The London Medical Gazette; December 27, 1828: Being a Weekly Journal of Medicine and the Collateral SciencesVarious
Science
The London Medical Gazette; December 27, 1828: Being a Weekly Journal of Medicine and the Collateral Sciences
Various
Medicine -- Periodicals
This condition of the heart and arteries, considered as
inflammation, has been assigned by some as the cause of fevers
of the more malignant kind. The frequency with which it has been
found in some particular epidemic, must have led to the conclusion.
But, however this may be, from my own observation, not restricting
myself to the fever of any particular season, but taking into
account all complaints called febrile, and belonging to all
seasons, also from the result of inquiry among medical men who
have had large acquaintance with morbid dissections, and from the
experience of those who have made this particular point a subject
of investigation (Laënnec and Andral) I venture to conclude that it
has no essential connexion with fevers of any kind, either as cause
or as effect.
On some occasions the internal membrane of the heart and arteries,
wherever it exhibits the appearance described, will allow itself to
be peeled off from the subjacent structure with the least possible
force; this facility of separation ceasing entirely beyond the
boundary of the red tinge.
Here unquestionably is further evidence of a diseased condition:
but of what nature? Most pathologists would consider this to be of
the nature of inflammation--and I believe justly.
There is indeed much difficulty in pronouncing upon the nature of
minuter changes of structure detected in the internal parts of the
body after death. We are obliged to arrive at conclusions by help
of analogies drawn from morbid processes, which we have watched in
their progress during life, upon the external surfaces; for during
life we have the functions and sensibilities of the part to aid us
in forming a right judgment concerning its disease. When, during
life, one tissue is separated from another, as the periosteum from
the bone, or the cuticle from the skin, or the mutual cohesion
between different tissues is sensibly weakened, we find it to be
owing to the intervention of serous fluid which does not belong to
their healthy state; and this, together with increased vascularity,
or redness and heat, and pain, is enough to bespeak the presence
of inflammation. All these conditions cannot remain after death.
Hence, if we desire to form positive opinions concerning much
which is unfolded by dissection, we must supply the defect by
analogy. Thus, whenever, in any part of the heart or arteries,
the cohesion between the internal membrane and the subjacent
structure is manifestly lessened, and the membrane is unusually red
at that part, we may regard these appearances as the vestiges of
inflammation, without thinking that we go too far in so regarding
them.
The internal lining of the heart and arteries is often found red
solely in the neighbourhood of ulcerated spaces, when there can be
no doubt concerning the existence of inflammatory action.
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