I.

INFLUENCE OF BODILY POSITION ON THE PULSE. By T. R. BLACKLEY, A.B.

[Dublin Journal, July, 1834.] This subject was ably investigated by Dr. Graves, in the fifth vol. of the Dublin Hospital Reports, and is noticed by us in the 15th vol. of this Journal, p. 152 et seq. Dr. Graves acknowledged his inability to explain the reason why position of the body influenced the number of pulsations of the heart, and this acknowledgement stimulated our author to unriddle the mystery. The following extract is necessary, to shew the basis on which Mr. B. rests his conclusions.

"I believe it will be readily conceded, that the action of the heart in a strong and healthy individual, while in a state of rest, is uniform and equal, that it is possessed of a power sufficient to expel a certain quantity of blood at each contraction of the left ventricle, which power is necessary to overcome the obstacles presented to the egress of the blood.

Let us suppose, for instance, that the heart of a healthy man in the erect posture beats sixty times a minute, and at each beat expels one ounce of blood, sixty ounces per minute will be of course expelled; but if the power of the heart be increased or diminished, we must expect a corresponding alteration in the number of beats. Thus, if the power be increased one-tenth, it will require but fifty-four beats to expel sixty ounces in a minute; but if VOL. XXI. No. 42.

it be diminished one-tenth, it will require sixty-six beats.

To this variation of power in the heart are the phenomena of which we speak attributable, or rather, I should say, the variation of resistance to the heart, which comes to the same thing. A question may here be asked, namely,

can you prove that the heart discharges a greater quantity of blood at one time than another, or that the left ventricle does not at each contraction expel the entire of its contents?"

I am fully aware that the general opinion is opposed to mine; indeed, actual experiment would seem to be against me, for it has been affirmed, that on inserting the finger into the left ventricle of a recent heart, it contracts through its whole extent; nevertheless, I think I can prove the reverse, from the anatomy and mechanical construction of the heart itself.

1st. There are no muscular fibres going from the substance of the left ventricle to be inserted into the opposite edges of the valves, or above them into the aorta; therefore the space immediately inferior to the valves cannot be compressed.

2dly. We never find the left ventricle perfectly closed after death, even though it should be at the time that rigidity of the muscular fibre prevails.

3dly. If the valves had no support, as by a certain quantity of blood under them, to act as a counter pressure, they would be liable to injury from the superincumbent mass of blood in the

aorta.

4thly. A vacuum being formed by the expansion of the ventricle, the valves would be drawn downwards with considerable force to fill it up, and thus an additional weight be unnecessarily imposed on them.

Lastly. In a very rapid pulse, say 160, we can scarcely conceive the sides of the left ventricle to be closely approximated through their whole extent at each pulsation, and separated again, the usual quantity of blood as in health being expelled at each contraction. But we can readily admit that such a number of palpitations may be effected, the ventricle contracting but slightly at each beat; or a very small quantity of blood may be contained in the ventricle at each contraction, and thus supersede the Lecessity of the ventricle being much dilated; and we may observe, that in those cases where the pulse is so frequent as I have mentioned, it is never full and strong, but on the contrary, weak and thready, evidently proving that a very small quantity of blood indeed is forwarded at each contraction of the ventricle."

Our author goes on to state that, in the erect posture, the column of blood in the arch of the aorta, together with that in the carotids, presses on the semilunar valves, and opposes the egress of blood from the left ventricle. The arteries being all full, a considerable vis à tergo is necessary to force the blood in all directions, but especially upwards. In the perpendicular position, too, the return of blood by the veins from all the lower part of the body is much retarded by gravitation, and consequently requires greater force from the heart to drive it through the capillaries, and, if you please, pump it up from the veins.

"In the horizontal position these obstacles are lessened or removed; the blood in the carotids and arch of the aorta does not press with such force upon the valves, but chiefly the veins, namely, all those below the heart, being placed in the most favourable position for spontaneously returning their contents, remove an immense obstacle to the egress of blood from the left ventricle. Hence it follows, that resis

tance being opposed to the heart in the horizontal position, and the same power exerted, a greater quantity of blood is propelled at a time, and consequently the number of pulsations necessary to transmit the same quantity in a given time in the erect posture diminished.

The frequency of pulsation, then, is in a direct ratio to the obstacles presented to the heart's action, whether those be mechanical or arising from the debility of the heart itself. On the supposition of the correctness of this view, can be explained, I think, all the phenomena so closely observed by Dr. Graves."

We do not think that this explanation is correct or satisfactory. Mr. B. seems to forget that the heart, having once overcome the resistance of the arteries, and injected its contents into these vessels, their elastic and muscular coats perform all the rest. The blood is prevented from returning into the ventricle by the semilunar valves, and consequently it must be forced along the arteries and through the capillaries by the arteries themselves. Now, as far as gravitation is concerned, the arterial circulation, in all parts below the heart, is favoured rather than checked;

so

that the ingenious theory here broached cannot be made available. We cannot offer a satisfactory reason, ourselves, for the increased frequency of the pulse in the erect posture; but we imagine that it is far more connected with the muscular exertion of standing than with gravitation. Thus, the pulse is increased by the simple change from the horizontal to the perpendicular position; but it is still more accelerated by running up stairs, or up a hill, proving how much influence muscular contraction has on the heart and arteries. We apprehend that standing and walking give rather resistance than assistance to the arterial circulation, by the pressure of the muscles on the vessels; and the heart may thus be called upon for a greater number of contractions. The venous circulation ought to be accelerated by muscular action; and yet we invariably see the veins swell by exercise, as is very apparent in horses, and in the

DANGER OF ERGOT OF RYE IN LARGE

DOSES.

In a report from the Wellesley Female Institution, in the July Number of our Dublin contemporary, there are a few remarks on the indiscriminate and inordinate employment of secale cornutum, by Dr. Maunsell. Mary Redmond, in the fourth month of pregnancy, was seized, after a fright, and severe exercise, with hæmorrhage from the vagina, which continued at intervals for several days. On the 10th of March, 1834, at six in the afternoon, Dr. Churchill saw her, and gave her 45 drops of laudanum. At 9, she was so weak that a plug was introduced. At 7 next morning the plug was expelled, with considerable hæmorrhage, and a grain of opium, with some acid mixture, was given every two hours. At 8, p. m. the haemorrhage set in again, and Dr. C. gave her 3ss. of the ergot at once, repeating it in half an hour. On the 12th, she had a violent head-ache; and, in the course of the day, became delirious, and could hardly be kept in bed. These symptoms yielded to purgatives, cold lotions, blisters, &c. In a few days afterwards, the hæmorrhage again returned, and the ergot was repeated, with another recurrence of delirium, but in a slighter degree.

The second case was a Mrs. Forest, two months pregnant, who was attacked with hæmorrhage on the 21st April, and for which the usual remedies were prescribed. Next day, the discharge having recurred in an alarming degree, the infusion and substance of half a drachm of the ergot was given by Dr. Churchill in two doses, at 15 minutes interval. After taking it, she fell asleep, and on awaking the discharge returned. Another scruple of the ergot was given her, which produced vomiting after an hour. On the following day she was in a state of half stupor, with violent

symptoms gave way to proper medicines. These two cases excited inquiry, when it was found that they did not stand alone. A case was related to our author by Dr. Johnson, in which, through mistake, the infusion and substance of two drachms of the ergot were given in two doses. In six hours, Dr. J. was again called, and found the patient in a state of incomplete coma, with livid face and muttering delirium. There was no uterine action induced by this extreme dose. She was delivered by the forceps, and remained 30 hours delirious and and in a state of partial stupor. She had a bad recovery. In another case, where the ergot was largely used, Dr. Johnson saw complete gangrene of the external parts, with death in six hours after delivery. In a third, the same experienced physician witnessed extensive sloughing of the vagina, without any other probable cause. Mr. Cusack informed our author that similar cases had occurred in his praetice. In a German work, too, the author finds that Professor Joerg, of Leipzig, made experiments on himself, his pupils, and on animals, from which it appeared that nausea, vomiting, pains in the abdomen, weight and pain in the head, with vertigo, followed large doses of the ergot.

The foregoing facts are not sufficient to prevent the moderate use of this important medicine; but they ought to be borne in mind, and prove a check to the reckless manner in which this medicine is now sometimes administered.

ON SCROFULA. By JAS. EAGER, M.D.

Dr. Eager has published a somewhat elaborate paper on the nature and treatment of a disease, which proves a great scourge in this country. The author was a house surgeon in some of the Parisian hospitals, and had good opportunities of witnessing the effects of various modes of treatment, and especially the treatment by iodine. On the nature and causes of this too well known

disease, we need not dwell. The exhibition of iodine on a large scale at the Hospital of St. Louis, in Paris, and the wonderful cures which are said to be performed there, engage our author's chief attention in this paper, and our's also. "The use of iodine requires the greatest prudence. It has been administered internally both in a simple form and combined with iron, mercury, and potass, in the form of pill or in solution. Externally, combined with lead under the form of ointment, or dissolved in water in its simple state, either in lotion, injection, or bath. All these means have had their respective advantages. They were consequently used on various occasions. Iodine taken internally constitutes the basis of the treatment where the stomach is not affected. The results of cutaneous absorption are too doubtful to admit of frictions as the principal form of administering iodine. Children take pills with much difficulty. Pure iodine may be given in the form of tincture diluted with water. Two reasons, however, prevent us from using the tincture at this hospital. In the first place the fear of mistakes in dropping, mistakes the more easily made when there are many children under treatment; and secondly our apprehensions lest the water of Arcueil (which is used exclusively in this establishment, and which contains a large quantity of calcareous salts,) may alter the nature of this medicine. The same objection holds good with regard to the æthereal tincture of iodine, the simple or ioduretted solution of hydriodate of potass, and the alcoholic æthereal tincture of ioduret of mercury. We use the solution of iodine in distilled water called by Lugol, 'Eau minerale iodée.' Each pint of water contains two grains of iodine and four grains of hydriodate of potass, the latter being added to render the former more soluble. We have not deemed it prudent to adopt the use of the solutions of different degrees of strength which Lugol employs; because in the treatment of children, particularly when they are numerous, these different proportions offer many inconveniences without any real advantage. It is much more simple to administer a

solution that contains a fixed quantity of iodine, which may be prescribed at will in more or less large doses, than to have for each patient solutions that contain a variable quantity of iodine.

The dose varies with the age, the state of the digestive canal, its influence on the disease, always beginning with three ounces of the solution, which may be gradually augmented to 12 ounces in the day. This is the strongest dose we have given, viz. vj. in the morning and 3vj. in the evening. Each ounce contains the of a grain of iodine and 4 of a grain of hydriodate of potass. In following this method we know the exact quantity prescribed. After the use of this proportion for some time, we thought to double the quantity of iodine for each pint, but were soon obliged to abandon it in consequence of the disagreeable taste of the medicine, and a sensation of heat which it occasioned in the throat. The solution may be sweetened immediately before use with sirup of gum. If mixed with this sirup long before hand, the iodine becomes decomposed, and the solution loses both its colour and taste. In order to preserve it long fit for use, it should be kept in bottles well corked and opened as seldom as possible. The smallest dose to begin with is 3j. morning and evening, which may be increased to zvj. each time as before-mentioned. This dose is even stronger than that Lugol recommends for adults. When no accidents occur to contra-indicate its use, we continue this solution during four or five weeks, then we stop it, and give a purge of sulphate of soda or magnesia. The purgative is repeated two or three times before we return to the use of the solution. The suspension continues generally fifteen or twenty days. We then resume, and continue its use a month, then stop it again to give the purgative as before said. It sometimes happens that acute accidental diseases oblige us to discontinue the treatment for some time. Diarrhoea and emaciation, which have been so much dreaded, seldom occur; when they do, they always cease on stopping the medicine. I have seen but one case in which the patient became thin; all the other chil