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the fruits they yield or the qualities they exhibit. But diseases are not like trees, which retain their character and continue to yield a similar produce through an infinite succession of ages. Who can undertake to say that the disease he subdued a week ago with an opiate and a blister, will appear again in the same form, or submit to the same management, at any subsequent period? No one surely would be so ignorant and preposterous. Let us cease then to prescribe for names alone, and learn to accommodate our remedies to the condition of our patients, and to the variable and ever-changing characters of diseases. Reason and experience, uniting together in this great work, shall teach us to surmount the obstacles which lie in our way to the temple of truth; whilst improvements will be constantly making in our science, honourable to human genius, and fraught with blessings to future generations. J. NORCOM.

February, 1815.

Account of a Case of Spontaneous Extravasation within the Theca Vertebralis, which soon terminated fatally. By TноMAS CHEVALIER, Esq. Surgeon Extraordinary to the Prince Regent, and Surgeon to the Westminster General Dispensary.

[From the London Medico-Chirurgical Transactions for 1812.] Miss D -, aged 14, for several days felt pain in the head and back, which induced her, on the 26th of February, to apply for medical assistance. Blisters were applied behind the ears, and opening medicines were ordered, which operated the following day, and relieved the pain in the head; but the pain in the back grew much worse, and was aggravated and accompanied with a tendency to sickness, on sitting up. On the 3d of March the pain in the back increased much, and on the following day her mother thought she discovered a little projection of the spinous processes of the lumbar vertebræ, in consequence of which I was desired to see her. I could

not discover any thing in the appearance of the back that was not natural, nor was any particular pain excited by pressure. The effort to sit up distressed her much; but her countenance was clear and healthy. The tongue was rather white: she had a moderate, regular pulse at 120. Under these circumstances the pain did not excite any particular alarm in my mind: I directed some leeches to be applied as nearly as possible to the seat of the pain, and afterwards an opiate lotion: she was also ordered to take three grains of antimonial powder, with a saline draught, every six hours, and I left her in full expectation of finding her relieved on the morrow, especially as, on strict enquiry, she could recollect no exertion or other violence by which the symptoms could have been produced.

On the following morning, to my great surprise, I was informed that, on the evening after I had seen her, she complained of a sudden and violent increase of the pain, and immediately went into convulsions, in which she continued between five and six hours and then expired. On the 6th of March I examined the body in the presence of Mr. Johnston, of Mortimer street, who had attended her from nearly the commencement. There was not the least appearance of disease in the brain or in any of the thoracic or abdominal viscera. The appearance of the spine was also perfectly natural. I therefore proceeded to cut away the bodies of the lumbar vertebræ, in order to expose the cavity of the spinal canal, close to the seat of the pain. I found it filled with extravasated blood, which, from its florid colour, must certainly have been arterial, and which covered the whole of the cauda equina. The cavity appeared to be filled much higher up; but I did not prosecute the dissection, as it did not appear to me of much consequence to ascertain the exact limits of the extravasation, and the violence that must have been committed in opening the cavity farther, would have rendered it difficult, if not impossible, to tell precisely from what vessel the blood had issued. The original seat of the pain would naturally lead me to suppose that the rupture must have taken place

near the commencement of the cauda equina, and it is probable the effusion of blood stopped within that part of the cavity inclosed by the dorsal vertebræ, as there was no appearance of it at the foramen magnum occipitale, when the brain was examined.

The blood, though florid, was not at all of an equal tint, it was very imperfectly coagulated; it is therefore probable that the vessel first gave way at the commencement of the illness, and again to a much greater extent at the time the convulsions came on.

I apprehend cases exactly of this description have not been very commonly seen; but that similar mischief should frequently occur, in consequence of violent strains, is naturally to be expected: and I believe the foundation of carious spine, which is often laid by such accidents, is not unfrequently attended by some such mischief, which, as it may take place in various degrees, would account for the great disproportion one sees in examining a multitude of cases of this sort, between the degree of curvature in the spine, and diminution of power in the lower extremities.

A child of 12 months old, who had just recovered from the operation for hair 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 more completely rotten, than I have found them after many weeks'

maceration in putrid water, after removal from the dead body.

These cases seem to have a very close resemblance to apoplexy, and point out the propriety of bleeding as early as possible after their occurrence, in order to prevent an increase of extravasation before constitutional debility takes place, and show also the importance of distinguishing betwixt that primary weakness of the lower extremities, which is the direct result of the local injury, and that subsequent weakness, in which indeed they will participate, but which is the effect of the shock the constitution has received, and which probably does not fully predominate till several days after; the intermediate time being occupied by more or less of symptomatic fever, which requires a moderate antiphlogistic plan of treat

ment.

An account of a New Mode of Treatment in Chronic Rheumatism, and especially in Sciatica. Communicated by ALEXANDER MARCET, M. D. F. R. S. One of the physicians to Guy's Hospital.

[From the London Medico-Chirurgical Transactions for 1812.]

I HAVE frequently had the opportunity of observing, for the last six or seven years, that the profuse and unavailing sweats which often spontaneously take place in the early stages of rheumatism, and exhaust the strength of patients without alleviating their sufferings, are almost in every instance checked, and the pains proportionally relieved, by the use of antimonial medicines. Several distinct instances of this kind were recorded some years ago at Guy's Hospital in our clinical diaries, and the explanation which I ventured to offer of this paradoxical result, was, that the profuse flow of moisture from the pores, is not, in itself, the circumstance which diminishes pain in rheumatic affections; but that the relief is produced by a certain condition of the surface, or peculiar action of the cutaneous vessels, which, though generally productive of

moisture, is not necessarily connected with profuse perspiration. It is this peculiar action which antimonials are so apt to promote; and there is no difficulty in conceiving, how the violent and colliquative paroxysms of sweating which occur in rheumatism, gradually yield to this gentle and uniform operation.*

The following interesting case, which I think in every respect worthy of being communicated to the Society, appears to me to contain ingenious and instructive hints on the treatment of rheumatism, and on various physiological points, and to throw some light upon the preceding observations. It was drawn up by the patient himself,† a gentleman, who, although not belonging to the medical profession, is so well known in the philosophical and literary world, that his name, had I been at liberty to give it at full length, would have added great weight to the opinions and statements which his paper contains.

"About eighteen years ago," says Mr. C. "I received a sprain on horseback which occasioned very violent pain in my loins, and still more in the left hip, thigh, and leg, following the course of the sciatic nerve, and spreading itself over the sole of the left foot. I was then on the continent at Bruxelles; and after severe blistering and other remedies, not finding myself better, I was ordered to try the mud baths and douches of St. Amand. Having used them six weeks to no effect, I proceeded to Paris. I tried various methods of cure under the most eminent surgeons there, as warm and cold bathing, vapour, air conducted through a heated pipe directly to the part affected, warm and strengthening plasters, fumigations, &c. till at length the celebrated and unfortunate Monsr. De Seaux proposed the moxa. This was accordingly applied with

*It is probable also that the invariable tendency of antimonials to determine gently to the intestines, may contribute to this beneficial effect. Opium alone, often checks the most distressing symptoms, but its mode of operation is altogether different.

R. C. Esq. F. R. S. &c. &c.

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