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“ Master, a fine youth aged twelve years, in June 1814, was swinging in a heavy wooden swing, and just commencing the moving forward, was caught by a line which had got under his chin, by which accident his head was violently strained, and the whole of the cervical vertebræ; as however, the line slipt immediately off, he thought no more of it. Subsequently to the accident for some months, he was not aware of any pain or inconvenience, but his school-fellows observed he was less active than usual; instead of filling up his time by play, he would be laying on the school forms, or leaning on a style or gate, when in the fields. They were always teasing him on this account, and at last, he was persuaded himself, that he must be weaker than he used to be. From this time he continued to decline both in strength and power. About the middle of May following, he came to London. His complaints were occasional pains in the head, which were more severe and frequent about the back of his neck, (where a blister had been applied without relief,) and down his back. The muscles at the back of the head and neck were stiff, indurated, and very tender to external pressure. He felt pain in moving his head or neck in any direction; added to these symptoms, there was a great deficiency in the voluntary powers of motion, especially in the limbs.
May 18th. Two setons were made in the neck, and he was ordered various medicines, without any being useful.
“ May 29th. His complaints and the paralytic affection of his limbs, were getting much worse, added to which, he felt a most vehement hot burning pain in the small of his back. This, by the next day, was succeeded by a sense of extreme coldness in the same part. Some time after, the same pain occurred higher up in the back, and then disappeared. Pulse, and heat, natural.
" June 3rd. A consultation of Dr. Baillie, Dr. Pemberton, Mr. A. Cooper, and Mr. Heaviside, was held, and the application of mercury was determined on. The pil. hydr. was taken for a few days, but as it run off by the bowels, mercurial frictions were consequently preferred. He felt his limbs getting every day weaker, but his neck was more free from pain when moved, and he was more capable of moving it by his own natural efforts.
“ June 7th. His respiration became laborious, he passed a bad night, on the following day all his symptoms increased, and at five in the afternoon, he expired.
« Examination. The whole contents of the head were carefully examined, and found perfectly healthy; but upon sawing out the posterior parts of the cervical vertebræ, the theca vertebralis was found overflowed with blood, which was effused between the theca and the enclosing canals of bone. The dissection being further prosecuted, this effusion extended from the first vertebra of the neck, to the second vertebra of the back, both included.
preparation only shews a small proportion of the effused blood which had become coagulated on the theca, as much of it escaped in the act of removal, it being fluid.” 548.
- The particulars of the above were obtained from Mr. Henviside, whose splendid museum is ever found open for the good of the profession.
Fracture of the Spine. These accidents, even when the bones retain their situation, produce very extraordinary symptoms, by admitting unnatural variations in the positions of the spinal column. When there is fracture with displacement, the symptoms differ according to the seat of the fracture. These injuries our author divides into two classes Ist, those which occur above the third cervical vertebra-and 2dly, where the injury is below that bone. In the first class, the accident is almost always fatal, if the displacement be to the usual extent. Death, in the second class, occurs at various periods after the injury: The circumstance of the pbrenic nerve taking its origin from the 3d and 4th cervical pair, is the cause of this difference. If the lumbar' vertebræ be displaced, the lower extremities are rendered completely insensible-the power of volition is completely destroyed - the sphincter ani loses its function, and the fæces are passed involuntarily. The bladder is unable to contract, and the urine is retained till drawn off by the catheter. Nevertheless, the circulation goes on, though somewhat more languidly, and inflammation can be raised by blisters. It is curious, that priapism is a common phenomenon under such circumstances, In general, in fractures of the lumbar vertebræ, patients die in a month or six weeks after the injury. In fractures of the dorsal vertebræ, the symptoms are nearly similar; but the paralysis extends higher, and the abdomen becomes greatly inflated, from the diminution of nervous energy. Death sooner takes place here, than in lumbar fracturc--the patient usually sinking in a fortnight or three weeks. “The period of existence is short or protracted, as the injury is near or distant from the cervical vertebræ, and as the displacement is slight or considerable, as well as the degree of injury the spinal marrow has sustained.”
“ Fractures at the cervical vertebræ below the origin of the phrenic nerve, produce paralysis of the arms, as well as of the lower parts of the body; but this paralysis is seldom complete; if it occurs at the sixth or seventh vertebra, the patient has some feeling and pow. ers of motion, but if at the fisth, little or none; sometimes one arm is much more affected than the other when the fracture is oblique, and the axillary plexus of nerves is consequently, partially influenced. Respiration is in these cases, difficult, and performed wholly by the diaphragm, the power of the intercostal muscles being destroyed by the accident. The abdomen is also tumid from flatulency, as when the dorsal vertebræ have sustained injury. The other symptoms are the same as in fractures of the vertebræ below the cervical, as regards the lower extremities, the bladder, and the sphincter ani. Death ensues in these cases in from three to seven days, as it is seated in the fifth, sixth, or seventh vertebra. I have scarcely known the subject of this injury to live beyond a week, and but rarely to die on the second day, although they sometimes do if the fifth cervical vertebra has sustained the injury. I have already stated, that in fractures and displacements above the fourth cervical vertebra, death instantaneously follows." 556. "In the dissection of these cases, the spinous process of the displaced vertebra is depressed—the articular processes are fractured—the body of the vertebra is broken through—but, it rarely happens, that the displacement and separation occur at the intervertebral substance. The body of the vertebra is usually advanced from half an inch to an inch-between the vertebra and the sheath of the spinal marrow, blood is extravasated; and, frequently, there is extravasation of blood of the spinal chord itself
. The spinal marrow is compressed and bruised in slight displacements, and is torn through when the injury has been very extensive, the dura matral covering remaining entire. A bulb is formed at each end of the lacerated spinal marrow, which laceration is usually produced by the bony arch of the spinous processes. A very interesting case is related, from the practice of Mr. Harrold of Cheshunt, where the spine was broken at the lower part of the dorsal, or beginning of the lumbar, vertebræ. The principle on which Mr. Harrold proceeded, was to produce union of the bones by preserving the spine in perfect rest; to effect which, the patient was put into a fracture bed, where he had the means' of evacuating the bowels without disturbance. The urine was drawn off daily by the catheter, for several weeks, after which, he was able to retain and discharge it when he pleased, At the end of six months, the following was the report of his health. His back straight, flexible, and apparently as strong as ever-retains and discharges his urine-has a stool once in three or four days--health and spirits good—but no sensation or voluntary motion in the lower extremities. He died in twelve months from the accident, owing to a sore on the tuberosity of the iscbium, and disease of the bone. Sir Astley examined the body with great care, and the preparation is preserved in the museum of the College. The bodies of the first and second lumbar vertebræ had been fractured the first baving advanced, and the second having been forced backwards. The fracture had united by ossific matter, which had spread over the fore part of both vertebræ to a considerable extent, and a little had been deposited upon the dorsal vertebræ. The spinal canal had been much diminished by a portion of bone being forced into it from the first vertebra of the loins. This portion of bone had split the tbeca vertebralis into two, and divided the spinal marrow almost entirely-a bulbous projection of the latter appearing above and below the bone, formed by its divided extremities, which were separated nearly an inch from each other.
In respect to the treatmeut of these unfortunate cases, our author has little to offer that is at all consolatory. Rest will be essential to ossific union; but ossific union will not save the patient, if the spinal marrow be not relieved from pressure. The late Mr. Henry Cline took a scientific view of this subject. He considered the accident as similar to fracture with depression of the cranium--and to require the removal of that pressure. He, therefore, thought himself justified in making an incision upon the depressed bone, as the patient was lying upon his breast-he then raised the muscles covering the spinal arch, and applied a small trephine to the arch, cutting through it so as to remove the spinous process, and the arch pressing on the spinal marrow. The case did not succeed ; and, unfortunately, he did not live long enough to prosecute the practice. The operation bas lately been repeated by Mr. Tyrrel, at St. Thomas's Hospital, and, also, without success. We are convinced that the fatal issue, in both cases, was owing to the extent of the injury done to the spinal marrow, and not to the operation, which, we think, offers the best, or rather the only chance of success.
Whether the operation be ventured on or not, cupping, leeching, blisters, and the proper antiphlogistic measures, will be indispensible till the fever subside, and then a drain should be established near the part, to obviate the effects of local inflammation.
We have now presented our readers with an analysis of all except that part of the work which was formerly reviewed by us-namely, the scction on Compound Dislocations of the Ancle-joint. It has been obvious, that it was for the interest of the reader that we should confine ourselves strictly to analysis, without squandering our own, or our readers' time in useless criticism. Such a mass of important practical matter was never, we believe, before laid open to the public; and Sir Astley Cooper's work will continue to exercise that influence on the surgical profession at large, when the author has mouldered in the dust, which the living author has so long exercised (and which we hope he will still long exercise) within the sphere of his personal acquaintance and practice.
PUERPERAL FEVER. 1. A Treatise on the Epidemic Puerperal Fever, as it
prevailed in Edinburgh in 1821-22. "To which is added an Appendix, containing the Essay of the late Dr. Gordon on the Puerperal Fever of Aberdeen in 178990-91-92. By William CAMPBELL, M. D. Fellow of the Royal College of Surgeons; one of the Medical Officers of the Royal Public Dispensary, Lecturer on Mid
wifery. 8vo, pp. 400. Edinburgh and London, 1822. 2. A Treatise on the Disease termed Puerperal Fever;
illustrated by numerous Cases and Dissections.' By JOHN MACKINTOSH, M.D. Octavo, pp. 323. Edinburgh and
London, 1822. Tris fatal scourge this “ morbus lethalis," as Hippocrates describes it, “ ex quo paucæ effugere possunt,” has been assuming one of its worst forms, the epidemic, and carrying devastation through the lower orders of the Scottish metropolis, notwithstanding the great strength of the doctorate in that quarter.
Although the pathology of the disease termed puerperal fever is pretty unanimously agreed upon on this side of the Tweed, yet there is still some little discrepancy here respecting the treatment. Beyond the Tweed all is discord in regard both to pathology and treatment. An eminent ob stetrical teacher in the intellectual city bas marshalled under his banners a considerable host of practitioners who declare war against the lancet, and maintain that real puerperal fever is a disease differing, in some mysterious mander, from puerperal peritonitis, with which, they aver, it is confounded by the other party. Many active and intelligent practitioners, however, guided by the light of pathology, have dared to dissent from the dictum of the medical autocrat and his proselytes, and to affirm that the fever which, in all ages, has proved so fatal to parturient females is truly inflammatory, while the seat of the inflammation is the peritoneum or sexual organs. Among this class are to be ranked the two authors before us, who have enriched the medical and pathological literature of their country by two publications of very considerable merit. As puerperal fever bas not yet occupied an article in the present series of the journal, we shall take this opportunity of entering pretty fully into