lings, and potatoes, and half-a-pint of beer; the next, soup, with potatoes and dumplings, alternately.

At two, work is resumed, and at four a luncheon is distributed, similar to that in the forenoon. At seven they have supper, of milk pottage and bread. At eight, the bed-room doors and window shutters are carefully locked, the clothes folded, and placed on the outside of each door. The résident physician, (who is director) the matron, the apothecary, and housekeeper, reside in the Institution. They not only visit each patient once a-day, but are constantly amongst them. The two visiting physicians attend twice a-week each, and more frequently if necessary. The two visiting surgeons once a-week, and as often as there are surgical cases requiring their attendance.

The number of patients employed will be seen from the following table :

Here, as elsewhere, the utility of labour would appear to have been proved.

MARYLEBONE INFIRMARY.

ON LONG-CONTINUED CONTRACTION OF THE LOWER EXTREMITIES, FROM AN AFFECTION OF THE SPINE. By R. A. STAFFORD, Esq. Surgeon to the St. Marylebone Infirmary, &c.

We shall allude to some cases detailed by Mr. Stafford, before we notice the views he has founded on them. The cases are five in number.

Case 1.-Jan. 1833.-Mary Kean, æt. 20, a slight-made girl, and of small stature, was admitted into St. Marylebone Infirmary with complete contraction of the right lower extremity, and contraction of the third and little finger of the hand of the same side. She possesses the full power of feeling in both limbs, but the knee-joint is firmly bent and stiff; the calf of the leg rests upon the back part of the thigh; and the heel presses closely upon the nates, the foot being turned backwards. She states that she has been the subject of epileptic fits ever since her infancy; that about two years ago she was seized with violent pain in the spine in the lumbar region; pain in the hip and knee; and extreme pain along the course of the ischiatic nerve, accompanied with considerable tenderness and increased sensibility of the whole limb. At this period the lower limb became gradually and firmly contracted, and no means employed could prevent it. Some little time afterwards the two last fingers also became contracted, and thrown across the two first on the hand of the same side. She was admitted into one of the London hospitals, where the symptoms became mitigated, but the limbs remained the same.

For the last two years, excepting the contraction, she has continued pretty well, but at present she is suffering from her original symptoms. The pain in the back, hip, and knee, is extremely acute; and the tenderness and sensibility of

the whole limb is so great that she cries out at the slightest touch, and she cannot even bear the weight of the bed-clothes upon it. On tracing and pressing upon the ischiatic nerve, it is extremely painful and tender. Her pulse is quick, fever high, tongue furred, skin hot and dry, and thirst great. She has constant restlessness and sleepless nights.

These symptoms continued, being more or less violent, for three or four months; and the treatment adopted was, frequent abstraction of blood from the lumbar region by cupping; the application of leeches along the course of the ischiatic nerve; the exhibition of antimonials, opiates, and aperients, as often as required, and according to the necessity of each remedy. When the chronic stage commenced, counter-irritants were employed and frequently repeated, both on each side of the spine and along the course of the ischiatic nerve, in the form of blisters and the tartar-emetic ointment. Lastly, issues were made and kept open for a considerable time on each side of the spine in the lumbar region.

When the inflammatory symptoms had entirely subsided, the pain in the back had ceased, and the tenderness of the limb had diminished, an attempt was made to unbend the contraction, and bring the limb into its natural state. To effect this purpose small thin pillows were first introduced between the calf of the leg and back part of the thigh, drawing them as near as possible to the flexure of the knee-joint. At first this caused extreme pain, and occasioned several attacks of epilepsy. By degrees, however, the patient was able to bear the treatment. Thicker pillows were then employed, and, as before, occasioned great pain, but which, after the limb was accustomed to them, subsided. When the pillows had been worn for some time (six weeks or two months) the contraction has relaxed sufficiently for a machine to be introduced between the two limbs, and which is so contrived that, by turning a screw, the leg can be gradually extended. It consists of two splints joined by a hinge at the flexure of the knee-joint-one resting on the back part of the thigh, and the other on the calf of the leg; a bow made of iron, the extremities of which rest upon each splint, and through the centre of which passes a screw, which is also attached to the angle at the junction of the splints. A nut (as it is termed) is turned on the screw, and presses on the centre of the bow; consequently when the centre is pressed upon, the two extremities extend the splints.

With this machine the limb was gradually extended inch by inch, until at length the leg and thigh were as straight as natural. During the progress of the extension, friction was employed, and the knee was frequently steamed. The limb was then exercised; and after the period of seventeen months from the beginning of the treatment to the termination of it, the patient was discharged from the hospital cured. The fingers likewise were gradually extended, and returned to their natural use and position.

This case is one of some interest. We have given it in the words of the author, as it is not susceptible of useful abbreviation. The disease on which the contraction of the leg and of the fingers depended, was probably seated in the spine. The existence of epileptic fits from infancy furnishes collateral evidence of lesion of the nervous centres. The affection was probably inflammatory, from the severity and course of the pain, and from the pyrexia which attended it. The case is peculiarly instructive, because, to use the words of Mr. Stafford, it shews, that, however firm and complete a contraction of this description may be, yet by perseverance and care, and the gradual and equal employment of extension, the limb can be restored to its healthy action.

We pass over the second case, and pause at the third.

Case 3.-"A young lady, æt. 18, of a strumous habit, fell into bad health. She first found that she had partially lost the power over her legs; she then was seized with violent spasms and involuntary twitchings of the lower extremities.

At length these spasms increased, and became so confirmed that the legs were half drawn up in a semi-flexed position, and would remain so, unless they were put down again by another person. At this period of the complaint the case was considered as chorea, and treated as such. No improvement, however, took place; the spine, therefore, was examined, and it was found that five or six vertebræ were diseased, and that there was angular curvature in the dorsal region of the spine, beginning at the fourth dorsal vertebræ. The friends of the patient would not consent to any treatment, consequently the curvature increased, and the contraction of the legs likewise. She remained in this state for a few months, when she came under my care. I found her as above described, and my first object in the treatment was to get the limbs back to their natural position. Leeches were frequently applied to the back, and counter-irritants employed. Under this treatment she improved, some consciousness of feeling in the legs returned, and the contraction became sufficiently relaxed to enable me to place her on one of Mr. Earle's beds; but if the limbs were touched or moved they immediately retracted. After she had been under my care for a twelvemonth, improving in health, and there being some slight amendment both in the power of feeling and of motion in the legs, her friends became extremely impatient at the tediousness of the case; they made an attempt, without my consent, to get her up; employed friction, and exercised the limbs. The spasms returned in a violent degree; they extended on to the arms and all over the body. At length she became comatose, and in this melancholy state died. No examination of the body was made."

Case 4, that of a lad aged 15, is one of angular curvature of the spine, beginning at the fifth dorsal vertebra, and ending at the tenth. He states that about three years ago, when stooping down, a young man in play jumped upon his back and knocked him down. From this time he felt pain in the spine, and the curvature commenced. About two years ago his lower limbs became in one week contracted, and drawn up in a semi-flexed position, so that the heels are within four inches of the nates, and they have remained so ever since. They can be straightened to a certain extent, but immediately they retract as if by a spring with great force. The treatment has been abstraction of blood from the spine and counter-irritants, &c. At length the contraction subsided, the limbs could be straightened, and the boy is now (July 3d) walking about like other people.

Case 5.-In this, dissection was obtained, and the nature of the lesion ascer tained with precision. Ann M'Cartney, æt. 41, died in St. Marylebone Infirmary, September 7th, 1838. Nearly three years previous to her death, her lower extremities became firmly contracted, so that the heels almost touched the nates. After this she became insane, and was an inmate in the Lunatic Asylum at Hoxton. On examination of her body the arachnoid membrane of the spinal marrow was thickly studded along its whole course by specks of bony matter, consisting of patches of various sizes. These bony concretions had spicule on their surfaces, which, from their roughness, must have been a constant source of irritation, if not inflammation of the spinal cord itself.

Having related these cases, we may now pass to the views engrafted on them, It will probably appear that those views outrun the data.

"In many cases," says Mr. Stafford," which have been termed Local Hysteria-the symptoms of which Sir Benjamin Brodie has so ably described, in a work lately published by him-I have every reason to believe, if they were traced to their original source, that the medulla spinalis and its membranes would be found to be the scat of the disease. I am induced to come to this conclusion from the symptoms of these affections. For instance, one individual shall wholly or partially lose the sensation of a limb; another shall wholly or partially lose the power of volition; a third shall have a limb contract, as in the cases

I shall presently mention; and others, again, shall have extreme pain in the hip, the knee, or ankle, accompanied with extreme tenderness and sensibility, and even swelling, and yet have no actual disease of either joints. Some also shall have extreme tenderness of the spine itself; so much so, that they shall flinch even at the slightest touch. Retention of urine, tympanitis, and many other symptoms, shall affect others, and all which appear to me to be alone traceable to the nerves belonging to the parts themselves, or to the grand trunk from whence they spring.

When we reflect on these various affections-loss of sensation-loss of motion -increased sensibility-spasm and contraction of muscles-we are led to inquire how such different phenomena can be produced. It appears to me that the different functions which the brain and medulla have to perform, will explain the whole. First, the medulla spinalis governs the power of feeling in the trunk and limbs; therefore, if feeling be lost, it must necessarily arise from some affection of the cord: secondly, it governs motion; consequently if motion be lost, it has suffered some functional derangement, or morbid alteration of structure: thirdly, if contraction of the limbs takes place, we know that the medulla spinalis governs the action of muscles, and therefore that most probably the affected part is the spine fourthly, if there be increased sensibility of a limb, as in the cases which I shall presently relate, there can be but little doubt that it is produced from some morbid condition or inflammation of the nerve itself, or of that part of the substance of the medulla which governs sensation, from whence it has its origin: and, fifthly, when contraction and spasm; inflammation of that part of the substance of the cord which governs motion, or at the origin of the nerve which supplies the muscles of the affected part. When we compare these affections with the injuries of the spine, we may observe a great similarity in the symptoms of both. When paraplegia is not complete in concussion of the spine, there may be partial loss of feeling or of motion in the lower limbs. The same occurs in what has been termed local hysteria. A sense of numbness, or partial paralysis, is often complained of by the patient, and I have known individuals thus affected drag one leg from this cause. The same feeling of disordered sensation I have observed takes place in the upper extremities, and which sometimes happens in injuries of the spine without the lower suffering. It is not uncommon, also, in injuries of the spine for the patients to complain, as they do in local hysteria, of severe pain in the hip, the knee, and the ankle. A case of this kind occurred some time ago in St. Bartholomew's Hospital. A man threw himself from a high wall, having the impression that it was falling. He injured his spine in the lumbar region, and partially lost the feeling of one leg, having also retention of urine, and inability of retaining the fæces. When he was admitted into the hospital he referred the chief of his sufferings to severe pain in the hip, the knee, and the heel, accompanied with extreme tenderness and sensibility of the whole limb. He was relieved by abstraction of blood from the lumbar region and moxas; but he returned again, after his discharge, three times, suffering from the same symptoms, before he ultimately recovered.

Contraction of the limbs is occasionally produced from an injury of the spine. An instance of this kind occurred a few years ago at Penkridge, in Staffordshire. A man fell from off a waggon-load of hay, and fractured the spine at the second, third, and fourth lumbar vertebræ, they being considerably displaced laterally. He was paralyzed below the injury for a considerable period, although now he is partially recovered; but the arms became contracted, and so firmly that the humeral part of them rests fixed to the side-the fore-arm on the humeral part, and the hand on the fore-arm, with the fingers firmly clenched. The cases which I shall presently relate very much resembled this, without an accident occurring.

Tympanitis frequently occurs in local hysteria. In concussion of the spine we see the same. Tympanitis is a frequent symptom attending it. Again total

or partial retention of urine occurs in local hysteria. The same happens in injuries of the spine also; and if the bladder be sufficiently long paralyzed in the former affection, the same morbid changes of the organ occur; the mucous membrane is found inflamed, and the urine fætid and decomposed."

After some remarks upon tympanitis, to which we need not refer more particularly, Mr. Stafford proceeds :

"To continue, however, with the comparison of the similarity of local hysteria with affections of the spine, let us observe the symptoms where there is visible disease of the vertebral column. In these cases we see the same class of symptoms total or partial paralysis of the lower extremities; loss of motion, or of feeling individually, or in an equal ratio; spasms and cramps in the muscles; paralysis of the bladder causing retention of urine; loss of power of the rectum; and inaction of the bowels. How commonly, also, do we find that the patients complain of pain in the hip, the knee, and the ankle, and refer their sufferings rather to one of these joints than to the spine, where there is evident disease!

Contraction of the lower limbs likewise not unfrequently occurs where there is angular curvature, examples of which I shall presently relate. In some cases, also, there may be extreme tenderness and increased sensibility of the legs, and more particularly in the feet. On the contrary, in others there may be a sense of numbness and dead weight, although the locomotive powers are complete.

In addition to these symptoms, how frequently do we find, when destruction of the vertebræ has taken place, and the curvature is advancing, that the patients, and particularly females, suffer from symptoms resembling inflammation of the viscera! Hence they may have acute pain and extreme tenderness in the region of the liver, the stomach, and intestines; and bearing all the characters of hepatitis, enteritis, gastritis, and peritonitis. When we consider the intimate and frequent connexion of the medulla spinalis with the sympathetic, and the various organs this latter nerve supplies, it is not difficult to account for any symptoms which may occur; it is natural to suppose, if any portion of the cord be affected by disease, from pressure, irritation, or deviation from its normal course, that not only the nerves immediately derived from it, but those collaterally connected with it, would suffer derangement of function. Such, then, being the similarity of the symptoms of these affections, with those where there is real and perceptible injury and disease of the spine, it appears to me fair to infer that they arise from some functional derangement or morbid condition of the medulla spinalis."

We notice these views not simply on their own account, but because they are ramifications of the doctrine of spinal irritation, which has become rather fashionable.

Mr. Stafford, it will be observed, uses a certain chain of argument to shew that "local hysteria "* is identical with spinal affection-and he supports that argument by cases. Those cases, at least some of them, are certainly instances of spinal affection, attended with pains and contraction of the muscles of the extremities. But we do not hesitate to affirm that those cases are not fair instances of "local hysterical affection," and therefore prove nothing with regard to its nature. On this point then we join issue with our author. His cases, we repeat, may be instances of spinal affection, but they are not instances of hysteria.

We therefore turn to his argument. The gist of it is, that the various symp

There cannot be a doubt of the impropriety of the application of the term hysteria" to the local nervous affections in question. But the term is applied, and provided that all understand its force and meaning, it matters little what the term may be.