WARDEOP ON DISEASES OF THE HEART. * This volume is the
result of many years' observation, experience„ and reflection, not only on the diseases of the heart, but on the anatomy and physiology of that organ, as well in themselves as in physiological relation to other parts of the body, especially of the lungs and the cerebro-spinal system. Dr. Wardrop has carefully examined the structure of the heart, and of every other organ which appears to be influenced by the action of the heart, or to influence that action in return; and he has applied this know- ledge of structure to a consideration of the various functions which structure is intended to fulfil. These inquiries, however im- portant as extending our knowledge, and leading to new ideas upon the heart's action through the influence of the muscular, the pul- monary, and the cerebro-spinal system, are in a certain sense only abstract knowledge as regards anbut physiology ; some- times bearing as much upon natural theology as medicine. In Dr. Wardrop's hands this knowledge is introductory to the more use- ful subject of the discovery and treatment of disease. In this elaborate reproduction of his medical experience, it is probable that the author may speak with too great certainty as to some of his con- clusions, and may seem (a common error) to ascribe too much effect to the causes of disease, to allow too little to the warding, ba- lancing, and restoring powers of life, even when the particular life is not of the most vigorous kind. But the book is a remarkable example of patient observation, inventive reflection, and long-sna- tained. philosophical investigation applied to a practical purpose. The medical results of Dr. Wardrop's inquiries lead him to hold that functional diseases of the heart are much more common than is usually supposed ; that they are easily discovered in an early stage, and amenable at any stage to medical treatment. His phy- siological conclusions are the grounds of his medical opinions, either directly or consequentially. " The musculo-eardme, the pulmo-cardiac, and the veno-pulmonary functions" of the title- page, form the direct base of his theory, which ascribes disorder of the functions of the heart to the continual changes of action to which it is subject, and to the influence exercised by other organs upon the circulation—that is, upon the heart. Of all the or- gans of the body, the lungs and heart alone never rest; for to stop is death. Not only is this incessant action going on, and in the heart with great muscular force, but both organs, and more espe- cially the heart, are every moment liable to an irregular if not a disordered action, except during healthy sleep. The emotions of the mind, whether sorrowful, joyful, or passionate, instantly dis- order its action ; violent exercise or great bodily exertion has the same effect: and in these effects the lungs participate. The man- ner in which these actions are produced by the " musculo-car- diac " function,—certain muscles when the heart requires an in-, creased quantity of blood to stimulate its action compressing the vessels that pass within them, so as to furnish that supply,—is traced with a minute and elaborate fulness. The author also unfolds his view of the mode by which the " pulmo-cardiac " function relieves the heart when overcharged with blood through _ the violence of passion or exertion, by the pulmonary ves- sels receiving the surplus, and when they are full by the veins relieving the pulmonary vessels of any superabundant blood which they are not capable of receiving without inter- ruption to respiration. The anatomical and physiological acumen which these expositions display are only appreciable by the anatomist ; though this section of the book is very far from being a mere technical treatise. The simple yet all-sufficient means b which Nature acts, the wonderful provisions by which she guards against deprivation where deprivation would be fatal, and the re- sources she supplies, as in the case of the " o'ercharged heart," are explained with the clearness though not with the objects of a Bridgwater Treatise. In explaining these adaptations, perhap& the author does not sufficiently impress tneir conservative effect upon the healthy subject and within certain limits; so that the text may seem to imply that a greater general probability to heart affec- tions exists than is really the case. This, however, is a prevalent peculiarity in special treatises, and very difficult to guard against. The original views of the action of the heart, and its important connexion with other organs, of which we have barely indicated the character, form only a portion of the volume. The remainder is occupied by remarks on the influence of other and remoter organs of the body, on the derangements and diseases of the heart, on the general nature of medicines and treatment of disease, on disorders' of the heart in general, and on all the morbid conditions to which it is subject, as well as their symptoms and mode of treatment. Upon this large field we have not room to enter, even were a miscel- laneous journal the place ; but a few broad features may be noted. From the action and reaction of organs, it is not easy to discrimi- nate between first and secondary affections of the heart : yet it is. only in their early stages, and while the disorder is merely func- tional, that much hope of cure can be entertained; when altera- tion of structure has taken place, alleviation is all that can be looked for. It is therefore important to have some leading rules to assist the judgment on the particular case. If there be difficulty in deciding whether the lungs or the heart is the primary seat of the complaint, the size of the chest will be an indication : if large, it is probably the heart that is diseased—if small, the lungs. Languid or irregular respiration is a sign of heart disease : "respiration in pulmonary affections is only quickened." If the stomach seems to be the probable origin of disordered circulation, and signs of in& * On the Nature and Treatment of the Diseases of the Heart : containing also an Account of the Musculo-cardiac, the Pnlmo-cardiac, and the Yelp-pulmonary Functions. By James Wardrop, M.D., &c. die. Published by Churchill. gestion arequesent, the attention should be first-directed to the atnautelt;-, foreven-if a complication with heart disease exist, the cure of indigestion- will facilitate the, future treatment. of the heart disorder;, if no, symptomaaf a deranged digestion are present,. it is a. sign that the disease of the; heart is primal. There are- nu-. =,-roue other leading ruleta. but. we have adduced enough ta, show.
their natal*.
The arrangement or the work. in orderly and clear; its treat,- meat elaborate, to minuteness.. This„ coupled with the. great ex- tent: of the leading subject,. and the number of its collateral branohes, proclaims a sense of length and ponderosity ; of which, indeed;, the author is. aware, and which. he aufficiently. accounts for. "Impresied with the uncertainty of human life and of the continuance of intellectual vigour, I run induced to effete the work( in its present state, and must apologize for the numerous defects, andfor the general manner in which some •of the topice, in.. it are discussed; for, although I have been long em- ployed in collecting and condensing the materials of these pages, yet I am quite aware that, on at subject so oomprehensive as that on. whichl profess to bleat, with whatever industry, I may be able. further Oa prosecute 14 the field.of inquiry safer too extensive to be satisfactorily explored by any one "Mtich indulgence may surely be with justice claimed' by those who, to- wards-the close of a long and busy lifb, devote a portion of theirtime to re- cord the, results of their experience and observation ; and it is only to be re- ripened that, inu.practical profession like that of medicine, so. many of our Wait distinguithed brellarenhave not left behind them. even the most trifling memorial of all their /abours ; a circumstance much to be deplored in the lives of professional men, and which results; perhaps, too frequently from the- desire which most of es feel to undergo lbw mental exertion and fatigue, and to.enjoy more trauquillk y.and repose, as. weadvance intim vale of years."
This literary defeot is, after all, a very secondary matter in a work whose object is to advance new views in physiology and to advocate a more philosophical treatment of disease, and which is intended for the study of the professional man and not the perusal afit.he general reader. From the nature-of the-case, the book must be recondite, and-ofbm technical; but it has parts: and frequent passages of popularity.. It abounds in facts, either common to physiological science or collected by the- author's. observation. It s, ea we have already intimated, the wonders of Nature in her resourceful simplicity, her-prescient precautions, her variations from established laws to carry out their ends; and it continually displays the. haxactor which. Bacon ascribed to Galen, of a wise man as welt as a.physician. Of the manner in which Dr. Wardrop %Ueda frmta and expound'' the operations of Nature, this passage may be taken as:an example.
. (kin the• arrangements of the animal economy-. it may be frequently ob- served that one organ is. destined taperform several. distinct functions—fungi-- thins, indeed, in.some- instances so 6Mimilar„atui apparently, so.uneennected With one another, that it could not be well anticipated that they should. be executed by the samaphysical apparatus: Thus, for example,, the. muscles of the jfEW use not only employed' to masticate the food". but they, at the asiso timei, and by-the same ransanlar °Ora, evacuate the salivary gland* squeezing. the sallies into the mouth by the pressure which they produce-
during their contractions on the. salieary.apparatus." * * * "load the bones not, only support the body like a framework,. but they afford fixed peintstfor the origin and insertion of the various muscles, and aikaform wails of defence foe the inteinal organs, as the brain and the the-- tack and pelvic viscera.
"The functions of the respiratory apparatus are still more multiplied. tfesides'arterializing the blood, conveying odorous substances thrmigh the nasal passages.to the.organ of smell, assisting the return of the venous and limg* the systemichlood, and producing the voice they- also, as I shall an fly-endeavour tademonstrat* are employed' modifying* the-sup- ple-o blood' th the heart. In birds we: find that.the.fnnetiona of the reapi. rat=.y apparatus are even more numerous,; the air passing into membranous saes within the chest and abdomen, as. well as into, their hollow hones, in. eider to assist their flight. "In likamenner, we.shall find that the voluntary muscles;, besides being *meetly° organstof motion, destined to perform the various-movements of the body, are essential auxiliaries in the circulation of the blood,. in the- at, /cries as well as in thaseins, performing both these office& merely by the pressure which they produce during their contractions upon the adjacent-- WM/IL And further, when such muscular efforts are required, an additional, vigour being at the some moment wanted for the heart, this office is per- itonea by tWateme mnsoular-contractions which are employed. to accomplish: theeffort;. and. thuelt iawiselyeonstituted that the:very same orpauswhich: parfonn the movements, and necessarily cause a certain degree of exhaustion,; are also the means of. invigorating the heart itself."
Among the:means, says Dr. Wardrop, to influence the.ciroulation and.relieve. the heart, not. is the poetical though proper enough. aenseof " the spirif.a," are laughing, crying„weepuig, sobbing„ sigh- ihg., coughing, mieeziu. gt. hiccup, and vomiting;; that whioh. we sup- wee to be a mental, beingin.part tt. mechanical or at. least. a pity-, =logical action. " Owing, which consists in a succession of violent and long-protractedexpirations,,will have the effect, by diminishing the, circulation in the pul- monary arterie* of.unloading. the left heart and large arteries:of-any-surplus quantity of blood; caused. by the, action: of the• heart having- been disturbed, wisether by moral causes. or from bodily pain: hence the relief which those rim suffer mental affliction. or bodily pain derive. from crying,„7-aziact which sa resorted to throughout the whole animal. kingdom, to relieve. the: heart. ftem the hurtfiil effects of pain.. ” From the-same cause arise the great languor in the circulation and even. the pernicious. effecta which have. so. often fieen.known to follow le endur- ance-of severe bodily pain without crying. Ai man who made no signs of great suffering-during ..military flogging dropped' down lifeless. `. We see-many examples of crying in hysterimil women ; and thascreama which are made from fear or. ftom mental` agony must. have. a powerful in,
ffaenee unlbadingsa congested- heart *
" Weeping, also, which. consists in irregular respiration, either with or Without crying, is as ant or voluntary act made to faoilitatealie pulmonary maculation: atarelieve that congestion. in. the heart which is caused by grief.,Weeping,7 observes Haller, ' begins with & full inspiration, after which fallow- short expirations and inspirations. It is finished by a deep expires tiom and immeTrately followed-by, a deep inspirations' " Hence arise the baneful effect*, and the sensation of fulness, ' the ful- ness of heart,' and even of pain in. the• cardiac, region, so frequently. expo. rienced by those who, have- not wept when. themind has been greatly agitated. "'Sighing appears also to be re movement employed. by sante, texislleye the heart from congestion. The Mainspiestiena whit& are made, ila_40ing, by withdrawingsthe venous bleed' from the head, will assist in restoring, the balance of the circulation,, both within the head and,thest, when. it has been destroyed by some violent mental emotion or bodily, pain. .-ftesighed'a sigh so porteous and profound, as it Did seem to sbatterall his bulk and'end his being:--Earaesreen."
The propriety of the following rule is generally admitted:;, but few perhaps carry it so far as Dr. Wamirop. Many physieliton stop.. at food.; civilized man having been trained:to gormandise.. " To enable the economy to perform some of the. processes for redwing. the healthy state of the blood, mall appease> to, be. endowed with instincts, by which he can make choice of such kinds of food and drinks as contain the. elementary substances which are necessary in the chemieo-vital laboratory, and enable it-to form such compounds as may be required for restoring the blood to a healthy state. This impulse prompts man: to change his food: when suffering from disease; and, however inconsistent or improper *aka:t- he selects may appear, the choice is always found to benefit and never tein- jure him.. "-To allow the sick to obey these instincts, is. a very• useful practical maxim; for when the most accomplished practitioner cannot. presume- to -dies tate either the kind or the quantity of food or drink,. the sick man can-with- confidence select for himself such as are most palatable and grateful., Hence, amongst the sick there are some whe prefer animal to vegetable food; some salted to fresh meats, some fermented liquors, and other&wines, some acid- ulated drinks, and others give the preference to plain water."
Disease of the heart would seem a product of high oivilization.. The savage is possibly-heart-whole; so is the wild animal; the poor man is seldom afflicted with it; the victims are those wile Eve, artificially, excite the nervous system, and train the mind. at,:the. expense of the body. " Diseases of the heart may he considered almost exclusively- incidental te mankind. In domestic animals, such as the horse, which is much exposed to inordinate muscular exertions, the heart is frequently found in cediseased condition ; but in wild animals diseases of the vascular system: have seldom on never been. observed."
Previous page
