< :■&'■? ■ 'fr'-ti-X'^AVy %?f$- ’ <^?i'«?! %;••' ?$.'£’" ; ■•> :.c/ ,>J ’. 'i 1 , » •. •■ ■ .'.; $&«* .. * ; • V »>. • •,' ■ '■'- ' ■Y'*:' ■ ' V • vA.-V-' '• '-* «•• « • M V' V, . 1 1 11 1 * - 1 jy • A l.f*'1* " • .* T 1 ' ' V t * y J ^ •_ ’ , *-. . ■» V* «O . I * ‘ • . ■ • A •' ■ ■ ‘ » 1 t ■ A> ft: ■ "£.& ■ 1' f '•'■ ;v Z&% ' Mi* Wiliv V*«fi ^*R-' ‘ •' ...... , ... ... . .. . '• ■ •;• • ' •■;,( o'. :'*>• '• • • ••■• > ' '- '■ ’ ■•'•• i;"„*:.Y->* \ ■■■■.:■- ■>■-?* t.,i ••-,• ■ if'.V *2®-' ■ afia x.rap#a& -■- w:-i*.***a* . z^yry-or' ••- V/ ^ t &V ■" .*'■£'! ? 'v' ?*'•' -'v ' -" 1H® i®®? •• ^gis i ; * -^1 i:‘- -i: -,.K n'.V - ,V-*‘ -- > . :&3 C • ^•HrfcRjp c njr 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. V» - i Iff : ) '' r— • r v J r: . " •; A 3 .7 c:h:.a < f i ti V : I ■ A'- • j .. ' - i o D K '» r v r J •r •. • • v r t • ,, ’ T \ .. > ii. _■ ; j :> ' , / 3f£*Jv.> -a : A I- sua.! , . j ) . - j ‘ - - - ■ > r.i:r. v * * »r . ' A Ci - • G' ! i A . ’ .yj . 'y : 1<. *: . ; i i j i -J *•- / an - r' r - ?•* y*. I 1 * ■ * ■<o :.oa r- . i < ) j ./ ■ T O 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. THE ; . .■ . «- - ■ , * . * * » *• i s% ' • • • - ' * - . .;•! • ' - ' • ’ ' . ’ ‘ ' ' - ' - - ■ - • ■' t ' . * A * V - I T H E 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 . ' • - * ■ * * ' t ' . • , ’ 'fJ : ■ ■ t- - ■ , , :■> . ■ :■ , V * * 'J ' If I . . . s't* H , t ' . . V1 r . . 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