A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 3).

  • Copland, James, 1791-1870.
Date:
1834-59
Catalogue details

Licence: Public Domain Mark

Credit: A dictionary of practical medicine: comprising general pathology, the nature and treatment of diseases, morbid structures, and the disorders especially incidental to climates, to the sex, and to the different forms of life : with numerous prescriptions for the medicines recommended, a classification of diseases according to pathological principles, a copious bibliography, with references, and an appendix of approved formulae : the whole forming a library of pathology and practical medicine and a digest of medical literature (Volume 3). Source: Wellcome Collection.

Provider: This material has been provided by the National Library of Medicine (U.S.), through the Medical Heritage Library. The original may be consulted at the National Library of Medicine (U.S.)

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    both external and internal, or pathological, par- ticularly those already specified (A 9), seem to act coetaneously and co-ordinately upon the brain and heart, through the medium of the or- ganic system of nerves j while others of the same class of causes (<$ 9) seem to influence more immediately and especially the heart through the same channel. 5. Certain causes may suddenly derive the circulating fluid to the external surface or other parts ; and the sud- den diminution of the quantity returned to the heart and propelled to the brain may induce faintness or full syncope. 6. The sadden re- flux of blood to the right side of the heart, es- pecially when it supervenes rapidly upon the states just specified, may occasion fainting, by overpowering the heart's action, and thereby diminishing the supply of blodd to the brain. 7. Fainting may arise from inflammation of the heart, or effusion into the pericardium. 8. It may also occur from the imperfect action of the heart caused by deficient organic ner- vous power, particularly of the cardiac nerves, with or without dilatation of the cavities, and weakness or softness of the parietes of the or- gan. 9. It may be occasioned by circumstan- ces preventing the return of blood to the heart. To either of these last two are to be imputed the fatal cases of syncope related by Mr. Chev- alier and Mr. Worthington, in which the cavities of the heart were found empty and re- laxed, and the large veins adjoining devoid of blood. 14. Indeed, death may supervene in any of the modes in which syncope is produced, es- pecially when carried to the extreme. Thus I have seen, in two instances, a moderate dose of the acetate of morphine occasion loss of vol- untary motion, and scarcely-perceptible pulse and respiration—the characteristic phenome- na of swooning. A larger quantity might have caused death ; its operation—extended from the stomach to the heart and brain—being the same, but so great as to put an end to the func- tions of these parts. Other causes, inducing any one of the pathological states now assign- ed, may act, in favourable circumstances, and in highly predisposed persons, so energetically as to terminate altogether the vital actions; predisposition or pre-existing states of the frame, such as have been mentioned, being often as influential in producing the result as the more direct cause. 15. III. Diagnosis.—Syncope may be con- founded with apoplexy, with the seizures to which the term leipothymia is strictly applica- ble, with asphyxy, with certain states of hys- teria, and with death.—a. The strong, labour- ed, or stertorious breathing, and the full, strong pulse sufficiently distinguish apoplexy (see that article, § 66) from fainting.—h. In leipothymia, volition and voluntary motion are abolished, and consciousness nearly or altogether; but the pulse either is not affected, or is even fuller than usual; and it is more frequently the first stage of, or followed by, epileptic and apoplec- tic seizures than true syncope. Frequently, also, leipothymia is intimately associated with epilepsy, the former being either the earlier manifestations or the lesser grade of the lat- ter.—c. In asphyxy, the actions and functions of respiration are the first to cease ; the cir- cuhition of venous blood continuing for some time, until, owing to the privation of pure at- mospheric air, the passage of blood through the lungs becomes obstructed, as first shown by Dr. Williams (Edin. Med. and Surg. Journ., Oct., 1823), when total arrest of the pulmonary circulation, abolition of the cerebral and ner- vous functions, and, lastly, cessation of the heart's action (see Asphyxy, 4 14, et seq.), are the consequences. Respiration and circula- tion are here quite at an end ; and the counte- nance and general surface are reddish, livid, tumid, or bloated ; whereas, in syncope the face and surface are pale and collapsed, and the re- spiratory functions and circulation still contin- ue, although in a low and occasionally almost imperceptible state. In the former there is remarkable congestion of the lungs and head ; in the latter the brain is generally insufficient- ly supplied with blood ; and the circulation of the lungs, although languid, is seldom obstruct- ed, and never altogether arrested, unless a ter- mination in death supervenes. — d. Various manifestations of hysteria either very closely resemble fainting, or are in some way or other associated with it. The more remarkable phe- nomena of hysteria may follow, or precede, fainting, most frequently the former; but the loss of motion and sensation often partakes more of the characters of leipothymia than of swooning, the pulse at the wrist being but lit- tle affected. Pain under the left breast, bor- borgymi, and a sense of suffocation, which commonly precede the hysterical form of syn- cope, sufficiently mark its nature; and, even when these are not present, other signs soon manifest themselves, especially convulsions, weeping, laughing, &c. (See Hysteria.)—e. Syncope is rarely so profound as to be mistaken for death; but Portal and Chamberet, with some writers on medical jurisprudence, con- cur in thinking that it may be both so complete and prolonged as to endanger premature inter- ment in countries where the last rite is early performed. Whether or not the action of the heart, which cannot be altogether abolished even in such cases, may be detected by the stethoscope, I am unable to state; but it surely cannot continue many minutes without detec- tion upon a strict scrutiny, unless death have taken place. The state of the cornea, which is soon covered with a film, or deprived of its delicate transparency, and afterward collaps- ed ; the appearances of the thorax upon exam- ination ; the signs yielded by auscultation ; the condition of the body in respect of flexibility, &c. ; and the temperature under the armpits, &c, will generally decide the question even in the most doubtful cases. Placing a mirror be- fore the face, or down beneath the nostrils, and observing whether the former be moistened, or the latter moved, have been long popular means of ascertaining the certainty of death, as hap- pily shown by Shakspeare {Lear, act v., sc. 3, and Henry the Fourth, act iv., sc. 3.) 16. IV. Treatment.—Syncope is frequently not only its own cure, but often the means of removing the cause which induced it. When occasioned by haemorrhage, the languid state of the circulation permits the formation of co- agula, which plug the vessels, and arrest far- ther discharge ; and the loss of the voluntary powers causes the patient to fall in the Very position which, of itself, generally restores the