699

wary from danger. The want of vigourwhich distinguishes his mind, as well ashis body, is perceptible through every partof his practice, and no where does it appearin more glaring colours than in his devo-tion to sarsaparilla, which gentle, innocent,and demulcent drug, lie conceives, weildsthe very arm of a giant in the eradication ofdisease. Ye gods ! what would the strong-minded professors of the North, or the boldsurgeons of our native land, " the sweetestisle in the ocean," whom we have oftenheard from their chairs denounce this hum-ble lierb as a mere placebo, and only on apar with the decoction of saw-dust, say,were they to know that it is employed hereas an engine of incalculable power, whosevery name is almost sufficient to call the

dying from their destined end.

In the pure Georgian depôt, whose wardsare almost completely filled with ulcers andaccidents, the treatment of fractures is con-ducted in the most miserable style. Thelimbs are placed in splints, without anyattention to the principles or laws of me-chanics ; and in deficiency of mathematicalknowledge, Brodie stands unrivalled. It isthe common method in fractures of the tibiaand fibula, to place the limb in the double-inclined plane, but without affording anyproper support to the foot, so that by keep-ing it at a right angle with the leg, theflexor muscles might be relaxed, and thepowerful effect of the gastrocnemii pre-vented. The consequence is, that not allthe soft, persuasive, and feminine tones ofthe house-surgeon Bushel, can convince thepatients that their limbs are straight.But among the successors in office of what

" extra limites" Jemmy calls ’’ one JolinHunter," we must not pass over BobbyKeate, President of the Bat Club, andPrince of Vanity. On the whole, and par-ticularly as an operator, the language ofthe world would denominate him respect-able, except when he has paid visits tothree princesses in one day, or after lie hasbeen called to one of the scholars by hisbrother the -BM?K6rKs/: of Eton, when hisvanity and consequence surpass all under-standing. But, Mr. Editor, as our edge isbeginning to get blunt, and as there stillremains enough for another field day, wemust, for the present, bid you adieu.

Acms.

HOSPITAL REPORTS.

GUY’S HOSPITAL.

CASE OF FRACTURE OF THE SPINE, WITH

DISPLACEMENT, IN WHICH ATTEMPTS WEHBMADE TO REDl’CE THE FRACTURE BY

MEANS OF EXTENSION.

THE subsequent case of fracture of the

spine, which was attended with consider-able displacement of bone, has been the

subject of much conversation, in conse-

quence of the somewhat novel mode oftreatment employed—namely, extending the

spine forcibly,-in order to reduce the frac-

ture :-

J. Harlow, 19 years of age, stout and

healthy in appearance, was admitted intoLuke’s Ward on the afternoon of the lothof July, on account of severe injury to thespine. The accident occurred at St. Catha-rine’s Dock, and the injury was occasioned

by the excavation of some glavel, whichfailing in upon the poor fellow, buried himmid-deep.

Mr. Key, the surgeon of the week, beingat the Hospital when the case was broughtia, immediately examined the patient, andfound considerable irregularity of the spine.The spinous processes of the last dorsal ver-tebrae were depressed, whilst those of theupper lumbar vertebræ apparently pro-jected-in fact, as Mr. Key remarked, itseemed that the dorsal portion of the spinewas thrown forward.’ from the lumbar. Theextent of depression in the spinous pro-cesses of the inferior dorsal vertebra?, as

compared with the spine of the first lumbar,was strikingly manifest ; and, in addition tothe depression, there was some lateral dis-tortion. The lower extremities were com-

pletely paralysed, and the integuments ofthe abdomen were devoid of sensation.

Lender these circumstances, Mr. Key de-termined on the application of an extendingforce to the spine, in order to effect a re-duction of the displaced bones. In the firstplace, the spine was extended with con-

I siderable force, by placing the patient onhis belly with pillows beneath him, andthen bending his back over timm, and thisbeing found inadequate, the man was nextlaid on his side with his body bent, a napkinwas passed under the -arms, and one alsoabove the ilia. By means of assistants,considerable foree was applied in each di-rection, upwards and downwards, and underits use the depressed vertebrae regainedtheir natural situation. Mr. Kev, whosehand was at this time over the seat of in-F

700

jury, stated that the bones passed into theirsituation, with a distinctly andible noise. How-ever this may be, it was apparent enough,after the employment of the extension andcounter-extension, the regularity of the

spine was restored nearly to its naturalstate. The depression existed but in a

slight degree-the lateral contortion re-

itiained. During the time in which theforce was used, there was a distinct sense Iof crepitus communicated to the hand, asapplied over the last dorsal vertebra;.

It was considered by Mr. Key, that afterthe reduction of the fracture, there wasamelioration in the patient’s condition, butit was very trivial. Sixteen ounces of blood Iwere ordered to be taken from the seat ofinjury by means of cupping, and a dose ofhouse-physic exhibited. "

July 17. Sensation and motion of the lower extremities completely extinct ; there ’’is slight sensibility of the integuments, im- ’,

mediately below the crista of the right ’,ilium. The bladder has lost its expulsivepower, and the urine has, in consequence,been drawn off, both to day and yesterday.The pulse is moderate, skin hot, and tongueslightly furred ; he complains but of littlepain.

Ordered to take the almond mixture, withfifteen grains of the nitrate of potash, threetime a day. Twenty leeches to be appliedto the back.

18. The patient has passed a restlessnight ; his bowels were relieved last night,and also this morning ; he has slight con-sciousness in passing his stools.

Ordered to take lime water for his ordi-nary drink.

19. Mr. Key thinks there is rather moresensibility in the cutaneous nerves of thefore part of the thigh. The tongue is furred,and pulse accelerated ; he complains ofwant of rest. There are small vesicationson the inside of each knee, and ecchymosedspots near the. right crista ilii, which are at-tributed to the frequent pinchings made, inorder to ascertain the degree of sensibilityin the part. It being observed, however,that the skin becomes discoloured under

slight pressure, care is taken, repeatedly,to change the position of the patient. Theurine is drawn off frequently ; it is some-what high coloured, has an ammoniacalsmell, and deposits a copious sediment,some of which ]’.lr. Key placed on a card,adding a drop of nitric acid, s<nd then sub-mitted it to the name of a candle when itwas evaporated to dryness, a bright pinkcolour was left on the card. Mr. Key re-marked, that this test indicated the presence of lithic or uric acid, with which theurine, apparently from the copious sediment,abounded. With a view, therefore, of cor-recting the lithic acid diathesis, which is

said to be most prevalent under the use ofanimal food, and to be checked by a vegeta-ble diet, Mr. Key directed the patient to bekept on vegetable diet-in fact, with theexception of a small quantity, this plan hadbeen observed from the beginning.*

Ordered to take soda water for commondrink, in lieu of the lime water.

21. Not so well as on the 19th. Hecomplains of pain in the back, which is,however, less than yesterday. The pulse isquickened, skin hot, and tongue furred; hehas felt, for the last two days, a most in-tolerable itching and tingling over the wholebody. Leeches were applied to the backyesterday, and a purgative enema ad-ministered.The same indications are pursued with

respect to diet, in order to lessen the stimu-lating quality of the urine ; it still, how-ever, deposits a considerable sediment.

83&mdash;27- We have visited the patientdaily during these periods, nothing materialhas occurred. The patient is now allowedto take a little broth ; care is taken to shifthim frequently; his countenance is good,but he is evidently becoming emaciated.

30. The sister informs us, that the pa.tient has been delirious for the last twoevenings. The aberration came on at a cer.tain time each night, and during its conti-nuance he laughed and shouted, and sungto an immoderate degree. The urine is of.fensive, and partially dribbles away into abladder which is appended to the penis.There are vesicles in different parts of thebody, and the sense of formication still con-tinues.

August 2. No delirium for the lasttwo nights; countenance cheerful; bowelsmoved two days ago.

10. From the date of the last report,nothing important has transpired ; the pa-tient is evidently becoming emaciated andweaker. The urine partially flows away,and although great care has been taken veryfrequently to change the position, yet sloughshave formed on the hips.

18. The poor fellow went on graduallydeclining until this morning, when deathclosed the melancholy scene. He had be-come reduced almost to a skeleton, and forthe last few days animal food was allowed.

* Magendie, from various experiments,found, that with animals living altogether ondesh, their urine contained a very large por-tion of uric acid ; and that, on the other

hand, with herbiverous animals, the urinehad no lithic acid ; that the proportion oflithic acid varied according to the quan-’ity of food taken, abounding in azote, astiesh of every kind, he ascertained fromother numerous experiments on animals.

701

The urine was purulent and highly offen-sive ; the sloughs on the hip had increased.

Post-mortem Examinatiin.

The body was examined by Dr. Hodgkinon the day of the patient’s decease. Thebladder was found to be highly diseased onits inner surface, there were several largepatches of ulceration, which passed throughall the coats. In the cellular membrane atthe fore part of the bladder, there was acollection of pus, which, however, did notappear to be generally diffused, but commu-nicated with the ulcerated openings in thebladder. The ureters were sound, as wasalso the left kidney, but that of the rightside had a small abscess in its cortical por-tion. With respect to the immediate seatof injury, the spine, there was found to bea fracture through the arch and body of thetwelfth dorsal vertebra. The broken archdid not apparently press upon the spinalchord, but there was an insulated fracturedportion of the body of the bone which had dbeen thrown backward, and was filling upa large portion of the spinal canal, so asgreatly to compress the sheath. There wasfracture of the left transverse process of thefirst lumbar vertebra, but notwithstandingthe pressure upon the spinal chord was verycomplete, from the insulated portion of thebody of the bone, yet there was not muchapparent irregularity in the spinal column,as viewed from before or behind. Thetwelfth dorsal vertebra had been evidently IIvery much fractured, but was now so muchconsolidated by a reparative process, thatit would not admit of the displacementwhich formed so prominent a feature in theaccident.The spinal marrow, where pressed upon,

was completely disorganised, being for thegreater part pulpy and soft, whilst the re-maining portion was not thicker than cream.The coverings did not appear to participate Iin the disease.

ST. THOMAS’S HOSPITAL.

INTERESTING CASE OF PARTIAL PARALYTIC

AFFECTION, COMMENCING IN THE EXTRE-MITIES OF THE TOES AND FINGERS.

W. HrCKS, a’t. 44, of spare habit, a weaver,came into the Hospital on the 12th of July,under the care ot’ Dr. Scott, on account ofpartial paralyses of the hands and feet.The history of the case, which is very

curious, was thus given :&mdash;he was first at-tacked with numbness in the toes, a generaldeficiency of sensibility and loss of powerafterwards gradually extended over the footand up the le, until at length in walking

he dragged his limbs along. At this time

. he had pain in the head, with vertigo, forwhich he was cupped, and took various me-dicines, and derived much benefit to the1 affection of the head, but the partial loss of, sensation and power in the feet and legswas much the same. From this period until

last Christmas, he continued to pursue hisordinary employment, the legs having be-t come much stronger, although the feet stillcontinued numb, as far as the ancles; he wasnow attacked with numbness at the extre-

mities of the fingers of each hand, the senseof feeling gradually becoming obtuse to themiddle of the metacarpus, above which

point sensation was perfect. The imperfectparalysis also extended in the lower extre-. mities, gradually reaching as high as the

, knee; he had no pain of the head or vertigoduring this period.

.

When admitted into the Hospital, he wasin the condition described above, with im-

perfect sensation, and partial loss of muscu-lar power in the hands, as far as the middleof the back of the hand, and also of the

legs as high as the knee. He had no painof the head, vertigo, or uneasy sensation;his memory and faculties were perfect. He

had strabismus, with a very small contract-ed pupil in each eye, and imperfect vision,especially with the right eye, the power ofsight in which was nearly gone. The squint-ing, he said, came on suddenly, seven yearspreviously ; he had no power of moving- theleft eye outwards, nor the right eye anyway, except obliquely, and a little down-wards ; hence the eyes, not moving in uni-son, occasioned the strabismus. The man’sgeneral health was tolerably good, his bowelssomewhat constipated, and he complainedof feeling pain occasionally in different partsof the body, especially of the extremities.

Dr. Eliiotson, who took charge of the casein the absence of Dr. Scott, was of opinion,that the paralytic affection was referrible tosome disease of the brain, and probablyowing to the formation of a tumour, which,by its pressure, occasioned the strabismusand imperfect vision ; with this view of thecase, lie directed the head to be shaved,and the ointment of iodine to be well rubbedover the scalp twice a-day, at the same timeprescribing tere minims i!t the tinctnre of iodineto be taken three times a-day.The iodine was gradually increased to thedoses of fifteen, twenty, and twenty-five mi-

nims, which iattpr dose was takell far sometime without producing any very sensibleeffects.On the 18th of A ugust, when this report

is written, the iodine, by the direction ofDr. Scott, has been discontinued for sometime, and the patient only takes a dose ofhouse medicine occasionally. The paralyticaffection of the legs is not at all relieved,