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LONDON, SATURDAY, JULY 30. [1830-31.
Observations on Distortions of the Spine,with a few Remarks on Deformities of theLegs. By LIONEL J. BEALE, M.R.C.S.,&c. London. John Wilson. 1831. 8vo.
Observations on Distortions of the Spine,with afew Remarks on Deformities of theLegs. By LIONEL J. BEALE, M.R.C.S.,&c. London. John Wilson. 1831. 8vo.
pp. 102.Ou duty with this publication is extremelysimple, and having no desire to complicateour task, we shall make it as easy as longextracts aud short comments will per-mit us. We have already noticed a Trea-tise on Deformities, written by the sameauthor. Since the appearance of that work
(for an account of which see TnE LANCET,No. 3.52), Mr. Beale has changed his mindwith regard to some of the opinions whichit contains, and instead, therefore, of pub-lishing at present a new edition of the trea.tise, he prints these supplementary obser-vations in a separate form,-a plan whichwe highly approve, and one which it wouldbe more just to the public, and wiser forauthors, oftener to pursue. The proper timefor a second edition will have arrived whenthe impressions of both the original workand the supplement have been sold. By theusual course of proceeding, purchasers offirst editions are saddled with what, in the
eyes of the trade, is considered a valuelesswork, and are compelled, if they desire tohave such additions as the author has to
make to his volume, to buy the whole bookover again. There are occasions which jus-tify a deviation from the plan which werecommend, but the majority of cases aresuch as in fairness demand its adoption.Farther,—Mr. Beale wishes to elicit fromothers such criticisms and opinions as the
matter discussed in this pamphlet is calcu-lated to demand, before he unites it to its
predecessor.To recount the new views which have
(to use a convenient but illegitimate phrase)
obtained within the last few years on the
subject of " nervous disorders," would bea waste of our space. It is now generallyadmitted, that to an irritable state of the
spinal cord, or its immediate adjuncts, maybe traced a host of what were, formerly, intheir pathology, and are yet, in their treat-ment, amongst the most perplexing of mala-dies. Still it is desirable, observes our
author, that " additional facts should berecorded to confirm these opinions."Eschewing then all but the facts, we pro-
ceed to submit so much of it to the notice ofour readers. Our copy is what is called a" presentation copy." Were it worth wast-ing any feeling at all on the subject, thecircumstance would excite our contempt.Mr. Beale is, we understand, one of an un-happy crew, the leisure half of whose livesis spent in attempts to defame the principlesof the Editor of this Journal. The motivesof that party it would be superfluous to makepublic in this place. Those who have watch-ed the course of medical politics during thelast seven years, and the stealthy stepswhich the various assassins of reputationhave taken behind the backs of indepen-dent and intrepid surgical reformers, are toowell acquainted with the proceedings of ourenemies to need any exposure of them here.
The honourable portion, the immense majo.rity of the profession, know them intimatelyand despise them thoroughly, and so too
do we ourselves, while, for the thousandth
time, we render strict justice to a puny,but not less bitter, foe.Curvature of the spine necessarily stretches
one-half of the circumference ot’the spinalchord and compresses the other. The fibres
composing the inner surface of a hoop arebrought into closer contact than those in themiddle, while the exterior fibres are elon-
gated. In a proportionate extent must the
same effects follow curvature of the verte- ness how much disturbance a very slight in.bral column. Disturbances such as these flection of the spine could occasion in the
undoubtedly do not always affect the health heart and lungs, and how readily it was allay-of the deformed party; that is to say, they ed, by directing the treatment to the primaryis malady. This treatment has, in my hands,do not always occasion disorder or pain; or been very simple, consisting chiefly in regn-even inconvenience to which habit will not lation of the bowels, suitable diet, thia beingfully reconcile the sufferer ; but permanent nutritive without pampering; tonics, espe.curvature, with very few exceptions indeed, pecially quinine, sometimes steel, recum
perhaps without any, checks the growth, bent posture alternated with exercise of the
perhaps without any, checks the growth, spine, cold sponging, shower-bath, partialand m a multitude of cases materially exercise of the muscles of the back byranges some function of the body. " If means of the weight and pulley, with thethe primary curvature," says the author, cord attached to the head, I have used with" occur in the upper dorsal region, the advantage ; but, in the incipient cases to
respiratory organs are principally affected which I allude, the simpler means in gene.respiratory organs are principally affected ; ral suffice. From repeated examination ofif the lower dorsal, or lumbar region, be such cases, my impression had long been,the seat of disease, we have derangement that in them the dorsal curve was thatof the functions of digestion, and sometimes which first occurred, the countervailing bendthose of generation." afterwards taking place below. It is very
, ,. , possible that my scrutiny might not haveIt may be no compliment to Mr. Beale been conducted with sufficient accuracy ;for us to make the first extract from a por- and while I still retain my original belief, Ition of the work which is not his own, but by no means contend that I may not beour politeness must yield to our sense of wrong. My reasons for the belief were,
the excellence which distinguishes the fol- that in the earlier stages I saw only the
lowing remarks by Dr. E. Barlow, ,. Bath, slight curve between the scapuls, and thatlowing remarks by Dr. E. Barlow, of the raised shoulder and protruding scapulawho, in a letter to the author, thus clearly, occurred where no projection of hip wasconcisely, and sensibly, expresses his views perceptible. In short, I doubted not of theon this subject. They contain also, and are fact, nor am I yet convinced, even by Mr.
quoted as confirming, the opinions of Mr. Belt’s highly ingenious explanation of the- n , variety ,.. i rise and progress of lateral curvatures, thatBeale, on a variety of points. At the same am wrong. He considers the first bendtime we may be permitted tp say, that the in the lumbar vertebrae to take place in thewhole forms one of the most elegant and cor. standing posture. It may be so in mauyrectly-written passages with which we have instances, but I cannot believe it to be so yin
lately met in a medical work. all. In those which I have seen in the 10., .
cipient stage, the parties had not been ac-For many years, lateral curvature in its customed to long standing. They sat mucb,
incipient stage had attracted my observa- and were accustomed to make forced efforts
tion, first, from remarking the incidental de- towards keeping the trunk of the body erect,rangements of health so often attendant on when the natural strength was inadequate.it, and afterwards from tracing back such de- This state of weakness can never be dis-
rangements to curvature, in cases where guised. Even under ordinary medical er.that was not conspicuous. This latter course amination, enough occurs to display it,of investigation has led me oftentimes to de- which no observant practitioner can mis.tect incipient curvature where none had take. The party makes a forced effort to
been suspected,] and hence to adapt the sit erect; in a few moments the effort re-treatment to the primary derangement, with laxes and the spine yields, the trunk sen-
great satisfaction to myself and benefit to sibly sinking, the chest becoming flattened,the parties concerned. I had seen, in con- and the back arched. When this degree ofnexion with lateral curvature, hurried re- weakness exists, the spine is never safe, itspiration, short cough, palpitation, hyste is sure to yield in some direction, and therics, with a host of other nervous derange- early inflection begets a long train offer-ments, all yielding readily to proper treat- vous, thoracic, and other disturbances. Inment of the spine and improvement of the such cases, whether curvature be discover-general health. When I afterwards met with able or not, 1 enjoin the parties to take re-these symptoms, unattended by the consti- fuge in the recumbent posture, whenevertutional derangements which usually accom- they feel that they cannot support them-pany them when resulting from inflammatory selves, alternating this as much as possibleaffection of the lungs or heart, I suspected with active exercise. So long as the dor-the spine, and was led to look more closely sal muscles are in action, the mischief caa.after it. It has often surprised me to wit- not advance, and restoration of power ta
these muscles by local and constitutionalmeans, is the only effectual cure. The cure,too, is not difficult when commenced earlyand judiciously pursued. So long as theweakness continues, there is no security.save in avoiding the sitting posture when-ever the trunk cannot be fully supported.I have found a great advantage in this re-spect in dispensing with the board,’ as itis termed, and converting a common sofainto an inclined plane. This is readilydone by any carpenter, a plane raised to
seven or eight inches at one end, and ter-minating in a point, being slipped underthe cushion. This arrangement excites noobservation, a consideration of some momentwhere feelings are sensitive ; it is always athand, and will be used freely, when the for-mality and display of lying down on theboard would be repulsive. From the sen-sible relief afforded, it becomes the favouriterepose; and no time being enjoined, theparties lie down and use exercise alternately,precisely as the most accurate judgmentwould direct. Sometimes there is prejudice to encounter, especially in schools.The young lady is accused of neglectingher ’carriage.’ Under remonstrance, per-haps reproof, she can draw herself up, andthe power of doing so being thus demon-strated, obstinacy is imputed, the total in.ability to sustain the forced effort beingwholly overlooked. In this way, much in-
justice is practised against these weaklycreatures, much injury inflicted. Your ac-knowledgment that curvature occasionallyoriginates with the dorsal vertebrae, is sa-tisfactory to me, as showing that cases haveoccurred to others in which the dorsal bendwas the earliest. The difference, however,is of little momeat, a common origin beingacknowledged in both cases, and the prin-ciples of treatment being consequently thesame. I am the more pleased to see thismatter subjected to free discussion, from thelight which this cannot fail to shed on manyderangements of female health, in which amistake of their real nature leads to muchmaltreatment. Young females have beenbrought to me with alleged disease of the
heart, phthisis, &c., whose maladies, trace-able to muscular weakness and incurvatedspine, have readily yielded to such treat-ment as I have mentioned ; while bleeding,digitalis, and remedies of this class, wouldhave sunk their powers and accelerated theirfate. Had either disease actually existed,the treatment employed must have failed.I have seen local excitement enough tomislead an unwary practitioner into bleed-ing and depletory treatment, which, how.ever it might abate symptoms, must, byincreasing weakness, aggravate the realdisease. These cases require close discri-miuation, for it does ItappeuL that the pulmo-
nary disturbance leads to a state of conges-tion and inflammation, so as even to requirethe lancet to be used ; but these cases differwidely from primary inflammation of thechest, and require the treatment to be modi-fied accordingly. In reflecting on this sub.ject it has occurred to me, that the insidiousdisorganisation of the lungs characteristic ofphthisis, may not unfrequently have itsorigin in the disturbance of pulmonaryfunction occasioned by curved spine."We add the paragraph which is imme-
diately subjoined by Mr. Beale for the rea-son expressed in the closing sentence.‘ Many cases of spinal curvature have
their origin in the dorsal region, and theconvexity of the curvature is sometimesdirected towards the left side. Sometimesthe whole dorsal and lumbar vertebrse areimplicated in one curve ; at others the cur-vature is confined to four or six dorsal ver-tebrx. Such cases cannot arise from mus-cular debility, or from position or bad habitsof sitting, standing, or lying ; they occur
from a very early age to 12 or 14, in chil-dren of bad constitution, of hereditary oracquired strumous habit. The disease is inthe fibrous tissues connecting the vertebrae,of a precisely similar nature to that whichoccurs in the hip and knee-joints of subjectsof a similar habit. This disease of the
fibro-cartilages has not attracted much at-tention in this country, but on the Conti-nent, and especially by Delpech, numerouscases of lateral curvature have been tracedto it. I shall not here enter into a detailof the symptoms, but shall refer to the tenthchapter of my Treatise on Deformities, where1 have endeavoured to concentrate all thatis known on the subject. One of the objectsof the present tract is, to call the attentionof my professional brethren to this subject,that by accumulated observations we maybe enabled to elucidate the real nature ofthe disease, and adopt sound treatment."One of the earliest texts on which the
author dwells, is the extent to which dis-tortion of the spine exists in this country.He is, perhaps, an alarmist on this head.
" From a variety of causes (he says) lateralcurvature of the spine has of late years be-come so common, that there is hardly afamily in the middle or upper ranks of societyin this country which has not one or moreof its members so afflicted." Nay, he goesso far as to say that there are very few re-spectable females at all in this isle of beauty(beauty of face then it must be, and not offigure) who are quite straight, compellingus to believe that milliners and dressmakersare the greatest of impostors, inasmuch as
their art must thus be one entirely of dis guise. His subsequent remark may be verycorrect, that " a small degree of curvatureexists in numerous instances without beingsuspected ; but if excesses of deformity arevery seldom indeed to be seen or suspectedin our daily walks, and small degrees of un-suspected curvature occur only " in nume-rous instances," the opinion that distortion ’,,exists almost universallyis not made out, butwill, if Mr. Beale do not take care, becomethe same " sort of scarecrow " in his oracu-
lar cavity, which he says " inflammation "
is in the mouths of some other practitionerswho are nameless." The causes which give rise to this
widely-spread calamity, are very -numer-ous and very different. There are variouskinds and degrees of lateral curvature, somearising from a single, some from a combina-tion of several of these causes. The originof different cases may be traced to the tol-
lowing :-a softened state of the bony partsof the spine-chronic inflammation of thecartilages and ligaments of the vertebræ—the long-continued operation of peculiarattitudes, tight-lacing, &c.-contraction ofone of the sides of the chest from inflamma-tion, and destruction of a portion of lung byabscess-overgrowth, especially when ope.rating in conjunction with the debilitatingeffects of some of the diseases peculiar tochildhood. as scarlet fever, &c."
The softened state of the bony parts ofthe spine is the malady of children. It isthe result of mal-treatment by mothers andnurses, and of residence in the unsuitable
atmosphere of towns, giving rise to dis-ordered action of the nutrient organs.There is no occasion for us to enlarge onthe symptoms and treatment of rachilis.
Chronic inflammation of the cartilages andligaments of the vertebrae is a cause of spinalcurvature which operates on children of a
lymphatic or strumous habit, between theages of six and fourteen, and most common-ly in girls. The following are cases whichwere treated on the principle that this wasthe cause of mischief in the portion of thespine where the seat of the disease was in-dicated either by a curvature, or by pain oruneasiness on pressure.
EXCESSIVE DEBILITY FROM SPINAL
F. S. began to complain at tile age of17, of pain in the back; she had frequentaccessions of fever, tenderness on pressure
at the pit of the stomach ; the uterine func.tions not regular. On examination of the
spine at the age of 19, a considerable dis-tortion was discovered. The body wasmuch emaciated from two years’ suffering,and the spinal curvature being attributed toweakness, a residence at Harrogate, andthe use of the waters, were prescribed. At
i first some improvement took place in the
health, but after a time the deformity in.creased, the lumbar and lower dorsal verte-brae formed a curvature, the convexity ofwhich was to the right, the upper part ofthe spine having a countervailing bend to
the left. The recumbent position on a firmmattress, with daily moderate extension,
sensibly diminished the curvature, while
regulated exercises, and the internal exhi.bition of steel, improved the health and in-creased the strength. Frictions on eachside of the lumbar vertebrse tended to relaxthe contractions and rigidity the musclesand ligaments had acquired from long-con.tinued disarrangement." Remarks.—This had been a case of
chronic inflammation of the fibro.cartilagesof the lumbar vertebrae ; the effects of thedisease alone remained when it came under
my notice, and the deformity of the spineand excessive debility alone required to beattended to. The curvature now remainingis very slight, and I have no doubt that
perseverance in the course of exercise pre.scribed, with attention to diet and regimen,, will remove it. In such cases the deformitymight be altogether prevented in the earlystages of the disease ; by strict repose, re-peated leeching, counter-irritation, and at.tention to the general health, that tbicken-I ing and softening of the cartilages in whichthis variety of curvature originates would
not take place. The following case is alsoone of chronic inflammation of the fibro-
cartilages, but which being arrested at an
early stage, was accompanied with only a
very slight distortion."
DISORDER OF THE CHEST AND STOMACH,
. ‘ A girl of 12, of fair complexion, blueeyes, languid circulation, and other indica-tions of a lymphatic temperament, bad longbeen subject to a variety of disorders of thechest and stomach. Sometimes attacks ofdyspncea and cough, sometimes pain andtenderness in the epigastric region, &c.;these symptoms had been treated in theusual manner, but with no complete suc-cess, for the attacks still recurred as fast asthey were to appearance subdued. Com-
plaining of slight uneasiness in the back,her spine was examined, when a teudencrto curvature was found implicating thewhole lumbar and dorsal vertebrae; andthere was much pain on pressure about thellth and 12th dorsal vertebræ. In the re-
cumbent position the deformity did not dis.appear, nor could extension with prudencebe employed ; this is one mark of distinc-tion between these cases and those result-
ing from muscular debility. Iu this case,in all probability, there was chronic inflam-mation and lymphatic infiltration into allthe fibro-cartilages, from about the first.dorsal to the third lumbar vertebrae ; therewas a general inclination of the trunk to.wards the left side, the curvature not havingexisted long enough to have caused a coun.tervailing bend to the left. A strict re.cumbent position was ordered to be main-taiued; a few leeches were applied dailyfor four days, and afterwards two successiveblisters; the bowels were kept free by dec.aloes com. In about a month, all pain onpressure having ceased, tiuct. ferri mur. wasprescribed; and, after three months’,repose, iall deformity had disappeared, the healthwas much improved, and there had been norecurrence of mischief eighteen monthsafterwards." In this case the fibro-cartilages were
increased in thickness, and diminished in
tenacity; the connecting media of the ver-tebrse being relaxed, the weight of the bodyand the action of the muscles drew it to-wards the right side, and had the diseasebeen neglected, permanent deformity wouldhave ensued."
The recumbent position forms the mostessential part of the treatment,-not on aninclined plane, that pressure on the diseasedparts may be avoided. Leeches should thenbe applied,-" Not in great numbers (for the disease
is chronic, and the patient generally blood-less), to the part of the spine which exhi.bits pain on pressure. The applicationshould be repeated daily, or every two orthree days, according to circumstances ; inall chronic diseases more benefit is derivedfrom the repeated application of a small n um-ber of leeches, tiian of a larger number onceor twice ; the malady is of slow growth, andits decline will be likewise tedious. Blis-ters are useful, but not to the same degreeas the repeated application of leeches orcupping. Caustic issues always do mischief- in almost everv instance that I havewatched where caustics have been made,the jrritation to the system has been mostiujurious. I have been obliged to allow theissues to be healed from the suffering theyproduce ; the subjects of these spinal dis.eases are generally of a very sensitive,irritable habit; their nerves appear tofeel more acutely than the generality ofother persons, and the peculiarly distressingnature of their complaints renders thempeevish and highly susceptible. I am quite
sure that unremitting rest will, in the ma-jority of cases, supersede the necessity ofissues. In young children, more especiallyunder the age of four, caustic issues are verydistressing, and I think the same remark willequally apply to setons."
The functions of digestion are to be kept in tolerable order," as an important addi-tion to the process of cure.
Particular attitudes, want of exercise,tight stays, &c., are the exciting causes oflateral curvature at all ages. We need quotebut little from our author here, for hehimself resorts to copious quotations. Ofcourse he deprecates a long continuance inany position, sedentary occupations, and allthose attenuations of our modern sylphs, inwhich Vistirin and her imps delight. The
remedy is in the hands of sensible fathers,and on them be the affliction of havingcrooked daughters if they suffer their chil-dren to attempt to attract the admiration ofmen of vitiated and disgusting inclinations,by the exhibition of small waists. Theauthor approves of the use of instruments to
support the spine, only as adjuvants to suchother treatment as would be pursued by allwell-educated practitioners, and so long asthe period of life affords a hope of cure.After this they are useful in preventing anincrease of deformity, and as conducing tothe comfort of the wearer. Speaking ofexercise he says-
’, The health always suffers in cases oflateral curvature, primarily or secondarily,and it is surprising to witness the effect ofexercise in improving it. Where any de.gree of perseverance in exercise is observed,the health speedily improves, and, if thediet be at the same time judicious, little orno medicine will be required. The greatdesideratum in these cases is perseverance,with which almost all may be benefitted,but without it no method of treatment willavail. In the exercises usually adopted it isessential to fix the pelvis, in order that thebody should bend at the loins, and the mus-cles of the back be called into action, other-wise the whole trunk with the pelvis, willmove on the heads of the thigh-bones. Thiscircumstance will also point out the absur-dity of expecting benefit to result fromexercise while a patient is wearing a steelsupport, the very object of which is to fixthe spine immoveably on the pelvis, andthus prevent all possibility of exercise to
the muscles of the back and loins. When amechaiiical support is used, it should be inthe intervals of exercise alone, to be taken
off on every occasion when the exercises areresumed."—p. 54.
In a few cases, which we shall now quote,will be found illustrations of the leading factsreferred to, or yet remaining unnoticed.It is very proper on the appearance of
symptoms, such as are therein described, topay minute attention to the spine, in
order to detect derangements in it, if theyexist, before the treatment is commenced,but at the same time it must be remember-
ed, that as these cases tend to establish a
principle, it will be proper that through overzeal for its confirmation the scrutinisingeyes of medical attendants do not fix upona cause for the disease which has, after all,little or nothing to do with it. In the firstcase which we transcribe, the lumbar ver-tebras were found, at the commencement,11 two bend slightly towards the left side;"and nearly at the consummation of the treat-ment the curvature still had such an ex.
istence, that it is obliged to be spoken ofas being " hardly perceptible." It is no-where said that it entirely disappeared.
CASE OF SLIGHT CURVATURE.
" Miss --, aged 16, tall and thin,had about a year before suffered from an at-tack of scarlet fever, which had much ener-vated her. She complained of lassitude,weakness, want.of refreshing sleep, risingin the morning with aching limbs, and asmuch weariness as would be felt after greatfatigue; her complexion was pale and sal-low, her appetite bad, and she often had
.... slight febrile attacks in the evening. Thesesymptoms had been treated as consequenton derangement of the digestive organs.Sometime after the commencement of theseattacks, pain was felt in the back, but wasat first disregarded, under the idea that itarose from circumstances to be expected atthis period of life. However, as her healthdid not improve under the treatment pre-scribed, the back was examined, and theupper lumbar vertebrae were found to bendslightly towards the left side. Pain wasfelt on pressure at each side of the spine,and on tapping the spinous processes, espe-cially that of the second lumbar vertebra.She now complained- of frequent headachs ;there was some accession of fever in the
evening ; the pain in the back was describedas dull and heavy ; a sense of constrictionwas felt over the stomach, which organ wasvery irritable, and often rejected its con-tents. There was little or no disturbancein the thoracic organs. The functions of
digestion were much impaired; the alvine
evacuations were scanty, irregular, and un-healthy ; she was much troubled with thatpeculiar noise in the bowels so common tonervous women, and those who lace tight;the catamenia had not yet appeared. Themost comfortable position was lying on theback. The curvature in the loins was veryslight, so little that the ribs did not appearin the least distorted, and it was removableby the slightest extension. The treatmentconsisted of the recumbent position, the ap.plication of several successive blisters, gen.tle aperients, and alteratives. When thefever had passed away, and the pain in theback was removed, small doses of quininewere administered; gentle exercise waspermitted, but still the recumbent positionwas strictly enforced in the intervals of ex.ercise. A few months’ perseverance in this
simple treatment restored the health, andthe curvature in the loins became hardlyperceptible. Still I thought it right to re-commend strict attention to the health, es-pecially the functions of nutrition, for Ihave no doubt that any circumstance whichwould again derange the health, would de.bilitate the muscles of the back, impair thetenacity of the connecting ligaments andcartilages of the spine, and allow the weightof the upper parts of the body again to bearit out of its natural position." Remarks.—In this case attention was
fortunately directed to the vertebral columnat a very early period of the curvature,when the disease was in a very incipientstage. The distortion was not fixed, forthe smallest extension removed the curva.ture, and while the patient remained in thehorizontal position it did not recur.
VARIOUS AFFECTIONS FROM SPINAL
°° Miss B., aged 19, had been long sub.ject to coughs ; had been considered, duringthe winter of 1829-30, to be labouring underpneumonia and inflammation of the liver ;her difficulty of breathing at times was sogreat as to appear to threaten suffocation-her bowels were extremely torpid, and theattacks of supposed pneumonia and inflam-mation of the liver repeatedly recurred.The treatment to which she was subjectednecessarily weakened her ; and in the lastsummer she was removed to the coast,
where she in some degree recovered her
strength. On her return to town she was
extremely delicate and weak, her appetitecapricious, her bowels inactive without me-dicine ; she still had frequent attacks ofpain in the chest, difficulty of breathing,cough, and expectoration, and in the eyes ofher friends was considered consumptive." At this period, when I first saw her,
’ she was extremely thin, her countenancesallow, her eyes dull, her tongue coated,
te!lpiration rather hurried, occasional dry males have been sacrificed to the indiscri-
cough, pulse weak and frequent ; she com- minate employment of anti-inflammatoryplained of palpitation of the heart, and flut- remedies. There is a peculiar nervous rao-tering at the pit of the stomach, some de- bility, call it what you will, in the femalegree of tenderness over the region of the constitution, or something in their mannerliver and stomach, the bowels seldom act- of life, which disposes them to neuralgic oring oftener than once in three days, and congestive diseases, and but little to increas-then not without medicine. Her sleep was ed arterial action. The uterine system fromunrefreshing, seldom having more than two puberty commences its influence, and thereor three hours during the night. is no organ or function which is not occa-" I found, on inquiry, that before and sionally influenced by sympathy with it. A
during the paroxysm of difficulty of breath- delicate palefaced, bloodless female, com-ing, &c., which generally recurred once in plains of pain in the side, may have a slighta week orfortnight, she experienced a sense cough, her breathing is hurried, her pulseof choking, that her heart beat much, and frequent, her appetite bad, her tonguethat her urine was pale and in large quan- coated. A routine practitioner pronouncestity ; from these circumstances, and her it a case of pleurisy, the lancet is called intogeneral appearance, I had no hesitation in play, drastic purgatives are administered,concluding all her suffering to be neuralgic foxglove or colchicum is prescribed, and thator hysterical; and, as the uterine functions irritation which really constituted the com-were regular, I pursued my inquiries to the plaint is kept up by the treatment adopted.spine. On examination, a curvature of the Perhaps the symptoms ’are aggravated, thedorsal vertebrm was discovered, the con- obstinacy of the disease calls for further
vexity towards the left side, the ribs on this antiphlogistic remedies, and the patient dies,side being preternaturally separated, while or falls into a state of apparent consump-those of the right side were approximated. tion.The left shoulder-blade was nearer to the ‘‘ Such cases are not uncommon, and itspine by an inch and a half than the right, behoves the young practitioner to endea-but there was no material difference in their vour to form a correct judgment with regardelevation. There was no pain on pressure, to them. Unfortunately the kind of caseseither on the spinous processes, or at their which is seen by students at hospitals andsides. On extending the spine, the curva- dispensaries, being chiefly that of theture was much lessened, which not only labouring classes, and for the most part in-proved the recent state of the distortion, flammatory, misleads the judgment, and hebut the probability of an entire cure. The commences practice with the admonitions ofrecumbent position, with occasional exten- his teacher and his own experience, leadingsion, was strictly adhered to for the first him to see inflammation at every step."two months, after which exercises were
employed, principally that of raising a CASE OF PAINS BENEATH THE BREAST.
weight over a pulley, by the action of the Mrs. T., aged 40, had been subjectmuscles of the neck and back. Mild ca- for Many years to attacks of pain under thethartics and a regulated system of diet after left breast, more severe on some occasionsa time restored the action of the digestive than on others ; they were generally, butorgans. Tonics were employed to give tone not always, accompanied with palpitation of
to the system, and a few months restored the heart; sometimes she was simulta-this young lady to better health than she had neously troubled with a cough. On the firstexperienced for some years. two or three attacks she had been leeched,
" Remarks.—This case exhibits an ex. cupped, and blistered, without any relief,ample of the sympathetic affections which and subsequently she has done nothing butsometimes result from pressure or irritation take simple aperients, and has submitted toof the spinal marrow, or the nerves at their the evil as one that was irremediable, find.exit. We have neuralgic affections simu- ing that the pain subsided after a few dayslating the most important diseases. It is an continuance, without materially injuring herinstance of the necessity of a strict investi- health. These attacks occurred at differentgation before we determine the nature and intervals, from a few weeks to some months.consequently the treatment applicable to On the last occasion the pain was seatedsuch cases. In delicate women, we should about the sixth rib, and was occasionallyalways hesitate before pronouncing a ver- extremely severe, and darting backwardsdiet of inflammation-it is hardly probable towards the spine ; the countenance ex-
that such persons should be liable to violent pressed suffering; the complexion was sal-inflammatory affections, and as far as my low, the tongue was furred, the appetiteexperience goes, I should say that in bad ; the bowels were regular; the pulsetuch subjects, what ought to be fairly quick, but soft. On examining the spine,denominated inflammation is rare, and I there was considerable sensibility on pres-am quite certain that many delicate fe- sure of the fifth dorsal vertebra; and on
inquiry it was ascertained, that uneasinessand a sense of heat bad frequently been feltin this part of the spine. Cupping wasordered, and on the two following daysleeches were applied on the part ; an em-brocation containing ant. tart. was after-wards used to keep up a counter-irritationthe bowels were evacuated by rhubarb andcalomel ; under this simple treatment the
recovery was complete, and the patient hasbeen longer free from pain than at anyformer period."
We have spoken of and eulogised thestyle of Dr. Bat low. It is sadly contrastedby that of Mr. Beale.-,’ We are all ac-
quainted with that characteristic of nervousand hysterical disorders to simulate in-
flammation ; this fact," &c.; such sen-tences often occur,-’° Rickets, in everydegree of intensity, is produced," may bevery correct, but it is much more correct
than elegant. ’ Rickets" would be well trans-lated into " rachitis.’ =« That peculiar mo-bility of the nervous system which, in suchpersons, simulates every kind of disease,"and" if they mistake their nature, which isfrequently the case," are very odd modes ofexpression. What is frequently the case ?Answer-,, They mistake their nature."The remarks on deformities of the legs
contain nothing that is new.
REVOLUBLE INVALID BED.*
* For an account of which see LANCET for 19thJuly, 1828.
To the Editor of THE LANCET.SIR,—I shall feel obliged by your giving
publicity to the two following cases in THELANCET ; the first being a singular one ofdisease of the tibia in a very old person, the iother a compound fracture of the femuroccasioned by a gunshot. Both cases, I
think, possess much interest, inasmuch astheir having done well appears entirelyattributable to the use of the revoluble in-valid bed, and that without it both patientsmust have been lost. I remain, Sir, yourobedient servant,
J.A.JERRARD.Honiton, July 21, 1831.
SINGULAR CASE OF DISEASE OF THE TIBIA.
A lady, about 80 years of age, complainedof a pain in the right leg, four inches abovethe ancle, in the beginning of April, 1827.I was requested to see her on the l1th of
June following. From the time she firstfelt the pain there has been a red spot on theanterior part of the tibia, the size of a crown-piece, a little elevated and very painfulwhen touched. It appeared to be occa.
sioned by inflammation of the periosteumand integument. I advised rest; occasionallaxatives (the bowels being sluggish),leeches, and a bread-and-water poultice.About a fortnight after the time I first saw
her, I observed that the limb had the appear.ance of being slightly bent, which I con-sidered to be occasioned by the swellingabove-mentioned, and on being informedthat there had been at times a twitching ofthe muscles, attended with great pain inthe inflamed part, I was induced to examinethe limb more carefully, and found that ithad the appearance of a recent fracture ofthe tibia, and that the portion below the in-flamed part could be moved in any directionwith almost the same facility as if it hadbeen fractured. There was not the slight.est crepitus. The fibula appeared to besound. The limb had never before sufferedfrom fracture or any other disease, nor hadthere recently been any sudden or violentaction of the muscles, or great exertion ofthe limb. The only way in which I couldaccount for the flexibility of the tibia, wasby supposing the earthy portion of it at thispart to have been either partially or whollyabsorbed. The limb was put in splints andplaced in the best position in bed, and per-fect rest recommended. In less than a
week my patient began to complain verymuch from the pressure of the bed, the limbalso continuing extremely painful. At this
period her sleep and appetite had nearlyleft her, her pulse became quick, her tonguedry, and in a word, she appeared to be sink.ing. As a last resource I proposed a trial ofmy revoluble bed, which really did for herwhat I believe no other contrivance or plancould have effected.From the easy posture and capability ofchanging it at pleasure, without any exer-tion or relative motion of the limb, she wasenabled to sleep most comfortably, her appe-tite returned, and in about seven weeks sherecovered the use of the limb, and wasenabled, with the assistance of a stick to
walk in her garden. No medicines eitherexternal or internal were exhibited, withthe exception of a few doses of castor oil,which she had been in the habit of takingoccasionally before.
,I CASE OF COMPOUND FRACTURE OF TftE
I FEMUR AT ITS NECK.
On the 7th of October, 1830, I was calledto see William Coombes, a lad about 13years of age, who had accidentally shothimself. The muzzle of the gun (loadedwith shot) was in contact with the front and
J. A. JERRARD.