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Further Remarks on Two Cases of Spinal DeformityAuthor(s): Samuel HareSource: Provincial Medical and Surgical Journal (1844-1852), Vol. 10, No. 4 (Jan. 28, 1846), pp.38-39Published by: BMJStable URL: http://www.jstor.org/stable/25499045 .

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38 REMARKS ON TWO CASES OF SPINAL DEFORMITY

action. In insanity the automatic nervous action is too intense to be controlled in any of these ways, the

portions of the encephalon which are not in a state of

irritation being paralysed to the natural influence of

soul, X. The organology of the soul's faculties. ,'t

psychic phenomena may be physiologically arranged into two classes,-corporeal and super-corporeal; there are two orders of the first class,-sensorial and moto

rial; the sensorial order contains five genera, those of the five senses, three of which only, the optic,

auditory, and tactile, have an important relation to

psychology. There are also various genera of motorial phenomena, that is, various independent movements of

different sets of muscles.

The super-corporeal, super-sensuous, or mental

phenomena are also referrible to two orders,-int% lectual states, and emotions. The sensorial and motg rial phenomena are known to belong to different nerves. The problem is how to determine the

situation of their encephalic ganglions ? Natural

and experimental observation of living phenomena and structure, has yet failed to supply the wants of the science on this question; and until this

deficiency is supplied we cannot hope to arrive at exact conclusions regarding the mental organs. HWe have (a) the olfactory nerve: where are its cells in the

encephalon ? (b) The optic nerve; is its ganglioh ascertained ? (c) The auditory nerve; its cells? (d) The gustatory nerve; its cells? (e) The tactile seq sory nerves; their cells ?-distinguishing those of the cutaneous nerves, and the muscular nerves ? (f) 'he

motor nerves; their cells --distinguishing those of the face, and the organs of speech, of respiration, and of the

upper and lower limbs?

Anatomy is full of contradiction on these points. My researches have adduced the conclusion, that the nervous corporeum, the systems of sensoria and motorist, is a distinct portion of the encephalon,-the "figurate brain" of Solly, the "isthmus" of Wilson; that no

motor or sensory nerve is continuous with the convo luted hemispheric brain, nor with the cerebellum, so far as it is composed of the arbor vitae and its cortical

grey matter; that the cerebellum and the cerebrum are purely mentoria; and that the former ip one mental

organ, the latter more than one.

The illustration of this doctrine will be given in a

subsequent communication.

December, 1845.

FURTHER REMARKS ON TWO CASES OF SPINAL DEFORMITY.

By SAMUEL HARE, M.R.C.S.

TO THE EDITOR OF THE PROVINCIAL MEDICAL AND

SURGICAL JOURNAL.

SIR, I last year communicated two cases of extreme

spinal deformity, which appeared in your number for July 16th The latter case had been under treatment scarcely two months; I therefore concluded-after giving the various symptoms, and reports of them up to the time when I forwarded the cases-by observ.

ing, that I would at some future period, transmit to

you an account of the further progress the patient might make.

In accordance with this promise, I have to state

that the improvement, considering the extent of the

deformity and the former bad state of her health, has

been most rapid and favourable. The extreme dorsal

curvature to the left has nearly disappeared, and the

equally projecting state of the ribs to that side has

improved in proportion, so that the two sides of the

chest are now nearly symmetrical, while the umbilicus, instead of being at a point directly below the

anterior border of the left axilla, has almost regained its natural

position. The projection of the right hip has al;Do, in

consequence of the straightened condition of the spine, become exceedingly reduced. An apparatus has been

adapted to the right leg and foot, so regulated as to

press gradually but firmly along the inner surface of

these parts, thus tending continually to bring them to a proper position; and although from the age of the

patient, nearly 25, much less benefit was to be expected than if she had been younger, yet a considerable im

provement, even under these circumstances, has been

effected, the foot and lower part of the tibia being con

siderably less bent than before. The spinal curvature

and the deformity of the ribs being relieved, the folds

which were formed by the integuments have ceased to

exist, and she consequently no longer.suffers from the

severe excoriations caused by them; and the attacks of

spinal irritation and hysteria, which were formerly both severe and frequent, have, of late, rarely occurred.

Not less marked is the alteration which has taken place in her general health ; she has gained flesh considerably; her complexion and skin generally, from being pale, sallow, and swarthy, have become quite clear, while

the cast of her countenance is more animated, and her

spirits exceedingly improved; she has also gained so

much strength as to be able to sit up during a consi

derable portion of each day, and to attend to sewing,

netting, and other light work, besides taking occasional

carriage airings, while, as stated in the report of the case already alluded to, she had not, when I first saw

her, been out of the house for nine years, and for seven

years had only been once off the bed on which she was

laid. She suffers very little from her former difficulty of breathing; she sleeps well; the circulation has become more regular, her feet being seldom cold, which used to be almost constantly the case; the febrile attacks

rarely supervene; her appetite is improved, and the

digestive organs are more healthy, the evacuations being of a more natural appearance than for many years.

The treatment adopted has been a continuation of that mentioned in the former report of the case; gentle but continued extension having been employed to the

spine, while the patient lay in the recumbent position; and regulated pressure has been applied, as necessary, to the projecting parts, while especial pains have been taken to correct the state of the digestive organs, by giving alterative medicines, with gentle laxatives, at the same time employing tonics, particularly the preparations of iron.

I would state, in conclusion, that much, very much,

may be effected by attention and perseverance, even in such protracted cases as this; and I would strongly recommend those who have such cases under their care,

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NEWCASTLE-ON-TYNE INFIRMARY. 39

not to despair of producing the desired effect, however

tedious the improvement may be, for even where cures

cannot be effected, very satisfactory relief may be given. As regards the other case, that of W. F., I have to

give an equally good account. He has continued to

progress most favourably, having passed the summer

in an exceedingly improved state of health, and has

been able to take excursions to Richmond, Hampton Court, &c.

I have the honour to be, Sir, Yours respectfully,

9, Langbam Place, London, S. HARE. Nov. 12, 1845.

CASES IN THE HOSPITAL PRACTICE OF T. M.

GREENHOW, ESQ., SENIOR SURGEON TO THE NEWCASTLE-ON-TYNE INFIRMARY.

(Reported by Mr. C. J. GIBB, House Pupil.)

THE EFFICACY OF THE TREATMENT OF ULCERS BY LOTIONS.

CASE I.

William Snowdon, aged 44, carpenter, a stout

healthy man, admitted April 24th, 1845, with a

large callous ulcer covering the stump, that followed the natural amputation of all the toes with the meta tarsal bones of the right foot; the injury that caused, nature to throw them off by sloughing was the fall of a heavy piece of timber on his foot fifteen months ago; the ulcer has never been healed, its edge is hard and

greatly elevated, and its surface is indolent and un

healthy; has no constitutional complaint. To have a purge; to keep as much as possible in

bed; and the ulcer to be dressed every morning with

lint, dipped in a lotion containing half a drachm of

sulphate of copper to six ounces of water, with oil-silk and bandage over it.

May 6th. Surface of ulcer covered by healthy granulations, and its horny edge greatly softened and

removed; complains of flatulence.

To continue and have some infusion of gentian, carbonate of soda, and rhularb twice a day.

17th. Ulcer much smaller and surrounded by a

thin, blue, healthy margin; flatulence relieved. June 1st. Cicatrization going on favourably. 12th. Lotion has been applied too freely to the

ulcer, its granulations are corroded and covered by a

cupreous deposit. To discontinue lotion; ulcer to be dressed twice a

day with lint dipped in cold water, and to have a purge. 30th. Ulcer healthy again, about one fourth of its

former size, and promises to heal favourably.

July 20th. Continues to do well.

August 15th. Ulcer healthy and extremely small; health good.

22nd. Ulcer almost well; complains much of pal pitation, with vertigo; pulse 100 and jerking.

To be bled to sixteen ounces, and have a calomel

purge, with low diet.

24th. Easier; bowels freely moved.

To take five grains each of blue pill and rhubarb

every night, and to be bled again. 28th. Sent out quite well.

Here, as in other cases, where nature throws off a

part of an extremity the remaining ulcer is especially difficult to heal when it occurs in the lower limb, this

man having been under surgeons and in a hospital with

very little benefit. When he was admitted many doubts were entertained whether a cure could be

effected, and the favourable issue adds another to the

many examples of the great superiority of this mode

over the ordinary lardaceous plan of dressing sores;

the bleeding and purging quickly relieved the embar

rassment of the heart and congestion of the head, for

they most probably arose from repletion of the vessels

consequent upon the cicatrization of the ulcer.

CASE II.

.Andrew Allcorn, aged 20, a rather robust-looking

countryman, admitted August 14th, 1845, with an

extensive phagedenic ulcer of the penis, which covers

the greatly swollen glands and prepuce, and commenced

six weeks ago; sleeps ill and endures much pain; no

other ailment. Had a chancre six months ago which

soon healed, and since that has had sore-throat; has

been ptyalized three or four times.

To have ten grains each of Dover's powder and

,rhubarb every night, with castor oil to-morrow morn

ing, and a poultice to ulcer to-night. 15th. To keep a lotion containing a drachm each of

liquor plumbi and laudanum to a pint of camphor mix

ture constantly to penis. 20th. Easier and sleeps better; ulcer continues to

spread. To go on with the powders and take a pint of

the decoction of sarsaparilla with fifteen grains of

iodide of potassium, in the day; also to use with lint and

oil-silk to the penis a lotion of two ounces of the solu

tion of chloride of lime to six of water, and omit the

other. September 1st. Ulcer healthy and considerably

smaller; sleeps well and is stronger. To persist diligently. 15th. Ulcer continues to heal rapidly. 27th. Doing exceedingly well; ulcer about the size

of sixpence and very healthy. To use the sulphate of copper lotion, and continue

the medicines.

October 1st. Sore appears stationary; health quite recovered. To resume the chloride of lime lotion.

12th. Sent out cured.

The appearance and extent of this ulcer were very

unpropitious; the previous baffled attempts at cure

very evidently indicated that the mercurial course was

not the mode of treatment to be pursued, and the

iodide of potassium, being almost invariably found to

suit most admirably this formidable species of syphi litic ulceration, was prescribed, with the local appli cation of the chloride of lime lotion. The surprisingly

rapid change must be mainly attributed to the lotion, for it seemed to be peculiarly fitted to the case, as the

others that were used did not check the advancing strides of the disease, or accelerate the cure when once

commenced.

CASE 111.

Jane Riddell, aged 15, a tall, thin, and cadaverous

looking girl, admitted September 1 th, 1845, with a very

large foul ulcer, covering the front of the left ankle

and dorsum of the foot, and exposing, in a carious

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