Howell's Duke of Alva's camp, and an experiment was made by one of the authorities to test his courage. At midnight the provostmarshal, accompanied by his guard and a confessor, awoke him from his sleep, informing him that, by order of the viceroy, he was to be immediately executed, and that he had only a quarter of an hour left to make his peace with Heaven. After he had confessed, he said that he was prepared for death, but declared his innocence. The provost-marshal at this moment burst into a fit of laughter, and told him that they merely wanted to try his courage! Placing his hand upon his heart, and, with a ghastly paleness, he ordered the provost out of his tent, observing, that he had "done him an evil office;" and the next morning, to the wonder of the whole army, the hair of his head, from having been of a deep black colour, had become perfectly white! CHAPTER XI. SYMPTOMS OF DISEASES OF THE HEART DERIVED FROM Connection of the heart with the organs of digestion; symptoms derived from disorders of the stomach; nausea; sickness; vomiting; vomiting of blood; discharge of blood from the rectum; symptoms derived from the bi'iary organs.-Conclusion. ALTHOUGH it has been from amongst the phenomena in the cerebral, respiratory, and vascular systems, where we have sought for the most remarkable symptoms in the disorders of the heart, there are, nevertheless, other systems which are deranged in these affections, and from which symptoms equally important, though not so numerous, may be derived. When alluding to the reciprocal influence of the heart and See page 81. digestive organs, I have remarked how much the functions of the heart were under their influence, how frequently disorders of the digestive organs disturb the functions of the heart, and how these symptoms may arise either from disturbances in the functions of the stomach, of the intestinal canal, or of the biliary organs. Though the stomach may be, according to Hunter, con- Symptoms sidered as the seat of "universal sympathy," and that many of its diseases exercise a great influence upon the circulation, yet we shall find that the heart, when disordered, does not, in its turn, cause so frequently disturbances in the stomach. Indeed, the relation between the stomach and the heart is quite of a different character from the relation of the heart with the respiratory and cerebro-spinal systems. The intimate relation of the lungs and the brain with the heart I have endeavoured to show depends upon the blood; whereas See page 88. the consent between the heart and the stomach depends entirely upon the nervous system. Of the symptoms in disorders of the heart derived from derangements of the stomach the most remarkable are nausea, sickness, vomiting, and hemorrhagy. derived from the stomach. Vomiting. Case. I have already endeavoured to point out that vomiting is one of those instinctive acts of the economy-indeed, a striking example of the vis medicatrix-which is resorted to for the purpose of restoring the balance of a disturbance of the thoracic circulation; and the disorders of the heart wherein vomiting occurs may arise from different causes, such as syncope, hysterical and epileptic paroxysms, mental excitement, the unaccustomed motion of turning round rapidly, or sailing in a ship. It is for the purpose of restoring a disturbed circulation that vomiting takes place in the different states of the system which I have just now enumerated, and in each of which the functions of the heart are deranged, so that vomiting must form an essential symptom, though it has not, as far as I know, been noticed as such by any of those authors who have treated of the semiology of the heart. It must, at the same time, be remembered that vomiting may arise from other causes besides a disordered heart. The presence of noxious food, the passage of a renal calculus through the ureter, of a biliary calculus into the duodenum, a pregnant uterus, or a portion of intestine which is strangulated, are all accompanied by vomiting. A youth complained of a sense of nausea, and sometimes vomiting, with which he had been afflicted every morning for several months. He had no symptom of derangement in any of the digestive organs, and my attention was directed to an examination of the circulation. The radial pulse was small, contracted, and of natural frequency; but the heart's impulse was greatly increased. Leeches were applied to the precordial region, and, notwithstanding the condition of the stomach, a quarter of a grain of the tartrate of antimony was given twice a day; by which treatment the disorder of the heart was relieved, and the sickness never returned. Hence we find that some patients with disorders of the heart are relieved, whilst others may suffer from accidental vomiting. An emetic may often be had recourse to with advantage for restoring a disturbed circulation; and there are some with a disease of the heart who suffer very severely from sea-sickness, whilst healthy people who are sea-sick experience temporary relief from the act of vomiting. Hence may be accounted for the good effects of artificial vomiting in some coughs, which may be deemed an indication that the cough in such cases had been depending upon a disturbance in the action of the heart. And, indeed, whenever nausea or vomiting is observed without any other symptom of digestive derangement, or any symptom which would lead to the suspicion of the head being the seat of disease, of a stone passing along the biliary ducts or ureter, we may then conclude that some disorder of the heart is the cause of the vomiting; whilst, on the other hand, whenever nausea and vomiting occur accompanied with the ordinary signs of cerebral, biliary, or digestive derangement, then we may conclude that they are not caused by, or symptomatic of, a disturbed heart. Page 193. Though there may be vomiting without nausea, or nausea Nausea with vomiting; without vomiting, yet they are generally linked together, forming, as it were, two distinct stages of one act; and the condition of the circulation appears to be so different in the two stages that at first sight the sensible effects of each upon the system seems quite incompatible with their performing conjointly only one office in the economy. In a pathological point of view it is necessary to consider them separately. Nausea greatly lowers the action of the heart and diminishes the powers of life. Antimonials, by the nausea which they produce, are therefore employed to diminish the vigour of the circulation in inflammatory diseases, and are successfully administered either singly or in conjunction with bloodletting, the effects of nausea and the abstraction of the vital fluid upon the heart being equivalent. The act of vomiting, on the other hand, appears to be purely mechanical, the abdominal muscles and diaphragm squeezing the stomach and evacuating its contents, propelling the venous blood to the right heart, and impeding the flow of the blood in the great arterial trunks. Such being the differences in the effects of nausea and their effects explained. vomiting upon the circulation, we are naturally led to consider how they could be combined in order to perform what appears only to be one act of the economy. To me it seems probable that by nausea the action of the heart is so greatly diminished in vigour, and the velocity of the blood so much lessened, that the vomiting which succeeds is the better enabled, by its mechanical action on the heart and vascular system, to restore the balance of the circulation, than it would have been enabled to effect had the action of the heart been more vigorous, and had the stream of blood passing through its cavities flowed with greater velocity. In corroboration of the nature and purposes of the two stages of this act, it may be remarked that the vomiting which is preceded by nausea is an instinctive act employed for restoring a disturbed circulation; whereas vomiting employed to evacuate the stomach of pernicious contents is not preceded by nausea, properly so called, but only by the sensation of sickness. That there should be some wise purpose fulfilled by nausea and vomiting being thus combined and co-operating with one another to execute one particular act cannot be doubted; and by glancing over other acts of the economy we perceive that in some of these the same principle is resorted to, two processes apparently quite dissimilar being employed by the vis medicatrix in order to execute only one purpose. For instance, no two processes can be more dissimilar than syncope and that which is employed by nature to arrest the bleeding from a divided artery, and yet we find it requisite that, in order to fulfil this important purpose, both processes are necssary. To arrest the hemorrhage, it is required that the mouth of the bleeding vessel be closed by a coagulum of blood, but to accomplish that process, and in order that the blood may the more speedily coagulate, it is also necessary that its momentum be greatly diminished; the first effect of the hemorrhage is to produce a fainting state, or syncope, by which the circulation becomes languid, and thus favours the formation of a coagulum. |