GEN. I. SPEC. IX. Entasia Acrotismus. Pulseless ness. In these anomalies often a want of har mony in the stroke of different arteries. Acrotism strikingly exemplified as related in his life by Home. skin, white and furred and parched tongue, and occasional delirium." * In many of these anomalies there is not only no perceptible pulse or a very retarded one, but often intermis sions more or less regular, and occasionally a want of harmony between the stroke in some of the arteries compared with that in others. Reil gives a case in which the heart, the carotids, and the radial arteries all pulsated differently + and Beggi another, in which the acrotism, or want of pulsation, extended over the entire frame with the exception of the heart, which pulsated violently ‡. : This species is strikingly exemplified in the biographical sketch of Mr. J. Hunter, drawn up and prefixed to in J. Hunter his volume on Blood and Inflammation by Sir Everard Home. Mr. Hunter for the four preceding years had annually suffered from a fit of the gout in the spring, In the year 1773, this did not return, and having, on a particular occasion, been greatly affected in his mind, "he was attacked", says Sir Everard Home, "at ten o'clock in the forenoon, with a pain in the stomach, about the pylorus it was the sensation peculiar to those parts, and became so violent that he tried change of position to procure ease; he sat down, then walked, laid himself down on the carpet, then upon chairs, but could find no relief: he took a spoonful of tincture of rhubarb, with thirty drops of laudanum, but without the smallest benefit. While he was walking about the room he cast his eyes on the looking-glass, and observed his countenance to be pale, and his lips white, giving the appearance of a dead man. This alarmed him, and led him to feel for his pulse, but he found none in either arm. He now thought his complaint serious. Several physicians of his acquaintance, Dr. William Hunter, Sir George Baker, Dr. Huck Saunders, and Sir William Fordyce, all came but could find no pulse the pain still continued, and he found him * Med. Trans. Vol. iv. Art. xx. + Memorabilia Clinica. Vol. 11. Fasc. 1. 6. Hall. 1792. GEN. I. SPEC. IX. Entasia Pulseless ness. self at times, not breathing. Being afraid of death soon taking place if he did not breathe, he produced the voluntary act of breathing; his working his lungs by the Acrotismus. power of the will, the sensitive principle with all its effects on the machine not being in the least affected by the complaint. In this state he continued for three quarters of an hour, in which time frequent attempts were made to feel the pulse but in vain. However, at last the pain lessened, and the pulse returned, although at first but faintly, and the involuntary breathing began to take place. While in this state he took Madeira, brandy, ginger, &c. but did not believe them of any service, as the return of health was very gradual. In two hours he was perfectly recovered." * This case highly extraordinary and strikingly elucidative of a close symprevailing between pathy often discontinu This is one of the most extraordinary cases on record, considering the extensive group of important functions that were jointly affected, and the total freedom of the rest and nothing can more strikingly prove how close is the sympathy that in many instances prevails between discontinuous organs. The chief disease seems to have prevailed in the heart, the chief pain in the stomach on its upper side; and for this we may, perhaps, account, ous organs. from a law of the animal economy we have so often of Case exlate had occasion to keep in view, by which a morbid ac- plained. tion affecting one extremity of a nervous fibre, or bundle of fibres, is, under particular circumstances, most severely felt at the other extremity: for as one of the branches of the phrenic nerve passes over the apex of the heart, and is afterwards continued to the diaphragm which maintains so intimate an association with the stomach, it serves as a direct line of communication between each of these organs; and the painful impression imparted to the end of the nervous twig that rests on the heart may, by this law, be transferred to its other extremity that lies so contiguous to the upper part of the stomach. The nature of the pain and the collateral symptoms • Sir E. Home's Life of Mr. Hunter prefixed to the Treatise on Blood, &c. P. xlvi. GEN. I. Entasia scem sufficiently to show that this disease was of a spasSPEC. IX. modic kind: for the deficiency of pulse was subsequent Acrotismus. to, and consequent upon the pain, and ceased upon its removal, while the deadly paleness of the face gave proof of a constriction of the capillaries. Pulseless ness. All such cases com monly connected with a diseased state of the larger ar teries or lead to sudden death. Exemplified. So far as my own experience has extended, such failures of the pulse, whether consisting in a total suspension, or a preternatural retardation, and attended with acute or with very little pain, are dependent upon a diseased state of the larger arteries, or the larger viscera of the thorax viscera, and or abdomen, and generally lead to sudden death. The case of the captain of the navy which I have just related and which was drawn up while the first edition of this work was in the press, I may now apply to, in illustration of this remark: for I have since been informed by his sister that while at Swansea, apparently in as good health as he had ordinarily enjoyed for several years, he was attacked with a fit of apoplexy which carried him off in less than an hour. Such, too, was the fate of Dr. Latham's patient, for we are told that "one day, when in complete health, as he then considered himself, he dropped down in the street and expired." And so sudden was the decease of Mr. J. Hunter, that feeling himself unwell while in the course of his professional attendance at St. George's Hospital, he went into an adjoining room, gave a deep groan, and dropped down dead. Mode of treatment, where the disease is constitutional. In all cases of this kind, therefore, the mode of treatment must depend upon the nature of the exciting or predisponent cause as far as we are able to ascertain it. Where the cause is constitutional, a sober, quiet, and regular habit of life, with a due attention to the ingesta and egesta, and particularly to a tranquillized state of mind, will often enable the valetudinarian to reach his threescore and tenth year, with cheerfulness and comfort: but he must content himself with the cool sequestered vale of life, and not form a party in its contentions, and its glitter, its bustle and "busy hum". GEN. I. SPEC. IX. Entasia Pulseless ness. When de Where the affection appears to be dependent upon a particular state of any one of the larger thoracic, or abdominal organs, as the heart itself, the lungs, the stomach Aerotismus. or the liver, our attention must be specially directed to the nature of the primary disease. And in these cases it is often essentially relieved by some vicarious irritation, pendent as a seton or issue, a regular fit of the gout, a cutaneous eased state eruption, or a painful attack of piles. During the paroxysm of the larger itself, the most powerful and diffusive stimulants should organs. be had recourse to, as brandy, the aromatic spirit of ammonia, or of ether, which is still better, and opium in any of its forms. : upon a dis of some one spontane Some persons are said to possess a natural power of thus Sometimes keeping the heart upon a full stretch, and hereby proproduced ducing an universal deficiency of pulsation, and of simu- ously. lating death. Dr. Cleghorne, and Dr. Cheyne both give an instance of this. It should be observed, however, that the individual in either case died suddenly and one of them, Colonel Townshend, within a few hours, after having maintained this rigidity of the heart for half an hour, at the expiration of which time he consented to resuscitate himself, and awoke from the apparent sleep of death. It should hence seem that the natural energy of the heart sinks gradually or abruptly beneath the mischievous exertion wherever such a power is found to exist. GEN. II. Origin of the generic term. FORCIBLE AGITATION OF ONE OR MORE MUSCLES IN THE Greek terms, xxóvos and zλóvnos, import "agitation, commotion, concussion." The clonic, or agitatory spasms form two distinct orders in Sauvages, and a single genus Synonyms. in Parr. The first is unnecessarily diffuse; the second is too restricted. The two orders of Sauvages are in the present arrangement reduced to two genera, and constitute that immediately before us, and SYNCLONUS, or that which immediately follows. Dr. Cullen seems at one time to have had a desire of distinguishing the diseases of both these genera by the name of convulsions; and of limiting the name of spasms to the permanent contractions or rigidities of the muscular fibres produced by spastic action, constituting the different species of the preceding genus. "I think it convenient", says he, in his First Lines, Spasm and convulsion how distin Cullen. 66 to distinguish the terms of spasm and convulsion, by guished by applying the former strictly to what has been called the tonic, and the latter to what has been called the clonic spasm." Yet the whole are treated of in his nosological arrangement under the common name of SPASMI, and even in his First Lines, notwithstanding this distinction, under that of "spasmodic affections without fever". These spasmodic affections are, indeed, subsequently divided into a new arrangement of "spasmodic affections of the animal functions ;-of the vital;-and of the natural:" throughout which an attempt is still made to separate the term convulsion from that of spasm, and apply it to |