SPEC. III. y C. Palpi motion more rapid and less regular than that of the pulse GEN. II. felt at the wrist; and a similar vibration was observable in the heart itself: the pulsation in the neck was not con- tatio comfined to the jugular veins; it was more forcible and ex- plicata. Complicated tensive than it could have been if it had originated from palpitation. those vessels; and it had more the appearance of a violent throbbing of the carotid artery; although in the axillary artery the pulse was comparatively regular and natural." Dr. Young found, nevertheless, upon making a strong pressure on the right side of the neck with a single finger, that the motion of the carotid artery was very perceptible, and totally independent of that of the superficial parts, being precisely synchronous with the pulse at the wrist, although it required considerable attention to distinguish it from the more irregular palpitation. The symptoms, however, of a dropsy of the chest or pericardium in this patient appear to have been obscure; and at the time when the general hydropic enlargement, which had been much reduced in the course of the autumn, began to increase towards the end of October, the palpitation was considerably less, as well as the pulsations in the abdomen and neck, though the motion of the heart was still fluttering, the pulse at eighty, intermitting and very irregular. On the death of the patient, which occurred soon afterwards, a considerable quantity of fluid was found in the pericardium, in the right cavity of the thorax, and in the ventricles of the brain, but little or none on the left side of the chest the heart was inconsiderably enlarged, and some of its valves, as also some of those of the pulmonary artery, which were much ossified, so that a free passage of the blood was impeded. : sometimes neral irri I have said that palpitation is sometimes dependent Palpitation upon a morbid irritability of the sanguiferous system in dependent general. In some instances, however, we find it rather upon a gedependent upon a morbid irritation and debility of the tability of entire frame, and consequently connected with a very the system. irregular performance of many or all the functions of the body. Of this highly complicated state of the dis Illustrated in Bateman. GEN. II. SPEC. III. y C. Palpi motion of the heart sometimes synchro nous, some times rate. sepa ease we have a striking example in Dr. Bateman's history of himself as given in one of the volumes of the Medicotatio com- Chirurgical Transactions *, which he ascribes to a poiplicata. Complicated sonous action of mercury employed on his own person palpitation. copiously in the form of an unguent to relieve an amaurosis of the right eye, and which seems to have produced something of the mercurial erethism described by Mr. John Pearson †, as taking place in some singular idiosyncrasies, already noticed by us under the head of Syphilis. Subsultory In this case the heart and arteries were equally subject to subsultory and violent motions, sometimes separately, and and arteries sometimes synchronously, but inaccordantly as to the number of the throbs in a given time, and almost perpetually accompanied with a most distressing sense of languor and sinking. There was also a very irksome cough, an occasional sense of constriction across the region of the diaphragm, and such a difficulty of respira tion as to render an erect position at night imperatively necessary. Life was, in this case, unquestionably a forced state of being, and all the stimuli of the external senses and of the will seemed necessary to excite the sensorial organ to a secretion of vital fluid sufficient for the mere preservation of life. And, hence, during sleep, or as soon as these stimuli were cut off, there was such an increase of languor, irregular action of the heart, and sinking, as though in the act of dying, that it was at times necessary, notwithstanding the extreme drowsiness of the patient from a previous and long continued watchfulness, to interrupt the sleep every two minutes; since by this time or even sooner, the failure of the pulse and the appearance of the countenance indicated a supervening deliquium. The powers of the stomach, from the repeated paroxysms of the disease seem to have declined rapidly. Frequent • Vol. 1x. p. 227. Observations on the Effects of various Articles of the Materia Medica in Lues Venerea, ch. xii. Vol. II. Class III. Ord. IV. Gen. vII. Spec. I. GEN. II. SPEC. III. supplies of food and cordials, as spiced wine, appeared at first serviceable in warding off the languor; but at length, C. Palpinothing but fluids could be taken and retained without tatio complicata. increasing the disturbed action of the heart. Yet so ex- Complicated treme was the sense of sinking and immediate dissolution, palpitation. that, on one occasion after a quarter of an hour's sleep, Languor insupportair was importunately demanded, and three glasses of un- able: and diluted brandy were drank in five minutes, without much the most powerful relief; and afterwards ammonia and ether repeated every stimulants ten minutes for two hours; when the paroxysm rapidly unavailable. declined after a copious discharge of limpid urine. The disease continued a twelvemonth before the patient felt, in any essential degree, amended and little benefit was derived from medicines of any kind. It is well known, however, that this acute pathologist, and excellent man, has since fallen a sacrifice to a return of the complaint. : plan of Primary in dication where the disease is sympto matic. In a disease produced by so great a diversity of causes, No general often obscure, and very generally complicated with other treatinent. affections, it is impossible to lay down any one plan of treatment that will apply to every case. Our first endeavour should be to ascertain, as far as we may be able, whether the palpitation be idiopathic or symptomatic; and if the last, while we endeavour to palliate the present distress, our attention should chiefly be directed to the primary malady. If acrimony or any other morbid state of the stomach or bowels be suspected, this, as far as possible, should be removed; and if we have reason to suppose hydrothorax or any other kind of dropsy, the means hereafter to be recommended for this tribe of complaints should be resorted to from the first. In pregnancy, the disease will most probably cease upon a cessation of this state of body, and usually, indeed, ceases during the latter months, or after the period of quickening. And if it seem to be chiefly dependent upon a general irritability of the sanguiferous system, or of the whole constitution, the sedative antispasmodics, tonics, and especially the metallic, quiet of mind as well as of body, regular hours, light meals, pure air, and such exercise as agrees GEN. II. SPEC. III. Clonus Palpitatio. Palpitation. Treatment. Indication where the disease is idiopathic or structural. Disease has sometimes been carried off by other complaints. best with the individual, will often prove of essential service and sometimes effect a radical cure. Much of this plan will also be requisite where we have reason to apprehend some structural affection of the heart or larger blood-vessels: and when, from any incidental excitement the irritation is here more than ordinarily troublesome, recourse must be had to narcotics. Opium is by far the best where it agrees with the system : but its secondary effects are often very distressing, and we cannot employ it. In such cases we must find out, by trial, what is its best succedaneum : the hop, henbane, hemlock, and prussic acid, have all been essayed in their turn, and sometimes one has succeeded where the rest have all failed. But upon the whole the henbane has answered far better and more generally under the author's own hands; and in one or two instances of great obstinacy he has known it effect a perfect cure when all the rest had been tried in succession and had totally failed. In Dr. Bateman's case, however, which was peculiarly severe and complicated, the henbane, though it seemed serviceable at first, taken in doses of from three to five grains of the extract every night, gradually lost its effect even when repeated three times a night in doses of five grains at a time. The tincture of hop, in doses of thirty drops every six hours, was next tried, but produced no other effect than a slight drowsiness. Musk seemed most successful in draughts of ten grains each; yet even this was of transient duration, and was abandoned as of no Where the palpitation is accompanied with a distressing tendency to deliquium I have occasionally relieved it by camphor pills, with the ammoniated tincture of valerian or the aromatic spirit of ether. use. The disease has occasionally been carried off by a sudden attack of some other complaint, as gout, herpes, diuresis, or the formation of an abscess: and hence, setons, and issues have been recommended, and have occasionally proved serviceable. Zacutus Lusitanus found the latter produce a radical cure in a palpitation of the heart which GEN. III. Clonus Palpitatio. he ascribed to the rapid healing of some chronic ulcers *. Schenck advises the wearing a bag of aromatics at the pit of the stomacht; and hence, perhaps, the origin of camphor-bags as a specific for irregularities of the heart of Treatment. another kind. Palpitation. SPECIES IV. CLONUS NICTITATIO. Twinkling of the Eye-lids. RAPID AND VIBRATORY MOTION OF THE EYE-LIDS. 66 It GEN. II. SPEC. IV. Common nictitation action for useful pur a natural poses: especially for the pur pose of supplying the cornea with moisture. To a certain extent, twinkling or winking of the eyes is performed every minute without our thinking of it. is a natural and instinctive action for the purpose of cleansing and moistening the eye-ball, and rendering it better fitted for vision. Dr. Darwin has some ingenious "When the cornea", says remarks upon this subject. he, becomes too dry it becomes at the same time less transparent, which is owing to the pores of it being then too large; so that the particles of light are refracted by the edges of each pore instead of passing through it; in the same manner as light is refracted by passing near the edge of a knife. When these pores are filled with water, the cornea becomes again transparent." Moisture is, indeed, a frequent cause of transparency in various bodies; and hence, in dying people whose eye-lids are become torpid and do not nictitate, the cornea is sometimes so dry that its want of transparency is visible to bystanders. So when white paper is soaked in oil, and its Illustrated. Prax. Hist. Lib. VIII. Obs. 30. Lib. II. Obs. 216. Advantage of such sup ply. |