Welcome, Zacynthus, welcome are thy shades, Whose echoing cliffs repeat the boatman's song ; And virtue's palm, and wisdom's olive crown. The conclusion of the poem is in a style which does honour to modern poetry. Whence bursts this flood of light, before whose ray As if some daring hand aside had thrown The mystick veil that shrouds the world unknown, And tempt the trackless deep, unbounded by a shore. From reason's light he taught the list'ning youth Or in mysterious symbols half conceal'd The secret lore which Memphis had reveal'd. And whence in human breasts immortal glows Unseen celestial beings hover nigh THE BOSTON REVIEW, FOR NOVEMBER, 1810. Librum tuum legi, et quam diligentissime potui annotavi quae commutanda, quae eximenda arbitrarer. Nam ego dicere verum assuevi. Neque ulli patientius reprehenduntur, quam qui maxime laudari merentur. Plin. ARTICLE 13. Cases of Organick Diseases of the Heart. With dissections and some remarks intended to point out the distinctive symptoms of these diseases. Read before the counsellors of the Massachusetts Medical Society. By John C. Warren, M. D. Boston; T. B. Wait and Co. 1809. No subject in medicine has hitherto been more involved in doubt and obscurity than diseases of the heart. Notwithstanding the frequency of these complaints, the formidable train of symptoms, which marks their progress, the very gradual manner in which they are fully unfolded, the favourable opportunities thus afforded to physicians to compare these symptoms and form a correct judgment of the nature of the morbid affection and the liberal and candid views of the publick, of the advantages resulting from a careful examination. of the changes of organization after dissolution, it is to be lamented that no branch of this science has been less investigated or so little understood. From the age of Morgagni to the present time, these diseases have hardly constituted a subject of medical research; and, if we except the imperfect collections of Baillie, and the observations of Corvisart, we shall find no separate work, not even a treatise, on the characteristick symptoms of morbid affections of the heart. In consequence of the obscurity diffused over these diseases, and the great difficulty of forming an accurate diagnosis, physicians, it would appear, have been contented with the prominent fact, that they existed somewhere among the thoracick viscera. Hence the symptoms of diseased organization of the heart itself, of the great blood vessels connected with it, of the pericardium, of the cavities of the pleurae and even of the lungs, have been often confounded with each other, their classification has been neglected, and no criteria of either have been permanently established. The diseases, whose symptoms resemble those arising from changes of structure or volume of the heart, and which are often mistaken for it, are asthma, phthisis pulmonalis, and hydro-thorax ; and it is the object of Dr. Warren, in publishing these cases, to show, "that whatever resemblance there may be in the symptoms of the first, when taken separately, to those of the latter diseases, the mode of connection and degree of those symptoms at least are quite dissimilar; and that there are also symptoms, peculiar to organick diseases of the heart, sufficiently characteristick to distinguish them from other complaints." In this work we are presented with ten cases of the symptoms which preceded, and of the morbid changes of the heart and its great vessels, which appeared on accurate examination after the decease of the subjects. Of these, the first, of a late governour of Massachusetts, is undoubtedly the most interesting, not only from the character and station of the patient, and the accuracy and fidelity with which the gradual progress of the symptoms is recorded; but from the minute examination of the diseased organs, and the perfect demonstration of the unchangeable cause on which depended the whole series of his dreadful suffering. As we shall soon quote the observations of Dr. Warren on the symptoms of these cases taken collectively, we think it unnecessary to insert the whole of the case above mentioned, and we shall therefore confine ourselves to the description of the morbid appearances after death, which will afford a good example of the mode of investigation, and of the changes in organization in most or all of the subsequent cases. "DISSECTION, NINE HOURS AFTER DEATH. "EXTERNAL APPEARANCE. "The whole body was much emaciated; the face pale and contracted. The hands were slightly oedematous. Discolourations, answering to the ribs, were observed on the thorax; many small purple spots, hard and prominent, on the back; excoriations on the nates; and purple spots, resembling incipient mortification, on the heel and toe. "THORAX. "The integuments of the thorax were free from fat: the cartilages of of the ribs ossified in various degrees, some perfectly, others slightly. Upon laying open the cavity of the thorax, it was found to contain about three pints of water, the proportion being greatest on the left side. "The lungs were contracted into a smaller compass than usual, and were very firm to the touch. Their colour anteriorly was whitish, with small distinct purple spots; posteriourly, of a deep red, with similar spots. The right lobe adhered closely to the pericardium; it also adhered to the pleura costalis, by a great number of strong cords, which seemed to be elongations of the original adhesions. Some of them were nearly as hard as ligament, and many an inch in length. Internally the lungs presented a very compact structure. Their cells were crowded with mucus, and their vessels filled with black blood, partly fluid, and partly coagulated. Some portions were firmer and more condensed than others, but no tubercles were discovered. "The pericardium, viewed externally, appeared very large, and occupied almost the whole space behind the opening formed by removing the sternum and cartilages of the ribs. It was situated principally on the left side, and contained about double the usual quantity of water; but was principally filled by the enlarged heart, to which it adhered anteriourly about two inches, near its base. Its parietes were, in every part, very much thickened and hardened. "The heart presented nearly its usual colour and form, excepting on its anteriour surface, which was somewhat discoloured by coagulated lymph. It was enlarged in bulk to, at least, one half more than the healthy size. The auricles and ventricles contained coagulated blood. The tricuspid valves were in a sound state. The left auricle was double the usual size. The left ventricle was enlarged, about three times thicker and much firmer than usual. The mitral valves were very much thickened, and near the insertion of their columnae, which were sound, cartilaginous, so that they were quite rigid, and the opening made by them, from the auricle to the ventricle, was scarcely large enough to admit the passage of a finger. The semilunar valves of the aorta were ossified at their bases and apices, and the portion intermediate, between the base and apex, partly ossified, and partly cartilaginous, so as to render the valves very rigid. The aorta was at least one half larger than usual, especially at its arch. The arteria innominata, the carotid, and subclavian arteries, were uncommonly large and thick. The coronary arteries were considerably ossified. "ABDOMEN. "The omentum was destitute of fat. The stomach distended with £atus on the pylorick side; its cardiack extremity, lying under the liver, was pressed down and contracted. The liver was shrunk; its tunick |