der. Phyficians were called in. The diforder was attributed to the gout; and remedies for the gout were accordingly prescribed. Their attempts, however, were to no purpose. The pains feemed to affume a new force after the ufe of thefe medicines, and fixed themselves more and more to the left fide of the breaft; fo that it was found impoffible to remove their feat. Blood-letting, opening medicines, oil, opium, &c. were all given, without affording any relief. To thefe pains, after, a certain time, there was added another, and an infinitely more excruciating one, which was felt immediately under the left breaft, and feemed, as the marquis expreffed himfelf, as if the infide of his breaft was torn out by violence. Tormented himself to this degree, and tormenting all about him, by his lamentable and inceffant groans, he could find no place or fituation that afforded him the leaft mitigation of his mifery. He ufually fat upon his bed, leaning a little forwards, and reclining his elbows on his thighs. In this fituation he, now and then, at intervals, got a little reft, and flept a few moments; but it was only to be waked foon, and on a fudden, by a cruel exacerbation of the fame relentless pain. Such was the fituation of the marquis when Boerhaave was defired to vifit him, with his phyfician in ordinary, the fame Dr. Bye, whom we have already mentioned. When Bye related to Boerhaave all the particulars of the difeafe, and the remedies that had been employed to no purpose, they ac knowledged to each other, that it was impoffible to fay any thing. with certainty, either of the feat or the nature of the difeafe. Bye prefumed, there was an abfcefs in the lungs; becaufe he had obferved the patient expectorate a vifcid matter after much agony. Boerhaave, however, differed from him in opinion; because, excepting the fingular and urgent fymptoms of pain, the marquis was in other respects healthy. He was then asked, what he thought of the nature of the dif eafe? It was not till after fome confiderable reflection that he anfwered, that he really did not know what to think. He was inclined, however, to be of opinion, he faid, from the fymptoms, that the organs deftined to dilate the breaft, were unable to fupport the contractions effential to the action of each muícle; and the parts of the breaft which required to be dilated, refifted to this dilatation at each inspiration; and that, from this arofe the violent pain, the difficulty in breathing, and the fenfe of fuffocation. The patient and his friends were fatisfied with this reflection. Boerhaave advifed cataplafins to be frequently applied to the parts that are the moft in motion in refpiration; as the ribs, cartilages, and fternum. He likewife prefcribed emollient drinks, a fparing diet, and the frequent infpiration of the vapour of fome foftening decoction. His prefcription was followed, and the patient found himself much relieved. His friends began to indulge hopes of his recovery. The pain never returned again with fo much violence as before, even till his death. death. How blind and precarious, fays Boerhaave, is the joy of us mortals ! At length, the cough returned, as it were, with new violence. Nothing could calm it but opium; but this calm was not of long du ration: his expectoration was exceedingly painful, and his refpiration fo difficult, that the patient was obliged to throw his neck backwards, to raise his breaft; and, at the fame time, to draw in his breath, with fo frightful a noite, that it could be compared only to the cry of a bittern. Then again, perhaps, for a few moments, the refpiration would be more eafy but this relief was but trifling. He was obliged to be almoft conftantly feated upright, both night and day, with his neck ftretched out, and his head raifed. At the leaft change of poiture, when he by chance flept for a moment, he felt the most horrid pain. If he attempted to lie down on his pillow, to repofe himfelf for an inftant, his face became black; the veins of his head fwelled, and his eyes feemed to be bursting from their fockets. He appeared to draw his breath only from the bottom of his entrails. An hideous hollow found feemed to be his only relief. It he attempted to freak, a few words ufually revived all his pain. clyfter, occafionally thrown up, was now the only thing that gave him any relief. The great ftricture of his breast perfuaded him that his disease was hypochondriacal; and that this fenfation was the effect of flatus. He was the more perfuaded of this, because his appetite was fo keen that he would have eaten to excefs, if his fervants had not taken care to prevent him. What he eat, ferved only to increase his pain. About eight days before his death, the hemorrhoids began to return; and this gave him great fpirits. He now began to have hopes of being cured, and even reproached his phyficians with not having attempted to bring them back fooner. On the 7th of July he voided, by the anus, a confiderable quantity of blood, which immediately coagulated. The next morning the flux continued, and in greater abundance. The marquis was fo enlivened at this, that he attempted fo make a few fteps in his chamber, leaning upon his fervants. The fame day he had a moft craving ap petite, and eat of many different things, fwallowing every thing, juft then, without any fear of fuffocation. He likewife fupped with the fame good humour; rejoiced at being able to do what he had fo long been incapable of; having, for fome time before, not even dared to take any folid nourifliment, without danger of immediate fuffocation. Boerhaave remarked, with aftonifhment, that in the midst of this deplorable ftate, the pulfe was ftill regular; nor did it begin to On the 9th of July, however, fall or vary, or become intermit- Dr. Bye found him again in bed, tent, till a few days before his after påffing a most painful night. -death. The marquis dragged on He feemed to be in the agonies of this unhappy life till the 9th of "death. His face and neck were July. At the leaft return of the confiderably fwelled; his face was pain, his face became black. A of a dark complexion, and his eyes eyes feemed as if starting from his head. He was able, however, to relate what had happened in the night. He mentioned the danger he had been in of fuffocation, and defired to be let blood. The physician refused this. You are determined then that I fhall perifh, faid the marquis. You would not furely with, faid Bye, that I should haften your death? While he was fpeaking thefe words the fuffocation increased; his face became quite black: he attempted to bid adieu to the mar chionefs, who was by the bedde; and ther, yielding to his laft efforts to breathe, bowed down his head and expired. Bye immediately informed Boerheave of this event, to whom he had every day communicated the ftate of the patient. Boerhaave came to him; and they were permitted to open the body. Boerhaave, before this opera tion, was willing to reflect on all the circumstances of the difeafe, to fee whether he could not foretell what he should discover on diffection; and thus fay what part was diseased. But this great man candidly owns, that he was unable to determine any thing before hand; and he requests the reader to judge for himself, from the circumftances he has related, of what might be the effential caufes of the marquis's death, before he goes any farther. The body was, externally, of a very healthy appearance; and, notwithstanding the marquis's long abtinence and extreme fufferings, he was by no means emaciated. The abdomen only was a little fwelled. This tenfion rendered Boerhaave very attentive: he even ventured to say to the af fiftants, that they were going to difcover the cause. On opening the breast, there immediately fpouted out a ftream of limpid, yellow, infipid water. Boerhaave reflected a moment on what this water might be, and whether it was not a dropfy of the breaft which had fuffocated the patient, after caufing fo many ills. It continued to flow during the diffection, but in lefs quantity. The breaft seemed to be filled with water, on looking into it, through this narrow opening. Boerhaave introduced his finger into it, and found the right lobe in its place, but adhering to the pleura. He went no farther on that fide, but opened the left cavity of the breast, and found there no water: but the whole lobe, from the top to the bottom, was adhering to the pleura. He then carefully laid this part of the thorax open; taking care not to disorder any part of its contents. The moment he had accomplished this, he faw that, from the neck to the diaphragm, the whole of the cavity was filled with a white fubftance, of a found appearance, except that, in the middle of its furface, there was a little tumour, which included a fluid, of a milky colour, but not purulent. fubftance was pretty hard and uniform, through the whole of its furface. Boerhaave was stupified at the fight of this fingular phenomenon. This fubftance was much more confiderable in the left than in the right fide of the heart; and even entirely filled it. This was the reason why the lobe of the lungs was preffed to close to the pleura on that fide, that neither air nor blood could penetrate it any longer. The first feat of the disorder had, there. fore, fore, probably, been in the left cavity, under the fcapula; and hence the pain the patient complained of at the beginning. This excrefcence had indeed extended to the right fide of the breaft; but ftill it was not fo confiderable there as not to leave fome room for the admiflion of air, and for fome degree of action to the lobe on that fide, in refpiration. The great veffels how ever, and even the heart itfelf, with its pericardium, were pufhed fomewhat out of their places. The refpiration could, therefore, only take place in this lower part of the right cavity of the thorax, becaufe this excrefence being at the top of the breaft, where it is narrowest in the human fubject, the lungs were preffed down towards the inferior part of the cavity, where the breaft becomes fomewhat wider. This, therefore, explains the extraordinary efforts made by the patient, to draw his breath from this lower part; the bronchiæ being comprefied above by this fubfiance. Hence, too, the hollowness of his voice. Befides all this, the right lobe was found adhering to the pleura, only at the upper part of the breaft. About the middle, it was feen attached to this tumour; fo that here was another hindrance to the action of this lobe. Boerhaave attempted to feparate the whole of this fubftance from the other parts, to which it was attached. It was impoffible to take it out at once and entire, on account of the pericardium, lungs, and great veffels. He extracted it, however, in the best manner he was able, and found the weight of it to be fix pounds and three quarters. As it was light in proportion to its fize, fome idea may be formed of its exceffive bulk. The whole of this fubftance was as white as fnow. Here and there appeared a milky fluid, on cutting into it. No veffels, however, were to be perceived in it, excepting those to which it was attached. Except the fkin, that enclosed the whole, there was no appearance of any cauls, or cavities, or membrane within. If any portion of this fubftance was rubbed between the fingers, it melted like fat oil. It was, therefore, in Boerhaave's opinion, the true fteatoma. The difplacement of all the thoracic vifcera was altogether fingular. This fubftance had pushed the diaphragm downwards; and this had occafioned the tumefaction of the lower belly, which Boerhaave noticed at the first as a fingular appearance. The pericardium being united to the diaphraghm, had followed it, and, of courie, removed from its natural fituation. This was followed by a depreffion of the great vefels. We have already feen the ftate of the lungs. Here then was a new example of human mifery. A mild, unctu. ous, an innocent humour, occafioned, by its abundance, a fingular difeafe, and death; and this, from its fixing itself in too great a quantity on parts which can in no degree be compreffed without danger. We learn from this, therefore, that, in extraordi nary difeafes, we may reasonably fuppofe fome hidden and unknown caufe, which anatomy alone can be likely to explain. It were to be wifhed, fays Boerhaave, that the experienced phyfician might be able to discover the the fource of a fimilar complaint, from his first feeing the patient; and that he might then be able to prevent this fat from fpreading, fo as to form fo deftructive a mais; we might then hope to be able to prevent the diforders it occafions; because it is impoffible to refolve or diffipate a fteatoma that is once formed, unlefs its fituation fhould admit of manual operation. Boerhaave confeffes, that he knew no medicine that would prevent a beginning fteatoma from enlarging; and that which is not to be done externally, must be lefs poffible within. Every time, therefore, fays he, that I hear great talkers vaunting their remedies for this purpofe, I wifh to fee them cure fchirrous tumours, occult and ulcerated cancers, meliceris; fteatoma, &c. by certain means, and thus give us a proof of their art. As for my part, I have obferved that all prudent and experienced phyficians allowed their infufficiency on thefe occafions, though they did it with regret. It would feem as if Boerhaave mg his might meet with fome reproaches, for his method of treating the Marquis before this complaint. Nothing could be more grateful to the ignorant and illiberal, men of little minds, and of a narTOW way of thinking, than an opportunity of cenfuring fo great a genius as Boerhaave. There are, even now, perfons of this difpofition, who, in reading this narrative, will perhaps be led to afcribe the diforder of the Marquis to the fuppreffion of the hemorrhoids. But the great Boerhaave has replied to thefe frivolous judges, by VOL. XXV. faying that a fteatoma cannot be derived from the cure, or the fuppreffion of the hemorrhoids; that he had cured them neither by cauftic nor by any other external application, but by mild, emollient, and deterfive remedies; and that no figns of plethora had been perceived when the hemorrhoidal flux began to diminish. In fhort, fays he, with his ufual candour and dignity of mind, let every one judge freely and fincerely for himself; I have defcribed the dif eafe, fuch as I faw it. The phyfician, therefore, as well as the mathematician, has fulfilled his duty, when he has proved that a difficulty is, in every fenfe and point of view, inexplicable. He who proves a difeafe to be impenetrable, and of courfe incurable, deferves as much of our efteem as he who points out the feat of a difcafe, and the method of curing it. Account of Mount Vesuvius in the Year 1777. From Travels into the Two Sicilies, by Henry Swinburne, Efq. arrival, prevented me THE unavoidable hurry upon from vifiting Vefuvius while the eruption continued. As foon as I was at liberty, I hired a hackney two-wheeled chaife, called a Caleffo; which is no more than a very uneafy triangular feat, gilt and bedaubed with gaudy colours, fixed upon an axletree, and drawn by a fingle horfe. Some of thefe horfes fell very dear, and go at a prodigious rate, always in a high trot. The driver ftands behind, and with the whip and voice diᏀ |