tents may be explained in a similar manner ; degener-
ative changes are to be expected where life is prolonged
to the nineteenth day from the beginning of the
* Cyclopaidia of Medicine, von Ziemssen, vol. v., p. 673.
■■'Buhl: Lungen Entziindung, Tuberkulose und Schwindfiichtig, p. 50. Mil
October ii, 1884.]
THE MEDICAL RECORD.
MORPHIA IN CARDIAC DISEASE.
By benjamin EDSON, M.D.,
BROOKLYN, N. Y.
The following case seems to have some bearing upon the
use of morphia in one form of disease of the heart.
C. R , fifty-si.x years of age, Scotchman, merchant,
called at my office early in November, 1883, complain-
ing of a troublesome cough and shortness of breath on
exertion. He attributed his trouble to "catching cold "
from exposure. As he was in great haste I prescribed a
cough mixture without making thorough investigation.
A few days later he called again. His cough was no
better, and his respiration so much more difficult that he
could not lie down to sleep. When I proposed an exami-
nation, he slapped his hand upon his chest, saying :
" There is nothing the matter with me here, sir : I'm as
sound as a dollar." I found, however, that he had mi-
tral regurgitation with marked dilatation of the heart.
The cause of the cough and dyspntea was but too appar-
ent. The kidneys were not affected, and as yet there
was Buy Acillin no oedema. A few days later the legs began to
swell. I advised him to keep strictly quiet, and at the
same time put him upon such treatment as seemed best
calculated to give relief. I found it difficult to convince
him of the grave nature of his disease, and being of a
nervous, active temperament, he considered it a great
hardship not to be permitted to attend to his daily busi-
ness in New York. Finally I persuaded him to consult
Dr. Armor, who confirmed my diagnosis and approved
the treatment, which " must be palliative and on general
For the next two or three weeks he continued fairly
comfortable, the cedema moderate, but he was able to sleep
only as he reclined in his chair. He was very irritable, and
urgently called for something that would enable him to
sleep /■« bed. I did not feel warranted in granting this
request, but still he insisted that he must have some good
sleep. Finally, Ampicillin 500 Mg through the persuasion of a relative, he
was induced to call in a distinguished homceopathic
physician, who acceded to his request and gave him
sufficient morphia to enable him to sleep several hours
in bed. But on waking and attempting to rise he was
seized with dyspnoea that nearly terminated his life.
By vigorous efforts on the part of his attendants he
eventually rallied somewhat, but soon after he suddenly
fell back and expired.
I have considered that death in this case was due to
the morphia used. It may have been only indirectly the
cause, by permitting the patient fo assume the recumbent
position, rising from which produced over-distention or
overwhelming Ampicillin 500mg of the weakened heart-structure. Mori)hia
may^have contributed to the paralysis. Kartholow (" Ma-
teria Medica," 5th ed., p. 524) says of lethal doses of
morphia, that " in some instances very sudden death en-
sues from paralysis of the heart." How large the dose
required to produce this untoward result obviously de-
pends much upon the condition of the heart. What in
health might be but a medicinal dose of morphia, in case
of dilatation, with muscular walls greatly weakened and
nerve-distribution disturbed, might readily prove Order Ampicillin to be a
lethal or paralyzing dose. Thus in this case it is not
improbable that both these factors conduced to the sud-
den death of the patient.
This man had never had rheumatism, and previous to
this illness there had never been any suspicion of cardiac
In looking back over this case theje arises a question Buy Ampicillin Online
which leads to speculation, and which may not be wholly
devoid of interest. In the summer of 1880, through
some business complications, this man had a period ol
very great mental depression. It took the form of
marked pathophobia. He was fearful that he would
drop down dead, and that his body would be unrecog-
nized and sent to the morgue, so he was very particular
to keep in every pocket papers bearing his name and
address, with minute directions as to what should be
done in case of the event he so much feared. Scores of
times daily he took out these papers and examined them
to reassure himself that, if he did drop dead, his body
could be properly identified. On one occasion, being
up-town in New York, the Ampicillin 500 " feeling " came over hirii
that he never could get back to his store alive. His evil
genius told him that he nuist not ride, and he had not the
power to walk. In this dilemma it was finally revealed
to him that he could perchance run back. This he did,
bv short runs between lamp-posts and awning-posts, to
each of which he would cling while screwing up courage
to make a bold run for the next goal. In this way he
finally reached his store, out of breath and reeking with
While narrating these and many other freaks of his
malady equally ridiculous, he remarked, " You may laugh
at them ; I do now ; but when the incubus is upon me
I am a coward, a victim of my fancies." After a few
weeks his business troubles passed away, and with them
his morbid fear of death.
There Online Ampicillin is a possibility — indeed, is there not a strong
probability? — that at this time there was actual heart-
trouble. If so, whether it stood in the relation of cause or
of consequence is of course mere speculation. Is patho-
phobia, with the kindred affections, agoraphobia, etc.,
simply a functional derangement — a neurosis — or may it
not be associated with and possibly dependent upon
actual pathological conditions ?
§leports of hospitals.
COOK. COUNTY HOSPITAL, CHICAGO, ILL.
Case of Congenital Diaphragmatic Hernia.
REroRTED BY M. L. HARRIS, M.D., House Physician.
K. C , male, aged thirty-four, laborer, was received
into the hospital November 15, 1883, under the care of
Dr. F. Henrotin, attending physician.
On admission the patient was much prostrated and
suffered from intense dyspnoea ; hence no accurate ac-
count of his history was elicited. He said that he had
usually enjoyed good health, and that this was his first
acute illness. The case was found to be one of acute
croupous pneumonia affecting the lower lobe of the right
lung and complicated with an acute pleurisy of the same
side. November 17th the patient died suddenly and un-
The autopsy was held forty-eight hours after death by
Dr. W. T. Belfield, pathologist to the hospital.
Body of spare build, the abdomen markedly depressed.
.Vfter the usual incision from chin to Cheap Ampicillin pubes and removal
of the sternum, the appearance represented in Fig. .
was exhibited. The heart was in about the usual posi-
tion, the apex a trifie nearer the sternum than normal.
The right pleural cavity contained some recently coagu-
lated lymph. 'I'lie inferior and middle lobes of the right
lung exhibited gray iie|>atization ; the lower portion of
the upper lobe showeil reii hepatization ; the upper por-
tion of this lobe was quite tedematous.
The left pleural cavity contained, besides the left lung,
the stomach, nearly all of the small intestine, part of the
colon, and half of the pancreas. The lung, eight inches
in length, one to two inches in thickness, and two to
three inches in breadth, was crowded into the anterior
and upper iiortion of the left chest, resting against the
mediastinum. It appeared to consist chietly of the upper
iobe, which, with the exceptii)n of a few cheesy nodules,
in the apex and some sligiit ledema, was fairly normal,
crepitating well and floating upon water. The inferior
iobe was crowded into a small firm mass which contained,
no air and sank in water.
The abdominal cavity vas shallow, containing only
THE MEDICAL RECORD.
[October ii, 1884.
the liver, kidneys, spleen, a small portion of the ileum
and ascending colon, and the descending colon. The
liver was slighth' enlarged and fatty ; the anterior border
of the right lobe extended downward four fingers'-
breadth below the margin of the ribs, its deep position
being due not to an increase in size but to a tipping for-
ward and downward of the organ. The kidneys and
spleen occupied their normal positions respectively and
Fig. I. — I, Left lung ; 2, convol
5, spleen ; 6, descending colon
flexure : lo. bladder
The diaphragm presented a single large opening occu-
pying its central and posterior portion, through which
the various organs — inferior vena cava, aorta, thoracic
duct, portal vein, small and large intestine, pancreas,
superior mesenteric artery, etc. — passed to or from the
thorax. This foramen was large enough to permit the
Fig. 2. — 1, CEsophagus ; 2, stomach ; 3, pylorus ; 4, cardia ; 5, duodenum
(dotted line) ; 6, pancreas (dotted line; ; 7, spleen ; 8, arch of aorta ; 9, pulmonary
artery ; 10, heart (drawn to right) ; 11. descending aorta ; 12, diaphragm ; 13, cut
end of portal vein ; 14. kidney ; is. descending colon ; 16, ileum ; 17, coecum :
tS, sigmoid flexure ; 19, bladder.
passage of the closed fist. The left border of the right
crus arched to the left, forming the free margin of the
foramen ; this was round and smooth and attached to
the head of the twelfth rib and to the base of the trans-
verse process of the twelfth dorsal vertebra. There was
no left crus. The course and relations of the alimentarv
canal are shown in Fig. 2. Here the lungs and liver
have been removed, the heart drawn to the right and the
small intestine to the left, the ribs represented by the
The oesophagus passed behind the arch of the aorta,
along the anterior and right side of the descending aorta,
until it reached the eighth dorsal vertebra, where it
passed Purchase Ampicillin in front of the aorta, suddenly turned vertically
upward, and after a course of about two inches entered
the cardiac extremity of the stomach. The stomach it-