Imagens das páginas

deal in novelties, nor could he; but what he advances is judicious. The last portion of the volume is occupied with the Diseases of the Medulla and its Membranes. It is generally lamented, and with too good reason, that few are sufficiently conversant with either the natural or unnatural appearances of these parts. We trust that, in spite of the obstacles which interfere with their inspection, the reproach will not be a perpetual one.

Mr. Stafford draws a parallel between arachnitis and tetanus, at least idiopathic tetanus; he seems almost inclined to consider them identical. With this sentiment we cannot agree, for two reasons;-first, we know too little of the symptoms of one disease, and morbid characters of the other, to be justified in pronouncing decidedly on their affinity-secondly, arachnitis does certainly occur, unattended by any tetanic symptoms whatever-and, thirdly, tetanus proves fatal, and yet leaves no traces of arachnitis after death. Of the latter assertion we need bring no proof. In support of the former, we need only mention one case which we recently witnessed at St. George's Hospital. A man had compound fracture of the skull, for which he was trephined. Hernia cerebri followed-it increased—a state of partial stupor, with some increase of pulse and heat of skin ensued, and he died. On dissection, there was found, with other things, inflammation of the arachnoid and pia mater of the brain, and continuous inflammation of those membranes investing the medulla. Over the latter there was decided effusion of coagulated lymph, &c. This patient had evinced no tetanic symptom whatever. It is right to mention that four cases are related by Mr. S. in three of which the spinal arachnitis was unequivocal, and in the fourth doubtful. In the first of the three, there were distinct symptoms of traumatic tetanus; in the other two, there were also tetanic symptoms occurring idiopathically. In the fourth, there was tetanus after burn. We give Mr. Stafford's hypothesis all the benefit it can obtain from the foregoing cases; but we venture to observe that they are too few and inconclusive to confirm his opinions.


This arises from secretion of fluid from the spinal arachnoid, which gradually collects till it fills the whole canal. Its progress is usually very slow -its causes obscure-its symptom, paralysis, gradually developed-its treatment rather regulated by general principles than by experience. Mr. Stafford witnessed the following case in St. Bartholomew's Hospital.

Case. Thomas Cox, light porter, æt. 23, admitted Sept. 30, 1830.

"This patient, who is of moderate strength and stature, has usually enjoyed good health, with the exception of occasional headaches, which have troubled him from childhood. He has been accustomed to indulge pretty freely in liquors; but since his marriage, which took place a twelvemonth back, he has not, on an average, got drunk more than once a week. For three or four weeks previous to admission, he experienced uneasy sensations in the lower part of the belly, and a numbness of the thighs, accompanied with swelling of the right testicle. On Saturday evening, Sept. 25, he walked to the hospital to have his water drawn off, having never found any difficulty in passing it before. He afterwards walked home, a distance of half a mile, without difficulty, though he did not feel altogether firm upon his legs. He slept that night as well as usual, and found to his surprise, on Sunday morning, that there was complete loss of motion, and

partial loss of sensibility of the lower limbs, with inability to make water. The fæces caine away involuntarily in the course of the day; and the paralyzed limbs were occasionally affected with spasms, of which he was conscious. He was not feverish, and had neither head-ache nor other pains. On Monday he was cupped on the back by order of a Dispensary-Surgeon, who supplied him with medicines, and drew off his water till Thursday, when he was received into the Hospital, having derived no relief from the treatment." 274.

Cupping, leeching, blistering, warm-bath, the catheter, &c. were the means employed, but on the 5th the patient was worse; there was great weakness, furred tongue, dry skin, and feeble pulse. An alkaline calumba draught was prescribed, and a moxa applied on each side of the spine. The integuments covering the sacrum sloughed from pressure, the urine became loaded with ropy mucus, and offensive, and in spite of wine and broth the debility increased. A communication was now established between the bladder and rectum, its formation being preceded by the discharge of a small portion of sloughing membrane from the anus. Great emaciation ensued, with hectic cough, and on the 20th of January the patient died.

On examination, the arachnoid membrane, covering the upper surface of the brain, was raised by thin serous effusion, and the same kind of fluid was discovered under this membrane in the vertebral canal. The kidneys and ureter were healthy, the mucous membrane of the bladder dark-coloured, with the perforation of the viscus already alluded to. The legs were much swollen from anasarca.

Our author relates a case of effusion of blood into the spinal canal, independent of injury inflicted. He also cites a case which has been previously published by Sir Astley Cooper, and another by Mr. Chevalier. We shall take only the first, because it is original.

Case. J. Connell, æt. 31, was admitted into the St. Mary-le-bone Infirmary, May 23, 1828, with the secondary symptoms of syphilis. Mercurial ointment was prescribed, but, on the third night, having great dyspnoea, the ointment was discontinued, a blister applied on the sternum, and an aperient given. By these measures he was relieved, but he was seized in the night of the 26th with an attack of complete paraplegia; with severe pain in the dorsal region: pulse 80, sharp and full; bowels costive; retention of urine. He was cupped to 16 ounces, placed in the warm-bath, and the catheter directed to be used night and morning.

June 1st. Since last report has usually had hot skin, pulse above 100, sleeplessness, obstinately costive bowels; paraplegia still complete. He gradually grew weaker, a slough formed on the nates, the fæces were discharged involuntarily, and the catheter required to be passed twice daily, and on the 11th he died.

On examination, all the viscera were healthy, excepting the mucous membrane of the bladder, which was inflamed. A large quantity of blood was extravasated between the arachnoid and pia mater of the cord; it was semifluid, and filled nearly the lower part of the canal. The medulla was rather softer than natural in the dorsal region.

In Sir Astley Cooper's case the effusion was between the theca and bony canal; this case appeared to date its commencement to injury. The other case was that of a young lady, who had suffered no injury. She first com

plained of pain in the head and back upon the 26th of February, and died on the 4th of March. The extravasation was in the lumbar region.

"A child of 12 months old, who had just recovered from the operation for hare-lip, was carried out by the nurse. On its return home, it seemed in much pain, and appeared to have lost the use of its lower extremities: it died in three days. On opening the body I found the spinal canal full of a bloody serum, which, I have no doubt, was occasioned by slight extravasation from a strain, and subsequent inflammatory effusion. And how destructive such extravasation and inflammation combined, may be to the structure and office of the nerves, was illustrated by the case of a miller, who suddenly lost the use of his lower extremities, by lifting a heavy sack of flour. He died on the 15th day after the accident. On examining the vertebral canal, some extravasated blood was found mixed with a sanious matter, the theca vertebralis was evidently inflamed, and the nerves of the cauda equina were more completely rotten than I have found them after many weeks' maceration in putrid water, when removed from the dead body." 288.

We shall conclude this article by an instance of ramollissement of the medulla, which was witnessed by Mr. Stafford at St. Bartholomew's Hospital. It illustrates the general character of the symptoms.

Case. "Rebecca Dixon, æt. 16, admitted into St. Bartholomew's Hospital, November 1st, 1827: said that she had been struck with the handle of a mangle on the back part of the neck, in February last; but the injury was so slight that she took no notice of it until the beginning of September, a space of six months, when she applied to some public institution, on account of a severe pain in the upper and back part of her neck, and her face being drawn towards the right side: she took a number of remedies without benefit.

When she was admitted, she complained of severe and continued pain in the upper and back part of her neck; her face was directed over the right shoulder; she had not the least power of moving her head from side to side, and the least attempt made by another person to move it in that direction, produced excruciating pain. There was no defect either in motion or sensation of the extremities at this time. No disease of the vertebral column could be detected by an attentive examination. Her pulse was quick and feeble; her bowels were torpid, and required large and frequently repeated doses of aperient medicines to keep them free. Neither her respiration, nor her voice, were much affected at this time. She had never menstruated; her countenance was bloated and pale, without being particularly anxious. Her bowels were cleansed with calomel and jalap; and under the supposition that these symptoms arose from uterine irritation, the preparations of iron were given, with the occasional abstraction of blood from the back of the neck by cupping. This plan was persevered in during three weeks without benefit. About this time she had an attack of pain and tenderness in the abdomen, more particularly towards the right side, attended with vomiting, which continued till her death. The pain and tenderness were relieved in three or four days, by the use of leeches, and the exhibition of calomel and opium, the state of the pulse not justifying the use of the lancet.

Nov. 29th.-About this time she first perceived an inability to hold any thing small in her hands, and a sensation of numbness over the whole body, and an inability to stand or walk. These symptoms gradually increased, till they amounted to a total loss of sensation and voluntary motion: during the last two days of her life she passed her urine and fæces involuntarily: her muscles were rigid, and her limbs could be put in any position without pain. She died on the 11th of December." 296.

On examination, the spinal cord was found in a state of ramollissement

about an inch below its commencement; it was pulpy, and stuck to the finger when touched, was of reddish-brown colour, and exhibited no traces of its original structure; this change occupied about an inch of the cord, the remainder being healthy. There were tubercles at the apex of each lung, adhesions on the convex surface of the liver, ulceration of the mucous membrane of the lesser curve of the stomach and of the intestines.

We have selected from this work such portions as appeared to offer any novelty, instruction, confirmation or otherwise, of unsettled points. It might be much condensed, and more attention might be paid to its literary composition. We meet with instances of defective grammatical construction, and such vulgarisms as, "it stands to reason." Faults of this kind are serious only because remediable with care and circumspection on the part of the author. Mr. Stafford is active, industrious, intelligent, and we

wish him all success.



Ir is a difficult matter, and history proves it, to decide on the merits of any innovation, or any proposition running wide of established practice or doctrine. The cause of this difficulty is not obscure. Reason will enable a few men to ascertain the essential value of thoughts or of things, with little aid from experience. But there are highly gifted beings, far surpassing the mass of mankind in intellectual powers. We usually form our comparisons from experience; we know that one object is more pleasing or more profitable than another, because we have seen, or have found, or have learnt from the observations of others that it has been so. Our data are

founded in the evidence of experience, and judgment for the most part consists in the soundness of the reasonings based on, and conclusions drawn from them. Thus it is that men rarely decide amiss on subjects admitting of experience, and thus it is that errors so signal have been committed where this great instrument of human knowledge was not, or could not be applied. The delusions of astronomy, the history of the Harveian doctrine of the circulation of the blood, are obvious and notorious instances of this fact.

In former times innovations were regarded with more than indifference; they were looked on with positive repugnance, with absolute horror. We need not go farther than the Galilean persecution for an illustrious example.

The cause of this is to be sought and found in the narrow circle to which education was confined, and the cramped and scholastic character of education itself. These circumstances combined to produce a certain train of thinking, in a certain set of men, the most unfavourable to the investigation of new views, or the unprejudiced examination of those which custom and antiquity had established. These causes can hardly be imagined to operate at the present day. Education is no longer scholastic, no longer limited to special classes; all men would learn all things, and if they have not hitherto succeeded, it is not from want of inclination on their own parts, or of confident promises from those who teach. So far as the influence of education extends, it may now be considered as rather tending towards hasty assent to what is plausible and seems new, than to obstinate rejection of what is alike new and true. Undoubtedly there is and always will be in the world, a conservative party, high-tory doctrinaires, inclined to risk every thing in defence of old opinions. With them, every notion to which they have been habituated is a fortress to be defended against all attacks, and the worse the wall and wider the breach the more gallant do they deem the defence to be, the more imperative on them the refusal to abandon it. This party, however, is weak and is daily growing weaker; the majority, as we have remarked, are rather disposed to embrace than to repudiate novelties, as such.

The candid and cautious reasoner finds how difficult it is to pronounce upon the merits of new proposals in the arts or sciences. Of the merits and defects of the old plan he is aware from the almost unerring lessons of experience; but what is to inform him of those of the new? Can he, should he trust the specious promises of the inventor, or rather should he not endeavour to exercise his reason, and be guided in the main by its decisions? We think that he should; but we also think that, as the surest basis for such reasoning and support of it is experience, which in such a case is necessarily wanting, no man of candour or of philosophic mind will venture to offer an uncompromising or dogmatic opinion, unless the proposition submitted to his examination is unequivocally confirmed or opposed by common and recognized principles or facts.

These remarks seem to us to be applicable to the question of lithotrity and lithotomy, and the actual state of those respective operations. When lithotrity was proposed we affirm that no surgeon could pronounce upon its merits. He had no experience of such an operation; he could have no data of sufficient accuracy to enable him to tell where it failed or where it answered. Reasoning from what he knew might enable him to form analogical opinions on the probable effects of what he did not know, but it could not do more. He was conscious that lithotomy was an old operation, built up by a series of failures and successes, adopted after many trials and abandonments of other operations either more ancient, or proposed in modern times as substitutes for it. He was also conscious that many futile efforts had been made to remove the stone by other means than the knife, by caustics, solvents, drilling, bruising, and that all ultimately failed. Yet, on the other hand, he perceived that most of these attempts, and especially the mechanical ones, had been engaged in at a comparatively early period, when mechanical resources were greatly inferior to what we now possess, and that, independent of the clumsiness of the instruments, their application

« AnteriorContinuar »