Sabatier, were forgotten both here and in France, until the subject was distinctly and practically brought forward by Mr. Home. Even the latest French author, Richerand,* still speaks of the enlargement of the anterior angle of the "trigone vesicale," and the growth of fungosities near the neck of the bladder obstructing the course of the urine. It still remained to be explained, why the small part of the prostate gland, the third lobe of Mr. Home, should be so frequently enlarged, without the affection of the body generally being apparent, or why this part should enlarge more rapidly than the rest of the gland. It was in the prosecution of this inquiry, that I discovered the muscles of the ureters; and after ascertaining their nature, I saw through the obscurities of authors, in treating of the diseases of this part of the bladder; so that, in speaking of the enlargement of the anterior extremity of a natural tubercle, they were deceived; and that, in treating of the uvula, they were describing the diseased prostate gland. History of a Case of Anesthesia, by JOHN YELLOLY, M. D. Physician to the London Hospital. [From the Medico-Chirurgical Transactions, for 1812.] THE following case exhibits an example of the loss of sensation in the upper and lower extremities, independent of paralysis: and as some of the particulars are curious, and the occurrence of such a complaint is exceedingly rare, I have drawn up an account of it for the use of the society. I. S. aged 58 years, a native of Scotland, resided for many years in Jamaica as a planter; and with the exception of being now and then bilious (to use his own term) he enjoyed, during the whole of this period, very good health. About three years Nosographie Chirurgicale, ii. ed. p. 458. ago, after being much heated and fatigued in his attendance, as one of the grand jury in Kingston, in very sultry weather, he went to bed with the window open. On awaking in the morning, he found his feet and ancles perfectly numb, but without any sensation of pain, and without the muscular power being at all affected. Soon afterwards, he felt a numbness, with a tingling pain in his little finger, such as occurs in a part which is said to be asleep; and, by degrees, finger after finger became affected, until the whole of both hands was in a considerable degree insensible. He never had any pain or giddiness in the head, nor was he ever affected with the dry colic, which so often gives rise to paralytic affections in the West Indies. A physician of eminence in Jamaica confidently assured him, that his complaints originated from scurvy in some lurking form or other; but it does not appear that Mr. S. ever had the least appearance of cuticular affection, till about twelve months after the occurrence of the numbness, when some red pimples showed themselves in his legs, on his lying down on the ground, after being much heated by walking up a steep hill. He arrived in this country on the 20th of July last; and from the time of my first seeing him, (which was on the 25th of October) till now, he had been as nearly as possible in the same state, except that his appetite and digestive powers, which were then a good deal affected, have been for some time past much improved. The following are the principal circumstances which I have had occasion to observe relative to this case. The hands, up to the wrists, and the feet, half way up the leg, are perfectly insensible to any species of injury, as cutting, pinching, scratching, or burning. The insensibility, however, does not suddenly terminate; but it exists to a certain degree, nearly up to the elbow, and for some distance above the knee. He accidentally put one of his feet, some time ago, into boiling water, but was no otherwise aware of the high temperature, than by finding the whole surface a complete blister on removing it. No species of injury to a vesicated. part, of either hands or feet, is felt by him. The extremities are insensible to electrical sparks taken in every variety of mode. The cubital nerve where it passes the elbow communicates the sensation produced by pressure or a blow only half-way down the fore-arm. He perspires much in the left side, just above the hip, but no where else. He is generally rather chilly, and the extremities are cold, except when he is in a comfortable room; and in this case they are of the usual temperature of the body. The thermometer however rises to 101° in the mouth. The hands are of somewhat a purple hue. If he wishes to ascertain the temperature of any body, he is under the necessity of putting it to his face or neck, or the upper part of his arm. His skin seems to be more than usually sensible to the effects of heat. On putting his hand, at the desire of a friend, into a pail of hot grains, which his friend assured him were not too hot, and to convince him of this, previously thrust his hand and arm into it, there was a very extensive vesication produced. His hands are never free from blisters, which he gets by inadvertently putting them too near the fire; and he has met with several severe burns, without being aware of it. No degree of pressure is felt by him; but a blow produces a slight degree of tingling. He has a general uneasy sensation in the extremities, which warmth rather relieves. His skin, in general, heals very readily, after being burnt or scalded in the most severe way; and there is no fever, nor is there, as far as he has been able to determine, any increased heat or throbbing during the process of healing. This * I have remarked in some cases of paralysis from Colica Pictorum, that this nerve has its sensibility very much diminished; and in the case of a bricklayer, in whom there was a total loss of power, and in a considerable degree of sensation in both of the fore-arms and hands, from sudden exposure to cold, after working in a very hot furnace, the cubital nerve was totally insensible to any degree of pressure or force applied to it. It is probable that a similar insensibility might have been found to exist in other nerves, had they been accessible. seems to be also the case with some other parts of his body which are not altogether insensible; for a little time ago, he got burnt in the front of the patella, and though there was a considerable slough separated in consequence, he suffered no pain, and little inconvenience during the cure. If the heat to which the insensible parts are exposed is moderate, vesication is not immediately produced. The part becomes red, and in a few minutes, but sometimes not till the lapse of an hour or two, is blistered. That a smaller than ordinary temperature produces vesication in this individual, seems to be ascertained by the circumstance, that exposure to the heat of a common fire gave rise to a blister in the knee, which was followed by the slough abovementioned, though the clothes which covered the part, were not at all injured. Immersion in water at 120° produces no change in the affected parts; but exposure to the same temperature at a common fire, speedily blisters. That degree of heat, is, as far as I can judge by myself, about the utmost which can be long borne by the hand, in ordinary circumstances, without pain. Cold water and warm water of every temperature invariably appear lukewarm to him. Water at the freezing point produces no degree of sensation whatever; but when his hand is kept in it for some time, he feels a slight coldness at the end of the thumb. After his hand had been immersed in water of the common temperature, and was introduced into water of 32°, he had some sensation of warmth. The cold produced by means of a mixture of snow or ice, and salt, communicates no sensation except a slight chilliness in the thumb, and when this freezing mixture follows the use of water of the common temperature, it produces a slight degree of warmth. A solid body produces no sensation, whatever its temperature may be. The power of motion exists in the muscles of both hands and feet. With the former he can grasp pretty firmly; but in holding any thing he is apt to drop it, if his attention is at all called away. There has been of late a slight loss of substance in the hands. He can lift a chair, but cannot raise himself from the ground, by taking hold of any thing placed above him. The susceptibility of impression, generally, as well as the muscular power, seem to be in this individual in some degree diminished. The functions are natural, and the pulse regular and moderate.* In the treatment of these symptoms, no advantage has been derived from any plan which I have myself adopted, or which has been employed by others. The warm bath, electricity, galvanism, tonics, the rhus toxicodendron, and mercury, given both with a view to its action on the bowels, and the system at large, have been equally unavailing; though it must be owned, that the patient has never shown a sufficient degree of perseverance in the prosecution of any means which have been adopted for his relief. The possession of voluntary power over the muscles of the hands and feet, which do not derive their origin above the part where sensibility commenced, might seem to be incompatible with a total loss of sensibility in such muscles; and it might therefore be imagined, and with some appearance of truth, that the insensibility was confined to the integuments. From the observations which I had frequently made upon this case, I had no doubt, however, of the insensibility extending to the muscles themselves; but in order to ascertain this point experimentally, I requested Mr. Travers, demonstrator of anatomy at Guy's Hospital, when examining the case with me, to introduce a couching needle into the fleshy part of the thumb; having previously had the best surgical authority (with which Mr. Travers agreed) for believing, that such an injury could be inflicted without danger or material inconvenience. A lancet-shaped couching needle was accordingly thrust by him, to the depth of nine sixteenths of an inch, into the ball of the thumb, at the distance of an inch and a quarter from the middle of the dorsum of the metacarpal bone. It touched the * In Venerem minime habilis est. VOL. V. 2 Y No. 19 |