s)  P.  3.  c.  8.  n.  9.  &  is.  libri  cit.  fupra,  ad  rl  13, 

(/)  n.  12.. 

and 


(r)  Sett,  hac  4.  Append,  ad  Obf.  39. 


£>4°  Book  IL  Of  Difeafcs  of  the  Thorax. 

and  the  neareft  part  of  the  ribs  on  the  left  fide,  in  like  manner.  And  all 
thefe  bones  were,  in  thofe  places,  extremely  hollow’d  out  ;  and  that  part  of 
the  lungs  was  black,  and  l'o  hard  and  compact,  as  to  perform  that  wonderful 
office,  which  I  juft  mention’d  in  the  fecond  of  the  Adverfaria  («)•  For  the 
internal  furface  of  the  aneurifm  not  being  cover’d  over  in  this  woman  with 
any  polypous  concretions,  fhew’d  the  internal  furface  of  the  artery,  in  fome 
parts  of  it,  though  very  rare,  and  narrow,  to  be  lo  lax,  that  feales,  as  it 
were,  might  be  eafily  pull’d  away  from  it  •,  fo  alfo  the  internal  and  external 
fubftance,  where  the  aneurifm  was  clofely  conglutinated  with  the  lungs,  ap¬ 
pear’d  to  be  corroded,  and  quite  deftroy’d,  for  the  fpace  of  two  inches. 
This  deficiency,  however,  of  the  arterial  coat  was  wonderfully,  but  evidently, 
fupplied  by  the  lungs  •,  fo  that  no  blood  could  pafs  out,  either  at  the  borders 
of  that  fpace,  by  reafon  of  the  very  conhderable,  and  very  firm  congluti¬ 
nation  ;  or  through  the  fubftance  of  the  lungs,  inafmuch  as  this  vifeus  was 
very  compact  in  that  fpot,  and  in  the  neighb’ring  parts  about  :  for  which 
reafons,  the  woman  had  no  bloody  lpittings  ;  and  1  found  the  internal  furface 
of  the  afpera  arteria,  and  of  the  bronchia,  to  be  entirely  without  any  extra- 
vafations  of  blood.  But  there  was  no  diforder  in  the  heart,  and  no  poly¬ 
pous  concretion,  except  one,  fome  what  long  and  (lender,  which  went,  from 
the  left  ventricle,  through  the  aorta,  quite  to  its  curvature  :  and,  indeed, 
the  blood  in  the  heart,  and  in  other  parts,  was  found  to  be  no  lefs  fluid 
than  black. 

The  abdomen,  which  was  not  without  rugm,  being  open’d,  befides  that 
Angular  flexure,  and  fituation  of  the  large  inteftines,  which  1  have  fufficiently 
•delcrib’d  in  the  third  of  the  Adverfaria  (x),  and  the  difcolour’d  liver,  the 
parts  deftin’d  for  generation  exhibited  fome  things  worthy  of  notice.  For 
both  of  the  teftes  were  black,  the  left  being  alfo  hard,  and  in  part  full  of 
half-concreted  blood.  Both  of  them  were  fo  connected  to  the  tubes,  and  the 
neighb’ring  parts,  that  you  could  not  know  for  certain,  to  which,  in  parti¬ 
cular,  the  hydatids  that  lay  about  them  belong’d,  which  on  the  right  fide 
were  fmall  in  their  fize ;  but  on  the  left,  was  one  very  large  hydatid,  and 
others,  adhering  to  the  parietes  of  this  tube,  to  fo  great  a  number,  and  of 
fuch  a  magnitude,  that  all  of  them  together  were  fuppos’d  to  contain  water 
to  the  quantity  of  four  ounces.  This  water  was  yellowifh  •,  and  the  coat  of 
each  hydatid  was  double,  the  internal  of  which  being  the  thinner,  was  fur- 
•niffi’d  with  fmall  veflels  of  a  whitifh  colour,  as  they  then  appear’d. 

Each  of  the  tubes,  amongft  thefe  hydatids,  and  from  thence  to  their  ter¬ 
mination,  was  impervious ;  but  near  the  uterus  was  become  thicker,  and  not 
only  pervious,  but  dilated  :  and  in  this  parr,  the  left  tube  was  full  of  an 
almoft  limpid  mucus.  But  in  the  internal  part  of  the  cervix  uteri,  which 
was  here  very  long,  was  a  very  tenacious  mucus  of  a  yellow  colour,  dege¬ 
nerating  into  black.  But  the  corona,  or  circle  of  the  os  uteri,  which  hangs  out 
into  the  vagina,  and  the  vagina  itfelf,  were  fmear’d  over  univerfally  with  a 
Find  of  whitifh  matter,  as  if  the  woman,  which  could  not  be  certainly  known, 
had  labour’d  under  fome  kind  of  fluor,  which  had  its  origin  no  higher  than 

.(«)  Animad.  39.  adlia.  (*)  Animad.  14. 

from 


Letter  XXI.  Articles  48,  49.  6 41 

from  this  part,  as  is  indicated  by  the  mucus  I  have  defcrib’d  in  the  cervix, 
and  in  the  tube,  being  fo  different  in  its  colour  from  this. 

I  alfo  wifh’d  to  know,  whether  the  woman  had  complain’d  of  her  breafts, 
but  in  vain  :  for  examining  thefe  internally  and  externally,  and  obferving  that 
they  were  here  and  there  harder  than  they  ought  naturally  to  be,  efpecially 
in  thole  that  are  rugous  and  flabby,  I  prefs’d  out  a  ferum  by  fqueezing  them, 
which  proceeded  from  little  foramina  of  the  nipples,  in  a  turbid  ftate,  and 
of  a  dilute  colour,  but  nearly  approaching  to  that  which  I  faid  was  like  to¬ 
bacco;  and  from  other  foramina  a  ferum  iffu’d,  quite  of  a  greenifh  colour, 
degenerating  into  black.  And,  indeed,  from  the  glandular  fubftance  of  the 
bread,  when  cut  into,  a  green  ferum,  in  fome  places,  burft  forth,  and  in 
other  places  a  black  :  yet,  when  this  ferum  was  wip’d  away,  the  fubftance 
itfelf  appear’d  white,  and  fufficiently  found. 

Laft  of  all,  as  I  had  perceiv’d  that  there  was  water  in  the  fpine  of  the 
tube,  by  examining  carefully,  both  internally  and  externally,  thofe  vertebras 
of  the  thorax,  which  I  have  faid  were  hollow’d  out  by  the  aneurifm,  it  was 
very  evident,  that  the  injury  of  thefe  vertebras  had  not  reach’d  through  to 
the  cavity  of  the  tube. 

48.  Of  that  green  and  black  ferum  of  the  breads,  I  lhall  fay  fomething 
on  another  occafion  (jy),  not  to  digrefs  from  my  prefent  defign.  But  if  you 
fhould  here  be  furpriz’d,  that  the  aneurifm,  whofe  force  had  hollow’d  out 
thofe  bones,  could  not,  in  like  manner,  deftroy  the  fo  much  fofter  fubftance 
of  the  lungs,  or,  at  leaft,  tear  afunder  that  conglutination  which  was  about 
the  borders  of  the  opening,  I  would  advife  you  to  read  the  obfervation  of 
the  celebrated  Maloet  (z),  in  which,  though  an  aneurifm  adher’d  to  the  trunk 
of  the  afpera  arteria,  and  the  cartilages  of  this  tube  made  up  a  part  of  the 
parietes  of  the  aneurifm,  as  the  lungs  did  in  ours,  yet  that  impetus  of  the 
blood  which  had  worn  away  thofe  cartilages,  and  in  part  eroded  them,  had 
neither  diffolv’d  that  cohefion  which  was  round  about,  nor  yet  had  corroded, 
or  perforated,  the  other  fo  much  fofter,  and  more  (lender  parietes  of  the 
aneurifm.  For,  without  doubt,  thofe  parts  which  yield  to  the  ftroke  are 
lefs  injur’d,  but  thofe  which  moft  ftrongly  refill  receive  the  greateft  detriment. 
So  alfo,  to  ufe  a  more  recent  example  among  many,  you  will  learn  from  the 
obfervation  of  Schreiberus  ( a ),  that,  although  a  large  aneurifm  of  the  aorta, 
under  the  mufcles  pedtoralis  major  and  minor,  was  ruptur’d  in  fuch  a  manner, 
that  the  foramen  might  admit  a  fill,  and  had  confum’d  three  ribs  in  that 
part,  it  had,  neverthelefs,  neither  injur’d  the  lungs,  which  it  had  prefs’d 
back,  nor  the  diaphragm,  with  which  it  had  grown  into  one  fubftance,  nor 
in  any  way  hurt  the  pedtoral  mufcles,  with  which  it  was  Ihut  up  externally. 
But  now  let  us  come  to  the  laft  obfervation. 

49.  A  young  man,  who  was  much  giv’n  to  the  cuftom  of  drinking  great 
quantities  of  wine,  and  the  more  fo,  becaufe  his  trade,  which  was  that  of 
a  cook,  excited  his  thirft,  after  great  fatigues  in  this  bufinefs,  began,  a 
month  before  he  came  into  the  hofpital,  to  be  very  bad  in  his  cheft  and  fto- 

(y)  Epifl.  50.  n.  47.  (a)  Nov.  Comment.  Acad.  Sc.  Imp.  Petro- 

(s)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1733.  pol.  Tom.  3.  in  Phylic,  Obf. 4. 

4n 


VOL.  I. 


mach3 


642  Book  II.  Of  Difeafes  of  the  Thorax. 

rnach,  and  to  breathe  with  difficulty  :  foon  after,  alfo,  a  kind  of  hardnefs 
came  on  about  the  navel.  All  thefe  fymptoms  were  without  a  fever.  Having 
loft  blood  from  his  arm  twice,  but  in  moderate  quantity,  and  taken  fuch 
things  as  tend  to  foften  and  promote  expectoration,  he  was  fo  far  better, 
that  he  feem’d  to  himfelf  to  be  quite  well  But  eight  days  after,  having 
aCted  imprudently,  according  to  his  own  confeffion,  in  this  one  circumftance 
only,  that  he  had  walk’d  too  much,  his  legs  being  even  then  weak,  all  thefe 
fymptoms  return’d  in  a  much  more  violent  degree.  I,  at  length,  faw  him, 
when  he  was  brought  into  the  hofpital  of  St.  Mary  de  Vit3,  at  Bologna,  on 
the  laft  day  of  April,  in  the  year  1703,  either  on  the  eighth  or  ninth  day 
after  the  relapfe.  His  face  was  whitifh,  and  fomewhat  fwell’d  ;  his  feet  cold, 
and  for  three  days  paft  had  become  tumid,  in  the  fame  manner  as  his  legs. 
He  made  but  little  water,  and  had  a  very  great  thirft.  He  lay  down  with 
equal  difficulty  in  every  pofture ;  but  if  he  attempted  to  lift  up  his  head,  a 
fweat  broke  forth  on  his  forehead.  He  complain’d  of  thefe  things,  and  of 
thofe  which  I  fpoke  of  above  •,  but  raoft  of  a  tightnefs  of  the  cheft,  and 
efpecially  of  a  very  great  weight,  juft  as  if,  according  to  his  own  mode  of 
expreffion,  a  loaf  of  bread  lay  upon  his  breaft.  Attempting  to  feel  his 
pulfe,  I  touch’d  both  his  wrifts  to  no  purpofe  *,  for  no  pulfe  could  be  per¬ 
ceiv’d  in  either,  notwithftanding  the  man,  in  regard  to  his  head,  was  ex¬ 
tremely  well,  and,  as  far  as  the  difficulty  of  refpiration  fuffer’d  him,  related 
all  the  circumftances  that  I  have  related  with  fufficient  readinefs ;  and  added 
this,  moreover,  that  he  was  now  feiz’d  every  night  with  a  fever,  from  which 
his  body  was  hot,  but  only  from  the  middle  upwards.  I  was  very  defirous 
to  know,  whether  the  pulfe,  which  lay  latent  in  the  day-time,  might  not 
difcover  itfelf  at  that  time,  at  leaft  j  yet  all  the  fymptoms  growing  fo  much 
worfe,  that  he  died  on  the  next  day,  it  was  not  in  my  power  to  enquire  into 
that,  or  any  circumftance,  otherwife  than  .by  the  difleCfion  of  the  body , 
out  of  the  mouth  of  which  a  large  quantity  of  blood  had  i  flu’d . 

In  the  thorax  and  belly  was  fome  water,  yet  not  in  a  very  confiderable 
quantity.  But  in  the  thorax  was  a  heart,  which  was  one  of  the  largeft 
1  had  ever  feen ;  and  that,  as  alfo  the  right  auricle,  which  was  very 
much  dilated,  and  the  coronary  veflels,  which  were  very  large,  were  full  of 
black  blood,  almoft  fluid,  and  without  any  polypous  concretion.  And  the 
fibres  of  this  heart  were  very  lax,  fo  that  even  thofe  columnae,  which  are 
prominent  in  the  ventricles,  eafily  follow’d  the  fingers  of  the  perfon  who 
pull’d  them. 

In  the  belly,  that  part  of  the  fmall  inteftines  which  correfponded  with  the 
navel,  feem’d  to  be  inflam’d,  as  it  were,  to  the  extent  of  a  hand’s  breadth. 
But  the  fpleen,  being  clofely  annex’d  to  the  diaphragm,  was  of  a  colour 
really  preternatural.  And  the  liver,  in  like  manner.  Thefe  two  vifcera  were 
alfo  hard  ;  but  the  liver  the  moft  fo,  and  for  that  reafon  very  heavy  :  fo  that 
1  did  not  doubt,  but  the  weight  of  this  vifcus,  being  added  to  that  of  the 
heart,  when  enlarg’d,  and  fill’d  with  blood,  had  caus’d  the  diaphragm  to  be 
more  opprefs’d,  and  dnv’n  downwards ;  and  that  by  the  fame  diaphragm, 
the  liver,  and  the  other  neighb’ring  vifcera,  were  urg’d  downwards.  But 
from  whence,  or  by  what  means,  the  blood  came  into  the  mouth  of  the  car- 
cafe,  was  not  found  out,  as  there  was  not  time  diligently  to  enquire. 

50.  But 
4 


Letter  XXII.  Articles  i,  2.  643 

50.  But  from  the  other  appearances,  which  I  have  faid  were  found  in  the 
dead  body,  it  is  eafy  to  explain  thofe  fymptoms  that  had  troubl’d  him  when 
living.  1  will  not,  however,  do  this,  left,  if  I  add  any  thing  more,  I  ftiould 
feem  to  have  intended  to  fend  you  a  volume,  rather  than  a  letter.  If  you 
compare  this  obfervation  with  the  others  that  I  have  written  to  you  before  (£)> 
upon  the  prolapfus  and  aneurifm  of  the  heart,  and  the  foregoing  with  thofe 
that  I  have  written  upon  the  aneurifms  of  the  great  artery  (c),  you  will  do 
what  is  very  much  to  the  prefent  purpofe,  and  will  find  join’d  to  each  of 
them  moft  of  thofe  explications  which  are  purpofely  omitted  here.  Farewel. 


LETTER  the  TWENTY-SECOND 


Treats  of  the  Hemoptoe,  of  purulent  and  ill-condition’d  Ex¬ 
pectorations,  the  Empyema,  and  Confumption. 


1.  TT  is  but  juft,  at  length,  to  make  amends  for  the  prolixity  of  one  letter 

i  by  the  brevity  of  another.  For  which  reafon,  this  will  not  be  long, 
notwithstanding  it  will  comprehend  the  difeafes  upon  which  there  are  three 
fedtions  in  the  Sepulchretum,  and  one  of  them  very  long.  But  left  you 
fhould  l'uppofe  this  to  happen  from  a  kind  of  carelefsnefs,  or  too  great  hafte, 
firft,  I  will  give  you  the  reafons  for  the  prolixity  of  others,  and  my  own 
brevity. 

2.  It  is  true,  you  will  find  a  great  number  of  articles,  and  many  of  them 
very  ufeful  and  curious,  in  thofe  three  fedtions  of  the  Sepulchretum,  that 
is  the  fifth,  fixth,  and  feventh,  whether  you  read  the  obfervations  or  the 
fchoiia.  But,  at  the  fame  time,  you  will  ?find  many  things  that  you  would 
be  very  willing  to  do  without.  And  for  inftances  of  what  I  afiert,  take  the 
following,  in  the  fifth  fedtion  ( a )  :  “  the  fubftance  of  the  heart  thrown  up 
“  by  fpitting  *,  ( b )  an  hasmoptoe  from  the  rupture  of  a  veflfel  in  the  right 
“  fide  of  the  fulpenforium  of  the  liver  j  (c)  the  vena  cava  ruptur’d  in  the 
“  lungs  and,  in  the  feventh  fedtion  (J),  “  a  confumption  arifing  from  the 
“  kidnies,  and  efpecially  the  right,  being  grown,  as  it  were,  to  the  liver, 
“  by  peculiar  membranes,  with  which  they  were  invefted.”  Some  of  the 
obfervations  alfo  are  repeated,  and  among  thefe  the  very  firft  in  one  of  thefe 
fedtions  (<?),  as  the  fchoiia  are  alfo  (/).  But,  to  keep  to  one  fedtion  only, 
pray  compare  the  fixty-nir.n  obfervation  with  article  the  fecond,  under  obfer¬ 
vation  the  twenty-fourth  ;  and  article  the  firft,  under  the  hundred  and  thirty- 


( b )  Epift.  17.  n.  28. 

(<r)  Epift.  ead.  &  18. 

(<a)  Obf.  21. 

p?)  In  Schol.  ad  Obf.  24, 


( c )  In  Additam.  Obf.  1. 

(d)  Obf.  126,  ( e )  Seft.  6.  Obf.  14. 

\  f)  Ibid,  fecundum  ad  Obf.  g.  &  ad  31.  in 
Sedt.  7. 

4N  2 


firft 


6 44  Book  II.  Of  Difeafes  of  the  Thorax. 

firft  obfervation,  with  article  the  fecond  and  finally,  the  hundred  and  forty- 
fourth  obfervation,  with  the  hundred  and  fifty-fourth  ;  and  you  will  fee  that 
thofe  things  are  produc’d  fix  times  over,  which  it  would  have  been  fufficient 
to  have  produc’d  three  times :  and  that  they  are  repeated  fo  as  to  confound 
the  readers,  who  will  fuppofe,  that  two  books  of  Thomas  Bartholin  are 
quoted  in  the  third  obfervation,  whereas  one  and  the  fame  is  referr’d  to  ; 
and  in  the  fecond,  the  readers  will  be  in  doubt,  whether  it  happen’d  at 
Frankfort  ad  Viadrum ,,  or  rather  at  Frankfort  ad  Oderam ,  or  on  the  Oder, 
where  the  obfervation  was  really  made  *,  and  finally,  in  the  firft  obfervation, 
when  the  readers  fhall  obferve,  that  in  the  diflcdtion  of  the  body  of  Chrifto- 
phorus  Richterus,  the  “  uterus”  is  fpoken  of,  by  I  know  not  what  ftrange 
accident,  how  muft  they  be  aftonilh’d  ?  I  fay  nothing  of  the  obfervation  (^), 
“  of  a  conlumption  from  a  gland  growing  to  the  pylorus,”  which  is  by  no 
means  an  obfervation,  but  a  conjedture,  and  that  not  a  very  well-founded 
one  neither,  if  we  attend  to  the  fimilar  appearances  which  I  have  feen  in  the 
fame  place,  without  any  confumption  attending  them. 

Nor  do  I  fay  any  thing  of  the  fcholium  fubjoin’d  to  the  thirty-feventh 
obfervation,  to  which  it  can  by  no  means  belong,  as  there  is  nothing  faid 
about  “  a  matron,”  or  about  “  the  cerebrum,”  in  the  obfervation  (which 
miftake  has  alfo  crept  in  elfewhere  :)  ( h )  nor  is  what  Diemerbroeck  Formerly 
took  notice  of  in  regard  to  the  adtion  of  the  liver,  fpleen,  and  pancreas,  of 
fo  much  importance  as  to  take  up,  with  juftice,  a  great  number  of  pages 
in  the  fcholium  added  to  obfervation  the  hundred  and  fifty-fifth.  But  what 
fhall  we  fay  of  the  additamenta  to  this  fame  feventh  fedtion  ?  I  pafs  by 
many  pages  that  are  taken  up  with  confultations  (*).  I  pafs  by  the  obferva- 
tions,  in  which  there  is  not  fo  much  as  the  name  of  the  diforder  that  is  the 
fubjedt  in  queftion  ;  I  mean  the  confumption,  as  in  the  ninth.  But  certainly, 
the  third  obfervation,  with  a  part  of  its  fcholium,  had  already  been  pro¬ 
duc’d  before,  in  this  very  fedtion,  and  fomewhat  more  at  large,  under  obfer¬ 
vation  the  fixty-fecond,  as  obfervation  the  ninety-eighth  and  fifty-firft,  which 
are  already  given,  are  the  fame  with  obfervation  the  tenth  and  twenty-firft, 
in  the  additamenta,  if  you  except  a  few  words  that  are  added  in  the  firft  of 
them,  and  many  in  the  fecond  ;  which  Blancardus,  according  to  his  cuftom,. 
has  either  omitted,  or  chang’d,  as  if  it  had  not  been  the  obfervation  of  Tho¬ 
mas  Bartholin,  but  his  own,  of  which  circumftance  Bonetus  was  more  cau¬ 
tious,  though  not  fo  much  as  might  be  wifti’d,  even  in  this  very  fedtion. 

If  to  all  thefe  things,  and  others  of  the  like  nature,  which  you  yourfelf 
will  probably  obferve,  by  enquiring  more  diligently,  that  great  number  of  ob- 
fervations  be  added,  which  Bonetus,  although  he  confeffes  they  belong  to 
other  titles,  does  not,  however,  entirely  pals  by  in  this  place,  and  other 
obfervations  alfo,  of  which  he  does  not  confefs  the  fame  thing,  notwithftand- 
ing  they  equally  belong  to  other  places-,  and  finally,  that  great  number  of 
thofe  which,  whatever  was  the  caufe  of  the  wafting,  we  fee  thrown  together 
into  the  feventh  fedtion,  wherein,  as  the  title  of  this  fecond  book,  De  Affec¬ 
tibus  PedtoriSy  indicated,  no  other  confumption  ought  to  have  had  a  place, 
but  fuch  as  had  its  caufe  feated  within  the  thorax  j  for  we  are  not  to  judge 

CXXVIII.  {b)  ut  Sett.  5.  Obf.  10.  Schol.  quod  attinebat  ad  9.  (/')  Obf.  17. 

the 


Letter  XXII.  Articles  3,  4.  6 45* 

the  fame  of  a  confumption,  as  of  the  injuries  of  refpiration,  which  is  always 
an  evident  affeftion  of  the  thorax,  wherever  the  caufe  of  it  may  be  feated : 
if,  therefore,  you  attend  to  all  thefe  things  which  I  have  faid,  you  will 
eafily  find  from  what  caufe  it  happen’d,  that  thofe  obfervations,  which  are 
produc’d  on  account  of  the  diforders  propos’d  in  the  Sepulchretum,  have 
taken  up  fo  great  a  number  of  pages. 

3.  I,  however,  on  the  other  hand,  am  fo  far  from  intending  to  relate  any 
obfervations  twice  over  to  you,  in  this  letter,  or  to  throw  together  difleftions 
which  do  not  particularly  refer  to  the  thorax,  that  I  fhall  not  fo  much  as 
mention  a  word  of  any,  which,  although  they  do  relate  to  the  prefen t  fub- 
je£t,  I  have  had  occafion  of  mentioning  before,  or  fhall  have  occafion  of 
mentioning  hereafter.  And,  indeed,  there  were  fome,  perhaps,  that  re¬ 
lated  rather  to  confumption,  than  to  peripneumony,  which  I  chofe  to  refer 
to  the  latter,  in  the  two  laft  letters,  when  I  treated  of  that  fubjeft.  For  al¬ 
though  fometimes  there  were  expectorations,  and  a  fever,  of  luch  a  kind, 
that  agreed  better  with  a  phthifis  than  a  peripneumony,  or  the  difeas’d  ap¬ 
pearance  found  in  the  lungs  did  not  feem  to  be  very  recent  *,  yet  when  Val- 
falva,  who  had  infpe&ed  the  patients,  and  the  bodies  after  death,  has  ex- 
prefsly  faid,  that  they  had  died  of  a  peripneumony  •,  or  when  1  was  entirely 
ignorant  of  the  inconveniences  of  the  thorax,  that  had  preceded,  but  knew 
what  had  happen’d  lateft  of  all ;  I  rather  referr’d  thefe,  in  purfuance  of  his 
opinion,  to  the  place  where,  without  doubt,  they  belong’d  in  part,  and 
whence  you  may,  if  you  choofe  it,  eafily  recal  them.  But  befides  thefe, 
I  will  give  you  another  principal  reafon  for  my  brevity  at  prefent.  Vallalva, 
after  having  been  in  danger  of  a  confumption,  when  a  young  man,  as  is 
written  in  his  life,  was  rather  cautious,  I  believe,  of  difiedting  bodies  that 
had  been  wafted  away  by  diforders  of  that  kind.  And  I,  to  open  myfelf 
freely  to  you,  confefs,  that  when  I  was  a  young  man  I  purpofely  avoided 
them,  and  do  at  prefent  avoid  them,  though  I  am  now  an  old  man,  not  only 
for  the  fake  of  myfelf,  but  of  the  ftudents  who  generally  are  about  me  j 
more  cautious,  perhaps,  than  you  will  think  neceftary  for  me  to  be,  though 
you  cannot  deny  but  it  is  the  fafeft  method  ( k ).  For  which  reafons  he  did 
not  difiedt  many,  and  I  but  one.  The  hiftories  of  thefe  I  will  now  recite 
in  order;  and  firft  the  hiftories  of  thofe  which  Valfalva  differed. 

4.  A  man  of  fifty  years  of  age,  having  fuffer’d  great  fatigues  in  journey¬ 
ing,  and  at  length  returning  home,  complain’d  very  much  of  a  pain  in  his 
cheft,  and  a  cough,  by  means  of  which  he  fpat  up  a  very  little  quantity  of 
matter  :  he  lay  down  molt  commodioufiy  with  his  head  bent  forwards :  his 
belly  and  feet  were  tumid  :  he  thirfted  much :  he  breath’d  with  a  kind  of 
panting  motion  r  and  was  extremely  opprefs’d  after  food.  To  thefe  fymp- 
toms  a  fpitting  of  blood  was  added.  But  this  was  appeas’d  •,  the  others, 
however,  continu’d,  except  that  for  almoft  a  whole  month  before  his  death, 
he  was  quite  free  from  a  pain  of  the  breaft.  Yet,  on  the  three  or  four  laft 
days,  he  was  not  able  to  lie  down  on  the  right  fide.  At  length,  a  great 
quantity  of  blood  burfting  forth  from  the  lungs,  he  was  fuffocated. 

The  belly  was  univerfally  fill’d  with  a  yellowifti  water,  not  unlike  the  fe- 


(i)  Vid.  Epift.  49.  n.  32. 


rum 


646  Book  II.  Of  Difeafes  of  the  Thorax. 

rum  which  we  fee  fwimming  round  the  blood,  after  it  has  been  taken  away 
from  a  vein,  and  coagulated.  No  lymphasduCts  were  feen  in  any  part.  The 
fpleen  was  equal  in  its  bulk  to  the  natural  bulk  of  the  liver,  and  was  fo 
clofely  connected  with  the  neighb’ring  parts,  that  it  could  not  be  feparated, 
but  with  difficulty.  The  liver  leem’d  to  be  in  fome  meafure  contracted, 
and  was  pale  both  internally  and  externally;  the  coats  of  the  gall  bladder 
being  very  confiderably  thicken’d.  But  to  the  coats  of  the  urinary  bladder, 
cartilaginous  concretions  adher  d,  heie  and  there. 

In  the  right  cavity  of  the  thorax  the  lungs  were  found,  except  that  they 
were  very  red  in  the  inferior  part.  But  in  the  left  cavity  the  whole  lobe 
was  pallid,  contracted,  and  hard,  and  contain’d  a  famous  matter :  befides, 
it  was  fo  connected  with  the  furrounding  parts,  that  it  feem’d  to  form  one 
body,  as  it  were,  with  them,  nor  could  it  be  feparated  without  applying  vio¬ 
lence.  The  pericardium  alfo  was  every  where  connected  with  the  heart. 
And  the  ventricles  of  the  heart  were  quite  empty. 

5.  You  will  alk,  perhaps,  how  the  left  lobe  of  the  lungs  can  be  faid  to 
be  contracted,  and,  at  the  fame  time,  connected  in  fo  remarkable  a  manner 
with  the  furrounding  parts  ?  Without  doubt,  it  was  either  not  connected 
to  all  the  parts  about  it,  but  only  to  fome  of  them  ;  or,  if  it  was  connected 
to  all,  it  was  not  contracted  in  its  circumference,  but  in  its  internal  fubftance; 
for  which  reafon  it  is  faid  to  be  contracted,  and  hard,  the  famous  matter 
fillino-  up  the  fpace,  whatever  was  left  within  the  contracted  fubftance,  the 
more’eafily,  becaufe  the  cough  was  but  little  able  to  difcharge  it  from  the 
luncrs,  that  wele  thus  contracted,  and  connected  all  round.  And  as  the  pain 
of  die  breaft,  and  cough,  indicate  that  thefe  diforders  of  the  lungs  had  not 
be<um  after  the  firft  fpitting  of  blood ;  and  as  the  abfence  of  the  fame  pain, 
for&a  month  before  death,  indicates  that  the  hardnefs  of  the  lungs  was  greatly 
encreas’d  before  the  fecond  and  more  plentiful  fpitting  of  blood  happen’d  ; 
it  is  probable,  that  this  hardnefs  much  contributed  to  both  of  thofe  bloody 
eruptions,  which  by  ftreightning  and  compreffing  a  part  of  the  veffiels,  and, 
foon  after  that,  by  compreffing  them  all,  compell’d  the  blood,  firft,  to  break 
through  fome  veffel  in  the  fame  left  lobe,  and,  laft  of  all,  to  do  the  like 
in  the^right  lobe.  For  that  the  blood,  which  was  almoft  excluded  from  the 
left  lobet  that  was  now  univerfally  hard  and  contracted,  and  for  that  reafon 
pale,  had  made  its  impetus  on  this,  not  only  the  patient’s  incapacity  of  lying 
down  on  the  right  fide,  in  thofe  laft  days,  but  alfo  the  great  rednefs  of  the 
ricffit  lobe  of  the  lungs,  towards  the  lower  part,  though  in  other  refpeCts 
found,  feem  jointly  to  demonftrate.  And  certainly,  not  only  in  confumptive 
perfons,  fuch  as  this  man  was,  who  had  thrown  out  blood  from  the;  mouth, 
a  hardnefs  of  the  lungs  was  found,  both  by  Wirfungus  (/)  and  Ingraffia  (m), 
but  alfo  by  others,  in  whom  there  had  never  been  purulent,  but  always 
bloody,  fpittings,  as  by  Willis  (/*),  whole  explication  1  have  in  general  fol¬ 
low’d  here  ;  yet  ffiall  be  ready  to  follow  any  other  at  another  time,  if  it 
jffiould  appear  to  me  to  be  more  proper. 

But  whichfoever  you  chufe  to  follow,  in  that  fpitting  of  blood,  for  which 

(!)  Sepulchr.  1.  2.  S.  7.  Obf.  6.  (»)  L.  1.  Sepulchr.  S.  21.  Obf.  7. 

(m)  Ibid.  Obf.  102. 

a  young 


Letter  XXII.  Articles  6,  7.  6 47 

a  young  pried  of  the  order  of  St.  Dominic  confulted  me,  it  will  not  be  eafy 
to  give  a  reafon,  why  it  fhould  happen  to  tnofe  perfons  of  whom  he  related 
the  hiftory.  For  when  1  afk’d  him,  whether  his  father,  or  mother,  or  the 
relations  or  anceftors  of  either,  had  labour’d  under  a  fpitting  of  this  kind, 
he  exprefsly  denied  it  ;  but  immediately  added  this,  that  his  father  was  an 
Armenian,  and  his  mother  an  Italian  ;  and  that  it  had  been  obferv’d  at  Ve¬ 
nice,  in  three  other  families,  that  the  children  whom  an  Italian  mother  had 
brought  forth  by  an  Armenian  father,  were  liable  to  a  diforder  of  this  kind, 
to  which  their  parents  and  -  anceftors  had  not  been  liable  ;  and  that  three  or 
lour  of  his  brothers  had  died  of  this  diforder  already.  And  this  fpitting  of 
blood  feem’d  to  him,  and  to  me,  to  be  fcorbutic.  But  let  us  go  on  to  the 
obfervations  of  perfons  labouring  under  an  empyema. 

6.  A  young  man,  of  about  eighteen  years  of  age,  feeming  to  have  got  rid 
of  an  inflammation  of  the  right  lobe  of  the  lungs,  by  a  proper  application 
of  remedies,  was  again  feiz’d  with  a  frefh  fever,  together  with  a  cough,  a 
purulent  fpitting,  and  third.  In  the  mean  while,  his  face  fwell’d.  He  lay 
continually  on  his  right  fide,  nor  could  he  bear  to  lie  in  any  other  pofture, 
even  for  a  very  Ihort  time.  His  belly  became  tumid.  At  length,  after  he 
had  been  troubl’d  two  months,  and  longer,  with  thefe  fymptoms,  he  died. 

The  abdomen,  which  in  the  dead  body  feem’d  to  have  loft  its  fwelling, 
being  open’d,  a  large  quantity  qf  limpid  ferum  came  forth  :  yet  no  mark  of 
injury  appear’d  in  the  vilcera  of  that  cavity.  When  the  thorax  was  open’d, 
the  right  cavity  thereof  was  found  to  be  entirely  full  of  pus,  and  the  lobe  of 
the  lungs  on  that  fide  lb  contracted,  that  it  feem’d  as  if  it  had  been  originally 
deficient.  And  becaufe,  while  the  carcafe  was  previoufly  mov’d,  pus  had 
burft  forth  through  the  afpera  arteria,  enquiry  was  made  whether  it  might 
not,  poftibly,  have  come  from  the  cavity  of  the  thorax,  through  the  pores  of 
the  coat  of  the  lungs,  or  by  means  of  an  ulcer,  with  which  this  coat  was 
eroded,  into  the  bronchia.  But  no  ulcer  could  be  perceiv’d  in  this  membrane, 
or,  at  leaft,  as  far  as  it  was  in  our  power,  by  reafon  of  the  intolerable  flench, 
to  enquire.  Nor  was  any  large  ulcer  perceiv’d,  when  the  contracted  fubftance 
of  the  lungs  was  cut  into,  but  only,  in  fome  places,  very  fmall  tubercles, 
which  difcharg’d  a  little  quantity  of  pus.  The  pleura,  however,  was  found  : 
but  the  pericardium  full  of  water. 

7.  It  were  much  to  be  wifh’d,  that  the  conftitution  of  the  membrane  of 
the  lungs  could  be  fearch’d  into  by  a  longer  and  more  accurate  examination, 
that  we  might  be  at  liberty  to  determine  fomething  in  regard  to  the  pafiage 
of  pus,  not  fo  much  from  the  cavity  of  the  thorax:  into  the  lungs,  as  from 
the  lungs  into  the  cavity  of  the  thorax.  For  as  the  pleura  was  found,  it  re¬ 
main’d,  that  this  quantity  of  pus  had  fall’n  into  that  cavity  from  the  lungs. 
In  which,  although  no  large  ulcer  was  found,  but  only  fmall  tubercles,  from 
whence  we  may  fuppofe  that  the  pus,  which  had  flow’d  out  of  the  mouth  of 
the  carcafe,  had  proceeded,  and  been  collected,  by  degrees,  in  the  bronchia  j 
yet  the  contracted  fubftance  of  the  lungs  might  not  only  greatly  diminifh  the 
cavity  of  the  abfcefs,  which  had  been  in  it  before,  but  even  entirely  conceal 
it.  Nor  yet  was  the  fubftance  of  the  lungs,  in  this  young  man  alfo,  con¬ 
tracted  in  fuch  a  manner  as  it  was  in  the  man  of  whom  we  fpokejuft  now  (o)i 

[0)  N.  4. 


I  mean, 


6  48  Book  II,  Of  Difeafes  of  the  Thorax. 

1  mean,  fo  that  the  circumference  was  not  at  all  diminiftt’d  ;  but  had  been 
fo  far  wafted  in  this  cafe,  that,  at  firft,  the  lungs  feem’d  to  be  deficient. 
And  the  caufe  of  this  very  great  wafting  might  be  double ;  in  the  firft  place, 
the  great  confumption  of  the  internal  fubftance  of  the  lungs  by  fuppuration  ; 
and,  lecondly,  the  compreftion  upon  the  furface  of  the  lungs,  from  the  great 
quantity  of  pus  which  was  effus’d  into  the  thorax,  fo  as  to  fill  the  cavity  of 
it  entirely.  And  how  great  is  the  force  of  either  of  thole  caufes,  may  be 
conceiv’d  from  thele  very  fe&ions  of  the  Sepulchretum.  For  you  will  read 
in  them  many  different  obfervations  of  different  perfons  (/>),  from  which  it 
appears,  that  not  only  a  great  part  of  one  lobe  of  the  lungs,  but  the  whole 
fubftance  of  it,  was  entirely  confum’d  by  fuppuration.  And  other  obferva¬ 
tions  are  not  wanting  to  add  to  them.  For  the  illuftrious  Senac  (q)  has  fome- 
times  feen  a  whole  lobe  of  the  lungs  entirely  confum’d,  and  reduc’d  into 
pus ;  and  Laubius  (r)  the  lungs  on  the  right  fide  more  than  half  confum’d, 
and  furrounded  with  an  almoft  incredible  quantity  of  pus :  and  the  obferva¬ 
tion,  alfo,  of  that  moft  humane  old  man  Dominic  Pafferi,  an  eminent  phy- 
fician  at  Peflaro,  which  was  written  to  me  in  the  fame  year  that  it  was  pub- 
liflh’d,  that  is,  in  1734,  feems  referable  to  this  clafs ;  and  alfo  the  obfervation 
of  Marcus  Gerbezius  (j),  who  found  the  whole  right  lobe  of  the  lungs,  to¬ 
gether  with  the  afpera  arteria,  to  be  fall’n  down  into  a  pultice-like  con- 
iiftence,  by  reafon  of  putrefa&ion.  And  although  Jo.  Tackius  (/)  faw  the 
lungs  fo  thoroughly  corrupted,  that  he  affirm’d  the.  right  fide  to  be  quite 
devoid  of  lungs ;  yet  Ritterus  the  younger  («)  would  excite  our  admiration 
more,  by  afferting,  that  in  the  left  fide  of  the  thorax,  which  was  half-full 
of  a  white  purulent  matter,  the  mouths  of  the  veffels  in  that  lobe,  which 
was  almoft  entirely  confum’d,  were  open ;  if  the  very  celebrated  anatomift 
Haller  (x)  did  not  confirm  it,  by  faying,  that  he  had  found,  inftead  of  the 
left  lobe  of  the  lungs,  which  had  totally  difappear’d,  a  great  quantity  of  al¬ 
moft  foetid  water,  vifcid  like  the  white  of  an  egg,  and  in  that  the  afpera 
arteria,  and  the  larger  arterial  and  venous  veffels,  in  a  manner  cut  off,  and 
gaping  fo  evidently  at  their  termination,  that  it  would  be  difficult  to  find 
out  what  put  a  ftop  to  the  flux  of  the  blood.  For  Platerus,  who  had  found, 
more  than  once,  in  confumptive  perfons,  that  no  part  of  the  lungs,  on  one 
fide,  was  remaining,  at  leaft  faw  “  the  veffels  of  the  heart,  which  went 
“  thither,  and  the  branches  of  the  arteries,  flopp’d  up,”  as  you  will  read 
in  this  feventh  fedlion  of  the  Sepulchretum  (y). 

And  when  you  have  well  confider’d  all  thefe  things,  in  relation  to  the 
former  of  thofe  two  caufes  of  the  decreafe  of  the  lungs,  which  I  have  men¬ 
tion’d  ;  I  would  then  have  you,  in  regard  to  the  other,  turn  to  the  firft  part 
of  that  fcholium,  which  is  fubjoin’d  to  the  fourth  obfervation  of  the  fixth 
fedtion,  in  order  to  obferve,  that  not  only  the  lungs  themfelves  are  melted 
down  by  fuppuration,  and  pour’d  out  into  the  thorax,  but  that  even  a  far 


(p)  S.  6,  Obf.  4.  1 1.  &  in  Additam.  Obf.  1. 
§  2.  &  Obf.  4.  &  S.  7.  Obf.  20.  &  55.  103.  & 
cast. 

(7)  Traite  du  Coeur,  1.  4.  ch.  3,  n.  2. 

\r)  Ad.  N.  C.  Tom.  2  Obf.  107. 


(s)  Eorund.  Eph.  Dec.  3.  A.  3.  Obf.  6. 
(/)  Dec.  ead.  A.  8.  Obf.  155. 

(«)  Eorund.  Ad.  Tom.  6.  Obf.  14. 

(*)  Opufc.  Pathol.  Obf.  17. 

OJ  Obf.  55* 


I 


greater 


Letter  XXII.  Article  3.  6 49 

greater  quantity  of  pus  is  form’d  from  the  fluids,  which  are  carried,  by 
means  of  the  vefifds,  into  -that  lobe.  It  muft  therefore  of  courfe  happen,, 
that  this  cavity  of  the  thorax  being  fill’d,  the  lungs  muft  decreale  fo  much 
the  more,  as  the  pus  is  ftill  more  encreafing,  and  urges,  (till  more,  the  re¬ 
maining  fubftance  of  the  lungs,  which  was  eafily  to  be  comprefs’d  into  a 
narrow  compafs,  as  well  becaufe  the  membranous  veficles,  of  which  it  con- 
fifts,  render  it  foft,  as  becaufe  the  cavities  that  are  made  internally  from  fup- 
puration,  make  it  ftill  more  liable  to  yield  to  the  external  force. 

And  indeed,  from  thefe,  or  fome  other  caufes  of  the  like  kind,  do  I 
think  it  has  happen’d,  that  the  lungs,  being  fometimes  furrounded  with  a 
large  quantity  of  water,  have  been  lb  comprefs’d,  that  they  feem’d  almoft 
to  be  deficient.  Thus  Columbus  (2)  fays,  “  I  have  found,  that  a  part  of 
te  the  thorax  was  deftitute  of  lungs,  that  is  to  fay,  that  a  very  fmall  portion 
<c  only  could  be  found  :  and  what  remain’d  of  the  cavity  was  occupied  by 
tc  an  aqueous  humour.”  So  alfo,  at  another  time,  Valfalva,  whofe  obfer- 
vation  will  be  produc’d  hereafter  (<?),  believ'd,  at  firft  fight,  that  there  were 
no  lungs,  fo  contracted  were  they  under  a  great  quantity  of  fluid!  Thus,  not 
to  be  too  tedious,  the  defervedly  commended  Haller  (b)  faw  the  lungs,  u  in 
“  a  dropfy  of  the  thorax,  fo  comprefs’d,  and  grown  to  the  pleura,  that  it 
<c  would  feem,  to  an  incautious  obferver,  that  there  were  none  at  all,  as  they 
“  were  at  mod  fcarcely  more  than  three  lines  in  thicknefs.”  And  that  a 
deception  of  the  fame  kind  had  happen’d  in  the  obfervation  ( c )  which  is 
exhibited  in  the  fifty-fixth  deputation,  among  the  practical  ones  collected  by 
him,  feems  very  probable  to  this  illuftrious  author  (d).  He  nevertheless 
commends  the  hiftories  which  are  inferted  here  and  there  in  this  diflertation, 
and  relate  to  the  vomicce  of  the  lungs,  and  of  the  neighbouring  glands. 

I  would  have  you  read  them  over.  For  you  will  find,  as  far  as  I  could  fee, 
no  fmall  number  to  be  added  to  the  Sepulchretum  none  of  which  it  was 
in  my  power  to  take  notice  of  in  this  letter,  as  the  diflertation  came  fo  late 
to  my  hands,  that  the  letter  being  not  only  revis’d,  but  alfo  copied  fair,  I 
could  but  juft  infert  thefe  few  things,  which  I  at  prelent  fay.  But  let  us  go 
on  to  the  other  obfervations  of  Valfalva,  in  which  the  bulk  of  the  lungs  was 
diminifh’d. 

8*  A  man,  aimoft  five  and  forty  years  of  age,  who  had  liv’d  in  a  fwatnpy 
and  fenny  country,  began  to  complain  of  inconveniences  in  his  cheft ;  and 
among  others  of  rei'piration  being  opprelVd,  and  efpecially  after  motion. 
After  fome  months,  he  was  feiz’d  with  a  violent  fever,  together  with  an 
heavy  and  pungent  pain  of  the  left  fide,  fo  as  not  to  lie  down  upon  it  but 
with  difficulty,  a  great  third,  a  troublefome  cough,  a  {pitting  of  matter,  at 
times,  of  a  reddifti  colour,  and  a  hard  and  quick  pulfe.  Thefe  fymptoms 
growing  milder,  after  he  had  been  in  the  hofpital  about  a  month,  he  went 
home  again,  with  his  third  ftill  remaining,  a  flight  pain,  and  a  plentiful 
{pitting  of  ferous  matter.  About  twelve  days  after,  a  more  ardent  fever 
came  on,  being  attended  with  a  great  third,  a  fenfe  of  weight  in  the  whole 

(2)  De  Re  Anat.  1.  15.  (r)  §  65. 

(a)  Epift.  50  n.  4,  (a)  in  Tabula  Deputation.  Volum.  z. 

{b)  Ad  Boerh,  Praeleft.  §  102.  not.  17. 

Vol.  I.  ft  -  4  O  theft, 


6s°  Book  II.  Of  Difeafes  of  the  Thorax. 

cheft,  and  a  troublefome  cough.  The  hypochondria  were  opprefs’d,  as  if 
they  had  been  bound  round  with  a  roller.  At  length  he  died. 

In  the  belly  nothing  preternatural  was  obferv’d,  except  that  the  fpleen  was 
extremely  foft.  In  the  left  cavity  of  the  thorax,  the  anterior  furface  of  the 
dungs  adher’d  to  the  pleura;  but  the  remaining  furface  of  that  lobe,  where 
it  approach’d  to  the  back,  being  disjoin’d  from  the  pleura,  comprehended 
betwixt  this  membrane  and  its  own,  which  was  much  thicken’d,  a  kind  of 
finuous  cavity,  full  of  ferous  matter,  wherein  fvvam  many  fmall  pieces  of 
membranes,  refembling  jelly  ;  fome  of  which  kind  were  firmly  connected, 
in  a  few  places,  to  the  membrane  of  the  lungs.  This  lobe  was  internally 
fprinkl’d  over  with  black  fpots,  and  l'o  fmall  in  its  bulk,  that  it  fcarcely 
equall’d  a  fourth  part  of  its  natural  fize.  On  the  other  hand,  the  right  lobe 
fufikiently  compenfated,  by  its  encreas’d  magnitude,  for  the  frnallneis  of  the 
other.  The  blood,  except  fome  fmall  coagula  of  it,  that  were  found  in  the 
right  ventricle  of  the  heart,  preferv’d  almolt  the  fame  fluidity  that  it  gene¬ 
rally  has  in  the  living  body. 

9.  Although  Valfalva  does  not  feem  to  defcribe  any  other  ferum  in  the 
left  cavity  of  the  thorax,  in  this  difieCtion,  than  what  he  frequently  has 
done,  after  a  pleuripneumony ;  yet  it  muft  have  been  fanious,  for  this  rea- 
fon,  becaufe  he  prefix’d  the  title  of  empyema,  to  this  diforder.  And  indeed 
it  did  fucceed  to  an  inflammation  of  the  lungs,  to  which  a  perfeCt  crifls  had 
not  been  form’d  :  and  what  that  lobe  had  fufter’d  befldes  this,  the  great  di¬ 
minution  of  its  bulk,  not  very  obfcurely,  indicates.  But  in  regard  to  the 
black  fpots,  with  which  they  were  internally  diftinguifh’d,  if  you  here  follow 
the  opinion  of  Olaus  Borrichius,  in  the  hundred  and  fixteenth  obfervation 
of  feCtion  the  feventh  (e)t  they  were  “  proofs  either  of  a  prefent  corruption, 
“  or  of  one  fpeedily  to  enfue  for  he  fays,  “  that  he  had  often  obferv’d  them 
4t  in  the  lungs  of  fuch  dead  bodies  as  had  been  troubl’d  with  a  catarrh, 

while  living:”  although,  as  Valfalva  has  fo  often  taken  notice  of  thefe 
fpots,  in  the  hiftories  delcrib’d  in  the  twentieth  letter,  and  elfewhere,  you 
may  eafily  judge  whether  it  be  probable,  that  all  thefe,  or  the  greateft  part 
of  thefe  perfons,  had  been  troubl’d  with  a  catarrh,  as  Olaus  Borrichius,  in 
that  obfervation,  if  you  read  it  over,  feems  to  conjecture. 

10.  A  man,  of  about  thirty  years  of  age,  whofe  habitation  was  among 
fens  and  marfhy  places,  having  become  fubjeCt  to  an  inflammation  of  the 
thorax,  after  a  lues  venerea,  had  lain  ill  a  long  time  in  the  hofpital  at  Fer¬ 
rara,  in  which  he  got  quite  rid  of  his  ardent  fever,  but  not  entirely  of  the 
tightnefs  at  his  cheft.  By  degrees  this  laft-mention’d  fymptom  became  even 
more  troublefome.  And  indeed  his  legs,  belly,  and  in  Ihort  his  head  itfelf, 
began  to  fwell,  together  with  a  flight  fever,  a  third,  a  greater  difficulty  of 
breathing,  a  pain  of  the  left  fide,  on  which  he  lay  with  the  moft  eafe,  a  fre¬ 
quent  cough,  and  a  continual  expe&oration  of  ferous  matter.  In  the  mean 
while,  the  oedematous  fwelling  of  the  head  had  fo  encreas’d,  that  not  a  little 
ichor  flow’d  out  of  the  left  ear;  till  at  length,  his  pulfe  growing  languid,  fo 
that  for  the  two  laft  days  it  could  fcarcely  be  perceiv’d,  death  put  an  end  to 
the  difeafe. 


(c)  1.  2,  Sepulchr., 


While* 


Letter  XXII.  Article  i  i.  6$x 

While  a  paflage  was  made  by  the  knife  to  the  internal  parts,  ferum  diftill’d 
from  the  integuments,  and  flelh  of  the  body.  In  the  belly,  alfo,  was  found 
a  pellucid  ferum,  but  of  a  yellowilh  colour,  which  being  put  upon  the  fire, 
was  almoft  entirely  diffipated ;  that  is,  a  pellicle,  and  fome  fmail  ftrise  ex¬ 
cepted.  The  inteftines  v/ere,  univerfally,  of  a  pale  colour,  and  turgid  with 
air.  But  the  liver  was  black.  -  <- 

The  thorax  being  open’d,  while  the  vena  mediaftina  was,  by  accident-,  cut 
into,  the  blood  rulh’d  forth  with  an  impetus  almoft  equal  to  that  of  the  living 
body,  when  a  vein  is  open’d  :  but  the  blood,  in  the  whole  of  this  bodyr 
was  extremely  fluid,  and  in  a  manner  diflolv’d,  no  polypous  concretion  ap¬ 
pearing  any-where,  not  even  in  the  heart  itfelf.  The  right  lobe  of  the 
lungs  was  connected,  at  the  upper  parr,  by  (lender  membranes,  to  the  ribs, 
and  on  the  back  part  was  inflam’d.  But  the  upper  part  of  the  left  lobe  was 
hard,  and  feem’d  to  be,  in  a  manner,  flelhy,  from  inflammation  ;  and  the  in¬ 
ferior  part  was  divided  into  fmail  pieces,  fwimming  in  fanies,  which  refembPd 
a  kind  of  gelatinous  fubftance,  and  was  found,  in  great  quantity,  in  that  left 
eavitry.  The  pericardium,  every-where,  adher’d  to  the  heart  fo  clofely,  that 
it  feem’d  to  make  up  one  body  with  it.  In  fome  places  it  was  cartilaginous, 
and  in  others  it  was  become  lo  thick,  as  to  be  equal  to  half  an  inch  :  but 
this  thicknefs  was  owing  to  the  filaments  thereof  being  made  thicker,  and, 
as  it  were,  flefhy,  at  the  fame  time  that  a  kind  of  oval  bodies  were  intercepted 
betwixt  them,  which,  when  cut  into,  difcharg’d  a  yellow  ferum,  and  when 
this  was  prefs’d  our,  reprefented  a  fmail  kind  of  bladders,  or  follicles. 

ii.  This  was  common  to  both  of  thefe  men,  that,  as  they  liv’d  in  a 
moory  country,  they  had  the  blood  in  a  fluid  ftate ;  and  this  fecond  man  ftill 
more  than  the  other,  fo  that  he  not  only  labour’d  under  an  empyema,  but  a 
dropfy  of  the  thorax  :  which  difeafe,  in  the  former  man  alfo,  being  in  fome 
meafure  join’d,  perhaps,  with  the  empyema,  would  afford  a  reafon,  why  the 
humour  found  in  the  thorax  might  appear  to  be  rather  ferous,  than  purulent. 
But  in  this  fecond  man,  as  the  force  of  the  dropfy  was  fo  much  greater  in 
the  other  parts  of  the  body,  may  we  not  fuppofe  it  to  have  happen’d  from 
this  caufe,  that  although  a  frelh  inflammation  of  the  lungs  had  been  added 
to  the  other  difeafes,  the  fever,  nevcrthelefs,  appear’d  to  be  flight  ?  or  fhail 
we  fuppofe  it  to  have  been  flight  for  this  reafon,  becaufe  the  pericardium, 
being  more  thick  than  the  ftrufture  difcover’d  by  Malpighi,  and  every-where 
adhering  to  the  heart,  refilled  its  greater  agitation  ? 

However,  the  lues  venerea,  which  had  firft  made  this  man  liable  to  af¬ 
fections  of  the  thorax,  feems  to  have  render’d  the  lungs  more  inclin’d  to  this 
very  great  corruption.  At  leaft,  thofe  who  are  exercis’d  in  anatomy  and 
phyfic  are  not  ignorant,  that  a  confumption  is  frequently  at  length  added  to 
this  difeafe.  And  you  may  fee  this  from  the  difledlion  that  I  have  defcrib’d 
to  you  in  a  former  letter  (/),  in  which  the  genitals  were  exceedingly  difeas’d, 
and  the  lungs,  at  the  fame  time,  purulent.  And  alfo,  when  I  difle&ed  the 
head  of  a  woman  (^j,  who  ran  about  through  madnefs,  and,  for  the  fame 
reafon,  was  more  expos’d  to  the  lower  and  infedted  fort  of  people,  I  law  her 

(f)  Epjft.  17.  n.25.  TT  Epift.  3.  n,  9. 

body 


4O  a 


6  5  2  Book  II.  Of  Difeafes  of  the  Thorax. 

body  wafted,  and  heard  that  her  lungs  were  fill’d  with  a  great  quantity  of 
pus.  So  I  alfo  heard,  that  the  lungs  of  a  (trumpet,  fome  other  parts  of 
whom  I  infpeded  in  the  latter  end  of  the  year  1716,  were  extremely  injur’d. 
This  woman  had  thrown  up  pus  by  expectoration,  and  had  been  long  ma¬ 
cerated  with  a  flight  fever,  from  a  venereal  caule;  fo  that  in  the  body  after 
death  “  no  traces  remain’d  of  her  breads,  but  the  nipples  only  were  dif- 
“  fcern’d,”  as  Aretaeus  fays  in  the  defcription  of  a  confumptive  body  (, h ). 
Thus  you  will  fee  prefently  (z),  what  kind  of  lungs  Valfalva  found  in  another 
ftrumpet,  after  like  marks  of  a  confumption.  For  now,  before  we  go  on 
to  the  hiftories  of  confumptive  patients,  there  remains  another  of  an  empye- 
matic  man,  which  I  will  immediately  relate. 

1 2.  A  certain  man  was  thought  to  be  free  from  a  foregoing  fever,  but  af¬ 
terwards  began  to  complain  of  a  third,  and  a  difficult  refpiration  ;  fo  that  he  " 
was  oblig’d  to  draw  his  breath  with  his  neck  quite  (trait  •,  and  alfo  of  a  fenfe 
of  a  certain  weight  in  the  middle  of  the  thorax.  Fie  could  by  no  means 
bear  to  lie  down  on  the  left  fide.  And  if  his  leet  had  fwell’d  befldes,  tho’ 
they  did  not  lwell  at  all,  in  fact,  it  would  not  have  been  very  abfurd  to  have 
an  idea  of  a  dropfy  of  the  thorax.  But  after  death,  the  diforder  was  found 
to  be  an  empyema,  or  pus  filling  the  left  cavity  of  the  thorax.  The  upper 
lobule  of  the  lungs,  on  the  left  fide,  had  grown  fomewhat  hard;  and  where 
it  was  turn’d  towards  the  clavicle,  had  the  velicles  of  which  it  confifts  encreas’d 
to  an  amazing  degree;  fo  that  fome  of  them  were  equal  to  the  bignefs  of 
a  filbert,  the  other  being  much  lefs.  Some  of  them  were  of  the  figure  of  a 
globe,  the  reft  of  an  oblong  and  oval  one  ;  all  of  them  full  of  air,  and  ex¬ 
ternally  furnifh’d  with  fanguiferous  veffcls  round  about,  inofculations  of  which 
appear’d  in  one  or  another.  And  one  of  them,  moreover,  (liew’d  fome  fmall 
foramina  opening  upon  the  internal  furfaee. 

13.  It  does  not  appear  in  this  hiftory,  why  the  patient  could  not  lie  down, 

on  the  a  fie  died  fide,  which  mod  of  the  others  could,  efpecially  as  no  pain  is 
taken  notice  of  in  that  fide,  as  was  in  the  firft  ( k )  of  thofe  two  men  laft  de- 
fcrib’d.  Nor  is  it  very  eafy  to  conceive,  in  regard  to  that  man  with  whofe 
hiftory  we  began,  in  this  letter  (/),  to  give  the  obfervations  of  Valfalva,  why 
he  lay  more  commodioufly  with  his  head  (looping  downwards,  than  with  his  , 
neck  (trait,  as,  befldes  the  caules  which  had  their  feat  in  the  belly,  others  in 
the  thorax  were  not  wanting  to  excite  a  difficulty  of  refpiration.  But  the 
explication  of  an  obfervation  of  the  celebrated  Capperus  (m),  may  feem  much 
more  difficult  ;  I  mean,  that  of  a  certain  man  who  had  putrid  and  corrupted 
lungs,  and  who,  for  the  lad  five  hours  of  his  life,  could  at  length  lie  on  his 
back,  after  having  been  oblig’d  to  fit  up  in  bed  conftantly,  with  his  body 
fo  bent  forwards,  that  he  feem’d,  as  it  were,  to  hide  his  head  betwixt  his 

knees.  And  this  confumptive  patient  is  one  of  the  two,  in  whom  riding  on 

hori'eback,  fo  much  recommended  by  Sydenham  (»),  accelerated  death  : 
which  circumftance  gave  occafion  to  the  illuftrious  prefident  Buchnerus,  of 
adding  a  fchoiium,  from  whence  you  may  judge,  when  that  kind  of  exercile 

(. b )  De  Cauf.  &  Not.  diuturn.  AfFett.  I.  1.  (1)  N.  4. 

c.  8.  (/)  N.  15.  (/«)  Aft.  N.  C.  Tom.  4.  Obf.  47. 

(«)  N.  8.  («)  In  Differt.  Epiit.  ad  G.  Coie. 

v 

»  is 


1 


Letter  XXII.  Article  13.  653 

is  to  be  forbidden  in  a  confumprion,  and  when  to  be  recommended  with 
hope  of  fuccels.  Without  doubt,  as  in  other  diforders,  fo  in  this  alfo,*the 
fame  remedies  are  not  advantageous  to  all.  For  which  reafon,  if  any  phyfician 
fhould  enjoin  to  thofe  who  are  fubjeCt  to  a  confumption,  to  harangue  in 
public,  or  to  Ipeak  in  any  other  manner  vehemently  and  acutely,  or  to  fing, 
bcxaute  our  Sanctori  us  (c)  not  only  recommended  thefe  things,  but  alfo  con- 
firm’d  their  life  by  the  example  of  an  eminent  orator  in  the  church,  who  in 
his  youth  being  liable  to  this  difeafe,  had  afterwards  acquir’d  a  very  good 
fiate  of  health  for  himfelf,  by  making  a  public  difcourfe  every  day  with  a 
loud  voice ;  and  yet  this  phyfician  did  not  pay  any  attention  to  the  fiate  of 
lungs,  which  this  orator,  and  the  others  to  whom  Sanctorius  recom¬ 
mended  it,  were  of,  how  many  do  you  fuppofe  he  would  rafhly  precipitate 
into  that  very  evil  from  which  he  intended  to  withdraw  them  !  When  there 
was  in  Marcus  Tullius,  as  he  has  laid  of  himfelf,  in  the  book  which  is  en¬ 
titl’d  Brutus  \  I  fay,  when  there  was  in  him  “  the  greateft  flendernefs  and 
“  weaknefs  of  body,  with  a  long  and  thin  neck,  which  habit  and  figure  is 
“  fuppos’d  not  to  be  very  remote  from  death,  if  fatigue  and  exercife  of  the 
tc  voice,  together  with  confiderable  exertions  of  the  body,  were  added  and 
as  he  “  fpoke  with  all  poffible  exertion  both  of  voice  and  gefture,  both 
“  friends  and  phyficians  advis’d  him  to  leave  off  pleading  caules  :  ”  for 
which  reafon  he  withdrew  from  the  Forum,  and  did  not  return  ’till  after  two 
years,  when  he  was  “  almoft  transform’d.  For  having  ceas’d  from  fo 
“  great  an  exertion  of  his  powers,  and  the  bufinefs  of  oration  having  been 
“  quite  at  a  ftand,  he  had  recover’d  ftrength  in  his  voice,  and  a  tolerably 
“  good  habit  of  body.” 

On  the  other  hand,  our  Ramazzini  (p)  will  {hew,  what  frequently  happens 
in  the  iungs  of  orators,  readers,  and  lingers,  who  do  not  ufe  thefe  exercifcs 
with  moderation  :  and  that  the  fame  vilcus  was  entirely  ulcerated,  purulent, 
and  altogether  putrid,  in  a  young  man  who  play’d  upon  the  pipe,  and  in  a 
certain  mufician,  the  already  commended  Duiffingius(j),  and  Stegmannus  (r), 
will  teach  you.  And,  indeed,  I  mylelf  remember,  that  in  a  young  man, 
a  native  of  Forli,  who  had  lung  in  the  emperor’s  court  with  great  applaufe, 
and  with  a  very  fhrill  voice,  the  organs  of  refpiration  were  fo  ulcerated,  that 
the  diforder  being  now  continu’d  to  the  larynx  and  the  fauces,  he  could 
fwallow  nothing,  and  even  died  fuffocated,  while  he  attempted  to  fup  down 
gradually  the  yolk  of  a  foft  egg.  But  what  Valfalva  fiw  in  the  lungs  of 
another  perfon,  who  had  been  practis’d  in  the  fame  art,  and  the  ufe  of  wind- 
inftruments  of  mufie,  you  will  read  prefently  (j).  For  previoufly  to  this, 
a  few  things  are  to  be  added,  in  relation  to  the  hiftory  which  I  la  ft  of  all 
propos’d  (t)  1  mean,  that  it  does  not  appear  from  whence  the  pus  had 

proceeded,  with  which  the  thoracic  cavity  of  the  left  fide  was  fill’d,  whether 
it  was  tranflated  thither  from  any  other  part,  or  pour’d  out  from  that  upper 
part  of  the  lobe  of  the  lungs,  which  was  fomething  hard,  and  dilated  into 
•  / 

(0)  Comment,  in  Art.  Med.  G&l.  e.  67.  (7)  Commere.  Litter.  A.  1741.  Hebd.  44. 

partic.  2.  D.  1. 

(y)  De  Morb.  Ardfic.  c.  37.  (>)  Eph.  N.  C.  Dec.  3.  A.  4.  Obf.  109. 

10  N.  14.  {0  N.  13. 

large 


6  s  4  Book  II.  Of  Difeafes  of  the  Thorax. 

large  veflcles.  For  if  it  were  certain  what  fymptoms  the  foregoing  fevers 
had  been  attended  with,  or  what  other  part  of  the  body  preferv’d  any  traces 
of  injury,  there  might  then  be  fome  room  for  our  firft  conjecture.  Now, 
notwithstanding  thofe  cavities  of  the  lungs  appear’d  in  fuch  a  manner,  that 
they  feem’d  not  unlikely  to  be  taken  for  the  vehicles  thereof  enlarg’d,  yet 
that  high  fituation  in  which  they  were,  and  the  hardnefs  join’d  to  it,  may 
perhaps  give  rife  to  a  fufpicion  that  favours  another  conjecture,  efpecially 
with  thofe  who  do  not  believe  it  to  be  the  effeCt  of  chance  only,  that  it  hap¬ 
pen’d  to  Valfalva,  in  the  diflfeCtions  of  confumptive  perfons,  to  find  the  fame 
part  of  the  lungs  particularly  injur’d,  as  the  next  observation  will  fhew,  and 
two  others,  that  (hall  be  produc’d  afterwards,  will  confirm.-^7 

14,  A  certain  man  fkill’d  in  the  art  of  mufic,  and  the  ufe  of  its  inftru- 
ments,  being  already  of  a  middle  age,  had  fall’n,  three  years  before,  into  a 
{pitting  of  blood,  to  which  a  cough,  with  a  {pitting  of  a  catarrhous  matter, 
as  it  is  commonly  call’d,  fucceeded.  After  many  months  being  elaps’d,  the 
hemoptoe  return’d,  and  after  this  ftill  at  another  time  ;  ’till  at  length  it  left 
behind  it  an  expectoration  of  matter,  not  only  in  great  quantities,  but  thick, 
and  of  a  very  bad  appearance.  It  is  true,  he  could  lie  down  eafily  on  which 
fide  he  pleas’d,  and  there  was  no  pain  in  the  thorax :  but  at  night,  and,  in 
particular,  after  fupper,  the  cough  was  troubiefome.  His  refpiration  was 
alio  difficult,  efpecially  after  motion,  though  never  fo  flight.  Add  to  thefe, 
a  great  thirft,  and  an  oppreffion  at  his  ftomach  after  taking  food.  Some 
weeks  before  his  death,  he  had  frequent  noCturnal  fweats;  and  although  his 
feet  had  been  accuftom’d  to  fwell  fometimes,  and  afterwards  to  fall  quite  to 
their  natural  fize,  in  the  laft  days  of  his  life  the  fwelling  fell  no  more.  And 
a  diarrhea  coming  on,  by  which  a  great  quantity  of  ferous  matter  was  dif- 
charg’d,  and  the  patient  beginning  to  put  on  his  cloaths,  in  order  to  get  up 
from  bed,  died  luddenly. 

The  lungs  of  this  man  were  fill’d  with  many  tubercles.  Moreover,  the 
upper  lobule  of  the  lungs,  on  the  left  fide,  and  in  its  upper  part,  towards 
the  fternum,  was  externally  very  hard,  and  had  within  it  an  ulcer  of  a  con¬ 
siderable  fize,  in  which  was  a  quantity  of  fanies,  almoft  of  the  confidence  of 
a  pultice.  And  here  Valfalva  obferv’d,  that  in  all  the  confumptive  perfons 
he  had  difieCted  to  that  time,  the  ulcer  and  difeafe  was  in  the  upper  part  of 
the  lungs.  As  to  what  remains,  near  half  a  pint  of  ferum  was  found  in  the 
right  cavity  of  the  thorax,  and  as  much  in  the  pericardium.  This  ferum  of 
the  pericardium,  being  put  upon  the  fire,  evaporated  wholly,  except  that  it 
left  a  pellicle  in  the  bottom  of  the  vefitl. 

15.  A  ftrumpet,  of  about  twenty  years  of  age,  had  labour’d  many  months 
under  a  flow  fever,  a  cough,  an  ill-condition’d  expectoration,  and  a  wafting 
of  the  whole  body.  She  complain’d  of  a  pain  in  the  left  part  of  the  thorax, 
fo  that  fhe  could  fcarcely  bear  to  lie  down  upon  it.  She  was  troubl’d  with  a 
difficulty  of  breathing.  To  which  was  added  a  copious  fpitting  of  blood: 
but  this  being  check’d,  and  two  days  after  a  fouth  wind  blowing  hard,  in 
which  ftate  of  air  thofe  who  labour  under  a  fimilar  diforder,  for  the  mod 
part,  perifh,  death  put  an  end  to  her  difeafe. 

The  right  lobe  of  the  lungs  adher’d  very  little  to  the  ribs.  Both  of  them 
abounded  with  hard  tubercles,  which  inclin’d  to  a  white  colour,  and  re- 

fembl’d 


4 


Letter  XXII.  Articles  i6,  17.  65$ 

fembl’d  glandular  bodies.  Befides,  the  upper  lobules  of  the  lungs,  on  both 
tides,  had  other  diforders  in  that  upper  part.  For  the  right  lobe,  towards 
the  (ternum,  contain’d  a  large  hollow  ulcer,  and  in  this  a  purulent  matter  j 
but  the  left,  towards  the  fide,  contain’d  a  hard  fubftance,  equal  to  the  bignefs 
of  a  large  pear,  which,  in  fome  meafure,  refembl’d  the  fubftance  of  the 
pancreas,  when  indurated  j  and  in  the  middle  of  this  fubftance  was  a  fmall 
ulcer,  full  of  pus.  In  the  pericardium  was  a  fmall  quantity  of  ferum  :  in 
the  left  ventricle  of  the  heart  was  a  fmall  polypous  concretion  ;  in  the  right 
was  one  of  a  moderate  fize,  the  greater  produdtion  of  which  was  inferted 
into  the  neighbouring  auricle. 

16.  A  virgin,  of  four-and- twenty  years  of  age,  was  troubl’d  with  a  cough 
after  a  fpitting  of  blood  :  (lie  expectorated  a  catarrhous  matter,  which  at 
laft  refembl’d  a  fanies :  the  had  a  fever,  and  a  pain  in  the  thorax,  but  par¬ 
ticularly  on  the  left  fide,  on  which  (lie  could  not  lie  down :  (he  was  wafted 
in  her  whole  body,  except  in  her  feet,  which  were  both  fomewhat  fwell’d ; 
and  the  right  was  even  attack’d  with  an  eryfipelas,  fome  days  before  death. 

The  left  cavity  of  the  thorax  was  found  to  be  fill’d  with  ferum,  fmall 
portions  of  coagulated  blood  adhering,  here  and  there,  both  to  the  pleura, 
and  to  the  lower  edge  of  the  lungs.  The  pleura  was  very  red,  juft  as  if  it 
had  been  inflam’d.  And  the  lungs  alfo  had  grown  extremely  hard,  as  in¬ 
flam’d  lungs  are  us’d  to  do.  But  the  other  cavity  contain’d  only  a  little 
ferum,  and  had  the  pleura  in  a  found  ftate.  Neverthelefs,  the  lungs  of  that 
fide,  where  they  were  turn’d  towards  the  clavicle,  were  a  little  hard,  and  in 
the  center  of  this  hardnefs  conceal’d  an  ulcer.  The  pericardium  fcarcely 
'  Ihew’d  any  traces  of  its  natural  moifture.  The  ventricles  of  the  heart  were 
entirely  full  of  concreted  blood. 

17.  Not  to  mention  the  pleuripneumony,  which  feems,  at  length,  to  have 
degenerated  into  a  confumption  in  this  virgin,  it  was  common  both  to  her, 
and  to  the  man  (#)  laft  fpoken  of,  to  have  had  not  only  tumid  feet,  but  wa¬ 
ter  in  the  thorax :  whereas  in  the  (trumpet  laft  mention’d  (x),  as  the  latter 
was  abfenr,  fo  the  former  was  wantinp  alfo.  And  there  is  an  old  obferva- 
tion  of  Coiterus,  commended  here  alfo  in  the  Sepulchretum  (y),  of  water 
being  extravafated  in  the  thorax  of  confumptive  perfons  ;  although,  as  to 
what  he  fays,  that  he  had  found  it  extravafated  on  the  right  fide,  which  “  is 
“  the  molt  liable  to  thefe  diforders,”  notwithftanding,  according  to  his  own. 
inflections,  it  is  no  lefs  truly  faid,  than  in  the  fame  page  of  the  Sepulchre¬ 
tum  (z),  by  Bontius,  “  that  he  had  never  feen  the  left  lobe  of  the  lungs 
“  alone  connected  to  the  ribs,  but  that  he  had  either  feen  both  connected  thus, 
“  or  the  right  only.”  Yet  thefe  things  have  been  feen  by  others  in  a  dif¬ 
ferent  manner  from  what  happen’d  to  them,  and  not  very  feldom  neither. 
So  alfo  you  will  fuppofe  it  owing  to  accident,  that  it  happen’d  to  Valfalva,. 
in  all  the  confumptive  perfons  he  difleCted  to  that  time  (a),  to  find  the  prin¬ 
cipal  injury  of  the  lungs  in  the  fuperior  part  (where  it  certainly  was  in  the 
three  bodies  juft  now  defcrib’d,  as  it  was  in  another  alfo,  of  whom  the  cele- 

( u )  n.  14.  (2)  in  Schol.  ad  Obf.  38, 

(*)  »5-  (?)  n.  14. 

(y),  Se&.  7.  Obf.  40. 

brated 


6  $6  Book  H.  Of  Difeafes  of  the  Thorax. 

bratcd  Hoyerus  (b)  fpeaks)  unlefs  it  be  probable,  that  the  greater  diftance 
from  the  feptum  tranfverfum  and  the  inferior  ribs,  and  confequently  from 
the  ,  moft  confiderable  agitation,  is  the  reafon  why  matter  is  more  eafily 
depofited  in  the  upper  part  of  the  lungs,  and  more  eafily  becomes  inherent 
there,  fo  as  at  length  to  ulcerate  them.  For  tubercles,  from  which,  accord¬ 
ing  to  the  obfervations  of  Francifcus  Sylvius  (c),  and  others,  a  confumption 
frequently  has  its  origin  ;  tubercles,  i  fay,  as  ycu  will  obierve  in  the  man 
and  the  (trumpet,  fo  in  others  alio,  are  found  in  any  part  of  the  lungs  pro- 
mifcuoufly.  And  although  Valfalva  found  them  in  the  upper  part  of  the 
lungs  in  a  boy  (d),  whofe  fifter  and  brother  had  been  taken  off  by  a  con¬ 
fumption,  yet  in  a  certain  virgin,  whofe  hiftory  I  (hall  immediately  fubjoin, 
he  himfelf  has  declar’d,  that  there  was  no  certain  feat  for  tubercles  in  the 
lungs,  nor  yet  in  the  young  man  of  whom  we  fpoke  above  (<?)  ;  and  in  the 
woman,  whofe  diftedion  is  already  defcrib’d  (/),  he  law  the  left  lobe  of  the 
lungs  containing  fmall  tubercles  “  here  and  there,”  fome  of  which  were  fup- 
purated. 

1 8.  A  virgin  was  feiz’d  with  a  fever,  in  confequence  of  a  fright ;  and  this 
fever  was  attended  with  a  pain  in  her  bread.  The  parotids,  and  almoft  all 
the  glands  of  the  neck  were  fwell’d.  She  died. 

The  abdomen  contain’d  a  little  quantity  of  limpid  water.  The  omentum 
was  connected  by  a  fmall  kind  of  ligaments,  with  the  mefentery  and  perito¬ 
naeum.  Thefe  three  parts,  and  the  furface  of  the  inteftines,  uterus,  gall¬ 
bladder,  and  bladder  of  urine,  were  unequal  with  protuberating  bodies,  ly¬ 
ing  at  a  diftance  from  each  other  up  and  down,  and  of  different  figures  and 
magnitudes,  yet  fo  difpos’d,  that  in  the  upper  part  of  the  omentum,  they 
were  very  fmall,  and  in  the  lower  part  very  large,  and  befides  this  very 
thickly  fown,  and  contiguous  to  each  other.  In  the  left  lobe  of  the  lungs 
there  was  not  only  an  ulcer  which  contain’d  a  famous  ichor,  but  befide  this, 
l'uch  a  kind  of  bodies  as  were  found  in  the  mefentery,  and  other  parts  of 
the  belly.  Some  of  them  contain’d  a  pus,  fome  a  matter  almoft  like  a 
pultice  in  its  confidence,  and  others  were  dill  more  folid,  as  if  they  refem- 
bl’d  the  nature  of  conglobated  glands. 

lg.  Morton  rightly  obferves  (g),  “that  it  is  not  to  be  wonder’d  at  if 
“  fcrophulous  perfons,  who  are  frequently  fubjed  to  glandular  tumours  in 
“  other  parts  of  the  body,  are  frequently  affeded  with  tubercles  of  the 
“  fame  kind,  in  the  lungs  themfelves  alfo  and  indeed,  “  that  the  moft 
“  certain  diagnoftic  ”  of  a  fcrophulous  confumption,  “  is  to  be  taken  from 
“  glandular  tumours  attending  it,  on  the  external  furface  of  the  body.” 
And  I  follow’d  this  opinion  and  method  of  reafoning,  confirm’d  by  the  ob- 
fervation  of  the  celebrated  Laubius  (h),  and  others,  in  a  young  nun,  whofe 
neck  I  faw  to  be  unequal  with  glands,  as  it  was  in  the  virgin  of  Valfalva, 
when  I  afcrib’d  the  violent  diforders  of  her  thorax,  fuch  as  attend  a  con¬ 
fumption,  to  the  lungs  being  occupied  with  tumours  not  unlike  thole,  efpe- 


ft)  Adi.  N.  C.  Tom,  4,  Obf.  1 18. 
ft)  Sepulchret.  Sedt.  7.  cit.  in  Schol.  ad 
Obf.  30. 

(dj  Epift.  i.  n.  2. 


ft)  n.  6. 

(f)  Epift.  17.  n.  5. 

(g)  Phthifiolog.  ].  3.  c.  r. 

( b )  Act.  N.  C.  Tom.  2.  Obf.  106. 


daily 


Letter  XXIL  Article  20.  6^7 

dally  as  I  perceiv’d  there  were  others  alfo  in  the  belly:  and  the  noble  father 
of  this  virgin  faid,  after  he  had  heard  my  opinion,  1  believe  you  have  judg’d 
but  too  well ;  for  having  loll  a  girl,  the  filter  of  this,  by  a  fimilar  diforder, 
and  having  order’d  her  lungs  to  be  examin’d,  after  death,  it  was  reported  to 
me,  that  they  were  befet  here  and  there  with  tubercles.  And  the  very  lame 
writer  will,  by  his  obfervations,  which  are  even  extant  in  the  Sepulchretum  (/), 
fhew  that  he  has  frequently  found  thel'e  tubercles  in  the  lungs,  and  indiferi- 
minately  in  all  parts  of  them.  One  of  thefe  obfervations  (£)  demonftrates 
a  threefold  variety  of  matter  comprehended  in  thefe  tumours,  fmee  it  re- 
prefents  fome  as  being  fill’d  with  pus,  others  with  a  honey-1  ke  fubftance, 
but  the  greater  part  of  them,  and  thefe  of  the  lelfer  kind,  with  a  fteatoma- 
tous  matter  ;  of  which  kind,  probably,  was  the  matter  that  Valfalva  faw  in 
the  larger  tubercles  of  the  boy,  of  whom  mention  was  made  juft  now  (/), 
which  in  its  colour  and  confidence  refembl’d  the  medullary  fubltance  of  the 
brain.  But  others,  alfo,  contain  a  different  kind  of  matter,  as  for  inftance, 
not  to  digrefs  too  far  from  the  virgin  fpoken  of  by  Valfalva,  in  appearance 
almoft  like  a  pultice.  But  thefe,  or  other  appearances,  we  have  in  the  ad¬ 
vance  of  the  difeafe,  according  to  the  variety  of  the  caufes  and  conftitutions ; 
for  before  the  difeafe  has  made  fome  progrefs,  as  you  perceive  from  the  in- 
fpe&ion  of  that  virgin,  thefe  tubercles  are  folid,  and  refemble  conglobate 
glands.  And,  indeed,  they  may,  in  the  firft  years  of  their  exiftence,  be  fo 
fmall  as  to  efcape  the  notice  of  the  fenfes,  in  great  meafure,  and  yet  difeover 
themfelves  as  the  patient  advances  in  life,  and  be  fo  much  the  fooner  en- 
creas’d,  and  become  perfect,  as  luch  caufes  lhall  the  fooner  come  on ;  as  for 
inftance,  in  the  fame  virgin,  that  fright,  which  lhall  retard  the  motion  of 
the  humours  in  the  lungs,  that  are  already  thick  and  vifeid,  and,  in  other 
refpe&s,  difpos’d  to  ftagnate. 

20.  And  I  think,  in  concert  with  Sylvius  (*»),  that  in  this  manner  chiefly 
an  inbred  phthifis  is  produc’d,  fuch  as  would  have  happen’d  in  the  boy  that 
is  taken  notice  of*,  but  differently  in  different  perfons,  and  at  different  times, 
according  to  the  various  difpofition  of  the  firm,  or  fluid  parts  in  the  lungs. 
For  according  to  this  variety,  we  alfo  fee,  that  an  adventitious  confumption 
may,  on  the  other  hand,  eafily  have  its  origin  in  fome  perfons,  (the  fame 
accidental  caufes  being  fuppos’d,  which  either  do  not  at  all  injure  the  greater 
part  of  conftitutions,  or  but  little,  and  flowly)  and  very  foon  come  to  a 
dangerous  height.  Nor  is  it  to  be  doubted,  but  that  the  lungs,  if  they  are 
very  found,  may  refill  the  caufes  which  would,  otherwife,  infallibly  produce 
a  confumption.  And  caufes  of  this  kind  are  inflammations  of  the  lungs,  and 
wounds,  if  both  of  them  are  ill-cur’d,  and  others,  and  amongft  thefe  fuch 
extraneous  bodies  as  fall  in  from  without;  as  for  inftance,  the  globular  body 
which  got  into  the  afpera  arteria  of  a  boy  lix  years  old  (»),  in  reading  of  whole 
hiftory,  you  will  naturally  fufpedt,  that  there  is  fome  great  inaccuracy,  owing 
to  the  carelefsnels  of  the  workmen;  for  a  globule  little  lefs  than  a  walnut” 
could  not  have  got  in  there,,  and  if  it  had,  mull  have  brought  on  a  very 
•  \ 

(/)  Additam.  ad  Se£t.  7. 1.  2.  Obf.  34,  3 6,  (m)  Cit.  fupra  ad  n.  17. 

37,  38,  40,  &  43.  («)  Vid.  Eph.  N.  C.  Cent.  4.  Obf,  121.1*1» 

{*)  38.  (0  N.  17.  Schol, 

,Vol.  I.  4  L  fpeedy 


6' 5  8  Book  II.  Of  Difeafes  of  the  Thorax. 

fpeedy  fuffocation,  and  not  a  flow  difeafe,  from  which  “  the  lungs”  could 

be  fill’d  with  pus.”  There  is  alfo  another  caufe  j  I  mean,  quantities  of 
cold  liquor  fwaliow’d  down,  while  the  body  is  very  hot  from  too  great  exer- 
cife  ;  a  circumftance  generally  very  pernicious,  though  not  from  the  injury 
of  the  lungs  only.  For,  to  fay  nothing  of  the  refervoirs,  or  large  channels 
of  blood,  that  iie  near  to  the  oefophagus,  Lentilius  ( o )  contended,  that  the 
Itomach,  into  which  the  draught  is  receiv’d,  was  firA  injur’d  from  thence, 
in  a  confumptive  boy,  and  not  without  fome  appearance  of  probability.  And 
though  I  do  not  contradid  his  opinion  in  that  cafe,  nor  in  others,  perhaps, 
in  which  the  injuries  of  the  ftomach  are  obferv’d  to  be  much  prior  to  thole 
of  the  lungs,  lo  that  a  bad  digeftion  is  brought  on,  from  whence  vifcid  and 
acrid  juices  are  prepar’d,  which  not  only  excite  a  cough,  by  vellicating  the 
ftomach,  but  at  length,  by  ftagnating  in  the  lungs,  and  irritating  them,  give 
rife  to  a  confumption,  in  which  way  he  himfelf  would  have  chofen,  perhaps, 
to  explain  the  obfervation,  if  not  of  Vaterus  (p),  at  leak  of  the  celebrated 
Heifter  (q)  j  I  fay,  though  in  fome  cafes  I  do  not  much  argue  againft  his 
opinion,  yet  even  in  thefe  very  cafes  it  cannot  be  denied,  that  the  then  pa¬ 
rietes  of  the  afpera  arteria,  and,  beginning  bronchia,  which  adhere  to  the 
oefophagus  anteriorly,  and  the  neighbouring  parts  of  the  lungs,  on  both  lides, 
are  either  immediately  injur’d  from  a  great  quantity  of  cold  water  falling 
on,  or  betwixt  them,  when  the  body  is  extremely  hot,  or  are,  at  leaft,  vehe¬ 
mently  difpos’d  to  receive  fuch  injuries  as  could  not  have  happen’d  without 
fome  preceding  one. 

Thefe,  therefore,  and  other  caufes,  whether  inbred  or  adventitious,  bring 
on  confumptions,  and  deftroy  in  various  proportions,  according  to  the  va¬ 
riety  of  thefe  caufes,  and  the  ftrength  of  the  conftitution  :  and  this  you  will 
perceive,  by  examining  either  the  obfervations  that  are  transferr’d  into  the 
Sepulchretum,  or  others,  that  I  have,  from  time  to  time,  pointed  out,  dr 
fhall  immediately  refer  to.  In  the  greater  part  of  them  you  will  find  pus, 
in  fuch  a  quantity,  as  to  fill  and  fluff  up  the  lungs  (r) :  on  the  other  hand, 
in  fome  there  was  fcarcely  any  trace  of  it  (s);  and  even  in  the  greater  number 
of  bodies,  that  were  differed  by  a  certain  furgeon,  as  you  will  read  in  the 
Sepulchretum  (/),  none  rat  all.  And  if  you  fuppofe  with  Sylvius  (u),  that 
this  happen’d  for  the  fame  reafon,  as  external  ulcers  are  alfo  dried  up,  ia 
dying  perfons,  I  fhall  not  controvert  your  opinion  ;  though  I  fhould  not  fa 
readily  coincide  with  you,  if  with  the  fame  author  (x)  you  in  general  affert, 
that  “  if  any  one  diffecl  the  bodies  of  confumptive  patients,  he  will  not  find 
“  fo  great.a  quantity  of  pus  in  the  lungs —  as  to  give  reafon  for  any  one  Co 
“  fuppofe  the  patient  could  have  been  fuffocated  from  thence.”  For  the 
difleftions  of  others  argue  the  contrary  ;  and  among  them,  to  pafs  over  fome 
of  thole  juft  now  referr’d  to,  that  of  Rodericus  aFonfeca(jy),  and  another 


(&)  Earund.  Dec.  3.  A.  7.  in  Append,  n.  10. 
ad  Obf.  6. 

(p)  Dec.  ead.  A.  10.  Obf.  161. 
q )  Eorund.  Ad.  Tom.  1.  Obf.  174. 

(?  )  Eorund.  Cent.  4. -Obf.  1 16,  &  1 18.  & 
Aft.  Tom.  1.  Obf.  59..  &  Tom.  2.  Obf.  19. 
&  Halier  Opufc.  Pathol.  Obf.  1 5. 


(j)  Ad.  N.  C.  Tom.  4.  Obf.  47. 

(r)  Sed.  Ad.  7.  Obf.  77. 

( u )  Ibid,  in  Additam.  Schol.  ad  Obf  2. 

(x)  Obf  ead. 

(y)  Comment,  in  Hipp.  1.  7.  Aph.  16. 


Of 


Letter  XXH.  Article  20.  659 

of  the  celebrated  Jo.  Adam  Gorizius  (z).  Whofe  obfervation  fets  forth, 
that  a  purulent  matter  fluff’d  up  the  lungs  and  the  bronchia,  lbme  of  it 
“  being  white,”  fome  of  it  “  greenifh,”  and  another  part  of  it  “  like  the 
“  dregs  of  fmall  beer and  the  famous  Daniel  Hoffman  ( a )  faw  it  “  of  a 
“  brown  colour  and,  finally,  the  illuftrious  Haller  (b)  faw  it  “  corrupted, 
“  and  black  to  fuch  a  degree,  as  to  be  like  ink.” 

But  it  is  fuperfluous  to  mention  thofe  cafes,  in  which,  when  the  lungs  were 
cut  into,  blood  mix’d  together  with  pus  and  lanies  flow’d  out.  Nevc-r- 
thelefs,  as  Tozzius  (c)  has  afferted  his  having  more  than  once  obferv’d  “  thofe 
“  who  died  of  a  confumption  to  have  been  brought  to  fo  great  a  decay  of 
“  their  blood,  that  luch  a  quantity  only  remain’d  in  the  veins  and  arteries, 
“  as  was  fcarcely  fufficient  to  carry  on  the  circulation,  the  reft  being  totally 
“  exhaufted  left  you  fhould  believe  this  to  be  univerfal,  it  muft  not  be 
pafs’d  over  in  filence,  that  in  a  confurnptive  woman  (d),  in  whom,  by  reafon 
of  the  very  emaciated  ftate  of  her  whole  body,  the  fkin  feein’d  fcarcely  to 
adhere  to  her  very  thin  bones,  the  lungs,  when  cut  into,  pour’d  out  “  a 
“  large  quantity  of  blood,”  mix’d  with  fanies  :  and  I  muft  alfo  add,  that 
in  two  other  patients,  one  of  whom  had  expe&orated  pus,  both  of  them 
had  a  great  quantity  in  their  ulcerated  and  putrid  lungs  ( e ),  notwith- 
ftanding  they  had  diicharg’d  a  vaft  quantity  of  blood  from  their  mouth  and 
noftrils,  and  the  fecond  of  them,  moreover,  from  all  parts  by  which  hemor- 
rages  happen  *,  and  yet  that  the  carcafe  of  the  fecond,  neverthelefs,  fhew’d, 
in  the  left  kidney,  “  a  great  ftagnation  of  blood,  and,  in  the  lumbar  region, 
“  had  the  languiferous  veffels  very  tumid  and  inflated  5”  and  that  the  blood- 
veffels  of  the  firft  “  were  very  turgid  with  blood  in  the  omentum,  ftomach, 
“  and  mefentery.”  But  to  return  to  my  fubjedl :  pus  and  fanies  have  a  dif¬ 
ferent  nature  in  different  perfons,  as  well  as  a  different  odour,  and  exift  fome- 
times  feparately  from,  and  fometimes.in  conjun&ion  with,  the  indurated  parts 
of  the  lungs.  Which  you  will  not  only  perceive  from  the  greater  part  of 
the  obfervations  already  pointed  out,  but  alfo  from  thofe  which  I  fhall  con¬ 
tinue  to  point  out.  Thus,  in  a  young  man  (/),  the  concave  part  of  the 
lungs  was  loaded  with  pus,  and  the  convex  part  almoft  tophaceous  :  and  in 
a  man  (g),  the  right  lobe  contain’d  a  fluid  pus,  and  the  left  a  certain  indu¬ 
rated  matter.  And  as  in  fome  (£),  the  lungs  were  full  of  cartilaginous  fcirrhi, 
or  befet  with  hard  fteatomatous  tumours,  and,  in  others,  found  to  be  fill’d 
with  very  fmall  purulent  abfceffes,  of  the  bignefs  of  hail-ftones,  or  made  un¬ 
lightly  with  a  vomica,  or  vomicte  (*)  ;  fo  they  were  at  other  times  callous, 
and  compadl  at  the  fame  time ;  at  the  fame  time  befet  with  vomicae  here  and 
there,  and  in  like  manner  (k)  entirely  obftrudted,  and  exulcerated  ^  or  (/)  fluff’d 
up  with  innumerable  fteatomata  and  vomicae  in  feveral  parts  5  or,  finally  (#»), 


(z)  Eph.  N.  C.  Cent.  8.  Obf.  19. 

(a)  Eorund.  A£t.  Tom.  2.  Obf.  2. 

(i)  Obf.  cit.  15. 

(r)  Comment,  in  Hippocr.  1.  7.  Aph.  16. 
(d)  Eph.  N.  C.  Cent.  7.  Obf.  83. 

\e)  Eorund.  Aft.  Tom.  1.  Obf.  173.  & 
Cent.  10.  Obf.  36. 

(f)  Commere.  Litter.  A.  1731.  Specim.  46. 


(^)  Eph.  N.  C.  Cent.  3.  Obf,  2. 

( h )  Vid.  Halleri  cit.  Obf.  15. 

(/')  Commere.  Litter.  A.  1743.  Hebd.  30. 
n.  11.  &  A.  1745.  Hebd.  24.  n.  1.  ad  V. 

(i)  Aft.  N.  C.  Tom.  2.  Obf.  8.  . 

(l)  Eorund.  Dec.  3.  A.  9.  Obf.  243. 

(m)  Dec.  ejufd.  A.  7.  Obf.  9. 


defac’d 


66 o  Book  If.  Of  Difeafes  of  the  Thorax. 

defac’d  with  a  great  number  of  apoftems  and  tubercles,  fome  of  which  feem'd 
to  be  inflam’d, "others  as  yet  immature:  fuch  as  I  have  already  fpoken  of  in  the 
virgin  defcrib’d  by  Valfalva  («). 

2i.  And  although,  in  the  great  number  of  examples  which  I  have  referr’d' 
to,  and  in  others  which,  as  the  difeafe  is  very  frequent,  are  almoft  innume¬ 
rable,  there  appears  fo  great  a  variety  of  caufes  and  effects ;  yet  if  you  omit 
atprefent  this  variety,  which  depends  upon  the  particular  circumftances,  and 
feek  to  find  out  one  common  origin  of  all  the  efleds  which  you  fee,  you  will 
readily  acknowledge  this  to  refide  in  fome  tumour,  which  either  by  reafon  of 
an  inbred,  or  adventitious  caufe,  of  whatloever  kind  it  may  be,  ftagnating 
in  the  lungs,  loon  grows  hard  there,  fo  that  it  be  pretty  thick,  and  the  thin¬ 
ner  particles  fly  off,  and  for  this  reafon,  fometimes  give  rife  to  the  ftagnation 
of  fome  humour  there,  which  is  worfe  than  itfelf,  and  more  likely  to  erode  ; 
fo  that,  if  it  be  of  itfelf  already  acrid,  or  if  by  ftagnation,  and  admiflion  of 
other  humours,  it  becomes  acrid,  it  begins  fooner  or  later  to  erode  the  mem¬ 
branous  cellules  of  the  lungs.  And  when  once  a  cellule  is  eroded,  the  dis¬ 
order  is  propagated  to  the  next ;  and  when  many  are  confumed,  an  evident 
cavity  of  an  ulcer  is  made,  which  may  be  fhut  up  all  round  by  indurated 
parietes,  made  up  of  the.  membranes  of  the  furrounding  cells,  which  are 
comprefs’d  by  the  pus,  and  for  that  reafon,  made  thicker  than  natural,  as 
we  fee  by  external  ulcers,  particularly  in  thofe  of  a  fiftulous  kind.  Nor  yet 
can  it  be  denied,  that  the  extravafated  humours,  and  efpecially  thofe  which 
abound  with  fibrous  particles,  as  they  are  call’d,  having  depofited  thefe  par¬ 
ticles,  and  they  being  agglutinated  to  the  parietes  of  the  cavity,  form  to 
themfelves  a  cyft,  out  of  a  falfe  membrane  of  that  kind,  as  the  celebrated 
Maloet  (o)  fhews.  And  Valfalva,  in  a  certain  Italian  paper,  among  the  ob- 
fervations  he  had  taken  from  thofe  who  had  been  wounded  in  their  lungs,  did 
not  doubt,  but  nature  fometimes  produc’d  a  kind  of  membranous  filaments, 
which  had  been  feen  by  him  twice  or  three  times,  and  which  being  encreas’d, 
in  procefs  of  time  grew  into  a  firm  follicle,  that  contain’d  an  effus’d  pus,  as 
he  thought  he  had  found  in  fome,  who  had  liv’d  pretty  long  in  the  difeafe. 
Be  this  as  it  will,  a  pulmonary  confumption  may  be  brought  on  from  other 
caufes  alfo,  as  you  have  very  fufficiently  learn’d,  befides  fuppurated  tubercles  ; 
nor  are  we  immediately  to  conclude,  if  pus,  or  an  ulcer  contain’d  in  a  pecu¬ 
liar  coat,  be  found,  that  it  is  from  a  tubercle,  the  coat  of  which  is  re¬ 
maining. 

But  fhould  we  believe  that  thofe  tubercles  are  true  glands,  which  every 
body  naturally  has,  and  even  thofe  very  glands  which  they  defcribe  here  and 
there,  at  the  divifion  of  the  bronchia,  or  within  the  lungs,  and  call  by  the 
bronchial  glands  ?  which,  although  they  are  naturally  in  themfelves  very 
fmall,  may  be  encreas’d  by  accidental  caufes,  particularly  in  thofe  whom  an 
hereditary  diforder  difpofes  thereto.  Are  we  taught  to  believe  it  from  that 
fign  of  a  future  confumption,  which  Morton  has  related  in  the  following 
words  (p)  ?  44  A  continu’d  difcharge  of  black  and  vifcid  phlegm  in  a  morn- 

“  ing,  jnafmuch  as  it  proceeds  from  the  glands  fituated  near  the  trachea, 

(«)  n.  18'.  (/)  Phthifiolog.  I.  2.  c.  2.  ad  n.  10. 

(0)  Mem.  de  1’ Acad.  R.  des  Sc.  A,  1732. 

“  in 


Letter  XXI.  Article  2 1 .  ,  6  6 1 

*c  in  the  lungs,  being  fill’d  with  a  blackifn  humour.  Which  fymptom,  as 
<(  it  is  common  to  fcorbutic  and  fcrophulous  patients*,  fo  it  (hews  that  an 
“  afthmatic  confumption  will,  in  procefs  of  time,  follow  ”  And  lately  in¬ 
deed,  it  feem’d  to  a  learned  man,  that  thefe  glands  naturally  difcharg’d  their 
fluid  into  the  bronchia,  “  by  reafon  of  the  expectorated  matter  being  of  the 
“  fame  blackifli  colour  with  the  juices  of  thefe  glands.”  But  natural  fpittings 
are  not  of  a  black  colour  *,  and  I  fhould  think  it  was  better  to  follow  the  fame 
gentleman,  where  he  has  affirm’d  that  thefe  glands  “  moft  certainly  are  of 
“  the  fpecies  of  conglobated  glands  and  alfo  where  he  has,  for  this  reafon, 
denied  “  that  they  pour  out  their  juice  into  the  afpera  arteria  and  in  like 
manner,  where  he  has  rightly  obferv’d,  that  as  fome  of  them  are  fprinkl’d 
throughout  both  the  furfaces  of  the  pericardium,  quite  to  the  diaphragm,. 
“  they  are  remote  from  all  communication  with  the  afpera  arteria.”  i,  how¬ 
ever,  having  cut  afunder  fome  of  thefe  glands,  taken  from  the  firft  divifion 
of  the  afpera  arteria,  and  from  four  bodies  which  I  fucceffively  examin’d;  and 
having  feen  that  thefe  fedtions  of  the  glands,  when  rubb’d  upon  paper,  gave  a> 
colour  to  it  of  a  fuliginous  kind,  juft  as  if  you  fhould  dilute  the  dull  of  char¬ 
coal  with  a  large  quantity  of  water*,  and  that  this  happen’d  in  the  fame  man¬ 
ner  in  the  three  firft  bodies,  but  that  in  the  fourth  carcafe,  which  was  that 
of  a  middle-aged  man,  as  the  others  were,  and  had  thofe  glands  nolefs  found, 
nor  lefs  black  internally  and  externally  than  the  others,  they  yielded  nothing 
but  a  yellowifh  colour,  very  dilute,  and  almoft  effete;  I  neverthelefs  found' 
the  neighbouring  trunk  of  the  afpera  arteria,  and  the  beginnings  of  the  bron¬ 
chia,  which  I  open’d,  to  be  tindlur’d  juft  in  the  fame  manner  in  the  three 
former  bodies,  as  they  were  in  this  fourth,  that  is,  to  have  nothing  at  all,  or 
at  lead  only  a  flight  tinge  of  a  blackilfi  colour.  For  which  reafon,  with  what- 
foever  colour  thefe  glands  may  be  internally  ting’d,  I  do  not  yet  think  that  I 
ought  to  depart  from  my  conflant  opinion,  but  (till  remain  in  this  perfuafion,. 
not  eafily  to  believe  that  they  communicate  with  the  cavity  of  that  artery,., 
elpecially  as  other  glands  are  not  wanting,  which,  as  they  evidently  difeharge 
their  juice  into  that  tube,  and  the  beginnings  of  the  bronchia  (q),  fo  they 
may  afford  a  paffage  for  this  kind  of  frecal  blood  into  thefe  tubes,  as  Willis  (r) 
fays,  to  whom  fome  perfons  alfo  were  known,  who  threw  up  matter  from  the 
trachea  of  a  black  colour  like  ink;  and  fome  of  the  fame  kind  were  known 
to  Salius,  as  he  declares  in  his  commentary  on  thofe  words  of  Hippocrates  (/)  :  . 
“  A  thick  and  fuliginous  faliva  is  thrown  up  by  the  cough.” 

However,  as  I  fhall  not  deny  that  the  bronchial  glands  may  fometimes 
communicate  with  the  bronchia  preternaturally,  when  any  erofion  is  made ; 
fo  whether  they  are  the  fame  which  conftitute  the  tubercles,  in  the  lungs  of 
confumptive  patients,  I  leave  undetermin’d  for  that  very  reafon  which  I  fpoke 
of  above  (/),  that  is  to  fay,  becaufe  I  was  fcarcely  ever  willing  to  diflfedt 
lungs  of  this  kind,  and  much  lefs  compare  thofe  tubercles  and  thefe  glands 
accurately  and  diligently  one  with  another,  in  reference  to  their  particular 

(7)  Vid.  Adverf.  i.  Tab.  i.  ad  F.  &  Tab.  (r)  Sepulchr.  ].  2.  S.  1.  in  Schol.  ad  Obf. 

3 b  Fig.  1.  ad  O.  O.  O.  9.  &  ad  §.  2.  Obf.  105.  hujus  7.  Sett. 

(/)  De  Morbis  1.  2.  t.  117.  (0  n.  3. 


fituatiom’ 


66  z  Book  II.  Of  Difcafes  of  the  Thorax. 

fituation.  For  this  reafon  then,  I  ftiall  here  give  no  more  than  one  obfervati- 
on,  which  was  attentively  taken  by  me. 

22,  A  woman,  who  liv’d  in  the  country,  who  was  forty  years  of  age,  had 
a  tumour  on  the  internal  fide  of  her  right  heel,  which  encreas’d  to  fo  confi- 
derable  a  fize,  as  to  equal  that  of  a  man’s  head.  On  account  of  this  magni¬ 
tude,  and  its  beginning  to  degenerate  from  the  nature  of  a  fteatomato'us  tu¬ 
mour  into  that  of  a  cancerous  one,  the  woman  was  receiv’d  into  the  hofpitai 
for  Incurables  at  Venice,  and  the  tumour  extirpated.  But  as  it  began  to 
grow  again,  after  the  woman  had  remain’d  there  more  than  a  twelvemonth, 
and  complain’d  of  no  diforder  at  all.  that  had  any  reference  to  the  thorax,  it 
happen’d  that  fhe  was  leiz’d  with  a  pungent  pain  at  the  left  part  of  it,  which 
a  fever,  and  difficulty  of  breathing  accompanied.  Blood  was  taken  away 
once  and  again,  on  which  a  white  cruft  form’d  itfelf;  frefh  drawn  oil  of 
fweet  almonds  was  given;  nor  other  remedies  which  are  generally  of  ufe  in  a 
pleuripneumony,  were  omitted.  However,  the  fortieth  day  had  not  yet 
come  on,  from  the  time  that  the  pleuripneumony  began,  when  a  difficulty 
of  breathing  attack’d  the  patient,  attended  with  a  lenleof  tightnefs,  and  fuf- 
focation  ;  fo  that  file  was  now  under  a  neceffity  of  lying  with  her  head,  and 
back,  rais’d  up  pretty  high  in  bed  :  and  her  puife,  which,  when  there  was 
an  inflammation,  had  intermitt -d,  intermitted  again  ftill  more.  Neverthelefs 
flie  had  no  pain,  no  cough,  no  fpitting,  no  fever;  except  that  in  the  laft 
days  of  her  life,  a  flight  fever  at  length  came  on :  by  which,  and  by  the 
difficulty  of  breathing,  that  became  more  troublefome  at  the  fame  time, 
and  particularly  in  the  night,  the  woman,  being  reduc’d  to  an  emaciated 
ftate,  and  an  extreme  dejection  of  ftrength,  fo  i hat  fhe  could  fcarce  complain 
with  a  (lender  voice  of  an  erofion  in  the  fauces,  in  which  no  fuch  thing  how¬ 
ever  could  be  feen,  died  on  the  fifteenth  day  after  the  new  difficulty  of  refpi- 
ration  had  come  on.  Having  heard  this  relation,  both  I  and  my  friends, 
from  the  phyfician  of  that  hofpitai,  who  was  a  diligent  and  worthy  man, 
Sencnlis  Rinaldi  by  name,  and  being  entreated  to  it  by  all  of  them,  and  be¬ 
ing  affifled  by  Rinaldi  himfelf,  I  differed  the  body,  being  now  about  the 
beginning  of  April  1708. 

Having  begun  to  open  the  cheft,  and  cut  through  the  cartilages  by  which 
the  ribs  are  join’d  to  the  fternum,  a  bloody  water  iflfu’d  forth  from  the  left 
cavity  of  the  thorax,  which  I  prefently  faw  fill’d  again  with  the  fame  fluid. 
I  did  not  doubt,  although  no  ftrongfmell  iffu’d  from  this  water,  or  from  the 
lungs,  but  that  pus  had  been  mix’d  with  it,  as  I  faw  that  the  lungs  at  their 
lower  and  anterior  parts  were  corrupted  and  confum’d,  a  great  cavity  offer¬ 
ing  itfelf  readily  to  the  eyes  in  that  place.  But  when  this  lobe  was  differed, 
it  fhew’d  here  and  there,  to  very  confiderable  tradts,  a  fubftance,  which  at 
firft  fight,  and  on  the  firft  examination,  refembl’d  a  fteatoma,  that  is  to  fay, 
by  its  whitenefs  and  firmnefs ;  but  when  you  mov’d  it  with  the  knife,  it  was 
more  like  a  purulent  matter.  The  remaining  part  of  the  lungs  was  not  at  all 
hard,  but  ting’d  of  a  red  colour,  as  if  from  blood  ftagnating  in  them.  The 
right  lobe  was  much  lefs  difeas’d  than  the  left,  inafmuch  as  it  conceal’d 
within  its  own  fubftance,  which  was  not  altogether  found  indeed,  yet  but 
(lightly  affedted,  fewer  of  thofe  fteatomatous  kind  of  tumours,  which  were  alfo 
lefs  in  their  fize,  and  feem’d  to  be  fliut  up  in  their  own  peculiar  coats.  How¬ 
ever, 


Letter  XXII.  Articles  23,  2 4,  25.  6  6  3 

ever,  both  lobes  of  the  lungs  adher’d  almoft  univerfally  to  the  parietes  of  the 
thorax,  though  the  right  adher’d  the  moft  clofely.  In  the  pericardium  was  a 
great  quantity  of  turbid  and  yellowifh  water.  In  all  the  cavities  of  the  heart 
were  polypous  concretions,  which  were  produc’d  from  thence  through  the 
great  velfels,  and  were  all  of  a  moderate  firmnefs ;  but  that  was  the  leaft, 
which  belong’d  to  the  left  auricle. 

The  belly  was  very  livid  before  it  was  open’d-,  but  when  it  was  open’d, 
it  appear’d  that  this  lividnels  was  owing  to  the  inteftines  being  turgid  with 
air.  Of  the  omentum  there  were  fcarcely  any  remains.  The  liver  was  foroe- 
what  hard,  white,  and  variegated  ;  and  the  gall-bladder  extremely  full  of 
bile.  The  fpleen  was  very  large,  and  harder  than  it  ought  to  be.  The 
pancreas  was  alfo  very  hard.  The  ovaria  were  hard,  white,  and  confiderably 
large,  and  had  in  them  fome  black  cellules.  Although  within  the  higher 
part  of  the  vagina,  I  found  a  ring  of  the  kind  commonly  call’d  a  peffary, 
lb  that  it  appear’d  the  woman  had  been  fubjedt  to  a  prolapfus  of  the  uterus 
and  vagina;  yet  when  this  ring  was  taken  away,  I  did  not  find  the  vagina  to 
be  by  any  means  fo  lax,  that  it  fhould  feern  poffible  for  it  to  be  inverted 
downwards  eafily,  and  I  faw  the  uterus  in  its  proper  fituation  ;  for  which 
reafons  I  fuppos’d  that  the  woman  had  receiv’d  much  benefit  from  the  af- 
filtance  of  this  ring,  and  the  recumbent  pollute  of  the  bed  As  to  what  re¬ 
mains;  a  turbid  water  had  ftagnated  in  the  belly  ;  but  not  in  great  quantity. 

23.  Here  you  have  an  example  of  an  empyema,  and  a  conlumptive  dif- 
pofition  in  the  lungs  at  the  fame  time.  I  will  give  you  another  of  a  con- 
fumption,  in  which  a  fmall  bone  was  difeharg’d  by  coughing.  Not  that  I 
differed  the  body;  for  they  who  attempted  to  do  this,  unknown  to  the  re¬ 
lation  of  the  man,  could  not  even  themfelves  go  through  with  it.  BiJc  be- 
fides  that  I  was  fure  I  could  depend  upon  their  veracity,  the  patient  himfelf, 
and  his  complaints,  in  like  manner,  were  very  well  known  to  me,  when  I 
liv’d  at  Bologna. 

24.  A  phyfician,  of  a  middle  age,  who  had  long  had  a  cacheblic  appear¬ 
ance  in  his  face,  and  afterwards  became  fhort  of  breathing  alfo,  and  hoarie* 
at  length  began  to  fpit  up  a  varioufly-colour’d  matter,  with  which  he  alfo 
cough’d  up  a  little  curv’d  bone,  not  very  fmall  in  its  fize,  that  he  flhew’d  to 
me,  being  fmooth  on  the  hollow  part,  and  rough  on  the  convex  fide.  In 
the  mean  while,  he  was  feiz’d  pretty  frequently  with  a  fenfe  of  fuffocation. 
At  length  on  a  certain  night,  when  he  had  faid  that  he  found  himfelf  better, 
he  was,  a  few  hours  after,  found  dead  ;  the  perfon  who,  for  the  fake  of  at¬ 
tending  upon  him,  lay  in  the  fame  bed,  having  perceiv’d  nothing  at  ail  of 
it,  and  for  that  reafon  having  flept. 

The  lungs  were  befet  with  veficles,  both  internally  and  externally,  which 
were  full  of  white  pus,  and  unequal ;  but  did  not,  when  largeft,  exceed  the 
fize  of  a 'grape.  In  the  pericardium  was  much  turbid  water.  In  the  heart 
was  no  more  than  one  very  fmall  polypous  concretion.  The  higher  part  of 
the  trunk  of  the  afpera  arteria  and  larynx,  ic  was  not  in  their  power  to  cut 
into,  for  the  reafon  abovemention’d. 

25.  And  yet  it  was  moft  neceffary  to  examine  into  thofe  parts,  that  it 
might  be  found  out  from  whence  that  little  bone  had  proceeded.  For  there 
were  different  opinions  upon  this  head,  fome  foolifhly  taking  it  for  a  fmall 

1  part 


6  6  4  Book  II.  Of  Difeafes  of  the  Thorax. 

pare  of  the  os  hyoides,  and  others  for  a  portion  of  a  ring  of  the  afpera  arte¬ 
ria,  that  had  become  bony:  which  latter  opinion,  probably,  came  the  neareft 
to  the  truth,  fince  Blafius  («)  found  even  a  fmall  branch  of  this  tube  con¬ 
verted  into  bone,  in  the  lungs  of  a  confumptive  patient;  and  I  have  obferv’d 
not  only  the  rings  of  that  artery  to  have  become  bony,  from  a  cartilaginous 
flate,  but  alfo  thole  little  fegments  of  circles,  which  are  to  be  met  with  in 
great  numbers,  within  the  lungs,  2nd  are  fubllituted  in  the  place  of  rin^s 
as  1  have  already  written  to  you  (x) :  and  Bontius  (y)  affirms,  that  a  con¬ 
fumptive  man,  in  his  knowledge,  “  was  accuftom’d  to  fpit  up  in  great  quan- 
“  tity  ”  fragments  of  the  bronchia,  of  the  fame  kind  with  thofe  which  were 
found  in  the  fames  within  the  thorax,  and  had  been  torn  away  from  the  cor¬ 
rupted  lungs.  Nor  was  Hippocrates  ignorant  of  this  (2),  when  he  wrote 
fpuit  pus,  fcf  velut  ulceris  ricinos  bronchia  in  pulmone  cartilaginofa  :  upon  which 
words,  fee  what  Salius  ( a )  has  added  in  regard  to  the  prelent  queflion.  And 
Arctasus  (£),  when  he  fpeaks  of  thofe  pcrions  who  labour  under  abfeeffes  of 
the  lungs,  has  come  Hill  nearer  to  the  cale  I  have  delcrib’d.  For  he  has 
faid,  that  “  they  grow  hoarfe,  and  breathe  ffiort;  and  fometimes  it  happens, 
“  that  they  are  ltrangl’d  by  the  Hidden  attradion  of  a  great  quantity  of 
“  nioifture,  becaufe  the  artery  being  obftrucled  by  the  multitude  of  pus, 
“  does  not  admit  the  air:”  and  that,  by  thefe  perfons,  “  the  bronchia  that 
“  is,  the  circles  of  the  afpera  arteria,  are  fometimes  fpit  up,  by  reafon  of 
“  the  different  fituation  of  the  ulcer,  when  the  ablcefs  penetrates  deep:  at 
“  which  time  fragments  of  this  vilcus  are  alfo  expell'd.”  Yet  this  author 
alfo  meant  the  little  pieces  of  the  bronchia,  which  lie  hid  within  the  luno-s 
as  the  laft  words  ffiew.  But  that  piece  of  bone  which  was  thrown  up  by  the 
phyfician,  could  neither  be  compar’d  with  thofe  fmaller  pieces  of  the  bronchia 
in  figure,  nor  in  magnitude;  fo  that  it  muftof  courfe  be  referr’d  to  the  larger 
annuli  of  the  afpera  arteria.  And  indeed  Valfalva  fufpeded,  that  it  had  been 
feparated  from  the  larynx  itfelf,  the  larger  cartilages  of  which,  we  know,  fre¬ 
quently  become  bony  ;  aferibing  the  fudden  and  unforefeen  death  of  this  phy¬ 
fician  to  a  confiderable  diforder  of  the  larynx,  for  this  reafon  alfo,  becaufe  he 
had  obferv’d,  that  two  patients  in  the  hofpital  of  Incurables,  the  one  labour¬ 
ing  under  an  ulcer,  and  the  other  a  cancer  of  the  larynx,  had  both  of  them 
died  fuddenly,  and  when  he  but  little  expe&ed  it:  to  which  clafs  you  may 
alfo  refer  the  cafe  of  the  virgin  that  I  have  deferib’d  to  you  before  (c), 

26.  Mention  being  made  of  the  larynx,  calls  to  mind  that  very  trite  and 
common  opinion  among  the  ancient  pbyficians,  of  an  acrid  matter  diftillino- 
from  the  head  upon  the  larynx  and  the  lungs,  and  at  length  bringing  on  a 
consumption.  With  which  1  fhould  not  deny  fometimes  to  agree,  if  by  the 
term  head,  we  meant  only  to  underftand  the  roof  of  the  pharynx,  and  in¬ 
ternal  noftrils.  For  that  the  glandular  coat,  with  which  thefe  parts  are  fur- 
nilh’d,  does  fometimes  fecrete  a  humour  that  is  capable  of  eroding,  the  ero- 
fions,  which  do  really  happen  in  thefe  parts,  feem  fufficiently  to  prove ;  from 


(«)  Sepulclir.  1.  2.  S.  7.  Obf.  164. 

(*]  Epift.  15,  n.  18. 

( y )  Sepulchr.  S.  7.  modo  cit.  Obf.  12. 
(«)  De  Morbis.  1.  2. 


(a)  Comment,  in  ejufd.  I.  t.  119. 

{b)  De  Cauf.  &  Not.  diuturn.  AfFett.  ].  1. 
c.  10. 

{c)  Epift.  15.  n.  13. 


2 


whence 


Letter  XXII.  Article  27.  66  $ 


whence  both  myfelf  (d)  and  others  have  fometimes  obferv’d  a  fpitting  of 
blood  to  have  its  origin  *,  which  proceeding  from  what  they  call  the  haemor¬ 
rhoids  of  the  mouth,  might  impofe  upon  the  phyfician  for  a  pulmonary  hae¬ 
morrhage,  if  he  were  not  attentive  to  the  figns  formerly  laid  down  by  Hip¬ 
pocrates  (e),  by  Ariftotle  (/),  and  by  Cselius  Aurelianus  (g),  and  learnedly 
illuftrated  by  Helwichius  (£),  with  the  addition  of  his  own  obfervations ; 
to  which  you  may  alio  add  another  of  the  celebrated  Dethardingius  (/). 
Wherefore  if  the  moveable  palate  below,  and  the  uvula  which  is  added  to 
this,  do  not  avert  the  humour  from  the  larynx,  as  it  falls  down  from  the 
higher  parts  which  I  have  mention’d,  and  is  endow’d  with  a  corrohve  pro¬ 
perty,  nothing  forbids  it  from  entering  into  that  tube,  and  caufing  difeafe, 
and  at  length  erofion  there,  and  in  the  lungs.  For  which  reafon,  the  ob¬ 
fervations  of  more  than  one  phyfician  and  anatomift  fliew  that  they,  in 
whom  that  part  of  the  palate  and  the  uvula  are  confum’d  by  the  lues  ve¬ 
nerea,  or  any  other  caule,  are  fubje<5t  to  a  cough  and  confumption  •,  as  you 
will  learn  from  the  writings  of  the  celebrated  Jo  Zacharias  Petfche  { k ),  and 
even  from  ours  alfo  (/).  Nor  will  you  imagine,  becaufe  it  has  happen’d  to 
me  to  fee  it  otherwise,  or  becaufe  I  have  hinted,  that  what  I  have  feen  may 
be  otherwife  explain’d,  that  therefore  the  explanation  which  I  have  juft  now 
taken  notice  of,  and  which  I  even  glanc’d  upon  then,  is  entirely  diflatif- 
fadlory  to  me.  And,  indeed,  taking  this  explication  for  granted,  I  confefs 
that  we  may  better  underhand  why  Mercurialis  (m)  and  Gavalfetti  («)  pre¬ 
scrib’d  a  fupine  pofture  of  the  body,  with  the  head  bent  downwards,  in  or¬ 
der  to  avert  very  violent  and  tedious  defluxions  from  the  head  into  the 
thorax,  and  rather  promote  their  dilcharge  into  the  oefophagus  and  ftomach. 
For  by  this  means,  the  firft  of  thefe  gentlemen  recover’d  a  German  woman, 
without  the  afliftance  of  any  other  remedy  *,  and  the  other  fo  far  was  of  ufe 
to  a  virgin,  who  already  fpat  blood,  to  a  confiderable  degree,  from  this 
caufe,  and  was  given  up  by  the  moft  eminent  phyflcians,  and  deplor’d  by  all 
as  loft,  that  he  was  afterwards  able  to  cure  her,  even  perfectly,  by  other 
remedies. 

27.  But  Aetius(fl)  taught  us  to  cure  ulcers  of  the  afpera  arteria,  by  keep¬ 
ing  the  patient  “  in  a  fupine  pofture,  and  by  raifing  the  pillows  that  lie 
te  under  the  head  to  a  confiderable  height,”  I  believe  when  nothing  flow’d 
down  into  the  larynx.  And  he  aflferted,  even  in  dependance  upon  his  own 
experiments,  that  thofe  ulcers,  efpecially  near  the  extremity  of  the  afpera 
arteria,  or  in  the  extremity  itfelf,  “  were  certainly  curable.”  For  which 
reafon,  it  is  proper  to  take  care,  left  fome  examples  of  a  confumption  being 
cur’d,  fhould  not  relate  to  the  ulcers  of  the  lungs  themfelves,  but  rather  to 
thofe  of  the  afpera  arteria.  And  this  I  would  not  have  underftood  to  be  laid 
fo  much  of  the  cure  of  others,  as  of  a  certain  cure  of  my  own,  by  which  I 
got  great  reputation,  when  I  was  a  young  man,  and  prablis’d  phyfic  in  the 
place  of  my  nativity.  I  will  give  you  a  defcription  of  the  cafe. 


O)  Epift.  Anat.  9.  n.  14. 

(e)  Praedift.  1.  2.  n.  27. 

(f)  De  Partib.  Animal.  1.  3.  c.  5. 

G)  Morb.  Chron.  1.  2.  c.  11. 

( b )  Eph.  N.  C.  Dec.  3  .  A.  9.  Obf.  118. 

VOL.  I. 


(7)  Earund.  Cent.  7.  Obf.  73. 

{k)  Sylloge  Anat.  Obf.  §  87- 
(/)  Epift.  Anat.  9.  n.  9.  &  10. 

(777)  (h)  De  indicat.  Curat,  c.  52. 

(e)  Medic.  Tetrabibl.  3.  Serm.  1.  c.  64.. 

4  Tlierd 


666  Book  II.  Of  Difeafes  of  the  Thorax. 

There  was  a  man  of  Lucca,  by  name  Stephen  Cheli,  of  a  tall  ftature,  and 
a  fpare  habit  of  body,  who  was  diligent  and  induftrious,  conftantly  employ’d 
in  bufinefs  of  great  importance,  and  burden’d  with  many  cares  ;  and  for  thefe 
caufes  alfo,  hypochondriacal.  This  man  had  long  been  troubl’d  with  a 
cough,  which  was  attended  with  expectorations  tinCtur’d  with  blood.  The 
elder  phyficians  having  attempted  to  cure  this  diforder,  at  one  time  by  the 
juices  of  foftening  herbs,  and  fuch  as  are  fuppos’d  to  be  of  ufe  to  the  lungs ; 
and  fometimes  by  affes  milk  *  fometimes  by  jellies  of  different  kinds,  and  the 
broth  of  tortoifes ;  and  at  other  times  by  dilute  decoCtions  of  the  woods,  or 
by  fuch  medicines  as  being  prepar’d  from  fteel,  or  the  lapis  haematites,  have 
an  aftringent  property  •,  befides  the  drinking  the  waters  of  the  baths  of  Villa, 
and  bathing  in  river  water,  and  other  remedies  of  a  fimilar  kind  ;  were  fo  far 
from  gaining  any  advantage,  that  they  made  the  patient  ftill  more  emaciated, 
and  the  diforder  itfelf  more’  confiderable  •,  for  the  affringents  feem’d  to  di- 
minifli  the  quantity  of  urine,  and  the  baths  to  encreafe  the  quantity  of  blood 
in  his  fpittings ;  and  the  waters  of  Villa  were  under  a  neceffity  of  being  left 
off,  within  the  few  firft  days  trial,  becaufe  they  did  not  at  all  pafs  off ;  and, 
in  Ihort,  the  patient’s  ftomach  loath’d  almoft  every  thing.  At  length,  when 
the  patient  was  as  much  tir’d  of  the  phyficians,  as  the  phyficians  were  of 
the  difeafe,  he  came  to  me;  but  from  a-principle  of  reverence  to  my  feniors, 
and  being  alfo  influenc’d  by  the  opinion  of  every  one,  in  regard  to  the  def- 
perate  Hate  of  the  difeafe,  I  made  ufe  of  many  apologies  to  decline  taking 
upon  me  the  management  of  the  difeafe ;  till  at  laft,  being  overcome  by  the 
authority  and  perfuaflon  of  thofe  who  had  the  health  of  the  patient  at  heart, 
I  confented  in  fuch  a  manner  as  to  convince  every  one  that  I  took  him  under 
my  care  again!!  my  own  will,  and  without  promiflng  any  thing,  in  compli¬ 
ance  with  the  defire  of  other  perfons,  and  in  order  that  the  patient  might 
not  be  deferted,  rather  than  with  a  view  to  the  cure  of  his  diforder.  For 
he  was  very  thin  and  weak,  and  got  but  little,  and  that  difturb’d,  fleep. 
Yet  when  I  found  that  a  fever,  or  at  lead  a  continual  one,  did  not  attend 
the  difeafe,  and  according  to  the  words  of  Aetius  (y>),  “  a  fmall  quantity  of 

purulenc  and  bloody  matter  was  thrown  up  by  fpitting and  that  “  a 
€t  fenfe  of  pain  was  manifeftly  perceiv’d  ”  in  no  other  place,  but  “  near 
Cl  the  ulcerated  part  ”  of  the  afpera  arteria,  that  is,  a  little  below  the  larynx : 
and  when  I  alfo  found,  that  out  of  all  the  remedies  which  had  been  made 
ufe  of,  two  of  them  had  been  of  fome  advantage,  which  are  recommended 
by  Aetius  ( q )  againfl:  thofe  ulcers  of  the  afpera  arteria  ;  I  mean,  “  medicines 
“  laid  under  the  tongue,  fo  that  being  melted  by  degrees,  they  may  fall 
“  down  into  the  afpera  arteria ;  and  milk  drunk  every  day,  as  it  is  milk’d 
“  from  the  animal,  while  Handing  by  the  patient I  began  to  cherifh  fome 
litttle  hope  tacitly,  and  to  endeavour  to  find  out  the  method  of  bringing 
about,  that  the  fame  remedies  which  had  been  of  fome  advantage,  might  at 
length  perfectly  cure.  They  had  us’d  troches,  which  were  diffolv’d  in  the 
mouth,  made  of  the  fpecies  diatragacanthi  frigidae,  and  affes  milk ;  by  which 
the  fenfe  of  pricking,  in  the  afpera  arteria,  was  at  the  time  they  were  ap¬ 
plied,  almoft  entirely  taken  away,  and  the  ftrength  of  the  patient  fomewhat 


(/>)  c.  64.  cit. 


(?)  Ibid. 


encreas’d 


Letter  XXII.  Article  27.  667 

encreas’d  by  deep.  When  I  afk’d  him  why  he  did  not  perfift  in  the  ufe 
of  thole  things,  which  had  been  of  fervice  to  him,  he  anfwer’d  that  his  do- 
mach  was  hurt  by  the  troches  ;  and  as  to  the  milk,  though  at  fird  that  ad-? 
'vantage  feem’d  to  refult  from  it,  yet  all  the  fymptoms  return’d  foon  after. 
But  in  the  mean  while,  faid  I,  “  did  you  avoid  the  wind,  and  the  fun  ?”  for 
I  remember’d  that  this  was  exprefsly  prefcrib’d  by  Hippocrates  (r),  to  thofe 
in  whom  the  jiftula  -pulmonis ,  or  “  afpera  arteria,  was  affefted  with  a  hot  ulcer, 
“  call’d  aphtha.”  But  I  found  that  he  had  not  avoided  them :  and  l  per¬ 
ceiv’d  alfo  that  thefe  troches  had,  by  their  fweetnefs,  naturally  hurt  the  do- 
mach,  inafmuch  as  it  was  the  domach  of  an  hypochondriacal  perfon.  After 
having  determin’d  then  with  myfelf  what  was  to  be  done,  and  what  was  to 
be  avoided,  it  happen’d  accidentally,  that  I  had  it  in  my  power  to  commu¬ 
nicate  my  intentions  to  Paul  Piella,  an  eminent  phyfician  at  Bologna,  who 
at  that  time,  together  with  myfelf,  attended  the  count  John  Baptifb  Urfi, 
afterwards  bifhop  of  Cefena,  who  lay  ill  of  a  very  violent  difeafe.  But 
Paul,  although  he  did  not  difapprove  what  had  been  propos’d  by  me, 
yet  having  attentively  examin’d  the  lpittings,  and  heard  that  they  were  fo 
thin,  and  in  fo  fmall  quantity,  and  yet  not  always,  but  that  they  were  now 
and  then  bloody  •,  I  fear,  faid  he,  very  much,  that  you  will  not  be  able  to 
heal  thefe  ulcers,  which,  befides  their  being,  probably,  very  deep  feated, 
certainly,  if  I  fee  at  all  into  the  diforder,  come  near,  in  their  nature,  to  that 
kind  of  herpes,  which,  if  it  were  even  on  the  furface  of  the  fkin,  would 
be  brought  to  a  cicatrix  with  the  greated  difficulty.  This  prognodic,  as  it 
was  made  by  a  well-experienc’d  mailer,  in  chirurgical  matters  in  particular, 
mad£  me  rejoice  that  I  had  promis’d  nothing,  but  did  not  prevent  me  from 
making  the  trial  of  what  I  had  determin’d  to  try.  It  was  now  the  time  of 
year  in  which  it  was  peculiarly  neceffary  to  avoid  the  injuries  of  the  external 
air  with  the  utmoft  caution  ;  nor  could  much  be  hop’d  for  from  the  milk  of 
brute-animals,  by  reafon  of  their  provender  being  unfit  for  them. 

Firft  of  all,  then,  I  order’d  the  patient  to  ffiut  himfelf  up  in  a  warm 
chamber,  not  low,  nor  clofe ;  and  there  giving  up  every  kind  of  concern, 
rather  to  hear  his  friends  and  acquaintance,  than  to  talk  much  himfelf ;  and 
when  he  did,  to  fpeak  in  a  low  tone,  and  by  no  means  quick.  Then  having 
prefcrib’d  fuch  things  as  might  tend  to  foften  the  afpera  arteria,  nor  yet  hurt 
the  ftomach,  and  the  ftomach  being  prepar’d  for  the  ufe  of  the  milk,  I  or¬ 
der’d  woman’s  milk,  not  in  great  quantity  at  firll,  for  the  fake  of  trying 
how  it  would  agree  ;  and  afterwards,  when  I  found  that  it  fucceeded  very 
well,  I  order’d  as  much  to  be  fuck’d  from  the  breads,  as  to  the  patient 
himfelf,  who  was  fagacious  and  attentive,  would  nearly  equal  half  a  pint,  in 
the  morning,  and  in  the  evening  *,  that  is,  about  four  or  five  hours  before 
dinner  and  fupper.  Both  of  which  meals  were  moderate,  but  the  fupper  in 
particular  •,  and  wine,  or  any  thing  elfe  that  might  be  injurious,  was  avoided. 
His  dinner  and  fupper  frequently  confided  of  a  pudding  made  of  barley- 
dower,  with  an  addition  of  the  powder  of  the  china  root,  in  the  proportion 
of  one  ounce  to  the  pound,  but  without  any  fugar :  and  thefe  ingredients 


(r)  D.  Morb.  1.  2.  t.  apud  Salium  uz,  &  114. 

4  0^2 


being 


668  Book  II.  Of  Difeafes  of  the  Thorax. 

being  mix’d  up  with  milk,  frefli  drawn  from  a  cow  which  had  been  fed  upoij> 
barley  and  chaff,  not  upon  beans  and  hay,  were  reduc’d  into  a  kind  of  calx, 
as  it  were,  over  a  flow  fire.  I  took  particular  care  alfo  to  have  a  nurfe  who 
was  in  good  health,  and  order’d  her  to  make  ufe  of  proper  aliments,  and  as 
much  as  poffible  to  avoid  variety  of  them ;  which  circumftance,  when  neg¬ 
lected,  feems  to  be  the  only  reafon,  why  the  milk  of  women  is  not  better 
than  the  milk  of  other  animals  for  medical  purpofes  ;  although  even  the  an¬ 
cient  phyficians,  and  in  particular  Euryphon  and  Herodotus,  who  are  com¬ 
mended  by  Galen  (j),  “  preferr’d  it  to  others  in  confumptive  diforders,  as 
“  it  was  familiar  to  us,  and  of  the  fame  nature  with  ourfelves.”  By  ob- 
ferving  this  regimen  very  ftridly,  from  the  end  of  November  to  the  middle 
of  May,  the  patient  was  fo  far  recover’d  as  to  be  extremely  well  for  fixteen 
years  after.  At  the  end  of  which  period,  his  blood  being  again  loaded 
with  eroding  particles,  depofited  them  upon  the  fkin,  for  the  fpace  of  two 
years  together,  in  the  form  of  a  tetterous  eruption.  But  thefe  eruptions  going 
off  all  of  a  fudden,  the  bottoms  of  his  feet  were  feiz’d  with  very  acute 
pains,  attended  with  fome  tumour,  and  confiderable  rednefs.  Which  dil¬ 
appearing  of  a  fudden  after  twenty  days,  a  fupprdlion  of  urine  came  on  for 
the  fpace  of  two;  and  after  this  a  fwelling  of  the  legs,  which  often  vanifh’d, 
and  as  often  return’d  ;  and  a  fever  of  an  inconftant  period  ;  and  at  length,  be¬ 
twixt  the  navel  and  the  pubes,  a  kind  of  hard  internal  protuberance,  befides 
other  complaints  of  the  belly  ;  with  which  being  grievoufly  afflided,  he 
finally  exchang’d  difeafe  for  death.  But  all  thefe  things  happen’d  when  I 
was  abfent :  which  I  mention  only  for  this  reafon,  that  you  might  underftand 
my  cure  to  have  been  perfed,  as  the  patient  not  only  continu’d  well  for  fo 
long  a  time,  but  even  after  he  began  to  grow  ill  again,  among  fo  many 
diforders,  never  was  attack’d  with  the  firft.  Which  being  generally  efteem’d 
to  have  been  a  confumption,  there  was  no  conlumptive  perfon  in  the  city 
who  did  not  prefcribe  the  fame  method  of  cure  to  himfelf ;  yet  not  one  of 
them  efcap’d. 

28.  There  are,  alfo,  much  deeper  diforders  of  the  afpera  arteria,  which 
the  common  people  very  often,  and  even  the  phyficians  lometimes,  confound 
with  the  confumption;  though  at  the  fame  time  the  lungs,  in  thefe  perfons, 
are  found.  Thus,  not  to  repeat  the  obfervations  which  I  have  already  written 
to  you  (/)  ;  thus,  I  fay,  I  remember  Valfalva  to  have  afferted,  that  he  never 
faw  lungs  in  a  better  condition  than  thofe  of  Zani,  bifhop  of  Imola,  were  ; 
though  they  were  generally  luppos’d  to  be  difeas’d,  by  reafon  of  the  great 
-quantity  of  humours  that  he  expedo rated,  which  were  fecreted,  without 
doubt,  from  the  proper  glands  of  the  bronchia.  Which,  notwithftanding 
they  are,  in  fad,  not  purulent,  yet  lometimes  are  of  fuch  a  nature,  that  if 
any  one  fhould  contend  for  their  being  purulent,  he  might  very  eafily  find 
fome  one,  amongft  that  great  number  of  “  forms  and  fpecies  of  pus,”  which 
Aretaeus(«)  enumerated  fo  as  to  fay,  “  that  they  were  almoft  infinite,”  to 
which  he  may  feem,  with  fome  reafon,  to  refer  them.  And  I  could  wifh, 
as  doubts  do  lometimes  arife,  that  figns  and  marks  of  the  true  pus  were 

CO  De  fuccor/bonit.  &  vit.  c.  4.  (a)  De  Cauf.  &  not.  diuturn.  affeft.  1.  1. 

p)  Epilt,  4.  n.  2i.  &  Epift.  10.  n.  1 1.  c.  g. 

extant, 


Letter  XXII.  Article  28.  66 9 

extant,  which  Should  be  always  certain,  and  which  all  perfons  would  agree 
upon.  For  as  to  Jacotius  (#),  for  example’s  fake,  distinguishing  pus  from 
phlegm  in  fuch  a  manner  as  to  fay,  that  the  former  is  cineritious,  and  the 
other  white-,  the  one  foetid,  or  at  leaft  moderately  fo,  but  the  other  not  at 
all;  and,  in  fhort,  the  one  dividing  into  parts,  efpecially  if  thrown  into 
water,  but  the  other  glutinous ;  I  do  not  fufficiently  understand,  by  what 
means  he  can  reconcile  all  thefe  affertions  with  the  dodtrine  of  Aretseus,  who, 
when  Speaking  of  the  various  kinds  of  pus,  had  exprefsly  plac’d  amongSt 
them  even  that  which  is  “  glutinous,  and  without  odour ;”  particularly  as 
Aretaeus  has  done  this  in  the  very  place  where  he  is  commended  by  Jacotius, 
forjudging  “  that  pus  could  be  distinguish’d  from  mere  phlegm  by  the  fight 
66  only  ;  and  that  they  were  not  much  Skill’d  in  the  knowledge  of  fuppuration, 
“  who  examine  thefe  expectorated  matters  by  the  fire  and  by  water  ;”  taking 
notice,  at  the  Same  time,  how  they  abufe  the  aphorifm  of  Hippocrates  ( jy ), 
repeated  in  the  Coaca  Praenotiones  (z),  and  another  added  in  this  laft  work  (a), 
in  order  to  make  the  diagnofis  of  pus  ;  fince  neither  of  them,  as  Jacotius 
rightly  admonifhes,  was  written  in  order  to  distinguish  pus,  but  both  of 
them,  evidently,  in  order  to  make  a  prognosis  of  death  ;  whether  the  Spitting 
of  the  consumptive  patient,  when  put  upon  the  fire,  fmell  very  Strong,  or 
fubfide,  when  thrown  into  fea-water  which  is  contain’d  in  a  brazen  veSTel. 
And  although  Duretus  (b)  and  Jacotius  himfelf  have  both  endeavour’d  to 
give  a  reafon,  why  Hippocrates  thinks  fuch  a  veSTel  neceSTary,  yet  I  fear 
they  have  not  done  it  fufficiently  to  their  own  fatisfadtion,  not  to  fay  to  yours  : 
and,  without  doubt,  the  latter  of  them  at  length  comes  back  to  this,  that, 
to  follow  the  opinion  of  Hollerius(c),  he  thinks  it  is  but  of  little  confequence 
in  what  veSTel  that  water  may  be  contain’d  ;  but  whether  this  Supposition 
agrees  with  the  great  brevity  of  Hippocrates,  you  yourfelf  will  fee.  And 
John  Jerom  Zanichelli,  a  man  of  much  experience,  both  in  the  medical 
and  chymical  art,  converfing  with  me,  at  Venice,  about  a  very  learned  friend 
of  both  of  us,  Vidtorio  Francefco  Stancario,  who  was  already  attack’d  with 
a  confumption,  at  Bologna,  in  confequence  of  a  cough  and  Spitting  of  blood  ; 
and  mentioning  two  consumptive  patients  that  wrere  cur’d  by  an  eclegma ; 
the  one  by  that  which  is  call’d  the  rcb  of  nuts,  and  the  other  by  the  rob  made 
from  ripe  elder-berries,  prepar’d  in  a  certain  manner;  nor  concealing  what 
he  himl'elf  look’d  upon  as  an  arcanum,  balfam  of  Sulphur  prepar’d  with 
balfam  copaiba  ;  and  having  happen’d  to  digrefs  from  thence  to  this  paSTage 
of  Hippocrates,  as  frequently  happens  in  difcourfe,  he  declar’d  it  to  be  his 
opinion,  that  by  a  brazen  veSTel  fomething  was  taken  from  the  Sea-water,  fo 
as  to  make  it  lei's  able  to  refill;  the  defcent  of  the  expedtoraced  matter,  than 
if  it  were  to  be  contain’d  in  any  other  veSTel  but  a  brazen  one  :  nor  is  pure 
water  proper  in  order  to  make  this  experiment  more  eafily  and  certainly,  nor 
yet  lea-water,  as  many  fuppofe  ;  for  the  former  refills  the  delcent  of  the 
matter  lei's  than  it  ought,  and  the  latter,  in  any  other  but  a  brafs  veSTel, 
Somewhat  more  than  is  requir’d.  And  he  affirm’d,  that  the  prediction  of 

(*)  Comm.  i.  in  1.6.  3.  2.  Aph.  9.  Coacar.  (a)  Aph.  ro. 

(y)  Seft.  i,.  Li»  (&)  In  Coae.  1.  2.  c.  17.  n.  3. 

( z )  Aph.  modo  cit.  (cj  Comm,  in  cit.  Aph,  10. 

Hippocrates 


6  7  o  Book  II.  Of  DifeafeS  of  the  Thorax. 

Hippocrates  had  alway  anfwer’d,  on  his  frequently  making  this  experiment, 
in  the  manner  that  Hippocrates  prefcribes  :  nor  did  thofe  whole  fpittings 
had  floated  in  water,  die  in  fo  fliort  a  time  as  they  whofe  fpittings  had  fub- 
fided:  fo  that  he  did  not  doubt,  but  if  the  experiment  were  made  after¬ 
wards,  that  is,  when  the  difeafe  was  become  much  worfe  ;  he  did  not  doubt, 
I  fay,  but  the  fpittings  would  fall  to  the  bottom.  Nor  would  he  have  the 
fpittings  collected  together,  as  many  do,  and  thrown  out  of  a  bafon  into 
water,  but  from  the  very  mouth  of  the  patient,  according  to  the  method  of 
Hippocrates,  and  even  from  the  very  lungs  of  the  patient,  and  that  many 
times  over;  well  knowing  that  the  expectorated  matter  does  not  alway  proceed 
from  the  part  of  the  lungs  that  is  moil  difeas’d ;  and,  on  the  other  hand, 
what  alteration  may  happen  to  it,  by  lying  in  the  open  air  fome  time  after 
it  is  difcharg’d ;  fo  that  it  may  feem  to  be  of  quite  a  different  nature  in  the 
experiment,  from  what  it  would  have  been  immediately  after  its  excretion. 

29.  But  Caelius  Aurelianus  (d),  where  he  takes  notice  of  a  great  number 
of  phyficians  who  put  the  expectorated  matter  of  patients  into  water,  (he 
does  not  fay  fea-water)  or  laid  it  on  the  fire,  not  in  order  to  make  a  diagno- 
fis  of  death,  but  in  order  “  to  diftinguifh  a  purulent  fluid ;”  and  in  like 
manner  Cornelius  Celfus  ( e ),  where  he  makes  mention  of  them  who  made 
ufe  of  this  fecond  fign,  when  they  were  in  doubt  about  a  confumption  ;  feem 
pretty  clearly  to  prove,  that  cuftoms  of  this  kind  did  prevail :  and  the  firft 
exprefly  fays,  that  in  perfons  who  have  fall’n  into  a  confumption  from  a 
fpitting  of  blood,  the  expectorated  matter  from  livid  or  greenifh,  “  becomes 
“  white  and  purulent;”  which  is  diametrically  oppofite  to  the  firft  mark  of 
diftinCtion  between  pus  and  pituita,  that  is  laid  down  by  Jacotius  (/).  Be¬ 
tides,  both  thefe  antient  phyficians,  whom  moft  phyficians  follow,  and  indeed 
I  myfelf  in  general,  in  this  letter;  in  fuch  a  degree  however,  as  not  to  dif- 
commend  thofe  who  think  differently  ;  did  not  call  that  wafting  a  true  con¬ 
fumption,  or  phthifis,  in  which  there  are  no  fanious  or  purulent  expectora¬ 
tions;  not  even  though  there  were  pus  collected  in  the  thorax  and  in  the 
lungs.  The  firft  of  them,  therefore,  taught  that  there  was  alfo  this  difference 
betwixt  the  “  confumptive  and  the  empyematic  diforder ;”  as  in  this  latter, 
pus  is  not  thrown  off  gradually  by  fpitting,  but  in  large  quantities  at  a  time; 
and  Celfus  would  not  have  faid(^),  “  that  pus  is  fpit  up”  by  confumptive 
patients,  if  he  meant  to  have  empyematic  perfons  taken  for  confumptive 
patients.  For  in  defcribing  empyematic  patients  (£),  and  to  thofe  figns 
which  Hippocrates  had  before  given,  adding,  as  Ronffeus  (/)  obferves,  fome- 
thing  of  his  own,  in  relation  to  the  veins  that  are  under  the  tongue  ;  he  ne- 
verthelefs  made  no  change  in  regard  to  thofe  things  which  are  fpit  up.  For 
he  faw  that  Hippocrates,  not  only  in  that  place  of  the  Praenotiones  (£),  which 
Celfus  particularly  referr’d  to  at  that  time,  but  alfo  even  in  the  Coac Pr*- 
notiones  (/),  conftantly  plac’d  this  among  the  figns  of  perfons  being  empye¬ 
matic,  «  that  they  fpit  up  nothing  worthy  of  obfervation.”  And  if,  in  ano- 


(if)  Morb.  Chron.  1.  2.  c.  14. 
(<■)  De  Medic.  1.  3.  c.  22. 

(/)  Vid.  n.  28. 

(g)  c.  cu. 


F)  h  2,  c.  7.  _ 

(i)  Enarrat,  ejufd.  c.  7. 

(£)  n.  16.  apud  Marinell. 

(/)  n.  3.  ante  med. 

ther 


Letter  XXII.  Articles  30,  31.  6  71 

ther  book,  I  mean  that  which  is  entitled  De  locis  in  bomne  (m\  before  he 
taught  us  to  conjecture  that  a  patient  was  empyematic  from  this  fign,  that 
“  he  is  fhort  of  breath,  and  fpeaks  with  a  fomewhat  hoarfe  voice,”  he  has 
faid  that  the  fame  perfon  “  fpits  up  pus  he  meant  that  they  did  this  dif¬ 
ferently  from  coniumptive  patients,  or  at  lead  after  different  fymptoms,  as 
you  will  gather  from  the  paffage  of  Caelius  already  referred  to  :  and  without 
doubt,  that  the  confumptive  or  phthifical  patients  of  Hippocrates  were 
different  from  thofe  who  were  empyematic,  or  fuppurated,  is  very  evidently 
fhown  from  what  he  had  faid  a  little  before  (»);  “  that  patients  become  lup- 
<c  purated  from  being  tabid,  or,  as  they  are  call’d  in  the  Greek  language, 
“  phthifical,  when  the  body  has  been  made  very  moift:  and  on  the  contrary, 
“  that  they  become  tabid  from  being  fuppurated,  or  empyematic,  when  the 
“  body  has  been  made  very  dry.” 

30.  But  to  return  to  that  difcourfe  from  which  I,  perhaps,  feem  to  you 
to  have  digrefs’d,  you  readily  underftand  how  eafily  men  may  be  deceiv’d,  in 
fo  great  a  difficulty  of  judging  fometimes,  and  finding  out  what  is  really 
purulent-,  fo  that  although  it  ffiould  be  determin’d  that  a  confumption  fhould 
be  allow’d  to  confiff,  not  only  in  the  hidden  ulceration  of  the  lungs,  but  in 
the  evident  difcharge  of  pus  by  fpitting,  they  may  neverthelefs  frequently 
feem  themfelves  to  be  right,  in  fuppofing  that  to  be  a  confumption  which  is 
not  fo  in  fa£t.  And  this  I  fay,  not  in  fuch  a  manner  as  to  deny  that  patients 
really  confumptive  have  been  fometimes  cur’d,  efpecially  in  the  beginning  of 
the  difeafe,  when  a  great  quantity  of  pus  is  not  yet  collected  in  the  lungs, 
from  whence  it  has  a  free  and  open  accefs  into  the  bronchia :  but  I  judge  this 
to  happen  very  rarely,  more  fo  than  they  imagine,  who  have  had  no  experi¬ 
ence  how  great  a  diligence  of  the  phyfician,  and  how  ftricl  a  compliance  of 
the  patient,  at  the  fame  time,  is  requir’d,  even  to  remove  thofe  diforders 
which  are,  perhaps,  not  true  confumptions  *  although  in  moft  refpedts  they 
may  feem  to  be  very  fimilar  thereto.  A  cafe  of  this  kind  I  will  defcribe  to  you 
here,  in  order  to  give  you  fome  fatisfadtion,  by  obfervations  taken  from  pa¬ 
tients  when  living,  describ’d  minutely,  and  at  large,  as  I  know  you  would 
wifti  them  to  be,  becaufe  I  cannot  fatisfy  fo  much  in  this  letter  as  I  am  us’d 
to  do  in  others,  by  giving  you  diffedlions  of  morbid  bodies.  You  will  judge, 
when  you  have  read  over  the  fuccefsful  cure  of  this  difeafe,  by  what  name  it 
•ought  to  be  call’d. 

31.  The  count  of  Feltri  being  every  year  fubjedl,  not  only  to  trouble- 
fome  complaints  of  the  gums  and  teeth,  as  the  reft  of  his  noble  brothers  alfo 
were,,  but  to  ulcerations  of  the  noftrils  befides,  and  to  itching  diforders  of 
the  fkin,  which  were  of  the  tetterous  kind  and  having,  in  purfuit  of  the 
pleafure  in  which  he  took  in  hunting,  expos’d  himlelf  frequently,  through  the 
autumn,  to  the  morning’s  early  cold,  was  taken  with  a  violent  catarrh,  to 
which  a  cough  was  added  -,  and  at  length,  in  the  month  of  November,  a 
fpitting  of  blood.  For  which  reafon  a  vein  was  open’d  •,  and  as  the  hsemoptoe 
return’d,  blood  was  taken  away  a  fecond  time ;  and  goats  milk  was  admi- 
nifter’d;  and,  in  like  manner,  the  jelly  of  ivory  and  of  calves  feet,  which  was 
prepar’d  with  water  wherein  loot  fteel  had  been  frequently  extinguiffi’d,  and 


{m)  a.  28. 


(*)  n.^7. 


other 


6 72  Book  II.  Of  Difeafes  of  the  Thorax. 

other  remedies  that  have  an  aftringent  and  agglutinating  property.  This 
method  being  purfu’d  through  the  whole  month  of  December,  the  diforder 
feem’d  to  be  overcome;  though  the  cough  return’d  now  and  then.  But  in 
the  month  of  March,  all  the  fymptoms  were  renew’d.  For  which  real'on  de¬ 
coctions  were  given  in  the  morning,  from  fuch  woods  and  roots  as  are  gene¬ 
rally  recommended  againft  defluxions,  antifcorbutic  and  vulnerary  herbs  be¬ 
ing  added;  and  in  the  evening  the  antihe&icum  polerii,  as  it  is  call’d,  firft 
with  an  emulfion  of  the  cold  feeds,  and  after  that,  with  the  aqua  bardanm. 
And  having  made  ufe  of  thefe  remedies,  and  other  things  of  a  limilar  kind, 
from  the  middle  of  March  to  the  latter  end  of  April,  he  again  took  the 
goat’s  milk,  and  at  the  fame  time,  twelve  drops  of  the  ball'am  of  Peru  ;  and 
this  regimen  he  continu’d  about  forty  days.  In  the  mean  while  one  of  his 
upper  limbs  had  the  actual  cautery  applied  to  it,  and  the  ulcer  was  kept  open. 
Although  he  at  times  perceiv’d  fome  little  alleviation,  indeed,  from  thefe  ap¬ 
plications,  yet  the  cough  and  the  hoarfenefs  very  obftinately  affliefted  him: 
and  indeed  the  cough  had  grown  much  more  violent,  and  feem’d  to  arife  even 
from  the  very  bottom  of  his  thorax;  and  his  fpittings,  from  being  whitifh 
and  catarrhous,  began  now  to  be,  at  different  times,  of  a  different  colour 
and  weight,  and  of  a  different  tenacity:  to  thefe  fymptoms,  a  certain  fenfe 
of  narrownefs  and  conftritftion  at  the  cheft  was  added,  and  an  internal  heat  at 
the  fternum  ;  the  latter  of  which  the  patient  complain’d  of  frequently,  but  of 
the  former  continually.  All  which  appearances  feem’d  to  be  fo  much  the 
more  threat’ning,  as  the  fauces,  which  had  been  before  troubl’d  with  a  de¬ 
fluxion,  grew  better  from  the  time  thefe  fymptoms  came  on ;  and  at  the  fame 
time  the  cutaneous  fpots  became  pale,  nor  caus’d  any  itching  whatever;  fo 
that  all  the  violence  of  the  difeafe  feem’d  to  have  turn’d  itfelf  upon  the  breaft. 
And  it  was  now  alfo  perceiv’d  by  every  one,  that  not  only  the  ftrength  of  the 
body  in  general,  in  a  man  not  two  and  thirty  years  of  age,  was  much  weak¬ 
en’d,  and  that  the  iivelinefs  of  his  face,  the  vigour  of  his  eyes  and  underftand- 
ing  were  diminifli’d,  and  his  flefh  ftill  more  decreas’d,  but  that  even  the 
voice  itfelf  was  made  very  weak.  In  this  ftate  was  the  difeafe,  when  1  was 
confulted  by  letter,  in  regard  to  his  cafe,  that  is  about  the  latter  end  of  June; 
being  ftrenuoufly  recommended  to  the  patient  by  one  who  had  it  in  his 
power  to  command,  the  moft  excellent  Angelo  Emo,  a  Venetian  fenator, 
and  that  time  governor  and  lord  chief  juftice  of  Padua.  There  were  many 
circumftances,  as  you  fee,  that  gave  us  reafon  to  fear:  yet  others  were  not 
wanting,  which  1  thought  fufficient  to  prevent  us  from  being  quite  out  of 
hope  ;  as  for  inflance,  eafy  fleep  by  night,  a  capacity  of  lying  down  on  either 
fide,  his  appetite  for  food  not  being  loft,  and  the  quicknefs  of  his  pulfe  not 
being  encreas’d  after  taking  nouriftiment;  no  foetid  fmell  in  his  fpittings,  no 
fenfe  of  weight  in  his  cheft,  no  fhortnefs  of  breath.  And  though  juft  after  this 
account  had  been  fent  to  me,  the  patient  expe&orated,  by  means  of  the  very 
deep  and  violent  cough,  fuch  matter  as  had  never  been  difeharg’d  before,  be¬ 
ing  bloody  and  corrupted,  and  that  five  or  fix  times  over,  yet  I  did  not,  for 
that  reafon,  change  my  opinion ;  efpecially  from  the  time  I  was  inform’d, 
that  the  patient  had  made  no  complaint  of  the  fenfe  of  heat  and  conftridtion, 
ever  fince  this  matter  had  been  thrown  up.  I  therefore  determin’d  to  re¬ 
commend  various  remedies,  as  the  fummer  feafon  at  that  time,  and  the  va¬ 
rious 
6 


.Letter  XXII.  Article  31.  67  3 

tious  caufes  and  effedts  of  the  difeafe  induc’d  me,  yet  fo  that  one  might 
agree  and  co-operate  with  the  other.  There  is  no  occafion  here  to  recount 
the  whole  particulars  of  the  treatment ;  or  to  tell  you.  what  I  fubftituted  in 
the  room  of  lome  remedies  which  the  patient  did  not  feem  to  bear  well ;  it 
is  fufficient  to  point  out  to  you  fuch  of  them  as  were  of  moll  advantage, 
and,  confequently,  moft  freely  us’d.  Every  day,  in  the  morning,  a  little 
of  the  refin  of  turpentine  was  taken,  by  which  the  patient  affirm’d  that  his 
fauces  and  bread:  were  confiderably  reliev’d.  After  that,  for  the  firft  twenty 
-days,  the  aqua  ladtis,  as  it  is  now  call’d,  was  drunk,  in  which  were,  and 
had  been  previoully,  macerated,  brook-lime,  ground  ivy,  flowers  of  St. 
John’s  wort,  and  a  little  of  the  bark  of  faflafras ;  the  drinking  of  which 
water  was  always  repeated  five  hours  after  dinner.  But  after  thefe  twenty 
days,  a  draught  of  viper  broth  was  fubftituted  in  the  Head  of  the  morning 
draught  of  this  water,  prepar’d  alfo  from  frogs,  and  the  tails  of  river- 
crabs.  From  the  firft  ule  of  which  he  evidently  found  advantage ;  for  the 
fpots  on  his  (kin,  as  I  had  wiffi’d,  became  again  colour’d,  and  itching,  and, 
at  the  fame  time,  the  colour  of  the  face  was  better,  and  the  ftrength  fome- 
what  increas’d,  the  habit  of  the  body  fomewhat  lefs  thin,  the  cough  lefs 
frequenr,  the  hoarfenefs  more  flight,  and  the  fpittings  lefs.  His  food  was 
nothing  elfe  but  young  female  chickens,  or,  as  they  are  call’d  among  us, 
and  as  Varro  (0),  perhaps,  has  written,  pullaftra,  which  having  the  belly 
fluff’d  with  the  herbs  mention’d  above,  were  roafted,  and  pudding  made  of 
rice,  or  oats,  together  with  almonds.  At  table  he  always  drank  water  in 
which  the  radix  chinte,  and  the  faflafras  bark,  had  been  flightly  macerated  ; 
and  at  other  times  the  aqua  Brandulae,  which  in  the  fummer-time,  and 
when  he  was  troubl’d  with  thirft,  was  allow’d  him  in  a  conflderable  quantity. 
By  means  of  this  regimen,  the  patient  was  able  to  come  from  the  place  of 
his  nativity  to  Venice,  after  the  middle  of  Auguft,  and,  about  the  beginning 
of  September,  to  Padua,  to  confult  me  again  ^  full  of  hope,  that,  as  I  had 
fo  much  reliev’d  his  diforder,  by  having  it  defcrib’d  to  me  by  letters,  I  ffiould 
be  able  entirely  to  cure  it,  upon  feeing,  and  examining  into,  its  nature.  It 
.pleas’d  me  very  much,  that  this  confidence  had  fucceeded  to  fo  great  a  fear 
in  which  he  had  previoully  been.  And  upon  obferving  this  gentleman,  and 
his  diforder,  very  clofely,  for  two  days  that  he  was  here,  I  was  alfo  pleas’d 
to  find,  that  all  the  circumffances  of  the  difeafe,  which  had  given  me  reafon 
to  hope,  ftill  continu’d ;  and,  likewife,  that  the  conformation  of  the  thorax 
fhew’d  nothing  from  whence  I  could  conjedture  that  he  was  difpos’d  to  a  con- 
fumption  ;  for  the  ffiape  of  it  was  fuch,  that  it  lay  quite  contiguous  to  the 
broad  bones  of  the  fcapulas,  and  did  not,  by  receding  therefrom,  render 
them  prominent  like  wings  ;  alfo,  that  there  was  no  hedtic  heat,  no  quicknefs 
of  pulfe,  no  thirft,  no  difficulty  of  breathing,  not  even  when  he  went  up 
fteep  places  ;  at  length,  that  his  long  and  very  obftinate  hoarfenefs  had  now 
been  entirely  remov’d  for  many  days.  Yet  his  cough,  fpitting,  and  emaciated 
flate  of  body,  ftill  gave  me  pain.  For  1  found  him  to  be  more  emaciated 
than  I  had  fuppos’d  from  the  tenour  of  the  letters  that  I  had  receiv’d.  And 
-his  fpittings,  although  nothing  of  a  corrupt  or  bloody  kind  had  appear’d 


Vo l.  I. 


(o)  De  Re  Ruftic.  1.  3.  c.  9. 

4  R 


ever 


6  74  Book  II.  Of  Difeafes  of  the  Thorax. 

ever  fince  the  time  of  expectorating  fuch  matter  which  I  have  already  men¬ 
tion’d,  neverthelefs,  had  not  yet  loft  their  yellowifh  and  cineritious  colour, 
efpecially  in  a  morning,  and  their  faltilh  talte  :  finally,  his  cough,  although 
it  was  grown  much  milder,  at  other  times  was  ftill  troublefome  in  a  morning 
and  evening,  and  feem’cl  to  arife  from  an  irritation  within  the  thorax,  not- 
withftanding  it  lay  pretty  high.  My  folicitude  was  encreas’d  by  the  time  of 
year  wherein  the  difeafe  had  begun,  being  at  hand,  which  the  patient  was, 
for  more  than  one  reafon,  oblig’d  to  fpend,  and  the  winter  likewiie,  in  the 
place  of  his  nativity.  And  how  early,  long,  and  fharp,  the  cold  is  there* 
you  may  eafily  conjs&ure  from  the  fituation  of  it,  and  the  ancient  verfe, 
which  is  fuppos’d  to  be  Csefar’s,  confirms, 

Feltria  perpetuo  nivium  damnata  rigori  (p)  : 

“  Where  its  bleak  face  the  rugged  Fehri  fhows, 

Doom’d  to  the  rigour  of  eternal  fnows 

•whereas,  in  the  age  of  Celfus,  on  the  contrary,  in  diforders  of  this  kind  (q)y 
ts  the  patient  went  from  Italy  to  Alexandria.”  For  which  reafon,  I  again 
and  again  inculcated,  with  how  much  care  and  diligence  he  ought  to  defend 
himfelf  againft  thefe  inclemencies,  when  he  was  there,  and  with  how  much 
care  ufe  tnofe  remedies  that  I  recommended  to  him.  And  as,  in  the  number 
of  thefe,  milk  was  the  chief,  firft  afTes  milk,  and  then  cows,  the  patient: 
having  return’d  home,  and  us’d  the  former  for  a  month,  faw  his  fpittings  fo 
much  chang’d  for  the  better,  that  in  quantity,  colour,  and  all  other  con¬ 
ditions,  they  were  now  almoft  within  their  natural  bounds ;  then  leaving 
affes-milk,  and  going  to  that  of  cows,  and  perfifting  very  long  in  the  ufe  of 
it,  as  I  had  order’d,  if  it  feem’d  to  be  of  fufficient  advantage  to  him,  fo  as 
to  take  it  quite  to  the  latter  end  of  December;  and  his  fpittings  being  now 
become  entirely  of  a  natural  and  healthy  kind,  and  all  irritation  and  trouble- 
l'ome  afre&ion  of  his  thorax,  or  fauces,  being  entirely  remov’d,  he  recover’d 
the  former  colour  of  his  face  ;  and  both  the  habit  and  ftrength  of  his  body, 
in  general,  was  then  in  perfect  health,  and  continu’d  ftill  lo  when  I  revis’d 
thefe  letters,  which  was  in  the  twenty-fecond  year  from  the  time  he  regain’d 
his  health  :  fo  much  was  one  fingle  kind  of  remedy  able  to  effedl,  by  the 
fingular  blefting  of  God,  in  an  unfavourable  place,  and  feafon  of  the  year, 
a  Hilled  by  the  great  diligence  and  caution  of  the  patient  in  taking  care  of 
himfelf,  and  by  the  equal  ftudioufnefs  and  vigilance  of  Ludovico  Alberti,  a 
very  ingenious  phyfician  at  Feltri,  and  deferving  of  a  much  longer  life ;  who, 
both  in  refpedt  of  diet  and  medicine,  took  care  that  every  thing  fhould  be 
adminifter’d  according  to  the  opinion  I  had  given  ;  and  whofe  letter  written 
to  me  on  the  fixth  of  January,  in  the  year  1740,  related  this  fuccefsful 
event,  which  was  extraordinary,  and  but  little  hop’d  for  by  moft  perfons 
who  knew  the  patient.  And  this  was  alfo  confirm’d  in  the  fucceeding  fpring, 
by  the  fight  of  the  gentleman  who  had  been  ill,  which  was  very  pleafing  to 
me  j  though  if  he  had  not  made  himfelf  known,  I  fhould  not  have  known 
him  again.  You  have  what  I  promis’d.  Farewel. 

(?)  Apud  Bembum  in  Rer.  Yenetar.  Hill.  I.  9.  (?)  De  Medic.  I.  3.  c.  22. 


LETTER 


Letter  XXIII.  Article  i. 


67$ 


LETTER  the  TWENTY-THIRD 

Treats  of  Palpitation  and  Pain  of  the  Heart. 

1.  A  S  in  the  laft  letter  you  receiv’d,  together  with  fome  diflfedtions  of 
JT\.  Valfalva’s,  not  more  than  one  of  mine*,  fo,  on  the  other  hand,  in 
this  you  will  have  fome  of  mine  and  none  of  his ;  not,  indeed,  but  there 
are  many  extant  in  his  papers,  which  relate  to  the  palpitation  and  pain  of 
the  heart,  but  becaufe  there  feem’d  to  be  a  more  proper  place  for  each  of 
them,  in  the  letters  which  I  have  already  fent  to  you,  or  am  to  fend  here¬ 
after.  For  whether  thefe  indifpofitions  of  the  heart  have  their  caufes  remote 
therefrom,  or  in  this  vifcus  itfelf,  or  near  it,  in  the  former  cafe  it  for  the 
mod  part  happens,  that  at  the  fame  time  other,  and  often  more  violent 
diforders,  difcover  themfelves  in  other  places ;  and,  in  the  latter  cafe,  it 
rarely  happens,  that  the  heart  is  agitated  with  a  palpitation,  without  other 
and  greater  injuries.  For  which  reafon,  my  obfervations,  that  I  (hall  pro¬ 
duce  prelently,  will  themfelves  alfo  leem,  in  fome  meafure,  to  relate  to  other 
fubje&s,  in  the  fame  manner  as  many  do  in  the  eighth  fe&ion  of  the  Sepul- 
chretum,  which  anfwers  to  this  letter  *,  nor  yet  thofe  only  of  which  Bonetus 
confeffes  it,  when  he  exprefsly  adds  in  what  feCtions  befides  they  have  been 
before  propos’d  by  him,  or  will  be  afterwards  propos’d  but  others  alfo,  and 
in  particular  thofe  in  refpeft  to  which  the  authors  have  either  pointed  out  no 
diforder  wherewith  the  patients  were  troubl’d,  or  have  mention’d  fome  other 
than  that  of  the  heart.  To  this  clafs  you  will  refer  the  eighth  obfervation, 
in  which  [a)  a  fcabies  and  dropfy  only  are  mention’d  ;  but  palpitation  is 
mention’d  in  the  fcholium  in  fuch  a  manner,  that,  if  you  attend  to  it  never 
fo  clofely,  you  do  not  certainly  know  whether  it  was,  or  was  not,  obferv’d  in 
the  patient.  And  that  obfervation  the  tenth  and  fixteenth  are  of  this 
kind,  even  Bonetus  himfelf  does  not  deny  ;  and,  indeed,  he  readily  acknow¬ 
ledges,  in  the  fcholia  which  are  added  to  both,  that  there  might  be  other 
diforders  than  what  he  treats  of  there.  Yet  in  both  places,  although  con¬ 
jectures  ought  not  to  have  been  given  inftead  of  obfervations,  you  will,  per¬ 
haps,  better  bear  this,  than  that  he  fhould  again  repeat  the  obfervations  which 
he  had  already  produc’d  in  this,  not  very  long,  leCtion,  without  being  fen- 
fible  of  it  himfelf.  For  that  which  we  read  under  obfervation  the  eighth, 
article  the  third,  is  the  fame  with  what  we  find  in  the  very  firft  verfe  of  ob¬ 
fervation  the  firft :  you  will  know  with  what  accuracy  other  things  are  de- 
fcrib’d  therein,  when  you  take  the  trouble  to  compare  it  with  the  fcholium 
of  Hollerius  himfelf,  in  the  chapter  quoted,  which  is  in  his  firft  book. 


(*)  § 

4  R  2 


Moreover, 


6  y  6  Book  II.  Of  Difeafes  of  the  Thorax. 

Moreover,  that  which  is  firft  fubjoin’d  to  the  fifteenth  obfervation,  is  the' 
fame  as  the  firft  under  the  fifth ;  that  in  the  eighteenth  the  fame  with  that  in 
the  latter  part  of  the  firft  ;  that  which  is  about  the  beginning  of  the  fcholiurrr 
to  the  fixth  article,  under  the  twenty-firft  obfervation,  is  the  fame  with  that 
which  is  at  the  end  of  the  fcholium  to  the  tenth  obfervation.  Finally,  the 
girl  who  is  fpoken  of  under  the  fecond  article  of  the  fourteenth  obfervation, 
is  no  other  than  fhe  who  is  again  fpoken  of  under  the  eleventh  article  of 
the  twenty-firft  obfervation,:  and,  what  you  would  not  eafily  believe,  if  you 
did  not  yourfelf  know  it,  in  the  eighth  article  of  this  laft  observation,  it  is 
the  fame  boy  that  is  again  fpoken  of  under  article  the  ninth.  Nor  are  there 
fewer  marks  of  forgetfulneis  in  the  additamenta  to  this  feflion.  For  if  of 
thofe  obfervations  that  are  collefted  together  into  one  under  number  three, 
you  compare  the  two,  one  of  which  relates  to  a  certain  citizen  of  fifty,  and 
the  other  to  a  nobleman,  with  thofe  which  Bonetus  had  produc’d  above* 
under  number  twenty-one,  article  five,  and  under  number  fourteen,  and  in 
the  beginning  of  the  fcholium  added  to  this,  giving  their  authors  names  at 
the  fame  time,  you  will  immediately  know  that  they  are  the  fame ;  the  latter 
being  the  obfervation  of  Riverius,  and  the  former  of  Hildanus.  Nor  will 
Blancardus,  who,  in  his  Anatomica  PraRica ,  has  given  both  of  them  (£), 
fomewhat  newly  modified,  as  his  own,  or  “  from  the  relation  of  others  (c),” 
having  omitted  forne  things,  and  even  added  others,  which  Flildanus  had 
taken  no  notice  of  in  the  body,  be  able  to  difguife  them  from  you,  as  you 
are  fo  much  the  lefs  likely  to  believe  him,  becaufe  even  in  the  obfervation 
which  immediately  precedes  them,  in  the  Sepulchretum,  he  fpeaks  of  Ruyfch 
as  being  “  prefent”  while  he  differed,  who  fhew’d  afterwards  (i),  as  you 
very  well  know,  that  he  himfelf  “  had  made  the  diflebtion.”  But  to  pafs 
over  Blancardus,  with  thofe  little  arts  of  his ;  to  what  purpofe  was  it,  in  fine, 
to  add  to  the  obfervations  deferib’d  from  his  book ;  which,  let  them  be  of 
what  kind  foever,  do  relate  to  palpitation  at  leaft ;  I  fay,  to  what  purpofe  was 
it  to  add  that  obfervation,  which,  as  it  is  of  an  afphuxia  only,  did  not  be¬ 
long  to  this  fedlion,  but  to  the  next  entirely  ?  I,  however,  am  not  difpos’d 
to  imitate  any  thing  of  this  kind.  I  fhall.  repeat  no  hiftories  •,  and  thofe  which 
may  feem  to  belong,  rather,  to  other  letters,  I  will  defer  till  I  fend  them  : 
and,  in  particular,  I  will  deferibe  the  diffection  of  no  bodies,  which  either  I, 
or  my  friends  whom  I  can  name,  did  not  diHedb.  1  fhall  begin  with  that 
which  Jo.  Francefco  Bernardoni  differed  at  Modena  •,  he  who  was  afterwards 
archiater  at  that  court,  and  who  refided,  together  with  me,  at  Bologna,  for 
the  fake  of  profecuting  his  ftudies,  at  the  time  the  diffe&ion  was  perform’d, 
when  he  alfo  related  it  to  me. 

2.  A  woman,  who  educated  young  children  of  noble  families,  was  feiz’d 
with  a  palpitation  of  the  heart.  Blood  being  taken  away  from  her  arm, 
ihe  was  greatly  reliev’d  thereby  for  about  two  days.  But  thefe  being  elaps’d, 
the  palpitation  return’d  with  fuch  vehemence,  that  the  breaft  was  perceiv’d 
to  be  lifted  up  by  every  ftroke.  At  the  fame  time  there  was  fuch  a  pain  in 
the  thorax,  a  difficulty  of  breathing,  and  fever,  as  gave  great  fufpicion  of 
a  peripneumony.  Blood  being  again  taken  away  from  the  arm,  Ihe  receiv’d 

(£)  Obf.  35,  Sc  75.  ft)  Vid.  ej us  Praffat.  (d)  Obf,  Anat.  Chir.  69. 

not 


Letter  XXIII.  Article  3.  6  77 

not  the  leaf!  advantage  therefrom.  And  having  a  vein  open’d  in  her  foot, 
fhe  died  within  about  an  hour  after,  which  was  indicated  by  the  pulfe  grow¬ 
ing  gradually  lefs  and  lefs,  from  the  time  of  being  bled,  and  giving  lefs  re¬ 
finance  to  the  fingers  of  the  phyfician,  when  he  comprefs’d  the  artery  :  but 
the  pulfe  was,  at  the  fame  time,  more  quick.  A  great  quantity  of  blood 
flow’d  from  the  mouth  of  the  carcafe.  Yet  in  the  thorax,  and  in  the  belly, 
every  thing,  was  found.  The  head,  as  no  fufpicion  of  diforder  being  there 
had  arifen,  was  not  differed. 

3.  Although  the  difeafe  and  death  of  this  woman,  join’d  together  with 
this  difledion  of  the  body,  are  difficult  to  be  explain’d,  let  us  ufe  whatever 
mode  or  order  of  explication  we  chooie  ;  yet  I  fnould  believe  that  internal 
convulfions  had  in  fotne  meafure,  at  leaft,  confpir’d  to  her  death.  For  tho5 
we  fhould  quite  exculpate  the  brain,  yet  the  nervous  plexufles,  and  the  nerves 
themfelves,  ftill  remain  to  be  held  in  fufpicion.  But  who  is  able  to  enquire 
into  the  injuries  of  thefe  parts,  wherever  it  might  be  neceflary  ?  or  indeed 
to  diftinguilh  thefe  injuries,  for  the  moft  part,  by  enquiry  ?  which  without 
doubt  is  the  reafon,  that  in  the  examination  of  bodies  of  this  kind,  they 
are  very  rarely  fought  into.  Neverthelefs,  if  a  palpitation  of  the  heart  im¬ 
mediately  fucceed  to  fome  certain  motions  in  the  brain,  as  even  happens  to 
perfons  in  health,  under  the  influence  of  fome  of  the  paffions  of  the  mind, 
who  can  deny,  if  motions  are  made  in  the  nerves,  which  anfwer  in  a  juft 
proportion  to  thofe  motions  of  the  brain  ;  who,  I  fay,  can  deny,  but  the 
lame  palpitation  may  then  be  brought  on  ?  For  whatever  the  brain  is  able 
to  perform  in.  the  heart,  it  is  able  to  do  only  by  means  of  the  nerves  that 
go  betwixt  itfelf  and  the  heart,  or  the  veflels  neareft  to  the  heart,  by  which, 
without  doubt,  thefe  motions  are  propagated  to  the  fleffiy  fibres  of  the  heart, 
or  the  veflels ;  or,  if  you  choofe  rather  to  confider  it  in  that  view,  externally- 
conftringe  the  coats  of  thefe  veflels  •,  fo  that  it  now  very  clearly  appears,  that 
the  fame  eflfed  muft  of  courfe  follow,  if  the  fame  motions  which  at  one 
time  begin  from  the  brain,  fometimes  alfo  begin  from  the  nerves,  that  arc 
interpos’d ;  juft:  as  in  thofe  perfons,  who  after  having  a  foot  amputated,  go 
on  ftill  to  complain  of  a  pain  in  that  part,  there  is  the  fame  effed  from  a 
motion  which  arifes  in  the  nerves  that  are  interpos’d,  as  there  was  a  fimilar 
motion  which  arofe  even  from  the  difeas’d  foot.  Rightly,  therefore,  did 
even  our  Saxonia  formerly  teach,  “  that  a  palpitation  of  the  heart  did  not 
“  only  take  its  origin  from  the  brain,  but  that  it  alfo,  fometimes,  arofe  frpm 
“  the  injury  of  the  nerves  alone,  without  any  apparent  injury  in  the  brain:** 
which  words  you  will  alfo  read  fubjoin’d  to  the  forty-fecond  obfervation  in 
this  fedion  of  the  Sepulchretum,  from  which  the  pofition  I  made  juft  now 
is,  in  other  refpeds,  confirm’d-,  I  mean,  that  the  natural  motion  of  the 
heart  is  immediately  chang’d  from  a  certain  change  and  motion  in  the  brain. 
But  if  in  a  tender  female  infant,  who  is  fpoken  of  in  the  “  Commercium 
“  Litterarium  (<?),”  no  other  appearance  could  in  fad  be  found,  to  which 
the  diforder  might  be  imputed,  but  thofe  polypous  concretions,  you  will  fo 
much  the  more  readily  explain  the  palpitations  of  the  heart  with  which  Ihe 
was  troubl’d,  by  convulfions,  from  whencefoever  thefe  convulfions  might 


(f)  A.  1744;  Hebd.  42.  n.  1.  ad  art.  15. 


arife, 


6  7  8  Book  II.  Of  Difeafes  of  the  Thorax. 

arife,  becaufe  “  the  died  of  convulfions.”  However,  thefe  things,  which  I 
have  faid,  you  may  alfo  transfer  to  the  nerves  that  communicate  with  thofe 
of  the  heart,  or  great  veffels,  fo  as  to  underftand  that  thefe  palpitations  of 
the  heart,  which  frequently  happen  in  hypochondriacal  and  hyfterical  pa¬ 
tients,  in  particular,  do  either  altogether,  or  in  part,  derive  their  origin 
from  thence.  For  the  nerves,  in  bodies  of  this  kind,  are  much  more  prone 
to  run  into  fudden  and  irregular  motions  *  for  which  reafon  we  fee,  that  thefe 
perfons,  above  all  others,  are  immediately  feiz’d  with  palpitations  of  the 
heart,  even  from  the  flighted:  emotions  of  the  mind.  And  although  in  three 
women,  whofe  hiftories  I  fhall  immediately  fubjoin,  you  will  acknowledge 
that  there  were  fome  other  caufes  of  the  palpitation,  yet  you  will  by  no  means 
doubt,  but  that  has  fometimes  confpir’d  together  with  the  others. 

4.  The  wife  of  a  certain  painter  at  Padua,  of  forty  years  of  age,  and  the 
mother  of  four  children,  who  was  not  accuftom’d  to  any  irregularities,  either 
in  eating  or  drinking,  but  being  of  a  delicate  conftitution,  and  for  that  rea¬ 
fon  more  irafcible,  nor,  indeed,  being  without  caufes  of  anger  and  fadnefs, 
had,  for  a  long  time  paft,  loft  her  appetite  to  food  ;  yet  was  not  deficient  in 
her  menftrual  purgations,  when  fhe  began  to  complain  of  a  palpitation  at  her 
heart,  with  which  fhe  was  troubl’d  to  the  very  day  of  her  death,  though  in 
different  degrees  at  different  times.  To  this  were  added  other  complaints  of 
a  fenfe  of  erofion  within  the  thorax,  and  at  the  fpine  of  that  cavity,  and  of 
a  palpitation  produc’d  to  the  fide  of  the  fpine,  alfo  of  a  very  difficult  paffage 
of  the  aliments  into  the  ftomach,  after  they  had  already  defcended  through 
the  oefophagus,  very  near  to  the  ftomach ;  at  length  fhe  complain’d  of  a 
pain  in  the  nerves,  as  fhe  herlelf  faid,  and  particularly  in  the  arms :  as  to 
the  other  fymptoms  which  attended  the  diforder,  an  oedematous  tumour  be¬ 
gan  alfo  to  come  on,  that  was  particularly  confpicuous  in  the  lower  limb  on 
the  right  fide  ;  and  by  this,  among  many  even  eminent  phyficians,  the  opi¬ 
nion  of  an  aneurifm  of  the  aorta  was  confirm’d.  Others,  on  the  contrary, 
as  they  obferv’d  that  the  patient  could  lie  down  eafily  on  either  fide,  and 
that  the  pulfe  was  not  tenfe,  or  intermittent,  and  fimilar  in  both  arms,  attri¬ 
buted  all  thefe  fymptoms  to  an  hyfterical  diforder ;  and  that  with  fo  much 
the  more  readinefs,  as  they  knew  that  fhe  had  been  in  the  mean  while  feiz’d 
with  a  kind  of  paroxyfm,  in  which  the  women  found  her  with  her  teeth 
clofely  ftuit ;  and  they  faid  alfo  that  they  had  frequently  perceiv’d  her  to  be 
cold  in  many  places.  While  thefe  controverfies  were  agitated,  the  woman, 
finally,  having  her  pulfe  already  diminifh’d,  died  as  fhe  was  fpeaking. 

Having  heard  all  thefe  circumftances  accurately  related  by  my  moft  ex¬ 
cellent  collegue,  Anthony  Vallifneri,  and  being  afked  by  him  two  things, 
the  one,  that  I  would  tell  him  what  my  opinion  was  of  the  difeafe,  and  the 
other,  that  I  would  be  prefent  with  him  at  the  diffection  of  the  body,  I  im¬ 
mediately  promis’d  him  the  latter ;  but  in  regard  to  the  former,  I  only  an- 
fwer’d  at  that  time  by  faying,  it  happen’d  to  me,  more  than  onca,  after  many 
and  even  very  violent  fymptoms,  that  I  did  not  find  an  aneurifm  in  the  great 
artery,  but  only  fome  diforders  of  the  internal  furface  of  it. 

The  body  was  ftill  warm  many  hours  after  death,  notwithftanding  the 
weather  was  colder  than  was  ufual  in  that  feafon  of  the  year-,  for  it  was  the 
twentieth  of  March,  in  the  year  of  our  Lord  1726  j  externally  it  had  a  lau¬ 
dable 


Letter  XX  III.  Article  4,  6jy 

dable  appearance ;  but  the  neck  was  rather  thickifh,  and  the  belly  fomewhat 
turgid ;  yet  not  fo  that  there  appear’d  any  mark  in  the  fkin,  of  her  having 
been  four  times  pregnant. 

Both  the  cavities  of  the  thorax,  but  particularly  the  right,  contain’d  a 
conliderable  quantity  of  water,  which  had  not  the  leaft  difagreeable  fmell : 
the  lungs  were  found,  notwithftanding  the  lower  furface  of  the  left  lobe,  and 
alfo  the  pofterior  furface,  in  fome  meafure,  had  adhefions  to  the  neighbour¬ 
ing  parts ;  the  one  to  the  diaphragm,  and  the  other  to  the  back  :  finally,  in 
the  afpera  arteria,  in  the  cel'ophagus,  when  open’d  quite  down  to  the  fto- 
mach,  in  the  mediaftinum,  pericardium,  heart,  auricles,  and  all  the  great 
veflels,  when  examin’d  carefully  both  internally  and  externally,  was  no  ap¬ 
pearance  of  diforder,  if  you  except,  however,  thofe  appearances  which  I 
thought  would  be  obferv’d  in  the  heart  and  great  artery.  For  as  I  look’d 
upon  this  artery  and  the  heart  externally,  and  compar’d  them  one  with  ano¬ 
ther,  and  with  the  other  parts  of  the  body,  the  artery  feem’d  to  be  fome¬ 
what  more  contracted  than  it  ought  to  be,  and  the  heart  more  enlarg’d  ; 
yet  neither  in  a  very  great  degree.  The  heart  being  foon  after  difleCted, 
and  two  very  fmall  polypous  concretions,  one  of  which  was  at  the  valvulae 
tricufpides,  and  the  other  at  the  beginning  of  the  aorta,  being  taken  away, 
together  with  the  blood,  which  in  the  ventricles  of  the  heart  was  fcarcely 
lefs  fluid  than  in  the  reft  of  the  body,  I  obferv’d  that  the  corpufcles  in  the 
middle  of  the  border  of  the  valves,  plac’d  at  the  beginning  of  the  arteries, 
were  harder,  and  at  the  fame  time  larger,  than  they  ufually  are,  and  parti¬ 
cularly  one.  However,  thefe  appearances  were  of  no  great  confequence. 
But  thofe  which  were  found  in  the  aorta,  although  at  firft  fight  they  might 
feem  to  be  flight  alfo,  yet  when  the  whole  trunk  of  it  was  open’d  longitudi¬ 
nally,  not  only  in  the  thoracic  portion,  but  in  the  abdominal  alfo,  foon  af¬ 
ter  they  were  known  to  be  of  great  importance.  For  the  whole  internal  fur¬ 
face  of  this  vefiel,  quite  from  the  heart  to  that  part  of  it  which  lies  below 
the  orifices  of  the  emulgent  arteries,  if  you  compar’d  it  with  the  other  part, 
that  goes  to  the  divifion  of  this  artery  into  the  iliacs,  manifeftly  inclin’d, 
from  the  natural  whitenefs  and  fmoothnefs  which  was  in  this  lower  part,  to 
a  yellownefs  of  colour  and  inequality  of  furface  ;  and  this  inequality,  if  you 
look’d  attentively  upon  it,  feem’d  to  be  owing  to  thefe  circumftances  of  the 
artery,  that  in  fome  places  it  was  rais’d  up  into  little  protuberances,  and  in 
other  places  fubfided  into  very  fmall  finuffes.  But  all  this  was  upon  the  fur¬ 
face  ;  except  that  a  little  above  the  valves,  there  was  a  fmall  narrow  fpace, 
where  the  furface  being  fomewhat  hollow’d  out,  as  it  were,  by  erofion, 
ftiew’d  the  fibres  which  lay  under  it  in  a  divided  ftate :  and  in  the  neigh¬ 
bourhood  of  the  emulgent  arteries,  the  internal  lamella  of  the  artery  was 
very  eafily  rubb’d  off,  by  applying  the  nail  to  it  (lightly.  However,  there 
was  no  induration  in  any  part  of  the  aorta.  But  the  appearance  of  diieafe, 
which  I  have  defcrib’d  as  fubfifting  through  fo  great  an  extent  of  it,  was 
at  leaft  produc’d  into  fome  of  its  upper  branches,  as  I  obferv’d  by  looking 
in  upon  their  orifices  from  the  curvature  of  the  aorta. 

In  the  belly  was  water,  and  not  in  very  fmall  quantity.  The  omentum 
was  contracted,  and  extremely  lax,  but  a  fmall  quantity  of  fat  being  left  here- 
and  there.  Theftomach  was  very  large,  and  full  of  a  fluid.  The  liver  was 

pale. 


6 


68  o  Book  II.  Of  Difeafes  of  the  Thorax. 

pale,  and  the  gall-bladder  contain’d  but  a  little  quantity  of  difcolour’d  bile. 
The  fpleen  was  hard,  yet  not  large.  The  parietes  of  the  uterus  alfo,  though 
in  other  refpedts  found,  were  very  hard  and  thick.  The  ovaria  were  hard 
iikewife,  externally  white,  and  not  fmall ;  internally  were  cellules,  fome  of 
which  were  empty  ;  and  in  one  of  them  the  parietes  were  yellowiffi,  while 
others  were  fill’d  with  a  bloody  kind  of  fluid.  The  other  parts  were  in  their 
natural  ftate.  The  head  was  not  differed.  I  have  already  told  you  that  the 
neck  was  fomewhat  thick,  which  was  owing  to  the  thicknels  of  the  thyroid 
gland,  that  was  much  larger  than  when  in  a  natural  ftate.  When  it  was  cut 
into,  it  feem’d  to  be  made  up  as  it  were  of  fmall  lobes,  in  the  middle  of 
which  was  found  a  globule  full  of  fluid,  which  was  very  much  like  the  oil 
-that  is  prefs’d  out  from  almonds.  There  was  a  great  quantity  of  blood  in 
this  carcale ;  and  it  was  every  where  fluid,  as  I  have  faid,  except  thofe  very 
fmall  concretions  in  the  heart. 

5.  In  regard  to  a  woman  of  an  irafcible  difpofition,  who  happen’d  to  have 
a  juft  caufe  of  anger  and  fadnefs,  and  who  had  loft  her  appetite  for  food  in  a 
great  meafure,  it  is  eafy  “for  you  to  conceive  what  kind  of  chyle  would  be 
prepar’d  from  the  aliments  ffie  took  in,  and  what  kind  of  humours  would  be 
prepar’d  from  this  chyle.  Therefore,  if  together  with  that  oleaginous  liquor, 
by  which  Lancifi  (f)  thought  that  the  internal  furface  of  the  arteries  was 
preferv’d  fmooth  and  flippery,  rough  and  heterogeneous  particles  infinuated 
•themfelves  into  the  interior  fubftance  of  the  aorta,  and  were  detain’d  about 
the  innermoft  coat;  it  will  not  be  difficult  to  conceive  how  thefe  particles 
were  generated,  or  how  they  could  bring  about  the  change  which  I  have 
mention’d  in  that  part.  But  if  you  alfo  enquire  why  they  ffiould  be  detain’d 
in  that  trad  of  the  aorta  particularly,  and  its  fuperior  branches,  you  may  very 
properly  account  for  it,  from  thofe  affections  of  the  mind  which  1  have  already 
fpoken  of,  unlels  you  ffiould  perhaps  fufped,  that  this  part  was  more  weak 
and  infirm  than  the  others,  from  the  firft  formation  of  the  body.  For  the 
nerves  being  mov’d  by  thefe  paffions  of  the  mind,  adt  chiefly  (as  the  fenfations 
and  appearances  then  fufficiently  teftify)  I  fay,  aft  chiefly  on  the  larger  vefifels, 
and  thofe  that  are  neareft  the  heart ;  fo  that  we  muff:  not  wonder,  if  in  that 
traft,  in  which  the  aorta  is  the  largeft,  and  in  which  this  artery  itfelf  and  its 
branches  are  at  the  leaft  diftance  from  the  heart,  the  annular  arterial  fibres 
are  then  compell’d  into  very  vehement  or  obftinate  contraflions,  without  any 
certain  order  or  law,  and  by  that  means  force  out  from  the  fmall  veflels 
which  lie  betwixt  themfelves  and  the  internal  coat,  even  very  grofs  and  rough 
particles,  if  fuch  there  are,  into  paflages  where  of  themfelves  they  would  not 
have  gone,  and  thus  give  occafion  to  their  adhering  there.  And  as  thofe  par¬ 
ticles  being  driven  here  and  there,  may  alfo  bring  on  a  fenfe  of  erofion,  by 
reafon  of  their  afperity,  befide  that  change  of  internal  furface,  it  will  be  eafy 
•to  underftand  from  whence  arofe  that  troublefome  kind  of  fenfation,  which 
the  woman  complain’d  of  at  her  fpine;  and  in  like  manner  that  other,  which 
extending  itfelf  particularly  through  her  arms,  encreas’d  the  fufpicion  of  an 
aneurifm  ;  whereas  it  certainly  was  from  the  artery  not,  however,  being  dilated, 
but  in  fome  meafure  eroded ;  which  although  it  gives  off'  branches  that  go 


throughout 


(/)  De  Aneuryfm.  1.  2.  c.  1,  Propof.  6. 


letter  XXIII.  Article  6.  6  8 1 

throughout  the  whole  body,  yet  it  afifeded  the  arms  mod  of  all,  to  which  it 
fent  off  branches  that  were  themfelves  affeded  with  the  fame  diforder,  or  at 
lead  near  to  the  trunk.  Now  then,  if  you  attend  to  the  internal  furface  of 
the  aorta  not  being  fmooth,  as  if  fmear’d  over  with  an  oily  kind  of  humour, 
but  being  made  rough  and  unequal,  as  I  have  faid,  and  for  that  reafon  dill 
lefs  flippery  and  foft,  and  confequently  lefs  yielding,  not  only  to  the  circu¬ 
lating,  but  alfo  to  the  didending  blood,  and  the  mufcular  coat,  as  being  dill 
lefs  liable  to  give  way,  on  account,  I  mean,  of  the  fibres  being  more  or  lefs 
convuls’d,  and  frequently  to  fuch  a  degree,  that  even  in  the  body  after  death, 
I  found  the  trunk  of  the  artery  to  be  fomewhat  more  contraded  than  ufual *, 
it  will  appear  very  clear,  how  much  for  all  thefe  reafons,  and  particularly  for 
the  lad  mention’d  reafon,  the  aorta  would  redd  the  blood  ;  fo  that  it  would 
be  necefiary  for  the  heart  to  contend  with  its  utmod  vehemence,  in  order  to 
overcome  thefe  obdacles,  and  to  thrud  out  the  blood  entirely  from  its  cavities, 
which  often,  in  fome  meafure,  dagnated  in  them:  and  from  thefe  confidera- 
tions  we  gather  the  caufe  of  the  palpitation,  and  alfo  the  caufe  of  the  encreas’d 
magnitude  of  the  heart.  But  as  1  have  already  (g)  written  to  you  on  this  lad: 
fubjed,  I  have  no  occafion  now  to  fay  any  thing  more,  either  of  its  caufes  or 
effeds,  or  of  the  obfervations  relative  thereto:  it  is  fufficient  to  point  out 
from  among  them  thole  in  which  a  palpitation  of  the  heart  was  obferv’d,  as 
thofe  which  were  made  by  Valfalva  (£),  by  Meckel  (*},  by  Schreyus  ( k ) :  others 
of  which  kind  I  fhall  alfo  mention  below. 

Thus  you  have  the  explication  of  the  principal  parts  of  the  hidory  propos’d, 
from  whence  you  will  be  quite  at  liberty  to  admit  whatever  may  be  agreeable 
to  your  own  opinion,  and  to  negled  the  remainder,  and  even  to  make  a  little 
more  ufe  of  the  convulfions  of  the  nerves  than  I  have  done.  For  there  are  in 
this  hidory  fuch  circumftances,  as  it  feems  quite  impoflible  to  explain  without 
them ;  as,  for  indance,  that  paroxyfm  in  which  the  mufcles  that  raife  up  the 
lower  jaw  had  fo  drongly  contraded  themfelves,  and  that  obdacle  which  pre¬ 
vented  the  aliments  from  defcending  into  the  domach,  after  they  had  come 
very  near  it;  which  I  luppofe  was  owing  to  the  mufcular  fibres  of  the  dia¬ 
phragm,  through  which  the  lower  part  of  the  oefophagus  paffes,  being  con¬ 
vuls’d.  But  now  fee  whether  the  next  obfervation  does  not  alfo  require  that 
the  nerves,  or  at  lead  in  fome  part,  be  fuppos’d  to  have  given  rife  to  that 
dileafe. 

6.  A  woman,  who  was  fixty-four  years  of  age,  was  troubl’d  with  a  violent 
palpitation  of  the  heart.  At  the  fame  time  a  pulfation  was  feen  in  the  veflels 
on  both  fides  of  the  neck:  and  in  the  wrids  the  pulfe  was  unequal,  and 
fomewhat  obfcure.  Her  refpiration  was  difficult;  and  in  the  lad  days  of  her 
life  extremely  difficult,  fo  that  lhe  could  not  now  draw  her  breath,  unlefs 
with  her  neck  ered.  Lately,  alfo,  an  cedematous  fwelling  of  both  hands  had 
come  on,  but  dill  more  of  the  inferior  limbs,  join’d  with  an  univerfal  tu¬ 
mour  of  the  belly.  The  woman  was  fuppos’d  to  labour  under  a  polypus 
or  aneurifm,  or  fome  other  very  great  diforder  of  that  kind,  when  fhe  died 
;in  this  hofpital,  about  the  middle  of  February,  in  the  year  1741*  But 

(/)  Epift.  18.  n.  4. 

(/£)  Ibid.  n.  15. 

4  S 


(£-)  Epift.  17.-  &  18. 
(h)  Epift.  17.  n.  21. 

'  VOL.  I. 


when. 


6$ 2  Book  II.  Of  Difeafes  of  the  Thorax. 

when,  and  from  whatcaufes,  the  diforder  had  begun,  it  was  not  pofilble  t6 
learn  after  her  death  ;  for  fhe  bad  come  here  a  few  weeks  before  from 
Venice. 

I  examin’d  the  body  the  day  after  her  death,  or  at  lead  not  more  than 
two  days  after.  The  fwelling  of  the  hands  had  gone  down,  but  the  tumour 
of  the  belly  and  the  inferior  limbs  continu’d.  Nothing  was  more  eafy  than 
to  disjoin  the  clavicles  from  the  lternum,  and  to  cut  into  the  cartilages  of 
the  ribs-,  io  that  if  the  woman  had  not  herfelf  confefs’d  that  age  which  I 
have  mention’d  above,  file  might  have  been  fuppos’d  to  be  much  younger. 
When  the  fternum  was  remov’d,  the  lungs  appear’d  turgid,  and  in  like 
manner  whitilh;  except  that  on  the  back  part  they  were,  as  ufual,  of  a  fa- 
turated  red.  They  were  foft,  and  not  annex’d  to  the  parietes  of  the  thorax 
in  any  part.  There  was  in  both  cavities  of  the  thorax  no  very  fmall  quan¬ 
tity  of  water,  and  alfo  in  the  pericardium  ;  but  thefe  fluids  had  not  the  lead 
fmell,  though  they  were  yellow  in  their  colour.  The  ventricles  of  the  heart 
and  the  auricles  were  didended  with  blood,  which,  although  it  had  form’d 
itfelf  into  a  coagula,  had  nothing  at  all  polypous  in  it ;  and  thefe  cavities,  even 
after  they  were  become  quite  empty,  feem’d  to  be  bigger  than  they  naturally 
are  which  1  particularly  obferv’d  in  the  left  auricle.  The  pulmonary  artery 
and  aorta  were  more  capacious  than  was  natural;  and  all  the  valves  enlarg’d. 
But  almod  all  thefe  circumdances  I  have  mention’d,  were  of  a  jud  proportion 
with  each  other-,  and  if  you  compar’d  the  heart  and  its  parts,  and  the  above 
mention’d  arteries,  with  the  other  parts  of  the  body,  you  then  perceiv’d 
that  the  magnitude  of  them  was  encreas’d ;  yet  not  to  a  very  confiderable  de¬ 
gree.  This  being  the  date  of  things,  and  there  being,  as  1  have  faid,  no 
very  great  quantity  of  water  in  the  thorax  or  pericardium,  and  as  the  lungs 
appear’d  to  be  found,  1  began  very  diligently  to  examine,  internally,  not  only 
the  heart  and  thofe  arteries,  but  alfo  other  vefiels,  both  without  and  within 
the  lungs.  But  in  the  heart  I  could  obferve  nothing,  befides  what  I  obferv’d 
before  •,  except  that  in  the  larger  valvula  mitralis,  on  that  furface  which 
look’d  towards  the  other,  there  was  a  fmall  femilunar  orifice,  through  which 
^he  probe  afeended,  betwixt  the  membranes  of  the  valve,  to  the  extent  of 
about  a  line  longitudinally :  and  there  was  alfo  a  thicknefs  and  hardnefs, 
particularly  in  the  borders  of  one,  and  of  the  other  of  the  valves  of  the  great 
artery.  But  this  artery,  being  open’d  longitudinally,  from  the  heart,  quite 
down  to  the  diaphragm,  1  faw  fird,  that  in  this  whole  tradd,  fome  obfeure 
lines  as  it  were  feem’d  to  be  drawn  every  where,  according  to  the  length  of 
the  vefiel  -,  and  particularly  from  the  heart  to  the  curvature,  about  which,  in 
one  place,  a  whitifh  kind  of  fpot  alfo  was  feen:  in  the  next  place,  I  obferv’d 
that  the  internal  coat  being  taken  hold  of  by  the  nails,  wherever  you  would, 
or  even  pufh’d  againd  by  them,  might  be  drawn  very  eadly  afunder,  and 
into  pieces  that  were  not  very  fmall.  Then  having  diile&ed  the  trunk  of 
the  pulmonary  artery,  and  fome  of  its  branches,  I  found  in  feveral  of  them 
blood  that  had  form’d  itfelf  into  a  kind  of  tubuli  in  fome  places.  This  blood 
alfo  had  a  polypous  fubdance  adhering  to  it,  and  was  itfelf  of  a  certain  de¬ 
generated  colour;  whereas  nothing  of  this  fubdance  was  feen  in  the  heart,  as  I 
have  faid,  nor  in  any  other  part;  but  the  blood  was  every  where  extremely 
black. 


6 


As 


Letter  XXIII.  Article  21.  683 

As  in  the  branches  of  the  pulmonary  artery,  when  cut  into  in  like  manner, 
$nd  the  vena  cava  itfelf,  which  had  been  before  open’d,  nothing  appear’d 
worthy  of  remark,  the  bronchia  were  laid  open;  and  in  thefe  tubes  was  a 
frothy  humour,  which  although  it  might  feem  in  fome  places  to  be  puru¬ 
lent,  and  in  others  to  be  bloody,  yet  was  in  fad  not  at  all  purulent.  The 
fedion  then  being  carried  on,  from  the  bronchia  through  the  trunk  of  the 
afpera  arteria,  quite  to  the  larynx,  and  the  cefophagus  being  open’d  in  the 
fame  manner,  and  all  thefe  parts  and  the  pharynx  being  clofely  examin’d,  not 
the  lead  tindure  of  blood  appear’d  any  where ;  fo  that  it  was  uncertain  by 
what  means  blood  had  come  into  the  mouth  of  the  carcafe. 

The  belly,  in  which  I  did  not  doubt  but  there  was  water,  there  was  nei¬ 
ther  time  nor  occafion  for  opening;  for  this  cavity  had  not  been  affeded  with 
a  fwelling  till  the  lad  days  of  her  illnefs ;  nor  were  any  complaints  ever 
heard  from  the  woman  of  the  abdomen  ;  nor  yet  of  the  head.  And  the  brain, 
indeed,  when  I  differed  it  the  day  following,  for  the  fake  of  public  de- 
mondration,  offer’d  nothing  worthy  of  obfervation,  unlefs  that  a  larger  quan¬ 
tity  of  blood  than  ufual  flow’d  out  of  its  veffels. 

7.  If  out  of  the  appearances  I  obferv’d  in  this  body,  you  fet  afide  all  thofe, 
which,  although  they  might  encreafe  the  violence  of  the  difeafe,  yet  did  not 
give  rife  to  the  difeafe  itfelf,  but  rather  were  the  confequences  of  this  difeafe, 
as  effeds  are  the  confequences  of  their  caufes ;  you  mud  then,  of  courfe, 
come  back  to  a  few  things,  which  may  be  confider’d  as  the  proximate  caufe 
of  the  diforder;  unlefs  you  fufped,  indeed,  that  out  of  thefe  very  circum- 
ftances,  fome  are  equally  to  be  look’d  upon  as  effeds,  and  others  as  being, 
perhaps,  of  too  little  importance,  to  be  conflder’d  as  having  it  in  their 
power  to  excite  fuch  a  difeafe.  For  I  fliould  be  inclin’d  to  believe  either  of 
thefe  fufpicions,  in  regard  to  that  blood  which  I  deferib’d  in  fome  of  the 
branches  of  the  pulmonary  artery  :  and  if  you  fhould  chufe  rather  to  fup- 
pofe,  that  it  had  not  dagnated  there  in  the  latter  part  of  life,  but  long 
before,  and  that,  by  this  means,  it  had  laid  that  obdacle  to  the  remaining 
blood,  which  was  about  to  enter  behind,  from  whence  the  dilatation  of  that 
artery,  and  of  the  right  ventricle  of  the  heart,  and  its  neighbouring  auricle, 
is  to  be  accounted  for ;  though  I  could,  indeed,  make  other  objedions,  I 
will,  however,  only  afk  this  one  quedion,  From  what  caufe,  then,  will  you 
deduce  the  dilatation  of  the  aorta,  and  the  left  ventricle,  and  auricle,  and 
the  delay  of  the  blood,  by  which  they  were  thus  diflended  ? 

But  as  to  what  was  obferv’d  in  the  valves,  one  of  the  appearances  does 
not,  perhaps,  relate  to  any  difeafe;  as  that  orifice  in  one  of  the  valvulas  mi¬ 
trales,  which  led  into  a  fmall  interdice  of  the  membranes,  whereof  it  was 
compos’d.  For  I  have,  more  than  once,  feen  this  kind  of  fmall  disjunc¬ 
tions  of  one  membrane  from  the  other,  in  the  valves  of  the  heart,  without 
any  other  mark  of  diforder  being  there,  and  fuppos’d  it  to  have  exided  from 
the  very  birth.  So,  particularly  in  one  of  the  valves  of  the  aorta,  I  ob¬ 
ferv’d  the  membranous  laminas  to  be  fo  disjoin’d,  that  they  admitted  a  probe 
betwixt  them!  But  becaufe,  as  1  (hall  tell  you  hereafter  (/),  the  heart  be¬ 
long’d  to  a  man  who  had  labour’d  under  an  aneurifm  at  the  curvature  of  the 


(/)  Epift  58.  n.  13. 

4  S  2 


aorta, 


68  4  Book  II.  Of  Difeafes  of  the  Thorax. 

aorta,  if  you  Ihould,  perhaps,  choofe  to  confider  both  the  one  and  the 
other  disjunction  as  owing  to  the  violent  impetus  of  the  blood,  in  its  circu¬ 
lation  ;  then  this  will  alfo  be  an  effeCt,  and  not  a  caufe  of  the  difeafe ;  as  in 
like  manner  thofe  appearances  will  be,  which  were  feen  on  the  internal  fur- 
face  of  the  great  artery.  And  as  to  the  thickncfs  and  hardnefs  of  the  edges, 
which  I  remark’d  in  the.  two  valves  of  the  fame  artery,  if  they  are  not  the 
effeCls  of  the  difeafe  alfo,  yet  they  have,  at  leaft,  been  fo  often  found  by  me 
in  thofe  perfons  who  had  fuffer’d  no  diforder,  of  any  confequence,  about 
the  heart,  that  they  by  no  means  feem  admiffible,  as  caufes  of  thofe  fymp- 
toms  with  which  this  woman  was  fo  violently  affeCted,  as  I  have  already  re¬ 
lated  in  her  hiftory.  Some  indication  of  which,  thefe  dilatations  in  the  cavi¬ 
ties  of  the  heart  and  the  annex’d  arteries  afforded  :  dilatations  that  were». 
in  other  refpeCts,  inconfiderable,  and  nearly  correfpondent  with  each  other : 
yet  their  ftate  was  fuch  as  ftill  to  leave  it  undetermin’d  from  whence  they  had 
their  origin.  And  if  this  origin  be  accounted  for  from  convulfions,  it  will  not 
be  contrary  to  all  probability,  and  will  even  be  accommodated  tb  the  better 
underftanding  of  the  diforder.  But  now  let  us  join  to  the  three  women  al¬ 
ready  fpoken  of,  a  fourth,  jn  whom  not  fo  much  a  palpitation  although  this 
was  not  wanting,  as  a  troublefome  fenfe  at  the  heart,  will  require  an  explica¬ 
tion  from  us. 

8.  A  woman,  a  little  younger  than  that  lafl  defcrib’d,  complain’d,  in  the 

fame  hofpital,  of  a  palpitation  of  the  heart  fometimes,  but  always  of  a  dif¬ 
ficulty  in  her  breath,  which  fhe  could  not  draw  but  with  her  neck  ereCt ;  and. 
ftill  more  of  fo  great  a  ftreightnefs  and  anxiety  at  her  heart,  that  very  often 
fhe  feem’d  juft  at  the  point  of  death.  Some  fuppos’d  her  to  labour  under 
a  dropfy  of  the  pericardium.  Her  pulfe  never  was  intermitting  ;  but  her, 
veins  were  large.  She  died  at  the  time  that  the  genital  parts  of  a  woman 
were  wanted  to  finifh  the  public  demonftrations  of  the  year  1731,  a  little 
before  the  middle  of  March.  * 

The  thorax  and  belly  being  open’d,  fome  quantity  of  water  was  found  in 
both  cavities  ;  but  there  was  no  dropfy  of  the  pericardium..  The  valves  of 
the  aorta  were  indurated,  and  one  of  them  even  bony.  The  trunk  of  the 
artery  itfelf  fhew’d,  up  and  down  on  its  internal  furface,  either  fomething 
bony,  or  fomething  verging  to  the  nature  of  a  bone  ;  fo  that  the  part  of  the 
artery  which  went  through  the  belly,  and  which  I  diffeCted  after  demon- 
ftration  of  the  genital  parts,  was  in  the  fame  ftate.  Nor  did  I  find  it  bony 
only  at  the  fide  of  the  inferior  mefenteric  artery,  and  in  other  places,  but 
even  at  the  very  divifion  of  it  into  the  iliacs  :  and  in  feveral  places  it  was 
unequal,  and  here  and  there  of  a  whitilh  colour,  as  it  generally  is  when  it 
begins  to  become  bony. 

9.  It  certainly  cannot  be  denied,  that  the  aorta,  in  the  ftate  1  have  de¬ 
fcrib’d  it,  muft  refill  the  blood,  as  it  is  driven  by  the  heart, 'and,  for  that 
reafon,  be  able  to  create  a  palpitation,  a  difficulty  of  breathing,  and  that 
fenfe  of  ftreightnefs  with  which  the  woman  was  tormented.  But  at  the 
fame  time  it  is  necefiary  to  declare,  why,  out, of  fo  great  a  number  of  per¬ 
fons  in  whom  there  was  an  aorta  of  this  kind,  as  1  have  already  written  to 
you,  and  lhall  write  hereafter,  many  of  them,  certainly,  did  not  labour  under 
thefe  diforders  at  all,  or,  at  leaft,  not  fo  vehemently.  And  in  order  to  do 

..this. 


Letter  XXIII.  Article  9.  6S5 

this,  other  circumdances,  without  doubt,  muft  be  added  to  the  diforder  of  the 
aorta,  which  did  exift  in  this  woman,  and  did  not  exid  in  the  others  •,  as,  for 
indance,  a  different  fault  in  the  organs,  or  a  different  conftitution  of  the  blood, 
different  quantity,  and  other  things  of  a  fimilar  kind  beffdes,  that  we  may  not 
feem  to  be  always  bringing  in  the  more  exquifite  fenfe  of  the  nerves,  and 
convulfions.  So  in  an  obfervation  of  Verdrieffus,  already  pointed  out  (*»), 
after  a  violent  palpitation  of  the  heart,  and  a  very  great  afthma,  the  aorta 
was  found  to  be  internally  bony  near  the  heart;  but  the  heart  itfelf  was  found 
to  be  of  a  dupendous  magnitude,  hard,  and  tumid.  So  in  another  perfon, 
who  having  been  long  affli&ed  with  various  diforders,  had  been,  in  the  be¬ 
ginning  of  them,  very  much  fubjedt  to  a  palpitation  of  the  heart,  the  cele¬ 
brated  Plancus  {a)  not  only  found  the  aorta  in  many  places  become  bony, 
but  alfo  both  the  coronaries  of  the  heart,  and  the  heart  itfelf  very  large, 
particularly  its  right  auricle,  which  was  the  larged  and  dronsed  of  all  :  and 
from  hence  you  may  eafily  perceive,  that,  in  confequence  of  tins  one  diforder, 
the  heart  might  be  more  vehemently  irritated  by  the  blood  being  moreftrongly 
impell’d  into  the  fubjedled  ventricle  ;  and  may  the  lefs  wonder,  if  in  the  ob- 
iervation  of  Graflius  the  younger,  fpoken  of  already  in  this  work  (<?),  it  (hall 
perhaps  appear,  that  nothing  elfe  could  be  the  caufe  of  the  palpitation,  but 
the  right  auricle  being  enlarg’d  to  the  double  of  its  ufual  capacity.  Finally,, 
not  to  detain  you  too  long,  in  a  woman  of  an  illudrious  family,  whofe  pal¬ 
pitation  of  the  heart  was  fo  great,  and  fo  conftant,  as  to  be  heard  by  thofe 
who  ftood  near  her,  and  be  difcern’d  by  thofe  who  were  at  fome  diffance,  the 
celebrated  Cohaufen  ( p )  not  only  faw  the  aorta  entirely  callous  ;  but  he  even 
faw  in  the  heart  itfelf,  not  to  mention  the  lungs,  fcirrhi,  and  the  blood  vifcid 
and  mucous. 

Wherefore,  in  the  woman,  alfo,  fpoken  of  by  me,  beffdes  the  aorta  being 
here  and  there  bony,  or  inclining  to  a  bony  date,  the  valves  of  it  are  alfo  to 
be  attended  to.  For  as  one  of  thefe  was  bony,  and  the  others  indurated,  fo 
being,  of  confequence,  lefs  yielding  to  the  blood,  they  might  encreafe  the 
obftacles  to  its  exit,  and,  on  the  other  hand,  not  diffidently  prevent  its  re¬ 
turn,  when,  foon  after,  repuls’d  by  the  contradion  of  the  great  artery;  fo 
that,  as  fome  portion  of  it  return’d  into  the  left  ventricle  of  the  heart,  when 
this  ventricle  ought  to  receive  the  blood  that  was  coming  in  from  the  lungs, 
it  would  necedarily  happen,  that  the  returning  portion,  as  well  as  the  portioa 
which  had  not  been  extruded  jud  before,  mud  occupy  fome  part  of  that 
fpace,  which,  from  the  defign  of  nature,  was  entirely  due  to  the  blood  that 
was  coming  in  from  the  lungs.  Which  circumdance,  finally,  could  not  but 
overload  both  the  lungs  and  the  heart,  and  compel  the  latter  to  throw  out, 
every  now  and  then,  with  a  great  impetus,  the  blood  that  dagnated  in  it. 

And  thefe  things,  which  reafon  feems  to  lead  us  to,  are  confirm’d  by  more 
than  one  obfervation  of  the  anatomids.  Thus  VieufTens  (<7),  in  a  man  and 
a  matron,  both  of  whom  had  been  long  troubl’d  with  a  palpitation  of  the 
heart,  and  incapacity  of  lying  down  with  the  head  low,  join’d  with  an  ine- 

(m)  Epift.  18.  n.4.  (p)  Commere.  Litter.  A.  1743.  Hebd.  21 . 

(»)  Epift.  de  Monftr.  n.  4. 

(0)  Epift.  18.  n.  4.  (f)  Traite  du  Coeur,  ch.  16. 

quality 


6  86  Book  II.  Of  Difeafes  of  the  Thorax. 

quality  of  the  pulie,  relates,  that  the  aorta  and  its  valves  were  found  to 
be  bony  in  the  matron  ;  and,  in  the  man,  that  the  aorta  was  very  hard,  and 
in  a  manner  cartilaginous  •,  and  the  valves  not  only  bony,  but  alfo  with  their 
edges  cloven  afunder,  and  the  fame  really  become  ftony  ;  I  fay  really,  left 
you  fhould,  perhaps,  imagine,  that  what  was  bony  Ihould  have  been  taken 
for  being  ftony  in  the  heart,  as  it  has  happen’d  fometimes  in  other  places. 
For  befides  thofe  which  will  be  mention’d  below,  you  will  read  of  fimilar 
cafes,  here,  in  the  Sepulchretum,  in  obfervations  which  are  pretty  ancient ;  as 
that  of  Gregorius  Horftius  the  elder  (r),  who  found  “  a  calculus  concreted 
“  from  tartar  adhering  to  the  membranous  fubftance  of  the  valves  55  of  the 
right  ventricle  of  the  heart;  and  that  of  Jo.  Georgius  Greifelius (j),  who 
faw  one  of  thofe  valves  of  the  aorta  which  we  are  fpeaking  of  lt  half-con- 
“  fum’d,  and  loft,  and  that  part  where  it  adher’d  to  the  artery  even  friable 
“  into  a  kind  of  fand  and  there  was  “  a  kind  of  white  particle,  like  the 
“  nail  of  a  little  finger,”  which  was  the  part  of  the  valve  that  the  blood 
had  lately  torn  away ;  the  heart  being  in  both  of  them,  who  died  after  a  pal¬ 
pitation,  very  much  enlarg’d,  in  the  fame  manner  as  the  left  ventricle  had 
been  in  that  man  of  Vieuffens. 

You  will  not  wonder,  therefore,  at  the  affertion  of  Vieuffens,  that  the 
borders  of  the  femilunar  valves  had  been  found  by  him  to  be  in  a  ftony 
ftate.  You  will  rather  wonder,  that  he,  once  and  again,  denied  his  having 
ever  heard,  or  read,  that  there  had  been  found  any  variation  from  the  na¬ 
tural  ftruCture  of  thefe  valves  by  anatomifts,  when  even  that  obfervation  of 
Greifelius,  which  is  publifh’d  by  Bonetus,  being  taken  no  notice  of,  there 
v/ere  not  wanting  other  obfervations  of  the  valves  of  the  aorta  being  bony, 
in  books  that  are  commonly  known  ;  as  that  which  Raygerus  has  given  in 
the  Mifcellanea  Nature  Curio  forum  (t) ;  and  that  which  Ruylch  has  fet  forth 
in  his  Obfervaticnes  Anatomico-Chirurgicte  (u)i  although  with  the  addition  of 
a  figure  (x)  by  no  means  worthy  of  him.  After  thefe  follow’d  fix  obferva¬ 
tions  of  Cowper,  and  other  Englishmen,  which,  to  pafs  over  others,  delcribe 
thefe  very  valves  (jy)  as  being  bony,  either  in  the  part  where  they  form’d  an 
excrefcence,  or  altogether  fo,  o  ras  being  become  ftony,  or  gypfeous ;  or,  in 
fine,  fo  denfe,  contracted,  and  white,  that  it  feem’d  as  if  they  muft  have  loon 
grown  into  a  bony,  or  a  ftony  nature.  To  which  obfervations  you  may  at 
leaft  add  three  or  four  others  of  very  emineut  men,  Theodorus  Zwinger  (z), 
jofephus  Exup.  Bertinus  (<-*),  and  Albertus  Haller  (£)  ;  who  found  the  fame 
valves,  the  firft,  in  an  old  man,  to  be  very  hard  and  cartilaginous  in  the 
part  by  which  they  coher’d  to  the  aorta  ;  the  fecond,  in  two  virgins,  to  be 
hard  and  bony,  and  fo  difpos’d,  that  a  common  goofe- quill  would  hardly 
pafs  between  them  ;  and  the  third,  in  a  young  man,  found  a  fabulous  matter 
betwixt  their  membranes,  and  bony  fcales  in  their  tendons,  fo  as  to  render 
them  rigid,  and  not  capable  of  giving  way  to  the  force  of  dilatation. 

(r)  Obf.  33.  (s)  Obf.  13.  (2)  Aft.  N.  C.  Tom.  1.  Obf.  78. 

{/)  Dec.  1.  A.  3.  Obf.  282.  ( a )  Quseft.  Med.  an  caufa  mot.  altern.  cord. 

(u)  Obf.  69.  (*)  Fig.  57.  multipl.  n.  3. 

(y)  Saggio  delle  Tranfaz.  tradotte  dal  Dcr-  (<£)  Opufc,  Patholog.  Obf,  52. 

bam,  Tom.  2.  F.  2,  c.  3.  %  7,  8,  9,  1 3,  &  Fig. 

Tab.  5. 


10.  But 


Letter  XXIII.  Article  ro.  68  7 

10.  But  do  not  imagine,  that  in  all  thefe  obfervations  the  palpitation  of 
the  heart  is  mention’d ;  for  out  of  the  four  laft,  you  will  read  of  it  only  in 
the  laft  of  all,  and  will  be  in  doubt  to  which  diforder,  in  particular,  among 
fo  many  very  confiderable  diforders,  that  will  be  mention’d  below  (c),  this 
fymptom  was  to  be  afcrib’d  :  as  you  would  alfo  doubt,  in  regard  to  the  firft, 
whether  a  palpitation  had  preceded ;  for  the  pulmonary  artery  was  fomewhat 
cartilaginous,  and  the  heart  bigger  than  it  naturally  is,  as  I  have  hinted  al¬ 
ready  (d)  ;  but  a  long-continu’d  afthma  had  preceded,  and  a  dropfy  of  the 
thorax :  as  in  the  two  of  Bertinus,  anxieties,  faintings,  and  inequalities  of 
the  pulfe  of  all  kinds  had  preceded.  In  like  manner  the  laft  of  thofe  fix 
hiftories  of  the  Englifh  (e)  mentions  palpitation,  but  in  fuch  a  manner  only 
as  to  account  for  it  from  the  univerlal  and  clofe  adhefion  of  the  pericardium 
to  the  heart;  which  is  a  circumftance  that  we  fhall  confider  hereafter  (/) ; 
at  leaft  this  adhefion  and  other  preternatural  appearances  were  not  wanting, 
as,  in  particular,  a  great  dilatation  of  the  left  cavities  of  the  heart.  But  the 
fourth  and  the  fifth  mention  nothing  befides  a  dropfy,  and  an  afthma :  the 
others  fpeak  of  intermitting  pulfes ;  and  the  fecond  of  a  very  fhort  refpira- 
tion,  befides  an  uneafinefs  in  lying  down,  a  kind  of  troublefome  fenfation  at 
the  heart,  and  fwoonings ;  fo  that  it  is  natural  to  fuppofe  a  palpitation,  if 
there  had  been  any,  would  not  have  been  omitted.  Nor  has  Ruyfch  (jf) 
mention’d  any  thing  of  this,  though  he  did  not  only  not  omit  the  aiphuxia, 
and  lypothymke,  which  attended  the  latter  days  of  the  diforder,  but  even 
not  the  afthma,  which  had  been  of  a  long  continuance  before:  whether  de- 
fignedly,  or  from  forgetfulnefs,  he  will  perhaps  determine,  who  gives  more 
credit  to  Blancardus  than  to  him ;  for  this  is  that  difiedlion,  at  which  he  has, 
with  his  ufual  difingenuoufnefs,  fignified,  that  Ruyfch  was  only  prefent  as  a 
fpedtator,  as  has  been  already  faid  in  the  beginning  (h). 

But  if  we  believe  Blancard,  that  a  palpitation  was,  fometimes,  not  want¬ 
ing,  we  muft  of  courfe  alfo  believe,  that  the  heart  was  twice  as  big  as  is 
ufual :  the  dilatation  of  the  left  ventricle  of  which,  together  with  other  things 
that  were  preternatural,  is  propos’d  in  the  greater  part  of  thofe  obfervations- 
of  the  Englilh,  which  I  juft  now  commended.  That  obfervation  indeed, 
which  Raygerus  had  before  publifh’d  (/),  feems  to  lie  open  to  exceptions  of 
this  kind  the  leaft  of  all,  as  he  fays,  tc  that  in  the  whole  body  nothing 
“  morbid  or  preternatural  was  found,  except  that  the  three  femilunar  valves, 
“  fituated  at  the  entrance  of  the  great  artery,  from  the  right  ventricle  of  the 
“  heart,  were  bony.”  Yet  if  you  accurately  confider  all  the  things  which: 
are  hinted  in  regard  to  that  man,  you  will  perhaps  think  that  he  had  been 
fubjedt  to  no  complaint,  till  he  was  taken  oft'  by  a  fudden  death,  whatever 
the  caufe  of  this  might  be. 

But  as  thofe  exceptions,  which  are  drawn  from  other  injuries  of  parts,  be¬ 
ing  join’d  together,  may  have  more  room  in  the  place  where  the  enquiry 
is  made,  what  was  the  caufe  of  the  palpitation,  than  where  it  is  enquir’d, 
why  it  did  not  exift ;  and  as  I  preferve  the  exceptions  which  I  have  pointed 


out 


(r)  I).  12. 

(</)  Epift.  18.  n.  4. 
\e)  C.  3.  cit.  §  13. 


(f)  n.  17.  &  feqq. 

(g)  cit.  fupra,  ad  n.  9. 

\h)  p.  i,  (/)  fupra  n.  9. 


688  Book  XL  Of  Difeafes  of  the  Thorax. 

out  now  and  then,  for  that  place,  where  I  fhall  treat  of  the  dilorders  of  the 
pulfe,  which  were  prefent  at  the  fame  time  (k) ;  I  fhall  here  make  ufe  of 
thofe  obfervations,  in  which,  though  the  valves  of  the  aorta  were  rigid  and 
inflexible,  yet  no  palpitation  is  taken  notice  of:  which  it  does  not  feem  pro¬ 
bable  could  have  happen’d  from  careleffnefs  or  forgetfulnefs,  efpecially  as 
this  has  certainly  not  happen’d  to  me;  as  by  reading  over  again  fome  of 
thofe  hiftories  that  I  have  fent  you  before,  you  will  eafily  perceive.  For 
you  will  fee,  that  in  the  fhoemaker  (/),  thofe  valves  were  fomewhat  rigid, 
hardifh,  and  contracted  into  themfelves;  yet  amongft  all  the  other  dilorders 
of  which  he  complain’d,  I  never  heard  any  thing  of  a  palpitation  at  the  heart. 
And,  to  omit  a  certain  old  woman  (^),  who,  although  fhe  had  the  aorta, 
and  one  of  its  valves,  fo  conftituted,  nearly,  as  that  woman  («)  had,  who 
gave  occafion  to  my  entering  upon  this  difquifition,  yet  was  by  no  means 
troubl’d  with  the  fame  diforders  ;  I  have  defcrib’d  to  you  two  old  men  (o'), 
in  enquiring  into  whofe  complaints  very  accurately,  I  heard. nothing  at  all  of 
palpitations  of  the  heart ;  but  the  pulfe,  I  was  certainly  inform’d,  as  in  the 
fhoemaker  likewife,  (for  in  regard  to  the  old  woman,  I  do  not  clearly  re¬ 
member)  did  not  intermit ;  I  mean  at  the  times  when  they  ought  to  be  par¬ 
ticularly  attended  to,  that  is,  when  there  were  no  faintings,  nor  any  confi- 
derable  fever:  and,  notwithstanding  all  this,  the  great  artery  in  both  of  the 
old  men  was  internally  belet  with  bony  lamina,  and,  in  one  of  them,  had 
the  valves  here  and  there  hard ;  in  the  other,  already  perfectly  bony,  and 
inflexible  ;  and  the  fame  protuberating  inwards,  in  their  body,  which  was 
diftant  from  the  parietes  of  the  orifice ;  the  corpufcles  alfo,  which  are  in  the 
middle  of  their  borders,  being  bony,  and  encreas’d  in  their  bulk  :  the  val¬ 
vulae  mitrales  were  fomewhat  thicken’d  likewife  in  the  latter ;  but  in  the 
former,  they  were  here  and  there  hard,  in  the  fame  manner  as  the  femilunar 
valves.  But  I  have  other  obfervations  alfo,  befides  thofe,  which  are  not  of  a 
diflimilar  nature,  as  thefe  that  immediately  follow. 

in.  A  decrepid  old  woman,  having  gangrenes,  that  remain’d  after  an  acute 
difeafe,  was  at  length  brought  down  to  the  mod  emaciated  (late  of  body, 
and  to  death.  From  the  very  time  fhe  had  efcap’d  that  firft  difeafe,  her 
pulfe  had  been  fmall  and  weak,  yet  not  quick  on  the  firft  days ;  though  af¬ 
terwards,  when  fhe  was  thirfty,  they  became  quick,  but  never  intermittent 
nor  unequal.  She  had  no  palpitation  of  the  heart,  no  difficulty  of  breath¬ 
ing;  for  all  thefe  circumftances  I  particularly  enquir’d  into,  from  the  phy- 
fician  who  had  vifited  her  every  day :  and  I  enquir’d,  after  having  examin’d 
the  heart  of  this  old  woman,  in  the  college,  about  the  end  of  January,  in 
the  year  1739.  After  having  anlwer’d  what  I  have  juft  related  to  you,  he 
added,  that  fhe  had  complain’d  only  of  her  ftomach ;  by  which  term  we 
fuppos’d  her  to  have  meant  the  prmcordia,  as  moft  of  the  common  people 
do  ;  efpecially  as  the  had  an  appetite  for  food,  and  took  down  what  was  of¬ 
fer’d  her;  nor  did  the  difleClion  give  us  reafon  to  fuppofe  otherwife. 

For  when  the  belly  was  open’d,  every  thing  was  iound  except  the  uterus ; 
as  the  ftomach  was  alfo,  though  contracted  into  itfelf.  But  the  uterus  had 

(&)  Epift.  24.0.  21.  («)  fupra  n.  8. 

(/)  Epill.  18.  n.  2.  (0)  JEpift.  7.  n.  9.  &Epifl:,  21.  n.  jjj. 

(m)  Epift.  19.  n.  49. 

its 


7 


Letter  XXIII.  Article  12.  689 

its  fundus  almoft  univerfally  black,  on  its  internal  furface;  or  at  leaf!  of  a 
brownifh  colour,  as  parts  affedted  with  a  gangrene  generally  are  ;  and  the 
fame  was  unequal,  particularly  in  one  place,  where  the  furface  rais’d  it- 
felf  up  into  a  fmall  and  low  excrefcence.  The  tubes  of  it  were  altogether 
impervious  to  about  the  middle  of  their  length. 

In  the  thorax,  befides  white  fpots  of  the  accta  internally,  and  fome  long 
fcales,  this  was  particularly  to  be  remark’d,  that  I  found  the  valves,  of  the 
fame  artery  contracted,  hard,  and  bony,  and  at  the  edge  thereof  thickening, 
as  it  were,  into  pretty  large  tubercles. 

12.  It  appears  therefore,  from  the  obfervations  of  others,  and  from  my 
own,  that  a  palpitation  of  the  heart,  contrary  to  what  generally  happens, 
does  not  always  follow  where  the  valves  of  the  great  artery  are  rigid  and 
bony:  and  the  fame  thing  appears  in  regard  to  the  intermiftion  and  in¬ 
equality  of  the  pulfe.  The  diforders  of  which,  although  they  belong  to  the 
next  letter,  I  here  neverthelefs  touch  upon  now  and  then,  with  one  and  the 
fame  trouble,  as  they  were,  or  were  not,  join’d  with  the  diforders  of  thofe 
valves,  that  there  may  not  be  occafion  to  repeat  the  fame  obfervations  in  that 
letter,  but  it  may  be  fufficient  to  point  them  out.  And  this  method  it  is  my 
intention  to  purfue,  in  the  examination  of  the  greater  part  of  thole  caufes  of 
palpitation  which  I  fee  advanc’d. 

And  amongft  thefe,  that  fir  ft  offers  itfelf  to  our  confideration,  which  con- 
fifts  in  fome  diforder  of  the  neighbouring  mitral  valves.  Thus  Vieuffens  (p) 
afcribes  a  moft  vehement  palpitation  of  the  heart,  attended  with  a  very  low, 
weak,  and  altogether  unequal  pulfe,  to  the  contraction  that  he  found  of  thefe 
valves,  and  their  change  into  bone ;  which,  in  confequence  of  the  orifice 
whereat  they  are  plac’d,  being  thus  diminilh’d,  not  admitting  any  great 
quantity  of  blood,  and  (as  you  yourfelf  will  add)  not  being  able,  altogether, 
to  prevent  the  return  of  that  which  they  had  admitted,  compell’d  the  greateft 
part  of  the  blood  to  remain  behind  in  the  veffels  of  the  lungs,  and  in  the 
right  cavities  of  the  heart,  which  it  had  dilated.  So  the  celebrated  Reiman- 
nus  (q),  having  obferv’d  the  fame  fymptoms  which  I  juft  now  fpoke  of  in  a 
patient,  found  “  the  valves  of  the  vena  cava  called  mitrales,”  which  name, 
befides  other  things,  fhews  that  he  meant  to  fay  “  the  pulmonary  vein” 
inftead  of  the  vena  cava,  “  and  one,  in  particular,  of  them,  with  its  fafci- 
“  culi  and  carneae  columnae,  which  are  prominent  at  the  fides  of  the  ven- 
“  tricle,  rough,  and  entirely  oflified.”  So  the  very  experienc’d  Morand  (r), 
in  a  man  who  had  been  fubjecl  to  palpitations  of  the  heart,  found  one  of  thefe 
valves  dilated  into  a  facculus  big  enough  to  admit  a  man’s  thumb  ;  I  fup- 
pofe,  becaufe  the  quantity,  or  the  impetus  of  the  blood  had,  by  degrees, 
enlarg’d  the  interftice  of  the  fame  kind  with  that  which,  as  I  faid  above  (. s ), 
I  obferv’d  to  be  form’d  by  an  orifice  opening  betwixt  the  membranes  of  the 
valves-,  the  parietes  of  which  facculus  were  not  only  much  thicken’d,  but 
befet  here  and  there  with  little  bones.  Yet  the  valves  of  the  aorta  were  alfo 
thicken’d,  and  furnifh’d  with  fmall  bones  of  a  confiderable  hardnefs:  and 
Reimannus,  befides  the  columnas  tarneae  being  offified,  as  is  already  faid, 

(p)  Traite  du  Coeur,  ch.  16.  (r)  Hilt,  de  1’Acad.  des  Sc.  A.  1729.  Obf. 

{q)  Adt.  N.  C.  Tom.  1.  Obf.  170.  Anat.  7.  (/)  n.  6. 

Voi.  L  4  T 


had 


())  o  Book  II.  Of  Difeafes  of  the  Thorax. 

had  feen  that  artery  much  contracted  by  ftony  concretions  adhering  to  it  inter” 
nally,  and  a  dropi'y  of  the  pericardium  at  the  fame  time  :  and  Vieufiens  had 
found  both  the  thorax  and  the  lungs  full  of  ferum,  and  all  the  great  veffels, 
except  the  aorta,  dilated.  So,  alfo,  the  molt  excellent  Haller  (/),  after  an  heredi¬ 
tary  palpitation  of  the  heart,  found  the  valvulas  mitrales  to  be  univerfally  very 
hard  and  folid,  and  fo  full  of  calculous  matter,  that  it  grated  againft  the  knife, 
as  the  fibres  were  cut  into  in  different  places  :  he  alfo  found  the  flefh  of  the 
neighbouring  pulmonary  Onus  to  be  ftony,  and  a  part  of  the  heart  itfelf  to  be 
half  ftony,  and  the  pericardium  to  be  here  and  there  befet  with  fcirrhi,  and 
grown  to  the  heart;  to  pafs  over  other  circumftances  in  the  fame  body,  and 
amongft  thefe,  what  I  before  related  of  the  valves  of  the  aorta  being  rigid, 
and  undilatable;  and  ftill  more  what  he  faw  in  a  certain  old  woman  («),  not 
only  in  one  of  the  fame  valves,  but  alfo  in  the  neighbouring  aorta  and  the 
pulmonary  artery,  and  even  in  the  heart  itfelf,  and  the  coronary  arteries 
thereof ;  inafmuch  as  thefe  difeafes  were  more  confiderable  than  that  which 
was  in  one  of  the  mitral  valves,  but  efpecially  becaufe  there  is  no  certainty 
with  what  diforders  the  woman  had  been  afflicted. 

13.  But  we  muff:  alfo  add,  in  this  place,  the  obfervations  of  thofe  who, 
when  they  found  the  valvulas  mitrales  bony  or  rigid,  and  unequal  to  their 
offices,  amongft  other  fymptoms  which  had  afflicted  the  patients  when  living, 
faid  not  a  word  of  palpitation  of  the  heart.  For  Rayerus,  although  he- 
fpeaks  in  more  than  one  work  {x)  of  that  virgin,  who  was  differed  by  Gla- 
ferus  his  praeceptor,  in  whom  he  faw  them  chang’d  “  entirely  into  a  bony 
“  fubftance,  and  (hutting  up  the  orifice,”  makes  no  mention  of  any  other 
diforder,  in  any  place,  than  a  fudden  dropfy  in  a  perfon  who  was  in  good 
health,  a  difficulty  of  breathing,  and  an  unexpected  fuffocation  :  and  indeed 
Mangoltius  (jy),  who  wrote  to  Bonetus  of  the  fame  virgin,  fays  ftill  lefs  of 
her  diforders.  Nor  does  Bellini  (z)  fay,  that  a  {tone  generated  in  one  of  the 
valvulre  mitrales  had  produc’d  any  other  difeafe  but  “  a  very  various  inter- 
“  million  of  the  pulfe,  the  patient  being  afflicted  at  the  fame  time  with  very 
furprizing  pains.”  Nor  have  you  feen  that  Cowper,  from  whom  are  four 
of  the  fix  Kngliffi  obfervations  fpoken  of  above  (a)-,  although  he  relates,  or 
reprefents  by  figures,  that  the  fame  valves  were  alio  in  part  ftony ;  nor  have 
you  feen,  I  fay,  that  he  mentions  any  thing  of  palpitation.  But  if  you 
fhould  contend  that  this  might  be  omitted  by  mere  accident,  or  in  confe- 
quence  of  thefe  writers,  who  were  in  other  refpeCts  very  diligent,  being  em¬ 
ploy’d  upon  fome  other  purfuit  or  enquiry,  I  will  not  obltinately  conteft 
the  point  with  you.  Nor  will  I  judge  otherwife,  if  you  would  have  it  fo, 
of  Hunauld  (£),  who  mentions  nothing  but  a  confumption  in  the  cafe  of  that 
woman,  whole  mitral  valves  he  found  beginning  here  and  there  to  be  offi- 
fied,  and  fo  glued  together,  one  with  another,  that,  the  paffage  of  the  blood, 
into  the  ventricle  being  ftreighten’d,  the  left  auricle  was  confequently  en¬ 
larg’d.  Yet  I  will  beg  of  you  to  read  the  obfervation  of  the  celebrated  Fan- 

(/)  Obf.  cit.  fupra,  n.  9.  &  10.  (2)  De  Morb.  Ped.  1. 

(u)  Obf.  51.  (a)  n.  9.  &  10. 

(x)  Meth.  Hid.  Anar.,  c.  6.  in  Scbol.  Sc  ( b )  Hilt,  de  1’Acad.  R.  des  Sc.  A.  1735. 

Paeon.  8c  Pythag.  Exerc.  24.  Obf.  Anat.  6. 

(y)  Sepulchr.  1.  3.  S.  19.  Obf.  3.  §  6. 


tonus 


Letter  XXIII.  Article  J  4.  691 

tonus  (c),  who  found  the  valvulas  mitrales  “  of  an  unufual  hardnefs  and  thick- 
“  nefs ;  and  in  one  of  them  faw  two  follicles,  and  in  the  other  one,  each  be- 
“  ing  nearly  about  the  bignels  of  a  vetch,  from  which,  when  open’d,  a  yei- 
lowiffi,  and  almoft  greenilh,  matter  flow’d  outf’  and  thefe  things  he  tefti- 
fies  that  he  faw  in  a  certain  old  man,  in  whom,  “  although  he  himfelf  faid 
“  that  he  had  long  been  troubl’d  with  a  flow  fever,  and  a  weaknefs  of  the 
<c  ftomach,  no  figns  of  the  heart  being  affefted  ever  had  appear’d.”  And 
if  you  read  over  again  the  letters  I  have  fent  to  you,  you  will  find  a  huf- 
bandman  (*),  in  whom  I  faw  “  an  excrefcence,”  of  a  cineritious  colour,  grow¬ 
ing  upon  the  fame  valves,  which  was,  as  Lancifi  (d)  obferves,  a  very  rare 
difeafe  indeed,  even  in  the  other  valves  of  the  heart :  and  yet  amongfl  other 
things  with  which  the  patient  was  affedted,  was  there  not  any  palpitation 
of  the  heart,  or  inequality  of  the  pulfe ;  although  the  latter,  perhaps,  would 
not  have  been  wanting,  if  the  pulfe  had  been  lefs  vehement  and  quick. 

You  will  alfo  find  the  hiftory  of  an  engraver  (e),  and  a  porter  (/),  who, 
till  they  were  feiz’d  with  a  fudden  apoplexy,  and  both  inftantly  carried  ofiy 
had  not  been  fubjedt  even  to  the  flighted:  difeafe  •,  in  the  former  of  whom 
one  of  the  mitral  valves  was  chang’d  in  its  colour,  and  in  its  nature,  and 
became  much  harder  than  it  ought  naturally  to  be  and  in  the  latter,  fome, 
both  of  the  mitrales  and  tricufpides,  protuberated  at  their  edges  into  a  kind 
of  glands,  made  up  of  a  denfe  and  firm  fubftance.  But,  to  be  brief,  I 
will  not  mention  over  again,  here,  thofe  two  old  men,  of  whom  I  fpoke 
above  (£),  when  the  queflion  was  of  the  femilunar  valves,  in  one  of  whom 
the  mitrales  alfo  were  thicken’d,  and  in  the  other,  in  leveral  places,  hard : 
and  I  fhall  omit  many  others,  in  whom  I  found  their  edges  to  be  hard  and 
tuberous,  which  circumftance  renders  them  fomewhat  lefs  fit  for  their  office, 
whether  it  be  from  any  peculiar  difeafe,  or  only  the  mere  confequence  of 
old  age  ;  for  I  have  even  feen  the  fame  circumfiance  in  an  old  dog ;  and  it 
is  both  in  thefe  valves  and  the  tricufpides,  in  which  I  have  in  like  manner 
frequently  feen  it,  a  kind  of  ftep,  as  the  celebrated  Haller  alfo  imagines  (i?), 
to  the  taking  on  a  bony  nature.  But  thofe  which  I  have  found  already  be¬ 
come  bony,  I  muft  defer  the  confideration  of  to  another  time,  on  account  of 
the  very  violent  diforders  with  which  they  were  join’d. 

14.  But  in  the  mean  while,  as  you  fee,  that  though  a  diforder  of  the  mitral 
valves  is  fuppos’d,  and  that  not  a  flight  one  neither,  fometimes  a  palpitation 
of  the  heart,  or  an  intermiffion  of  the  pulfe,  does  not  immediately  follow  •,  fo, 
alfo,  I  would  have  you  believe,  that  whatever  other  obftacle,  that  is  even  fearer 
to  the  right  cavities  of  the  heart  than  thefe  valves  are,  may  have  dilated  them, 
by  confining  the  blood  therein,  a  palpitation  may  not  immediately  be  the  con¬ 
fequence  ;  for  in  the  eighteenth  letter  (/)  it  is  hinted,  that  an  inequality  of 
the  pulfe  is  but  little  likely  to  happen  in  that  cafe.  But  I  remember,  you 
will  fay,  that  in  this  very  place  it  is  acknowledg’d  and  confirm’d  by  you,  that 
a  palpitation  generally  troubles  patients  at  fuch  a  time.  And  you  remember 

(r)  De  Obf.  Med.  Epift.  8.  n.  20.  (<?)  Epift.  3  .  n.  26.  (f)  Ibid.  n.  4. 

(*)  Epift.  11.  n.  11.  ( g )  N.  10.  in  fin. 

(d)  De  Subit.  Mort.  1.  2.  §  7.  &  8.  Schol.  ( h )  Ad  Boerh,  Prselett.  §  149. 

.ad  Obf.  Phyf.  Med.  4.  (?)  N.  11. 

4  T  2 


rightly  5 


6  p  2  Book  II.  Of  Difeafes  of  the  Thorax. 

rightly  ;  for  I  did  indeed  acknowledge,  that  there  was  “  often”  a-1  palpi tatio& 
at  fuch  a  time.  But  do  I  deny  it  now  ?  So  far  from  this,  that  I  fhall  even  corr- 
firm  it,  by  adding  other  obfervations  over  and  above.  Let  it  be  fufficient,  at 
prefent,  to  have  pointed  out  that  of  the  celebrated  Chomel(£),  who  remark’d, 
that  a  man,  whole  pulmonary  artery  was  internally  and  externally  befet  with 
ftony  tubercles,  and  whofe  heart  was  very  much  enlarg’d,  had  been  troubl’d 
with  frequent  palpitations.  For  I  certainly  would  not  deny,  that  any  one  of 
the  caufes  of  palpitation  which  have  been  propos’d,  has  been  fometimes  join’d 
with  it ;  but  I  will  confefs,  that  fome  have  more  frequently  been  join’d  to  it 
than  others.  I  only  admonifh  you  of  this  one  thing,  that  where  any  caufe  of 
that  kind  is  fuppos’d,  we  mull  not  immediately  recur  to  this  fecond  fuppo- 
fition,  that  a  palpitation  of  the  heart  was  necefiarily,  and  invariably,  attendant 
upon  it.  For  1  would  have  you,  by  way  of  example,  turn  to  the  difledlion 
of  that  virgin  (/),  in  whom  Valfalva  found  the  valves  that  are  plac’d  at  the 
entrance  of  the  pulmonary  artery,  tied  together  one  with  another,  fo  as 
fcarcely  to  leave  a  paffage  for  the  blood  equal  to  the  diameter  of  a  lentil, 
which,  for  this  reafon,  llagnating  in  the  right  cavities  of  the  heart,  had  di¬ 
lated  them.  Yet  you  will  not  find  any  thing  remark’d  of  a  palpitation,  among 
the  other  fymptoms  which  had  afflidted  the  patient  when  living.  But  if  you 
chance  to  light  on  any  hiftories,  from  which  the  courfe  of  the  blood  being 
retarded  through  the  luugs,  that  were  internally  and  externally  comprefs’d* 
may  feem  to  have  given  rife  to  palpitations  of  the  heart ;  fuch  as,  amongll 
other  obfervations,  is  that  of  the  celebrated  Grimmius  ( m ),  in  which  he 
fpeaks  of  a  man  who  had  been  troubl’d,  perpetually,  for  more  than  a  year* 
with  this  complaint,  and  whofe  lungs,  on  one  fide,,  were  furrounded  with: 
extravafated  water,  and  both  of  the  lobes  internally  befet  with  almoft  innu~ 
merable  vomicse  ;  I  would  give  you  free  leave  to  fuppofe,  that  the  palpitation: 
had  had  its  origin  from  hence  :  yet,  at  the  fame  time,  I  would  have  you  re¬ 
member,  that  this  fymptom  was  feldom  or  never  obferv’d  among  that  great 
number  of  perfons  whom  I  have  fpoken  of  in  the  former  letters,  as  dying  o£ 
a  dropfv  of  the  thorax,  or  a  hardnefs  of  the  lungs,  as  in  a  peripneumony*. 
or  of  tubercles,  as  in  a  confumption. 

15.  It  would  take  up  too  much  time  to  go  through  all  the  caufes  of 
palpitation  that  have  ever  been  propos’d,  efpecially  as  I  am  not  willing  to 
repeat  what  has  been  already  faid,  or  give  at  prefent  what  muft  be  faid  here¬ 
after.  For  as  to  ofiifications  of  the  heart  itfelf,  ulcers,  or  polypi,  there  will 
be  a  better  occafion  to  fpeak  of  thefe  in  the  next  letters. 

And  in  regard  to  the  dropfy  of  the  pericardium,  from  which  there  are  fo 
many  who  account  for  palpitation  of  the  heart,  it  is  to  no  purpofc  to  add 
any  thing  to  what  has  been  already  faid,  in  the  fixteenth  letter  ( n ),  of  that, 
former  diforder  being  fometimes  join’d  to  the  latter,  and  fometimes  not.. 

It  will  be  better,  therefore,  to  confider,  in  this  place,  fome  other  affedtions 
of  the  pericardium,  which  have  been  produc’d  in  the  number  of  the  caufes 
of  palpitation  •,  and  one  in  particular,  which  I  have  more  than  once  feen  in 
the  bodies  of  patients  after  death.  For  fiatuffes  fhut  up  within  this  cavity, 


(/£)  Mem.  de  1’  Acad.  R.  des  Sc.  A,  1707. 
(I)  Epilt.  13.  n.  12. 

6 


(m)  A£t.  N.  C.  Tom.  1.  Obf.  111. 
(*)  Prsefertim  n.  23. 


and 


Letter  XXIII.  Article  i  5.  69  3 

and  much  lefs  worms,  have  never  happen’d  to  occur  to  me.  And,  indeed, 
although  many  obfervations  of  palpitation  or  tremors  of  the  heart  are  read 
in  this  feCtion  of  the  Sepulchretum  (<?),  from  worms  of  the  pericardium  ;  yet, 
in  fome  places,  I  want  a  more  certain  teftimony  of  worms  being  feen  there, 
and  in  other  places  a  more  weighty  one ;  I  fay,  of  worms  being  feen ;  for 
the  names  of  great  men  are  not  wanting,  even  in  the  Sepulchretum,  as  of 
Francifcus  Sylvius  (/>),  Hartmann  (q)9  Ballonius  (r),  Hollerius  (j),  Riola- 
nus  (/),  and  others,  who,  in  agreement  to  the  doctrine  of  fome  of  the  an¬ 
cients,  have  fuppos’d,  without  any  doubt,  that  there  were  fometimes  worms 
in  the  pericardium,  and  even  in  the  heart  itfelf.  But  if  it  be  afk’d  whether 
any  one  has  feen  them,  Riolanus,  indeed,  fays,  “  that  Salius  had  treated  of 
cc  this  difeafe but  where  he  had  treated  of  this  very  thing,  he  by  no 
means  fays.  We  muff,  therefore,  return  to  obfervators.  And  the  firft  of 
the  obfervations  pointed  out(«)  has  a  very  great  man,  indeed,  for  its  author  : 
yet  if  you  read  it  attentively,  it  is  not  an  obfervation,  but  a  conjecture. 
For  he  does  not  fay  that  he  had  even  once  feen  thofe  worms,  which,  if,  as 
he  believ’d,  they  tc  very  often  ”  gnaw’d  the  heart,  not  only  he,  but  others 
alfo,  muft  have  found  within  the  pericardium.  And  if  you  afk  who  it  was 
that  faw  the  worm  of  the  fecond  obfervation  (x),  or  in  what  prince,  and  at 
what  time  the  writer  of  the  obfervation  himfelf  does  not  feem  to  have 
known  thefe  things.  The  third  is  from  a  manufcript  of  Stockerus  ( jy),  who, 
however,  does  not  fay  that  he  had  ever  feen  thofe  worms. 

And,  finally  (z),  in  regard  to  the  iaft,  that  we  may  read  it  entirely,  we  are 
referr’d  to  the  tenth  fe&ion.  But  after  having  turn’d  over  the  pages  of  this 
feClion,  and  having  found  that  it  is  under  the  very  firft  article  of  the  eighth 
obfervation,  we  can  neither  underftand  it  entirely,  by  reafon  of  the  carelefs- 
nefs  of  the  printer  ;  nor  yet,  on  the  fcore  of  his  negleCf,  can  we  find  it  in 
that  author  from  whom  it  is  faid  to  be  taken,  that  is,  from  Zacutus,  lik% 
2.  prax.  admir.  cap.  cx.  for,  it  is  in  the  firft  book,  chapter  cxxxix.  And  in 
this  Zacutus  fays,  that  the  worm  was  “  dead,  black,  and  of  the  fhape  of  a 
“  large  fly-,”  as  in  the  next  chapter  he  defcribes  “  a  little  fnake”  in  another 
heart.  And  as,  from  the  very  defcription  of  the  latter  of  thefe,  you  will 
perceive  that  it  was  a.  polypous  concretion,  of  the  fhape  of  a  little  fnake-, 
fo  you  will  eafily  fufpeCt  with  me,  that  what  he  fays  refembl’d  a  great  black 
fly,  was  a  polypous  concretion  of  the  fame  kind,  adhering,  to  the  internal 
paries  of  the  ventricle  of  the  heart,  and  particularly  after  you  have  examin’d 
other  obfervations  of  this  kind  in  other  places  (a).  And  yet  I  would  not 
have  you  fuppofe  me  to  lay  thefe  things  by  way  of  obftinate  contention,  that 
it  is  impoflible  for  a  worm  ever  to  exift  within  the  membranes  of  the  peri¬ 
cardium,  as  I  have  fo  often  found  them  within  the  coats  of  the  great  artery 
in  dogs  ( b ).  But  I  fay  them  for  this  reafon,  becaufe  I  would  fain  read  more 
certain  obfervations  before  I  allow  of  it.  And  in  the  mean  while,  I  (hall  fay 


(0)  19,  &  25.  §  1,  2, 3*. 

(p)  Jn  Schol.  ad  §  6.  Obf.  21. 
(7)  Ad  §  1.  Obf.  25. 

(r)  Ad  §  1.  Obf.  27. 

(/)-Ad  §  1.  Obf.  7.  Sed.  10.. 


0)  Ibid.  §  3.  (^)  19.  Se&.  hsc  8. 

(x)  Ibid.  Obf.  2j.  §  1. 

(y )  Tbid.  §  2.  (•?)  Ibid.  §  3. 

(a)  'Epift.  24.  n.  23. 

(&)  Epift.  Anar.  9.  n,  45, 

wkh 


6  94  Book  II.  Of  Difeafes  of  the  Thorax. 

with  Trallianus,  who  is  commended  under  that  very  obfervation  of  Zacutus, 
that  the  worms  which  are  troublefome  to  the  heart,  are  thofe  that  injure  the 
left  orifice  of  the  ftomach,  which  draws  the  heart  fo  into  confent,  that  it  is 
call’d  K.a.pS'/A  ;  as  was  alfo  the  opinion  of  Sennertus,  produc’d  under  the  fame 
obfervation  where  that  fourth  was  produc’d.  And  in  this  manner  are  very 
eafily  underftood  thofe  things  that  are  remark’d,  under  the  fecond  and  third 
obfervation,  from  Hartman,  and  Hollerius,  in  regard  to  worms  being  ex¬ 
creted  in  the  palpitation  of  the  heart  which  has  its  origin  from  worms :  nor 
does  it  feem,  that  the  method  of  cure  of  Lower,  which  is  produc’d  in  the 
fir  ft:  obfervation,  if  it  did  really  drive  away  the  worms,  is  to  be  explain’d 
much  otherwife. 

1 6.  But,  although  I  equally  well  remember,  as  I  have  already  faid,  that 
it  has  never  yet  happen’d  to  me,  to  find  the  pericardium  diftended  with  air, 
yet  I  fhall  the  more  readily  give  credit  to  Hollerius  (<r),  a  very  grave  man, 
who  afferts,  u  that  he  had  found  it  in  differed  bodies,  who  died”  of  a  pal¬ 
pitation  of  the  heart  -,  becaufe  I  myfelf  have  found  other  cavities  turgid  with 
air,  and  the  blood  veflfels  alfo(^) ;  and  other  authors,  whom  I  have  fpoken 
of  to  you  before  (e),  even  the  heart  itfelf ;  fo  that  if  other  circumftances  per¬ 
mit  you,  you  are  at  liberty  for  me  to  affent  to  thofe,  who  account  for  a  pal¬ 
pitation  of  the  heart  from  air  diftending,  not  only  the  pericardium,  as  here 
in  the  Sepulchretum,  obfervation  the  eighteenth,  but  alfo  the  heart  itfelf;  yet 
this  within  thofe  bounds  which  are  hinted  at  by  Francifcus  Sylvius,  in  obler- 
vation  the  twenty-firft  (/).  And  I  have  faid,  if  other  circumflances  permit 
you,  for  fome  reafons,  among  which  takes  place  that  of  the  difengagement 
of  air  from  the  blood  of  living  perfons,  not  fo  eafily  to  be  fuppos’d  in  the 
greater  part  of  them,  in  which  it  would  be,  otherwife,  very  eafily  to  explain 
a  palpitation  in  this  manner.  And  this  it  will  be  very  eafy  for  you  to  under- 
itand,  from  thofe  things  that  have  been  difputed  upon  in  the  fifth  letter  (g). 
And  how  difficult  that  very  fuppofition,  which,  as  it  is  faid  in  that  letter  (X), 
was  advanc’d  by  Redi,  I  mean,  that  an  intermiffion  of  the  pulfe  was,  for  the 
moft  part,  to  be  accounted  for  from  fome  pretty  large  bubbles  of  air  paf- 
fing  through  the  heart;  I  fay,  how  difficult  this  fuppofition  feem’d  to  his 
difciple  Bellini,  the  writings  of  this  author,  which  are  publiffi’d  (z),  demon- 
ftrate.  Wherefore,  as  I  juft  now  faid  of  worms,  fo  1  now  fay  of  flatufies,  that 
thefc  are  for  the  moft  part  troublefome  to  the  heart,  not  by  occupying  the 
cavity  of  this  vifcus,  or  of  the  pericardium  itfelf,  but  by  occupying  the 
inteftines  and  ftomach,  that  lie  beneath  them.  Which  vifcera  are  often  fo 
diftended  with  flatus,  as  to  incommode  very  much  the  diaphragm,  and  the 
heart  lying  upon  it.  For  on  this  fuppofition,  what  is  inculcated  frequently 
In  the  icholia  added  to  that  eighteenth  obfervation,  that  by  the  eruption  of 
flatus,  a  palpitation  of  the  heart  is  frequently  cur’d,  or  reliev’d,  becomes 
evident  and  intelligible:  which,  if  it  occupied  the  cavities  of  the  heart,  or 
pericardium,  as  in  that  obfervation  is  fuppos’d,  could  certainly  find  no  paf- 

fage  through  which  it  might  burft  forth  luddenly  and  plentifully. 

-  * 

(<•)  De  Morb.  Int.  1.  i.  c.  29.  in  Schol.  ( g )  n.  25.  &  feqq. 

(^/)  Vid.  ex.  gr.  Epift.  5.  n.  19.  ( b )  n.  21. 

(f)  Ibid.  n.  20.  (/)  De  Morb.  Pe&.  1. 

(/)  5-  6. 


7 


At 


Letter  XXIII.  Article  17.  $ 

17.  At  length  I  come  to  that  caufe  of  palpitation,  which  evidently  oc¬ 
curs,  and  not  very  feldom  neither,  and  in  which  water,  air,  or  any  thing  elfe, 
is  fo  far  from  being  interpos’d  between  the  pericardium  and  heart,  that  the 
pericardium  adheres  to  the  heart  in  fuch  a  manner,  that  it  may  frequently 
feem  to  be  wanting  at  fuch  a  time,  unlefs  you  diftinguifh  by  an  accurate  en¬ 
quiry;  which  leads  the  celebrated  Haller  (I),  after  Meyerus  (/),  Stalpart  {ni\ 
Freind  (»),  and  Lancifi(<?),  to  doubt,  whether  thofe  who  have  written  that 
they  had  feen  the  human  heart  without  a  pericardium,  were  not  deceiv’d  in 
this  way  ;  among  whom,  befides  thofe  who  are  fpoken  of  by  the  writers  juft 
now  commended,  is  to  be  reckon’d  Antonius  M.  Conanus,  in  the  works  of 
Hippolytus  Bofcus(p);  and  among  the  more  modern  authors,  Alexander 
Littre(j),  and  Jo.  George  Hover  (r).  Yet  Peyerus,  after  having  explain’d 
his  doubts  upon  this  head  in  the  following  manner;  44  It  is  reafonable  to 
44  fuppofe,  that  the  pericardium  had,  in  thefe  cafes,  fo  adher’d  and  grown  to 
44  the  lungs,  or  rather  to  the  heart  itlelf,  that  they  might  not  feem  to  be  dif- 
tinft ;”  left  to  more  fagacious  enquirers,  a  method  by  which  they  might  ex¬ 
plain  the  fubjedt:  and  that  method  you  will  fee  plac’d  in  a  very  ftriking  point 
of  view,  by  the  fkill  and  induftry  of  that  celebrated  man  Kaav  Boerhaave  (j). 
However,  the  adhefion  of  the  pericardium,  not  to  the  lungs,  but  to  the  heart, 
which  he  himfelf  faw  twice,  from  an  unknown  difeafe,  and  of  which  I  am  to 
fpeak  at  prefent ;  this  adhefion,  I  fay,  whether  you  account  for  it  from  the 
defedt  of  that  water,  or  from  glutinous  and  vifcid  particles  being  either  fe- 
creted  with  it,  or  diftilling  from  little  ulcers,  which  are  generated  in  the  fur- 
face  of  the  pericardium  or  heart,  or  both;  you  will  always  more  eafily  con¬ 
ceive  if  any  caufe  be  added,  which  may  prefs  the  pericardium  clofely  to  the 
heart,  and  the  heart  itfelf  be  fuppos’d  to  have  had  for  a  long  time  a  very 
languid  and  inconfiderable  motion. 

For  I  would  have  you  take  care  how  you  underftand  otherwife,  what  Her- 
manus  Boerhaave  (/),  ufing  the  fame  example  as  Peyerus  (#),  has  fakU  44  As- 
44  the  eye-lids,  when  they  have  been  excoriated,  fometimes  grow  together, 
44  by  the  reft  of  one  night,  fo  the  lungs  feem  to  grow  to  the  pleura,  and  the 
44  heart  to  the  pericardium.”  For  neither  the  lungs  nor  the  heart  can  be 
quite  at  reft  fo  long;  yet  it  is  fufficient  if  they  feem  almoft  to  be  at  reft.  So 
alfo,  where  it  is  faid  by  the  fame  author  (x),  44  The  vapour  which  keeps  the 
44  furfaces  moiftand  disjoin’d,  being  deficient,  it  has  been  feen  that  the  heart 
44  being  grown  to  the  pericardium,  has,  after  miferable  anxieties  and  palpi- 
44  rations,  kill’d  perfons ;  a  hiftory  of  which  kind  is  related  by  Peyerus;” 
there,  I  fay,  we  muft  in  like  manner  beware,,  left  we  believe  that  this  great 
man  faid  more  than  he,  perhaps,  really  meant.  For  Peyerus(j)  has  indeed  re¬ 
mark’d  44  a  very  great  anxiety  of  the  cheft,”  with  a  very  difficult  refpira- 

( )  Ad  Praeleft.  Boerh.  §.  132.  rot.  a.  (q)  Hift.  de  P  Acad.  R.  des  Sc.  A.  1712. 

(/)  Meth.  Hift.  Anat.  c.  6.  in  Schol.  Obf.  Anat.  1. 

( m )  Cent.  1.  Obf.  Med.  Anat.  37.  in  Adnot.  (r)  Aft.  N.  C.  Tom.  5.  Obf.  68. 

(»)  Hift.  Medic,  ubi  de  Avenzoare.  p)  Nov.  Comment.  Imp.  Sc.  Acad.  Petro¬ 

so)  De  Mot.  Cord.  1.  1.  Propof.  23.  &  in  pol.  Tom.  1.  Obf.  Anat.  4. 

Schol.  ad  Hift.  (/)  Pneleft.  in  Inftit.  §.  709. 

(/)  De  Facult.  Anat.  Left.  4,  («)  Schol.  cit. 

(x)  Prxleft,  $.  182.  (y)  c.  6.  cit. 

tion. 


696  Book  il.  Of  Difeafcs  of  the  Thorax. 

turn,  but  has  not  exprefsly  mention’d  palpitations ;  although  he  has  faid* 
st  that  the  pulfe  was  always  weak,  and  fometimes  fmall  and  tremulous,  in  the 
«  two  laft  months  intermittent,  and  to  the  very  laft  languid  and  creeping.” 
Nor  indeed  is  mention  made  of  anxieties  always,  much  lefs  of  palpitations, 
in  all  the  obfervations  which  are  pointed  out  under  that  paflage  of  Boerhaave, 
nor  in  many  others  which  occur  to  me  as  I  write  :  and  this  you  will  perceive 
from  thole  things  that  will  be  immediately,  though  nightly,  hinted  at  upon 
each. 

18.  Four  of  the  more  ancient  are  in  the  Sepulchretum,  but  in  different 
places  •,  as  that  of  Gul.  Ballonius  (2),  Otho  Heurnius  (a),  and  that  of  the 
elder  Phil.  Sarazanus  (£),  who  communicated  to  Hildanus  (<r)  this  adhefion 
of  the  pericardium  to  the  heart,  “  which,  as  far  as  he  knew,  had  been  ob- 
“  ferv’d  by  nobody  before  him,”  in  that  year  1616,  in  which  year  Ballonius 
died  (r/),  whofe  books  indeed  did  not  come  out  till  nineteen  years  after. 
But  Ballonius  had  known  it  in  the  year  1578.  For  amongfl  the  annotations 
which  he  made  in  the  fpring  of  that  year,  you  will  read  the  following  ( e ) : 
“  D.  Duretus  being  fent  for — he  fuppofes  the  caule  or  all  the  palpitation 
“  at  the  heart  to  confift  in  opprelfion,  or  in  excufiion.  The  former  is,  when 
“  the  diforder  is  in  the  heart  itfelf,  or  about  the  heart.  As  when  too  great 
“  a  quantity  of  water  has  been  fecreted  within  the  pericardium,  or  the  peri- 
“  cardium  adheres  to  the  heart.”  This  may  feem  to  be  known  to  Duretus 
himfelf.  For  indeed,  when  Ballonius  enumerated  that  amongfl:  the  caufes 
of  palpitation,  he  neither  hinted  by  whom,  nor  in  what  manner,  it  was  ob- 
ferv’d.  For  thefe  are  his  words  (/)  •,  “  The  adhefion  of  the  pericardium  to 
“  the  body  of  the  heart  itfelf,  which  has  been  obferv’d  in  two  hydropic 
“  patients.”  But  be  this  as  it  will,  thefe  two  obfervations,  which  are  pro¬ 
duc’d  under  the  name  of  Ballonius,  do  particularly  mention  a  palpitation  of 
the  heart.  Yet  this  will  be  enquir’d  after  in  vain  in  the  obfervations  of  Sa¬ 
razanus  and  Fleurnius,  as  far  as  appears  from  the  Sepulchretum.  Both  of 
them  take  notice  of  a  difficult  refpiration  ;  and  Sarazanus,  of  other  things 
befides,  as  in  an  affair  that  was  quite  new  to  him,  which  I  lee  are  confirm’d 
by  Meckrenius  (g)  alone,  perhaps  by  mere  chance ;  but  not  a  word  of 
ftreightnefs  or  anxiety,  pulfes  or  palpitation.  So  alfo  •,  to  pafs  over  to  the 
more  modern  obfervators  who  have  feen  the  pericardium  adhering  to  the 
heart,  and  to  take  no  notice  of  the  obfervation  of  Meckrenius  ( h ),  by  rea- 
ibn  of  the  wound  of  the  heart  being  join’d  to  it,  in  which,  however,  there 
is  not  one  word  of  palpitation,  or  intermifiion  of  the  pulfe  ;  Lower  (/'),  al¬ 
though  he  has  accurately  put  down  what  diforders  had  preceded,  and  amongfl 
them,  “  a  fhortnefs  of  breath  upon  the  flighted:  motion,  a  fmall  and  inter- 
*4  mittent  pulfe,  a  troublefome  pain  about  the  praecordia,  with  a  remarkable 
“  opprefiion,  and  frequent  fwoonings  *”  yet  has  not  inferted  th-e  leafl  men¬ 
tion  of  palpitation. 


(A  Sect,  hac  8.  Obf.  20. 

(*/)  Sect.  1.  Obf.  74. 

(6)  Ibid.  Obf.  94. 

(c)  Vid.  Hildan.  Cent.  4.  Obf.  32« 

(d)  Vid.  Ballon.  Vitam. 


( e )  Epidem.  I.  2. 

(/)  1.  1.  Confil.  Med.  109. 
(gj  Obf.  Med.  Chir.  c.  35. 
(b)  Ibid. 

(0  Trad,  de  Corde,  c.  2. 


And 


Letter  XXIIL  Article  1 8.  697 

And  Peyerus  (k),  in  regard  to  two  difieCtions  communicated  to  him  by 
Wepfer,  fays  nothing  elfe  of  thofe  fymptoms  which  had  preceded,  except 
that  there  had  been,  in  one  patient  only,  44  an  anxiety  of  the  praecordia  f* 
which  patient  44  never  was  able  to  deep,  or  even  to  breathe,  unlefs  in  a  prone 
44  fituation,  fupported  on  his  knees  and  elbows.’*  But  Stalpart  (/)  does  not 
fay  any  thing  even  of  that  anxiety,  but  only  mentions  a  continual  and  flow 
fever,  and  a  cough,  44  by  which  was  difcharg’d  a  great  quantity  of  blood.” 
And  Malpighi  ( m )  does  not  give  the  lead  hint  of  the  diforders  with  which 
Landinus  had  been  afflicted,  However,  to  return  to  the  Sepulchretum,  and 
to  gather  together  here  thofe  things  which  may  eafily  efcape  fuch  as  look  for 
them,  as  they  are  difpers’d  out  of  this  fe&ion  through  many  different  flec¬ 
tions;  neither  do  Garnerus  in)  nor  Helvigius  (0)  mention  any  thing  of  the 
diforders  which  had  preceded,  befides  an  ulcerated  bread  and  a  dropfy, 
notwithdanding  the  adhering  pericardium  contain’d,  either  a  heart  very  fmall, 
and  contracted  into  itfelf.  or  encreas’d  to  twice  its  ufual  magnitude.  Hiar- 
nius(y>)  does  but  juft  make  flight  mention  44  of  fome  little  inquietude  at 
44  the  heart,”  and  fome  other  things  which  relate,  in  general,  to  a  very  great 
tumour  of  the  belly,  befides  a  difficulty  of  breathing.  Stegmannus  (q)  has, 
indeed,  many  things  in  reference  to  obdinate  and  long  diforders,  which  be¬ 
long  to  this  clafs,  but  fays  full  as  little  of  the  injuries  of  the  vifcera  •,  for 
relating  a  hidory  of  a  palpitation  of  the  heart,  inequalities  of  the  pulfe,  and 
a  perpetual  dyfpnoea,  quite  from  childhood,  he  refers  them  to  a  kind 
of  cartilaginous  excrefcence  near  the  left  auricle  of  the  heart,  to  a  quantity 
of  fat  covering  the  heart,  fo  as  not  a  little  to  encreafe  its  bulk,  and  to  other 
things,  not  only  to  the  adhefion  of  the  pericardium;  and  that  very  prudent¬ 
ly,  efpecially  as  this  was  made  only  by  fibrous  net-works,  and  thofe  belong¬ 
ing  to  the  fat  which  cover’d  the  middle  region  of  the  heart.  But  in  all 
parts,  and  on  all  fides,  was  this  adhefion  obferv’d  by  the  phyficians  at  Gene¬ 
va  (r),  in  a  young  man  to  whom  a  palpitation  of  the  heart  had  been  44  fa- 
44  miliar as  indeed  almoft  all  the  others  were,  to  which  I  make  no  excep¬ 
tions. 

On  the  other  hand,  this  palpitation  v/as  not  obferv’d  by  Hottinger  (j),  in 
a  woman  in  whom  he  found  the  pericardium  become  very  thick,  like  buff- 
leather,  very  hard,  and  fix’d  clofely  to  the  heart,  but  only  a  fhortnefs  of 
breathing.  Littre(/)  had  nothing  at  all  to  mention  in  two  patients,  for 
both  of  them  died  of  wounds  ;  the  one  of  a  wound  in  the  thigh,  whereas  he 
faid  he  was  well  in  other  refpeCts  ;  and  the  other  of  a  wound  in  I  know  not 
what  part,  but  within  a  quarter  of  an  hour  •,  and  this  man,  although  that 
indeed  is  to  be  wonder’d  at  in  both,  does  not  feem  to  have  been  ill  before. 
And  indeed  Ruyfch  («),  where  he  fhews  the  heart  44  to  have  been  grown 
44  into  one  fubftance  with  the  pericardium,  and  that  from  an  inflammation 


(£)  Schol.  cit.  fupra,  ad  n.  17. 

(/)  Cent.  1.  Obf.  rar.  37. 

( m )  De  Struft.  Glandul. 

(«)  1.  4.  S.  2.  Obf.  7.  §  1. 

(0)  1.  3.  S.  21.  Obf.  21,  in  Addifc 
(p)  S.  ead.  Obf.  36. 


(7)  1.  2.  S.  1.  Obf.  32.  in  Addit. 

(r)  1.  3.  S.  10.  Obf.  3.  in  Addit. 

(j)  Eph.  N.  C.  Dec.  3.  A.  10.  Obf.  231. 
(/)  Hift.  de  l’Acad.  R.  des  Sc.  A.  1701.  & 
1706. 

(a)  Thef.  Anat,  6.  n.  36.  not.  1. 

4  u 


Vo x.  I. 


of 


6  p  S  Book  IL  Of  Difeafes  of  the  Thorax, 

“  of  thefe  parts  having  preceded,  from  whence  the  patient  was  feiz’d  with 
“  an  intolerable  pain  about  the  anterior  parts  of  the  bread,  not  without  a 
«*  continual  fever;”  neither  adds  any  other  fymptoms,  nor  does  it  fufficiently 
appear,  whether  he  refers  thofe  that  he  does  mention  to  that  time  of  the 
inflammation,  or  to  that  which  follow’d  it,  when  the  pericardium  was  already 
conne&ed  with  the  heart.  But  on  the  other  hand,  a  violent  and  continual 
palpitation  of  the  heart  was  obferv’d  by  Dionis  ( x ),  befides  other  fymptoms ; 
and  amongft  thefe  a  difficulty  of  breathing,  a  vehemence  and  quicknefs  off 
pulfe.  A  very  violent  palpitation  is,  likewile,  fpoken  of  in  the  laft  of  thofe 
fix  Engliffi  obfervations,  of  which  we  have  fpoken  above  (y).  Yet  that 
which  is  added  to  the  fourth,  and  which  is  one  of  the  celebrated  Chefiel- 
den’s,  mentions  nothing  but  a  dropfy,  and  a  wafting  of  fleffi.  So  alfo  Lan- 
cifi,  in  neither  of  the  two  whom  he  defcribes  (z),  although  he  gave  an  ac¬ 
curate  account  of  other  things,  and  among  thofe  of  contradtions  and  oppref- 
fions  of  the  praecordia,  and  faintings  ;  in  neither  of  them,  I  fay,  did  he 
name  palpitation  ;  and  in  the  firft  of  them  {a)  has  told  us,  that  even  the  pulfe 
was,  “  for  the  moft  part,  equal.”  But  a  continual  palpitation  was  obferv’d 
by  Vieuflens  (£),  together  with  a  flight  oppreffion  of  the  cheft,  which  was 
alfo  remark’d  by  Freind  (c),  “  in  a  violent  degree,”  at  leaft;,  "  near  the  end 
“  of  the  difeafe,  with  a  pulfe  always  quick,  and  fometimes  even  unequal 
“  and  intermittent.” 

But  Cantius  (i),  who  wrote  between  both  of  thefe  gentlemen,  was  en¬ 
tirely  ignorant  of  the  hiftory  of  the  man  who  was  difledted  by  him,  or  of 
what  diforder  he  died.  And  Abraham  Vaterus,  although  in  a  kind  of  pre¬ 
fatory  difcourfe  (<?),  where  he  gives  us  an  oblervation  that  he  took  from  the 
body  of  an  old  woman,  he  has  omitted  to  mention  the  difeafes  that  had  pre¬ 
ceded  ;  yet  in  his  Ofteogony  (/)  at  length,  fpeaking,  as  it  feems,  of  the 
fame  old  woman,  he  has  mention’d  nothing  of  palpitation,  but  a  vehement 
afthma,  a  cachexy,  an  oedematous  tumour  of  the  feet,  and  an  inflammation 
of  the  loins.;  nor  yet  was  there  any  palpitation  in  the  man  (g),  in  whom, 
befides  anxieties  and  oppreffions  of  the  heart,  there  was  no  complaint  that 
correfponded  with  the  concretion  of  this  vifcus  to  the  pericardium,  or  de¬ 
pended  upon  it.  Nor  was  there  in  the  failor,  of  whom  the  celebrated  Lau- 
bius  (b)  gives  the  hiftory,  any  fymptoms  befides  a  moft  violent  afthma,. 
which  you  could  refer  to  the  prefent  queftion,  although  the  pericardium,  be¬ 
ing  very  firmly  concreted  with  a  very  fmall  heart,  and  with  the  diaphragm* 
was  equal  in  hardnefs  to  a  cartilage,  and  in  thicknefs  to  a  man’s  thumb;  un- 
lefs  a  great  quantity  of  ferum,  with  which  the  belly  and  thorax  were  fill’d,, 
and  a  number  of  vomicse,  form’d  upon  the  larger  veffels  of  the  lungs,  and 
other  things  of  that  kind,  could  have  been  the  occafion  of  it.  In  like  man¬ 
ner  the  celebrated  Daniel  Hoffman  (/),  although  he  accurately  defcribes  fo 


{x)  Defcript.  d’une  oreill.  da  coeur. 

(y)  n.  9.  &  10. 

(«)  De  Subit.  Mort.  1.  2.  Obf.  Phyf.  Med. 
4.  &  de  Mot.  Cord.  Prop.  23. 

(tf)  in  Schol.  ad  cit.  Obf.  §  10. 

(b)  Traite  du  Coeur,  ch.  1. 

(c)  ubi  cit.  fupra,  ad  n.  17. 


(d)  Impet,  Anat.  Tab.  4. 

(e )  poft  Obferv.  rariff.  calculor. 

(fj  Thefi.  20. 

(g)  DilTert.  decalcul.  in  vefica  fell,  generat. 
Thef.  9. 

(b)  Aft.  N.  C.  Tom.  2.  Obf.  20. 

(/)  Ibid.  Obf.  2. 


many 


Letter  XXIII.  Article  i£.  699 

many  diforders  with  which  a  girl,  whofe  difieCtion  he  produce?,  had  been 
afflicted,  does  not  reckon  palpitation  in  the  number  of  them  ;  and  exprefsly 
remarks,  that  the  pulfe  was  never  found  to  be  “  either  unequal  or  inter- 
“  mitttent.” 

But  you  will,  without  doubt,  compare  the  obfervation  of  that  very  cele¬ 
brated  man  Heifter(&)  with  thofe  of  Littre,  which  were  fpoken  of  a  little 
above  *,  as  it  was  taken  from  a  young  man,  who  was  not  only  not  a  valetu¬ 
dinarian,  but  who  was  drinking  “  very  freely  in  a  tavern  ”  with  his  compa¬ 
nions,  till  he  fell  down  fuddenly  from  the  bench  on  which  he  fat,  as  if  he 
were  drunk,  and  there  died  in  a  little  time  after.  And  although  that  learned 
man  Jo.  Guil.  Agricola  (/),  when  accurately  defcribing  the  pericardium  as 
being  connected  with  almoft  the  whole  heart,  after  an  inflammation  of  the 
thorax,  (after  which,  not  only  Ruyfch(w),  but  Hottinger  (n),  and  even 
others,  had  feen  it)  takes  notice  of  a  very  quick  palpitation  of  the  heart, 
even  to  the  very  end  of  life  ;  yet  he  does  not  omit,  that  the  magnitude  of 
the  heart  was  furprifingly  increas’d,  and  that  the  auricles,  ventricles,  and  vena 
cava,  were  unufually  capacious,  and  the  lungs  full  of  tubercles.  And  in¬ 
deed,  although  he  faw  the  fame  concretion  of  the  heart  with  the  pericardium 
at  three  other  times  (0),  and  once  where  the  lungs  were  without  any  taint, 
he,  neverthelefs,  does  not  mention  a  word  of  palpitation  ;  but  only  fufpeCts, 
that,  in  fome  malignant  fevers,  the  very  great  debility,  faintings,  and  fyncopes 
that  attend  them,  are  to  be  accounted  for  from  thence. 

Moreover,  neither  has  the  excellent  Plancus  (/>),  who  oftentimes  obferv’d 
an  adhefion  of  the  pericardium  to  the  heart,  from  a  very  violent  blow  on 
the  fternum,  mention’d  any  thing  of  a  palpitation,  in  defcribing  of  this  ad¬ 
hefion  from  the  fame  caufe,  in  a  dropfical  patient,  And  even  if  this  adhefion 
had  exifted,  it  would,  neverthelefs,  be  doubtful,  whether  you  fhould  afcribe 
it  to  that  caufe,  or  to  the  bony  ring  with  which  the  lower  part  of  the  left 
Ventricle  was  furronnded ;  juft  as  in  the  obfervation  of  Jo.  Sebaltian  Albrechtus, 
which  you  have  read  lately  (j),  you  will  doubt,  whether  you  fhould  attribute 
the  palpitation  of  the  heart  not  without  pain,  and  the  periodical  afthma,  to 
corrupted  lungs,  and  to  a  very  confiderable  tumour,  which  grew,  pofteriorly, 
on  the  firft  divifion  of  the  afpera  arteria,  and  the  magnitude  of  the  heart, 
which  was  increas’d  to  twice  its  natural  fize,  to  which  all  the  vefiels  that  go 
out  from,  or  come  into  it,  and  the  right  ventricle  correfponded,  but  not  the 
left  ventricle,  and  the  auricles  j  I  fay,  whether  you  fhould  attribute  the  pal  ■ 
pitation  to  all  thefe  caufes  aCting  jointly,  or  rather  to  the  foie  connection  of 
the  pericardium  with  the  flat  furface  of  the  heart  in  the  greater  part  of  it, 
and  even  to  the  very  apex  itfelf,  by  pretty  ftrong  and  fhort  fibres. 

The  celebrated  Haller  (r),  alfo,  faw  a  cohelion,  “  which,  like  a  bridle, 
<s  conftrain’d  the  extreme  point  of  the  heart,  though  it  was  not  general-,” 
but  of  what  fymptoms  the  man  complain’d  he  has  not  added.  And  in  ano- 

(t)  Obf.  Med.  Mifcell.  4.  (0)  Commere.  Litter.  A.  1736.  Hebd.  41. 

(I)  Commere.  Litter.  A.  1735.  Hebd.  8.  in  fine, 
poll  n.  4.  '  (p)  Epift.  de  Monftr. 

(«)  («)  Supra  «it.  (q)  Ai\.  N.  C.  Tom.  5.  Obf.  21. 

( r )  Ad  Prieleft.  Boerh.  §  iSz,  not.  m. 


4  U  2 


ther 


7oo  Book  II.  Of  Difeafes  of  the  Thorax. 

ther  who  had  been  troubl’d  with  an  hereditary  palpitation,  he  faw  the  peri¬ 
cardium,  in  feveral  places,  connected  to  the  heart,  but  by  the  means  of  fcirrhi; 
and  obferv’d  fo  many  and  fo  confiderably  difeas’d  appearances,  befides,  in  that 
fame  heart,  as  I  have  faid  above  (s),  that  it  is  not  ealy  to  conjecture  to  which 
of  them  in  particular  you  ffiould  aicribe  the  palpitation.  The  very  excellent 
Kaaw,  in  like  manner,  found  the  heart  and  the  pericardium  connected  to¬ 
gether  in  two  male  bodies  •,  in  one  by  filaments,  the  longed:  of  which  were 
equal  in  length  to  the  finger  when  extended  ;  and  in  the  other  more  clofely, 
efpecially  where  the  heart  lay  upon  the  diaphragm  :  but  it  was  out  of  his 
power  to  learn  with  what  diforders  either  of  them  had  been  troubl’d  when, 
alive,  as  was  hinted  in  the  beginning  (f). 

Yet  out  of  thofe  three  men,  the  firft  of  whom  was  differed  by  that  ex¬ 
cellent  furgeon  Le  Fay  ( u ),  the  fecond  by  that  very  learned  phyfician  Pafla  (*),, 
and  the  third  by  Hieronymus  Queye,  at  that  time  a  ftudent  in  phyfic(jy), 
before  the  laft  ten  bodies  of  which  1  fpoke  were  diffeCted  ;  the  firft  had  labour’d, 
under  a  long  and  violent  palpitation  of  the  heart,  with  which  the  pulle  alfo 
correfponded  j  the  fecond  had  been  often  troubl’d  with  the  fame  palpitation, 
and  a  difficulty  of  breathing,  particularly  after  any  motion  of  body,  or 
emotion  of  mind,  with  a  pulfe  perpetually  unequal  and  intermittent;  and 
the  laft  had  been  fubjeCt  to  an  unufual  palpitation,  and  fudden  but  momen.r 
tary  intermiffions  of  the  pulfe,  and  to  frequent  but  flight  fwoonings.  What 
other  diforders  of  the  heart,  or  of  the  adjacent  parts,  all  thefe  bodies  had, 
or  had  not,  befides  the  pericardium  being  generally  become  very  much 
thicken’d,  and  adhering  to  the  heart,  will  be  prefently  related. 

19.  Now,  then,  if  out  of  all  thefe  obfervations  that  I  could  light  on  while 
I  was  writing  this  letter,  which  are  in  number  forty-five  (2),  you  firft  let  afide 
thefe  fix,  which  do  not  tell  us  what  diforders  had  preceded,  and,  in  the  next 
place,  take  away  four-and-twenty  more,  in  which  no  mention  is  made,  of  a 
palpitation,  no  more  than  fifteen  will  then  remain  wherein  mention  thereof 
is  made  ;  that  is  to  fay,  two  of  Ballonius,  and  of  Hiarnius,  Stegmannus, 
the  Genoefe  phyficians,  Dionis,  the  Englifh,  Vieufiens,  Freind,  Agricola, 
Albrechtus,  Haller,  Le  Fay,  Pafta,  and  Du  Queye,  each  one  obfervation. 
But  if  you  read  over  thefe  very  obfervations  attentively,  and  fee  how  many 
preternatural  circumftances  were  found  almoft  in  every  one  of  them,  except 
the  laft,  befides  the  adhefion  of  the  pericardium,  you  will  be  much  in  doubt, 
whether  this  adhefion,  or  any  other  difeafe,  had  been  the  caufe  of  the  pal¬ 
pitation.  For,  to  pafs  by  the  polypi  that  are  read  of  in  the  fourth,  eighth, 
ninth,  and  tenth  obfervations,  which  Michelotti  did  not  pafs  by  in  the  fame 
eighth  obfervation  (a),  though  in  other  refpeCls  he  rightly  advifes  us  to  be 
cautious  where  many  difeas’d  appearances  are  found  together,  at  the  fame 
time,  left  any  one  in  particular  lhould  be  taken  for  the  caufe  of  the  diforder 
without  a  juft  and  real  foundation  *,  and,  in  like  manner,  not  to  attend  to 
the  water,  which  in  the  thirteenth  and  fourteenth  obfervations,  and,  perhaps, 

(s)  N.  12.  (/)  N.  1 7.  (y)  Differt,  de  Syncop.  c.  3.  Prop.  1.  n.  1. 

(k)  Hift.  de  l’Acad.  R.  des  Sc.  'A.  1735.  (2)  Vid.  alias  Epift.  24.  n.  3.  in  fine; 

Obf.  Anat.  8.  («)  Comment.  Bonon.  Sc.  Acad.  Tom.  1. 

(^)  EpiR,  de  Cord.  Polyp,  n.  13.  in  Opufc. 


in 


Letter  XXIII.  Article  20.  701 

in  thofe  two  of  Ballonius,  fill’d  the  whole  capacity  of  the  thorax;  but  rather 
take  them  for  the  effedl  of  this  long- continu’d  palpitation,  and  the  effeft  of 
its  caufes  ;  in  the  greater  part  of  thofe  fifteen  obfervations  of  which  I  fpeak, 
you  will  find  other  circumftances  to  detain  your  attention  ftill  more. 

For,  to  fay  nothing  of  thofe  in  which  I  have  pointed  them  out  upon  quoting 
them,  in  the  eighth,  the  lungs  were  fo  far  impregnated  with  ferous  juices, 
that  they  entirely  fill’d  the  cavity  of  the  thorax :  in  the  ninth,  the  part  of 
the  pericardium  adhering  to  the  heart,  abounded  with  fmall  abfcefles,  which 
had  fucceeded  to  the  inflammation  :  in  the  fixth,  the  feventh,  the  thirteenth, 
the  fourteenth,  at  one  time  the  right  auricle,  and  at  another  time  the  left, 
and  even  the  left  ventricle  itfelf,  were  dilated  in  an  alrrioft  incredible  manner. 
I  pafs  by  other  circumftances ;  as,  for  inftance,  in  the  greater  part  of  thefe 
four,  bones,  either  in  the  beginning  of  the  great  artery,  or  in  the  pericar¬ 
dium,  or  in  the  whole  right  auricle,  or  the  narrownefs  and  fmallnefs  of  the 
adjoining  ventricle,  added  to  that  vaft  dilatation  of  the  left,  as  in  the  four¬ 
teenth  ;  or,  finally,  a  tumour  form’d  upon  the  pericardium  itfelf,  on  the  fur- 
face  towards  the  ribs,  which  was  equal  in  bignefs  to  a  fmall  egg,  and  full  of 
coagulated  blood,  as  in  the  thirteenth.  And  juft  to  mention  a  few  things 
of  this  tumour  only,  for  I  have  fpoken  of  almoft  all  the  other  appearances 
already,  and  in  part  am  to  fpeak  of  them  hereafter,  as  alfo  of  this  kind  of 
tumours  ( b )  ;  fee,  I  befeech  you,  what  remarks  Lancifi  has  made  in  the  latter 
end  of  the  firft  book  of  aneurilms  (c),  which  he  put  down  juft  by  way  of 
memorandum,  as  he  was  writing  :  44  Obferve,  that  the  queftion  here  is  of 
44  the  figns  by  which  an  aneurifm  of  the  heart  is  diftinguifh’d  from  a  tumour 
41  of  the  pericardium.  For  I  have  feen  a  certain  gilder,  who,  when  living, 
44  labour’d  under  a  palpitation  of  the  heart,  and  a  ftreightnefs  of  breathing, 
44  and  who  was  generally  believ’d  to  be,  without  any  doubt,  troubl’d  with 
44  an  aneurifm  ;  this  man  died  fuddenly,  after  many  blood-lettings,  by  which 
44  he  feem’d  to  be  eas’d.  But  in  his  body,  after  death,  was  found  a  very 
44  large  abfcefs,  which,  when  ruptur’d,  pour’d  out  a  melliceroid  liquor:  and 
44  it  occupied  the  bafts  of  the  pericardium,  betwixt  one  coat  and  the  other.” 
From  hence  you  certainly  perceive,  that  even  one  tumour  of  the  pericardium 
may  of  itfelf,  fometimes,  be  the  caufe  of  a  palpitation. 

20.  And  this  being  the  ftate  of  the  queftion,  you  fee  plainly  whether  in 
determining  it,  that  is,  in  determining  whether  the  adhefion  of  the  pericar¬ 
dium  to  the  heart  excites  the  palpitation  of  this  vifcus,  thofe  obfervations 
ought  not  to  have  the  moft  weight,  in  which  no  other  appearance  of  difeafe 
was  found  befides  that  adhefion.  Of  which  kind  five,  in  particular,  are  to 
be  met  with,  among  all  thofe  that  are  pointed  out  above  (d)  ;  that  is,  one  of 
Sarazanus,  Lower,  the  Genevois,  Heifter,  and  Du  Queye.  And  mention  is 
made  of  palpitation  in  the  third,  and  in  like  manner  in  the  laft.  But  in  this 
laft-mention’d  obfervation,  as  in  the  firft  alfo,  it  by  no  means  appears  in  what 
ftate  the  remaining  vifcera  and  vefiels  were ;  fome  diforders  of  which  may 
fometimes  be  the  caufes  of  palpitation,  as  real'on  itfelf,  and  what  I  have  faid 
from  time  to  time  in  thefe  letters,  fufficiently  demonftrate.  But  Lower  and 

(£)  Infra  n.  23.  (c)  Propof.  5,  in  ipfo  fine.  (<t)  N.  18. 

7 

Heftier, 


7  02  iBook  IT.  Of  Difeafes  of  the  Thorax. 

Heifter,  as  they  were  diligent  in  the  examination  of  the  other  parts  of  the 
bodies  they  differed,  which  appears  from  the  defcription  of  each  ;  fo,  if  they 
had  contain’d  any  other  appearances,  there  is  no  doubt  but  they  would  have 
been  able  to  diftinguifh  them,  as  they  were  well  (kill’d  in  the  art  of  dif- 
fe£lion,  and  all  anatomical  matters.  But  whether  a  palpitation  had  preceded 
their  obfervations,  and  that  of  Sarazanus,  you  will  know  from  what  I  have 
faithfully  reported  in  taking  notice  of  each. 

But  left  you  fhould  believe,  that  they  had  found  the  pericardium  to  adhere 
to  the  heart  in  fome  places  only,  or  very  loofely,  Heifter  fays,  that  the  peri¬ 
cardium  certainly  was  “  every- where  connected  very  clofely  to  the  heart;  fo 
that  without  laceration  it  could  by  no  means  be  feparated  therefrom  and 
Lower,  46  that '  it  had  every-where  grown  fo  clofely  to  the  whole  heart,  that 
“  it  could  not  be  feparated  by  means  of  the  fingers,  but  with  difficulty 
and,  moreover,  that  it  was  “  thick,  opaque,  and,  in  a  manner,  callous and 
this  I  add,  left,  if  you  fhould  read  in  moft  of  thole  obfervations,  in  which 
I  faid  there  was  a  palpitation,  that  the  pericardium  was  thick  and  hard,  you 
fhould  be  ready  to  fulpeft,  that  the  palpitation  ought  rather  to  be  accounted 
for  from  thence  than  from  the  adhefion  ;  although  Heurnius,  Peyerus,  Hot- 
tinger,  Laubius,  and  Hoffman,  who  have  feen  the  pericardium  thicken’d, 
hard,  cartilaginous,  and  flelhy,  have  not  remark’d  any  palpitation,  as  I  faid 
above  (<?). 

21.  But  yon  will,  certainly,  enquire  here,  (fince  our  obfervations  are  re¬ 
duc’d  to  fo  fmall  a  number)  whether  in  thole  in  which  Yalfalva  and  I  have 
feen  the  pericardium  adhering  to  the  heart,  there  was,  or  was  not,  a  palpi¬ 
tation  ?  And  firft,  in  regard  to  Yalfalva,  although  he  faw  it  three  times, 
once  in  a  boy  of  whom  I  fhall  fpeak  hereafter  (/),  and  a  fecond  and  a  third 
time  in  two  men  of  whom  I  have  already  fpokeri  in  the  laft  preceding  let¬ 
ter  (g) ;  yet  he  obferv’d  nothing  elfe  in  regard  to  the  boy,  except  that  he 
died  quite  emaciated  :  and  in  regard  to  the  men,  although  he  remark’d  many 
and  various  things,  yet  you  will  read  the  obfervations  over  again  in  vain,  in 
order  to  find  any  thing  relative  to  palpitation,  or  any  peculiar  diforders  of 
the  pulfe :  and  yet  the  pericardium  not  only  adher’d  to  the  heart,  in  all  thefe 
bodies,  and  on  all  fides,  but  in  the  fecond  of  them,  who  had  complain’d  of 
a  ftreightnels  of  the  cheft  (which  might  be  referr’d  to  another  caufe,  if  any 
one  fhould  wifh  to  refer  it),  it  was,  belides  the  adhefion,  in  fome  places  very 
thick,  and  in  other  places  cartilaginous.  And  as  to  myfelf,  I  have  found 
the  pericardium  adhering  to  the  heart  in  feven  different  bodies,  and  that  uni- 
verfally.  Four  hiftories  of  which  kind  I  have  fent  you  the  defcription  of, 
in  other  places  ;  as  of  the  oftler  or  ftable-keeper  ( h ),  the  fifherman  (/'),  the 
butcher  (k),  and  the  fheerer  of  woollen  cloth  (/) :  in  none  of  which  it  was  in 
my  power  to  learn  whether  there  had  been  a  palpiration  of  the  heart,  nor 
whether  there  had  been  any  ftreightneffes  of  the  praecordia,  and  diforders  of 
the  pulfe ;  nor  is  it  to  be  wonder’d  at,  fince  the  butcher  was  bereft  of  his 
fenfes,  and  the  reft  were  all  carried  off  by  fudden  deaths,  fome  from  one 

(i)  V.  n.  I9.  (i)  VIII.  n.  6. 

(/)  XVIII.  n.  25. 

caufe^ 


( e )  Ibid. 

(f)  49.  n.  4.  (g)  N.  4  &  ro. 

(/.>)  Epift.  IV.  n.  19. 


4 


Letter  XXlII.  Article  22.  703 

caufe,  and  fome  from  another :  although  in  the  (heerer,  a  large  aneurifm  in 
the  neighbourhood  of  the  heart,  had  render’d  the  circumftance  doubtful, 
efpecially  as  the  pericardium  was  not  of  itfelf  connefted  to  the  heart,  but  by 
means  of  a  mucous  matter  that  was  interpos’d. 

Yet  in  the  fifherman  and  the  (table-keeper,  to  both  of  whofe  hearts  the 
pericardium  adher’d  immediately,  and  of  itfelf,  as  it  did  in  the  butcher;  and 
in  the  firft,  indeed,  fo  clofely,  that  it  could  not  be  feparated  without  a  la¬ 
ceration  of  the  heart ;  I  cannot  eafily  fuppofe  that  there  had  been  any  great 
inconveniences  of  the  thorax,  as  the  firft  was,  a  little  before  death,  equal  tO' 
the  laborious  bufinefs  of  fifhing.  And  the  ftable-keeper  having  been  receiv’d 
into  the  hofpital  three  times  before  his  laft  apoplexy,  had  never  complain’d 
of  a  palpitation;  and  even  in  that  inflammation  of  the  thorax,  for  which  he 
had  lain  there  but  a  very  few  months  before,  he  had  no  irregularity  of  the 
pulfe,  befides  the  hardnefs  and  quicknefs  ufual  to  thofe  diforders,  as  I  was 
certainly  inform’d  by  thofe  phyficians  who  had  attended  to  his  cure,  while 
the  cafe  was,  as  yet,  quite  recent  in  their  memory.  I  would  not,  however, 
deny,  that  an  adhefion  of  the  pericardium  might  take  its  origin  afterwards,, 
and  from  that  very  inflammation  of  the  thorax,  as  I  have  faid  that  Henninger, 
Ruyfch,  and  Agricola  had  obferv’d  (m) ;  and  by  this  means,  perhaps,  that 
diforders  of  the  heart  and  pulfe,  which  had  not  exifted  before,  might  exift 
afterwards.  But  the  remaining  three  of  my  obfervations,  which  were  taken, 
from  one  man  and  two  women,  you  will  read  in  other  letters  (»),  to  which 
they  more  immediately  belong:  and  you  will  fee,  that  in  one  only,  there  was* 
an  intermitting  pulfe  and  a  palpitation ;  and  this,  certainly,  from  a  very  clofe 
adhefion  of  the  pericardium,  not  only  to  the  heart  univerfally,  and  its  right 
auricle,  but  even  beyond  the  bafis  of  the  heart,  to  the  great  veflels  which 
have  communication  with  it. 

22.  How  then,  you  will  fay,  is  it  that  Lower (0),  Vieuflens  (p),  and; 
Michellotti  (<7),  have  taught  us,  that  not  only  a  difficulty  of  breathing,  but 
the  firft  alio,  an  intermiftion  of  the  pulfe,  and  the  third,  even  that  an  op- 
preflion  of  the  heart  and  palpitation,  ought  naturally  to  be  the  conlequence,, 
if  an  adhefion  of  the  pericardium  to  the  heart,  efpecially  when  grown  hard,, 
be  fuppos’d  ?  Does  not  the  pericardium,  being  become  more  contrafled,  for 
this  reafon  keep  the  diaphragm,  which  is  naturally  connected  with  it,  drawn 
upwards,  and  renders  the  depreflion  of  it,  when  the  air  is  taken  into  the 
lungs,  lefs  eafy ;  and  that  fo  much  the  more  in  proportion  as  the  pericardium  itfelf 
is  more  hard  ?  And  does  not  the  diaphragm  neverthelefs,  at  the  time  of  its- 
defcent,  by  haftily  drawing  the  pericardium  after  it,  caufe  the  heart  to  be 
more  confin’d  and  ftraiten’d  by  this  its  inverting  membrane,  and  fo  render 
the  expanfion  of  its  cavities  much  more  difficult;  from  whence  oppreffion,. 
intermiftion  of  the  pulfe,  and  palpitation  confequently  follow  ? 

As  to  me,  however,  although  I,  perhaps,  out  of  thefe  three  efledls,  more 
eafily  fee  the  reafon  why  the  two  former  than  why  the  third  fhould  happen, 
yet  I  am  not  ignorant  what  may,  in  like  manner,  be  faid  for  the  third.  But 

(w)  Supra,  n.  19.  (0)  [p)  (^)  locis  indicatis  fupra,  ad  n.  18. 

(«)  XXIV.  n.  11.  XXX.  n.  7.  XXXV.  n.  &  19,, 

12. 


where 


704  Book  II.  Of  Difeafes  of  the  Thorax. 

where  a  more  frequent  experience  is  againd  them,  as  we  have  feen,  I  think 
it  quite  needlefs  to  take  up  time,  by  examining  into  the  force  of  any  argu¬ 
ments  whatever.  Or  ought  we  not  rather  previouily  to  confider,  whether  a 
palpitation  of  the  heart  was  really  wanting  in  all  thofe  obfervations  where  it  is 
not  mention’d  ?  For  l'ome  might  have  omitted  it  through  negleft ;  others 
might  not  have  obferv’d  it,  though  it  did  exift ;  and  they  not  from  mere  negli¬ 
gence  neither,  but  for  that  reafon,  alfo,  which  is  remark’d  after  a  certain  ob:er- 
vation  in  this  eighth  fedtion  of  the  Sepulchretum  (r),  in  the  following  manner; 
“  It  fometimes  happens,  that  though  the  caufes  of  a  palpitation  of  the  heart 
“  are  prefent,  the  palpitation  neverthelefs  is  not  produc’d ;  becaufe  the  pa- 
<c  tients  have  lain  for  a  long  time  in  a  recumbent  podure,  and  the  blood, 
“  by  reafon  of  the  quietnefs  of  the  body,  has  perform’d  its  courfe  in  a  very 
“  tranquil  manner.  For  it  is  known  by  experience,  that  the  heart  of  ca- 
“  chedic  perfons  rarely  palpitates,  if  they  live  quietly :  but  that  from  the 
<c  flighted:  motion  whatever,  efpecially  in  the  afcent  of  deep  places,  it  is  ve- 
hemently  agitated.”  So  likewife  it  is  faid  below,  after  another  obfervati- 
on  (i);  4‘  It  is  very  difficult  to  didinguilli  a  palpitation  of  the  heart,  which  is 
brought  on  by  content  with  the  inferior  parts,  from  one  that  is  idiopathic; 
“  for  it  frequently  happens,  that  although  the  heart  contain  thecaufe  within 
“  itfelf,  yet  the  effeds  of  that  caufe  return  periodically  ;  as  when  ferum  that 
“  is  included  in  the  pericardium  is  dirr’d  up  by  an  crgafmus  or  turgefcency  of 
<c  its  quantity,  or  when  flatulencies  are  added.” 

But  although  thefe  things  ought  to  be  in  great  meafure  admitted,  and 
ought  alfo  to  be  transferr’d  to  other  fubjeds  of  difpute,  led  we  ffiould  at  any 
time  deny  that  there  is  an  organical  diforder,  for  this  caufe  only,  becaufe  it 
does  not  perpetually  produce  its  effeds;  yet  can  you  fuppofe  that  the  force  of 
all  the  obfervations,  in  which  l  have  fliown  that  the  adhefion  of  the  heart  to  the 
pericardium  had  been  propos’d,  without  any  mention  of  palpitation,  is  diffid¬ 
ently  enervated  by  thofe  things  which  have  jud  been  faid,  or  by  other  things  of 
the  like  kind  ?  And  particularly,  as  there  are  otherobfervations  to  be  confider’d, 
which  were  made  by  that  diligent  and  cautious  man  Albertini  (/),  who,  in 
enquiring  after  the  figns  of  that  adhefion,  if  any  there  were,  is  fo  far  from 
mentioning  palpitation,  that  if  we  confider  attentively  all  he  fays  on  that  fub- 
jed,  he  has  rather  obferv’d  the  contrary ;  I  mean,  that  the  motions  of  the 
heart  are  then  naturally  redrain’d  and  diffl’d  by  the  pericardium,  fo  that  they 
can  hardly  be  perceiv’d  by  us ;  and  if  they  are  fometimes  perceiv’d,  it  is  in 
confequence  of  another  diforder ;  as,  for  indance,  of  the  magnitude  of  the 
heart  being  at  the  fame  time  encreas’d  :  and  although  didurb’d  motions  of  the 
heart  and  of  the  pulfe  may  come  on,  as  in  the  hidory  given  by  Lower  (&),  as 
if  there  were  a  polypus  of  the  heart,  yet  “  that  the  hand  being  applied  to  the 
“  feat  of  the  heart,  the  motion  of  it  is  more  fenfibly  felt  by  the  phyfician,” 
when  there  is  a  polypus,  than  when  there  is  that  adhefion. 

23.  While  I  read  over  again  thefe  paflages  from  Albertini,  from  which  it 
is  to  be  fuppos’d  that  he  had  often  feen  this  adhefion  of  the  pericardium, 

(0  Comment,  de  Bonon.  Sc.  Acad.  Torn, 
I.  in  Opufc. 

{«)  Vid.  fupra,  n.  18. 


(r)  1 6.  in  Scbol. 
40  31.  in  Schol. 


Letter  XXIII.  Article  23.  703: 

of  which  we  fpeak,  I  obferve  two  things  befides  ;  one  that  Bartolettus  had 
very  frequently,  alfo,  obferv’d  the  fame,  whofe  books  that  1  fhould  at  prefers t 
be  without  will  be  lefs  furprizing  to  you,  than  that  Bonetus  fhould  have  been 
always  without  them,  as  appears  from  the  index  of  the  authors  whom  he 
made  ufe  of  in  the  Sepulchretutn ;  and  the  other,  that  in  a  prince,  in  whofe 
pericardium  Albertini  found  44  a  bloody  tumour,  which  was  extended  from 
“  the  right  fide  of  the  heart,  according  to  the  whole  length  of  that  vifcus  f 
fuch  fymptoms  had  preceded,  as  cc  feem’d  to  give  u£  reafon  for  fuppofing, 
44  that  there  was  an  organical  diforder  of  the  varicofe  kind:”  and  he  had 
faid  above,  that  thele  things  happen’d  when  there  is  no  pulfation,  or  when  it 
is  46  almoft  infenfible.”  But  Lancifi,  as  appears  from  his  obfervation,  which 
I  have  related  above  („v),  has  obferv’d  a  palpitation  of  the  heart  from  a  tu¬ 
mour  of  the  pericardium  j  and  Zacutus,  from  one  Rill  lefs,  who  has  affLm’d, 
that  he  had  feen  this  diforder  three  times,  in  the  laft  preceding  and  leventh 
fedtion  of  the  Sepulchretum  (jy) :  which  you  muft  read  not  in  the  fecond 
book  that  is  there  quoted,  but  in  the  firfl,  in  order  to  underftand  the  paf- 
fage  in  the  Scholium,  which  is  itfelf  alfo  taken  from  Zacutus,  wherein  he 
has  propos’d  a  method  of  cure,  of  fome  nature  or  other.  What  then  is 
the  cafe?  Did  the  different  kind  of  humour  that  was  contain’d  in  the  tu¬ 
mour,  as  the  yellow  of  Zacutus,  and  the  meliiceroid,  or  honey-like,  of  Lan¬ 
cifi,  ad  fo  differently  from  the  bloody  humour  of  Albertini,  as  to  ftir  up  a 
palpitation  by  their  irritating  the  heart  ?  or  was  the  different  feat  of  the  tu¬ 
mour,  in  the  different  bodies,  the  caufe  of  this  variety  ?  for  that  of  Lancifi 
was  fituated  at  the  bafis  of  the  pericardium  ;  that  of  Albertini  at  the  fide  of 
the  pericardium,  and  at  the  right  fide  of  the  body  ;  but  the  fituation  of  the 
tumour  obferv’d  by  Zacutus,  he  has  not  related.  And  this  difference  of 
fituation  may  be  of  the  greateft  importance,  if  from  the  tumour  which  is 
in  the  bafis,  one  or  the  other  of  the  great  arteries  be  prefs’d  upon,  and 
ftreighten’d,  and  thus  a  bar  be  put  to  the  blood  which  is  going  out  of 
the  heart,  from  whence  a  palpitation  will  happen  ;  which  feems  lefs  to  be 
fear’d  from  a  tumour  that  occupies  the  fide  of  the  pericardium.  Nor  would 
I  have  you  fay,  that  out  of  thefe  fifteen  obfervations  (*),  in  which  a  palpita¬ 
tion  is  mention’d,  the  thirteenth  defcribes  a  tumour,  in  its  nature  and  fitua¬ 
tion,  fimilar  to  that  which  was  feen  by  Albertini.  For  the  tumour,  in  that 
thirteenth  obfervation,  was  added  to  the  great  dilatation  of  the  left  ventricle, 
and  to  the  bony  beginning  of  the  aorta:  and  befides,  I  do  not  hint  at  con¬ 
jectures,  efpecially  fuch  as  do  not  depend  upon  a  great  number  of  obferva¬ 
tions,  that  you  fhould  follow  them  •,  but  that  having  get  together  other, 
and  fill  other  obfervations,  whenever  you  have  it  in  your  power,  you 
may  compare  them  with  thefe,  and  at  length  either  approve  or  rejedt  them. 
But  if  it  fhould,  by  chance,  happen,  that  you  confirm  this  laft  conjedture, 
it  might  then  alfo  be  enquir’d,  whether  the  heart  palpitates  from  the  adhe- 
fion  of  the  pericardium,  when  the  pericardium  is  not  only  fo  fix’d  to  the 
heart,  but  alfo  to  the  arteries  which  proceed  from  it,  that  by  conftringing 
them  it  ftreightens  the  pafiage  for  the  blood,  that  is  about  to  come  forth  from 

,(*)  n.  19.  in  fin.  (y)  Obf.  no.  (z)  fupra,  n.  19. 

Yol.  I.  4  X  the 


7  o  6  Book  II.  Of  Difeafes  of  the  Thorax. 

the  heart,  as  it  probably  did  conftringe  them  in  that  obfervation  of  ours  (^), 
which  a  palpitation  of  the  heart  had  preceded. 

Yet  I  would  not  have  you  fuppofe,  that  I  mean,  by  this  examination  into 
the  caules  of  palpitation,  to  bring  you  to  rejedl  any  one  of  them  entirely,  but 
only  to  induce  you  to  acknowledge  with  me,  that  any  one  caule,  adling  in 
a  different  mannner,  and  in  a  different  place,  join’d  with  fome  other  caufe,. 
or  disjoin’d  from  it,  may  at  one  time  produce  a  palpitation,  and  at  another 
time  not ;  and  that  you  may  fcarcely  affert  more  of  any  one  caufe,  in  parti¬ 
cular,  than  what  you  will  find  laid  in  the  very  beginning  of  this  fection  in 
the  Sepulchretum,  in  the  words  of  the  lcholiographer,  or  rather  in  the  words 
of  Hollerius  himfelf :  “  A  palpitation  of  the  heart  may  be  excited  by  a  tu- 
4'-  bercle,  an  abfcefs,”  and  other  things  of  that  kind.  For  it  is  quite  a  dif¬ 
ferent  thing  to  fay,  that  it  “  may  be  excited,”  and  to  fay,  that  it  muff;  necelTa- 
rily  be  excited.  The  latter  of  which  afiertions,  and  not  the  former,  feems 
to  me  to  be  but  little  agreeable  to  truth,  in  the  prefent  point  of  difpute. 

24.  I  do  not  doubt  but  you  have  often  wonder’d,  in  reading  over  this 
letter,  that  you  have  never  obferv’d  me  to  depend  upon  the  obfervations, 
doflrine,  and  authority,  of  the  excellent  archiater  Senac,  as  if  he  had  writ¬ 
ten  nothing  at  all  on  the  fubject  of  palpitation,  or  as  if  his  opinion  had  been 
very  far  different  from  mine.  It  is  true,  that  he  has  written  many  things 
upon  that  fubjedt  ;  but  I  have  found  them,  in  general,  fo  far  to  agree  with 
thofe  that  I  had  lent  you,  in  the  compafs  of  this  letter,  that  I  thought  it 
would  be  better  to  fpeak  of  him  a  little  more  largely  at  once  in  this  place, 
than  to  name  him  a  hundred  times  over  in  paffing.  If  then  you  read  over 
the  whole  chapter  that  he  has  written  upon  this  fubject  of  palpitation  (£), 
and  what  he  has  alfo  faid,  in  other  parts  of  his  work,  on  this  affedtion,  not 
in  a  curfory  manner,  but  with  an  attentive  mind,  as  they  well  deferve-,  you 
will  firfi;  obferve  what  he  teaches  in  regard  to  the  caufes  of  palpitation,  not 
only  in  general,  but  in  particular.  And  in  general  he  deduces  the  palpita¬ 
tion  of  the  heart  from  its  irritation  and  in  particular  from  fuch  things  as¬ 
caule  irritation,  or  at  lead  furnifh  a  caufe  of  irritation,  Some  of  which  he 
fhews  to  exift  on  the  outfide  of  the  heart,  and  others  within  the  heart  itfelf. 
And  in  the  number  of  the  latter  he  places  the  diforders  of  the  heart,  and  ex¬ 
plains  from  whence  the  irritation  has  its  origin,  whether  an  obftrudtion  be 
oppos’d  to  the  egrefs,  or  to  the  ingrefs  of  the  blood;  as  alfo,  whether  the. 
cavities  of  the  heart  are  dilated  and  conftridted :  on  which  occafion  he  attri¬ 
butes  the  lefs  free  egrefs  of  the  blood  to  the  dilatation  of  the  auricles,  the 
bulk  of  whole  cavities,  when  diftended  with  blood,  compreffes  the  trunks  of 
the  arteries  that  lie  near  to  them,  which  you  will  the  more  readily  believe, 
if  you  call  to  mind  the  fmall  flefhy  “  excrefcence”  that  was  found  by  Gar- 
nerius'tg)  in  the  bafis  of  the  heart,  and  betwixt  the  arteries,  which,  by  com- 
preffing  them,  brought  on  a  perpetual  palpitation.  And  how  far  the  valves, 
lubjedted  to  the  auricles,  may  contribute  to  the  impediment  of  the  egrefs  or 
ingrefs  of  the  blood,  if  they  are  indurated,  or  agglutinated  to  the  parietes  of 
the  heart,  as  he  found  them  to  be  in  a  certain  man,  he  has  explain’d  in  an- 

( a )  Supra,  n.  2 1.  in  fin.  (£)  Traite  du  Coeur,  1,  4.  ch.  n.  (<•)  Se&.  hac  8.  Sepul.  Obf.  23.. 


Letter  XXIII.  Article  24.  707 

other  place  (d).  He  has  alfo  excellently  well  taught,  in  one  part  of  his 
work(<?),  that  an  impediment  of  this  kind  is  frequently,  but  very  unjuftly, 
afcrfo’d  to  polypous  concretions  in  the  heart,  particularly  when  certain  and 
evident  caufes  of  palpitation  occur  in  the  valves,  auricles,  and  larger  vefiels ; 
in  which  point  Vieufiens  and  Langelottus  thus  have  fail’d.  Then,  as  to  the 
caufes  that  are  on  the  outfide  of  the  heart,  you  will  fee,  that  in  the  number 
of  thefe  he  reckons  the  nerves,  when  irritated  in  the  brain,  orelfewhere; 
and  even  without  any  regard  to  the  nerves,  the  compreffion  of  the  pulmo¬ 
nary  veflels  :  in  treating  of  which,  with  his  ufual  excellence  and  perfpicuity, 
he  does  not  omit  to  admoniih  us,  how  cautious  we  ought  to  be  of  accufing 
this  laft  caufe,  inafmuch  as  a  palpitation  is  frequently  not  the  confequence  of 
this  alone.  Moreover,  unwillingly  to  pafs  over  a  great  number  of  very  ufe- 
ful  things,  of  which  he  muff  neceffarily  treat,  in  conformity  to  his  plan, 
and  to  leave  off',  as  I  began,  by  infilling  on  thofe  things  of  which  I  have 
had  occafion  to  write,  efpecially  fuch  as  relate  to  the  pericardium  ;  he  fhov/s 
how  a  palpitation  may  happen  from  a  dropfy  of  this  cavity  :  but  of  ambi¬ 
guous  marks,  either  of  tumours  of  this  part,  or  of  the  more  uncertain  ob- 
fervations  of  worms  exifting  there,  he  treats  very  judicioufly,  in  another 
place  (/) :  where  (^)  he  alfo  weakens  the  force  of  thofe  examples  of  the  pe¬ 
ricardium  being  deficient,  and  confirms  the  adhefion  of  it  to  the  heart,  by 
his  own  manifold  obfervations :  and  he  teaches  what  kind  of  adhefion,  and 
to  what  parts  of  the  heart,  it  is  that  ferves  as  an  impediment  to  the  motion 
of  the  heart,  or  is  the  caufe  of  palpitation  {h) :  nor  does  he  fail  to  put  us  in 
mind  how  cautious  we  ought  to  be,  where  there  are  many  different  caufes 
together,  and  particularly  thofe  of  a  more  important  nature,  left  we  rafhly 
aferibe  the  palpitation  to  adhefion  ;  and  admonifhes,  in  general,  that  where 
there  are  many  caufes  together,  it  is  not  poffible  for  us  to  diftinguifh  the  pe¬ 
culiar  e debts  of  each  ;  and  even  that  all  together  may  jointly  produce  certain 
effebls,  which  when  feparate  they  were  by  no  means  able  to  produce. 

And  thefe  things  alfo  are  excellent  (/) :  that  where  the  figns  of  thofe  caufes 
or  difeafes  are  ambiguous  or  obfeure,  the  phyficians  muff  take  great  pains, 
and  be  making  continual  enquiries,  in  order  that  they  may  be,  at  length, 
illuftrated  and  clear’d  up  :  and  that  though  they  fhould  not  be  able  to  attain 
to  this,  yet  they  might,  in  the  mean  while,  be  reaping  this  advantage  from 
their  enquiries,  that  they  would  naturally  become  more  cautious,  in  pro¬ 
nouncing  upon  difeafes,  and  in  determining  the  method  of  their  cure ;  and 
by  this  means  greatly  improve  the  phyfical  lcience,  in  which  the  hiftory  of 
all  the  difeafes  that  men  are  liable  to,  altho’  fome  of  them  are  not  dilcover’d 
till  after  death,  is,  of  itfelf,  fufficiently  worthy  of  our  knowledge  and  attention. 
But  if  it  at  length  happen,  as  it  does  happily  fall  out  in  many  caufes  of  palpita¬ 
tion,  that  they  are  fufficiently  known  and  diftinguifh’d  from  each  other;  how 
great  an  advantage  muff  arife  from  thence  in  the  prognofis  of  difeafes,  and 
how  great  in  the  method  of  curing  them,  nothing,  believe  me,  can  fhow 
more  clearly  than  what  this  very  great  archiater,  fupported  by  reafon  and 

Cg)  n-  4* 

(b)  Vid.  etiam  ch.  9.  in  fin. 

(/)  ch.  y.  n.  1. 

4X2 


(,V)  Ch.  9.  n.  5. 

( e )  Ch.  10.  n.  10. 

(f)  Ch.  5.  n.  2.  &  3. 


experience, 


7  o  8  Book  II.  Of  Difeafes  of  the  Thorax. 

experience,  has,  in  a  very  copious  and  diftin<5t  manner,  fubjoin’d  to  the  ex¬ 
amination  of  thefe  caufes,  in  the  much  greater  part  of  the  chapter  upon  the 
palpitation  of  the  heart,  which  has  been  already  pointed  out.  And  after 
having  read  this,  you  will  no  more  wonder,  that  in  fo  great  a  plenty  of  re¬ 
medies  as  the  antients  have  left  us  againft  this  difeafe,  fo  many  occur,  at 
one  time  or  other,  which  very  evidently  counteradt  each  other.  For  as  the 
caufes  of  palpitation  are  fo  various,  and  fome  of  them  fo  diametrically  oppo- 
fite  to  each  other ;  it  is  of  courfe  neceflary,  that  each  muft  be  counteracted 
by  different  remedies,  and  fome  of  them  even  by  fuch  as  are  diredtly  adverfe 
to  each  other.  The  caufes,  therefore,  being  digefted,  every  one  in  their 
proper  order,  from  that  kind  of  confus’d  chaos,  the  particular  remedies,  as 
he  truly  fays,  diftribute  themfelves  naturally,  if  I  may  be  allow’d  fo  to  fpeak, 
every  one  into  their  correfpondent  places.  However,  though  what  1  have 
now  faid  may  be  fufficient  to  ftir  up  in  you  a  defire  of  reading  the  whole 
work,  yet  it  is  by  no  means  fufficient  to  render  a  juft  praife  to  writings  fo 
highly  deferving  thereof.  Farewel. 


LETTER  the  TWENTY-FOURTH 

Treats  of  Preternatural  Pulfes. 


i.TF  I  fhould  take  upon  me  to  difcourfe  on  every  diforder  of  the  pulfe,  in 
this  letter,  I  fhould  undertake  not  only  an  infinite  but  a  ufelefs  labour. 
For  what  diforder  is  there  of  the  more  confiderable  kind,  in  which  the  pulfe 
is  not,  in  fome  meafure,  in  fault  ?  or  in  which  it  is  in  our  power  to  fhew  the 
true  caufe  of  this  variation  from  anatomy. 

It  will,  for  thefe  reafons,  then,  be  fufficient  to  attend  pretty  diligently  to 
fome  of  the  more  confiderable  diforders  of  the  pulfe,  which,  on  that  account, 
particularly  attraft  the  ftudy  of  the  phyfician,  and  the  refearches  of  the  ana- 
tomift,  beginning  with  the  moft  confiderable  of  them  all  :  which  feems  to 
me  to  confift  in  that  fmallnefs  and  debility  of  the  pulfe,  fo  that,  as  it  is  now 
no  longer  perceiv’d,  the  patient  is  faid  to  be  feiz’d  with  an  afphuxia,  or  to 
be,  at  prefent,  without  pulfe.  And  to  this  the  obfervation  of  our  Valfalva 
relates,  which  runs  in  the  following  manner. 

2.  A  man,  of  fifty  years  of  age,  having  fome  time  before  eicap’d  very 
happily  from  a  peripneumony,  fell  again  into  a  diforder  of  the  thorax.  For 
befides  that  he  complain’d  of  thirft,  and  a  dry  cough,  it  was  not  in  his  power 
to  lie  down  on  the  left  fide.  And  as  often  as  he  attempted  this,  by  turning 
himfelf  a  little  towards  that  fide,  the  more  he  continu’d  to  turn  himfelf,  the 
more  he  perceiv’d  that  a  fwooning  was  coming  on :  to  avoid  which,  he  re- 

„  "  ~  '  turn’d! 


f 


/ 


Letter  XXIV.  Article  3.  709. 

turn’d  to  a  fupine  fituation,  or  lay  upon  the  oppofite  fide.  Whether  he  had 
a  fever  or  not  could  not  be  difcover’d  from  his  pulfe,  as  no  pulle  was  per¬ 
ceiv’d. 

After  death,  the  pericardium  was  found  to  be  very  much  dilated,  and  fill’d 
with  a  purulent  matter  diluted  with  a  large  quantity  of  ferum.  The  mem¬ 
brane  which  inverted  the  heart  was  extremely  thicken’d  :  and  from  this  to 
the  pericardium,  two  folid  and  firm  productions  were  carried,  each  of  them 
in  the  form  of  a  cylinder,  like  a  thick  and  fhort  ligament,  rtrongly  con¬ 
necting  the  heart  to  the  pericardium.  One  of  them  had  taken  its  origin  near 
the  right  auricle,  and  was  continu’d  in  a  horizontal  direction  into  the  anterior 
fide  of  the  pericardium  ;  and  the  other  went  from  the  very  apex  of  the 
heart  itfelf  into  the  apex  of  the  pericardium,  and  in  fo  tenfe  artate,  that  at 
the  time  of  the  fyftole  the  apex  of  the  heart  could  not  be  brought  towards 
the  bafis,  unlefs  it  drew  the  pericardium  with  it,  and  confequently  the  dia¬ 
phragm. 

3.  According  to  this  animadverfion  of  Valfalva,  it  will  feem  very  eafy  to 
you  to  underftand  this  caufe  of  an  afphuxia ;  that  is,  from  the  heart  being  fo 
confin’d,  that  in  thrufting  out  the  blood  it  was  fcatcely  able  to  perform  its 
office  even  fiightly.  You  will  alfo  believe,  that  not  ignorant  of  the 

reafon  why  the  patient  was  threaten’d  with  a  fwoomng,  from  attempting  to 
turn  on  the  left  fide  of  his  thorax  •,  without  doubt,  becaufe  the  great  quan¬ 
tity  of  matter  which  diftended  the  pericardium,  did  then  moft  opprefs  the 
apex  of  it,  and  by  that  means  increas’d  the  refiftances  to  the  heart  when  about 
to  contraCl  itfelf,  fo  that  it  was  now  by  no  means  able  to  execute  its  office. 
Neverthelels,  there  may,  perhaps,  be  fome  things  which  prevent  you  from 
underftanding  the  cafe  in  this  manner.  I  pafs  by  thofe  things  which  I  re¬ 
member  to  have  heard  from  Valfalva,  of  a  band  drawn  betwixt  the  pericar¬ 
dium  and  the  fide  of  the  heart,  in  a  man  who  had  different  pulfes  from  the 
different  poftures  in  which  he  lay:  and  what  you  will  read  in  Albertini  («), 
of  the  tremor  of  the  heart,  if  the  patients. underwent  any  quick  motion,  in 
whom  he  found  “  the  pericardium  tied  in  a\  lax  manner  to  the  heart,  by  a 
“  thin  membranous  band  5”  and  alfo  what  you  will  read  in  the  Sepulchre- 
tum(£),  of  die  inequality  of  the  pulfe  in  a  man  whole  “  pericardium  ad- 
“  her’d  by  fibrous  connexions  to  the  middle  region  of  the  heart,  and  indeed 
“  to  its  adipofe  fubftance,”  as  I  have  already  laid  in  the  fi^iper  Ietter*  For 
you  would  fay,  that  all  thefe  connexions  were  more  lax  than  tojobftruCt  the 
motion  of  the  heart,  in  fuch  a  manner  as  to  bring  on  an  afphuxtf,  efpeciaiiy 
as  they  did  not  relate  to  its  apex.  ,  ■  Y 

But  what  will  you  fay  to  the  obfervation  of  the  illuftrious  Haller  (c),  wno 
faw  “  the  heart  grown  to  the  pericardium  by  flefhy  fibres  afcending  from 
“  the  apex,  without  any  inconvenience  to  the  man,  as  far  as  he  knew  ?” 
Certainly,  had  he  labour’d  under  an  afphuxia,  it  could  not  have  been  un¬ 
known.  Will  you  then  fay,  that  this  connexion  alfo  was  but  lax,  which  he 
has  laid  in  another  place  (i),  for  he  feems  to  be  fpeakingof  the  fame,  “  had 

(a)  Comment,  de  Bonon.  Sc.  Acad.  Tom,  (c)  Differt,  de  Vafis  cord,  propr.  not.  ultima. 

L  in  Opufc.  (a)  Ad  Boerh.  Framed  §  182.  not.  m, 

(£),  L.  2.  Sc&.  I.  in. Addit.  Obf,  32, 

u 


confin’d 


rj  x  o  Book  II.  Of  Difeafes  of  the  Thorax. 

confin’d  the  apex  of  the  heart  like  a  bridle  ?”  However,  let  us  fuppofe 
that  it  was  lax  :  yet  was  it  lax  in  that  great  number  of  obfervations  which 
are  taken  notice  of  in  the  former  letter  (<?)  ?  In  them  the  pericardium  itfelf, 
certainly,  was  become  connected,  not  only  to  the  apex  of  the  heart,  but  to 
the  heart  univerfally  :  yet  there  is  not  one  of  them  in  which  an  afphuxia 
was  obferv’d,  even  in  the  latter  part  of  life.  And,  indeed,  although  three 
other  obfervations  of  very  famous  men  are  extant,  as  of  John  Fantonus  (/), 
Benedict  Gulmann  (g-),'  and  of  the  fame  Albertus  Haller  (A),  whom  I  juft 
now  defei  vedly  commended,  which  efcap’d  me,  I  know  not  how,  as  I  was 
revifing  that  letter;  in  the  firft,  nothing  is  mention’d,  but  “  that  the  heart 
44  perform’d  its  motions  in  a  convulfive  manner  ;”  in  the  third,  not  even 
this  ;  and  in  the  fecond,  though  a  palpitation  of  the  heart,  an  inequality  of 
the  pulfe,  an  afthma,  and  other  fymptoms,  are  particularly  taken  notice  of, 
yet  an  afphuxia  is  not  at  all  mention’d  ;  notwithftanding  the  left  ventricle  of 
the  heart  was,  both  internally  and  externally,  of  a  cartilaginous  firmnels  ; 
and  notwithfianding  the  pericardium,  in  the  obfervation  laft  fpoken  of,  being 
flefhy,  and  in  the  firft  cartilaginous,  was  connected  44  ftrongly  to  the  heart 
44  on  all  fides,  and  very  clofely,  intimately,  and  tenacioully,”  as  in  the  third 
alfo. 

What  anfwer,  then,  muft  we  give  ?  And  what  think  you  of  the  following  ? 
That  Valfalva,  bcfides  this  connexion,  had  found  the  external  membrane  of 
the  heart  grown  much  thicker,  and  the  pericardium  fill’d  with  a  lerous  and 
purulent  matter.  For  the  thicknefs  of  that  membrane  was,  perhaps,  the 
caufe  that  the  heart  could  not  fufficiently  expand  itfelf;  and  as,  for  that  reafon, 
it  could  admit  but  little  blood,  nor  could  the  fmall  quantity  which  would  be 
foon  after  expell’d  into  the  arteries,  nor  the  force  with  which  it  was  extruded, 
be  able  fufficiently  to  dilate  them,  being  confin’d  by  this  connexion,  and  re¬ 
lax’d  from  that  matter  befides,  by  reafon  of  its  being  lerous  ;  and  as  in  con- 
fequence  of  its  being  purulent  alio,  the  heart  was  in  forne  meafure  tainted  by 
ir,  whether  this  matter  had  been  tranflated  hither  from  the  lungs  in  the  de- 
clenfion  of  a  peripneumony,  or  whether  the  peripneumony  had,  alfo,  had  an 
inflammation  of  the  membrane  of  the  heart  join’d  with  it :  but  which  of 
thefe  two- is  the  moft  credible,  by  reafon  of  our  ignorance  of  thofe  things 
which  had  then  afflicted  the  patient,  and  of  what  was  found  in  the  lungs 
after  death,  does  not  appear.  It  is  true,  indeed,  that  the  inflammation  of 
both  or  one  of  thefe  membranes  had,  more  than  once,  troubl’d  the  patient, 
from  the  coalition  of  one  with  another,  according  to  the  obfervations  of 
Ruyfch  and  Freind,  taken  notice  of  in  the  former  letter  (i).  But  it  is  alfo 
true,  that  the  ferum  being  impregnated  with  thick  particles,  and  fuch  as  are 
readily  prone  to  concretion,  they  are  often  prefs’d  out  within  the  pericardium, 
efpecially  of  thofe  who  labour  under  a  peripneumony,  as  I  have  written  to 
you  before  (£).  And  that  from  concretions  of  this  kind  fomewhat  like  hairs 
may  be  form’d,  if  they  adhere  to  the  heart  in  a  (lender  and  disjoin’d  manner  \ 
and  if  two  or  more  of  them  are  crowded  together,  as  if  bundles  of  rods 

(?)  N.  17,  18.  &  feqq.  ( h )  Opufc.  Pathol.  Obf.  49, 

(f)  Anat.  corp.  hum.  DHT.  n.  (?)  N.  1  8,  &  19. 

{.£)  Adi.  N.  C.  Tom.  1.  Obf.  4.  (/■)  Epilt.  20.  n.  37. 

were 


Letter  XXIV.  Article  4.  7  j  r 

were  drawn  betwixt  the  heart  and  pericardium,  that  thick  bands  may  be  pro¬ 
duc’d,  tying  the  one  to  the  other ;  the  fecond,  indeed,  is  hinted  at  by  Rio- 
lanus(/),  but  both  of  them  are  confirm’d  from  obfervations  by  Weitbrecht(w). 
For  Riolanus  had  faid  only  this,  “  If  the  water  of  the  pericardium  be  thick 
<c  and  vifcid,  the  craflfamentum  of  it  is  converted  into  hairs.  And  from 
“  hence  the  heart  has  been  obferv’d  in  fome  bodies  to  be  hairy.”  Yet  when 
I  attend  to  the  firmnefs  of  the  band  found  by  Valfalva,  and  the  membrane 
of  the  heart  being  fo  much  thicken’d,  befides  the  pus,  I  am  much  more  in¬ 
clin’d  to  fufpedt,  that  it  had  been  produc’d  in  the  firft  manner  than  in  the 
fecond  ;  I  mean,  by  a  coalition,  and  that  not  of  the  ftreighteft  kind,  which 
happen’d  at  the  apex  only. 

4.  But  if  the  mention  accidentally  made  of  the  heart  being  hairy  fhould 
chance  to  make  you  defirous  of  knowing  whether  I  think,  that  whatever  is 
extant  in  regard  to  hairs  being  found  upon  it,  in  hiftorians,  and  in  like  manner 
among  phyficians,  is  to  be  explain’d  in  the  fame  manner  which  I  hinted  at 
juft  now ;  I  would  have  you  underftand,  that  moft  of  the  ancient  examples 
of  this  obfervation  feem  to  me  to  be  very  doubtful  *  and  that  for  more  caufes 
than  one.  .  For  as  to  what  Valerius  (n)  had  afierted  to  have  been  found  by 
the  Athenians  in  Ariftomenes  Meflenius,  Pliny  (<?)  afterwards  afierted,  that 
this  was  done  by  the  Lacedemonians ;  and  Paufanias  (p),  that  Ariftomenes  had 
not  died  a  captive  in  the  hands  of  cruel  enemies,  but  in  a  ftate  of  freedom, 
at  a  great  diftance  both  from  Athens  and  Sparta,  as  he  had  pafs’d  over  to 
his  fon-in-law  among  the  Rhodians,  where  “  he  died  a  natural  death.” 
And  as  to  what  Plutarch  (q)  relates  to  have  been  feen  by  Xerxes,  in  the 
heart  of  Leonidas,  when  cut  out,  in  conformity  to  Ariftides,  who  wrote  of 
the  Perfian  affairs,  the  heart,  it  is  true,  might  be  cut  out  by  a  barbarous  and 
hoftile  king  ;  but  it  is  fcarcely  probable,  that  in  a  man  who  fought  very  gal¬ 
lantly  to  the  laft,  the  heart  had  any  thing  morbid  in  it.  And  I  would  have 
you  fuppofe  that  I  fay  the  fame  things  of  Lyfander,  who  being  at  the  head 
of  his  army,  and  under  the  walls  of  Haliartus,  “  fell  in  battle  (r).”  I  grant 
you,  indeed,  that  his  body  after  death  might  be  torn  into  pieces  by  his 
Theban  and  Athenian  executioners,  who  hated  him  moft  bitterly.  But  neither 
Paufanias  nor  Plutarch,  in  the  life  of  Lyfander,  do  by  any  means  hint  at  this 
fadt,  though  the  latter  has  told  us  that  the  body  was  return’d  to  the  La¬ 
cedemonians. 

Euftathius,  as  far  as  I  know,  is  the  only  one  who  makes  mention  of' it  in 
Lyfander,  and  in  the  dog  of  Alexander,  as  you  have  it  in  C relius  Rhodi- 
ginus  (j)  ;  who  adds,  that,  among  the  Grecians,  the  fame  circumftance  was 
alfo  found  in  Hermogenes,  a  writer  in  the  art  of  rhetoric.  But  although  I 
am  willing  to  confefs,  that  this  dog  might  be  diffedted,  I  fhould  not,  how¬ 
ever,  readily  believe  that  this  rhetorician  was  differed,  as  he  died  in  thole 
times  in  which  it  was  not  allowable  to  diffedt  human  bodies ;  and  as  by  reafon 
of  long-continu’d  idiotifm,  or  ftupidity  of  mind  (/),  into  which  he  fell  from  , 


(/)  Anthropogr.  1.  3.  c.  7. 

(«)  Comment.  Acad.  Sc.  Imp.  Petropol. 
Tom.  6. 

(?i)  Fad.  ac  Did.  MemorabiL  1,  1.  c.  ult. 
(o)  Natur.  Hift.  1.  m.  c.  37. 


(p)  De  tota  Graecia,  1.  4. 

(7)  In  Parallel. 

(/■)  Vid.  Paufan.  Oper.  cit.  I.  3,  k  1.  9. 

(j)  Led.  Antiq.  1.  4.  c.  16. 

(/)  Ibid .1.  31.  c.  6. 

the 


7  i  2  Book  II.  Of  Difeafes  of  the  Thorax. 

the  mod  keen  and  juvenile  ingenuity,  he  was  rather  entitled  to  the  commi- 
feration  of  every  one,  than  to  the  hoftile  natred  or  rage  of  any  one ;  in  con- 
fequence  of  which  it  might  be  fuppos’d,  as  it  might  have  been  of  the  former, 
that  he  was  inhumanly  treated  after  death.  You  fee,  then,  why  I  fufpend 
my  belief  in  regard  to  moil  of  the  ancient  examples,  and  fear  left  men  ikould 
be  more  inclin’d  to  believe  thefe  circumftances  becaufe  Homer,  in  order  to 
denote  wifdom,  as  Euftathius  («)  thinks,  has  been  obferv’d  to  fay,  “  that 
“  the  heart  was  thick  with  hairs  and  Nonnus  (, x ),  alfo,  that  he  might  better 
exprefs  the  boldnefs  of  the  Sabines,  has  attributed  to  them  “  a  heart  inverted 
“  with  thick  hairs  whether  they  fuppos’d  that  a  kind  of  prudence,  fub- 
tlety,  or  boldnefs,  could  not  eartly  exirt  without  a  hairy  heart ;  efpecially  fince, 
to  pals  over  to  lefs  ancient  examples,  they  have  read  in  Muretus  (y),  Beni- 
venius  (2),  and  Amatus  Lufitanus  ( a ),  that  a  heart  of  this  kind  was  found 
in  three  robbers,  who  had  been  eminent  for  their,  wickednefs  and  boldnefs. 
The  laft  of  which  authors  does  not  give  any  hints  of  what  kind  the  hairs 
were  in  the  man  who,  he  fays,  was  differed  by  him :  nor  yet  does  Scultetus 
Noribergenfis  (Z>),  who  fays,  that  in  a  young  man  who  was,  in  like  manner, 
very  bold  and  audacious,  and  was  diftected  in  this  very  anatomical  theatre, 
in  the  year  1650,  the  heart  was  found  to  be  “  every- where  befet  thickly  with 
“  hairs nor,  in  fine,  did  Lanzonus  (c),  who  found  in  a  plebeian  that  he 
diftected,  the  heart  “  univerfally  hairy.”  Yet  in  regard  to  this  man,  as  it 
appears  that  he  had  been  peripneumonic,  it  is  natural  to  conjefture,  that  he 
had  not  hairs  upon  his  heart,  but  vifcid  concretions,  which  following  the  pe¬ 
ricardium  when  it  was  remov’d  from  the  heart,  by  their  ftendernefs  and  white- 
nefs  reprefented  hoary  hairs.  But  whether  there  be  room  for  the  fame  con¬ 
jecture  in  the  others  who  are  juft  now  fpoken  of,  I  would  not  be  too  hafty 
in  determining  :  although  in  regard  to  the  robbers,  as  they  are  generally 
confin’d  for  a  long  time  in  a  very  filthy  jail,  in  order  to  make  them  difcover 
their  accomplices,  and  confefs  all  their  robberies,  it  is  allowable  to  fuppofe, 
that  they  labour’d  under  a  cachexy’;  and  that  from  this  caufe  a  plentiful,  and 
perhaps  vifcid  and  thick  humour  had  ftagnated  in  the  pericardium. 

Nor  will  you  imagine,  becaufe  the  young  man  difleCted  in  this  theatre  had 
died  immediately  from  a  wound  he  had  receiv’d,  that,  for  this  reafon,  he  had 
been  of  courfe  in  good  health  while  living,  in  regard  to  his  heart  and  peri¬ 
cardium,  efpecially  after  you  have  read,  that  (d)  “  for  many  years  he  had 
“  complain’d  of  a  heat  in  his  heart.”  And  if  you  obferve  befides,  that 
neither  Anthony  Molinetti,  nor  Peter  de  Marchettis,  nor  Dominic  the  fon, 
who  was  an  aftiftant  to  his  father,  nor  the  friend  of  all  thefe,  John  Rhodius, 
who  collected  fuch  a  great  number  of  the  more  rare  oblervations  that  had 
been  taken  here,  have  made,  as  far  as  I  remember,  any  mention  of  this  cir- 
cumftance  in  queftion ;  notwithstanding  iome  of  them,  by  reafon  of  the  of¬ 
fices  enjoin’d  them,  and  others,  by  reafon  of  their  conftant  attendance  in  the 
theatre,  could  not  have  been  ignorant  of  it ;  I  fay,  have  not  made  any  men- 


(n)  Ibid.  1.  4.  cit.  c.  16. 

(x)  Apud  Muret.  Var.  Left.  1.  12.  c.  10. 

(y)  Ibid. 

(z)  De  abdit.  Morb.  &c.  Cauf.  c.  83. 

S  . 


( a )  Cent.  6.  Curat.  Med.  6y. 

(£)  Trichiaf.  admir. 

(c)  EpH.  N.  C.  Dec.  3.  A.  5.  Obf.  122, 

(d)  Trichiaf.  cit. 


f 


tion 


Letter  XXIV.  •  Article  4.  713 

tion  of  it,  not  even  where  Anthony  or  Dominic  have  fince  written  of  the 
heart,  and  of  this  kind  of  hairs  :  if,  therefore,  you  obferve  thefe  things, 
you  will  certainly  be  of  opinion,  that  thofe  appearances,  which  at  firft  fight 
leem’d  to  be  hairs,  had,  when  examin’d  into  more  nicely,  been  found  to  be 
very  far  different  from  them.  And,  indeed,  when  I  call  to  mind  the  rank 
and  family  of  that  young  man,  both  of  which  forbad  him  to  be  brought  into 
the  theatre,  and  publicly  differed,  1  fhoulcl  fuppofe  that  this  cafe  had  been 
forg’d  by  fomebody,  and  related  to  Scultetus  in  fome  other  place,  if  it  did 
not  appear  from  the  books  of  the  univerfity,  in  which  the  names  of  thofe 
of  this  famous  German  nation  are  regifler’d,  that  he  fpent  that  whole  fpace 
of  two  years  here,  in  which  the  year  1650  falls  ;  and  that  for  the  fake  of 
carrying  cn  his  ftudies,  which  the  Germans  had  always  done,  nor  did  after¬ 
wards  ceal'e  to  do,  as  long  as  all  were  at  liberty  to  do  it.  They  who  think 
otherwife  would  fee,  if  they  could  infpedt  thefe  books,  that  this  cuftom  had 
been  really  preferv’d  (to  pais  over  almoft  an  innumerable  number  of  thofe 
who  are  lefs  known)  by  Philip  Jacob  Sachfius,  Jacob  Pancratius  Bruno, 
Chriftian  Mentzelius,  Paul  de  Sorbait,  Jo.  Sigifmund  Elfholt,  Eralmus  Bar¬ 
tholin,  Michael  Syferus,  Henry  a  Moinichen,  Jo.  Daniel  Major,  Mark  Map- 
pus,  Gabriel  Clauderus,  Henry  Meibomius,  Michael  Etmuller,  Jo.  Nico¬ 
laus  Pechlinus,  George  Abraham  Marcklin,  Paul  Hermann,  Luke  Schrock 
the  younger,  Charles  Raygerus,  David  Vander  Becke,  Godfrey  Schulz, 
Jo.  Fabricius,  Jacob  Barnerus,  Jo.  Maurice  Hoffmann,  Jo.  Cafpar  Spar, 
Ferdinand  Charles  Weinhart,  Vitus  Riedlinus,  Francis  Stockhamer,  Jo. 
Adam  Limprechr,  Jo.  William  Pauli,  Jo.  George  Wolckhammer,  Michael 
Frederic  Lochner,  Jo.  Sigifmund  Henninger,  George  Dethardingius,  and 
Jo.  Adam  Genfelius,  who  was  alfo  created  Dodtor  here  in  the  year  1702,  as 
a  great  number  of  the  preceding  gentlemen  were  in  like  manner. 

But  it  is  fufficient  for  me,  left  I  fhould  pafs  over,  without  intention,  any 
one  of  the  juniors,  to  have  brought  you  down  from  that  very  year  1650, 
through  the  fucceffion  of  the  following  years,  quite  to  the  beginning  of 
the  p relent  age-,  lb  that  you  may  eafily  perceive,  whether  about  the  middle 
of  the  former  age,  fo  great  a  change  of  things  was  made  in  Italy,  that  fo¬ 
reigners  left  off  more  and  more  to  come  among  the  Italians  on  account  of 
their  medical  ftudies  ;  being  influenc’d  by  this  reafon  among  others,  that  in 
Italy,  through  the  whole  of  that  age,  they  Hill  follow’d  the  theories  of  Galen ; 
as  if  Thomas  Cornelius,  Leonardo  de  Capua,  Marcello  Malpighi,  Jo.  Al- 
phonfo  Boreili,  Francefco  Redi,  Laurence  Bellini,  Luke  Tozzi,  Bernardin 
Ramazzini,  and  others,  who  have  been  celebrated  among  our  own  country¬ 
men,  and  among  foreigners,  had  either  been  followers  of  Galen,  or  had  not, 
after  the  middle  of  the  preceding  age,  adorn’d  Italy  with  their  do&rine,  and 
with  their  writings.  At  which  time,  neither  Carlo  Fracaffati,  nor  Francefco 
Spoleti,  nor  Jo.  Baptift  Scaramucci,  nor,  finally,  Pompeius  Sacci  himfelf,  were 
by  any  means  propagators  of  the  Galenic  theories,  as  their  lucubrations  (hew, 
as  all'o  the  works  of  Dominic  Gulielmini,  and  George  Baglivi ;  for  fome 
pieces  of  both  thefe  gentlemen  had  come  out  before  the  conclufion  of  that 
age. 

And  fince  nothing  but  the  love  of  truth  has  brought  me  to  this  digrefilon, 
fuffer  me  alfo  toadmonifh  you  of  this  one  thing,  which  relates  equally  to  the 

Vol.  I.  *  4  Y  literary 


7  i  4  Book  II.  Of  Difeafes  of  the  Thorax. 

literary  hiftcry  of  the  fame  age,  that,  if  you  at  any  time  read  the  catalogue 
of  the  Paduan  profeflors  from  the  year  1611  to  the  year  1694,  given  in  the 
Adi  a  Eruditorum ,  which  are  publifh’d  at  Leipfic,  and  in  the  firft  volume  of 
thefe  Ads  (<?),  I  would  have  you  take  notice,  that  no  others  are  lpokcn  of  in 
that  catalogue  but  fuch  as  taught  the  feveral  arts  in  that  year  1682  ;  and  that, 
therefore,  the  names  of  Galilaeo,  Sandorius,  Cafiferi,  Spigellius,  Veflingius, 
Peter  de  Marchetti,  Anthony  Molinetti,  Profper  Alpinus,  Jo.  Praevoti,  and 
Sertorio  Urfato,  are,  of  courfe,  deficient  ;•  not  to  mention  a  great  number  of 
other  illuftrious  men,  who,  within  that  fpace  of  more  than  eighty  years,  en- 
creas’d  the  fame  of  this  our  univerfity. 

But  to  return  to  Scultetus  :  although  it  does  not  fufficiently  appear,  either 
from  his  writings,  or  the  writings  of  thole  I  pointed  out  before  him,  whether 
real  hairs  were  ever  found  within  the  pericardium,  or  only  a  fimilitude  of  hairs  ; 
yet  I  would  not  obftinately  deny  but  it  might  happen,  that,  as  I  myfelf 
found  a  little  bundle  of  hairs  v/ithin  the  dura  mater  of  the  brain  (/),  and 
others  have  found  hairs  in  other  places,  and  even  within  the  right  ventricle 
of  the  heart  of  a  dog  {g)  (could  they  be  carried  thither  with  the  blood  from 
the  purulent  parts  in  which  they  were?);  fo,  I  fay,  I  would  not  obftinately 
deny,  that  fome  perfon  may  have  found,  or  may  find,  the  heart  to  be  fome- 
titnes,  in  fad,  hairy  :  but  if  this  fhould  ever  happen,  I  would  recommend  to 
the  obferver  to  ufe  great  diligence  in  examining  into  their  nature,  and  in 
comparing  them  with  real  hairs.  And  I  fo  much  the  more  rejoic’d,  upon 
revifing  thefe  letters,  that  I  had  with-held  my  aflent  in  this  manner  in  regard 
to  thefe  appearances,  as  the  illuftrious  Senac  (£),  where  he  treats  of  the  ob- 
fervations  which  afifert  that  the  heart  was  hairy,  does  himfelf  alfo  think  in  the 
fame  manner.  But  let  me  return  from  my  digreffion,  which  has  been  longer 
than  I  thought  in  the  beginning  it  would  have  been,  and  yet,  for  more  than 
one  reafon,  not  altogether  ufelefs,  not  to  fay  neceflary,  to  me,  and  go  back 
to  the  purpofe  of  my  letter. 

4.  In  the  papers  of  Valfalva  I  find  no  other  obfervation  but  that  which 
has  been  given  (i),  that  relates  particularly  to  the  pulfe  ;  whereas  there  are  a 
great  number  which  relate  to  this,  at  the  fame  time  that  they  relate  more  to 
other  circumftances :  fo  that  I  have,  for  thefe  reafons,  deferib’d  fome  of  them 
to  you  already,  and  fhall  deferibe  others  hereafter.  I  fhall,  therefore,  proceed 
to  add  my  own,  which  are  not  in  very  great  number  :  nor  need  you  wonder 
at  it;  for  in  the  ninth  fedion  of  the  Sepuichretum,  although  five  and-forty 
obfervations  are  produc’d,  yet  the  firft  feven  ought  to  be  blotted  out,  on  ac¬ 
count  of  their  being  repeated,  as  you  will  immediately  fee  by  comparing  the 
eighth  with  the  twenty-feventh,  the  twelfth  with  the  forty-third,  the  thirteenth 
wTth  the  thirty-ninth,  the  fourteenth  with  the  forty-fourth,  the  fixteenth  with 
the  twenty- firft,  and  the  thirty-eighth  with  the  forty-firft  :  and  Bonetus  him¬ 
felf  exprefly  admoniflies,  that  out  of  the  remaining  obfervations  there  are 
twenty-four  which  belong  fo  much  the  more  to  other  heads,  as  they  are  given 
the  more  at  large  under  thofe  heads.  Wherefore,  from  forty- five  we  are 

ft)  Pag-  375*  ftO  Traite  du  Coeur,  1.  4.  ch.  9.  n.  1.  & 

(/)  Epift.  Anat.  20.  n.  58.  feq. 

{g)  Ait. Erud.Lipf.M.Maj.  A.  1684.  p.215.  (/')  N.  z. 


reduc’& 


Letter  XXIV.  Article  6 .  715 

reduc’d  to  fourteen.  But  be  this  as  it  will,  I  would  have  you  receive  with 
a  willing  mind  what  it  is  in  my  power  to  furnifh  you  with  j  and  firfi:  this 
obfervation,  which  itfelf  alfo  relates  to  an  afphuxia. 

6.  An  old  man  had  already  lain  in  this  hofpital  three  months  from  the 
time  of  breaking  his  leg,  .being  troubl’d  with  a  (light  but  obftinate  fever, 
when,  contrary  to  expectation,  it  was  luddenly  obferv’d  that  the  man  had  no 
pulfe,  though  it  had  not  been  accuftom’d  fo  much  as  to  intermit,  and  not- 
withftanding  he  affirm’d  that  he  was  not  worfe  at  this  very  time  than  he  us’d 
to  be.  And  to  confirm  what  he  faid,  he  immediately  lifted  himfelf  up  in 
bed,  and  fat  upright :  yet  very  foon  after  he  really  died. 

His  head,  together  with  his  neck,  and  the  greater  part  of  the  vifeera,  were 
accurately  differed  by  me,  in  order  to  demonftrate  to  the  fiudents,  at  that 
convenient  feafon,  for  it  was  about  the  beginning  of  December,  in  the  year 
1730,  many  parts  which  do  not  relate  to  the  fubjeft  now  in  hand.  But 
what  appearances  of  difeafe  there  were,  or  of  any  thing  preternatural,  fall,  of 
courfe,  under  our  prefent  confideration.  Although  no  water  had  come  forth 
from  the  tube  of  the  vertebrae,  while  the  upper  vertebrae  of  the  neck  were 
disjoin’d  from  the  lower,  yet  a  confiderable  quantity  flow’d  out  from  the 
cavity  of  the  cranium,  while  it  was  cut  through  round  about.  And  there 
was  no  fmall  quantity  in  the  lateral  ventricles.  Yet  the  fubftance  of  the 
cerebrum  was  not  only  not  lax,  but  perhaps  the  hardeft  of  all  the  fubftances 
which  occurr’d  to  me  :  nor  were  the  blood-veffels  pallid,  but  even  fill’d  with 
black  blood  in  the  greater  part  of  them,  and  efpecially  the  (inufles.  In  thofe 
two  arteries  which  run  between  the  two  hemifpheres  of  the  brain,  and  near 
the  upper  furface  of  the  corpus  callolum,  were  bubbles  of  air  contain’d  :  and 
yet  the  weather  was  very  cold,  and  it  was  no  more  than  the  third  day  after 
his  death,  nor  was  there  the  lead  mark  of  putrefaction.  A  confiderable  por¬ 
tion  of  the  parietes  of  the  right  carotid  artery,  where  it  arofe  from  its  re¬ 
ceptacle,  was  become  thicken’d,  and  of  a  middle  nature  betwixt  a  ligament 
and  a  cartilage,  yet  (till  on  its  internal  furface  was  membranous :  a  diforder 
of  which  kind  feem’d,  alfo,  to  have  already  begun  in  other  of  the  larger. ar¬ 
teries  of  the  cerebrum.  But  on  the  outlide  of  the  cranium  this  offification 
was  (till  more  confiderable.  For  on  one  fide  of  the  neck,  at  the  very  divifion 
of  the  carotid  artery,  a  pretty  large  bony  plate  was  within  its  coats :  and  the 
trunk  of  the  fame  artery  was  univerfally  and  confiderably  dilated,  whereas  in 
the  other  carotid  there  was  a  proper  degree  of  latitude. 

However,  when  I  examin’d  the  vifeera  of  the  thorax,  and  the  great  vefiels, 

I  no-where  obferv’d  any  dilatations  •,  although  the  aorta,  near  to  the  valves, 
fhew’d  fome  tokens  of  a  future  offification,  and  in  other  places  alfo  ;  and, 
indeed,  it  had  a  fmall  bony  lamina  under  its  innermoft  coat,  where,  having 
lent  off  the  lefc  fubclavian,  it  already  began  to  delcend.  The  ventricles  of 
the  heart,  and  efpecially  the  right,  and  the  great  vefiels,  were  occupied  here 
and  there  with  polypous  concretions ;  and  in  one  of  thefe  vefiels  was  a  whitifli 
kind  of  concretion,  of  fo  compact  a  nature,  that  it  greatly  refilled  the 
fingers  when  we  attempted  to  pull  it  afunder. 

iThe  vifeera  of  the  belly  had  no  mark  of  difeafe,  except  one  of  the  kidnies, 
which,  under  its  own  proper  coat,  contain’d  a  cell  capable  of  admitting  a 
horfe-bean  ;  and  this  cell  was  full  of  ferum.  I  will  not  omit  even  this,  that, 

4  Y  2  at 


7  i6  Book  II.  Of  Difeafes  of  the  Thorax. 

at  the  fides  of  the  feminal  caruncle,  granules,  as  it  were,  of  tobacco  were 
found  ;  and  that  in  the  pendulous  part  of  the  urethra  there  was  no  more 
than  one  of  all  the  little  canals  found  out  by  me ;  and  that  a  very  frnall  one. 
And  to  (hew  you  the  more  clearly,  that  I  had  negledted  nothing  of  any  ap¬ 
pearance  which  feem’d  to  depart,  even  in  a  fmall  degree,  from  the  general 
cuftom  of  nature  in  this  body,  take  alio  this  obiervation,  that  from  almoft 
the  whole  circle  of  the  helix  of  both  the  external  ears,  fuch  long  hairs  hung 
down,  in  this  man,  and  grew  fo  thick,  that  you  rarely  meet  with  whifkers 
which  could  be  compar’d  with  thefe  hairs. 

7.  You  mu  ft  confider  with  yourfelf,  whether  you  would  have  this  fbort 
afphuxia  accounted  for  from  the  water  being  fuddenly  extravafated  within 
the  cranium,  which,  not  being  able  to  injure  the  cerebrum  greatly,  as  it  was 
in  this  body  very  hard,  fo  comprefs’d  the  cerebellum,  that,  the  influx  of  fpirits 
into  the  heart  being  dimin.fh’d,  it  could  not  at  firft  drive  forth  the  blood 
into  the  arteries,  except  with  a  weak  and  almoft  infenfible  impulfe ;  and  foon 
after,  when  death  at  length  came  on,  it  could  exert  no  impulle  at  all.  So 
alfo,  if  you  read  over  again  the  fourteenth  letter  that  I  have  fent  to  you  (£), 
you  will  fee,  that  the  boy  whofe  cerebellum  had  been  partly  deftroy’d  by 
pus,  had  been  entirely  without  pulfe  for  a  great  number  of  days.  But  if 
you  (hould,  perhaps,  be  lefs  pleas’d  to  explain  the  cale  in  this  manner,  which 
does  not  exceedingly  pleafe  me,  or  by  any  other  theory  of  this  kind,  than 
to  refer  the  whole  to  thole  polypous  concretions,  you  will  then,  indeed,  have 
a  great  number  of  modes  of  explication,  by  which,  if  you  ftretch  them  to 
their  utmoft  extent,  you  may,  at  length,  bring  this  reference  about;  but 
whether  you  can  do  it  with  juftice,  or  nor,  you  ought  to  enquire  with  dili¬ 
gence  again  and  again.  You  may  be  fure  it  does  not  efcape  me,  that  you 
may  read,  in  the  Sepulchretum,  two  obfervations  of  an  afphuxia,  the  one  (/) 
in  a  man  for  a  whole  day,  the  other  ( m )  in  a  virgin  for  four-and  twenty  hours, 
both  of  which  deferibe  concretions  of  this  kind  found  in  the  heart;  and 
that  to  thefe  may  be  added,  from  others  previoufly  publifh’d,  although 
omitted  in  that  work,  one  of  Sebaftianus  Piflinius  ( n)y  made  upon  a  noble 
matron,  by  name  Clara  Spada,  who,  having  been  without  pulfe  “  for  forty 
“  days  and  more,”  exhibited  bodies  of  this  kind  in  both  the  ventricles  of 
the  heart :  and,  moreover,  not  to  depart  from  the  Sepulchretum  ;  that  the 
large  veflels  of  the  heart  were  fill’d  with  concreted  blood  in  a  man  who  had, 
for  a  very  long  time,  labour’d  under  an  afphuxia  (0) ;  and  that,  in  another  who 
had  been  affected  in  the  fame  manner  “  for  four  months  before  his  death, 
“  no  other  caufe  M  of  fo  long- continu’d  an  afphuxia  was  found,  but  ten  or 
twelve  coagula  of  black,  thick,  and  concreted  blood  in  the  aorta  near  the 
heart  (/>). 

But  not  to  enquire,  whether,  in  all  thefe  obfervations,  there  was  no  caufe 
befides,  and  efpecially  in  this  laft,  which,  as  it  is  given  in  more  than  one 
place  of  the  Sepulchretum  (q)  pretty  much  at  large,  may  be  better  examin’d 
into  by  you  ;  or  in  that  which  I  faid  related  to  a  virgin,  in  whom  you  will 

(A  N.  3.  (1)  Sett,  hac  9,  Obf.  4.'  ( 0 )  Sett,  hac  9.  Obf.  45. 

(m)  In  ipfo  fine  Sett.  8.  (/>)  Ibid.  Obf.  7. 

(«)  Epift.  de  Polypo  Cordis.  (^)  Ex  gr.  1.  2.  S.  3.  Obf.  22.  §  2. 

;  obferve 


Letter  XXIV.  Article  8.  717 

obferve  that  the  heart  was  very  much  enlarg’d  ;  I  (hall  have  a  very  proper 
occafion  belofo  (r)  of  admonifhing  what  ought  to  be  done,  before  we  depend 
upon  obfervations  of  polypous  concretions  without  an  almoft  certain  danger 
of  falling  into  errors.  In  the  mean  while,  however,  call  to  mind  that  young 
man,  whom  I  defcrib’d  in  the  latter  end  of  the  twenty-firft  letter  (j),  as  being 
without  pulfe,  and  whofe  heart,  like  that  of  the  virgin,  was  very  much  en¬ 
larg’d,  but  without  any  concretion  of  blood.  And  the  fibres  of  this' heart, 
being  foften’d  to  the  greateft  laxity,  may  render  it  doubtful,  whether  this, 
or  the  enlarg’d  ftate  of  the  heart,  deferv’d  moft  to  have  the  afphuxia  attri¬ 
buted  to  it  ;  although  there  feems  not  the  lead:  reafon  to  doubt,  that  it  was 
owing  to  the  conjun&ion  of  both.  So,  alfo,  you  will  remember,  that  in  the 
eighteenth  letter  (/)  a  woman  has  been  defcrib’d,  who  had  her  heart,  in  the 
fame  manner,  much  enlarg’d  ;  yet  that  I,  neverthelefs,  thought  the  caufe  of 
her  frequent  afphuxia  could  not  be  fufficiently  explain’d  without  the  addition 
of  convulfion.  For  although,  as  often  as  fhe  was  leiz’d  with  a  convulfive 
afthma,  as  it  feem’d,  and  came  into  the  hofpital,  her  pulfe  could  not  be  per¬ 
ceiv’d  ;  yet  it  is  more  probable,  that  (he  had  been  without  pulfe  only  in  the 
paroxyfms,  as  hyfterical  women  frequently  are,  than  that  fhe  had  been  con¬ 
tinually  without  any  pulfe  for  the  fpace  of  fix  years  together.  For  they  who 
are  continually  without  a  pulfe,  do  not  feem  able  to  live  fo  long,  (although 
Riolanus  ( u )  fays,  that  he  has  leen  fuch  perfons  live  even  much  longer,  but 
“  with  the  moft  extreme  dejedtion  of  ftrength,”  which  was  not  in  this 
woman)  unlefs  it  fhould  happen  from  the  arteries,  which  phyficians  are  us’d 
to  feel,  being  either  fmall,  or  not  lying  in  their  natural  fituation,  or  for  fome 
reafon  or  other  obftrudled  •,  none  of  which  circumftances  was  found  in  this 
woman.  And  they  are  fmall  in  thofe  perfons  where  they  are  divided  into 
many,  or  in  whom  the  ulnar  arteries  have  happen’d  to  be  the  thickeft  :  and 
they  are  out  of  their  natural  fituation,  when  they  are  fituated  at  a  greater 
depth  than  ufual;  where  they  were  found  by  the  celebrated  Torres  (x), 
in  the  diffedtion  of  a  woman  who,  when  living,  feem’d  to  be  without 
pulfe;  or  when  they  run  upon  the  back-part  of  the  radius  ;  for  this  courfe 
I  fhould  fuppole  the  artery  muft  have  taken  in  Starkmann  ( jy),  whofe  pulfe 
was  not  in  its  ufual  feat,  but  between  the  thumb  and  the  fore-finger.  And 
that  it  may  be  obftrudted  in  more  ways  than  one,  I  fhall  (hew  prefently. 

8.  Other  examples  of  that  kind  of  natural  afphuxia,  either  in  both  of  the 
wrifts,  or  in  one  of  them,  you  find  remark’d  in  the  Sepulchretum  (z)  •,  fo 
that  there  is  no  occafion  to  relate  fuch  as  have  occurr’d  to  me  in  the  prac  ¬ 
tice  of  phyfic.  And  you  have,  at  the  fame  time,  the  method  pointed  out,, 
which  we  ought  to  ufe,  by  way  of  caution,  to  prevent  our  being  impos’d 
upon  by  either  the  one  or  the  other  kind  of  afphuxia:  although  the  fecond 
can,  indeed,  deceive  no  phyfician  whatever,  but  fuch  as  having  felt  one  wrift 
only,  immediately  pronounce  upon  the  pulfe,  which  I  wonder  that  Mina-- 
dous  (a)  fhould  do  ;  for  in  proportion  as  one  pulfe  feems  to  be  the  more  terrily- 


(r)  N.  30.  (s)  N.  49. 

(/)  N.  34,  &  35. 

(«)  Encheir.  Anat.  1.  5.  c.  4 6. 
(*•)  DifT,  de  Cord,  inverfo. 


(y)  Eph.  N.  C.  Cent.  10.  Obf.  42. 

(z)  in  Schol.  ad  Obf.  1.  Sedt.  hujus,  &  ad. 
Obf.  10. 

(«)  Ibid. 


7  i  8  Book  II.  Of  Difeafes  of  the  Thorax. 

ing,  fo  much  the  lei's  ought  the  examination  of  the  other  to  be  omitted  :  and 
if  the  pulfe  be  deficient  in  both  wriits,  other  arteries  are  to  be  examin’d  •,  as, 
for  inltance,  the  temporal  arteries  and  carotids ;  and  finally  alio,  when  it  is 
permitted,  the  crural  arteries,  which  have  a  puliation  in  the  groins  j  for  it  is 
not  altogether  true,  “  that  the  evidence  and  magnitude  ”  of  the  carotid  ar¬ 
teries  “  is  no  lei's  ”  than  of  thefe  •,  though  it  does  not  efcape  me,  however, 
that  by  reafon  of  their  lefifer  diltance  from  the  heart,  they  are  worthy  of  pe¬ 
culiar  attention  in  regard  to  this  point. 

And  either  kind  of  alphuxia  does  fometimes  happen  from  an  accidental 
obltruCtion  of  both  or  one  of  the  arteries,  which  we  generally  feel  in  the 
wriits  ;  nor  are  examples  of  this  kind  wanting,  in  the  Sepulchretum  (b).  And 
to  thefe  belongs  that  which  Lancifi  (c)  takes  notice  of,  and  which  I  have  feen 
in  “  the  marquis  Paulucci.”  For  he  refers  to  the  fame  nobleman,  of  whofe 
difeafe  and  difiedtion  I  have  written  the  greater  part  to  you  already  {d)  :  to 
which  you  may  alfo  add  this  for  a  certainty,  that  in  the  left  wriffc  no  pulfe 
could  be  perceiv’d.  But  whether  this  was  owing  to  a  polypous  concretion, 
that  almolt  fill’d  the  left  fubclavian  artery,  in  which  way  a  fimilar  obferva- 
tion,  that  was  afterwards  made  in  another  nobleman,  is  explain’d  ;  or  whether 
it  could  be  accounted  for  from  any  other  caufe ;  as  I  was  abfent,  and  did  not 
examine  the  aneurifm  which  was  at  the  curvature  of  the  aorta,  I  leave  quite 
undetermin’d.  '  However,  I  remember  a  certain  obfervation  of  Harvey  (<?), 
which  I  do  not  find  in  the  Sepulchretum  ;  I  mean  one,  in  which  an  aneurifm 
was  found  “  on  the  right  fide  of  the  neck,  near  to  the  defcent  of  the  fub- 
“  clavian  artery  into  the  axilla,  that  had  its  origin  from  the  corrofion  of  the 
“  artery  itlelf;-  -and  that  in  this  man  the  pulfe  of  the  fame  arm  was  very 
“  fmall,  for  this  reafon,  becaufe  the  greater  part  of  the  blood  was  diverted 
“  from  its  ulual  courfe  into  the  tumour.” 

But  from  what  caufe  fhall  we  fay  it  happen’d  in  a  much  fhorter  difeafe  ; 
I  mean,  in  a  peripneumony,  that  the  man  from  whom  the  thirtieth  obfer¬ 
vation  of  this  feCtion  was  taken,  “  had  the  pulfe  in  his  right  hand  almoft 
“  abolifh’d  ?”  Was  it  from  what  the  author  of  the  obfervation,  Saxonia,  fays, 
“  that  the  inflammation  in  the  right  fide  of  the  lungs  was  more  hard,  and 
“  more  extenfive  ?”  And  if  it  were  from  thence,  was  it  for  this  reafon, 
that  the  right  fubclavian  artery  was  comprefs’d  by  the  neighbouring  lungs 
being  in  that  Ihate  ?  But  if  we  fuppofe  this,  we  mult  then  confider  to  what 
caufe  it  can  be  owing,  that  where  there  is  a  fimilar  inflammation  of  the  lungs 
on  one  fide,  and  in  their  upper  part,  which  certainly  is  no  very  rare  cafe, 
we  do  not  find  a  fimilar  abolition  of  the  pulfe  on  the  fame  fide. 

Yet  1  fhould  much  more  readily  believe,  that  a  vomica  of  the  lungs  had 
been  difcover’d,  in  difleCtion,  by  Spindlerus  (/),  to  have  been  the  caufe  of  an 
afphuxia  in  an  infant,  than  I  fhould  grant,  that  from  a  diforder  of  the  lungs, 
on  the  left  fide,  (which  a  celebrated  profefibr  formerly  faid  he  had  predicted 
from  the  pulfe,  and  that  he  found  agreeably  to  his  prediction)  the  pulfe  in 
the  left  wrilt,  in  like  manner,  had  become  very  low  and  very  weak. 

/ 

(e)  De  mot.  cord.  Exerc.  i.  c.  3. 

(f)  Vid.  ACl.  Lipf.  A.  1691.  M.  Janu. 

9.  But 


( b )  in  Schol.  ad  cit.  Obf.  1. 

(r)  De  Aneur.  1.  2.  Propof.  38. 
(d)  Epift.  17.  n.  26.  &  27. 


Letter  XXIV.  Article  9.  719 

9.  But  to  pafs  by  thefe  afphuxite  of  one  or  of  both  the  arms,  whether 
they  proceed  from  difeafe  or  from  nature  itl'elf,  and  thofe  alio  which  occur 
in  all  the  arteries  whatever,  that  phyficians  can  feel  about  the  latter  end  of 
mortal  diforders,  and  that  frequently  for  the  fpace  of  two  or  three  days  be¬ 
fore  death,  and  which  therefore  are  not  to  be  wonder’d  at,  inafmuch  as  they 
are  join’d  with  the  greateft  dejection  of  all  flrength  and  vital  powers,  and 
a  dullnefs  of  all  the  fenfes  ;  there  certainly  is  great  difficulty  in  accounting 
for  thofe  other  fpecies  of  afphuxia,  which  I  fpoke  of  above.  For  the  pa¬ 
tients  have  their  internal  and  external  fenfes  in  a  very  vigorous  ftate  ^  they 
fpeak  with  eafe ;  they  turn  themfelves  from  fide  to  fide  (g)  •,  and  fome  even 
raife  themfelves  up  haftily  (h)  •,  and  which  our  Ramazzini  faw  himfelf  (/),  a 
young  man,  who  was  a  Jew,  in  whom,  for  four  days,  “  the  arteries  had 
“  pulfated  in  no  part,  was  fo  robuft  and  ftrong,  and  fo  nimble  in  his  mo- 
“  tions,  that  even  on  the  very  day  on  which  he  quitted  this  ftate  of  the 
“  living,  he  rofe  up  out  of  bed,  and  put  on  his  clothes.”  He  had  been, 
indeed,  for  the  whole  fpace  of  thofe  four  days,  quite  cold,  and  had  not  dif- 
charg’d  any  urine.  But  coldneftes  and  renal  ifchuriae  were,  in  other  refpefts, 
<c  very  frequent  ”  in  thofe  patients  (k) :  yet  I  do  not  remember,  that  either 
of  them  has  been  obferv’d  in  molt  of  the  hiftories  of  this  kind,  till,  per¬ 
haps,  about  the  end  of  the  afphuxia  •,  yet  in  that  fellow-citizen  of  mine,  at 
lead,  whom  I  have  taken  notice  of  in  the  Adverfariaf/),  coldneffes,  at  length, 
came  on  the  laft  night ;  and  I  then  faw  that  the  urine  was,  indeed,  of  a  black 
colour,  but  not  fupprefs’d. 

Now  then  fuppofe  whichever  caufe  of  an  afphuxia  you  pleafe,  out  of  thofe 
that  generally  happen,  and  that  are  taken  notice  of  above  (m) ;  and  then  tell 
me,  I  befeech  you,  why  the  motions  and  functions  of  the  other  parts  do  not 
ceafe  immediately,  as  they  do  in  a  fyncope,  when  the  motion  of  the  arteries 
is  ceas’d  ?  You  will  fay,  that  in  an  afphuxia  the  heart  is  not  only  not  at 
reft,  which  I  myfelf  acknowledge,  for  even  Pilfinius  confeffes,  in  regard  to 
the  noble  matron  Clara  Spada  (»),  “  that  the  hand  being  applied  to  the  left 
“  part  of  the  thorax,  there  appear’d  to  be  a  kind  of  obfcure  motion  in  the 
<c  heart  but  that  the  arteries  themfelves,  efpecially  the  larger  and  more  in¬ 
ternal  arteries,  do  really  pulfate,  though  it  is  but  very  (lightly.  Yet  you 
cannot  clearly  fhow  how  it  happens,  that  in  fo  great  a  diminution  of  the  mo¬ 
tion  of  the  blood,  the  patients  are  able  to  do  thofe  things  which  I  juft  now 
mention’d  •,  and  why  palenefs,  coldnefs,  dullnefs,  and  an  incapacity  of  fpeak- 
ing,  eating,  and  moving  themfelves,  do  not  immediately  come  on,  as  they 
did  not  in  that  man  whom  I  faw :  and  even  why,  after  “  they  have  liv’d 
<c  many  days  together  in  an  entire  ftate  of  coldnefs,”  the  power  ftiil  remains, 
in  fome  of  them,  of  again  “  growing  warm,”  as  Ramazzini  has  obferv’d  {0) ; 
nay,  what  is  (till  more,  of  reviving  into  very  good  health  again,  after  having 
been,  for  fix  whole  days,  without  pulfe,  as  I  have  taken  notice  of  from  Bar¬ 
tholin,  in  the  Adverfaria  (y>). 


(g)  fupra,  n.  2. 

(b)  n.  6. 

(0  Conftit.  Epid.  A.  1692.  &  feqq.  n.  23. 
\k)  Ibid.  n.  53. 

(ft  u.  Animad.  44. 


(»>  n-  3-  4-  7- 

(»)  Vid.  fupra,  n.  7. 

(0)  Conftit.  cit.  n.  33. 

(p)  Animad.  indicam.  * 

But; 


y  2  0  Book  II.  Of  Difeafes  of  the  Thorax. 

But  you  and  pofterity  will,  perhaps,  clear  up  thefe  things:  as  to  myfelf, 

1  ingenuoufly  confefs,  that  1  am  not  quite  clear  on  this  head,  which  I  there 
alio  acknowledg’d  (q). 

But  you  will,  perhaps,  fay  here,  that  it  is  much  more  difficult  to  conceive, 
how  life  can  be  preferv’d  in  thofe  who  have  been  long  plung’d  under  water, 
and  are  brought  out  like  dead  perfons.  For  that  in  an  afphuxia,  refpiration, 
and  confequently  forne  internal  kind  of  circulation,  does,  at  lead,  continue, 
which,  in  the  others,  is  entirely  intercepted ;  and  for  this  reafon  it  mult  of 
courfe  happen,  that  the  circulation  is  entirely  fufpended  *,  becaufe  without 
the  air  alternately  to  dilate  the  veffels  of  the  lungs,  no  blood  can  pafs  out 
from  thence  into  the  left  ventricle  of  the  heart*,  and  if  this  cavity  throw  out 
nothing  into  the  arteries,  the  circulation  immediately  fails. 

And  who  do  you  fuppofe  will  deny,  that  thefe  things  are  alfo  very  diffi¬ 
cult  to  be  explain’d  ?  Yet  thefe  drown’d  perfons  lie  like  thofe  that  are  re¬ 
ally  dead  :  whereas  thofe  who  are  feiz’d  with  an  afphuxia,  go  on  to  perform 
all  the  functions  that  healthy  men  are  wont  to  perform,  as  I  have  faid  ;  and 
not  only  fuch  as  living  men  neceffarily  perform  :  and  this  was  chiefly  what 
excited  my  wonder.  Hereafter,  perhaps,  fome  light  will  be  thrown  upon 
this  very  obfcure  fubjedt,  if  the  carcale  of  the  woman,  who  perhaps  {till 
lives  at  Paris  (r),  fhall  be  examin’d  with  fuch  care  as  it  ought  to  be,  and  as 
they  generally  are  in  that  place  :  although  the  afphuxia  of  this  woman  has 
been  from  her  very  birth  *,  and  if  we  confider  what  kind  of  a  body  hers  is, 
as  to  its  colour,  heat,  menltrual  purgations,  and  health  ;  and  at  the  fame 
time,  if  you  confider  the  fmallnels  and  fpare  habit  of  her  only  child ;  it  will 
l'eem  to  be  lefs  lurprizing  that  not  the  leaft  puliation  of  any  artery,  or  of 
the  heart  itfelf,  not  even  after  the  molt  violent  exerciles,  or  in  the  greateft 
heat  of  fevers,  to  which  (lie  is  very  liable,  has  been  perceiv’d. 

to.  The  neareft  diforder  to  an  afphuxia,  is  that  of  a  very  remarkable 
fmallnefs  of  the  pulfe,  join’d  with  vveakncls,  fometimes  from  nature  itfelf, 
but  more  frequently  from  difeafe.  That  this  fymptom  was  natural,  I  judg’d 
in  a  woman  us’d  to  great  exercile,  and  robuft,  who  was  troubl’d  with  a  vi¬ 
olent  angina :  for  which  reafon  I  was  by  no  means  deterr’d  by  this  pulfe, 
though  a  young  man,  from  ordering  fo  much  blood  to  be  taken  away,  as 
the  diforder  requir’d.  And  the  recovery  of  the  woman  prov’d  to  me,  that  I 
had  not  been  deceiv’d,  as  I  afterwards  found  in  her,  when  fhe  was  in  very 
good  health,  the  very  fame  kind  of  pulfe,  and  aferib’d  it  to  the  natural 
llendernefs  of  the  arteries,  which  lie  immediately  under  the  (kin. 

But  when  this  pulfe  has  been  owing  to  difeafe,  it  has  happen’d,  that  I 
found  it  quite  different  in  different  perfons,  as  the  hiftories  which  follow  will, 
in  part,  demonflrate :  I  fay  in  part,  for  thofe  which  give  inftances  of  the 
very  great  laxity  of  the  fibres  of  the  heart,  are  either  already  fent  to  you  (s), 
or  will  be  fent  to  you  hereafter  (7).  . 

1 1 .  A  man,  of  forty  years  of  age,  had  a  tumour,  which  grew  under  the  fkin 
that  invefts  one  fide  of  the  occiput,  of  the  kind  that  is  call’d  talpa,  and  tef- 
tudo.  This  tumour  having  degenerated  into  an  abfeefs,  at  length  carried  off 

(7)  Vid.  &  Animad.  42.  43.  (s)  Epift.  11.  n.  13.  &  Epilt.  21.  n.  49. 

(r)  Hill,  de  l’Acad.  R.  des.  Sc.  A.  1748.  (/)  Epift,  30.  n.  15. 


6 


the 


Letter  XXIV.  Article  12»  721 

the  patient.  Never  were  there  any  complaints  ,pf  the  thorax,  nor  any  diffi¬ 
culty  of  refpiration.  The  pulfe  was  neither  very  quick  nor  (low,  nor  inter¬ 
mitting,  nor  by  any  means,  or  at  any  time,  unequal ;  and  had  only  been  de¬ 
ficient  in  this  one  circum  fiance,  that  it  was  weak,  and  very  fmall.  All 
which  fymptoms  I  was  particularly  afiur’d  of,  upon  enquiry,  by  the  phyfi* 
cian  who  had  vifited  him  very  often,  and  who  happen’d  to  be  in  the  anato¬ 
mical  theatre  at  the  time  the  man’s  thorax  was  cut  into,  and  alfo  examin’d 
the  vifcera  of  this  cavity  himfelf,  while  I  was  examining  them. 

The  lungs  coher’d,  univerfally,  with  the  pleura,  were  lax,  and  extremely 
foetid.  The  heart  alfo,  and  its  auricles,  although  the  latter,  in  a  fomewhat 
lels  degree,  had  the  pericardium  attach’d  to  them  all  round  about.  The 
aorta,  where  it  defcended  upon  the  vertebras  of  the  thorax,  fhew’d,  here  and 
there,  confiderable  marks  of  a  kind  of  incipient  erofion,  and  (till  more  of  a 
future  ofimcation,  though  fmaller  in  their  extent.  Nodiforder,  befides  thefe, 
was  obferv’d  in  the  thorax. 

All  the  other  parts  in  general,  and  amongft  thefe  the  head,  I  negle<5ted  to 
dified:-,  not  fo  much  on  account  of  the  putrid  fmell,  as  from  the  neceffity  of 
differing  a  better  body  that  was  brought  to  me,  in  the  mean  while,  in  order 
to  finiQi  the  public  demonftrations  of  that  year,  which  was  1727,  and  was 
now  very  far  advanc’d,  as  to  the  feafon  for  dilTedion. 

12.  I  could  wifii,  now,  that  I  had  examin’d  the  infide  of  the  cranium  of 
this  man,  to  fee  whether  the  cerebellum,  which  lay  fo  near  to  the  tumour 
and  abfcefs,  had  any  taint  therefrom,  that  I  might  have  compar’d  it  with 
what  I  have  hinted  above  (u)  •,  not  fo  much,  indeed,  in  regard  to  the  com- 
prefilon  of  the  cerebellum  in  an  afphuxia,  as  in  regard  to  its  being  vitiated 
by  the  pus,  which  had  penetrated  through  the  caries  of  the  cranium  from 
the  exterior  abfcefs,  in  the  manner  defcrib’d  above  ;  or  with  thofe  things  which 
I  wrote  in  another  letter  (#),  of  a  woman  who  had  her  pulfe  very  low,  and 
her  cerebellum  very  lax :  although  to  you,  perhaps,  there  will  leem  to  have 
been  found  caufes  enough  in  the  thorax  of  the  man  we  are  fpeaking  of.  But 
that  the  univerfal  adhefion  of  the  lungs  to  the  pleura  makes  nothing  to  the 
prefent  purpofe,  is  demonftrated  by  a  great  number  of  other  bodies,  of  which 
you  will  read  even  in  my  letters.  And  as  to  the  ftrong  and  putrid  fmell  of 
this  vifcus,  it  is  better,  perhaps,  to  account  for  it  from  the  fanies,  which  had 
been  carried  thicher  from  the  abfcefs  in  the  laft  days  of  his  life,  by  the  cir¬ 
culation  of  the  blood,  than  to  endeavour  to  account  for  the  previous  diforder 
of  the  pulfe  from  this  putrid  and  lax  ftate  of  the  lungs.  Finally,  there  was 
a  difeafe  in  that  part  of  the  aorta,  from  whence  the  arteries  that  go  to  the 
wrifts  do  not  proceed.  It  remains,  therefore,  to  fpeak  of  that  univerfal  ad¬ 
hefion  of  the  heart  to  the  pericardium,  from  which  you  may  fuppofe  it  to 
have  happen’d,  that  the  heart  being  conftrifted  and  confin’d  within  its  co¬ 
vering,  could  expand  itfelf  lefs  than  it  ought,  in  order  to  receive  a  proper 
quantity  of  blood,  and  confequently  lefs  than  is  requir’d,  in  order  to  pufii 
the  blood  forwards  into  the  arteries ;  efpecially  as  I  (hall,  hereafter,  give  you 
another  hiftory  (j),  in  which,  after  a  fmall  and  weak  pulfe,  I  found  the  pe- 

(»)  n.  7,  (*)  XV.  n.  8.  (y)  Epift.  35.  n.  12. 

V01..  I.  4  Z  ricardium 


722  Book  II.  Of  Difeafes  of  the  Thorax. 

ricardium  every  where,  though  not  very  clofely,  connected  to  the  heart  ;  and 
as  in  the  former  leiter  (z),  I  took  notice  of  Peyerus  and  Lower,  both  of 
whom  obferv’d  a  pulfe  of  this  kind  in  thofe  who  had  the  pericardium  con¬ 
nected  to  the  heart-,  that  13,  the  latter  a  “  weak  55  pulfe,  and  the  former,  one 
both  “  fmall  and  weak.” 

Yet,  on  the  other  hand,  we  mult  not  forget  that  Dionis,  Freind,  and  Le 
Fay,  whom  I  in  that  place  equally  commended  0),  have  mention’d,  in  a  cafe 
of  this  kind,  a  pulfe  that  was  vehement  and  quick,  and  correfponding  with 
the  palpitation,  which  was  great.  It  leems,  therefore,  that  fomething  elfe 
ought  to  be  added,  or  not  added,  that  the  fame  caufe,  in  appearance,  may, 
at  one  time,  produce  this  kind  of  pulfe,  and  at  another  time,  the  kind  of 
pulfe  which  is  quite  oppofite  to  it.  But  whether  any  thing  was  added,  in 
the  obfervations  of  thofe  three  very  learned  men  of  whom  1  fpoke  laft,  and 
what  it  was  that  was  added,  if  any  thing  really  were  added,  you  will  be  able 
to  conjecture  from  thofe  things  which  have  been  already  hinted  in  the  exa¬ 
mination  of  thefe  obfervations. 

There  is,  alfo,  more  than  one  paffage  in  the  illuftrious  author  Senac,  by 
reading  over  which  attentively  you  may  be  better  able  to  judge  of  the  caufes 
of  pulles,  which  are  diametrically  oppofite  to  each  other;  as,  for  inltance, 
w'here  ( b )  he  fhews,  how  it  may  come  to  pafs,  that  with  vehement  and  large 
pulfations  of  the  heart,  fmall  and  weak  pulfations  of  the  arteries  are  fre¬ 
quently  join’d;  yet  fometimes  both  ftrong  and  large  :  or  where  (r)  he  teaches, 
and  that  even  when  there  is  no  palpitation,  why  both  the  former  and  the 
latter  kind  of  palpitations  in  the  arteries  are  fometimes  to  be  accounted  for 
from  the  lungs:  or  finally,  where  (d)  very  clearly  explaining  all  the  doCtrine 
of  pulfes,  which,  in  regard  to  the  feveral  diftinCtions  of  pulfe,  you  will 
not  be  forry  for  having  confulted  ;  he  deduces  this  diftinCtion  of  weak- 
nefs  and  fmallnefs,  which  we  fpeak  of  (<?),  not  only  from  the  force  of  the 
heart  being  languid,  or  from  the  fmall  quantity  of  blood,  but  even  from 
the  refiftance  of  the  arteries  being  encreas’d,  by  reafon  of  which  they 
yield  fo  much  the  lels  to  the  dilating  force  of  the  heart,  as  at  the  fame 
time  they  are  able  to  admit  fo  much  the  lefs  quantity  of  blood,  on  account 
of  the  fame  refiftance  (/).  And  he  teaches  that  the  refiftance  is  encreas’d 
at  one  time,  by  the  too  great  plenitude,  which  leaves  fcarcely  any  room 
for  farther  dilatation,  nor  yet  for  conftriCtion ;  from  whence  it  happens, 
that  in  thefe  cafes  the  pulfe  becomes  not  only  larger,  but  ftron^er  alfo  from 
blood-letting  ;  and  at  other  times,  by  reafon  of  the  coats  of  the  arteries  be¬ 
ing  contracted  by  the  nerves,  as  particularly  happens  in  hyfterical  women 
when  we  perceive  the  arteries  to  be  reduc’d  to  the  fize  of  a  (lender  thread  • 
and  even  the  pulfe,  in  fome  parts,  is  entirely  fupprefs’d,  from  whence  thefe 
parts  are  cold,  at  the  time  that  the  other  parts  are  warm  (g).  And  from 
hence,  I  fuppofe,  you  will  be  able  to  underhand  this  circumftance ;  I  mean 
how  afphuxise  are  at  one  time  fhort,  and  at  another  time  long,  and  mortal* 
and  not  only  in  hyfterical  women,  but  alfo  in  fome  other  perfons,  in  whom 


(z)  n.  17.  &  18. 

(a)  n.  18. 

\b)  Traite  du  Coeur,  I.  2.  ch.  xi.  r.  9. 
(*)  I.  3.  ch.  8.  n.  9. 


(i)  ch.  7. 

(0  n-  7- 

(f)  n.  $• 

(g)  ch.  9.  n.  6. 


there 


Letter  XXIV.  Article  13.  723 

there  certainly  does  not  appear  any  thing  to  account  for  it  from,  unlefs  you 
account  for  it  from  the  nerves,  as  in  that  obfervadon  which  is  given  us  by 
Starckius  (h).  But  now  let  us  return  to  my  obfer^ations. 

13.  A  middle-aged  man,  who  was  by  trade  a  fiax-dreffer,  came  himfelf 
into  the  hofpiral  of  St.  Mary  de  Morte,  at  Bologna,  in  the  fpring  of  the  year 
1705,  complaining  of  a  pain  in  the  right  hypochondrium:  and,  indeed, 
there  was  a  tumour  in  that  part,  which  refilled  the  hand  of  the  perfon  who 
touch’d  it,  and  feem’d  to  be  feated  in  the  liver  :  but  the  pulfe  was  very 
fmall,  very  weak,  and  very  quick,  and  to  the  greateft  degree  fo  that  I  had 
ever  met  with  it  in  any  one  even  to  that  very  day.  About  four  hours  after 
he  came  to  the  hofpital,  he  was  feiz’d  with  fo  violent  a  pain  in  the  ftomach, 
as  he  call’d  it,  that  from  the  palenefs  of  his  face,  his  cold  fweats,  and  his 
pulfe  being  almoft  quite  loll,  and  his  refpiration  luch  as  it  generally  is  in 
dying  perfons,  he  feem’d  juft  about  to  expire.  He  efcap’d,  however,  and 
related  to  thofe  about  him,  that  he  had  been  feiz’d  with  the  fame  kind  of 
paroxyfm  before,  at  feveral  times.  In  the  mean  while,  his  pulfe  had  re¬ 
turn’d  to  the  former  Hate  which  I  have  deferib’d  juft  now.  The  day  fol¬ 
lowing,  the  phyfician  order’d  blood  to  be  taken  from  his  arm,  and  fuch 
things  to  be  given  internally,  and  applied  to  his  fide,  as  are  generally  us’d 
in  tumours  of  the  liver.  A  few  days  after,  this  tumour  having  by  degrees 
vanifh’d,  behold  the  patient  was  feiz’d  with  a  pain  in  the  region  of  the  heart, 
join’d  with  a  difficulty  of  breathing.  Blood  was  again  taken  away,  but  in 
fmall  quantity  only  ;  which  coagulated  Qowly,  and  in  a  fmall  degree.  From 
this  blood-letting  the  refpiration  was  made  fomewhat  lefs  difficult,  but  the 
pulfe,  at  moft,  only  a  little  better :  for  it  had  the  fame  fmallnefs  and 
weaknels,  in  proportion,  in  the  temples  as  in  the  wrifts ;  fo  that  it  could 
fcarcely  be  found  there  at  all.  I  applied  my  hand  to  the  heart,  and  found 
that  it  beat  with  equal  frequency,  but  with  moderate  force.  And  this  pul- 
fation  was  produc’d  even  far  below  the  region  of  the  heart,  as  one  of  the 
fenior  phyficians  thought,  though  I  could  not  very  well  perceive  it  myfelf : 
I  fo  far  perceiv’d  it,  however,  that  befides  the  polypous  concretions,  and 
the  quantity  of  water  in  the  pericardium,  which  we  had  fufpe&ed  before,  I 
added  the  fufpicion  of  the  increas’d  magnitude  of  the  heart. 

The  heart  feem’d  quite  to  labour ;  and  the  patient  himfelf  petition’d  for 
what  are  commonly  call’d  cordial  medicines.  At  length,  on  the  eighth  or 
ninth  day  from  his  coming  into  the  holpital,  the  fame  fymptoms  that  I  have 
mention’d  ftill  continuing,  having  begun  to  eat  a  roafted  apple,  as  his  ap¬ 
petite  was  now  almoft  gone,  and  having  juft  fpoken  to  fome  perfons  who 
pals’d  by  him,  he  died  of  a  fudden  foon  after,  while  he  had  as  yet  the  apple 
in  his  hands:  which  Hippocrates  (*J,  as  you  very  well  know,  has  Laid  will 
happen  to  thofe  who  44  have  frequent  and  violent  fvvoonings  without  any  ma- 
“  nifeft  caufe.” 

Having  obferv’d  the  body  to  be  here  and  there  livid,  but  efpecially  the 
face,  and  the  adipofe  membrane  to  be  yellowifh,  we  open’d  the  thorax,  and 
haften’d  to  infpedt  the  pericardium.  And  in  this  cavity  was  a  great  quantity 


(t>)  Eph.  N.  C.  Dec.  3,  A.  10.  Obf.  171. 

4  Z  2 


(*)  S.  2.  Aph.  41. 


of 


724  Book  II.  Of  Difeafes  of  the  Thorax. 

of  water  of  a  yellowilh  colour  ;  but  the  heart  was,  of  all  the  large  hearts  1 
had  feen,  together  with  its  fat,  the  moft  unfightly  to  look  at.  In  it  were 
three  polypous  concretions,  made  up  of  a  kind  of  yellowilh  mucus,  but  not 
very  loft,  the  larged:  of  which  was  in  the  right  auricle,  and  the  others  in  the 
ventricles  ;  and  from  one  of  thefe  cavities  a  polypous  concretion  was  produc'd 
into  the  pulmonary  artery,  and  from  the  other  into  the  aorta  ;  fo  that  there 
was  not  one  of  all  our  fufpicions  of  which  we  faw  reafon  to  repent.  How¬ 
ever,  there  was  fome  portion  of  the  blood  alfo  black,  and  concreted  into 
coagula;  but  the  greater  part  was  fluid  as  water:  which  we  particularly  ob- 
ferv’d  when  we  difiecfted  the  pulmonary  and  the  other  large  veflcls,  And 
we  had  before  look’d  upon  the  fmall  vefiels  which  are  carried  through  the 
furface  of  the  lungs,  which  were  black,  not  very  fmall,  and  diftended  with 
blood  *,  thefubftance  of  this  vifcus,  in  the  lpaces  betwixt  thefe  veflels,  being 
whitilh,  except  the  upper  part  of  both  lobes,  which  was  both  internally  and 
externally  black,  and  extremely  hard  befldes  ;  and  from  thence,  when  cut 
into,  there  flow’d  out,  on  all  fides,  a  thickifh  ichor,  of  that  colour  which, 
in  our  country,  is  commonly  call’d  tobacco  colour. 

At  length,  the  belly  being  open’d,  in  order  to  find  out  what  had  been  the 
occafion  of  the  pain  and  tumour  in  the  right  hypochondrium,  we  found  the 
liver  to  be  hardifh,  and  every-where  variegated  like  marble ;  and  having  not 
only  fmall  white  fpots,  but  alfo  fpots  of  the  colour  I  fpoke  of  juft  now  :  and 
although,  upon  lifting  up  this  vifcus,  we  found  the  part  of  the  pylorus  and 
duodenum  which  was  contiguous  to  the  gall-bladder,  of  a  yellowifli  colour; 
yet  the  bile,  neverthelefs,  with  which  this  veficle  was  diftended  and  dilated, 
of  itfelf  refembl’d  ink  ;  or,  at  lead,  we  law  the  coats  of  it  to  be  externally 
blackifb,  and  internally  to  be  already  quite  black. 

14.  It  might  happen,  that  this  colour  of  the  coats  were  lefs  from  the  bile 
than  from  the  inflammation  of  the  gall-bladder,  which  had  already  dege¬ 
nerated  into  a  gangrene  :  and  if  it  were  fo,  you  have  a  clue  from  whence  to 
underftand  the  more  clearly  the  caufe  of  that  pain  which,  in  the  beginning, 
had  infefted  the  right  hypochondrium  :  although  you  might  account  for  it 

from  the  mere  diftradlion  of  the  dilated  veficle  ;  and  from  the  fame  dilatation* 
*  * 

which,  perhaps,  had  been  greater  at  that  time,  or  join’d  with  flatufles  in  the 
fubjedled  inteftine,  yqu  might,  perhaps,  equally  account  for  the  tumour  that 
had  then  Ihew’d  itfelf. 

But  whatever  there  was  of  diforder  in  the  upper  part  of  the  lungs,  you 
will  fuppofe  to  be  of  a  more  ancient  date  ;  efpecially  if  you  call  to  mind 
what  was  the  occupation  of  this  man,  and  what  confequences  I  have  feen 
therefrom  (/)  in  another  man.  Wherefore,  if  we  let  afide  thofe  polypous 
concretions,  according  to  our  prefent  cuftom,  which  I  believe  is  not  by  any 
means  injurious  to  truth,  thefe  two  things  only  will  remain  -,  a  great  quantity 
of  water  in  the  pericardium,  and  the  increas’d  magnitude  of  the  heart ;  from 
which  you  may  deduce  the  ftate  of  the  pulfe,  fuch  as  has  been  defcrib’d, 
and  thofe  circumftances  which  by  intervals  afflicted  the  heart,  and  confe- 
quently  difturb’d  the  refpiration. 

As  to  that  water,  you  not  only  have  in  the  Sepulchretum  the  fixteenth  ob- 


CO  Epkh  7.  n.  13,  &  14. 


fervat  ion 


Letter  XXlV.  Article  i  725 

fervation  of  the  fedtion  which  relates  to  the  prefent  fubjedt,  in  which  obfer- 
vation,  although  you  will  read  that  other  things,  and  thole  of  great  impor¬ 
tance  too,  were  obferv’d  in  the  thorax,  where  it  is  given  more  at  large  (*). 
yet  the  weak  and  creeping  pulfe  is  deduc’d  from  the  pericardium  being  full 
of  water  •,  and  you  will  all'o  find,  in  the  fixteenth  letter  that  I  fent  to  you, 
many  things  which  feem  to  agree  therewith  •,  as  in  the  man  (/)  who  had  a 
weak  and  low  pulfe,  the  pericardium  was  diftended  with  water ;  as  in  the 
boy  and  in  the  man  whom  Vieufiens  difledted  (. m ),  and  who  had  labour’d  under 
this  difeafe,  the  pulfe  had  been  weak,  fmall,  quick,  and  finally,  as  in  thofe 
difiedted  by  Diemerbroeck  («),  languid  ;  which  is  confirm’d  by  thofe  who 
do  not  doubt,  but  that  the  fibres  of  the  heart  muft  be  relax’d  by  that  quan¬ 
tity  of  water  which  lay  round  them  :  nor  will  you  fuppofe  it  to  be  an  argu¬ 
ment  to  the  contrary,  that  the  fame  author  then  found  the  pulfe  at  the  fame 
time  more  rare,  fince  Diemerbroeck  himfelf  confefs’d,  that  the  heart  may  be 
irritated  by  an  acrid  water,  fuch  as  the  yellownefs  of  this  found  in  the  man 
of  whom  we  fpeak,  prov’d  it  to  be  ;  and  that  from  thence  a  quicknefs  of 
pulle  may  arife.  To  thefe  add  the  obfervations  of  Albertini,  which  we  have 
already  referr’d  to(<?)  ;  who  mentions  that  the  pulfe  was  frequent  and  fmall, 
and  indeed  extremely  fmall,  very  quick,  or  faultering,  in  proportion  to  the 
greater  or  lefter  quantity  of  water  in  the  pericardium.  And  he  fuppofes, 
that  it  is  fmall,  and  pretty  quick,  but  at  the  fame  time  tenfe,  and  chord¬ 
like,  where  there  is  a  water  of  a  vellicating  quality.  But  he  there  (peaks 
of  the  dropfy  of  the  pericardium,  when  it  is  the  foie  diforder  with  which  the 
patient  is  troubl’d.  And  we  had  this  diforder  join’d  with  that  enlarg’d  date 
of  the  heart,  which  I  fhall  confider  prelently.  Nor  would  I  have  you  be 
difturb’d,  either  that  in  other  letters,  and  particularly  in  thofe  where  I  treated 
of  the  peripneumony,  I  have  defcrib’d  a  far  different  kind  of  pulfe  as  being 
fometimes  join’d  with  that  quantity  of  water;  or  that,  in  the  fixteenth  letter, 
i  did  not  admit  a  fmall  and  weak  pulfe  among  the  particular  figns  of  a  dropfy 
of  the  pericardium.  For  in  that  letter  I  enquir’d  after  the  figns  which  in¬ 
variably  diftinguifh  this  diforder  from  all  others ;  in  which  number  that  this 
kind  of  pulfe  is  not,  plainly  appears  even  by  what  was  juft  now  quoted  from 
Albertini. 

And  in  the  other  letter,  fuch  a  dropfy  was  for  the  mod  part  defcrib’d  by 
us,  as  had  not  been  of  long,  but  of  fhort  continuance,  and  which,  therefore, 
could  not  diffidently  have  relax’d  and  weaken’d  the  fibres  of  the  heart ; 
whereas,  in  the  man  at  prefent  fpoken  of,  who  had  been  fo  long  before  fubjedt 
to  the  paroxyfms  I  have  defcrib’d,  and  who  had  brought  with  him  into  the 
hofpital  fuch  a  pulfe  as  I  have  related,  the  dropfy  feems  to  have  been  of  a 
long  ftanding,  as  well  as  the  enlarg’d  date  of  the  heart. 

15.  Nor  does  it  efcape  me,  that  a  vehement  and  chord-like  pulfe  lias  fre¬ 
quently  been  join’d  with  an  encreas’d  magnitude  of  the  heart;  that  is,  when 
there  was  nothing  which  obftrudted  it ;  as  in  the  old  man  (p),  whofe  hiftory 
I  have  given  you  from  the  papers  of  Valfalva  ;  and  in  the  man  alio  (q)t  and. 

(*)  L.  2.  S.  1.  Obf  83,  ( 0 )  Comment,  de  Bonon.  Sc.  Acad.  Tom.  1 . 

(!)  N.  40.  in  Opufc. 

(//j)  N.  24.  (?)  N.  23,  CpJ  Epift.  17.  n.  6.,  (?)  Epilh  i3.  n.  30. 


in 


726  Book  II.  Of  Difeafcs  of  the  Thorax. 

in  the  old  woman  (r),  whole  hiftories  I  have  lent  to  you  before,  as  defcrib’d 
jn  my  own  papers.  However,  in  neither  of  the  former  did  the  pericardium 
contain  water  by  which  the  fibres  of  the  heart  were  relax’d  ;  and  the  heart 
of  the  man  had  the  parietes  of  its  ventricles  very  thick.  And  this  circum- 
fiance  being  found  in  the  heart  of  the  old  woman  alfo,  it  is  not  fo  much  to 
be  wonder’d  at,  if  the  more  internal  fibres  of  this  vifcus  could  not  have  been 
weaken’d  by  the  great  quantity  of  water  which  lay  around  it.  On  the  con¬ 
trary,  in  another  man  taken  notice  of  by  Valfalva(j),  as  the  heart  was  in¬ 
deed  large,  and  furrounded  with  a  great  quantity  of  water  in  the  pericardium, 
but  the  parietes  of  it  were  not  very  thick,  as  he  has  remark’d,  fo  the  pulfe 
was  fcarcely  to  be  perceiv’d  :  and  this  man,  like  the  other,  to  whom  the  pre¬ 
lent  difcourfe  relates,  died  fuddenly  likewife.  For  what  can  a  heart  fo  much 
enlarg’d  do,  when  the  fibres  of  it  are  weaken’d,  but  admit  a  greater  quan¬ 
tity  of  blood  than  it  is  able  to  expel  ?  It  muft,  therefore,  neceflfarily  be  fill’d, 
and  confequently  become  ftill  more  relax’d.  And  when  it  is  more  and  more 
relax’d,  it  will  throw  out  a  lels  quantity  of  blood  into  the  arteries,  and  with 
lefs  force,  from  whence  the  fmallnefs  and  weaknefs  of  the  pulfe  will  arife. 
But  the  laxity  of  the  fibres  of  the  heart,  even  when  not  macerated  in  the 
water  of  the  pericardium,  may  fometimes  be  lo  great,  that  not  only  the  heart 
may,  by  degrees,  acquire  an  enlarg’d  ftate,  but  that  no  pulfe  at  all  can,  at 
length,  be  perceiv’d.  And  this  happen’d  in  that  young  man  defcrib’d  in  the 
latter  end  of  the  twenty-firft  letter,  whom  I  have  alio  taken  notice  of  above(/). 
The  obfervations  of  which  young  man,  and,  in  like  manner,  of  the  man  of 
whom  I  have  fpoken  of  thus  far,  1  referr’d  to  when  I  told  Homobonus 
Pifo  (a),  a  profeffor  of  this  univerfity,  “  that  I  had  feen  an  enlarg’d  ftate  of 
“  the  heart  together  with  a  (lender  pulfe.” 

16.  In  an  old  man,  who  was  of  a  lean  habit,  and  whom  1  differed  in  the 
month  of  December  of  the  year  1 743,  the  pulfe  had  been  weak  and  fmall, 
but  not  intermitting,  when,  on  account  of  an  incarcerated  hernia,  as  it 
is  call’d,  he  was  brought  into  the  hofpital  at  Padua.  And  notwithftanding 
it  was  out  of  my  power  certainly  to  inform  myfelf,  whether  the  pulfe  had 
been  in  that  ftate  before  this  diforder  came  on,  or  whether  it  was  rather 
brought  on  by  this  difeafe,  join’d  with  an  inflammation  of  the  inteftines,  to 
fuch  a  degree,  that  a  fpeedy  death  prevented  any  method  of  cure  being  at¬ 
tempted  j  yet  the  appearances  which  I  obferv’d  in  many  parts  of  the  body, 
and  particularly  in  the  heart  itfelf,  and  demonftrated  to  a  very  crowded  circle 
of  ftudents,  are  of  luch  a  nature,  that  I  cannot  judge  them  to  be  unworthy 
of  being  communicated  to  you. 

As  I  examin’d  the  external  furface  of  the  heart,  the  left  coronary  artery 
appear’d  to  have  been  chang’d  into  a  bony  canal,  from  its  very  origin  to  the 
extent  of  many  fingers  breadth,  where  it  embraces  the  greater  part  of  the 
bafis.  And  part  of  that  very  long  branch,  alfo,  which  it  fends  down  upon 
the  anterior  furface  of  the  heart,  was  already  become  bony  to  fo  great  a 
fpace,  as  could  be  cover’d  by  three  fingers  plac’d  tranfverfly.  For  which 
reafons,  a  paflfage  was  open’d  on  both  fides,  not  through  a  membranous  canal, 

(r)  Ibid.  N.  28.  («)  Vid.ejus  Specileg.  Curation.  S.  4.  Obf. 

{s)  Epift.  16.  n.  6.  («■)  N.  7.  1.  in  fin.  ; 

or 


letter  XXlV.  Article  i  6.  727 

or  one  which  was  made  fomewhat  hard,  here  and  there,  by  disjoin’d  bony 
lamellae,  but  through  a  continued  bony  tube,  which  for  hardnels  might  with 
juftice  have  been  compar’d  with  any  other  hard  bone,  except  that  in  fome 
places  it  was  Ids  hard  ;  though  thofe  were  very  fmall,  and  inconfiderable, 
and  refembl’d  the  tranfverfe  lines  form’d  by  the  knots  of  a  (lender  reed.  The 
heart  then  being  open’d,  and  fome  polypous  concretions  being  taken  away, 
although  1  law  the  tubercles  of  the  valves  of  the  great  artery  much  harder  than 
ufual,  and  almoft  bony  •,  yet  I  found  nothing  bony  either  in  them,  or  in  any 
other  valves,  or  in  that  artery  near  the  heart.  But  at  fome  interval  from 
the  heart,  and  at  the  origins  of  the  upper  arteries,  and  from  thence  downwards 
quite  to  the  divifion  into  the  iliacs,  the  internal  furface  of  the  aorta  was  fre¬ 
quently  unequal  on  account  of  very  hard  bony  laminae,  many  of  which  equall’d 
in  bignefs  the  nail  of  a  man’s  thumb  :  yet  I  found  the  thin  internal  membrane, 
by  which  all  thefe  offifications  were  cover’d,  to  be  hurt  only  in  one  place, 
a  thickifh  kind  of  humour  flowing  itfelf  there  •,  in  regard  to  which,  and  the 
feat  itfelf  of  thefe  laminae,  I  fhall  have  a  more  convenient  opportunity  of 
fpeaking  hereafter  (x),  and  telling  you  what  I  obferv’d  in  this  man,  and  in 
others.  And  bony  feales  were  not  wanting,  either  at  the  divifion  into  the 
fubclavian  and  carotid  arteries,  on  the  right  fide,  or  in  the  iliacs,  nor  yet  in 
the  fplenic  in  particular,  in  which  they  were  found  very  thick,  quite  to  the 
fpleen.  Neverthekfs,  within  the  cranium,  and  in  like  manner,  both  in  the 
upper  limbs,  and  in  the  lower  limbs,  1  obferv’d  nothing  bony  in  the  arteries  •, 
although  this  clafs  of  vefiels  was,  in  the  limbs,  more  firm  and  hard  than 
ufual,  and  perhaps  even  fomewhat  wider  than  they  generally  are :  and  while 
I  was  cutting  ;into  thefe  arteries,  I  faw  that  the  blood  which  remain’d  in  the 
crural  vefiels  was  not  fluid  indeed,  yet  not  polypous. 

But  in  the  lateral  (unifies  of  the  dura  mater  were  polypous  concretions, 
of  a  pretty  confiderable  thicknefs.  And  in  the  right  and  left  ventricles  of 
the  brain  water  was  not  wanting,  nor  hydatids  in  the  choroid  plexus  of  both  ; 
and  among  thefe  fome  of  a  pretty  large  fize. 

But  to  return  to  the  thorax  and  belly  :  I  obferv’d,  when  I  cut  into  the  af- 
pera  arteria,  and  the  firft  of  its  branches,  that  the  cartilages  were  in  feveral 
places  become  bony  *,  and  that  the  fame  cartilages  were,  in  the  trunk  of  that 
artery,  reduc’d  to  fuch  a  form,  that  each  of  them,  rather  than  being  in  the 
fihape  of  one  curv’d  line,  as  they  us’d  to  be,  refembl’d  the  two  fides  of  a 
triangle,  which  met  and  form’d  an  angle  anteriorly:  on  which  account  I  re¬ 
mark  it  here  •,  for  it  is  not  very  uncommon  that  thefe  cartilages,  and  thofe  of 
the  larynx,  fiiould  become  bony  in  old  men,  as  appears  by  the  obfervations 
colle&ed  from  many  authors  by  the  celebrated  Winkler  (y) ;  fo  as  to  make  it 
rather  remarkable  that  Cafifebohmius,  who  was,  when  living,  a  very  expe¬ 
rienc’d  anatomifi,  fiiould  never,  as  he  himfelf  relates  it,  have  feen  them  be¬ 
come  ofiified  :  for  I  have  certainly  feen  both  the  one  and  the  other  in  a  flate 
of  oflification  more  than  once  (2). 

And  m  the  belly,  although  befides  inflam’d  inteftines,  as  I  faid  in  the  be¬ 
ginning,  it  had  all  the  vifeera  in  a  found  ftate,  and  amongft  thefe  the  liver 

(a)  Epift.  27.  n.  22.  ( z )  Epift.  7.  n.  11.  &  Adver f.  Anal.  1.  n, 

(y)  in  ca!ce  DiiT.  de  vafor.Corp.hum.Lithiafi.  24. 

and 


72S  Book  II.  Of  DifeaTes  of  the  Thorax. 

and  the  fpleen,  both  of  which  were  of  a  moderate  magnitude ;  yet  in  the 
liver  thefe  things  were  to  be  excepted.  The  gall  bladder  was  plac’d  tranl- 
verfly :  and  although  even  that  was  of  a  proper  and  natural  fize,  it  had  not 
form’d  the  lead  bed  or  finus  for  itfelf  in  the  liver,  into  which  it  was,  ac¬ 
cording  to  its  ufual  cuftom,  receiv’d  ;  fo  that  after  I  had  disjoin’d  its  fundus 
from  the  liver  entirely,  which  I  did  without  the  lead  force  or  trouble,  the 
iituation  to  which  it  had  adher’d,  could  fcarcely  be  known  ;  and  the  lurface 
ol  the  liver,  in  that  part,  was  fo  fmooth  and  uniform,  that  if  there  had  been 
any  ftnall  velfel,  of  any  kind  whatever,  going  from  the  liver  to  the  fund  of  the 
veficle,  or  from  the  fund  of  the  veficle  to  the  liver,  it  muft  neceffarily  have 
been  of  an  incredible  fmallnels,  fo  as  entirely  to  efcape  all  notice  of  the 
fenfes.  And  in  this  date  had  the  gall-bladder  been  quite  from  the  original 
formation.  But  in  it  was  contain’d  a  blackifh  and  vifcid  bile,  in  a  fmall 
quantity,  in  which  were  calculi  to  the  number  of  twenty.  And  feeing  thefe 
calculi  to  be  black,  I  immediately  predicted,  to  thofe  who  v/ere  prefent, 
what  did  in  fact  happen,  that  they  would  neither  tafce  flame,  nor  be  melted  ; 
and  when  applied  to  the  flame,  that  they  would  fcarcely  give  the  flighteft 
cracks.  They  were  all  of  a  fmall  fize,  and  nearly  equal  in  their  magnitude  : 
and  all  of  them  confided,  as  it  were,  of  many  globules,  which  being  plac’d 
upon  one  another,  were  contiguous  to  each  other,  on  their  fmaller  furface. 

Lad  of  all,  I  infpected  the  fcrotum  alfo,  from  whence  an  intedine  had 
been  withdrawn  a  little  after  the  man’s  death,  when  I  was  abfent,  and  re¬ 
mov’d,  together  with  the  others,  that  the  body  might  keep  the  longer.  I 
found  that  the  tedes  which  had  been  neared  to  the  hernia,  was  confidera- 
bly  lefs  than  the  other.  Being  cut  into,  it  had  the  internal  fubdance  of  a 
brown  and  reddifh  colour,  whereas  the  other  had  it  of  a  natural  colour.  Yet 
betwixt  this  and  the  tunica  vaginalis  was  a  fmall  quantity  of  water  ;  nor  was 
that  prominent  corpufcle  wanting  at  the  other  extremity  of  this  very  tedicle, 
of  a  roundiffi  figure,  which  I  have  alfo  obferv’d  on  a  former  occasion,  and 
taken  for  the  remains  of  a  ruptur’d  hydatid  ( a ). 

17.  Referving  many  things  out  of  this  difiedtion  to  another  place,  to  which 
they  more  immediately  belong,  I  fhall  here  add  a  few  things  upon  the  fub- 
jedt  of  that  coronary  artery  being  bony. 

Laurence  Bellini  ( b )  fays,  “  I  have  feen  a  done  growing  to  the  larger 
“  branches  of  the  coronary  artery,  where  they  divide  the  right  from  the 
“  left  ventricle.”  Whether,  with  Pcchlinus  (c),  he  didinguifli’d  the  nature 
of  bone  and  done  in  the  rigid  indurations  of  the  veflels  and  membranes,  or 
whether  he  comprehended  all  under  the  term  of  done  ;  as  when  a  little  lower, 
in  making  mention  of  the  indurations  in  other  arteries,  and  in  the  valvula 
mitralis,  which  he  had  feen,  he  makes  ufe  of  the  fame  term  of  done  ;  for  it 
is  very  difficult  to  fuppofe,  that  he  had  never  lit  upon  bony  laminae,  but  al¬ 
ways  upon  dony  concretions ;  fo  that  in  regard  to  the  prefent  quedion,  the 
thing  amounts  jud  to  the  fame;  for  how  far  that  didindtion,  betwixt  bony 
and  dony  formations,  may  take  place,  I  (hall  take  particular  notice  hereaf¬ 
ter  {d).  They  who  have  given  the  obfervation  of  their  preceptor  Drelincurt, 

% 

(a)  Epift.  21.  n.  19.  (<■)  Eph.  N.  C.  Dec.  1.  A.  9.  &  10.  Obf.  31. 

(4)  De  Morb.  Pe$.  \d)  Epift.  25.  n.  9.  &  Epift.  27,  n.  20.  feq. 

.  in 


Letter  XXIV.  Article  17.  729 

in  the  firft  book  of  the  Sepulchretum  (<?),  have  fpoken  in  the  fame  manner 
as  Bellini ;  and  Drelincurt,  in  the  fame  body  in  which  he  found,  as  I  did, 
“  the  fplenic  artery  here  and  there  protuberating  and  tophaceous,”  found, 

“  all'o,  the  coronary  artery  of  the  heart  ftony.”  But  Thebefius  fays,  that 

he  had  feen  (/)  “the  larger  branches  of  the  arteries - which  run  down 

“  upon  the  convex  lurface  of  the  heart,  quite  to  the  apex,  partly  offified 
“  in  feveral  places.”  Finally,  the  celebrated  Crellius  has  publilh’d  an  ob- 
fervation,  accompanied  with  fcholia,  very  worthy  to  be  read,  “  of  the  coro- 
“  nary  artery  of  the  heart  being  harden’d  like  bone  j”  that  is  to  fay,  the 
fame  which  was  afterwards  found  to  be  fo  by  me,  the  left,  and  equally  from 
its  origin,  and  in  its  moll  confiderable  branch,  befides. 

I  wilh  we  could  know,  as  we  have  it  in  the  fecond  book  of  the  Sepulchre¬ 
tum  (£),  what  diforders,  and  what  kind  of  death,  had  preceded  in  the  man, 
in  whom  the  coronary  veins  of  the  heart  were  found  to  be  bony,  although 
not  without  other  diforders  of  the  internal  parts ;  I  wilh,  I  fay,  we  could 
know,  in  like  manner,  what  peculiar  inconveniences  had  been  felt  by  thofe 
in  whom  the  correfponding  arteries  were  bony ;  fince  Lancih  ( h )  has  fup- 
pos’d,  that  nature  had  wrapp’d  up  thefe  arteries  in  little  bundles  of  fat,  in 
order  to  take  care7  that  they,  when  harden’d  into  a  bony  fubftance,  in  the 
fame  manner  as  other  arteries  frequently  are,  “  might  not  be  prevented  from 
“  a  free  diftenfion  and  elongation,  when  there  was  need.”  But  neither  Bel¬ 
lini,  nor  the  difciples  of  Drelincurt,  have  added  any  thing  in  regard  to  the 
foregoing  diforders :  Thebefius  has  fuppos’d,  that  this  circumftance  might 
be  “  extremely  fatal  *”  but  that  it  was  fo  he  has  not  faid  :  Crellius  could  not 
fo  much  as  fee  the  other  part  of  the  body  of  the  old  man,  in  whofe  fhrivell’d 
and  already  half-rotten  heart  he  obferv’d  this  appearance  :  and  finally,  I  had 
it  not  in  my  power  to  learn  any  more  circumftances  than  what  I  have  given 
you,  in  relation  to  this  very  poor  man,  who  had  nobody  to  take  any  farther  care 
of  him,  than  to  fee  that  he  was  carried  into  the  hofpital,  a  little  before  his 
death,  notwithftanding  I  took  a  great  deal  of  pains,  and  was  extremely  de- 
firous  to  know. 

At  length,  when  I  read  thefe  things  over  again,  and  look’d  into  the  feve¬ 
ral  oblervations  that  are  extant,  by  the  mod  famous  men,  of  this  very  dif- 
order  of  the  heart ;  firft  bySenac(f),  lecondly  by  Plancus  (£),  and  laft  of 
all  by  Haller  (/)  :  I  obferv’d  that  the  firft  and  the  fecond  were  taken  from 
men  who  had  been  fubjedt  to  a  palpitation  of  the  heart.  But  although  in 
the  fecond,  as  I  have  before  related  (m),  other  evident  caufes  of  palpitation 
were  not  wanting;  yet  the  firft,  particularly,  fhow’dfiom  whence  this  palpi¬ 
tation  had  arifen,  at  leaft  in  that  cafe,  as  it  did  not  exhibit  the  leaft  appear¬ 
ance  of  diforder,  except  that  of  the  coronary  arteries  being  become  bony, 
and  forming  branches  like  the  branches  of  coral ;  lb  that  it  was  very  eafy  to 
underftand,  whether  fome  of  the  oftified  branches  of  thefe  veffels  pafs’d  down 
between  the  fibres  of  the  heart,  or  whether  they  remain’d  on  the  outfide,  and  - 

(*)  $e&.  12.  in  Addit.  Obf.  S.  in  fin.  (/')  Traite  du  Cncitr,  I.  4.  ch.  9.  n. 

(f)  Difp.  de  Circul.  fangu  in  Corde,  §  4.  (/•)  Epifit.  de  Monllr. 

(g)  Seft.  1.  in  Addit.  Obf.  31.  (/)  Opufc.  Pathol.  Obf.  50.  Sc  51. 

( h )  De  Mot.  Cord.  Propof.  39.  (w)  Epiit.  23.  n.  9. 

Vol.  I.  5  A 


-embrac’d 


7  3  0  Book  II.  Of  Difeafes  of  the  Thorax. 

embrac’d  thefe  fibres ;  that  either  in  one  way  or  the  other  they  mull  have  ir¬ 
ritated  the  fibres  of  the  heart,  either  in  the  fyftole,  or  in  the  diaftole  *,  and 
by  this  means,  according  to  what  our  author  teaches  in  another  place  (#), 
have  brought  on  a  palpitation.  Haller  produces  one  or  two  obfervations 
made  upon  old  women,  in  whom  other  parts  had,  likewife,  degenerated  into 
bone  •,  but  what  inconveniences  they  had  been  troubled  with  when  living,  he 
does  not  fay,  I  fuppofe  for  the  fame  realon  which  prevented  me  from  knowing 
any  other  circumftances  in  relation  to  my  old  man.  And  I  was  before  not 
a  little  difappointed  for  a  fimilar  reafon,  that  the  fame  thing  Ihould  have  hap¬ 
pen’d  to  me  in  regard  to  the  pulfe  of  a  certain  man,  when,  about  the  latter 
end  of  the  year  1725,  I  difie&ed  the  greateft  part  of  his  vifcera,  which  were 
brought  home  to  me,  while  my  friends  infpeded  the  difiedion.  However, 
whatl  heard,  and  what  I  faw,  at  that  time,  I  will  relate  to  you. 

18.  A  man  about  fix-and- thirty  years  of  age,  of  a  large  ftature,  and  who 
was  fervant  to  a  miller,  fell  into  a  difeafe  which  feem’d  to  be  a  dropfy  of 
the  thorax.  For  which  reafon,  his  legs  being  fwell’d,  his  pulfe  being  very 
low,  and  a  virulent  gonorrhasa,  moreover,  affiiding  him,  he  died. 

There  was  not  only  water  in  the  thorax,  but  in  the  belly  alfo,  as  they  who 
had  remov’d  the  vifcera  related  ;  and  befides  this,  that  the  larger  inteftines 
were  in  fome  places  inflam’d,  and  had  a  very  ftrong  fmell,  for  which  reafon 
they  had  not  been  fent  together  with  the  other  vifcera.  And  that  thefe  cir¬ 
cumftances  were  true,  was  confirm’d  by  the  difagreeable  odour  of  thofe  which 
had  been  brought,  particularly  by  the  vifcera  of  the  belly,  and  not  a  little, 
indeed,  by  the  vifcera  of  the  thorax.  Wherefore,  pafling  over  the  lungs, 
which  were  extremely  heavy,  I  very  accurately  enquir’d  into  the  ftate  of  the 
heart  and  the  veffels,  into  which  I  happen’d  at  that  time  to  be  defirous  of 
making  fome  particular  enquiries.  Some  whitilh  polypous  concretions,  fome 
of  which  kind  were  alfo  in  the  vena  portarum  and  the  inferior  cava,  being 
taken  away  from  the  right  auricle,  and  no  concretion  of  this  kind  being 
found  in  the  other  cavities  of  the  heart,  and  no  diforder  appearing  in  any 
part  of  this  vifcus,  or  its  veffels,  except  in  the  valves  of  the  great  artery, 
and  that  being  very  confiderable,  upon  looking  upon  and  examining  it  very 
attentively,  I  found  it  thus  :  All  thefe  valves,  on  the  upper  part  of  their 
border,  and  on  the  neighbouring  part  of  that  furface  with  which  they  look 
upon  each  other,  fwell’d  out  into  fhort  and  unequal  excrefcences ;  by  the  load 
of  which  being  weigh’d  down,  they  were  all  brought  fo  near  together  by  this 
means,  as  to  leave  but  a  very  narrow  paffage  betwixt  each  other  through  which 
the  blood  might  pafs  out.  But  when  I  examin’d  each  valve  in  particular,  I 
law  that  the  right  had  its  border  much  Ihorter  than  ufual,  or  was  become  lefs 
tranfverfely  ;  and  that  the  left  was  ruptur’d  through  the  middle,  from  the 
border  quite  to  the  lower  part ;  and  that  from  the  very  lips  of  this  rupture 
other  excrefcences  were  protuberant.  The  fubftance  of  all  thefe  valves  was 
in  part  lax  and  flaccid,  fo  that  it  might  be  very  eafily  pull’d  away  by  the 
fingers  and  by  the  nails  •,  and  yet  it  was  partly  harder  than  ufual,  alfo ;  fo 
that  when  you  rubb’d  it  betwixt  your  fingers,  you  would  perceive  fome  par¬ 
ticles  to  be  mix’d  with  it,  which  approach’d,  in  fome  meafure,  to  the  nature 


7 


(*)  Ch.  1 1.  n.  2. 


of 


Letter  XXIV.  Article  19.  731 

of  a  cartilage.  Thefe  excrefcences  being  taken  away,  the  fubftance  of  the 
valves  remain’d,  but  was  contracted  and  deficient,  and  confirm’d  what  had 
appear’d  at  firft  light;  I  mean,  that  this  diforder  had  taken  its  rife  from  a 
kind  of  erofion,  efpecially  as  the  internal  furface  of  the  ventricles,  where  it 
border’d  upon  the  valves,  Ihew’d  itlelf  alfo  fome  marks  of  erofion.  Having 
feen  thefe  things,  and  other  preternatural  appearances  being  look’d  for  in 
vain  in  the  aorta  and  the  other  velfels,  and  in  the  whole  heart  itfelf ;  and 
the  borders  of  the  mitral  valves  being  only  fomewhat  thicker  here  and  there 
than  they  generally  are,  and  being  at  the  fame  time  obferv’d  to  be  harder 
than  ufual ;  I  went  on  to  examine  into  the  remaining  parts. 

Some  of  the  vifcera  of  the  belly  had  only  thefe  few  things  which  were  wor¬ 
thy  of  remark.  1'he  liver  was  large,  and  yet  not  to  an  immoderate  degree,  of 
a  palilh  complexion  ;  and  in  its  whole  external  furface  there  appear’d  a  kind 
of  brownifh  network,  with  which  fome  very  fmall  and  white  fpots  wer® 
mix’d.  The  fpleen,  being  internally  foft,  had  on  the  external  furface  fome 
thick  adipofe  ramifications,  as  it  were,  if  our  eyes  were  to  be  believ’d  ;  but 
the  fubftance  of  them  was  of  a  tendinous  firmnefs,  and  even  of  a  middle 
nature  betwixt  a  cartilage  and  a  ligament.  The  glands  in  the  centre  of  the 
mefentery,  and  at  the  trunk  of  the  vena  portarum,  were  enlarg’d. 

When  I  call’d  to  mind  the  gonorrhasa,  I  was  forry  that  it  had  not  been 
allow’d  to  bring  the  penis  away  with  the  vifcera.  I  examin’d,  therefore,  with 
the  utmoft  diligence,  the  beginning  of  the  urethra,  the  proftate  gland,  and 
the  veficulae  feminales.  The  urethra,  in  the  part  cf  it  which  I  had  in  my 
power  to  examine,  was  without  any  mark  of  difeafe ;  however,  the  feminal 
caruncle  was  low.  The  proftate  was  fmall.  In  the  veficulae  was  a  watery 
femen ;  but  as  the  patient  had  been  dropfical,  this  was,  perhaps,  lefs  to  be 
attended  to. 

19.  This  obfervation  of  mine  upon  excrefcences  in  the  femilunar  valves, 
holds,  in  fome  meafure,  a  middle  place  betwixt  that  extraordinary  obfervation 
of  Lancifi(fl),  who  faw  flelhy  excrefcences  in  them,  and  the  other  lefs  ex¬ 
traordinary  obfervations  of  Cowper,  in  particular,  and  Vieufiens,  who,  as  we 
have  alfo  taken  notice  in  the  former  letters  (p),  have  feen  them  bony  or 
ftony.  For  which  reafon  it  were  more  defirable  for  me  to  know,  if  it  were 
poftible,  whether  the  man  of  whom  I  fpeak  had  ever  been  accuftom’d  to  have 
an  intermitting  and  unequal  pulfe,  as  thefe  gentlemen  obferv’d  in  their  pa¬ 
tients  ;  or,  as  Lancifi  found  it  in  his,  for  the  moft  part,  regular  and  equa¬ 
ble  (q).  But,  as  I  have  already  faid,  I  could  learn  nothing  elfe  but  that  it 
had  been  very  low ;  which  in  other  refpe<fts  agrees  very  well  with  that  fmall 
quantity  of  blood  which  of  courfe  enter’d  into  the  aorta  through  the  paflage 
that  was  fo  much  ftreighten’d  by  the  valves :  nor  does  it  difagree  with  my 
obfervations  on  the  old  woman  and  the  old  man,  the  firft  of  which  I  gave 
you  in  the  fame  letter  (r),  and  the  latter  in  the  twenty-firft  (s ).  For  as  the 
femilunar  valves  of  both  were  bony,  and  in  the  woman  were  beginning  to 
thicken  on  their  edges  into  confiderably  large  tubercles,  and  in  the  man  were 

(«)  De  Subit.  Mort.  1.  2.  Obf.  Phyf.  Med.  (7)  Vid.  §  10.  Schol.  ad.  cit.  Obf. 

4-  §  3.  (r)  24.  n.  1 1. 

(/>)  N.  9,  ( s )  N.  15. 


5  A  2 


even 


7  3  2  Book  II.  Of  Difeafes  of  the  Thorax. 

even  more  protuberating  internally  than  ufual ;  To  the  pulle  in  both  was  weak, 
and  that  of  the  woman,  moreover,  fmall ;  but  in  neither  of  them  intermitting. 

20.  Now  that  mention  is  made  of  the  intermilTion  of  the  pulfe,  which  ap¬ 
proaches  more  nearly  to  the  nature  of  an  afphuxia  than  even  their  flendernefs 
or  weaknefs,  (for  what  elle  is  the  intermiflion  of  the  pulfe  but  a  very  fhort 
afphuxia,  or  what  is  an  afphuxia  but  an  intermilTion  which  lafts  very  long  ?) 
the  caufes  of  this  diforder  in  the  pulfe  are  not  to  be  pafs’d  over  without  exa¬ 
mination  in  this  place,  as  the  greater  part  of  phyficians  are  very  greatly  ter¬ 
rified  thereby,  often  with  good  reafon,  yet  frequently  without  any  ;  as  when 
there  is  fome  caufe  of  it  in  the  ftomach  or  inteftines,  which  may  either  va- 
nilh  away  of  itfelf,  or  be  eafily  remov’d  by  the  phyfician.  For  in  what 
manner  a  palpitation  of  the  heart  may  be  fometimes  brought  on  by  flatus 
diftending  thefe  parts,  and  again  carried  off  by  the  diflipation  of  fuch  flatus, 
I  have  already  faid  (/)  ;  and  in  the  fame  manner,  or  one  not  very  diffimilar, 
it  is  alfo  evident,  that  an  intermiflion  of  the  pulfe  has  been  fometimes  gene¬ 
rated,  and  gone  off  of  itfelf,  in  many  whom  1  have  known.  At  another 
time,  in  thefe  very  fame  vifeera,  there  is  a  matter  which  produces  the  fame 
effeft,  by  irritating  their  nerves,  with  which  you  know  how  eafily  the  nerves 
of  the  heart  confent.  And  this  matter  is  fometimes  of  fuch  a  nature,  that 
it  may  readily  be  prevented  from  harbouring  itfelf  there.  Thus  1  remember, 
when  I  attended  to  the  cure  of  a  virgin,  who  had  a  fever,  and  an  intermiflion 
of  the  pulfe  was  added  to  the  other  fymptoms,  contrary  to  my  expectations, 
I  was  not  at  all  deterr’d  from  giving  fuch  a  medicine  as  I  had  before  deter¬ 
min’d  upon,  that  the  ftomach  and  inteftines  might  be  well  cleans’d ;  and 
even  that  I  gave  it  fo  much  the  more  boldly  ;  and  that  on  the  fame  day, 
after  thefe  parts  had  been  deterg’d,  the  pulfe  return’d  to  its  former  ftandard. 
But  you  will  read,  even  in  the  Sepulchreium  («),  that  Ballonius  had  not  only 
feen  this  diforder  of  the  pulfe,  but  alfo  that  of  a  languid  and  fmall  ftroke, 
remov’d  in  the  fame  manner.  “  According  to  the  degrees  to  which  the 
“  purging  was  carried,”  fays  he,  “  the  pulfe  was  reftor’d.”  And,  indeed, 
there  is  an  intermiflion  of  the  pulfe  that  is  of  a  far  longer  continuance,  as 
that  with  which  Lancifi  fays  he  had  been  troubl’d  “  for  the  fpace  of  fix 
years  (x)  yet  if  this  intermiflion  fhould  be,  as  it  was  in  him,  <£  from  a 
“  confent  with  the  hypochondria, ”it  may  be  entirely  and  perfe&ly  taken  away, 
by  perfectly  reftoring  thofe  parts. 

And  in  regard  to  what  I  have  faid  of  the  nerves  which  are  irritated  in  the 
hypochondria,  the  fame  cannot  be  denied  of  the  nerves  in  any  other  part,  or 
from  any  other  caufe,  if  difpos’d  in  the  fame  manner  as  thefe.  This  was  ex¬ 
tremely  evident  to  me  in  a  certain  very  experienc’d  and  judicious  profeflor  of 
phylic  at  Bologna,  who  having  happen’d  to  obferve  that  his  pul'e  inter¬ 
mitted,  and  being  very  anxious  and  felicitous  for  that  reafon,  as  if  it  were 
irnpoflible  it  fhould  happen  from  an  accidental  caufe,  was  every  now  and  then, 
as  is  generally  the  cafe  with  men  of  phyfical  fcience,  applying  his  fingers  to 
his  wrift,  and  perceiv’d,  with  very  great  grief  to  himfelf,  that  the  intermiflion 
was  continually  increafing  :  yet  the  very  fame  gentleman,  after  having  not 

(■*)  De  Subit.  Mort.  1.  i.  c.  19.  §■  3.. 


(/)  Epift.  23.  n.  16. 

Seft.  hac  9.  in  Schol.  ad  Obf.  8. 


4 


difdain’d 


Letter  XXIV.  Article  21.  733 

difdain’d  to  take  my  advice,  though  a  young  man,  which  was  to  apply  his 
fingers  to  his  pulfe.much  lels  frequently  ;  and  having,  in  confequence  thereof, 
lei's  increas’d  the  anxiety  of  his  mind  upon  the  occafion,  the  intermifiion  foon 
became  much  lefs  obfervable  ;  till  at  length,  by  not  attending  to  it,  it  entirely 
vanifn’d  away. 

But  I  learn’d  from  a  patient,  that  not  only  thofe  nerves  which  go  to  the 
heart,  but  even  thofe  which  are  fubfervient  to  the  arteries  or  mufcles  that  lie 
near  them,  may  alfo  vary  the  motion  of  thefe  arteries ;  for  this  patient,  having 
but  juft  efcap’d  the  danger  of  a  moft  violent  difeafe,  was  aftefted  with  a  very 
great  fadnefs,  on  account  of  unfavourable  news  that  had  been  brought  to 
him  unleafonably  ;  and  this  fadnefs  was  fo  much  the  greater,  in  proportion  as 
he  endeavour’d  to  conceal  it :  and  1  found  his  pulfe,  at  a  time  when  I  ex¬ 
pected  no  fuch  thing,  at  firft  in  both  the  wrifts,  but  on  the  following  days 
in  the  left  wrift  only,  to  labour  under  all  kinds  of  irregularities,  fo  as  to 
make  it  very  evident,  as  the  pulfe  was  extremely  equal  at  the  fame  time  in 
the  right  arm,  that  the  caufe  related  only  to  the  left  brachial  artery  *  which 
did  itlelf  alfo  foon  after  return  to  its  natural  motions  when  the  grief  was  al¬ 
leviated,  and  the  nerves  were  brought  back  to  their  former  difpofition. 

21.  Yet  when  there  is  an  intermiffion  of  the  pulfe  which  does  not  arifefrom 
an  impediment,  or  irritation,  in  any  other  part,  but  from  a  caufe  which  has 
its  origin  in  the  heart  itfelf,  or  in  the  neighbouring  trunk  of  the  great  ar¬ 
tery,  or  in  both  ;  then,  indeed,  I  mull  confefs,  it  becomes  a  fymptom  of 
importance,  and  we  are  under  a  neceflity  of  confidering  it  as  fuch.  And 
this  caufe  may  be  manifold  and  various  ;  and  among  the  firft  may  be  that 
very  conftitution,  or  ftate,  of  the  femilunar  valves  which  was  juft  (jy)  now 
fpoken  of.  For  I  am  not  inclin’d  to  be  carelefs  what  has  happen’d  to  others, 
becaufe  it  has  happen’d  differently  to  me.  And  I  even  attend  to  that  which 
1  confider  as  a  (till  more  important  caufe,  and  what  Gregorius  Horftius  and 
Laurence  Bellini  have  oblerv’d.  For  the  former,  as  you  fee  in  this  ninth 
fedtion  of  the  Sepulchretum,  and  will  read  at  large,  not  in  the  following 
feCtion  on  the  fyncope,  but  in  the  preceding  fection  on  palpitation  of  the 
heart  (z),  faw  a  calculus,  fimilar  to  a  pretty  fmall  chefnut,  growing  to  the 
membranous  fubftance  of  the  valves  of  the  right  ventricle  of  the  heart  •,  and 
Bellini  faw  a  done  which  had  been  generated  in  one  of  the  valvulae  mitrales; 
both  of  them  after  an  intermitting  pulfe  :  which  obfervaiions  I  have  even 
taken  notice  of  in  the  former  letter  (a).  Yet  Horftius  (for  Bellini  promis’d 
that  he  would  give  us  his  obfervation  more  at  large  on  fome  future  occafion) 
found  at  the  fame  time  a  putrid  humour  in  the  per.cardium,  and  the  heart 
enlarg’d  to  double  its  ufual  capacity.  And  even  Cowper  and  Vieuffens,  as 
is  laid  in  that  fame  letter  (i>),  for  the  moft  part,  found  in  thofe  who  had  had 
intermitting  or  unequal  pulfes,  befides  a  bony  or  ftony  hardnefs  of  the  valves, 
a  dilatation  of  the  left  ventricle  of  the  heart.  But  it  accidentally  hippen’d, 
that  although  I  faw  the  valves  thus  chang’d,  I  did  not  at  the  fame  time  find 
an  enlargement  of  the  cavities  of  the  heart  :  and  in  like  manner  it  happen’d, 
that  when  I  found  this  enlargement  by  itfelf,  the  pulfe  was  not  intermitting, 

(j)  N,  19.  (a)  Obf.  25.  §.  1.  (a)  N.  9.  &  13.  (£)  N.  9.  &.  10. 


which 


734  Book  II.  Of  Difeafes  of  the  Thorax. 

which  the  eighteenth  letter  will  particularly  fliew  (c)  •,  or  if  in  one  man  (J) 
they  had  been  intermitting,  yet  there  were  other  things  at  the  fame  time, 
which,  perhaps,  might  be  accus’d  with  juft  ice  of  contributing  thereto  :  and 
you  will  fee  that  it  has  happen’d  nearly  in  the  fame  manner  to  Valfalva  (e). 

What  then  are  we  to  conclude  ?  Will  thefe  caufes,  which,  when  feparate 
from  each  other,  are  always  unable  to  produce  an  intermiftion  of  the  pulle, 
be  always,  or  almoft  always,  able  to  produce  this  fymptom,  when  they  are 
join’d  together  ?  As,  in  order  to  difcufs  thefe  points  properly,  a  much  greater 
number  of  obfervations  are  requir’d,  it  will  be  fufficient  at  prelent  to  have 
pointed  out  thofe  things  which  do  not  always  anfwer. 

22.  I  fee  alfo,  that  in  this  fedtion  of  the  Sepulchretum  (/),  that  caufe  of 
an  intermitting  pulfe  of  which  I  have  already  written  fo  largely  in  the  former 
letter  (g)9  is  produc’d ;  I  mean,  the  adhefton  of  the  pericardium  to  the  heart. 
And  that  this  adhefton,  certainly,  does  not  always  produce  that  fymptom,  I 
have  likewife  fufficiently  confirm’d  in  the  fame  letter  ( h ). 

Ulcerations  of  the  heart  are  alfo  produc’d  here  (*).  Yet  whether  with  thefe 
there  are  always  intermitting  pulfes,  I  fhall  enquire  in  the  next  letter  ( k ) ;  as 
I  fhall  likewife  equally  enquire,  whether  fwoonings  or  fyncopes  are  always 
join’d  with  thofe  exulcerations. 

But  now  I  fhall  particularly  attend  to  one  caufe,  pafling  by  thefe  and 
others  that  are  not  fo  frequently  accus’d ;  which  one  caufe  is  generally  men¬ 
tion’d  more  often  than  any  other  by  phyficians,  when  the  queftion  is  of 
intermiffion  and  inequality  of  the  pulfe  ;  I  mean  the  polypus.  And-  fome 
perfons  are  not  wanting,  who  would  make  us  believe,  that  this  had  been 
known  to  Galen,  inafmuch  as  he  defcribes  its  “  conformation  from  a  great 
“  number  of  pellicles  ”  in  a  cock,  as  if  he  were  not  there  (/)  exprefsly 
fpeaking  of  “  the  coat  of  the  heart  being  affedted  with  a  fcirrhous  tumour, 
<c  juft  as  if  many  thick  membranes  had  been  wrapp’d-up  one  over  another.” 
Certainly  they  would  have  aflerted  lefs  improbable  things,  if  they  had  affirm’d, 
that  when  he  judg’d  the  diforder  of  Antipater  (m)  to  be  from  an  obftrudtion 
of  the  fmooth  arteries  of  the  lungs,  by  “  thick  and  vifcid  humours,”  he  had 
conceiv’d  an  idea,  in  his  own  mind,  of  fomething  like  a  polypus.  At  lead 
thofe  circumftances  which  are  faid  to  arife  from  a  polypus  of  the  heart,  Ga¬ 
len  accounted  for,  from  that  caufe  which  he  had  conjedtur’d  that  is,  firft, 
“  inequality  of  all  kinds  in  the  pulfe and  after  that,  in  the  progrefs  of 
the  difeafe,  <c  a  palpitation  of  the  heart,  and  a  difficulty  of  breathing  j”  and 
finally,  a  fudden  “  death  or  Salius  (»),  without  a  doubt,  attributed  thefe 
fymptoms  to  that  caufe,  following  the  fame  conjecture,  and  added  to  them 
“  a  kind  of  dropfy  and  lwooning.”  But  the  firft  who  really  found  polypi 
in  the  veins,  not  in  conjecture  only,  but  with  his  eyes  and  his  hands,  as  far 
as  I  remember  to  have  read,  to  this  time,  feems  to  have  been  my  fellow- 
citizen  Helidasus  de  Paduanis,  a  very  celebrated  phyfician  in  his  time  ;  fo 
that  if  Schultz  were  living,  and  I  would  to  God  he  were,  he  could,  perhaps. 


{c\  n.  2.  28.  30. 

(d)  Epiit.  21.  n.  34. 

(e)  Vid.  Epift.  17.  n.  21. 

(f)  Obf.  15. 

(g)  n.  17.  &  feqq. 


(/j)  n.  11.  (?)  Obf.  n.  Sc  42. 

(6)  n.  19.  &.  feqq. 

(/)  De  loc.  aff.  1.  5.  c.  2. 

(tn)  De  iifd.  I.  4.  c.  8.  in  fin. 

(«)  De  Affeft.  Partic.  c.  21. 


no 


Letter  XXIV.  Article  23.  735 

no  longer  believe  he  had  reafon  to  repent,  that  “  he  had  deduc’d,  without 
“  fufficient  reafon,  the  beginnings  of  this  doctrine  from  Italy  (<?).”  For 
Spigelius  hasfaid(/>),  that  Helidaeus  found,  in  the  body  of  a  perfon  who 
died  of  a  long-continu’d  quartan,  “  large,  long,  white,  and  pituitous  con- 
u  cretions  in  the  heart,  the  vein:,  and  all  the  limbs.”  Nor  yet  did  Heli- 
daeus  live  in  the  lame  age  in  which  Spigelius  fiourilh’d,  that  is,  in  the  feven- 
teenth  century  ;  for  this  is  one  of  the  many  typographical  errors  that  are 
admitted  in  the  work  of  PiiUnius  (q)  ;  but  in  “  the  paft  century,”  as  Spigelius 
had  rightly  faid,  that  is,  in  the  fixteenth ;  and  even  Petrus  Foreftus,  who 
died  before  the  end  of  the  lame  fixteenth  century,  in  an  extreme  old  age(r), 
has  pretty  clearly  pointed  out,  how  long  before  Helidseus  had  begun  to  flou- 
rifn,  when  he  fpeaks  of  him  in  this  manner  (j)  ;  “  Helidasus,  a  very  eminent 
“  phyfician,  and  my  preceptor,”  whom  I  ftiould  alfo  afifert  to  have  firft  ob- 
ferv’d  a  polypus  in  the  heart,  if  that  “  little  piece  of  blackifh  flefh,”  found 
before  by  Benivenius  (/),  in  the  left  ventricle  of  the  heart,  above  the  artery, 
in  the  lhape  of  a  medlar,  after  a  pain  of  the  heart  and  fwoonings,  were  not 
taken  by  mod  perfons  for  a  polypus;  in  the  fame  manner  as  “  the  two  pounds 
“  of  glandular,  but  at  the  fame  time  blackifh,  flefh,”  found  afterwards  by 
Yefalius  («),  in  the  fame  ventricle,  which  was  dilated  like  the  uterus,  after  a 
pulfe  which  was  furprifingly  unequal  and  various:  although  Donatus  (#) 
reckon’d  both  thefe  pieces  of  flelh,  as  they  are  call’d,  without  any  hefitation, 
among  the  number  of  “  flefhy  excrefcences”  of  other  parts  which  he  was 
defcribing,  juft  as  Schenek  (y)  did  among  tc  the  flefhy  excrefcences  of  the 
“  ventricles  of  the  heart:”  and  Riolanus  (2)  has  diftinguifh’d  “  a  remarkable 
“  gland,”  which  the  heart  of  a  certain  Polander  “  had  on  the  middle  of  its 
“  feptum,”  from  polypous  concretions ;  and  our  Pafta  (, a )  wonders,  as  he 
finds  no  other  obfervations  of  blackilh  polypi  being  contain’d  in  the  left 
ventricle,  in  the  whole  Sepulchretum,  how  thofe  two  polypi  of  Benivenius  and 
Yefalius,  which  were  in  that  ventricle,  fhould  be  black. 

23.  But  whether  thefe  two  bodies  were,  or  were  not,  polypous  concretions, 
though  there  is,  perhaps,  little  or  no  room  to  doubt  it;  they  certainly  were, 
as  l  have  Ihown  in  another  place  {b\  which  were  found  by  the  phyficians  in 
the  year  1557  ;  one  under  the  appearance  “  of  a  flefh-hke  fubftance,”  and 
about  this  another,  “  which  refembl’d  melted  hog’s  lard;”  and  not  only  thefe, 
but  thofe  alfo  which  were  extracted  by  Coiterus  (c)  from  the  finufles  of  the 
dura  mater,  and  from  the  ventricles  of  the  heart  of  a  phrenetic  woman,  and 
at  other  times,  from  the  brain  of  thofe  who  had  been  kill’d  by  hanging  ;  all 
thefe  being  “  not  unlike  worms,  but  made  up  of  a  white  pituitous  matter.” 

And  as  this  author  had  begun,  even  from  that  very  time,  to  admonifh 
phyficians  to  be  cautious,  as  it  feem’d  to  him  that  they  had  been  impos’d  upon 


(0)  Epill.  add.  ad  Goetzii  differt,  de  poly¬ 
pos.  concret.  &c. 

( p )  De  Febre  Semit.  I.  i.c.  15. 

(7)  Epill.  de  Polypo.  Cord. 

(>)  Vid.  Freher.  Theatr.  Viror,  erud.  cl, 
P.  3. 

(j)  1.  1.  Obf.  Med.  i?.  in  SchoL 
(/)  Sepulghr.  1.  2.  S.  10.  Obf.  6. 


(a)  Ibid.  Se£I.  hac  9.  Obf.  2, 

(A  De  Med.  Hill.  Mirab.  1.  5.  c.  3. 

(y)  Obf.  Med.  1.  2.  ubi  de  Corde. 

(z)  Anthropogr.  1.  3.  c.  12. 

(a)  Epill.  de  Cord.  Polypo,  n.  14. 

(4)  Epill.  17.  n.  2.  &  29.  &  Epill.  4.  n,  23.. 
(c)  Obferv.  An  at. 


by 


736  Book  II.  Of  Difeafes  of  the  Thorax. 

by  concretions  of  this  kind,  who  affirm’d  that  they  had  found  worms,  either 
within  the  heart  or  the  cranium  ;  we  cannot  be  lufficiently  aftoniffi’d  that  the 
admonitions  of  this  very  great  man  were  negleCted  to  fuch  a  degree,  or  fo 
buried  in  oblivion,  that  thofe  things  which  we  read  in  theSepulchretum,  to  go 
no  farther,  and  which  are  the  productions  of  writers  in  other  refpeCts  learned, 
Ihould  be  deliver’d  down  to  poftericy  in  the  manner  they  are.  For  you  will 
read,  for  example’s  fake,  the  younger  Vidius  (d)  averting,  that  he  had  heard 
from  men  who  deferv’d  to  be  credited,  and  who  had  diffeCted  perfons  carried 
off  by  peftilential  fevers,  “  that  worms  had  been  fometimes  generated  in  the 
“  ventricles  of  the  heart.”  But  you  do  not  read  that  he  had  made  any  enquiry 
from  them,  what  kind  of  examination  they  had  made  ufe  of,  and  how  they 
had  diftinguifh’d  real  worms  from  concretions  which  had  the  fhape  of  worms. 
You  will  read  that  Spigelius  ( e )  had  found,  in  a  woman  who  died  of  a  con- 
fumption,  “  four  round  worms,  of  the  length  of  a  fpan,  which  had  infinuated 

themfelves  into  the  very  trunk  of  the  vena  portarum,  and  had  been  an  ob- 
“  ftruCtion  to  the  entrance  of  aliment  into  the  whole  body.”  But,  although  you 
will  indeed  find  this  obfervation  in  Spigelius  himfelf(/),  yet  you  will  never- 
thdels  fee,  that  he  did  not  make  it  in  the  year  1562,  in  which  he  was  not  yet 
born,  but  in  the  year  1601,  in  which  he  had  fcarcely,  perhaps,  compleated  his 
three-and-twentieth  year;  but  by  what  method  of  diftinCtion  he  found  out  that 
they  were  real  worms,  you  will  fee  that  he  fays  not  one  word.  You  will  ra¬ 
ther  wonder  that  he  fhould  have  believ’d  them  to  have  come  thither  from  the 
inteftines,  “  through  the  narrow  orifices  of  the  meferaic  veins,”  and  that  they 
“  had  remain’d  there  fo  long  as  to  obftruCt  the  paffages  of  the  aliment.” 
For  although  other  worms  have  fometimes  perforated  the  inteftines,  as  l  have 
alfo  feen  in  a  hen  (g),  when  dead  •,  yet  by  what  fort  of  ingenuity  or  inftinCt 
thefe  creatures  feleCted  the  orifices  which  he  mentions,  and  went  through 
them,  and  liv’d  fo  long  out  cf  their  natural  fituation,  in  one  which  was  quite 
foreign  to  them,  and  by  this  means  “  were  an  obftruCtion  to  the  entrance  of 
#<  the  aliment  into  the  whole  body,”  does  by  no  means  appear.  On  the 
other  hand  it  appears,  that  no  difficulty  of  this  kind  remains,  if  you  fuppofe 
that  there  were  four  polypi,  which  refembl’d  worms,  elpecially  as  they  are 
very  frequently  met  with  in  the  bodies  of  confumptive  patients. 

But  what  fhall  we  fay  of  that  little  fnake  which  Zacutus  (b)  and  Severi¬ 
nus  (/)  have  fuppos’d  to  be  found  among  the  Englifh,  in  the  left  ventricle  of 
the  heart  ?  Why  truly  nothing,  but  what  I  have  already  fignified  in  the  former 
letter  (&),  when  I  happen’d  to  fall  accidentally  upon  the  fame  fubjeCt;  I 
mean,  that  it  was  lufficient  to  have  read  the  defcription,  in  order  to  be  con¬ 
vinc’d  that  it  was  a  polypous  concretion.  For  which  reafon,  even  Severi¬ 
nus  (/),  although  he  firft  laid  quite  different  things  of  this  little  fnake,  and 
amongfl  thefe,  fomething  which  has  come  even  into  the  head  of  a  certain  per- 
Ion  of  our  age,  in  order  to  explain  the  generation  of  polypi,  I  mean,  that 
they  were  rather  in  the  clafs  of  vegetable  than  animal  productions ;  yet  after- 

(d)  L4.  S.  1.  Obf.  62.  §.  il .  ( h )  (»)  Sepulchr.  I.  2.  S.  4.  Obf.  6.  §.  1.  &  2. 

(0  1.  2  S.  7.  Obf.  163.  (i)  n.  15. 

(f)  De  Lumbr.  lato,  c.  5.  (/)  in  Schol.  ad  cit.  Obf. 

(g)  Epift.  Anat.  14.  n.  44. 

wards 


Letter  XXIV.  Article  23.  73 7 

wards  he  comes  with  juftice  to  this  point,  to  fuppofe,  viz.  that  they  rather 
belong  to  the  clafs  of  thole  concretions  which  he  himfelf  had  even  feen,  and 
which  now  we  call  polypous  concretions.  And  if  Riolanus  had  not  read  this 
author,  or  if  he  himfelf  had  not  alfo  feen  concretions  of  this  kind;  1  fhould 
much  the  lefs  wonder  at  his  ufing  in  his  Encheiridion  (m)  the  following  words; 
“  Worms  are  alfo  generated  in  the  heart :  -  -  -  there  is  a  remarkable  hiftory  of 
“  a  certain  Englifhman,  whofc  heart  was  gnaw’d  by  a  worm:  you  will  read 
“  the  hiftory  in  the  works  of  Aurelius  Severinus.”  Finally,  as  we  have  al¬ 
ready  fpoken  in  the  laft  letter  (»),  of  another  worm  under  the  form  of  a  fly, 
of  which  the  fame  Zacutus  had  written,  you  will  fee  added  under  the  fame 
obfervation,  when  repeated  in  another  place  by  Bonetus  (0),  a-fecond  obfer- 
vation  (/>),  of  two  worms,  which  a  man,  in  other  refpefh  learn’d,  fhow’d  to 
thofe  who  were  prefent,  being  envelop’d  in  black  and  grumous  blood,  with 
which  the  ventricles  of  the  heart  were  occupied  ;  both  of  them  of  a  white  co¬ 
lour,  half  an  inch  long,  and  furnifh’d  not  only  with  a  probofeis,  but  with 
ears  and  eyes  ;  fuch,  I  fuppofe,  as  they  us’d  in  that  very  dark  place,  unlefs 
you  can  believe  it  was  at  that  time  furrounded  with  a  kind  of  vital  flame  ! 

Both  of  them,  however,  were  dead,  or  rather,  had  never  liv’d,  as  I  fup¬ 
pofe  ;  and  were  only  a  kind  of  polypous  filaments,  which  grew  (lender  at  one 
end,  and  form’d  themfelves  into  a  kind  of  probofeis,  with  particles  of  blood 
adhering  to  them,  as  generally  happens,  which  look’d,  in  fome  meafure,  like 
eyes  and  ears. 

But  you  will  reply,  that  the  worm  which  was  found  by  the  phyficians  in 
the  pericardium  of  a  certain  Florentine,  who  had  been  carried  off'  by  a  hid¬ 
den  death,  was  ftill  “alive.”  Who  fays  fo  ?  Petrus  Sphererius  (q).  But 
v/as  he  himfelf  prefent?  It  does  not  appear  that  he  was.  Was  he  who  re¬ 
lated  it  to  him?  Not  even  that. 

I  refided  at  Bologna,  at  a  time  when  a  rumour  happen’d  to  be  fpread 
about,  that  upon  differing  fome  horfes  of  a  nobleman,  which  had  fall’n 
down  dead  fuddenly,  lizards,  which  are  a  fpecies  of  many-footed  animals, 
were  found  in  their  hearts.  The  learn’d  laugh’d.  Yet  fome  half  learn’d 
perfons  were  not  wanting,  who  contended,  partly,  that  there  might  have 
been  fo  ;  and  partly  added,  by  way  of  confirmation  to  the  report,  that  thefe 
lizards  had  been  found  to  be  not  quite  deftitute  of  life  and  motion.  To  thefe 
Valfalva  replied,  What  need  have  we  of  difpute  ?  Let  us  examine  thefe  lizards. 
Another  horfe,  therefore,  having  died  in  the  fame  liable,  and  in  the  fame 
manner,  we  examin’d  the  carcafe  of  the  animal ;  nor  did  we  need  any  very 
long  examination,  in  order  to  perceive  very  plainly,  that  they  were  nothing 
elfe  but  polypous  concretions,  which,  in  fome  meafure,  re  (enabl’d  lizards  in 
their  external  form. 

Do  you  think  it  was  deftin’d,  then,  to  thofe  times,  by  fome  kind  of  fata¬ 
lity,  that  worms  fhould  be  found  in  the  fanguiferous  veflfels,  and  the 
heart  ?  or  do  you  not  rather  imagine,  that  if  the  admonitions  of  Coiterus  had 
not  quite  flipp’d  the  memory  of  our  anceftors,  they  would  have  found  worms, 

(/«)  1.  3.  c.  8.  (/)  In  Schol. 

(n)  n.  15.  (7)  Obf.  cit.  §.  1. 

(0)  1.  z.  S.  1  r.  Obf.  3.  §■  2. 

Vol.  I.  5  B  Ut 


738  Book  II.  Of  Difeafes  of  the  Thorax. 

in  places  of  that  kind,  no  oftener  than  their  pofterity  have  done  ?  But  left 
you  fhould  fufpedft,  that  it  was  purpofely  done  of  me  not  to  recede  from  the 
obfervations  which  are  given  us  in  the  Sepulchretum,  either  here,  or  where 
I  treated  of  worms  in  the  pericardium  (r)  ;  I  will  juft  hint  at  the  principal 
obfervations  which  either  have  not  been  related  there,  or  could  not  be  re¬ 
lated  there  :  and  I  will  touch  upon  them  in  fuch  a  manner,  that  you  may 
not  only  plainly  perceive  me  not  to  be  unmindful  of  what  I  then  ingen noufly 
confefs’d  ;  I  mean,  that  I  do  not  contend  in  regard  to  what  I  have  frequently 
feen  in  dogs,  that  the  fame  can  never  happen  in  human  bodies,  but  alio, 
that  I  fhall  not  conteft  the  point  with  you,  if  you  fhould  chance  to  believe 
that  fuch  a  thing  has  really  fometimes  happen’d  •,  as  it  might  have  happen’d 
in  more  ways  than  one.  For  if  you,  firlt  of  all,  read  thofe  things  which  I 
have  faid  (j)  had  been  feen  by  me  and  by  others  in  dogs,  and  in  other 
animals,  that  there  was  more  than  one  place  in  which  worms,  of  a  reddilh 
colour,  and  of  the  flendernefs  of  needles,  are  generated,  and  from  whence 
they  attempt  an  exit,  and  particularly  into  the  fanguiferous  veflels  ;  you  will 
not  be  extremely  furpriz’d  that  Thomas  Cornelius  (/)  fhould  have  found,  in 
a  ftarling  which  had  been  troubl’d  with  convulfions,  “  a  kind  of  fmall  round 
«  worms  twining  about  the  balls  of  the  heart  5”  and  ftill  lefs,  that  the  emi¬ 
nent  furgeon  Lapeyronie  ( u )  had,  in  more  than  one  dog,  feen  worms  con¬ 
glomerated  betwixt  the  bafis  of  the  heart  and  the  pericardium,  and  fometimes 
even  in  the  ventricles  themfelves.  And  if  you  fuppofe,  that  neither  of  thefe 
gentlemen  was  deceiv’d  by  any  fimilitude  or  appearance  of  thefe  worms,  you 
will  ftill  lefs  imagine,  that  Lochner  was  deceiv’d,  when  he(*)  affirm’d  that 
he  found  “  fmall  and  redilh  worms  moving  themfelves,  and  creeping  about 
“  in  a  furprifing  manner,”  and,  as  he  fufficiently  fhews  by  the  example  he 
gives  (y),  “  in  thicknefs  and  length  to  be  compar’d  with  a  fmall  needle 
and  thefe  in  the  left  ventricle  of  the  heart  of  a  little  girl,  in  whom  he  de- 
fcribes  tortures  of  two  months  continuance,  and  a  fenfe  of  gnawing  about 
the  praecordia,  together  with  a  tremor  and  palpitation  of  the  heart,  an  in- 
termiffion  of  the  pulfe,  lwoonings,  cold  fweats,  and  convulfive  motions 

It  were  much  to  be  wifh’d,  indeed,  that,  before  he  pronounc’d  the  "  nidus” 
of  thefe  little  worms  to  have  been  in  the  heart,  which  is  a  vifeus,  by  reafon 
of  its  alternate  conftribtions,  and  thofe  in  confequence  of  irritation  more 
vehement  and  ftrong,  very  unfit  for  worms  to  form  their  nidus  and  take  up 
their  refidence  in  for  the  fpace  of  two  months  ;  it  were  to  be  wiffi’d,  I  fay, 
that  he  had  enquir’d  after  thofe  erofions  and  indurations  of  the  fubftance  of 
the  heart,  which  have  been  obferv’d  by  us  in  nidufles  of  that  kind,  left, 
perhaps,  they  fhould  have  been  feated  in  the  coats  of  feme  veflel  not  very 
far  diftant  *,  fo  that  the  heart  might  be  eafily  drawn  into  confent,  and  the 
worms  might  at  length  have  pafs’d  on  to  the  heart,  at  the  time  when  worms 
always  fly  from  their  nidufles,  where-ever  they  are;  I  mean,  at  the  time 
of  their  jfeath,  or  foon  after,,  as  has  been  obferv’d  by  Vaiiifneri  (z). 

(r)  Epift.  23.  n.  15.  (*)  Eph.  N.  C.  Cent.  8.  Obf.  1. 

(j)  Epilh  Anat.  9.  n.  44.  ic  feqq.  (y)  Vid.  Earund.  Dec.  2.  A.  6.  Append. 

(/)  Progvmn.  Phyf.  6.  n.  1.  Obf.  13. 

(u)  Apud  Senae  Traite  du  Coeur,  1.  4.  ch.  9.  (s)  Rifp.  allaLettera  di  MonCgn.  d’Adria. 

r.,  6. 

And 


Letter  XXIV.  Article  23.  739 

And  this  I  fuppofe  to  have  happen’d  at  that  time  in  dogs  alfo,  and  other 
animals  ;  and  (till  more  readily  where  the  queftion  is  not  of  other  kinds  of 
worms,  but  of  the  common  round  worms  of  the  ftomach  and  inteftines 
being  fometimes  really  found  within  the  pericardium.  Yet  I  do  not  luppofe 
that  they  have  gone  through  the  fanguiferous  veffels,  in  the  coats  of  which 
thefe  creatures  do  not  form  their  nidus  ;  but  through  the  fhort  and  eafy  way 
of  the  cefophagus,  which  they  perforate  in  the  fame  manner  as  they  do  the 
inteftines,  and  not  very  feldom  neither  ;  fo  that  they  can  very  eafily  penetrate 
into  the  neighbouring  pericardium.  By  which  way,  and  at  the  time  I  have 
faid,  I  fhould  fuppofe,  that  the  worm  of  Baglivi,  which  Le  Clerc  (a)  takes 
notice  of,  had  come  thither,  and  in  like  manner  another,  which  the  cele¬ 
brated  Hcehnius  ( b )  fays,  upon  drawing  it  away  from  the  heart,  to  which  it 
was  fix’d,  “  immediately  curl’d  itfelf  round  his  fingers  like  a  fnake.”  For 
this  laft  worm  was  in  a  man,  in  regard  to  whom  it  is  not  faid,  that  while 
he  liv’d  any  fymptoms  of  diforder  relative  to  the  heart  were  obferv’d ;  and 
the  firft  was  found  in  a  man  who  had  labour’d  under  pains  of  the  ftomach, 
and  other  diforders  which  relate  to  the  heart,  indeed  ;  but  this  might  be 
eafily  drawn  into  confent  by  the  ftomach.  You,  therefore,  underftand  my 
doubts  and  conjectures,  which  I  fhall  not  get  rid  of  till  a  number  of  obfer- 
vations  have  been  produc’d,  which  have  not  been  taken  without  the  moft 
accurate  examination,  that  I  fo  frequently  want,  and  which  may  at  length 
bring  me  fo  far  as  to  acknowledge  readily,  that  the  circum ftance  which  I 
do  not  now  pretend  to  fay  did  never  happen,  or  never  may  happen,  has  really 
happen’d.  You  fee,  at  the  fame  time,  that  where  an  author  is  worthy  of 
credit,  and  fays  that  living  worms,  either  of  the  inteftinal  kind,  or  of  others, 
were  feen  to  be  alive,  I  take  it  for  granted  that  it  was  fo,  in  deference  to 
his  teftimony.  But,  in  fine,  how  many  obfervations  of  this  kind  are  extant  ? 
For  of  thofe  which  I  at  prefent  remember,  I  think  there  is  not  one  that  I 
have  omitted  here;  and  among  them  there  is  one,  I  think,  of  a  worm  not 
alive. 

But  Du  Yerney,  you  will  fay,  is  faid  (7)  “  to  have  obferv’d  ”  a  worm  like 
an  earth-worm,  and  that  living  too,  within  the  longitudinal  finus  of  a  boy 
who  had  been  troubl’d  with  a  continual  and  violent  pain  at  the  root  of  the 
nofe,  and  who,  after  a  flow  fever  of  three  months  continuance,  was  at  length 
carried  off  by  violent  convulfions.  Yet  when  I  read  this  very  cafe  in  the 
hiftory  of  the  Royal  Academy  of  Sciences  {d\  and  well  weigh  every  word 
feparately,  he  feems  to  me  rather  to  have  reported  a  thing  which  was  related 
to  him,  than  one  which  he  had  obferv’d;  and  from  hence  arifes  even  fome 
fulpicion,  that  the  perfon  who  related  it  to  him  had  not  even  himfelf  feen 
it ;  but  that  having  heard  it  from  thofe  who  had  feen  the  worm,  he  had  pro¬ 
bably  transferr’d  it,  as  frequently  happens  in  fimilar  cafes,  from  finus  to 
finus,  that  is,  from  the  frontal  (e)  to  the  longitudinal  finus.  For  which 
reafon,  the  queftion  is  not  here,  as  you  fee,  whether  we  fhall  believe  Du 

(a)  Hift.  Lat.  Lumbr.  c.  13.  ubi  de  Ver.  (<-)  Vid.  apud  Palfin.  Anat.  du  corps  hum. 
mib.  Cord.  p.  2.  ch.  3. 

(£)  Aft.  N.  C.  Tom.  7.  Obf.  14.  (d)  A.  1.  1700.  Obf.  Anat.  10. 

\e)  Vid.  Epift.  1.  n.  8,  &  9. 


5  B  2 


Yerney, 


7  4°  Book  II.  Of  Difeafes  of  the  Thorax. 

V  erney,  or  not  •,  as  it  is  nor,  in  like  manner,  whether  we  fhall  believe 
T  homas  Cornelius  (/) ;  fince  fpeaking  of  a  girl  in  whom,  after  pains  of  the 
praecordia,  which  were  very  troublelome,  and  a  frequent  epilepiy,  no  other 
eaufe  of  death  appear’d,  except  that  “  worms,  like  earth-worms,  had  eaten 
“  away  the  vefiels  of  the  heart,”  he  lays,  indeed,  that  he  “  had  known  ”  the 
girl ;  buc  does  not  fay  that  he  had  feen  the  worms,  although  he  at  the  fame 
time  exprelsly  fays,  that  he  had  feen  the  little  worms  in  that  llarling  in  the 
glands  which  lie  upon  the  cefophagus  of  a  dog,  and  in  other  parts  of  other 
animals  which  he  there  mentions  ;  and,  in  like  manner,  that  he  had  leen 
worms  “  in  the  brain  alfo,  and  in  the  heart,  of  various  fizes  and  forms,  and 
“  fometimes  not  lefs  furprifing  for  their  quantity  than  for  their  magnitude.” 
Which  words,  however,  l'eem  to  indicate,  that  thele  were  rather  polypous 
concretions  in  the  lhape  of  worms,  asVallifneri  (g)  conjetftur’d  that  they  were 
alfo  in  that  girl  fibres  in  the  fhape  of  worms,  made  up  of  a  white  and  vifcid 
matter,  and  adhering  to  the  ulcers  of  the  heart. 

But  though  we  Ihould  be  unpardonable  at  this  time  to  take  things  of  that 
kind  readily  for  worms,  yet  we  muft  pardon  both  the  man,  and  the  times, 
in  which  the  admonitions  of  Coiterus  were  not  at  all  read,  or  at  leaft  fo  neg¬ 
ligently,  by  moft  even  of  the  learned  phyficians,  that  they  number’d  thofe 
very  concretions,  which  he  had  faid  bore  the  fimilitude  of  worms,  indeed', 
but  were  in  facft  made  up  of  a  pituita,  as  he  call’d  it,  among  the  inftances 
of  true  worms,  which  were  found  in  the  heart  and  in  the  brain.  Probably 
you  would  not  believe  me,  if  I  were  not  to  produce  the  very  words  them- 
lelves  which  Cornelius  has  made  ule  of  in  his  enumeration  of  thofe  worms 
that  he  look’d  upon  as  perfedtly  real :  they  are  as  follows :  “  Volcherus 
“  Coiter  alfo  fays,  that  worms  of  the  fame  kind  have,  in  like  manner,  been 
“  fometimes  oblerv’d  by  him  •,  and  not  in  the  heart  only,  but  even  in  the 
“  brain,  of  thofe  perfons  who  have  undergone  the  punifhment  of  public 
“  hanging.”  Nothing  could  have  been  more  truly  laid,  if  Cornelius  had 
judg’d,  in  the  fame  manner,  of  forne  of  his  worms,  as  Volcherus  did  of  his. 

24.  But  now  let  us,  at  length,  return  from  a  prolix,  but  not  perhaps  in 
vain  prolix,  difcourfe  upon  falfe  and  true  worms,  to  that  by  which  I  was  led 
into  it  I  mean,  to  the  hiftory  of  polypous  concretions  that  1  had  begun  ; 
which,  left  it  fhould  be  any  longer  lufpedted,  that  the  polypus  of  the  heart 
is  a  new  difeafe,  and  to  be  accounted  for,  perhaps,  from  a  new  method  of 
living  in  this  our  age,  I  have  brought  it  down  from  the  time  of  Helidmus, 
in  which  it  was  begun  (£),  to  that  of  Coiterus.  The  oblervations  of  this 
anatomift  were  fucceeded,  in  the  following  years,  by  the  oblervations  of  thofe 
who  law  polypi  in  the  heart  and  veftels  •,  as  of  Jo.  Baptift  Cananus,  Guliel- 
mus  Ballonius,  and  Thomas  Eraftus.  For  the  firft,  in  the  year  1574,  found 
“  a  lump  of  fat,  in  the  fhape  of  a  large  tallow  candle,”  in  the  left  ventricle 
of  the  heart  of  Oftiario,  the  moft  ferene  duke  of  Ferrara,  who  died  of  a 
fudden  death,  as  is  related  in  the  Sepulchretum  Anatomicum  (/),  from 
Bofchius  the  difciple  of  Cananus. 

And  if  you  compare  this  obfervation  with  that  which  immediately  pre~ 


(f)  Progymn.  6.  cit. 
C)  Rifp.  cit. 


4 


(/q  N\  22. 

p)  L.  2.  S,  1 1,  Obf.  5.  §  5. 


cedes. 


Letter  XXIV.  Article  24.  741 

cedes  ( k ),  you  will  conjecture  that  both  are  the  fame,  the  word  OJliario  only 
being  through  negligence  omitted  by  thofe  from  whom  it  is  copied  •,  fo  that 
what  was  found  in  him  may  feem  to  have  been  found  in  the  duke  alfo.  This 
you  will  better  know  by  looking  upon  that  fourth  leCtion  of  Bofchius,  which 
is  pointed  out,  not  page  438,  for  the  whole  does  not  exceed  76,  but  page  3«  •, 
nor  will  you  wonder  that,  as  often  as  ever  he  there  names  Cananus,  and  he 
often  does  name  him,  he  adorns  him  with  the  title  of  “  the  very  reverend.” 
For  after  the  time  that  he  was  the  phyfician  of  pope  Julius  the  third,  he 
feems  ftill  to  have  retain’d  the  habit  of  a  prieft •,  and  perhaps  more  than  the 
habit  ♦,  fince  Fioravantio  (/),  when  he  wrote,  which  was  in  the  fifteenth  year 
after  the  death  of  this  pope,  and  extoll’d  this  Canan,  who  was  living  even 
then,  as  more  fkilful  than  others  in  the  anatomy  of  the  eyes,  fpoke  of  him 
thus,  II  Rev.  Monfignor  Canan  Fcrrarefe  ;  which  is  an  addrefs  made  life 
of  to  prelates  and  dignified  clergymen  only.  And  that  he  was  the  phyfician 
of  pope  Julius,  I  have  been  inform’d  from  a  very  learned  and  humane  man, 
Thyrfo  Pagliarini,  the  prebendary  of  Ferrara,  who  alfo  gave  me  a  very  fcarce 
work  of  the  fame  Canan’s  (m) ;  as  is  confirm’d  by  Profper  Mandofius  [n}t 
who  befides  takes  notice  of  the  noble  family  of  Cananus,  and  his  own  brother 
Julius,  who  was  a  cardinal  of  the  holy  Roman  church.  Which  circum  fiances, 
and  others  that  relate  to  the  life  of  Cananus,  and  to  his  work,  1  fhall,  per¬ 
haps,  have  a  more  convenient  occafion  of  enlarging  upon.  Let  it  at  prefent 
fuffice  to  have  thus  pointed  out  thefe  things  in  a  tranfitory  manner,  in  order 
to  give  you  to  know,  that  wKat  I  could  not  find  out  in  regard  to  this  ana- 
tomift,  for  want  of  time  and  opportunity,  when  I  added  that  poftfeript  to: 
the  fifteenth  anatomical  epiftle  (<?),  I  foon  after  met  with  in  fuch  a  manner,, 
tnat  great  weight  was  thereby  added  to  the  defence  of  him,  which  1  at  that 
time  began  \  though  I  hope  there  will  be  no  reafon  for  profecuting  that  de¬ 
fence  hereafter. 

But  to  go  on  to  fpeak  of  the  obfervations  of  polypi  :  Gulielmus  Ballonius,. 
in  the  autumnal  epidemic  conftitution  of  the  year  1575  (/>),  mentions  a  cer¬ 
tain  perfon  in  whom  were  found  “  caruncles,  as  it  were,  and  thofe  of  an 
“  oblong  figure,”  in  the  orifices  of  the  vefifels  which  go  from  the  heart  to 
the  lungs. 

Finally,  Thomas  Eraftus,  as  you  have  it  in  the  Sepulchretum  (<?),  in  a 
book  publilh’d  in  the  year  1^80,  deferib’d  a  concretion  “  of  a  yellowifh  co- 
“  lour,  like  marrow,  that  has  been  boil’d,  in  the  bones  of  oxen,”  which 
was  found  in  the  hearts  of  two  perfons  •,  one  of  whom,  together  with  a  fever 
and  a  pleurify,  had  had  a  great  irregularity  of  the  pulfe ;  and  the  other  the 
fame  irregularity,  but  without  a  fever. 

There  is  no  occafion  to  mention  every  one,  who  having,  after  thefe,  found 
fuch  kind  of  concretions  in  the  heart  and  vefiels  annex’d  to  it,  compar’d 
them,  at  one  time  to  marrow,  at  another  time  to  fat,  and  fometimes  even 
to  fiefli  itfelf.  For  I  have  not  fo  much  as  nam’d  all  that  I  had  it  in  my 
power  to  name  of  the  former  authors  j  although  Smetius  (r),  in  the  year 

(«)  N.  66.  (p)  Epid.  1.  2-. 

($>)  Sedt.  hac  9.  Obf.  j. 
p)  Sepukhr,  1.  3.  S.  21,  Obf.  3.  §  24% 

*57 


(k)  Ibid.  §  4.  (7)  Chirurgia,  !.  2.  c.  16. 

\m)  Mufcul.  hum.  corp.  pidt.  diffedt, 

{n)  Poatif.  Arcbiatr. 


7  4-  Book  II.  Of  Difeafes  of  the  Thorax. 

1576,  in  the  body  of  a  prince,  whofe  pulfe  had  been  unequal,  irregular,  and 
intermittent,  befides  concretions  in  the  ventricles  of  the  heart,  like  thofe 
which  Erafius  has  defcrib’d,  has  moreover  remark’d,  “  that  they  were  fur- 
“  nifh’d  with  certain  appendages  which  were  certainly  feen  to  have  the 
greatelt  degree  of  length  by  Neretius(j),  in  a  woman  who  had  labour’d 
under  a  peripneumony,  inafmuch  as  they  went  out  from  the  right  ventricle 
of  the  heart,  flefliy,  whitifli,  and  flaccid,  and  entering  into  the  vena  cava, 
both  where  it  afcends  and  delcends,  “  were  propagated  quite  to  the  head 
“  and  the  os  facrum.”  And  through  another  orifice  of  the  fame  ventricle, 
Guarinoni  (/)  often  faw  a  thick  pituita,  for  fo  he  call’d  thefe  concretions,  ex¬ 
tend  themfelves  in  fuch  a  manner  into  the  pulmonary  artery,  that,  by  laying 
hold  of  the  beginning  of  this  pituita,  he  drew  it  out  at  once  from  all  the 
branches  of  the  artery,  which  was  “  fo  moulded  by  the  veflels  into  their 
“  own  form,  that  it  feem’d  to  be  a  tree.” 

But  the  firft  of  all  who,  as  far  as  I  can  now  remember,  afterwards  pub- 
lifh’d  a  delineation  of  that  kind  of  tree,  as  it  were,  was  Cafpar  Bauhin  (a) ; 
and,  at  the  fame  time,  of  a  polypus  both  of  the  right  and  the  left  ventricle 
of  the  heart  (x),  together  with  polypous  roots  which  had  been  inferted  into 
the  fubftance  of  both  the  ventricles,  and  a  propagation  of  the  left  polypus 
into  the  great  artery,  the  fubclavians,  the  carotids,  and  the  vertebrals.  And 
though  he  comprehended  all  thefe  appearances  under  the  general  term  of 
<c  adipofe”  matter,  fuch  as  he  had  frequently  obferv’d  in  dropfical  and  con- 
fumptive  perfons ;  yet  in  a  certain  girl  (y)  he  has,  befides  a  matter  “  like 
“  fat,”  in  the  right  ventricle,  taken  notice,  that  a  kind  of  a  white,  “  mem- 
“  branous,”  thick,  and  oblong  matter  had  been  feen  by  him  in  the  annex’d 
auricle,  which  was  fwell’d  to  a  very  great  degree.  Nor  yet  were  others 
wanting,  about  thofe  times,  and  afterwards,  until  Tulpiusfz),  in  the  year 
164.7,  gave  his  figure  and  description  of  the  polypus  of  the  heart,  who  have 
mention’d,  that  the  fame  things  had  been  feen  by  them  ;  out  of  whom  it 
is  fufficient  to  name  one,  whofe  books  were  in  the  hands  of  all,  Riolanus. 
For  he  had  publifh’d  the  fame  things,  which  are  extant  in  the  Sepulchretum(^), 
of  “  pieces  of  flefli  of  the  bignefs  of  a  fill,  condens’d,  and  wrapp’d  up  in 

each  other,”  being  found  by  him  “  within  the  right  ventricle,  at  the  ori- 
“  fice  of  the  vena  cava,  in  fome  perfons  who  had  been  luffbcated  by  a  fud- 
“  den  and  unexpected  death  and  particularly  in  the  bilhop  of  Malaga,  at 
leaft,  in  the  year  1626,  in  the  chapter  of  his  Anthropographia,  there  pointed 
out :  to  which  he  afterwards  added  others,  as  we  read  in  the  laft  edition  of 
the  fame  work,  which  belongs  to  the  year  1649. 

And  indeed  the  very  name  of  polypus ,  which  all  the  phyficians,  who  were 
prefent  when  the  concretion  was  found  by  Tulpius,  gave  to  it  “  with  one 
“  confent,”  feems  to  be  hinted  at,  as  learned  men  have  obferv’d,  in  the 
books  of  Fabricius  Bartoletus,  publilh’d  in  the  year  1633,  in  which,  when 


(fl  Apud  Schenck.  Obf.  Med.  1.  2.  ubi  de 
Cord.  Excref. 

(/)  Sepulchr.  1.  2.  S.  1.  Obf.  14.  &  1.  4,  S. 
1  •  Obf.  14. 

(*)  Tab.  9.  Fig.  2.  in  Append,  ad  Tab. 
Theatri  Anat. 


{x)  Ibid.  Fig.  1. 

(y)  Sepulchr.  1.  2.  S.  8.  Obf.  14.  §  2. 
(2)  Obf.  Med.  1.  1.  c.  27. 

(*)  1.  2.  S.  ii.  Obf.  5.  §  2. 


he 


Letter  XXIV.  Articles  25,  26.  74 3 

he  fpoke  of  concretions  that  had  been  feen  by  him,  he  us’d  the  word  44  po- 
“  lypodi. 

25.  But,  although  it  had  been  feen  by  fo  many  phyficians  and  others,  for 
it  was  not  my  intention  to  mention  every  one  by  name,  but  only  by  touch¬ 
ing  upon  the  heads,  and  the  times,  to  digeft  into  order  moft  of  the  obferva- 
tions  that  are  very  well  known,  and  fo  trace  out  to  you  a  kind  of  hiftory 
of  the  polypus  ;  I  fay,  although  it  had  been  feen  by  fo  great  a  number  of 
phyficians  and  others,  and  taken  for  the  caufe  of  the  moft  violent  diforders, 
and  even  of  death  itfelf;  yet  nobody  publifh’d  a  particular  treatife  upon  it 
before  the  year  1654,  in  which  Sebaftian  Piflini,  a  phyfician  of  Lucca,  at 
length  publifh’d  his  epiftle  de  Polypo  Cordis  *,  in  which  having  confefs’d,  that 
the  polypus  was,  indeed,  44  a  new  name,”  but  44  not  a  new  appearance 
and  having  given,  or  referr’d  to,  fome  of  his  own  obfervations,  and  fome 
alfo  both  of  the  ancient  and  modern  phyficians  ;  he  endeavour’d  to  produce 
the  figns  of  it,  and  to  folve  fome  theoretic  and  practical  problems  in  regard 
thereto.  He  was  about  to  be  fucceeded  by  Michael  Kirftenius,  the  lame 
whofe  obfervation  and  figures  of  the  polypi  of  the  heart  were  publifii’d  by 
Thomas  Bartholin  (b).  For  he  intended,  as  Segerus  (c)  had  written  to  Bar¬ 
tholin  in  the  year  1657,  “  to  draw  up  a  difiertation  on  the  diforders  of  the 
44  heart;”  with  which  intention  44  he  had  made  obfervations  upon  many  po- 
44  lypi  of  the  heart,  and  had  Ihown  them  delineated”  to  Segerus  :  44  from 
44  which  he  fuppos’d  fufi'ocative  catarrhs  principally  to  arife,  for  this  reafon, 
44  becaufe  all  tbofe  perfons,  in  whom  he  had  found  thefe  polypi,  had  been 
44  carried  off  by  this  catarrh  that  is,  by  the  circulation  of  the  blood 
44  being  obftrudled,  and  altogether  ftopp’d  by  concretions  of  that  kind.” 
Whether  this  difiertation  ever  came  out,  I  do  not  know  :  at  leaft  I  do  not  re¬ 
member  to  have  read  that  any  one  had  feen  it.  Jn  the  mean  while,  Malpighi 
fent  forth  his  difiertation,  entitled,  De  Polypo  Cordis ,  in  the  year  1666,  having 
made  an  enquiry  into  the  matter  and  ftrubture  of  it.  But  as  this  difiertation, 
as  well  as  moft  of  the  other  principal  things,  which  were  publifh’d  fince  that,? 
upon  the  polypi  of  the  heart  and  veflels,  by  fo  many  others,  is  very  welf 
known  to  you,  and  of  courfe  more  than  what  I  have  mention’d  before  ;  I 
fhall  carry  no  farther  thefe  outlines  of  the  hiftory  of  the  polypus,  but  fhalh 
immediately  pafs  over  to  thofe  things,  for  the  fake  of  which  I  did  not  think 
it  ufelefs  to  premife  the  foregoing. 

26.  As  to  what  relates,  then,  to  the  matter  of  the  polypus,  they  who  have 
compar’d  it  with  fat,  or  flefh,  or  membrane,  or  pituita,  are  by  no  means  to 
be  argu’d  againft,  as  they  have  confider’d  reiemblance  only  *,  which,  in  the 
judgment  of  the  eyes,  is  fometimes  fo  great,  that  it  feems  as  if  no  refem- 
blance  could  be  more  perfedt.  And  they  who  have  imagin’d,  not  only  that 
it  was  like  thefe  things,  but  was  really  one  or  other  of  them,  were  fatisfied 
with  a  flight  examination,  or  no  examination  at  all,  and  confequently  de¬ 
ceiv’d  by  the  appearance  of  the  thing.  Thus  they,  wiio  fo  far  were  con¬ 
vinc’d  of  its  being  of  the  adipofe  kind  (d),  as  to  wonder  how  it  could  con- 

(£)  Cent.  3.  Hift.  Anat.  17.  (d)  Vid.  Bofchii  Left.  4.  &  Barthol.  Cent;. 

(*■)  Tho,  Bartholin.  Cent.  2.  Epift.  Medic.  1.  Epift.  Med.  2.. 

26. 


2 


Crete. 


744  Book  II.  Of  Difcafes  of  the  Thorax. 

crete  in  fuch  a  manner,  even  in  that  place,  the  heat  of  which,  according  to 
Galen,  “  could  fcarcely  be  borne  by  the  finger  of  a  living  perfon,”  feem,  be¬ 
yond  a  doubt,  to  have  neglected  the  experiment  of  the  fire.  And  it  is  very 
furprifing,  as  they  believ’d  it  to  be  fat,  that  they  did  not  either  doubt  upon 
that  dodtrine  of  Galen,  or  in  regard  to  the  concretion,  whether  it  had  hap¬ 
pen’d  while  the  man  was  living,  or  rather  after  the  body  was  already  grown 
cold  :  although  it  is  more  to  be  w'onder’d  at,  that  in  a  much  more  modern 
time  there  were  not  wanting  fome  who  deriv’d  the  matter  of  the  polypus  from 
the  fat  of  the  heart  itfelf,  by  carrying  it  through,  I  know  not  how,  from  the 
external  to  the  internal  parts. 

But  they  who  have  judg’d  polypi  to  be  flefh  or  membrane,  if  they  really 
have  not  always  been  deceiv’d,  but  have  feen  their  fibres  to  be,  fometimes, 
continu’d  with  the  fibres  of  the  heart,  and  that  true  blood-veflels  were  pro¬ 
duc’d  through  them,  neither  of  which  it  has  yet  happen’d  to  me  to  fee 
among!!  the  alrnoft  innumerable  polypi  that  have  occurr’d  to  me;  they  then 
did  not  meet  with  thofe  polypi  of  which  we  treat  at  prefent,  but  excrefcences 
of  the  heart.  But  it  is  one  thing,  that  the  fmall  roots  or  fibres  of  the  po¬ 
lypi  fhould  be  ingrafted,  as  it  were,  into  the  very  fmall  foveolae,  or  cavities, 
and  little  foramina,  of  the  heart,  and  at  the  fame  time  fhow  a  kind  of  fimi- 
litude  of  veflels  creeping  through  them,  cr  within  them  ;  and  another  thing, 
that  the  fibres  themfelves  fhould  be  continu’d,  and  that  veflels  furnifh’d  with 
certain  and  peculiar  coats  fhould  fall  under  the  eyes,  and  knife,  of  the  per- 
fons  who  cut  into  thefe  polypi. 

Valfalva  was  formerly  inclin’d  to  this  opinion,  and  imagin’d  that  he  had 
feen  a  great  number  of  fmall  veflels  in  a  certain  polypus,  which  he  had  alfo 
accurately  delineated ;  but  from  the  examination  of  fimilar  polypi,  he  per¬ 
ceiv’d  the  fallacy,  and  what  he  had  before  delineated  afterwards  blotted  out. 

At  length,  they  who  have  faid  that  the  polypi  were  made  up  of  a  pituita, 
if  by  that  they  meant  any  thing  elfe  than  the  matter,  of  which  the  cruft  that 
lies  upon  the  top  of  coagulated  blood  is  compos’d,  are  certainly  not  fo  much 
to  be  approv’d  of,  as  they  who  have  underftood  that  very  matter  itfelf.  For 
what  elfe  do  we  fuppofe,  at  prefent,  but  that  this  matter  is  the  principal  anti 
peculiar  matter  of  the  polypus  ?  or  what  difference  would  the  celebrated 
man  Andreas  Pafta  ( e )  find  to  have  been  obferv’d  between  that  cruft  and 
the  polypous  concretion,  by  Malpighi  and  Willis  ?  or  what  difference  could 
he  find,  in  fa£V,  not  only  by  reading  thefe  authors,  but  by  comparing  thefe 
matters  together  accurately,  and  examining  into  their  ftrudture  ? 

But  that  this  matter  was  really  the  pituita  of  the  ancients,  that  excellent 
phyfician  Salius,  who  was  extremely  well  fkill’d  in  their  dodtrine,  has,  among 
others,  clearly  fliown  (/).  His  words  are,  “  We  fee  that  not  only  both  the 
“  fpec.es  of  bile,  when  thrown  out  with  the  blood  from  the  vein,  coagu- 
<c  late,  but  even  the  pituita  itfelf,  which  is  fometimes  concreted  on  the  fur- 
tc  face  of  the  blood,  to  fuch  a  degree,  that  it  can  fcarcely  be  cut  through 
“  with  a  knife;  and  that  unlefs  this,  and  the  fiimy  part  of  the  blood,  be 
tc  mix’d  with  it,  tho’  the  blood  may  indeed  coagulate,  however  it  is  thrown 
**  out  from  the  vein,  yet  it  does  not  coagulate  fo  foon,  nor  make  fo  firm  a 

[e)  Epift.  de  Cord.  Polypo,  n.  17.  &  ieqq.  (fj  De  Affefl.  Partic.  c.  4. 

“  coalition, 


Letter  XXIV.  Article  27.'  745 

**  coalition,  as  generally  happens  to  it,  when  the  melancholic  and  pituitous 
sc  humours  are  copioufly  mix’d  with  it.”  And  thefe  words  I  was  willing  to 
copy  over  perfedtly,  that  you  might  compare  them  with  thole  which  that 
very  experienc’d  man  Louis  Petit  has  written  in  a  memoir  (g)  upon  the 
method  of  flopping  haemorrhages,  where  he  has  obierv’d,  that  the  red  part 
of  the  blood  coagulates  fo  much  the  more  loofely,  as  it  has  the  lefs  of  the 
white  part  mix’d  with  it,  and  vice  verfa ;  fo  that  the  cruft  is,  for  this  reafon, 
moft  hard,  becaufe  it  is  made  up  of  the  white  part  of  the  blood  alone.  But 
you  Will  fee  that  this  remark  was  likewife  made  even  on  dead  bodies,  by 
the  fame  gentleman  ;  I  mean,  that  in  the  blood,  which  has  fo  coagulated  in 
the  heart,  and  in  all  the  veffels,  whether  venous  or  arterial,  the  white  part 
is  diftinct  from  the  red ;  the  red  occupying  the  inferior  place,  and  the  white 
the  fuperior;  “  provided  the  body  has  grown  cold  in  an  horizontal  fituation, 
“  as  generally  happens.” 

27.  But  although  thefe  things,  in  regard  to  the  matter  of  polypi,  and 
their  ftrudture,  lo  much  like  that  which  is  obferv’d  to  take  place  in  the  cruft 
of  blood,  and  in  regard  to  the  formation  of  the  cruft,  on  the  upper  part  of 
blood  which  has  been  fuffer’d  to  cool  quietly,  as  is  almoft  every  day  feen  ; 
although  thefe  things,  I  fay,  as  they  were  very  well  known,  ought  to  have 
created  a  doubt  in  the  minds  of  phyficians,  whether  polypi  were  form’d  long 
before  death,  or  rather,  whether  they  were  not  form’d  after  death,  efpecially 
from  the  time  that  they  had  read  the  obfervation  which  1  juft  now  mention’d, 
made  by  Petit  on  dead  bodies  ;  yet  fo  much  did  that  too  prevailing  perfua- 
fion  of  the  pre-exiftent  polypus  encreafe  every  day,  that  unlefs  the  very  ce¬ 
lebrated  man  Andreas  Pafta,  whom  1  juft  now  fpoke  of,  had  rifen  up,  qui 

T olkre  contra  j 

Eft  oculos  aufus ,  primufque  cbfijlere  contra  (b)  ; 

“  Who  firft  the  rage  of  error  dar’d  reftrain, 

“  And  fhow  to  ruling  pride  the  madnefs  of  its  reign;” 

what  end  this  dodtrine  would  have  had  amongft  moft  perfons,  or  when  It 
would  have  had  an  end,  I  do  not  very  well  know.  And  I  faid  “  firft,”  be¬ 
caufe  Kerckringius  (/)  attack’d  the  concretion  of  all  the  parts  of  the  blood, 
rather  than  the  concretion  of  the  white  parts  in  particular,  that  is  the  poly¬ 
pus  ;  or  if  he  did  attack  this,  it  was  with  fo  feeble  an  arm,  that,  as  the  de¬ 
fence  of  Malpighi  (*)  feem’d  to  be  much  more  firm,  and  was  really  fo,  if 
you  attended  only  to  Kerckringius,  after  the  time  in  which  both  of  thefe  pieces 
came  out,  moft  perfons  ftill  went  on  more  and  more  to  produce  obfervations 
of  polypi,  from  whence  both  the  preceding  diforders,  and  death,  were  ac¬ 
counted  for,  and  explain’d.  Suppofe  any  perfon  had  been  of  a  weak  and 
tender  conftitution,  and  often  indifpos’d  in  his  health,  for  fifteen,  or  even 
for  twenty  years  together.  If  in  the  heart  of  this  body,  after  death,  fhould 
•have  been  found  a  polypus,  this  was  immediately  faid  to  have  exiftedfrom  the 

(g)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1732.  (/)  Spicileg.  Anat.  Obf.  73. 

\b )  Lucrei.  de  rer.  nat.  1.  1.  v,  67.  (*)  Op.  Pofth. 

5  c 


Vol.  I. 


very 


74^  Book  II.  Of  Difeafes  of  the  Thorax. 

very  beginning  of  his  diforder,  and  to  have  been  the  perpetual  author  of  all 
his  evils.  And  the  fame  was  equally  accus’d,  when  found  after  a  diforder 
that  had  luddenly  carried  off  the  perfon.  But  perhaps  the  heart  was  found, 
at  the  fame  time,  to  be  bigger  than  was  natural;  or  its  auricles  were  found 
to  be  of  an  amazing  magnitude ;  or  the  lungs  were,  at  the  fame  time,  much 
difeas’d,  and  the  afpera  arteria  comprefs’d.  Yet  {till  the  polypi  were  blam’d. 
There  is  no  neceftity  for  me  to  mention  any  one  in  particular,  fince  there 
have  long  been,  in  the  hands  of  every  one,  writings  which  teflify  this. 
However,  they  can  do  lefs  harm  when  they,  at  the  fame  time,  produce  to 
us  fuch  caufes  as  we  may  with  more  juftice  accufe.  But  thole  which  do 
not  produce  them,  do  not  only  produce  very  confiderable  arguments  that 
frequently  they  were  not  fought  after,  but  alfo  fhow,  pretty  clearly,  how 
much  disadvantage  medical  fcience  has  receiv’d  from  polypi ;  fince  after  a 
polypus  being  found  in  the  diffedtion  of  a  body,  it  was  immediately  pro¬ 
nounc’d,  that fufficient  enquiry  had  been  made;  fo  that  what  difeas’d  appear¬ 
ances,  befides  thefe,  might  lie  hid  in  the  thorax,  in  the  belly,  or  in  the 
head,  from  whence  the  more  real  caufes  of  difeafe  and  death  might  be  learn’d, 
were,  by  this  means,  negledled  to  be  enquir’d  into. 

And  you  will  fuppofe,  that  the  adminiftration  of  juftice  has  receiv’d  no 
lefs  inconvenience  from  thence ;  for  you  will  read  that  the  polypus  has,  by 
the  phyficians,  been  brought  in  guilty,  before  the  judges,  of  the  crime  of 
the  perfon  who  was  really  guilty ;  I  mean,  of  thole  who  had  kill’d  men, 
that  were  ftrong,  and  in  good  health,  either  by  the  fword,  by  clubs,  or  by 
poifon,  whether  there  appear’d  any  marks,  internally,  of  the  injury  which 
thefe  things  had  brought  on,  or  whether  fuch  injury  was  not  very  nicely  en¬ 
quir’d  into,  after  the  polypus  had  been  found.  Without  doubt  phyficians 
fuffer’d  themfelves  to  be  carried  away  by  this  method  of  reafoning,  that  a 
polypus  could  not  be  fo  fpeedily  form’d  after  death  :  and  did  not  attend  to 
thefe  two  other  arguments,  that  the  cruft  was  no  lefs  fpeedily  form’d  on  the 
top  of  the  blood,  when  taken  from  a  vein  ;  and  that  if  the  polypus  had  occu¬ 
pied  the  heart  long  before  death,  the  man  could  not  poftibly  have  been  thus 
llrong,  and  perfectly  in  good  health,  as  they  confefs’d  he  had  been.  And 
even  from  this  very  circumftance,  by  which  they  ought  to  have  been  admo- 
nilh’d  that  thefe  polypi  were  not  difeafes,  I  mean,  the  frequency  of  them ; 
(for  who  was  there  then  that  had  not  labour’d  under  this  diforder?)  by  this 
very  circumftance,  I  fay,  they  fuffer’d  themfelves  to  be  perfuaded  to  affert, 
that  the  polypus  was  a  much  more  frequent  difeafe  than  was  in  general 
imagin’d  ;  whereas  Guarinoni  (k),  even  formerly  in  regard  to  the  polypus, 
which,  as  I  have  fhown  above  (/),  he  us’d  to  mark  out  by  the  name  of  pi¬ 
tuita,  has  written  the  following  words,  in  a  certain  obfervation,  from  which 
the  true  ftate  of  the  cafe  might  have  been  learn’d  :  “  The  heart  was  without 
“  that  pituita  which  it  commonly  has  in  dead  bodies.”  Nor  are  thofe  words 
of  Celfus  (m)  more  true,  perhaps,  of  any  other  thing  in  dead  bodies,  than 
of  the  blood  :  Tale  ejfe  quale  mortui  fit ,  non  quale  vhi  fuit.  “  That  it  is  of 
“  fuch  a  kind  as  is  natural  to  a  dead  body,  and  not  what  it  was  in  the  liv- 

{ k )  Sepulchr.  1.  4,  S.  1.  Obf.  13.  in  Addit.  (/).n.  24.  ( m )  De  Medic,  in  Prsel. 


Letter  XXIV.  Article  27.  747 

ing.”  How  little  effect  then  the  confutation  of  polypi,  undertaken  by 
Kerckringius,  in  a  part  of  his  work,  had  had  upon  the  minds  of  the  greater 
part  of  phyfieians,  you  want  no  farther  information. 

But  Pafta  having  purpofely  attack’d  thefe  polypi,  in  quite  another 
manner,  and  by  a  different  method  of  reafoning,  fo  far  call’d  them  into 
queftion,  both  in  his  letter  publifh’d  for  that  purpofe,  and  in  another 
fhorter  epiftle,  which  was  publifh’d  by  that  celebrated  man  count  Fran- 
cefco  Roncailo  Parolini  («),  as  to  make  appear  to  me,  that  very  few  po¬ 
lypi  can  now  be  produc’d,  of  which  we  may  not  doubt  whether  they  were 
form’d  long  before  death.  And  it  is  long  fince,  indeed,  that  I  began  my- 
felf  to  doubt  fometimes,  not  only  of  thofe  (lighter  concretions,  which,  as 
1  met  with  them  in  moll:  bodies,  I  often  was  difpleas’d  with,  or  fometimes 
fcml’d  at,  if  I  happen’d  to  hear  any  one  of  the  perfons  who  was  prefent  ac¬ 
counting  for  the  diforder  from  thence,  as  from  its  caufe,  which,  at  the  fame 
time,  was  fufficiently  apparent  and  obvious  in  another  place  ;  but  of  thofe 
larger  and  harder  concretions,  fuch  as,  in  the  year  1703,  I  found  occupying 
both  the  ventricles  of  the  heart,  and  all  the  large  veffels  adjoining  thereto, 
in  the  body  of  a  young  man  who  had  been  taken  off  within  three  days  by 
the  mod  acute  d  ilea  ft,  though  of  what  kind  the  difeafe  was  I  have  not  made 
any  remark  j  but  I  have  noted  down  this  lufpicion  of  mine ;  that  is  to  fay, 
as  there  were,  together  with  thefe  concretions,  only  a  very  few,  fmall,  and, 
at  the  fame  time,  foft  coagula  of  black  blood,  by  which  it  feem’d,  that  life 
could  not  have  been  preferv’d,  even  for  a  few  moments  of  time,  that  after 
death,  finally,  the  greateft  part  of  the  blood  had  been  form’d  into  thefe  con¬ 
cretions. 

And  I  fufpeded  the  fame  thing  to  have  happen’d  in  thofe  whom  Lower  (0) 
has  faid  to  have  been  diftldted  by  him,  and  in  whom  the  heart  and  the 
veffels  were  fo  fluff’d  up,  as  to  make  him  44  wonder,  that  the  heart  was,  by 

44  any  means,  conflring’d  ;  or  that  the  remaining  part  of  the  blood,  which 

44  was  ftill  fluid,  had  any  room  to  circulate  in  thole  veffels,  in  order  to  pre- 

44  ferve  the  life  and  heat  in  thofe  parts  f  ’  to  fay  nothing  of  that  body  in 

which  the  orifice  of  one  of  the  ventricles  of  the  heart  was  fo  far  flopp’d  up 
by  thefe  concretions,  that  44  there  fcarcely  remain’d  a  paflage  into  the  ven- 
44  tricle,  fufficient  to  admit  a  goofe- quill,  whereby  the  blood  could  flow  in,’* 
and  the  orifice  of  the  other  44  could  not  be  open’d  by  the  fingers  without 
44  difficulty.”  Thefe  fufpicions  were  help’d  forwards,  not  only  by  fimilar 
hiflories,  but  alfo  by  other  circumftances,  part  of  which  I  have  hinted  at 
juft  now,  and  fhall  partly  take  notice  of  below,  as  well  as  by  thofe  things 
that  I  read  in  l'ome  authors ;  as,  for  inftance,  Coiterus  and  Riverius.  The 
former  of  whom  having  found  polypi,  which  had  the  fhape  of  worms,  as  is 
related  above  (p),  juft  in  the  fame  manner  in  thofe  who  died  by  hanging, 
as  in  a  woman  who  had  died  of  a  phrenitis,  and  there  appearing  to  him  no 
reafon  why  they  fliould  be  fuppos’d  to  have  been  form’d  before  death,  in  the 
hang’d  criminals,  it  feem’d  to  him,  that  they  might  alfo  have  been  form’d 
after  death  in  the  phrenetic  woman. 


[n)  in  Epifto’.is  poll  Hiltorias  Morbor.  (0)  Trad,  de  Corde,  c.  2.  (p)  n.  23. 

5  C  2  And 


748  Book  II.  Of  Difeafes  of  the  Thorax. 

And  Riverius,  as  you  will  read  in  the  Sepulchretum  (y),  has  given  us  an 
obfervation  of  caruncles,  of  which  44  the  larger,  being  almoft  as  big  as  a 
44  fdbert,  and  {hutting  up  the  orifice  of  the  aorta,”  in  a  man  who  had  firft 
labour’d  under  an  inequality  of  the  pulle,  and  at  length  had  died  of  an 
afphuxia,  was  fuppos’d  by  Riverius  to  have  been  the  caufe  of  thefe  di {'orders ; 
notwithstanding  other  caufes  were  not  wanting  to  which  they  might  have  been 
more  jultly  attributed  :  nor  does  it  feem  pofiible,  that  a  caruncle  of  this  fize 
only  ihould  ftop  up  that  large  orifice  in  a  man  ;  efpecially  as,  in  the  fcholium, 
44  a  fimilar  caruncle  ”  is  fpoken  of  by  the  fame  author,  44  but  of  a  much 
44  larger  fize,”  which  was  found  in  the  heart  of  a  foldier  who  had  been  (lain, 
and  who,  44  neverthelefs,  had  previoufly  enjoy’d  good  health.”  There  is 
no  doubt  but  you  fee  what  is  the  confequence  of  this  obfervation ;  although 
Riverius  did  not  omit  endeavouring  to  obviate  the  objection,  by  producing 
that  diftindion,  which  I  fee  many  others  alfo  have  made  ule  of  after  him, 
of  the  caruncle  in  the  foldier  being  in  part  connected  to  the  parietes  of  the 
ventricle  ;  whereas  in  the  other  it  was  quite  loofe  and  free  ;  fo  that  in  the 
latter  it  might  be  driven  into  the  mouths  of  the  veffels,  and  in  the  former 
could  not. 

However,  I  fupprefs’d  all  my  fufpicions  in  filence,  till  the  matter  might 
become  more  clear  to  me;  and,  to  confefs  the  truth,  fhould  certainly  have 
{fill  fupprefs’d  them,  being  detain’d  in  a  ftate  of  hefitation  by  the  arguments 
which  were  generally  advanc’d  in  favour  of  ' polypi,  it  I  had  not,  at  length,., 
leen  that  they  were  nearly  overthrown  by  the  induftry  and  ingenuity  of- 
Pafta. 

28.  And  in  the  firft  place,  the  figns  of  a  polypus,  which  I  fuppos’d  to- 
have  been  collected  by  the  moft  learned  men,  not  without  an  accurate  and 
cautious  examination  into  moft  of  the  obfervations  which  were  extant  of: 
this  diforder,  feem’d  to  forbid  my  difbelief.  And  although  I  was  not  ig¬ 
norant,  that  any  one  pathognomonic  fign  could  rarely  be  had  in  difeafes, 
and  wonder’d  that  there  was  not  wanting  in  my  memory  a  perfon  who  taught, 
that  a  very  vehement  puliation  of  the  carotid  and  iubclavian  arteries  was 
the  fymptom  of  that  kind  in  the  cafe  ot  a  polypus,  as  1  knew  that  this  had 
been  often  obferv’d  where  there  was  no  polypus,  which  is  confirm’d  even  by 
fome  obfervations  that  I  have  written  to  you  (r) ;  yet  I  Scarcely  read  any 
author  of  all  thole  by  whom  the  figns  of  polypi  are  taken  notice  of,  who  did 
not  place  an  intermitting,  or,  at  leaft,  an  unequal  pulfe  among  them  ;  which 
you  may  have  obferv’d  to  be  often  related  even  in  the  fhort  hiftory  of  the 
polypus  that  I  have  trac’d  out  (j)  ;  and  you  know  it  is  pointed  out  by  fome 
one  as  the  pathognomonic  fign  of  a  polypus.  And  I  did  not  wonder  that  this 
man  was  refuted  even  by  the  fenior  doctors  of  his  own  fe£t,  when  I  call’d  to 
mind  thole  obfervations  in  which  I  had  found  polypi  without  this  fymptom, 
or  had  not  found  them  where  it  was  :  of  which  kind  thofe  are,  in  regard  to- 
the  firft-  fpecies,  that  you  have  in  the  feventh  letter,  number  eleven  and 
thirteen,  and  in  this  very  twenty-fourth  letter,  number  fix  ;  and  in  regard 
to  the  lecond,  thofe  which  you  will  have  in  other  letters  :  to  which  you  wili- 

(<l)  L.  2.  S.  8.  Ob/,  14.  (r)  Epift.  17.  n.  23.  &  Epift.  23.  n.  6,  (j)  N.  22.  &  24. 


then 


Letter  XXIV.  Article  28.  7 49 

then  add  thofe  in  the  twenty- firll  letter,  number  thirty- four,  and  in  the 
twenty-third,  number  fix. 

And  when,  in  reading  over  again  the  ninth  letter,  you  light  on  that 
hiftory  (/),  by  which  it  appears  that  an  inequality  of  the  pulfe  had  been  re¬ 
mov’d  by  the  fparing,  but  continu’d,  ufe  of  opium,  you  will  not  fuppofe,  if 
I  am  fufficiently  acquainted  with  you,  that  this  arofe  from  a  polypus. 

Yet,  notwithftanding  thefe  things  were  at  that  time,  in  part,  clear  and 
obvious  to  me,  I  neverthelefs  (till  thought  that  thefe  were  a  few  exceptions, 
fuch  as  are  often  met  with  in  medicine,  not  of  fufficient  importance  to  be 
oppos’d  to  the  diagnofis  that  had  been  determin’d  upon  by  the  moll  expe¬ 
rienc’d  men  ;  el'pecially  as  it  did  not  efcape  me,  that  the  force  of  figns  was 
not  to  be  weigh’d  by  confidering  one  or  two  feparately,  but  by  confidering 
many  in  conjunction.  But  about  this  time  came  out  the  letter  of  the  molt 
learned  Pafta,  in  which  («)  fo  many  oblervations  of  polypi  are  collected,  and 
of  thofe  even  that  were  remarkable  for  their  number  or  for  their  bulk,  which  • 
had  been  found  by  the  molt  famous  authors  when  no  figns  of  polypi  had 
preceded,  that  the  diagnofis  thereof  which  has  been  given  may  feem  to  be 
frequently  ufelefs  ;  or,  if  it  has  been  made  under  the  guidance  of  real'on, 
mutt  lay  us  under  a  neceffity  of  doubling,  whether  thofe  polypi,  of  which 
not  the  leaft  fign  had  exilted  in  the  living  body,  had  exilted  previous  to 
death.  And  while  I  read  over  again  thefe  obfervations,  I  find  two,  the  one 
of  Winclerus,  the  other  of  Borrichius,  which  I  fhall  objeCt  to  that  diftinCtion 
of  Riverius(x)  taken  from  the  caruncle  being  loofe  or  connected.  For  there 
were  polypi  in  both  of  thefe  obfervations,  “  which  had  grown  to  no  part,-. 
“  were  no  where  connected,  but  free”  and  loofe;  yet  not  the  lead  remark 
was  made  of  any  intermiffion  or  inequality  of  the  pulfe.  I  will  alfo  add 
here  what  was  obferv’d  by  the  celebrated  Joerdenfius  (jy),  who  having  inge- 
nuoufly  confefs’d,  “  that  all  thofe  figns  which  have  been  brought  by  authors 
“  to  ddtinguifh  a  polypus  that  is  already  form’d,  even  when  collectively 
tc  taken,  did  not  fatisfy  him  fo  far  as  to  fuller  him  to  determine  any  thing 
«  for  a  certainty  in  regard  to  the  prefence  of  it prefently  teftifies,  when, 
in  the  examination  of  each  feparate  fign,  he  comes  to  the  intermitting  pulfe, 
that  he  had  “  never”  obferv’d  this  in  perfons  who  had  polypi,  “  except  in 
“  thofe  that  were  dying  and  yet  in  the  great  number  whole  diforders  and 
difieCtion  he  either  particularly  defcribes,  or  briefly  refers  to,  it  happen’d  to- 
him,  that  “  he  found  all  the  polypi,  except  one,  which  was  the  largelt  of 
“  all,  not  connected  to  the  fides  or  columnae  of  the  ventricles  of  the  heart, 
“•  but  quite  free  and  loofe.” 

Now  then,  as  that  firft  pofition,  I  mean,  that  a  polypus  has  often  been' 
found  without  an  intermiffion,  or  any  inequality  of  the  pulfe,  is  fufficiently^ 
demonltrated  •,  to  omit  other  obfervations  which  were  at  hand,  and  particu¬ 
larly  thofe  of  the  celebrated  Trew  (z)  •,  we  may  confirm  the  other  equally  ; 
to  wit,  that  intermiffion  of  the  pulfe,  and  even  other  inequalities,  amazingly 
various,  had  been  obferv’d  where  no  polypus  wasj  found,  not  by  one  only, 

(/)  N.  7.  (y)  Ad.  N.  C.  Tom,  4.  Append,  n.  5. 

(«)  N.' 4.  §  5,  &  6. 

(j t)  Vid.  fupra,  n.  27.  circa  fin.  .  (a)  Eorund.  Ad.  Tom.  2.  Obf.  53. 

6.. 


but 


7  5°  Book  II.  Of  Difeafes  of  the  Thorax. 

but  by  many  obfervations  of  the  moft  eminent  men,  as  indeed  it  ought  to 
be  confirm’d,  and  yet  not  by  all  which  ic  is  in  our  power  to  produce.  Firft, 
then,  let  it  fuffice  to  have  pointed  out  feven  only  from  the  great  number  in 
the  Sepulchretum ;  as  of  Gregorius  Horftius  (<z),  Nicolaus  Tulpius  (/»), 
Lazarus  Riverius,  (c),  Loelius  a  Fonte  (d),  Joannes  Pnevotius  (<?),  each  one 
fingle  obfcrvation,  and  of  Hieronymus  Cardanus  (/)  two.  For  if  you 
read  thele  obfervations,  you  will  find  that  the  pulfe  had  been  “  intermitting,” 
alfo  “  unequally  intermitting that  it  had  been  “unequal,”  even  “  fur- 
“  prifingly  unequal,  exceedingly  unequal  j  difturb’d  by  every  kind  of  ine- 
“  quality,  and  very  much  varying  in  each  different  ftate,  without  the  leaft 
“  regularity  or  order.”  But  although  you  will  find  in  every  one  of  thefe 
feven  patients,  that  diforders  either  of  the  heart  or  pericardium,  which  in 
home  of  them  were  very  confiderable,  or  of  the  lungs,  as  in  the  greater 
part  of  them,  or  of  other  parts,  are  defcrib’d  •,  yet  in  none  of  them  will  you 
fee,  that  a  polypus,  or  polypous  concretion,  has  been  taken  notice  of. 
Nor  will  you  fee  this  in  other  hiftories  that  may  be  added  to  thefe,  as  of 
Brunnerus  (g),  Gullmann  (£),  and  Lancifi  (/),  in  which  the  pulfe  is  faid  to 
have  been  “  unequally  intermitting,  unequally  unequal,  irregular  and  un- 
“  equal,  unequal  and  intermittent  ;  although  whatever  of  morbid  appear¬ 
ances  was  found  after  thefe  pulfes,  particularly  in  the  heart,  the  great  ar¬ 
tery,  and  the  vena  cava,  were  by  no  means  pafs’d  over  in  filence.  And  what 
will  you  fay  to  this,  that  in  a  girl  of  four  or  five  years  of  age,  whofe  difeafe 
and  difie&ion  that  very  eminent  man  Du  Verney  the  younger  (£)  has  written, 
although  her  pulfe,  being  at  one  time  quick,  at  another  time  flow,  and  inter¬ 
mitting  befides,  and  even  at  intervals  for  a  time  fufpended,  made  them  afraid 
of  a  polypus  of  the  heart ;  nothing  was  found  worthy  of  obfervation  in  the 
heart,  but  a  fcirrhous  tumour  at  the  bafis  of  it,  of  the  bignefs  of  a  nut, 
which  lay  upon  the  pulmonary  artery,  and  was  connected  by  a  kind  of  roots 
with  the  fpine.  And  the  moft  celebrated  man  John  Targioni  (/),  when  he 
defcrib’d  the  diforders  of  the  great  vefiels  of  the  heart,  and  the  neighbouring 
parts,  in  a  nobleman  of  Florence  *,  left  any,  by  reafon  of  the  pulfe,  which 
had  conflantly  been,  for  a  longtime,  “  irregularly  irregular,  and  intermittent,” 
lhould  fufpect  that  a  polypus  had  been  omitted  by  him  ;  exprefsly  added, 
“  that  not  the  leaft  polypous  concretion  had  been  found.”  And  that  you 
may  not  fufpedt  this  of  others,  which  I  fpoke  of  juft  now  ;  call  to  mind, 
not  only  the  accuracy  of  moft  of  them,  but  the  common  cuftom  of  all,  by 
which,  as  phyficians  did  not  yet  make  ufe  of  the  word  polypus  to  fignify  the 
appearance  we  are  fpeaking  of,  they,  neverthelefs,  did  not  omit  to  take  notice 
of  it  under  other  names  which  are  mention’d  above  (m)  ;  and  alfo  how  much 
effect  fome  certain  diforders  of  the  lungs,  or  of  the  heart,  or  of  the  vefiels 
annex’d  to  it,  may  have  in  perverting  the  pulfe  ;  and,  finally,  that  from  thefe 


(rf)  L.  2.  S.  8.  Obf  35.  §  1. 
(6)  Ibid.  Obf.  23.  §  1. 

(c)  Sett.  5.  Obf.  2i. 

(d)  L.  4.  S.  1.  Obf  45.  §  6. 

(<?)  Ibid.  Obf  3.  §  10. 

(f)  L.  2.  S.  9.  Obf.  33,  &  22. 


(g)  Eph.  N.  C.  Cent.  6,  Obf  1. 

(<6)  Eorund.  Att.  Tom.  1.  Obf  4. 
p)  De  Aneur.  Propof  53. 

{k)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1704. 
(I)  Prima  Raccolta  d’Offerv.  Med.  pag.  1 1 6. 
ic  1 19.  (/».)  N.  22.  &  feqq. 


4 


diforders 


Letter  XXIV.  Article  29.  751 

diforders  of  the  lungs  and  the  heart  only  (for  there  was  no-where  44  any  po- 
44  lypous  appearance”)  Pafta(tf)  had  all'o  found,  in  two  men,  whofe  bodies 
he  examin’d  for  that  reafon,  befides  other  figns  of  a  polypus,  that  44  an  un- 
44  equal  and  continually  intermitting  pulfe  ”  had  come  on  even  fome  months 
before  their  death. 

29.  And  as,  in  order  to  confirm  that  polypi  had  exifted  long  before  death, 
the  dilatations  of  the  cavities  in  which  they  are  found  are  wont  to  be  pro¬ 
duc’d,  as  if  they  had  fucceeded  to  the  polypus,  as  effects  to  their  caufe  ; 
Pafta  does  not  do  what  J  have  done  in  the  fecond  Adverfaria  (0),  where  I 
fhew’d,  that  the  circumftances  might  be  confider’d  in  quite  an  inverted  ratio  ; 
but  even  by  thofe  very  hiftories  from  which  fome  believe  it  to  be  clear,  that 
dilatations  had  been  the  confequence  of  polypi,  he  plainly  fhewsfp),  that 
polypi  in  living  bodies  are  not  fufficiently  prov’d  •,  becaufe  it  not  only  does 
not  neceffarily  follow  that  tbefe  polypi  had  exifted  previously  to  the  dilatations, 
but  not  even  that  they  had  exifted  afterwards  in  thofe  bodies  when  living, 
as  they  might  finally  have  been  generated  after  death  :  for  he  makes  it  ap¬ 
pear,  that  dilatations  are  frequently  found  without  polypi,  and  that  the  figns 
of  polypi,  which  had  exifted  in  thole  in  whom  dilatations  are  found,  might 
have  been  the  figns  of  thefe  dilatations  only.  From  which  fingle  circumftance 
many  things  feem  to  me  to  follow,  but  two  in  particular.  And  firft,  that 
they  who  have  deliver’d  down  to  us  the  diagnofis  of  a  polypus  from  thofe 
things  that  they  had  obferv’d  in  patients  in  whom  dilatations  and  polypi  were 
found  at  the  fame  time,  did  not  a<5t  with  fufficient  caution.  Thus,  not  to 
depart  from  the  ninth  fe&ion  of  the  Sepulchretum,  if  any  one,  for  example’s 
fake,  turn,  to  the  titles  that  are  prefix’d  to  the  fecond  and  tenth  obfervations,. 
he  will,  doubtlefs,  fuppofe  that  44  the  inequality  of  the  pulfe,”  in  the  firft, 
had  arifen  44  from  the  left  ventricle  of  the  heart  being  fluff’d  up  with  blackifti 
44  fiefh  ’  whereas  fome  regard  is  to  be  had  to  the  heart  itlelf,  which  was 
44  extended,  like  the  uterus,  to  the  bulk  of  that  fiefh,”  the  weight  whereof 
was  equal  to  that  of  44  two  pounds  and  in  the  tenth  obfervation,  44  the 
4*  interception  of  the  pulfe”  will  feem  to  any  one  to  be  owing  to  44  two. 
44  polypi  in  the  heart particularly  as  that  obfervation,  which  is  produc’d 
there  only  in  part,  relates  nothing  befides  thefe  that  was  preternatural.  But 
a  great  danger  of  erring  is  thrown  in  the  way  of  curfory  readers  by  this 
cuftom  of  producing  mutilated  hiftories.  For  who  would  fuppofe,  that  where 
the  queftion  was  of  the  pulfe,  a  great  diforder  of  the  heart  itfelf  fhould  be 
pafs’d  over  in  filence  ?  And  yet  if  the  fame  obfervation  be  look’d  into, 
where  it  is  gives  in  another  place  (q),  in  its  entire  ftate,  we  find  that,  toge¬ 
ther  with  thofe  polypi,  there  w;as  44  a  heart  bigger  than  that  of  an  ox,  filling 
44  the  whole  capacity  of  the  thorax.” 

The  fecond  confequence,  which  I  hinted  at  juft  now,  ftill  more  weakens 
the  diagnofis  of  the  polypus.  For  they  who  have  propos’d  it,  as  they  plainly 
forefaw  that  the  figns  which  they  brought  might  be  common  to  other 
diforders,  have  added  this,  that  thofe  figns  would  be  ufeful  44  when  other 
44  fymptoms,  by  which  fimilar  diforders  are  wont  to  be  diftinguifh’d,  are 

(»)  Epift.  de  Cord.  Polyp,  n.  9.  (p)  N.  5.  7.  &  feq.  &  13, 

( 0 )  Animad.  40,.  &  41.  {q)  L.  3,  S.  7.  Obf.  45.. 

44  wanting.”’ 


75*  Book  II.  Of  Difeafes  of  the  Thorax. 

wanting.”  Thus  laid  Pifiinius  (r).  And  before  him  Riolanus  (j),  wherfc 
he  happen’d  to  mention  polypi,  had  fubjoin’d  the  following  words  :  “  Thofe 
“  who  are  opprels’d  with  a  difficulty  of  breathing,  with  an  interception  of 
44  the  pulfe,  without  a  cough,  without  any  fufpicion  of  a  dropfy  of  the  lungs, 
“  or  a  vomica,  ought  to  be  fufpicious  of  a  ludden  fuffocation  of  the  heart,” 
that  is,  from  a  polypus.  And,  in  ffiort,  others  added  exceptions  of  the 
fame  kind  in  a  different  manner.  But  how  the  lymptoms  of  fimilar  diforders 
will  be  wanting,  if  thofe  which  are  fu  p  pos’d  _  to  be  the  figns  of  a  polypus 
agree  alfo  with  dilatations  of  the  heart,  “  and  aneurifms  either  of  the  trunk 
44  of  the  aorta,  or  of  the  left  ventricle  of  the  heart,”  as  is  confirm’d  by  the 
celebrated  Pafta(r),  “  deceive  us,  more  than  other  diforders,  with  the  ap- 
41  pearance  of  polypi,”  I  am  not  able  to  conceive. 

But  you  will  lay,  when  a  polypus  fhall  be  found  without  any  aneurifm, 
without  any  other  injury  of  the  heart  or  veffels  to  which  you  can  attribute 
the  preceding  diforders  of  the  patient ;  then  thefe,  at  leaft,  will  be  figns  of 
the  polypus,  and  confequently  the  polypus  muft  have  exifted  before  death. 
But  Pafta  does  not  allow  that  thefe  things  follow,  even  then,  for  a  cer^ 
tainty  (u)  \  as  he  had  fometimes  obferv’d  all  the  lymptoms  of  a  polypus  in 
thofe  perfons  alfo,  in  whom  there  was  neither  any  of  thefe  injuries,  nor  a 
polypus  :  for  which  reafons,  as  thofe  fymptoms  muft  then  of  courfe  have 
proceeded  from  fome  other  caufe,  which  even  efcapes  the  notice  of  the 
lenfes;  as,  for  inftance,  from  the  diforder  of  the  cardiac  nerves,  which  he 
hints  at  in  another  place  (x)  •,  fo  nothing  forbids  us  to  fuppofe  that  they  may 
proceed  from  the  fame  caufe  in  thofe  alfo,  in  whom  polypi  are  found,  parti¬ 
cularly  as  the  whole  letter  -fufficiently  fhews  how  much  more  probable  it  is 
that  the  polypi  are  not  form’d  ’till  after  death. 

When  I  revis’d  this  letter  of  mine  to  you,  I  took  into  my  hand  that  ex¬ 
cellent  treatife  upon  the  heart  by  the  illuftrious  Senac  ;  and  reading  over  that 
chapter  (y)  which  is  entitl’d,  44  Of  the  polypi  of  the  heart,”  I  rejoic’d  that  his 
judgment,  alfo,  difapprov’d  of  thofe  perfons  (z)  who  chofe  rather  to  afcribe 
the  figns  of  the  polypus,  and  amongtt  others  the  inequality  of  the  pulfe,  to 
the  polypus,  than  to  the  diforders  which  are  found  together  with  the  polypus, 
and,  amongft  thefe,  that  of  the  dilated  auricle  of  the  heart.  Were  not,  lays 
he,  all  thefe  fymptoms,  and  even  the  polypus  itfelf,  to  be  attributed  to  this 
dilatation  ?  And  he  has  not  only  a  great  many  other  things  worthy  of  lin¬ 
gular  praife,  but  this  in  particular,  that  there  is  a  great  difficulty  in  knowing 
and  dittinguifhing  true  polypi.  For  he  fays,  that  in  fo  great  a  number,  thofe 
which  he  acknowledges  to  be  true  are  “  rare  (a):**  and  as  he  affirms,  that  the 
effects  of  thefe  are  the  fame  with  thofe  of  fo  many  other  obftrudtions,  which 
oppofe  themfelves  to  the  circulation  of  the  blood  through  the  heart,  he  at 
length  fcarcely  attributes  thus  much  to  the  inequality  of  the  pulfe  alone,  and 
that  varying,  not  what  others  had  already  done,  that  we  may  take  the  diao-- 
nofis  of  polypi  from  thence,  but  only  that  we  may  fufpebl  44  them:”  I  fay, 
fufpebt  them  ;  for  it  could  not  have  efcap’d  him,  that  there  were  other  even 

( u )  N.  6.  (*•)  N.  ii. 

(y)  L.  4.  ch.  10. 

(2)  N.  10.  («)  N.  9. 


( r )  Epift.  de  Polypo  Cord. 

(j)  Anthropogr.  ult.  edit.  1.  3.  c.  12. 

(/)  N.  27. 


inconftanc 


Letter  XXIV.  Article  30.  7x3 

inconftant  obftru&ions  befides  a  polypus,  fuppofe  from  the  various  irritation 
of  the  nerves,  which,  if  it  fall  on  the  nerves  of  the  lungs,  for  inftance,  will 
lay  various  difficulties  in  the  way  of  the  blood  that  is  about  to  go  out  from 
the  heart  into  the  lungs,  or  return  from  the  lungs  into  the  heart :  and  this 
example  I  make  ufe  of,  becaufe  the  very  fame  is,  in  fome  meafure,  hinted  at 
a  little  afterwards  (b) ;  for  other  examples  may  be  collected  alfo  from  the 
following  chapter  (c) ;  and  even  without  thefe,  the  opinion  which  he  has  laid 
down  in  another  place  (d)  will  be  fufficient ;  I  mean,  that  an  inequality  of  the 
pulfe  is  owing  to  a  difturb’d  adtion  of  the  heart  and  nerves. 

And  how  long  this  difturbance  may  laft,  and  at  the  fame  time  how  various 
it  may  be,  perhaps  nothing  will  better  ffiew  you,  than  what  I  lately  read  in  the 
third  volume  of  the  Commentaries  of  the  Inftitution  of  Sciences  at  Bologna  (e). 
For  that  celebrated  man  Molinetti,  having  tied  up  one  of  the  nerves  of  the 
par  vagum,  in  the  neck  of  four  dogs,  nor  having  immediately  untied  them, 
as  Vallalvaus’d  to  do,  prefently  oblerv’d  in  all  of  them,  that  the  motion  of 
the  heart  “  was  in  no  refpedt  equal,  was  irregular,  and  intermitting,  without 
“  any  order and  in  one  of  them,  befides,  in  whom  he  had  even  cut  the 
fame  nerve,  he  obferv’d  that  motion  to  be  “  immoderately  confus’d,”  and 
that  it  had  not  return’d  to  its  ufual  regularity,  in  thofe  dogs,  before  the  fe- 
venteenth,  the  twenty-ninth,  the  twenty-third,  and  the  twenty-feventh  day. 
Therefore,  if  any  confiderable  injury  happen  to  this  nerve,  or  any  other 
which  belongs  to  the  heart,  you  perceive  what  may  be  the  confequence  of 
it ;  and  how  judicioufly  that  archiater  whom  I  juft  now  commended,  has 
determin’d,  that  the  diagnofis  of  a  polypus  could  not  be  taken  from  a  pulfe 
of  that  kind,  but  only  the  fufpicion  of  one.  But,  perhaps,  you  will  fay 
here,  What  if  an  unequal  inequality  of  the  pulfe  be  produc’d  beyond  the 
twenty-ninth  day,  as  I  have  known  it  happen  in  many,  and  perfevere  very 
long  ?  Pafta  even  obviates  this  objedtion(/) ;  and  I  wiffi  that  thofe  injuries 
of  the  brain,  or  of  the  nerves,  did  not  often  happen,  which  can  neither  be 
cur’d,  nor  be  chang’d,  and,  for  that  reafon,  laft  a  great  number  of  years, 
and  even  to  death  itfelf.  But  as  injuries  of  that  kind,  for  the  moft  parr, 
efcape  the  fenfes,  it  is  not  to  be  wonder’d  at,  if  in  the  bodies  of  thofe  who 
had  been  troubl’d  with  a  varioufiy  unequal  pulfe,  either  with  or  without 
diforders  of  the  heart,  nothing  at  all  be  found  to  which  you  could  attribute 
this  fymptom.  For  although  thofe  diforders  of  the  heart  are  of  fuch  a  kind, 
that  they  cannot  now  appear  in.  one  ftiape,  and  prefently  in  another  yet  the 
injury  of  the  nerves  might  be  added  to  them,  from  whence  that  variety 
might  arife,  which  may  even  arrfe  from  thence  without  thofe  diforders,  as  is 
hinted  at  by  Pafta  by  no  improbable  doubt. 

30.  It  is  not  my  intention  to  run  through  all  the  heads  of  his  epiftle, 
which  you  yourfelf  may  read,  and  perhaps  have  already  read.  It  is  fufficient, 
if  I  fay,  that  fcarcely  any  of  thofe  things  is  omitted,  which,  on  one  hand, 
ought  to  incline  us  to  doubt  whether  there  are  any  polypi  in  living  bodies  ; 
and,  on  the  other,  ought  to  make  us  leis  confide  in  thofe  reafons  which  are  ge¬ 
nerally  produc’d  in  order  to  demon ftrate  that  they  do  exift  in  living  bodies. 

(r)  Ch«  ii.  n.  9.  (<7)  L.  3.  ch.  7.  n.  9. 

5  D 


(3)  N.  11. 
Vol.  L 


(*)  In  Opuic.  (f)  N.  ii. 

What 


75  4  Book  XL  Of  Bifeafes  of  the  'Thorax. 

What  then,  you  will  fay,  are  we  to  do  in  the  mean  time  ?  We  muff  wait 
till  another  experienc’d  and  learned  man  fhall  anlwer  that  epiftle,  in  fuch  a> 
manner  as  to  remove  all  thefe  doubts  by  a.  clear  and  ftrenuous  way  of  rea- 
fonincr -/which  tome,  as  I  have  formerly  faid  (g ),  does  not  feem- very  eafy 
to  do°  *  And  unlefs  this  be  done,.  I  will  certainly  continue  to  fpeak  very 
cautioufly  of  polypi ;  nor  will  I  buffer  myielf  to  lay  down  thole  things  as¬ 
certain,  which  are  doubtful with  me.  Nor  are  we  any  longer  at  liberty  to 
life  that  excufe  which  we  were  formerly  at  liberty  to  ufe.  Zollicofferus  had- 
written,  for  inftance,  in  his  differtation  De.  Polypo  Cordis  (£),  in  the  year  1685,. 
“  In  the  fame  manner  in  which  the  blood  of  pleuritic,  cache&ic,  or  other 
«  difeas’d  perfons,  taken  away  by  opening  a  vein,  while  it  by  degrees  lofes 
*c  t^e  motion  which  had  before  mix’d  all  its  parts  together,  and  involv’d 
ct  them  one  with  another,  thrufts  out  upon  the  furface  a  white,  vifcid,  and 
“  denle  fubftance,  entirely  fimilar  to  our  polypus ;  there  is  nothing  which 
,c  hinders  me  from  believing,  that  fuch  a  concretion  may  be  form’d  in  the 
ti  heart,  and  the  veffels  of  lubjedts  of  that  kind  after  death,  as  well  as  in- 
u  the  blood  that  has  been  taken  from  a  vein  ;  efpecially  as  in  thefe  fubjedls 
a  fome  portions  of  coagulated  blood  are  found  fubfiding  from  that  polypous^ 
4t  concretion,  which  are  very  much  like  the  black  and  thick  blood  of  pleu- 
“  ritic  patients.”  But  if  you  fhould  then  have  enquir’d  of  him,  why,  after 
iavino-  thefe  things,  he  immediately  went  fo  far  on  the  other  fide  of  the 
queffton  as  not  only  to  profefs  that  he,  however,  “  could  by  no  means- 
4<  CTrant’  that  every  polypus  was  at  length  form’d  after  death,”  but  evem 
afferted  almoft  the  fame  things  of  polypi  that  others  had  done-,  he  would,.; 
without  doubt,  have  produc’d  thofe  arguments  for  the  fa£t  which  he  has  fub- 
loin’d  (r)  j  and  thefe  arguments  were  a  iufficient  excule  for  him,  as  they  had1 
never  been  call’d  into  queftion  by  any  body. 

But  what  pardon  could  be  granted  to  us,  if  we  us’d  the  fame  arguments  ?> 
after  thefe  very  arguments  have  been  fo  overturn’d  by  Pafta,  as  I  have  ffiewn 
above  (k).  And  if  we  would  depend  upon  other  arguments,  as,  for  inffance, 
thofe  which  you  will  read  in  fome  authors,  to  except,  at  lead,  thofe  polypi- 
that  adhere  to  the  parietes  of  the  ventricles,  and  are  entangl’d  with  the  ten¬ 
dinous  fibrillte  either  of  the  valvulas  mitrales  or  tricufpides,  or  thofe  which 
are  of  fuch  a  hardnefs  and  firmnefs  that  they  cannot  be  difiolv’d  by  the 


fingers,  and  for  that  reafon  ihew  that  they  are  not  the  work  of  a  very  ffiort 
time  •,  Pafta  has  alio  taken  up  and  confider’d  thefe  exceptions  (/).  For  as 
to  the  hardnefs  and  firmnefs  ob  thefe  concretions,  he  takes  notice  how  great 
thefe  properties  fometimes  are  in  the  cruft  of  blood  that  has  been  taken  from 
a  vein,  and  inehow  ffiort  a  time  this  may  be  generated.  And  as  to  the  adhefiom 
to  the  parietes  of  the  ventricles,  he  affirms  that  blood,  if  it  be  receiv’d  -in 
the  ventricles  of  an  ox’s  heart,  inftead  of  a  glafs  veffel,  provided  the  matter 
of  which  the  cruft  is  made  up  equally  abounds,  adheres  to  the  parietes  of 
thefe  cavities  juft  as  polypi  are  wont  to  do  :  which  I  fuppofe  he  might  alfo 
have  faid  of  their  being  entangl’d  with  the  fibrillas  of  the  valves ;  fince  f 
oblerve  that  he  has  produc’d  an  example,  from  Moinichenius,  of  polypi 


(g)  Ep'fft.  18.  n.  9. 


PO  §  13- 


(0  §  14. 


( k )  N.  29. 


(/)  N.  20. 

that 


Letter  XXIV.  Article  36.  755 

that  (m)  u  were  entangl’d  with  the  tendons  of  the  valvulas  mitrales,”  among 
thofe  obfervations,  which,  as  there  had  been  no  fymptom  of  a  polypus  in 
the  living  body,  relate  to  thofe  polypi  that  are  produc’d  after  death. 

But  (hall  we  believe  that  thofe  polypi,  at  lead,  had  not  been  compared 
together,  but  in  a  long  courfe  of  time,  and  on  various  occafions,  which  are 
fibrous;  which,  in  fome  meafure,  emulate  the  nature  of  a  membrane,  a  ten¬ 
don,  or  a  nerve,  whether  you  look  upon  them,  or  draw  them  backwards 
and  forwards  with  your  hands ;  which  fhow  flrata  or  layers,  roll’d  one  over 
another;  or,  finally,  thofe  which  are  hollow  like  tubes?  We  fliould,  per¬ 
haps,  have  believ’d  it,  if  Pafta(/z)  had  not  produc’d  obfervations,  from 
"  which  it  appears  plainly,  that  all  thefe  things  may  be  evidently  feen  alfo  in 
the  cruft  of  blood  that  has  been  taken  from  a  vein:  and  in  refpeft  to  the 
hollow  polypi,  he  had  obferv’d  fome  things  (0),  from  which  it  is  eafy  to  form 
a  conjecture,  that  a  cruft  may  have  been  form’d  out  of  the  blood  which  was 
Bill  fluid,  and  in  a  ftate  of  reft,  round  about  a  coagulum,  which  was  already 
form’d  within  fome  veflel ;  I  fay  round  about  •,  which  you  will  more  readily 
underftand,  if  you  luppofe  with  me,  that  the  body  has  been,  when  it  was 
not  yet  internally  deftitute  of  its  warmth,  turn’d  upon  its  face  or  fide  for  the 
fake  of  wafhing  it,  or  for  any  other  reafon ;  and  that  after  this,  at  the  time 
of  difletftion,  or  taking  out  the  vifcera,  the  coagulated  blood  may  have  fallen 
t)ut  from  the  furrounding  cruft,  and  left  it  in  the  fhape  of  an  empty  tube. 

But  you  will  fay,  perhaps,  there  are  fome  disorders  fo  join’d  with  a  poly¬ 
pus,  that  they  feem  entirely  to  have  proceeded  from  this.  For  in  the  firft 
place,  Schulzius  (/>)  produces  examples  of  two  cedematons  tumours;  the 
one  in  the  feet  and  the  nates  of  a  young  man,  and  the  other  in  the  right 
foot  of  a  woman.  The  young  man  had  a  thick  polypus  in  the  vena  cava, 
at  the  conflux  of  the  iliacs ;  and  the  woman  had  one  in  the  right  iliac.  It 
therefore  feems,  that  the  polypus  muft  have  exifted  in  both  of  them,  when 
living;  which  oppofing  itfelf  to  the  quick  return  of  the  blood,  was  the  caufe 
of  the  oedematous  tumour.  And  this  I  perhaps  might  have  aflented  to,  if 
there  had  not  been  other  polypi  in  the  young  man,  and  thofe  of  a  “  ftu- 
“  pendous”  magnitude  indeed,  not  only  in  the  heart,  but  alfo  in  the  veftels 
which  communicate  with  it,  and  not  the  leaft  effeCls  of  them  were  fhown  elfe- 
where ;  and  if  the  difeafe,  of  which  the  woman  had  died,  and  the  external 
caufes  which  probably  had  preceded  the  oedematous  tumour  of  the  foot,  and 
whether  there  were  any  other  polypi  likewife  in  the  diftant  vefiels,  were  not 
pafs’d  over  in  fllence. 

You  would  then,  perhaps,  produce  fome  dilatations  of  the  heart,  or  the 
auricles,  which,  as  there  may  have  occurr’d  to  you  no  other  caufe  of  them, 
you  would  poflibly  contend  were  brought  on  by  the  polypus  that  you  had 
feen  contain’d  within  them.  But  I  would  not  advife  you  to  be  too  fanguine 
in  your  contention,  for  there  are  fo  many  caufes  of  dilatation,  even  among 
the  antecedent  caufes,  and  fome  of  them  are  of  fo  hidden  a  nature,  or  of 
fo  long  a  {landing,  that  they  are  frequently  not  even  known  to  the  phyficians 
of  the  patient  himfelf,  or  to  the  attendants  of  whom  you  may  enquire;  as, 

(/)  Act.  N.  C.  Tom.  1.  Obf.  220.  Sc  Com. 
Litter,  A.  173 1.  Specim.  io. 

5  D  2  for 


\m )  n.  4. 
(0)  n.  24. 


(#)  n.  20. 


7 5&  Book  II.  Of  £>ifeafes  of  the  Thorax. 

for  example,  vehement,  but  conceal’d,  pafTions  of  the  mind  ;  foregoing  vio¬ 
lent  inflammations  of  the  lungs,  which  the  patient  had  labour’d  under,  at  a 
different  age,  or  in  different  countries  •,  and  other  things  befides  of  the  like 
kind,  which  may  be  read  in  the  treatife  of  the  mod  illuftrious  Senac  (y). 
For  thefe  caufes,  particularly  if  they  have  happen’d  to  thofe  whofe  heart 
was  already  difpos’d  to  dilatation,  have  frequently  dilated  it,  fooner  or  later, 
in  proportion  as  that  difpofition  to  dilatation  was  greater  or  lefs  *,  fo  that, 
for  this  reafon,  the  patients  have  not  been  always  able  to  obferve,  from  what 
caufe,  and  at  what  time,  the  beginning  of  this  dilatation  was  made. 

But  finally,  you  might  take  an  argument  to  appearance  much  more  ftrong, 
from  the  obfervation  of  the  illuftrious  Haller  (r),  which  tells  us,  that  in  the 
vena  cava  of  a  woman,  betwixt  the  renal  veins  and  the  iliacs,  “  nothing  re- 
main’d  in  the  place  of  the  cavity  but  a  kind  of  fibrous,  polypous,  and, 
“  as  it  were,  hard  flefh.”  For  as  the  right  fpermatic  vein,  in  order  to  carry 
back  the  blood  that  was  brought  in  by  the  inferior  aorta,  and  to  difcharge  it 
into  the  ureteric  vein,  which  belongs  to  the  iliac  of  the  fame  fide,  was  made 
“  enormoufly  wide,”  and  was  even  “  an  inch  in  its  diameter,”  and  the  ure¬ 
teric  vein  alfo  was  “  equally  dilated  it  feems  that  this  polypous  concretion, 
which  prevented  the  afcent  of  the  blood,  muft  have  been  form’d  there,  long 
before  the  death  of  the  woman. 

But  as,  neyerthelefs,  Haller  writes,  that  the  vena  cava  had  been  “  concreted” 
in  that  place,  and  points  out  an  example  of  the  concretion  thereof,  from  the 
MantiJJa  Anatomica  (j)  of  Rhodius,  who  fays,  that  the  cava  “  had  been  very 
„  “  cloiely  confolidated,  fo  as  not  even  to  admit  a  probe,  without  doubt  from 
“  ulceration  and  as  even  the  very  ingenious  Haller  confeffes,  “  that  he 
“  does  not  underftand  the  reafon  of  the  vena  cava  being  grown .  together 
“  in  its  fides,”  in  the  woman  he  fpeaks  of,  u  as  in  the  body  no  caufe  which 
*£  could  be  fuppos’d  capable  of  comprefling  fo  large  a  vein,”  was  found  ; 
and  Winklerus  (/),  the  celebrated  profeflor  in  the  Anatomical  Theatre  at 
Gottingen,  fpeaking,  as  it  feems,  of  that  fame  woman  (notwithftanding  nei¬ 
ther  the  age,  nor  the  year  of  making  the  obfervation,  which  is  pointed  out, 
greatly  agrees  therewith)  in  whom  the  fpermatic  vein  equall’d  the  vena  cava 
in  magnitude,  fays,  that  he  faw  it  to  be  totally  obftruCted  “  from  coalition 
it  is  eafy  to  conjecture,  that  this  coalition,  which  was  certainly  like  what  I 
fhall  defcribe  to  you,  as  it  was  feen  by  me  in  another  fetter  («),  had  been 
previous  to  death  indeed  *,  but  that  the  polypous  concretion,  which  was 
form’d  under  the  very  place  of  coalition,  within  the  vein,  had  been  produc’d, 
as  fo  many  others  have  been,  in  the  latter  moments  of  life. 

And  this  being  the  ftate  of  the  queftion,  and  as  I  do  not  fee  that  any  thing 
has  been  produc’d,  by  which  what  you  argue  for  is  put  beyond  the  reach  of 
very  juft  doubts  and  hefitations ;  I  fhould  believe,  that  but  very  few  con- 
cetions  could  be  excepted  out  of  fo  great  a  number,  of  which  we  may  not 
deny,  that  fome  were  begun,  and  that  others  were  completed,  in  the  living 
body.  For  they  may  poflibly  have  been  begun  in  dying  perfons,  or  in  thofe  who 

(y)  Traite  du  Coeur,  1.  4.  ch.  8.  n.  3.  &  4.  (r)  Differt,  de  Yafor.  Lithiafi,  Si  1.  §.  6. 

(r)  Opufc.  Pathol.  Obf.  20.  Adnot.  2. 

(j)  Obf.  21.  («)  56.  n.  10. 

have 


Letter  XXIV.  Article  31.  73*7 

have  been  fo  opprefs’d  by  a  very  long  fyncope,  and  which,  by  reafon  of  the 
blood  being  already  almoft  cold,  is  incurable,  that  they  feem  juft  like  dead 
perfons,  rather  than  living,  if  the  blood  be  of  fuch  a  kind  as  that  generally 

is,  which  is  molt  apt  to  generate  a  cruft.  And  they  are  perfected  in  thofe 
aneuriftns,  in  particular,  which  refemble  the  fhape  of  an  appending  fac. 
For  there  I  have  feen  them  myfelf,  not  44  under  the  appearance  of  that  hol- 
“  low  flefh”  which  the  polypi  fometimes  have  in  the  ventricles  or  the  au¬ 
ricles  of  the  heart ;  and  ftill  lefs  fo  that  they  could,  by  any  means,  be 
look’d  upon  44  as  excrefcences  of  the  coats  of  the  aneurifms but  of  fuch 
a  kind,  as  I  have  defcrib’d  to  you  in  other  letters  (x),  where  1  have  declar’d 
the  caufes  of  this  exception  of  mine,  in  fuch  a  manner,  that  I  do  not  think 
it  neceftary  to  repeat  them  here. 

Nor  fhall  1  think  this  foreign  to  the  truth,  that  if  any  orifice  of  the  branches 
communicating  with  the  aneurifrn,  be  in  part  cover’d  by  thofe  polypous  con¬ 
cretions  which  are  within  the  aneurifrn,  fo  that  lefs  blood  (hall  flow  into 

it,  they  may  begin,  during  the  life  of  the  patient,  to  extend  themfelves  into 
that  branch  ;  and  that  when  to  the  weak  motion  of  the  blood  out  of  the 
aneurifrn,  is  added  that  extreme  languor  of  the  heart,  in  dying  perfons,  which 
now  propels  the  blood  lefs  and  lefs,  the  concretion  in  this  branch  may  be 
en creas’d ;  and  finally,  that  it  may  be  fo  fill’d  up,  on  all  fides,  by  the  vifcid 
and  polypous  blood  ftagnating  and  growing  cool  there,  after  death,  that  no 
cavity  fhall  remain :  and  by  this  means  you  will  more  eafily  underhand  ano¬ 
ther  obfervation  of  Halier  (jy). 

Do  not,  however,  imagine,  although  I  acknowledge  that  there  may  be 
polypi  in  the  dilated  arteries,  even  a  long  time  before  death ;  do  not,  I  fay, 
imagine  it  to  follow  from  hence,  that  I  (hould  no  lefs  acknowledge  them  in 
the  dilated  heart  alfo.  For  the  fibres  of  the  dilated  heart  are,  generally, 
wont  to  ad  more  ftrongly,  as  Senac  (z)  ftiows,  from  the  violence  of  the  pal¬ 
pitations  ;  or  if  they  do  at  any  time  act  more  weakly  at  length,  yet  the  very 
ffnall  ftrength  of  the  fibres,  in  a  dilated  artery,  is  by  no  means  to  be  com¬ 
par’d,  at  any  time,  with  the  force  of  thefe  palpitations,  in  breaking  down, 
mixing,  and  expelling  the  blood. 

31.  I  know  very  well  that  you  may  here,  with  great  propriety,  afk  me 
this  queftion  ;  to  what  purpofe  is  it,  if  there  are  fo  few  polypi  in  the  living 
bodies,  that  not  only  in  all  the  obfervations  of  Valfalva,  from  which  l  am 
not  at  liberty  to  take  away  any  thing,  but  alfo  in  mine,  always  to  make 
mention  of  thefe  concretions,  whick  were  not  the  caufes  of  death,  but  the 
effects  ?  I,  however,  take  notice  of  them  for  this  reafon;.  in  the  firft  place, 
in  order  to  let  you  fee  in  fad,  that  what  Schacht,  the  preceptor  of  Zolli- 
cofferus  (a}y  faid,  is  alfo  true  in  Italy  *,  I  mean,  44  that  a  polypus  was  fo  far 
4!  from  being  a  rare  thing  in  Holland,  that  it  feem’d  to  him  to  be  fomething 
44  extraordinary,  if  he  found  none  in  thofe  who  died  of  a  difeale  and.  when 
you  have  feen  this,  you  will  the  more  readily  believe,  that  the  polypus,  of 
which  there  were  not  the  leaft  fymptoms  in  the  perfons  when  living,  had 
been  form’d  after  death. 

( x )  Epift.  17.  n.  29.  ( z )  ch.  8.  cit.  n.  5. 

0)  Opufc.  citi  Obf.  191.  {a)  DifTeit.  cit.  §  3. 

And 


y  ft  Book  TL  Of  Bifeafes  of  the  Hiorax. 

And  in  the  fecond  place,  notwithstanding  the  polypus  has  been  form’d  in 
the  dead  body,  yet  the  abfence  or  prefence,  and  various  condition  of  the 
polypus,  (how,  at  leaft,  what  was  the  nature  and  quality  of  the  blood,  in 
the  living  body.  Finally,  there  have  been  obferv’d,  by  Malpighi  (£),  to  be 
fome  differences  betwixt  thofe  polypi  which  are  form’d  on  the  right  and  on 
the  left  fide  of  the  heart,  though  partly  call’d  into  queftion  by  Pafta  (c). 
For  Malpighi  had  faid,  that  thofe  on  the  right  fide  were,  for  the  moft  part, 
of  a  whitifh  colour,  and  thole  of  the  left,  of  a  black  ;  the  former,  of  a  larger 
fize  ;  the  latter,  of  a  leffer.  Pafta,  however,  doubts  as  to  the  colour  *,  though 
as  to  the  magnitude,  he  does  not  difagree.  If  you  confider  the  reafon  given 
by  Malpighi,  of  the  chyle  and  lymph  that  is  jutl  added  to  the  blood,  going 
to  the  right  finus  of  the  heart,  and  the  largenefs  of  this  firius,  you  will  be 
inclin’d  to  grant  to  Malpighi  both  his  propofitions  *,  but  ft  ill  more  the  greater 
bulk  of  the  polypus,  on  the  right  fide,  when  you  at  the  fame  time  attend 
to  this,  that  the  right  ventricle  is  weaker  than  the  left  j  fo  that  it  cannot  prefs 
upon,  and  expel,  the  blood,  but  with  Id’s  force  *,  and  mu  ft  foon  after  be 
the  more  eafily  relax’d  and  diftended,  as  by  reafon  of  refpiration  being  more 
and  more  deficient,  in  the  laft  extremity  of  life,  it  throws  out  lefts  blood  than 
it  receives. 

But  in  order  to  come,  more  certainly,  to  the  truth,  obfervations  muff  be 
•collected.  And  this  was  done  by  Pafta,  'as  I  have  laid  above  ( d ),  in  reipetft 
to  the  colour,  for  which  reafon  he  could  not  affent  to  the  opinion  of  Mal¬ 
pighi.  In  regard  to  the  magnitude  of  the  polypi,  1  have  done  it  rnyfelf ; 
and  having  examin’d  into  all  the  obfervations  contain’d  in  Pafta’s  letter,  that 
are  in  great  number  indeed  ;  fome  of  which  are  produc’d  for  one  reafon,  and 
fome  for  another ;  I  have  really  feen  that  the  polypus  had  been  the  larged: 
frequently  in  the  right,  and  very  rarely  in  the  left  *,  and  I  have  even  ob¬ 
ferv’d,  that  it  is  very  often  taken  notice  of  in  the  right  ventricle  only,  but 
very  l’eldom  in  the  left  ventricle  alone.  Nor  indeed  will  you  find,  that  Val- 
ialva  was  accuftom’d  to  find  it  otherwife,  if  you  read  over  all  his  hiftories, 
especially  thofe  which  I  have  compriz’d  in  the  twentieth  letter.  And  he 
made  no  hefitation  to  predift,  in  dependance  upon  his  long  feries  of  obfer¬ 
vations,  as  you  will  learn  from  my  eleventh  letter  (<?),  that  when  he  had  hap¬ 
pen’d  to  fee  a  polypus  taken  out  by  me  on  the  left  fide  of  the  heart,  ano¬ 
ther  would  be  found  on  the  right  fide  *,  nor  did  the  event  falfify  his  predic¬ 
tion. 

In  order,  therefore,  more  certainly  to  determine  upon  diftindfions  of  that 
kind,  and  others  befides  ;  as  that,  for  inftance,  which  Malpighi  has  added  (/), 
in  regard  to  the  lubftance  of  the  polypus  being  more  denfe  on  the  left  fide, 
than  on  the  right  *,  that  their  caufes,  which  may  be  fometimes  ufeful  in  the 
very  violent  controverfy  about  polypi,  that  I  have  taken  notice  of  above,  may 
be  enquir’d  into,  you  certainly  perceive  that  the  circumftances  which  have 
been  feen  in  the  feveral  dsffeftions,  in  regard  to  thefe  polypi,  have  not  been 
remark’d  in  vain  :  and  I  even  wifh  that,  in  general,  we  could  have  done  it 
with  more  accuracy. 

(I)  Differt,  de  Polypo  Cordis.  (d)  n.  22.  in  fin. 

fq  Epid.  fa;p,  cit.  n,  14.  &  23.  \c)  n.  22.  -{/)  Differt,  cit* 

32.  But 


Letter  XXIV.  Article  32. 

32.  But  to  return,  at  length,  to  the  inequality  and  intermiflion  of  the 
pulfe ;  whether  polypi  are  or  are  not  to  be  allow’d  of  in  the  heart,  before 
death,  it  appears  from  thole  things  which  I  have  now  and  then  interfpers’d, 
that  this  admonition  of  the  celebrated  Fantonus(^)  is  very  juft:  “  I  fay 
“  again,  we  muft  beware  not  to  form  a  rafh  and  imprudent  judgment, 
“  in  regard  to  polypi  from  diforders  of  the  pulfe.  For  it  certainly  de- 
“  ceives  many.  Let  the  difledion  of  bodies  render  us  more  cautious.  For 
w  you  find  polypi-,  yet  the  pulfe  was  equal  and  conftant:  polypi  are  want- 
“  ing;  yet  every  kind  of  diforder  was  found  in  the  pulfe.” 

However,  all  the  diforders  of  the  pulfe  are  found  out,  as  you  very  well 
know,  by  attending  to  a  number  of  pulfations,  or  to  each  of  the  feparate 
pulfations.  By  attending  to  a  number,  and  by  comparing  one  with  another, 
in  reipedt  to  every  diftindtion,  the  inequality  is  diftinguifh’d  ;  and  as  to  the 
number  within  a  certain  time,  the  intermiflion  ;  and  if  this  laft  a  very  long 
time,  the  afphuxia  ;  properties,  of  which  I  have  hitherto  fpoken  ;  and  befides 
thefe,  the  frequency  or  the  rarity.  And  by  attending  to  the  feparate  pulfa¬ 
tions,  the  quicknefs  or  the  flownels,  the  hardnefs  or  the  foftnefs,  the  great- 
nefs  or  the  frnallnefs,  the  vehemence  or  debility,  or  any  other  properties 
of  the  pulfe,  are  to  be  diftinguifh’d  ;  if,  however,  any  other  there  are  to  be 
added  to  thefe;  for  I  confefs  that,  in  this  part  of  medicine,  the  ancients 
have  been  too  prolix.  And  yet,  if  on  the  other  hand  I  fhould  fay,  that 
lbrne  of  the  more  modern  phylicians  have  been  more  fparing  than  they  ought 
to  be,  you,  perhaps,  would  not  think  that  I  faid  it  without  reafon,  For  it 
certainly  does  not  follow  of  courfe,  that  all  frequent  pulfes  are  fwift  or  quick* 
nor  that  ail  hard  pulfes,  or  all  great  pulfes,  are  vehement;  which  they  may 
be  thpught  to  have  attended  to  but  little,  who  have  omitted  the  quicknefs,, 
the  hardnefs,  the  too  great  magnitude,  and  the  diforders  that  are  diametri¬ 
cally  oppofite  to  thefe.  But  the  celerity  or  flownefs  “  cannot  be  diftinguifh’d 
“  by  the  touch,”  in  the  point  of  time  which  one  pulfation  continues.  And 
this  I  certainly  confefs  with  Bellini  (-6),  “in  a  ftate  of  pulfe  which  recedes 
“  but  little  from  the  natural  one.”  But  can  they  not  be  diftinguiih’d  when 
the  ftate  of  the  pu’fe  is  very  different  from  the  natural  ftate  ?  And  if  they 
can,  by  what  name  then  would  they  have  this  kind  of  dilorder  call’d  ?  fince 
they  have,  without  the  lead;  neceffity,  now  confounded  the  terms  of  celerity 
and  frequency,  flownefs  and  rarity,  by  a  promifcuous  ufe  of  them,  which,; 
among  the  ancients,  were  prudently  and  properly  diftinguifh’d  ;  and  this  mo¬ 
dern  cuftom  is  not  approv’d  of  by  Stahl  (?).  For  with  them  we  fhould  cer¬ 
tainly  be  thought  to  fay  things  diametrically  oppofite  to  each  other,  if  we 
fhould  fay  that  we  had  found  a  celerity,  join’d  together  with  a  rarity,  in  the 
pulfes  of  patients.  Yet  this  has  lometimes  happen’d  ;  and  never  more  than 
in  a  young  man,  in  whom  I  found  no  great  rarity  of  the  pulfe,  but  the 
greateft  celerity  imaginable.  He  was  one  of  thofe  who  drefs  hemp,  and  was, 
through  a  hypochondriac  affedtion,  of  a  timid  nature,  but  robuft  :  he  lay  in 
the  hofpital  of  St.  Mary  de  Morte  at  Bologna,  in  the  beginning  of  May,  in, 
the  year  1705.  Blood  had  been  taken  away  three  times,  which,  I  remern- 

(A  inSchol.  ad  Patris  Obf.  Med.  Anat.  27.  (/)  F.xcuf.  refp.  Exam.  Pulf.  celer.  &  frcqu. 

(/>)  De  Pulfibua.  c.  4. 

6  beiv 


760  Book  II.  Of  Difeafes  of  the  Thorax. 

ber,  was  not  only  without  a  cruft,  but  even  coagulated  flowly,  and  with 
difficulty ;  or  at  leaft  that  which  was  taken  away  the  fecond  time.  On  the 
fecond  and  the  third  day  the  fpitting  was  bloody,  and  after  that  there  was 
none,  or  nearly  none ;  but  he  had  frequent  nocturnal  fweats,  which  were  at 
firft  of  no  advantage ;  yet  about  the  tenth  and  eleventh  day,  they  were  fo 
far  of  advantage,  that  the  pulfe,  which  had  been  chord-like,  and  very  frequenr, 
as  was  natural  to  an  acute  fever,  was  on  the  eleventh  day,  when  this  fever 
was  at  an  end,  no  longer  tenfe  nor  frequent,  but  even  rare,  yet  not  immo¬ 
derately  fo.  But  with  this  rarity,  a  vibration  or  tenftty  was  foon  after  join’d, 
and  fo  great  a  celerity,  that  although  both  motions  of  the  artery,  that  is, 
outwards  and  inwards,  did  not  take  up,  when  taken  together,  much  more 
time  than  they  generally  do  when  in  a  natural  ftate,  yet  the  firft  was  three 
times  ffiorter  than  the  fecond.  And  this  circumftance  continu’d  about  two 
days,  until  the  watchings  and  the  thirft,  which  even  then  remain’d,  by  degrees 
going  away,  the  pulfe  alfo,  having  its  vibration  and  its  celerity  diminiffi’d, 
return’d  gradually  almoft  to  its  natural  ftate,  as  we  perceiv’d  on  the  four¬ 
teenth  day. 

33.  But  I  have  found  a  ftill  much  greater  rarity  without  any  celerity  or 
flownefs,  particularly  in  two  old  men,  from  the  time  that  they  had  been  firft 
attack’d  with  epileptic  paroxyfms,  beginning  from  the  belly.  The  hiftory  of 
one  of  thefe  I  have  written  to  you  already  (k) :  and  of  the  other  I  (hall,  per¬ 
haps,  fend  you  the  hiftory  at  fome  other  time  (/)  ;  whom  vifiting  by  way  of 
confultation,  I  found  with  fuch  a  rarity  of  pulfe,  that  within  the  fixtieth  part 
of  an  hour  the  pulfations  were  only  twenty-two  ;  that  is  to  fay,  they  were 
in  number  only  about  two-thirds  lefs  than  they  ought  to  be  ;  and  this  had 
been  fo  already  for  many  months. 

You  will  fee,  indeed,  in  the  Sepulchretum  (m),  that  Rumlerus  had  obferv’d 
many  fewer  pulfations  in  a  young  man,  as  “  a  fign  of  the  greateft  dejedtion 
“  of  ftrength,”  join’d  with  a  flow  fever.  But  neither  of  them  of  whom  I 
fpeak  had  any  fever,  or  fuch  a  dejedtion  of  ftrength  but  that  they  could  rife 
from  their  bed;  and  if  they  could  not  always  “  walk  about  like  healthy 
“  perfons,”  as  that  nobleman  of  Vefalius  (»)  did,  at  leaft  they  could  fome- 
times.  Yet  in  thefe  very  perfons  the  pulfe,  for  the  moft  part,  was  not  un¬ 
equal,  nor  various,  whether  you  examin’d  it  in  one  wrift  or  in  both  ;  as  it 
was  in  the  young  country-fellow  whom  I  faw  at  Bologna,  in  the  hofpital  of 
St.  Mary  de  Vita.  This  boy,  having  formerly  fall’n  from  a  tree,  and  bruis’d 
his  back,  when  he  was  twelve  years  of  age,  and  having  made  at  that  time 
bloody  urine,  was  attack’d  with  a  continual  palpitation  of  the  heart,  which 
troubl’d  him  even  then,  though  it  was  nine  years  after,  and  was  wont  to  be 
exacerbated  three  or  four  times  every  year,  and  bring  with  it  a  difficulty  of 
breathing,  which  had  then  happen’d.  As  I,  therefore,  tried  both  the  wrifts 
at  the  fame  time  in  this  young  man,  I  found  the  pulfe  in  both  places  un¬ 
equal  and  irregular ;  yet  in  fuch  a  manner,  that  it  was  manifeft,  when  I  at¬ 
tended  to  the  greater  part  of  the  pulfations,  that  in  the  left  wrift  they  could 
neither  be  call’d  rare  nor  frequent,  and  that  in  the  right  they  were  almoft 

(i)  Epift.  9.  n.  7.  (/»)  Seft.  hac  9.  in  Schol.  ad  Ob f.  2. 

('/)  Vid.  Epift.  64.  n.  5.  («)  In  cir.  2.  Obf. 

4 


three 


Letter  XXIV.  Article  33. 


7  6  1 


three  times  more  rare  than  in  the  left.  If  this  young  man  had  happen’d  to 
die  at  that  time,  I  fhould,  perhaps,  have  found  fomething  which  would  have 
been  of  life  in  order  to  underftancl  the  caule  of  this  difference,  provided  it 
had  not  confided  in  the  ftrudture  of  the  nerves,  which  go  to  the  right  ar¬ 
tery,  being  vitiated  from  the  fall.  For  I  believe  that  many  diforders  of  the 
pulfe  arife  frequently  from  the  nerves,  and  thole  in  particular  which  are  more 
difficult  to  be  explain’d.  For  that  “  languid  and  pretty  rare”  pulfe  which 
you  fee  is  in  the  Sepulchretum  (0)  afcrib’d  to  a  great  quantity  of  turbid  water 
in  the  pericardium,  was  not  rare  to  lo  great  a  degree,  as  appears  from  that 
very  method  of  fpeaking  ;  nor  was  in  one  arm  only  •,  and  therefore  may,  per¬ 
haps,  be  fufficiently  explain’d  from  the  caufes  there  propos’d  :  although  out 
of  fo  many  not  diffimilar  obfervations  of  water  contain’d  in  the  pericardium, 
which  I  have  often  produc’d,  or  taken  notice  of,  1  know  not  how  many  at 
length  make  mention  of  a  rare,  rather  than  of  a  frequent  pulfe,  which  had 
preceded.  And  the  explication  of  the  frequent  pulfe  feems  very  eafy,  whether 
fome  irritating  caufe  veliicates  the  nerves  of  the  heart,  or  the  heart  itfelf,  and 
that  either  internally  or  externally  :  externally,  as  when  there  is  acrid  water 
in  the  pericardium,  to  which  the  thirteenth  obfervation  is  referr’d  in  that  very 
ninth  lection  of  the  Sepulchretum  ;  and  internally,  when  the  blood  that  is 
pafs’d  through  the  cavities  or  lubltance  of  the  heart,  is  of  fuch  a  kind  as  to 
be  able  to  vellicate;  or  even  when  the  paffages  of  thofe  nerves  through  which 
the  fpirits  flow  into  the  heart,  lie  open  fo  wide,  after  a  long  irritation  of  the 
heart,  that,  when  this  irritation  is  taken  away,  they  go  on  neverthelefs,  and 
for  a  confiderable  time  flow  more  frequently  into  the  heart  than  they  ought: 
which,  perhaps,  is  the  reafon  why  it  frequently  happens,  that,  when  fevers 
are  already  overcome,  the  patients,  notwithflanding,  if  you  attend  to  nothing 
elfe  but  the  frequency  of  the  pulfe,  feem  to  be  ftill  feverifh  ;  and  for  that 
reafon  are,  by  timorous  phyflcians,  confin’d  longer  and  longer  to  their  beds ; 
whereas  they  ought  to  be  dragg’d  out  of  them  by  degrees,  and  in  propor¬ 
tion  to  their  ftrength,  if  we  would  indeed  wifh  them  to  recover. 

But  the  hardnefs  of  the  pulfe  has,  for  the  molt  part,  fo  manifeft  caufes, 
that  they  evidently  appear  of  themfelves ;  and  it  evidently  appears,  likewife, 
why  it  is  lefs  to  be  attended  to  in  old  men,  unlefs  perhaps  it  be  either  too 
large,  or  they  have,  contrary  to  the  generality  of  old  men,  their  fleffi  even 
at  that  time  fomewhat  foft,  and,  as  it  were,  tender. 

And  if  the  caufe  of  the  magnitude  of  the  pulfe  were  not  extremely  evi¬ 
dent,  it  might  be  conjectur’d  from  thofe  things  which  I  have  touch’d  upon 
above  (p)  in  feveral  places,  when  I  treated  of  the  diforder  direCHy  contrary 
to  it :  nor,  indeed,  is  there  leifure  to  dwell  upon  it  here,  where  you  fee  I 
point  out  certain  caufes  by  way  of  example,  as  it  were,  of  the  feveral  dif¬ 
ferences  which  feem  to  me  the  more  certain ;  for  I  have  fhewn  above  (q)  what 
the  fountains  are,  from  whence  you  .may,  when  you  think  proper,  draw, 
not  only  a  greater  number  of  obfervations,  but  l'uch  as  are  more  accurate. 
At  prefent,  this  one  thing  only  remains,  that  we  enquire  in  regard  to  the 
vehemence  of  the  pulfe.  For  although,  when  I  fpoke  of  the  alphuxia  and 


( 0 )  Se&.  cit.  Obf.  19. 


(/)  Ut  n.  15.  19. 

5  E 


(?)  N.  12. 


VOL,  I. 


the 


7^2  Book  II.  Of  Difeafes  of  the  Thorax. 

the  debility  of  the  pulfe,  I  pointed  out  fome  caufes,  the  oppofite  of  which 
nmft  of  courfe  bring  on  a  vehemence  in  the  pullations  ;  yet  it  fometimes 
happens,  that  there  is  fo  great  a  vehemence,  and  join’d  with  fuch  circum - 
fiances,  that  the  peculiar  caufe  of  it,  if  it  fliould  chance  to  fall  under  the 
notice  of  the  fenfes,  mu  ft,  according  to  appearances,  be  enquir’d  into  in  the 
bodies  after  drath  :  and  this  I  did  in  the  man  whole  hiftory  will  be  imme¬ 
diately  fubjoin’d  •,  fo  that,  as  I  began  with  afphuxia,  and  ran  over  all  the 
intermediate  diforders,  I  fhall  end  my  letter  with  the  diforder  which,  of  all, 
is  the  moft  contrary  to  it. 

34.  A  fhoemaker,  of  a  middle  age,  who,  as  he  faid  himfelf,  had  been  ac- 
cuftom’d  to  no  irregularity,  except  that  of  drinking  too  much  wine,  had 
begun,  about  four  months  before,  to  be  attack’d  with  a  laffitude  of  the 
whole  body,  and  a  puliation  in  the  region  of  the  heart,  jo;n’d  to  a  difficulty 
of  breathing.  And  thefe  fymptoms  increafing  every  day,  Paul  Salano,  a 
moft  experienc’d  phyfician  at  Bologna,  judg’d  that  the  man  labour’d  under 
an  aneurifm,  and  order’d  blood  to  be  taken  way  from  him  more  than  once. 
At  length,  fwoonings  were  added  to  the  fymptoms  1  have  mention’d,  when 
he  was  receiv’d  into  the  hofpital  of  Sc.  Mary  de  Morte,  at  Bologna.  Theft: 
fwoonings,  and  the  difficulty  of  breathing,  were  more  violent  in  the  night¬ 
time,  and  efpecially  when  the  patient  endeavour’d  to  go  to  deep  ;  and  when 
thefe  fymptoms  attack’d  him,  his  right  arm  was  feiz’d  with  a  grievous  pain, 
juft  as  if  it  were  torn  to  pieces.  And  fo  great  and  fo  conftant  a  pulfation 
was  there  at  the  region  of  the  heart,  and  from  thence  quite  to  the  navel, 
that  I  fcarcely  remember  ever  to  have  felt  or  to  have  feen  a  larger.  For 
the  whole  of  it  was  perceiv’d  by  the  eye  •,  and  although  it  was  the  moft  con- 
fiderable  in  the  breaft,  yet  that  part  of  the  belly,  alfo,  which  I  have  men¬ 
tion’d,  ftruck  the  hand,  when  laid  upon  it,  in  fuch  a  manner,  that  there 
feem’d  to  every  one  to  be  an  aneurifm,  not  only  in  the  thorax,  but  in  the 
belly  alfo.  The  patient  himfelf  faid  that  he  perceiv’d  this  pulfation  every¬ 
where;  fo  that  it  came  even  down  to  the  extremity  of  his  feet.  And,  indeed, 
the  carotids  alfo,  and  the  temporal  arteries,  and  the  radials,  which  I  often 
felt,  were  agitated  with  the  fame  large  and  vibrating  pulfations.  The  feet 
were  fomewhat  fwell’d.  Scarcely  any  food  was  taken  down.  And  although 
there  was  no  fever,  and  though  the  patient  could,  when  his  refpiration  was 
become  lefs  difficult,  lie  down  either  upon  one  fide  or  the  other,  and  was 
extremely  well  in  his  head  ;  yet  he  bore  his  diforder  fo  extremely  ill,  as  to 
think  that  death  was  much  more  defirable  to  him.  And  this  defire  he  was 
fatisfied  in,  on  the  fourth  day  from  his  coming  into  the  hofpital.  For  having 
happen’d  to  rife  in  order  to  go  to  (tool,  he  was  fcarcely  return’d  into  his 
bed,  when  he  could  not  take  his  breath  but  with  his  neck  ftretch’d  out  j  and 
in  that  difficulty  of  breathing  he  died. 

1  differed  his  body  on  the  firft  of  July,  in  the  year  1705;  obferving,  as 
we  diffiected,  that  the  lips  were  very  livid,  and  the  blood,  which  flow’d  down 
while  we  cut  through  the  integuments  about  the  throat,  black  and  fluid. 

The  thorax  being  open’d,  a  yellow  ferum  was  obferv’d  to  be  contain’d  in 
its  right  cavity.  In  the  left,  the  whole  convex  furface  of  the  lungs  adher’d 
to  the  pleura,  by  a  thick  and  foft  kind  of  membrane  that  was  interpos’d, 
and  which  could  be  feparated  without  laceration  on  one  fide  from  the  mem¬ 
brane 


Letter  XXIV.  Article  35'.  76  3 

brane  of  the  lungs,  and  on  the  other  from  the  pleura ;  the  relics  and  token, 
in  my  opinion,  of  a  peripneumony,  which  had  formerly  preceded.  The 
lungs  themfelves  were  found.  In  the  pericardium  was  a  little  turbid  water. 
The  heart  was  rather  large,  but  only  moderately  fo.  In  the  cavities  and 
veffels  of  it,  which  communicated  with  each  other,  was  no- where  any  thing 
polypous-,  the  blood  was  only  black,  and  (lightly  colledted  into  coagula. 
Notwithstanding  I  carefully  examin’d  into  every  circumftance,  I  could  but 
juft  obferve,  in  one  of  the  three  valves  that  are  plac’d  at  the  beginning  of 
the  pulmonary  artery,  fomething  hardilh,  and  approaching  to  the  nature  of 
a  cartilage,  in  the  middle  of  the  valve,  and  efpecially  at  its  edge.  How¬ 
ever,  there  was  no  dilatation  of  the  heart,  or  of  the  auricles,  or  of  any  of 
the  veffels,  either  in  the  thorax  or  belly.  And,  indeed,  although  I  open’d 
the  aorta,  from  the  heart  quite  to  its  divifion  into  the  iliacs,  I  could  not  ob- 
ferve  any  preternatural  appearance  on  its  whole  internal  furfaee,  except  a 
flight  and  unequal  kind  of  fulci,  as  it  were,  drawn  in  a  longitudinal  diredtion  ; 
and  thofe,  firft,  from  the  very  beginning  of  the  artery  quite  to  that  part 
which  begins  to  adhere  to  the  vertebrae  of  the  thorax  and  again,  but  more 
(lightly,  where  it  gives  off  the  caeliac  artery  below  the  diaphragm. 

The  belly  being  open’d  before,  I  examin’d  into  the  laft-mention’d  circum¬ 
ftance  -,  and  no  inconliderabie  quantity  of  yellow  water  being  feen  in  it,  we 
obferv’d  that  the  colon,  from  the  liver  quite  to  its  termination,  was  contracted 
into  very  narrow  cells,  and  that  the  ftomach  alfo  was  much  contracted  ;  but 
neither  of  thefe  appearances  furpriz’d  us,  as  they  were  in  a  man  who  had 
fcarcely  taken  any  thing,  as  I  have  (aid,  for  many  days.  Wherefore  nothing 
preternatural  was  found  in  the  vif  era  of  the  belly,  except  that  the  liver 
was  fomewhat  hard,  and  mark’d  with  fpots  on  its  external  furfaee,  refembling 
a  kind  of  fmall  granules.  1  he  brain,  which  was  the  only  part  remaining 
to  be  examin’d,  I  found  to  be  in  a  very  found  and  natural  ftate  ;  although 
it  was  not  very  difficult  to  draw  off  the  pia  mater  from  the  cortical  part  of 
the  cerebrum  without  injuring  it,  Finally,  from  the  tube  of  the  vertebrse 
I  faw  no  water  at  all  proceed. 

35.  From  whence,  then,  could  lb  great  and  fo  vehement  a  pulfation  of 
the  heart,  and  of  all  the  arteries,  arife  ?  Without  doubt,  from  the  fame 
caufe  that  it  arifes  in  moft  of  thofe  perfons  who  are  beginning  to  be  attack’d 
with  an  aneurifm  of  the  aorta.  For  in  thefe  perfons,  it  is  not  from  the 
aneurifm  itfelf,  which  is  not  yet  form’d  ;  and  if  it  were  form’d,  it  would  then 
rather  diminiffi  the  impetus  of  the  circulating  fluid,  as  we  fee  in  the  dilated 
channels  of  rivers ;  but  it  is  from  that  caufe  which,  either  alone  or  with 
others,  produces  the  aneurifm  itfelf,  by  violently  urging  the  parietes  of  the 
veflels,  by  weakening  them,  and,  finally,  by  compelling  them  outwards. 
And  that  caufe  confifts  in  the  preternatural  increafe  of  the  force  with  which 
the  heart  thrufts  the  blood  into  the  beginning  of  the  aorta,  and  this  into  the 
next  part  of  the  artery,  and  fo  on  in  iucceffive  progreffion  j  efpecially  when 
the  blood  is  in  luch  a  quantity,  and  of  fuch  a  quality,  that  it  cannot  only  have 
that  very  violent  motion  communicated  to  it  more  eafily,  but  can  more  ve¬ 
hemently  transfer  it  to  the  parietes  of  the  arteries.  What,  then,  more  in- 
creafes  the  force  of  the  heart  and  arteries,  than  that  method  of  diet  which 
immoderately  increafes  the  quantity  of  more  viyid  fpirits,  and,  if  you  will 

5  E  2  alfo, 


764  Book  II.  Of  Difeafes  of  the  Thorax, 

alfo,  the  quantity  of  more  irritating  fpirits  ?  At  lead,  I  have  feen,  that  a 
pulfation  of  the  arteries  of  this  kind  has  fucceeded  to  fuch  a  method  of  diet ; 
and  not  only  in  this  man,  but  even  in  others,  and  in  particular  in  one  by 
whom  1  was  confulted  about  forty  years  ago. 

I  have  feen  the  fame  thing  in  others  befides  ;  among  whom  was  an  honed: 
old  man,  my  fellow- citizen,  and  two  merchants,  the  one  a  Paduan,  and  the 
other  a  Venetian  ;  the  latter  of  whom  {till  lives  in  a  fiourifhing  time  of  life, 
but  the  other  died  of  the  difeafe :  yet  we  could  by  no  kind  of  entreaties 
whatever,  obtain  a  permifiion  from  his  wife  that  the  body  fhould  be  open’d. 
That  all  thefe  perfons  were  given  to  drinking,  I  do  not  believe  *  and  that  one 
of  them  was  nor,  1  even  know.  Yet  I  fhould  believe,  that  in  all  thefe  perfons 
the  puliation  had  been  owing  to  the  nerves,  as  there  were  no  particular  figns 
of  other  difeafes  j  or  if  there  were,  they  either  pretty  clearly  related  to  the 
irritated  nerves,  as  I  fhall  fhew  in  the  cafe  of  that  Venetian  merchant  on 
another  occafion  (r),  or  to  fuch  diforders  as  could  not  bring  on  that  pulfation 
but  by  irritating  the  nerves  ;  as  you  will  underhand  hereafter  from  the  dif- 
fedlion  of  the  old  man  (j)  whom  J  juft  now  fpoke  of,  and  who  died  from 
the  irritation  of  calculi  in  the  kidnies  and  bladder.  But  I  am  confirm’d  in 
my  opinion  from  other  oblervations  alfo.  For  befides  that  one  is  extant  (/), 
in  which,  after  a  pulfation  in  the  brain,  a  palpitation  of  the  heart  and  ar¬ 
teries  came  on,  which  was  perceiv’d  even  at  the  fingers  ends  •,  and  befides 
that  Rhodius  fulpedted  this  diforder  to  be  from  the  uterus,  in  a  matron  of 
Padua  (a) ;  and  although  you  may  afcribe  it  thereto,  in  a  fervant-maid  whom 
the  fame  author  mentions  (x)  as  being  cur’d  by  Platerus  (y)  I  enquire  of 
you,  in  what  manner  a  flaccid  heart  can  by  its  own  force  make  fuch  pulfes 
as  are  in  themfelves  not  weak  ? 

Yet  in  the  hufbandman  whofe  hiftory  I  have  defcrib’d  to  you  in  the  ele¬ 
venth  letter  (z),  the  heart  was  flaccid,  and  the  pulfe  vehement.  Without 
doubt,  becaufe  in  proportion  asjais  cerebrum,  in  the  ftate  it  is  there  defcrib’d  in, 
was  able  to  fecrete  the  fewer  fpirits,  the  greater  quantity  was  fecreted  by  the 
cerebellum j  or,  if  you  chufe  rather  to  consider  it  fo,  by  the  fpinal  marrow, 
and  fent  to  the  heart  j  or  elfe,  together  with  a  refolution  of  fome  nerves, 
the  irritation  of  others,  as  frequently  happens,  was  join’d,  and  amongft  them 
of  the  cardiac  ;  or,  at  leafl,  fomething  of  that  kind  was  the  cafe.  And  to 
make  ufe  of  the  obfervations  which  take  notice  of  a  great  pulfation  of  all  the 
arteries,  1  beg  of  you  to  turn  to  thofe  two  which  are  related  in  the  Sepul- 
chretum,  from  two  very  celebrated  Parifian  authors.  One  is  that  of  Bal- 
lonius  (a),  in  a  young  man  who  had  long  been  affedted  with  a  palpitation  of 
the  heart,  and  in  whom  “  all  the  arteries  were  feen  to  have  an  evident  pul- 
“  fation  in  almoft  every  part.”  The  other  is  that  of  Parey  (£),  in  a  certain 
dealer  in  cloaths,  who  “  faid  that  he  perceiv’d  a  pulfe  from  the  impetus  of 
‘‘  all  the  arteries  when  in  adlion.”  In  the  firft,  “  all  the  valves  of  the 


(r)  Epift.  64.  n.  10. 

(j)  Epift.  42.  n.  13. 

(/)  Commere.  Litter.  A.  173 6.  Hebd.  32. 
n.  3. 

[ u )  Cent,  2.  Obf.  Med.  40, 


(x)  Ibid. 

(y)  Obf.  1.  2. 

(2)  N.  1 1. 

(a)  L.  2.  S.  8.  Obf.  26.  §  2, 

(£)  Sett,  hac  9.  Obf.  9. 

<£  heart. 


Letter  XXIV.  Article  3 6.  t6; 

**  heart,  and  the  great  artery,  were  found  to  be  diftended  to  fuch  a  degree, 
“  that  the  heart  i'cem’d  to  be  three  times  larger  than  its  natural  fize,  or  at 
“  lead  twice  as  large.”  And  in  the  dealer  in  cloaths,  “  the  arteria  venofa 
“  was  found  dilated  to  fo  large  a  fize,  as  to  admit  a  clench’d  fid,  and  its  in- 
“  ternal  coat  was  bony.”  And  now  I  afk  of  you,  whether  didenfions  and 
dilatations  of  the  veffels  increafe  the  impelling  force  of  the  fibres,  and  the 
impetus  of  the  circulating  humour?  or  whether  they  diminifn  both  the  one 
and  the  other,  as  was  juft  now  hinted  at  ?  And  if  you  allow  of  this,  it  will 
therefore  leem  more  probable,  that  the  fame  caufe  which  had  before  produc’d 
the  aneurifms  in  both  the  one  and  the  other,  had  even  continu’d  to  act  when 
the  aneurilms  were  form’d  ;  and  even  that  it  had  been  fo  ft  rang,  contrary 
to  what  generally  happens,  as  to  keep  up  that  very  great  puliation  of  all  the 
arteries. 

36.  And  I  made  ufe  of  the  plural  word  aneurifms ,  in  order  to  include  the  ob- 
vation  of  Parey  alfo ;  firit,  becaufe  he  us’d  this  very  word,  aneurifm  of  the 
arteria  venofa  ;  and,  alfo,  becaufe  it  is  doubtful  with  me,  left  he  fhould,  per¬ 
haps,  have  written  thus  through  careleffnefs,  when  he  really  meant  to  write 
vena  art  eric  fa ,  that  is,  the  pulmonary  artery.  And  there  are  many  reafons 
for  doubting.  For,  in  the  firft  place,  in  the  hiftories  which  I  remember  to 
have  read,  and  which  are  in  all  two  in  number,  of  a  very  great  dilatation  of 
the  arteria  venofa,  that  is,  of  the  pulmonary  vein  *,  this  very  great  and  uni- 
verfal  puliation  is  fo  far  from  being  mention’d,  that  either  nothing  is  laid  of 
the  pulfe,  or  it  is  faid  to  have  been  very  fmall  and  weak.  One  of  them  is 
given  by  Hildanus,  century  the  fecond,  obfervation  the  eighty-ninth  ;  and  not, 
as  is  faifiy  pointed  out  by  the  printers  of  Lancifi(c),  the  ninety-ninth  :  and 
the  other  by  Vieuffens,  in  his  treatife  of  the  heart,  which  is  written  in  French, 
chapter  the  fixteenth.  And,  indeed,  it  has  fo  happen’d  to  me,  that  when  I 
have  found  the  trunk  of  this  vein,  that  is,  the  finus  into  which  all  its  branches 
*  flow,  larger  in  its  fize  than  was  natural,  1  heard  that  a  languid  pulfe,  or  no 
pulfe  at  all,  had  preceded  \  as  you  will  learn  («?)  from  reading  over  again  the 
eighteenth  letter  (d).  I  alfo  read,  that  in  both  of  thofe  obfervations,  a  pal¬ 
pitation  of  the  heart,  and  a  difficulty  of  breathing,  had  been  remark’d  i  which 
I  not  only  fee  are  not  mention’d  in  the  obfervation  of  Parey,  but  I  ought  to 
believe  were  abfent ;  fince  I  obferve  that  the  patient  of  whom  he  fpeaks,  was 
“  playing  at  tennis  ”  in  his  laft  hours  ;  which  kind  of  exercife,  by  exacer¬ 
bating  both  of  thefe  fymptoms,  would  have  caus’d  uneafinefs  inftead  of 
pleafure.  On  fhe  other  hand,  I  find  in  the  fame  obfervation,  which  does  not 
occur  in  either  of  thofe  two  before-mention’d,  nor  does  it  feem  reafonable  to 
expedl  it,  in  the  dilatation  of  this  vein,  that  “  a  painful  and  tumid  place  ” 
fhould  appear  externally.  This  is  generally  oblerv’d  to  happen  from  the  pul- 
fation  either  of  the  dilated  heart,  or  of  its  arterial  vefiel  when  dilated  ;  and  it 
is  much  more  frequent  in  the  latter  than  in  the  veins,  that  “  the  internal 
“  coat”  is  found  to  be  “  bony:”  although  I  do  not  very  well  underftand 
with  what  propriety  Parey  could  have  faid  even  this  of  a  vein,  as  he  had  af- 
ferted  (/),  “  that  a  vein  confifted  of  one  coat  only  j”  and  that  it  did 
not,  like  the  arteries,  46  obtain  two  coats.” 

(<r)  De  Aneur.  Propof.  53.  (/)  N.  2.  &  34. 

(ej  Vid,  etiam  Epift.  64.  n.  7.  (f)  Oper,  1.  2.  c,  10, 

You 


766  Book  II.  Of  Difeafes  of  the  Thorax. 

You  fee,  then,  what  the  circumdances  are,  in  his  obfervation,  which  give 
me  occafion  for  doubt.  Yet  they  do  not,  altogether,  abfolutely  influence  me 
to  believe,  that  he  meant  to  write  “  vena  arteriofa;”  for,  on  this  fuppofition, 
difficulties  would  alfo  remain  •,  not  fo  many  indeed,  yet  fome,  however,  of 
thole  that  I  have  hinted  at.  It  does  not  efcape  me,  indeed,  that  there  have 
been  indances  of  the  dilatation  even  of  this  vein,  that  is,  of  the  pulmonary 
artery,  although  much  fewer  than  of  the  great  artery  :  as  in  that  plate  of 
Kiva  (£),  for  inftance,  in  which  the  dilatations  of  all  the  larger  vefiels  were 
jfirft  reprefented  ;  and  in  that  very  hiftory  of  Vieu flens,  which  was  referr’d  to 
juft  now-,  and  in  the  work  of  Kerckringius  {h) ;  and  to  infift  upon  thole  ob- 
iervations  which  have  the  preceding  figns,  and  are  extant  in  the  Sepulchre- 
tum,  Alardus  Mauritius  Egerdes  (i)  defcribes  “  a  preternatural  magnitude” 
of  the  pulmonary  artery,  “  as  if  it  were  affedted  with  an  aneurifm,  and  bav- 
tc  ing  facculi  hanging  to  it,  here  and  there,  that  were  turgid  with  coagulated 
“  blood  and  if  the  obfervation  of  the  fcholiographer  of  Hollerius  ( k ), 
“  of  an  abfcefs”  in  the  fame  artery,  which  Poterius  (/)  alio  fays  he  had  had  an 
opportunity  of  obferving,  “  in  many,”  is  not  to  be  referr’d  to  in  this  place. 
Cfefalpinus  (m)  undoubtedly,  however,  gives  an  account  of  “  the  artery  that 
“  leads  into  the  lungs  being  twice  as  wide  as  it  naturally  is.” 

For  take  care  how  you  believe  with  Bonetus  («),  that  he  had  thus  lpoken 
of  <{  what  is  commonly  call’d  the  arteria  venofa,  and  by  moderns,  the  pul- 
“  monary  vein  he,  I  fay,  who,  in  the  Quefticnes  Peripatetica (0),  taught 
thefe  very  moderns  to  fpeak  as  they  now  fpeak  ;  and  who,  in  that  very  fixth 
book  of  his  Ars  Medica ,  before  he  wrote  this  obfervation,  being  always  con¬ 
fident  with  himlelf,  has  twice  affirm’d  (y>),  that  what  the  ancients  had  call’d 
“  vena  arterialis  was,  in  every  refpedt,  a  real  artery ;”  an  artery,  I  lay, 
“  which  leads  into  the  lungs whereas  there  is  “  a  vein,”  which  they  call’d 
“  arteria  venalis ,  leading  from  the  lungs  ”  into  the  heart.  Now  then  fee, 
that  in  the  reverend  old  man,  of  whom  Caefalpinus  fpeaks,  there  had  been, 
together  with  the  dilatation  cf  the  pulmonary  artery,  not  only  a  palpitation 
of  the  heart,  but  alfo  a  manifed  external  place,  by  reafon  of  two  ribs  being 
broken  away  from  their  cartilages,  in  which  the  bread  was,  alternately,  rais’d 
into  a  tumour.  Nor  was  a  palpitation  of  the  heart  wanting  in  the  obferva¬ 
tion  of  that  fcholiographer,  if  it  really  belongs  to  the  prefent  queflion  :  and 
this  Bonetus  may  feem  to  have  forgotten,  when,  referring  a  part  of  the  fame 
obfervation,  as  I  think,  which  certainly  relates  to  a  fyncope  that  happen’d 
to  Antipater,  to  an  inequality  of  the  pulfe  (<?),  he  has  oppos’d  to  the  obfer¬ 
vation  (r)  the  conjeflure  of  Saxonia,  insfmuch  as  this  author  was  then  fpeak- 
ing  of  a  man  who  was  ltill  alive :  and  whether  I  am  deceiv’d  in  this  opinion, 
you  will  determine  when  you  have  again  look’d  over  thofe  things  which  I 
have  now  hinted  at,  in  Saxonia  himfelf,  and  that  fcholiographer,  not  in  chap¬ 
ter  the  third,  but  in  chapter  the  thirtieth. 


(^)  Eph.  N.  C.  Dec.  1 .  A.  1 .  Obf.  1 7.  litt.  R. 
(£)  Spicil.  Anat.  Obf.  16. 

(/)  Sepulchr.  1.  2.  S.  5.  Obf.  4.  in  Addit. 
(/(’)  Ibid.  S.  8.  Obf.  27.  §  1. 

(/)  Infign,  Curat.  Sc  Obf.  Cent,  3.  c.  22. 
in  iin. 


(m)  Sepukhr.  Obf.  27.  modo  cit.  §  2. 
(«)  in  Schol. 

d)  f  5*  4- 

(p)  c.  9.  Sc  c.  19. 

(q)  1  2.  S.  hac  9.  Obf.  6. 

(r)  in  Schpl, 


And 


Letter  XXIV.  Article  37.  767 

And  as  to  what  relates  to  refpiration,  that  this  would  be  lefs  difficult  when 
there  is  an  impediment,  that  is,  a  dilatation  at  the  beginning  of  the  pulmo¬ 
nary  artery,  than  when  there  is  one  at  the  termination  of  the  vein,  is  not 
only  demonftrated  by  reafon  •,  but  alfo  from  what  Bellini  has  taught  (j),  and 
from  what  Albertini  (i)  has  obfcrv’d,  may  be  fairly  concluded  (u).  But  in 
many  of  the  obfervations  of  the  dilatation  of  one,  or  of  the  other  vefTel, 
which  are  pointed  out,  there  were  other  difeafes  in  the  heart  particularly, 
from  which  fome  of  the  fymptoms  that  were  prefent,  might  have  been,  in 
great  meafure,  accounted  for,  as  well  as  the  abfence  of  others  •,  and  in  the 
obfervation  of  Alardus,  none  of  thofe  things  which  are  taken  notice  of  above, 
is  extant.  I  grant  it ;  and  for  this  reafon  I  laid,  that  I  hefitated.  But  ne- 
verthelefs,  the  more  I  weigh  all  the  circumftances,  and  the  more  frequently 
I  read  over  again  the  hiftory  of  Parey,  the  more  I  am  under  a  neceifity  of 
fufpeiling,  that  fome  things  are  left  out,  at  lead,  which  might  lead  us  to 
underlhnd  fome  of  the  fymptoms ;  and  among  the  reft,  that  vehement  pulfa- 
tion  of  all  the  arteries  in  particular. 

37.  But  to  return  to  the  caufe  of  this  pulfation,  and  the  hiftory  thereof, 
which  I  have  defcrib’d ;  if  you  fuppole  this  hiftory  not  to  be  wrongly  ex¬ 
plain’d  by  that  caufe ;  you  firft  perceive,  that  we  ought,  fo  much  the  more 
carefully,  to  counteract  the  beginnings  of  fpurious  aneurifms,  as  Lancifi  calls 
them  (x)  ■,  as  it  is  more  manifeft,  that  even  before  a  true  aneurifm  is  produc’d, 
fwoonings,  and  an  intolerable  weight  of  diforder,  and  even  death  itfelf,  is 
fometimes  brought  on  by  the  caufe  of  the  aneurifm  :  all  which  confequences 
might  be  avoided  by  a  proper  method  of  cure  being  begun  early,  iuch  as 
was  made  ufe  of  in  thofe  of  whom  flight  mention  has  been  made  above  (jy), 
from  Platerus,  and  the  Commercium  Litterarium  ;  and  particularly  that  mild 
method  of  treatment  fimilar  to  thofe  of  Lancifi,  which  our  Bonhomo  Prae- 
votius  (2)  applied  :  and  indeed  how  much  diet  alone  is  capable  of  doing, 
in  thele  cafes,  is  hinted  by  Bailonius,  in  thefe  very  few  words  ( a ) :  “  A  cer- 
“  tain  perfon  had  an  evident  puliation  of  all  the  arteries.  And  what  was 
“  equally  wonderful,  he  was  cur’d  by  a  courfe  of  diet.” 

In  the  next  piace,  you  fee  of  what  kind  the  beginnings  of  thofe  aneurifms 
in  an  artery  are  •,  1  mean,  thofe  which  arife  neither  from  the  original  weak- 
nefs  of  its  coats,  nor  from  erofion,  and  ftill  lefs  from  a  wound  or  contufion. 
That  is,  a  vehement  impetus,  by  which  the  blood,  from  the  too-much-aug¬ 
mented  force  of  the  heart  and  arteries,  is  urg’d  for  a  long  time  into  thefe 
veflfels ;  and  finally,  by  fo  frequent  and  repeated  a  violence  of  its  ftrokes, 
and  by  the  very  confiderable  diftenfions,  begins  to  injure  their  fides,  although 
in  themfelves  lufficiently  firm,  by  fo  drawing  afunder  the  villi  of  their  inter¬ 
nal  coat,  which  are  very  (lender  indeed,  but  very  clofely  compacted  together, 
that  the  firft  injury  difcovers  itfelf  in  the  form  of  the  fulci,  which  1  have 
defcrib’d.  After  this,  other  injuries  follow  in  the  next  coat,  fometimes 
fooner,  fometimes  later,  in  proportion  as  the  impetus  of  the  blood  is  greater, 


(j)  De  Morb.  Pe&or. 

(/)  Comment,  de  Bonon.  Sc.  Acad.  Tom.  i. 
in  Opufc. 

(«)  Vid,  tamen  Epift.  64.  n,  7.  &  8* 


( x )  De  Aneur.  Propof.  5. 

(y)  n*  35* 

(z)  apud  Rhodium  Cent.  2.  Obf.  Med.  40. 
\a)  Paradigm.  15. 


and 


7  68  Book  II.  Of  Difeafes  of  the  Thorax. 

and  the  firmnefs  of  the  artery  lefs ;  or  as  the  impetus  of  the  blood  is  lefs,  and 
the  firmnefs  of  the  artery  greater:  and  a  true  aneurifm  is  at  length  produc’d, 
either  expanded  on  all  fides,  or  hanging  like  a  fac  on  the  fide  of  it,  accord¬ 
ing  as  the  diftra&ion  of  the  villi  is  made  equally  all  round,  or  on  one  fide 
only.  Thus  reading  over  again,  in  the  eighteenth  letter  (£),  the  appearances 
which  I  have  defcrib’d  in  the  great  artery  of  a  certain  woman,  you  will  find, 
that  fulci  of  this  kind  are  drawn  in  a  longitudinal  direction,  in  that  part  of 
the  artery  which  had  not  yet  been  dilated  :  and  that  above,  in  a  certain  place, 
juft  as  if  it  had  been  more  diftra&ed,  the  fibres  of  the  artery  itfelf  had  ap¬ 
pear’d  ;  in  which  place  we  may,  without  doubt,  reafonably  fuppofe  it  would 
have  happen’d,  if  the  woman  had  liv’d  longer,  that  the  artery  muft  have  grown 
out  into  the  form  of  a  fac  :  and  finally,  that  almoft  from  this  place,  quite 
to  the  heart  itfelf,  the  coats  of  the  artery  were  already  expanded  on  every 
fide.  Nor  need  it  be  a  caufe  of  any  hefitation  to  you,  that  the  pulfe  in  this 
woman  could  not  be  perceiv’d.  For  it  was  not  certain  whether  it  was  always 
fo  or  not ;  and  if  that  did  happen  in  the  limbs  by  the  force  of  the  convul- 
fions,  fo  much  the  greater  might  the  impetus  of  the  blood  upon  the  coats  of 
the  aorta  itfelf  have  been,  for  this  very  reafon,  becaufe  it  was  compounded 
of  “  the  encreas’d  diretft  and  reflected  impetus,”  as  is  demonftrated  by  Lan- 
cifi  (c). 

And  fuppofe  me  to  fay  the  fame  things  of  that  other  woman,  in  whom 
there  were  lines  in  the  aorta,  not  unlike  thofe  fulci,  and,  at  the  fame  time, 
a  fomewhat  obfcure  pulfe  in  the  wrifts,  as  you  will  find  in  the  twenty-third 
letter  (d) :  and  that  I  fay  them  fo  much  the  more,  becaufe  in  her  there  was  a 
great  palpitation  of  the  heart,  and  the  pulfation  of  the  vefiels  in  the  neck 
was  obvious  even  to  the  eye.  And*  although  it  is  uncertain  what  kind  of 
pulfe  there  was  in  others,  whofe  great  artery  I  found  furrow’d  internally  ;  yet 
nothing  forbids  us  to  believe,  that  it  had  been  more  vehement,  and  inter¬ 
nally  in  particular,  than  the  nature  of  thofe  bodies  requir’d  :  and  in  fome  of 
them,  indeed,  it  is  probable,  as  in  the  prieft  of  whom  we  fpoke  in  the  fourth 
letter  (*-),  and  in  the  Venetian  woman,  of  whom  I  fhall  fpeak  in  the  twenty- 
fixth  (/),  whofe  aorta  fhow’d  more  remarkable  fulci  than  any  other,  join’d 
with  dilatation,  and  in  a  certain  place  alfo  with  erofion.  For  in  the  progrefs  of 
the  dileafe,  through  its  feveral  ftages,  another  caufe  is  frequently  added  to 
the  impetus  of  the  blood,  which  caufe  has  the  power  of  eroding,  and  from 
whence  the  beginning  of  a  true  aneurilm  may  be  accelerated,  as  Lancifi 
rightly  obferves  (g),  and  Fernelius  has,  in  general,  hinted  ( h ).  And  with 
what  kind  of  injury  the  caufe  of  a  fpurious  aneurifm,  before  it  become  a  true 
one,  that  is,  before  the  artery  is  dilated  from  the  impetus  of  the  blood  (the 
fign  of  which  is  taken  from  the  pulfation  being  made  wider  from  a  more  nar¬ 
row  ftate),  begins  to  vitiate  the  artery,  I  think  is  now  plac’d  before  our  eyes  *, 
and  it  is  at  the  fame  time  demonftrated,  that  even  at  this  ftate  of  the  difeafe, 
a  man  may  be  fometimes  very  grievoufiy  tortur’d  from  the  fame  caufe,  and 
depriv’d  of  his  life.  And  thofe  things,  if  you  think'  proper,  you  may  add 
to  what  Lancifi  has  taught :  in  the  mean  while  farewel. 

{b)  n.  54.  ft)  Oper.  modo  cit.  Prop.  36.  (g)  Oper.  cit.  Propof.  39. 

(^)  n.  6.  ft)  n.  21.  (f)  n.  21.  \b)  Patholog.  1,  5.  c.  12. 

8 


LETTER 


Letter  XXV.  Articles  i ,  2. 


LETTER  the  TWENTY-FIFTH 


Treats  of  Lypothymia,  and  Syncope. 


i.rpHE  afphuxia,  as  is  ffiown  in  the  preceding  letter (0),  may  be  with- 
JL  out  a  fyncope:  but  not  a  fyncope  without  an  afphuxia.  The  former 
is  very  difficult  to  be  underftood  :  the  latter  very  eafy.  For  it  is  not  at  all 
furprizing,  that  they  who  lie  like  dead  perfons  ffiould  hive  the  pulfe,  as  well 
as  all  the  other  figns  of  life,  wanting.  On  the  other  hand,  you  cannot  fuf- 
ficiently  wonder,  that  in  thofe  perfons,  in  whom  you  find  no  motion  of  the 
arteries,  the  greater  part  of  thofe  faculties  and  powers  which  we  fee  in  living 
and  even  in  healthy  perfons  ffiould  ftill  continue  and  be  vigorous.  It  is  more 
eafy  therefore  to  treat  of  the  fyncope,  than  of  the  afphuxia:  nor  is  it  very 
difficult  to  treat  of  the  lypothymia,  inafmuch  as  it  differs  from  the  fyncope 
only  in  degree.  The  caufes  of  both  thefe  complaints,  which  have  offer’d 
themfelves  to  Valfalva  and  to  me  in  difife&ions,  you  will  learn  from  this  letter. 
To  Valfalva  they  have  appear’d  as  follows. 

2.  A  young  man  of  eight  and  twenty  years  of  age,  tall  in  flature,  fat, 
naturally  of  a  red  face,  and  fubjeft  to  a  frequent  pain  in  the  ftomach  •,  who 
feem’d,  when  he  held  his  head  downwards  and  inclin’d  his  body,  to  feel 
fomething  going  from  his  ftomach  to  his  fauces  •,  and  who,  fometimes,  by 
reafon  of  weaknefs,  mov’d  himfelf  laborioufly,  and  breath’d  with  anxiety ; 
and  had  twice  fainted  away,  to  fuch  a  degree  as  to  feem  dead  ;  and  frequent¬ 
ly  complain’d  alfo  of  a  pain  in  his  head  and  vertigoes;  and  having,  fome 
months  before,  loft  his  ufual  fatnefs,  but  ftill  preferv’d  the  red  colour  of  his 
face ;  at  length,  on  a  certain  day,  return’d  home  in  the  evening,  fatigu’d  and 
troubl’d  with  the  ufual  pain  in  his  ftomach:  he  anointed  the  region  of  his 
ftomach  with  petroleum,  fupp’d  and  pafs’d  the  night  in  placid  reft  ;  fo  that 
when  he  wak’d  in  the  morning,  and  was  afk’d  by  his  wife  how  he  did,  he 
anlwer’d  he  was  very  well.  He  rofe  to  go  to  ftool.  While  he  went  to  bed 
again,  he  was  leen  by  his  wife  to  be  fcarcely  able  to  lift  up  his  feet,  to  flag¬ 
ger,  and  almoft  to  faint.  At  length  to  bed  he  came,  and  immediately  threw 
himfelf  into  it,  juft  crying  out  once  only,  Oh  I  am  exceedingly  ill !  He  was 
very  red  in  his  face,  he  afterwards  grew  pale,  ffiow’d  fome  flight  inclination 
to  vomit,  his  tceces  and  urine  both  came  from  him,  and  he  died  in  a  Ihort 
time. 

The  face  of  the  dead  body,  and  the  neck  at  the  fides  of  the  larynx, 
were  tumid  and  livid.  The  belly  being  open’d  the  chyliferous  vefiels  were 


feen 


Vol.  I. 


(a)  n.  9. 

5F 


y  jo  Book  II.  Of  Difeafes  of  the  Thorax. 

feen  through  the  mefentery  ;  as  from  fupper  to  the  time  of  his  death  about  fix 
hours  had  been  interpos’d.  The  fpleen  was  twice  as  large  as  it  naturally  is. 
And  the  ftomach,  on  the  fide  of  it  which  is  turn’d  towards  the  fpleen,  was 
fo  thin  that  it  did  not  even  equal  half  of  that  thicknefs  which  it  had  in  other 
parts  and  in  the  fame  place,  at  the  upper  part,  was  internally  diftinguifti’d 
with  many  bloody  points.  In  the  cavity  of  the  ftomach  was  a  yellowilh 
matter.  The  thorax  being  open’d,  nothing  was  found  to  be  worthy  of  re¬ 
mark,  except  in  the  heart,  the  right  auricle  of  which  was  dilated  to  fuch  a 
degree,  as  to  equal  a  third  part  of  the  heart  itfelf :  the  right  ventricle 
contain’d  a  large  quantity  of  fluid  blood,  and  with  it  a  fmall-fiz’d  polypus, 
differing  much  in  its  nature  from  thofe  concretions  which  frequently  occur  in 
bodies  that  a  fever  or  other  diforders  of  the  like  kind  have  carried  off.  For 
it  was  of  a  much  thicker  fubftance,  and  differently  compared  from  what 
it  is  in  thole  perlbns,  and  of  a  colour  like  flefti.  The  top  of  the  cranium 
being  taken  off,  while  the  dura  mater  was  cut  into,  ferum  iflli’d  forth,  to 
the  quantity  of  two  ounces:  a  little  quantity  of  which  was  alfo  found  in  the 
ventricles  of  the  cerebrum  ;  but  they  were  in  other  refpedls  found. 

3.  Although  this  hiftory  relates  to  the  difeafes  of  the  ftomach,  head,  and 
heart,  I  chofe  rather  to  put  it  among  the  laft,  for  this  reafon,  becaufe  the 
two  foregoing  fwoonings,  which  were  fo  confiderable  as  to  make  thofe  who 
were  about  the  young  man  fuppofe  him  to  be  dead,  feem  fufficiently  to  Ihow  of 
what  kind  the  laft  diforder  was  whereof  he  really  died.  For  whatever  was  the 
manner  in  which  the  beginning  of  this  laft  attack  came  on,  and  however  the 
head  and  the  nerves  might  confpire  thereto,  there  is  nothing  which  greatly 
forbids  us  to  fuppofe  that  it  ended  in  a  fyncope :  and  this  is  confirm’d  by  the 
fucceeding  palenefs  of  the  face,  nor  rendered  lefs  probable  by  the  exit  of  the 
fceces  and  urine,  inafmuch  as  the  relaxation  of  the  fphindters  is  alfo,  fome- 
times,  common  to  the  fyncope.  Without  doubt  a  great  diforder  was  found 
in  the  heart.  Nor  do  I  fay  this  on  account  of  that  little  polypus,  as,  whatever 
the  fubftance,  ftru<5ture,  and  colour  of  it  might  appear  to  be,  we  ought  not,  for 
thefe  reafons,  to  be  unmindful  of  what  I  have  expatiated  upon  in  the  former  let¬ 
ter  (£).  But  I  fay  it  on  account  of  that  very  great  dilatation  of  the  right  ca¬ 
vities  of  the  heart.  For  unlefs  that  ventricle  had  been  much  dilated,  it  could 
not  have  contain’d  a  large  quantity  of  blood:  nor,  as  this  cavity  was  turgid 
with  fo  great  a  quantity  of  blood,  could  the  dilatation  of  the  neighbouring 
auricle  be  otherwife  than  very  confiderable,  which  was  equ^l  to  the  third  part 
of  fo  large  a  heart.  And  that,  when  the  cavities  of  the  heart  are  enlarg’d, 
it  is  not  unufual  for  faintings  to  happen ;  you  may  not  only  learn  from  the 
obfervations  of  Albertini  (c),  who  accounts  for  them  from  dilatations,  “  in 
Xi  particular,  of  the  trunk  of  the  vena  cava,  or  of  the  right  auricle  of  the 
“  heart,  fo  that  they  fometimes  terminate  in  a  fyncope  of  the  heart;”  and 
from  the  eleventh  obfervation  which  is  in  the  tenth  lection  of  the  Sepulchretum, 
and  relates  to  the  prefent  fubjedt  *  and  from  others,  perhaps  of  the  fame  kind; 
and  finally,  from  that  which  I  have,  alfo,  had  occafion  to  fpeak  of  elfewhere, 
of  Graffius  the  younger  ( d ),  in  regard  to  a  woman  who  was  fubjeft  to  the 

(b)  n.  30.  &  aliis.  ( d)  Eph.  N.  C.  Cent.  5.  Obf.  24. 

(c)  Comment,  de  Eonon.  Sc.  Acad.  Tom.  I. 

.  in  Opufcul. 


4 


frequent 


Letter  XXV.  Article  4.  771 

frequent  return  of  lypothymiae,  and  who  dying,  at  length,  fo  fuddenly,  as 
fcarcely  to  be  obferv’d  by  any  one,  and  being  taken  for  an  apoplectic  perfon, 
fhow’d  no  mark  of  difeafe,  to  thofe  who  examin’d  the  body,  in  any  part,  ex¬ 
cept  in  the  right  auricle  of  the  heart,  which  was  twice  as  big  as  itufually  is  ; 
I  lay,  you  may  not  only  learn  from  thofe  obfervations,  but  alfo  from  fome  of 
mine  •,  as  from  that  which  is  given  you  in  the  preceding  letter,  of  the  hemp- 
dreffer  (<?),  and  from  that  in  the  eighteenth  letter  of  the  (hoemaker  (/)  •,  in  re¬ 
gard  to  both  which  perfons,  if  you  fhould  fay,  as  they  were  fubjedt  to  thefe 
raintings,  that  their  life  was  taken  away  by  a  fyncope,  I  fhould  readily  con- 
fent  to  your  opinion.  But  you  will,  moreover,  read  in  the  lame  eighteenth 
letter,  two  other  obfervations  (£),  which  you  may  compare  with  this  of  Val- 
falva  ;  and  you  will  alfo  find  it  explain’d  (/6),  how  the  heart,  when  dilated, 
may  at  length  eafily  fink  under  the  oppreflive  load  of  the  blood,  and  bring  on 
a  fpeedy  death,  efpecially  if  any  caufe  be  added  from  whence  the  expulfive 
forces  thereof  are  diminifh’d.  1  he  caufe  of  which  circumftance  you  may  eafily 
account  for,  in  this  young  man  of  whom  we  fpeak,  from  the  nerves  either  be¬ 
ing  convuls’d  by  the  acute  pain  which  fuddenly  feiz’d  the  injur’d  ftomach,  or 
from  that  water  which  had  been  almoft  inftantaneoufly  extravafated  under 
the  dura  mater,  or  at  lead  almolt  inftantaneoufly  encreas’d,  and  which  com- 
prefs’d  ali  the  parts  within  the  cranium  ;  the  nerves  being  either  fo  prefs’d 
upon,  or,  in  part,  depriv’d  of  the  influx  of  fpirits,  that  they  could  no  longer 
be  equal  to  the  talk  of  preferving  the  motion  of  a  heart  fo  difeas’d.  Wherefore, 
the  blood  being  accumulated  in  the  right  cavities  of  it,  and  confequently  in 
the  cavities  of  the  vena  cava,  and  the  neareft  branches  of  this,  the  jugulars, 
ftagnated,  and  brought  on  that  tumefa&ion  and  lividnefs  in  the  neck,  at  the 
fides  of  the  larynx  and  in  the  face. 

4.  A  prieft,  of  fixty  years  of  age,  having  been  troubl’d  about  half  that 
time  with  a  weaknefs  of  the  head  and  ftomach,  alfo  with  a  third  and  fudden 
faintings,  efpecially  when  he  flood  up,  together  with  a  ftreightnefs  of  his 
cheft  and  an  intermiflion  of  the  pulfe,  at  length  fell  into  a  double  tertian  and 
continual  fever  ;  which  becoming  more  acute  every  day,  degenerated  into  an 
ardent,  and  even  into  a  mortal  fever. 

The  abdomen  being  open’d,  the  omentum  was  found  to  be  very  large, 
and  was  twin’d  up  in  the  manner  of  a  rope.  The  right  kidney  was  wanting, 
nor  were  there  any  traces  of  its  emulgent  vefiels;  the  left  was  of  the  natural 
fize,  and  contaih’d  in  it  a  veflfel  full  of  water,  of  that  kind  which  they  call 
hydatids.  Upon  examining  the  cheft  and  its  contents,  the  right  ventricle  of 
the  heart  was  found  to  contain  a  pretty  large  polypous  concretion,  which  pro¬ 
duc’d  itfelf  to  a  confiderable  trad!  through  the  vena  cava :  and  the  left  had 
one  of  a  fmaller  fize  that  went  to  the  pulmonary  vein. 

At  length,  the  upper  part  of  the  cranium  being  taken  off,  which  was  fup- 
pos’d  to  contain  the  feat  of  the  old  dil'eafe,  a  confiderable  quantity  of  water 
was  feen  within  the  ventricles  of  the  brain,  and  very  tumid  glandules  in  the 
plexus  choroides. 

(g)  n.  8.  &  14; 
ftO  n.  3. 


If 


ft)  n.  M. 
(f)  n.  2. 


-5  F  2 


772  Book  II.  Of  Difeafes  of  the  Thorax. 

If  this  pried  was  not  the  fame  with  that  monk  of  whom  Valfalva  had 
fpoken  to  me  (*),  it  follows,  that  he  muft  have  twice  feen  a  deficiency  of  the 
kidney  on  one  fide.  And  if  it  was  the  lame,  as  I  fuppofe,  either  it  fhould 
not  have  been  laid  in  his  treatife  De  Aure  Humana  (/£),  that  the  left  kidney 
was  deficient,  but  the  right ;  or  it  fhould  not  be  faid  here  that  it  was  the 
right,  but  the  left.  Be  this  as  it  will,  however,  one  or  other  of  the  kidnies 
was  wanting  •,  and  as  that  with  which  the  man  was  fupplied  had  only  its  na¬ 
tural  magnitude,  and  confequently  did  not  fecrete  lo  much  urine  as  two 
would  have  fecreted  ;  whether,  or  not,  fhould  we  account  for  from  thence 
the  greater  part  of  thofe  difagreeable  fymptoms  with  which  the  patient  was 
fo  long  affli&ed  ?or  did  more  water  begin  to  be  accumulated  in  the  ventricles 
of  the  brain,  from  the  time,  at  leaft,  that  fome  injury  had  been  further 
added  to  the  fecretion  of  urine  by  the  internal  hydatid,  which,  if  it  did  no¬ 
thing  elle,  certainly  took  fomething  from  the  bulk  of  the  kidney,  that  was 
already  lefs  than  in  proportion  to  the  bulk  of  the  body  ?  For  that  there 
had  been  fome  quantity  of  water  there  before,  feems  to  be  argu’d  from  the 
weakr.efs  of  his  head,  and  the  fymptoms  of  diforder  which  relate  to  his 
thorax  ;  as  in  the  head  nothing  was  found  befides  ;  and  in  the  thorax  nothing 
at  all  was  found  by  diffeCtion,  which  you  could  with  jullice  accufe.  But 
whence  did  it  happen,  that  he  was  feiz’d  with  thofe  faintings  when  he  flood, 
rather  than  at  other  times  P  Was  it  becaule  no  fituation  of  body  tires  a  man 
more  than  Handing  ?  Or  was  it  from  the  weight  of  the  very  large  omentum 
drawing  down  the  ftomach  more  at  that  time,  which  was  already  weak  ?  But 
from  what  caule  was  the  omentum  fo  twilled  up  ?  If  it  appear’d  from  the 
hillory  what  had  happen’d  either  internally  or  externally  to  the  man,  befides 
thofe  things  that  have  been  obferv’d,  from  which  the  omentum  might  have 
been  long  forc’d  together  into  one  place  and  comprefs’d  •,  1  fhould  have  en¬ 
deavour’d  io  explain  it  almofl  in  the  fame  manner  in  which  Ruyfch  (/)  ex¬ 
plain’d  the  coarftation  of  the  fame,  and  its  change  into  the  form  of  a 
fauiage. 

But  to  return  to  that  which  is  principally  in  view  here,  that  is,  to  fwoonings^ 
do  not  be  furpriz’d,  if  in  this  man  alfo  1  cannot  explain  the  caufe  of  them 
without  bringing  in  fome  mention  of  the  nerves,  fince  nothing  was  found, 
except  in  the  brain  and  at  the  ftomach,  where  we  may  conjecture  this  caufe 
to  have  been  ;  and  the  nerves,  when  comprefs’d  at  their  origin,  or  irritated 
in  any  other  place,  are  very  frequently,  and  very  evidently,  the  caufe  of 
fvvoonings.  This  appears  from  the  great  number  of  faintings  with  which 
perfons  are  feiz’d,  when  fuddenly  dilturb’d  by  certain  paflions  of  the  mind, 
or  affeCled  by  very  ill  fmells,  or  feiz’d  with  the  moft  cruel  pains  of  the  ner¬ 
vous  parts,  and  particularly  of  the  ftomach.  Nor  will  you  imagine  that  thofe 
things  which  are  now  controverted  in  regard  to  the  motion  of  the  heart,  as 
if  it  did  not  depend  upon  the  nerves,  is  an  objection  thereto.  For  it  is  one 
thing,  that  the  heart  may  be  mov’d,  for  a  time,  without  the  nerves  ;  and 
another  thing,  that  they  being  hurt,  and  particularly  being  irritated,  the 
motion  of  the  heart  cannot  be  vitiated,  greatly  diminifh’d,  and  even  inter- 

(0  Adverf.  Anat.  III.  Animad.  32.  (^)  C,  2.  n.  14.  (/)  Obf.  Anat.  Chir.  63, 

•r  rupte  d. 


Letter  XXV.  Article  6.  773 

rupted.  The  flrft  of  thefe  was,  certainly,  known  to  the  moft  learned  Se¬ 
nae  (*»),  and  tinderftood  by  him  clearly,  if  it  was  by  any  one.  But  did 
he  tor  that  reafon  deny  the  iecond  ?  It  you  read  over  his  excellent  chapter 
on  the  iyncope  (»),  you  will  then  fee,  that  he  accounts  for  tthis  diforder 
fometimes  from  the  nerves  being  irritated  in  one  place  or  other,  but  efpe- 
cially  when  they  are  comprefs’d  in  the  brain,  or  ftimulated  there  in  the  fto- 
mach.  But  not  to  recede  from  what  is  found  in  the  diffection  of  morbid 
bodies,  read  the  following  obfervation  of  Vallalva,  and  then  fpare  to  accule 
the  nerves  if  you  can. 

6.  A  nobleman,  who  was  defeended  from  a  father  that  had  been  fubjeft  to 
pains  of  the  joints  and  catarrhs ;  having  been  himfelf,  from  his  childhood  almoft, 
troubl’d  with  pimples  and  fcabies  •,  and  in  his  youth  with  virulent  gonorrheas  and 
ulcers  of  the  penis  ^  and  finally,  when  he  was  yet  young,  having  been  troubl’d 
with  pains  of  the  fame  kind  with  thole  of  his  father-,  and  being  defirous  of 
getting  rid  of  all  thele  diforders,  he  did  not,  however,  meet  with  the  fuccefs 
he  had  hop’d.  For  in  regard  to  thofe  venereal  injuries,  they  indeed  eafily 
yielded  to  remedies,  and  went  elf  without  leaving  any  traces  of  a  luts 
hind  them.  But  the  pains  of  the  joints,  although  frequently  attack’d  by  phy- 
ficians  in  different  ways,  and  efpecially  by  thofe  who,  fufpedting  that  there 
was  fomething  venereal  in  the  cafe,  had  fometimes  given  him  mercury,  at 
other  times  decodions  of  the  woods,  and  fuch  remedies  as  excite  fweats, 
could  not,  neverthelefs,  be  driven  away  to  fuch  a  degree,  but  that  they  now 
and  then  brought  more  or  lels  inconvenience  with  them,  and  left  the  joints 
very  weak.  And  in  order  to  ftrengthen  thefe  parts,  having  us’d  to  great 
excefs  the  baths  that  are  near  Verona,  and  the  mud  of  thole  baths,  without 
any  advice  but  his  own  raffi  determination,  he  was  not  at  all  the  better,  but 
even  foon  after  began  to  be  troubl’d  with  pains  of  the  head,  not  without  a 
fenfe  of  plenitude,  with  inflammations  of  the  eyes,  and  hemorrhages  at  the 
nofe.  Thefe  inflammations  were  the  moft  injurious  to  the  left  eye  ;  becaufe 
this  having  been  long  affeded  with  a  fimilar  diforder  many  years  before,  had 
contraded  an  albugo,  from  an  erofion  of  the  cornea  tunica,  which  had  been 
much  increas’d  by  this  fecond  inflammation,  that  was  equally  long  with  the 
firft,  fo  as  to  be  in  fome  mealure  prominent  j  and  being  diredly  oppofite  to 
the  pupil,  caus’d  all  objeds  to  feem  double.  And  the  hemorrhages  continu’d 
very  long,  a  great  number  of  remedies  being  tried  in  vain  by  leveral  phy- 
ficians,  ’till  Vallalva  pointed  out  an  eafy  and  Ample  kind  of  remedy,  which 
I  have  fufficiently  explain'd  on  a  former  occaflon  ( 0 ),  when  I  was  writing  to 
you  of  this  fame  nobleman. 

But  having,  afterwards,  weaken’d  his  head  more  and  more  with  continual 
cares  and  very  dole  thinking,  a  frequent  flux  of  blood  return’d,  but,  as  I 
fuppofe,  from  the  upper  vcflels  of  the  noftrils  -,  and  in  the  mean  while,  a 
confiderable  inflammation  of  the  eyes  return’d  alfo  -,  and  at  the  fame  time, 
a  frequent  and  fudden  rednefs  of  the  face,  a  fenfe  of  heat  in  the  head,  and 
of  a  kind  of  weaknels  at  the  lower  part  of  the  occiput ;  and  all  thefe  fymp- 
toms  were  more  troublefome  when  the  difeharges  by  ftool  or  urine  were  di- 

(/«)  Traite  du  Coeur,  1,2.  ch.  7.  («)  L.4,  ch.  12,  n.  2,  5,  7,  9. 

8 


(c)  Epift.  14.  n.  24. 

minilh’d. 


774  Book  II.  Of  Difeafes  of  the  Thorax. 

minifh’d.  At  length,  about  feven  months  before  his  death,  as  often  as  ever 
he  went  up  ftairs,  or  walk’d  pretty  fall  through  a  fmooth  and  level  place, 
or  mov’d  his  arms,  in  particular,  in  the  manner  we  move  them  when  we  put 
on  our  clothes,  he  began,  fir  ft,  to  obferve  that  a  kind  of  troublefome  fenfe 
of  cold  was  excited  at  the  lower  part  cf  his  fternum.  Which  fenfation  was 
io  chang’d  gradually,  and  in  procefs  of  time,  that  after  a  month  or  two  that 
coldnefs  degenerated  into  the  moft  acute  pain,  which  feem’d  to  the  patient 
immediately  to  afcend  to  his  head  •,  and  then  his  fight,  pulfe,  and  fenfes,  were 
immediately  taken  away  •,  fo  that  he  fell  into  a  lwoon.  And  although,  at  firft, 
thefe  fymptoms  only  fucceeded  thole  motions  of  the  body  which  I  have  men- 
tion’d  ;  yet  afterwards  he  feem’d  to  fall  into  the  fame  kind  of  fainting  pa- 
roxyfm  even  without  any  motion. 

But,  what  is  wonderful,  he  fuffer’d  nothing  of  this  kind  upon  fotne  of 
the  more  violent  motions  •,  as  oi  lneezing  and  coughing,  for  inltance  :  nay, 
they  even  gave  him  not  the  leaft  inconvenience  at  all.  He  never  perceiv’d 
any  difficulty  of  breathing  ;  but  often  a  weaknels  of  the  head ;  fo  that  he 
fometimes  feem’d  to  himfelf  to  be  ready  to  fall,  if  lie  did  not  lay  hold  of 
fomething  to  fupport  him.  And  often,  both  by  night  and  by  day,  convul- 
five  motions  fometimes  feiz’d  the  whole  body  •,  and  at  other  times  a  part  of 
the  body  only,  particularly  the  eyelids  and  the  left  arm  :  at  one  time,  a  con- 
vulfion  feiz’d  one  of  the  fingers  of  the  right  hand  with  pain  •,  at  another 
time,  a  ftupor  feiz’d  the  fame  hand,  and  the  whole  of  the  leg  on  the  fame 
fide  of  the  body  :  fometimes  the  faculty  of  feeling  was  entirely  deficient  in 
both  arms,  and  fometimes  both  of  them  were  aftedted  with  pain  :  there  was 
frequently,  alfo,  a  pain  in  the  finciput,  or  a  fenfe  of  conftridtion  at  the  oc¬ 
ciput.  And  all  thefe  fymptoms,  promifeuoufly,  troubl’d  the  patient  even 
to  the  very  day  of  his  death.  However,  even  to  that  very  day,  an  appetite 
for  food,  good  deep,  a  natural  colour  of  the  body,  and  the  chearfulnefs  of 
his  intrepid  mind,  continu’d. 

This  being  the  ftate  of  the  difeafe,  it  is  difficult  to  fay  how  many,  and 
how  different  opinions  phyficians,  of  no  inconfiderable  note,  gave  of  the 
difeafe;  and  not  only  thofe  who  were  confulted  by  letters,  but  thofe  who 
were  prefent  likewife  ;  fome  faying  that  it  was  nothing  elle  but  an  hypochon¬ 
driac  diforder,  others  I  know  not  what  drynefs  of  the  humours  ;  fome,  again, 
a  drying  up  of  fome  of  the  branches  of  the  nerves,  join’d  with  too  great  a 
mobility  of  the  humours  ;  others,  a  fpafmodic  rheumatilm,  or  a  convulfion, 
from  faline  particles  falling  upon  the  mufcles  of  the  thorax  and  limbs,  and 
there  ftimulating  the  nerves  ;  while  lome,  in  fhort,  affirm’d  it  to  be  an  irri¬ 
tation  from  the  virulent  particles  of  the  lues  venerea,  which  ftagnated  in  the 
mediaftinum. 

Valfalva  was  the  only  one  amongft  them  all,  who  accounted  for  the  greater 
part  of  the  fymptoms  with  which  the  patient  was  troubl’d,  from  a  caufe  that 
was  fhut  up  within  the  cranium  ;  and  that,  not  only  from  confidering  the 
almoft  continual  pains  of  the  head  and  convulfions,  which  belong’d  to  fo 
many  and  fo  different  parts,  but  alfo  from  what  he  had  fometimes  feen  in 
bodies  after  diforders  that  were  partly  fimilar  to  thefe.  Wherefore,  as  others 
propos’d  fuch  kinds  of  remedies  as  were  fuitable  to  their  feveral  opinions  of 
the  dileafe  ;  fo  he  difapprov’d  of  thofe  things  which  either  encreas’d  the  quan¬ 
tity 


Letter  XXV.  Article  7 .  775 

tify  or  turgefcency  of  the  blood,  or  caus’d  a  confiderable  quantity  of  it  to 
flow  to  the  head,  in  proportion  as  he  recommended  fuch  remedies  as  would 
have  the  oppofite  effe&s  to  thefe  ;  efpecially  as  he  faw,  that  if  a  turgefcency 
was  brought  on  in  any  other  part  of  the  body,  the  head  was  then  reliev’d  ; 
and  that  by  drawing  blood  from  the  veffels  which  are  about  the  lower  in- 
teftine,  the  patient  had  been  a  iittle  better  for  fome  days.  But  although  he, 
in  general,  knew  the  feat  of  the  caufe  which  brought  on  the  difeafe,  and 
what  things  conipir’d  to  lengthen  out  his  life  a  little  longer,  and  leflen  his 
inconveniences-,  yet  the  particular  feat  of  the  caufe,  and  the  nature  of  it, 
which  was  infuperable  by  remedies,  it  was  not  pofiible  for  him  to  con¬ 
jecture. 

For  when  the  body  was  diflfedted,  all  the  other  parts,  not  only  in  the  thorax 
and  bellv,  but  in  the  head  alfo,  being  found,  in  the  falciform  procefs  of  the 
dura  mater  were  found  five  bones  of  different  forms  and  magnitudes  -,  but  al- 
moft  all  of  them  horrid,  as  it  were,  with  fharp  fpines.  The  largeft  of  thefe, 
being  fifteen  lines  in  length,  leven  broad  in  the  middle,  and  one  and  a  half 
thick,  according  to  the  meafure  of  Bologna,  was  ftrongly  connected  to  the 
beginning,  and  the  neareft  part  of  that  procefs,  whofe  form  it  alfo  refembl’d. 
This  bone  was  intercepted  for  fome  trad  by  two  bones,  which  were  join’d  to 
each  other  clofely  in  the  remainder  of  their  extent.  Thus  join’d,  they  were 
equal  in  breadth  to  ten  lines ;  but  the  broadeft  was  five  lines  long,  and  the 
narrowed:  nine,  which  was  two  lines  thick ;  yet  on  its  lower  fide,  or  where  it 
look’d  towards  the  corpus  callofum,  it  was  very  thin.  To  the  extremity  of 
this  laft  the  two  other  bones  were  connected,  and  clofely  intercepted  the  pro¬ 
cefs  i  for  although  the  longer  bone,  which  was  equal,  for  inftance,  to  fourteen 
lines,  was,  like  the  former,  plac’d  on  the  right  fide,  yet  the  Ihorter,  which 
equall’d  nine  lines,  was  on  the  left  fide.  Therefore,  all  thefe  five  bones  oc¬ 
cupied  two-thirds  and  more  of  the  whole  length  of  the  procefs,  beginning 
from  the  anterior  part,  and  going  backwards.  Befides  thefe,  there  was  a 
bone,  which  perhaps  had  been  the  laft  form’d,  of  the  bignefs  of  a  lentil. 

7.  Valfalva  judg’d,  that  from  the  time  the  patient  had  abus’d  the  mud  of 
the  baths,  above  mention’d,  and  ftudied  to  difpel  from  the  joints  the  mat¬ 
ter  which  had  been  accuftom’d  to  caufe  a  gout,  fome  part  of  this  matter  was- 
intercepted  betwixt  the  fibres  of  the  falciform  procefs,  and  begun  to  bring 
on  pains  of  the  head,  to  which  he  had  never  before  been  fubjeCt :  and  that 
the  lame  matter  gradually  concreting  afterwards  into  thele  bones  which  have 
.  been  deferib’d,  had  excited  thofe  convulfions,  after  they  had  begun,  with 
their  ftiarp  points,  to  prick  both  the  meninges,  which  happen’d  particularly 
in  certain  motions  of  the  body  -,  and  from  thefe  convulfions,  not  only  the 
other  fymptoms,  but  thofe  fainting  paroxyfms  alfo,  arofe :  on  account  of 
which,  chiefly,  I  have  related  the  difeafe,  and  difledtion  of  the  patient,  in 
this  letter.  Yet  he  readily  confefs’d,  that  it  could  not  be  fufficiently  explain’d, 
why  nothing  of  the  fame  kind  happen'd  upon  the  motions  of  coughing  or 
fneezing,  by  which  the  meninges  feem  to  receive  very  vehement  concuffions. 

I  do  indeed  remember  to  have  faid,  when  I  took  notice  to  you  on  a  former 
occalion  (/>),  of  molt  of  the  examples  of  bones  being  found  in  the  falciform 

(p),  Epift.  3.  n.  21. 


procefs, 


Book  II.  Of  Difcafes  of  the  Thorax. 

proccfs,  that  great  diforders  were  occafion’d  by  them,  when  they  prick’d  the 
meninges.  But  I  do  not  remember  that  they  were  not  brought  on  by  the 
more  confiderable  motions,  though  they  were  by  the  lefs  confiderable.  Thus, 
for  inftance,  in  that  obfervation  which  is  related  in  the  Hiftory  of  the  Royal 
Academy  of  Sciences  at  Paris,  under  the  year  j  7 1 1 ,  that  young  man  who, 
from  the  fame  caufe,  was  feiz’d  with  epileptic  paroxyfms,  and  thofe  gene¬ 
rally  in  the  night,  fell,  neverthelefs,  into  the  fame  paroxyfms  in  the  day¬ 
time,  if  he  walk’d.  And  if  we  ought  not  only  to  attend  to  the  concufilon, 
but  alfo  the  greater  quantity  or  impetus  of  the  blood  in  the  veflels  of  the 
meninges,  from  whence  the  meninges  themfelves  are  more  urg’d  to  the  little 
bones,  as  is  evident  from  reafoning,  and  is  confirm’d  by  the  obfervations  of 
Scheidius  (q)  and  Hunauld  (r)  ;  the  firft  of  whom  obferv’d  fome  alleviation 
to  a  head-ach,  or  epilepfy,  brought  on  by  a  caufe  of  that  kind,  from  blood¬ 
letting  •,  and  the  other,  that  this  was  the  only  ufeful  remedy ;  who  is  there, 
that  would  fuppofe  the  quantity  or  impetus  of  the  blood  to  be  more  en- 
creas’d  from  a  flight  motion  of  the  arms,  than  from  the  violent  motion  of 
coughing  or  fneezing  ?  But  although  what  Valfalva  could  not  underftand  is 
equally  inexplicable  to  me  at  prefent,  yet,  what  is  fufficient  for  our  purpofe, 
it  is  plain,  as  there  was  nothing  elfe  befides  thofe  bones  in  the  whole  body, 
from  whence  the  violent  diforders  which  had  preceded  could  be  accounted 
for;  it  is  plain,  I  fay,  in  this  cafe  alfo,  what  we  ought  to  accufe.  For  there 
was  nothing  found  here  in  the  heart  or  the  brain,  as  there  was  in  the  bifhop 
whom  Lancifi  (j)  deferibes,  as  being  fubjed  to  fwoonings,  and  attack’d  with 
convulfions,  when  he  mov’d  himfelf;  nothing,  I  lay,  to  which  you  could 
with  more  juft  ice,  aferibe  thefe  diforders,  than  to  the  bones,  which  were  alfo 
found  in  the  dura  mater  of  the  bifhop. 

8.  But  there  are,  you  will  fay,  examples  extant  of  bones  being  found  in 
the  fame  membrane,  from  which,  however,  no  inconveniences  have  been 
obferv’d  to  arife.  And  J  am  fo  far  from  denying  this,  that  I  make  no  feru- 
ple  to  confirm  it  by  my  own  obfervations.  For  befides  that  large  bone, 
which  I  have  deferib’d  to  you  before  (/),  I  found  another,  in  a  man  of 
whom  I  fhall  fpeak  to  you  on  a  future  occafion  (.#),  of  the  fize  of  a  fmall 
grape,  and  of  a  furface  (lightly  granulated,  lying  betwixt  the  dura  and  pia 
mater,  which  had  hollow’d  out  to  itfelf  a  correfponding  cavity,  in  a  diftended 
furrow  of  the  brain,  where  the  upper  part  of  the  left  hemifphere  was  diftant 
about  four  inches  from  its  anterior  extremity,  and  about  an  inch  and  a  half 
from  the  right  hemifphere;  the  parietes  of  the  cavity,  and  the  furrounding 
fubftance,  being  in  their  natural  (late.  And  not  to  digrefs  too  far  from  the 
falciform  procefs,  in  the  year  1726,  and  the  year  1744,  when,  according  to 
cuftom,  I  diffefted  more  than  one  brain  in  the  college,  I  faw  bones  there  in 
a  man,  and  in  like  manner  in  a  woman,  which  had  the  following  fituations 
and  appearances.  In  the  man,  under  the  very  vertex,  on  each  fide  of  the 
longitudinal  finus,  in  the  very  fubftance  of  the  dura  mater,  was  a  feparate  bone, 
of  no  inconfiderable  fize  ;  one  of  which  terminated  in  a  great  number  of 

($0  DiiTert.  de  duob.  oflicul.  in  Apopl,  qu.  6.  (j)  De  Subit.  Mort.  1.  1.  c.  20.  n.  3.  4. 

(r)  Hill,  de  l’Acad.  R.  des  Sc.  A.  1734.  (/)  Epill.  3.  n.  20. 

Obi'.  Anat.  2.  («)  Epift.  52.  n.  32. 

oblong 


Letter  XXV.  Article  9.  777 

oblong  and  lharp  little  teeth,  as  it  were.  And  in  the  woman  were  three  lit¬ 
tle  bones,  plac’d  nearly  under  the  vertex,  the  thickell  of  which  fent  forth 
the  fame  kind  of  little  teeth  from  two  fides  of  it,  but  principally  from  one; 
the  others  were  only  like  two  feales,  a  fmaller  and  a  larger.  The  former 
of  thefe  was  in  the  external  fide  of  the  fame  finus,  which  I  mention’d  a  little 
before  ;  and  the  two  latter  were  bordering  upon  each  other,  nor  very  diftant 
from  the  lower  border  of  the  falx  •,  and  adher’d  in  fuch  a  manner  to  the  right 
furface  of  this  procefs,  that  they  could  be  eafily  pull’d  away.  But  if  you 
enquire  now  to  what  difeafe  or  inconvenience  each  of  thefe  perfons  had  been 
fubjeft,  before  their  laft  diforder,  I  anfwer,  that  I  alfo  had  enquir’d,  and  ef- 
pecially  in  regard  to  this  woman,  who  being,  to  appearance,  of  a  middle 
age,  had  died  after  a  fpitting  of  blood  ;  but,  as  generally  happens  in  beg¬ 
gars,  I  could  find  out  nothing  to  note  down  as  certain.  Is  it  therefore  to 
be  taken  for  granted,  that  no  inconvenience  at  all  had  been  brought  on  by 
thofe  little  bones  ?  No  more,  certainly,  than  where  Cafpar  Hoffman  (x) 
takes  no  notice  what  injuries  had  been  brought  on  by  “  a  cartilaginous  bone, 
“  exa<5tly  round,”  which  he  had  found  cover’d,  on  both  fides,  with  the  dura 
mater,  and  “  of  the  bignefs  of  a  rix-dollar;”  or  rather,  to  omit  the  fmaller, 
and  mention  the  larger,  than  where  Dionis  (j)  fays,  that  he  had  found  the 
fame  dura  mater  become  almoft  bony  in  a  noted  artificer,  and  docs  not  point 
out  to  what  diforders  he  had  been  fubjeCt.  Without  doubt,  he  either  could 
not  get  fufficient  information  what  thefe  had  been  ;  or  if  he  had  information, 
which  I  am  rather  inclin’d  to  believe,  of  this  noted  man,  and  not  a  beggar, 
he  deferr’d  it  to  a  more  convenient  place  and  time :  and  if  he  has  done  this 
at  any  time,  or  in  any  place,  that  hiftory  feems  to  me  to  be  very  ufeful, 
cither  to  confirm,  in  part,  fome  of  the  ufes  of  that  membrane,  about  which 
there  is  great  difpute  in  the  prefent  age,  or  entirely  to  reject  them. 

And  this  is  to  be  obferv’d  befides,  that  although  bones  which  prick  the 
meninges,  are  extremely  hurtful ;  as  that  which  Peter  Borelli  (2)  has  men¬ 
tion’d  as  being  found  “  in  the  dura  mater,  and  being  arm’d  with  many 
“  lharp  points,  from  whence  the  patient  had  long  fuffer’d  pains  of  the  head,” 
and  a  great  number  of  other  bones  of  the  fame  kind  ( a ) ;  yet  unlels  they 
are  of  fuch  a  form,  and  in  fuch  a  fituation,  that  they  can  prick  the  menin¬ 
ges  ;  or  of  fuch  a  weight,  and  a  bulk  fo  encreas’d,  that  by  prefiing  or  draw¬ 
ing  downwards  fome  one  of  the  finufies  in  particular,  and  that  of  the  falci¬ 
form  procefs,  which  I  have  mention’d,  fo  as  to  ftreighten  it ;  they  will  fcarcely 
produce  any  marks  of  their  exiftcnce,  as  I  have  faid  elfewhere  (If).  And  as 
you  fee  how  much  thofe  that  were  found  by  Valfalva  differ’d  from  thefe, 
both  in  lhape  and  fituation,  to  fay  nothing  of  number  and  magnitude  ;  fo  I 
would  not  have  you  object  other  obfervations  to  his,  which  are  not  to  be 
compar’d  with  it. 

9.  And  I  wifh  that  thofe  bones,  at  leaft,  which  are  fo  hurtful,  would  af¬ 
ford  no  lefs  certain  and  peculiar,,  than  confiderable,  marks  of  their  exiftence. 


( x )  Apolog.  pro  Gal.  1.  z.  S.  4.  c.  287. 

(y)  Defcript.  d’  line  oreille  du  Coeur,  extr. 
dilat. 

5  G 


(2)  Hift.  &  obf.  Med.  Phyf.  Cent.  4.  obf.  99. 
(«)  ut  Sepulchr.  1.  1.  S.  1.  Obf.  1 13. 

\b)  Epift.  3.  n.  20.  &  21. 

But 


•» 


VOL.  I. 


7  78  Of  Difeafcs  of  the  Thorax.  Book  II. 

But  thefc  marks  are  common  to  fo  many  other  caufes,  that  Scheidius  (c)  has 
juftly  determin’d  that  there  is  fcarcely  room  for  any  fufpicion  of  thofe  bones, 
even  when  l'ome  long  and  obflinate  diforders  of  the  head  give  place  to  no 
remedies,  and  fcarcely  ever  remit.  And,  indeed,  if  it  were  poffible  clearly 
to  determine  the  caufe,  thele  little  bones  could  not  be  remov’d,  nor  their 
farther  production  be  prevented,  as  is  fliown  by  the  fame  author  (d).  And 
he  has  laid,  in  that  place,  with  great  elegance  and  propriety,  which  formerly 
came  into  my  mind,  when  a  fenior  phyfician,  who  often,  for  the  fake  of  dii- 
fenfion,  involv’d  himfelf  in  difficulties,  propos’d  that  a  bone,  which  had  been 
form’d,  as  he  faid,  at  the  beginning  of  the  aorta,  in  a  noble  patient,  fhould 
be  diffolv’d  by  remedies  j  for  it  was  very  poffible  that  the  fubllance  which 
from  fluid  had  become  hard,  might  be  brought  back,  again  from  its  ftate  of 
hardnefs  to  fluidity :  Scheidius,  I  lay,  has  faid,  “  that  it  is  not  fo  much 
“  from  the  parfimony,  as  from  the  bounty  of  nature,  that  we  are  depriv’d  ” 
of  remedies  of  this  kind ;  for  wherever  we  ffiould  diflolve  the  bones  which 
are  generated  by  the  force  of  difeafe,  there  alio  the  other  bones,  which  aref 
the  conftruCtion  of  nature  itfelf,  would  be,  in  like  manner,  deftroy’d. 

However,  whether  there  are  remedies,  not  by  which  the  bones  that  are 
already  form’d  may  be  diflolv’d,  but  whereby  thofe  that  are  about  to  be 
form’d,  or,  at  lead,  about  to  be  encreas’d  in  the  arteries,  may  be  prevented ; 
you  will  underftand  from  thofe  things,  which  will  be  confider’d  in  another 
letter  (*),  upon  the  production  of  bones  in  the  arteries,  proceeding  from  a 
kind  of  fuppuration,  and  join’d  with  ulcerations  thereof-,  for  thofe  remedies 
that  could  prevent  this  caufe,  could  alfo  prevent  the  effeCt.  But  however 
the  matter  may  take  place  in  fome  offifications  of  the  arteries,  whether  the 
fame  judgment  is  to  be  form’d  of  thofe  which  we  are  fpeaking  of  at  prefent, 
you  will,  in  the  mean  while,  doubt,  in  conjunction  with  me.  For  neither 
have  I  yet  feen,  that  marks  of  fuppuration  or  ulceration  have  been  join’d 
with  bones,  which  I  have  found  in  the  meninges:  nor  have  I  feen  that  they 
were  any  kind  of  bony  feales,  or,  if  you  pleafe,  offiform  feales  only ;  but 
really  genuine  and  true  bones.  For  to  pafs  over  other  marks  of  true  bone, 
if  you  will  read  over  again  the  defeription  of  that  great  bone  (/),  which  I 
found  in  the  falciform  procefs,  you  will  certainly  fee  how  it  terminated  on 
each  fide  in  a  Ample  ftratum  of  parallel  bony  fibres :  and  to  this  even  thofe 
long  and  fharp  little  teeth,  as  it  were,  feem  to  relate,  into  which  fome  of 
the  leffer  bones,  that  I  have  delcrib’d  above  (g),  were  extenuated.  And  this 
mark,  which  conflfts  “  in  an  order,  as  it  were,  of  fibrillas  running  out  in  a 
“  ftrait  direction,  as  we  obferve  in  bones,”  I  fee  is  not  only  propos’d  and 
confirm’d  by  the  already  commended  Scheidius  (£),  but  alfo  by  other  very 
fkilful  men,  in  order  to  diftinguilh  true  bones  from  hard  concretions  of 
any  other  kind.  Thus  Abraham  Vater  (i)  always  diftinguiffi’d  a  true  bone 
from  a  calculus,  “  by  its  whitifh  ftrias,  and  its  ftriated  texture.”  So  by  John 
Saltzman,  even  in  the  judgment  of  the  celebrated  Crellius  (£),  “  a  regular 


{<•)  qu.  6.  cit.  fupra,  ad  n.  7. 

(d)  qu.  7.  (e)  Epill.  27.  n.  30. 

(f)  Epill.  3.  n.  20. 

(g)  8.  (6)  qu.  2. 


(/)  Progr.  ad  Obf.  rarilT.  calcul.  Sc  Ofteogen. 
thef.  27. 

(k)  Obf.  de  art.  Coron.  Cord,  inllar.  olT. 
indur.  n.  9. 

“  difpofition 


Letter  XXV.  Article  io.  779 

<c  difpofition  of  fibres,  according  to  a  certain  diredtion,  is  given  as  the  mark 
“  and  character  of  a  true  bone.”  As  far,  therefore,  as  I  have  been  able  to 
obferve  to  this  time,  I  am  not  at  liberty  to  be  of  the  fame  opinion  with  thofe 
very  learned  men,  who  acknowledge  true  bones  in  the  arteries,  rather  than 
in  the  meninges.  And  in  thefe  membranes  I  have  feen,  as  I  think,  if  not 
a  bone,  at  lead:  the  beginning  of  a  bone,  not  only  within  the  cranium,  but 
alfo  within  the  tube  of  the  vertebrae,  and  there  in  the  tunica  aracnnoides 
itfelf  *,  and  I  do  not  know  whether  this  has  happen’d  to  others  before.  For 
in  that  old  man  in  whom  I  found  fome  part  of  the  pleura,  or  of  the  mem¬ 
brane  of  the  adhering  lungs,  bony,  as  I  have  written  to  you  in  another  let¬ 
ter  (/),  when  I  demonftrated  to  the  ftudents  in  anatomy,  the  integuments  of 
the  medulla  fpinalis,  which  was  laid  bare,  pofteriorly,  in  its  fituation,  having 
drawn  afide  the  dura  mater,  and  blown  in  air  betwixt  the  tunica  arachnoides, 
and  the  pia  mater  •,  I  obferv’d  in  the  former  of  thefe  coats,  which  was  uni- 
verfally  elevated,  a  particle  of  the  fhape  of  a  feed  of  a  gourd,  and  about  the 
fize  of  a  fmall  one,  plac’d  tranfverlly,  and  whitilh,  already  almofb  opaque, 
and  on  its  internal  lurface  roughifh,  and  evidently  unequal.  This  particle 
being  nearer  to  the  left  fide,  anfwer’d  to  the  eleventh  vertebra  of  the  thorax ; 
nor  did  any  thing  of  that  kind  appear  in  the  other  meninges.  But  I  will 
difmifs  this  fubjedt,  and  to  three  obfervations  of  Valfalva  upon  fwoonings,  I 
will  fubjoin  fome  of  my  own. 

10.  A  poor  woman,  feemingly  of  fifty  years  of  age,  or  more  than  that, 
fmall  in  ftature,  and  rather  of  a  lean  habit  of  body,  having  been  feiz’d,  a 
year  before,  with  fo  confiderable  a  fyncope  as  to  be  taken  for  dead,  and  after 
that  time,  with  feveral  others,  was  at  length  found  dead  in  her  bed. 

The  body  was  given  to  be  difiedted  in  our  theatre  at  the  time  that  I  began 
to  give  the  anatomical  ledlures,  in  the  year  1726.  In  the  belly  there  was 
nothing  worthy  of  remark,  if  you  except  the  fpleen  being  too  fmall,  and, 
wherefoever  you  cut  into  it,  almoft  difiolv’d  into  a  fiuor ;  and  one  of  the 
tubes  of  the  uterus,  which  was  fo  condens’d  at  its  extremity  with  the  ovari¬ 
um,  as  to  have  its  orifice,  which  was  there,  entirely  fiiut  up. 

In  the  thorax,  the  left  lobe  of  the  lungs  was,  in  feveral  places,  connedted 
to  the  fide.  In  the  vena  cava,  the  right  auricle,  and,  in  fome  meafure,  in 
the  neighbouring  ventricle,  were  thick  polypous  concretions,  of  a  white  and 
flefh-like  colour,  which  very  much  refilled  diftradlion,  and  had  fome  coagula 
of  black  blood  adhering  to  them.  In  the  left  cavities  of  the  heart  was  a 
fmall  quantity  of  blood.  Both  the  valvulae  mitrales  near  the  edges  were  be¬ 
come  pretty  thick  and  hard,  and  protuberated  in  that  part  into  a  feries,  as 
it  were,  of  largilh  globules,  which,  when  cut  into,  fhow’d  a  fubftan®  fimi- 
lar  to  that  of  a  tendon.  The  neighbouring  femilunar  valves  were  all'o  thicker 
than  ufual,  but  in  a  lefs  degree  :  and  one  of  thefe  had  the  corpufculum  Arantii 
encreas’d,  and  adhering  only  in  a  fmall  part  of  it.  The  great  artery,  immedi¬ 
ately  as  it  went  out  from  the  heart,  was  dilated  :  and  near  the  orifices  of  the 
branches  that  go  to  the  fuperior  parts,  on  its  internal  furface,  it  was  unequal 
and  yellowifh,  and  fo  lax,  that  the  yellowifh  membranous  laminse,  if  you 
attempted  it  with  your  finger,  could  be  pull’d  away  with  eafe.  The  pulmo- 

(l)  XXI.  n.  22. 

5  G  2 


nary 


780  Book  II.  Of  Difeafes  of  the  Thorax. 

nary  artery  alio  Teem’d  to  be  larger  than  its  natural  fize.  But  to  return  to  the 
heart;  the  parietes  thereof*  wherever  you  cut  into  them,  ftiow’d  fedions, 
that  from  a  cineritious  colour,  degenerated  into  a  brown  and  livid  appear¬ 
ance;  and  1  difieded  the  heart  on  the  thirteenth  day  after  death  ;  which  I  tell 
you  for  this  reafon,  that  if  you  rather  choofe  ir,  you  may,  in  fome  meafure, 
attribute  that,  or  any  thing  which  was  remark’d  in  the  aorta,  to  this  delay, 
notwithftanding  it  was  in  the  winter-feafon.  And  fuppofe  me  to  fay  the  fame 
thing  of  fome  of  the  appearances  which  1  law  in  the  difledion  of  the  brain  ; 
and  lb  much  the  more,  as  being  taken  up  with  other  bodies,  I  deferr’d  the 
diffedion  of  this  part  for  the  fpace  of  two  whole  days  befidcs. 

When  the  head  was  cut  off'  from  the  neck,  no  inconfiderable  quantity  of 
water  flow’d  out.  Yet  under  the  pia  mater,  in  the  lateral  ventricles  of  the 
brain,  and  in  the  third  ventricle,  a  great  quantity  of  water  ftagnated,  which 
was  not  at  all  turbid.  The  plexus  choroides  were  palifh,  except  that  in  the 
middle  they  were  black,  from  ftagnating  blood.  And  the  fame  plexufles, 
where  they  are  infleded,  and  about  to  enter  the  upper  part  of  the  ventricles, 
fwell’d  forth  into  large  veficles,  and  efpecially  on  the  left  fide,  that  were  full 
of  water.  The  feptum  lucidum,  although  I  difleded,  according  to  my  ufual 
method,  the  brain  in  its  fituation,  was  either  ruptur’d  before,  or  was  eafily 
ruptur’d  in  the  diffedlion  ;  for  it  was  fo  thin  and  lax  as  fcarcely  to  appear. 
And  the  roots  of  the  fornix,  and  the  fubftance  of  the  fornix  itfelf,  were  very 
fofr,  as  the  cortex  of  the  cerebellum  was  alfo ;  which,  like  the  cortex  cerebri, 
was  of  a  dirty  pale  colour,  inclining  to  yellow.  But  the  medullary  fubftances 
of  both,  and  particularly  of  the  cerebrum,  were  of  their  natural  firmnefs  ; 
but  in  this  laft,  the  fanguiferous  veffels  were  here  and  there  confpicuous : 
which  I  had  alfo  remark’d,  in  the  pia  mater,  to  be  in  fome  places  turgid  with 
blood.  The  carotid  arteries,  at  the  bafis  of  the  cerebrum,  were  pretty  hard, 
and  the  bafilary  artery  in  like  manner-  And,  indeed,  the  latter  of  thefe,  being 
about  the  middle  of  its  length  of  a  white  colour  inclining  to  yellow,  fhew’d 
an  unequal  furface  when  open’d,  fo  as  to  convince  us,  that  the  difeafe  which 
we  had  feen  in  the  aorta  at  the  beginning  of  the  fuperior  branches,  was  pro¬ 
pagated  through  fome  of  them  quite  into  the  cranium.  Finally,  the  pitui¬ 
tary  gland  had  not  only  fubfided  immoderately,  but  contain’d  fcarcely  any 
thing  of  its  own  fubftance. 

1 1.  As,  by  reafon  of  the  dilatation  of  the  aorta  and  the  pulmonary  artery, 
the  heart  wanted  greater  ftrength,  in  order  to  protrude  the  blood  fo  far  as  it 
us’d  to  do  by  the  help  of  them  ;  and  as,  by  reafon  of  the  canals  which  con¬ 
vey’d  the  blood  to  the  brain  being  vitiated,  the  ftrength  of  the  heart,  alfo, 
was  lefs  than  ufual ;  from  hence,  I  fuppofe,  the  heart  was  under  a  necefiity 
of  becoming  quiet  very  often,  till  by  reafon  of  the  great  quantity  of  water 
within  the  cranium  being  increas’d  from  the  difeafe  of  the  pituitary  gland,  it 
was  depriv’d  of  all  its  ftrength,  and  was  reduc’d  to  a  perpetual  quiet,  by  an 
affedion  compounded  of  a  fyncope  and  an  apoplexy.  However,  other 
examples  of  fwoonings  from  dilatations  of  the  great  artery,  I  ihall,  perhaps, 
produce  in  other  letters,  befides  thofe  which  I  have  already  given  you  {m)y 
as  copied  from  Yalfalva.  But  let  us  now  go  on  to  other  things. 


{m)  Epifh  17.  n.  1 7,  Si  21. 


12.  A 


Letter  XXV.  Articles  i  2,  i  3,  781 

12.  A  man,  of  a  middle  age,  had  already  lain  fix  months  in  this  hofpital, 
on  account  of  a  very  bad  ulcer  in  one  of  his  legs,  when  he  was  carried  off 
by  an  unexpe&ed  fyncope,  in  the  beginning  of  May,  in  the  year  1729. 
The  thorax  and  pericardium  being  open’d,  in  the  former  was  a  confideraHe 
quantity  of  water,  with  fome  concretions  refembling  jelly  :  and  in  the  latter 
I  obferv’d  the  left  ventricle  of  the  heart  to  be  thicker  and  harder  than  it  na¬ 
turally  is.  And  as  I  fuppos’d  this  to  have  happen’d  from  pretty  large  and 
firm  polypous  concretions.  I  cut  into  the  heart,  but  found  only  fome  {lender 
and  mucous  concietions  in  both  of  the  ventricles  equally  :  and  I  found  that  this 
thicknefs  and  hardnefs  arofe  from  *10  other  caufe  than  from  the  corneae  co¬ 
lumnas  being  grown  thicker,  and  protuberating  internally  into  the  cavity  of 
the  left  ventricle  ;  which  in  other  refpe&s,  however,  had  their  natural  ap¬ 
pearance  both  internally  and  externally. 

13.  Iam  not  a  little  in  doubt,  whether  I  have  fufficiently  underftood  the 
caufe  of  that  fyncope.  For  in  whatfoever  method  I  attempt  to  explain  the 
cafe,  this  objection  always  occurs,  that  other  fyncopes,  or,  at  lead,  fainting?, 
had  not  preceded.  Without  doubt,  the  increafe  of  thicknefs  in  thofe  co¬ 
lumns  could  not  happen  in  a  point  of  time.  Why  then,  if  from  the  com¬ 
pletion  of  this  thicknefs  a  fyncope  was  brought  on,  had  not  a  lypothymia 
been  the  confequence  of  its  being  almoft  perfected  ?  Or  are  we  to  call  in 
here,  alfo,  the  aid  of  fome  other  caufe  j  as,  for  inftance,  a  convulfion  in  con¬ 
fequence  of  deprav’d  ichor  being  taken  up  from  the  ulcer  of  the  leg,  and 
carried  fuddenly,  at  that  time,  to  the  origins  of  the  nerves,  as  it  had  been 
fome  time  before  to  the  thorax ;  which  thofe  gelatinous  concretions  feem  to 
Ihew  ?  By  this  convulfion,  without  doubt,  juft  as  in  that  man  of  Piftoia, 
fpoken  of  by  Lancili  (»),  the  apex  of  the  heart  being  violently  and  obftinately 
contracted  towards  the  bafis,  a  fudden  fyncope  might  be  brought  on;  and  the 
heart  being  at  the  fame  time  conglobated  into  itfelf,  its  hardnefs  and  thick¬ 
nefs  might  be  increas’d.  And  that  the  heart  may  be  “  convuls’d,”  was  not 
only  formerly  faid  by  Hippocrates,  in  more  places  than  one  ( 0 )  *,  but  as  it  has 
been  confirm’d  by  the  more  modern  authors  that  it  is  a  mufcle,  fo  it  could 
not  be  denied,  that  it  was,  certainly,  fubjeCt  to  the  fame  diforders  to  which 
other  mufcles  are,  and  confequently  to  convulfion  alfo ;  fo  that  the  nerves 
being  irritated  by  the  moft  acrid  ichor,  the  fibres  of  the  heart  may  remain  in 
an  obftinate  convulfion. 

On  the  other  hand,  it  fometimes  happens,  that  a  refolution  and  laxity  of 
the  heart  feem  to  be  the  properties  that  are  to  be  accus’d  in  diforders  of  that 
kind.  Thus,  in  a  hiftory  of  the  celebrated  Gretzius(p),  which  has  been 
taken  notice  of  in  another  place,  in  like  manner  as  in  a  woman  who  died 
“  of  continual  lypothymias,”  no  blood  was  found  in  the  cavities  of  the  heart, 
but  the  heart  “  was  univerfally  diftended  with  flatus  ”  to  fuch  a  degree,  that 
“  you  would  have  call’d  it  a  tympanites  of  the  heart whether  the  air  had 
difeharg’d  itfelf  while  fhe  was  living,  or  whether  it  rather  was  extruded  in  the 
greater  part  of  it  from  the  blood  after  death  you  will  not  eaflly  underftand 
how  it  could  poflibly  diftend  the  parietes  to  that  great  degree,  efpecially  of 

(*)  De  Subit.  Mort.  Obf.  Phyf.  Anat.  4.  (/)  Difp.  de  Hydr.  Pericard.  in  Proocm. 

(0)  De  Morbo  Sacro  n.  18  De  Nat.  Mu!. 
iK  46.  DeMorb.  Mul,  1.  1.  n.  72. 

th?- 


7$Z  Book  II.  Of  Difeafes  of  the  Thorax. 

the  left  ventricle,  unlefs  you  will  fuppofe  that  they  had  been  very  lax,  and, 
finally,  entirely  paralytic.  But  as  to  the  paralyfis  of  the  heart,  I  (hall  have 
an  opportunity  of  writing  of  that  alfo  in  another  place  (q). 

14.  As  I  have  in  part  propos’d  the  remaining  obfervations  of  mine  relative 
to  the  diiorders  of  which  I  treat  here,  in  other  letters  (r)  already  lent  to  you, 
and  in  part  am  to  propofe  them  hereafter  ;  I  fhall  now  fubjoin  two  very  fhort 
hillories,  which,  when  I  liv’d  at  Bologna,  I  had  communicated  to  me  from 
men  of  learning  and  undoubted  credit.  They  came  into  my  mind  as  I  turn’d 
over  this  tenth  fedion  of  the  Sepulchretum,  and  read,  and  compar’d  one 
with  another,  many  obfervations  which  relate  both  to  the  diforders  of  the 
membranes  furrounding  the  heart,  and  particularly  to  thole  of  the  heart  it- 
felf.  Thefe  membranes  are,  as  you  know,  the  mediaftinum,  the  pericardium, 
and  the  proper  membrane  of  the  heart.  In  regard  to  the  inflammation  of  the 
mediaftinum,  if  you  read  what  is  produc’d  under  number  eighteen,  you  will 
fuppofe  that  there  are  three  obfervations,  whereas  there  are  only  two ;  for  that 
which  is  given  under  article  the  fecond,  is  the  fame  that  is  immediately  pro¬ 
pos’d  again  under  the  third  article •,  and  this  you  will  be  evidently  convinc’d 
of,  not  fo  much  by  attending  to  the  words,  which  are,  by  I  know  npt  what 
chance  or  licence,  different  in  the  different  obfervations,  as  by  comparing  the 
firft  of  them  with  that  which  is  pointed  out  to  be  read  under  the  title  De 
Byfpnceo,  that  is,  in  the  firft  fedion  of  this  fecond  book,  obfervation  the  hun¬ 
dred  and  twenty-fifth,  article  the  firft; ;  for  you  will  then  obferve,  that  the 
firft  is  taken  from  the  fame  place,  and  from.  the  fame  author,  from  whence 
that  is  faid  to  be  taken  which  follows  it.  Nor*  indeed,  is  there  any  reafon  to 
doubt,  but  that  article  the  fourth,  which  is  immediately  fubjoin’d,  and  re¬ 
lates  to  pus  being  (hut  up  within  the  pericardium,  after  an  inflammation  of 
that  cavity,  is  the  fame  which  had  been  given,  fomewhat  more  at  large,  a  little 
before,  under  article  the  fecond,  obfervation  the  thirteenth.  And  if  you 
read  it  over  where  the  whole  of  it  had  been  defcrib’d,  that  is  to  fay,  not  in 
the  third,  but  the.  fourth  feBion,  obfervation  the  fourth  5  you  will  find  that  it 
relates  to  the  third  membrane  alfo,  that  is,  the  proper  membrane  of  the 
heart,  and  even  to  the  heart  itfelf,  being  in  part  corroded  and  wither’d.  But 
if  you,  at  length,  enquire,  whether  that  “  kind  of  coat,  which  lay  upon  the 
**  heart  itfelf,  and  was  full  of  a  certain  humidity  of  a  foetid  odour,”  relates 
to  this  membrane,  or  to  the  pericardium,  or  rather  to  fome  other  preterna¬ 
tural  membrane  that  had  grown  upon  one  or  the  other  of  the  two ;  which  coat, 
according  to  the  teftimony  of  Galen,  as  is  faid  in  the  twelfth  obfervation, 
“  was  found  in  the  difledion  of  the  body,  when  the  caufe  of  the  fyncope 

“  was  enquir’d  after  I  fear  how  far  you  may  be  able  to  learn  that  from 

the  books  of  Galen  :  and  l  fufped,  that,  if  the  commentaries  from  whence 
thefe  things  are  taken  are  indeed  thole  of  Philotheus,  or  Theophilus,  or  Ste¬ 
phaniis,  for  they  are  afcrib’d  to  one  of  thefe  authors  in  one  place,  and  to  ano¬ 
ther  in  another-,  I  fay,  I  fufped  that  the  book  of  Galen  in  which  thefe  things 
might  have  been  read,  has  been  loft :  bur,  otherwife,  that  what  Galen  had 

written  (s)  of  an  ape  being  emaciated  more  and  more,  and  of  a  tumour  in 

if  Epift.  26.  n.  38.  (r)  XVIII.  n.  2*.  &  XXIV.  n.  13,  &  34.  (>)  De  Loc.  afF.  1.  5.  c.  z. 

the 


Letter  XXV.  Articles  is,  16,  17  18.  783 

the  coat  which  furrounded  his  heart,  containing  a  humour  like  that  of  hy¬ 
datids,  have  been  by  fome  kind  of  negledt  or  other  transferr’d,  perhaps,  to 
a  fyncope  and  a  foetid  humour.  But  be  thefe  things  as  they  may,  they  have 
brought  to  my  mind  the  following  obfervation. 

15.  A  monk,  having  been  affti&ed  with  many  fymptoms  of  ill  health,  and 
particularly  with  fwoonings,  clos’d  the  period  of  his  life.  The  pericardium 
was  found  full  of  water,  and  in  part  conne&ed  with  the  heart :  and  from 
the  bafis  of  the  heart  hung  a  large  hydatid. 

16.  That  a  dropfy  of  the  pericardium  may  be  brought  on  by  the  humour 

that  is  effus’d  from  hydatids,  I  have  already  taken  notice  on  a  former  occa- 
fion  (/),  when  among  the  other  caufes  of  this  difeafe  I  alfo  recounted  this. 
And,  indeed,  it  is  very  natural  to  that  diforder  to  have  taken  place  in  this, 
monk  from  hydatids,  like  that  which  even  then  remain’d  entire,  being  pre- 
vioully  ruptur’d.  .  . 

And  that  fwoonings  have  been,  fometimes,  alfo  join’d  with  a  dropfy  of  the 
pericardium,  the  observations  which  I  have  fent  to  you  formerly  (»)  fhew. 
But  with  this  you  will  particularly  compare  that  which  is  copied  from  Val- 
falva  in  the  former  letter  (*),  and  which  exhibits  a  dropfy  of  the  pericardium, 
and,  at  the  fame  time,  certain  connections  to  the  heart,  with  an  impediment 
of  its  apex.  A  very  confiderable  obftacle  of  another  kind  to  the  motion  of 
the  heart  was  found  by  Lanzonus(y),  within  the  pericardium,  when  he  dif¬ 
fered  the  body  of  a  woman  who  died  of  a  frequent  fyncope;  I  mean,  three 
greenilh  calculi,  one  of  which  was  fo  large  as  to  equal  the  weight  of  two 
ounces. 

But  the  other  obfervation  that  I  have  promis’d  you,  relates  to  a  much  more 
violent  dilorder,  inafmuch  as  it  was  a  diforder  of  the  heart  itfelf;  I  mean,  an 
ulcer.  I  fhall  not  comprife  this  in  more  words  than  the  former,  that  is,  in 
juft  lb  many  as  I  receiv’d  it  from  the  mouth  of  Albertjni  himfelf,  who  had 
attended  upon  the  patient,  night  and  day,  under  his  preceptor  Malpighi. 

17.  The  commander  of  the  city  fortrefs  was  frequently  feiz’d  with  a  pain 
at  the  region  of  his  heart,  and  a  fyncope  that  was  the  confequence  of  it. 
Being  under  the  cautious  and  diligent  care  of  Malpighi,  he  feem’d  likely  to 
have  recover’d,  when  at  length  being  feiz’d  with  an  acute  fever  he  died.  In 
the  heart  were  found  both  polypi  and  an  ulcer. 

18.  Take  care  how  you  fuppofe  this  to  be  the  fame  commander  of  the  lame 
citadel,  whofe  difeafe  and  dilfeClion  Malpighi  (z)  himfelf  has  made  mention 
of ;  and  who,  being  fubjedt  to  a  very  acute  pain  at  the  fternum  and  in  one  of 
his  arms,  had  a  heart  twice  as  big  as  the  natural  fize,  with  a  large  polypus  in 
the  right  auricle.  For  that  gentleman  was  of  the  Baldefchi  family,  and  this, 
if  I  remember  rightly,  was  of  the Paftionei,  which  was  a  very  noble  family; 
nor  could  Albertini  have  attended  upon  the  former,  as  he  died  in  the 
year  1667  :  nor,  indeed,  does  difeafe  agree  with  difeafe,  nor  diftedion  with 
difteCfion.  However,  1  do  not  imagine  you  are  in  the  number  of  thofe  who, 
being  followers  of  Harvey  in  every  thing  without  referve,  wonder  that  there 

(/)  Epift.  16.  n.  44.  (y )  Eph.  N.  C.  Dec.  3.  A.  7.  Obf.  75. 

( u )  Epift.  ead.  n.  43.  &  XXIV.  n.  34.  (z)  Op.  Pofth.  ubi  de  Polypo  cordis. 

(*)  Ibid.  n.  2. 


I 


fhould 


784  Book  II.  Of  Difeafes  of  the  Thorax. 

fliould  have  been  any  pain  from  an  ulcer  of  the  heart;  becaufe  he(^)  had 
taught  that  it  was  “  infenfible  9”  for  this  reafon,  that  a  young  man  in  whom, 
from  an  extraordinary  accident,  the  apex  of  the  heart  could  be  touch’d,  did 
not  perceive  when  it  was  touch’d  ;  as  if  44  an  excrefcence  of  fungous  flelh,” 
as  he  himfelf  relates,  had  not  44  cover’d  over”  this  apex.  I  confefs,  that 
where  fuch  a  kind  of  flefh  has  been  form’d ;  or  where  the  heart  is  lax  and 
flaccid  ;  and  where  it  has  the  membrane  which  is  proper  to  it,  with  the  nerves 
that  lie  under  it,  lefs  tenfe  than  ufua),  either  from  its  Iring  maceration  ?n  a 
great  quantity  of  water  that  is  contain’d  in  the  pericardium,  or  from  any 
other  caufe  whatever ;  I  will  not  then  be  very  hafty  in  denying  that  ulcers  of 
the  heart  may  exift  without  any  considerable  fenfe  of  pain.  But  before  thefe 
things,  or  others  of  that  kind  come  to  pafs,  I  fhall  wonder  if  the  heart  be 
eroded,  or  ulcerated,  without  pain.  Therefore,  when  Olaus  Borrichius,  de¬ 
scribing  the  heart  of  the  centurion  (£),  relates,  that  the  external  flelh  of  it  was 
deeply  eroded,  and  transform’d  into  jagged  pieces  and  putrefcent  villi,  it  is 
not  fo  furprifing  to  me  that  the  centurion  had  at  that  time  no  pain  ;  I  mean, 
beca’ufe  44  the  membrane  proper  to  the  heart  was  confum’d  ”  by  an  acrid 
humour  with  which  the  pericardium  had  been  diftended.  But  as  to  the  “  pa- 
44  tient  never  having  complain’d  of  a  pain  of  the  heart,”  that,  indeed,  can¬ 
not  be  otherwife  than  furprifing  ;  unlefs  we  perhaps  fuppofe,  that  this  mem¬ 
brane  being  relax’d  by  maceration,  had  been  confum’d,  or  at  leaft  made 
very  infenfible,  before  the  humor  pericardii  had  become  acrid  and  fit  for 
crofion.  •  . 

19.  It  feem’d  incredible  to  the  ancient  authors,  that  the  heart  could  bear 
fo  violent  and  fo  long-continu’d  diforders,  although  Pliny  (c)  has  exaggerated 
the  opinion  much  more  than  Ariftotle  (d),  by  afierting,  as  I  have  mention’d 
in  another  place  (<?),  44  That  the  heart  being  hurt,  is  the  immediate  caufe  of 

death.”  For  Ariftotle,  although  he  had  faid,  44  that  the  heart  had  been 
44  hitherto  never  feen  to  be  fo  affected  in  any  vidtim  as  the  other  vifcera  had 
“  been  9”  yet  he  did  not  deny  that  thofe  parts,  being  fometimes  vitiated, 
which  are  moft  clofely  conne&ed  to  the  heart,  44  the  animals  that  died  of  a 
44  diforder  or  vitiated  ftate  of  this  kind,  fhew’d  morbid  affe&ions  in  the 
41  heart,  when  differed  and  thefe,  I  fuppofe,  he  did  not  believe  were 
-  made  fo  confpicuous  in  an  inftant  of  time.  Nor  indeed  did  Aretscus  (/), 
nor  Galen  (£),  teach  that  life  was  immediately  taken  away  by  every  injury 
of  the  heart  9  as  the  latter  has  ex^prefsly  faid,  that  of  thofe  in  whom  the 
wound  of  the  heart  did  not  reach  quite  to  the  ventricle,  44  fome  might  live, 
44  not  only  through  the  fame  day  on  which  they  were  wounded,  but  alfo 
“  through  the  following  night  9”  and  the  other,  that  if  the  aphthm  go  down 
from  the  fauces  into  the  penetralia  of  the  thorax,  they  do  not  inftantly,  14  but 
44  only  on  the  fame  day,  caufe  ftrangulation.”  Yet  the  fame  author  has  faid, 
that  the  heart 44  neither  bears  ulcers  nor  fanious  humours  9”  and  Galen,  that 
from  inflammation,  or  eryfipelas,  44  while  it  begins  to  be  form’d,  and  before 

(a)  De  Generat.  Animal.  Exercit.  52.  (i)  De  Part.  Animal.  1.  3.  c.  4. 

\b)  In  Bartholini  A&.  Med.  Hafn.  Vol.  1.  (#)  Epift.  21.  n.  5. 

Obf.  89.  (f)  De  Cauf.  Acut.  Morb.  1.  1.  c.  9. 

(r)  Nat.  Hill.  1.  11.  c.  37.  (g)  De  Loc.  aff.  1.  5.  c.  2. 

44  a  dil- 


$ 


Letter  XXV.  Article  io.  785 

e(  a  difordcr  of  this  kind  can  be  increas’d,  the  animal  is  immediately  taken 
“  off for  which  reafon,  as  he  had  before  afierted  (£),  “  it  was  impoffible 
“  that  the  heart  fhould  be  affedted  with  an  abfcefs.”  And  the  fame  opinion 
was  embrac’d  by  more  modern  phyficians  than  thefe,  who  follow’d  the  opi¬ 
nion  of  their  predecefifors,  and  even  that  of  the  very  ancient  author  of  the 
book  Be  Morbis  (/),  who  had  faid,  “  that  no  difeafe  arot'e  in  the  h  art  ;”  none 
of  them  indeed  through  their  own  faults,  but  all  through  the  fault  of  the 
times  till  the  difie&ion  of  bodies  began  to  teach  quite  different  things  ;  not 
the  bodies  of  beads,  but  of  men,  as  being  thofe  animals  whom  a  various 
kind  of  intemperance,  but  efpecially  cares,  and  violent  paffions  of  the  mind 
long  continu’d,  frequently  make  liable  to  difeafes  of  the  hea>t,  and  the 
adjoining  veffels.  The  firff  obfervation,  as  far  as  I  cm  now  call  to  mind, 
or,  at  leaft,  one  of  the  firft,  was  that  of  Benivenius  (-kj  about  the  be¬ 
ginning  of  the  fixteenth  century,  who,  in  a  thief  that  had  been  publ  cly 
hang’d,  found  “  an  abfcefs  in  the  left  ventricle  of  the  heart  redundant 
“  with  pituita.”  This  obfervation  was  fucceeded,  not  many  years  a' ter,  by 
another  of  the  phyficians  at  Vienna,  from  whom  Matthias  Cornax  having 
heard  it,  publifn’d  it  long  after  in  an  explication  added  to  his  hiftory  {l)  ; 
which  obfervation  is  the  firft  of  this  fedfion  in  the  Sepulchretum,  and  relates, 
“  that  more  than  half  of  the  heart  was  fanious,  and  waited  away  with  pu- 
“  trefaftion ;”  that  is,  as  I  underftand  it,  in  regard  to  the  thicknefs  of 
the  parietes.  After  the  interval  of  a  very  few  years,  Nicolaus  Mafia  ( m ) 
added  a  third,  the  fummary  of  which  you  have  in  the  lcholium  to  the  ob¬ 
fervation  made  at  Vienna,  as  far  as  the  memory  of  Cornax  could  furnifii  him 
with  it ;  for  Maflfa,  to  take  no  notice  of  other  things,  faw,  in  the  right  ven¬ 
tricle,  a  remarkable  impofthume,  “internally;  and  the  left  auricle,  which 
“  was  extremely  fmall,  univerfally  ulcerated  on  its  external  furface,  with  a 
gt  manifeft  fanies ;”  but  he  faw  an  ulcer  much  larger  “  than  the  half  of  a 
“  hen’s  egg-fhell,”  not  in  the  heart,  but  “  in  the  fubftance  of  the  lungs, 
“  on  the  left  fide.”  Which  blunder  of  Cornax,  although  confiderably  en- 
creas’d  in  the  Sepulchretum,  where  the  ulcer  is  faid  to  be  “  of  the  bignefs 
“  of  a  hen’s  egg,”  I  fhould  willingly  have  pafs’d  by,  in  this  place,  if  it  had 
not  been  abfolutely  necefifary  for  me  to  take  notice  of  it,  as  you  will  fee  pre¬ 
sently,  in  order  to  perform  what  l  promis’d  you  in  the  former  letter '(»);  I 
mean,  to  enquire,  whether,  with  ulcers  of  the  heart,  both  faintings  and  inter- 
miflions  of  the  pulfe  are  always  join’d. 

20.  For  as  the  obfervation  of  Benivenius,  and  not  a  few  of  the  many 
which  follow’d  it  afterwards,  are  altogether  filent,  or  at  leaft  more  fo  than  I 
could  wifn,  in  regard  to  the  fymptoms  of  diforder  which  had  preceded;  fo 
that  the  two  next  obfervations,  that  of  the  Vienna  phyficians  and  Mafia, 
are  the  more  to  be  regarded  ;  the  firft  of  which  informs  us,  that  many  and 
frequent  fwoonings  had,  for  a  year  before,  preceded  the  laft  and  fatal  fyn- 
cope  ;  and  the  fecond  feems  to  (hew  clearly,  that  in  a  man  who  died,  in  other 
refpects,  of  abfeefifes  of  the  cerebrum  and  cerebellum,  after  a  wound  in  the 


(b)  Ibid.  I.  i.  c.  5. 

(0  1*  4- 

(6)  De  abdit,  morb.  cauf.  c.  89. 


(/)  Geft.  in  utero  fet.  mort.  c.  3. 
(m)  lib.  Introduci.  Anat.  c.  28. 
(«)  n.  22. 


VOL.  I. 


5  H 


head. 


7B6  Book  II.  Of  Difeafcs  of  the  Thorax. 

head,  no  fign  had  preceded,  which  had  any  relation  to  the  heart  *,  you  readily 
perceive  that  I  am  to  confider,  whether  I  ought  to  follow  Cornax  or  not, 
who  believes  that  there  had  not  been  any  fwoonings  in  this  patient  of 
Mafia,  for  this  reafon,  that  the  diforder  of  the  heart  was  more  recent. 
And  I  follow  him  the  more  readily,  when  I  obferve  that  there  was  pus, 
not  only  in  the  heart,  but  alfo  in  the  lungs  j  both  of  which  might,  with¬ 
out  doubt,  have  been  eafily  tranflated  from  the  head,  juft  before  the  clofe 
of  life,  when  the  man  lay  hemipledtic,  delirious,  and  like  a  dying  per- 
fon.  For  that  lanies  is  not  always  carried  by  metaftafis  from  the  head, 
when  wounded,  to  the  liver,  but  fometimes  to  the  other  vifcera  in  like  man¬ 
ner,  has  been  found  by  the  very  experienc’d  phyfician  and  furgeon  Moli- 
nelli  (o) :  and  although  it  happen’d  to  him  to  obferve,  that  thefe  vifcera 
“  were  always  in  the  number  of  thofe  that  are  contain’d  in  the  belly yet 
I  do  not  fee,  that  this  is  at  all  repugnant  to  our  fuppoling  the  vifcera,  which 
are  contain’d  in  the  thorax,  to  be  fometimes  capable  of  being  thus  affecfted 
likewife  (*) :  nor  do  I  fee,  that  thofe  things  can  be  eafily  explain’d  otherwife, 
which  Mafia  found  in  the  lungs  and  the  heart  of  this  man,  whom,  before 
the  wound,  “  he  had  known  to  be  healthy,  and  never  to  have  complain’d  of 
“  any  pain,  nor  to  have  cough’d,  after  his  being  confin’d  to  bed  with  his 
“  wound,  ffV.” 

To  this  I  might  perhaps  add  that  fanies  which  the  celebrated  Daniel  Hoff¬ 
man  (p)  faw  diftil  from  ulcers  that  had  been  open’d  in  the  arm  and  the  thigh, 
of  the  fame  colour  with  that  which  came  from  a  wound  of  the  head  and  ce¬ 
rebrum  ;  fo  that  he  did  not  doubt  but  it  had  been  carried  from  the  head  into 
all  the  parts  of  the  body.  However,  it  is  fufficient  for  me,  that  the  great 
archiater  Senac  (q)  alfo,  whom  I  frequently  read,  as  I  revife  thefe  letters,  has 
chofen  rather  to  explain  the  obfervation  of  Mafia  in  the  fame  manner  that  I 
have  explain’d  it.  Setting  this  afide,  therefore,  let  us  attend  to  other  things. 
In  this  tenth  feftion  of  the  Sepulchretum,  therefore,  there  are,  in  all,  five 
obfervations,  in  which  the  ulceration  of  the  heart  is  read  of ;  that  is  to  fay, 
the  firft,  as  I  have  already  faid,  the  fecond,  the  eighth,  the  tenth,  and  that 
which  is  the  fecond  in  the  additamenta.  And  in  the  ninth  fe&ion  are  no 
more  than  two,  which  are  the  eleventh  and  forty-fecond.  Read  them  all 
over.  In  the  two  laft  you  will,  indeed,  find  an  intermifiion  of  the  pulfe,  but 
no  deliquia.  In  the  former,  on  the  other  hand,  you  will  generally  find  thefe  de¬ 
liquia,  but  not  an  intermifiion  of  the  pulfe.  There  is  then,  not  one  of  all 
thefe  obfervations  which  has  both  thefe  circumftances  join’d  together.  For 
although  the  eighth  of  the  tenth  fe&ion  has  this  title  prefix’d  to  it,  “  A  Ly- 
“  pothymia  in  confequence  of  an  ulceration  of  the  heart  yet  in  fa6t,  if  it 
be  very  attentively  examin’d,  not  only  then,  or  in  the  ninth  iecftion,  under 
number  the  forty-fecond,  for  it  is  the  fame,  but  particularly  in  the  fifth  fec- 
tion,  under  number  twenty-one,  where  it  is  defcrib’d  more  at  large,  from  the 
author  Riverius ;  we  are  fo  far  from  finding  any  fwooning  which  preceded 
d'eath,  that  we  ftiall  even  perceive,  that  the  intermifiion  of  the  pulfe  “  had 

(o)  De  Boaon.  Sc.  Acad.  Comment.  Tom.  2.  (/)  Ad.  N.  C.  Tom.  5.  Obf.  54. 

P.  1.  ubi  Medica.  Q)  Traite  du  Coeur,  1.  4,  ch.  7..11.  2.. 

(*)  Quin  de  his  rebus  Vid.  quse  fufuis  fcri- 
buntur  Epift.  ci.  n.  21.  &  feqn. 

w  ceasM”’ 


§ 


Letter  XXV.  Article  21.  787 

44  ceas’d”  many  days  before  death.  Thus  alfo,  if  you  perhaps  doubt,  whe¬ 
ther  in  the  eleventh  obfervation  of  the  ninth  fedtion  fomething  may  not  be 
wanting,  that  relates  to  deliquia ;  turn  to  the  fame  where  it  is  given  more  in 
full  under  the  twenty-feventh  number  of  the  firft  fedtion,  and  I  anfwer 
for  it,  it  will  not  only  happen  that  you  will  find  not  a  fi ngle  word  of  thefe 
fymptoms,  but  you  will  probably  think  with  Riverius,  from  whofe  accurate 
defeription  this,  as  well  as  the  former,  was  taken,  that  the  dilatation  of  the 
right  auricle  of  the  heart,  join’d  together  with  an  exulceration  of  the  fame, 

had  been  the  caufe  of  fo  great  an  inequality  and  intermiffion  of  the  pulfe.” 
And  becaufe  I  have  obferv’d  above  (r),  that  a  certain  obfervation  of  the  tenth 
fedtion,  which  is  given  under  number  the  thirteenth,  article  the  fecond,  and 
again  under  number  the  eighteenth,  article  the  fourth,  if  it  be  examin’d  into 
in  another  place  (j),  where  the  whole  of  it  may  be  read,  fhews  the  heart  to 
have  been  in  part  44  corroded  and  wither’d  left  you  Ihould,  perhaps,  ima¬ 
gine,  that  there,  at  leaft,  befides  fwoonings,  an  intermitting  pulfe  is  alfo  men¬ 
tion’d,  you  may  take  it  for  granted,  that  even  there  you  will  not  find  any 
thing  of  this  kind  mention’d. 

21.  But  are  no  other  oblervations  of  the  heart  being  ulcerated,  you  will 
fay,  befides  thofe,  produc’d  or  referr’d  to  in  the  Sepulchretum  ?  In  thefe 
two  fedtions,  that  is  to  fay,  the  ninth  and  tenth,  indeed,  others  are  not  pro¬ 
duc’d  befides ;  unlefs  you  Ihould,  perhaps,  fuppofe  that  the  twenty-third  of 
the  ninth  relates  to  the  prefent  fubjedl  of  difpute,  in  which  it  is  faid  that  the 
membrane  of  the  heart  44  was  eroded  and  excoriated  which  obfervation  I 
have  defignedly  pafs’d  over,  not  only  becaufe  the  heart  itfelf  was  un¬ 
hurt,  but  particularly  becaufe  no  diforders  which  were  join’d  with  it,  are 
exprefsly  mention’d  j  or  if  any  one  does  feem  to  be  mark’d  out,  it  relates  to 
the  frequency,  and  not  to  the  intermiffion,  of  the  pulfe. 

But  in  certain  fcholia  of  the  tenth  fedtion,  fome  obfervations  are  indeed  re¬ 
ferr’d  to,  as  you  will  fee  under  number  the  fecond,  both  in  that  fedtion,  and 
in  the  additamenta  to  that  fedtion.  However,  the  firft,  which,  that  you'  may 
compare  them  with  his  book,  are  thofe  of  Tulpius,  have  deliquia,  but  not 
intermiffions  of  the  pulfe :  the  others,  which  refer  to  Cabrolius  as  their  au¬ 
thor,  have  not  the  former  fymptoms,  but  only  the  following  afiertion  :  44  Left 
“  any  one  Ihould  think,  that  death  had  been  brought  on  them  ‘from  thefe 
“  caufes,  both  of  them  ended  their  life  by  the  halter.”  And  if  any  regard 
is  to  be  paid  to  that  wonderful  obfervation  of  Bernardin  Telefius,  which  is 
pointed  out  before  thefe  ;  although  in  that  mention  is  made,  not  of  an  erofion, 
but  of  a  hedtic  drynefs  of  the  heart,  which  was  wafted,  and,  44  only  the  coat 
“  of  it”  excepted,  entirely  deftroy’d  ;  that  is,  as  I  underftand  it,  much  in 
the  fame  manner  as  Peyerus  (t)  found  it  in  a  certain  phthifical  patient,  44  fo 
44  extenuated,  that  the  left  ventricle  of  it  was  fcarcely  equal  in  thicknefs  to 
44  a  common  piece  of  leather,  and  the  right  was  equal  in  the  thicknefs  of  its 
“  parietes  only  to  a  fimple  coat  j”  you  will  certainly  read  nothing  elfe  in  Te- 
lefius,  but  that  this  man  had  been  44  wafted  away  by  a  long-continu’d  difeafe  :** 
and  you  will  look  after  this  hiftory  (which  is  .incredible,  unlefs  you  explain 

fi)  N.  74,  fi)  Se&.  4.  Oh f.  4.  1.  z.  fi)  Method,  Hift.  Anat.  c.  6.  in  fchol. 


it 


5«  2 


788  Book  II.  Of  Difeafes  of  the  Thorax. 

it  in  the  manner  I  have  mention’d)  in  his  fifth  book  Rerum  Naturalium 
chapter  the  twenty-fourth,  not  the  twenty- eighth,  that  is  referr’d  to  by 
Meckrenius  himfelf,  as  well  as  in  the  Sepulchretum :  and  if  it  feem  to  you 
alfo,  as  it  did  to  Meckrenius,  that  inftead  of  the  “  coat  of  the  heart”  the 
pericardium  is  to  be  underftood  ;  you  will  underftand  that  the  heart  itfelf,  as 
frequently  happens  in  hedtical  bodies,  was  clofely  connected  to  the  pericar¬ 
dium  :  and  although  the  other  oblervation  («)  feems  ftifl  lefs  credible,  inaf- 
much  as  it  relates  to  a  healthy  man  who  died  fuddenly  *,  I  mean,  that  “  of 
“  the  pericardium  which  contain’d  the  membrane  of  the  heart  fill’d  with 

black  blood,  inftead  of  the  parenchymatous  lubftance,  which  was  entirely 
“  confirm’d  yet  whatever  truth  there  was  in  it  cannot,  in  my  opinion,  be 
otherwife  explain’d  than  in  the  method  1  before  pointed  out. 

But  befides  thofe  two  fcdtions,  the  ninth  and  tenth,  in  which  we  have  hi¬ 
therto  enquir’d,  I  do  not  doubt  but  there  are  others  which  produce  obfer- 
vations  of  the  ulcerated  heart,  and  indeed  I  in  part  know.  Among  which, 
however,  take  care  how  you  number  what  is  produc’d  in  the  firlt  book, 
fedtion  the  fecond,  under  number  the  ninth,  For  Blancardus  has  deceiv’d 
Bonetus,  who  took  him  for  the  author  of  the  obfervation  in  the  fcholium. 
For  it  is  the  fame  in  effedt,  though  not  in  words,  as  the  fecond  of  the  two, 
which  above  (x)  is  by  me  and  by  Bonetus  juftly  and  defervedly  attributed  to 
Riverius  ;  from  whom  alfo  Blancardus  (jy)  had  taken  the  firft  in  a  furrep- 
titious  manner,  without  mentioning  it.  But  he  has,  befides,  adted  in  the 
fame  manner  with  that  which  I  have  confider’d  after  thofe  of  Riverius ;  fo  as 
to  make  me  very  much  fufpedt  that  he  has  impos’d  upon  Bonetus,  and  moil 
other  writers,  and  perhaps  upon  me  alfo,  in  more  than  one  place.  Where¬ 
fore,  difmiffing  this  homo  verfutiloquus ,  or  crafty-talking  man,  if  I  may  be  al¬ 
low’d  to  ufe  the  word  of  an  ancient  poet  (z),  let  us  look  out  for  authors  who 
are  more  to  be  depended  upon.. 

22.  There  is  then,  in  the  fecond  book  of  the  Sepulchretum,  fedtion  the 
firft,  obfervation  the  eighty  fixth,  which  is  taken  notice  of  above  (a),  and  was 
made  by  Claus  Borrichius,  in  a  man  who  had  the  external  flefh  of  the  heart 
“  deeply  corroded,  and  transform’d  into  jagged  pieces  of  fiefh  and  putrefcent 
“  villi.”  And  I  fee  that  Peyerus  (b)  had  obferv’d  fomething  of  the  fame 
kind,  and  Graetzius  (c),  who  reprefented  what  he  had  feen  in  a  figure  by  no 
means  inelegant.  But  the  latter  of  thefe,  (hewing  briefly  what  fymptoms  had 
preceded,  fays,  £<  that  the  patient  had  bren  long  troubl’d  with  fymptoms  that 
“  teem’d  to  argue  a  dropfy  of  the  thorax.”  Peyerus  has  (aid  no  more  than 
that  the  young  man  had  been  “  confumptive,  and  dropfical.”  And  Borri¬ 
chius,  although  he  mentions  many  things  diftincftly,  and  in  particular,  men¬ 
tions  not  a  word  of  fwoonings,  or  of  intermitting  pulfes.  Nor  is  any  men¬ 
tion  of  this  kind  made  by  Bonetus,  when  in  the  hundred-and-thirty-fourth 
obfervation,  which  ieems  to  relate  to  the  prefent  fubjedt,  by  reafon  of  the 
right  auricle  of  the  heart  ct  being  fill’d  with  pus  that  flow’d  out  of  the  ven- 

(uj  Eph.  N.  C.  Det.  1.  A.  6.  Obf,  25.  &  (2)  Apud  Cicer,  de  Orat,  1.  3. 

in  Sepuldir.  1.  2.  S.  n.  Obf.  21.  (a)  N.  18. 

( x )  N.  20.  \b)  In  Schol.  fupra  Tt.  ad  n.  21. 

OJ  AnauPract.  Obf.  40.  (c)  Difput,  de  Hydr.  Pericard.  §  3. 

tricies,” 


Letter  XXV.  Article  22.  789 

tricies,”  he  enumerates  other  things.  I  lefs  wonder  at  that  in  the  fixth  fe&ion, 
obfervation  the  fifteenth,  and  fed:ion  the  feventh,  obfervation  the  hundred- 
and-ninth,  articles  one  and  two.  For  Rota,  Fernelius,  and  Trincavellius, 
have  mention’d  old  ulcers  of  the  heart ;  and  the  latter  even  fays,  that  the 
“  greater  part  of  it  was  corroded  ;”  which  you  will  underftand  in  the  fame 
manner  as  has  been  explain’d  above  (d),  in  the  hiftory  taken  at  Vienna :  yet 
as  they  only  mention’d,  not  defcrib’d,  the  cafes,  one  of  them  has  fignified,  that 
the.  patient  had  for  a  long  time  labour’d  under  an  empyema  ;  another,  that 
a  confumption  had  been  brought  on  by  degrees ;  and  the  third,  that  the  pa¬ 
tient  had  fuffer’d  a  long  illneis  ;  and  no  more  :  although  it  is  highly  probable, 
that  if  the  pulfe  had  intermitted,  or  there  had  been  accuftom’d  to  be  any 
iwooning,  that  fome  one  or  other  of  them  would  have  juft  fignified  it  by  a 
word  at  leaft. 

And  this  I  believe  ftill  more  readily  of  our  Marchetti,  not  “  Dominic,” 
but  Peter  the  Chevalier,  a  relation  of  the  other  ;  for  Dominic,  although  I  fee 
that  his  Opera  Chirurgica  are  commended  by  a  great  writer;  and  indeed  he 
was  not  only  a  very  eminent  phyfician,  but  as  eminent  a  furgeon  ;  yet  has  in 
fact  publifh’d  nothing  but  his  Anatomia.  Wherefore  the  Ohfervationes  Medi- 
co- chirurgicae  are  the  works  of  Peter ;  one  of  which  is  that  forty-fixth  obfer¬ 
vation,  wherein  you  have  the  relation  of  an  ulcer  penetrating  quite  to  the 
left  cavity  of  the  heart,  and  is  immediately  fubjoin’d  to  the  foremention’d 
obfervations  of  Fernelius  and  Trincavellius,  article  the  third;  but  is  given 
in  quite  a  different  manner  from  what  it  is  by  the  author.  Who  having, 
befides  a  wafting  of  flefh,  alfo  enumerated  “  fever  and  lofs  of  ftrength,”  it 
does  not  feem  that  if  there  had  been  any  deliquia,  or  intermiffion  of  the  pulfe, 
he  would  have  neglefted  to  mention  them,  in  order  to  give  a  reafon  why  the 
cure  of  that  fiftulous  ulcer  which  follow’d  the  wound  of  the  fternum,  could  be 
attempted  “  with  no  hope  of  recovery.” 

Nor  do  I  doubt  but  Hollerius  alfo,  if  the  archdeacon  who  had  “  an  ab- 
“  feels  in  the  fubftance  of  the  heart,”  and  the  woman  who  had  “  many,” 
had  been  troubl’d  with  thefe  fymptoms,  would  have  mention’d  both  of  them 
in  the  fcholia  to  his  chapter  De  Syncope ,  as  he  had  mention’d  in  the  laft  chap¬ 
ter  (e)  De  cordis  Palpitatione,  what  fymptoms  they  had  been  afflicted  with  : 
and  Bonetus  has,  in  like  manner,  given  us,  under  article  the  fecond  of  the 
eighth  obfervation,  fe£tion  the  eighth,  which  is  on  the  fame  Fubjecft  of  pal¬ 
pitation,  what  relates  to  this  very  archdeacon  ;  although  I  do  not  know  why 
he  has  commended  Foreftus,  as  being  the  author  of  it,  rather  than  Holleri¬ 
us,  from  whom  Foreftus  has  confeffedly  copied  this  and  many  others  that 
follow.  But  as  to  what  is  faid  under  the  firft  article  of  the  fame  obfervation, 
of  the  ulcer  of  the  heart  in  a  woman,  in  fuch  a  manner  as  only  to  inform  us, 
that  being  fent  to  the  hot  baths  on  account  of  a  fcabies,  fhe  came  back  from 
thence  dropfical ;  this  is  no  more  ufeful  to  us  than  what  we  likewife  read 
under  the  eighth  obfervation  of  the  twelfth  fetftion,  book  the  fourth,  of  the 
heart  being  eroded  in  a  certain  man,  from  a  long-continu’d  ufe  of  acidulated 
vitriolic  waters.  However,  on  the  contrary,  thofe  are  very  ufeful  which  are 
to  be  met  with  in  the  fame  fe&ion,  among  the  poft humous  obfervations  of 


(/)  N.  19. 


(e)  29.  libri  2.  de  Morb.  intern. 

6 


790  Book  11.  Of  Difeafes  of  the  Thorax. 

Jo.  Bapt.  Fantonus,  the  fixteenth  and  the  twenty-eighth.  For  they  arc  no 
imperfedt,  but  both  of  them  exprefsly  inform  us  with  what  fymptoms  the 
patient  had  been  afflicted,  and  particularly  the  firft.  Although  then  the  heart 
of  one  was  “  externally  purulent,”  that  is,  as  the  celebrated  fon  of  Fantonus 
afterwards  publifh’d,  “  corrupted and  the  heart  of  the  other  had  “  an  abfcefs, 

“  which  was  already  ruptur’d  yet  in  neither  of  them  any  deliquium  is  faid 
to  have  been,  or  any  intermiflion  of  the  pulfe. 

23.  And  thefe  are  the  obfervations  of  ulcers,  or  open  abfcefies  in  the  heart, 
on  which  it  has  hitherto  happen’d  that  1  have  lit  in  turning  over  the  Sepul- 
chretum  ;  or  rather,  which  I  remember  to  have  read  in  this  or  other  books  ; 
for  I  do  not  fuppofe,  either  that  I  have  feen  all  the  obfervations  which  ever 
were  publifh’d,  or  that  I  remember  all  that  I  have  feen.  And  indeed,  now 
I  read  thefe  things  over  again,  a  pafiage  of  Lancifi  comes  into  my  mind  (/), 
in  which  he  fays,  that  he  had  two  or  three  times  “  found  the  furface  of  the 
“  heart  corroded  and  ulcerated  but  “  that  the  figns  of  this  diforder  were 
“  nearly  common  with  the  fymptoms  that  accompany  the  aneurifms  of  the 
“  praecordia.”  Which  is  not  at  all  to  be  wonder’d  at,  becaufe  he,  “  for  the 
«  mod  part,”  found  it  complicated  with  the  aneurifms :  and  that  among  the 
figns  of  thofe  aneurifms,  the  two  after  which  our  enquiry  is  at  prefent,  are 
not  neceflarily  to  be  confider’d,  you  readily  underftand,  from  a  number  of 
other  hiftories  of  aneurifms  of  the  praecordia,  which  I  have  fent  to  you 
already. 

It  might  feem  to  thofe  who  read  over  the  thirty- fifth  chapter  of  Meck- 
renius  (g)>  that  even  many  other  obfervations  of  ulcers  of  the  heart  are  ex¬ 
tant,  and  perhaps  are  really  extant.  Neverthelefs,  out  of  thofe  that  he  pro¬ 
duces  or  points  out,  you  will  find,  if  you  diligently  compare  them,  that 
fome  are  the  fame  with  thofe  that  I  have  already  confider’d,  and  the  greater 
part  of  the  others  you  will  riot  find  in  the  paflages  of  thofe  writers  to  whom 
he  himfelf  refers;  and  you  will  find  that  l'ome  are  related  by  their  original 
authors  in  quite  a  different  manner  from  that  in  which  he  has  related  them. 
For  when  he  relates  his  own  obfervation,  the  latter  part  of  which  it  is  not  eafy 
to  underftand,  he  fays,  “  An  example  fimilar  to  this,”  that  is,  of  an  ulcer 
of  the  heart,  join’d  with  frequent  fwoonings,  “  Realdus  Columbus  writes, 
“  in  his  fifteenth  book,  De  re  Anatomica ,  that  he  had  obferv’d  in  a  difciple 
“  of  his,  whom  he  had  difiedted  at  Rome.”  But  Columbus,  though  it  is 
true  he  does  fay  that  this  difciple  u  had  fallen  now  and  then  into  a  fyncope,” 
does  not,  however,  fay  that  he  had  an  ulcer  in  his  heart,  but  “  that  the  peri- 
“  cardium  was  wanting.”  But  to  what  diforders  they  had  been  fubjedt  while 
living,  in  whole  hearts,  after  death,  he  faw  “  ulcers  or  an  abfcefs,”  he  does 
not  tell  us. 

One  author,  however,  yet  remains,  whom  I  had  not  in  my  hands  when  I 
wrote  thefe  things  to  you  before  ;  I  mean  the  illuftrious  Senac.  He,  in  that 
chapter  (b)  which  he  has  entitled,  “  Inflammations,  abfcefies,  and  ulcers  of 
“  the  heart,”  has  taken  notice  of  fo  many  obfervations,  in  which  the  heart  was 
dileas’d,  that  if  you  fhould  compare  them,  feparately,  with  thofe  that  I  have 

(f)  De  Mot.  Cord.  Propof.  23,  in  Schol.  (£)  Traite  da  Coeur  1.  4.  ch.  7. 

( g )  Obf.  Med.  Chirurg. 

pointed 


Letter  XXV.  Article  24.  7  pi 

pointed  out  above,  which  I  have  not  time  to  do  at  prefent,  it  could  not 
happen  but  that  you  mult  find  others  which  have  been  remark’d  by  this  very 
learned  man,  befides  thefe  ;  at  leaf!;  fome  which  were  made  at  Paris ;  and 
particularly  that  taken  from  a  woman,  whom  I  heartily  with  he  had  had  the 
opportunity  of  feeing  when  fhe  was  difledled  after  death  alfo,  as  he  had  had 
the  opportunity  of  feeing  her  when  fhe  was  living,  and  labouring  under  her 
dileafe.  1  would,  therefore,  have  you,  in  as  many  as  you  find  that  have 
not  been  confider’d  by  me,  attend  to  this  at  leaft  in  particular,  whether  both 
thefe  figns,  that  are  at  prefent  in  queftion,  are  remark’d.  For  although 
Senac  himfelf  (i)  exprefsly  denies,  that  an  inequality  of  the  pulfe  is  the  ne- 
ceflary  confequence  of  ulcers  of  the  heart  ;  yet,  as  he  mentions  this  (£),  and 
frequent  deliquia,  amongft  the  figns  which  “  generally  ”  attend  thofe  ulcers  ; 
you  muft  fee  whether  he  is  to  be  underflood  to  fpeak  of  both  the  figns  toge¬ 
ther,  or  rather,  as  I  fuppofe,  of  one  or  the  other  only  :  for  there  is  nothing 
from  which  you  can  better  determine  this  queflion,  than  from  thofe  obferva- 
tions  which  flill  remain  to  be  particularly  confidered  by  you,  in  his 
work. 

24.  But  if  you,  in  the  mean  time,  enquire,  what  it  has  happened  to 
Valfalva,  Albertini,  or  me,  to  obferve,  you  may  read  over  again  my  fix- 
teenth  letter  to  you,  at  number  feventeen,  and  forty-three  ;  and  the  twenty- 
fourth,  at  number  eighteen.  You  will  find  nothing  of  intermiffion  of  the 
pulfe,  nothing  of  fwoonings,  if  you  except  fome  flight  faintings,  obferved 
by  Albertini.  But  thefe,  you  will  fay,  were  flight  erofions,  and  only  fuper- 
ficial.  I  confefs  they  were  fo;  but  they  were  true  erofions,  and  were  in  that 
part  where  it  is  hinted  above  (/),  that  the  greatefl  trouble  to  the  heart  could  be 
excited.  And  I  laid  that  they  were  true  erofions,  left  you  fhould,  perhaps, 
put  them  amongft  the  number  of  thofe,  in  which  the  external  furface  of  the 
heart  feems  to  be  eroded,  but  is  not  really  fo  :  an  example  of  which  falfe 
erofion  is  given,  for  inflance,  in  the  twenty-firfl  letter  (02),  where  it  is  alfo 
ihown  from  what  caufe  it  may  happen,  although  fomewhat  briefly,  and  by 
what  method  it  may  be  diftinguifh’d.  That  is  to  fay,  from  the  humor 
pericardii,  which  is  in  a  preternatural  flate,  a  kind  of  concretions  fometimes 
adheres  to  the  heart ;  which,  by  their  inequality  and  colour,  refemble  an 
erofion.  It  is  eafy  for  thofe  who  are  not  uninform’d  of  thefe  concretions,  to 
avoid  fallacy,  by  taking  them  off';  and  by  difcovering  the  fubjedled  membrane 
of  the  heart  to  be  found.  In  thofe  obfervations,  therefore,  of  Borrichius, 
Peyerus,  and  Graetzius,  which  I  have  pointed  cut  above  (;;),  do  not  be  too 
forward  to  fufpedt  the  fame  thing,  when,  enquiring  after  that  membrane, 
they  found  it  to  be  “  confumed,  in  fome  places  a£lually  corroded,  ”  and  the 
heart  “  deprived  ”  of  it.  But  to  Valfalva  and  Albertini  concretions  of  this 
kind  were  not  unknown  ;  and  thefe  concretions  refemble  other  things,  at 
other  times ;  and  amongft  thefe  fat,  villi  and  hairs,  as  I  have  written  in  the 
preceding  letter  (<?).  For  which  reafon  I  have  with- held  my  afierit,  when  I 
happened  at  any  time  to  hear,  that  in  a  certain  perfon,  who  had  been  trou¬ 
bled  with  pains  and  convulfions  of  the  heart,  befides  the  pericardium 


•7T  : 


being* 


(?)  Ibid.  n.  1.  in  fin. 

(&)  n.j.  (/)  n.  lS. 


r  ( m )  n.  2. 
(0)  n.  4. 


( n )  n.  zz. 


7  9  2-  Book  II.  Of  Difeafes  of  the  Thorax. 

being  full  of  the  mod  yellow  water,  all  the  fat  of  the  heart  was 
found  to  be  jagged,  here  and  there,  as  if  it  had  been  eaten  by  mice. 
For  an  appearance  of  this  kind  had  offer’d  itfelf  to  me  before,  in  an  old  fol- 
dier,  of  whom  I  (hall  write  to  you  hereafter  (p) ;  nor  did  I  fuffer  it  to  im- 
pofe  upon  me  :  nor  did  the  celebrated  Schreiberus  fuffer  himi'elf  to  be  im¬ 
pos’d  upon,  when,  in  an  obfervation  which  I  have  already  related  (q),  after 
having  exprefsly  admonifh’d,  “  that  the  large,  long,  and  broad  villi,  which 
C4  were  almoft  like  tender  and  fungous  fiefh,”  and  which  every  where  adhere 
to  the  heart,  “  were  form’d  from  the  ferum  of  the  blood  ftagnating  within 
“  the  pericardium  he  added  figures  of  the  villous  hearts,  accurately  ex- 
prefs’d  ;  which  if  any  one  look  upon  that  is  ignorant  of  the  circumftances, 
he  will  be  immediately  deceiv’d,  nor  in  the  lead  doubt,  but  they  reprefent 
hearts,  the  fat,  and  the  remaining  lurface  of  which  were,  in  feveral  places, 
deeply  eaten  into  by  corrofions.  But  whether,  in  the  third  obfervation  of  the 
fecond  febtion  of  the  lecond  book  of  the  Sepulchretum,  the  external  lurface 
of  the  heart,  which  is  defcrib’d  as  being  “  altogether  like  to  a  piece  of  downy 
“  cloth,  or  the  internal  coat  of  the  ftomach  of  ruminating  animals,”  ap¬ 
pear’d  to  be  “  in  a  manner  corroded,”  by  reafon  of  concretions  refembling 
villi,  which  had  been  depofited  from  the  ferum  wherewith  the  pericardium 
was  extremely  tumid  ;  or  whether  it  really  was,  and  “  without  a  doubt, 
“  from  the  acrimony  of  the  ferum,  with  the  external  fubftance  of  the  heart,” 
as  is  faid  in  the  fcholium,  entirely  corroded,  I  leave  quite  undetermin’d;  as 
in  the  obfervation  of  Laubius  alfo  (r),  whether  the  lurface  of  the  heart  was 
really  eroded ;  for  although  the  pericardium  contain’d  “  more  than  a  pound 
“  of  black  and  coagulated  blood,”  yet  this  might  eafiiy  have  dillill’d  from 
another  part  than  the  lurface  of  the  heart  ;  and  Laubius  himfelf,  like  a  per- 
Ibn  who  hefitates,  relates  the  appearance  in  the  following  manner  :  that  blood 
<c  being  wip’d  away  by  a  fponge,  the  fubftance  of  the  heart  offer’d  itfelf  to 
“•  the  eyes,  cover’d  over,  as  it  were,  with  lamellae,  and  eroded.”  But  if 
the  fubftance  of  the  heart,  in  both  the  obfervations,  was  really  corroded  and 
eaten  away  ;  for  I  pafs’d  by  both  of  them  above,  in  confequence  of  my  doubts 
upon  this  head  ;  1  would  have  you  attend  to  this,  that  among!!  the  fymptoms 
which  the  patients  fuller’d,  not  a  word  is  to  be  met  with  in  regard  to  inter- 
million  of  the  pulle  or  fwooning.  And  as  in  fo  great  a  number  of  hiftories, 
frequently,  neither  of  them  is  mention’d,  never  both,  and  fometimes  only 
one  or  the  other,  you  naturally  fee,  without  any  induction,  what  is  to  be 
thought  of  the  queftion  propos’d. 

25.  And  if  this  be  the  cafe  in  open  abfeeffes  and  ulcers  of  the  heart,  do 
you  fuppofe  that  it  will  be  different,  in  thofe  that  are  conceal’d  ?  What 
fymptoms  had  preceded,  when  Columbus  found  “  hard  tumours  in  the  left 
“  ventricle  of  the  heart,  even  to  the  bignefs  of  an  egg,”  as  in  the  Cardinal 
Gambara,  this  author,  according  to  his  general  cuftomf  does  not  relate  (/)  : 
nor  does  Hildanus  give  any  hints,  in  regard  to  the  inconveniencies  which 
were  felt  about  the  cheft  in  a  young  man  (#)  who  “  had  a  white  tubercle  in 


(P)  Epift.  43.  n.  17. 

(7)  Epift.  16.  n.  46. 

(r)  Eph.  N.  C.  Cent.  9.  Obf.  15. 


(.<)  n.  19.  in  fin. 

(/)  De  Re  Anat.  1.  15. 
(»)  Cent.  1.  Obf.  51. 


“  the 


Letter  XXVI.  Article  i .  793 

“  the  apex  of  the  heart,  to  the  bignefs  of  a  filbert;”  nor,  to  return  to  the 
Sepulchretum,  has  Rhodius  (a:)  mention’d  any  thing  elfe  in  a  man  who  had 
<c  a  follicle  in  the  right  auricle  of  the  heart,”  than  a  dropfy  *,  nor  Bartholin, 
any  thing  befides  a  wafting  of  flefli  in  an  ox  (y),  which  had  “  an  abfcefs  of 
“  the  bignefs  of  an  apple,”  that  adher’d  to  the  right  ventricle  of  the  heart, 
and  contain’d  a  ferum  within  two  follicles:  nor  has  Gantius(z)  mention’d 
any  thing  but  a  “  difficulty  of  breathing  with  a  fever,”  in  a  certain  man, 
who  had  “  many  excrefcences  ”  in  the  bafis  of  the  heart ;  and  amongft  thele 
one,  “  equal  in  bignefs  to  a  pigeon’s  egg,”  all  fluff’d  up  with  foft  matter. 
And  you  know  (<?),  that  when  I,  to  pafs  over  others  defignedly,  found  a  tu¬ 
bercle,  which  had  form’d  itfelf  in  the  heart  of  an  old  man,  I  was  well  in¬ 
form’d,  that  no  intermiffion  of  the  pulfe,  no  fwoonings,  no  palpitations,  nor 
any  lymptoms  at  all,  had  preceded,  from  whence  that  tubercle  could  have 
been  fuppos’d  to  exift.  For  which  reafon,  it  is  to  be  lefs  wonder’d  at  if  they 
are  at  any  time  feiz’d  with  fudden  deaths,  who  complain’d  of  no  inconveni¬ 
ence  preceding ;  fince  a  part  fo  neceffary  to  life,  the  heart  itfelf,  may,  fome- 
times,  without  any  particular  fymptoms  of  inconvenience  to  attend  it,  la¬ 
bour  under  a  diforder  of  fuch  a  kind,  that  by  the  increafe  of  it,  the  parietes 
of  the  heart  being  perforated,  the  life,  together  with  the  blood,  may  be  loft. 
On  the  fubjed  of  deaths  of  this  kind,  the  next  letter  will  turn.  Farewel. 


LETTER  the  TWENTY-SIXTH 

Treats  of  fudden  Death,  from  a  Diforder  of  the  fanguiferous 
VefTels,  efpecially  thofe  that  lie  in  the  Thorax. 


i.  A  LT HOUGH  fudden  deaths  feem  to  be  grown  more  frequent  than 
ufual  in  this  age,  yet  that  they  have  not  been  uncommon,  now  and 
then,  at  various  times,  in  Italy,  and  in  other  countries,  in  preceding  ages, 
I  have  demonftrated  to  you  in  a  former  letter  (a).  This  will  be  confirm’d, 
to  omit  Pliny  (£),  who  has  written  that  they  were  “  frequent and  although 
he  mention’d  many  himlelf,  has  even  inform’d  us,  “  that  Verrius  had  pro- 
“  duc’d  a  greater  number  of  inftances this,  I  fay,  will  be  confirm’d  by 
the  more  recent  examples  of  the  eleventh  fedion  of  the  Sepulchretum,  which 
is  entitled,  De  Morte  Repentina  ;  there,  in  particular,  where  you  will  either 
find  Bartholin  (c)  afferting,  that  in  the  year  1652,  “  in  the  beginning  of  the 


(x)  1.  3.  S.  21.  Obf.  3.  §  iS. 

(y)  1.  2-  S.  7.  Obf.  1 12. 

(2)  Ibid.  S.  1.  in  Addicam.  Obf.  z. 
(a)  Epift.  21.  n.  4. 

.  Vos,.  I. 


(/?)  Epift.  2.  n.  2.  &  feqq. 
{6)  Nat.  Hift.  1.  7.  c.  33. 
(c)  Obf.  24. 


Ll  month 


7  94  Book  II.  Of  Difeafes  of  the  Thorax. 

“  month  of  February,  by  reafon  of  the  uncertain  temperature  of  the  air, 

“  many  were  fuddenly  taken  off  in  the  city  of  Copenhagen,  by  an  unexpected 
“  death;”  or  where  Panarolus  (d)  informs  us,  “  that  in  the  year  1651,  a 
“  great  number  was  taken  off,  by  a  fudden  and  inftantaneous  death,  in  a 
“  Ihort  fpace  of  time,”  at  Rome.  To  thefe  add  Lancifi(e),  who  fhows  that 
the  fame  thing  had  happen’d  under  Alexander  the  leventh ;  that  is,  a  few 
years  after,  in  the  fame  place,  and  in  Tufcany  about  the  fame  time,  as  I 
fuppofe,  but  before,  that  is,  about  the  beginning  of  the  laff  age,  both  at 
Rome  and  at  Venice,  and  in  other  cities  alfo. 

2.  But  whenfoever,  and  wherefoever,  deaths  of  this  kind  have  happen’d,  I  da 
not  doubt  but  the  caufe  is  to  be  enquir’d  after  by  anatomifts,  either  in  the  brain 
and  nerves,  or  in  the  lungs  and  afpera  arteria,  or,  finally,  in  the  heart  and 
fanguiferous  veffels ;  and  Lancifi  has  before  fufficiently  demonftrated  the  fame 
thing,  in  the  excellent  books  which  he  publifh’d.  De  Subitaneis  Mortibus  (/). 
Since,  therefore,  that  caufe  has  been  already  enquir’d  after  by  me,  in  the 
two  firfh  of  thole  different  feats,  when  I  wrote  to  you  the  letters  upon  apo¬ 
plexy  and  upon  fuffocation  ;  it  will  remain  at  prefent  to  enquire  after  it  in 
the  third  feat,  that  is,  in  the  heart  and  the  fanguiferous  veffels,  and  parti¬ 
cularly  in  thofe  that  are  contain’d  in  the  thorax.  For  I  am  not  willing  to 
do  what  I  fee  is  frequently  done  in  this  feCtion  of  the  Sepulchretum,  1  mean, 
to  repeat  what  I  have  before  faid  of  apopleCtic  or  fuffocated  perfons  ;  nor  yet 
to  fpeak  of  thofe  who  have  died  fuddenly  from  a  peculiar  injury  of  any  of 
the  abdominal  vifcera,  before  I  begin  to  treat  of  the  difeafes  of  the  belly : 
although  the  proximate  caufe  of  this  kind  of  death  is  not  in  that  difeas’d 
vifcus,  but  by  means  of  the  nerves,  or  the  fanguiferous  veffels,  is  generally 
in  the  brain  and  the  heart.  That  is  to  fay,  in  this  vifcus  of  the  belly,  either 
the  nerves  are  fo  irritated  as  to  convulfe  the  mufcular  part  of  the  heart;  or 
the  meninges  of  the  brain,  or  the  veffels  are  fo  eroded,  that  the  blood  being 
extravafated,  a  proper  quantity  thereof  is  fuddenly  deficient  in  the  heart  and 
the  brain.  But  thefe  things  we  fhall  confider  in  their  proper  places. 

I  will  now  tell  you  what  caules  of  fudden  death  have  offer’d  themfelves  ' 
to  Valfalva,  and  to  me,  in  the  heart  and  the  neighbouring  veffels.  And 
under  the  term  of  fudden  death,  I  here  underftand  that  which,  whether  there 
is  any  previous  apprehenfion  of  it  or  not,  fnatches  a  perfon  away  fuddenly, 
contrary  to  his  own  expectation,  or  the  expectation  of  others,  at  that  time. 
Examples  of  which  kind  of  death,  from  the  diforder  either  of  the  heart,  or  the 
veffels  that  lie  near  it,  I  have  had  occafion  to  give  in  letter  the  feventeenth  (^), 
the  eighteenth  (h),  the  twenty-firft  (;),  the  twenty-fourth  (k),  and  the  twenty- 
fifth  (7).  But  now  take  the  greater  part  of  thofe  which  remain  :  and  firft, 
thefe  three  from  Valfalva,  that  relate  to  the  veffels ;  for  thofe  that  refer  to 
the  heart,  we  lhall  refer  to  the  next  letter. 

3.  A  man,  of  fifty  years  of  age,  who  had  been  us’d  to  fpit  blood  at  times, 
though  in  fmall  quantity,  and  lbmetimes  alfo  to  breathe  Ihort,  having  laid 


(-0  9-  . 

(<)  De  Subit.  Mort.  I.  2.  c.  3.  n.  7. 

(f)  1.  1.  c.  5.  n.  4.  &  c.  9.  &  feqq. 

(g)  n.  10.  17. 


( h\ )  n.  2.  8.  14.  zf. 
(0  n*  47- 

(i)  n.  ij. 

(/)  n.  2.  10.  12. 


hold 


) 


Letter  XXVI.  Articles  4,  6,  7,  S.  795 

hold  of  a  hammer  with  both  his  hands,  and  ftricken  fomething  or  other 
with  a  great  force,  and  for  a  long  time  together,  fell  down  fuddenly,  and 
with  one  or  two  words  call’d  out  for  help.  Soon  after,  having  loft  his  fpeech, 
and  breathing  with  great  difficulty,  and  having  his  face  very  pale,  he  died 
within  half  an  hour. 

The  left  cavity  of  the  thorax  was  found  quite  full  of  blood,  the  greater 
part  of  which  had  coagulated.  This  blood  had  burft  forth  from  the  great 
artery  that  was  eroded  at  the  part  where,  being  about  to  delcend  to  the  ver¬ 
tebras,  it  is  infledted.  For  in  that  place,  being  dilated  into  an  aneurifm,  it 
had  hollow’d  out  the  correfponding  vertebrae  •,  and  where  thefe  were  hollow’d 
out,  there  the  artery  feem’d  to  be  confum’d. 

4.  How  much  they  ought  to  avoid  any  exertion  of  their  ftrength,  in  whom 
there  is  a  dilatation  of  an  artery,  even  the  prefent  cafe  ihows.  For  an  exer¬ 
tion  of  ftrength  is  follow’d  by  an  encreas’d  impetus  of  the  blood,  by  which 
the  coats  of  the  arteries  being  extended,  or  in  part  eroded,  are  broken 
through.  And  although  this  happens  to  many  of  them  fpontaneoufly,  as  it 
did  to  that  young  man  of  whom  I  am  next  to  give  you  the  hiftory,  yet  to 
many  alfo  it  does  not  happen:  and  it  becomes  every  body  to  beware,  left  they 
themfelves  accelerate  that  death  which  otherwife  would  have  come  more 
(lowly. 

5.  A  young  man,  of  about  twenty- (even  years  of  age,  had  been  affiifted, 
already,  for  a  long  time  with  a  pulfatrng  kind  of  tumour  in  the  right  part  of 
the  thorax,  betwixt  the  third  and  the  fourth  rib  •,  in  which  tumour,  while  he 
turn’d  himfelf  from  one  fide  to  the  other,  he  felt  a  fluctuating  matter  that 
was  afted  upon  by  that  motion  :  in  the  mean  while,  he  had  been  often  feiz’d 
with  a  fhortnefs  of  breath  ;  which,  however,  in  a  fhort  time  after  a  vein  was 
open’d,  remitted.  One  day,  as  he  was  at  his  devotions,  he  fell  down  fudden¬ 
ly  ;  his  face  was  pale,  he  could  fearcely  fpeak  ;  he  foon  died. 

In  the  thorax  was  feen  a  large  aneurifm.  For  where  the  carotid  arteries 
came  off  from  the  aorta,  it  began;  and  extending  itfelf  to  the  fternum,  to 
which  it  then  ftrongly  adher’d,  fo  that  it  could  not  be  feparated  without  la¬ 
ceration  ;  it  was  alfo  produc’d  under  the  right  clavicle  to  the  third  and  fourth 
rib,  the  internal  furface  of  which  it  had  hollow’d  out,  and  had  render’d  rough 
and  unequal.  Finally,  it  came  within  the  pericardium,  where,  being  rup¬ 
tur’d,  it  had  fill’d  all  the  cavity  of  it  with  blood.  There  was  no  polypous 
concretion  in  the  heart. 

6.  But  the  great  artery  is  fometimes  eroded,  even  without  an  aneurifm,  and 
pours  out  its  blood,  as  the  next  very  fhort  hiftory  teaches. 

7.  A  certain  man  was  taken  off  by  a  fudden  death,  in  the  latter  end  of 
June,  in  the  year  1689.  Permiffion  being  obtain’d,  with  great  difficulty, 
from  the  relations  to  diffect  the  body,  the  aorta  was  found  to  be  ruptur’d 
where  it  was  neareft  to  the  heart;  and  the  pericardium  was  from  thence  quite 
full  of  coagulated  blood. 

8.  Do  not  be  furpriz’d  that  I  make  little  or  no  remarks  to  thefe  obferva- 
tions.  For  where  I  wrote  upon  the  fubjeCt  of  aneurifms,  I  interfpers’d  a  fuf- 
ficient  number  of  remarks  that  are  fuitable  to  the  prefent  occafion  ;■  and  thefe 
obfervations  are,  in  general,  pretty  clear  of  themfelves  ;  and  befides  thefe,  I 
have  a  confiderable  number,  which  are  not  very  fhort  neither,  to  fubjoin. 


7  9  6  Book  II.  Of  Difcafes  of  the  Thorax. 

And  that  they  may  correfpond,  as  far  as  poffible,  to  the  obfervations  of  Val- 
lalva,  already  propos’d,  I  will  begin  with  aneurifms  of  the  aorta. 

9.  A  man  who  had  been  too  much  given  to  the  exercife  of  tennis  and  the 
abufe  of  wine,  was,  in  confequence  of  both  thefe  irregularities,  feiz’d  with  a 
pain  of  the  right  arm,  and  foon  after  of  the  left,  join’d  with  a  fever.  After 
thefe  there  appear’d  a  tumour  on  the  upper  part  of  the  fternum,  like  a  large 
boil:  by  which  appearance  fome  vulgar  furgeons  being  deceiv’d,  and  either 
not  having  at  all  obferv’d,  or  having  negledted,  the  puliation,  applied  fuch 
things  as  are  generally  us’d  to  bring  thefe  tumours  to  fuppuration  ;  and  thefe 
applications  were  of  the  molt  violent  kind.  As  the  tumour  ftill  encreas’d, 
others  applied  emollient  medicines,  from  which  it  feem’d  to  them  to  be  di- 
minifh’d  ;  that  is,  from  the  fibres  being  rubb’d  with  ointments  and  relax’d ; 
whereas  they  had  been  before  greatly  irritated  by  the  applications.  But  as 
this  circumftance  related  rather  to  the  common  integuments,  than  to  the  tu¬ 
mour  itfelf,  or  to  the  coats  that  were  proper  thereto,  it  not  only  foon  re¬ 
cover’d  its  former  magnitude,  but  even  was,  plainly,  feen  to  encreafe  every 
day.  Wherefore,  when  the  patient  came  into  the  Hofpital  of  Incurables,  at 
Bologna,  which  was,  I  luppofe,  in  the  year  1704,  it  was  equal  in  fize  to  a 
quince ;  and  what  was  much  worfe,  it  began  to  exfude  blood  in  one  place  ; 
lo  that  the  man  himfelf  was  very  near  having  broken  through  the  fkin  (this 
being  reduc’d  to  the  utmoft  thinnefs  in  that  part,  and  he  being  quite  ignorant 
of  the  danger  which  was  at  hand)  when  he  began  to  pull  off  the  bandages, 
for  the  fake  of  fhowing  his  diforder.  But  this  circumftance  being  obferv’d, 
he  was  prevented  going  on,  and  order’d  to  keep  himfelf  ftill,  and  to  think 
ferioufly  and  pioufly  of  his  departure  from  this  mortal  life,  which  was  very  near 
at  hand,  and  inevitable.  And  this  really  happen’d  on  the  day  following,  from 
the  vaft  profufion  of  blood  that  had  been  foretold,  though  not  fo  foon  expedled 
by  the  patient.  Neverthelefs,  he  had  the  prefence  of  mind,  immediately  as 
he  felt  the  blood  gufhing  forth,  not  only  to  commend  himfelf  to  God,  but  to 
take  up  with  his  own  hands  a  bafon  that  lay  at  his  bed-fide  ;  and,  as  if  he  had 
been  receiving  the  blood  of  another  perlon,  put  it  beneath  the  gaping  tumour, 
while  the  attendants  immediately  ran  to  him  as  faft  as  poftible,  in  whofe  arms 
he  foon  after  expired. 

In  examining  the  body  before  I  difledled  it,  I  faw  that  there  was  no  longer 
any  tumour,  inafmuch  as  it  had  fubfided  after  the  blood,  by  which  it  had  been 
rais’d  up  externally,  had  been  difeharg’d.  The  fkin  was  there  broken  through, 
and  the  parts  that  lie  beneath  it  with  an  aperture,  which  admitted  two  fingers 
at  once.  The  membrana  adipofa  of  the  thorax  difeharg’d  a  water  during  the 
time  of  difiedtion,  with  which  fome  vefiels  were  alfo  turgid,  that  were  pro¬ 
minent,  here  and  there,  upon  the  furface  of  the  fkin  in  the  feet  andthe  legs. 
In  both  the  cavities  of  the  thorax,  alfo,  was  a  great  quantity  of  water,  of  a 
yellowifh  colour.  And  there  was  a  large  aneurifm,  into  which  the  anterior 
part  of  the  curvature  of  the  aorta  itfelf  being  expanded,  had  partly  confum’d 
the  upper  part  of  the  fternum,  the  extremities  of  the  clavicles  which  lie  upon 
it  and  the  neighbouring  ribs,  and  partly  had  made  them  difeas’d,  by  bring¬ 
ing  on  a  caries.  And  where  the  bones  had  been  confum’d  or  affedted  with 
the  caries,  there  not  the  leaft  traces  of  the  coats  of  the  artery  remain’d  :  to 
which,  in  other  places,  a  thick  fubftance  every  where  adher’d  internally,  re- 

fembling 


# 


Letter  XXVI.  Article  io.  797 

fcmbling  a  dry  and  lurid  kind  of  fle(h,  diftinguifh’d  with  fome  whitifh  points; 
and  this  fubftance  you  might  eafily  divide  into  many  membranes,  as  it  were, 
one  lying  upon  another,  quite  different  in  their  nature  from  thofe  coats  to 
which  they  adher’d,  as  they  were  evidently  polypous.  And  thefe  things  be¬ 
ing  accurately  attended  to,  nothing  occur’d  befides  that  was  worthy  of  re¬ 
mark. 

10.  The  deplorable  exit  of  this  man  teaches,  in  the  firfb  place,  how  much 
care  ought  to  be  taken  in  the  beginning,  that  an  internal  aneurifm  may  ob¬ 
tain  no  increale :  and  in  the  fecond  place,  if,  either  by  the  ignorance  of  the 
perfons  who  attempt  their  cure,  or  the  difobedience  of  the  patient,  or  only 
by  the  force  of  the  diforder  itfelf,  they  do  at  length  encreale,  fo  that  they 
are  only  cover’d  by  the  common  integuments  of  the  whole  body ;  that  then 
we  ought  to  take  care  left  the  bandages,  efpecially  when  they  are  already 
dried  to  the  part,  be  haftily  taken  off:  and  finally,  if  the  cafe  proceed  to 
fuch  an  extremity,  that  the  rupture  of  the  fkin  is  every  day  impending,  and 
bleeding,  either  on  account  of  the  conftitution  or  infirmity  of  the  patient,  or 
on  the  fcore  of  other  things  which  I  have  hinted  at  (m)  already,  is  dangerous; 
that  every  thing  is  to  be  previoufly  ftudied,  by  which,  for  fome  days  at 
lead,  life  may  be  prolong’d.  That  is  to  fay,  befides  the  greateft  tranquility 
of  body  and  of  mind,  and  the  greateft  abftinence  that  can  be  confiftently 
obferv’d,  fo  that  no  more  food  be  taken  than  is  barely  neceffary  for  the 
prefervation  of  life,  and  that  in  fmall  quantities,  and  of  fuch  a  quality  as 
is  by  no  means  ftimulating ;  befides  that  fituation  of  body,  by  which  the 
weight  of  the  blood  being  leffen’d,  does  not  prefs  upon  the  fkin,  and  other 
things  of  the  like  kind  ;  l'omething  ought  to  be  thought  of  by  the  furgeon, 
by  way  of  defence  ;  as,  for  inftance,  if  the  bladder  of  an  ox,  four  times 
doubl’d,  were  applied,  or  a  bandage  of  foft  leather ;  and  the  edges  of  this, 
bandage  were  all  daub’d  over  with  a  medicine,  by  which  they  would  be  firm¬ 
ly  glued  down  to  the  neighbouring  fkin  that  lay  around  the  tumour,  and 
was  as  yet  found  and  entire.  But  you  will  judge  better  of  thefe  things  ;  for 
as  to  me,  carried  away  with  a  defire  of  preferving  a  man’s  life,  though  but 
for  one  fhort  hour,  I  perhaps  talk  foolilhly.  As  to  (height  bandages,  and 
plates  of  elaftic  (feel  or  the  like,  I  fay  nothing  of  them  ;  not  fo  much  on  ac¬ 
count  of  thofe  things  which  Lancifi(«)  has  obferv’d,  of  the  molt  confiderable 
injuries  being  brought  on  by  them  in  procefs  of  time;  for  the  queftion  is  not 
at  prefent  how  the  patient  may  live  the  longelt  time  he  poffibly  can,  but 
only  how  to  prevent  his  dying  immediately;  as  on  account  of  the  fkin  being 
extenuated,  in  which  cafe  all  preffure  is  dangerous.  However,  in  regard  tO’ 
the  three  patients  who  may  be  compar’d  with  this  that  we  have  defcrib’d, 
and  who  were  difiedted  by  Wagnerus  (0),.  by  Lafagius(p),  and  Lentilius  (q), 
you  may  fee  what  was  applied  in  the  laft,  in  order  to  retard  the  torrent  of 
blood;  although  in  the  fecond  only,  nothing  now  remain’d  but  the  attenu¬ 
ated  (kin  to  be  broken  through  by  the  impetus  of  the  blood  ;  for  which  rea- 
fon  the  event  was  the  fame  in  him  as  in  this  man  of  mine ;  fo  that  as  foon  as. 

(«)  EpiiE  17.  n.  31.  &  feq. 

( n )  De  Aneuryfm.  Propof.  38'. 

\o)  Eph.  N.  C.  Dec.  3.  A.  5.  Obf.  179. 


t 


{p)  Aft.  Erud.  Lipf.  Suppi.  T.  3.  S.  9. 
(y)  Eph.  N.  Cent;  1.  Obf.  96, 


the* 


798  Of  Difeafes  of  the  Thorax.  Book  II. 

the  tumour  began  to  be  ruptur’d,  at  the  fame  time  a  vaft  haemorrhage  and 
death  were  brought  on. 

As  to  what  remains,  this  example  of  mine,  of  a  very  fpeedy  death,  from 
the  burfting  of  an  aneurifm  externally  •,  although  I  confefs  that  it  does  not  fo 
immediately  belong  to  our  prefent  defign,  becaufe  that  cannot  be  call’d  Hid¬ 
den,  which  was  evidently  known  to  be  at  hand,  and  foretold ;  1  neverthelefs 
produc’d  here,  in  order  to  lay  before  your  eyes  a  kind  of  picture,  as  it  were, 
of  the  internal  rupture  of  an  aneurifm.  For  when  the  coats  of  the  artery  are 
extenuated,  juft  as  we  have  feen  in  t’nefkin,  it  muft  of  courfe  happen  that  an 
aperture  is  made,  and  that  the  blood  is  pour’d  out  in  the  fame  manner  that  I 
have  defcrib’d  to  you  formerly  (r),  in  a  woman,  from  my  own  obfervation  ;: 
and  as  I  fhall  defcribe  to  you  now,  in  a  man,  from  an  obfervation,  which ; 
being  taken  in  the  latter  end  of  November,  in  the  year]  708,  by  the  very 
accurate  Sandtorini,  he  communicated  to  me  the  day  following,  when  he 
was  returning  to  Venice  together  with  me. 

11.  A  robuft  young  man,  who  had  been  us’d  to  live  on  board  of  the 
gallies,  being  fubjeCt  to  a  diforder  which  perfons  among  the  Venetians,  who 
are  not  acquainted  with  phy.fical  matters,  call  flato-,  fuppofing  it  to  be 
from  wind,  notwithftanding  it  is  frequently  join’d  with  fome  internal  and 
organic  diforder ;  was  feiz’d  with  a  difficulty  of  breathing  after  any  violent 
motion.  Two  other  things  were  alfo  obfcrv’d  by  his  companions  ;  the  one, 
that  he  was  accuftom’d  to  become  immoderately  fleepy  after  food  ;  and  die 
other,  that  he  us’d  frequently  to  apply  both  of  his  hands  to  his  loins,  arid 
rub  them  ftrongly  downwards,  as  if  he  felt  fome  uneafinefs  in  that  place, 
which  was  alleviated  by  thefe  frictions.  This  man  died  fuddenly,  as  he  was 
fitting  by  the  fire-fide,  in  a  houfe  of  ill  fame.  His  body  being  examin’d,  of 
which  neither  the  legs  or  the  belly  appear’d  fwell’d,  and  this  c'avity  being 
open’d,  the  diaphragm  was  found  to  be  deprefs’d.  The  right  cavity  of  the 
thorax  contain’d  a  great  quantity  of  extravafated  blood.  This  had  iffu’d 
forth  from  the  great  artery ;  which  being  now  very  near  to  the  diaphragm, 
had  there  dilated  its  own  trunk  into  an  aneurifm  of  the  bignefs  of  a  fift.  And 
this  aneurifm,  being  fill’d  with  polypous  and  with  membranous  concretions, 
as  it  were,  was  ruptur’d  quite  through  on  the  right  fide1";  and  on  the  left  fide 
had  fo  injur’d  the  bodies  of  the  neighbouring  vertebrae,  that  a  large  bony 
fcale  was  drawn  off  from  them  without  the  lead  difficulty.  However,  there 
was  no  edification  in  the  aorta.  The  heart  was  very  hard,  and  contracted 
into  itfelf. 

12.  That  the  heart  may  be  convuls’d,  is  already  faid  in  the  former  letter  (j). 
An  example  of  which  kind  you  have,  unlefs  I  ami  deceiv’d,  in  this  young 
man,  but  to  be  attributed  to  another  caufe.  However,  that  after  food  he  be¬ 
came  more  fleepy  than  others,  feems  to  be  owing  to  the  aneurifm,  and  to  the 
diftenfion  of  the  ftomach  ;  which  although  at  that  time  it  turn  its  fundus  for¬ 
wards,  yet  in  proportion  as  it  occupies  morb  fpace  itfelf,  fo  much  the  lei’s,  how- 
muchfoever  the  abdomen  may  yield,  it  leaves  to  the  other  vifeera  of  the  belly  ; 
fo  that  the  fanguiferous  veffels  being  there  comprefs’d,  the  blood  is  carried  to 
the  brain,  to  which  the  paffage  is  more  free  and  eafy.  If,  therefore,  from 

(r)  Epift,  21.  r.  47.  (;)  n.  13. 


4 


this 


Letter  XXVI.  Article  13.  799 

this  caufe  others  become  more  prone  to  fleep,  this  young  man  was  fo  much 
the  more  prone  thereto,  from  the  fame  caufe,  as  by  reafon  of  the  aneurifm 
being  fituated  in  that  place,  the  courfe  of  the  blood  downwards  was  (till  more 
obftruded.  The  other  circumftances  of  this  hiftory  it  is  eafy  to  explain  ;  and 
among  thefe,  the  rupture  of  the  aneurifm  being  brought  on,  particularly,  in 
that  houfe,  where,  perhaps,  he  did  not  fit  by  the  fire  when  it  happen’d. 
Without  doubt,  many  things  are  very  often  forg’d  by  the  women  and  the 
friends  of  the  patient,  for  the  fake  of  making  the  affair  feem  more  decent. 
See  what  Lancifi  (/)  has  fufpeded,  in  regard  to  the  fudden  death  of  another 
young  man,  in  a  fimilar  place.  He  was  alfo  laid  to  have  come  “  near  the 
“  fire,  for  the  fake  of  warming  himfelf.”  What  if  it  was  that  fire  of  which 
Parmeno,  in  Terence  («),  if  I  rightly  remember,  fays, 

Accede  ad  ignem  hunc  ;  jam  calefces  pius  fatis. 

Come  near  to  this  fire,  and  you  will  be  abundantly  warm’d. 

But  the  Deity,  neverthelefs,  who  is  the  avenger  of  fin,  does  not  always 
fuffer  it  to  be  conceal’d,  how  he  punifhes  in  the  crime,  by  the  crime  itfelf. 
Which  might  be  eafily  underftood  in  the  cafe  of  that  foldier,  whofe 
“  fudden  death  happening  in  ”  cejlu  venereo ,  “  with  a  horrible  clamour  and 
“  tolling  of  the  body,”  is  related  by  the  celebrated  man  Chriftian  Vater  (x) ; 
and  that  from  an  eruption  of  blood  into  the  pericardium,  without  doubt  from 
forne  pretty  large  vein  (jy),  it  there  really  was  no  “  rupture  of  the  heart,  or 
“  auricle.”  But  it  is  ftill  more  clear  in  that  dreadful  cafe,  which  the  fol¬ 
lowing  hiftory  will  inform  you  of. 

13.  A  ftrumpet  of  eight-and-twenty  years  of  age,  of  a  lean  habit,  having 
complain’d  for  fome  months,  and  particularly  for  the  laft  fifteen  days,  of  a 
certain  laflitude,  and  a  loathing  of  food,  and  almoft  of  every  thing,  for  this 
reafon  made  lefs  ufe  of  other  aliments,  and  more  of  unmix’d  wine ;  to  the  ufe 
of  which  Hie  had  been  always  too  much  addided.  A  certain  debauchee 
having  gone  into  the  houfe  to  her,  and  after  a  little  time  having  come  out, 
with  a  confus’d  and  difturb’d  countenance,  and  (he  not  having  appear’d  for 
two  or  three  hours  after,  the  neighbours,  who  had  obferv’d  thefe  things, 
entering  in,  found  her  not  only  dead  but  cold ;  lying  in  bed  with  luch  a 
pofture  of  body,  that  it  could  not  be  doubted  what  bufinefs  fne  had  been 
about  when  fhe  died,  efpecially  as  the  femen  virile  was  feen  to  have  flow’d 
down  from  the  organs  of  generation.  I  was,  therefore,  afk’d,  whether  I  de- 
fir’d  to  have  the  genitals  or  not  ?  and  whether  I  would  have  the  other  vifcera 
alfo  ?  I  anfwer’d,  that  I  fliould  be  glad  of  both ;  not  that  I  expeded  to  fee 
any  thing  particular  in  the  organs  of  generation,  now  that  the  femen  had 
flow’d  out,  but  that  I  wifh’d  to  take  frefii  notice  of  fome  things  which  I  had 
often  obferv’d  *,  for  I  conjedur’d,  as  I  then  faid,  that  the  caufe  of  this  fudden 
death  would  certainly  be  found  to  confift  in  the  rupture  of  fome  large  veffel. 
It  was  at  this  time  extremely  hot,  it  being  June  of  the  year  1725  *,  nor  were 
we  allow’d  to  diffed  the  body  till  about  the  latter  end  of  the  following  day. 
For  which  reafon,  changing  my  defign,  I  fent  my  friend  Mediavia  to  ex- 

(r)  De  Subit.  Mort.  Obf.  Pbyf.  Anat.  z.  (*)  Epb.  N.  C.  Dec.  3.  A.  9.  Obf.  163. 

$*0  Eunuch.  Aft.  1.  Sc.  2,  (y)  Vid.  infra,  n.  26.  &  27. 


amine 


8oo  Book  II.  Of  Difeafes  of  the  Thorax. 

amine  all  the  parts  •,  and  to  take  care  to  bring  home  the  principal  of  them 
only  to  me. 

The  neck  was  livid  under  the  chin,  yet  without  any  marks  of  force  having 
been  externally  applied.  The  back  was  alio  fomewhat  livid.  The  abdomen 
was  tenlc,  and  did  not  fhew  any  mark  of  the  woman’s  having  ever  been 
pregnant.  The  uterus  being  taken  away,  the  fmall  inteftines  appear’d  very 
red.  The  large  inteftines,  and  elpecially  the  lower  ones,  were  full  of  ex¬ 
crements  :  the  ftomach  was  very  large,  although  almoft  empty.  There  was 
ferum  extravafated  in  the  belly,  to  about  the  quantity  of  a  pint,  not  unlike 
turbid  water  in  which  frefh  meat  had  been  walh’d  ;  and  fo  acrid,  that  it  af- 
fedted  the  extremities  of  the  fingers  with  the  fenie  of  a  kind  of  heat.  In  the 
thorax,  the  lungs  were  fo  far  of  their  natural  colour,  that  they  were  not  black 
even  on  the  pofterior  part.  But  the  pericardium  was  fo  diftended,  that  no 
fooner  was  a  little  wound  made  into  it,  but  a  ferum  burft  forth,  of  the  lame 
'nature  with  that  which  had  been  feen  in  the  belly.  Yet  ftill  a  great  quan¬ 
tity  remain’d,  and  under  it  a  black  and  firmly-concreted  blood  cover’d  the 
furface  of  the  heart.  Which  being  brought  to  me  on  the  following  day,  in 
the  morning,  together  with  the  large  vefiels  and  the  genitals,  I  obferv’d,  be¬ 
fore  I  cut  into  them,  that  neither  the  heart  itfelf,  nor  the  trunk  of  the  great 
.artery,  was  dilated  ;  and  even  that  both  of  them,  by  their  fmallnels,  cor- 
refponded  very  well  with  the  ftature  of  the  woman,  which  they  faid  had  been 
rather  fmall.  Being  then  about  to  lay  open  that  artery  from  the  inferior  ex¬ 
tremity,  which  was  at  the  feptum  tranfverfum,  and  having  feen  that  one  fide 
of  it,  not  much  higher,  was  black  to  the  extent  of  five  or  fix  fingers  breadth ; 
J  found  that  this  was  owing  merely  to  the  effufion  of  blood  into  the  cells  of 
the  external  coat ;  for  the  other  parts  were  quite  in  their  natural  ftate.  But 
■an  internal  difeafe  began  from  the  left  extremity  of  the  curvature  of  the  aorta, 
.and  going  from  thence  quite  to  the  heart,  became  fo  much  the  larger  in  pro¬ 
portion  as  the  artery  came  nearer  to  the  heart.  That  is  to  fay,  in  fome  places 
whidffi  marks  of  a  future  oflification  occurr’d ;  in  others,  fome  fmall  foramina, 
as  it  were,  had  begun  to  be  form’d  ;  and  in  ftill  other  places  were  parallel 
furrows,  drawn  longitudinally :  and  in  this  manner  was  the  furface  of  the  ar¬ 
tery  unequal  here  and  there.  But  when  I  came  near  to  the  femilunar  valves, 
■which  feem’d  to  be  lank  and  contra&ed,  at  the  diftance  of  half  an  inch  above 
that  which  lies  on  the  back-part,  was  an  orifice  that  would  have  admitted  the 
end  of  a  man’s  thumb,  by  means  of  which  the  aorta  communicated  with  a 
roundilh  aneurilm,  that  hung  to  it  in  the  form  of  a  facculus.  This  facculus 
exceeded  the  fize  of  a  walnut  before  it  is  ftripp’d  of  its  green  coat;  and  was 
fo  plac’d  at  the  back  of  the  aorta,  that,  as  it  inclin’d  a  little  to  the  left  fide, 
it  feem’d  that  it  could  not  happen  otherwife,  but  it  muft  have  obftru&ed  the 
offices  of  the  left  auricle,  or  the  adjoining  finus.  And  it  had  been  ruptur’d 
in  the  upper  part  by  the  blood  flowing  from  thence  into  the  pericardium 
through  a  fmall  foramen,  the  edges  of  which  were  lacerated  and  black.  The 
internal  furface  of  the  facculus  was  invefted  with  red  and  polypous  pellicles, 
which,  like  the  texture  of  an  onion,  you  might  divide  into  as  many  ftrata  or 
lamina  as  you  pleas’d.  But  in  the  auricles  and  the  ventricles  of  the  heart, 
neither  was  there  any  polypous  concretion,  nor  did  the  leaft  quantity  of  blood 
remain. 

Having 


Letter  XXVI.  Article  14.  801 

Having  found  thefe  appearances,  I  turn’d  my  eyes  and  knife  to  the  uterus, 
the  ovaria,  and  the  tubes.  One  of  the  tubes  had  the  extremity  of  it  grown 
into  one  fubftance  with  one  of  the  extremities  of  the  ovarium.  And  the  ex¬ 
tremities  of  both  tubes  were  quite  fiiut  up  ;  fo  that  no  orifice,  nor  fimbrice, 
any  where  appear’d.  But  as  both  the  tubes  were  fomewhat  wider  than  ufual 
at  that  part,  they  fhew’d,  when  cut  into,  even  fomewhat  more  than  ufual  of 
that  humour  which  belongs  to  it,  and  which  has  been  by  fome  taken  for  the 
femen  virile  ;  but  this  iffu’d  forth  in  a  very  thick  ftate,  and  in  the  end  was 
even  fomewhat  bloody.  That  ovarium,  to  which  I  faid  that  the  tube  was  at¬ 
tach’d  fo  as  to  form  one  fubftance  with  it,  contain’d  a  great  number  of  veficles, 
and  thofe  of  a  pretty  large  fize.  And  although  both  of  them  were  fomewhat 
round,  fmooth,  juicy,  and  turgid  ;  one  of  them  was,  however,  rather  en¬ 
larg’d,  becaufe,  befides  veficles  of  that  kind,  it  had,  on  one  fide,  under  the 
very  membrane  of  it,  a  black  and  almoft  coagulated  blood,  the  quantity  of 
which  was,  in  proportion  to  the  bulk  of  the  ovarium,  not  inconfiderable. 

Finally,  in  the  uterus  was  nothing  worthy  of  obfervation,  except  that  the 
interior  furface  of  it  only  was  of  a  brown  colour,  mix’d  with  red,  and  that 
univerfally,  even  to  the  internal  borders  of  the  os  uteri.  This  aperture  was 
narrow ;  but  disfigur’d  with  a  kind  of  white  and  thickifh  humour,  which,  as 
it  was  not  only  unlike  the  femen  virile,  but  alfo  unlike  that  mucus  which  is 
generally  found  there  in  the  natural  ftate  of  the  parts,  gave  us  a  fufpicion  of 
fome  kind  of  fluor  under  which  this  woman  had  labour’d. 

14.  They  who  contend  that  the  male  femen  reaches  quite  to  the  tubes  of 
the  woman,  carried  away  by  a  fimilitude  which  has  not  only  impos’d  on  “  good 
“  phyficians,”  as  Hippocrates  fays  (z),  but  alfo  fometimes  impofes  upon  ana- 
tomifts ;  would  fuppofe,  on  this  occafion,  that  the  whole  of  the  femen  had  not 
flow’d  out  of  the  pudendum  of  this  woman.  For  me,  however,  whofe  in¬ 
tention  it  is  not  by  any  means  to  call  into  queftion  what  the  greateft  anatomifts 
teftify  that  they  have  fometimes  feen,  but  what  fome  others  determine  to 
be  the  more  frequent  and  the  more  certain  *,  it  is  fufficient  to  have  related 
what  I  had  mylelf  obferv’d.  But  although  Donatus  (a)  has  collected  many 
examples  of  thofe  who  died  fuddenly  in  the  a6t  of  venery,  yet  he  has  not 
taken  notice  of  all  that  he  had  it  in  his  power  to  take  notice  of ;  fince  Pliny 
alone,  in  that  very  place  which  he  quotes  (&),  has  not  produc’d  two  only,  but 
four. 

Yet  amongft  thefe  he  has  produc’d  no  example  of  a  woman,  if  you  except 
thofe  who  had  been  kill’d  by  debauching  with  an  unfufferable  multitude  of 
men  at  one  time.  Nor  has  Schurigius  (7),  although  he  colledted  all  the 
examples  of  deaths  of  this  kind  from  every  author,  found  any  example  that 
relates  to  women,  two  inftances  excepted,  which  not  the  hiftories  of  phyficians, 
but  certain  inferiptions  have  fupplied  ;  and  whether  thefe  were  genuine  or 
forg’d,  neither  he,  nor  thofe  from  whom  he  copied  them,  have  enquir’d.  And 
although  Valerius  Maximus  (d)  fays,  that  thofe  perfons  who  have  died  thus, 
have  not  died  “  by  reafon  of  their  own  luft,  but  merely  from  the  frailty  of 

( z )  Epidem.  1.  6.  verf.  fin.  (<•)  Spermatolog.  c.  5. 

(«)  De  Med.  Hift.  Mirab.  1.  4.  c.  17.  (V)  Fa&.  ac  Did.  memorab.  1.  9.  c.  12. 

(^)  Nat.  Hift.  1.  7.  c.  53. 

Voi.  I.  5  K 


*4  human 


2  0  2  Book  II.  Of  Difeafes  of  the  Thorax. 

“  human  nature;  for  that  the  termination  of  our  life  being  expos’d  to  various 
“  and  occult  caufes,  this  event  is  frequently  attributed  to  caufes  which  are 

by  no  means  acceffary  to  it,  as  they  rather  happen  at  the  time  of  death, 
<l  than  give  occafion  to  it  of  themfelves  ;”  yet  diffedtion,  and  reafon  alfo, 
fufficiently  demonftrate  how  much  the  indulgence  of  venery,  added  to  thofe 
caufes,  accelerates  death,  by  exciting  the  circulation  of  the  blood,  and  by 
bringing  on  a  rupture  of  occult  aneurifms,  or  even  by  burfting  fome  weak 
veffels  within  the  cranium  :  which,  without  .this  or  fome  other  fimilar  caufe, 
would  have  continu’d  to  do  their  offices  much  longer,  and  perhaps  even  to 
old  age,  as  had  happen’d  in  that  man  in  whom  I  obferv’d  what  I  (hall  imme¬ 
diately  fubjoin,  and  whom  I  diffedted  in  the  college  the  year  before  I  differed; 
that  ftrumpet. 

15.  A  fat  old  man,  of  about  fixty  years  of  age,  had  died  fuddenly  of  an 
apoplexy,  as  was  fuppos’d  by  thofe  who  had  known  him  to  labour  under  a 
tremor.  The  pericardium,  according  to  the  account  brought  to  me,  (for  I 
did  not  difiedt  this,  though  I  did  the  other  parts)  was  diftended  with  as  great 
a  quantity  of  blood  as  two  glals  veffiels,  in  which  the  blood  taken  from  a  vein 
is  generally  receiv’d,  would  contain.  The  heart  was  enlarg’d,  and  the  great 
artery  dilated  above  the  heart;  and  even  in  its  whole  curvature  wasdiftinr 
guiffi’d,  on  the  internal  furface,  with  bony  fcales,  fome  of  which  kind  were 
alfo  found  in  the  arteries  of  the  limbs.  From  the  fame  furface,  not  at  a  great 
diftance  from  the  heart,  a  foramen  big  enough  to  admit  a  finger  took  its  origin  ; 
and  going  on  through  the  coats  in  an  oblique  courfe  of  almoft  four  fingers 
breadth,  from  below  upwards,  it  at  length  open’d  on  the  external  furface  of. 
the  artery  within  the  pericardium.  And  by  this  pafiage  the  blood  had  been, 
difcharg’d  into  that  cavity. 

1 6.  Although  it  does  not  certainly  appear  at  what  time  the  aneurifm  began 
in  this  man,  yet  it  is  mod  probable  that  it  had  begun  at  the  fame  time  of 
life  in  which  moil  others  begin.  At  leaft,  thofe  difeafes  of  the  artery  that  I 
have  defcrib’d  do  not  feem  likely  to  have  happen’d  within  a  ffiort  fpace  of 
time.  Difeafes  fimilar  to  thefe  were  difcover’d  by  their  proper  marks,  for  two. 
or  three  years  before  death,  in  a  woman  whofe  fimilar  exit  from  this  life  I 
ffiall  immediately  relate. 

17.  A  woman,  of  a  fat  habit  of  body,  of  fifty  years  of  age,  of  a  fober 
difpofition,  and  naturally  rather  inclin’d  to  fadnefs  and  taciturnity;  who  had 
already  been  fourteen  years  a  widow,  being  fubjedt  to  no  difeafe,  except  that 
for  the  laft  two  or  three  years,  that  is,  ever  fince  her  menfes  had  been  leaving 
her,  fire  had  been  every  now  and  then  troubl’d  with  a  kind  of  wind,  as  ffie 
call’d  it,  about  the  heart  and  its  neighbourhood  ;  having  rifen  early  in  the 
morning  to  her  work,  for  ffie  was  by  trade  a  weaver,  and  having  got  every 
thing  in  readinefs  that  is  neceffary  to  begin  a  new  piece  of  work,  cried  out 
Oh  !  and  fpoke  not  another  word,  but  died  inftantly,  as  ffie  lean’d  with  her 
arms  on  the  beam.  It  was  the  fame  month  of  the  year  1729,  in  which,  as  I 
formerly  wrote  to  you  (<?),  fo  many  others  in  this  city  were  taken  off  by  a, 
fudden  death ;  wherefore,  although  this  woman  died  in  the  country,  in  that 
part  which  is  call’d  Pons  Medoaci,  taking  its  name  from  our  neighbouring 

(e)  Epift.  3.  n.  11,. 

6  v  river. 


Letter  XXVI.  Article  17.  803 

river,  yet  thither  the  phyfician  and  furgeon  whole  bulinefs  it  was,  were  Tent 
to  difledl  the  body. 

The  neck  and  arms  were  rigid ;  fo  that  they  could  not  be  bent  without 
force.  The  cranium  being  cut  open,  a  great  quantity  of  blood  immediately 
flow’d  out  j  and  it  feem’d  to  them  that  fome  veflel  betwixt  the  cerebrum  and 
cerebellum  was  ruptur’d.  This,  however,  was  more  certain,  that  when  they 
examin’d  the  thorax,  the  pericardium  was  fo  extremely  diftended,  that  when 
they  made  a  pundture  into  it,  a  bloody  ferum  rulh’d  out.  And  the  remaining 
part  of  the  blood  adher’d  about  the  heart  in  a  coagulated  ftate,  like  a  pretty 
thick  bark  Nor  did  they  only  relate  thefe  things  but  they  brought  the  he  art, 
with  the  veflels  annex’d  to  it,  in  an  untouch’d  ftate,  with  them,  that  I  might 
examine  them  accurately.  And  this  I  did  on  the  day  after,  while  the  fame 
perfons  and  others  aflifted  ;  and  I  found  the  parts  in  the  following  ftate  :  The 
heart  was  fmail,  but,  neverthelefs,  furnilh’d  with  fat,  of  a  healthy  apearance, 
and,  as  far  as  relates  to  the  left  ventricle,  with  pretty  thick  parietes.  There 
was  no  blood  in  that  or  iir  the  other  cavities,  nor  any  in  the  large  veflels  •,  I  do 
not  fay  fluid  blood,  but  even  not  coagulated,  and  (till  lefs  polypous.  All 
the  other  parts  of  the  heart  were  found,  if  you  except  the  borders  of  the 
valves  that  are  call’d  tricufpides  and  mitrales,  inafmuch  as  they  were  univer- 
fally  diftinguifh’d  by  a  fmail,  roundifli,  and  fiefhy  kind  of  tubercles,  refembling 
glands.  But  thefe  appearances  are,  certainly,  not  rare ;  and,  indeed,  have 
been  already  deferib’d  to  you  in  many  bodies.  This,  then,  being  the  ftate  of 
the  heart,  and  nothing  being  found  to  exift  that  was  preternatural  in  the  other 
veflels  which  are  annex’d  to  it,  the  great  artery  was  the  only  one  that  remain’d 
to  be  examin’d.  Having,  therefore,  open’d  that  tradt  of  it  which  was  fix’d 
to  the  vertebrae  of  the  thorax,  and  having  firft  obferv’d  a  whitifti  fpot,  and 
in  the  next  place,  at  a  long  interval  above  this,  another  of  a  larger  fize,  and 
of  a  yellowilh  colour,  the  marks  of  a  future  oflification  ;  I  in  like  manner 
faw,  internally,  an  oblong,  but  fmail  prominence,  where  the  artery  began  to 
defeend,  form’d  of  the  natural  fubftance  of  the  artery,  but  itfelf  by  no  means 
natural. 

After  this,  before  I  continu’d  to  open  it  farther,  I  obferv’d  that  the  ar¬ 
tery  was,  from  that  part  whence  it  fends  oft'  the  left  carotid,  almoft  quite 
to  the  heart,  much  wider  than  it  ought  naturally  to  be.  But  foon  after, 
having  laid  it  quite  open,  I  faw,  in  the  whole  of  this  large  extent,  which  I 
faid  was  dilated,  that  the  artery  was  internally  rough  and  unequal,  by  rea- 
fon  of  rigid  and  hard  bony  lamellae  which  were  fo  thickly  fprinlded,  and 
in  fo  great  a  number,  as  fcarcely  to  leave  fome  very  fmail  intervals  betv/ixt 
them.  And  as,  in  thele  intervals,  the  internal  coats  of  the  artery  were  per¬ 
ceiv’d  to  be  corroded  and  attenuated  by  a  kind  of  ulceration ;  it  was  fur- 
prizing  that  what  any  one  would  fuppofe  might  have  happen’d,  in  fo  many 
other  places  before,  ihould  at  length  only  have  happen’d  in  one  place,  and 
that  at  the  pofterior  part  of  the  tube,  and  fomewhat  to  the  left.  That  is  to 
fay,  the  blood  had,  by  degrees,  made  itfelf  a  way  through  one  of  the  inter¬ 
vals  of  this  kind,  and  had  come  out  under  the  external  coat  of  the  ar¬ 
tery  ;  and  firft  by  drawing  it  from  the  internal  coats,  and  then  by  raiftng  it, 
as  a  large  kind  of  ecchymofis,  wdiich  itfelf  had  form’d,  by  coagulating  there, 
demonftrated  to  us ;  and  finally,  by  diftending  it  more  and  more,  had  burft 

5  K  2  through 


804  Book  II.  Of  Difeafes  of  the  Thorax. 

through  this  external  coat  in  one  place,  and  had  pour’d  itfelf  out  within  the 
pericardium.  However,  thofe  branches  which  went  to  the  head  and  the  Ihoul- 
ders,  notwithdanding  they  came  from  fo  difeas’d  a  flock,  were  all  of  them, 
as  far  as  I  could  conje&ure  from  the  parts  of  them  which  were  annex’d,  en¬ 
tirely  found. 

18.  In  regard  to  the  bony  lamellae,  and  the  ulceration  of  the  aorta,  that 
attended  them,  I  fhall  enquire  into  thefe  in  the  next  letter,  to  which,  for 
this  reafon,  I  defer  a  fingular  obfervation,  that  otherwife  belong’d  to  this 
place  (*),  which  is  an  obfervation  communicated  to  me  by  a  celebrated  man, 
of  a  fudden  death  from  blood  having  fall’n  into  the  pericardium  through  a 
foramen  of  the  great  artery,  which  was  much  difeas’d.  But  you,  in  the 
mean  while,  wonder  that  thofe  deaths  fhould  be  fo  fudden  (/),  from  no 
greater  a  quantity  of  blood  being  extravafated  than  the  pericardium  can  con¬ 
tain  :  the  capacity  of  which  is  fo  defin’d  by  Boerhaave  (g),  as  to  be  twice 
as  big  as  the  heart  •,  and  by  Fantonus  ( h ),  that  befides  the  heart,  it  can  re¬ 
ceive  “  almofl  two  pints  ”  of  water.  And  if  we  fuppofe  it  to  be,  not  only 
fill’d,  as  they  have  fuppos’d,  but  alfo  didended,  as  is  fhown  in  the  women 
that  I  have  defcrib’d  (z),  by  the  ferum  iffuing  forth  with  fuch  an  impetus  ; 
and  if  we  even  fuppofe  it  to  be  relax’d  befides,  as  in  the  old  man  ( k\  fo  far 
as  to  be  able  to  contain  the  quantity  of  blood  they  related ;  yet  we  ought 
not  to  forget,  you  will  fay,  how  much  a  greater  quantity  of  blood,  beyond 
any  comparifon,  fometimes  comes  forth  in  haemorrhages  within  twelve  or 
fifteen  hours,  as  Littre  teftifies  (/),  without  bringing  on  death  j  not  to  men¬ 
tion  the  ancient  examples  which  are  extant  in  Schenck  (z?z),  of  twenty  pounds 
of  blood  being  difcharg’d  within  five  days,  and  even  within  one  day  and  two 
nights  ;  or  of  forty  pounds  flowing  within  fix  days  from  the  nodrils,  or  of 
twenty-five  within  three  days  from  the  uterus,  without  the  lives  of  the  pa¬ 
tients  being  deftroy’d  thereby  :  and  that  women,  in  particular,  have  in  ge¬ 
neral  more  blood,  and  more  eafily  bear  evacuations  of  this  kind,  does  not 
feem  at  all  doubtful :  and  as  things  are  to  be  confider’d  in  this  view,  it 
feems  probable,  that  the  woman  of  whom  I  fpoke  lad,  was,  perhaps,  taken 
off  by  an  apoplexy,  rather  than  by  the  rupture  of  that  aneurifm. 

If  you  fay  thus,  I  fhall  beg  of  you,  in  the  fil'd  place,  to  attend  to  the  dif¬ 
ference  that  there  is,  betwixt  a  large  quantity  of  blood  being  difcharg’d  at 
once,  and  a  far  greater  quantity  being  difcharg’d  in  the  courfe  of  many  hours 
and  days  -,  and  in  the  next  place,  betwixt  blood  flowing  from  the  very 
trunk  of  the  aorta,  near  its  origin,  and  that  which  flows  from  the  didant 
branches  of  it  j  and,  finally,  betwixt  that  which  is  difcharg’d  within  the  pe¬ 
ricardium,  and  on  the  outfide  of  the  body.  And  the  fird  difference  will  (how 
you,  that  in  this  cafe  there  is  not  fufficient  time  for  the  veffeis  to  contrail 
themfelves  about  the  remaining  quantity  of  blood  ;  nor  yet  for  the  blood  to 
receive  any  fupply,  from  which  the  parts  of  this  fluid  would  become  conti¬ 
guous  to  each  other,  and  to  the  coats  of  the  veffeis  internally,  without  which 


(*)  n.  28. 

(f)  Vid.  &  Epift.  64.  n.  13. 

( g )  Prided,  in  Inftit.  §  182. 
(6)  Anat.  corp.  hum.  DiiT.  11. 
(;)  n.  13.  &  17. 


(/£)  n.  15. 

(/)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1714. 
(w)  Obf.  Med.  1.  1.  ubi  deNsrib.  Promifc. 
Obf.  4.  &  1.  4.  ubi  de  Menftr.  hvpercfcth, 
Obf.  7. 


* 


the 


Letter  XXVI.  Article  19.  -  80s 

the  circulation  of  the  blood  cannot  be  carried  on.  And  from  the  fecond  dif¬ 
ference  you  will,  at  the  fame  time,  perceive,  that  a  proper  quantity  of  blood 
is  luddenly  withdrawn  from  the  whole  body.  And  from  the  third  you  will 
conclude,  that  the  heart  is  certainly  injur’d  by  the  unufual  contaff  of  blood 
externally,  and  that  by  the  quantity  of  this  fluid  lying  round  itr  the  proper 
affion  thereof  is  impeded  :  and  that  if  a  fluid  diftend  the  pericardium,  it 
muft  alfo  prefs  upon  the  heart. 

Nor  let  it  be  any  objection  with  you,  that  in  a  dropfy  of  the  pericardium 
the  heart  continues  to  be  mov’d  ;  for  it  is  one  thing  for  the  water  to  be  gra¬ 
dually  encreas’d,  and  another  thing  for  the  blood  to  be  fuddenly  extravaiated  ; 
one  thing  for  the  heart  to  be  prefs’d  upon  by  water,  and  another  to  be  prefs’d 
upon  by  blood;  which,  befldes  that  it  is  prone  to  coagulation  immediately 
upon  effufion,  without  doubt  approaches  the  more  nearly  to  the  nature  of 
folid  bodies,  in  proportion  as  it  is  thicker  than  water;  and  if  a  folid  body 
be  applied  to  the  heart,  it  immediately  brings  on  a  fyncope,  by  (topping  the 
motion  of  it,  as  the  very  celebrated  Senac  (#)  demonftrates,  by  the  examples 
of  a  probe,  or  a  finger,  being  applied  to  it,  in  the  cafes  of  two  wounded 
men,  in  whom  that  fymptom  was  thereby  brought  on.  Or  if  thefe  are  not 
fufficient,  add  thereto  the  two  firfl:  differences  1  mention’d.  Add  alfo,  that 
the  trunk  of  the  aorta  was  dilated,  and  that  the  flefhy  fibres  being  in  great 
meafure  eroded,  it  had  rigid  little  bones  within  :  and  it  is  very  evident  how 
much  difficulty  mud  be  thrown  in  the  way  of  the  blood’s  circulation,  by  cir- 
cumftances  of  this  kind  -y  and  confequently,  how  much  greater  powers  of  the 
heart  are  requir’d,  in  order  to  overcome  them,  which,  it  is  very  certain  from 
what  I  have  already  faid,  were  greatly  weaken’d  and  injur’d.  But  if  all  thefe 
confiderations,  fumm’d  up  together,  (hould  perhaps  not  be  able  to  fatisfy  you, 
and  you  would  rather  choofe  to  fuppofe,  that  this  woman  was  taken  off  by  an 
apoplexy,  by  reafon  of  that  quantity  of  blood  which  appear’d  within  the 
cranium,  than  by  the  rupture  of  the  aneurifm,  read  the  hiftories  of  two  wo¬ 
men  that  follow,  which  are  not  much  unlike  the  one  already  given  ;  except, 
however,  that  no  blood  at  all,  not  to  fay  that  great  quantity  which  feem’d.  to 
be  extravafated  within  the  cranium,  was  found  by  us. 

19.  About  the  middle  of  May,  in  the  year  17^8,  a  woman  of  more  than 
thirty  years  of  age  was  carried  off  in  this  place,  by  a  fudden  and  unexpected 
death.  The  belly  and  thorax  being  open’d,  in  the  former  a  little  extrava¬ 
fated  water  was  found  by  our  Mediavia,  but  in  the  latter  none  at  all ;  how¬ 
ever,  the  pericardium  was  fill’d  with  blood,  from  an  aneurifm  of  the  great 
artery  being  ruptur’d  within  it ;  into  which  aneurifm,  not  only  the  whole 
curvature  of  this  veffel  had  dilated  itfelf,  but  alfo  the  part  neared:  to  the  be¬ 
ginning  of  that  curvature. 

The  head  and  the  greater  part  of  the  vifeera  I  differed  myfelf.  But  within 
the  cranium  I  found  no  greater  quantity  of  blood  than  what  was  fufficient  to 
render  the  veffels  of  the  pia  mater  moderately  turgid,  as  they  in  faff  were, 
and  to  furnifh  the  fmall  red  drops,  that  appear’d  up  and  down  in  the  medul¬ 
lary  fubflance  when  cut  into.  In  the  lateral  ventricles  was  no  great  quantity 
of  turbid  water,  nor  any  palenefs  in  the  choroid  plexuffes.  But  the  other  cir- 


(«)  Traite  du  Coeur,  1.  4.  ch.  5.  n.  5. 


cum  (lances 


8o  6  Book  II.  Of  Difeafes  of  the  Thorax. 

cumftances  that  I  obferv’d  in  the  brain,  the  nerves,  the  ears,  and  in  other 
parts,  and  particularly  in  the  renes  fuccenturiati,  do  not  relate  at  all  to  the 
prefent  fubje£t •,  for  this  is  that  woman  from  whom  I  defcrib’d  the  right  of 
thefe  bodies  as  endow’d  with  a  peculiar  form,  in  the  twentieth  anatomical 
epiftle  (0). 

20.  I  will  now  fubjoin  the  whole  of  that  obfervation,  one  fmall  part  of 
which  only  has  been  given  in  the  fixth  of  the  Aclverfaria  (p).  For  although 
it  was  the  firft  wherein  I  faw  an  aneurifm  of  the  aorta  ruptur’d  within  the  pe¬ 
ricardium,  yet  1  defignedly  deferr’d  giving  you  the  relation  of  it  till  at  pre¬ 
fent,  becaufe  it  contains  many  and  various  things,  and  requires  many  and  va¬ 
rious  remarks. 

21.  A  Venetian  woman,  of  the  fame  age  as  the  laft  I  have  defcrib’d  ;  of  a 
flature,  colour,  and  habit  of  body  that  were  laudable,  but  rather  fattifh  *, 
being  the  mother  of  many  children  ;  and  having  been,  ten  years  before,  feiz’d 
with  a  pally  of  the  lower  limbs,  was  laid  to  be  made  found  by  the  ufe  of 
rofemary  •,  or,  at  leall,  fhe  had  been  fubjedt  to  no  inconvenience  from  that 
time,  which  was  worthy  of  remark  :  but,  for  fome  months  pall,  had  labour’d 
under  a  difficulty  of  breathing,  which,  however,  was  not  continual ;  and  be  - 
fides  this,  with  a  pulfating  tumour  that  ran  upon  the  neck,  longitudinally, 
in  the  region  of  the  right  carotid  artery  *,  yet  never  (which  you  will  remark, 
on  account  of  thofe  things  that  we  found  in  the  dead  body)  did  fhe  complain 
of  any  pain,  numbnefs,  or  tumour  of  the  right  arm.  But  four  or  five  days 
before  her  death,  file  complain’d  of  a  troublefome  kind  of  fenfation,  juft  as 
if  her  ribs,  as  file  faid,  had  fall’n  towards  the  abdomen ;  when,  on  a  fudden, 
about  the  middle  of  December,  in  the  year  1708,  being  feiz’d  with  a  kind  of 
fainting,  and  affirming  that  fhe  fiiould  die,  fhe  was  with  great  difficulty  fup- 
ported  by  the  women,  who  ran  to  her,  and  plac’d  her  in  bed ;  where,  her 
face,  and  particularly  her  lips,  being  livid •,  fhe,  being  cold  and  fenlelefs, 
with  a  very  fmall  pulfe,  a  difficult  and  flow  refpiration,  departed  this  life, 
in  lefs  than  a  quarter  of  an  hour  from  the  time  of  her  being  attacked. 

Upon  infpedting  the  body,  it  exhibited  no  cedematous  tumour  in  any  part, 
or  any  thing  elfe  that  was  worthy  remark;  but  when  the  belly  was  opened, 
fome  parts  of  the  inteftines  appear’d  to  be,  as  it  were,  inflamed,  if  you  at¬ 
tended  to  the  colour  :  which  colour  was  foon  after  obvious  in  the  pancreas 
alfo.  But  upon  examining  the  fmall  inteftines  more  attentively,  in  one  part 
of  them,  to  the  length  of  a  man’s  hand,  appear’d  fome  very  fmall  and  innu¬ 
merable  tubercles  of  an  obfcure  kind,  which  were  nothing  elfe  but  tokens  of 
the  cells,  that  being  diftended  with  air,  betwixt  the  flefhy  coat  and  that 
which  lay  beneath  it,  lifted  it  up  outwadrs  ;  the  air,  therefore,  having  ef- 
cap’d,  by  means  of  wounds  in  the  neareft  fanguiferous  vefiels,  thefe  cells 
collaps’d. 

In  the  gall-bladder  were  four  or  five  little  ftones.  of  an  unequal  magnitude 
among  themfelves,  which  being  applied  to  the  flame  took  fire.  From  the 
vena  cava,  when  cut  into,  a  confiderable  quantity  of  blood  flow’d  down  ;  but 
from  the  great  artery  only  a  fmall  quantity.  The  vifeera  of  the  belly  being 

(0)  n.  53.  (p)  Animad,  24.  in  princip. 


# 


now 


Letter  XXVI.  Article  21.  807 

now  fufliciently  infpected,  and  for  that  reafon  remov’d,  it  was  evident  that 
the  diaphragm  did  not  afcend,  on  both  fides,  in  the  form  of  a  vaulted  roof  j 
but  that  it  rather  fell  downwards. 

When  the  thorax  was  open’d,  we  faw  that  a  very  bloody  ferum  had  been 
extravafated  in  both  the  cavities  of  it,  to  the  quantity  of  a  few  ounces :  but 
that  the  lungs  were  found,  although  fomething  turgid ;  for  the  bronchia,  and 
efpecially  the  left,  as  I  afterwards  faw,  were  fill’d  with  a  ferum  like  that 
I  juft  now  fpoke  of.  In  the  mean  while,  the  pericardium,  by  its  tumid 
and  livid  appearance,  had  given  marks  of  its  having  blood  extravafated  in  it: 
with  which,  however,  it  was  not  full ;  but  contain’d  fomewhat  lefs  than  a 
pound  ;  about  two  ounces  of  which  were  a  bloody  ferum  -,  the  remaining  part 
of  the  blood  having  form’d  itfelf  into  a  thick  and  pretty  firm  lamina  :  whereas 
all  the  blood  that  I  faw  in  this  body  was  black,  indeed,  like  this,  but  quite 
fluid.  The  blood  being  taken  from  the  pericardium,  as  we  faw  that  the 
aorta,  as  foon  as  ever  it  came  out  from  the  heart,  was  manifeftly  dilated,  by 
purfuing  the  trunk  and  the  principal  branches  thereof,  I  found  that  the  former 
of  them  was  dilated  almoft  quite  to  the  emulgent  arteries,  and  that  the 
branch  of  the  aorta,  which  is  itfelf  a  common  trunk  of  the  right  carotid  and. 
fubclavian,  and,  in  like  manner,  that  both  of  thefe  branches  were  fo  dilated,, 
as  to  make  the  breadth  of  the  carotid,  from  the  beginning  of  it  quite  to  the 
divifion,  more  than  twice  as  large  as  it  ought  naturally  to  be  •,  and  the  fub¬ 
clavian  artery,  to  the  extent  of  three  inches,  was  not  expanded  equally  on 
all  fides  indeed,  but  had  its  pofterior  and  luperior  paries  only  curv’d  out 
into  a  prominent  aneurifm  ;  by  means  of  which,  nothing  at  all  being  inter¬ 
pos’d,  two  or  three  nerves,  of  thole  that  go  from  the  neck  into  the  upper 
limb,  were  comprefs’d.  From  this  aneurifm,  which  would  have  admitted 
my  thumb,  two  arteries  proceeded  :  thefe  having  a  broader  beginning  than 
they  naturally  have,  put  on  the  form  of  a  cone,  and  the  farther  they  pro¬ 
ceeded  the  more  they  were  contra&ed  till  having  meafured  out  the  fpace  of 
an  inch  and  a  half,  they  were  reduc’d  to  their  natural  dimenfions.  One  of 
thefe  went  to  the  thyroid  gland,  which  was  in  this  woman  large,  and  in  fome 
places  hard. 

After  having  examin’d  all  thefe  parts  externally,  I  began  to  lay  open  all 
thefe  vefiels,  and  even  that  part  of  the  aorta  which  had  been  in  the  belly,  in 
a  longitudinal  direction,  beginning  with  the  iliacs.  And  from  thefe  arteries 
quite  to  the  emulgents,  I  found  no  appearance  of  dileafe,  except  whitilh 
lpots  in  fome  places,  and  very  fmall  furrows  here  and  there.  But  as 
the  dilatation  of  the  trunk  began  above  the  emulgents,  fo  from  thence, 
quite  to  the  heart,  the  parietes  of  the  artery  were  much  thicker  than  -they 
ufually  are  •,  yet  not  equally  in  every  place,  and  were,  in  like  manner,  more 
hard  and  rigid  than  ulual ;  although  I  found  no  where  any  appearance  of 
ofllfication  •,  but  in  fome  places  whitifh  fpots,  in  others  very  conliderable  pa¬ 
rallel  fulci,  drawn  in  a  longitudinal  direction,  and  fo  much  the  more  remark¬ 
able,  as  they  were  interrupted,  after  having  run  over  a  fhort  fpace,  by  other 
tranfverfe  fulci,  the  direction  of  which  was  not  near  fo  ftrait  •,  after  that  others 
follow’d,  fimilar  to  the  former,  which  were  prefently  interrupted  by  tranl- 
verfe  furrows  ;  and  after  thefe  ftill  others  in  the  fame  manner  :  fo  that  in  this 
morbid  conftitution  akind  of  elegant  order  waspreferv'd  quite  to  the  whole  arch 

of 


SoS  Book  II.  Of  Difeafes  of  the  Thorax. 

of  the  aorta  ;  and,  indeed,  it  was  continu’d  from  this  curvature  into  the  left 
fubclavian  to  the  extent  of  an  inch ;  into  the  neighbouring  carotid  to  the 
extent  of  two  inches  ;  but  into  the  other  through  the  whole  of  it,  together 
with  the  fpots,  the  thicknefs  and  hardnefs  of  the  coats.  But  that  aneurifm 
of  the  fubclavian  refembl’d  the  ftrudture  of  an  auricle,  as  it  were,  of  the 
heart,  form’d  of  an  unequal,  hard,  and  thick  coat,  not  internally  lin’d  with  po¬ 
lypous  laminae,  or  ftrata,  but  only  having  a  very  fmall,  whitifh,  and  oblong 
jagged  concretion  adhering  to  it;  befides  which,  I  found  no  other  polypous 
concretion  in  the  whole  body. 

Finally,  the  trunk  of  the  aorta  itfelf,  from  that  place  where  it  fends  off  its 
firft  branch  to  the  upper  parts  quite  to  the  heart,  was  both  diftinguifh’d  with 
fpots,  and  mark’d  out  into  furrows ;  but  thefe  were  fo  confus’d  and  irregular, 
that  nothing  but  a  perpetual  and  very  great  inequality  of  that  furface  ap¬ 
pear’d.  Yet,  befides  this,  a  kind  of  ulceration,  as  it  were,  was  found  about 
two  inches  above  the  femilunar  valves,  where  the  artery  looks  towards  the 
right  and  poflerior  parts  ;  and  in  that  ulceration  were  three  or  four  very  deep 
foramina,  very  near  to  each  other,  each  of  them  of  the  bignefs  of  a  lentil, 
but  of  an  angular  form  rather  than  round.  From  thefe  foramina,  winding 
fmuffes  were  carried  obliquely  outwards,  and  reach’d  to  the  external  lamina 
of  the  aorta  ;  which  was  in  that  place,  therefore,  of  a  brownifh  colour  mix’d 
with  red,  as  if  in  confequence  of  inflammation,  and  become  much  thicken’d 
by  a  great  flow  of  moifture :  and  in  the  middle  of  that  rednefs,  the  lamina 
being  at  length  lacerated,  the  blood  had  made  a  way  for  itfelf  into  the  peri¬ 
cardium,  by  a  foramen  fimilar  to  the  internal  foramina,  and  almofl:  of  the 
lame  magnitude. 

The  left  ventricle  of  the  heart  was  greatly  dilated  ;  but  the  auricle  that 
lay  clofe  to  it,  was  very  much  contracted  and  thin.  In  that  ventricle,  and  in 
the  tight,  blood  was  not  wanting;  and  in  the  pulmonary  artery  there  was  a 
great  quantity  ;  nor  were  the  carotids,  nor  the  jugular  veins,  devoid  of  it. 

Finally,  1  found  the  cerebrum  and  cerebellum  to  be  very  lax,  notwith- 
flanding  there  was  no  water  in  the  ventricles,  a  very  little  of  which  was  found 
in  fome  places  only  under  the  pia  mater.  The  veffels  of  this  membrane  were 
l'omewhat  turgid  with  blood.  The  vertebral  arteries,  where  they  enter’d  the 
cranium,  feem’d  to  be  a  little  wider  than  ufual.  The  other  circumftances 
that  were  remark’d  in  this  body  by  me,  and  by  my  friends,  that  affifted  me 
in  the  diffeClion  of  it,  relate  to  other  fubjeCls. 

22.  There  were  found  in  this  woman  four  aneurifms  at  leaft ;  one  of  the 
left  ventricle  of  the  heart,  one  of  the  greater  part  of  the  aorta,  one  of  the 
right  fubclavian,  and  one  of  the  carotid  on  the  fame  fide;  fo  that  there  not 
only  appears  to  have  been  fufficient  caules  for  the  fymptoms  with  which  the 
woman  was  troubl’d,  but  it  is  even  furpriflng  that  fhe  had  not  been  afflicted 
with  more.  As  to  the  aneurifm  of  the  carotid,  which  difcover’d  itfelf  by  its 
prominence  and  pulfation,  although  I  readily  confefs  that  thefe  arteries  are 
Ibmetimes  dilated,  from  peculiar  caufes  that  affeCt  them  in  particular;  yet 
that  their  dilatation  is  join’d  more  frequently  with  the  dilatation  of  the  aorta, 
and  is  even  a  propagation  and  effeCt  of  it ;  nobody  fince  the  time  that  the 
caufes  of  difeafes  were  begun  to  be  enquir’d  into,  by  frequent  diffeCtions, 
will  deny.  The  ancient  phyflcians,  indeed,  being  in  want  of  this  afliftance 

7  to 


Letter  XXVI.  Article  23.  809 

to  their  enquiries,  Teem’d  to  fufpeft  nothing  of  that  kind  ;  and  thought  that 
they  had  nothing  elfe  to  do  in  an  aneurifm  of  the  carotids,  than  to  make  a 
revulfion  of  the  blood  ;  to  diminifh  and  correfl  the  acrid  particles  in  it ;  and, 
finally,  to  apply  fuch  things  as  had  a  property  of  contracting  and  conftring- 
ing  the  coats  of  the  arteries  ;  as  you  will  very  clearly  perceive  from  reading 
that  chapter  of  Arantius  (<y),  in  which  he  particularly  treats  of  this  aneurifm. 
But  if  any  one  attempt  to  conftringe  the  artery,  when  it  is  a  produdtion  or 
effedl  of  an  aneurifm  of  the  great  artery,  he  will  encreafe  the  latter,  and  not 
remove  the  former;  but  he  even  will  not  be  able  to  effedl  this,  when  it  is 
only  from  an  eroding  caufe,  as  Lancifi  (r)  Ihows,  by  producing  an  example 
of  a  noble  matron. 

23,  But  as  to  the  aneurifm  with  which  the  right  fubclavian  artery  prefs’d 
upon  the  nerves  that  went  to  the  upper  limb,  without  any  thing  at  all  being 
interpos’d,  I  enquir’d  in  the  fixth  of  the  Adverfaria  (j) ;  where,  by  I  know 
not  what  negligence,  “  the  left  fubclavian”  is  written  inftead  of  the  right;  I 
enquir’d,  1  fay,  why  no  mark  of  this  comprefiion  had  exilted  in  the  living 
body  ?  Neverthelefs  I  Hill  enquire.  For  fince  pains,  as  is  frequently  the  cafe, 
and  was  the  cafe  in  the  man  whofe  hiftory  is  written  above  (/),  or  numbnefs, 
happen  to  thofe  in  whom  an  aneurifm  is  form’d  in  the  trunk  of  the  aorta 
itfelf,  above  the  heart;  I  fee  that  the  circumftance  is  explain’d  by  learned 
phyficians,  by  means  of  contradlions,  which  being  propagated  from  that 
trunk  into  the  fubclavians,  comprels  the  fame  brachial  nerves  whereof  we 
fpeak  at  prefent;  why  then  are  not  thefe  nerves  fo  much  the  more  comprefs’d 
by  an  aneurifm  feated  in  the  fubclavian  itfelf,  and  contiguous  to  them  ?  For 
although  other  very  experienc’d  men  are  not  wanting,  who  affirm  that  fenfe 
and  motion  has,  finally,  been  obferv’d  to  be  quite  uninjur’d  in  that  part  to 
which  the  nerve  goes,  when  the  nerve  has  been  not  only  comprefs’d,  but  even 
for  a  long  time  clofely  confin’d  by  a  ligature ;  yet  they  do  not,  neverthelefs, 
deny,  that  immediately  after  the  ligature  was  put  on,  at  leaft  fome  lofs  of 
fenfe  and  of  motion  had  been  perceiv’d.  Is  the  reafon  of  this  that  the  nerves 
bear  with  impunity  that  comprefiion  which  is  brought  on  gradually,  and 
gradually  encreas’d,  by  cuftom  accommodating  themfelves  thereto  l  But  of 
thefe  things  you  will  confider,  as  alfo  of  the  great  number  of  experiments 
which  have  been  lately  made  by  more  than  one  perfon,  in  which  fome  cir- 
cumftances  occur  in  a  different  manner  from  what  I  have  juft  pointed  out, 
that  ought  not  to  be  pafs’d  over  with  negleft :  and  you  will  likewife  confider 
of  thofe  obfervations,  which  I  here  purpofely  pafs  over,  from  which,  perhaps, 
it  would  not  be  altogether  abfurd  to  conclude,  that  the  ftnall  branches  of 
other  nerves  which  communicate  with  the  branches  of  thofe  that  are  tied  up, 
may,  by  degrees,  and  after  fome  time,  be  able  fo  to  dilate  their  tubular  ca¬ 
vities,  as  to  carry  fupplies  to  them  tranfverfely,  in  the  fame  manner  as  hap¬ 
pens. in  the  fanguiferous  vefiels. 

Of  thefe  things,  I  fay,  and  of  others  you  will  confider.  For  what  I  was 
unwilling  to  do  then,  I  am  equally  unwilling  to  do  now  ;  I  mean,  to  en¬ 
tangle  myfelf  in  abftrufe  and  tedious  difputes  about  the  nerves.  It  is  much 

(?)  De  Tumor,  prast.  nat.  c.  38.  {s)  Animadv,  24. 

(r)  De  Aseur.  Propof.  31.  (/)  n.  9, 

Vol.  I.  .  5  L 


better 


8 1  o  Book  If.  Of  Difeafes  of  the  Thorax. 

better  to  remark  every  thing  that  occurs  to  each  of  us  upon  the  fubjeCt,  till  a 
proper  number  of  oblervations  and  faCts  fhall  fhow  us  what  we  may  follow, 
fparing,  in  the  mean  while,  fome  certain  conjectures  ;  and  making  inducti¬ 
ons  with  caution,  which,  although  they  may  be  eafily  defended,  yet  we  do 
not  all  attain  to  the  knowledge  of :  how  much  lefs  likely  is  it,  then,  that  we 
fhall  attain  to  the  knowledge  of  the  truth,  which  is,  as  yet,  fo  deeply  myfte- 
rious  and  involv’d  ? 

But  you,  perhaps,  will  rather  alk  on  this  occafion,  why  the  difeafe,  which 
was  propagated  from  the  aorta  to  the  right  carotid  and  fubclavian  arteries, 
was  not  equally  propagated  into  the  left  carotid  and  fubclavian  ?  And  this  I 
fhould  fuppofe  to  have  happen’d  for  more  caufes  than  one.  For,  in  the  firit 
place,  the  vellels  on  the  right  fide  are  nearer  to  the  heart  than  the  left,  if  we 
confider  their  firft  origin.  Wherefore,  as  the  powers  of  the  heart  were  pre- 
ternaturally  increas’d,  the  former  began  looner  than  the  latter  to  be  weaken’d  ; 
for  which  reafon,  the  diforder  that  afterwards  began  in  the  arteries  on  the  left 
fide,  was,  I  faw,  carried  farther  on  in  the  carotid,  in  confequence  of  this 
veffel  being  nearer  to  the  heart,  than  it  was  in  the  fubclavian.  And  in  the 
fecond  place,  whatever  was  the  occupation  or  handicraft  of  this  woman,  in 
regard  to  which  I  have  no  certain  information,  it  is  highly  probable,  that  (he 
had  been  accu hom’d  to  ufe  her  right  arm  more  frequently,  more  ftrongly, 
and  for  a  longer  continuance,  than  die  did  her  left;  and  that  there  is  room 
here,  in  l'ome  meafure,  for  the  explication  of  the  celebrated  Maloet  ( u ),  who 
accounted  for  the  dilatation  of  the  fubclavian  artery  in  an  artificer,  from  the 
more  frequent,  conftant,  and  ftronger  contractions  of  the  mufcles  of  the 
right  limb ;  that  is  to  fay,  from  the  blood  being  retarded  in  the  arteries  of 
that  arm  which  are  fo  comprefs’d,  and  confequently  more  accumulated  in 
the  origin  of  thefe,  the  fubclavian,  which  is  by  no  means  liable  to  thofe 
compreflions.  What  ?  if  in  this  woman  another  caufe  of  that  dilatation  was 
added;  I  mean,  flays,  which  are  furnifh’d,  as  Petronius  fays  (x),  balenatiis 
virgis,  “  with  rods  of  whalebone  ;”  which,  by  their  too  great  hardnefs  and 
confinement  under  the  arm-pits,  as  frequently  happens,  would  fo  much  the 
more  prefs  upon  the  artery,  in  proportion  as  the  artery  fhould  be  more  prefs’d 
againft  that  hardnefs  in  the  motions  I  have  juft  now  mention’d,  and  for  that 
reafon  refleCt  the  impetus  of  the  blood,  which  was  ftrongly  driven  by  the 
heart  into  the  fubclavian  artery,  back  upon  this  artery.  And  if  you  do  not 
difapprove  this  fuppofition,  you  will  add  it  to  the  other  difadvantages  that 
the  very  ingenious  Window  (jy)  has  imputed  to  this  kind  of  ftiff  ftays  about 
the  cheft,  which  too  much  conftringe  the  axillary  veflels. 

Finally,  if  all  thefe  caufes  join’d  together  do  not  fufficiently  explain  rthe 
circumftance,  call  to  mind  whatCelfus  has  very  juftly  Paid  (z) :  “  It  happens 
■“  but  feldom,  that  a  perfon  has  not  fome  part  of  the  body  more  weak  than 
“  the  reft.”  And  if  you  admit  of  this  fuppofition,  you  will  not  only  under- 
ftand  why  that  fubclavian  artery  might  be  fubjeCt  to  an  aneurifm,  but  even 
why  it  might  have  one  in  that  particular  part. 

Mem.  de  RAcad.  R.^des  Sc.  A,  1733.  (y)  Mem.  dela  meme  Acad.  A.  1741. 

(a)  Satyric.  *  (z)  De  Medic.  1.  i.  c.  3. 


24.  But 


Letter  XXV.  Articles  24,  25*.  811 

24.  But  in  regard  to  the  aneurifm,  and  the  other  diforders  of  the  aorta  it¬ 
felf,  as  we  have  made  many  remarks  in  other  places,  it  will  be  fufficient  to 
add  only  a  few  things  at  prefent,  that  relate  in  particular  to  thefe  difeafes. 
And  firft,  that  the  artery  was  more  thick  and  more  rigid  than  ufual ;  whereas 
one  would  naturally  luppofe  that,  by  reafon  of  its  dilatation,  it  fhould  have 
been  thinner  and  i'ofter;  arofe  chiefly,  in  my  opinion,  from  thofe  very  thick 
and  whitifh  fpots,  which,  as  they  are  the  beginnings  of  a  future  bone,  are, 
in  like  manner,  made  up  of  an  increas’d  fubftance  in  that  part,  which  ap¬ 
proaches,  as  I  have  often  obferv’d,  to  the  nature  of  that  which  is  in  the  liga¬ 
ments.  And  that  thefe  lpots,  and  the  other  difeafes  of  the  heart,  were  fo 
much  the  more  frequent  and  confiderable  as  the  aneurifm  was  lefs  diftant  from 
the  heart,  you  fee  was  owing  to  the  impulfe  of  the  impinging  blood,  which 
muft  be  driven  on  with  a  greater  force  in  proportion  as  it  was  nearer  to  the 
heart.  For  which  reafon  no  more  need  be  faid  to  make  you  conceive  how  it 
happen’d,  that  as  a  part  of  the  aneurifm  was  within  the  pericardium,  it  was 
ruptur’d  within  that  cavity,  as  it  alfo  happen’d  in  many  other  cafes  which  I 
deicrib’d  above  (a).  We  fhould  rather  endeavour  to  explain  why  the  aneu¬ 
rifm  was  ruptur’d  at  the  pofterior  part  of  the  artery  (b).  For  as  I  faw  it  to 
be  open’d  in  that  part  alfo  in  the  woman-weaver  (c)  ;  and  as  the  orifice  of  the 
aneurifm  was  likewife  delcrib’d  in  that  part  in  the  ftrumpet  (d) ;  it  becomes 
lefs  probable  that  all  thefe  women  had  the  fame  one  part  of  the  artery  in 
particular  weaker  than  the  others.  It  is,  perhaps,  more  fuppofable,  that  this 
circumftance  was  owing  to  the  weight,  and  at  the  fame  time  to  the  impulfe, 
of  the  blood  that  came  out  from  the  heart,  as  the  pofition  of  the  artery  leems 
to  fhow  ;  which,  as  it  begins  to  incline  to  the  pofterior  parts  immediately 
from  its  origin,  confequently  fubjedts  that  part  of  itfelf  to  the  weight  of  the 
blood,  and  at  the  fame  time  lays  it  in  the  way  of  the  blood’s  impulfe. 

Perhaps  you  alfo  wifh  to  know  why,  when  the  artery  was  ruptur’d,  this 
woman  did  not  immediately  die  alfo.  I  luppofe,  becaufe  the  foramen  was, 
at  the  firft,  much  lefs  than  I  found  it ;  as  appear’d  from  the  blood  being  ef¬ 
fus’d  in  lefs  quantity  than  in  other  perfons  :  although  it  was  alfo  effus’d  in 
lefs  quantity,  and  flowly,  on  account  of  the  powers  of  the  left  ventricle  of 
the  heart  (which  had  been  formerly,  indeed,  when  they  diftended  the  aorta, 
very  great,  but  in  the  latter  part  of  his  life  were  weaken’d  and  broken  down 
by  all  the  diforders  of  the  aorta  itfelf)  ftrongly,  and  for  a  long  time,  refilling; 
as  the  great  dilatation  of  this  ventricle  demonstrated.  And  whether  this  flow 
extravafauon  of  the  blood,  which  entirely  agreed  with  the  very  flight  motion 
of  the  heart,  as  was  fignified  by  the  pulfe,  was  the  caufe  of  this  blood’s 
having  coagulated  in  the  pericardium  ;  which  was  a  circumftance  that  ap¬ 
pear’d  in  no  other  part  of  the  body  whatever  ;  or  whether  the  water  in  this 
cavity,  which,  perhaps,  by  reafon  of  the  diforder  in  the  heart,  was  previoufly 
morbid,  could  effect  this  concretion ;  or  whether  there  might  be  any  other 
more  probable  caufe  that  efcapes  me  now  I  leave  quite  undetermin’d. 

25.  And  as  to  the  aneurifm  of  the  heart,  and  in  regard  to  this  of  itfelf 
being  frequently  the  caufe  of  iudden  death,  I  have  already  fpoken  of  thefe 

(d)  N.  13. 


(a)  N.  5,  15,  1 7,  19. 


(*)  N.  21. 

5  L  2 


(0  N.  17. 


fubje&s 


8 1  2  Book  II.  Of  Difeafes  of  the  Thorax. 


fubjefts  in  other  letters,  and  fhall  treat  of  them  hereafter.  It  remains  to  add 
fomething  upon  that  fenfation  which  was  troublefome  to  her  in  her  laft  days, 
and  feem’d  to  herfelf  to  be  that  of  her  ribs  falling  down,  as  it  were.  The 
ancient  author  of  the  book  De  Veteri  Medicina  ( e )  has  laid,  that  when  they 
omit  their  dinner  who  have  always  accuftom’d  themfelves  to  eat  a  dinner,  their 
“  vifcera  feem  to  them  to  be  hanging  downwards.”  And  this  had  been 
handed  down  in  fo  many  words  in  the  book  De  Vidius  Ratione  in  acutis  (f) ; 
and  in  that  part  too,  which,  from  the  teftimony  of  Galen  (£■),  is  lhppos’d  to 
be  “  the  mod;  genuine  work  ”  of  Hippocrates :  nor  did  they  judge  differently 
in  the  time  of  Pliny,  who  would  not  otherwife  have  faid  (£),  “  that  Hippo- 
“  crates  had  dedicated  one  whole  volume  to  the  praifes  of  ptifan  j”  for  there 
is  not  the  lead  doubt,  but  that  by  thefe  words  he  meant  the  fame  part  as 
Galen  did,  whether  he  attended  to  the  long  difcourfe  that  is  made  here  upon 
ptifan,  or  whether  he  read  this  book  in^the  codex,  in  which  it  was  entitl’d  De 
Ptifana ,  in  which  manner  Galen  (i)  faw  it  infcrib’d,  and  under  which  title 
Caelius  Aurelianus  (k)  has  quoted  it :  which  Duretus  (/),  who  was  a  man  in 
other  refpe&s  very  learned,  may  feem  to  have  forgotten,  when  he  has  fup- 
pos’d  that  this  title  had  been  “  given  to  it  by  Pliny,”  whofe  authority,  rather 
than  that  of  the  Grecian  manufcripts  which  they  had  in  their  hands,  I  fuppofe 
neither  of  thefe  authors  would  follow  in  fuch  a  circumftance,  as  they  have 
not,  on  any  occafion  that  1  know  of,  ever  fpoken  of  Pliny.  And  Dalecham- 
pius  ( m )  thinks,  that  thofe  very  words  of  Hippocrates  which  I  have  quoted 
relate  to  this  circumftance  •,  fince  he  has  faid  in  another  place  (/*),  for  inftance, 
“  that  Hippocrates  afferts  the  entrails  of  thofe  who  eat  no  dinners  to  grow 
“  old  very  foon  for  thefe  words  are  interpreted  thus,  “  that  they  are  tor- 
“  tur’d  with  a  pain  at  their  praecordia,  as  if  their  vifcera  were  hanging  down- 
“  wards.”  And  the  opinion  of  Thevartius  is  the  fame  in  the  annotations  to 
a  certain  confultation  of  Ballonius  (a),  except  that  inftead  of  fenefcere ,  “  or 
“  grow  old,”  he  judges  that  we  fhould  read  'pendere  fsf  fuccrefcere ,  or,  that  they 
“  hang  and  grow  downwards.”  What  if  Pliny  fhould  not  have  had  an  eye 
to  thefe  words  in  that  paffage  ;  but  to  that  place  of  the  fecond  book  De 
Di<eta(p),  where  it  is  faid,  “To  take  food  once  in  a  day  attenuates  and 

“  dries,” - but  “  that  dinners  have  quite  the  contrary  effects ;”  and  fo 

that  in  Pliny  it  fhould  have  been  written  ficcefcere ,  or  “  grow  dry  ?”  What  if 
we  fuppofe  that  one  letter  only  has  been  alter’d,  and  that  inftead  of  fenefcere , 
or  “  grow  old,”  it  fhould  be  written  fanefcere ,  or  “  grow  healthy  ?  ”  On. 
which  fuppofition  Pliny  may  be  thought  to  have  had  fome  other  paffage  of 
Hippocrates  in  view  •,  which  I  omit  to  enquire  after,  as  the  opinion  of  Pliny, 
by  reafon  of  the  corruption  of  his  words  in  that  chapter,  feems  to  me  to  be 
not  altogether  fo  clear  and  certain  as  I  could  wifh.  But  the  opinion  of  Hip¬ 
pocrates  in  that  former  paffage  feems  to  be  by  no  means  obfcure,  notwith- 
Handing  different  interpreters  have  thought  that  he  meant  quite  different 


{e)  N.  i9.  (f)  N.  1 6. 

(g)  In  1.  3.  Epid.  Comm.  z.  in  princip. 

(b)  Nat.  Hift.  1.  1 8.  c.  7. 

(/)  In  1.  de  Rat.  Vitt.  in  Acut.  Comm.  1. 
i.  18. 

(k)  Acut.  Paff.  1.  1.  c.  1.2. 


(/)  Comm,  in  modo  cit.  Hipp.  1.  Schol.  ad 
titul. 

(»)  In  Annot.  ad  cap.  mox  citand.. 

(«)  L.  28.  c.  5. 

(O)  L.  2.  16. 

(P)  N.  25. 


things. 


Letter  XXVI.  Article  a*.  815 

things.  For  Francifcus  Vallefuis  fays  (q) :  “  The  vifcera  in  thefe  perfons 
“  Item  to  be  fnfpended  ;  that  is  to  fay,  they  feem  to  be  drawn  upwards ; 
“  becaul'e  the  veffels  being  emptied,  they  are  in  a  manner  convuls’d.”  Others, 
on  the  contrary,  underftand,  that  the  vifcera  feem  to  be  fo  fufpended,  that 
the  patient  feels  them  to  be  drawn,  not  upwards,  but  downwards ;  where, 
without  doubt,  the  very  weight  of  the  vifcera  would  draw  them,  juft  as  if  a 
kind  of  fulcrum,  or  fupport,  were  taken  away  ;  and  that  this  fulcrum  had 
before  been  the  ftomach,  when  it  was  fill’d  with  food.  And  to  this  opinion 
the  interpretation  of  Duretus  (r)  relates,  which  I  do  not  doubt  but  Ballonius 
had  read  (j),  as  he  delivers  the  fame  thing  in  the  fame  words.  And  this 
opinion  Thevartius  not  only  follows  in  his  annotations,  but  even  confirms 
the  interpretation  by  another  paffage  of  Hippocrates  (f)  ;  who  teaches  us, 
that  in  a  fracture  of  the  ribs,  u  a  moderate  repletion  of  the  belly  becomes  a 
“  dire&ion  and  fupport  to  the  ribs ;  but  that  an  emptinefs  of  the  belly  makes 
“  the  ribs  hang  downwards-,  and  that  this  depending  (late  caufes  pain.” 

And  Galen  (u),  in  explaining  this  paffage,  is  fo  far  from  doubting  “  whe- 
“  ther  the  tumour  of  the  belly  is  made  a  foundation  for  the  ribs  to  fupport 
“  themfelves  on,”  or,  as  he  fpeaks  foon  after,  “  their  feat  and  prop,”  as  to 
affirm,  that  “  they  who  have  pretty  large  bellies,  are  wont  to  be  troubl’d 
44  with  lefs  pain  if  they  have  their  ribs  broken  ;  and  that  they  who  have  their 
“  bellies  fmall  and  contracted,  feel  great  pain  from  a  fraCture  of  this  kind, 
“  as  they  feel  the  ribs  weaken’d,  and,  as  it  were,  fufpended.”  But  it  is 
more  eafy,  you  will  fay,  to  conceive  of  this,  I  mean,  how  the  belly,  when 
tumid,  may  fupport  the  ribs,  than  of  the  other-,  that  is  to  fay,  how  the 
ftomach,  when  tumid,  may  fupport  the  vifcera  that  are  laid  upon  it.  For 
although,  when  it  fwells,  it  may  turn  the  fundus,  not  downwards,  but  for¬ 
wards,  and  by  this  means  be  able  to  fupport  the  fpleen,  and  the  lower  part 
of  the  liver;  yet  it  cannot  fupport  the  fide  of  the  liver,  that  is  more 
to  the  right,  which  is  much  the  heavier.  And  to  this  you  may  add,  fay  fome, 
the  inteftines  that  lie  under  this  part,  and  under  the  ftomach  itfelf,  and,  in 
particular,  the  colon  :  for  by  this  means  you  will  perceive,  that  thefe  parts 
and  their  veffels,  being  fill’d,  fuftain  both  the  liver  and  the  ftomach  equally. 
To  which  if  you  reply,  that  you  do  not  enquire  after  this  at  the  time  when 
the  inteftines  and  the  veffels  are  fill’d,  but  when  the  ftomach  only  is  fill’d  ; 
for  that  this  fenfe  of  the  vifcera  hanging  down,  as  it  were,  is  not  then  at 
length  remov’d  after  the  ingefta  have  reach’d  to  the  inteftines,  and  in  parti¬ 
cular  to  the  colon,  2nd  fill’d  their  veffels,  but  long  before  ;  the  fame  perfons 
will  know  how  to  fet  the  whole  of  the  circumftance  in  a  more  diftindt  view, 
and  clearly  to  fhow  what  the  mufcles  of  the  abdomen  contribute  thereto, 
even  when  the  ftomach  and  the  firft  part  of  the  inteftines  are  fill’d,  and  per¬ 
haps  what  that  vigour  which  we  feel  diffus’d  through  the  whole  body  the 
very  moment  that  refrefhing  aliments  are  thrown  into  the  ftomach  ;  I  fay, 
what  this  vigour  contributes  to  affording  thefe  fupports  of  which  I  fpoke, 
and  raifing  up  the  vifcera  in  forne  meafure.  I  think  I  have  now  faid  quite 

(y)  Comm,  in  Hipp.  1,  de  rat.  Vift.  in  Acut.  ft)  Be  Artie,  n.  51. 

ft)  In  Schol.  ad  ea  verba,  («)  In  eum  Hipp.  1.  Comm.  3.  ad  t.  56. 

ft)  Confii.  cit.  16. 

enough-,. 


8 1 4  Of  Difeafes  of  the  Thorax.  Book  II. 

enough,  in  order  to  make  you  underftand  from  whence  that  fenfe  of  the  ribs 
falling  downwards,  as  it  were,  arofe  in  this  woman,  whofe  ftrength  and  ap¬ 
petite  were  extremely  languid,  as  the  diforders  of  the  great  artery,  and  of  the 
heart,  proceeding  from  thofe  caufes  that  I  have  demonftrated,  requir’d.  To 
thefe,  moreover,  was  added,  what  was  obferv’d  in  the  difle&ion,  to  fay  no^ 
thing  of  the  cerebrum  being  very  lax,  that  the  diaphragm,  before  the  thorax 
was  touch’d,  did  not  afcend  on  both  fides,  but  rather  fell  downwards :  for  if 
this  had  happen’d  to  be  in  forne  meafure  brought  on  in  the  laft  days  of  her 
life,  by  reafon  of  the  power  of  reftoring  themfelves  to  a  natural  ftate  being 
weaken’d  in  her  mufcles,  you  eafily  fee  that  thofe  parts  of  the  diaphragm, 
from  whence  the  liver  by  its  right  and  left  ligament,  and  the  fpleen,  alfo,  by 
its  proper  ligament,  are  fufpended,  are  drawn  downwards  by  the  weight  of 
the  vifcera ;  and  that  the  ribs  at  the  fame  time,  inafmuch  as  they  are  an¬ 
nex’d  to  the  diaphragm,  are  under  a  neceffity  of  following  this. 

2 6.  However,  I  partly  know,  and  partly  fufpedt,  that  others  have  before 
alfo  lit  on  cafes  fimilar  to  thefe  that  are  above  defcrib’d  by  me.  1  know  that 
Bofchius  had  feen  a  cafe  of  this  kind  “  twice;”  for  in  the  eighth  fedtion  of 
the  fecond  book  of  the  Sepulchretum  (x),  you  will  read  that  it  was  obferv’d 
by  him  “  twice,  in  thofe  who  labour’d  under  a  palpitation  of  the  heart,  and 
“  who  having  the  coats  of  the  aorta  dilated,  were  feiz’d  with  a  fudden  death, 
“  as  it  were,  becaufe  the  fpirituous  blood  had  rufli’d  headlong,  in  a  manner, 
“  into  this  coat  call’d  the  pericardium  for  which  reafon  the  heart  could 
not  be  dilated.  And  I  fufpedt  it,  when  I  read  in  this  eleventh  fedlion  (jy), 
that  the  body  of  a  perion  “  who  died  fuddenly  from  anger,”  had  fhown 
“  the  pericardium  to  be  fill’d  with  blood;”  and  “  had  two  abfcefies  found 
“  in  the  trunk  of  the  artery,  near  the  heart,  from  whence  the  blood  had 
“  flow’d  out.”  For  certainly  it  is  much  more  probable,  that  they  were  two 
fmall  aneurifms  fluff’d  up  with  polypous  concretions,  which,  without  exa¬ 
mining  the  aorta  internally,  were  taken  for  “  crude  and  bloody  or  inflam- 
“  matory  abfceffes,  not  yet  fuppurated  fuch  as  could  not  be  ruptur’d 
from  anger,  and  when  ruptur’d  could  not  have  pour’d  out  fuch  a  quantity 
of  blood  ;  although  the  great  artery  being  even  examin’d  internally  and  ex¬ 
ternally  in  our  times,  and  found  to  be  corroded  on  both  fides,  near  the  heart, 
as  1  have  often  feen  it,  from  whence  the  blood  had  burfl  fuddenly  into  the  pe¬ 
ricardium,  both  this  burfting  of  the  blood  has  been  confider’d  as  an  uncom¬ 
mon  cafe,  and  that  corrofion  taken  for  an  ablcefs  of  the  aorta,  which  was, 
however,  better  conceiv’d  of,  and  explain’d. 

But,  to  return  to  our  fufpicions ;  you  have,  perhaps,  read  the  hiftory  «  of 
u  a  very  fat  man,  who  complain’d  of  a  palpitation  and  pain  of  the  heart, 
“  with  an  unequal,  and  fometimes  a  faltering  pulfe after  whofe  death, 
which  happen'd  “  fuddenly,  while  he  was  at  ftool,  the  pericardium  was  found 
“  full  of  coagulated  blood,  of  a  very  black  colour,  and  a  very  filthy  odour; 
“  and  appear’d  fo  form’d  in  the  fuperior  part,  as  to  refemble,  in  fubftance, 
“  the  renes  fuccenturiati.”  It  is  true,  I  would  not  pretend  to  deny  that  tu¬ 
mours  oi  the  pericardium  may  be  form’d,  which  may  be  ruptur’d  within  this 
cavity ;  and  I  confels  the  ill  fmell  of  the  blood  agrees  very  well  with  a  l'up- 


(*)  Obf.  26.  §  1. 

8 


(y)  Obf.  8. 


pofition 


Letter  XXVI.  Article  2  6.  815 

pofition  of  this  kind  :  but  I  fay  this  neverthelefs,  that  if  any  man  more  du¬ 
bious  of,  or  better  (kill’d  in,  anatomy,  had  lit  on  that  cafe,  he  would  have 
fet  about  to  enquire,  from  whence  fo  great  a  quantity  of  coagulated  and  very 
black  blood,  that  is  without  any  mark,  as  far  as  the  eyes  could  judge,  of 
ichor  or  pus,  had  fuddenly  proceeded,  and  whether  the  large  veflfels  were 
found  ;  and  lince,  about  thefe  veffcls,  (for  it  was  thus  that  he  pointed  out 
the  upper  part  of  the  pericardium)  that  fubftance  had  appear’d,  whether 
only  one  of  them  was  eroded,  or  pierc’d  through. 

For  this  may  happen  not  only  to  the  aorta,  of  which  I  have  fpoken  hi¬ 
therto,  but  alfo  to  the  pulmonary  vein,  and  the  vena  cava,  as  I  (hall  fay  pre- 
l'ently  ;  and  to  the  pulmonary  artery  alfo,  from  the  erofion  of  which,  the  ce¬ 
lebrated  Tabarrano  (z)  mentions,  that  blood  burfting  into  the  pericardium, 
had  been  the  occafion  of  fudden  death  in  the  cardinal  Boncompagno  at  Rome : 
and  I  formerly  heard  at  Bologna,  from  my  praeceptors,  who  were  his  phyfi- 
cians,  that  he  had  been  us’d  to  complain  of  mod  of  the  fymptoms  which  are 
mention’d  in  the  cafe  defcrib’d  juft  now.  Whether,  therefore,  the  blood 
had  iflfu’d  from  the  pulmonary  artery,  or  from  thofe  veins,  or,  finally,  from 
the  aorta  itfelf,  (for  I  have  found  (a)  the  blood  which  had  come  from  this 
vefiel,  to  be  black  alfo,  and  not  of  a  bright  red)  I  leave  quite  undetermin’d, 
not  only  in  the  obfervation  defcrib’d  above,  but  equally  in  another  likewife, 
which  you  read  in  Ramazzini  (£),  of  “  a  man  of  fixty  years  of  age,  of  a 
“  very  fat  habit  of  body,”  who  died  a  fudden  death,  and  from  whole  “  pe- 
“  ricardium  almoft  two  pounds  of  coagulated  blood  were  extradted and 
finally,  in  that  which  is  extant  in  this  fedlion  of  the  Sepulchretum  (c),  of  a 
foldier  “  who  died  fuddenly,  after  a  long  (late  of  grief;”  and  who,  at  the 
fame  time  that  “  the  other  vifcera  were  found,  had  in  the  pericardium,  not 
“  only  water,  but  alfo  a  great  quantity  of  concreted  blood.”  Where,  not- 
withftanding,  you  will  alfo  fee  it  inculcated  in  the  fcholium,  that  the  heart 
had  been  overwhelm’d  and  opprefs’d,  “  both  by  the  quantity  of  water,  and 
•“  by  the  blood,”  yet  it  is  by  no  means  neceflfary  that  you  fhould  believe 
there  was  any  other  water  than  the  ferum  generated  in  a  very  confiderable 
quantity,  as  frequently  happens,  from  the  remaining  and  coagulated  part  of 
the  blood.  In  thefe  hiftories,  therefore,  it  is  certain,  that  the  blood  had 
burft  into  the  pericardium  from  fome  pretty  large,  or,  at  leaft,  from  fome 
moderately-fiz’d  vefiel  being  pierc’d  through  with  a  foramen,  and  not  from 
a  very  (lender  one,  efpecially  if  it  was  a  vein  ;  for  the  blood  flowing  down 
very  (lowly  from  a  fmall  vefiel,  or  through  a  very  fmall  foramen,  as  it  would 
have  been  encreas’d  to  fuch  a  quantity  gradually  and  (lowly,  would  not  have 
brought  on  fo  fudden  a  death.  But  from  what  veflfels  it  had  been  difcharg’d 
is  uncertain,  by  reafon  of  the  unfkilfulnefs  or  negligence  of  thofe  who  per¬ 
form’d  the  part  of  difife&or.  For  the  blood  being  taken  out,  and  wafh’d 
away  clean,  a  foramen  of  that  kind  could  not  be  conceal’d,  whether  it  was 
in  the  ventricles,  or  in  the  auricles,  of  the  heart,  which  we  here  compre¬ 
hend  under  the  general  name  of  veffcls,  or  in  the  other  veflfels  properly  fo 
call’d ;  and  not  only  in  the  very  largeft,  but  even  in  thofe  of  a  moderate 

(z)  Obf.  Anat.  n.  8.  (6)  Conft.  Epid.  TJrb.  A.  i6gr. 

( a )  Supra,  n.  21.  (<-)  Obf.  14. 

ifize  ; 


8  i6  Book  II.  Of  Difcafes  of  the  Thorax. 

fize ;  of  which  kind,  particularly  at  the  bafis  of  the  heart,  are  the  coronary 
veflels:  for  it  was  found  that  the  blood,  with  which  the  pericardium  was 
diftended,  in  a  matron  (d%  and,  in  like  manner,  in  a  foldier(^),  who  were 
taken  off  by  a  fudden  death,  had  flow’d  out  from  a  rupture  of  the  coronary 
artery.  And  if  the  foramen  had  neverthelefs  efcap’d  the  eyes  even  of  a  fkil- 
ful  and  attentive  man,  it  muft  have  been  very  eafily  difcover’d  by  inje&ing 
air  or  water  through  the  veins  to  the  heart,  and  into  the  heart,  and  from  the 
heart  into  the  arteries,  in  a  proper  quantity,  at  the  fame  time  making  a  li¬ 
gature  on  the  arteries  without  the  pericardium. 

But  if  after  a  death  that  is  not  fudden,  of  which  the  queftion  is  not  in 
this  place,  blood  be  found  within  the  pericardium,  you  muft  fuppofe  this  to 
have  diftill’d  gradually  from  the  fmalleft  veflels  and  pores :  as,  for  inftance,  in 
the  two  obfervations  of  the  celebrated  Laubius  (/)  ;  efpecially,  fince  in  the 
firft  of  them,  the  furface  of  the  heart  appear’d  to  be,  in  a  manner,  corroded. 
And  I  would  have  you  fuppofe  the  fame  thing  of  others,  which  you  will 
find  to  be  of  the  fame  clafs  with  thefe,  out  of  the  many  that  the  very  learned 
Senac  (g)  points  out  befldes.  But  do  not  readily  imagine,  that  thofe  which 
he  takes  notice  of  among  the  reft,  as  being  taken  after  a  fudden  death,  could 
have  been  made  without  a  foregoing  corrofion  or  rupture  of  fome  large  or 
middling  fiz’d  veflel  or  repofitory  of  blood  ;  for  inftance,  as  he  exprefsly 
relates,  in  two  of  the  aorta,  or  of  one  of  the  pulmonary  veins.  However, 
the  rupture  moft  frequently  happens  in  the  aorta,  when  it  happens  in  the  ar¬ 
teries  ;  and  in  the  vena  cava,  when  it  happens  in  the  veins:  in  the  former 
veflel  generally  for  thofe  reafons,  on  account  of  which  I  have  already  aflert- 
ed  ih)  aneurifms  to  happen  in  that,  rather  than  in  the  pulmonary  artery;  and 
in  the  vena  cava,  for  thofe  reafons  that  I  fhall  immediately  hint  at.  For 
why  this  happens  fometimes  in  the  heart,  we  fhall  fee  in  the  next  letter. 

27.  Although  all  the  blood  muft,  of  courle,  pafs  through  the  vena  cava, 
as  it  pafles  through  the  pulmonary  vein  ;  yet  there  are  many  things  which 
may  render  its  paflage  more  difficult  through  the  former  than  through  the 
latter.  In  the  firft  place,  the  oppofite.  and  almoft  adverfe  channels  of  the 
fuperior  and  inferior  cava,  fo  that  to  the  difficulty  of  the  afcent  on  one  hand, 
is  added,  on  the  other,  the  weight  and  impetus  of  the  blood  rufhing  from 
above  downwards.  In  the  fecond  place,  the  crude  and  thick  juices,  not  yet 
mix’d  with  the  blood,  with  which  the  effete  blood  of  the  cava  is  loaded. 
And,  finally,  the  obftrubtions  which,  by  the  force  of  dileafes,  or  paffions  of 
the  mind,  or  from  any  other  caufe  whatever,  may  be  thrown  in  great  num¬ 
bers  in  the  way  of  the  fpeedy  motion  of  the  blood,  through  the  vena  cava ; 
inafmuch  as  they  may  exift,  not  only  in  the  right  cavities  of  the  heart,  but 
in  the  pulmonary  artery  alfo,  and  the  lungs,  the  pulmonary  vein  itfelf,  the 
left  cavities  of  the  heart,  and  the  great  artery.  On  the  other  hand,  the  trunk, 
or  if  you  choofe  rather  to  call  it  fo,  the  fac,  of  the  pulmonary  vein  is  Am¬ 
ple,  and  receives  the  blood,  when  driven  thither  by  the  agitation  of  the 

(d)  Commere.  Litter.  A.  1732.  Hebd.  41.  (f)  Eplu  N.  C.  Cent.  9.  Obf.  15.  &  Aft. 

n  4  eorund.  Tom.  2.  Obf.  107. 

(e)  Aft.  N.  C.  Tom.  5.  Obf.  37.  (g)  Traite  da  Coeur,  1.  4.  ch.  5.  n.  3. 

( b )  Epiit.  1?.  n.  24. 


7 


lungs, 


Letter  XXVI.  Article  28.  817 

lungs,  and  that  in  a  vivid,  comminuted,  and  mix’d  ftate  ;  nor  can  it,  of  it- 
felf,  have  any  other  obftacles  to  op  pole  its  motion,  befides  thofe  which,  after 
the  lungs,  I  have  faid  may  be  common  alfo  to  the  blood,  that  is  about  to 
flow  through  the  vena  cava. 

And  this  being  the  ftate  of  the  matter,  and  examples  of  dilatation  of  the 
pulmonary  vein,  at  the  fame  time,  not  being  wanting,  nor  even  examples  of 
its  rupture  (/)  •,  for  to  put  that  out  of  the  queftion,  which  is  related  from 
Parey  (£),  “  the  pulmonary  vein  has  been  fometimes  found  ”  by  Bellini,  in 
thofe  who  have  died  fuddenly,  “  to  be  pull’d  afunder  fiom  the  left  auricle  (/),” 
which  Francis  du  Queye  alfo  law  at  Montpelier  (m)\  both  the  dilatation 
and  the  rupture  will  happen  fo  much  the  more  eafily  in  the  vena  cava,  in 
proportion  to  the  number  of  caufes  that  I  have  fhewn  to  exift,  by  which  the 
blood  may  be  retarded  therein,  and  confequently  accumulated  ;  and  being 
accumulated,  may  weaken  and  draw  afunder  the  fibres  of  its  coats  •,  from 
whence,  by  the  quantity  of  blood  that  is  urg’d  on,  the  vein  may  be  firft  di¬ 
lated  into  a  varix  ;  and  after  that,  by  reafon  of  the  extenuation  of  the  coats, 
which  is  the  confequence  of  dilatation,  or  even  on  account  of  the  erofion, 
which  generally  fucceeds  to  the  diftradtion,  may  be  ruptur’d.  But  the  va¬ 
rices  of  the  cava,  unlefs  they  are  very  confiderable  indeed,  are  Id's  obvious 
to  the  eyes  of  the  difledter  than  the  aneurifms  of  the  aorta  ;  for  the  veins 
collapfe,  by  reafon  of  the  thinnefs  of  their  coats,  when  the  blood  is  taken 
out  of  them  ;  which  happens  when  the  cava  is  cut  into,  in  the  belly. 

Wherefore,  when  there  is  any  fufpicion  of  diforders  in  the  cava,  the  dif- 
fedtion  ought  to  be  begun  from  the  thorax :  or  if  the  blood,  by  reafon  of 
the  body  having  been  previoufiy  examin’d  by  others,  and  the  vifeera  of  the 
belly  being  taken  out,  has  happen’d  to  be  difcharg’d,  care  mu’ft  then  be 
taken  to  injedt  a  fufficient  quantity  of  air  or  water,  in  order  to  fhow  you  what 
is  the  full  breadth  of  the  cava  :  and  that  in  particular,  when  you  have  ob- 
ferv’d  the  right  cavities  of  the  heart  to  be  affedted  with  too  great  a  dilatation, 
or  contradlion,  or  even  the  left :  for  hence  it  alfo  happens,  as  was  faid  juft 
now,  that  the  motion  of  the  blood  being  retarded,  the  cava  may  be  dilated  ; 
as  is  fhown  in .  the  firft  of  the  hiftories  of  Vieuflens,  that  are  given  in  the 
fixteenth  chapter  of  his  treatife  on  the  ftrudture  of  the  heart. 

28.  But  whether  Aretteus  (#)  hinted  at  this  diforder,  or  any  other  of  the 
vein,  when  he  wrote  “  that  Kifp&Ttt  arife  in  this  vein,  when  the  blood  burft- 
“  ing  forth  copioufly,  very  foon  deftroys  life,”  I  omit  to  enquire;  not  only- 
on  account  of  the  various  ledtions  in  that  part ;  as  Peter  Petit  (0)  would  have 
it,  “  if  a  ruptur’d  vein  pour  out  its  blood ;”  but  in  particular,  on  account 
of  the  very  extenfive  fignification  of  that  word  yAJ'y.a.Ta.y  which  is  thus  ex¬ 
plain’d  according  to  Galen,  in  the  Exegefis,  “  old  diforders  from  a  flux  of 
“  humours.”  This  is  more  certain,  that  Aretasus  fpeaks  of  the  rupture  of  this 
vein,  and  firft  in  the  thorax  ;as  thofe  things  which  he  immediately  adds,demon- 
ftrate :  altho’  the  paftage  does  not  appear  by  which  he  carries  the  blood  from 
that  when  ruptur’d,  into  the  lungs,  and  the  afpera  arteria,  from  whence  it  may 


(/)  Epift.  24.  n.  36. 
(i)  Ibid. 

(/)  De  Morb.  Pe£t. 

VOL.  I. 


5  M 


{fh)  Difput.  de  Syncope,  c.  3.  Prcpof.  2. 
(*)  De  cauf.  &  fign.  morb.  Acut.,1.  2.  c.  8. 
(0)  Comment,  ad  hunc  Ioc. 


be 


8 1 8  Book  II.  Of  Difeafes  of  the  Thorax. 

be  difeharg’d.  But  the  rupture  of  the  cava,  which  was  conje&ur’d  by  Are- 
tasus,  anatomy  at  length  has  fet  before  our  eyes.  For  to  omit  the  examples 
of  this  vein  being  ruptur’d  in  the  belly,  to  which  I  am  uncertain  whether  the 
cafe  that  Donatus  (j>)  points  out  in  Amatus  Lufitanus,  in  whofe  writings  I 
have  not  yet  found  it,  refers;  Laurentius  (j),  Hacquinettus  (r),  Puera- 
rius  (j),  Lancifi  (/),  and  others,  have  feen  it  in  the  thorax,  and  even  within 
the  pericardium.  But  all  of  them,  except  the  fecond,  whofe  obfervation  is 
very  lame  and  imperfedt,  as  far  as  Bartholin  has  related  it,  found  it  to  be 
join’d  together  with  other  diforders  in  the  neighbouring  parts  ;  the  firft,  witli 
the  dilatation  of  the  aorta,  and  the  ventricles  of  the  heart ;  the  fourth,  with 
the  dilatation  of  the  aorta  only  ;  the  third,  with  a  kind  of  membranous  and 
fielhy  body,  which  was  “  the  tomentum,  as  it  were,  of  the  varicofe  veins,’* 
being  a  little  lefs  than  the  heart,  and  connected  to  its  auricles,  of  which  body 
you  will  read  thefe  lad,  and  other  circumftances,  in  this  fedtion  of  the  Se- 
pulchretum  («) ;  in  which  that  hiftory,  with  fome  of  thofe  juft  pointed  out, 
is  related  fotnewhat  more  clearly  than  it  had  been  deferib’d  in  the  words  of 
Puerarius,  in  the  eighth  fedtion  (*).  For  I  confels  that  I  was  lefs  able  to 
learn,  in  that  place,  in  what  manner  I  Ihould  underftand  thefe  paftages, 
“  the  vena  cava  being  ruptur’d,  and  the  blood  being  effus’d  into  the  peri- 
«  cardium,  and  the  right  ventricle  of  the  heart,”  which  in  the  obfervation  of 
Laurentius,  who  was  unacquainted  with  the  circulation  of  the  blood,  is  faid 
to  have  happen’d  on  account  of  “  the  mouth  of  the  vena  cava  being  rup- 
“  tur’d,  and  all  thofe  tricufpidated  membranes  being  lacerated,”  by  which. 
«  a  mortal  eft ufion  of  blood  was  made  into  the  finus  ”  of  the  heart  alfo,  on 
the  right  fide  :  which,  to  fpeak  the  truth,  as  he  takes  notice  of  in  the  ven¬ 
tricles  only,  and  that  in  a  very  great  quantity,  and  not  only  does  not  men¬ 
tion  the  pericardium,  but  even  does  not  hint  at  it ;  I  fufpedt,  but  am  not 
fufficiently  clear,  whether  the  rupture  of  the  vena  cava  happen’d  on  the  in¬ 
ternal  furface  only.  But  without  doubt  the  ventricles  of  the  heart,  by  fome 
unlucky  fate  or  other,  often  create  a  great  deal  of  trouble  in  underftanding 
the  deferiptions  of  ruptures  of  the  vein.  For  turn  to  Poterius  alfo  (y)9  who 
propofes  as  the  caufe  of  a  fudden  death,  which  he  relates,  “  the  rupture  of 
“  a  vein  in  the  ventricle  of  the  heart but  what  vein  he  means,  or  where 
it  lies,  declare  to  me  if  you  can.  The  fame  author  has  written,  that  in  fome 
afthmatic  perfons,  “  the  vena  arteriofa  has  been  ruptur’d  in  the  left  ventricle 
of  the  heart  ”  (z);  a  veflel,  which  you  know,  is  on  the  outfide  of  the  ventri¬ 
cles,  and  belongs  to  the  right  fide,  not  to  the  left.  Without  doubt  it  is 
much  to  be  wilh’d,  as  I  believe  was  done  in  the  Strafburg  diflertation,  which 
I  have  not  yet  feen,  except  in  review  (a),  and  which  gives  an  account  of  the 
rupture  of  the  dilated  fac  of  the  vena  cava ;  it  is  to  be  wilh’d,  I  fay,  that  they 
who  (hall  light  on  ruptures  of  the  vena  cava  hereafter,  efpecially  when  they 
are  quite  uncomplicated  with  other  diforders,  may  take  pattern  from  Lancifi, 
in  his  accuracy  and  perfpicuity ;  not  only  in  fetting  down  all  the  fymptoms 


(/>)  De  Med.  Hid.  Mir.  1.  4.  c.  9. 

(?)  Hift.  Anat.  hum.  corp.  1.  9.  qu.  18. 

(r)  Eph.  N.  C.  Dec.  1.  A.  1.  Obf.  101. 

(j)  Ad  Burnet.  Thef.  Med.  1.  3.  S.  58.  in  fin. 
(?)  De  Subit.  Mort.  Obf.  Phyf.  Anat.  5. 


(«)  Obf.  1.  §.  1. 

(x)  Obf.  30. 

(y)  Infign.  Curat.  &  Obf.  Cent.  3.  c.  60. 

(z)  Ibid.  c.  22. 

(a)  Commere.  Litter.  A,  1731.  Spccim.  47. 

that 


Letter  XXVI.  Articles  29,  30,  31.  Si  9 

that  had  preceded  death,  but  alfo  in  defcribing  the  appearances  that  offer’d 
themfelves  in  difiHtion.  And  I  heartily  wilh  that  the  rupture  of  another 
confiderable  vein  had  been  unattended  with  other  diforders,  which,  as  it 
happen’d  within  the  thorax,  and  was  the  caufe  of  fudden  death,  ought  by  no 
means  to  be  pafs’d  over  in  this  place:  the  obfervation  is  very  rare,  and  was 
communicated  to  me  by  that  very  learned  phyfician,  and  familiar  friend  of 
mine,  Heraclito  Manfredi,  in  the  year  1718. 

29.  A  woman  who  had  been  luppos’d  for  a  long  time  to  be,  and  really 
was,  confumptive,  was  found  dead  fuddenly.  The  left  cavity  of  the  thorax 
fhow’d  the  interior  part  of  that  lobe  of  the  lungs  to  be  difeas’d,  inafmuch  as 
it  contain’d  three  or  four  tubercles,  full  of  pus.  In  the  right  cavity,  how¬ 
ever,  the  lungs  were  found  indeed,  but  there  was,  at  the  fame  time,  coagu¬ 
lated  blood  in  that  cavity,  to  the  quantity  of  four  pounds.  It  had  been  ef¬ 
fus’d  from  the  trunk  of  the  vena  fine  pari;  which,  although  it  had  collaps’d 
from  that  effufion,  yet,  by  reafon  of  the  vaft  diftenfion,  had  retain’d  fo 
much  of  its  breadth,  that  it  might  be  well  compar’d  with  the  vena  cava. 
This  dilatation  extended  itfelf  to  about  the  length  of  a  fpan.  And  about  the 
middle  of  that  length,  a  foramen  lay  open,  in  the  form  of  an  ellipfis.  And 
through  this  foramen  the  blood  had  been  extravafated. 

30.  Now  let  us  return  from  the  varices  of  the  veins,  to  the  aneurifm  of 
the  great  artery,  but  not  tothofe  that  are  ruptur’d  ;  for  of  thefe  we  have  feen 
enough  already  :  but  fuch,  neverthelefs,  as  are  caufes  of  fudden  death.  Of 
which  take  thefe  three  inftances  that  have  been  obferv’d  by  me. 

31.  The  mother  of  a  family,  who  was  two-and-forty  years  of  age,  had 
liv’d  long  in  a  ftate  of  infirm  health,  and  had  long  been  fubjedt  to  a  kind  of 
paroxyfm,  which  appear’d  in  the  following  manner :  on  ufing  pretty  quick 
exercife  of  body,  a  kind  of  violent  uneafinefs  came  on,  within  the  upper  part 
of  the  thorax,  on  the  left  fide,  join’d  with  a  difficulty  of  breathing,  and  a 
ftupor  of  the  left  arm  :  all  which  fymptoms  foon  remitted  when  thefe  motions 
ceas’d.  This  woman  then,  having  fet  out  about  the  middle  of  Odtober,  in 
the  year  1707,  from  Venice,  to  go  up  the  continent  in  a  wheel-carriage,  and 
being  chearful  in  her  mind,  behold  the  fame  paroxyfm  return’d  :  with  which 
being  leiz’d,  and  faying  that  fhe  fhould  die,  fhe  adually  died  on  the  fpot. 

The  body,  being  brought  back  into  the  city,  was  examin’d  by  me  on  the 
following  day  :  the  face  of  it  was  fomewhat  livid ;  the  other  parts  appear’d  to 
be  quite  of  a  good  colour  and  habit ;  but  the  upper  parts  were  fomewhat 
lank  and  wrinkled.  And  as,  on  account  of  thofe  things  already  related,  I 
had  a  fufpicion  of  an  aneurifm  at  the  curvature  of  the  aorta,  the  difleftion 
was  begun  from  the  thorax.  In  this  cavity  was  contain’d  a  ferum,  of  itfelf 
bloody,  and  in  equal  quantity  on  both  fides,  and  not  inconfid^rable ;  for  it 
had  been  obferv’d  that  no  blood  had  fall’n  down  thither,  in  making  the  in- 
cifion  of  the  thorax.  The  lungs  were  found,  except  that  being  cut  into,  as 
I  law  afterwards,  they  abounded  with  too  great  a  quantity  of  frothy  ferum. 
The  heart  was  rather  large,  very  hard,  and  very  ftrong.  The  aorta  was  not 
a  little  dilated  at  the  curvature  ;  but  in  other  parts  of  the  trunk,  and  the 
larger  branches,  of  a  proper  width.  But  internally,  wherever  you  cut  into  it, 
it  was  here  and  there  unequal,  and  not  without  compleat  bony  fcales,  of  a 
fmall  ffze  ;  not  to  mention  frequent  marks  of  oflification  being  begun.  And 

5  M  2  feeing 


82  0  Book  If.  Of  Difeafes  of  the  Thorax. 

feeing  this,  I  open’d  the  whole  trunk,  and  the  larger  branches  :  and  in  this 
trunk  from  the  very  origin  behind  the  femilunar  valves,  which  were  in  fome 
places  hard,  1  obferv’d  the  diforders  that  have  been  deferib’d,  together  with 
the  beginnings  of  future  bone,  quite  to  the  iliac  arteries.  Yet  through  thefe, 
and  others  that  are  even  higher,  and  in  particular  the  left  fubclavian,  they 
were  not  propagated,  if  you  except  a  part  of  that  other  artery,  which  gives 
origin  to  the  carotid  and  fubclavian  on  the  right  fide.  Carrying  our  eyes 
back  from  hence  to  the  heart,  and  to  the  other  velfels  that  are  annex’d  to  it, 
we  favv  no  kind  of  diforder  any  where,  except  that  the  trunk  of  the  pulmo¬ 
nary  vein  feem’d  to  be  fomewhat  larger  than  it  naturally  is.  In  this,  and  in 
the  adjoining  ventricle,  was  a  fmall  quantity  of  blood,  which,  like  the  blood 
in  all  other  parts  of  the  body,  was  black,  and  altogether  fluid.  But  in  the 
trunk  of  the  pulmonary  artery  was  no  fmall  quantity  of  blood  ;  notwithstand¬ 
ing  in  the  right  ventricle,  and  its  auricle,  there  was  none  ;  without  doubt, 
becaufe  it  had  flow’d  down  through  the  vena  cava,  which  had  been  previoufly 
cut  into  a  little  below  the  liver. 

And  in  examining  the  vifeera  of  the  belly,  we  made  the  following  obser¬ 
vations.  The  fmall  inteftines  were  tnoPdy  fomewhat  red,  and  a  little  livid. 
T  he  ftomach  was  in  a  manner  double,  by  reafon  of  the  antrum  pylori  being 
in  fome  meal'ure  divided  from  the  other  part,  by  a  kind  of  conftriCtion  ;  but 
in  other  refpeCts  found.  The  liver  was  extended  very  far  to  the  left,  and  on 
the  right  edge  of  it ;  and  on  the  lobe  which  was  continu’d  from  that  edge,  it 
was  of  a  more  faturated  colour  for  fome  fpace,  both  within  and  without,  and 
rather  hard.  The  pancreas  was  alfo  very  hard,  and  on  the  fide  which  lay 
near  the  fpleen,  of  a  red  and  blackifh  colour,  from  the  blood  that  ftagnated  in 
it.  But  the  fpleen  was  lax  ;  fo  that  it  could  eafily  be  broken  down  with  the 
fingers.  The  teftes  were  contracted.  The  ofculum  uteri  was  dilated,  and 
fubfiding  :  and  the  upper  part  of  its  fundus  was  ting’d,  externally,  of  the 
fame  colour  with  that  which  I  faid  the  fmall  inteflines  were  ting’d  with  ;  and 
not  without  a  difagreeable  fmell.  And  there  was  in  the  pelvis  of  the  abdo¬ 
men  a  ferum  of  the  fame  kind  with  that  in  the  thorax,  but  in  fmall  quantity. 
The  other  parts  had  nothing  worthy  of  oblervation.  The  head  I  did  not 
touch,  for  it  was  already  late  at  night,  and  the  woman  died  while  fhe  was 
fpeaking,  as  I  faid  before. 

32.  Although  you  will  read,  in  this  feCtion  of  the  Sepulchretum,  the  thirty- 
fifth  obfervation,  which  has  this  title  prefix’d  to  it,  “  Sudden  death  in  a 
“  man  in  whom  the  ftomach  feem’d  to  be  drawn  together,  as  it  were,  with 
“  a  bandage;”  yet  if  the  appearance,  as  I  fuppofe,  was  like  that  which  I 
have  juft  now  deferib’d,  it  ought  to  be  accounted  for  from  the  original  for¬ 
mation  of  the  part,  rather  than  from  any  adventitious  difeafe  ;  nor  ought  by 
any  means  to  be  compar’d  with  thofe  firm  coardlations  of  the  fmall  inteftines, 
which  have  l'ometimes  occurr’d  in  a  volvulus,  and  ftill  lefs  be  look’d  upon  as 
the  caufe  of  a  fudden  and  unexpected  death.  Without  doubt,  that  woman, 
in  whom  I  have  alreadyc(£)  deferib’d  to  you  a  ftomach  of  the  fame  kind,  was 
gradually  carried  off,  and  by  a  flow  difeafe:  nor  have  others  died  fuddenly, 
in  whom  I  fhall  perhaps  deferibe  the  fame  circumftance  in  other  places  (c). 

(< b )  Epijft.  16.  n.  38.  (r)  Epift.  30.  n.  8.  &  Epift.  36.  n.  2. 

But 


Letter  XXVI.  Article  33.  821 

But  here  we  have  caufes  enough  in  the  difeafes  of  the  artery.  In  the  fir  11 
place,  the  inequality  of  the  internal  furface  renders  the  motion  of  the  blood 
lefs  eafy.  And,  .  fecondly,  the  bony  fcales  in  the  coats,  and  the  frequent  be¬ 
ginning  offifications  that  were  feen  up  and  down,  make  the  artery  lefs  fit  to 
yield  outwardly  to  the  impulfe  of  the  blood,  and  admit  it ;  and  lefs  fit,  like- 
wife,  promptly  to  refiore  itfelf  foon  after  by  contradting,  and  thus  pulh  for¬ 
ward  the  fluids.  Finally,  the  dilatation  of  the  curvature  being  added  to  thefe, 
help’d  forwards  their  effedts  ;  and  that,  not  only  by  delaying  the  blood’s  mo¬ 
tion,  but  alfo  by  propelling  it  with  lefs  force  than  ufual,  as  I  have  already 
explain’d,  with  the  other  circumflances,  on  more  occafions  than  one;  fo  that 
there  is  no  neceffity  of  repeating  thefe  explanations  at  large. 

Taking  thefe  elfedts  for  granted,  then,  if  from  any  caufe  whatever,  a 
quicken’d  motion  of  the  body,  and,  confequently,  a  quicken’d  motion  of 
the  blood,  is  brought  on  ;  you  fee  very  plainly,  that  the  aorta,  which  was 
fcarcely  equal  to  that  office  before,  mult  be  now  frill  more  unequal  to  the 
tafk  of  dilpatching  on  the  blood  with  greater  quicknefs.  In  the  mean  while, 
therefore,  a  more  plentiful  quantity  of  blood,  that  has  been  brought  together 
by  the  veins,  will  be  heap’d  up  ;  and  ftagnating  in  the  aorta  itfelf,  in  the  heart, 
in  the  vefiels  of  the  lungs,  and  the  vena  cava,  will  not  only  be  able  to  bring 
on  thofe  fymptoms  that  the  woman  had  when  living ;  the  violent  uneafinefs, 
the  difficulty  of  breathing,  the  numbnefs  of  the  arm  ;  or  what  were  obferv’d 
m  the  body  after  death  ;  that  is,  fome  dilatation  of  the  trunk  of  the  pulmo¬ 
nary  vein,  and  the  great  effufion  of  ferum  into  the  bronchia  and  the  cavities 
of  the  thorax ;  will  not  only,  I  fay,  be  able  to  produce  thefe  effedts,  but 
even  more  in  number,  and  more  violent  ones,  according  to  the  difpofition  of 
the  parts.  And  as  ail  thofe  diforders  of  the  aorta  were  encreas’d,  gradually 
indeed,  but  more  and  more  every  day ;  it  is  not  to  be  wonder’d  at,  if  they 
fhould  at  length  proceed  fo  far,  the  quantity  and  turgefcency  of  the  blood 
being,  perhaps,  at  the  fame  time  increas’d,  or  at  leafb  the  motion  of  it  being 
quicken’d  by  the  motion  of  the  carriage,  which  was  unufual  to  a  Venetian 
woman,  that  the  blood  ftagnating,  could  no  longer  be  propell’d. 

But  if  you  are  not  fatisficd  with  all  thefe  caufes,  one  of  which  only,  that 
is,  the  bony  fcales  in  the  aorta,  gave  fatisfadtion  to  the  very  ingenious  man 
with  whom  J  diftedted  that  woman,  that  is,  to  Santorini,  as  I  fliall  lhew  in 
the  latter  end  of  this  letter  {d) ;  or  if  you  are  not  fatisfied  with  them,  becaufe 
we  did  not  find  the  aorta,  and  the  left  ventricle  of  the  heart,  fill’d  with 
ftagnating  blood  ;  or  becaufe  you  think  that  you  can  better  conceive  of  that 
numbnefs  in  the  arm  from  fuppofing  fome  convulfion  with  which  the  me¬ 
ninges  were  contradted  about  their  origins,  than  from  fuppofing  the  diftradtion 
of  the  diftended  aorta  to  have  been  propagated  to  the  left  fubclavian,  and 
to  the  nerves  that  lie  near  it ;  I  am  fofar  from  replying  any  thing  to  your  ob- 
jedtions,  that  I  lhall  rather  advile  you,  if  you  choofe  to  add  a  convulfion  to 
the  other  caufes,  to  allow  of  it  principally  in  the  heart.  Indeed,  this  vifeus 
muft,  without  doubr,  have  been  very  ftrong  naturally,  when  compar’d  with 
the  aorta  ;  and  for  that  reafon,  according  to  the  dogma  of  Lancifr(<?),  nauft 
have  weaken’d  and  overcome  it :  but  tell  me,  I  beg  of  you,  why,  after  lu- 

{d)  N.  36,  37.  (cj  De  Met.  Cord.  Pjopof.  38. 

bo  tiring 


8  22  Book  II.  Of  Difeafes  of  the  Thorax. 

bouring  fo  long  in  fupplying  the  place  of  thofe  very  powers  of  the  aorta 
which  itfelf  had  deftroy’d,  we  not  only  found  it  very  ftrong,  but  very  hard 
alfo  ?  Read  over  again  what  I  wrote  of  a  certain  man  in  the  former  letter  (/). 
And  a  convulfion  of  the  vifcera  arifes  much  more  eafily  in  women,  parti¬ 
cularly  in  valetudinarian  women  ;  fo  that  we  may  add  this  to  the  number  of 
other  caufes  both  of  the  paroxyfms  and  death  ;  yet  fo  as  not  to  forget  thofe 
things  that  manifeftly  occur  in  the  vifcera  and  the  principal  vefiels  ;  nor  yet 
to  imagine  that  this  is  to  be  added  to  the  others,  as  is  the  cuftom  with  many, 
except  when  there  are  marks  of  it  alfo  in  the  living  body,  or  in  the  body 
after  death.  And  whether  this  fhould  be  done  in  the  old  man  whofe  hiftory 
I  fhall  immediately  relate,  you  yourfelf  will  judge. 

33.  This  old  man  was,  to  appearance,  about  fixty  years  of  age,  and  had 
three  months  before  been  in  this  hofpital,  complaining  of  a  difficulty  of 
breathing,  and  fpitting  up  an  ill  condition’d  matter.  Having  been  in  the 
country  lately,  about  the  beginning  of  March,  in  the  year  1742,  and  Jiaving 
been  expos’d  to  a  cold  wind,  upon  his  return  home  again,  he  was  feiz’d  in 
the  night  with  a  very  great  difficulty  of  breathing.  Wherefore,  being  brought 
into  the  fame  hofpital  again,  in  the  morning,  and  fitting  a  little  time  by  the 
fire-fide,  while  they  were  warming  his  bed,  he  had  fcarcely  laid  himfelf  down 
therein,  but  he  initantly  died.  The  ftudents  begg’d  of  me,  on  the  following 
day,  that  I  would  enquire  into  the  caufe  of  fo  fudden  and  unexpected  a  death. 
And  having  confented,  I  order’d  the  cranium  to  be  faw’d  round  in  the  mean 
while,  in  order  to  be  ready  againft  1  came. 

As  I  look’d  upon  the  body,  which  was  of  a  good  habit,  no  tumour  dis¬ 
covering  itfelf  any  where,  except  that  the  face  was  fomewhat  fwell’d  and 
reddiffi  ;  and  the  blood  being  look’d  upon  at  the  fame  time,  which  had  come 
from  within  the  cranium  as  it  was  cut  through,  almoft  in  the  quantity  of  a 
pound ;  although  I  did  not  deny  but  it  might  happen,  that  the  caufe  of 
death  fhould  lie  hid  within  the  cranium,  yet  I  fhew’d,  that  it  feem’d  to  me, 
we  fhould  rather  enquire  after  it  in  the  thorax,  as  it  was  certain  that  this  man 
had  labour’d  under  a  difficulty  of  breathing  •,  but  whether  he  had  labour’d 
under  any  diforder.  of  the  head,  did  not  appear:  in  which  part  although  a 
great  quantity  of  blood  generally  ftagnates,  in  thofe  who  are  fuffocated  from 
a  diforder  of  the  thorax,  as  is  perceiv’d  from  the  face  of  thefe  perfons  being 
livid  and  fwell’d  ;  yet  the  chief  caufe  of  death  is  not  for  that  reafon  fuppos’d 
to  be  on  the  outfide  of  the  thorax. 

The  thorax,  therefore,  being  immediately  cut  into,  and  the  fternum  being 
taken  away,  the  lungs  appear’d  to  be  fo  turgid  as  to  fill  up  the  whole  cavities  : 
they  were  neverthelels  foft,  of  a  white  mix’d  with  a  cineritious  colour,  and 
light,  as  we  afterwards  perceiv’d,  by  taking  them  out  of  the  thorax  together 
with  the  other  parts.  For  the  right  lobe  was  previoufly  to  be  loofen’d  from 
the  pleura,  to  which  it  adher’d  clofely,  efpecially  on  its  upper,  and  even  on 
its  poftcrior,  furface.  There  was,  in  both  cavities  of  the  thorax,  a  confi- 
derable  quantity  of  water,  not  turbid,  but  ot  the  colour  of  urine;  which 
kind  of  water,  alfo,  was  found  in  the  pericardium  in  fomewhat  larger  quan¬ 
tity  than  it  is  generally.  In  the  right  ventricle  of  the  heart  I  found  a  very 


(f)  N.  13. 


black 


Letter  XX VL  Article  34,  823 

black  and  almoft  fluid  blood,  as  I  did  in  fome  other  places  here  and  there  ; 
To  that  only  fome  grumous  coagula  appear’d,  which  were  not  very  firm,  to¬ 
gether  with  fome  flight  and  fmall  beginnings  of  polypous  concretions.  In 
that  ventricle,  and  the  adjoining  auricle,  I  could  meet  with  nothing  that  was 
preternatural  ;  if  you  except  the  valves  that  lie  at  the  beginning  of  the  pul¬ 
monary  artery,  which  feem’d  to  be  fomewhat  thicker  than  they  naturally  are. 
But,  although  the  left  auricle,  and  the  trunk  of  the  pulmonary  vein  that 
lies  near  it,  were  in  their  natural  ftate,  the  ventricle  adjoining  to  them,  ne- 
verthelefs,  although  of  its  ulual  thicknefs  in  the  parietes,  feem’d  to  be  wider 
than  natural,  and  the  mitral  valves  to  be  hard  and  thick ;  and  all  the  femi- 
lunar  valves  had  their  edges  hard,  white,  and,  what  is  more  than  all  the  reft, 
become  fo  much  thicken’d  as  to  equal  a  line  and  a  half  of  the  inch  of  Bo- 
logna  (g)  in  thicknefs. 

Moreover,  the  trunk  of  the  great  artery  was  much  dilated  from  thofe 
valves  quite  to  the  upper  veftels ;  and  beyond  thefe  was  ftill  dilated,  although 
in  a  lefs  degree;  the  parietes  of  it  being  thicken’d,  and  grown  much  harder 
befides,  from  the  heart  quite  to  that  part ;  and  the  internal  furface  being  here 
and  there  unequal,  and  efpecially  where  there  was  a  more  confiderable  dila¬ 
tation  ;  nor  was  it  without  white  and  yellowifh  beginnings  of  future  ofiifica- 
tions,  in  great  number. 

After  this,  I  examin’d  the  lungs  very  clofely,  but  could  make  no  farther 
difeoveries  than  I  had  done  before,  except  that  there  was  one  part  in  which 
they  feem’d  to  be  a  little  hard  :  this,  however,  when  cut  into,  Ihew’d  a  na¬ 
tural  ftrufture,  which  contain’d  a  white  and  frothy  humour,  but  not  any  dif¬ 
ferent  humour,  or  in  any  greater  quantity,  than  you  might  prefs  out  from 
the  other  parts  of  them  ;  and  from  every  part  a  fmall  quantity  only  was 
prefs’d  out.  Finally,  the  upper  part  of  the  cranium  being  taken  away,  (for 
we  did  notdifled  the  belly)  and  the  dura  mater  being  foon  after  cut  through, 
the  falciform  procefs  of  which  feem’d  to  be  very  thick  and  hard,  there  was 
nothing  found  worthy  of  remark  within  the  cerebrum,  or  cerebellum,  the 
fubftance  whereof  was  firm,  except  that  there  was  no  very  fmall  quantity  of 
water  in  the  lateral  ventricles,  fimilar  to  that  which  is  deferib’d  in  the  thorax, 
and  the  plexus  choroides  were  fomewhat  difcolour’d ;  fo  as  to  make  it  evi¬ 
dent  that  the  blood,  which  had  flow’d  down  from  the  cranium,  when  cut 
through,  had  proceeded  from  the  veflels  of  the  meninges,  which  were 
injur’d  by  the  faw,  mix’d  together,  perhaps,  with  water  which  was  within 
them. 

34.  What  the  internal  inequality  of  the  aorta,  what  the  hardnefs  of  its 
coats,  what  the  dilatation,  in  fine,  may  contribute,  by  way  of  impediment 
to  the  motion  of  the  blood,  has  been  fufficiently  taken  notice  of  in  the  re¬ 
marks  that  have  been  fubjoin’d  to  the  foregoing  hiftory.  To  thefe,  which 
were  in  the  old  man  alfo,  add  fome  dilatation  of  the  left  ventricle  of  the 
heart ;  add  the  thicknefs  of  the  figmoid  and  mitral  valves,  and  their  hardnefs ; 
add,  in  particular,  the  borders  of  the  femilunar  valves  being  fo  much  thicker 
and  harder  than  in  their  natural  ftate,  which  is  a  circumftance  that  difturbs 
the  motion  of  the  fu  art  and  the  blood,  if  any  thing  elfe  does,  while  they 

( g )  Vid.  apud  Valfalvam  de  Aurg  Tab.  9.  ad  *. 


8 


either 


824  Book  II.  Of  Difeafes  of  the  Thorax. 

either  oppofe  themfelves  to  the  blood  that  is  about  to  go  out  from  the  heart, 
and  break  the  force  of  the  motion  receiv’d  from  the  heart,  or  do  not  fuffici- 
cntly,  by  reafon  of  their  not  unfolding  themfelves  fo  fpeedily  as  ufual,.  prer 
vent  the  blood  flowing  back  in  the  contraction  of  the  artery ;  and  you  cer¬ 
tainly  will  not  want  more  circumftances  to  make  you  conceive  how  it  hap¬ 
pen’d  that  the  motion  of  the  blood  through  the  aorta  and  the  left  ventricle, 
being  retarded,  a  difficulty  of  breathing  was  brought  on  by  the  blood  being 
retain’d  in  the  lungs-,  or  how  it  at  length  came  about  that  thefe  diforders  be¬ 
ing  encieas’d  every  day,  the  whole  conftitution  was  affeCled  to  fuch  a  degree, 
that  the  blood,  efpecially  when  augmented  in  its  quantity,  by  that  addition 
of  moillure,  which,  if  it  had  not  been  obftrudted  by  a  cold  wind,  would 
have  pafs’d  off  by  the  invifible  foramina  of  the  fkin  j  that  the  blood,  I  fay, 
could  no  longer  be  circulated. 

Nor  would  I  have  you  be  much  furpriz’d,  that  in  this,  and  in  the  former 
obfervation,  we  did  not  find  the  blood  accumulated  in  thofe  parts,  in  which 
I  have  laid  it  was  retarded  For  nothing  happens  more  eafily,  while  the  bo¬ 
dies  are  turn’d  about  on  every  fide,  and  while  they  are  carried  from  one 
place  to  another,  and  particularly  up  flairs,  where,  fometimes  their  heads, 
and  fometimes  their  feet,  are  turn’d  downwards,  than  that  the  blood,  efpe¬ 
cially  when  fluid,  as  it  was  in  thefe  bodies,  in  great  meafure  changes  its 
place :  and  the  fame  mud  of  courle  happen  when  the  vifcera  are  taken  out  j 
and  indeed  the  blood  muft  then  flow  down  through  the  veffels  that  are  al¬ 
ready  cut  into,  and  afterwards  through  thofe  that  are  open’d  in  the  neigh¬ 
bouring  parts.  But  if  you  fhould  be  willing,  neverthelefs,  to  attribute  fome- 
thing  to  that  water  alfo,  which  was  leen  in  the  ventricles  of  the  brain,  and 
to  fuppofe  any  circumftance  from  whence  the  nerves  that  go  to  the  heart  and 
the  lungs  have  encreas’d  the  caufes  of  fudden  death,  and  fo  by  this  means 
alfo  explain  that  tumour  of  the  putrefeent  lungs,  by  fuppofing  that  they  were 
not  able  to  thrufl  out  their  air-,  I  fhall  not  greatly  oppofe  your  opinion.  But 
(hall  you  imagine  that  there  was  fometbing  paralytic,  or  rather  foinething 
convulfive,  in  that  man  whom  I  fhall  immediately  deferibe  to  you  ? 

35.  A  man  of  fome  family  and  credit  (who  was  not  yet  fixty  years  of  age, 
having  been  formerly  affected  with  a  lues  venerea,  fo  that  the  rheumatic  pains 
with  which  he  was  much  troubled,  were  alfo,  for  the  mod  part,  aferib’d  to 
that  caufe,  after  having  got  rid  of  thefe  for  fourteen  or  fifteen  years,  by 
means  of  fvveats  being  excited,  with  the  ufual  decodtions  of  woods,  and  the 
dry  bain)  grew  fat,  yet  not  immoderately,  and  particularly  in  his  belly  and 
thorax,  but  not  fo  in  his  lower  limbs.  His  intimate  acquaintance  had  ob- 
ferv’d  him  to  be  fubject,  at  intervals,  to  a  cough,  with  which  he  expedto- 
rated  nothing  and  in  like  manner,  to  a  certain  difficulty  of  breathing,  ef¬ 
pecially  after  eating.  However,  at  a  time  that  he  was  very  robuft,  and 
feem’d  to  every  body  to  be  in  excellent  health,  except  that  he  had  faid,  not 
long  before  to  a  friend,  that  his  head  was  confus’d  ;  having  fupp’d  very 
fparingly,  he  was  firft  feiz’d  with  a  flight  cough,  which  foon  after  encreas’d 
fo  much,  that  being  already  foaming  at  his  mouth,  he  order’d  a  phyfician  to 
be  call’d.  The  phyfician,  however,  found  him  dead,  the  foam  difeovering 
itfelf  at  his  mouth  and  his  noftrils,  from  whence  they  faid  that  fomething 
of  a  bloody  humour  alfo  had  afterwards  proceeded.  The  death  of  this  man 

hap> 


2 


Letter  XXVI.  Article  35.  825 

happen’d  in  the  beginning  of  May,  in  the  year  1729,  in  which  month  it  is 
hinted  in  this  letter  (h)9  and  in  others,  and  particularly  in  the  third  (?)  and 
the  fourth  (k)9  that  many  had  died  fuddenly  in  the  city,  and  in  the  country 
round  about  it :  and  if  you  compare  the  difiedtions  of  thefe  perfons  one 
with  another,  you  will  readily  conceive,  that  notwithstanding  all  of  them 
were  taken  off'  by  an  unexpedted  death,  yet  that  different  perfons  were  taken 
off  from  different  caufes,  as  this  man,  whofe  thorax  and  internal  parts  of 
the  head  I  examin’d,  together  with  the  primary  profeffors,  my  collegues, 
about  thirty  hours  after  death,  and  made  thefe  obfervations. 

The  thorax,  which  was  on  its  fides  of  a  livid  and  reddifh  colour,  had  a 
confiderable  quantity  of  fat  on  its  external  part ;  and  when  it  was  open’d,  we 
allb  found  a  confiderable  quantity  in  the  mediaffinum.  The  lungs  were  in¬ 
ternally  and  externally  brown,  and  yet  loft,  both  lobes  being  connected  with 
the  pleura  anteriorly,  but  the  left  allround;  and  internally,  they  were  found 
to  be  moiff,  but  not  to  any  very  confiderable  degree;  fo  that  they  were  nei¬ 
ther  externally  heavy,  nor  did  they  difeharge  a  froth,  or  any  thing  elfe,  from 
the  afpera  arteria. 

In  both  the  cavities  of  the  thorax  and  in  the  pericardium  was  a  much  greater 
quantity  of  moiff ure  than  there  ufually  is.;  which  was  of  itfelf  of  a  bloody 
colour,  and  not  fo  from  the  blood  that  had  fall’n  down  in  the  difiedtion. 
The  heart  and  its  auricles  not  only  contain’d  nothing  polypous,  no  appear¬ 
ance  of  which  kind  I  faw  any  where  in  this  body,  but  even  contain’d  fcarccly 
any  blood.  As  in  this  fubjedt  I  could  find  nothing  worthy  of  remark,  in 
the  valves,  or  in  the  great  veffels,  each  of  which  I  order’d  to  be  laid  open, 
except  in  the  aorta ;  1  at  length  fix’d  my  attention  to  this  veffel.  For,  ip 
the  firff  place,  from  the  heart  quite  to  the  curvature  it  feem’d  to  be  dilated. 
It  was  alfo  mark’d,  here  and  there,  on  the  internal  furface,  with  white  fpots. 
And  it  was,  befides,  on  the  fame  furface,  univerfally  unequal  in  fome  mea- 
fure.  And  what  feem’d  to  me  the  moff  remarkable  of  all,  of  a  black  colour 
mix’d  with  red,  as  if  it  had  been  affedted  with  a  kind  of  inflammation. 
Thefe  white  fpots  did  not  appear  beyond  the  bounds  of  the  dilated  artery. 
But  thofe  other  affedtions  were  produc’d  through  the  curvature,  and  where 
the  artery  goes  down  in  the  courfe  of  the  vertebrae ;  yet  not  fo  much  as  in 
the  dilated  tradf.  So  alfo,  although  they  were  produc’d  through  that  branch, 
which  fends  off  the  fubclavian  and  the  carotid  on  the  right  fide,  yet  the 
greater  diftance  this  artery  obtain’d  from  the  beginning  of  it,  the  lefs  did 
thefe  difeas’d  appearances  difeover  themfelves.  Having  begun  the  difiedtion 
of  the  head  immediately  (the  face  being  then  livid)  when  the  cranium 
was  open’d,  nothing  at  all  flow’d  out.  The  veffels  of  the  pia  mater  were  tur¬ 
gid  with  blood ;  and  in  the  lateral  ventricles  we  obferv’d  a  water  which  was 
fomewhat  bloody,  though  not  fo  to  any  confiderable  degree.  However,  the 
colour  of  the  plexus  choroides,  and  all  the  parts  of  the  ventricles,  or  thofe 
in  the  medulla  oblongata,  the  cerebrum,  or  the  cerebellum,  which  were  ra¬ 
ther  hard  than  lax,  that  are  wont  to  be  enquir’d  into  by  difiedtion,  were  all 
in  a  natural  flate.  The  abdomen  was  not  open’d. 


Vol.  I. 


\h)  n.  17. 


(/)  11.  1 1.  &  26. 

5  N 


(k)  n.  21. 


36.  if 


826  Book  II.  Of  Difeafes  of  the  Thorax. 

36.  If  you  fhould  fay  that  this  man  was  fuffocated  by  a  convulfive  cough, 
I  fhall  be  fo  far  from  contefting  it  with  you,  as  I  know  that  the  invifible 
caufe  thereof  might  lie  hid  in  fome  nervous  ganglion,  that  I  will  put  you  in 
mind  over  and  above  of  the  examples  which  are  in  Lancifi  (/),  of  a  convul¬ 
five  cough  that  has  fuddenly  carried  men  off.  Yet  I  do  not,  for  this  reafon, 
think  that  thole  appearances  which  I  obferv’d  in  the  great  artery,  are  entirely 
to  be  overlook’d  by  you.  For  this  man  had,  indeed,  been  fubjett  to  a  cough  ; 
but  one  which  was  not  wont  to  attack  him  with  fuch  violence,  that  it  could, 
as  in  the  examples  of  Lancifi,  be  forefeen  and  foretold  that  he  would  fome 
time  or  other  be  fuffocated  thereby. 

We  mull  confider,  therefore,  what  affiftance  the  inflammation  of  the 
aorta  may  lend,  to  the  bringing  on  of  a  fudden  death  ;  whether  join’d  with  a 
cough  and  convulfion,  or  not  join’d  therewith.  Yet  we  muft  previoufly 
confider,  what  things  have  been  obferv’d  by  others,  when  there  was  an  in¬ 
flammation  of  the  aorta;  left  our  fpeculations  fhould,  perhaps,  lead  us  fo  far 
as  not  to  agree  with  obfervation  and  experience.  But  when  you  have  ex¬ 
amin’d  the  paffages  of  Aretmus  (;»),  in  which  this  difeafe  is  treated  of,  tho* 
there  fhould  be  no  other  caufe  of  doubt,  yet  this  at  leaft  will  occur;  I  mean, 
whether  thole  figns  which  he  produces,  are  confirm’d  from  the  infpe&ion  of 
bodies  after  death,  But  I  do  not  at  prefent  recoiled:,  that  any  one  has  made 
this  enquiry,  from  the  time  of  Aretaeus  quite  to  our  times.  I  only  remem¬ 
ber  that  Boerhaave  ( n )  fays  of  an  ox,  who  had  run  away  with  a  moll  violent 
impetus,  that  he  had  feen  this  diforder  to  fuch  a  degree  in  this  creature, 
that  the  “  aorta”  was  “  extremely  black.”  If  you  fhould  fee  other  things 
faid  by  him,  or  others,  on  this  fubjedt,  I  would  have  you  put  me  in  mind 
of  them  :  and  when  I  have  read  them,  I  will  either  rejedl  my  prefent  fpecu¬ 
lations,  or  if  it  is  in  my  power  to  confirm  them  I  will  write  them  to  you. 

In  the  mean  while,  1  will  not  omit  to  add  fome  other  certain  inftances, 
that  have  been  obferv’d,  by  my  friends,  in  the  great  artery,  or  in  any  other 
within  the  thorax,  from  whence  either  a  fudden,  or,  at  leaft,  a  fpeedy  death, 
contrary  to  expedation,  has  been  brought  on  :  and  firft,  what  I  promis’d 
above  (0),  that  is  to  fay,  how  much  the  celebrated  Santorini  believ’d,  that 
the  bony  fcales  in  the  aorta  related  thereto ;  which,  in  confequence  of  his 
own  obfervations,  he  did  not  doubt  were  even  of  themfelves  fufficient  to  kill 
a  man  fuddenly.  For  he  related  to  me,  and  the  reft  of  his  friends,  fix  or 
feven  inftances  of  perfons  who  died  in  this  manner,  in  whofe  bodies  he  could 
find  nothing,  befides  thefe  little  bones,  from  whence  to  account  for  their 
fudden  death  ;  and  amongft  them,  the  moft  recent  was  of  that  man  of  whom 
I  have  made  mention  in  another  place  (p),  on  account  of  the  appendicula 
vermiformis  being  deficient.  The  narration  was  as  follows : 

37.  A  Venetian  taylor,  who  was  given  to  hard  drinking,  and  in  regard  to 
whom  it  was  not  certain  that  he  had  made  complaint  of  any  thing  in  refpeft  to 
his  health ;  except  formerly  of  a  hernia,  and  that  he  had  very  lately  faid  to  fome- 
body,  that  he  feem’d  not  to  be  very  well ;  fitting  by  the  fire,  on  the  very  fame 
day  that  he  had  faid  this,  at  the  houle  of  one  of  his  acquaintance,  and 

{/)  De  Subit.  Mort..  1.  1.  C.  18.  n.  3.  («)  Prseled.  ad  Inflit.  §.  827. 

(m)  De  cauf.  &  fign.  moib.  Acut.  1.  2.  C.  8.  (o)  n.  32. 

&  de  eorund.  curat.  1.  2.  c.  7.  (/)  Epfft.  Anat.  14.  n.  62, 

6  .  '  having 


Letter  XXVI.  Article  38.  827 

fiaving  eaten  two  little  fifh  call’d  gurnets,  and  drank  fome  new  wine ;  for  it 
was  now  almoft  the  middle  of  October,  in  the  year  1708  ;  not  long  after,  as 
he  ftill  fat  in  the  fame  place*  he  cry’d  out,  Oh  !  oh  !  and  no  more;  for  he 
was  inftantly  dead. 

The  thorax  being  open’d  on  the  day  following,  the  lungs,  indeed,  were 
not  very  found  ;  and  in  the  pericardium  was  found  fome  quantity  of  water. 
But  as  it  was  evident  that  the  man  could  not  have  died  in  this  manner  from 
either  of  thofe  caules  ;  and  as  the  heart,  and  the  other  vifcera,  had  no  ap¬ 
pearances  worthy  of  obfervation  ;  the  great  artery  was  open’d,  from  the  cur¬ 
vature  quite  to  the  loins ;  and  flow’d,  internally,  frequent  bony  fcales ; 
which  were  feen  in  both  of  the  carotids  alfo,  but  not  farther  than  to  a  mode¬ 
rate  height. 

However,  the  blood  was  fluid,  the  liver  very  natural  and  fine  in  its  ap¬ 
pearance,  as  the  other  vifcera  alfo  were,  except  that  the  ftomach,  as  gene¬ 
rally  happens  in  drinkers,  was  very  large  ;  and  that  part  of  the  inteftines 
which  I  have  faid  was  without  the  appendicula  vermiformis,  was  in  the  her¬ 
nial  fac,  together  with  a  portion  of  the  annex’d  mefentery ;  and  the  orifice  of 
the  fac  was  three  or  four  inches  broad. 

38.  After  he  had  accurately  related  thefe  things,  and  after  we  had,  as  is 
ufual  among  friends,  faid  fome  one  thing,  and  fome  another,  in  regard  to 
the  fudden  death  of  this  kind  he  had  given  us  the  hiftory  of,  and  even  thofe 
caufes  which  efcape  the  eyes  of  anatomifts,  whether  they  are  on  the  infide  or 
on  the  outfide  of  the  brain,  not  being  pafs’d  over  without  notice  •,  1  remember 
I  afk’d,  with  a  kind  of  fmile,  whether  they  alfo  plac’d,  in  the  number  of 
thofe  caufes,  that  which  Piccolhominus  has  hinted  at  (q)9  where  he  fays, 
“  it  is  his  opinion,  that  the  obftruCtion  of  the  little  nerve  which  goes  to  the 
“  heart,  fuddenly  brought  on,  is  the  caufe  for  which  fome  perfons  go  fud- 
“  denly  and  unexpectedly  out  of  this  world  ?”  At  lead,  faid  I,  you  are  not 
ignorant,  that  even  when  the  nerves,  which  are  about  to  go  to  the  heart, 
are  cut  through  in  the  neck,  the  animal  does  not  immediately  die  ;  fo  that 
although  an  obftruCtion  of  the  nerve  going  to  the  heart  may,  poffibly, 
when  join’d  with  other  caufes,  bring  on  a  fudden  death,  yet  it  cannot  of  itfelf 
have  that  effeCt,  unlefs  all  of  them  fiiould  be  obftruCted  at  the  fame  time: 
for  by  this  means  I  underftand  the  juftnefs  of  the  opinion  of  Herophylus  ; 
who,  as  we  have  it  in  Ccelius  Aurelianus  (r),  taught,  “  that  fudden  death, 
“  when  it  proceeded  from  no  very  evident  caufe,  was  brought  on  by  a  pa- 
ts  ralyfis  of  the  heart.”  Then  Santorini  related  the  other  fix  examples, 
which  were  fimilar  to  the  one  already  given  ;  and  faid,  that  he  fhould  very 
much  wonder,  if,  in  all  thefe  cafes,  fome  invifible  caufe  or  other  had  not  been 
at  hand,  and  had  join’d  itfelf  with  a  manifeft  one  ;  that  is,  with  the  bony 
fcales  in  the  aorta  :  and  fhow’d,  that  in  regard  to  himfelf,  he  had  not  the 
leaf:  doubt,  but  fudden  death  had  proceeded  from  thefe  alone  ;  efpecially  at 
the  time  when  the  blood  was  to  be  pulh’d  forwards,  by  an  artery  affeCted 
with  a  diforder  of  this  kind,  while  it  was  juft  encreas’d  in  its  quantity,  by  the 
recent  chyle  being  added  to  it  ;  or  turgid,  from  the  quality  of  this  chyle  •,  or, 
finally,  while  it  was  expanded  by  heat;  which  circumftances,  without  doubt, 

(f)  1.  5.  Anat.  Prasleft.  6,  Sc  I.  4.  Pradeft.  4.  (r)  Morb.  Chron.  1.  2.  c.  1. 

5N  2 


had 


8  2  8  Book  II.  Of  Difeafes  of  the  Thorax. 

had  all  of  them  coincided  in  the  taylor,  and  fome  of  them  in  the  others.  But 
why  an  artery  thus  difeas’d  was,  at  that  time,  unequal  to  the  talk  of  propel¬ 
ling  the  blood,  has  been  already  explain’d  by  me;  and  that  even  in  this 
letter  (j). 

3 g.  But  mention  being  made  of  my  mod  intimate  and  edeem’d  friend 
calls  to  my  mind  the  remembrance  of  another,  Sebadian  Anthony  Trom- 
belli,  a  mod  excellent  furgeon  and  phyfician,  at  Bologna;  whofe  fudden 
and  unexpected  kind  of  death  happens  to  be  the  more  lamentable  to  me,  for 
this  reafon  alfo,  that  I  had  a  fingular  regard  for  his  brother  John  Jerom,  the 
abbot  (a  mod  learned  divine,  as  his  writings  tedify)  and  dill  have  a 
fingular  regard  for  him.  You  cannot  be  ignorant  how  fudden,  violent,  and 
fhort,  the  lad  diforder  of  the  former  of  thefe  gentlemen  was  ;  and  how  many, 
and  various,  were  the  opinions  of  learned  men  upon  it.  If  you  afk  what  I 
myfelf  thought,  before  I  heard  any  thing  of  thefe,  I  will  tell  you  in  a  few 
words,  that  there  is  no  opinion  to  be  preferr’d ;  but  that  you  mud  accurately 
enquire,  and  confider,  over  and  over  again,  whether  it  is  probable  that  this 
diforder  has  any  relation  to  what  I  jud  now  premis’d  (/). 

For  as  foon  as  ever  I  had  read  over  the  letters  of  Jofeph  M.  Verlicchi, 
(whofe  diligence,  adiduity,  and  continual  dudy,  in  medical  dilcipline,  was 
well  known  to  me,  from  the  very  time  that  he  attended  my  leCtures  here) 
in  which  he  not  only  gave  a  full  account  of  all  the  appearances  that  he  had 
obferv’d  in  the  body,  which  he  difieCled  after  death,  but  alfo  of  what  had 
been  obferv’d  in  the  patient,  whom  he  had  attended  ;  the  cafe  feem’d  to  me 
to  be,  in  fome  meafure,  comparable  with  that  which  was  defcrib’d  by  a  very 
learned  man,  whofe  too  early  death  I  have  likewife  lamented,  Anthony  Le- 
protti  (a) :  and  this  I  wrote  back  to  Yerlicchi ;  and  found  by  other  letters, 
which  he  fent  to  me  afterwards,  wherein  every  circumdance  was  clearly  ex¬ 
plain’d,  that  his  opinion  agreed  exaCHy  with  mine.  That  is  to  fay,  as  in  the 
man  of  whom  Leprotti  gives  the  relation  ;  it  was  found  by  him,  and  the  cele¬ 
brated  Janus  Plancus,  that  blood  being  extravafated  from  the  bronchial  artery, 
which  was  ruptur’d,  under  the  membranes,  and  through  the  interdices  of 
the  fibres,  by  which  the  afpera  arteria,  the  aorta,  and  the  oefophagus,  and 
the  other  neighbouring  parts,  are  collected  together,  had  made  a  paflage  for 
itfelf,  to  a  confiderable  extent,  all  round ;  and  being  coagulated,  had  rais’d 
thefe  membranes  into  the  form  of  a  tumour  :  fo  in  Trombelli  blood  being 
extravafated  from  fome  other  artery,  that  was  ruptur’d  betwixt  the  oppofite 
laminas,  that  is  of  the  anterior  part  of  the  mediadinum,  feems  to  have  open’d 
a  pafiage  for  itfelf  through  the  cellular  fubdance  of  that  part ;  and  to  have 
coagulated  in  fuch  a  quantity  in  that  place,  in  particular,  where  it  was  car¬ 
ried  by  its  own  weight,  that,  near  the  diaphragm,  the  folid  thicknefs  of  the 
mediadinum  was  almod  equal  to  three  inches.  And  by  this  means,  all  the 
circumdances  which  had  preceded,  and  thofe  that  did  not  attend,  as  well  as 
the  appearances  which  were  found  in  the  body,  feem  to  be  very  eafy  to  be 
underdood. 

And  although,  as  I  have  promis’d  to  be  brief,  I  mud  not  confider  every 
one  of  thefe  circumdances  feparately,  yet  1  will  fay,  at  lead,  that  thofe  cor- 


( u )  Comment,  de  Bonoo,  Sc.  Acad.  Tom. 
i.  in  Opufcul,. 

pufcles^, 


(0  n.32. 
(0  n.  36.. 


Letter  XXVI.  Article  40.  82  9 

pufcles  which  had  before  corroded  the  fkin,  in  the  form  of  a  very  large  and 
troublefome  herpes,  did,  when  this  eruption  was  driven  back,  corrode  that 
artery ;  and  that  the  blood  which  iflu’d  from  the  artery,  while  it  drew 
afunder  the  laminae  of  the  mediaftinum  in  a  fpeedy  and  violent  manner,  had 
been  the  caufe  of  that  very  fevere  pain  in  the  fternum,  which  the  patient  de- 
ferib’d  to  be  of  fuch  a  kind  that  it  feem’d  to  be  tearing  him  afunder;  but 
that  it  ought  not  to  have  produc’d  the  other  marks  of  an  inflam’d  me¬ 
diaftinum,  which  were  abfent ;  and,  at  length,  that  fuch  a  great  quantity  of 
blood  as  was  colledted  into  grumous  concretions  between  the  two  laminae  of 
this  part,  efpecially  in  fo  fhort  a  time,  could  not  be  accounted  for  but  from 
fome  artery  being  pierc’d  through. 

However,  mod  of  thefe  things  the  letters  of  Verlicchi  explain’d  ;  and  not 
only  the  others,  which  alfo  anfwer’d  the  objection  of  thofe  who,  as  Leprotti’s 
patient  had  dragg’d  on  his  life  for  fome  days,  enquir’d  into  the  reafon  why 
Trombelli  was  taken  off  within  nineteen  hours.  For  beftdes  that  the  heart  was 
prefs’d  upon  by  fo  very  great  a  diftenfion  of  the  lower  part  of  the  mediaftinum, 
a  tubercle  had  been  form’d  before  this  difeafe,  at  a  fmall  diftance  above  the 
heart,  in  the  coats  of  the  great  artery,  of  the  bignefs  of  a  pretty  large  nut, 
full  of  a  humour  verging  to  the  colour  of  the  yolk  of  an  egg  ;  which  tu¬ 
bercle  being  protuberant  to  a  confiderable  degree  within  the  cavity  of  the 
artery,  the  bicod  was  not  able  any  longer  to  overcome  that  obftacle  as  before, 
the  powers  of  the  heart  being  weaken’d,  as  appear’d  from  the  pulfe  being, 
become  fmall  and  weak  ;  but  being  retarded  in  its  motion  more  and  more, 
opprefs’d  the  heart  and  the  lungs  themfelves  :  for  which  reafon  the  force  of 
the  difeafe  could  no  longer  be  fupported. 

40.  You  have  heard,  then,  which  way  my  opinion  of  this  difeafe  formerly 
inclin’d  ;  whereto,  however,  you  will  pay  no  greater  refpeft  than  accurately 
to  confider  of  it.  And  if  you  afk  what  marks  of  the  exiftence  of  this  tu¬ 
bercle  there  had  been  in  the  living  body,  and  whether  I  have  ever  read  any 
obfervations,  beftdes  that  I  juft  now  commended,  in  which  there  are  circum- 
ftances,  in  fome  meafure  at  leaft,  fimilar  to  thofe  that  were  found  in  Trom¬ 
belli  ;  I  will  fatisfy  you  as  far  as  it  is  in  my  power.  And,  firft,  I  have  heard; 
that  he  had  been  formerly  opprels’d  with  very  heavy  paflions  of  the  mind,, 
and  later  than  that  with  fome  flight  palpitation  of  the  heart ;  and  that  he  alfo; 
began  to  be  attack’d  with  fome  little  Jaintings,  fo  as  to  be  thought  hypo¬ 
chondriac  by  the  phyficians. 

And  as  to  what  relates  to  the  tubercle  of  the  aorta,  as  I  find  from  the  Aft  a 
Eruditorum  Lipfienfia  (#),  that  a  diflfertation  of  the  celebrated  Stentzelius,  en¬ 
titl’d,  “  Of  fteatomata  found  in  the  beginning  of  the  aorta,”  had  been  pub- 
lilh’d,  which  has  not,  that  I  know  of,  been  as  yet  imported  into  this  country, 

I  would  have  you  examine  it,  if  it  be  in  yours ;  for  if  it  anfwers  to  its  title, 
you  will  certainly  find  fome  things  that  are  not  altogether  unlike  whatyom 
enquire  after  (*),  If  1  have  any  thing  which  relates  to  internal  tubercles  of 
the  arteries,  I  fhall  take  notice  of  it  in  the  next  letter.  But  in  regard  to  blood: 
being  extravafated  within  the  laminae  of  the  mediaftinum,  as  far  as  1  re*. 

(A  A.  1731,  M.  Maj,  (*-)  Sed  vid.  Epift.  64.  n.  14. 

4"v 


memberr 


8 go  Book  II.  Of  Difeafes  of  the  Thorax. 

member  at  prefent,  Riverius  is  the  only  one  that  has  hinted  any  thing  in  re- 
fpedt  thereto,  and  that  in  the  fixtieth  oblervation  of  the  firft  century.  For 
as  to  Blancard’s  writing  fomething  of  the  fame  kind  likewife  (jy),  without 
doubt,  they  are  fo  far  fimiiar  as  to  be  quite  the  fame,  the  name  of  Riverius 
only  being  conceal’d,  and  the  words  fomewhat  chang’d.  If  you  read  the 
whole  of  this  obfervation  in  its  original  author  *,  for  it  is  not  univerfally  copied 
in  this  eleventh  fetftion  of  the  Sepulchretum  (2),  nor  yet  in  the  firft  (a)  of  the 
firft  book  ;  you  will  find  that  there  had  been  a  fufpicion  of  an  inflammation 
of  the  mediaftinum  alfo,  among  other  things,  in  a  certain  patient ;  and  that 
when  (he  feem’d  to  have  recover’d  from  this,  fhe  was  carried  off  by  a  fudden 
death  *  and  that  the  mediaftinum  was  found  “  full  of  bloody  ferum.”  How¬ 
ever,  in  regard  to  extravafations  of  blood  from  its  veffels,  confider’d  in  ge¬ 
neral,  not  into  the  great  cavities  of  the  body,  but  into  the  cellular  ftrudture, 
which  is  confin’d  under  membranes,  the  opinion  of  Gilbertus  deferves,  on 
the  (core  of  its  antiquity,  to  be  related.  For  he,  as  Nicolaus  Florentinus 
wrote  three  hundred  and  fifty  years  ago(£),  taught,  “  That  the  blood  which 
“  is  extravafated  by  the  vena  chylis,  that  is,  the  vena  cava,  is  not  always 
“  pour’d  out  into  the  cavity  of  the  belly,  but  is  retain’d  beneath  the  fat, 
“  which  furrounds  the  kidnies  and  other  parts and  this,  as  it  had  been, 
perhaps,  even  feen  by  Gilbertus,  is  not  to  be  fo  far  rejected,  if  the  rupture 
of  the  vena  cava  is  fmall,  as  that  which  is  fubjoin’d  by  Gilbertus  in  regard 
to  difcharging  from  the  bladder,  by  way  of  urine,  this  very  blood  that  has 
been  fo  retain’d.  The  other  things  that  I  have  promis’d  (c),  you  may  expect 
very  foon.  Farewel. 


LETTER  the  TWENTY-SEVENTH 

Treats  of  Sudden  Death  from  a  Diforder  of  the  Heart.  And 
in  the  End  a  few  Things  are  added  upon  the  Subject  of 
Gibbofity,  or  Incurvation,  of  the  Spine. 

1.  A  S  I  have  written  in  the  foregoing  letter  of  that  fpecies  of  fudden 
death  which  proceeds  from  diforders  of  the  blood-veffels,  whether 
they  are  ruptur’d  or  not  ruptur’d  •,  fo  I  am  now  to  write  of  that  which  is  the 
confequence  of  diforders  in  the  heart,  whether  it  be  ruptur’d  or  not  rup¬ 
tur’d. 

(y)  Anat.  Pratt.  Obf.  52.'  ( l )  Apud  Donat,  de  Med.  Hid.  Mirab. 

(*)  Obf.  20.  1.  4.  c.  9. 

(«)  Obf.  123.  (c)  Supra,  n.  2.  in  fin,  n.  18.  in  princip. 

n.  26.  in.  fin.  &c. 


The 


Letter  XXVII.  Article  i.  831 

The  firft  obfervation  of  a  ruptur’d  heart  is,  as  far  as  I  know,  given  by 
Harvey  ( a ),  who  defcribes  a  nobleman  to  have  been  often  feiz’d  with  a  kind 
of  paroxyfm,  particularly  in  the  night,  in  which,  from  an  44  oppreffive”  pain 
of  the  cheft,  he  fometimes  was  afraid  of  a  fvvooning,  and  at  other  times  of 
fuffocation  ;  till  44  the  dileafe  growing  more  violent,  he  became  cachecftic  and 
44  dropfical,  and  at  length,  being  violently  opprefs’d  in  one  of  the  paroxyfms, 
44  he  died.  In  this  patient,  by  reafon  of  the  circulation  of  the  blood  being 
46  obftrudted,”  (whatever  the  obftrudtion  was,  for  what  it  was  he  does  not 
fay)  44  from  the  left  ventricle  into  the  artery,  the  very  fubftance  of  the  left 
44  ventricle  itfelf,  which  feem’d  to  be  pretty  thick  and  ftrong,  had  been  rup- 
44  tur’d  and  perforated  with  a  large  opening,  where  it  had  difcharg’d  its  blood; 
44  for  the  foramen  was  fufficiently  large  to  admit  a  man’s  finger.”  And  this* 
obfervation  I  was  willing  to  copy  over  to  you  in  this  place,  becaufe  I  do  not 
remember  that  it  has  been  quoted  by  any  writer,  not  even  by  Bonetus ;  unlels 
you  fhould,  perhaps,  imagine,  that  the  words  of  Rolfinck,  which  are  quoted 
by  him,  not  in  this  eleventh  fe&ion,  but  in  the  eighth  (£),  44  the  impetus’* 
of  the  blood  upon  the  heart  44  is  fometimes  fo  violent,  as  to  break  through 
44  the  feptum  itfelf;  examples  of  which  tragical  cafe  are  given  us  by  Har- 
44  vey unlefs,  I  fay,  you  imagine  thefe  words  to  relate  to  that  obfervation. 
And  notwithftanding  it  appear’d  in  the  fame  light  to  him  alfo  who  added 
the  index  to  the  three  firft  exercitations  of  Harvey,  as  he  refers  to  the  ob¬ 
fervation  that  I  have  defcrib’d  in  the  following  words  ;  44  the  feptum  of  the 
44  heart  ruptur’d  from  the  blood  being  detain’d  in  it  yet  the  words  of  the 
author  himfelf,  without  doubt,  fignify  quite  a  different  thing.  To  this  ob¬ 
fervation  of  Harvey  I  join  another,  which  I  have  fufficiently  fpoken  of  in  the 
twenty-fifth  letter  (c),  from  Peter  de  Marchettis  (d).  For  although  the 
heart  was,  in  this  cafe,  open’d  by  a  fiftula,  that  reach’d  at  length  into  the 
left  ventricle  ;  yet,  whether  it  be  open’d  from  erofion,  or  from  diftenfion, 
the  rupture  is  in  fad  always  the  fame;  becaufe  when  the  erofion  has  pro¬ 
ceeded  fo  far,  that  only  a  very  thin  lamella  of  the  heart  remains,  it  is  evi¬ 
dent  this  muft  be  forc’d  through,  either  by  the  weight  or  the  force  of  the 
blood  with  which  it  is  urg’d  :  and  for  this  reafon,  even  when  I  fpoke  of  the 
aorta  being  ruptur’d,  I  pointed  out  various  caufes  of  the  rupture ;  yet  al¬ 
ways  call’d  it  rupture,  neverthelefs.  A  third  obfervation,  which  the  cele¬ 
brated  Morand(^)  has  alfo  mention’d,  you  will  read  in  Bohn,  not  in  his 
Circulus  Anatomicus ,  indeed,  but  in  his  book  De  Renunciatione  Vulnerum  (/), 
in  which  I  at  laft  found  it  by  accident.  And  it  is  an  inftance  44  of  a  rup- 
44  ture  of  the  left  ventricle  of  the  heart,  near  the  mouth  of  the  aorta,”  in  a 
nobleman  where  44  no  figns  ”  had  preceded,  and  who  44  being  of  an  athletic 
44  and  beautiful  habit  of  body,  had  died  fuddenly  by  the  fide  of  his  wife.” 
Of  which  rupture  you  will  eafily  fufpeft  the  laft  caufe,  being  mindful  of 
thofe  things  that  are  written  in  the  preceding  letter  (g).  And  the  very  learned 
Bohn  thought  this  kind  of  death  to  be  fuch  a  one,  44  as  was  fcarcely  ever 

(а)  De  Circul.  Sangu.  Exercit.  3.  (e)  Mem.  de  PAcad.  R.  des  Sc.  A.  1732; 

(б)  Obf.  11.  (f)  Seft.  1 . 

(c)  n.  12.  (0)  n.  14. 

(i)  Qbf.  Med.  Chir.  47,, 

44‘feera 


8  3  Book  H.  Of  Difoafes  of  the  Thorax. 

«  leen  by  the  molt  expert  diffe&ors.”  And  indeed  another  very  learned 
man,  John  Fantonus  (b),  has  faid,  that  it  ought  to  be  efteem’d  extremely 
rare,  when  he  related,  from  the  common-place  book  of  his  father,  “  that 
“  the  heart  of  a  man,  who  had  been  troubl’d  with  a  very  violent  ipafm,  was 
«  found  to  be  ruptur’d  ;  and  the  pericardium,  which  was  of  a  very  conlider- 

able  fize,  to  contain  a  large  quantity  of  blood  being,  at  the  fame  time, 
much  chagrin’d  that  his  father  had  made  no  farther  remark,  or  atleaft,  that 
•he  had  not  faid  from  which  ventricle  the  blood  had  burft  forth.  And  this 
being  the  Hate  of  the  queftion,  I  am  not  displeas’d  that  1  happen’d  to  light 
on  a  fifth  obfervation  of  the  heart  being  ruptur’d,  at  Venice,  in  the  year 
1707.  And  after  defcribing  this  to  you  in  an  accurate  manner,  as  our  order 
requires  •,  for  being  upon  another  fubjeft  in  the  Adverfania  (*),  I  have  but 
juft  hinted  at  it ;  I  fhall  not  omit  to  take  notice  of  others,  which  have  come 
to  my  knowledge,  and  partly  to  defcribe  them. 

2.  A  woman  of  feventy-five  years  of  age,  of  a  manly  afpeCt,  and  very 
far,  having  been  quite  Gender  to  her  five-and -fortieth  year,  was,  in  the  latter 
years  of  her  life,  become  a  valetudinarian  •,  yet  in  fuch  a  manner,  as  never 
to  complain  of  a  pain  in  her  head,  much  lefs  of  any  violent  indifpoficion  that 
could  be  referr’d  thereto  ;  but  fhe  rather  complain’d  of  other  things,  among 
which  her  acquaintance,  though  but  little  accuftom’d  to  attend  minutely  to 
thefe  lamentations  of  a  querulous  old  woman,  particularly  mention’d  a  kind 
of  fvvoonings,  as  it  were,  and  other  diforders  of  that  kind  •,  which  fhe  her- 
felf,  as  (he  did  not  know  how  to  explain  them  otherwife,  was  us’d  to  fignify 
bv  a  word  that,  as  I  have  faid  before,  was  common  among  the  inhabitants 
of  her  city,  that  is,  ftato,  or  wind.  Thefe  complaints  were,  in  general, 
much  exacerbated  in  the  laft  fix  months  of  her  life.  At  length  having  drunk, 
in  thofe  days,  fome  glafies  of  new  wine  (for  the  middle  of  October  was 
elaps’d)  and  having  been  fomewhat  worfe  therefrom,  fhe  all  of  a  fudden  faid, 
as  ike  happen’d  to  be  fitting  very  intently  at  her  domeftic  employments,  that 
{he  felt  fomething  or  other  move  up  and  down  within  her;  and  prefently, 
that  the  houfe  leem’d  to  her  to  totter ;  and  loon  after,  being  feiz’d  with  a  very 
fhort  ftertor.  Are  died. 

Examining  the  body,  on  the  day  following,  I  faw  a  bloody  humour  .pro¬ 
ceeding  from  the  mouth ;  the  back  was  of  a  red  colour  mix’d  with  lividnefs  ; 
the  fingers  contracted,  and  when  we  endeavour’d  to  extend  them,  they  re¬ 
fitted  the  extenfion  ;  but  this  was  not  the  cafe  in  the  arms.  And  when,  in 
the  prelence  of  feveral  friends,  and  being  affifted  in  the  difieftion  by  the  ce¬ 
lebrated  Santorini,  I  began  to  cut  through  the  common  integuments  of  the 
body,  a  black  and  frothy  blood,  fuch  as  we  afterwards  found  in  molt  of  the 
vettels,  flow’d  out.  The  membrana  adipofa,  which  was  in  other  places  thick, 
was,  at  the  pubes,  fo  extremely  thick,  as  to  exceed  four  fingers  breadth. 

The  cartilages  of  the  cheft,  that  join  the  ribs  to  the  fternum,  gave  no 
more  refiftance  to  the  knife  in  cutting  through  them,  than  they  generally  do 
in  very  young  fubjeCts ;  which  1  fuppofe  was  owing  to  their  being  preferv’d 
foft  by  the  fame  fat  wherewith  the  whole  body  abounded.  The  fternum  be¬ 
ing  taken  away,  this  fat  appear’d  in  fo  great  a  quantity  in  the  thorax,  as  to 

{h)  Anat.  Corp.  hum,  Diff.  12.  (/)  VI.  Animad.  84. 

cover 


Letter  XXVII.  Article  2 .  833 

cover  the  mediaftinum  on  one  hand ;  and  on  the  other  it  was  eafy  to  con¬ 
jecture  how  great  a  quantity  there  was  in  the  belly,  from  this  circum  dance,  that 
the  diaphragm  being  driven  up  pretty  high  into  the  thorax,  took  away  fo 
much  of  the  fpace  which  properly  belongs  to  it,  that  it  did  not  leem  at  all 
furprizing,  to  thofe  who  were  prefent  at  the  examination,  that  fat  perfons 
cannot  eafily  lie  on  their  backs,  unlefs  their  fhoulders,  and  the  upper  parts 
of  their  backs,  are  rais’d  pretty  high.  The  lungs  were  entirely  found,  al¬ 
though  they  were  internally  black,  from  the  blood  being  retain’d  in  them ; 
and  the  left  lobe,  on  its  pofterior  furface,  adher’d  to  the  pleura. 

The  bronchia,  and  trunk  of  the  afpera  arteria,  had  nothing  extravafated 
within  them.  But  the  pericardium  contain’d  fo  great  a  quantity  of  extrava¬ 
fated  blood,  partly  grumous  and  partly  fluid,  that  before  it  was  cut  into  it 
refembled  a  fpheroid,  the  diameter  of  which  was  nearly  equal  to  a  fpan.  Yet 
the  heart  itfelf  took  up  no  fmall  fpace  within  this  cavity,  by  reafon  of  the 
great  quantity  of  fat  adhering  thereto,  and  almoft  univerfally  covering  it 
over.  And  while  we  cleans’d  this  fat  from  the  blood  on  all  fides,  and  even 
by  inverting  the  heart,  we  obferv’d  it  to  be,  in  a  certain  part,  more  promi¬ 
nent,  and  almoft  black,  from  the  blood  which  ftagnated  in  it.  This  part 
was  on  the  pofterior  furface  of  the  heart,  very  near  to  the  apex :  and  the  fat 
in  that  part,  when  attentively  examin’d,  fhow’d  a  laceration  in  the  middle 
of  the  blacknels.  The  left  ventricle  being  then  open’d  longitudinally  on  the 
oppoflte  furface,  we  found  fcarce  any  blood  therein,  if  you  except  a  fmall 
coagulum  adhering  to  that  part  which  anfwer’d  to  the  lacerated  fat.  This 
coagulum  being  gently  remov’d  led  us  to  a  round  foramen  of  the  bignefs 
of  a  lentil,  with  which  the  fubftance  of  the  ventricle,  that  was  in  this  place 
naturally  become  very  thin,  had  been  penetrated  •,  fo  that  it  was  evident 
the  blood  had  come  forth  from  the  heart,  firft,  in  that  place,  under  the  fat ; 
and  had  afterwards  infinuated  itfelf  here  and  there,  through  the  membranous 
cells  thereof;  and  by  diftending,  raifing  up,  and  forcing  againft  them,  had 
at  length  eafily  broken  through  them. 

Thefe  things  being  found  in  the  ftate  I  have  deferib’d,  I  obferv’d  other 
appearances  in  the  fame  ventricle.  For  about  the  orifice  where  it  receives  the 
blood  in  the  very  fubftance  of  the  heart,  there  was  a  bone  of  more  than  an  inch 
in  thicknefs,  in  the  fhape  of  half  a  circle,  to  which  the  mitral  valves  adher’d, 
that  were  in  like  manner  become  bony  ;  except  that  one  of  them  had  pre- 
ferv’d  a  great  part  of  itfelf  found,  fo  as  to  be  able  to  fliut  up  the  orifice, 
which  was  contradled  by  thofe  bones  that  were  form’d  nearly  all  round  it,  and 
protruded  themfelves  inwards,  if  you  added  thereto  the  bony  part  of  the 
valves  ;  for  this  is  that  very  old  woman  from  whom  I  made  the  fame  deferip- 
tion,  in  the  fifth  of  the  Adverfaria  (£).  The  valves  of  the  great  artery,  alfo, 
were  partly  already  bony,  and  partly  had  begun  to  be  oflified. 

And  in  the  right  ventricle,  and  the  annex’d  auricle,  I  obferv’d  nothing, 
except  that  they  were  entirely  deftitute  of  blood,  as  the  left  auricle  nearly 
was  alfo  ;  whereas  the  trunk  of  the  pulmonary  artery  was  full  of  ir,  and  that  , 
of  the  fame  kind  with  what  we  had  feen  in  the  pericardium  ;  and  the  aorta,  in 


Vol.  I. 


(&)  Animad.  14. 

50 


like 


834  Book  II.  Of  Difeafes  of  the  Thorax. 

like  manner,  contain’d  a  great  quantity,  which  was,  however,  form’d  into 
coagula,  as  we  found  by  opening  this  veflel,  from  the  heart  quite  to  the  iliac 
branches.  This  veflel  began,  about  the  termination  of  its  curvature  (for  fo 
far  it  had  proceeded  quite  found)  to  become  internally  rough  with  large  bony 
feales ;  which  in  fome  places  being  more  frequent,  and  in  fome  places  leis  fo, 
were  feen  through  the  whole  of  the  remaining  trunk,  here  and  there,  and 
not  without  marks  of  an  obfeure  kind  of  ulceration.  And  indeed  we  found 
fome  of  the  arterial  branches  in  the  belly,  and  particularly  thofe  that  belong 
to  the  cceliac  artery,  already  become  bony. 

And  the  belly  having  been  open’d  a  little  before,  and  being  in  fome  places 
even  then  warm  (although  the  leafon  was  at  that  time  rather  cold)  which  had 
been  alfo  obferv’d  before  in  the  thorax;  and  the  thicknefs  of  the  omentum 
being  firft  taken  notice  of,  on  the  account  of  much  fat,  although  of  a  filthy 
hue  ;  and  foon  after  that  of  the  mefentery  ;  thefe  appearances  occurr’d  that 
feem’d  worthy  of  remark.  The  fpleen  was  turgid  with  frothy  blood.  The 
pancreas  was  hard.  The  gall- bladder  was  very  much  contradted,  and  full  of 
calculi,  to  the  number  of  fourteen  ;  eight  of  which  were  very  fmall,  and  the 
others  pretty  large :  thefe  calculi  were  nearly  of  a  cubical  form ;  and  being 
immediately  applied  to  the  flame,  took  fire.  The  right  kidney  was,  in  a 
certain  part  of  its  furface,  ulcerated  ;  and  in  another  cicatriz’d  :  and  both 
thefe  places,  if  you  touch'd  them,  feem’d  to  be  foft,  as  if  from  urine  that 
was  confin’d  within  :  when  they  were  cut  afunder,  they  appear’d  to  be  lax  in 
their  fubftance,  as  that  of  the  fpleen  generally  is,  and  very  moift ;  a  humour 
alfo  ftagnating  in  fome  places,  diftindtly  from  the  other,  in  a  kind  of  loculi, 
or  cellules,  as  it  were. 

At  length  having  open’d  the  cranium,  we  found  the  dura  mater  to  be  fo 
much  more  clofely  affix’d  to  the  futures,  and  the  parts  about  them,  and  par¬ 
ticularly  the  lagittal  and  lambdoid,  than  it  generally  is,  that  it  could  not 
be  pull’d  away  without  laceration.  On  the  contrary,  the  pia  mater  very 
eafily  follow’d  the  fingers,  when  applied  to  it  to  raife  it  up  ;  for  there  was 
water  beneath  it :  which  was  alfo  feen  in  the  lateral  ventricles,  in  both  of  them 
in  fmall  quantities.  The  cerebrum  was  found,  as  the  cerebellum  was  alfo ;  but 
the  latter  was  very  lax.  The  bafilary  artery  was  fomewhat  hard  ;  as  were  alfo 
the  other  arterial  branches  that  lie  about  the  cerebrum.  When  all  thefe  con¬ 
tents  were  taken  out  of  the  cranium  (which,  as  appear’d  from  the  breadth 
of  the  fedlions,  was  not  of  a  little  thicknefs)  on  the  bafis  of  it,  and  alfo 
upon  the  hollow  furface  of  the  os  frontis,  thofe  appearances  came  into  view, 
which  I  have  fpoken  of  in  the  fixth  of  the  Adverfaria  (/).  That  is  to  fay, 
the  os  frontis  was  prominent  in  that  part,  in  the  form  of  very  frequent  tu- 
berofities :  and  the  fame  kind  of  appearances  were  alfo  in  the  bafis  of  the 
cranium,  efpecially  on  the  petrofe  procefles ;  but  were  lefs  in  thefe  parts,  at 
a  greater  diftance  from  each  other,  and  did  not  rife  fo  high.  All  thefe 
tuberofities  were  made  up  of  a  more  white  fubftance  than  the  bones  in  any 
other  part  of  the  cranium  were ;  fo  that  they  feem’d  to  confift  of  a  new  ac- 
ceffion,  and,  as  it  were,  an  effufion  of  bony  matter.  And  though  the  fur¬ 
face  of  each  of  thefe  prominences  was  very  fmooth,  and  fluffing ;  yet  the 


(/)  Animad.  84. 


very 


Letter  XXVII.  Article  3.  833* 

very  great  inequality,  and  extuberating  ftate  of  them  all,  could  not  but  ex¬ 
tremely  comprefs  the  brain,  wherein  there  appear’d  to  be,  in  other  refpeCts, 
no  kind  of  injury,  in  what  part  foever  it  correfponded  with  thefe  tubero- 
fities. 

As  to  what  remains,  having,  befides  the  kidnies  and  the  aorta,  taken  out 
from  the  body  the  part  of  the  heart  that  was  nearefc  to  this  artery,  ard  the 
tubes  of  the  uterus,  which  were  of  a  white  colour,  that  I  mighr,  on  the  day 
following,  examine  into  fome  things  which  do  not  relate  to  the  difeafe  ;  I  was 
l'urpriz’d  to  find,  that  within  the  fpace  of  this  night,  although  the  weather 
from  cold,  as  it  was  before,  had  become  much  colder,  all  the  parts,  contrary 
to  our  expectation,  had  contracted  the  molt  intolerable  ftench  ;  and  not  only 
beyond  fufferance,  but  beyond  belief. 

3.  I  remember  that  I  have  taken  notice  to  you  before  (m)  of  the  intolerable 
ill-fmell,  which  arofe  fooner  than  we  Ihould  fuppofe  in  the  carcafe  of  anothe# 
woman,  in  like  manner  •,  which  woman  was  alfo  pretty  fat.  But  that  woman 
had,  at  lead,  been  macerated  by  a  difeafe  of  fifteen  days  continuance  in  the 
hofpital  ;  and  this  died  fuddenly  ;  but,  on  the  other  hand,  fhow’d  that  mark 
of  putrefaction  which  was  not  obferv’d  in  the  other  •,  I  mean,  bubbles  of 
air  in  the  blood.  What  is  the  cafe  then  ?  Does  the  fame  thing  that  hap¬ 
pen’d  to  this  fat  woman,  happen  to  others  alfo  who  are  of  a  fat  habit  of 
body  ;  I  mean,  that  by  a  rupture  being  fuddenly  brought  on,  the  blood  is 
pour’d  out  into  the  pericardium,  and  that  not  in  a  very  few  inftances  neither  ? 
For  if  you  only  turn  to  the  foregoing  letter,  you  will  find  four;  that  is  to 
fay,  an  old  man  (9),  and  a  woman  (<?),  both  of  which  I  faw,  and  two 
others  (y>),  whom  I  mention’d  as  having  been  feen  by  others.  Does  the  fat 
which  preferv’d,  as  I  have  already  fuppos’d,  the  cartilages  of  the  ribs  foft 
and  tender,  in  this  old  woman,  alfo  preferve  the  fibres  in  the  vefifels  and  their 
contexture  very  lax,  and  make  them  give  lefs  refiftance  to  the  diftraCtion  from 
each  other,  if  any  confiderable  diftenfion  be  brought  on  ?  And  you  will  the 
more  readily  fuppofe  a  diftenfion  of  this  kind  to  have  happen’d,  from  wine  that 
was  new  and  ftill  eftervefcing,  if  you  call  to  mind  what  happen’d  to  the  Ve¬ 
netian  taylor  (q)  after  the  ufe  of  it,  which  ought  to  be  avoided  where  there 
are  any  diforders  of  the  heart  or  the  vefiels,  and  what  Santorini  thought  of 
his  fudden  death  ;  and  alfo  call  to  mind  what  the  very  experienc’d  Mufchen- 
broeck  (r)  has  taught  in  regard  to  the  injuries  arifing  from  u  fluids  being 
“  taken  into  the  conftitution  in  the  very  aft  of  fermentation,  that  is,  when 
“  abounding  with  great  plenty  of  air  which  is  agitated  with  a  brifk  motion, 
16  which  takes  up  a  much  greater  fpace,  and  unufually  diftends  the  vefiels 
that  is  to  fay,  in  confequence  of  the  particles  of  this  air  being  expanded  by 
the  heat  of  the  blood. 

Or  are  we  to  fuppofe,  that  as  much  as  the  quantity  of  fat,  which  is  col¬ 
lected  and  confin’d  underneath  the  fkin,  refills  the  motion  of  the  blood  that 
is  about  to  fill  the  external  and  fmaller  vefiels,  fo  much  it  mult  of  courfe  be 
thrown  internally  upon  the  larger  vefiels  and  receptacles  ;  and  in  that  part  par- 

(q)  Epift.  26.  n.  37,  38- 

(r)  Difp.  de  aeris  pr^fent.  in  humorib.  ani¬ 
mal.  c.  1.  §  18.  coroll.  4,  &  5. 

5  O  2  ticularly 


(m)  Epift.  18.  n.  34. 

(*)  N.  15.  (0)  N.  17. 

,( pj  N.  26. 


836  Book  II.  Of  Difeafes  of  the  Thorax. 

ticularly  where  they  are  more  lax,  or  in  part  eroded,  break  through  their 
parietes  ?  Or,  finally,  is  erofion  fo  much  the  more  eafily  effected,  as  the 
blood  abounds  with  a  greater  quantity  of  fat?  It  does  not  efcape  me,  that 
to  almoft  every  body  it  feems  juft  the  reverie,  not  doubting  but  the  fat  cor¬ 
rects  the  eroding  particles,  or  at  leaft  obtunds  and  entangles  them.  For 
me,  however,  when  it  is  in  too  great  a  quantity,  whether  for  that  very  reafon 
it  cannot  be  good,  and  proper  to  correct  acrimony  ;  or  whether  by  prefling 
upon  the  fmali  vefiels,  and  retarding  the  humours  in  them,  it  is  the  reafon  of 
their  becoming  acrid  by  ftagnation  •,  or  whether  it  fo  entangle  the  more 
acrid  particles,  as  to  retain  them  in  the  conftitution,  which  muff  naturally 
exert  themfelves  at  length,  when  they  are  more  and  more  collected,  and  oc- 
cafion  is  given  ;  for  me,  I  fay,  not  to  difpute  upon  modes  and  caufes,  it  is 
fufficient,  that  erofions  have  been  frequently  obferv’d  in  fat  bodies  ;  and  that 
I  myfelf  have  found  in  this  woman,  and  in  another  alfo  of  a  fat  habit  (j), 
to  which  you  may  certainly  add  a  fat  old  man  (/),  the  great  artery  internally 
eroded.  And,  indeed,  the  kidnies,  as  well  as  the  heart,  which  are  always 
befet  with  a  greater  quantity  of  fat  than  any  other  vifeus,  did  not  efcape  ul¬ 
cer  tion  in  this  woman. 

4.  But  l  do  not  rank  thefe  bony  tuberofities  that  were  obferv’d  on  the  in¬ 
ternal  furfaceof  the  cranium,  with  that  kind  of  exoftofes  which  Boerhaave  («) 
mentions  to  have  been  feen  by  him  and  Rau  after  epileptic  paroxyfms  ;  but 
rather,  if  1  may  fo  fpeak,  with  the  clafs  of  new  vegetations,  fuch  as  Poupart  (x) 
deferib’d  in  the  vertebra  of  a  man  who  was  about  a  hundred,  years  old,  of  a 
peculiar  whitenefs  and  fmootbnefs,  of  which  thefe  of  ours  alfo  were.  And 
if  both  of  thefe  kinds,  as  his  feem’d  to  him,  and  as  ours  feem’d  to  us,  were 
form’d  from  an  effufion  of  bony  juice,  as  it  were,  it  will  be  lefs  eafy  to  ac¬ 
count  for  them,  according  to.  the  late  obfervations  and  opinion  of  a  moft  ex¬ 
perienc’d  man  •,  efpecially  as  in  our  old  woman  the  dura  mater,  which  holds 
the  place  of  the  internal  periofteum,  Ihow’d  no  mark  of  injury  in  itfelf  where 
it  cover’d  thefe  tuberofities ;  nor  did  it  adhere  to  them  very  clofely,  as  it  jdid 
to  fome  other  certain  parts  of  the  cranium  ;  nor  had  the  woman  complain’d 
of  any  pain  or  diforder  of  the  head  at  any  time.  And  how  this  circumftance 
may  be  underftood,  and  what  may  be  deduc’d  from  it,  it  is  to  no  purpofe  to 
repeat  here,  as  I  have  already  diffidently  fpoken  to  thefe  things  in  the  fixth 
of  the  Adverfaria  (jy). 

I,  therefore,  return  to  the  promis’d  feries  of  obfervations  of  the  heart  being 
ruptur’d,  that  have  come  to  my  knowledge.  And  among  thefe,  that  has  a  title 
to  this  place  which  was  made  by  that  very  worthy  and  refpe&able  man  An¬ 
thony  Marilati,  in  this  hofpital,  about  the  fame  time  that  mine  was  made  *,  and 
related  to  me  by  him  in  the  year  1708,  at  the  time  that  he,  with  great  dili¬ 
gence,  perform’d  the  office  of  afliftant  phylician  there. 

5.  A  woman  who  labour’d  under  a  palpitation  of  the  heart,  having  juft 
fat  up  in  bed  where  fhe  lay,  for  the  fake  of  eating  her  dinner,  cried  out,  I  am 
dying,  and  died  almoft  inftantly.  The  thorax  being  open’d  after  two  or 

(0  Epift.  26.  n.  17.  (*)  Hift.  de  PAcad.  R.  des  Sc.  A.  1 699. 

(/)  N.  15.  Obf.  Anat.  1. 

(u)  Pradett.  ad  Inflit.  §  860.  (y)  Animad,$4. 


three 


Letter  XXVII.  Articles  6,  7.  837 

three  days,  the  pericardium  was  found  to  be  diftended  with  concreted  blood. 
And  this  had  been  difcharg’d  from  the  left  ventricle  of  the  heart,  which  a 
kind  of  little  ulcer,  as  it  were,  had  perforated  at  the  apex. 

6.  This  cafe  is  pretty  fimilar  to  ours ;  but  whether  it  is  fimilar  to  thofe,  alfo, 
that  Lancifihas  obferv’d,  though  I  partly  furpebt  the  contrary,  I  do  not,  how¬ 
ever,  know  for  a  certainty.  For  in  his  pofthumous  work  De  Motu  Cordis  (z), 
publilh’d  in  the  year  1728,  he  has  really  both  made  mention  of  thofe  perfons 
who  “  are  carried  off  by  a  fudden  death  by  reafon  of  a  foramen  being  open’d 
“  prematurely  in  the  heart,”  and  has  teftified,  not  only  that  he  had  ieen  this 
“  kind  of  death,”  but  “  even  that  he  had  frequently  feen  it which  paffage 
has  efcap’d  the  notice  of  a  man  in  other  refpebts  learned,  as  fometimes  happens. 
And  I  wiffi  Lancifi  could  have  finifh’d  this  work  of  his ;  for  in  that  cafe  I  do 
not  doubt  but  we  fhould  have  had  both  thefe  and  other  obfervations  exprefsly 
and  particularly  written  by  him.  At  prefent,  however,  in  regard  to  thefe 
obfervations,  we  have  nothing  elfe  to  take  notice  of,  except  that  he  there 
fhews  his  opinion  to  be,  that  among  others  who  are  liable  to  this  kind  of 
death,  are  thofe  bodies  in  which  he  found,  in  an  age  that  was  yet  puerile, 
the  fibres  of  the  heart  not  only  “  more  languid,  and  not  fufficiently  cohering, 
“  but  alfo  deficient  as  he  found,  particularly,  “  in  the  left  ventricle,  a 
“  certain  place,  and,  as  it  were,  a  tranfparent  foramen,  which  the  external 
“  and  internal  membranes  only  prevented  from  being  quite  open.”  And  he 
has  juftly  faid,  “  among  ”  others :  for  thofe  that  are  fubjebt  to  internal  ulcers,, 
and  in  whom,  as  he  has  faid,  the  fibres  of  the  heart  are  “  more  languid,” 
are  alfo  liable  to  this  kind  of  death. 

7.  A  very  clear  and  ftriking  inftance  of  each  of  thefe  laft  kinds  of  death  is 
produc’d  by  him,  who  has  written  and  collected  more  than  any  other  perfori 
ever  did  yet  on  the  fubjebt  of  rupture  in  the  heart  j  I  mean,  that  celebrated- 
man  Morand  (a).  Both  of  thefe  cafes  happen’d  in  the  year  1740.  One  in- 
a  woman  of  princely  rank,  who  was  already  pretty  far  advanc’d  in  age,  and 
whole  right  ventricle#of  the  heart  was  obferv’d  by  the  celebrated  Lemery  to  be 
externally  corroded ;  fo  that  an  ulcer  had,  by  degrees,  penetrated  from  thence 
quite  to  the  cavity  of  the  ventricle  :  which  was  for  that  reafon  empty,  inaf- 
much  as  the  blood  was  effus’d  into  the  pericardium  from  that  ventricle, 
though  the  left  was  full.  The  other  in  a  nobleman  whom  Morand  himfelf 
diffebted,  and  found  the  pericardium  fill’d  with  concreted  blood,  and  the 
heart  fo  extremely  lax,  that  it  could  be  pierc’d  through  merely  by  the  weight 
of  a  probe  p  and  the  blood  had  been  pour’d  out  from  the  left  ventricle, 
through  a  fiffure  about  eight  lines  in  length,  which  was  found  in  the  middle 
of  that  ventricle.  The  other  circumftances  that  relate  to  thefe  cafes,  you  may 
read  in  the  fame  Morand,  except  the  caufes  and  figns  that  had  preceded  : 
which,  whether  becaufe  there  were  none  worthy  of  remark,  or  rather  becaufe 
they  are  deferr’d  to  a  future  treatife,  are  not  to  be  found  in  that  memoir. 

But  in  the  obfcrvation  of  the  ruptur’d  heart,  which  is  the  laft  but  one,  as 
far  as  I  know,  and  relates  to  ulceration,  as  both  the  caufes  and  figns  that  had 
preceded  were  written-  to  me  by  the  perfon  who  made  the  obfervation,  andf 
communicated  it  to  me  in  the  year  1740  ;  that  is,  by  Laurence  Mariani,  for.- 

[z)  Propof.  28,  (a)  Mera,  de  l*Acad.  R.  des  Sc.  A.  1732. 

merly 


£38  Book  II.  Of  Difeafes  of  the  Thorax. 

merly  a  mod  eminent  phyfician  at  the  court  of  Placentia;  fo  you  will  now 
have  them  related  to  you  by  me. 

8.  The  fubjecft  of  this  obfervation  was  a  man  of  great  figure,  and  by  de¬ 
gree  a  knight,  aged  fixty-five  years,  but  of  a  ft rong- built  conftitution,  and 
a  good  difpofition  of  humours,  except  that  for  fome  years  before  he  had  la¬ 
bour’d  under  long  and  obilinate  ulcers  of  the  legs  ;  which  being  tir’d  of,  he 
had  at  length  heal’d  up,  by  the  ufe  both  of  external  and  internal  remedies. 
This  gentleman  being,  at  laft,  frequently  fubjed:  to  rheumatic  pains,  but  fo 
flight  as  not  to  prevent  him  going  out  from  his  houfe,  which  he  had  done 
even  the  very  day  before  he  died,  was  more  violently  feiz’d  with  them,  on  a 
certain  day  in  the  beginning  of  June,  at  the  fternum,  and  in  the  arms,  not 
without  l'ome  convulfion  of  the  head.  And  fuch  remedies  having  been  made 
ufe  of  againft  thefe  pains  as  were  judg’d  moft  proper,  he  was,  about  the  noon 
of  the  fame  day,  in  great  meafure  reliev’d  ;  and  though  his  pulfe  was  very 
weak,  yet  he  was  very  brifk  and  chearful.  Having  fiept  after  dinner,  he  felt, 
when  he  awoke,  the  fame  pains  that  he  felt  in  the  morning.  Eor  which 
reafon,  he  began  to  walk  about  his  chamber ;  for  by  this  means  he  bore 
them  more  eafily.  But  after  having  done  this  fufficiently,  and  gone  to  bed 
again,  he  complain’d  of  fumes  afcending  to  his  head,  and  of  ftreightneftes 
at  his  cheft,  and  turn’d  himfelf  from  one  pofture  to  another  with  reftleflnefs 
and  anxiety.  And  having  done  this  for  a  confiderable  time,  he  on  a  hidden 
perceiv’d  that  he  was  dying;  and  growing  pale,  and  tolling  at  the  fame  time, 
he  inftantly  expir’d. 

Upon  opening  the  abdomen,  every  thing  appear’d  to  be  in  its  natural  ftate. 
But  when  the  thorax  was  open’d,  and  the  lungs,  which  had  been  forc’d  for¬ 
wards,  were  remov’d,  the  pericardium  was  found  to  be  diftended  with  black 
and  coagulated  blood.  This  blood  had  iflu’d  out  of  the  left  ventricle  of  the* 
heart,  through  a  fifth  re  half  an  inch  in  length,  and  in  the  longitudinal  di¬ 
rection  of  the  ventricle,  about  which  the  fibres  of  the  heart  were  feen  to  be 
deftroy’d  by  a  corrolion  that  was  not  recent. 

9.  Without  doubt,  what  the  cafe  of  Trombelli  (3)  had  demonftrated,  is 
confirm’d  to  us  by  this  ;  I  mean,  that  thofe  erofions  in  the  fkin,  which  we 
are  impatient  of,  being  repell’d  from  thence,  frequently  attack  the  internal 
parts,  and  bring  on  an  unexpected  death.  For  which  reafon  we  ought,  firfl 
of  all,  to  take  care  not  to  heal  up  external  ulcers,  and  other  diforders  of  that 
kind,  -that  have  been  of  long  continuance,  without  a  long  deliberation,  and 
that  even  debated  again  and  again  ;  and,  in  the  fecond  place,  where  they 
have  been  cur’d  more  by  internal  than  external  remedies,  that  the  patient  fo- 
licitoufly  avoid  every  thing  from  whence  corrofive  particles  may  be  afrefh 
generated  in  the  conftitution  :  and  again,  that  if  any  new  indifpofitions  begin 
to  arife,  art  may  do  all  in  its  power,  to  endeavour  to  bring  back  thofe  former 
erofions  ;  and  if  they  cannot  be  brought  back,  that  others  may  be  fupplicd 
in  their  room  :  and  laft  of  all,  when  the  firft  tokens  of  an  internal  diforder 
have  difcover’d  themfelves,  efpecially  in  the  thorax,  notwithftanding  they 
may  be  flight,  obfcure,  and  ambiguous,  and  as  you  will  perceive,  by  com¬ 
paring  them  together,  generally  different,  in  different  perfons ;  that  the  phy- 

(6)  Vid,  Epift,  26.  n.  39. 


fician 


Letter  XXVII.  Article  10*  83  p 

fician  be  upon  his  guard,  and  fearful  left  any  thing  terrible  fhould  be  che- 
rilh’d  within  ;  fo  that  if  he  has  it  not  in  his  power  to  prevent  the  generation 
and  progrefs  of  this  evil,  by  diminifhing  the  acrimony,  quantity,  and  en- 
c  reap’d  motion  j  or  to  prevent  its  breaking  forth  fuddenly  at  laft  ;  yet  he  may 
at  leaft  endeavour  to  protradft  it  as  long  as  poftible  j  at  the  fame  time  not  en¬ 
tirely  Concealing  his  fufpicions  among  the  domeftics  of  the  patient. 

10,  And  as  to  the  laft  obfervation  of  this  kind,  which  was  made  upon  a 
moft  powerful  monarch,  in  whom  the  left  ventricle  of  the  heart  was  found  to 
be  ruptur’d  into  an  oblong  fifiure,  you  do  not  expeft,  I  fuppofe,  that  I  Ihould 
fpeak  of  that ;  inafmuch  as  it  is  a  circumftance  not  unknown  to  you,  and  even 
not  unknown  to  the  whole  world. 

If  you  compare  this  obfervation  with  the  other  nine  that  I  have  produced 
out  of  the  ten,  or  at  leaft  out  of  the  eight ;  for  the  fecond  relates  to  a  fiftula, 
that  was  the  confequence  of  a  wound,  and  the  fourth  is  imperfect  •,  you  will 
find  one,  and  no  more,  in  which  the  right  ventricle  was  found  to  be  ruptur’d ; 
whereas  the  remaining  feven  all  give  an  account  of  the  rupture  of  the  left 
ventricle.  And  to  thefe  add  others,  of  which  1  have  been  inform’d  at  the 
time  I  was  reviling  this  letter.  For  to  pafs  over  that  which  Michelotti  ( c ) 
points  out,  in  an  ambiguous  manner,  from  Santorini,  as  if  fimilar  to  that 
which  has  been  defcrib’d  above  (d)  by  me,  in  the  Venetian  woman  *,  there  is 
no  doubt,  but  in  the  two  which  Mariana,  whom  I  have  already  fpoken  of 
with  juft  praife,  has  lince  communicated  to  me,  and  which  I  (hall  commu¬ 
nicate  to  you  in  another  letter  (e)  ;  one  taken  from  a  man  of  noble  rank,  and 
the  other  from  a  certain  phyfician ;  but  the  left  ventricle  of  the  heart  was 
pierc’d  through.  But  to  what  caufe  fhall  we  afcribe,  that  a  rupture  happens 
fo  much  lefs  frequently  in  that  place,  where  there  feems  to  be  fo  much  the 
more  reafon  for  apprehending  it ;  as  the  thicknefs  of  the  parietes  of  the  right 
ventricle,  and  the  firength  of  it,  are  fo  much  the  more  inconfiderable,  when 
compar’d  with  the  left  ventricle  ?  Firft,  the  lower  part  of  the  left,  in  which 
the  rupture  happen’d  in  the  fifth  and  fixth  obfervation  that  have  been  given 
you  (/),  is  more  thin  and  weak  than  the  parietes  of  the  right  ventricle.  And 
fecondly,  in  proportion  as  the  llrength  of  the  left  ventricle  is  greater  than 
that  of  the  right,  fo  much  the  more  forcibly  does  it  abt  upon  its  own  pari¬ 
etes,  efpecially  when  any  obftacle  oppofes  itfelf  to  the  blood  which  is  coming 
out  from  that  cavity  *,  fo  that  if  any  part  of  it  be,  either  by  reafon  of  an 
ulcer,  or  on  any  other  account  whatever,  whether  in  confequence  of  difeafe, 
or  originally  from  the  birth,  lefs  ftrong  than  a  natural  and  good  ftru&ure  re¬ 
quires  it  to  be,  it  cannot  be  equal  to  fo  great  a  force  ;  but  the  parietes  in  that 
part,  although  in  others,  and  even  in  the  parts  round  about  all'o,  fufftciently 
thick  and  ftrong,  as  in  the  obfervation  of  Harvey  (g),  muft  at  length  beburll 
afunder,  and  open’d  into  a  foramen. 

There  was,  alfo,  befides  thofe  that  are  produc’d,  the  obfervation  of  that 
celebrated  man  Chriftian  Vater  (£),  of  the  right  ventricle  of  the  heart,  “  not 
“  far  from  the  apex,  where  it  coheres  to  the  feptum,  as  if  by  means  of  a 

(?)  Comment,  de  Bonon.  Sc.  Acad.  Tom.  i.  (?)  Epift.  64.  n.  14.  &  15. 

in  Opufc.  (f)  n.  2.  &  5.  (g)  fupra,  n.  1. 

(d)  n.  2.  (> b )  Eph.  N.  C.  Dec.  3.  A.  9.  Obf.  164. 

“  future 

■i 


7 


840  Book  II.  Of  Difeafes  of  the  Thorax. 

«  future,  being  ruptur’d  beyond  the  length  of  the  finger-nail  of  a  man.” 
But  becaule  that  rupture  happen’d  entirely  from  a  mod  violent  blow  that  was 
given  to  the  perlon  by  a  carriage,  which  was  palling  him  ;  and  becaule  it 
happen’d  at  that  very  inftant  of  time,  without  any  previous  morbid  difpofi- 
tion  of  the  heart,  it  was,  for  that  reafon,  not  related  among  the  others, 
which  fuited  the  purpofe  of  our  enquiry.  And  thus  far  of  fudden  death  from 
a  rupture  of  the  heart. 

1  i.  Now  that  which  happens  from  other  diforders  of  the  heart,  is  to  be  at¬ 
tended  to.  Out  of  which,  as  i  have  already  ffiown  by  hiftories  produc’d  in 
other  places  (/),  that  the  dilatation  of  this  vifcus  has  brought  on  deaths, 
which  have  been  either  more  fpeedy  than  expectation,  or  entirely  fudden  ; 
and  as  it  is  not  my  cuftom  to  repeat  over  again  what  I  have  once  given  you, 
I  am  pleas’d  that  I  have  it  in  my  power  at  prefent  to  give  you  a  new  obfer- 
vation  ;  by  which  this  doCtrine  is  very  clearly  and  plainly  confirm’d.  This 
obfervation  is  one  of  my  friend  Mediavia’s,  that  was  made  about  the  begin¬ 
ning  of  March,  in  the  year  1741*,  and  communicated  to  me  on  the  lame 
day  it  was  made. 

12.  A  young  man  of  an  excellent  habit  and  proper  conformation  of  body, 
and  of  a  good  ftature,  having  been  long  troubl’d  with  a  difficulty  of  breath¬ 
ing,  was  reliev’d  by  blood  burfting  forth  every  now  and  then  from  the  noftrils. 
But  after  he  had  begun  to  be  deficient  in  this  dilcharge,  happening  to  take 
a  long  journey  from  Trent  to  Padua  ;  which  he  perform’d,  partly  on  foot  and 
partly  on  horfeback,  within  the  fpace  of  two  days  •,  immediately  after  coming 
off  his  journey,  and  while  he  was  {looping  to  his  portmanteau,  which  was 
laid  on  the  ground,  he  fell  down  dead. 

The  thorax  being  cut  into,  on  the  day  following,  the  veffels  of  the  neck 
and  the  head  were  previoufly  obferv’d  to  be  very  turgid  with  blood.  But 
when  this  cavity  was  open’d,  there  appear’d  to  be  no  extravafation  in  it;  nor 
were  the  lungs  feen  to  adhere  any  where  to  the  pleura.  Both  the  lobes  of 
this  vifcus,  however,  were  livid,  from  the  blood  ftagnating  in  them  :  and 
they  were  fmail  befides,  by  reafon  of  the  vaft  magnitude  of  the  heart;  which, 
when  the  pericardium  was  cut  into,  where  there  was  no  fmail  quantity  of 
reddiffi  ferum,  appear’d  to  be  even  bigger  than  that  of  a  bullock.  And 
indeed  the  auricles,  and  the  right  ventricle,  were  larger  than  ufual:  yet  the 
greateft  bignefs  was  obferv’d  to  be  in  the  left  ventricle.  Nor  was  this 
owing  to  the  parietes,  which  were  not  thicker  than  ufual ;  but  to  the  cavity 
of  the  ventricle  being  dilated  to  fuch  a  degree,  that  nothing  could  be  con¬ 
ceiv’d  as  being  more  fo  ;  and  not  only  fill’d  with  a  quantity  of  black  blood, 
(that  had  not  form’d  itfelf  into  polypous  concretions,  though  it  was  fome- 
what  collected  into  grumous  coagula)  like  the  other  cavities  of  the  heart,  but 
aifo  diftended  therewith.  Befides  thefe  appearances,  the  femilunar  valves, 
which  lie  at  the  orifice  of  it,  were  not  bony,  indeed,  but  hard,  and  what  im¬ 
mediately  occurr’xl  to  the  eyes,  very  fmail ;  for  they  were  contracted  and 
corrugated.  But  the  great  artery,  although  it  was  not  larger  than  it  natu¬ 
rally  is,  yet  in  proportion  as  it  receded  from  the  heart,  fo  much  the  thinner 
than  ufual  were  its  coats.  Nor  was  its  internal  furface  entirely  free  from 

(0  ut  Epift.  18.  n.  2,  8.  14.  &  Epift,  24.  n.  13. 

6  longitudinal 


Letter  XXVII.  Article  13.  841 

longitudinal  furrows ;  notwithftanding  they  were  fomewhat  obfeure.  However, 
in  the  heart,  and  the  whole  thorax,  there  was  nothing  befides,  that  was  not 
natural.  To  open  the  belly  and  the  head  after  thefe  appearances,  feem’d  quite 
fuperffuous  j  efpecially  as  he  had  never  made  any  complaints  of  the  one  or 
the  other. 

13.  If  this  young  man  had  made  ufe  of  the  hint  that  nature  had  given 
him  *,  I  mean,  if  he  had  taken  care,  after  the  blood  had  ceafed  to  flow  from 
his  noftrils,  to  have  fome  taken  away  at  proper  times,  by  opening  a  vein, 
he  either  would  not  have  died  thus  at  all,  or  at  leaft  would  not  have  died  fo 
foon.  It  is  a  good  argument  to  ffiow  phyficians  what  ought  to  be  done, 
where  any  perlon,  particularly  of  fuch  an  age,  and  of  fuch  a  habit  of  body, 
begins  to  be  deficient  in  an  evacuation  of  that  kind  :  efpecially  if  the  fame 
perfon  be  liable  to  any  diforder ;  as  this  young  man  v/as  to  a  difficulty  ot 
refpiration. 

And  to  this  you  will  find  that  mod  of  the  others  had  been  fubject,  whom 
I  have  already  delcrib’d  to  you  (£),  as  having  died  fuddenly  of  a  dilated 
heart,  it  you  turn  once  more  to  their  hiftories,  So,  alfo,  in  this  eleventh 
fedtion  of  the  Sepulchretum  (/),  you  may  fee,  that  a  coachman,  who  died  fud¬ 
denly  in  his  carriage,  and  whole  heart  was  44  larger  than  that  of  any  bullock,’* 
often  “  fuppos’d  that  he  was  about  to  be  fuffocated,”  unlefs  he  applied  his 
hand  very  hard  to  the  thorax  and  abdomen  •,  in  the  fame  manner  as  another 
that  you  read  of  in  Harvey’s  works  ( m ) ;  in  whom  “  the  fubftance  ol  the 
44  heart,  and  the  cavities  of  the  ventricles,”  being  diftended  with  blood, 
equalfld  44  the  magnitude  of  the  heart  of  an  ox  perceiv’d  fome  alleviation 
to  the  very  great  oppreffion  of  the  heart  and  the  cheft,  when  the  whole 
region  of  the  thorax  was  comprefs’d  by  a  very  ftrong  man  ;  and  “  fqueez’d 
44  and  kneaded,  juft  as  a  baker  kneads  his  bread  I  fuppofe,  becaule  by 
both  of  thefe  means,  the  motion  of  the  blood  was  help’d  on.  You  will 
read  of  another  alfo,  in  the  fame  feftion  (»),  who  was  fnatch’d  away  by  a 
fudden  death  ;  the  heart  tc  far  exceeding  its  natural  bulk,  and  being  full  of 
44  black  blood  and  who,  as  appears  Efficiently  clear  from  other  things 
that  are  added,  had  drawn  his  breath  with  difficulty.  And  in  the  fecond 
fe&ion  of  this  fecond  book  (0),  a  young  woman  is  fpoken  of,  who  was 
44  fuddenly  fuffocated,”  without  any  evident  caufe  :  in  whom  the  heart 
44  was  twice  as  big  as  its  ordinary  fize and  in  it,  as  is  more  exprefsly  faid 
in  the  fcholium,  had  “  a  large  quantity  of  blood  which  magnitude  of  the 
heart,  whether  it  happen’d  from  difeafe,  or  was  the  refult  of  a  natural  forma¬ 
tion,  in  that  young  woman,  which  is  in  the  fame  place  fuppos’d,  as  the  heart 
was,  for  that  reafon,  of  a  greater  weight  than  it  is  in  others,  and  had,  there¬ 
fore,  a  greater  difficulty  in  performing  its  motions ;  it  muft  have  been  more 
prone  to  delay  the  motion  of  the  blood  in  itfelf,  and  confequently  in  the  lungs ; 
particularly  in  a  paralytic  woman.  For  on  this  account,  Lancifi  has  exceed¬ 
ingly  well  judg’d  (p\  that  if  they  who  happen  to  have  the  heart  bigger  than 
ufual  from  the  birth,  have  the  powers,  by  which  the  mufcles  are  put  into 

(A)  Vid.  fupra,  ad  n.  n,  (»)  Obf,  -50. 

(0  Obf.  24.  '  (fl)  Obf.  33. 

(m)  De  Circul,  Sangu.  Exerc.  3,  ( p )  De  Mot,  Cord.  Propof.  38.  in  fin. 

Vob.  I.  -  5  P  motion. 


$4^  Book  II.  Of  Difeafes  of  die  Thorax. 

motion,  diminllh’d  from  any  caufe  whatever  ;  as,  for  inftance,  merely  from  life 
being  pretty  far  advanc’d  ;  the  blood  eafily  ftagnates  in  the  heart,  and  brings  oil 
an  aneurifm.  But  although  a  great  bulk  of  the  heart,  either  by  overloading 
the  diaphragm,  or  even  by  comprefling  the  lungs,  as  very  evidently  appear’d 
in  that  young  man  of  whom  we  are  fpeaking,  is  injurious  to  refpiration  ;  as  I 
have  elfewhere  hinted  :  yet  even  the  dilatation  of  the  left  ventricle  alone, 
which  we  here  attend  to,  will  be  the  caufe,  that  in  proportion  as  lefs  blood 
can  be  fent  out  of  that  cavity  into  the  aorta,  fo  much  lefs,  in  proportion,  can 
be  received  from  the  lungs:  from  whence,  not  only  a  difficulty  of  breathing 
arifes,  by  reafon  of  the  lungs  being  opprefs’d  with  blood,  but  at  length  a 
fudden  death  ;  where  that  ventricle,  being  continually  more  and  more  re¬ 
lax’d,  is  at  length  overwhelm’d  with  lo  great  a  quantity  of  blood,  that  it 
can  by  no  means  contradi  itfelf.  But  the  quantity  of  blood  with  which,  not 
only  in  thefe  cafes,  but  alfo  in  others,  of  fudden  death,  this  ventricle  has 
been  feen  to  be  fill’d  pretty  frequently  :  as  for  example,  not  to  digrefs 
far  from  hence,  in  that  woman  of  princely  rank,  whom  I  took  notice  of 
above  from  Morand  ( q )  •,  and  in  the  fervant  maid,  who  is  fpoken  of  in  this 
very  eleventh  fedlion  of  the  Sepulchretum,  obfervation  the  eleventh  ;  and  in 
others,  without  doubt,  that  are  mention’d  in  the  fame  fedtion,  under  ob¬ 
fervation  the  ninth  •,  or  in  the  additamenta,  obfervation  the  firft:  I  fay,  this 
quantity  of  blood  prevents  me  from  agreeing  with  thole,  who,  without  any 
diftindlion  of  caufes,  or  circumftances,  afiert,  in  a  general  manner,  ct  that 
“  in  perfons  who  die  fuddenly,  the  right  fide  of  the  heart  is  generallly  found 
“  to  be  fill’d  with  blood,  and  the  left  fide  to  be  empty.” 

14.  You  will,  perhaps,  afk,  why,  as  all  the  four  cavities  of  the  heart  were 
-  dilated  in  the  young  man  in  queftion,  the  dilatation  of  the  left  ventricle  was, 

neverthelefs,  the  greateft  ?  Without  doubt,  becaufe  the  dilatation  of  this 
ventricle  had  given  rife  to  the  dilatation  of  the  other  ventricle  and  the  two 
auricles  •,  that  is,  by  admitting  a  lefs  quantity  of  blood  than  it  ought,  for  the 
reafon  which  I  juft  now  gave  you  •,  and,  in  confequence  of  this  obftrudtion, 
by  retarding  the  motion  of  the  blood  in  the  left  auricle,  in  the  lungs,  in  the 
right  ventricle,  and  its  adjoining  auricle.  But  why  was  the  left  ventricle  the 
firft  of  all  to  be  dilated  ?  Why,  certainly,  becaufe  the  femilunar  valves, 
whatever  the  caufe  of  this  circumftance  might  be,  having  been  contra&ed 
and  corrugated,  could  not  properly  expand  themfelves,  fo  as  to  prevent  the 
blood  from  being,  in  part,  fent  back  into  the  ventricle,  from  whence  it  came,, 
during  the  conftridlion  of  the  aorta  :  which  part  of  the  blood  would,  per¬ 
haps,  have  been  lefs,  if  the  coats  of  the  more  diftant  parts  of  the  aorta  had 
been  able  to  drive  on  towards  the  veins  the  proper  quantity  of  blood  which 
it  had  receiv’d  •,  but  this  the  thinnefs  of  thefe  coats,  that  is,  the  decreas’d 
number  of  their  fleffiy  and  elaftic  fibres,  did  not  permit.  But  thefe  circum¬ 
ftances  I  do  not  explain  at  large,  partly  becaufe  they  are  of  themfelves  fuffi- 
ciently  clear,  and  partly  becaufe  they  have  been  explain’d  Efficiently  on  a 
former  occafion  (r). 

15.  This,  however,  is  always  to  be  obferv’d,  that  aneurifms  of  the  heart, 
like  aneurifms  of  the  aorta,  are  not  fo  neceftary  caufes  of  fudden  death  as 

(?)  N.  7.  (r)  Epift.  23.  n.  9. 

ruptures 


Letter  XXVII.  Article  1 6.  £43 

ruptures  of  the  heart  or  the  aorta  are.  And  even  thofe  dilatations,  except 
they  proceed  fo  far,  that,  upon  the  addition  of  forne  other  new  caufe  from 
within,  or  from  without,  the  circulation  of  the  blood  muft  indantly  and  na¬ 
turally  ceafe,  would  rather  bring  on  a  flow  than  a  fudden  death.  Of  which 
circumftance,  although  many  obfervations  are  extant,  and  are  even  not  want¬ 
ing  in  my  letters  to  you  •,  yet  in  regard  to  the  heart  itfelf,  of  which  we 
treat  here,  look  into  thofe  two  that  you  have  in  the  bepulchretum  (j);  the 
one  of  Thomas  Bartholin,  in  which  “  the  heart  ”  is  defcrib’d  “  as  being  fo 
“  large,  that  it  is  frequently  not  larger  in  oxen  the  other  of  Otto  Heurnius, 
in  which  it  is  faid  that  the  heart  “  had  exceeded  its  common  magnitude  about 
“  four  times.”  You  will  find  that  neither  of  the  patients  was  fnatch’d  away 
by  a  fudden  death,  but,  on  the  contrary,  that  both  of  them  were  confum’d 
by  a  flow  difeale.  And  you  will  moreover  obferve,  that  there  was  in  the 
heart  of  both  of  them  an  appearance,  on  the  account  of  whi.h  I  chiefly  took 
notice  of  thefe  two  obfervations.  For  the  firfl  of  them  had,  under  the  root 
of  the  great  artery,  “  a  cartilago  triquetra ,  or  a  bone  fomewhat  fpongy  and 
“  friable,  not  unlike  fome  of  the  calculi  which  are  difeharg’d  by  the  urinary 
“  paflages and  the  fecond  had,  “  in  the  villi  of  the  intermediate  feptum, 
“  three  calculi,  about  the  bignefs  of  a  pea,  as  yet  not  very  hard  and  folid, 
“  but  fandy,  as  it  were,  and  ealily  giving  way  to  the  razor.”  You  fee,  then, 
that  fudden  death  had  not  happen’d  even  on  account  of  thefe  other  disorders 
of  the  heart :  nor  will  you  read  that  it  had  happen’d  to  the  young  man  (/) 
in  whofe  heart  Platerus  found  “  a  bone  confiding  of  three  joints,  hollow,  and 
“  fill’d  with  a  kind  of  fandy  matter  ;”  nor  to  that  merchant  («)  in  whom  the 
right  ventricle  of  the  heart  was  internally  fo  “  hard,  every  where  rough,  and 
“  in  fome  meafure  fcaly,  that  the  hand  being  thruft  into  it  ”  by  Smetius, 
“  it  was  hurt  with  the  roughnefs  of  the  feales.”  Which  indances,  and  others 
of  the  like  kind,  I  quoted  to  fome  of  my  friends,  that  they  might  not  rea¬ 
dily  aferibe  a  fudden  death  to  bones  that  were  leen  in  the  heart  of  a  man, 
whofe  difiedtion  ufher’d  in  the  anatomical  demonftrations  of  this  theatre,  in 
the  year  1745.  What  I  obferv’d  to  be  preternatural  in  that  body,  linee  I 
have  fpoken  of  it  by  accident,  I  will  add  here  in  a  few  words. 

1 6.  A  beggar,  who  had  been  before  by  trade  a  wool-comber,  of  fifty  years 
of  age,  being  burnt  up  with  a  hot  and  confumptive  fever  in  the  mod  cold 
feafon  of  the  year;  for  the  month  of  January  drew  almod  to  its  conclufion  ; 
fo  .that  he  was  wont  to  deep  naked  upon  draw  in  his  little  cottage,  was  found 
dead  one  morning  in  this  fituation. 

The  abdomen  being  open’d,  1  faw  fomewhat  more  moidure  in  that  cavity 
than  there  generally  is  in  a  natural  date :  the  domach  was  didended  very  much, 
and  cover’d  pretty  thick  with  the  omentum,  that  was  in  great  meafure  drawn 
up.  Within  it  had  a  great  quantity  of  air,  and  dill  a  final!  quantity  of  wine, 
with  the  colour  of  which  it  was  ting’d.  The  glands  of  the  mefentery,  not 
only  in  the  center  of  it,  where  they  were  crowded  together*  after  the  manner 
of  a  double  cinder  of  grapes  that  was  not  large,  but  in  other  places  alfo, 
up  and  down,  where  they  lay  at  fome  didance  from  each  other,  were  larger 

(s)  L.  2.  S.  7.  Obf.  83.  &  S.  8.  Obf.  15.  (f/)  Ibid.  Obf,  14.  §  9. 

(/)  Sed.  ead.  8.  Obf.  24. 


5  P  2 


than 


844  Of  Difeafes  of  the  Thorax.  Book  II. 

than  they  naturally  are,  and  fomewhat  hard.  The  fpleen  was  rather  fmall ; 
whereas  the  liver  was  of  a  moderate  fize,  and  the  fplenic  artery  thicker  in 
proportion  than  the  fpleen.  The  other  vifcera  of  the  belly  were  very  found. 

In  the  thorax  I  chiefly  examin’d  the  heart,  which  was  not  fmall,  but  flaccid. 
In  this  vifcus  every  thing  was  natural,  except  that  externally,  nearly  in  the 
middle  of  its  polterior  furface,  it  had  a  bony  fcale,  of  no  inconfiderable  fize, 
and  another  much  lefs  than  this,  externally  likewife,  in  the  right  auricle. 
Both  of  thefe  fcales  were  fo  connected  to  the  membrane  of  the  heart  and  the 
auricle,  that  they  adher’d,  neverthelefs,  more  clofely  to  the  fieffiy  fibres, 
without  the  laceration  of  which  they  could  not  be  feparated.  The  other 
parts  or  the  thorax,  and  much  lefs  thofe  of  the  head,  it  was  not  in  my  power 
accurately  to  examine  ;  as  having,  in  the  mean  while,  got  a  more  proper  fub- 
je<5t  for  our  anatomical  demonftrations,  1  was  prevented  by  clofe  obfervation 
upon  this,  befide  my  ufual  office  of  teaching.  Yet  in  the  former  of  thefe 
cavities,  I  remember  to  have  feen  the  internal  furface  of  the  aorta,  even  be¬ 
hind  the  femilunar  valves,  mark’d  with  whitifli  lpots,  which  I  had  alfo  ob- 
ferv’d  near  its  divifion  into  the  iliacs,  and  even  in  the  iliacs  themlelves. 

17.  I  would  fain  have  known  fome  particulars  in  relation  to  this  beggar,  if 
it  had  been  poffible ;  as,  for  in  fiance,  to  what  diforders  he  had,  or  had  not, 
been  fubjedt,  while  he  was  living  ;  and  have  found  time  likewife  for  exa¬ 
mining  minutely  into  his  lungs,  as  he  had  been  a  wool-comber,  and  was  very 
much  emaciatea  ;  and,  as  he  had  died  of  a  fudden  death,  I  ffiould  have  been 
glad,  alfo,  to  have  differed  the  brain.  At  prefent,  all  we  can  do  with  much 
propriety,  is  to  conjeblure  what  part  the  cold,  or,  if  you  pleafe,  what  part 
thole  bony  fcales  of  the  heart,  had  alfo  had  in  occafioning  his  death  •,  although 
thefe  fcales  do  not  feem  to  me  to  have  had  any  great  part  in  producing  it, 
when  I  call  to  mind  what  I  laid  above  (x),  that  1  had  then  taken  notice  of  to 
my  friends.  But  if  you  fuppofe  thole  inflames  to  have  but  little  relation  to 
the  prefent  purpofe,  inafmuch  as  they  are  inftances  of  calculi  rather  than  of 
bones,  I  will  not  here  difpute  whether  all  thefe  bodies  were  really  calculous  ; 
and  even,  if  they  were,  whether  they  might  not  themfelves  be  injurious  to 
the  heart,  if  my  bony  laminae  were  as  injurious  as  you  imagine  :  but  I  will 
add  other  examples,  in  which  neither  you  nor  I  doubt  but  there  were  true 
bones.  For  I  cannot  be  of  opinion  with  thole,  who,  excepting  the  ar¬ 
teries  and  the  falciform  procefs  of  the  dura  mater,  do  not  feem  to  allow  of 
bony  concretions  being  found  elfewhere,  but  rather  look  upon  them  as  tar- 
tareous  and  calculous  formations:  neither  can  I  agree  with  thofe  who  think 
that  the  heart  and  the  arteries  are,  in  general,  the  only  parts  that  can  be 
chang’d  into  true  bones.  But  I  confide  not  only  in  thofe  who  have  fometimes 
feen  concretions  not  truly  bony  in  the  heart  and  arteries,  but  alfo  in  myfelf,  as 
well  as  others,  by  whom  real  bones  have  been  feen  in  the  heart  and  the  ar¬ 
teries.  But  of  the  arteries  hereafter.  Let  us  now  firft  confider  of  what  re¬ 
lates  to  the  heart. 

Our  Columbus  (jyN  faw  the  feptum  of  the  heart,  in  fome  bodies,  really  car¬ 
tilaginous;  and,  in  like  manner,  our  Veflingius  (z)  faw  the  left  ventricle  “  in¬ 
fs)  N.  15.  (y)  De  Re  Anat.  1.  15.  (»)  Obf.  Anat.  &  Epift.  Med.  15. 


4 


“  ternally 


N 


Letter  XXVII.  Article  17.  845 

“  ternally  furrounded  with  a  cartilaginous  cruft,”  not  with  bone  indeed,  as 
fome  fay.  And  in  this  fecond  book  of  the  Sepulchretum,  fedtion  the  firft  ( a ), 
and  fecond  (<£),  you  have,  “  near  to  the  left  auricle  of  the  heart,  a  cartila- 
*•  ginous  excrcfcence,”  and  even  the  auricles  themfelves  “  very  hard  and 
“  cartilaginous.”  And  where  cartilage  is,  there  it  does  not  feem  to  be 
doubtful  but  a  true  bone  may  be  form’d.  For  which  reafon,  it  is  not  to  be 
wonder’d  at  that  others,  as  well  as  I,  have  found  bones  in  the  heart ;  nor 
that  Dionis,  as  I  have  already  related  (r),  found  the  right  auricle  thereof  to 
be  internally  cover’d  with  a  bony  and  fcaly  fubftance.  But  if  any  one  fhould 
fay  that  thefe  bones  belong’d  to  the  membranes,  and  not  to  the  flefhy  fibres; 
and  that  thefe  cartilages  were  not  true  cartilages,  but  call’d  fo  from  their 
fimilitude  in  hardnefs,  juft  as  the  vagina  uteri  in  old  women  is  faid  to  be 
cartilaginous;  although  either  thefe  bones  in  membranes,  or  thole  cartilages 
in  the  flefhy  fibres,  muft  by  their  hardnefs  alfo  have  been  injurious  to  the 
mot  ons  of  the  heart  and  the  auricles  ;  J  will  not  conteft  it  with  him,  but 
will  rather  attack  him  by  another  method  of  reafoning.  For  it  is  certain, 
that  the  flefhy  fibres  of  the  heart  themfelves  fometimes  degenerate  into  a  ten¬ 
dinous  hardnels. 

Albertini(d),  therefore,  faw  in  fome  bodies,  “  that  the  fubftance  of  the  heart,. 
“  from  the  bafis  to  more  than  ha;f  its  extent,  had  become  tendinous,  as  it  were, 
“  both  in  its  confidence  and  colour  which  kind  of  metamorphofis  I  have 
in  my  power  to  confirm,  if  there  were  any  occafion,  by  an  obfervation  of 
my  own  (, e ).  And  that  bones  may  be  form’d  from  tendons,  efpecially  in  the 
advance  of  lire,  is  not  only  demonftrated  by  the  obfervation  of  Veflingius  (f)r 
who,  if  he  did  not  find  all  the  tendons  going  to  the  legs  and  anckles  of  a  very 
decrepid  old  man  “  bony,”  as  fome  aflert,  at  leaft,  found  them  “  almoft 
“  bony  but  even  very  evidently  prov’d  by  the  frequent  infpedtions  of  others, 
join’d  with  thole  obfervations  upon  the  feet  of  brute  animals,  and  particu¬ 
larly  of  birds,  which  have  already  long  been  publifh’d.  But  let  thefe  things 
be  faid,  not  becaufe  obfervations  are  wanting  of  bones  be  ng  found  in  the 
flefhy  fubftance  of  the  heart  itfelf;  but  that  it  may  not  be  objedted,  that 
thefe  might  not  have  been  true  bones,  unlefs,  perhaps,  by  thofe  who  would' 
contend,  in  oppofition  to  the  teftimony  of  the  fenfes,  that  even  thofe  ten¬ 
dons  of  birds  were  not  converted  into  bones,  but  rather  into  a'calculous  fub¬ 
ftance  :  for  it  is  paft  a  doubt,  to  take  no  notice  of  other  circumftances,  that 
thefe  tendons  were  fo  far  of  the  nature  of  bone,  rather  than  of  calculus,  that 
as  long  as  they  continue  to  be  thin  filaments,  or  thin  lamellae,  we  may  bend 
them  juft  as  we  fhould  hoofs,  or  horny  laminae  ;  and  they,  immediately  after 
flexion,  reftore  themfelves  to  their  previous  ftate  of  ftraimefs  :  whereas  if  they 
had  been  formations  of  calculous  or  tartareous  matter,  they  would  have  been 
inftantly  broken  upon  bending,  and  have  been  Ihivcr’d  into  a  number  of 
fragments. 

(a)  Obf.  32.  (J)  Comment.  deBonon.  Sc.  Acad.  Tom.  x„ 

(£)  Obf.  z.  in  Opufcul; 

(0  Epifl,  18.  n.  ii,'  &  12.  (*)  Vid.  Epifl.  45.  n.  23, 

(f)  Epift.  cit.  15. 


$8.  But 


84  6  Book  II.  Of  Difeafes  of  the  Thorax. 

18.  But  to  come  now  to  examples ;  I  will  not  here  quote  the  celebrated 
Reimannus  (g),  becaufe,  after  having  told  us,  that  he  had  feen  “  the  car¬ 
neas  columna;,”  which  lie  at  the  fides  of  one  of  “  the  ventricles  of  the  heart, 
“  entirely  offified,”  he  immediately  fubjoins  the  following  words,  “  or,  if  you 
“  would  rather  have  it  fo,  indurated  like  a  flint but  I  will  rather  ufe  my  own 
more  ancient  obfervations :  and  although  I  made  thefe  in  the  years  1707  and 
I7I7»  yet  I  flill  very  well  know,  that  they  were  not  flints  or  calculi  which  I 
faw  in  the  fielhy  fubflance  of  the  heart,  but  real  and  genuine  bones.  One 
of  thefe  obfervations  you  have  in  this  letter  (£),  the  other  in  the  third  (/) ; 
and  both  of  them  written  in  fuch  a  manner,  as  readily  to  fhow  you,  that  the 
perfons  to  whom  thefe  hearts  belong’d,  had  been  carried  away,  indeed,  by  a 
ludden  death,  but  not  on  account  of  that  bone.  For  in  the  year  1719,  I 
had  only  mention’d  each  of  thefe  bones,  that  is  to  fay,  in  the  fifth  of  the 
Adverfaria  (£).  But  I  had,  neverthelefs,  in  that  place,  as  I  imagine,  fuffi- 
ciently  demonftrated,  that  neither  of  them  had  been  indurated  in  a  part  of 
the  heart,  where  a  tendon  is  naturally  fo  thick,  in  particular,  as  the  thicknefs 
of  the  one,  and  the  fituation  of  the  other,  requir’d.  In  my  opinion,  there¬ 
fore,  both  of  them  feem  to  have  confided  of  flefhy  fibres,  previoufly  chang’d 
into  tendon,  by  the  force  of  the  difeal'e  (/).  I  afterwards  read  that  Boer- 
haave  (»2),  as  he  had  fometimes  feen  “  tendons  to  have  been  fboots,  as  it 
ct.  were,  of  bone,”  fo  he  had  alfo  feen,  “  that  the  feptum  of  the  heart,  and  its 
44  cavities,  had  put  on  a  bony  nature.”  And  in  particular  I  read  in  the  Hiflory 
of  the  Royal  Academy  of  Sciences  at  Paris,  in  the  year  1726,  that  the  fa¬ 
mous  furgeon  Garengeot  had  found  a  bone  much  longer  than  either  of  mine, 
fo  that  it  reach’d  to  both  the  ventricles  of  the  heart  5  nor  did  it  only  lie 
latent  among  the  fielhy  fibres  externally,  as  mine  did,  but  even  appear’d  in¬ 
ternally  j  for  which  reafon  it  was  much  more  eafy  to  conclude,  that  thefe  fi¬ 
bres  themfelves .had  been  chang’d  into  bone.  To  this  obfervation  I  fee  that 
another  is  now  added,  of  a  bone  which  was  much  larger,  fo  as  to  equal  al- 
moft  the  palm  of  the  hand,  and  to  be  produc’d  from  the  external  furfaces 
of  the  heart,  and  particularly  from  the  pofterior  quite  to  the  internal  fibres 
of  the  ventricles,  which  were  already  fomewhat  cartilaginous.  Nor  were 
cartilaginous  interftices  wanting  between  the  bony  fubflance.  You  will  find 
this  hiflory  related  by  the  very  illuftrious  Senac  (») :  who  alfo  teftifies,  that 
he  himfelf  had  feen  the  left  ventricle,  in  another  body,  and  the  carneas  co¬ 
lumns  alfo,  chang’d  into  a  bony  fubflance  ( 0 ).  Nor  did  the  obfervations 
of  thole  perfons  efcape  this  very  learned  man,  who  have  aflerted,  that  they 
had  not  feen  bones,  but  ftones,  in  the  fubflance  of  the  heart ;  and  he  has 
even  given  a  confiderable  number  of  them  colledted  together  (y?)  j  not  con¬ 
cealing,  however,  which  in  particular  he  fuppos’d  even  among  thefe  to  have 
been  made  up  of  a  bony  fubflance,  although  not  well  form’d  ;  not  doubting, 
in  regard  to  the  remaining  obfervations  (7),  in  which  it  was  more  perfectly 
form’d,  but  the  flefhy  fibres  of  the  heart,  though  after  the  membranous  and 


(g)  Aft.  N.  C.  Tom.  1.  Obf.  170. 
(!)  n.  2. 

(?)  n.  22. 

(i)  Animad.  14. 

(/)  Vid,  Epill.  45,  n.  23.  &  26. 


( m )  Prseleft.  ad  Inftit.  §  478. 

(«)  Traite  du  Coeur,  1.  4.  ch.  9.  n.  5.  ad  fin. 
(0)  1.  2.  ch.  9.  n.  10. 

( p )  1.  4.  cn.  9.  n,  4. 

(?)  *»•  5’ 


tendinous 


Letter  XXVII.  Article  19.  847 

tendinous  fibres,  were  themfelves  really  ofiified ;  or  if  any  of  the  parts  of 
the  heart  can  become  cartilaginous,  but  that  this  is  a  ftep  to  their  becoming 
bony  afterwards.  To  return,  however,  to  the  obfervation  of  Garengeot, 
although  the  bone  defcrib’d  by  him,  in  proportion  as  it  was  larger  than  thofe 
of  mine,  mull  fo  much  the  more  have  diminifh’d  the  force  of  the  heart,  as 
this  always  decreafes  in  proportion  to  the  decreafe  of  the  flelhy  fibres,  and 
have  been  fo  much  the  more  prejudicial  to  both  the  motions  of  the  heart, 
by  its  inflexible  hardnefs  ;  yet  I  read  that  it  was  found  in  a  man  who  had 
liv’d  to  the  age  of  leventy-two  •,  and  that  he  was  taken  off  by  a  fuddcn  ac¬ 
cident,  I  do  not  read;  nor  yet  that  any  one  of  thofe  perfons  was,  in  whofe 
hearts  either  calculi  or  bones,  as  I  have  already  laid,  were  obferv’d.  That 
one  perfon  alone,  by  name  Schomberg,  would  be  to  be  excepted,  who,  as 
you  will  fee  in  the  Sepulchretum  itfelf  (r),  Thuanus  relates,  “  was  inftanta- 
“  neoufly  kill’d  in  his  carriage,  his  breath  being  as  it  were  intercepted,”  if 
it  were  certain  that  the  caufe  of  his  death,  which  he  fubjoins,  ought  to  be 
underftood  as  it  is  underftood  in  the  Sepulchretum ;  I  mean,  “  that  the  pe* 
cc  ricardium,  and  the  left  region  of  the  heart,  were  become  bony.” 

But  if  the  words  of  Thuanus  are  well  confider’d,  46  the  membrane,  and 
“  all  the  flefhy  part  which  covers  the  left  region  of  the  heart,  and  which  for 
“  the  continual  ufe  of  refpiration  is  dilated  and  comprefs’d,  was  found  to 
“  be  univerfally  bony,  from  immoderate  heat,  and  a  too  liberal  diet,  fo  as 
<c  to  impede  the  power  of  refpiration  I  am  very  much  afraid,  that  moft 
perfons  will  think,  that,  together  with  the  left  part  of  the  pericardium,  the 
neighbouring  flefh  of  the  lungs,  as  was  at  that  time  the  cuftom  of  (peaking,, 
was  intended  to  be  underftood,  efpecially  in  a  man  who  “  had  already  la- 
“  bour’d  for  a  long  time  under  a  difficulty  of  breathing,  and  who  was  fup- 
<c  pos’d  to  have  been  fnatch’d  away  by  a  fudden  fuffocation.” 

19.  Nor  do  I  think  that  you  have  any  right  to  interrupt  me  here,  by  ob¬ 
jecting  to  this  two  of  the  obfervations  that  we  have  in  this  eleventh  feCtion 
of  the  Sepulchretum,  the  twenty-fixth  and  the  fifty-fixth.  Wherein  a  Hid¬ 
den  death  is  fuppos’d  to  have  happen’d  from  the  valvulae  femilunares,  or  mi¬ 
trales,  being  made  bony.  For  any  inluperable  obftacle,  of  whatever  kind 
it  may  be,  and  not  only  a  bony  one,  when  it  precludes  the  eg  refs  of  the 
blood  from  the  lefc  ventricle  of  the  heart,  or  the  ingrefs  into  it,  may,  with¬ 
out  doubt,  be  the  caufe  of  death,  nor  indeed  relates  to  the  prefent  difpute. 
For  here  our  enquiry  is,  in  regard  to  bones  being  found  in  the  heart  itfelf, 
and  not  in  the  fubftance  of  the  arteries  or  valves :  although,  by  our  ancef- 
tors,  thefe  were  alfo  call’d  bones  of  the  heart.  But  moft  perfons,  fince  the 
reftitution  of  anatomy,  have  rightly  judg’d  that  they  belong’d  to  the  root  of 
the  aorta  in  old  animals  ;  of  which  opinion  alfo  was  Riolanus  (j),  in  whofe 
commentary  you  will  fee  the  pafifages  of  Galen,  and  even  of  Ariftotle,  and 
of  others  pointed  out.  Nor  yet  did  Ariftotle,  who  is  quoted  by  Ingraffia(Z), 
acknowledge  them  to  be  found  in  all  large  animals ;  for  he  has  faid  that 
they  were  found  not  in  all  the  fpecies  of  the  ox  or  cow  kind,  but  in  “  a  cer- 
“  tain  fpecies and  that  he  “  having  difleCted  a  great  number  of  hearts  of 

(r)  1.  2.  S.  2.  Obf.  27. 

(4  Comm,  in  1.  Galeni  de  Oflib.  poll.  c.  32. 


6 


(/)  Comment,  in  1.  ejufd.  c.  24.  ad  text.  3. 

44  different 


848  Book  II.  Of  Difeafes  of  tlie  Thorax. 

“  different  animals  of  this  kind,  had  found  a  perfedt  bone  in  one  only,  not- 
“  withftanding  the  creatures  were  old,”  and  this  belonging  to  the  root  of 
the  aorta  But  in  the  other,  “  he  had  very  rarely  feen,  that  a  bony  carti- 
“  lage  could  be  faid  to  have  been  there,  and  much  lets  a  cartilaginous  bone.” 
And  it  fometimes  happens,  that  the  fame  things  are  obferv’d  in  men.  Thus 
Harvey  (u)  mentions,  that  in  a  very  noble  and  brave  man,  “  part  of  the 
great  artery,  near  the  heart,  was  turn’d  into  a  round  bone.”  But  more  fre¬ 
quently,  particularly  in  perfons  more  advanc’d  in  life,  has  a  bone  of  ano¬ 
ther  form  been  feen  there.  So  Bartholin  (x)  defcribes  “  a  triangular  bone,” 
in  Pope  Urban  the  eighth:  which  I  fuppos’d  to  refer  to  the  prelent  queftion, 
not  fo  much  becaufe  he  fays,  that  it  was  “  in  the  left  ventricle  of  the  heart,” 
as  becaufe  he  fubjoins  that  it  was  “  frequent  in  old  men  although  the  rea- 
fon  which  he  gives  for  this  appearance,  is  by  no  means  fatisfadtory  ;  1  mean, 
4‘  that  this  happen’d  from  the  very  great  providence  of  nature,  that  the 
tc  blood,  which  would  otherwife  be  torpid,  may  be  ftirr’d  up  to  motion  by  a 
“  ftimulus,  as  it  were,  being  added.”  Both-of  thefe  bones  have  been  taken 
notice  of  by  Raygerus  (y) ;  and  if  the  remainder  of  his  words,  that  are  made 
ufe  of  in  the  twenty- fixth  obfervation,  juft  now  cited,  ‘had  been  a  little  more 
accurately  copied  in  the  Sepulchretum,  we  (hould  have  read  not  that  this 
was  “  unufual  in  man,”  but  that  it  was  “  almoft  unulual,  or  at  lead  very 
“  rare.”  But  the  valves  of  the  aorta,  fince  the  time  in  which  he  wrote, 
have  not  been  fo  rarely  found  to  be  bony  •,  although  where  there  was  no 
other  diforder  Ibefides,  it  was  but  very  feldorn  that  a  fudden  death  could  be, 
with  juftice,  imputed  to  them.  For  unlels  they  do,  at  length,  preclude 
the  pafifage  of  the  blood,  as  1  faid  a  little  above,  they  do  not  bring  on  a 
death  ol  this  kind :  and  indeed  the  great  number  of  examples  of  bony 
valves,  many  of  which  I  have  already  taken  notice  of  to  you  (2),  were  rarely 
join’d  with  this  event ;  and  before  they  were  attended  therewith  in  the  few 
cafes,  other  diforders  had  not  been  wanting,  which  might  either  be  joint 
caufes  of  bringing  it  on,  or  might,  at  leaft,  lerve  to  foretel  it:  one  of  which, 
to  give  examples  here  from  the  Commercium  Litterarium,  you  fee  in  the 
obfervation  of  the  celebrated  Trew(<?);  whereas,  befide  the  valves  being 
quite  rigid  and  hard,  and  ct  barely  not  quite  (hutting  up”  the  orifice  of  the 
aorta,  “  the  whole  circumference  ”  of  the  fame  artery  was,  “  near  its  be- 
“  ginning,  hard  and  inflexible;”  and  another  in  the  obfervation  of  the  ce¬ 
lebrated  Kramerus  (l?),  who  obferves  that  an  afthma  had  preceded  a  fudden 
death  from  “  the  offification  ”  of  the  valves.  With  juftice,  therefore,  did 
Raygerus  doubt  in  his  cafe,  whether  thofe  bony  valves  “  had  been  the  caufes 
“  of  fo  fudden  a  death;  as”  it  did  not  feem  “  credible”  to  him,  “  that 
“  they  had  obftrudted  the  circulation  of  the  blood  nor  indeed  does  it  feem 
credible  to  me,  as  I  read  of  no  diforder  to  which  the  man  had  been  fubjedt 
before.  And  if  there  was  found  “  nothing  morbid  in  the  whole  body”  be- 
fides,  which  being  join’d  with  the  valves,  might  preclude  the  egrefs  of  the 
blood,  or  otherwife  obftrudt  its  motion,  I  will  not  fay  that  fufficient  enquiry 

(u)  De  Circul.  Sangu.  Exerc.  3.  (z)  Epift.  23.  n.  12.  13. 

(■*)  Cent.  2.  Hift.  Anat.  45.  (a)  Not.  1.  poll  Prsefat.  A.  1736. 

0)  Eph.  N.  C.  Dec.  1.  A.  3.  Obf.  282.  \b)  Hebd.  9.  n,  2. 

was 


Letter  XXVII.  Article  20.  849 

was  not  made  *,  I  will  readily  fay,  that  it  mu  ft  have  lain  hid  in  the  nerves  ; 
or  rather,  that  it  ought  to  be  acknowledg’d,  in  To  excited  a  motion  of  the 
blood,  to  which,  and  the  quantity  thereof,  being  both  very  greatly  increas’d 
at  the  fame  time,  the  valves  when  thus  affedted  could  not  fufficiently  cor- 
relpond  ;  if  this  really  be,  as  I  fufpedt,  and  as  you  will  be  better  able  to  judge 
by  comparing  them,  the  fame  hiftory  with  that  which  is  mention’d  by  the  ce¬ 
lebrated  Senac  (c)  from  Gayantius,  a  Pariftan  furgeon.  For  the  man  had  not 
only  taken  “  a  good  breakfaft,”  but  alfo  a  very  large  quantity  of  wine,  be¬ 
fore  he  died  fuddenly.  And  thus  you  fee  fo  much  the  more,  that  thefe  bony 
valves  do  not  relate  to  our  prefent  difpute,  not  only  becaule  the  fudden  death 
was  not  owing  to  them  alone  •,  but  becaufe  they,  as  is  before  faid,  belong 
to  the  clafs  of  bones  that  are  form’d  in  the  arteries,  and  not  of  thofe  that 
are  form’d  in  the  heart. 

20.  And  in  regard  to  the  bones  of  the  arteries,  which  have  been  fo  often 
taken  notice  of,  and  in  almoft  every  letter,  to  you,  it  now  follows  to  enquire 
whether  they  are  true  bones  or  not  as  I  have  promis’d  that  I  would  do,  not 
only  juft  now  (i),  but  in  other  places  alfo. 

And  firft  of  all,  it  is  clear  beyond  a  doubt,  that  many  concretions,  which, 
if  hardnefs  alone  were  confider’d,  might  be  taken  by  a  hafty  anatomift  for 
bones,  and  which  perhaps  have  been  fometimes  taken  for  them,  ought  ac¬ 
curately  to  be  diftinguifh’d  from  them,  and  to  be  call’d  ftony,  tophaceous, 
gypfeous,  and.  what  happens  more  frequently,  calculous,  as  the  various  na¬ 
ture  of  each  feems  to  approach  more  nearly  to  that  of  a  ftone,  a  toph,  gypfum, 
and  calculi,  which  are  more  frequently  form’d  in  the  kidnies  or  the  bladder 
of  urine.  And  as  I  have  acknowledg’d,  at  different  times,  that  this  does  take 
place  in  other  parts  of  the  body,  and  particularly  in  the  pineal  gland  ( e )  *  fo, 
alfo,  I  have  readily  acknowledg’d,  in  the  twenty-third  letter  (/),  that  it  takes 
place  in  the  arteries,  where  I  took  notice  of  the  obfervation  of  Greifelius,  as 
being  much  clearer  than  others,  of  part  of  an  artery  being  “  friable  into 
<c  fand.”  And  as  we  fpoke  there  particularly  of  the  valves,  I  now  add  the 
obfervation  of  the  celebrated  Chomel  (g) ;  who,  when  he  deferibes  ftony 
tubercles,  fo  fix’d  externally  and  internally  to  the  furface  of  the  pulmonary 
artery,  that  the  external  and  internal  were  contiguous  to  one  another  in  fome 
places,  afferts,  that  all  of  them  were  made  up  “  of  many  ftony  granules.” 
And  although  it  never  happen’d  to  me,  even  to  this  very  day,  among  fo  many 
hard  laminae  which  I  have  feen  in  the  arteries,  to  obferve  any  one  that  was 
friable  and  could  be  refolv’d  into  fand,  or  which  feem’d  to  be  made  up  of 
ftony  granules  ;  I  do  not,  however,  doubt,  but  that  which  has  not  happen’d 
to  me  may  have  happen’d  to  others  fometimes,  or,  if  you  pleafe,  fre¬ 
quently. 

Nor  do  I  doubt,  but  the  fame  perfons,  when  they  threw  their  lamellm  upon 
burning  coals,  perceiv’d  no  foetid  fmell  from  them,  l'uch  as  comes  from 
burning  b  >nes  *,  and  that  they  alfo  faw  no  blacknefs  in  them.  I  hope,  how¬ 
ever,  I  fhall  be  pardon’d  "by  thefe  celebrated  gentlemen,  if  1  think  differently 


(f)  Ch.  9.  n,  5.  cit.  fupra  ad  n.  18. 
(A  N.  17. 

(t)  Epift.  5.  n.  12. 


(f)  N.  9. 

(g)  Hift.  de  l’Acad.  R.  des  Sc.  A.  1707. 
Obf.  Anat.  3. 


VOL.  I.  5 


from 


850  Book  II.  OF  Difeaies  of  the  Thorax. 

from  them  in  regard  to  the  lamellae  that  I  have  met  with  *,  as,  having  made 
the  fame  experiment  more  than  once,  I  have  perceiv’d  this  fmell,  and  have 
feen  this  blacknefs ;  efpecially  as  I  found  thofe  which  were  at  that  time  pretty- 
thin,  and  very  flexible,  like  a  hoof  or  a  horn  ;  and  as  I  faw  that  the  thicker 
and  harder  ones,  while  I  attempted  to  bend  them  with  confiderable  force, 
were  broken  in  the  fame  manner  as  if  I  fhould  break  a  bony  plate,  and  heard 
them  make  the  fame  kind  of  noile  in  breaking  as  a  plate  of  bone  naturally 
makes  in  being  broken  j  and  that  there  was  not  one  from  which  any  dull  or 
powder  fell  at  the  time  of  breaking,  although  it  was  perfectly  dried.  Shall  I, 
therefore,  call  lamellse  of  this  kind  ftony,  tophaceous,  gypfeous,  calculous, 
or  bony  ?  Rather  fay,  you  will  perhaps  anlvver,  that  they  are  like  bones. 
Thus  Vernoius(^)  fuppos’d  of  a  fubftance  concreted  in  an  aneurifm  of  the 
aorta,  which  was  not  equally  friable  with  a  calculus,  but  more  flexible,  and 
which,  when  put  on  the  fire,  exhal’d  the  odour  proper  to^bones,  “  that  it 
“  was  more  inclin’d  to  the  fubftance  of  bone.”  So  the  celebrated  Haller  (/) 
has  faid,  that  there  were  fcales  in  another  aneurifm  of  the  fame  artery,  which 
were,  “  for  the  molt  part,  bony,  or  like  bone  ”  I  fhall  not,  however,  en¬ 
quire  whether  they  have,  by  laying  thefe  things,  faid  any  more  than  that  they 
had  a  fimilarity  to  bones  j  nor  will  I  fay,  that  the  firft  had  there,  however, 
been  fpeaking  of  a  fubftance,  which,  “  when  judg’d  of  by  the  touch,”  was 
“  like  a  calculus  and  the  other  of  thofe  very  fcales  which  the  celebrated 
Winklerus,  who  is  worthy  of  l'o  great  a  preceptor,  in  a  diflertation  dedicated 
to  him  (£),  had  call’d  “  ftony  fcales,”  inafmuch  as(/)  “  when  burnt  they  did 
<c  not  become  black,”  and  had  all  the  “  qualities  ”  of  a  true  ftony  body : 
I  will  not,  I  lay,  make  this  reply  j  but  this  one  thing  I  will  fay,  that  I  alfo 
conflder  no  more  than  the  limilitude  when  I  call  them  bony  ;  nor  when  I  fay 
that  they  were  really  bony,  or  true  bones,  not  only  in  the  arteries,  but  in  other 
parts  of -the  body,  do  I  mean  any  thing  more  than  to  prevent  you  from  being 
apt  to  fufpeft,  that  any  kind  of  hard  concretions  whatever  had  been  taken  by 
me  haftily  and  too  readily  for  bony  ones ;  but  to  make  you  underftand  for  a 
certainty,  that  thofe  which  I  call  bony,  when  attentively  confider’d,  have  really 
feem’d  to  be  fo  much  the  more  fimilar  to  bony  concretions,  in  proportion  as 
they  were  more  unlike  ftony,  tophaceous,  gypfeous,  and  calculous  con¬ 
cretions. 

Th  is,  therefore,  is  fufficient  for  me.  Nor  did  it  ever  come  into  my  mind, 
when  1  was  fpeaking  of  thefe  morbid  bones,  to  fuppofe  that  the  fame  elegant 
ftruflure  was  alfo  given  to  them,  that  was  given  to  the  natural  bones  ;  that 
they  had  the  fame  kind  of  periofteum,  fanguiferous  veflels,  and  medullary 
oil  :  although  I  wonder,  that  fome  of  thofe  who  contend  for  the  concretions 
in  which  thefe  circumftances  are  wanting,  not  being  call’d  bony,  but  earthy, 
jfhouid  reckon  the  cartilages  of  the  larynx,  in  which  I  have  frequently  leen, 
when  become  bony  through  old  age,  that  none  of  thefe  circumftances  were 
wanting  (m)  among  the  examples  of  ftony  concretions.  Why  they  do  this, 
I  am  not  fufficiently  inform’d,  as  they  have  readily  affirm’d,  on  the  other 

(£)  Comment.  Imp.  Acad.  Petropol.  Tom.  ( k )  De  Vafor.  Corp.  hum.  Lithiafi.  S.  1.  §  7. 

6.  Cl.  Phyf.  art.  4.  {1)  S.  2.  §  5. 

(/')  Opufc.  Pathol.  Obf.  18.  {m)  Vid.  ex  parte  Adverf.  I.  n.  23. 

hand. 


Letter  XXVII.  Article  21.  8  3*  r 

hand,  that  the  indurated  meninges  and  cartilages,  in  particular,  are  very 
nearly  akin  to  true  bones  :  and  that  others  except  no  cartilages  belides  thole 
which  were  already  become  bony  before  the  body  was  perfected.  Thefe  laft 
perfons  do  not  except  even  the  concretions  of  the  meninges;  and  even  ex- 
prefsly  pronounce,  that  thofe  which  are  generated  in  the  falciform  procefs  are 
earthy.  Yet  I  do  not  deny  that  fuch  may  have  been  found  by  thefe  very  ex¬ 
cellent  men  ;  and,  which  is  their  general  objection,  fuch  as  fhow  nothing  re¬ 
gular  in  them,  nor  fo  much  as  fibres,  even  if  you  ufe  the  microfcope.  Neither 
can  you  deny,  when  you  have  infpedted  that  larger  bone  formerly  found  by 
me  in  this  procefs,  without  making  ufe  of  a  microfcope;  or  have  read  over 
again  its  defcription  (;?),  that  it  is  of  the  fame  clafs  with  thofe  which  the  il~ 
luftrious  Haller (0)  has  lately  deferib’d  as  being  found  in  the  fame  place, 
“  terminating  in’ parallel  fibres,  after  the  manner  of  a  comb.”  I  omit  others 
who  are  already  quoted  in  another  letter  (p).  For  although  no  obfervations 
were  extant  of  fibres  being  obferv’d  in  morbid  concretions,  there  is  no  doubt, 
that  even  in  the  callus  by  which  broken  bones  are  conglutinated  together, 
after  it  is  quite  perfect,  no  fibres  are  to  be  met  with,  but  a  denfe  and  compabt 
fubftance :  and  fhall  we,  for  this  reafon,  contend  that  this  callus  is  not  of  the 
nature  of  bone  ? 

In  regard  to  the  two  arguments,  then,  that  are  thought  to  be  the  principal 
for  the  opinion  whereof  1  am  fpeaking  at  prefent,  the  firft,  which  was  taken 
from  the  ftrudure,  1  have  largely  enough  confider’d  :  particularly  in  thofe 
concretions  in  which  I  have  faid  it  is  fufficient  that  there  is  a  likenefs  to  the 
nature  of  bone;  and  in  which  it  happens  of  courfe,  that  the  foft  fibres  of  the 
parts  are  converted  into  that  fubftance,  or  incrufted  with  it,  and  finally  con- 
lum’d  ;  provided  that,  which  at  lead  cannot  be  denied,  be  granted,  I  mean, 
that  what  was  before  the  fituation  of  the  foft  fibres,  is  taken  up  by  this  con¬ 
cretion.  And  the  other  argument,  taken  from  this  confideration,  that  hard 
concretions  are  rarely,  if  ever,  found  in  any  other  bodies  but  in  thofe  of 
perfons  pretty  far  advanc’d  in  life,  whofe  blood,  without  doubt,  abounds  in 
earthy  matter,  can  by  no  means  attrabl  our  attention,  if  we  call  to  mind, 
that  Crellius  (<?),  who  was,  while  living,  a  very  learned  man,  has  brought 
examples  to  prove,  “  that  arteries,”  ot  which  our  principal  enquiry  is  here, 
«  have  been  chang’d  into  bones,  not  only  in  perfons  advanc’d  in  age,  but 
“  at  any  period  of  life  whatever  ;”  notwithftanding  he  follow’d  that  fame 
opinion,  but  explain’d  in  another  manner.  Which  explanation,  as  it  relates 
principally  to  the  arteries,  I  can  by  no  means  pals  over  at  prefent. 

21.  The  explication  therefore,  or,  if  you  pleafe,  the  peculiar  opinion  of 
Crellius  is(r),  that  thofe  concretions  in  the  arteries  which  are  call’d  bony, 
are,  in  fad,  not  bones,  but  tophaceous  concretions  from  pus  ;  the  thinner 
part  of  which  being  diffipated,  the  thicker  part  that  remains  becomes  indu¬ 
rated.  For  as  the  fmaller  vcflels,  that  creep  within  the  fubftar.ee  of  the  ar¬ 
teries,  are  obllruded  with  fiuggifh  juices,  and  a  kind  of  vifeid  lentor  (of 
which  there  is  great  plenty  in  old  perfons,  or  even  in  intemperate  young 

(»)  Epift.  3.  n.  20.  (y)  Obf.  de  arteria  cordis  Coronar.  inftar 

(0)  Opufcul.  Pathol.  Obf.  49.  offis  indurata  §  2. 

(/)  Epilt.  25.  n.  9.  (r)  Ibid.  §  8,  &  9. 

5  0^2 


perfons) 


8  £  2  Book  II.  Of  Difeafes  of  the  Thorax. 

perfons)  it  eafily  happens ;  that  inflammation  is  the  confequence  of  ob- 
ftrudtion,  and  fuppuration  the  confequence  of  inflammation  :  and  that  the 
pus  is  pour’d  out  into  the  cellular  membrane,  by  which  the  fiefhy  coat  of 
the  artery  is  feparated  from  the  internal ;  and  that  through  thefe  cells,  as  they 
communicate  one  with  another,  fometimes  a  larger,  and  fometimes  a  fmaller 
quantity  of  thefe  vifcid  juices,  in  proportion  to  the  quantity  of  them  that  is 
contain’d  in  the  body,  flow  down,  and  ftagnating  there  form  a  concretion. 
And  from  this  caufe  it  is,  that  thefe  fcales  are  found  betwixt  thofe  two  coats, 
unlefs  fome  very  confiderable  fuppuration,  or  one  that  continues  for  a  long 
time,  finally  corrupt  and  deftroy  thefe  coats.  Nor  does'  he  think  that  the 
«fmell  which  is  difcharg’d  by  thefe  fcales  when  thrown  into  the  fire,  is  any 
objection  to  his  hypothefis  •,  for  he  acknowledges,  and  does  not  deny  it,  as 
others,  of  whom  I  have  fpoken  above  (j),  do;  and  asVernoius  alfo(/)  does, 
and  Kulm  (#),  who  obferv’d  the  fame  thing  that  was  obferv’d  by  me.  But 
although  thefe,  and  before  them  others,  amongfi:  whom  are  Schrockius  (x) 
and  Scheidius  ( jy ),  have  made  ufe  of  that  experiment  as  a  mark  to  diftinguifh 
bony  from  calculous  concretions  ;  he  denies  their  arguments  to  be  conclufive, 
and  fays  that  it  does  not  at  all  repugnate  to  his  opinion  (z),  becaufe  pus  alfo, 
from  whatfoever  part  of  the  body  it  may  be  taken,  if  it -be  thrown  upon  the 
burning  coals,  diffufes  a  fmell  and  a  foetid  fmoke,  perfectly  like  thofe  which 
bones  diffufe  when  burnt.  And  when  I  read  thefe  and  other  things,  which 
he  alfo  objetfls  againft  the  opinion  both  of  Boerhaave  and  of  others,  and 
which  I  have  already  pointed  out  to  you,  in  great  meafure,  in  the  eighteenth 
letter  (a),  not  without  my  anfwer  to  each,  fuch  as  it  is  ;  I  cannot  help  calling 
to  mind  my  obfervations,  the  greater  part  of  which  are  written  to  you,  and 
allowing  the  confent  that  there  is,  for  the  molt  part,  in  each,  betwixt  what  I 
had  feen  and  what  he  had  laid  down.  For  that  the  bony  lamellae  frequently 
either  begin  to  be  form’d  even  at  a  greater  diftance  from  the’heart,  or  become 
more  frequent  and  larger  in  their  fize  ;  and  that  they  do  not  inhere  in  the  in¬ 
ternal  coat  of  the  artery,  but  are  cover’d  by  it ;  and,  particularly,  that  con¬ 
fiderable  marks  of  erofion  and  ulceration  are  join’d  with  thefe  lamellae  ;  and 
othei^things  of  this  kind,  you  have  read  in  fo  many  of  our  obfervations,  that 
it  would  be  tedious  and  fuperfluous  to  mark  them  out  to  you  feparately  here. 
It  feems  to  me  to  be  more  ufeful  to  communicate  ingenuoufly  to  you  thofe 
things  which  I  remark’d  in  confequence  of  an  accurate  examination,  while  I 
took  fome  of  thofe  obfervations,  and  which  I  now  fuppofe  to  relate  in  a  pe¬ 
culiar  manner  to  this  difpute. 

22.  And  to  begin  with  that  old  man  of  whom  I  remember  particularly  to 
have  promis’d  you  this  relation  ' b) ;  the  inner  coat  not  only  cover’d  that  great 
number  of  even  very  large  laminae,  but  alfo  adher’d  very  clofely  to  all  the 
hollow  fides,  or  internal  furfaces,  of  them,  in  a  found  and  uninjur’d  ftate,  ex¬ 
cept  that  at  one  of  them  only  there  was  an  aperture  :  in  which  aperture  there 
was  a  matter,  or  rather  a  thickilh  humour,  of  a  white  and  yellow  colour. 

(j)  N.  20.  (r)  Citatus  eod.  n.  '  (y)  De  duob.  Offic.  in  cerebr.  &c.  qu.  2* 

{u)  Dil'put.  de  Ten.  Achill.  &c.  c.  r.  (z)  §  9. 

(*)  Eph.N.  C.  Dec.  2.  A.  3..  Obf.  19.  in  (a)  N.  32. 

Schol.  Epift.  24.  n.  16. 


But 


Letter  XXVII.  Article  23.  83*3 

But  on  the  convex  furface  of  this  laft  lamina,  and  of  mod  of  the  others,  it 
was  very  ealy  to  feparate  the  annular  fibres  of  the  flefhy  coat,  and  that  with¬ 
out  injuring  them.  Yet  there  were  fome  laminae,  to  which,  on  the  fame  con¬ 
vex  furface,  a  matter  of  the  fame  kind  that  I  juft  now  defcrib’d,  that  is,  a 
white  and  yellow  matter,  adher’d :  but  there  fcarcely  any  flefhy  fibres,  and, 
indeed,  no  flefhy  fibres  at  all,  remain’d,  as  they  were  deftroy’d  quite  to  the 
outer  coat,  which  was  found.  I  would  have  you  here  call  to  mind  another 
old  man  of  whom  I  wrote  in  the  feventh  letter  (c).  The  aorta  of  this  man, 
that  externally  fhow’d  its  proper  fanguiferous  vefiels  to  be  much  diftended, 
which  is  to  be  confider’d  as  a  mark  of  permanent  inflammation,  was  not  only 
befet  internally  with  bony  fcales,  but  in  fome  places  fo  ulcerated,  that  not 
only  the  internal  coat,  but  alfo  the  neighbouring  flefhy  one,  feem’d  to  have 
been  converted  into  a  red  and  putrid  fubftance,  that  came  away  piece-meal. 
And  in  a  certain  old  woman,  whom  I  fhall  defcribe  hereafter  (d),  the  aorta 
being,  in  its  whole  tract  through  the  belly,  in  feveral  places,  and  many  of 
its  branches,  mark’d  with  yellow  bony  lamellte  under  the  internal  coat,  was 
alfo  here  and  there  internally  befet  with  a  brown,  thickifh,  and  bloody  hu¬ 
mour,  which  adher’d  to  it  up  and  down,  as  if  it  had  diftill’d  from  the  ulce¬ 
rated  places.  I  omit  other  obfervations  of  the  fame  kind,  and  the  marks  of 
erofion  and  exulceration,  as  it  were,  fo  often  remark’d  in  the  arteries,  toge¬ 
ther  with  the  bony  fcales,  that  is,  of  an  ulceration  fui  generis.  For  what  has 
been  already  advanc’d  feems  to  be  fufticient  to  conciliate  our  aflent  to  the 
new  opinion  ;  inafmuch  as  inflammation,  erofion,  and  a  purulent  humour, 
froip  which  the  bony  lamellae  are  form’d,  have  been  found  in  conjunction. 
And  by  one  obfervation  it  appears,  if  this  be  the  ftate  of  the  cafe,  that  they 
may  fometimes  reach  to  the  internal  parts,  and  at  the  fame  time  may  be  fo  con¬ 
tinu’d  as  to  extend  themfelves  to  the  external  parts  •,  as  we  read  in  an  obferva¬ 
tion  of  Chomel  (e),  that  thofe  ftony  concretions  were  in  other  places,  that  is  to 
fay,  the  coats  on  each  fide  being  at  length  deftroy’d  by  erofion  :  by  which 
method  of  reafoning,  they  who  were  followers  of  this  opinion,  perhaps, 
might  conjecture  that  the  obfervation  of  Scultetus  is  to  be  explain’d  (/)  ;  in 
which  the  trunk  of  the  aorta  is  defcrib’d  as  being  “  univerfally  bony  to  the 
*s  length  of  the  little  finger and  other  obfervations  fimilar  to  this;  and 
that,  alfo,  which,  being  taken  from  Harvey,  I  remember  to  have  objected  to 
this  opinion  (g) :  but  this  laft  with  more  difficulty,  by  reafon  of  there  being  a 
much  longer  tradt  of  artery,  without  the  leaft  remains  of  coats  whatever. 

23.  But  thefe  three  circumftances,  which  I  fpoke  of  laft,  could  by  no 
means  have  come  to  pafs,  without  a  profufion  of  blood  from  the  eroded  ar¬ 
tery.  And  notwithftanding  the  others  feem  to  go  a  great  way  in  confirming 
and  defending  the  new  opinion,  is  it  for  this  reafon  plain,  that  thofe  concre¬ 
tions,  which  are  fuppos’d  to  have  arifen  after  inflammation  and  fuppuration, 
are  always  tophaceous,  and  not  bony  ?  To  me,  at  leaft,  even  in  all  thofe 
bodies  that  I  fpoke  of  juft  now,  they  did  not  feem  to  be  tophaceous  but 
bony ;  and  thole  which  I  broke  afunder  were  broken  in  the  fame  manner 

( c )  N.  9.  (f)  Trichiaf.  admir. 

\d)  Epift.  10.  n.  24.  (g )  Epift.  18.  n.  33. 

(<?)  Vid.  fupra.  n.  20. 

as 


{ 


854  Book  II.  Of  Difeafcs  of  the  Thorax. 

as  plates  of  bone  are,  and  made  the  fame  kind  of  noife  in  breaking.  And 
it  is  one  thing,  that  thefe  fcales  are  form’d  after  inflammations  and  fuppura- 
tions  •,  and  another  thing,  that  they,  and  other  formations  of  this  kind,  are 
not  bony.  That  the  former  may  happen  frequently,  I  can  very  well  allow  j 
the  latter  I  cannot  grant,  but  at  fome  times.  And  indeed  what  can  be  the 
reafon  that  our  anceftors  ( h )  lb  very  conftantly  call’d  the  bafis  of  the  aorta, 
when  indurated  in  old  flags,  a  bone  ?  or  for  what  reafon  has  Ingraffias  (/) 
faid,  that  he  had  found  the  fame  part,  in  an  ox,  converted  into  “  the  molt 
“  perfedt  bone  ?”  Did  not  Ariftotle,  Galen,  and  other  very  experienc’d 
anatomifts  (not  to  mention  the  apothecaries  themfelves,  who  have  been  us’d, 
for  fo  many  ages,  to  reduce  this  bone  into  powder)  now  and  then,  know 
how  to  diftinguifh  a  tophaceous  concretion  from  a  bony  one  ?  Or  how  does 
it  happen,  that  when  thefe  lamellte  are  found  in  the  aorta,  other  parts  are, 
at  the  fame  time,  found  to  be  chang’d  into  true  bone  alfo,  in  the  lame  bo¬ 
dies  ?  Thus  Vieuffens  (&),  in  the  lame  matron  in  whom  he  enumerates  fo 
great  a  number  of  arteries,  which  were  in  part  oflifled,  relates,  that  in  the 
fame  body  even  the  annular  cartilages  of  the  bronchia  were  converted  into 
bone.  And  the  fame  thing  you  will  find,  by  reading  over  again  my  letters  (/), 
was  feen  by  me  in  two  bodies,  in  which  the  aorta  contain’d  bony  lamellae. 
And  in  this  very  letter  (m)  is  defcrib’d  a  woman,  who  Ihow’d  that  diforder 
in  the  arteries,  and  at  the  fame  time  a  bone  in  the  fubftance  of  the  heart, 
and  additamenta  of  new  bone,  on  the  internal  furface  of  the  cranium.  I 
purpofely  omit  other  obfervations  of  mine  relative  hereto,  and  amonglt  them 
fome  that  were  formerly  made  in  the  beginning  of  the  prefent  century,  when 
]  faw,  in  the  fame  bodies,  fmall  bony  fcales,  both  in  the  arteries  and  in  the  pe¬ 
ricardium.  I  therefore  afk  of  you,  whether  it  be  very  probable,  that  thefe 
concretions,  which  all  who  handled  them  and  faw  them  in  the  various  parts 
of  the  body  pronounc’d  to  be  of  the  fame  kind,  were  in  other  parts  indeed 
bony,  but  in  the  arteries  only  tophaceous  ?  Is  it  not  more  probable,  that 
they  were  equally  bony  in  every  part  ?  It  will  certainly  be  more  natural  for 
you  to  imagine,  that  in  thofe  bodies,  in  which  the  blood  abounds  with  cer¬ 
tain  laline,  earthy,  and  other  particles,  of  which  moft  authors  think  that 
bones  are  made  up  •,  I  fay,  it  will  be  more  natural  to  imagine,  that  in  thofe 
bodies,  the  fame  kind  of  particles  ftagnating  in  thefe  places,  which  either 
naturally,  or  by  the  force  of  difeafe,  are  more  difpos’d  to  retain  them,  do  at 
length  give  origin  to  concretions  of  the  fame  kind,  in  all  thefe  places,  than 
to  luppofe  that  they  are  of  a  different  kind  in  the  arteries  from  what  they  are 
in  all  the  other  parts  of  the  body. 

24.  You  fee  then,  that  the  new  opinion  is  fo  far  receiv’d  by  me,  provided 
the  fcales  that  are  form’d  in  the  arteries  are  not  confider’d,  or  in  general  at 
leaf!:,  as  tophaceous.  Befides,  I  do  not  doubt  but  their  formation  may  fome- 
times  happen,  even  without  previous  inflammation,  or  at  leaft  without  pre¬ 
vious  luppuration.  Turn,  I  beg  of  you,  to  the  eighteenth  letter  (»)  :  you 
will  find  that  the  great  artery,  from  the  heart  quite  to  the  firfb  orifice  of  the 

(0  VII.  n.  11.  &  XXIV.  n.  16. 

{mf  n.  2. 

(h)  n.  2. 

branches 


( h )  Vid.  fupra,  n.  19. 

(/)  Ibid. 

(<4)  Traite  du  Coeur.  ch.  16. 


8 


Letter  XXVII.  Article  24.  855 

branches  that  go  to  the  upper  parts,  was  of  fo  great  a  hardnefs  in  its  parie¬ 
tes,  that  it  could  fcarcely  be  cut  into,  even  with  the  application  of  the 
greateft  force,  by  reafon  of  its  fubflance,  which,  as  it  appear’d  in  fedtions  of 
the  artery,  had  already  obtain’d  a  hardnefs  of  a  middle  nature,  betwixt  that 
of  a  ligament  and  a  cartilage.  How  much  then  was  wanting,  if  the  man 
had  liv’d,  of  this  fubftance  becoming  at  length  bony  ?  Shall  we  then  believe, 
that  the  whole  of  this  very  large  tradt  of  artery  could  have  labour’d  under 
an  inflammation  and  fuppuration  that  occupied  its  whole  fubftance,  and  nei¬ 
ther  death  have  been  the  confequence,  nor  even  any  figns  of  the  moft  acute 
difeafe  have  been  oblerv’d  at  the  very  time  ?  And  a  difeale  of  that  kind 
had  certainly  not  preceded.  But  what  if  we  fuppofe,  that  in  the  many  bo¬ 
dies  in  which  I  have  found  eroflons  and  ulcerations  of  the  artery,  thefe  ap¬ 
pearances  have  not  always,  and  perhaps  not  often,  preceded  the  production 
of  thele  bony  fcales  ;  but  have  rather  been  the  confequence  of  them  ?  Or 
(hall  we  imagine,  that  thefe  very  fcales  have  been  form’d  out  of  the  purulent 
matter,  which  I  law  diftilling  at  that  time  from  the  eroded  places  ?  Nay, 
rather,  thefe  very  fcales,  by  their  edges,  which  are  rough,  and  often  more  or 
lefs  prominent,  have  been  the  caufe  of  thofe  eroflons  and  ulcerations,  by 
breaking  through  the  internal  coat.  For  the  artery  cannot  contract  itfelf 
without  forcing  the  afperities,  and,  as  it  were,  the  (harp  needle-like  points 
of  the  little  bones,  againft  that  coat :  nor  can  the  blood  that  is  driven  thi¬ 
ther  by  the  heart  diftend  the  arteries,  without  prefling  the  fame  coat  againft: 
thefe  (harp  points. 

See  how  Bellini  ( 0 )  exprefsly  accounts  for  the  inflammation  and  erofion 
of  that  coat,  from  thefe  little  bones,  which,  as  I  have  elfewhere  (y>)  faid, 
he  call’d  (tones.  His  words  are,  “  I  have  feen  (tones  in  the  internal  coat  of 
the  arteries,  which  had  in  feveral  places  deftroy’d  it,  and  in  a  manner  in- 
“  flam’d  it,  and  were  fix’d  to  the  inflam’d  places,  like  a  cruft  :  from  whence 
“  a  very  acute  pain  arofe,  and  a  contraction  of  the  arteries.”  So  alfo  Abra¬ 
ham  Vateri'^),  who  fuppos’d  that  the  little  bones  had  been  broken  into 
fmaller  pieces,  by  the  motion  of  the  artery,  fays,  “  the  extremities  of  thefe 
“  bones  had  perforated  the  internal  coat.”  And  although  Brunnerus  (r), 
while  in  describing  the  aorta  of  his  father-in-law,  as  diftinguifh’d  with  many 
bones,  he  tells  us,  **  that  the  internal  coat”  of  the  fame  artery  was,  in  fe¬ 
veral  places,  “  ruptur’d,  lacerated,  and  rotten,  like  fruit,  not  without  fear 
“  of  rupture  doubts  “  whether  this  had  happen’d  by  violence  and  evul- 
“  flon,  or  from  erofion  yet  whoever  obierves,  that. this  artery  “  had  hurt 
“  the  fingers  when  thruft  into  it,  by  the  roughnefs  of  the  bones,  and  had 
“  prick’d  them  by  a  kind  of  acute  prominence,”  will  eafily  conceive  that 
this  had  not  happen’d  from  erofion  only. 

And  as- to  his  faying,  that  it  was  not  without  danger  of  rupture;  without 
doubt  it  really  happen’d  fo  in  the  old  man,  and  the  woman,  of  whom  I 
wrote  in  the  preceding  letter  ( s )  For  I  faw  that  in  both  of  thele  perfons, 
and  particularly  in  the  woman,  the  blood  had  made  a  way  for  itfelf,  by  rup- 

(0)  De  Morb.  Pe£t.  ubi  de  Intermiff.  Pulf.  (r)  in  App.  ad  A.  3.  Dec.  3.  Eph.  N.  C. 
(/>)  Epift.  24.  n.  17.  (i)  XXVI.  n.  15.  &  17. 

(y)  Olleogtn.  th.  20. 

ture. 


8 $6  Book  II.  Of  Difeafes  of  the  Thorax. 

ture,  out  of  the  dilated  aorta,  where  the  internal  coats  were  eroded,  among 
the  thick-ftrown  and  rough  bony  hmellae :  fo  far  has  Parey  (/)  err’d  from  the 
truth,  that  what  he  imagin’d  to  be  oppos’d  “  by  the  providence  of  nature,” 
as  an  obftacle  and  bulwark,  as  it  were,  of  bony  cruft,  to  retard  the  impetus 
of  the  blood  in  the  dilated  artery,  does  itfelf,  by  perforating  the  coats  of  the 
artery,  as  certainly  happen’d  alfo  in  his  obfervation,  prepare  a  more  fpeedy 
exit  for  the  blood.  And  if  the  erofion  of  the  coats,  among  thefe  bony  con¬ 
cretions,  be  very  inconfiderable,  fo  as  rather  to  weaken  than  make  an  aper¬ 
ture  in  them,  and  the  blood  be  thrown  in  with  pretty  great  force,  the  fide 
of  the  artery  may  be  there  fometimes  relax’d,  and  fwell  out  into  an  aneu- 
rifm  of  the  form  of  a  facculus,  to  the  parietes  of  which  thefe  bones  may  be 
internally  fix’d.  And  this  being  granted,  it  will  be  perhaps  lefs  difficult  than 
was  fuppos’d  (&),  to  find  out  a  way  and  manner,  by  which  a  piece  of  bone, 
that  was  wanting  in  the  fternum,  might  feem  to  be  contain’d  within  an  aneu- 
rifm  of  this  kind,  by  the  force  of  which  the  clavicle  had  been  drawn  afunder. 
For  you  will  ealily  guefs,  that  this  little  part  of  the  fternum  had  been  really 
and  gradually  confum’d  by  the  neighbouring  aneurifm,  as  generally  happens ; 
and  that  the  piece  of  bone  which  was  within  the  aneurifm,  had  accidentally 
taken  fuch  a  figure  and  fize  as  in  fome  meafure  to  refemble  that  which  was 
deficient  in  the  fternum.  And  a  conjedture  of  this  kind  agrees  alfo,  perhaps, 
with  that  piece  of  rib  which  we  read  was  found  by  Lentilius  (#)  within  ano¬ 
ther  aneurifm. 

25.  But  do  not,  however,  imagine,  that  I  account  for  all  thefe  erofions  of 
the  arteries,  whether  they  are  (lighter  or  more  confiderable,  from  the  rough- 
nefs  of  thofe  little  bones.  For  as  this  roughnefs  is  fometimes  fo  great  that 
it  is  (ufficient  to  look  upon  the  internal  furface  of  the  artery,  or  to  touch  it, 
in  order  to  perceive,  beyond  a  doubt,  that  the  artery  had  been  wounded,  or 
lacerated  therefrom  :  fo  at  other  times  there  is  no  roughnefs,  or  inequality,  of 
the  bones  j  and  an  erofion  ,neverthelefs  appears.  And,  indeed,  fometimes 
there  is  as  yet  no  bony  appearance,  when  the  artery  is  already  eroded.  So  in 
a  mariner,  whom  I  (hall  defcribe  to  you  on  a  future  occafion  (y),  there  was 
no  bony  lcale  in  the  great  artery  ;  only  whitifh  fports  occurr’d  :  but  an  ero¬ 
fion,  if  you  examin’d  it  a  little  more  attentively,  was  already  begun.  So, 
not  to  recede  from  thofe  which  you  have  defcrib’d  to  you -in  the  letters  al¬ 
ready  lent,  read  over  again  the  twenty-third,  and  you  will  find  the  fame  thing 
obierv’d  by  me  in  a  man  (2)  •,  but  particularly  in  the  twenty-fixth  you  will 
fee,  that  a  Venetian  woman  (a),  who  had  no  bony  appearance  in  the  aorta, 
had,  neverthelefs,  fo  confiderable  an  ulceration  of  this  veffel,  above  the  femi- 
lunar  valves,  that  the  blood  had  there  made  itfelf  a  pafiage  whereby  it  was 
difcharg’d  into  the  pericardium.  Nor  has  it  happen’d  to  me  alone  to  light 
on  iuch  appearances,  but  to  others  alfo.  Turn,  for  inftance,  to  the  example 
given  by  Littre  (£),  who  found  an  ulcer  in  the  fame  part  of  the  aorta. ;  which 
1  fuppofe  was  the  reafon,  why  one  of  thofe  valves  that  lay  beneath  this  ulcer 

(/)  Oper.  1.  6.  c.  32.  (y )  Epift.  42.  n.  34. 

(a)  Hift.  de  l’Acad.  R.  des  Sc.  A.  1700.  (2)  N.  11.  (a)  N.  21. 

Gbf.  Anat.  6.  (£)  Hift.  de  l’Acad.  R.  des  Sc.  A.  1713.' 

(a-)  Eph.  N.  C.  Cent.  1.  Obf  96.  n.  14.  Obf.  Anat.  3. 


had 


✓ 


Letter  XXVII.  Article  26.  857 

had  been  glued  down,  as  it  were,  to  the  fide  of  the  artery.  Yet  he  does  not 
mention  a  fingle  word  of  any  bony  fcale  being  found  in  that  artery,  or  in  the 
valves  ;  fo  that  I  do  not  know  by  what  accident  it  has  happen’d,  that  fome 
perfons,  among  the  many  inftances  of  bony  valves,  have  put  in  the  firft  place 
this  very  obfervation  of  Littre. 

Wherefore,  although  erofions  are  moft  frequently  met  with  in  the  arteries 
when  they  are  befet  internally  with  bony  fcales  ;  yet  even  then  the  erofions 
are  not  all  to  be  imputed  to  thefe  fcales,  efpecially  when  they  are  fmooth,  and 
not  furnifh’d  with  fharp  points  and  prominencies;  but  many  of  them  to  the 
fame  eroding  particles  of  humours,  the  effects  of  which,  it  is  demonftrated, 
are  frequently  feen  even  before  any  little  bones  are  form’d  ;  and  the  manifold 
nature  and  origin  of  which  in  the  coats  of  the  arteries  are  already  hinted  at 
by  me,  in  conjunction  with  Lancifi,  in  a  former  letter  (c).  Befides,  if  it  ac¬ 
cidentally  happen,  that  a  great  quantity  of  blood  act  with  violence  upon 
any  arterial  trunk,  being  afiifted  by  a  peculiar  fituation  of  the  body,  or  the 
part,  there  is  no  doubt,  but  while  the  other  coats  are  as  yet  found,  the  in¬ 
ternal  one  is  form’d  into  chinks  ;  which  is  confirm’d  by  the  experiment  of 
the  illuftrious  Senac  (d)  made  upon  the  carotid  artery.  And  from  thefe 
chinks  it  is  not  only  eafy  to  deduce  the  origin  of  fome  of  thole  furrows,  that 
I  have  fo  often  taken  notice  of,  on  the  internal  furface  of  the  artery,  but  alfo 
the  origin  of  fome  ulcerations  which  have  been  obferv’d. 

26.  And  if,  then,  there  are  fometimes  erofions  in  the  arteries,  as  I  have 
faid,  before  any  bony  fcales  are  form’d,  certainly  fome  of  thefe  fcales  may 
have  been  form’d  out  of  that  purulent  matter  which,  before  the  internal  coat 
is  eroded,  ftagnates  betwixt  this  and  the  next  coat,  as  is  fuppos’d  by  the  cele¬ 
brated  author  of  the  new  opinion  (e).  Nor  are  fome  of  the  obfervations  of 
Leprotti,  or  of  mine,  in  regard  to  the  feat  or  nature  of  the  lpots,  which  are 
the  beginnings  of  thefe  little  bones,  haftily  to  be  objected  to  this  opinion. 
For  as  to  Leprotti  defcribing  lpots  (/)  which  “  not  only  made  the  internal 
“  furface  of  the  aorta  rough,  but  were  plainly  feen  through  it  on  the  external 
“  furface,  and  when  the  internal  coat  of  the  artery  itfelf  was  disjoin’d  from 
“  the  others  were  eafily  crumbl’d  away  without  doubt,  either  thefe  words 
are  fo  underflood,  as  that  this  coat  cover’d  over  the  matter  of  the  fpots, 
which  were  therefore  feen  through  it,  and  that  this  coat  being  taken  away, 
they  could  then  be  rubb’d  off ;  or,  perhaps,  they  are  even  to  be  underftood, 
as  if  that  matter  was  inherent  in  this  coat,  and  follow’d  it  when  remov’d. 
The  former  of  which  explications  lurprizingly  well  agrees  with  the  new 
opinion  :  and  the  latter  may  be  fo  manag’d  as  to  agree  therewith  ;  that  is, 
by  fuppofing  the  cellular  membrane,  in  which  this  matter  is,  eafily  to  follow 
the  internal  coat  to  which  it  adheres.  And,  certainly,  bony  fcales  are  wont 
to  be  found  cover’d  over  with  this  coat,  not  only  according  to  my  infpedlions, 
but  according  to  the  inflections  of  others  alfo ;  and  not  only  in  the  arteries, 
as  Vaterus  has  obferv’d  (g),  but  in  the  veins  alfo,  as  Furftius  remark’d  {h) : 

(c)  Epift.  1  B.  n.  27.  (f)  Comment,  de  Bonon.  Sc.  Acad.  Tom. 

(a)  Traite  cu  Coeur  I.  i.  ch.  9.  n.  3.  1.  in  Opul'c. 

\e)  Vid.  fupra,  n.  21.  (g)  Loc.  cit.  fupra,  ad  n  24. 

\b)  Eph.  N.  C.  Dec.  2.  A.  10.  Obf.  175. 

5  R  for 


VoL.  I. 


8  5  8  Book  II.  Of  Difeafes  of  the  Thorax. 

for  the  latter  of  thefe  gentlemen  law,  that  in  the  coronary  veins  of  the  heart, 
which  were  become  bony,  “  the  bone  was  inverted  on  both  fides  with  a  thin 
“  little  membrane  and  to  the  former  it  appeared  “  evidently,  that  not  the 
“  internal  coat  of  the  offified  artery  was  indurated,  but  the  middle  coat” 
only. 

Nor  much  different  from  this  obfervation  of  Vaterus  are  thofe  of  mine, 
taken  from  two  women,  the  difeale  and  difledion  of  one  of  whom  I  de- 
fcrib’d  to  you  in  the  latter  end  of  the  nineteenth  letter  (i)  ;  and  thofe  of  the 
other,  I  (hall,  perhaps,  defcribe  in  a  future  one.  Having,  in  the  firft,  chofen 
out  from  that  winding  aorta  a  bony  fcale,  and  examin’d  its  fituation  ;  l'ome 
fibres  feem’d  to  be  interpos’d  betwixt  that  and  the  internal  coat,  very  much 
like  annular  fibres  in  their  courfe,  but  from  a  yellowifh  colour  becoming 
white  and  foft;  moreover,  like  that  matter  which  is  wont  to  adhere  to  bony 
lamellae  of  this  kind.  And  in  the  other  woman,  having  open’d  the  great 
artery  from  the  heart  quite  to  the  feptum  tranfverfum,  and  having  obferv’d 
it  to  be  here  and  there  mark’d  with  whitifh  fpots,  of  a  greater  or  lerter  fize, 
luch  as  we  generally  take  for  the  beginnings  of  bony  feales,  I  cut  into  many 
of  the  larger  fpots,  and  found  that  they  were  all  made  up  of  a  fubftance 
which  was  not  at  all  moift  in  itfelf  or  about  the  edges,  the  lame  being  more 
white  and  more  compadt  than  that  was  of  which  the  healthy  parietes  of  the 
artery  confifted.  And  it  had  fuch  a  fituation,  that  beginning  from  the  in¬ 
ternal  lamina  of  the  artery,  which  it  rais’d  up  a  little  inwardly,  it  extended 
itfelf  from  thence  towards  the  convex  furface  of  the  artery,  to  which  it  cer¬ 
tainly  was  not  contiguous,  though  at  no  great  diftance  therefrom.  But  al¬ 
though  you  perceive  from  thefe  observations,  that  the  matter  from  whence 
the  bony  lamellae  are  form’d,  does  not  always  ft  agnate  in  the  cellular  contexture 
of  the  arteries,  but  alfo  occupies  a  part  of  the  flefby  coat  that  lies  around  it; 
it  is,  neverthelels,  by  no  means  a  confequence  from  thence,  that  it  does  not 
much  more  frequently  confine  itfelf  within  the  bounds  of  that  contexture. 
But  let  us  go  on  from  the  fituation  of  thefe  fpots  to  their  nature. 

27.  I  faid  juft  now,  that  the  fubftance  of  which  the  fpots  confift  is  more 
compafl  and  more  white  than  the  healthy  fubftance  of  the  artery  is,  and  with¬ 
out  moifture  befides  :  and  by  reading  over  again  my  letters,  you  may  alfo 
find,  that  the  marks  of  future  ofiification  in  the  arteries,  that  is  to  fay,  the 
fpots  in  the  arteries,  often  approach  to  the  nature  of  ligaments  in  their  fub¬ 
ftance  (&)  ;  and  that  in  a  certain  man  (/),  they  had  appear’d  to  be  of  a  ten¬ 
dinous  hardnefs,  as  it  were.  And  thefe  appearances  feem  lefs  to  agree  with 
the  idea  of  purulent  matter,  of  which  thefe  offifications  are  made,  than  with 
that  theory  of  Bocrhaave  ( m )  which  fuppofes  a  compreftion  of  the  fmall  veftels 
that  efcape  the  lenfes,  by  which  their  cavities  are  obliterated,  and  many  of 
them  condens’d  into  one  more  folid,  hard,  and  firm  body.  Which,  although 
it  may  leem  very  probable,  and  even  true  in  many  cafes;  lor  in  many  cales 
I  have  found  the  fmall  beginnings  of  thefe  fpots  to  be  quite  without  mo. (hire  ; 
and  not  only  fpots,  but  at  the  lame  time  fome  of  them,  which  were  equally 
without  moifture,  already  ofiifying,  and  others  I  obferv’d  in  part  become 

(!)  Epift.  18.  n.  25.  in  fin. 

)  Vid,  Epift.  ejufd.  n.  31,  32. 

8  bonya 


(0  N.  s8. 

(<£)  Epift.  26.  n.  24. 


Letter  XXVII.  Article  27.  859 

bony,  examples  of  which  kind  you  will  alfo  find  in  the  illudrious  Haller  (#), 
and  will  objedt  to  thofe  who  look  upon  thefe  fpots,  and  other  indurations  of 
the  arceries  of  the  lame  kind,  as  calli  that  are  always  to  remain  in  that  date  •, 
although,  I  fay,  in  many  cafes,  that  which  I  have  faid  may  feem  not 
only  probable,  but  true,  yet  in  others  even  my  letters  fiiovv  that  the  thing 
may  be  quite  different. 

For  if  you  turn  to  the  third  letter,  you  will  find  that  I  have  defcrib’d  a 
white  fpot  in  the  bafilary  artery  of  a  certain  woman  (<?),  belonging  more  to 
its  internal  than  to  its  external  parietes,  and  which  was  not  made  up  of  a 
more  firm,  but  of  a  more  foft  fubdance,  Then  look  into  the  fourth  letter, 
and  you  will  find,  that,  in  an  old  man  (p),  two  arteries  going  to  the  extre¬ 
mities  of  that  artery  I  jufl  now  mention’d,  had,  each  of  them,  a  white  little 
body,  hardith,  and  already  almod  cartilaginous,  which  protuberated,  not  from 
their  external,  but  from  their  internal  furface.  May  it  hot  feem  very  pro¬ 
bable,  that  from  a  foft  matter,  fuch  as  I  found  in  the  fird  obfervation,  the 
thinner  particles  being  in  procefs  of  time  abforb’d,  a  little  body  had  been 
form’d  of  a  more  firm  contexture,  fuch  as  1  faw  in  the  fecond  ?  Or,  at  leaft, 
if  you  chufe  rather  to  make  it  fquare  with  the  reafoning  of  Boerhaave,  does 
it  not  appear,  that  fome  beginnings  of  a  future  more  hard  concretion  are 
made  up  of  a  foft  matter  between  the  coats  of  the  arteries  ?  And  as  in  thefe 
bodies  I  found  this  matter  white,  fo  you  may  have  learn’d  from  this  very 
letter  (q),  that  I  found  it  to  be  in  others  of  a  white  colour  mix’d  with  yellow, 
adhering  to  the  bony  lamella,  and  thefe  lamellae  themfelves  fometimes  yellow. 
Crellius  (r)  had  alfo  found  a  concretion,  not  only  “  of  a  white  colour  dege- 
“  nerating  into  yellow  5”  which  lying  betwixt  the  coats  of  the  artery,  already 
“  refembl’d  the  confidence  of  a  bony  lamina but  alfo  a  matter  diffus’d 
around  it,  from  which  he  did  not  doubt  but  it  had  been  form’d ;  and  this 
“  fimilar  to  that  which  at  other  times  is  contain’d  in  an  atheroma,  or  mel- 
“  liceris  ?” 

And  this  feems  more  probable  to  me,  fince  I  have  lately  read  that  “  a  yel- 
“  low  juice  of  a  pultaceous  confidence,  and  not  unlike  that  fubdance  which 
“  is  found  in  an  atheroma,”  was  feen  by  the  very  illudrious  Haller  (j)  in 
parts  of  the  aorta  which  had  become  callous  and  yellow ;  and  that  in  the 
fame  body  were  other  very  fimilar  yellow  places,  already  “  coriaceous,”  or 
of  the  confidence  of  leather,  “  others  cartilaginous,  and,  finally,  others 
“  bony  and  that  the  obfervation  of  this  progredion  from  foftnefs  to  the 
various  degrees  of  hardnefs,  had  been  “  often  repeated  ”  by  him :  which 
you  may  alfo  confirm  from  hence  (/),  that  the  convex  furface  of  thefe  fcales 
preferves  the  mark  of  their  origin  from  foft  matter,  that  is,  “  a  tranfverfe 
14  direftion,  infcrib’d  by  fo  many  furrows,”  from  the  fledvy  fibres  of  the 
arteries  adhering  to  them  ;  which  furrows  I  remember  to  have  been  formerly 
obferv’d  by  me  alfo  on  fome  of  the  bony  lcales,  when  I  disjoin’d  them  from 
the  tranlverfe  fibres  of  the  artery. 


(«)  Opuf.  Pathol.  Obf.  51. 
(c)  N.  6.  (p)  N.  19. 

(?)  N.  22,  &  26. 


(r)  Obf.  ad  n.  20.  fupra  cit.  §  2,  &  9. 

(s)  Opufc.  cit.  Obf.  47. 

(/)  Ibid.  &  Obf.  17. 


5  R  2 


And 


£5o  Book  II.  Of  Difeafes  of  the  Thorax. 

And  an  argument  not  unlike  this  is  us’d  by  Haller  («),  to  (how  that  the 
lar^e  bony  laminae  form’d  on  the  external  furface  of  the  dura  mater,  had, 
in  Tike  manner,  been  made  from  a  coalition  of  juices.  He  alfo  thinks,  more¬ 
over  (#),  that  he  has  fometimes  feen  the  firft  materials  of  a  renal  calculus, 
“  which  had  very  great  affinity  to  the  firft  rudiments  of  arterial  crufts  that 
is  to  fay,  a  yellow  mucus  in  the  Bellinian  tubes,  as  they  are  call’d  ;  and 
this  by  degrees  becoming  harder :  lb  that  it  brings  back  to  my  mind  that 
prosreftion  which  1  have  obferv’d  in  calculi  of  the  pineal  gland,  from  a  yel- 
lowTnucous  matter  to  a  fandy,  and,  finally,  to  a  concreted  and  hardilh  fub- 
llance,  and  which  I  have  already  communicated  to  you  (j).  And  there  is  no 
doubt  but  the  matter  which  has  often  been  prefs’d  out  from  the  extremities 
of  thole  renal  duels  by  the  celebrated  Bertini  (2)  agrees  with  the  obfervation 
of  Haller,  not  only  in  thicknefs  and  colour,  but,  in  ffiort,  in  its  earthy  par¬ 
ticles  alfo. 

In  regard  to  all  thefe  remarks,  although  they  deferve  commendation,  and 
may  even  eafily  be  prov’d  to  take  place  in  molt  bodies ;  yet,  as  I  have  fre¬ 
quently  obferv’d  how  many  various  circumftances  are  wont  to  occur  to  us  in 
things  that  are  natural,  and  Hill  more  in  things  that  are  preternatural  ;  and 
as  I  have  compar’d  all  my  obfervations  with  the  obfervations  of  others  ;  I 
hope  a  pardon  will  be  indulg’d  me,  if  I  again  affert  that  the  cafe  happens  dif¬ 
ferently  in  different  bodies,  efpecially  in  regard  to  thole  concretions  of  the 
arteries  which  I  have  here  conlider’d.  I  do  not  mention  the  colour  of  the 
juice,  which  I  have  fometimes  feen  to  be  different.  But  I  affirm  that  there 
have  been  many  bodies,  in  which,  although  the  great  artery  was  befet  in  fome 
places  with  little  bones,  and  in  others  with  fpots  of  a  larger  or  fmaller  fize, 
of  a  thicker  or  thinner  confidence,  I  never,  however,  could  find,  not  even 
in  the  fmalleft  beginnings  of  them,  any  thing  of  juice  or  fluid.  If  in  all 
bodies  an  effufion  of  yellow  juice  preceded  the  bony  feales  of  the  arteries, 
which  rais’d  up  the  internal  coat  towards  the  infide  of  the  artery,  and  render’d 
it  in  feveral  parts  “  convex  and  prominent,”  without  doubt,  you  perceive, 
that  thefe  places  could  not  have  efcap’d  my  eyes,  when  attentively  infpedling 
the  artery. 

Nor  do  I  fay  this  becaufe  I  imagine  that  the  greater  number  of,  and  if  you 
pleafe  all,  the  fpots  begin,  increafe,  and  offify  without  any  morbid  juice ; 
but  I  fay  it  for  this  real'on,  becaufe  my  obfervations  teftify  to  me,  that  in 
fome  bodies  fuch  a  juice  is  indeed  pour’d  out  •„  and  that  in  others  it  is  only 
brought  together  gradually,  and  without  effufion,  from  the  fmall  arteries  of 
the  coats-,  fo  that  the  particles  are  plac’d  in  contact  with  each  other.  And 
if  this  juice  be  impregnated  with  particles  of  fuch  a  kind  as  are  fuppos’d  ne- 
ceffary  by  moft  perfons  to  give  nutriment  to  bone  -,  and  if  thefe  particles  are 
more  and  more  brought  into  firm  contact  with  each  other,  I  fuppofe  that  con¬ 
cretions  will  arife  therefrom,  fuch  as  1  have  frequently  met  with,  and  fuch 
as  refemble  bone:  as  they  would,  on  the  other  hand,  be  of  a  tophaceous  or 
gypfeous  nature,  or  of  the  nature  of  any  other  fimilar  fubftance,  if  this  juice 

(»)  Obf.  49.  Cy)  Epift.  5.  n.  12. 

(*)  Obf.  34.  (z)  Mem.  de  l’Acad.  R.  des  Sc.  A.  1744. 

ffiould 


Letter  XXVII.  Article  28.  861 

fhould  be  fill’d  with  particles  of  any  other  kind,  and  they  come  pretty  fpeedily 
into  any  degree  of  contact  whatever.  Of  which  kind  l  fufpedt  thole  to  have 
been,  that  the  latter  part  of  the  excellent  obfervation  of  Jano  Planco  will  de- 
fcribe;  which  obfervation  this  very  experienc’d  man  communicated  tome  by 
letter,  accurately  and  at  large,  about  the  end  of  the  year  1728,  a  few  days 
after  he  had  made  it.  The  whole  of  it,  therefore,  for  it  contains  many  and 
various  things  •,  fo  that  for  this  reafon  I  promis’d  it  to  you  in  the  preceding 
letter  (<?),  when  I  fpoke  of  the  eruption  from  the  great  artery  into  the  peri¬ 
cardium  ;  the  whole  of  it,  therefore,  I  fay,  1  will  copy  with  great  faithfulnefs 
from  thefe  letters,  and  will  give  you  with  no  lefs  care  than  if  it  were  my 
own. 

28.  A  nobleman,  who  was  not  far  from  the  age  of  fifty-nine,  of  a  black 
complexion,  but  ot  a  good  habit  of  body,  notwithstanding  he  had  been 
much  given  to  venery  from  his  youth  quite  to  that  time,  from  whence  he  had 
been  more  than  once  troubl’d  with  buboes,  made  ufe  of  grols  and  common 
food,  but  drank  generous  wine  and  fpirituous  liquors  with  great  freedom. 
Pie  alfo  play’d  much  at  dice  :  and  it  was  related  by  his  comrades  at  play, 
that  he  was  us’d  to  be  feiz’d  every  day  in  the  evening  with  a  fneezing;  fo 
that  he  fometimes  lneez’d  a  quarter  of  an  hour,  or  more,  and  that  for  two 
or  three  years.  At  which  time  he  alfo  began  to  be  emaciated,  and  not  in  a 
fmall  degree  neither,  and  to  be  affebted  with  a  kind  of  internal  fenfation,  juft 
as  if,  according  to  his  own  exprefiion  in  the  laft  months  of  his  life,  he  was 
about  to  faint  away.  Yet  he  would  ufe  no  other  remedy,  in  order  to  recover 
himfelf,  but  the  fame  fpirituous  liquors  1  have  mention’d.  Wherefore,  re¬ 
turning  home  one  day  about  evening,  and  having  drunk  once  or  twice  of 
thefe  fpirits,  and  his  domeftics  having  fuppos’d  that  he  had  afterwards  gone 
out  of  the  houfe,  it  there  happen’d  that  he  died  fuddenly,  without  any  body 
knowing  of  it :  and  at  length,  after  the  fifth  hour,  his  body,  as  it  was 
winter,  was  found  quite  cold. 

The  cranium  being  open’d  the  day  following,  and  the  meninges,  for  the 
whole  of  the  pia  mater  alfo  every-where  follow’d  the  hand  that  drew  it,  being 
eafily  remov’d,  nothing  was  found  within  that  had  a  preternatural  appearance, 
except  a  great  quantity  of  ferum  in  the  ventricles  of  the  brain,  and  that  of 
a  greenifh  colour.  But  in  the  pia  mater  all  the  trunks  of  the  arteries,  and, 
in  like  manner,  all  their  branches,  and  efpecially  thofe  which  go  towards  the 
plexus  choroides,  were  much  more  thick  and  hard  than  is  natural,  and  when 
dried  fhow’d  in  many  places  a  bony  nature.  And,  indeed,  nearly  the  fame 
thing  was  leen  throughout  the  dura  mater  in  the  arteries  thereof,  which  were 
themfelves  alfo  become  fomewhat  thick. 

But  in  the  thorax  the  lungs  were  flaccid,  and,  in  the  greater  part  of  them, 
black.  The  left  lobe  was  befides  every  where  clofely  connected  to  the  pleura, 
where  it  invefts  the  ribs  and  diaphragm,  except  where  fome  quantity  of  coagu¬ 
lated  blood  was  obferv’d.  There  was  a  much  greater’quantity  of  this  blood  in 
the  pericardium,  whither  it  had  burft,  as  I  fliall  fay  prefently,  from  the  great 
artery.  The  heait  was  fomewhat  larger  than  it  naturally  is,  by  reafon  of  the 
too  great  magnitude  of  the  left  ventricle,  and  tEe  capacity  of  it,  which  ex- 


(<7)  N.  j8. 


ceeded 


86  2  Book  II.  Of  Difeafes  of  the  Thorax. 

cceded  that  of  the  right  ventricle  by  two-third  parts ;  whereas  this  laft-men- 
tion’d  cavity,  befidcs  the  great  thinnefs  of  its  proper  parietes,  had  fafciculi 
of  fibres  on  its  infide,  fo  entangl’d  with  each  other  that  ir  fcarcely  ieem’d 
to  be  a  finns.  The  aorta  and  the  pulmonary  artery  were  fomewhat  larger 
than  they  generally  are.  The  latter  of  thefe  veffels,  however,  was  found  ; 
but  the  former  was  firft  ruptur’d  at  the  diftance  of  about  a  finger’s  breadth 
from  the  heart.  Yet  this  rupture  was  not  large ;  but  near  to  it,  and  round 
all  the  balls  of  the  aorta,  a  kind  of  blacknefs,  as  if  from  an  old  bridle,  ap¬ 
pear’d,  which  was  owing  to  black  blood  ftagnating  under  the  external  coat : 
and  this  blacknefs  extended  itfelf  through  the  lungs  in  general,  but  particu¬ 
larly  about  the  larger  branches  of  the  pulmonary  artery.  Befides  this,  the 
whole  internal  furface  of  the  great  artery  was  univerfally  full  of  prominences 
and  puftules,  both  of  which  were  continu’d  through  all  the  branches  of  it 
that  were  laid  open,  and  particularly  through  the  iubclavian  arteries,  the  ca¬ 
rotids,  and  the  coronaries  of  the  heart  itfelf :  the  laft  of  which  were,  more¬ 
over,  very  much  dilated,  and  one  in  particular,  fo  as  nearly  to  equal  the 
breadth  of  the  left  carotid. 

In  the  belly  the  fpleen  was  fmall,  and  very  lax,  although  the  liver  was 
pretty  found,  and  in  every  refpedt  natural ;  for  as  to  there  being  but  a  very 
fmall  portion  of  bile  in  the  gall-bladder,  that  was,'  perhaps,  owing  to  his 
having  died  but  a  few  hours  after  dinner.  The  kidneys  were  very  flaccid  ex¬ 
ternally  and  internally,  which  is  very  rare,  without  any  pelvis,  the  place  of 
thefe  being  Supplied  by  a  kind  of  fpongy  fubftance. 

As,  within  the  belly,  there  was  nothing  befides  thefe  appearances  worthy 
of  remark  ;  and  as  it  was  no  fecret,  that  the  patient  had  been,  more  than 
once,  affected  with  a  lues  venerea,  as  I  have  laid,  and  that  a  leaden  bullet 
from  a  piftol  had  been  lodg’d  in  his  left  thigh  thirty  years  before;  the  ure¬ 
thra  and  the  left  thigh  were  cut  into.  And  in  the  former,  one  or  two,  and 
no  more,  of  the  orifices  of  thofe  fmall  canals,  which  I  have  defcrib’d  in  the 
firft  of  the  Adverfaria  ($),  and  of  which  a  reprefentation  is  there  given,  were 
found.  And  in  the  thigh  was  a  membranous  follicle  about  that  bullet,  with 
which  it  was  ftreigh-tly  inclos’d  all  round. 

Having  feen  thefe  appearances,  I  had  a  mind  to  take  out  a  good  part  of 
the  aorta,  in  order  to  examine  it  more  accurately,  on  the  infide,  and  on  the 
outfide.  And  it  was  obferv’d,  that  the  external  coat  could  be  eafily  drawn 
away  from  the  trunk  and  branches  thereof,  juft  as  if  it  had  been,  for  a  long 
time,  macerated  in  water.  And  when  any  one  of  the  larger  of  thefe  inter¬ 
nal  prominences  Was  cut  into,  it  (bow’d,  internally,  a  kind  of  cavity;  and 
in  this  cavity  was  a  little  Toftifh  matter,  like  a  pultiee.  But  many  of  the 
fmaller  ones  appear’d  bony  after  they  were  dried. 

29.  Different  parts  of  this  hiftory,  which  I  have  given  you,  relate  to  dif¬ 
ferent  fubje&s.  And  indeed  many  circumftances  are  already  explain’d  in  the 
foregoing  letters.  But  you  fee,  that  the  remark  which  was  made  in  the  laft 
place  belongs  particularly  to  the  prefent  letter  :  I  mean,  that  what  the  leffer 
prominences  contain’d  was  demonftrated  by  the  diffedlion  of  the  larger,  that 
is,  a  matter  like  a  pultiee.  Since,  therefore,  it  appear’d  that  from  this  mat- 


( b )  n.  10.  &  Tab.  4.  Fig.  4. 


ter, 


Letter  XXVII.  Article  30,  863 

ter,  when  the  more  humid  particles  were  confum’d,  a  bone  was  form’d,  you 
will  at  the  fame  time  perceive,  1  imagine,  that  thofe  concretions  which,  I 
fuppofe,  refembl’d  bone,  by  their  whitenefs  and  hardnefs,  had  taken  their  ori¬ 
gin  from  foft  matter  ;  for  at  that  time  this  controverfy  was  not  agitated  :  and 
at  the  fame  time,  by  confidering  the  very  fpeedy  induration  of  the  fame 
matter,  you  will  naturally  fufpedt  with  me,  that  if  thefe  concretions  had  been 
larger,  fo  that  they  could  have  been  examin’d  by  many  different  experiments, 
it  muff  have  happen’d,  that  they  would  have  been  found  to  be  more  fimilar 
to  tophaceous  or  gypfeous  matter,  than  real  and  genuine  bone.  Nor  is  my 
opinion  different  in  regard  to  the  arteries  creeping  through  the  meninges, 
which,  after  being  dried,  have  appear’d  bony  in  feveral  places.  For  it  is 
much  more  probable,  that  the  fame  kind  of  prominences,  which  was  propo- 
gated  from  the  trunk  or  the  aorta  into  the  larger  branches  of  it,  had  more¬ 
over  been  continu’d  from  thefe  to  thofe  leffer  ones,  and  had  fhown  the  lame 
effeCt. 

30.  But  as  to  the  fame  gentleman,  who  communicated  this  obfervation, 
having  affur’d  me  in  the  fame  letter,  that  he  had  fometimes  differed  perfons 
who  were  taken  off  by  a  ludden  death,  in  whom  he  neither  found  the  aorta 
ruptur’d  nor  dilated,  but  only  affeded  with  this  kind  of  puftules  and  promi¬ 
nences  ;  neither  is  this  far  unlike  what  I  have  written  to  you,  at  different 
times,  in  obfervations  wherein  difeafes  of  the  fame  artery,  more  inconfider- 
able  in  appearance,  have  been  defcrib’d,  of  which  fatal  cafes  have  neverthe- 
lefs  been  the  confequence.  For  which  reafon,  the  greater  pains  ought  to  be 
taken,  to  prevent  any  figns  being  haflily  overlook’d  ;  if  any  figns  are  at 
length  difcover’d,  from  which  a  probable  fufpicion  may  be  drawn,  of  puf- 
tules  or  erofions  being  latent  in  the  aorta.  And  you  might  have  feen  above, 
that  lome  figns  of  erofions,  pointed  out  by  Bellini,  were  not  omitted  by 
me(Y);  figns  which  he  mention’d  at  the  fame  time  that  he  fpoke  of  the 
ftony  or  bony  fcales  which  were  the  occafion  of  them.  But  it  is  neceffary  to 
confirm  them,  and  to  add  others. 

And  as  it  is  ufeful  to  phyficians,  in  making  a  diagnofis,  to  know  what 
frequently  precedes  diforders,  I  would  have  you  attend  to  what  the  worthy 
Planco,  whom  I  have  already  commended,  has  immediately  added,  after 
having  defcrib’d,  from  another  patient,  the  great  artery  ( d )  to  be  internally 
“  ulcerated,  as  it  were,  and  corroded,  and  abounding  with  various  puftules  •, 
“  which  I  have  often  obferv’d,”  fays  he,  “  in  other  bodies,  and  particularly 
“  in  the  bodies  of  thofe  who  have  labour’d  under  the  lues  venerea,  or  have 
“  been  difpos’d  to  an  aneurifm  of  the  aorta,  or  to  a  dropfy  of  the  thorax.” 
But  as  ulcerations  of  this  artery  often  happen  from  little  bones,  as  is  hinted 
above  (e)  and  as  puftules  fometimes  produce  concretions  fo  very  fimilar  to 
bones  ;  no  doubt  but  you  fee  how  often,  in  diforders  of  the  aorta,  thofe  re¬ 
medies  may  be  iuitable,  which  are  generally  us’d  againft  internal  ulcers,  or 
at  lead:  thofe  which  do  not  at  all,  or  but  little,  excite  the  motion  and  effer- 
veicence  of  the  blood.  For  they  would  either  refill,  as  far  as  is  poifible,  the 
effect  of  the  bones ;  which  if  it  be  carried  to  its  height,  difpofes  to  fatal  rup¬ 
tures  of  the  aorta,  and  internal  effufions  of  blood  ;  or  would  counteract  the 

(0  n.  24.  (Y)  Epift.  de  Monflr.  (*)  n.  24. 

caufe 


86  4  Book  IL  Of  Difeafes  of  the  Thorax. 

caufe  by  which  thefe  hard  concretions  are  generated  :  and  by  this  means  would, 
at  leaft,  prevent  their  increafe,  if  not  totally  remove  them. 

But  I  Teem  already  to  have  written  enough  on  the  fubjed  of  fudden  death, 
and  of  the  change  of  arteries  into  bone  ;  of  which  Jail  I  took  occafion  to 
treat  from  the  confideration  of  the  former. 

31.  Now,  the  twelfth  fedion  would  furnifh  an  opportunity  of  writing  on 
the  fubjed  of  other  bones  that  are  in  a  preternatural  flate;  for  this  left  ion, 
which  clofes  the  lecond  book  of  the  Sepulchretum,  is  intitl’d  Be  Gibbofitate , 
and  gives  you  the  difledions  of  ricketty  bodies,  and  iuch  as  were  gibbous, 
or  had  incurvations  of  the  fpine.  But  I  do  not  remember  to  have  ever  dif¬ 
fered  any  who  had  been  aifeded  with  the  rickets  :  nor  do  I  remember  that 
Valfalva  ever  did,  nor  any  of  my  friends  in  Italy,  except  that  very  expe¬ 
rienc’d  man  Anthony  Benevoli  (/),  who  has  himfclf,  at  my  defire,  publifh’d 
his  own  obfervations,  written  in  a  clear  and  ingenious  manner;  and  not  only 
in  regard  to  what  he  remark’d  in  difiedion,  but  alfo  in  regard  to  thofe  me¬ 
thods  which  he  had  experienc’d  to  be  ufeful  in  the  cure  of  a  dileafe  which 
was,  in  other  refpeds,  very  difficult  to  cure.  But  from  foreign  writers  you 
will  have  many  diftedions  of  ricketty  bodies,  which  you  may  in  like  manner 
add  to  the  Sepulchretum.  For  if  you  turn  over  only  the  volumes  publilh’d 
by  the  Cmfarean  Academy,  as  Dec.  III.  A.  9.  ( g ),  Centur.  III.  (/6),  &  Ad. 
I.  (/),  &  V.  (/1),  you  will  find  feveral.  However,  in  regard  to  the  two  laft, 
fee  whether  that  retradion,  or  rather  that  defed  of  the  left  lobe  of  the  lungs, 
fo  as  not  entirely  to  cover  the  heart,  or  rather  that  part  of  the  mediaftinum 
which  includes  the  pericardium,  related  to  “  a  defed  of  conformation  ”  in 
ricketty  perfons ;  or  whether  it  was  the  fame  that  Euflachius  (/)  delineated  as 
being  natural,  and  Santorini  afterwards  defcrib’d  (m). 

I  have,  however,  diffeded  many  gibbous  bodies  ;  but  what  I  have  Teen  in 
them  relating  to  this  gibbofity,  has  partly  been  explain’d  to  you  already,  and 
will  partly  be  explain’d  hereafter,  inafmuch  as  tome  of  them  died  of  one 
dileafe  and  fome  of  another.  And  if  you  read  the  hiftories  of  thefe  perfons, 
it  will  be  ealy,  in  the  firft  place,  to  fee  that  this  diforder  does  not  appear 
fometimes  (n)  till  about  the  fortieth  year  ;  and,  in  the  fecond  place,  that  Se¬ 
verinus  had  rightly  admonifh’d,  in  oppofition  to  Cardanus,  as  you  will  fee  in 
the  fedion  of  the  Sepulchretum  above  fpoken  of(<?),  that  it  is  not  always 
neceffary,  that  to  the  diforders  which  are  found  in  the  fituation  of  the  bones 
of  the  ilernum,  and  of  the  ribs  that  are  conneded  therewith,  a  deprav’d 
fituation  of  the  vertebra  of  the  back  ffiould  alfo  correfpond  :  which  is  con¬ 
firm’d  by  my  obfervations,  and  particularly  in  a  certain  woman  (p),  and  partly 
in  an  old  man  (q)  :  to  which  you  may  add  what  was  obferv’d  in  a  ricketty 
child,  of  which  the  Ad.  Nat.  Cur.  juft  now  quoted,  give  the  hiftory  (r) ; 
and  what  the  celebrated  Haller  (j)  has  defcrib’d  from  another  little  child  very 
accurately. 


(/)  Oflervazioni  38.  e  fegu. 

Gg)  Obf..  240. 

(6)  Obf.  11.  (0  Obf.  53. 

(/£)  Obf.  146,  &  147. 

(/)  Tab.  9,  &  Tab.  15.  Fig.  1. 
(to;  Obf.  Anat.  c,  8.  §  1. 


(;z)  Epift.'io.  n.  13,  14. 

(0)  In  Schol.  ad  Obf  6. 

(p)  Epift.  43,  n.  23. 

(7)  Epiit.  7.  n.  11. 

( r )  Tom.  1 .  Obf.  53, 

(j)  Opufc.  Pathol.  Obf.  10. 


However, 


Letter  XXVII.  Article  32. 


8** 

However,  we  muft  confefs,  with  Severinus,  that  Cardan  us  h  as,  as  in 
moft  other  things,  taught  what  is  true  :  and  even  that  the  vitiated  pollure 
of  the  vertebras  is  the  much  more  frequent  caufe,  that  a  perverted  fituation 
of  the  ribs,  and  of  the  fternum,  follow,  is  demonftrated  by  other  of  my 
obfervations,  and  by  thofe  of  others.  Among  which,  if  you  read  one  in 
particular,  that  I  have  given  in  the  fourth  letter (/),  you  will  at  once  un¬ 
derhand,  that  not  a  perverted  and  incongruous  fituation  of  the  ribs,  and 
fternum,  was  the  consequence  of  a  diftortion  in  the  fpine,  but  a  perverted 
fituation  of  the  vifeera  and  veficls  of  the  belly  alfo,  and  will  at  the  fame 
time  conjecture,  how  much,  of  courfe,  not  only  the  fmaller  veffels,  among 
which  is,  in  particular,  the  thoracic  duCt,  but  alfo  the  greater  part  of  the 
nerves,  and  other  parts  of  the  like  kind,  muff  have  been  difturb’d  from 
their  natural  fituations,  which  confiderations  neither  time  nor  place,  nor  the 
principal  defign  we  had  then  in  view,  fuller’d  us  to  profecute. 

Moreover,  even  the  celebrated  Helwich  («)  will  teach  us,  how  much  all  the 
thoracic  vifeera  were  forc’d  into  a  very  narrow  compafs,  and  confin’d,  by 
the  fpine  being  diftorted  anteriorly  in  a  certain  matron  •,  and  the  illuftrious 
Haller  will  inform  you  (x),  how  far  the  great  artery  was  remov’d  from  its 
proper  feat  in  another  woman,  whofe  fpine  had  been  forc’d  into  ferpentine 
inflexions,  different  from  what  we  fee  in  a  natural  ftate,  by  carrying  heavy 
burthens  on  her  back,  which  was  her  method  of  earning  her  livelihood. 
And  that  this  kind  of  life  is,  at  other  times,  among  the  external  caules  of 
gibbofity,  efpecially  in  young  bodies,  is  not  only  demonftrated  by  reafon, 
but  by  the  obfervation  of  the  celebrated  Nebellius  (jy). 

32.  But  in  regard  to  the  other  caules,  from  which  diftortions  of  the  fpine 
begin,  for  the  moft  part,  to  arife,  and  by  which  they  are  encreas’d  and  con¬ 
tinu’d,  if  you  confult  the  ancients,  I  fear  you  will  not  be  able  to  find  any¬ 
thing  fatisfa&ory  *,  I  mean,  where  you  recede  from  that  kind  of  caufes 
which  evidently  proceeds  from  an  injury  that  happens  externally,  or  from 
violence.  Nor  is  it  to  be  wonder’d  at,  fince  in  ancient  times  the  bodies  of 
men  were  not  difie&ed,  and  much  lets  thofe  of  gibbous  perfons. 

And  after  they  at  length  began  to  difiedt  human  bodies,  if  they  happen’d 
to  light  on  bodies  of  that  kind,  it  either  feem’d  luflicient  to  them  to  have 
declar’d,  in  one  word,  that  there  was  “  a  bad  compofition  of  the  bones,” 
as  it  did  to  Vefalius  (z),  when  he  difledted  “  a  gibbous  girl,  who  had  pafs’d 
“  her  feventeenth  year  j”  or  to  have  deferib’d  and  reprefenced,  in  a  figure, 
the  lateral  flexures  of  the  fpine,  in  the  manner  of  a  ferpent,  as  Hildanus 
has  done  (a),  who  has,  perhaps,  given  the  firft  representation  by  drawing 
that  we  ever  had  of  a  diforder  of  this  kind,  from  another  girl  of  eight  years 
old.  Betwixt  thefe  two,  however,  befides  Falloppius  {b)%  Pinsus  flourilh’d, 
who,  as  you  will  even  read  in  this  twelfth  fedtion  of  the  Sepulchretum  (<r), 
obferv’d  that  the  vertebrae  of  the  fpine  “  were  very  frequently  united  to- 


(/)  N.  16. 

(»)  Eph.  N.  C.  Cent.  io.  Obf.  32. 

(at)  Opufc.  modo  cit.  Obf.  1 1. 

(y)  Aft.  N.  C.  Tom.  5.  Obf.  log. 

Vol.  I.  5  S 


(a:)  Epi ft.  de  Rad.  Cliyn. 

(a)  Cent.  6.  Obf.  75. 

(b)  Vid.  hujus  verba  Epi  ft.  56.  n.  36. 

(c)  Obf.  6. 

gethtr 


866  Book  II.  Of  Difeafes  of  the  Thorax. 

«  gether  into  one  iubftance,  fometimes  in  a  greater,  and  fbmetimes  in  a 

“  imaller  number, - and  reduc’d,  as  it  were,  into  one  bone  and  that 

thefe  vertebrae  “  were  indebted  outwardly,  or  inwardly,  or  to  one  fide,” 
(which  latter  he  fays  below  happens  «  the  molt  frequently”)  “  from  which 
«  inflexions”  all  the  fpecies  of  gibbofities  which  he  mentions  “  arife.”  As 
to  what  I  have  faid  that  Pinaeus  teaches  below,  you  will  not  fee  it  in  the 
Sepulchretum,  but  in  that  chapter  of  his  work,  which  is  there  referr’d  to, 
that  is  in  the  ninth  (d) ;  where,  in  regard  to  the  right  fcapula  of  the  girl  in 
France  being  higher  and  more  full  than  the  left,  and  the  caufes  of  this  cir- 
cumftance,  he  has  written  molt  of  the  things  which  Riolanus  ( e )  has  fince 
done  in  his  Encheiridion.  After  Pinaeus,  others,  among  whom  are  the  two 
gentlemen  lately  commended,  Helwich  (/)  and  Haller  (g),  have  obferv’d  the 
coalition  of  many  vertebrae  into  one  bone,  in  gibbous  bodies,  and  Ruyfch 
in  particular,  who  (b)  “  many  times”  faw  the  bodies  of  feveral  vertebrae  fo 
united  with  one  another,  and  comprefs’d,  that  fome  of  them  feem’d  not 
only  to  be  diminifh’d,  but  “  reduc’d  into  nothing.”  And  Palfin  (/)  has  ob¬ 
ferv’d  the  beginnings  of  fo  great  a  diminution  in  the  fkeletons  of  gibbous 
infants,  that  is  to  Gy,  the  bodies  of  the  vertebrae,  where  the  curvature  took 
place,  very  much  flatten’d,  and  the  cartilages  that  lie  betwixt  thele  bodies, 
in  that  place,  very  thin. 

33.  After  obfervations  it  feems  lefs  difficult  to  judge  of  the  caufes  of  in¬ 
flexion  of  the  bones  of  the  limbs,  and  of  the  fpine  itfelf.  Of  thefe  caufes 
you  have  two  kinds  propos’d  in  the  Sepulchretum  (k)\  one  from  Gliflon, 
and  the  other  from  Mayow.  Both  of  thefe  kinds  confift  in  a  more  plen¬ 
tiful  nutrition;  the  firft,  of  the  bones  of  one  fide  than  of  the  other;  and  the 
fecond,  of  the  bones  than  of  the  mufcles  which  are  attach’d  to  them.  That 
is  to  fay,  whether  one  fide  of  the  bones  continue  to  be  nourifh’d  a  longer 
time  than  the  oppofite  fide,  'as  Havers  fuppos’d(Z),  or  whether  both  fides 
are  nouriffi’d  for  an  equal  time,  but  one  of  them  more  plentifully  than  the 
other,  as  Gliflon  had  fuppos’d,  without  doubt  it  comes  juft  to  the  fame 
thing  ;  I  mean,  that  the  fide  which  has  been  nourifh’d  the  longeft  time,  or 
has  receiv’d  the  greateft  quantity  of  nutritious  matter,  inclines  itfelf  to  the 
oppofite  fide.  Thus  imagine,  that  if  the  right  fide  of  the  vertebrae  has 
grown  higher  than  the  other,  the  fpine  will  be  infleCted  towards  the  left : 
and  that  the  fame  thing  will  happen,  if  the  ligaments  that  lie  betwixt  the 

vertebrae,  or  rather  the  cartilages,  have  their  Iubftance  lefs  increas’d,  or 

have  their  height,  in  the  left  fide,  diminilh’d.  And  in  this  manner  you 
will,  in  general,  conceive  of  the  firft  kind  of  caufes.  And  the  fecond  you 
will  conceive  of,  if  you  fuppofe  that  the  mufcles,  which  lie  on  the  left 
fide,  are  lefs  increas’d  than  the  bones,  or  more  contracted  than  the  mufcles, 
which  lie  on  the  right  fide,  whether  this  is  the  confequence  of  convulfion, 
or  from  their  being  endow’d  with  greater  ftrength  than  the  mufcles  on  the 
right  fide,  and  that  either  from  the  birth,  or  by  reafon  of  the  power  of  the 

(J)  L.  2.  (f)  L.  6.  c.  17.  (ij  Anat,  du  corps  hum.  tr.  5.  ch.  9. 

(f)  (£•)  Obf.  cit.  fupra  ad  n.  3 1  in  fin.  (k  )  In  Append,  ad  Additam,  ad  hanc  ije&.i  1. 

( b )  Obf.  Anat.  Chir.  68.  (/)  Ofteolog,  Nov.  Diic.  2.  verf.  fin. 

mufcles, 


Letter  XXVII.  Article  34.  86  7 

mufcles,  on  the  right  fide,  being  diminifh’d,  from  a  paralyfis,  or  from  any 
other  caufe  whatever.  For  it  is  proper  to  add  all  thefe  confiderations  to  the 
theory  of  Mayow,  which  amount  to  juft  the  fame  thing. 

Nor  does  it  efcape  me  what  Havers  (m)  objedted  to  this  theory,  which 
has  been  approv’d  of  by  celebrated  men  ;  I  mean,  that,  as  betwixt  the  ex¬ 
tremities  of  the  mufcles  a  joint  is  interpos’d,  it  will  happen,  that  the  mufcles, 
when  fhorten’d,  by  drawing  the  bone  into  which  they  are  inferted,  do  indeed 
change  the  fituation  of  that  bone,  according  to  cuftom,  but  not  the  figure 
of  it.  However,  to  pafs  over  other  things,  when  the  queftion  is  of  the 
vertebrae  and  of  the  fpine,  as  it  is  at  prefent,  it  is  the  fame  thing  to  change 
the  fituation  of  the  vertebrae,  as  to  change  the  figure  of  the  fpine.  Thus 
there  was  a  diforder  in  the  mufcles  of  a  crooked  man,  of  a  tall  ftature,  as 
the  obfervation  of  Kerckringius,  which  you  have  here  in  the  Sepulchre- 
turn  (»),  demonftrates.  In  which  ( 0 )  you  will  alfo  find  this  to  approve,  that 
it  happens  from  the  mere  imbecillity  of  the  mufcles  of  the  back,  “  that  the 
“  nodding  lpine  is  curv’d,  and  that  this  is,  perhaps,  one  reafon  why  all  old 
<c  men  are  gibbous.”  And  indeed,  where  the  mufcles  (hall  continue  for  a 
long  time  to  keep  the  fpine  in  a  curv’d  pofture,  even  under  the  influence  of 
the  will,  they  will  change  the  figure,  not  only  of  the  cartilages  that  lie  be¬ 
twixt  the  vertebrae,  but  alfo  of  the  vertebrae  themfelves  •,  for  the  vertebra 
will  increafe  in  their  heighth  on  that  fide  where  the  convex  of  the  curvature 
(hall  be,  and  will  decreafe,  or  at  leaft  will  be  lefs  encreas’d,  on  the  oppofite 
fide,  in  confequence  of  their  being  more  clofely  comprefs’d  to  each  other ; 
whereas,  on  the  other,  that  is  on  the  convex  fide,  they  are  much  lefs  clofely 
prefs’d  one  upon  another  than  the  laws  of  nature  require.  And  thefe  cir- 
cumftances  will  fo  much  the  more  eafily  take  place,  in  proportion  as  the 
vertebra,  by  reafon  of  a  tender  age,  (hall  be  more  diftant  from  the  bounds 
of  their  increafe,  and  in  proportion  as  they  (hall  be  lefs  hard,  whether  this 
-  be  from  the  fame  tendernefs  of  age  or  even  from  difeafe,  as  in  that  gibbous 
girl  of  Hildanus  (p),  in  whom  “  the  bones  themfelves  were  fo  foft,  that 
“  fome  of  them  might  be  moulded  like  wax  and  the  fpine  was  “  loften’d:” 
and  in  like  manner,  in  a  crooked  young  man,  of  fixteen  years  of  age,  to 
whom  this  fecond  obfervation  of  the  Sepulchretum  relates,  “  the  vertebra, 
“  chiefly,”  were  afledted  nearly  in  the  fame  manner. 

Wherefore,  although  I  would  not  deny,  that  the  firft  kind  of  caufes  may 
fometimes  exift  by  itfelf,  and  be  the  caufe  of  gibbofity  ;  yet  I  believe  that 
it  is  more  frequently  the  eftedt  of  the  caufes  of  the  fecond  clafs,  that  is,  of 
the  contracted  mufcles. 

34.  And  indeed,  even  Mery  himfelf  (q),  by  whom  we  have  a  defeription, 
delineation,  and  explication,  of  the  fpine  being  infledled  laterally,  in  a  fer- 
pentine  figure,  which  is  certainly  the  beft  explication  of  all  that  have  hitherto 
ever  come  out,  has  confider’d  that  diforder,  which  might  be  in  the  feveral 
vertebra,  as  the  adt  of  the  mufcles  that  are  attach’d  to  the  fpine,  being 

(m)  Ibid.  ( P )  Vid.  fupra,  n.  32. 

(n)  Append.  1.  ad  Obf.  7.  (q)  Mem.  de  1’ Acad,  R.  des  Sc.  A.  1706. 

(0)  In  Schol.  ad  Obf.  1. 

6 


in 


8  68  Book  II.  Of  Difeafes  of  the  Thorax. 

in  contraction  on  one  fide ;  whereas  the  oppofite  mufcles,  being  paralytic 
by  reafon  of  the  obflrudtion  of  the  nerves,  had  no  power  at  all  to  aCt  as 
antagonifts  to  them. 

Yet  ftill  there  is  fomething  in  this  explication,  alfo,  of  which  you  may 
enquire  the  caufe.  For  if  the  fpine  had  only  had  one  curvature,  fuppofe 
towards  the  left  fide  j  it  would  not  be  at  all  difficult  to  underfland  the  cafe, 
only  by  fuppofing,  as  was  a  little  before  hinted,  that  the  mufcles  on  the  op¬ 
pofite  fide,  that  is,  on  the  convex  fide  of  the  curvature,  are  paralytic.  But 
now,  when  beneath  the  firft  curvature  another  fucceeds,  as  in  the  obfer- 
vations  of  Hildanus  (r),  and  as  frequently  happens  in  the  obfervations  of 
others  alfo,  quite  in  a  contrary  direction  to  the  upper  curvature  ;  it  actually 
appears,  if  we  are  to  fit  down  by  this  explication,  that  the  mufcles  muft  be 
iuppos’d  to  have  been  paralytic,  in  this  cafe,  even  on  the  convex  fide  or  the 
inferior  curvature  :  but  how  this  refolution,  or  paralyfis,  of  the  mufcles  can 
happen  alternately,  that  is,  how  the  refolution,  which  was  laid  to  be  on 
the  right  fide  above,  can  happen  below  on  the  left,  does  not  eafily  appear. 
However,  I  would  have  you,  in  fuch  a  difficult  queftion,  conlider  whether 
it  is  poflible,  that  the  fuperior  curvature,  which  is  owing  to  the  refolution  of 
the  mufcles  on  the  right  fide,  could  itfelf  be  the  caufe  of  refolution  in  the 
•  mufcles  which  are  on  the  left  fide  below.  For  the  nerves,  going  out  through 
the  foramina  which  are  intercepted  by  the  fides  of  the  vertebrae,  defeend  in 
great  meafure  obliquely,  to  infert  themfelves  into  the  mufcles  that  move  the 
vertebrae  which  lie  beneath.  If,  therefore,  the  fuperior  curvature  force  the 
vertebrae  fo  clofely  one  upon  another,  on  the  hollow  fide,  efpecially  when 
they  are  very  foft  by  reafon  of  the  tender  age  of  the  patient,  or  even  from 
difeafe,  fo  that  thefe  foramina  become  confiderably  lefien’d,  fome  of  the 
nerves  that  come  out  at  thefe  foramina  may  perhaps  be  fo  comprefs’d,  that 
the  mufcles,  into  which  they  go  down  to  infert  themfelves,  may  be  made  pa¬ 
ralytic.  But  thefe  mufcles  are  on  the  left  fide.  This  inferior  refolution, 
therefore,  will  be  on  the  fide  oppofite  to  that  in  which  the  fuperior  was ;  fo 
that,  for  this  reafon,  the  right  mufcles  prevailing,  an  inferior  curvature 
happens,  which  is  an  effect  of  the  fuperior  curvature,  and  in  oppofition  to 
this,  is  feen  to  be  turn’d  the  other  way. 

But  thefe  things  you  will  fuppofe  that  I  have  added,  as  many  obfervations, 
not  only  in  found,  but  in  gibbous  bodies,  require  them,  not  fo  much  with  a 
view  to  determine  any-thing  myfelf;  but  rather  to  ftir  you  up  to  devife  a 
better  theory.  Farewel. 

» 

(r)  Supra  cit.  ad  n.  32. 


END  of  the  FIRST  VOLUME.-