Past exam of the medicine course of the University of Oxford / 1864 / Second examination / Medical translations (No. VI.)

Original volume: Examination papers for the Degree of Bachelor of Medicine by the University of Oxford (1864–1867). PDF volume pp. 25–26; Oxford, 2 December 1864. Open the original paper in the scanned volume.

The original paper is untitled. The headings below identify three unnumbered medical translations and two interpretation tasks in their source order.

Original questions are transcribed from the public-domain edition. Credit: Wellcome Collection; original supplied by Royal College of Physicians, London. Source and public-domain rights statement.

Translate:—

Eques erat ornatissimus, annos natus quinque et sexaginta, sed robustis membris et proba humorum temperie, nisi quod ante annos aliquot diuturnis et contumacibus crurum ulceribus laboraverat : quae pertaesus remediis qua internis qua externis tandem persanaverat. Is novissime rheumaticis doloribus subinde obnoxius, sed levibus adeo ut qui domo exire non prohiberent, quod et pridie fecerat quam moreretur, iis acerbius prehensus est V. Nonas Junias ad sternum quidem et brachia, non sine capitis perturbatione. Quibus per ea quae sunt visa magis idonea cum occursum esset, jam circa meridiem magna ex parte relevatus, quamvis infirmo pulsu, alacriter se gerebat. A prandio cum quievisset, expergefactus, eosdem quos mane dolores sensit. Quapropter inambulare in conclavi coepit ; sic enim illos facilius ferebat. Sed postquam satis id fecerat, cum lectum repetiisset, querebatur de fumis ad caput ascendentibus, et de pectoris angustiis, inquietusque sese huc illucque vertebat. Quod cum spatio temporis non brevi fecisset, repente se mori sensit, simulque pallens et se agitans illico interiit. Abdomine diducto, inventa sunt omnia secundum naturam. Pectore autem aperto, et pulmonibus, qui antrorsum compulsi erant, dimotis, pericardium deprehensum est nigro, concretoque sanguine distentum. Is e sinistro cordis ventriculo exierat per scissuram longam unciae dimidium et secundum illius longitudinem ductam, circa quam cordis fibrae non recenti corrosione exesae conspiciebantur.

Morgagni. De Sed. Mor. II. 27, 8.

There was a very distinguished knight, sixty-five years old, but with sturdy limbs and a sound balance of the humoral fluids, except that some years earlier he had suffered from long-lasting, obstinate ulcers of the legs. Weary of these, he had at last completely healed them by remedies both internal and external. More recently he had occasionally been subject to rheumatic pains, but pains so slight that they did not prevent him from leaving home, as he had indeed done on the day before his death. On 1 June these seized him more severely, at the sternum and in the arms, accompanied by disturbance of the head. After they had been treated with the measures judged most suitable, he was already largely relieved by about midday and behaved cheerfully, although his pulse was weak.

After resting following dinner, he awoke and felt the same pains as in the morning. He therefore began walking about his room, for in this way he bore them more easily. But after doing this sufficiently, he returned to bed and complained of vapours rising to his head and of tightness in his chest; in his restlessness he turned this way and that. After doing so for a considerable time, he suddenly felt that he was dying and, at the same moment, grew pale, struggled, and died immediately.

When the abdomen was opened, everything was found in its natural condition. But when the chest was opened and the lungs, which had been pushed forwards, were moved aside, the pericardium was found distended with dark, clotted blood. This had escaped from the left cardiac ventricle through a tear half an inch long, running in the direction of its length. Around it the fibres of the heart were visibly eaten away by an erosion that was not recent.

The anatomical finding is rupture of the left ventricular wall into the pericardium. This is Morgagni's account in The Seats and Causes of Diseases Investigated by Anatomy by Giovanni Battista Morgagni, Book II, Letter XXVII, article 8. The language of balanced humoral fluids, rheumatic pain, rising vapours and erosion belongs to the account's historical descriptive framework. It does not establish a modern rheumatological diagnosis or a microscopic cause of rupture. The Roman date is the fifth day before the Nones of June, counted inclusively: 1 June. The translation retains the historical half-inch measure without assigning an unjustified modern measurement to the specimen. ^[ref]

Relate any similar case which you may have seen or heard of: and state the probable condition of the Cardiac Muscular Fibres.

A suitable published comparison is J. B. Junor's 1858 report of cardiac rupture with a soft, fatty ventricular wall and blood in the pericardium. The comparison comes from the published clinical record.

The patient was a woman of about seventy with repeated vomiting and an initially weak pulse. She deteriorated after a severe episode of vomiting, her radial pulse becoming almost imperceptible, and died a few hours later. At examination after death, a large gallstone was found impacted in the ileum. The pericardium contained much blood. The small, atrophied heart had an extremely soft and fatty right cardiac ventricle; when it was raised, blood emerged through several small fissures, and its tissue broke under very gentle handling. ^[ref]

The comparison is anatomical and pathological: a fragile ventricular wall, escape of blood and death. There are also important differences. Morgagni's tear is in the left cardiac ventricle; J. B. Junor's reported fissures concern the right cardiac ventricle and were described during handling of a very friable heart. The latter account includes intestinal obstruction and does not reproduce Morgagni's sternal and arm pain. It supports the possibility of severe muscular degeneration in a ruptured heart, without establishing that the two patients had identical disease or that every observed fissure opened before death.

Probable muscular condition in an 1864 answer. The fibres around the tear were probably structurally weakened and softened; fatty degeneration of the heart is a strong historical pathological suggestion. This means alteration within damaged muscular fibres, rather than merely an abundance of adipose tissue outside them. In Richard Quain's account, reproduced before the examination, microscopic fatty change involved loss of the normal transverse markings and refractile fatty particles within the fibre sheath. Extensive change could accompany a pale, mottled, flabby myocardium. Those are findings one would look for, not observations supplied by the Oxford passage. ^[ref]

An appropriate investigation would compare thin preparations from the tear's margin with apparently unaffected myocardium under a microscope, looking at the cross-striation, continuity of the muscular structure and position of the fatty particles. Fat lying between bundles is different from particles lying within damaged fibres. The gross appearance, the microscopic preparation and the sampling site must be reported separately. The word “erosion” does not by itself supply these microscopic findings. ^[ref]

Modern interpretation and its limit. Rupture of a left ventricular free wall can follow myocardial infarction, where a zone of damaged myocardium becomes friable. That is a plausible modern differential for the combination of chest and arm pain, weak pulse and a tear, but the historical record does not supply coronary anatomy or histology sufficient to prove it. A sudden collection of blood in the pericardium, or haemopericardium, can impair cardiac filling and cause cardiac tamponade. This provides a mechanism compatible with the abrupt pallor and collapse; pericardial pressure was not measured in the reported case. Present-day assessment could use urgent echocardiography; that technology belongs to the later comparison. ^[ref]

The defensible conclusion is a ruptured, locally weakened myocardium, with fatty degeneration of the heart a probable nineteenth-century interpretation and infarct-related damage a modern possibility requiring additional evidence.

Translate:—

Μανίης τρόποι εἴδεσι μὲν μυρίοι, γένει δὲ μοῦνος εἷς· ἔκστασις γὰρ ἐστι τὸ σύμπαν χρόνιος, ἄνευθεν πυρετοῦ· εἰ γάρ κοτε καὶ πυρετὸς ἐπιλάβοι, οὐκ ἀπὸ μανίης ἂν ἴδιος γίγνοιτο, ἀλλ’ ἐκ συντυχίης ἄλλης· ἐκφλέγει γὰρ καὶ οἶνος ἐς παραφορὴν ἐν μέθῃ· ἐκμαίνει δὲ καὶ τῶν ἐδεστῶν μετεξέτερα, ἡ μανδραγόρη, ἡ ὑοσκύαμος, ἀλλ’ οὔ τί πω μανίη τάδε κικλήσκεται. ἐπὶ γὰρ σχεδίου γιγνόμενα καθίσταται θᾶττον· τὸ δὲ ἔμπεδον ἡ μανίη ἴσχει· τῇδε τῇ μανίῃ οὐδέν τι ἴκελοι ἡ λήρησις, γήραος ἡ ξυμφορή. αἰσθήσιος γὰρ ἐστι νάρκη, καὶ γνώμης νάρκωσις ἠδὲ τοῦ νοῦ ὑπὸ ψύξιος· μανίη δὲ θερμόν τι καὶ ξηρὸν τῇ αἰτίῃ, καὶ ταραχῶδες τῇσι πρήξεσι· ἡ μὲν γὰρ λήρησις ἀρχομένη ἀπὸ γήραος οὔτε διαλείπει, καὶ ξυναποθνήσκει· μανίη δὲ καὶ διαλείπει καὶ μελεδῶνι ἐς τέλος ἀποπαύεται· διάλειψις δὲ ἀτελής, ἢν τῷ τῆς μανίης λόγῳ γίγνηται, οὐκ εἰκότως ἀκεομένου τοῦ κακοῦ ἰητρείῃ, ἢ τῆς ὥρης εὐκρασίῃ. μετεξετέρους γὰρ δοκέοντας ἀσινέας ἔμμεναι, ἡ ὥρη τὸ ἔαρ, ἢ ἁμαρτωλὴ διαίτης, ἢ ὀργὴ ἐκ συντυχίης ἐς ἀνάκλησιν ἤγαγε.

Aretæus. Χρον. Παθ. Α. ϛʹ.

The forms of ancient mania are innumerable in their varieties, but there is only one general kind: taken as a whole, it is a lasting derangement of the mind without fever. For if fever should at some time also occur, it would not arise as a feature peculiar to the ancient mania, but from some other coinciding cause. Thus wine also inflames the mind into delirious behaviour in drunkenness, and some things that are eaten, such as mandrake and henbane, drive people out of their minds. Yet these conditions are not called ancient mania: arising from a temporary cause, they settle more quickly, whereas ancient mania has persistence.

The senile dotage that is a misfortune of old age is quite unlike this ancient mania. It is a torpor of sensation and a numbing of judgement and intellect through coldness; ancient mania, by contrast, has something hot and dry in its cause and is turbulent in its actions. For senile dotage beginning in old age neither remits nor leaves the sufferer before death, whereas ancient mania does remit and, with care, can come to a complete end.

But a remission is incomplete when it occurs in keeping with the course of the ancient mania, without the illness having been properly cured by treatment or by the mildness of the season. For in some people who seemed to be unharmed, the spring season, an error in their way of life, or anger arising from some incident has brought the condition back.

Aretaeus of Cappadocia distinguishes persistent mental illness, transient intoxication and the cognitive decline attributed to old age. The opening of On the Causes and Signs of Chronic Diseases by Aretaeus of Cappadocia, I.6, organizes these distinctions by persistence, attributed cause and course, ending with examples of relapse. ^[ref]

Several terms need historical interpretation. “Derangement” renders a displacement from one's ordinary mental state, not a diagnosis based on a modern symptom checklist. “Way of life” includes diet and regimen; it is wider than a single meal. The sentence about incomplete remission concerns an apparent improvement within the illness's course, distinguished from a thorough cure through treatment or favourable seasonal conditions. A quiet interval can therefore be followed by recurrence. The hot, dry and cold explanations are historical physiology, not established modern causes.

The scope of ancient mania is broader than present-day mania. Current assessment examines the course of mood and activity changes, symptoms between episodes, medication and substance exposure, physical illness and alternative diagnoses; it does not define the disorder simply as every persistent mental disturbance without fever. Nor should historical senile dotage be equated with a precise diagnosis of one modern dementia, or the passage's assertions about old age be accepted as a modern prognosis. ^[ref]

Translate:—

Ἐν τροφῇ γὰρ κείσεται τὰ φάρμακα.

Ib.

“For the remedies will be found in food.” More literally, the sentence says that the remedies “will lie in nourishment”. The connective “for” is retained, and the future tense expresses where the therapeutic resource is to be sought. The statement allows diet to act as treatment; it does not say that every illness can be cured by ordinary eating.

The attribution is to Aretaeus of Cappadocia. The sentence also occurs in the dietary discussion of pleurisy in On the Treatment of Acute Diseases by Aretaeus of Cappadocia, I.10. Thus the printed “Ib.” need not place this separate aphorism inside the preceding chapter on ancient mania. The wider dietary recommendations there belong to ancient medicine; the short maxim can be illustrated without endorsing all of them. ^[ref]

Illustrate this aphorism from modern experience.

Scurvy supplies a clear illustration available to an 1864 candidate: an appropriate change in diet can act as a remedy. In A Treatise of the Scurvy by James Lind, James Lind described a shipboard comparison begun on 20 May 1747. Twelve affected sailors lived in the same sick quarters and shared a common basic diet, while pairs received different additions. The additions included cider, acidic preparations, sea water, a compound preparation, and fresh oranges and lemons. Thus the comparison asked whether a particular addition helped, rather than merely observing that patients ate while recovering.

The pair given fresh citrus each received two oranges and one lemon daily. Supplies lasted six days. James Lind reported that one was then fit for duty, while the other had recovered sufficiently to help nurse the remaining sick. The exact contrast matters: two recoveries are not proof that every sour substance is equivalent to citrus, and James Lind's physiological theories should not be confused with the observed result. The record is also a small comparison with incompletely specified allocation, rather than evidence for a modern randomized design. It nevertheless supplies a concrete, pre-1864 illustration of a therapeutic resource carried in food. ^[ref]

Present explanation. Scurvy is caused by deficient vitamin C intake. Humans require a dietary source of vitamin C; it is needed for normal collagen formation. Deficiency weakens connective tissue and can produce fragile small blood vessels, bleeding gums and poor wound healing. Suitable food can therefore correct the deficiency, not merely disguise its symptoms. This explanation is later knowledge: an 1864 candidate could cite the effect of fresh antiscorbutic food without knowing the chemical identity of vitamin C. The effective factor is not simply acidity, nor is the claim that more vitamin C cures every unrelated disease. ^[ref]

There is also a broader nutritional sense. In malnutrition, adequate food supplies energy and protein needed for recovery, and the composition and route of nutritional support depend on the person's capacity to eat and absorb it. Current guidance distinguishes ordinary enriched food and oral supplements from enteral or parenteral support when required. This extends the principle of using nourishment therapeutically, while distinguishing it from a specific cure such as correcting vitamin C deficiency. These present-day care pathways are not attributed to ancient practice or to the 1864 examiner. ^[ref]

The illustration therefore supports a specific relation between nutritional need, a suitable food, and a measurable clinical effect. It gives no warrant for replacing every other form of treatment with a general dietary slogan.