Imatges de pàgina

sympathize with them, or be affected through their medium, without their being themselves sensibly affected? I would answer this question in the affirmative. I think it very rational to suppose, that a part already habituated to a particular disease, a disease too that gains ground by repetition, may become severely affected by sympathy with another part that has been but slightly or imperceptibly affected. In no other way can we explain the fact, that persons subject to rheumatism can, in the morning, before they get out of bed, or even in the night-time, prognosticate with certainty a change of weather. In such cases, the effects produced in the system, by the change that takes place in the atmosphere, must be through the lungs only, for no other part of the body is exposed to its action.

Knee has not been at all troublesome for some nights past. Took off his stockings last night with his own hands, a thing he has not been able to do for twelve months past. Is gaining flesh. The fore-arms, it is remarked by strangers, are more plump than formerly.

January 6th.--Had severe pain last night in both ankles, but especially in the right, and also in a slight degree in the elbowjoints; motion of these parts, however, no way impaired today. On inquiry, I found he sat an hour yesterday after my visit, with his clothes hung round him, for want of aid to put them on. Has some catarrhal symptoms, with slight cough. Here I may remark, that I have uniformly observed the return of pain, in this patient, to be accompanied with more or less of catarrhal symptoms,ếan observation corroborative of what is advanced in yesterday's report, and indeed of our theory, and the whole reasoning on it, from beginning to end.

B Vin. ipecacuan. Zi.

Tinct. opii, gtt. xl.

Aq. font. Zvi. M. the half to be taken an hour before, the other half at bed-time.

January 9th.-Has got cold anew. Coughed a good deal last night; severe pain in the ankles, wrists, elbows, and leftknée. Cannot walk to-day, nor suffer the bandages so tight as usual. Keen frost yesterday; thermometer at 40 to-day; weather boisterous and damp.

12th.--Is able to walk again, but has still some pain among


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the tarsal bones of the right foot. I do not expect this patient to make any farther progress during the winter months, and shall be very glad if he retains what he has acquired. The bandages, it must be admitted, have done wonders; but they are not a match for an inveterate disease, weather variable in the extreme, an open house, with the patient's bed at the back of the door, a clay floor, and imprudent conduct, combined. I therefore close this case for the present, trusting I shall be able. to give a more decisively favourable account of it hereafter.

From the preceding details it will perhaps be inferred, that it is in chronic rheumatism chiefly, that decisive effects are to be expected from bandages. This may lessen, in the estimation of some, the value of the remedy. But if it is attended to, that chronic is as often a cause as a consequence of acute rheumatism, that chronic rheumatism occurs out of all proportion more frequently than acute, bandages, as a remedy applicable With the fairest prospect of success in so many instances, cannot, if viewed impartially, be considered in any other light, than as the accomplishment of what has hitherto been a desideratum in the cure of rheumatism. To render this evident, we have only to reflect how often every mode of cure of that formidable disease proves abortive. It certainly must be ascribed, as well to the imperfection of the healing art, as to the obstinate nature of the disorder itself, that so many, in every rank, are subjected, during a great part of their lives, to the visitations of this horrible malady. Bandages bid fair to supply this deficiency. They are not like medicines exhibited internally, concerning whose operations and effects we are liable to form the most erroneous conclusions. Their effects are immediate and visible. We are not left at a loss to determine, whether the good produced is to be ascribed to the efforts of nature, or to the remedy employed; nor is it a matter of doubt, whether the remedy is of real advantage or not. There can be no uncertainty as to the powers of a remedy, which, the moment it is applied, enables a person to walk, who immediately, and for many weeks before, could not set the sole of his foot to the ground.

But were it even admitted that bandages are applicable, with effect, principally in, chronic, it is evident that they may

operate, in many instances, as preventives, at least, of acute rheumatism. This is a fair inference from the girl's case above detailed. Iu her were present, though the symptoms did not run high, all the characteristics of acute rheumatism. But, by the timeous application of bandages, not only were the pains immediately relieved, but the fever soon after subsided. A most useful practical hint this-showing that, as the derangement of the system was occasioned by local affection, so the melioration of local symptoms had its influence on those of the system. Here naturally arises the question, may not bandages supersede the necessity of repeated detractions of blood in acute rheumatism, even when local affections are not the primary symptoms? At any rate, acute rheumatism is soon subdued by the lancet; and, if chronic rheumatism supervenes, the application of bandages in this stage, will, we have reason to believe, prevent that lingering illness, general debility, rigidity and coldness of the limbs, pain and stiffness of the joints, so often the sequelæ of acute rheumatism.

Every practitioner, surely, of even very limited experience, must have met with cases of acute rheumatism, in which the difficulty was, not to subdue fever, but to set the patient on his legs; and, having set him on his legs, to make him walk. In this stage of such cases, more benefit, I hesitate not to pronounce, will be derived from bandages, than from all other topical applications that have ever been prescribed by the regular physician, or advertised by the empiric.

But a mechanical remedy that possesses, in any degree, the power of moderating or preventing acute, must operate in tenfold effect in cutting short chronic rheumatism. Every body knows that, whoever have once become acquainted with rheumatism, may lay their account with a repetition of its visits; and the oftener it comes, and the longer it stays, it strikes its roots the deeper:—this to such a degree, as, in many instances, to render the patients miserable during its stay, and uncomfortable all the rest of their lives. The early application of bandages, by promoting, in the way formerly stated, circulation in the capillaries of the white parts, prevents their permanent obstruction, and consequently the disease from taking such hold of the system as to render it difficult afterwards to


be eradicated. That bandages, when early applied, must produce such effects, is proved by what they have done in Stewart's case; for, if they possess such powers in old inveterate in. stances of the disease, they must, a fortiori, be productive of like benefit in recent cases.

Summary of observations made on the effects of bandages in rheumatism.

At certain times, in some cases, but especially at the beginning, it is necessary to make the bandages tighter than they can be well borne for any length of time. In such cases, frequent removal of the bandages, and friction in the intervals, are indispensable.

The pains and rigidity of parts do not return immediately on the removal of the bandages; the effects remain for a considerable time after the cause is removed.

Parts that have for a considerable time been treated with bandages come at last to be covered, when the bandages are at any time removed, with a copious, warm, and fluid sweat, which gives a kindliness and pliancy to the skin, which it did not possess before.

Parts that have for a considerable time been treated with bandages acquire plumpness and strength, while parts of the same person, that do not admit of being bandaged, remain emaciated and tremulous as before. This observation is demonstrated in Stewart's case.

Observations on the Fætal Liver, &c. &c. By JAMES Bryce,

F. R. S. E. Fellow of the Royal College of Surgeons, Edin. burgh. [From the Edinburgh Medical and Surgical Journal, for January, 1815.]

It is a circumstance known to all anatomists and physiologists, that the size of the liver, compared with the other viscera, or with the body, is much greater before birth, than after that period; and, although the immediate cause of this be readily explained, by comparing the anatomical structure of this organ during the fætal state, with its structure in the adult, yet, for what purpose it is intended by nature that this peculiarity should constantly take place in the fætus, seeing less bile is secreted by the liver before than after birth, is a question which, as yet, has not been explained to the satisfaction of physiologists.

In the following pages I shall attempt to explain some important advantages which the constitution of the new-born infant obtains from the diminution which takes place in the size of the liver immediately after birth; and which, I presume, will appear to be of such consequence to the animal economy at that critical period, as to entitle me to deduce from them the final cause, or the purpose intended by nature to be effected, by the greater size of that organ during the foetal state. For this purpose, we shall first attend to the general situation and connections of the liver, and from a comparative view of its anatomical structure in the fætus with that in the adult, point out those circumstances on which its great size before birth seems immediately to depend.

The liver is the largest of all the abdominal viscera, and also the largest gland in the body. It is of a very irregular figure, being convex and smooth above, concave and uneven below. It is situated in the upper part of the abdomen, having its smooth and convex surface contiguous to the arch of the diaphragm, and its concave surface in contact with the stomach and part of the intestinal canal. In the adult, its size is such as, in a healthy state, to be easily contained in the right hypochondrium and epigastric regions; but, in the fætus, it not only fills these completely, but also the left hypochondrium and greatest part of the umbilical region. It is divided into lobes, which, from their situation in the abdominal cavity, have acquired the names of right and left, by a deep furrow on the inferior surface, and by a corresponding membranous ligament above. In the fætus, these lobes are nearly of an equal size; but, in the adult, the right is much greater than the left. Besides this division of the liver into two great lobes, there is, situated upon the right lobe towards its back part, and near the deep furrow already mentioned, a triangular eminence, called, by anatomists, the lobe of Spigelius; and near it another smaller eminence, which is anonymous; but to which and the other now mentioned the name of portæ has been applied, because VOL. VI.


No. 21.

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