87 



istering at nights from three to six grs. of opium, with an equal 

 quantity of quinine ; regulating the dose by the condition of the pupil 

 alone. With a dilated pupil I found patients bear the largest dose 

 without inconvenience, and I have not yet met with a single case in 

 which pain was not completely removed in from 24 to 86 hours, 

 provided the attack were recent, or of not more than a week's dura- 

 tion." 



72. As reference has been just made to diseases of the heart, the 

 Committee will here refer to some remarks of Dr. Burrows, corrobo- 

 rating the observations of other writers, that acute diseases of the 

 heart often simulate many of the diseases of the brain and spinal 

 chord. From the cases he has collected together he shows that pe- 

 ricarditis may take the symptoms of inflammation of the brain and 

 its membranes, of mania, tetanus, apoplexy, chorea and hysteria. 

 These are complications of great importance, because where the true 

 disease is lost sight of, and the treatment directed only against the 

 simulated one, the mortality may be very much greater.* 



But after all this, and with due respect for the authority of Dr. 

 Burrows, it must be admitted that the relation of cause and effect in 

 those cases is obscure. 



73. Speaking of chorea, Dr. Branson, f of Sheffield, comes to the 

 following conclusions : — 1st. The heart must be constantly examined, 

 since 9 out of 21 consecutive patients suffered from disease of the 

 heart. 2d. Disease of the heart is frequently the consequence, not 

 the cause of chorea. 3d. It is often insidious and only detected by 

 the stethoscope. 4th. The valvular souffle in chorea is the result of 

 inflammation and not of an altered condition of the blood, as in 

 anremia, the inorganic murmur in anaemia being heard invariably 

 with the first sound, and loudest over the aortic valves, and not at 

 the apex of the heart. 5th. That the endocardium covering the 

 mitral valves is much more frequently the seat of inflammation in 

 simple chorea, unaccompanied with rheumatism, than either the peri- 

 cardium or the endocardic covering of the aortic valves. 6th. That 

 early treatment alone can effect anything, since the "bruit" an- 

 nounces deposit of lymph on or under the endocardium, and this can 

 only be' removed when recent. 1th. Mercury rather produces ab- 

 sorption of lymph from the pericardium than from the endocardium. 



* Ranking's Retrospective Address. f Prov. Med. and Surg. Journal. 



