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THE
SEATS and CAUSES
v <•;• t
O F
DISEASES
INVESTIGATED BY ANATOMY;
IN FIVE BOOKS,
CONTAINING
A Great Variety of DISSECTIONS, with Remarks.
\
TO WHICH ARE ADDED
Very Accurate and Copious INDEXES of the Principal Things and Names therein contained.
Translated from the Latin of
„,-A
JOHN BAPTIST MORGAGNI,
Chief ProfefTor of Anatomy, and Prefidentof the Univerfity at Padua,
By BENJAMIN ALEXANDER, M. D.
IN THREE VOLUMES.
-•
VOL. I.
LONDON,
Printed for A. Millar; and T. Cadell, his Succeflor, in the Strand; and Johnson and Payne, in Pater-nofter Row.
MDCCLXIX.
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T O
Dr. F O T H E R G I L L.
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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
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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.
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LETTER the FIRST.
Of PAIN in the H E A D.
i. V N order to perform what I promifed you, I will begin with the pain I of the head ; but do not expeit, that 1 lhall include in this letter, all
A. the caufes of that pain, which have occurr’d to Vallalva, or myfelf in diffe&ions. Moft of them will be recounted hereafter, on other occa- fions. For this pain, not only attends dilorders of the head itfelf, but is frequently join’d, to thofe of the other parts of the body. And indeed, of itfelf alone, it is perhaps never mortal : for which reaibn, I have but few hi (lories thereof to introduce here, and thefe only treat of it as preceding other dis¬ orders, or as a threatening fymptom which attended them. I will firfl give you an indance of each kind from Yalfalva.
2. A boy of thirteen years of age, of a ready wit, whofe brother and fider had died of a confumption, having himfelf labour’d under an inflam¬ mation of the left lobe of the lungs the year before, was feiz’d with a pain in his head over his eyes : his eyes were alfo painful, and troubled with a vifcid defluxion. The day following he became delirious ; his eyes were fix’d on thofe about him ; and he threw up a little tough phlegm. Then on a fudden, he Was feiz’d with convulfions ; after which he fell into a kind of lethargy : yet was frequently rous’d by convulfions, attended with dif¬ ficult refpiration. At length he died. Vvhen the abdomen was open’d, the vifcera were all found to be in a found (late: but the (lomach, contain’d a kind of aeruginous humour, the bladder was turgid with urine, and the gall-bladder with bile. In the cheft, the right lobe of the lungs did not adhere to the pleura; but in the upper part toward the clavicle contain’d a tubercle almod as big as a walnut, in which were little cavities full of matter, that in colour and confidence refembled the medullary fubdance of the brain. And this perhaps would have given rife to a diforder, had the youth liv’d longer, fimilar to thofe which took off his brother and fider. But the left lobe of the lungs, which as I faid above, had been inflam’d the year before, was on the back part connected with the pleura. The pericardium contain’d two ounces of ferum, and was confequently enlarg’d ; and the right ventricle of the heart, had in it a little polypous concretion : yet the red of the blood was not in the lead concreted, although he had been dead feven-
B 2 " teen
4 Book I. Of Difeafes of the Head.
teen hours. Having faw’d open the ikull, the dura mater was found ting’d with a cineritious colour, along the fides of the blood-veflels. And when the dura mater was torn away from the crifta galli, a little fanious ferum burft forth : and about an ounce of limpid ferum, came from the origin of the optic nerves. But the whole brain appeared found -, and we could not help taking notice of the unufual magnitude of the pineal gland.
3, This laft article, which refpeds the ingenuity of the youth, you will underftand was written when the pineal gland was believ’d to be the feat of the foul. As to the difeafe, it began with the pain of the head and eyes ; the delirium, the vomitings, the convulfions, brought it to its acme, and the fame convulfions, it would feem, by bringing on death put an end to it. Nay, perhaps this convulfion though occult, was the beginning of it. Since pain, delirium, and vomiting, might be the effects of flight con¬ vulfions : as the turgid ft ate of both bladders, might be the effed of the delirium. For it is ufual with delirious perfons not to attend to the ftimulus of the urine and to refufe food, which by comprefling the cyft would fqueeze out the bile. Yet fome part of this may have been forced into the ftomach by the draining to vomit, and have given the aeruginous colour to the ejeded humour. The fame convulfion alfo left a fleepinefs behind it, the brain being comprels’d round about; which fleepinefs was frequently interrupted by the returning twitches of the convulfion. But was the ferum, found at the anterior bafis of the cerebrum, the caufe, or the effed of the convulfion? ’Tis no matter which you believe; for whether we fuppofe that the latent caufe of the convulfion, by conftringing the veflels and giving a remora to the blood, was alfo the caufe of the ferum being effus’d ; or that the ferum being firft extravafated, by irritating the meninges which lie at the lower part of the forehead and round the optic nerves, originally created flight convulfions and pains ; the cafe will be diffidently intelligible, which¬ ever mode of explication we choofe. For it is not neceflary we fhould believe, that becaufe the ferum was limpid it was confequently harmlefs; fince it is certain that falts which are the moft capable of erofion, by no means affed the pellucidity of water, when diffolv’d. Though, in fad the ferum was not altogether limpid, but in part fanious. But how that fanies is to be accounted for, we fhall enquire in other hiftories of a fimilar nature; whether it was a true fanies, or rather an appearance of it only ( a ). I fhall now give you the other hiftory from Valfalva.
4. A man about forty years of age, had been liable many years to a pain in the right hypochondrium, which return’d periodically, often attended with vomitings, and fometimes degenerating into the iliac paffion, with delirium. He was alfo troubled with violent pains in his head, which were almoft conftant, and join’d with a defluxion of ferum upom his eyes. This man having drunk too freely of wine, was foon after attack’d with his ufual pain and vomitings. However, he got rid of both thefe complaints by an undion which an empiric had order’d to be applied to his belly. But he was immediately feiz’d with a vehement heat in his head, both internally and externally : and the fame undion being applied to his head, it was atr
(«) Infra numb, 13. & epift. 5. n. 5 & 13.
tack’d
Letter I. Articles 5, 6. 5*
tack’d with the moft violent pain ; and this pain was accompanied with a delirium and convulfive motions : which cealing about an hour before death, or at leaft not being obfervable, he became apoplectic, with a difficult relpiration, a foaming at his mouth, and a ftrong full pulfe ; and in this manner he died. The face of the carcafe was pale, and the limbs con¬ tracted ; but whether this happened from the great coldnefs of the external air, or from the foregoing convulfion,s is uncertain. The pericranium about the finciput, was found much thickened by ftagnating juices, which were concreted into the form of a jelly. There was lome ferum betwixt the pia mater and brain, and fome alfo in the ventricles of the brain. Having open’d the abdomen, nothing appear’d that was worthy of notice, except a little quantity of ftagnant ferum, and a hard liver.
5. Thefe things which come laft in the difleCtion, anfwer to thofe that went firft in the hiftory. The hardnefs of the liver fhews that the periodical pain in the right hypochondrium, depended on the (late of the vifcus ; for in fuch a ftate it muft neceffarily fecrete a vitiated bile, which when collected in its cyft, would be plentifully pour’d out into the duodenum, and give rife to thofe pains in that inteftine and the parts about it : and thefe pains by in¬ verting more or lefs the mufcular contraction of the ftomach and inteftines, often brought on vomitings, and fometimes the iliac pafhon itfelf. But when the pain and vomitings, which had become the more urgent as they were the more neceflary to carry off the caules of the diforder, when encreas’cl by his late drunkennefs, were fuddenly fupprefs’d, part of thefe caufes ealily feiz’d upon the head which was already weakened by its pains ; and this part might poffibly have been fomewhat diflipated by the heat, had it not been imprudently repelled by the unCtion : for by this means, the morbid caufe became inherent in the neareft membrane without the cranium, in the form of a jelly, and violently diftended it; and within the cranium, by breaking in upon the parts mention’d, and by irritating the pia mater where it invefts the brain and ventricles, firft brought on thofe levere pains, then delirium and convulfive motions, and at length apoplexy itfelf. But if you choole to confider that ferum as an effeCt rather than a caule, I fhgll not conteft your opinion.,
6. To thefe two hiftories give me leave to add a third, which, though it does not relate to a man, but a fheep, is far from being unworthy of our no^ tice. Efpecially as Bonetus in order more fully to afcertain the feats of pain, has given us hiftories of fheep, and other animals in^his Sepulchretum (*)• This fheep avoided herding with the flock, and every day by intervals roll’d himfelf upon the earth, nor would fuffer his head to be touch’d, but avoided it by all poflible endeavours. Valfalva obferving this, and being defirous to know the origin of the pain, purchas’d and difleCted the fheep; nor did he find any thing morbid elfewhere than in the brain : for when he firft took it out from the cranium, a little acidulated water fell from that part, where the mamillary procefs approach’d to the os ethmoides. But a greater quantity of water was effus’d, when it was pull’d away from the pituitary gland, Then in difieCting the brain, when he came to the lateral ventricles, a follicle ap¬
pear’d
{&) Lib. 1. fed. xi. obf. 8. & feft. 9.
6 Book I. Of Difeafes of the Head.
pear’d Therein, containing a good quantity of water, being made of a mem¬ brane, which leem’d to be a production of the pia mater, except that fomc very fmall corpufcles were fcatter’d through it, refembling the medullary fu bit an ce of the brain. -The roots of the follicle came out from the bottom of the right ventricle : and wherefoever they were, below this ventricle, there the fubftance of the brain, both in its medullary, and cortical part, was cor¬ rupted all round to a confiderable extent. In fnort, the whole brain was ex¬ tremely flaccid ; neverthelefs the difpofition of the nerves was as ufual. The examination being carried on, that part of the os ethmoides which lies under the mamillary proceffes, was found to be fo much eroded by the conti¬ nual dripping of water from the brain, as to afford a free paffige from the cranium to the noftriis.
7. An obfervation nearly of this kind you will find in Bonetus’s Sepul- chretum(c), or rather in the firft century of the medico phyfical Inftories of Petrus Borellus, not the thirty-feventh, but the thirty-eighth obfervation : in this I lay rather, becaule Bonetus has omitted many things in his copy, nor has the other editor replac’d them, contrary to the admonitions of ( d ) Peyerus ; fo that by reafon of omifiions of this kind which I have obferv’d, not only in one place, but in many, it were to be wifh’d, that we had a new edition of the Sepulchretum, under the infpeCtion of 1'ome diligent man, who would be at the pains of comparing the ieveral articles, with the books from whence they were taken. A girl had been long troubled with a violent pain in the crown of her head, in whom Borellus law an ablcefs full of the moll limpid water, to the quantity of two pints, lying upon the nates cerebri and infun¬ dibulum. From fo deep and fo hidden a place, where the ablcefs could fcarcely be found, did this pain reach principally to the crown of the head ; and thus in fome meaiure confirm’d what we have elfewhere obferv’d from IVlalpighi (^), but render’d doubtful what Archangelus Piccolhominus (/) has advanc’d, that pains vyhich are felt at the upper, or lower part of the cerebrum, are leated in the pia mater, which invefts the lateral ventricles of the brain ; for though this may fometimes be true, yet we muft attend to what was juft now hinted, that the other parts which lie deeper than the ventricles, and the bafis cerebri, are invefted with the fame membrane alfo, and even under that ; not to mention other things, that the tranfverfe procefs of the dura mater is produc’d on both fides, quite to the borders of the fella equina ; and that in fo tenle a ftate, that even on this account, it might be fubjedl to the fharpelt pains, either from the irritating nature of an extravafated hu¬ mour, or only from a quantity of the fame preternaturally overloading and diflending it. And that orher parts of the meninges, may be opprefs’d by congefted humours, obfervations, which may be added to this firft fedtion of , the Sepulchretum, will alfo fhow, as for inftance, thofe made by Behrenfius^), and by Preuffius (A). For it happen’d to both thefe gentlemen, that fcarcely had the knife reach’d to the lateral ventricles of the brain, but the included humour rufn’d upwards with a confiderable impetus ; fo great was its quan¬ tity, and fo great the force with which it urg’d the fides of the ventricles and
(A L. 2. f. 1. obf. 46. (/) L. 5. anat. praelett. 3.
(d) MethoJ. hift. anat. rr.ed, c. 1 & fe<j. (g) A&. nat. cur. t. 2. obf. 31.
it) Epift. anat. 13. n. 7. (A) Eph. n. c. cent. 3. obf. 14. n. 3.
the
Letter I. Article 8. 7
the membrane that inverted them? It is therefore not to be wonder’d at, if the pains of the head were vehement to fuch a degree, that one of the pa¬ tients ran almoft mad with miferable howlings ; and that the other, though a woman, was feiz’d with a fury, and threw herfelf headlong into a well. And Preuflius has fhown, not only in this, but in two other obfervations (*), that where the pain was altogether on one fide of the head, there the ventricle of that fide only was diftended : and where it affedted one fide chiefly, and the other in part, there the ventricle of the one fide was much more diftended with water than the other; and though the water was extremely limpid, it was not the lefs noxious than if it had been yellowilh. For even the moft lim¬ pid may contain an occult ftimulus, as I faid above (£), and as the hiftory of Cohauienius (/) alfo proves, in which the right fide of the cerebrum *, and this it was that fuffer’d the moft vehement pains ; fcem’d as it were to fwirn in a great quantity “ of acrid, fait, and perfectly limpid ferum.” Which, in other obfervations, as for inftance that of Jo. Francus (; m ), whether it was limpid or not, feems to have been deftitute of ftimulating particles, and to have injur’d by preflure only : for although, upon opening thefkull, water was. univerfally found, yet the head had been aftedted only with a dull and heavy pain. But to return to the fheep : it is probable that the pia mater which cover’d the fundus of the right ventricle, had been pull’d away from the fub- ftance of the brain, by the gradual congeftion of the water, and form’d into, a follicle : and that fome particles of the brain, which were torn away with it, gave that corpufcular appearance I have fpoken of. As to the water, which was found to be fomewhat acid on tafting it, this doubtlefs confirms what has been already advanc’d, that water effus’d within the cranium, may even fometimes act by vellicating, fo as to give rife to diforders of the head. But in regard to the corruption of a part of the brain, and the great laxity of the whole, notwithftanding that the animal liv’d and mov’d at the fame time,, I fhall have a more proper occaflon of di feu fling this iubjedl hereafter ( n ).. Laft of all, the erofion of the os ethmoides muft not be pafs’d over without fome animadverfion.
8. As a palfage was open’d in this manner from the cranium to the noftrils, and conlequently from the noftrils to the cranium, fo if it ftiould have hap¬ pen’d that any animalcule had been feen in the brain of that fheep, our won¬ der would certainly have been lels, than when we read fo many hiftories col- ledted in the Sepulchretum (0), fpeaking of '(earth-worms and other worms,, flies, and with God’s leave, even fcorpions, having in every refpedt their na¬ tural appearances, as being found within human fkulls, and thence account¬ ing for the pains of the head. But fome are without teftimonies, fome want a. more diligent examination, wh;£h was certainly needful ; and others, if they are compar’d with the books from whence they were taken, will be found to have a. different meaning, as that which is produced from Fernelius (p). For if you turn to his defeription, you will wonder that Bonetus has been filent upon fome things which ought not to be omitted, eipecially as the
(/) Eph. n. c. cent. 3. obf. 14. n. 1 & 2. flz) Vid epife. 9. n. 15. 16. 19.
.(/') n. 3. (0) Seft. hac 1. obf. 116 & feqq.
(/) Aft., cir. t. 7. obf. 74. (y>) Paihol. 1. 5. c. 7.
f»0 Eqh. n. c. dec 3. a. 3, obf. 72,
deferiptiom
£ Book I. Of Difeafes of the Head.
defeription is ffiort ; and, if you well weigh in the medical fcale, the fenfe of thole things which immediately precede, you will readily acknowledge that thole two worms were found without the cranium, in the cavities of the noi'e. And it is probable that of the worms, fpoken of in the fcholia which are added to thefe hiftories, as difcharg’d from the nofe, fome had liv’d in its cavities •, but that others had crept from the ftomach into the noftrils, while the patient was sfleep. Nor is it uncommon for worms to grow in the frontal finufles, elpecially in fheep, by the irritation of which they are much agitated: fo that any one before diflection, might have fuppos’d this had been the cafe with the fheep above mentioned, fince he roll’d himfelf in fuch agonies on the ground. Nay, and that it fometimes happens to men, to have worms form a nidus in fimilar places, and bring on pains of the head, even the Arabians formerly, after the opinion of the Indian phyficians, deliver’d down in their writings, among whom was Avicenna (j), who gives the fymptoms and the cure of the diforder. And thefe things are even taken notice of in thofe fcholia ; and moreover, we are refcrr’d to iEgineta, book the fourth, chapter the 57th, as if he there “ granted that pains were indeed excited “ by worms, but denied that they were generated in the brain.” Yet they do not for this reafon rejedt thefe incredible hiftories ; but rather feek to con¬ firm them from thence (r), becaufe, as it appear’d that worms might be ge¬ nerated from putrid matter in the nofe, io they did not doubt but the fame might happen from an abfcefs within the fkull ; being led on by an error ealily pardonable in thofe times, when the ingenious obfervations of our Vallifneri (s) had not yet demonftrated that worms found in the nofe of a fheep were depofited by a fly*, nor the celebrated Reaumur, in his incomparable hiftory of inledls (/), had confirm’d it. Since then it is certain, that thefe worms are carried from without into the noftrils of fheep, and other animals of that kind ; and fince they are fo frequently found in the noftrils of thefe creatures, but never in their brain, why fhould we on the contrary believe, that although they fo feldom are found to exift in the noftrils of men, they are neverthelefs often found to exift in the human brain ? For there is not a paflfage from the nofe into the brain of a living perfon, as there is from the nofe to the frontal finufles *, but it is entirely Hopp’d up with nervous fibres, and vefiels and membranes, fo that not even the fmoke of tobacco, when drawn up, much lei's the lmalleft particle of its fineft powder, or the fmalleft new-born infect that exifts, can pal's through. And indeed there was for¬ merly a time, when it was affirm’d from diffe6tions, that the powder of to¬ bacco, and much more the fmoke of it, had enter’d the brain *, and thefe ob¬ fervations you will in like manner read in the Sepulchretum (#). Yet even there you will fee that one is rejected as falfe, that others are differently ex¬ plain’d, and that ail are immediately invalidated by a greater number of dif- fedtions of a contrary tendency, that are immediately put in contrail with •them ; and, if it were needful, many others of the fame nature might alfo be added to thefe, and particularly from the books of the Csefarean academy (x)'.
(7) Canon. ]. 3. F. 1. tr. 2. c. 3. 7. 31. (/) Tom. 4. mem. 12.
(r) Ad obf. 117. (a) Seft. ead. j. obf. 82. & 1. 4. S. ult.
P) Vid. preefertim oper. in fol. tom. 2. p, 4. obf. j. epiit. ad Gimmam. (*) Cefaresenat. cur. acad.cent. 10. obf. 89.
9. What
Letter I. Article 9. 9
9. What then ? yon will fay*, fhall we believe that no little animal, no foot, no fnuff, was ever found within the cavity of the fkull ? Indeed, I fuf- pe<5t, that whoever afierts in his writings his having really feen fuch things, was certainly impos’d upon, either by the tricks of fome juggler, by chance, or by his own incautioufnefs. For you know how deceitful the hands of jugglers are ; fo that a perfon who was before aware of their defigns, cannot with all his attention perceive, when they infinuate any thing into a place, which they pretend not to infinuate: how ealily then may a perfon be de¬ ceived, who is not only not forewarn’d, but intent on another thing ? Nor is it altogether unlikely that we may be impos’d upon by accident itfelf: as little infers may perhaps adhere to the fponge, which is generally us’d to wipe away the blood, upon opening the fkull, or to dry up any extravafated humour; and thefe infedls, by the frequent application of the fponge, may be left behind in the brain. But incautioufnefs would more frequently give rife to fuch afifertions : for inflance, when a llender polypous concretion, which is white and round, is taken for a worm ; for it is very rare, and very difficult, for a true and living worm to creep fo far as into the longitudinal finus, by the way which I fhall mention hereafter; yet in this finus du Verney (y) af- ferts, that a worm was found (2), whether he really faw it himfelf or not. Or the incautious obferver may have been deceiv’d by very fmall and crumbly concretions of matter, fuch as we often meet with in the male urethra at the orifices of the proflate gland, and even, as I have more than once feen, within the (a) proflate itfelf ; for thefe particles of matter exaftly refemble the moifl granules of tobacco, both in colour and form. Or it is eafy to conceive, that a particle of fnuff, which was lodg’d in the frontal finus, may have been drawn into the cavity of the fkull, by the faw or knife of the anatomift : for it is very certain, that the fmallefl dufl of tobacco may get into the frontal finus ; perhaps may fly in by chance ; or drop into it if the head were inverted ; but may molt furely be driven thither by the force of expiration. Or finally a narrow, winding, and for that reafon let's obfervable pafiage, might happen to reach from an external ulcer, into the cavity of this finus : and by that means, either in the dead or the living body, animalcules might be tranfmitted. Other things I defignedly pafs over; nor indeed is it neceffary to bring more argu¬ ments, efpecially on your account, as you are fkill’d in the hiflory of inledts, and can very well determine from thence, whether weevils, gnats, flies, fcor- , pions, and other animals, can live and thrive, notwithflanding they are flint up in a flreight place, altogether depriv’d of air, and without proper nourifh- ment to fubfifl on. And it is certain, that from the time in which natural hiflory began to be much fludied, and the feveral articles of it to be fcru- puloufly enquir’d into, no more obfervations of that kind came abroad ; or at lead very few only, and thofe believ’d by as few perfons. Nor did any difcovery of this kind ever happen to V alfalva or myfelf, though former phy- flcians afiert it to have happen’d fo often to them : and yet the number of heads which Yalfalva has examin’d, is very confiderable ; and the number I have examin’d myfelf, is perhaps not much inferior to his. So that, if I ffiould allow any one of thefe gentlemen to have really feen fuch appearances,
( y) Hifl. de l’acad. R. des Sc. an. 170c. (A Vid. epifh Z4. n, 23. (*) Epift. 44. n. 20.
Vol. I. C without
i o Book I. Of Difeafes of tlie Head.
./
without fraud or error ; you mull take it for granted that I do it rather from a reverence for their names, than from any convi&ion of my own mind. Nor need it furprife you, that after the molt fevcre pains of the head, no¬ thing elfe be faid to appear but a worm, or animalcule found within the cranium, or feen to come out therefrom. For there are many caufes of pain in the head, which either lie on the outfide of the cranium *, or if they do exift within, do not ealily, or perhaps at all, fall under the notice of the fenl'es. What if they are not fought after ? for inflance, when a worm coming out from the nofe of a dying woman, is believ’d to have come from the brain ; as if it were really impoffible, that it fhould have crepe up there from the inteftines. What if other caufes are fought after, when they have been al¬ ready found in the brain ? and yet the little worms which are obferv’d a day after in the water, where a portion of the brain had been macerated, are accus’d as the caufes of the diforder. Vehement alfo were thofe pains which two worms of the caterpillar kind created, before they were thrown out from the nofe j yet thofe learned men Littre (£), and Maloer (r), who faw them, did not at all fufpedt, that they came from the brain ; but accounted for them, by fuppofmg that they came from the frontal finus, into which the very minute egg of the infeft had been carried by the force of refpiration. In like manner the learned Henckelius ( d ), when he faw two little worms like weevils coming forth by the fame way, and freeing the patient from the mod violent tortures of the head, judg’d that they had been perhaps drawn up into the cavities of the nofe, by incautioufly lmelling to flowers : for the young of thefe animals are frequently harbour’d there, and it is not uncom¬ mon for us, to apply them clofe to our noftrils, while we make a full and ftreng inspiration. And before him Gahrliepius (h), w’hen he faw worms dis¬ charg’d from the nofe with the fame good effe<ft, becaufe he perceiv’d they were like thofe which are generated by flies, made no doubt of aferibing this offspring to a fly. And they were all in the right, becaufe it was their opi¬ nion, that thefe animals did not come from any putrefeent matter, nor were generated in the cavity of the fkull, but proceeded from the fmall eggs or rudiments of animalcules, carried from without, into the receffes of the nofe. It is rot fufficiently agreed betwixt the two celebrated men whom I firft quoted, what kind of remedies are to be applied, or in what manner, in order to bring out thefe worms from the noftrils. And this controverfy it is the more difficult perhaps abfolutely to decide upon, becaufe the worms arc of different kinds in different cafes ; fo that it does not feem pofiible they fhould always be allur’d, or put to flight by the fame things. But however this may be, it will certainly be cf advantage to know from medical hiftories, by what methods they have for the moft part been drawn out •, to which hiftories you will add thofe things that are extant in the A<fts of theCsefarean academy (/), already commended, and thofe in the Commercium Laterarium Norimber- genfe(o-), but efpecially what we read in the le&ures of the great Boerhaave on his inftitutiones Rei Medicae {b)t where he mentions a girl cured by him,
( b } Hift. de l’acad. R. des Sc. an. 1708. (f) T. 4. obf. 30.
(<•) Et an. 1733. (g) A. 1739, Hcbd* 21. II. n. 3.
ftO Aft. nat. cur. d. 3. obf. no. (/?) Ad. §. 792.
(e) Eph. nat. cur. dec. 3. A. 8-. obf. 141.
whofe
Letter I. Article 10. - 11
whofe pituitary finuffes were all full of worms. But as they chiefly inhabit the frontal finuffes, which is indicated by the pain beginning, and being the moft troublefome, in the region of either finus, efpecially when join’d with a fenfe of motion and gnawing ; Littre therefore judg’d it proper, that if all other afiiftances fail’d, the aid of furgery fhould be call’d in, as an operation on the frontal bone was neither difficult nor dangerous. And I do not doubt but he meant to recommend the fame operation which Caefar Magatus formerly us’d, as I have heard from Vallifneri ; that is, to trepan the bone quite into the finus, and to take out the worm, which he had predicted was contained there, to the great admiration of the fpedlators ; and thus he happily rid the patient of the pain, againft which all other applications had been of no ef¬ fect. And if Vallifneri had publifhed the account of this cure from the manufcript of the author, as 1 hop’d in my Adverfaria (*'), I fliould perhaps have learn’d among other things, not unworthy to be known, whether the fame fuccefs attended the clofing up of the expos’d finus, that had attended the trepanning of the bone; for how much difficulty there is to bring that about, Cornelius Celfus has already obferved (i) ; and after him the furgeons commended by Palfin (/) and Palfin himfelf has alfo obferved the caufes of this difficulty, and the great mifchiefs that arife from this finus not being clos’d up ; and in like manner that excellent archiater Nicolaus Rofenius (*»), whom I faw while I was revifing this letter; and from him you may feledt many things to be compar’d with Verheyen (w), who feems to fpeak of the fame ftage-quack as Palfin ; and to be added to what 1 have already given out (o), upon that obfervation of Celfus. But if you would have further ex¬ amples of worms found, as they fay, within the fkull, or thrown out from the cavities of the nofe, you will meet with both kinds of them, among thofe things which Daniel Le Clerc(y>) has related, and intermix’d with re¬ marks for the moft part: of the fecond kind you will find many among the inftances taken notice of, or propofed by John Saltzman (q), who has neg¬ lected neither to mention the fymptoms of them, nor the methods by which they were difcharg’d.
io. But I will now give you three obfervations of my own, which are taken from patients, with whom pain in the head was either the firft fymptom, or at leaft, the moft troublefome one among others. A beggar man was re¬ ceiv’d into the hofpital, who certainly had long before had a diforder in his head ; he had always been filly, but of late fo deftitute of fenfe, that he threw away even the bread which he had begg’d. It appear’d he had been much liable to pains of the head, and at that very time labour’d under ob- ftrudtions of the belly. He dying of a kind of fever which came upon him, his body was brought into this anatomical theatre, in the year 1728, much emaciated, yet not difcovering any figns of diforder in the belly or cheft, if you except an obftruftion of the fpleen ; but when the fkull was fawed through, and the upper part taken off, it was obferv’d that the dura mater
(/) VI. animad. 90.
(^) De medicina, ]. 8. c. 4.
(/) Anat. du corps hum. 1. 2. tr. 4. ch. 15. (m) Diflert. de off. Calvar, p. 1. n. 28.
(«) Anat. du corps hum. 1. 1. tr. 4. ch. 16.
. c
(0) Epift. in Celf. 4.
Ip) Hift. Jator. lumbric. c. 13.
(^) Diflert. de verme paribus excuflo § 4. .6. 1 1. & feqq.
was
i 2 Book I. Of Difeafcs of the Head.
was firmly attach’d to it on the left fide of the forehead ; and there for fome fpace this meninx was not membranous, but had degenerated into a middle date betwixt a bone and a ligament, and form’d the figure of an ellipfe. Though the cerebellum was loft and flaccid, and the medulla ob¬ longata not very firm ; yet the cerebrum I found to be hard, as is frequently the cafe in idiots : notwithftanding there was a little limpid water in the late¬ ral ventricles, with colourlefs plexufles, on the pofterior part of which a few vehicles appear’d, fill'd with the fame limpid water. Finally, fomething yel¬ low adher’d to the anterior part of the pineal gland, which when comprefs’d betwixt my fingers, 1 perceiv’d to have a kind of fand intermix’d with it.
i r. Thefe appearances relate to different affedlions, as I (hall fliew in the courfe of thefe letters (r) : and that only, to the pain of the head,' which v/as found in the dura mater. For whatfoever the caufe might be, whether in¬ ternal or external, of the dura mater being indurated, almoft to the con¬ fidence of a bone, though no traces of this caufe were obvious to me; yet it is eafy to imagine, that as often as the blood, either by its plenty, or by its turgefcency, or by its motion being accelerated through the head, put a force upon the veflels going to this part, it nmft necefiariiy be obflructed by that impediment to its courfe, and diftend the fibres which furround the veflels of the dura mater. And you will fee it is aferib’d to this caufe in the Sepulchretum (/), that thofe perfons were tc fubjedl to the moft miferable “ head-aches, in whom the two meninges for fome fpace, often two fingers “ breadth, had coalefc’d in fuch a manner with each other, that the mouths “ of the veflels were entirely lock’d up.” And it is probable that obftacles of this kind, as far as they oppofe the circulation of the blood, or other juices, through the meninges, may fometimes give occafion to pains which return periodically; as often, for inftance, as a fufficient portion of juices is ob- ilrudled, to caufe a diftenfion by its weight; and this cbltruflion will conti¬ nue, till the fluids being vitiated thereby, fhall irritate the meninges, and confequently bring on a contradlion of their fibres ; yet no fooner is the firfl: portion of thefe obitrufted juices thruft on by this new-excited force, into the narrow, and lateral canals, but a new portion fucceeds, and is in the fame manner delay’d, and expell’d; to this others alfo fucceed ; nor is there an end of the diforder, till the lateral canals are by thefe repeated impulfes, fo far dilated, that they no more refill the circulation of the juices. But pains of this kind are generally either the forerunners of a fatal event (/), or rarely, and with difficulty, admit of a cure ; and the more fo, as they more conftantly recur at the fame hour ; perhaps becaufe by this regular return it is prov’d, that the lateral canals more ftrongly refill the dilating impulfe. I remember when I was a young man, I had a patient among my companions, in the place of my birth, by name Lawrence Bagattrini, who had been feiz’d not long be¬ fore with an external, but very violent hemicrania, which return’d every day at the eleventh hour, according to the method of reckoning the hours among the Italians. Whatever I did, had either no effedl at all, or at leall only that of fhortening and alleviating the pain, for it Hill return’d at the fame
(0 Vid. Eph. n. c. cent. 3. obf. 14. n. 1. Sc 3. &Dec. 3. a. 7. append, pag. 74. obf. 75.
hour i.
(r) V15. viii. n. 13.
(/) Sedfl hac 1 obf. 12.
Letter I. Articles 12, 13. 1 3
hour*, and if any little error, or irregularity, was committed, it return’d with: its former vehemence. Having for many days us’d all ether remedies in- vain, I at length got the better of the diforder, by means of a flight decoc¬ tion of the woods-, which gently agitating and impelling the circulating juices, threw' the patient into lweats, and reliev’d him of his diforder. And Ballonius («) teftifies, that the fame method fucceeded with him allb, in in¬ tolerable hemicranias, that return’d every day, at a certain hour. In the cafe of this young man, there was certainly fomething hereditary ; for his mother, who was more than leventy years of age, had been feiz’d a little be¬ fore, with fo great a pain in her head, that fhe loft the fight of one eye ; yet: {he was {till afflidled with violent pains, which recurr’d from time to time. But as thefe pains did not begin always in the fame place, but fometimes in the vertex, and fometimes within the nofe, (fo that fluffing up warm milk was of fervice) and did not return at the fame hour, I found more eafe in removing the pain of the mother, than that of the fon and being cur’d of her pain, the fight of her eye was by degrees reftor’d. Among other things, bleeding was of fervice to her j but not fo much what was perform’d by my order, as what fhe perform’d for herfelf, by untying the bandage from her arm in her fleep, by which fhe loft a confiderable quantity: fo that nearly the fame fuccefs attended bleeding, even in a woman of that age, which Val- lifneri ( x ) afterwards remark’d in one of fixty. But let us return to the difieftions.
12. A young woman, who was the wife of a poor man, and the daughter of an epileptic mother, being extremely hot after a journey in the month of February, was feiz’d with a violent pain in her head, and an acute fever. She had no delirium, but was often refervedly filent; and with thefe fymp- toms in three or four days fhe died. As fhe gave fuck, and yet had her menftrua upon her, bleeding was for a long time deferr’d ; but as fhe grew much worfe, and yet the pulfe and flrengtn of the arteries was firm; half a pound of blood was taken from her foot, which was quickly and ftrongiy coagulated ; but it happen’d that her death immediately follow’d the lofs of it. The head was brought into the theatre to finifh the anatomy of that year 1738; but not the other parts, as I wifh’d. The infide of the fkulF had a fomewhat red appearance degenerating into brown -, and the outfide of the pia mater, where it cover’d the upper part of the brain, was fmear’d over with a yellowilh kind of matter, not much indeed in quantity, but fpread equally all over; its confiftence was fomewhat thick, and though it was perfectly inodorous, yet from the whole of fits appearance, it feem’d to myfelf, and to the other phyficians and furgeons who were prefent, to be pus. However, we could not find any where, in the meninges, or cerebrum, which- was difcolour’d, any traces of diforder, or any place from which we might fuppofe this matter had proceeded.
13. If it was really pus, lhall we fuppofe that it was taken up, from fome other part of the body, by the fanguiferous vefiels, and tranflated to the' head, agreeably to what is hinted of a fimilar cafe in- the Sepulchretum (jy)
(k) Epidem. lib. 2. conft, hyem. a. 1575. (•*) Eph. n- c. cent. 5. obf. 7.
i v) Sed», hac 1 . obf. 40,
Certainly/
i 4 Book I. Of Difeafes of the Head.
Certainly for this reafon, I fhould have been much more chagrin’d, that I was not permitted to examine the reft of the body, in order to have determin’d the queftion ; had not the rationale of the cafes been different, and other hiftories come under my knowledge, wherein, as in that of Valfalva before mention’d (2), no fanies was any where found but about the brain, which was itfelf in every other refpeCt found. Could this pus-like matter then, have its origin from the finall, and almoft in vifible foramina, of the meninges, from which, in a natural ftate, only a little limpid humour, to moiften their furfaces, is difcharg’d ? could it be prefs’d out by the force of the difeafe, as frequently happens to the glands of the reCtum and bladder in the tenefmus or dyfuria. Certainly, that the meninges were entirely free from difeafe, neither the violent pain of the head, nor the colour of the fkull, where it was contiguous to the meninges, fuffer us to believe.
14. Speaking of that colour brings to my mind the hiftory of another woman, whofe head I differed in the beginning of the year 1717. Being firft affefted with the lues venerea, and after that with a fever, join’d to fe- vere pains of the head and delirium, Hae died of this complication of disor¬ ders in the hofpital at Padua.
Her fkull alfo, when it was open’d, appear’d of a blackifh red in fome places ; and the dura mater, where it lay neareft to the upper and middle region of the lateral finus on the right iide, was much thicken’d, and per¬ fectly coalefc’d with the pia mater, and even with the fubftance of the brain : the meninges and brain were in that part alfo femiputrid, and glar’d with a very difagreeable colour, which was compos’d of a yellowifh, mix’d with an afh like hue, efpecially in the cortical part of the cerebrum. Moreover, the external furface of the cerebellum was fo firmly connected with the two me¬ ninges, that when I drew it out from the cavity of the dura mater, a part of its fubftance was left adhering thereto. But the extent of the adhefion was not fo great as in the cerebrum, as it did not exceed the breadth of two fin¬ gers. The veffels of the brain likewife, which creep through the pia mater, were larger than they naturally are, and diftended with a black blood, fuch as was alfo found in the finufies of the dura mater. And through the me¬ dullary fubftance of the brain, when diffefted piece-meal, the fanguiferous veffels appear’d to be very frequent in feveral places, and more diftinCt than ufual. The lateral ventricles were full of a brownifh water, with which colour alfo their furfaces were tinged. Finally, the pineal gland was firmer, larger, and whiter than common ; and feem’d to contain within it a kind of loculi or cells. I will not, however, conceal a remark, which may be join’d to that curious obfervation extant in the Commentaries of the imperial academy at Peterfburgh ( a ) ; I mean, that from the birth, or at leaft from early infancy, the woman had this peculiarity in her fkull, that the right fide pofteriorly, had a larger curve outwards than the left; for which reafon its internal ca¬ vity, and the hemifphere of the brain contain’d therein, were evidently larger en that fide than the other. The fame circumftance occurr’d to me alfo in another woman (/*), and feem’d the more worthy of attention, becaufe the whole cavity of the fkull was made oblique and winding; the right temple being more hollow’d, the left more contracted ; and vice verfa , the right
(a) Tcm. 7. p. 222 & feq. (£) Vid. ut in aliis quoque, epift. 62. n. 15.
fide
(*) N. 2.
Letter I. Articles is, i 6. 15*
lide of the occiput being more contradted, anfwered to the lefr, which was more hollow’d. But though in this woman alfo the lateral ventricles were full of a turbid water, yet as this hiftory does not immediately relate to our prefent fubjedt, we fhall for that reafon give it you hereafter (7).
15. For I do not know whether this woman had been fubjedt to pains of the head; nor yet whether fhe whofe hiftory was juft now related in full, had been troubled with them before fhe was afflidted with a fever : notvvith- ftanding, I know very well from other obfervations, “ that a mifhapen figure “ of the head is believ’d to be of great confequence, in bringing on obfti- tc nate pains which words are copied in the Sepulchretum ( d ) all'o, but the author’s name, to wit, Rolfinc (<?), through negledt, is omitted. But to re¬ turn to the hiftory deferibed. If this woman, and the other young woman fpoken of above (f) in like manner, had been men, and almoft continually employed in fmoking tobacco, that brown and almoft black colour obferved on the infide of their fkulls, fome would have thought, and efpecially for¬ merly, very eafily to be accounted for from thence ; that is, from the foot and dregs of the fmoke being drawn up and harbour’d there ; nor indeed did they negledt to account for it from thence, as we have (hewn by what goes be¬ fore (g). We however, as fome rednefs was mixed with that colour, did not hefitate to attribute it to the ftagnating blood. For though the woman la¬ boured under a lues venerea, yet there was no where any caries in the (leu If, which from the (harp pains might pofiibly have been fufpedted with fome reafon ; although the external furface of the head gave no mark of it either by colour, or tumor. And this is evident from many obfervations, but efpe¬ cially from that of the beautiful (trumpet, which I remember to have heard from Novefio at Bologna, who afterwards publilh’d it (h). The thicknefs then of the dura mater, and its coalition with the interior lamina of the (hull, is fufficient to account for the remora of the blood in the fmall vefiels, as we fhall (hew elfewhere. And I think it is equally fufficient to account for thofe pains, even from the arguments which were above (i) fet forth.
16. And that you may more fully underhand, how coalitions of that kind, by being an impediment to the blood, may bring on pains of the head, re¬ member, that as fome of the fanguiferous vefiels are veins, and fome arteries, the blood which is carried through the latter, will, when it meets with an ob- ftacle, whereby its progrefs is made flower, not only injure, by diftending the fibres, but alfo by encreafing the ftrokes of the vefiels. That is to fay, as many arterial pulfations as there are in the meninges, fo many ftrokes will they receive ; and thefe ftrokes will be fo much the greater, as the tranfit of the blood is more difficult. Thus Brunnerus (£) attributed the violent pains of the head, in a man whofe dura mater was befet with many verrucas of the bignefs of a pea, which were fcattered up and down, but efpecially about the ramifications of the arteries, to the feveral ftrokes of thefe vefiels ; although he confidered the force of the diftenfion only, and not of the percuffion. However, not only coalitions, by diminiftiing the capacities of the vefiels,
(r) Epift. 12. n. 2 (fj N. 12 (^) N. 8
(d) Seft. hac i. Tub obf. 46 (£) Lettres 1. 6
( e ) Ord. & meth. cognofe. dolorem cap. 1. 2. (?) N. 11
f. 2. art. 1 . p. 1. c.,24 ( k ) Eph. n. c. cent. 1. obf. 69
which
i 6 Book I. Of Difeafes of the Head.
which pafs through them, but alio whatever by pricking and vellicating, or comp re fling, can produce the fame effedls, will give occafion to pains of the head.
By pricking did that fharp bony particle, fltuated betwixt the meninges, give occafion to pain, of which you will read in oblervat. iii. an. vii. dec. iii. Ephemer. Caefare^ Nat. Cur. Academ. And by comprefling, that interior ex- oftofis of the cranium, defcrib’d in obfervation ccliii. dec. iii. an. x. the blood being thereby fo obftrudted in the meninges in like manner, that they were almoft a finger’s breadth in thicknefs, and had the appearance of fungous flefh : as alfo that in cent. vi. obferv. xxi. which by the remark added to it, does not Hand alone ; but efpecially that which is extant in obfervation xcix. vol. ii. of the Acts of the fame academy. And I defignedly coliedt you fe- veral examples from the lets antient books, becaufe I fee that many things from tbofe books which were publifh’d before the fecond edition of the Se- pulchretum, have been defervedly transferr’d thither.
17. Nor do we want examples taken from other obfervators, to add to thefe ; two of which I will mention, as they are not inelegant obfervations, and are much to the purpofe of the above difiedtion of the woman ; for they fhew, that too great a quantity of blood diftending the veflels within the fkull, will create pains of the head. One example is that given by Cowper in his Englifh Anatomy of the human body, or if you have not this book, in the Adta Erud. Lipf. (/), and another you will read in the Commercium Laterarium (m). The firil example is of a man, who from his youth had been liable to the pain of which we fpeak, in a violent degree; and in him the vefiels of the dura mater were fo diftended, as to equal the bignefs of a goofe-quill. And left you fhould imagine that this happened on the attack of the apoplexy, which was his late and final difeafe, I will prove to you that this phenomenon was of a very early date ; for the fulcior beds of thefe vefiels, in the internal lamina of the fkull, were fo deep and fo large, as to anfwer entirely to the thicknefs of the vefiels themfelves. And to this obfervation you may alfo add a fimilar one of Bajerus ( n ). The fecond ex¬ ample is that of a woman, who in like manner had been fubjedt from her youth to great pains in her head *, and thefe were always encreas’d in pro¬ portion to the encreas’d quantity or rarefadtion of the blood. For in her the right kidney being out of its proper fituation, had fo comprefs’d the aorta and vena cava againft the lower vertebrae of the loins, that where this vein receiv’d the tfood of the left iliac, a varix was form’d, the diameter of which exceeded the diameter of the cava in almoft a double proportion : and from this it is manifeft, that in proportion as the blood was impeded in its free courfe to the lower extremities, the greater quantity muft have been confe- ^quently carried to the upper parts, and to the head itfelf. And you eafily fee what thefe examples tend to prove ; to wit, that the quantity of blood with which I faw the vefiels of the meninges, and the minute veflels of the brain, diftended fo as to enlarge their peripheries, was fufficient to account for thofe fevere pains of the head, with which the woman had been affedted.
(!) A. 1699 M. Feb. ad Tab. 91 ( m ) A. 1744 Hebd. 43. 1
fo) Aft. n. c. t. 3. obf. 121.
18. As
Letter II. Articles i, 2. 17
18. As to the other things which the hiftory contains, Tome, for inftance the circumftance of water being found in the ventricles, I have explain’d already (0) •, and the remaining circumftances will be explain’d elfewhere. For, as I faid in the beginning, pain of the head is generally complicated with other diforders. Thus I have given you what occurr’d to me at prefent concerning this diforder : and fliall go on to confider others in the fame man* ner, if thefe firft obfervations fnould not be difagreeable to you. Farewel.
LETTER the SECOND.
Which treats, firft, of the Apoplexy in general ; and then in particular of the Sanguineous Apoplexy.
1. T70U tell me, that you was pleafed with my late letter on pain in the X head : but that you expedt thofe which fhall relate to the apoplexy, and other diforders in their courfe, will be fo much the more agreeable to you, as the diforders are more grievous, and attended with more danger. You, at the fame time, afk, whether the apoplexy be really more frequent in thefe days than before, fince you fee two learned phyficians of different opi¬ nions : and, what is ftill more wonderful, as you find both of them appealing to Celfus for a confirmation of their opinions.
2. To begin then with this enquiry : It cannot be deny’d that the following paffage is found in Celfus (a) : Attonitos quoque raro videmus , quorum & cor- pus , Gf mens, Jiupet. Fit interdum idtu fulminis, interdum morbo , hunc atoot^Uv Graeci appellant. “ It fometimes alfo happens, though but rarely, that we “ fee perfons fuddenly ftricken, fo as to have both body and mind render’d “ utterly inadtive. It is fometimes the effedt of a thunderftroke, and fome- fct times of difeafe ; the Greeks call it apoplexy.” But neither can it be de¬ ny’d, that having juft propos’d a very fhort method of cure for thefe atto¬ niti, or fuddenly ftricken, he goes on to fubjoin ( b ), At refolutio nervorum frequens ubique morbus eft. Sed interdum tota corpora , interdum partes infeftat. Veteres authores illud «,Voxah£i/su' ; hoc w&p&hveiv nominarunt. Nunc utrumque 'xapxMiriv appellari video. “ But a refolution of the nerves is every where “ a frequent difeafe. Sometimes, however, it attacks the whole body ; “ and fometimes a part of it only. Antient authors have call’d the firft “ apoplexy : the laft paralyfis. But now I fee, that each of them is “ term’d paralyfis.” But do not imagine that this apoplexy, which he fays was fo common every where, and was at that time us’d to be call’d para¬ lyfis, was a palfy of the whole body, rather than a true apoplexy ; for you muft obferve, that not only the whole body was refolv’d by it, fo that it might be call’d paraplexia (r), but alfo that it fufpended the adtion of the
ft) N. 3 ft) Vid. Galen, apud Gomeum defin, med.
(a) De medicina 1. 3. c. 26 to' ri.
(b) Initio Icq. c. 27 (<J) Cit. cap. 27
• VOL. I,
D
mind :
1 8 Book I. Of Difeafes of the Head.
mind : for in his method of cure for this diforder, Celfus {d) prefently pro¬ nounces, pofi J 'anguinis miffimem ft non redit & motus & mens , nihil ftei fu - •pereffe •, “ if after bleeding motion and fenfe do not return, there remains “ no hope f not to add a!fo, that a paraplexy often fucceeds to an apo¬ plexy (e) fo that if the one is frequent, the other of courle cannot be rare. What diforder then, you will fay, was that apoplexy firft fpokenof by Celfus ? in which he fays, both body and mind were inactive ; but that it was feldom to be met with. If Mercurialis (f)y and other learned men, both before and after him, had not determin’d that to be the true apoplexy, which Celfus there names the attonitus morbus (although attonitus, as Rubaeus (g) obferves, refers more properly to a perfon ftricken with the difeafe, than to the difeafe itfelf) I fhould perhaps have taken upon me long ago, to doubt, whether the word stVoTTAnf/ai' was a corrupt or a genuine one. For I fometimes fufpedted, even when I wrote the laft epiftles on Celfus, that fome other diforder, fup- pofe the catalepfy, or fome one fimilar thereto, which we lee but rarely, was intended by him in that paffage : for in the catalepfy both the mind and the body are inactive ; and this alfo happens fometimes from a thunder-ftroke, from whence they are properly call’d attoniti, or thunder-ftruck (h). And indeed I ho’p’d that my fufpicion was confirm’d, and that fome reafons for an emendation of the paffage might be drawn from Cselius Aurelianus ; who having treated more largely of the catalepfy (i) than any of the ancients whole works are extant, has taught us, who, in the early ages, firft fepa- rated this diforder from others, and gave it that name; and what method of cure was made ufe of by each. But being ftraiten’d for want of time, and delay’d by a kind of inconftancy, which ought perhaps to be attributed to the bookfellers ; and as I found that it afferted, that Afclepiades “ had “ called it catalepfy,” and prefently, “ that he had not given it this new name, “ but his followers I thought it would take up a great deal of time and pains to difcufs the fubjeft ; nor was I willing to compare the method of cure of Celfus with that of Themifon, who had liv’d fome time before. What you will determine upon I can eafily guefs, not fo much perfuaded by my own opinion, as by that of the very learned Gerard Van Swieten, who, in juftice to his merits, is the ennobled and imperial archiater. For when I perus’d the third volume of his Commentaries (£), which was very kindly lent to me while 1 was revifing this epiftle, I was rejoic’d to find that he had made the fame conjedure with myfelf ; and unlefs you agree with it, I hope you will find fome method to reconcile the difficulty that occurs ; which is, that one and the fame diforder is feldom feen, and is yet common every where.
3. But that before and after Celfus, the apoplexy was a frequent diforder, not only Hippocrates has Ihewn, but other obfervers of difeafes have con¬ firm’d ; for if this diforder had been but rarely feen, Hippocrates would Scarcely have number’d it among the difeafes which happen for the moft part “ in very rainy weather (/),” and alfo “ in winter (*») 5” and the other obfervers alfo, when they quoted his opinions, not only did not doubt of
O Apud Gorra’um Icc. citat.
(f) Pr»ied. Patav. 1. 1. c. 19
( g ) Annot. in cit. Celfi c. 26 O Servias ad v. 172. 1, iEneid
(/) Acut. morb. 1. 2.c, 10. 11. 12. & Cbron. 1. 2. c. 5
(k) In Boerhaav. Aphorefm. § 1007 (/) Seft. 3. Aph. 16 ( m ) Ibid. Aph. 23
their
Letter II. r Articles 4 , $. 19
their truth, but even confirm’d them by their own obfervations. Thus Hob lerius (to) gives an account of many whom he faw become apopieftic, 44 in “ a cold and damp ftate of atmofphere.” Thus, not to be too prolix, Foreftus (5), after producing his obfervations, fays, 46 the whole ftate of tc weather was at that time rainy, attended with foutherly winds ; and from 45 the beginning of December to the eighteenth day, many died apopledtic “ and convuls’d.” And indeed he has in general afterted, 44 that in his moift u and cold regions of Holland, the apoplexy was not rare, but even very 44 common ; common alfo in places which were cold by their natural fitua- 44 tion; as at Florence, Luca, and Bologna,” where he had ftudied for fome time; 44 and alfo in Germany and Britain, from the nature of the climates.” And thefe two phyficians had obferv’d thefe things about a hundred and fifty years before the beginning of the prefent age ; or if Foreftus was a little later, Jacchinus (p) certainly was not; and from him many of thefe things are let down in his own words, though Foreftus conceal’d his name.
4. But do not believe, that I fay thefe things in order to difavow what I very well remember ; I mean, that about the beginning of this age fudden deaths were fo common, that the people were aftonilh’d and terrify’d with the novelty of it. But this I fay, that it has happen’d in our times, and in other times alfo ; fometimes at longer, and fometimes at fhorter intervals, as the nature of the feafons has admitted ; and not only of thofe which are mention’d for the fake of example, but of others alfo, as I fhall (hew on a proper occafion ( q ) ; and that more or lefs, according to the fituation and con- ftitution of the countries, and the manner of living more or lels agreeably to the feafons. There even was a time when, among other peftilential dif- orders, which were perhaps the confequences of a noxious air from the ad¬ jacent places; and certainly of changing a laborious life into an idle and lux¬ urious one ; 44 that moft fevere difeafe, the apoplexy,” rag’d alfo ; as you will learn from Agathia(r). Who alfo defcribing another peftilence in the fame fixth century (j), after enumerating other kinds of death, fays, 44 that 44 a great number died of a fudden likewile, as if they had been feiz’d with 44 that dreadful diforder the apoplexy.” Then add this alfo, that not all the fudden deaths at the beginning of our century, were the effedts of apoplexy, but many were from fyncope, and fome from fuffocation. Laft of all, I affert, that of the many who died of an apoplexy in the fame month, or even in the fame day, all did by no means difcover the fame injuries in the brain; but fome of thefe appearances were widely different from others, and pro¬ ceeded from different caufes ; and fome of them were not recent, but of long Standing, as foregoing fymptoms had teftified. And this being in like manr ner obferv’d from diftedtions, gave much eafe to the minds of thofe, who were ready to attribute the great frequency of fudden deaths, to fome com¬ mon caufe which lay hidden in -the air.
5. For although the proximate caufe of every apoplexy, and that which contains the difeafe, feems to be one ; that is, a fudden diminution of the internal motions perform’d in the brain, to wit, when we move, think, or
(n) De'Morb. Int. 1. i. c. 7. in Schol. ' (?) Epift. 3. n. 13. 29
(0) Obferv. Med. 1. 10. obf. 70 (r) De Bello Gotth. 1. 2
(p) Vid. Init. c. 9. Com. in Raf. (i)'l. 5 -
D 2 perceive:
2o Book I. Of Difeafes of the Head.
perceive : and though this imminution is fometimes To great as to approach almoit to a ceffation, or immediately to degenerate into it; yet there are many and various caufes that bring it on. Tome of which entirely efcape the notice of the fenfes, though others fall under their obfervation. And we will endeavour, as far as we can, to form a conjecture about the former of thefe caufes, where the cafe fhall fometimes compel us. But, at the fame time, 1 lhall fpare no pains to defcribe clearly, and diftin&ly, thofe which are generally manifelt, and appear within the fkull.
6. Thefe lad-mention’d caufes, for the mod part, exift, either in the blood, or the ferum, though fometimes they are otherwife applied. But we will purlue the two more frequent caufes fird ; and leave the more rare to be confider’d in the lad place. For this being frequently obferv’d, gave rife to that celebrated divilion of the apoplexy into fanguineous and ferous : and they who have difapprov’d this divifion, have done it, I fuppofe, partly for this reafon •, becaufe they fhould then confider the continent caufe, more than the efficient caufes, and the advantage proceeding therefrom in the prognodication and cure ; but partly alfo, becaufe they did not confider the effufion of ferum as a caufe, but as an effeCt. Though of this matter I have already fpoken(/), and will again fpeak ; and I believe that one reafon for rejecting it was, becaufe they wiffi’d to explode all the opinions of the an- tients : and with them this dogma was perpetually inculcated, that apo¬ plexies in general had their origin from too vifcid a ferum, in the ventricles of the brain. But doubtlefs the prejudices of the moderns, againd antient doCtrines, have often carried them too far beyond proper bounds.
7. Yet the more learned phyficians have by no means been ignorant, that even the fathers of phyfic acknowledg’d an apoplexy from a fanguineous caufe; though the greater part of them believ’d the contrary. I fhall not bring quo¬ tations from Hippocrates and Galen, for you have them in theSepulchretum(«), as alfo the words of Turrifanus (x), who, in the fourteenth century, fhew’d that fuch a pafiage exided. And others, in the fifteenth and fixteenth cen¬ turies, efpecially among the Italians, went on to do the fame. Among thefe, were Jo. Matthaeus de Gradi (y), Jacobus Berengarius (z), Leonardus Jac- chinus (a), but particularly Petrus Salius my neighbour (£), in the whole of that' leparate chapter, which he entitled, “ Of the fanguineous apoplexy.’* Although fome of thefe underdood the thing differently from others, yet perhaps none of them, except Salius, believ’d that the diforder was brought about in the manner we generally fee it, and as I have frequently inculcated; and he himfelf even thought it happen’d but rarely. Yet Avicenna (r) formerly advanc’d this doCtrine, to wit, when he pronounc’d that the caufe of the fecondj and more frequent kind of apoplexy from repletion, “ was “ either a fanguineous humour, effus’d fuddenly about the ventricles, or a “ phlegmatic humour, which for the mod part gave rife to the fecond fpe- “ cies of apoplexy.” But a little before Salius wrote, another Italian, Leo¬ nardus Botallus, and Ludovicqs Duretus, a Frenchman, though his book
(/) Ep’ft. 1. n. 3. & Epift. 4. paffim.
(&) 1. 1. S. 2. in Addit, in Schof ad obf. 1 & J.l
(x) Ibidem (j>) Prax. tr. 2
(2) Ifag. ubi de Anat. part, colli. («) c. 9. cit.
(b) c. 2. de AfFedl. particularib. (<-) Canon. 1. 3. F. 1. tr. 5. c. 12
was
Letter II. Article 8. 21
was publifh’d fomewhat later, had feen the blood effus’d about thofe ventri¬ cles of apopleCtic bodies, as the words of both which are quoted in the Se- pulchretum (d) evidently fliew; lb that it is altogether amazing, that Cafpar Hoffman (<?), who was in every other refpeCt fo learned a phyfician, fhould afk, “ Who ever law the ventricles fill’d with blood in an apoplexy r” More¬ over, Profper Martianus (/) thought, that the apoplexy happen’d fo fre¬ quently, from blood, not extravafated, in the ventricles, or fomewhere elfe within the cranium, or at leaft from fome other caufe, befide a cold humour; that he did not hefitate to affirm, “ that of the three fpecies of apoplexy, <c one only, and that rarely feen, was to be afcrib’d to the cold juices, ac- “ cording to the opinion of Hippocrates.” To this you may add, that Variolus (£), writing to Mercurialis, had appeal’d to the diffeCtions of thofe perfons who die apopleCtic ; and in conlequence of his own diffeClions, fpoke thus : “ In the ventricles of the brain of apopleCtic perfons (I hope you will “ believe me) no greater quantity of excrementitious matter is found, than “ is commonly found in thofe of others and this, confider’d with the for¬ mer teftimonies, will plainly convince yon, that not only before the more modern times, there were fome who allow’d of a fanguineous apoplexy, but that there were even fome who afferted, that an apoplexy very feldom, I will not fay never, ow’d its origin to excrementitious ferofitics effus’d in the ven¬ tricles.
8. However, that this diforder is at one time to be accounted for from blood,, and at another from ferum, is not only confirm’d by the many obfervations collected in the Sepulchretum, but alfo by many others publifii’d fince the fecond edition of that book; and thefe I fhall mention hereafter, as occafion may require ; but at prefent fhall fpeak only of what were committed to writing, at the fame time with thofe of Duretus and Botallus ; and in France likewile, by an Italian phyfician, as he feems to have been, and whofe other obfervations certainly very well deferve to be publifh’d, by the very learned Targioni, as he was certainly no common, but an eminent man, as we may judge from thefe remarks of his given us by Targioni (h). “ In the diffec-
“ tion of Madam de Mauvoifin, who died in child bed, apopleCtic and epi- “ leptic at the fame time, I obferv’d that the whole left ventricle of the brain “ was full of a watry blood, ferous, putrid, and difcolour’d, and that the “ veins of the plexus retiformis, together with the arteries, were tumid, as “ if inflated, and of a black colour: as alfo in Monfieur de Boy fly, great “ fhield-bearer of France, the whole right ventricle was moiften’d with blood. “ Therefore, it is not without reafon, that Lampridius fays of Severus Csefar, “ that he died from a ftroke of the blood, which they call an apoplexy ; for “ in moft who die of apoplexies, we fee extravafations of blood in the ven- “ tricks.” Nor would I have you difpleas’d to find that he has, in making a memorandum for his own life, happen’d to forget names, and has fet down Severus inftead of Lucius Verus, and Lampridius inftead of Sextus Aurelius ViCtor, whofe words in the epitome, concerning Lucius, are thefe (/), to-
(d) Sett. cit. obf n. n. 2 & obf. 16 ft) De Nervis optic. Epift. 2
(e) Vid. Schol. ad cit. obf. 11 ( b ) In fine della Defcriz. d’un Tumore Foil ic.
{/) Adnot. in Hippocrat. de morbis 1. 2. ft) Hift. Aug, Epilom. in M. Antonin.
vexf. 64.
2 2 Book II. , Of Diforders of the Head.
wit, that he died “ of a ftroke of the blood, which difeafe the Greeks call 44 apoplexy from whence you will underftand, that even in the fourth century, the fanguineous apoplexy was known-, or, if you are in the number of thofe who afcribe this epitome to an uncertain author, turn to Eutropius’s hiftory (£), which was written in the fourth century alfo, and before the epi¬ tome, and you will read, that Verus died 44 fuddenly, ftricken with blood, “ a falling difeafe which the Greeks call apoplexy.” And that the difoider of Verus was, in effieCt, no other than a fanguineous apoplexy, is prov’d from what Julius Capitolinus (/), in the third century, had laid of his life, dif¬ eafe, method of treatment, and death. For after defcribing his banquets and his plate, he fays, 44 that he was feiz’d fuddenly, as he was travelling near 44 Altinum, with the diforder call’d apoplexy and being taken out of the 44 vehicle, and let blood, he was carried to Altinum, where, after lying three 44 days fpeechlefs, he died.” And with this paffage of Capitolinus we mull not omit the remark made by Egnatius (m) a little above, where the fame hiftorian had mention’d that apoplexy of Verus as it will make us more and more underftand, how frequent a diforder it was in the fixteenth century: 44 The apoplexy,” fays he, 44 being a very frequent difeafe among the peo- 44 pie, in thole years wherein thele commentaries were written, by reafon of 44 the immoderate ufe of wine and venery.”
But I return to prove the exiftence of ferous apoplexies ; and that from the writings of the fame obfervator, who has allur’d us, that in moft apo¬ plectic patients he faw blood pour’d out into the ventricles. For thefe words are intermix’d with thofe given above: 44 In others who died of apoplexies, 44 I faw the ventricle lull of the moft limpid water; whereas in a natural 44 ftate it is entirely empty.” And the exiftence of the two fpecies will be equally confirm’d, by the obfervations which you will fee taken, firft from Valfalva’s papers, and then from my own. Yet I will not do here what is done in the bepulchretum : that is, I will not mix with thefe diforders thofe which were the confequence of wounds and blows on the head ; but will defer them to a more proper opportunity : and thofe which v/ere publifh’d before, by either of us, I fhall only refer to. Yet even with thefe omiflions, this letter would be very long ; unlefs we fhould give you, at prefent, only the greater part of the diffeCtions which relate to the fanguineous apoplexy; and leave the remainder of them, and thole that relate to the ferous, to be fub- jeCts of a future letter.
9. To begin with a great man; whofe hiftory is for that reafon more ac¬ curately defcrib’d by Valfalva: The Cardinal Antonio Francefco Sanvitalis was of a moderate ftature, or fomewhat taller, of a full flefhy habit, and a florid colour : he had been much given to ftudy and clofe application ; was alfo Fubjedt to the gout, and had fome years before been attack’d with a cer¬ tain ineffectual irritation of the fauces, to fpit : and befide this, he was alfo troubled at intervals, with convulfive motions in his feet and hands. Fi¬ nally, when he was five-and-fifty years of age, having liv’d for two months together in a mountainous country, on which the fouth winds generally blew, and the air of which he had at other times found extremly inimical to him ;
(*) Hift. Rom. 1. 8. (/) In Vero Imperat, (m) Annot. ad Capitolini M. Antonion. Philof.
• . ' ’ - and
Letter II. Article io. 25
and being alfo troubled with cares and anxieties of mind, and the winter folftice of the year 1714 being at hand, he fell into a vertiginous diforder ; after which, although he was freed therefrom, he fhew’d a conflant fadnels, and propenlity to fleep. Within about twenty days the vertiginous diforder return’d, and brought a vomiting with it. Yet both thefe were in a fhort fpace remov’d, and after that a violent pain of the head, which had fucceeded them. But the day following, at the fame hour on which the vertigo had feiz’d him, all fenfe of feeling and power of motion was loft in the left part of his body, and he lay as if overcome with a profound deep. His refpira- tion, however, was natural*, but his pulfe frequent, large, and vehement; and though it was in vain to irritate the left limbs, yet the fame irritations being applied to the foie of the right foot, and the ufual ones to the noftrils, he was fomewhat rous’d, fo as to fay many things by figns, and fome even by proper words. But thefe irritations had a happier efFedt after blood being taken away ; more efpecially on the dxth day from the apoplexy, when the right jugular vein was open’d by Vallalva’s order; for about four hours after, his internal fenfes were awaken’d; and his fpeech, for more than an hour, was reftor’d. The fame change happen’d, about the fame hour, on the fol¬ lowing night, and was more evident, and of longer duration. But this roufing was his laft : for from that time he gradually declin’d ; and was leiz’d with convullive motions on his right fide, efpecially in his hand and foot: his whole face was likewife convuls’d, but efpecially about his eyes, and perhaps the heart itfelf ; for he frequently at the fame time lay entirely without pulle. In fine, thefe fymptoms recurring about the beginning of the tenth day, he died.
In the belly and cheft every thing was found in a natural ftate. The brain, however, was flaccid ; and in the left ventricle was a little ferum ; but the right contain’d more than two ounces of coagulated blood. The plexus choroides was here torn through, and the parietes of the ventricle, even on the external fide, toward the back part, were corroded into the form of a deep ulcer.
10. Many things concurr’d to difpofe this great man to an apoplexy : ftudies, clofe applications to important bufinefles, anxieties of mind, and even the gout itfelf, which often draws after it a calculous, and at other times an apopledlic, affedtion. In reading hiftories of this kind, pleafe to ob ferve, among the reft, thofe of a prince, and a count, both of whom were gouty, both apopledlic (») : and befides cyftic calculi in each, the lateral ventricles of one were full of ferum ; but thofe of the other, which is more to our prefent purpofe, were full of extravafated blood. Many of thofe common ligns which Caelius Aurelianus (0) formerly collected, foretold the apoplexy of the cardinal, to wit, the convulfive motions of the hands and face ; and even, as I think, the convulfive motion of the fauces too : next to thefe, the repeated vertigoes, which were follow’d by a pronenefs to fleep, fadnefs, and a violent pain of the head ; which fo far proclaim’d the approach of an apoplexy, that the laft vertigo may be in fome meafure taken for a kind of flight apopledlic paroxyl'm, inafmuch as a more heavy one iucceeded it on
(«) Eph. N. C. Cent. 4. obf. 169. (c) Acut. Morb. 1. 3. c. 5.
the
24 Book I. Of Difeafes of the Head.
the following day, at the fame hour. That this apoplexy was fanguineousr, the quantity of blood, demonftrated by the florid colour, might have (hewn, as alfo the rarefaction brought on by the fouth winds ; the veflels, now grow¬ ing rigid with age, being prefently flreighten’d by the winter, and on both thefe accounts made eafily liable to rupture. Nor yet was the apoplexy vio¬ lent in its beginning or progrefs ; as the natural relpiration, and the power of feeling and moving, not being wholly taken away, even on the left fide, con- curr’d to fhew. This was alfo teftify’d from the fpeech, together with the inter¬ nal fenfes, being once, and again, and even a third time reflor’d ; ’till at length, a laceration in the brain being encreas’d, and the blood more effus’d, the diforder became fatal. Nor was the febrile pulfe of the leaft advantage, though it at¬ tended from the very beginning of the diforder : nor yet the fever itfelf, if you will allow me to fuppofe what, I think, the remiffion and exacerbation, fome- times obferv’d at the fame hour, did in fome meafure fhew. I will even ven¬ ture to fay, that it was of great difadvantage, by ftrongly agitating and im¬ pelling the blood : fo that among the many and various things given out by the interpreters cf Hippocrates, and other antient as well as modern phyficians, of a fever fucceeding an apoplexy, this leems to claim the firfi: place here, that although, in the ferous apoplexy, it may fometimes be ufeful, yet it is rather hurtful in the languineous ; and the very experienc’d (/>) Werlhof has affirm’d, that an apoplexy is rarely folv’d by a fucceeding fever. But on the other hand, blood-letting had all the advantage it couid poflibly have, efpeciaf y from the jugular vein ; and that the right too., asValfalva, who flew from Bologna to the cardinal, has laid down as a maxim, taken from his ob* fervations on patients afflicted with a hemiplegia ( q ), and as difieCtion alfo at that time confirm’d. For the mifchief was in the right fide of the brain, whereas the left fide of the body was refolv’d ; whic h you will find was alfo the cafe in the dilTeCHons that follow. But I would have you obferve, that in opening the jugular vein, Valfalva took care, that what has been objected to many who ufc that remedy in apoplexies, fhould not be objected to him: that is to fay, he took care, that the difficulty of relpiration, already fo noxious to patients of this kind, inafmuch as it refifts the return of the blood from the brain, fli uld not be encreas’d by a bandage round the neck. Or if by the method wdiich the celebrated Heifter ( r ) recommends, a more lax bandage be drawn downwards to the cheff, fo as to comprels the jugular veins, and leave the afpera arteria free •, yet he was aware, that even this pref- fure impedes the return of the blood: and the manner alfo at prefent approv’d of by fome, which Berengarius Carpenfis ( s ) formerly defcrib’d, could not take place in an apoplectic perfon •, or if it fhould be made life of, it would not only by confining refpiration obftruCt the blood that was defending from the brain, but by means of the girdle with which the belly is conftring’d, would caufe much more blood alfo to be carried to the head. Valfalva, therefore, order’d the jugular vein to be open’d in apoplexies, not only preferving the natural refpiration, but alfo taking care to have the quantity of blood dimi-
(p) Vid. Commere. Litterar. a. 1734. hebd. ( r ) Inftit. Chirurg. p. 2. f. 1. c. 7. n. 1.
49, in fin. ' ( s ) Jfagog. in Anat. ubi de anat. aliquar.
(g) Trad, de Aure, c. 5. n. 8. part, colli.
nifli’d
Letter II. Article io. 25
nifh’d by prior ven&feCtions. So that there was lefs danger now from the compreffion of the jugular, (though the compreffion of the finger only, I know, is us’d at other times) than hope from its incifion ; and there was lefs realon to fear, left a ftreighter bandage fhould be afterwards neceftary to com- prefs the orifice of the vein. For as to its being moreover objected by others, that though it indeed be true, that by opening the jugular vein, blood is im¬ mediately drawn down from the brain, yet that fo much the more is, for this very reafon, carried up thither by the carotid artery; certainly Valfalva was by no means ignorant, that the external jugular, which we open in the neck, does not immediately bring back the blood from the brain, but the internal, which we cannot come at to open. Fie knew alfo, that the internal carotid artery, which carries blood to the brain, did not anfwer to the external, but internal jugular ; and that the external carotid, which goes to all parts of the head, fituated on the outfide of the brain, correfponded to the external jugular-, and that confequently, as upon this vein being open’d, the refiftanc.e of the blood, flowing to thefe external parts, is taken off, more blood is of courfe carried by the external carotid, and lefs remains to circulate through the internal to the brain. Nor am I here afraid left you objeCt, that there are fome communications betwixt the external and internal jugular-, for you fee it does not for this reafon happen, that blood is immediately drawn down from the brain : and ftill lefs, that it is drawn in fo great a quantity, as mult neceflariiy happen, if it were allowable to open the internal jugular ; for the internal jugular is a continuation of thofe finufies, in which the whole quan¬ tity of venal blood from the brain is collected, and has a much greater dia¬ meter than the external ; not to fay, than fome little branches of the external, which I have affirm’d to communicate with thofe finufles. And among thefe branches, if you pleafe, you may reckon the occipital vein ; for you will find, that on account of this immediate communication, I have recommended (/) taking blood from this vein, in many diforders of the brain -, but elpeci- ally in a certain obftinate lethargic diforder, as the celebrated Fleifter (u) has obferv’d. But I would not have it underftood, that bleedings or cuppings from fmall veins, are by any means to be compar’d with bleedings in the veins of the arm, or jugular, in the cure of a fanguineous apoplexy : and this caution I give, becaufe fome will, perhaps, be led to imagine it from the reading of Hoffman (#). Hoffman, however, did right not to negleCt to mention this kind of affiftance, as it was fo much approv’d by Soranus, as I afterwards obferv’d (y), “ in complaints of the head and by that eminent phyfician Ingraffia, “ in hot affections of the brain;” and fince it is fome- times neceftary even in the apoplexy itfelf, as you will gather from the ob' fervation of Zacutus, which I formerly pointed out. For by means of two deep fcarifications and cuppings in the occiput, he reftor’d an apoplectic young man, who had fo feeble a pulfe, that his death feem’d at hand, and who was incapable of difpenfing with any more violent remedies. Mead (z) alfo, the illuftrious Englifh phyfician, confirms “ the very great utility ” 0 1
(/) Sett. cit. c. 5, n. 2. [y ) Epift. Anat. 4. n. 11.
(») Adv. Anat. VI. animad. 83. ( z ) Monit. Medic, c. 2. f. 1.
( x ) Medic. Rat. t. 4. p. 2. f. 2. c. 7. Thef.
Therap. § 3.
Vol. 1. E
this
26 Book I. Of Difeafes of the Head.
this practice y and fays, that tc having made the experiment in feveral cafes “ of the molt dangerous apoplexy, it had greatly alleviated the diforder.” But no body has treated more copioufly and accurately of this remedy, than the celebrated German profelfor Aug. Fred. Walther, who, as well as Mead, always teftify’d great humanity towards me. This gentleman, in his Difiertation “ on the fcarification of the occiput, and its ufe in many diforders “ of the head,” when he mentions its utility in other diforders, among which are the phrenitis, the paraphrenitis, convulfive and lethargic difeafes, and the epilepfy itfelf *, as alfo long-continued ophthalmies , angina, vertigo, and obfti- nate headachs, though from the beginning fympathic, fo that they are but from the blood ; mentions alfo the ufe of it in fanguineous apoplexies, and proves it from the obfervations of others, but efpecially from his own. And befides thefe two modern authors, I would refer you on this head to Aret^us ( a ), that great mailer of healing among the antients ; who gives us this admonition as to the method of cure in apoplexies : “ When the difeafe “ is long protracted, and the caufe is in the head, cupping- glafifes mult be “ fix’d to the occiput, and blood muft be plentifully drawn •, for this appli- “ cation is of more ufe than vengefedlion, and by no means reduces the “ ftrength, &c.” But let us return to the obfervations of Valfalva.
11. A man of fixty years of age, of a fanguineous temperament, and en¬ dow’d with a good habit of body, by accident had a fall in walking, and flruck his head violently againft the ground. Being (lightly ftupid, his fore¬ head being bruis’d, and blood gufhing out from his noftrils, as alfo a palfy of the left arm having follow’d thele fymptoms, fo that neither fenfe nor motion remain’d in it, he was brought into *he hofpital of Sandla Maria de Vita at Bologna. He had a full red colour in his face, a laborious refpiration, a hard and moderately quick pulfe ; but in every other refpeCt there was no preternatural appearance, except the paralyfis already fpoken of. On the fourth day he was fpeechlefsj on the beginning of the fifth he died. In the belly and cheft every thing was natural : the os frontis bore no mark of in¬ jury, that the fenfes could perceive *, though a little blood was taken away from between the teguments and bone, which had (lagnated therefrom the contufion. Upon opening the fkull, the dura mater (hew’d only a (light mark of contufion, which did not reach to the pia ; but in the right ventricle of the brain, about two ounces of extravafated blood were found concreted : and the corpus ftriatum, with a part of the plexus choroides, was fo much eroded, that fcarce any veftige of it remain’d.
12. Do not imagine, that when I introduce this hiftory here, I forget my own refolution ; and that this (liould be rather related with thofe which de¬ rive their origin from blows of the head. It is true, that thofe hi ftories alfo, as you will fee in the proper place (£), furprifingly confirm the obfervation. of Yallalva in hemiplegias, which I mention’d above (c) y but I do not want, them at prelent. This hiftory, however, I transferr’d into the prefent letter, becaufe his opinion and mine of this apoplexy are different. Nor do I at¬ tribute it to his accidental fall, but the fall to it ; and I am induc’d by the.
(«) De Morb. Acut. Cur. I. i. c, 4, (£) Epift. 51. (<-) N. 10.
argument,
Letter II. Articles 13, 14. 07
argument, which Laubius (d) could not ufe, to determine a fimilar queftion, in almoft a fimilar cafe. That is to fay, my argument in the cafe before us, is from the nature of the mifchief, which lay hid in the brain ; and from its likenefs to that which you have read of above. From both of them a fatal apoplexy at length happen’d, as above explain’d (e) ; but the former difeafe was the more flight ; as the latter not only entirely took away the power of feeling and moving in the upper limb * but feems alfo to have taken away, for a little time, the power of moving, at leaft, in the lower : fo that, in the beginning of the diforder, the man muft inevitably, and fuddenly, fall. But however you may determine on this queftion, you will fee that the dodrine, for which Valfalva was an advocate, is always confirm’d by this obfervation. But I will give you Fill a ftronger argument of this, from an obfervation of V alfalva’s.
13. A woman of feventy years of age, had for many months declin’d in her memory; nor did flie always fee objects, when plac’d in a certain pofition; and as fhe walk’d, fcarce rais’d her feet from the ground. She having been feiz’d a year before with a fudden diforder of her head, had, by good for¬ tune, immediately recover’d : but now ihe fell down fuddenly, as fhe was eating; and became paralytic on the whole left fide of her body, and in her right arm. Her refpiration was altogether natural, and nearly fo the colour of her face, which in her was pale, nor did any convulfions appear ; but her head fell juft like that of a dead perfon ; nor did fhe give any fign of underftanding or feeling, unlefs that when an incifion was made into the ju¬ gular vein, fhe in fome meafure, contracted herfelf. She liv’d nine hours. The ventricles of the brain were found to be fill’d with a fluid blood, and the right was very much eroded, as well about the external margin of the corpus ftriatum, as of the thalamus nervi optici ; but the left about the tha¬ lamus alone, and that flightly. The plexus choroides could fcarcely be ob- ferv’d. The other parts were all found.
14. You fee that the brain had the leaft injury on that fide on which the body was mod refolv’d ; and on the other hand, that on the fide where the brain was injur’d mod, the body was leaft refolv’d; and the mifchief done to the thalami of the optic nerves, correfponded to the defect of vifion. But fome other things may be gather’d from this hiftory. Petrus Salius (/), indeed, the better to diftinguifh a fanguineous apoplexy from that which has its origin from cold humours, has given us many marks, for this purpofe, which are by no means contemptible; unlefs any one fliou Id forget, that marks of this kind are not to be confider’d apart from each other, but that mod of them are to be confider’d in conjunction. For they who had at¬ tended only to thefe things, “ that if a perfon labouring under an apoplexy, “ be old, or be a woman ; if there be not a rednefs, but palenefs in the tc countenance, the diforder is from cold humours ;” would have been much deceiv’d in this pallid feptuagenary. And thefe things I obferve for this rea- fon, becaufe I remember, that when a nun of eighty years of age, who was re¬ lated to me, was feiz’d with a flight apoplexy, which threaten'd a more vio¬ lent one, 1, though a young man, did not hefltate to agree with that phyfi-
{d) Eph. N. C. Cent. 9. ob £63. ft) n. 10. (f) 1. et c. cit. fupra ad n. 7.
E 2 cian,
28 Book I. Of Difeafes of the Head.
cian, who thought blood-letting, and the more temperate remedies, fhould be made ufe of, rather than agree with others, who, difapproving this treat¬ ment, inculcated a contrary method of cure. Thefe gentlemen confider’d the age only ; but we confider’d the other figns which indicate a fanguineous apo¬ plexy. The event vindicated the refolution ; for by this method the patient was once and again reftor’d : and this method might have been more ftrongly defended, againft thofe who difiented from it, if the obfervation of Lan- cifi (g), made upon a merchant of a great age, had been then publifti’d. This merchant had very grievous fymptoms of an approaching apoplexy, which \vere much alleviated by a lofs of blood from his nofe, to the quan¬ tity of eleven pounds : and after fifteen days, he was entirely cur’d, by the return of this haemorrhage, to the quantity of four pounds. In refpeCt to thofe two alfo, of whom we have written before, and as many, of whom we fhall write prefently, if you had attended to their age only, you would have deny’d that the dilorder was a fanguineous apoplexy. And it has even happen’d, that out of twenty-three oblervations, made by Valfalva and my- felf, which now lie before me, if you reckon thofe two produc’d in the Anato¬ mical Epiftles(£), there are to be found in them all, but juft three cafes which relate to youths, and four which relate to middle- ag’d men. And though it is more frequently true, that the apoplexies of old men degenerate into long-continu’d palfies, and thofe of young men are foon mortal : yet I have feen the contrary happen in both cafes, and that not rarely. And that thofe are the moft violent, and much the fooneft mortal, which have their origin from blood, extravafated within the cranium, we not only have daily proofs of ourfelves, but it has alfo been frequently obferv’d by others. But not thofe only are mortal, nor all of them, or certainly not at all times of the difeafe. Tor the woman whofe hiftory is laft defcrib’d, liv’d only nine hours: yet the great man, of whom I firft wrote, was preferv’d to the tenth day. So that the effufion of blood does not feem to have happen’d on the firft days of the difeafe, but rather on the laft, as I faid above (7) ; and there¬ fore it feems, that the apoplexy at firft was not violent, as I have confirm’d by the ftate of the fymptoms, and efpecially by the natural refpiration. For you know, that the principal criterion, by which phyficians determine the ft ranger or weaker degrees of apoplexy, is the greater or lefler change of the refpiration from its natural ftate. Although, by way of proof that icarcely any thing is perpetual in medicine, you fee, that in the cafe of this woman, the refpiration was not only “ equable and regular,” as in another woman differed by the celebrated Veratti (X'), which cafe fhould be com¬ par’d with this-, but that it was altogether natural. And in the old man, whole hiftory I am about to relate, you will be able eafily to judge, how late alter the effufion of blood into the ventricles of the brain, deatn follow’d.
1 5. A certain old man, long before death, had been feiz’d with an apo¬ plectic dilorder, and from thence the whole right part of his body had re¬ main’d paralytic. Ilis fkull being open’d arter death, the inferior part of the left ventricle was found corroded, together with its plexus choroidesr
(g) De Subit. Mort. J. 2. c. 5. n. 8. (^) Comment. Bonon. Sc. Acad. Tom. 2.
(&} XI.1I. n. 19. & 25. (/) r,. ic. P. 1. in Medicis.
about
Letter II. Article 1 6. 29
about which were polypous concretions of blood. So that this apoplexy feem’d to have had its origin from the corrofion of both thefe parts, and from the blood that was confequently pour’d into the cavity of the ventricle.
16. If Valfalva, in this hiftory, feems to write wonderful things ; how much more wonderful mull they feem, which are related in the Sepulchretum, and taken from Wepfer (/), another very grave writer. In a certain noble Pole, 44 without apoplexy, or any other grievous fymptoms,” not only within the cranium and meninges, but alfo, as he fays, 44 in the very fubftance of the 44 brain itfelf, blood was extravafated, without any diforder being the conie- 44 quence.” 46 But with reafon,” fays the perfon who copies ir, 44 do we,” as Wepfer himfelf does, “ put fuch things in the catalogue of thofe that are “ moft rare.” Yet Brunnerus (m), a man of folid judgment, in the cafe of a woman whom he had cur’d of an apoplexy aim oft five years before her death, did not doubt to colle<5t arguments, either from what he had obferv’d in her life-time, or what appear’d in her brain when dead, which induc’d him to believe, that blood was even at that time effus’d into the fubftance of the brain. For in one hemifphere he found 44 three little caverns, which “ had been long form’d, lying round about the corpus ftriatum, now grown 44 callous, and cover’d over with a cicatrix *, the whole hemifphere being for “ that reafon flaccid, of a dark yellowifh colour, and appearing fhrivell’d, as 44 if from an atrophy and I would have you obferve with me, that fome things fimilar to this occurr’d to thofe worthy men, Anthony Leprotti and Jano Planci, who were in the number of my friends. For this is part of a letter that Planci wrote to me on the firft of April, in the year 1721, from Rimini. 44 A few days ago we differed the body of that man, who con- 44 fulted you laft June at Padua, upon a hemiplegia, which had remain’d in 44 his left fide, from a violent fit of apoplexy. Yet he did not die of this 44 diforder, but from a dilatation of the heart and precordia, which you, from 44 the remedies you fo aptly prefcrib’d, feem to have been fenfible of at that 44 time. But the right hemifphere of the brain, towards the temple, feem’d “ to have been eroded with a kind of abfcefs ; for there the fubftance of is 44 was wanting to about four inches in breadth, and an inch and half in 44 depth. And the thalamus nervi optici, on that fide, was lefs by two 44 thirds, than the left: befides, it was- of a dun yellow, and appear’d to 44 have been clos’d by a cicatrix.” Nor, indeed, was 1 myfelf without a particular obfervation of this kind, before l read over again this letter, when lent back by you ; and this 1 [hall lend you, with fome others («). And, in- deen, I alfo happen’d to light on an obfervation of Jo. Wilhelmus Albrech- tus (0), in which, under the cranium, that had been depreis’d thirty years before, but never perforated ; and under the meninges, which were unhurt, he found a pit or cavity in the brain fufncient to receive his finger; a re- markab.e portion of the medullary fubftance being confum’d. And as this could not happen without a laceration of the fanguiferous veflels, he doe3 not doubt, but that the extravafated blood, or purulent matter, was by the mere afliftance of nature reabl'orb’d into the veins. But tilde things, you
(/) £cho1. ad obf. 6. 5n Addit, ad Se£l. 2.1. I. («) E p» ft. 3. n. 6.
(«) Ibid, in Schol. ad obf. 12. n, 3. {*) Obf. anat. circa duo Cadav. § 13.
30 Book I. Of Difeafes- of the Head.
fay, are rare, and contrary to the general opinion: for what phyfician is there, who will not pronounce, that blood being extravafated, and confin’d, within the very fubftance of the brain, is mortal ? Rare indeed ! even let them be very rare ; though perhaps not fo rare as you before believ’d for which rea- fon it is proper for us to mention them, not to make us forget that what ge¬ nerally happens in medicine, is chiefly to be attended to by us; but left we fhould be ignorant, that thofe things alfo may happen, which have in effect fometimes happen’d. Almoft with the fame defign, I have elfewhere ( p ) referr’d to fome difledtions of apoplectic perfons ; even two of them I have let forth at large, the one from Valfalva, and the other my own obfervation, which, like that of the lethargic boy, copied from Foreftus into the Se- pulchretum (^), fhew that the injury of the brain is fometimes on the fame fide with the paralyfisof the body : although that the cafe is generally, not to fay almoft always, otherwife, is plain from the obfervations of Valfalva. And although he did by no means commit to writing, all his obfervations relating to the languineous apoplexy ; yet thofe which we have defcrib’d above, re¬ main ; as thofe alfo do which I am about to defcribe.
17. An old man of leventy years of age fell down fuddenly on the ground, having loft the power of moving and feeling, on the left fide ; and the right being confiderably agitated by convulfive motions. His face was red. In lefs than twenty-four hours he died. His fkull being open’d, coagu¬ lated blood was found between the right pofterior lobe of the brain, and the dura mater ; and a kind of concreted ferum betwixt the fanguiferous vefiels of the pia mater, which being cut through, a little ferum flow’d out.
18. If you fhould happen to enquire why, out of the five apoplectic pa¬ tients, whofe hiftories are related, this, whofe original diforder was not in the brain, but upon it, fhould be the only one, to whom violent convulfive motions happen’d, on the fubjedted fide, (for in that firft delcrib’d, violent convulfions are not faid to have happen’d, and in the three others, they are not only not related, but in the woman they are exprefsly deny’d to have •exifted : and yet in all thefe, the injury, and that of the brain itfelf, was much greater) I contefs it is not eafy to account for, unlefs you can pof- fibly fuppole, that the coagulated blood, and lerum, did not more comprefs the brain, than irritate the meninges, which they were contiguous to in this patient only ; for as the right and left parts of the meninges do not decuflate each other like the fibres of the brain, but defcend ftrait down with the fpinal marrow and the nerves, each into their proper fide •, fo you may fup- pofe, that the fide of the body which was fubjedted to the irritated part of the meninges, was agitated with convulfive motions, in confequence of this irritation : or if the irritation could be propagated to the oppofite fide alfo, you may fay, that the mufcles of that fide, being become paralytic, could not be excited into motion. But if you are pleas’d with this reafoning, then fee how you can account for the irritation of the meninges in the firft apo¬ plectic patient ; in whom there were at leaft fome convulfive motions, though not fo great. And attend alfo to fome of the following hiftories, in which, though a caufe was not wanting to irritate the meninges, yet no convulfive
(/) Epift. Anat, 13. n. 19. & 25. (y) 1. 1. S. 3. obf. 34.
motions
Letter II. Articles 19, 20. 31
motions are taken notice of by Valfalva. But perhaps we (hall endeavour to inveftigate thefe things more thoroughly in another place.
19. A man of fifty-eight years of age, of a good natural conftitution, but much given to the ufe of tobacco, fell down fuddenly, as he buckled his fhoes. His fpeech was enirely loft ; he had no motion. His face was pale, then grew fomewhat yellow, as in a jaundice, and prefently grew pale again : fome little drops of faliva flow’d out of his mouth. In a quarter of an hour he died. His belly being open’d, every thing was found ; and in the thorax alfo, although the inferior part of the lungs adher’d to the diaphragm and back, and both the lobes were very red with blood, efpecially the right, which was fo turgid therewith, that on a flight laceration a great quantity burft forth. But in the cranium, a good quantity of coagulated blood was found, under the pia mater, on the anterior convexity of the brain, particu¬ larly on the right fide. In the right alfo, and the left ventricle of the cere¬ brum, a little blood was feen, with a flight coagulum ; but the plexus cho- roides, although it was found, might feem to have been affedted with an in¬ flammation.
20. But I fhall now give you obfervations of blood being effus’d about the trunk of the medulla oblongata, and cerebellum. A fervant-man, of two- and-twenty years of age, of a fprightly wit, endow’d with ftrong health, and undaunted by any labour, while he ran very faft after the chariot of his mafter,. in the depth of winter, and when fnow was falling on the ground, was thrown into an univerfal and profufe lweat ; yet without changing his cioaths, he re¬ turn’d in the evening to his ufual buflnefs. But the day after, when he leap’d out of bed in the morning, having loft all fenfe, he fell down three times headlong. Being lifted up, he complain’d of a deep-feated pain in his head* but efpecially in the occiput ; and was foon after affedted with a fever, at¬ tended with a fenfe of laffitude and pain in his whole body. The day fol¬ lowing he was purged with the pillula Galeni. On the third day he was let blood, but in vain * for the encreafing diforder grew into a kind of lethargy. On the fifth day he was fcarified on the fcapulte, and blood was drawn away by cupping-glafles. On the eighth he was fuddenly taken fpeechlefs, and lay immoveable for an hour, as if in an apoplexy. After that, the pain of the occiput was exafperated, and was extended even to the Ihoulders and lpine, in a moft violent manner. On the ninth day he loft blood in the other arm, from which the fymptoms feem’d to remit j till at length the apople&ic pa-? roxyfm returning, his life was exchang’d for death.
The abdomen and thorax being examin’d, nothing was obferv’d in the latter, but a lmall polypous concretion in the right auricle of the heart: but from the belly, the omentum had fallen down into the fcrotum, and had form’d an epiplocele ; and the whole internal fubftance of the tefticle on that fide, was chang’d into a membranous body. The head, the feat of the difeafe, was next enquir’d into ; and where the medulla goes out from the cranium, fome grumous blood was found, which had flow’d out from the lacerated trunk of the internal carotid artery. The ventricles of the brain contain’d a great quantity of faltifti water : the right and left contain’d alfo a portion of condens’d blood. Finally, throughout the crura medullae oblongatae,
many..
3 2 Book I. Of Difeafes of the Head.
many little prominent bodies were feen, which, except that they were pel¬ lucid, refembled the little grains of millet feed.
21. Thefe corpufcles recal to my rnind 44 the little prominent papillae, of 44 the fize of a frnall pin’s head,” which Brunnerus (r) faw in the back part of the right ventricle, into which the ferous blood, in an apopleCtic woman, had overflow’d •, and 44 which had alfo been obferv’d by him fometimes be- <c fore, on the othervvife fmooth and polith’d furfaces of the ventricles, when “ there was a difeale of the brain : and who, without being a foothfayer, 44 would not venture to affirm, that thefe were the little duds which dif- 44 charg’d this latex into the difeas’d brain.” Very pertinent alfo in this place, perhaps, is that obfervation made by BonfllioSo on a horfe, and related by Malpighi (s'), on account of the fimilitude of the external foregoing caufe : “ This horle, after vehement motion and extreme heat, being expos’d to 44 the winter’s cold, and a ruffiing wind, died ; and in him the pleura was 44 univerfally rough with vehicles, which were in great plenty, and turgid with 44 ichor.” The other appearances defcrib’d in Valfalva’s hiftory, except what relates to the epiplocele, which will be confider’d hereafter (/), very well account for the grievous pain of the head, and fet forth its internal caufes. As for inftance, the great quantity of faltifh water, together with a portion of condenfated blood, found in the ventricles, but efpecially the ex- travafated blood which was concreted in fuch a place, that it would at once p refs upon the beginning of the medulla fpinalis and the cerebellum, and by this means the cerebrum, and at the fame time be contiguous to the me¬ ninges ; fo that the rationale of the lethargic and apoplectic diforders, of pain deep feated in the occiput, and extended from thence to the whole fpine, is ealily underflood. And it is indeed much to be wonder’d at, that death was not fooner. brought on, which has been the cafe with others, who had blood extravafated about thefe parts •, as in a failor, whofe hiftory you may read in the ACta Cefarere Academiae (u) or in him, whofe hiftory is given immediately below : unlefs perhaps, in the fervant-man in queftion, the ca¬ rotid artery, being but little lacerated at firft, did not emit much blood, though it was difcharg’d freely at laft.
22. A man of about fixty years of age, who drank freely of generous wine, though he was frequently us’d to fall down with a vertigo, was at length, on a certain day, juft after dinner, when he feem’d to be very well, except that his cheeks were redder than ufual, found lying dead on the ground, his upper limbs being extremely contracted, and the foeces alvi emitted. The cranium being fawed through, and the dura mater perforated anteriorly, a limpid water burft from betwixt this and the pia : and the pia mater, which was of a p difh colour, contain’d a gelatinous concretion of ferum in the interftices of its veflels. In the lateral ventricles, fome of the glands of the plexus choroides were fo turgid, as to equal the largeft lentils in magnitude ; and in the right were two grumous concretions of blood. In
(r) Vide Sepulchret. in Addit, ad fed. cit. (/) Epift. 43. n. 12.
obf. 12. & in fchol. ad obf. 5. («) Tom. 2. obf. log,
( 5 ) Epift. de Struit. Gland.
both
Letter II. Articles *3, 24. £3
both Tides of the cerebellum, the blood was To coagulated, as to refeinble one folid polypous body ; but the right Tide had the largeft quantity of blood, even an ounce ; and that portion of the cerebellum which layabout this kind of concretion, had a foft confiftence, like rotten fruits.
23. That this fudden death was from a fanguineous apoplexy, not only the antecedent fymptoms argue, but the appearances in the diffeCted head abundantly prove •, yet that a convulfion was in fome meafure join’d with it, that great contraction of the upper limbs Teems to fhew. But that this apo¬ plexy Thould happen, when the patient Teem’d very well, doubtlefs teftines to us how much, according to the words of Celfus, thofe over whom this, or any other dileafe, from a rupture of an artery or vein, hangs threat’ning, fufpebia habere bona fua debent (x), “ ought to be fufpicious of their prefent <c welfare.” For by how much more languidly the heart and arteries contract themfelves, by To much lefs will the danger of that rupture impend : on the contrary, the more ftrongly they act, and impel the blood, as in healthy perfons, in To much greater danger of rupture are the debilitated parts of the veffels. And this Tpeculation we have often Teen confirm’d by obfervation ; but never more evidently than in the facred orator, whofe fudden death, from a fanguineous apoplexy, will be mention’d in the next letter (y).
24. But that the defcrib’d apoplexy was very violent, the thing itfelf ffiews, and the difcharge of the fceces, eipecialiy if we attend to the opinion of fome phyficians (z), did not obfcurely teftify : for they affert, that unlefs the difor- der be very violent indeed, even when all the other parts of the body are paralytic, the fphinCter ani will (till be contracted. But the fphinCter may. iometimes Teem not to be paralytic, although it be; becaufe the inteftines themfelves being more inert in apopleCtic patients, and the mufcles of the abdomen not being ftrong enough in their impulfe, the foeces, which are hard and few, are rather not expell’d by the contraction of thofe mufcles, than re¬ tain’d by the aCtion of the fphinCter : yet I would not deny this, that the re¬ tention of thofe things injeCted into the inteftines, often fhews that the aCtion of the fphinCter is fufficientlv preferv’d ; and that by means of the commu¬ nication of the fame nerves, by which the motions of moft of the vifcera, but efpecially the heart and lungs, are fupported. And that thofe nerves receive fpirits, if not chiefly from the cerebellum, at leaft from that as well as from the cerebrum, Teems an undeniable truth. But that the cerebellum is lefs frequently hurt in apoplexies, than the cerebrum, in part happens, from its being lefs than the cerebrum : and befides, though it lhould be a little, injur’d, it is not ridiculous to fuppofe, that it may ftill do its office to thofe nerves, longer than the cerebrum, becaufe it has a greater quantity of cortical fubftance, and feems tofecrete a greater quantity of fpirits in propor¬ tion thereto. .And another not improbable reafon may alfo be given for this, to wit, that the paffages through which the cerebellum fends lpirits to thofe nerves, are wider than the fimilar paffages from the cerebrum ; inafiUuch as the cerebellum, when every thing was in its firft tender ftate, began fooner to perform its office. For obfervations are not wanting to prove, that the cerebellum is much fooner perfected than the cerebrum ; and what it then firft
(*) De Medic. 1. 2. c. 2. (j) N. 17.
vol. r.
(2:) Sennert. Med. Praft. 1. 3. p. z. f. 2. c. 1 1.
F began,
34 Book I. Of Difeafes of the Head.
began, it goes on without intermiffion to perform, either in a waking or a fleeping ftate. But the more neceflary thofe nerves are to the prefervation of thefe motions, and to the fupport of their influence, the fooner all thefe vital powers, and of confequence, life itfelf, is loft : for the paflages of the nerves, which were fo open, and which us’d to convey fuch a quantity of fpirits, being now precluded, that is, the cerebellum being injur’d, the power of the vital vilcera muft of confequence fail ; and that fo much the fooner, in pro¬ portion as the cerebellum is more violently and fuddenly injur’d. And an injury in both thefe refpeCts does actually happen, when blood, and that in confiderable quantity, is fuddenly extravafated upon the cerebellum, or rather in its fubftance. Nor fhould that kind of rotten foftnefs, obferv’d in the ce¬ rebellum, where the blood was furrounded with its fubftance, make you the lefs believe, that the laceration was Ridden. For you will fee, from other of our letters (<?), that any little part of the cerebellum may gradually, and almoft latently, be difpofed to laceration ; and when at length this fuddenly happens, an injury of that kind may appear in the furrounding fubftance, which, though it be in effeCt recent, yet may eafily be taken for an erofion of long ftanding.
25. I wifli I could at any time determine, or rather divine, what it was Valfalva meant by what he formerly laid to me, but never left in writing that I know of; I mean, that when a certain porter had died of an apoplexy, he from the inipeCtion of the naked body, had foretold, that the caufe of the diforder would be found in the cerebellum ; and had prov’d it from diflec¬ tion. For that I had conjectur’d on which fide of the cerebrum the diforder was feated, by only obferving on which fide the patient had fall’n, I have al¬ ready obferv’d (b) ; but how to determine, whether the mifchief be in the cerebrum, or cerebellum, from the infpedion of the body, I confefs I do not clearly underftand. I fufped, however, that it might be in fome mea- fure afcertain’d, from what 1 have already hinted ; to wit, from refpiration being fuddenly fupprefs’d, the faeces of the inteftines being emitted, and other circumftances of that kind. Harderus, indeed, in a patient who died Rid- cienly of an apoplexy, concluded that a fuflfocation had happen’d from the following marks ; “ the face and lips were livid ; bloody lines ran in the “ courfe of the fpine, and were difpers’d in various directions round about “ it and agreeably to his conjecture, was found “ grumous blood lying “ about the cerebellum and this obfervation you have alfo in the Sepul- chretum(r). But you, according to your u fual and well-known fagacity, will enquire after lefs ambiguous matters. In the mean while farewel, and expeCt- the conclufion of my obfervations on the fanguineous apoplexy in my next' letter, having already fufficiently detain’d you in this.
(«) Epift. ^. n. 3. (r) Vide in Addit, ad Sepulchret. L 1. f. 2*
{ b ) Advert. Anat, VI. animadv.84. &.Epift. obf. 5. cam fchol.
Anat. VII, n. 6. & XIII. u. 16.
LETTER
Letter III. Articles 1,2,
35
%
LETTER the THIRD.
Which concludes the Obfervations on the Sanguineous
Apoplexy.
1. A I SHE obfervations of Valfalva, on the fanguineous apoplexy, you have I already in my lad letter : and now, in purfuance of my promife, you will have mine.
2. A Venetian woman, aged fifty-five years, of a florid countenance, a large ftature, and a full habit of body, was fubjedt to violent pains of the cholic. This woman, befides, had, ever fince a certain time of her delivery in child-birth, (for (he was the mother of many children) grown fo promi¬ nent in her belly, that fhe was thereby prevented from going about mod: of her domeftic offices, with promptnefs and expedition. On account of thefe complaints, ffie faid ffie could not bear to drink her wine diluted ; fhe there¬ fore drank it in a pure ftate, and that not fparingly. She was now flothful, dull, and inclin’d to fleep ; and for fome days pall, this fymptom alfo had attack’d her, either for that reafon, or becaufe her head was in pain, that ffie heard a very troublefome noife, of which ffie often complain’d. At length, about the third hour of the night, fhe faid fhe was very ill ; and mention’d particularly a pain in her right temple and right eye ; and while ffie was fitting down on a chair, and afking for affiftance, ffie was feiz’d with an apoplexy, in confequence of which ffie fell on her left fide; but the mo¬ tion of the right hand was not loft till an hour afterwards. At the fame time, ffie threw up from her ftomach, the wine which fhe had drunk that day, though the quantity of it had not been greater than ufual : but her ex- .ertions in vomiting were very weak and feeble. I don’t find fhe had any more affiftance, than that of being put into bed, where ffie began to have a ftertor ; and though fhe certainly liv’d till the fixth hour of the night, yet in the morning fine was found dead and cold; fo that it was conjectur’d, fhe died about the ninth hour. The weather was now extremely cold, for it was before the middle of February 1708.
I difleCted the body, in conjunction with that excellent anatomift Jo. Do¬ minico Santorini, other learned friends being prelent. The abdomen was turgid, and rather abounded in fat, as did the omentum alfo. Almoft the whole colon was in a manner like that of a dog: the cells were fo few and fo rare ! and for a confiderable traCt, it was much more narrow than is na¬ tural. But before it degenerated into the reCtum, it took a turn towards the navel, making larger folds than ufual. The colon had a kind of fmell, like that of an incipient gangrene, and the fmall inteftines were of a more faturated blood colour than ufual, here and there : and though the weather was fo cold, as I have faid, yet fome heat ftiii remain’d in the belly, no.r-
- F 2 withftandibg
3 6 Book I.i Of Difeafes of the Head.
withftanding it was thirty hours after death, when it was open’d. Moreover,, the fpleen was diftinguith’d by fome little bloody drops on the furface *, yet, in other refpects, found: and in the gall-bladder, which was more contracted than ufual, was contain’d a kind of bloody bile. But the liver was connected to the feptum tranfverfum by more connexions than common, and thofe were very irregular too *, fo that it feem’d to have been affebted formerly with inflammation : on the furface which lay towards the diaphragm, it was here and there livid ; and on the other, almoft univerfally fo : yet this livor did not penetrate deeply, and the vilcus was, in other refpebts, whitilh. The fplenic artery had on the fide of it, a kind of diverticulum, of a he- mifpherical figure, which was bony, and, to appearance, full of concreted blood. » In the pericardium was a kind of bloody water, in a moderate quan¬ tity 5 in the heart, and the great vefiels, were no polypous concretions : but blood only, and that neither harder nor fofter than it Ihould be. The valves of the aorta, at their lower circumference, were very hard, and near to ofli- fication. The lungs were found to the touch, but in fome places redder than ufual. Before we open’d the head, we obferv’d a large fpot, of fuch a kind, about the mouth, that we doubted, whether it was from the wine that had been brought up, or whether blood alfo had come with it. Thp mouth itfelf, which certainly had not been obferv’d in the firft hours of the apoplexy, was difiorted to the right fide ; nor was it the effebt of a convul- fion i for befide that the limbs, and the neck, tvere very flexible, I reduc’d the mouth to its proper place with my hand, the parts eafily following with¬ out any force, and remaining where they were plac’d •, fo that the paralyfis of the face feem’d alfo to have happen’d on the left fide. Having cut through the cranium, which we thought was thicker than ufual, we imme¬ diately law blood to be extravaiated beneath the dura mater, and to be fliining through its fubfiance. And that blood, as we perceiv’d by diflebt- ing farther, cover’d the whole right hemifphere of the brain •, for it even lay under the bafis of the brain, and was form’d into one continued lamina every where. This lamina being remov’d, not.only the fanguiferous vefiels of the pia mater, both in the left and right hemifphere, were found to be more turgid than ufual, here and there ; but we alfo perceiv’d two or three fora¬ mina in that part, which cover’d the outer fide of the right hemifphere, from which the blood, we have fpoken of, ifiu’d out betwixt the two me¬ ninges. For thefe foramina led into a certain large and longitudinal cavity, form’d in the medullary fubftance of the fame hemifphere, between the ex¬ ternal fide and the lateral ventricle, fo as to be equal to two fingers breadth in width, and in length to fix, or more. This cavity was contain’d within, unequal, and almoft eroded parieties *, it was full of a grumous blood, and had a communication with the right ventricle towards its pofterior part: by means of which communication, a fmall quantity of blood had been pour’d into that ventricle, and a fmall portion had even pafs’d over into the left, by breaking through the pofterior part of the feptum lucidum : but the blood had form’d itfelf into a laminated concretion in each of the ventricles. It teem’d, however, that fome other veflfel alio, mutt have been ruptur’d *, fince a lamina of blood was found below the tranfverfe procel's of the dura mater, covering the whole cerebellum, though of a moderate thicknefs : for
you.
Letter III. Article 3. 37
you very well know, that in a natural (late, there is no paflage, from the cavity of the meninx, that inverts the cerebrum, to that which inverts the cerebellum. Moreover, in the fpinal tube, as far as we could look into it from above, a quantity of blood lay extravafated about the fpinal marrow. But fome parts of the brain were of a {lightly yellowiih colour ; the plexus choroides were flaccid, and in a manner dertitute of blood; and the finulfes of the dura mater were empty.
3. The blood, to begin with that circumrtance, is fometimes effus’d into the tube of the fpine, and thence flows up to the cerebellum ; or, at other times, defcends from the cavity of the cranium to that of the fpine ; and even, fometimes, veffels may be ruptur’d in both cavities, and blood confe- quently extravafated in both. A remarkable example of the firft cafe, was obferv’d by Boerhaave (<2), in a certain victualler, who was, for that rea- fon, firrt made parapledtic, and then apoplectic. But if a confiderable quantity of blood, pour’d into the cavity of the vertebra, does not flow out from thence ; a mortal difeafe is brought on: “ the many nerves of the <c fpinal marrow, which give rife to the branches of the intercoftal, being <c comprefs’d, and confequently the motion of the interior parts ceafing.” And this du Verney (b) had long ago exceedingly well conjedur’d ; who had obferv’d another cafe of this kind ; in which cafe, though join’d with a pa¬ raplegia, “ the fenfes ftill remain,” nor does a true apoplexy happen. But in the cafe I have now propos’d, as preceding fymptoms had (hewn that the brain was difpos’d to apoplexy, and as mifchief enough of its own was found therein, there is no reafon, why we fhould have recourfe to blood, flowing up from the fpine into the cranium, to account for it: but whether any part of the extravafated blood had pafs’d from the cranium into the fpine, or from the fpine into the cranium, or whether it was extravafated in. both at once, I leave entirely open to conjedure. If, therefore, we fet af?de the conflderation of thefe things, as uncertain ; and defer thole which relate to other circumftances, and elpecially to the cholic pains, to be confider’d, in their proper place (c) ; two things only in this hirtory remain to be parti¬ cularly confider’d. The one relates to the dogma confirm’d by Valfaiva ; for in this woman alfo, though the paralyfis happen’d on the left fide, yet the injury in the brain was found to be on the right. The other relates to the dileas’d appearance of the brain itfelf: that we may enquire, from what caufe, and in what manner, it was brought about. We will begin with the latter : and as to the former, when we /hall have confirm’d it by more ob- fervations in this letter, it will then be not improper to fay fomething upon that alfo.
There is an old dodririe, and perhaps none is older, obferv’d by Varo- lius (d) and explain’d by Marcianus (e), in his own way ; who acknowledges, “ acrid and eroding matter ” to be a caufe of apoplexies ; which dodririe is exprefsly advanc’d by Hippocrates, or at leaft by the author of the book Be Glandulis (f), faying, “ that if the brain be really eroded, that
(a) Pradeft. ad Inftat. § 401. [d) De nervis Optic. Epift. 2.
(b) Vide du Hamel R. Sc. Acad. Hift. I. 3. (<■) Annor, in Hippocr. de Gland, vers. 103.
$. 5. c. 2. n. 1. (f) n. cj, in edit. MarinelL
(0 Epift. 33. n* 3.
n
diforder
3 8 Book I. Of Difeafes of the Head.
<i diforder is brought on, which is, among the Greeks, call’d apoplexy.” And the brain never leems to be more eroded, than when large and preter¬ natural cavities are found within its fubftance ; fuch as 1 have defcrib’d in this woman, full of blood, and with parietes fo horribly lacerated, and bloody, that there is nothing which they more effectually refemble than deeply eroded ulcers of the external parts ; therefore you fee, that Valfalva, in the four firft diffeCtions, produc’d in the former epiftle (£), has us’d the words ero- flon and corrofion, and the li^nilitude of deep ulcers alfo. Do not how¬ ever imagine, that thefe were real ulcers in the plexus choroides, or in the
neighbouring fides of the lateral ventricles, fo encreas’d by degrees, as to attain to the magnitude defcrib’d. For not to enquire here, whether thofe parts could long bear diforders of that kind, and yet life and the func¬ tions thereof continue •, it is lufficient to obferve one thing ; that although we all of us diffeCt fo many heads, and the heads of thofe who were difpos’d to a languineous apoplexy from the fame caufe ; yet that we never meet with ulcers of that kind in the parts fpoken of, which are begun, and ftill
little •, but only fee them already form’d, and of a confiderable flze, in thofe
whom a violent ftroke of the diforder has carried off. Yet I do not deny, nay even readily acknowledge, that the beginning of fuch large lacerations is from eroding matter : but I fay, that this beginning, whether it be from the erofion, or diftraCtion of tfre coats of one or more of the fmall veffels, which carry blood through the brain, is wont to be fo fmall and obfcure, that although I have very frequently differed, piece-meal, the brains of fo many perfons of all kinds ; it never yet happen’d, that any thing of this na¬ ture fell under my notice. What then is the reafon, you will fay, why it fo fpeedily brings on fuch devaluation, and produces fuch prodigious cavities in the brain ? I will tell you : but let me firlt give you another oblervation or two of the fame kind.
4. A porter, a flout mufcular man, in the fortieth year of his age, who was faid never to have had any