« PreviousContinue »
moistens and prevents the adhesion of the heart to the pericardium. (b) This fluid is sometimes found to exist in considerable quantity, to the amount of several ounces; but so large a quantity has been considered as the effect of disease ; and it is a question, about which there have been many disputes, whether any perceptible quantity of the liquor pericardii exists during life, and in the state of health; and the better opinion seems to be that, in health only, a very small quantity can be detected, because as fast as it is discharged by one set of vessels, it is, in general, absorbed by another. But when in disease, these actions do not correspond, and
CHAP. V. Sect. I. CIRculation.
when either the discharge is too rapid, or the removal too slow, an accu
mulation may take place. (c)
(b) 1 Bost. 363; 1 Bell's Anat. 489; izars, part ii. p. 1, 2, 146, 147; 3 Good, 473; Quain's El. 575; 3 Paris & Fomb. 56. (c) 1. Bost. 363, 364. (d) As to the effect of anger, &c., 4 Good, 121; and as to palpitation, see 4 Good, 449; and as to the diseases of the heart in general see Dr. Hope on Diseases of the Heart and Great Wessels; and see 2 Bell, 76 to 84; Forsyth, 41, 44; 2 Par. & Fonb. 178; Liz. 146, 147; A. Burn on Diseases of the Heart; Abercrombie's contributions to the Pathology of the Heart, Trans. 1824; Dr. Laennec's Traité de
L'Auscultation Mediate et des Maladies
(e) 2 Bell, 56.
(f) 3Good, 485.
(g) 2. Bell, 58.
(h) Id. 59.
(i) Id. 56 to 70.
(j) 3 Good, 482; 1 Bost. 352 to 354, 361, and quare if this does not arise from an imperfect congenital communication of the two auricles, as above.
(k) 2 Bell, 73 to 81; 2 Good, 492.
Defects and diseases of the heart.(d) Malformation.
is obstruction from disease of the semilunar valves of the aorta, but it
accelerating the flow of blood, or suddenly increasing the action of the
heart, and occasioning most agonizing pain, and which is to be treated differently during the paroxysm and in the interval, as there directed; (r) and in Sauvages this affection is termed Cardiogmus Cordis Sinistic, importing that this disorder proceeds from the left side of the heart; (s) whilst, according to others, angina pectoris is to be classed amongst the diseases of the respiratory functions, and affecting the lungs. (s) But the affection was not recognized as a distinct disease by medical authors until Dr. Heberden described it as such in the Medical Transactions of the London College of Physicians; (s) and one of the ablest anatomists of the present time still insists, that angina pectoris is a symptom of more than one disease of the heart, and is not of itself a disease. Its seat seems to be usually in the heart, or in some of the organs of circulation, and not in those of respiration. It has by Dr. Copland, in his valuable work, been recently defined to be “acute constrictory pain at the lower part of the sternum, inclining to the left side, and extending to the arm, accompanied with great anxiety, difficulty of breathing, tendency to syncope, and feeling of approaching dissolution,” and the alleviating remedies are there described. (s)
(1) I have been favoured with the above (p) Bell, 87.
most experienced anatomist. (r) Cyclop. Prac. Med. tit. Angina Pec(m) Smith, 37; 2 Bell, 82,83; Lizars, toris, 81 to 95.
part ii. p. 163, 164, 168. (s) Copland, Dict. Pract. Med, tit. An(n) 3 Good, 473. gina Pectoris.
The notion of what is commonly termed a broken heart, merely from mental suffering, seems to be questionable; and it is said that though violent passions of the mind very commonly produce syncope, yet that the person must have laboured under some previous organic affection of the heart or its vessels if death ensue. (u)
Wounds of the heart, even of the slightest and most superficial kind, have been generally considered as fatal, and the exceptions are few. The heart cannot be wounded without the pericardium, which surrounds it, being injured; but that membrane may be pierced without extending to the heart itself, and wounds of the pericardium merely are not necessarily mortal. (+)
2. OF THE ARTERIEs.(y)
The Arteries have been termed vital agents, endued with the properties of living matter, and forming part of an organized system endowed with vital powers, and have an important share in the circulation of the blood, (z) and they are stated to be in number about 1000, (a) but at least, as regards the named arteries, there are not perhaps even 300.
Arteries are elastic canals or vessels receiving and conveying the blood
from the heart to the different parts of the body, whereas reins carry
back the blood from the different parts to the heart; arteries are also distinguishable from veins by their pulsation. It has been observed, that to the surgeon the knowledge of the arterial system is valuable beyond calculation or belief, for he can perform no operation in which arteries are not engaged, nor can he cure any great wound in which arteries are not first to be tied, and without a knowledge of the arteries he can neither reason correctly nor act safely. (b) Nerves accompany and influence the arteries; the lymphatics and veins twine round them; the glands and
various organs contain a large distribution of them. The intimate ,
structure of parts is known only by understanding such distribution
(t) Liz. partii. p. 16; 4 Good, 121; as (c) 2 Bell, Introd. xxii.; 2 Good, 12, 4
to rupture of aorta of Geo. 2d, see 3 Paris 24.
& Fonb. 58; Smith, 37. (d) 2 Bell, Introd. 25, 26.
(b)2 Bell, Anat. Introd.23; El. Blum, 81.
The pulmonary artery and the aorta.
Sect. I. The ARTERIEs.
The Aorta and its branches, being similar arteries.
It is the trunk from which the general tree of the arteries is to be explained. It commences deep in the flesh or muscles of the left side of the heart, and mounts upwards and backwards from the heart till it begins to form its peculiar arch or curvature, and then bends downwards to the left side of the spine opposite the third or fourth dorsal vertebra, along which it proceeds gradually, reaching the front of the spinal column through the diaphragm into the abdomen. At the commencement of the aorta the two coronary arteries branch from it, and proceed on the heart itself, in order to supply it and cause its successive contractions ; and from the arch of the aorta go off three great arteries, which rise to the head, or bend sideways towards the arms, and so nourish all the upper parts of the body, viz. first, the arteria innominata, dividing into the right carotid and right subclavian artery. Secondly, the left carotid artery, going to the head; and thirdly, the left subclavian artery, going to the left arm. (g)
The aorta in the chest nourishes the lungs by the bronchial or small nutritient vessels, and when it gets below the diaphragm gives three great abdominal arteries; first, the caeliac, going in three branches, one to the liver, one to the stomach, and one to the spleen; secondly, the superior mesenteric, which furnishes all the smaller and a great portion of the large intestines; and thirdly, the loner mesenteric artery, which supplies a
rtion of the great intestines down to the rectum. The arteries of the
idneys and of the testicles may be added to these, and are branches of the aorta, and afterwards the aorta divides into two great branches for the pelvis and legs. The iliac arteries are the two great branches into which the aorta divides within the abdomen, and these again are each subdivided into two great arteries, the internal iliacs to supply the pelvis, and the external iliacs to go to the thigh. These are only a very few of the principal great arteries; and there are a great many others, formed by successive divisions and subdivisions of these, which are distributed to every part of the body, receiving names according either to their size or to the importance of their distribution. (h) The vena cava, proceeding upwards, leaves the aorta a little above the pelvis, and inclines gradually towards the right, that it may enter into the right side of the heart, which it does by passing under the liver, and penetrating the diaphragm. (i)
The F. trunks run in the centre or deepest and most protected parts of the body and extremities, where they are the least exposed to danger, deriving support or defence from the bones and muscles. (k) They are distinguished from veins by the whiteness of their colour and thickness of their coats; also in the circumstance of their not having like veins any valves, except at the roots of the aorta and pulmonary artery. (l) Arteries thus commencing from the aorta or from themselves are found to terminate in several ways, as by one artery anastomising or inosculating, that is, communicating with another, or in red veins, or in glands or follicles, by secerning or secreting orifices which separate a fluid from the general mass of blood by exhalent vessels, which discharge their contents into the internal cavities, or upon the external surface of the body; and finally, arteries terminate in that structure called erectile tissue. (m) . Other authors observe, that in the present state of our knowledge the umbilical vessels are to be regarded as the only exceptions
(g) 2. Bell, 93, 94. (k) 2 Good, 25, 26; Tuson, 101. (h) Id. 221. (l) 2 Good. 13; 1 Bost. 340. (i) Id. 97 to 321 ; see an eneumera. (m) Ell. Blum. 83; Tuson, 102; 2 tion and plates 3 Gregory's Economy of Good, 3. Nature, 243 to 255.
to the termination of arteries in veins; (n) at all events many of the
Blum. 81, 82; Lizars, part ii. p. 177; and () See Observations, 1 Bost. 338, note 9. see a good practical description in Coop.
CHAP. V. Sect. I. The ARTERIEs.