Christopher Heath

Clinical Lecture on a Case of Cystic Disease of the Lower Jaw

a series of meteorological observations, he traces a curve in accordance with the numerical values he has previously obtained. This curve, which rises, falls, or remains stationary, shows what has really taken place much more clearly than a column of figures, which is tedious and fatiguing to read down. The comparison of the two curves is as it were instantaneous; their identity and their dissimilarity strike the eye at once. The sum of every kind of observation can thus be expressed by curves: changes, pressure, weight, or bulk, or variations of intensity of any kind of force. Still more, all kinds of statistics lend themselves to the use of this method, and thus yield to the first essay results which could only be disengaged by a long and assiduous study. Therefore the use of the curve becomes daily more widely diffused, though not with sufficient rapidity for the wishes of those who realise the sum of its usefulness. How is it possible not to anticipate with impatience the day when long and obscure descriptions will give place to satisfactory representations ? All who occupy themselves with experimental study or observations, readers overwhelmed and invaded by the accumulation of written documents, the economist, the statistician, the financier, the statesman, who accumulate around them v.lumes full of figures, one of these days will find, in one atlas containing some luminous curves, the whole essence of these crude materials. If the graphic method, however, possesses such great advantages from the aspect of the exposition of observed facts, how great is its superiority when the phenomenon of which it gives up the tracing belongs to those which entirely escape the perception of our senses ! Here there is no longer any intermediary between the act and its graphic expression. Transformed into inscribing apparatus in meteorological observatories-the barometer, the thermometer, the hygrometer--incessantly determine the state of the atmosphere. Patient, conscientious, infallible, these instruments do what would be impossible to a legion of observers. Formerly, the boldest imagination could -not have dreamed that the velocity of a cannon-ball could be seized at all points of the trajectory. This important problem, however, is now solved, and still greater velocities are determined at the present day. The graphic method is equally applicable to the measurement of extremely slow movements. We do not see the growth of a plant; but we can obtain the tracing of its increase, and record that, at certain hours and under certain influences, vegetation is accelerated or retarded. The method of making these determinations is in all cases identical. To force a stylet to move under the influence of the movement which it wished to inscribe is never a very difficult operation. This done, it suffices to receive the tracing on a surface which moves more or less quickly according to the movement which is intended to be inscribed. To measure the velocity of a projectile, a velocity of 200 to 300 mNtres per minute is printed on the paper; whilst the growth of a plant should be inscribed on a paper which does not change its situation more than a few centim?/res in the twenty-four hours. In the enumeration just made, it may be noted that only very simple movements are treated of, moving in a rectilinear direction, sometimes in one direction only, sometimes altexnately in two opposite directions. How, indeed, would it be possible to seize those capricious movements which arise in all directions of space? Though more complicated, however, my problem is not insoluble. Everyone is acquainted with the pantograph; everyone knows that, if the outlines of any given object be followed with one limb of this instrument, the other reproduces the same figure either reduced or enlarged. An analogous arrangement allows the inscription, at considerable distances, of all movements on the same plane. My apparatus is, like the two others described, composed of two parts, of which the one is the explorer and the other the receiver. These two parts transmit the movement to each other by air-tubes; each carries a point ; and if one of them be led so as to trace a circle, you will see the other point likewise trace a circle; write your name with the first point, and your signature will be reproduced by the other instrument. An easily understood arrangement admits the reproduction of the movement according to its three dimensions in the space. With these complex transmissions, there is no movement which cannot be reproduced. A flying bird, if of sufficient size, can carry instruments constructed on this principle; the creature, bound by one or two India-rubber tubes to the inscribing instruments, gives the curves of every movement it performs. Thus the trajectory of the wing at every moment of the flight is determined: the torsion movements which are imparted to it by the resistance of the air, even to the oscillations and to the jerks the body of the bird receives from the reaction of its wing-strokes. I here terminate this exposition, which, though perhaps too long, is yet very much compressed. I have been able to show partly the results of a method which is yet in its infancy, and which, without doubt, will attain still greater perfection. Should we not, therefore, expect much from the graphic method ? Should we not hope that, thanks to its employment, experimental science will advance with a sure and rapid step ? Such is my profound conviction, and one which I should like to see widely shared.

Clinical Lecture on Cases of Injury to the Head.

case was that of a cabman, who was in the first bed on the riight handl in No. i Ward at the beginning of the session, having been admitted oni September 23rd, under the following circumstances. The night before, his cab, a four-wheeler, was accidentally upset, and he was thrown off the box, being stunned for the ilmoment, but quickly recovering himself, with a recollection of having fallen on his right side. lie was able to assist in righting his vehicle, which he then took liome

Clinical Lecture on Sacro-Iliac Disease.

THE disease of which I am about to speak to-day, gentlemen, is one which, perhaps, is not very common; but in fact it is only of late years that it has been recognised. It may be of some interest in the history of the disease for you to know that the first systematic description of it was given in this hospital by Mlr. Erichsen, in a clinical lecture, which was published in the Lancet, in January 1859. Since that time, of course, the attention of surgeons has been drawn to the disease; and, therefore,

Case of Traumatic Stricture

4th edit., p. II9; Dr. Sibson, Medical Anatomy), that in cases of effusion into the left pleura, or of contraction of the right lung, the apex of the heart passes over until the axis points to the right, the following simple experiment was undertaken with the object of testing the accuracy of the above view. Six pints of water were injected into the pleura of a female subject, causing displacement of the cardiac dulness to the right of the sternum; a stilette was then introduced at the third right interspace, close to the sternum, and passed horizontally through the chest; a second stilette was then passed in the same manner through the fifth space in a line with the first; the sternum and cartilages were then removed without disturbing the instruments, and the exact position of the heart noted. The upper stilette had passed close to the left side of the pulmonary artery at its insertion into the ventricle; the lower stilette had passed through the right ventricle nearer its left than its right border; a line drawn vertically from the middle of the right clavicle touched the border of the right auricle (the extreme right of the heart); a similar line, drawn from the left sterno-clavicular articulation, touched the apex of the heart (the extreme left); the axis of the heart was slightly more vertical than natural. Mr. Henry Arnott was present at this and at a previous experiment, in which the result was exactly similar, and was kind enough to take diagrams of the exact position of the heart in each case. In June I868, a patient died at the Brompton Hospital while under the care of Dr. Pollock. The case was one of extensive excavation from apex to base of the right lung, with thickened pleura and contracted side; the left lung was greatly enlarged, and encroached on the middle line; the cardiac impulse was distinct, both visibly and to the touch, at the fourth right interspace, and no impulse could be felt anywhere else. Post mortem, the heart was found to be displaced generally somewhat to the right, but the relative position of the apex and base unchanged, the apex being opposite the fifth cartilage, an inch and a half within the left nipple; the pericardium was completely uncovered on the right side by the retraction of the lung, and the portion of the heart opposite the fourth space was the upper part of the right ventricle. The character of the impulse in this case was indistinguishable from that of the apex beat. A similar case, one of cirrhosis of the right lung, has been this session brought before the Pathological Society by Dr. Fagge. I have notes of three such cases which have come recently under my observation, and are still living. Dr. Stokes relates an analogous case of displacement of heart, secondary to reabsorption of pleuritic effusion, in which it clearly appears that the impulse on the right side of the sternum was produced by the base of the heart. It thus appears that in cases of displacement of heart, following upon contraction of one pleural cavity, the axis of the heart is but slightly changed (usually, as above explained, slightly more transverse) ; and that, particularly when the right lung is affected, the displacement often appears to be much greater than it really is, owing to the covering up of the apex by the large left lung, also to its getting more under shelter of the sternum, and the uncovering of the base by the retraction of the right lung. When the left lung is contracted, the heart is also uncovered as well as displaced; and the pulsation which is felt at the second interspace is produced by the right ventricle at the base of the pulmonary artery; the apex can be felt at the same time below the nipple, or, if the contraction is great, the apex is raised by the ascent of the diaphragm; the axis of the heart is thus rendered more transverse, and the impulse is felt in the axillary region. Air or fluid within the pericardium causes displacement of the heart backwards, since the attachments of the heart are at its posterior part; in the case of fluid in the pericardium, the apex is slightly raised. But little can be said, in a general way, concerning the displacements of the heart caused by the growth of tumours, since every case has some peculiarity of its own. Tumour growths, when they approach the mediastinum, usually bear the heart before them in the direction in which they are growing; and this obvious fact is often of great importance in deciding between a lung consolidation and a tumour. There are, however, exceptions to this rule; a noteworthy example of which occurred in a patient of Dr. Cottons at the Brompton Hospital, in whom there was a cancerous tumour between the right lung and the pericardium, involving the lung and leading to secondary pleurisy, with moderate effusion; the heart in this case was scarcely at all displaced, and this was explained by the fact, ascertained post mortem, that the morbid growth which had originated in the bronchial glands on the right side had also affected those on the left, and had invaded the pericardium and also the left auricle, by which means the heart was fixed in position. Abdominal tumours affecting the position of the heart being mostly of liver origin, give rise to displacement upwards, and to the left. As before remarked, however, no general rule can be laid down. The aim in practice should be to ascertain, in all cases, the exact position of the heart; and by knowing the results of the more regular displacing causes, which are also by very far the more common, any special peculiarity of position will suggest further inquiry as to some special cause producing it. A continuance of this subject into further minutie of detail might be considered as an endeavour to elevate what is, after all, but a very important clinical feature of many diseases, into a disease by itself-a mistake most carefully to be guarded against.