he was relieved. Although no distortion of the spine could be detected, pain and increased numbness were occasioned by certain movements of the arms, and by deep lateral pressure on the vertebræ. It appeared to Mr. B. that there was a fracture connected with the right transverse process.

In January, 1820 (the accident had happened in the preceding September,) he was admitted into the County Hospital. He had the perfect feeling in every part of the body, except the extremities of the thumbs and fingers, which felt very numb; the muscles below the injury were as completely paralytic as they ever had been, but he could distinguish whatever touched him he complained of a pain in his head, which had continued ever since the accident; he complained likewise of a very great pain in the right shoulder: there were some enlargement and tenderness on pressure about the last cervical vertebra: he appeared in good health as far as the functions of the viscera were concerned. Mr. Swan made a seton on each side of the af fected vertebra. Soon after they began to discharge, he regained some power over the muscles. At the end of a month, he could just stand by himself, and walk, when steadied and supported by another. He had some use of the left arm, but very little of the right. We need not pursue the details. We need only state that he was discharged from the hospital in June, with such use of his lower extremities, as to be enabled to walk to a considerable distance. The use of his arms was also much improved, and he was entirely free from pain when they were moved. He was in perfect health. All enlargement and tenderness about the vertebra had disappeared.

This case will afford an opportunity for making a remark, with reference to the treatment of injuries of the spine. We think that the general occurrence of inflammatory action of the membranes or the substance of the spinal marrow, as a consequence of injury, has not been sufficiently attended

to.

The profession are anxiously alive to the supervention of inflammation of the brain, afier blows upon the head-they endeavour to prevent it by precautionary depletion-watch every symptom, in order to arrive at a ready recognition of it-and, when it has occurred, they treat it with activity and boldness. Yet when similar injuries have been inflicted on the spine, the patient is frequently allowed to take his chance, with little assistance from the surgeon or physician. He is placed upon his back, his diet is restrained, and his bowels may be regulated, but, so far as our opportunities of observing and of reading have extended, the catalogue of remedies most commonly embraces few further, nor any more potent items.

Yet, if cases of this description are accurately studied, it will be found that the symptoms commonly characteristic of inflammatory action are usually established at an earlier or a later period, subsequent to the infliction of the injury. The pulse increases in frequency and force, the skin grows warm, the secretions are altered, pain may be felt in the seat of the injury, and the parts supplied by the nerves from the medulla opposite and below the affected part, display the conditions which vascular excitement of the medulla, or pressure on it from effusion, might be thought to be respectively likely to produce. It would be foreign to our purpose to pursue this subject at the present moment. We have merely thrown out the hint, which observant surgeons will discover, we believe, to be founded in truth. We have reason to hope that Mr. Brodie will communicate the results of his observation and

his experience on this subject to the public, at no distant period, and we are much mistaken if he does not present a more scientific and exact account of the symptoms, the consequences, and the treatment of injuries of the spinal column, than has yet been offered to the profession.

Mr. Swan's observations on this subject are so judicious, that we willingly extract them.

"There are three occurrences always to be feared after an injury of the spine, any one of which sooner or later is destructive of life, and therefore their prevention ought to occupy seriously the mind of every surgeon. The occurrences I allude to are inflammation spreading to the medulla or its membranes; disease of the bladder; and mortification of the lower part of the back and nates.

When the spine is injured, the same changes take place as in injuries of other parts of the body. Inflammation, in a greater or less degree, is set up, and if the injury is below the part that supplies nerves to organs immediately necessary for the maintenance of life, it is the inflammation, I believe, which causes death, when it happens very soon after the accident. It becomes, therefore, necessary to prevent inflammation of the chord and its membranes, by general and topical bleeding; indeed the same care ought to be taken as in injuries of the head. The diet should be of the mildest kind, and an absolute state of rest in a recumbent position should be enjoined. It is not enough for the symptoms immediately ensuing on the accident to be removed, but attention to diet ought for some time to be adhered to, and every exertion of the body avoided, and especially riding in a carriage over rough roads. Should pain arise in the injured part, blood should be taken from it by leeches or cupping; or should numbness or any other symptom denoting impaired functions of the chord be complained of, blood may be taken away in the same manner; and if the patient is not relieved, setons or issues should be made near the part. In mentioning setons and issues I would by no means recommend their being made immediately over a fractured vertebra, unless some weeks have elapsed since the accident, as issues especially may communicate with the fracture, and make it a compound one, thus causing irreparable injury.

The urine should be drawn off twice or three times in twenty-four hours; and if the bladder be insensible, so much greater ought to be the care taken in using the catheter, for an injury may be easily done; and when ulceration has begun in a part deprived of the influence of the brain, nature seems to have but little power in controlling it.

Mortification of the parts below the injury must be prevented by keeping them very clean and dry, and washing them with a spirituous embrocation, as brandy, &c." 251.

In some cases, small general bleedings are productive of advantage. Of course their employment must be regulated by the general condition of the patient, and the actual character of the symptoms. In a case of severe injury of the dorsal portion of the spine, which was admitted into St. George's Hospital, repeated bleedings, to the amount of four or five ounces at a time, were highly useful. The blood displayed the usual characters of inflammation, as the patient evinced its ordinary symptoms. He had perfect paralysis of all the parts below the seat of injury. He gradually recovered, and we met him about twelve months ago, walking without the aid of a stick in the street.

Mr. Swan appears to deprecate, rather than to approve, the proposal to trephine the spine in cases of fracture with depression. He plausibly, indeed fairly, urges the difficulty of determining the nature and amount of injury, and observes that, were this as easy as it is impracticable, the pro

priety and safety of the operation would continue doubtful. The first argument is so weighty, that we fancy the operation will continue a subject of speculative reasoning, rather than one of practical application.

There are several omissions in Mr. Swan's notice of the effects of injury upon the spine. He has not alluded to, or has faintly glanced, at the alterations of the temperature of the body—the disturbance of the urinary secretions and organs-the variations in the sensibility and mobility of the parts below the seat of injury-the condition of priapism-and the structural changes which occur in the medulla. These are severally matters of interest and of importance to the scientific and the practical surgeon.

DISEASES OF THE NERVES OF THE SENSES.

These form the contents of the fourteenth chapter. Mr. Swan first considers disease of the olfactory nerves; but we perceive little in his observations to detain us. The only remark to which we think it necessary to allude, is in reference to the perception of unpleasant odours, when no apparent external cause for them exists: and no obvious alterations of the nerves, of the apparatus of smell, or, indeed, of any part of the body whatever, is present to account for them. He compares this unnatural condition of smell, to what is observed when morbid impressions are made on the optic nerve, spots of various colours and shapes being seen, as though they had a real and substantive existence. When this "morbid action" (the term may be exceptionable) of the nerves of smell is set up, the functions of the stomach and viscera connected with them are, as Mr. Swan assures us, frequently deranged, and if these are restored to a healthy state, the disorder will generally cease.

From diseases of the olfactory, Mr. Swan proceeds to those of the optic nerves. He subjoins some description of amaurosis, which we may omit. But he offers some observations, dictated by experience, on the treatment of "dizziness."

"When it comes on frequently, I have found it very difficult to cure by the means usually employed for that purpose. As I have in several obstinate cases removed it, I think it may not be useless to relate what has occurred to me on the subject.

When a person has become subject to dizziness, though he may in the first instance have been relieved by bleeding, yet should the complaint soon return, and especially if the body is much debilitated, a farther loss of blood will not only not relieve it, but will, on the contrary increase it. In many cases the usual remedies may be employed with advantage; but there are others in which the complaint is continued from habit, which must be interrupted by every thing that can improve the general health; and, with this view, I have several times given, with success, from half a drachm to a drachm of powdered bark every four hours; at the same time allowing a generous diet, with the use of wine. I have often thought malt liquor prejudicial.

Instead of dizziness, or accompanied by it, some people will have a very confused sensation in the head, attended with debility of body, restlessness, palpitations of the heart, and mental irritation, almost amounting to insanity; which I have known to be cured by the same means." 260.

Of course, dizziness is a symptom of several conditions of the cerebral or other systems. The inexperienced surgeon or physician must not rashly

follow Mr. Swan's advice. Proper care must be exercised in discriminating

cases.

When children, says our author, are affected with a disordered state of the digestive organs, or worms, squinting is frequently produced, in consequence of the impaired action of the abductor muscle, through an affection of its nerve produced by its communication with the sympathetic.

We will not follow Mr. Swan through his devious pursuit of the functions of the lenticular ganglion. His reasoning is ingenious, and his suppositions may be just.

In treating of diseases of the gustatory nerves, Mr. Swan observes, and he quotes a case in point from Sir Everard Home, that these nerves are sometimes violently bruised between the teeth, and that loss of the sense of taste has been the consequence. In a woman who was bitten on the tip of the tongue by a wasp, the part became swollen and very painful, and she lost the gustatory sense for a week. Mr. Swan also alludes to the wellknown circumstance, that taste is rendered imperfect, by obstruction to the passage of air through the nostrils. But we cannot admit his explanation to be a happy one. He supposes that the absence of taste is produced by the air, which should pass through the nose, being carried between the tongue and the palate, and keeping those parts too much asunder. A simple expe riment may convince any one that this is not a necessary consequence of obstruction of the nasal passage, and a more philosophical rationale of the circumstance may be found, in the consideration of the compound nature of taste. It is proved that this consists of the impression produced by sapid substances on the tongue, and, perhaps, upon the palate; and of the odour of the substance, or some sensible quality, appreciated in the nares. The obstruction of the passage of air through the latter prevents the develope ment of this species of sense, and impairs, in that ratio, the general function of taste.

Mr. Swan occupies twenty-two pages with diseases of the auditory nerves, or rather with some observations upon deafness. These are not arranged with sufficient precision to enable us to lay their substance before our readers, in the space which the pressure of other articles permits to dedicate to this. Yet we will endeavour to select the most novel or peculiar.

He first relates a case in which, after an injury of the head, and the flow of much blood from the right ear, accompanied with insensibility, permanent deafness of that ear ensued. He supposes that the auditory nerve was greatly injured or destroyed.

The characters of nervous deafness next occupy his attention.

ness.

"The functions of the auditory nerves may be impaired so as to produce deafWhen this is the case, the patient finds he cannot hear sounds that he was accustomed to, and is at the same time tormented with various noises, which are compared to the undulations of the sounds of bells, humming of bees, waterfalls, &c, and if the complaint increases, he becomes so deaf as not to hear at all without the greatest difficulty."

"The noises attending nervous deafness, likewise attend diseases of the external auditory meatus, as when it is filled with hardened cerumen, and likewise when there is a diseased state of the membrane lining the meatus. When there are noises with a loss of the sense, and the external auditory meatus and the membrane of the tympanum have every appearance of being in a healthy state, if the patient stops his nose and mouth and blows downwards, and feels that

peculiar sensation which every one does when the Eustachian tubes are perfect, and if a watch cannot be heard except very faintly, when it is in contact with the head, face, neck, or teeth, we may be certain that the disease is in the nerve." 269.

We fear we know too little of the real functions of the different component parts of the auditory apparatus, to enable us to acquiesce, without misgivings, in the foregoing positive annunciation. We conceive that, when the argument is fairly weighed, its value amounts to little more than this, that in the cases described by Mr. Swan, the external meatus and the membrane of the tympanum are probably not concerned in the production of the deafness, and that it is certainly not dependent on obstruction of the Eustachian tube. Beyond this, we see no certainy nor safety.

The treatment recommended by Mr. Swan, in cases of this nature, consists of mercurial purgation, with antiphlogistic regimen, and the application of blisters behind the ears. The patient should be bled, when symptoms of fullness of the cranial circulation are present.

Mr. Swan has some ideas, or rather some suspicions, on the action of the branches of the glosso-pharyngeal nerve, distributed upon the tympanum, which, although more fanciful than likely to produce conviction, may not be unworthy of the notice of the scientific reader.

"In tracing the tympanine branch of the glosso-pharyngeal nerve, which has been so particularly described by Jacobson, much of its distribution may be seen on the transparent membrane lining the tympanum when this part is perfectly sound, but when it is diseased a very considerable difficulty is experienced. In an attempt to trace this nerve in the head of an old woman, the membrane lining the tympanum was not only thickened, but there was at the same time some roughness of the bone. In the head of a man, who had a suppurating node on the forehead, and whose posterior nostrils were stopped up by adhesions of the soft palate, this membrane was also thickened; the spheno-palatine ganglion was very considerably enlarged. In the dissection of the head of a very young woman, the Schneiderian membrane, covering the inferior turbinated bone of the left nostril, adhered very considerably to that of the septum, so that a very little passage was left for the air; there was a perforation in the membrane of the tympanum of the same side, and purulent matter was contained in each tympanum. The membrane lining the tympanum was so much thickened, that the nerves could not be observed.

I believe deafness does not so often depend on a disease of the auditory nerve as has been supposed, but much more frequently on an inflammatory action attacking the membrane lining the tympanum, and involving these small branches of the tympanine nerve. There are very few deaf people who cannot hear music or singing, or who cannot hear conversation, whilst they are in a carriage in motion. But it is not so with those who are nearly blind, for when the optic nerve is paralysed, no light, or any modification of it, can produce perfect sight, and it must be the same with the auditory nerves with respect to sound. I will not deny that a very strong light may enable a person who has a slight degree of vision to see some objects almost in the same manner as a very deaf person hears with a speaking trumpet. I believe, therefore, that deafness depends very frequently on the inflammatory action which has impaired these minute branches of the glosso-pharyngeal nerve, distributed on the tympanum; and although many of the noises may depend on the disordered functions of the auditory I nevertheless think they may arise, too, from these small branches of the glosso-pharyngeal, and their communication with the sympathetic in the carotic canal." 271.

nerve,