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instantly died. The father in his passion pursued the unfortunate homicide, and threw at him a saddler's hammer, the sharp point of which penetrated between the first and second vertebræ, and divided the medulla spinalis, and killed him upon the spot also; and thus, as he remarks, they both perished from nearly the same accident. Mr. Stafford relates a case which occurred at St. Bartholomew's Hospital.

Case. A bricklayer ascending a ladder, at a great height, lost his hold and fell upon his head. He was taken up dead, and conveyed to the hospital. On examining the spine, it was found that he had dislocated the first vertebra from the second, the ligaments of the processus dentatus being torn. Mr. Stafford relates three cases, to prove that dislocation of the cervical vertebræ, lower down, can and does take place; they are interesting, and deserve to be recorded. In all, the dislocation appeared to have been effected by the neck being bent forward to an extreme angle, so that the articulating surfaces were dislocated and the ligaments torn.

Case 1. "A man was working upon the roof of a house, and, having lost his balance, fell upon the pavement with his head foremost, and bent his neck forward to an extreme angle. He was taken to the hospital. Some displacement was observed between the fifth and sixth vertebræ; and the upper part of the column was protruded a little more forward than the lower. He had paralysis of all the parts below the injury. The usual remedies were employed, but he died in a fortnight. It was found that there was a proper dislocation of the fifth vertebra from the sixth; but that neither the articulating processes, nor the rim of the body of the vertebræ were fractured.

Case 2. A man also fell from a height, and bent his neck forward to an extreme angle. He died, and it was discovered that he had dislocated the fifth vertebra from the sixth, without fracture of any part of either of them." 113.

Case 3. Charles Butcher, æt. 22, Jan. 8, 1827. Is a stout muscular man, and, while descending a step about two feet in height, with a barrel (1 cwt.) upon his shoulder, he fell upon his buttocks, the barrel resting on the back of the head and upper part of the neck. He was brought to the hospital forthwith. He was perfectly sensible-there was total loss of sensation and voluntary motion below the neck-respiration performed solely by the diaphragm-pulse weak and slow-body cold-priapism. He was placed on his back in bed, and, there being reaction in the evening, he was bled to 16 ounces, and a dose of calomel and jalap was prescribed; four ounces of urine were drawn off by the catheter. On the 9th, he complained of pain in the lower part of the neck-respiration slower-slight power of motion in the arms a little feeling in front of the chest-pulse full-heat diminished-fæces dark and offensive and passed involuntarily—a catheter introduced, but only a table-spoonful of urine drawn off; in the evening six ounces of high-coloured urine were abstracted. He slept during the night and felt better next day. The pulse and temperature of the skin remained the same there was a tingling sensation in the hands, and sensation in the upper parts of the arms and thighs-priapism continued more or less-the fæces had been discharged involuntarily-and he complained of distention. of the bladder. Eighteen ounces of high-coloured urine were drawn off; it deposited on cooling a small quantity of dark brown sediment. On the

11th he was worse-the countenance unfavourable-tongue brownish, and dry in the middle-fæces passed involuntarily-slight sensation still in arms and legs-thought he could walk home and asked for his clothes to dress himself. Six ounces of lighter coloured urine were drawn off. After this he sank rapidly, the priapism continuing, and died on the morning of the 12th. On examination there was found complete dislocation of the fourth cervical vertebra, its inferior oblique processes having passed in front of the superior oblique processes of the fifth; its body, separated at the fibro-cartilage, stood over that of the fifth by its whole depth. No mention is made of the state of the medulla or of other parts.

The succeeding chapters from the fifth to the tenth, including both, are occupied with the consideration of the diseases of the vertebral bones and intervertebral cartilages. After the many excellent monographs which have been published, it cannot be supposed that Mr. Stafford could offer much novelty on such a subject. He has not, and all we can do is to select here and there a passage conveying some new view, or interesting fact. We will take the following remarks on the cancellous structure of the spinal bones.

"It may be observed, that upon breaking the substance of the body of a vertebra in a fresh subject, the cancelli are found to be composed of thin transparent plates, and of round pillars of bone, both of which arise from the internal surface of the external plate surrounding the body, and are irregularly disposed and connected one with the other, throughout its whole substance. These plates are slightly transparent, and between their interstices is deposited an oily unorganized matter, which answers to the marrow in the long bones. When the phosphate of lime is dissolved by diluted nitric or muriatic acid, the bone is rendered soft, and the cancelli become quite transparent: they still retain their reticulated appearance, but their substance is so pliable that it resembles sponge, and can be compressed into a very small compass. Upon a closer examination of the cancelli in this state, they are found to be of a membranous structure, having a smooth, shining surface, on each side of them, with rounded edges, and being of a dense, tough consistence. Hence it would appear, from the common character of membranes being smooth on one side and rough on the other, that they are composed in their natural state of a duplicature of membrane, with phosphate of lime either deposited in their texture or on their surfaces.

Having so far shown by this description that the cancelli are of a membranous structure, I shall now endeavour to prove that they resemble other membranes in their functions as well as in their diseases. They possess the power of secretion as other membranes; for instance, they secrete phosphate of lime, and the oily matter deposited between their interstices. That the phosphate of lime is a mere secretion, is proved from the fact, that its quantity is increased or diminished according to the healthy or unhealthy state of the membrane, as may be seen from its deficiency in rickets and scrofula. In rickets the earthy matter is almost entirely absorbed, and the cancellous membranes are left uncovered by it. The same takes place in scrofula; the bone becomes softened, that is to say, the action of these membranes is changed; they do not secrete phosphate of lime, but an albuminous cheesy matter. In rheumatism the contrary takes place there is more earthy matter secreted than ought to be, and the bone is rendered hard. These facts are illustrated by many preparations preserved in museums. The membranes of the cancelli also secrete an oily matter, which is lodged between the interstices. This oily matter is frequently entirely wanting in affections of the spongy texture of bones, and in scrofula its place is supplied by an albuminous or caseous matter, (a secretion peculiar to this disease,) No. XXXIII.


which proves that the action of this membrane is altered, and that the natural secretion must have been previously absorbed.

Although the membranes of the cancelli no doubt are of a character sui generis, yet from the diseases which affect them they appear more to resemble the serous and synovial membranes than any. Both of these are liable to scrofula; so is the cancellous structure, and the matter secreted is the same in all. They are also affected by rheumatism, by the action of mercury, and by the venereal disease: so are the membranes of bone. A greater proof, however, of their resemblance is, that serous membranes sometimes secrete phosphate of lime. As a proof of this, I have frequently inspected bodies where I have seen bony matter deposited on the dura mater of the brain, the arachnoid membrane of the spinal marrow, on the pleura, pericardium, peritoneum, &c." 120.

We think it very probable that a membrane does exist in the cancellous tissue of short and flat, and the cancellous extremities of long bones, although its existence has been denied, if we remember right, by Bichat. But we think the analogy between this membrane and the synovial is too loose; it is more allied to the medullary system of the long bones, a system sui generis. That bone is secreted by it, or rather by the vessels which it supports, is very likely, and as rickets consists of a diminution of the secretion of the phosphate of lime, that disease may be deemed in some sort an affection of this membrane. But rickets is undoubtedly a constitutional disease, and that it is not essentially a spinal complaint, as Mr. Stafford imagines, is proved by the rickety alterations of other, and especially of the long bones.

Our readers are, perhaps, aware, that abscesses are occasionally found in the ends of long bones, as the tibia, and very serious complaints they are. Mr. Brodie has once or twice trephined the bone for symptoms of this complaint, and evacuated the abscess with success. But this by the way. There is a preparation of abscess in the substance of the bone of the sacrum, in the museum of St. Bartholomew's Hospital. The history of the case is unknown.

Ulceration occasionally takes place in the substance of the bony arches of the vertebræ. Practitioners should be aware of this fact.

Although it does not commonly happen, yet in some cases ulceration of the rings of the vertebræ takes place. There is a preparation of this species of the disease in the spine in the museum of St. Bartholomew's Hospital. Here the ulceration began in the back part of the rings of the dorsal vertebræ, and a portion of the bone is separated, and pressing upon the medulla, while the bodies are perfectly sound.

In the museum of Guy's Hospital also, there is a preparation where an abscess is connected with the vertebral canal. It appears in this case that the rings of one of the dorsal vertebræ is ulcerated, from which there is a fistulous passage leading from the vertebral canal to a large abscess in the back. This narrow passage is partly filled up by caseous matter, which proves it to have been a scrofulous abscess, arising in consequence of diseased bone, and connected, owing to the ulceration of the ring, with the vertebral canal." 149.

An interesting case of complicated luxation, from disease of the atlas and dentata, has been given to our author by Mr. Lawrence, and is related under the head of disease of the articular joints. If we are not much deceived, this case was published by Mr. Lawrence in the Medico-Chirurgical Transactions, and noticed at the time in this Journal. We will not, therefore, again refer to it. From the chapter on angular curvature of the spine, we only think it necessary to make the following extract, illustrative, we ima

gine, of the providential solicitude of Nature to guard her children, even in the midst of distempers and diseases. The good effects resulting from the following constitution of parts, during and after a morbid process, are sufficiently apparent.

"With regard to the curvature of the spine, it may be considered as a general law, that the medulla takes its course along the greater angle; that is to say, it follows the curve of the rings of the vertebræ rather than that of the bodies. It may be observed, also, in most of the morbid specimens of this disease, that the vertebral canal, where the curvature takes place, is even larger than natural, and that the projecting points of the broken-down vertebræ are absorbed, and rounded off. In some cases, no doubt, where only one or two bodies are rapidly destroyed, and the angle is very acute, the bones may press upon the spinal cord, but in the majority they do not, and even in those where they do, if the patient lives long enough, there is but little doubt they are in general gradually smoothed down by absorption.

The state of the medulla itself, if examined after death at the part where the curve takes place, varies; sometimes it does not in any way deviate from health, the structure, both of the medulla and its membranes, is natural, while at other times a considerable degree of disease may have gone on. The membranes may

be thickened, matter may be formed pressing upon them, or between them, and the medulla itself may be reddened, or partially softened, or softened in such a manner as to be almost in a fluid state. In these cases the paralysis below is usually complete." 167.

After enumerating the symptoms usually observed in ulceration of the vertebræ and intervertebral cartilages, Mr. Stafford properly observes that we must not be surprised at their absence in cases considerably advanced. There is no novelty in this remark, but there is truth, and truth so serious as to merit great attention on the part of practitioners. We recollect a striking instance of the fact, of which, indeed, we have seen several. A young man complained of some obscure pains about the hip-joint, without other evidence of organic disease in that articulation. Struck with this circumstance, we examined the spine very carefully, but detected no irregularity, no decisive tenderness on pressure, no appreciable functional disturbance. The patient had a fistulous opening in the integuments, under the right pectoral muscle, which was concluded, from its aspect, to lead to carious or dead rib, though no exposed bone could be felt with the probe. He was attacked with erysipelas around this ulcerated opening, and symptoms of latent pneumonia supervened about the fourth or fifth day. In thirty-six hours he died. On dissection, recent pleuro-pneumonia of the right side of the chest was found to have been the immediate cause of death. As had been suspected, two or three ribs were partly carious, partly dead. But this was not all. Between these carious ribs and the pleura costalis, which was thickened, chronically inflamed, and separated from the side, was a widelydiffused abscess. This passed backwards to the dorsal vertebræ, a great many of which (we now forget the precise number) were more or less ulcerated, with correspondent affection of the intervertebral cartilages. The hip-joint, to which the sympathetic pain had been referred, was healthy. We may insert some other instances of a similar description related by Mr. Stafford.

"Notwithstanding, however, all the symptoms here enumerated, so insidious is this disease that I have sometimes known angular curvature to occur without a single indication of it, as far as the health was concerned. A child, for in

stance, shall play about as usual, without its parents remarking any change in it; it shall have a good appetite, sleep well, &c. and yet ulceration of the bones shall be going on, which shall not be discovered until anchylosis of the part has taken place. I recollect a case of this description happening in a little boy of my own acquaintance. He had always been from his birth more lively and active than usual, and never had any illness to speak of. By mere accident his father discovered that he had an angular curvature of about two or three of the vertebræ, which had firmly anchylosed.

The completeness and incompleteness, also, of the symptoms, very much depends upon the rapidity with which the curvature takes place. If the destruction of the bodies of the vertebræ has been very quickly effected, the paraplegia is usually more complete; but if it has been slow in its progress, the paralysis below is frequently very imperfect. It is only astonishing in some cases how much mischief may occur to the vertebræ, both as to the extent of the curve and the acuteness of it, without the symptoms of pressure upon the medulla being produced. I have frequently seen six or eight of the bodies of the vertebræ destroyed without a single symptom as to the loss of the power of motion or feeling to denote it. I have at this present time a case of a child under my care, in St. Mary-le-Bone Infirmary, where at least six of the bodies of the dorsal vertebræ have been destroyed by caries, and the angle of the curve is very acute, and yet no paralysis has ever occurred. Such a phenomenon can only be explained by the very progressive and slow manner in which the alteration of form takes place." 185.

The directions for the treatment of the disease are judicious; but as most of the items are familiar to well-informed practical surgeons, we think it necessary to make but one extract. It shews that, possibly, the horizontal posture may be too assiduously maintained, or, at all events, that the injudicious extension sometimes resorted to by medicasters and quacks is not altogether devoid of danger.

"As the curative process by which the destruction of the bodies of the vertebræ, and that of the intervertebral substances, can only be effected by the anchylosis of the superior with the inferior portion of the spinal column, it may be advisable, perhaps, to assist the diseased parts in anchylosing. Instances have been known, one of which is shewn in a preparation in the Museum of St. Bartholo mew's, where several bodies of the vertebræ have been destroyed, and where the two diseased extremities have not come in contact with one another, so that a large gap has been left between them unoccupied. This has been attributed by some (and it certainly is a very rational conjecture), to the patient having lain too long in the horizontal position; thus it has been impossible to approximate the two extremities. Whether this really is the cause, or whether it arises from the rings of the vertebræ and their articulations having sufficient strength to bear the weight they have to sustain, is uncertain. From whatever cause, however, it may arise, it appears to point out the necessity of our assisting the anchylosis of the two separate parts, which can only be effected by gradually allowing the upper part by its own weight to fall upon the lower part of the vertebral column. The best method to accomplish this is, to raise the superior part upon which the body or trunk lies, of the double-inclined plane bed, to rather beyond that angle which would be equi-distant between the perpendicular and horizontal line. By this plan the diseased surfaces will be approximated, and at the same time will be kept in a perfect state of quietude; thus the process will be going on without disturbance; by which the disease is cured." 202.

Nearly fifty pages are devoted to the consideration of distortions of the spine, lateral and otherwise. The reader would almost be tempted to suppose that such a subject was exhausted. It is true Mr. Stafford does not

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