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seriously affected"* I have consequently recommended the use of mercury.' Thus, after Mr. O'Meara quitted the island, the same erroneous notion about the nature and treatment of the disease was adopted by Mr. Stokoe, and from them the blunder was communicated to Antommarchi.
Antommarchi, however, was not satisfied with his consultation at Rome, or his interviews with the learned O'Meara in London.
* I addressed circular letters,' says he, “to them' (the medical men in London); “I laid before them the consultation which had been delivered to me,' (by the physicians at Rome) and the reports which I had received' (from O'Meara and Stokoe),' and I requested them to give me their opinion respecting the emperor's complaint, and to point out the means which they considered the best calculated to effect its cure. All, but particularly the veverable James Curry, so celebrated for his labours on hepatitis, answered me with a zeal and kindness that affected me most sensibly.'
Dr. James Currie is since dead; he was a very ingenious, learned, eloquent, wrong-headed man, and, what is curious, fell into the same mistake about himself which he contributed to propagate concerning Napoleon. For many years he believed himself to be labouring under inflammation and abscesses in the liver; but when his body was examined after death, his liver was found to be perfectly healthy. He was a most impressive talker however, and would have been sufficient alone to overwhelm the feeble mind of the Prosecteur d' Anatomie, and to send him out incapable of using his own senses, or exercising the little judgment which on other occasions he may have possessed. When Antommarchi arrived at St. Helena, Napoleon perceived the absurdity which Cardinal Fesch had committed in supplying him with a dissector instead of a physician,' a kind of Cuvier, to whom he would give his horse for dissection, but not trust the cure of his own foot.' In his account of his reception by the medical men of London, Antoinmarchi says, the publication of the posthumous works of Mascagni had given me a sort of celebrity (!) and I naturally found myself en relation avec tout ce que Londres avait d'illustre. Mark the account which he gives to Buonaparte of his reception in London.
Napoleon. Whom did you see there more particularly?
Antommarchi. Physicians and professional men, chiefly those who have practised within the tropics.'
* Thus it stands in his report, published by Automnarchi; but in the written report delivered in at St. Helena, these words were added, “having distinctly felt a hardness in that viscus.' These are now omitted; but how foolish is cunning! What was the use of erasing them when it must be obvious, that an examination of the hepatic region could discover that the liver was affected only by feeling a liardness or swelling of that viscus?
There is not, nor, with the exception of Dr. Currie, was there one eminent physician or surgeon in London who ever practised: within the tropics.
On the 230 September, 1819, Artommarchi made his first deliberate inquiry into Napoleon's disease.
I examined minutely,' says he,' and observed that part of the left lobe of the liver which corresponds to the epigastric region was hard and, painful on being touched ; the resicle of the gall bladder was full, resisting pressure, and projecting outwards in the right hypogastric region, near the cartilage of the third false rib.'
Who but a charlatan would ever pretend to feel the gall bladder in a man whoin he describes as excessively fat'? As to the indurated lobe of the liver, if any tumour were felt at all, it is now certain, that it was not the liver, but the right end of the stomach. O'Meara, Stokoe, the Roman doctors, and his medical friends in London had sent him out with nothing but the liver disease in his head, and unable to feel anything else with his finger ends. One would have supposed that a long residence with Napoleon, and the daily opportunity, for months, of watching his symptoms, would have removed this illusion; but not so; after having been ten months in the island, he writes the following opinion to the Chevalier Colonna, at Rome :
"I have now been ten months in this island, and I can assure you that I have not passed a single day or night without devoting to the illustrious patient all the care and assistance my zeal and niy medical knowledge(!) could suggest. I found him labouring under a chronic hepatitis of the most serious nature.' And again, in the same letter, 'the influence of the climate, which is the primary cause of the chronic hepatitis, being too contrary to the constitution of the illustrious patient, and to the action of the remedies I have prescribed.'
After enumerating his symptoms, he adds
* I do not hesitate to affirm, that these affections are produced by a disordered state of the digestive, and an alteration of the functions of the biliary organs.'
On the 21st March, 1821, we find him persuading Napoleon to take an emetic—an emetic to a man with a cancerous ulcer in his stomach!
The bare name of the remedy wrought bis repugnance to the highest pitch, ayd he replied, exaggerating the uncertainty of medicine, “ can you tell me șimply in what my disease consists ? can you even point out the seat of it?" It was in vain that I represented to him that the art of healing does not proceed like the exact sciences; that the seat and the cause of the sensations which are felt can only be established by inference; he would not admit any distinction of the kind. “If such be the case,” said he, “ keep your physic; I will not have two diseases, that with which I am afflicted, and that which you would inflict upon me." When I inM 3
sisted, he accused us of working in the dark; of administering medicines at random; and of killing three-fourths of those who trust tbemselves to ns.'
How exactly Napoleon's opinions were verified by the event! he did not exaggerate the uncertainty of medicine, at least in Antommarchi's hands. Persuaded, however, he was to take a quarter of a grain of tartar emetic on the 22d, a quarter of a grain more on the 23d, another on the 24th ; and Antommarchi would have given him a fourth on the 25th. In the afternoon of the 24th, however, the symptoms were icy coldness, after having manifested itself at the lower extremities, extending all over the body; yawnings, general anxiety, pain in the head, distension of the abdomen, painful on pressure. These were the natural effects of vomiting from antimony, and might easily have been anticipated by any one whose medical knowledge exceeded that of a demonstrator of anatomy. But Antommarchi was heartily frightened at what he had done, I was afraid,' says he, on the 26th,' to trust to my own skill, and the emperor would not have any English physician. After the three cruel days on which he took an antimonial emetic every day, the stomach never again became tranquil, and was not relieved even by opiates. In every report we find nausea, vomiting of • glairy Auid. The patient was almost constantly complaining of distension of the abdomen, burning heat, and pain within the stomach; sometimes feverish heat, sometimes clammy perspirationsscarcely any thing remained on his stomach. Sometimes' filiaceous substances, like slender shreds, were vomited up.
symptoms it would have seemed impossible not to understand, and Dr. Arnott, who was consulted towards the end of the illness, saw into the case; he assured Napoleon and Antommarchi that the liver was not the seat of the disease that it was sound-but neither would believe him. At length the suspicion came across the mind, not of Antommarchi, but of Napoleon, that the stomach was the seat of the disease. • Doctor,' said he, • I recommend to you once more to examine my pylorus with the greatest care; write down your observations, and deliver them to my son. I wish, at least, to preserve him from that disease. On the 2d May we find him uttering the following words:• Recollect what I have directed you to do after my
death : proceed carefully to the anatomical examination of my body, and particularly of the stomach. The physicians of Montpellier declared that schirrosis in the pylorus would be hereditary in my family: their report is, I believe, in the hands of Louis; ask for it, and compare it with your own observations, in order that I may at least save my son from tliat cruel disease. You will see him, doctor, and you will point out to him what is right to be done, and will save him from the cruel sufferings I now experienceit is a last act of service which I ask of you.'
The disease now advanced rapidly. Napoleon was occasionally insensible, had oppressed breathing, spasmodie heaving of the muscles over the stomach, loss of voluntary power over the limbs, general agitation of the body, occasional delirium, icy coldness of the lower limbs, a pulse of 110 scarcely perceptible and intermitting, incessant hiccough, acrid eructations, vomiting of dark liquid matter. He died on the 5th. On the 6th the body was opened by Antommarchi, in the presence of Drs. Short, Mitchell, Bruton, and other medical gentlemen.
And now arrived the moment which was to verify and approve, or falsify and disgrace, the opinions entertained and the remedies employed successively by O'Meara and Antommarchi-the mercurial courses of the first, and the antimonial emetics of the last. According to them Napoleon's disease had depended on the climate in which he was placed—it was chronic inflammation of the liver, and this had been going on from the summer of 1817 down to the time of his death, the 5th May, 1821, nearly four years. If this had been the case, what would have been the state in which the liver would have been found? We could venture to answer this question ourselves, but we prefer giving the answer from the · Morbid Anatomy' of the late Dr. Baillie, a writer remarkable for his accuracy, and a physician in whose statements very many of our readers have had reason to feel confidence. Speaking of inflammation of the substance of the liver, he says, ! when this inflammation has continued for some time, abscesses are formed, and then the active state of the inflammation very much subsides. These abscesses are sometimes of large size, so as even to contain some pints of pus—sometimes the wbole of the liver is alnjost converted into a bag containing pus,'
For more than a year and a half Antommarchi had been talking and writing about chronic inflammation of the liver, and declaring that he could feel it enlarged and indurated near the pit of the stomach. It was important, therefore, that he should find something after death to corroborate these statements, and he probably would have succeeded, if the dissection had been performed in the absence of medical witnesses ; but unluckily there were persons present who had eyes as clear, judgments as competent, and integrity, to say the least, as unquestionable as his own. All, therefore, which remained for him to do, was to introduce into the account of the dissection a few words which might lead those who are ignorant of medicine to suppose that he had made no mistake, His words are these:
'The spleen and the liver, which was hardened, were very large and distended with blood. The texture of the liver, wbich was of a brownish red colour, did not, however, exhibit any remarkable alteration of struc
ture. The vesica fellis was filled and distended with very thick and clotted bile. The liver, which was affected by chronic hepatitis, closely adhered by its convex surface to the diaphragm; the adhesion occupied the whole extent of that organ, and was strong, cellular, and of long existence.'
In this account, the expressions the liver, which was hard, ened,' and the liver, which was affected by chronic hepatitis, might induce a general reader to suppose that Antommarchi had found what he expected; but any medical man will easily see through the fraud. If the texture of the liver, as he says, did not exhibit any remarkable alteration of structure, how could it be said to be affected by chronic hepatitis, and that, be it remembered, for nearly four years? Either he does not know the changes which chronic hepatitis induces in the liver, or it is a statement purposely fraudulent. On examining the stomach, however, the diseased appearance
organ was too remarkable and extensive to escape disclosure.
‘On examining that organ with care,' says he,‘I discovered on its anterior surface, near the small curve, and at the breadth of three fingers from the pylorus, a slight obstruction, apparently of a schirrous nature, of very small extent, and exactly defined. The stomach was perforated through and through in the centre of that small induration, and the aperture was closed by the adhesion of that part to the left lobe of the liver. * * * The mucous membrane of the stomach was sound from the small to the large cavity of this organ, following the great curve. Almost the whole of the remainder of the internal surface of the stomach was occupied by a cancerous nlcer.
An ulcerous, greyish and smooth surface lined this canal, which, but for the adhesion of the liver, would have established a communication between the cavity of the stomach and that of the abdomen. The right extremity of the stomach, at the distance of an inch from the pylorus, was surrounded by a tumour.' (This was the tumour felt during life, and mistaken for the liver.)
Amidst this jargon (and there is much more which we have been obliged to omii) the attentive reader will perceive that the diseased appearances discovered on dissection, were, Ist, a cancerous ulcer of the stomach, so extensive as to spread over almost the whole of its inside; 2dly, a hole in the stomach, which this cancerous ulcer had eaten, and through which every thing which was swallowed would have run out among the bowels, if it had not been for, 3dly, an adhesion between the part of the stomach which the disease had perforated, and that surface of the liver which lay opposite to it—the surface of the liver was, as it were, glued over the hole in the stomach, so as to shut it up, and prevent any thing from running out through it. This is one of the most common and wonderful provisions of nature, to stop the ravages or counteract the injuries of disease. The adhesion, it is true, is the effect of
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