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toms were so far mitigated as to permit free motion in the part. This patient recovered rapidly without any farther medication.
A fourth case, which had resisted acupuncturation, assisted by the free use of the stramonium ointment, yielded upon the fourth day from the first application of the niorphia, the patient expressing much satisfaction at the effects of the remedy.
Since treating the above cases, I have had an opportunity of testing the good effects of morphia in several other instances, and with results which induce me to entertain a very favourable opinion of its remedial powers. Judging from the limited experience which I have as yet had of its application, I should think it best adapted to the recent and active grades of the disease. I think it proper, however, to state that I have met with one case of rheumatism in which, though to all appearance a favourable one for its successful exhibition, the morphia failed in producing its beneficial effects.
For the American Medical Intelligencer. ART. II.-LUSUS NATURÆ. To Dr. Robley Dunglison.
Dear Sir,-I send you for publication, should you deem it worthy of an insertion in your valuable medical journal, a hastily drawn up description of a remarkable Lusus Naturæ, which occurred in this county, in Nov. 1840.
Wm. S. THRUSTON, M. D. Mathew's Court House, Va., April 20th, 1841.
Medical and physiological works abound with numerous cases of very novel and singular developments; with instances of monstrosities assuming every form and shape, both in the inferior and superior orders of creation. Cases of excess, and deficiency of parts, are found to be recorded in every physiological work; but I doubt exceedingly whether there is so remarkable and novel a case on record in any of the American or European publications, similar, in all its bearings, to the one which is now presented to the medical profession ;-one so remarkable in its conformation, or singular in its developmenis; or one so well calculated to excite the interest and curiosity, to elicit the speculations and opinions of the medical and physiological inquirer after truth, and to fill with astonishment and wonder the superstitious and uninformed spectator, as this admirable specimen of one of nature's freaks.
A free negro woman, in the county of Mathews, Va., was delivered on the night of the 29th of November, 1840, of three children. One of them, a remarkably fine child, is still alive, doing well, and apparently in perfect health and perfect in its conformation. The other two are as large as ordinary lwin children generally are, and present the following singular appearance. There are two heads and necks, perfect in their organisation; the head of one rather larger than the other, and somewhat deformed or injured from in proper delivery; four upper and two lower extremities, iwo chests, one abdomen or body, one umbilical cord, and one male organ of generation. There is to all appearance a perfect conformation of parts from the umbilicus to the apex, except about the chest, which is a little remarkable in its formation. They are united sidewise, from the clavicle to the umbilicus; the right chest of one, and the left of the other, appear deficient, or rather they seem to have grown into each other;
consequently the remaining portions project out somewhat unnaturally. The right and left arms of each are ihrown over each other's shoulders and back, presenting the appearance as if they were embracing. The other two arms hang in their natural position.
From the umbilicus downwards, they are one; and to all appearance there is a perfect development of parts, except the organ of defecation, which is somewhat imperfect, or rather nearer the scrotum than natural. It is thought that they were alive just before birth; they certainly possessed vitality during some portion of their uterine existence, every part being well proportioned in size, &c., and evidently nine months children. There being two chests, it is reasonable to suppose that there must be two hearts, and two sets of pulmonary organs, and one set of digestive apparatus. It seems to me, that so perfect a development of external parts could not have taken place without a corresponding development of the internal organs; or that two distinct children, as they appear to be, from the umbilicus to the head, could not be supported by one circulating system, and one set of pulmonary organs. There being one abdomen, it is not, I presume, dealing too much in speculation, to suppose there must be only one set of intestines or digestive apparatus; certainly if there be two, they must have, or rather open into, one common duct, ihe rectum. This, however, is mere speculation, as I have submitted them to no anatomical examination, designing at some future day to present them to some medical museum.
Í have them at present in a perfect state of preservation in alcohol. Could this very singular lusus naturæ have been delivered alive, and I doubt not its practicability, had the case been in the hands of a skilful accoucheur, and lived to maturity, we should have had presented to us the singular anomaly of two beings in one, and supported upon only two lower extremities. The celebrated Siamese twins, who have traversed every portion of the civilised globe, gaining notoriety wherever they have exhibited themselves, attracting the attention of the curious and enlightened, filling with astonishment and wonder the illiterate, and eliciting the speculations and opinions of the medical and physiological members of the profession, will not, I am sure, bear comparison will ihis remarkable lusus nature.
The writer of this, together with many members of the medical profession who have had the pleasure of visiting and seeing the numerous cases of monstrosities, both in the medical and other museums in Philadelphia, as also of seeing the noted Siamese twins, fully concur in the opinion that this is a far greater curiosity, and greatly surpasses any specimen they have ever seen or read of, in its singular development. Already different views and opinions have been advanced by the medical gentlemen who have seen it, as to its internal structure and physiological relations. It is indeed amusing to observe the countenances, and to hear the singular expressions and opinions of the numerous uninformed persons who have seen it, as to its uterine development and fætal existence, and finally its delivery; and surely this is not at all remarkable, for whether it may be attributed to the influence of the maternal imagination on the fætus in utero, or to accidental changes experienced by the fætus at some period of uterine existence, or to a primitive defect in the germ, are questions well calculated to puzzle the most profound physiologist to solve, as well as to open a wide field upon which the imaginary and speculative members of the profession may muse with pleasure and interest. The celebrated Siamese iwins have already elicited much speculation, and have drawn forth the different views and opinions of most of the distinguished members of the medical profession, both of this country and Europe, in relation to their internal organisation, &c. Whether there exists so great sympathy between their nervous and circulating system, in fact, among all their important organic developments, as to endanger their lives, were the ligamenious membrane that unites them severed, has been a question long mooted by medical men. The writer of this, as before observed, has had the pleasure of seeing this noted curiosity, but, to speak candidly, saw nothing about them calculated to excite very much his curiosity and astonishment, except the fact of their being united by a ligamentous substance, and the remarkable similarity in their countenances and physical conformation, &c. The most singular fact is, their having been delivered
alive, and survived to manhood in a country where the medical, and especially the obstetrical, art must have been, and still is, from the nature of things, in a very rude and imperfect condition; but dame Nature does, and would in a majority of instances, accomplish what the eager physician, either to afford speedily relief to bis suffering patient, or to enhance his own reputation, too frequenily takes out of her hands. How much more astonishing and remarkable, then, is this little curiosity, than the noted Siamese twins? How many more views and opinions would have been drawn forth from the medical profession, could this rare case of lusus paturæ have been delivered alive, and grown up to manhood ?
I have thus, Mr. Editor, given you, and through your valuable periodical to the world, as correct a description of this curiosity as I am capable of doing, and which I deemed a duty I owed 10 the medical profession. I have endeavoured to guard against giving it any false colouring, or rendering it more mysterious and wonderful than it really is; as it presents itself to me, thus I give it to you. I have avoided as much as possible running into any theoretical or speculative opinions of my own, as to its internal physiological relations. I leave this to you, and to the other distinguished members of the medical faculty, hoping that you will, should you deem this worthy of insertion in your journal, give us your views at length, and oblige
Your obedient servant and pupil,
Wm. L. THRUSTON, M. D.
ART. III.-ON THE ORDER OF SUCCESSION IN WHICH THE
VITAL ACTIONS ARE ARRESTED IN ASPHYXIA.'
BY JOHN REID, M. D., F. R. C. P. E. Lecturer on the Institutes of Medicine, President of the Anatomical Society, &c. A knowledge of the order of succession in which the vital actions of the body are brought to a stand in asphyxia, is not only useful in elucidating the exact nature of the function of respiration, and in pointing out rules for our guidance in the direction of certain remedial agents, but it may also be brought to bear in an important manner upon the investigations into the general laws of physiology. The inquiry is one, however, of unusual difficulty, from the intimate manner in which the respiration is associated in the higher animals with the other vital functions, and the rapidity and energy of the actions and reactions of these upon each other. In conducting such experiments, it is not only necessary to watch closely every phenomenon which presents itself, however fleeting it may be, but all the varied concomitant circumstances must also be carefully analysed, and, if possible, insulated, with the view of ascertaining how far they might affeci the results. Our progress in such investigations must, therefore, always necessarily be slow, frequently vacillating and uncertain. These difficulties were found so perplexing, that I had several times nearly given up the present inquiry in despair; and it was not without much labour, and repeated failures, that I arrived at what I considered satisfactory results.
The two points in the physiology of asphyxia which have of late years principally attracted attention are, the nature of the impediment to the circulation of the blood through the lungs; and the cause of the arrestment of the sensorial functions. A correct knowledge of the manner in which the vital actions are arrested in asphyxia, is supposed to be included in the true explanations of these two facts. The first of these, viz. the impediment to
| Ed. Med. and Surg. Journal, April, 1841, p. 437.
the free passage of the blood through the vessels of the lungs, and its consequent stagnation in the right side of the heart, and the large vessels leading to that organ, have been attributed to three causes-the cessation of the mechanical movernents of the chest; the effects of the venous blood upon the contractility of the heart; and the difficulty of transmitting the venous blood through the capillaries of the lungs, whea the chemical changes which go on there between the blood and the atmospheric air have ceased. The opinion, that the blood in death from asphyxia chiefly accumulates in the right side of the heart and the large vessels leading to it, in consequence of the stoppage of the mechanical movements of the chest, was advocated by Haller. He maintained, that when the lungs were distended with air, as in inspiration, that the blood flowed readily and abundantly through the pulmonary vessels; but, on the other hand, when these organs had collapsed, as in expiration, the pulmonary blood vessels were so compressed, and their angles rendered so acute, that they became in a great measure impermeable to the blood sent from the right side of the heart. Gondwyn argued, in opposion to the mathematical calculations and reasonings adduced by Haller, that, when the lungs are diminished in their bulk, and the acuteness of the angles of the blood vessels changed only to the extent which occurs during expiration, the flow of blood through them would not be materially obstructed. He also drew additional arguments in favour of this opinion, from the continuance of the circulation through the lungs, when an amount of fluid was present in the chest sufficient to compress the lung to the extent which occurs in expiration, whether this fluid had been effused in the human species from disease, or induced by artificial means in the lower animals. Goodwyn maintained that the cessation of the circulation in asphyxia was chiefly dependent upon the venous blood failing to excite the contractions of the left side of the heart. “ When respiration,"
,” he says, “is obstructed, the florid colour of the blood is gradually diminished, and the contractions of the left auricle and ventricle soon cease. The cessation of contraction arises from a defect of a stimulating quantity in the blood itself." The views of Goodwyn were attacked a few years after their promulgation by Coleman and Kite.? Both these authors adduced the results of various experiments, to prove that the left side of the heart can contract vigorously upon venous blood ;S and they also both maintained that they had proved experimentally, that, when the lungs are kept mechanically distended during the process of asphyxia, that the quantity of blood found in the right side after death is not found to preponderate much, if at all, over that contained in the left side.9 Bichat also furnished abundant evidence to prove that the left side of the heart can contract vigorously upon venous blood. In numerous experiments, he found that when an animal is asphyxiated, black blood at first traverses the lungs to reach the left side of the heart, and may for a short time be projected from a cut artery, with very considerable force; and he further satisfied himself, that the contractions of the heart could be renewed even after they had become quiescent in different kinds of violent deaths, by injecting venous blood along one of the pulmonary veins towards the left side of the heart.10 Bichat especially dwelt upon the importance of discriminating between the
Elementa Physiologiæ, Tom. iii. Lib. viii. Sect. iv. Opus cit. Tome iii. p. 246. 1776. 3 The Connection of Life with Respiration. London, 1788. 4 Opus cit. p. 40–47.
5 Opus cit.
85. 6 A Dissertation on Suspended Respiration, 1791. 7 Essays and Observations, &c. on the Submersion of Animals, &c. 1795. 8 Coleman, Opus cit. p. 118; and Kite, Opus cit. p. 26, 42, and 44.
9 Coleman, p. 107 to 116; Kite, “ From these experiments, it is evident that a small quantity of blood can pass through the lungs when they are in a state of perfect ex. piration.”—P. 58.
10 Sur La Vie et La Mort, article sixième, ii.
effects of asphyxia upon the functions of animal and those of organic life; of ascertaining the priority of the suspension of those two great sets of functions, and the influence which they exerted upon each other. He maintained that the heart's action does not cease because the dark blood transmitted to the left side of the heart cannot excite it to contract, but because the dark blood, by being circulated through the coronary arteries in the muscular tissue of the heart, arrests ils contractility. This effect of the dark blood upon the contractility of the heart was, however, regarded by Bichat as only an isolated phenomenon in asphyxia; for he believed that the vitality of all the tissues of the body was equally affected by the circulation of this dark blood, and that the functions of the brain, or the animal functions, were always arrested before those of organic life.' He maintained that the accumulation of the blood in the right side of the heart did not depend upon any mechanical obstruction in the bloodvessels of the lungs, but from various other causes, among which he enumerates the obstacles opposed to the force of the already enfeebled right side of the heart, by the effects of the circulation of dark blood in the bronchial arteries, and ihe cessation of the excitation of the lungs by the atmospheric air, aided by the circumstance that the systemic ventricle can more easily overcome the resistance presented by the capillaries of the body generally, than the veins and pulmonic ventricle can overcome that arising from the capillaries of the lungs. Bichat appears to have entertained doubts whether the circulation of the venous blood through the capillaries of the systemic circulation arrested the vitality of the tissues simply by default of excitation, or by exerting some deleterious influence upon it; for, while discussing its effects upon the brain, he thus expresses himself—“Je ne puis dire si c'est négativement ou positivement que s'exerce son influence : tout ce que je sais, c'est que les fonctions du cerveau sont suspendues par elle.”. Although Bichat failed in giving the correct explanation of the manner in which the vital actions are arrested in asphyxia, yet there can be no doubt that to him we are indebted for having pointed out the true path by which this knowledge was to be attained. Another important advance was made in the elucidation of asphyxia by the experiments of Dr. David Williams, of Liverpool, and Dr. J. P. Kay. Dr. Williams, in experimenting on this subject, found'" that when the chest is laid open immediately after the trachea has been tied during the acme of inspiration, the pulmonary veins soon become empty, while the pulmonary artery continues full." From these experiments, he inferred that, in asphyxia, the blood is obstructed in its passage through the lungs, while its circulation through the other tissues of the body continues; and that the obstruction in the lungs “arises from a deprivation of pure atmospheric air." Dr. Kay, from his numerous experiments, has also arrived at the conclusion, that the circulation is arrested after respiration ceases; because, from the exclusion of oxygen, and the consequent non-arterialisation of the blood, the minute pulmonary vessels, which usually convey arterial blood, are then incapable of conveying venous blood, which therefore stagnates in the lungs.95 Dr. Kay believes that this stagnation of blood in the right side of the heart and pulmonary artery, occurs in consequence of venous blood being incapable of exciting the arterial capillary bloodvessels of the lungs. The experiments of Dr. W. F. Edwardsø upon frogs, and those of Dr. Kay
Car, d'après ce que nous dirons, l'affaiblissement qu'éprouve alors le cæur n'est qu'un syınptome particulier de cette maladie dans laquelle tous les autres organes sont le siége d'une semblable débilité.
2 " Le défaut de son excitation par l'air vital."
3 On the Cause and the Effects of an Obstruction of the Blood in the Lungs. Edin. burgh Medical and Surgical Journal, Vol. xix. p. 524.
4 The Physiology, Pathology, and Treatment of Asphyxia, 1834.