FOOTNOTES:
[1] A careful examination of the works of some of the most eminent English practical writers does not afford evidence of any clear distinction of these diseases of the heart. Dr. Cullen, whose authority is of the highest estimation, evidently enumerates symptoms of them in his definition and description of the hydrothorax. In § 1702 Th. and Pr. he places much confidence on a particular sign of water in the chest, and remarks, that the same sign is not produced by the presence of pus. Now, there is no sufficient reason, why this symptom should not arise from the presence of pus, as well as from that of water; but it probably can depend on neither of those alone. See Morgagni de causis et sedibus morborum, Epist. 16. art. 11. The experienced Heberden says in the chapter “De palpitatione cordis,” “Hic affectus manifesta cognitione conjunctus est cum istis morbis, qui existimantur nervorum proprii esse, quique sanguinis missione augentur; hoc igitur remedium plerumque omittendum est.”—“Ubi remediis locus est, ex sunt adhibenda, quæ conveniunt affectibus hypochondriacis.”
Dr. Baillie’s knowledge of morbid anatomy has enabled him to make nearer approaches to truth; yet it will probably be found, when this subject shall be fully understood, that his descriptions of the symptoms of diseases of the heart and of hydrothorax are not quite accurate, and, that with respect to the former, they are very imperfect.
Some of the French physicians have devoted much attention to this subject; especially M. Corvisart, professor in the hospital of La Charite, at Paris, from whose clinical lectures is derived the most important information.
[2] During this time it was thought adviseable to acquaint his friends, that an organic disease of the heart existed, which doubtless consisted in an ossification of the semilunar valves of the aorta, attended, perhaps, by enlargement of the heart; that the disease was beyond the reach of art, and would prove fatal within three months, possibly very soon; that if it lasted so long, it would be attended by frequent recurrences of those distressing symptoms, general dropsical affections, and an impaired state of the mental faculties.
[3] The celebrated Morgagni has recorded some cases of organic disease of the heart discovered by dissection, the symptoms of which do not exactly accord with those observed in this and the succeeding cases. It should be remembered, however, that many of the subjects of those cases were not examined by him, while living, and others but a very short time before death. But it appears, that, in the last stage of this disorder, some of the most important symptoms may be materially changed, especially the state of the pulse, dyspnœa and palpitations. Thus in the case related above, and in some others, the pulse became regular, the palpitations subsided, and the dyspnœa was less observable. The cases of that accurate anatomist, therefore, are not so contradictory of those related here, as might at first be imagined.
[4] Governour Sullivan was born December 4th, 1744, and died December 10th, 1809.
[5] The symptoms of this patient were related by Dr. Rand, sen. to whose politeness and love of medical improvement I am indebted for the opportunity of examining this and the following case.
[6] The symptoms of this case were related to me by Dr. Rand, sen.
[7] See plate first.
[8] The symptoms in this case were related to me by Dr. Warren, sen.
[9] This dissection was performed by Dr. Gorham.
[10] See plate second.
[11] In this case, and in [case first], the vena cava ascendens had been divided, before the brain was examined.
[12] Morgagni uses this term, which he borrows from Ambrose Pare, to express dilatation of the cavities of the heart. It seems to be as applicable to the dilatation of the heart, as to that of an artery. I have therefore adopted it in this enumeration.
[13] The term fleshlike is employed to express that roughness of the valves, which somewhat resembles flesh in its appearance, but which is very different from the thickening of the parietes of the heart.
[14] It has been remarked by the French physicians, and particularly by M. Corvisart, physician to the emperor of France, that these organic diseases were very prevalent after the revolution, and that the origin of many cases was distinctly traced to the distressing events of that period.
[15] See Soemmerring de corporis humani fabrica, vol. 6, pag. 188 and Baillie’s morbid anatomy, pag. 248.