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of the thorax, or abdomen. Nothing but the disease above described, which had so pressed on the optic nerves at their origin as to have made them as flat as a piece of tape, and thereby occa sioned her loss of sight, which amounted to almost total darkness for some time before she died.

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How far the tap of the cane, almost forty years before, brought on this train of symptoms, it may not be easy to decide, and yet it should seem to have had a part in it, by the pain having never varied from the spot where the blow was originally given.

"Slight Injury to the Head, producing Internal Mischief, and ending fatally Six Years afterward.

"A young gentleman, at twelve years of age, received a rap at school with the edge of a flat ruler, because he was dull at his learning. The blow was on the right side of the head, and a small wound was the consequence, which, for the space of six years, nothing would heal. It then healed, and he very soon afterward perceived that his sight was beginning to fail. In this respect he continued to decline, till at length he became quite blind. Added to this complaint, he now began to suffer from epileptic fits, which most frequently returned upon him every day.

"In the above unfortunate state he was brought up to London to consult Dr. Lettsom and Mr. Heaviside. On examination, there was no particular appearance found in the cicatrix of the old wound, where the blow had been received.

"The only thing that was considered likely to afford any pros pect of real advantage, was the removal of a portion of bone by the trephine, to come at once, if possible, at the seat of the mis chief. This was determined upon, and the operation performed.

"On exposure, the bone was not found diseased, nor even discoloured. On removal of the piece separated by the crown of the trephine, some blood and serous fluid escaped from between the skull and dura mater. This membrane, however, did not appear to have lost its healthy colour. By the next day the pupil of each eye had recovered its natural sensibility, dilating and contracting, according to the degree of light. The blindness unfortunately remained absolute, as before the operation.

"No favorable change took place from what had been done for his relief, but on the contrary his strength hourly decreased, a de. gree of low fever supervened, and on the third day after the appli cation of the trephine, he was seized with an unusually severe fit, and very soon afterward expired.

"Examination.-On opening the head, the cranium was to ap. pearance every where healthy, and so was the dura mater. Below the part where the dura mater had been exposed by the trephine, and consequently opposite the seat of the original wound, the pia mater had evidently suffered from chronic inflammation, but this appearance was circumscribed.

"On cutting into the brain, it was found indurated to a consi

derable

derable degree, and this induration had extended itself, as in the last mentioned case, to the whole of the middle lobe of the cerebrum. It commenced upon the surface of the hemisphere, passing through the brain, down to the basis of the cranium.

There were no other morbid appearances.

"The two last cases are calculated to convey a useful lesson to young practitioners; they show how cautious we should be in venturing an absolute opinion as to the certainty of a person having nothing to apprehend in the future from injury to the head. In the first case particularly, it is extremely curious that a disposi tion to mischief should have remained, as it were, suspended over a part for so many years together, as it seems scarcely warrantable to suppose disease could have actually been going on, during the long period of years of total exemption from pain and inconvenience, which this lady enjoyed.”

Of the next chapter, On some Diseases of the Neck, affec tions of the larynx occupy the first place; and, as we have had several occasions to notice croup in some of our late Numbers, we transcribe the following in the author's own words.

"An inflammation of the mucous membrane lining the cavity of the trachea has been called croup, and, from a certain peculiarity in the sound of the voice being considered a constant attendant, this symptom has been very generally pointed out, as the diagnos tic sign of the disease. The inconstancy of symptoms, however, is such that it may be almost doubted whether there really are any symptoms, that can be absolutely relied upon to point out the existence of particular internal disease. I have seen a case of croup, in which this symptom was wanting, and on this very account, the true nature of the affection was not suspected till it was too late. I have attended in another, where, from the presence of this symp tom, the medical gentleman that was first in attendance was clear the complaint must be croup, and the disorder, which was not croup, was consequently aggravated by the means used for its relief.

"Inflammation of the Trachea,

"The former of these two cases, was in a child about eight years old, who had been attended by a physician of high reputation and much discernment. There were the general symptoms of fever, quick pulse, head-ache, &c. with some oppression, but no pain about the chest. On the turn of the first week, some degree of redness and inflammation took place about the fauces, the tonsils became sloughy, and the tongue lost its former white colour, and became first brown, and then black. At the end of the fortnight, the child was rapidly declining. Respiration then became extremely laborious, and this continued little more than twenty-four hours before the child expired apparently suffocated.

"At the commencement, the common medicines for fever were administered,

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administered, and, when latterly it became an object to raise the strength of the constitution, wine, bark, and opium, were prescribed.

"Examination.-I was requested to be present at the opening of the body, on which occasion the fauces and tonsils were found inflamed. A small slough had nearly separated from the right tonsil; but the opening into the larynx seemed also inflamed, and almost choaked up with mucus. The larynx and trachea were, therefore, removed and laid open, when the whole extent of the membranous lining was found highly inflamed.

"Upon the internal surface of the membrane lining the trachea, and very loosely connected with it, was deposited a considerable quantity of coagulable lymph. This was of a yellow colour, and pulpy consistence, which circumstances might have in some degree depended on its being mingled with a profuse secretion of viscid mucous matter. The coagulable lymph formed an irregular tube within the trachea, while the mucous matter, partly of a purulent colour, and partly clear and transparent, occupied the space within the adventitious lining. The mucous membrane itself, when exposed, was found of the brightest scarlet colour, from high inflammation.

“These appearances extended themselves very far down beyond the bifurcation of the trachea; and even in the smaller branches which the purulent action seemed scarcely to have reached, there was an unusually abundant secretion of mucus, the consistence of which was so viscid and tenacious, that it must have materially hastened the fatal termination of the disease, by preventing the passage of the air, and eventually producing suffocation,

"Spasmodic Affection of the Larynx, supposed to be Croup. "In the year 1812, I was desired to see Master H., a fine child about four years of age. Almost a twelvemonth had passed since the commencement of his complaint. The symptoms had been, extreme difficulty in breathing, with a sort of ringing or stridulous sound in the throat. The medical attendant had at first pronounced it croup, and the usual remedies for that complaint, with blistering, leeching, &c. had been adopted in, vain; indeed, the complaint seemed rather worse than better after them. In the course of a few days, the urgency of the first attack began to abate, and the child soon got the better of it. There had been no well.marked feverish paroxysm throughout, so that the circum stances of most importance were the fulness about the vessels of the head and face, arising from the occasional temporary aggrava, tion of the dyspnoea.

"This little boy, when he had recovered, did not remain very long well; but the return of his disorder proved less severe, and less tedious than it was at first. The presence of the croupy sound in breathing, and the manifest obstruction to the 'transmis sion of air through the larynx and trachea, induced the practi. tioner still to maintain his first opinion of the disease.

In this way the child went on, sometimes better and some. times worse, but occasionally altogether free from his complaint for a month together; until accidentally the father, mentioning, in company, the child having had the croup for so long a time, was fold it was no such thing; for that the croup was an acute disease, and always ran its course very rapidly, Soon after this, under the idea that the complaint had been misunderstood, I was requested to see the child; whom I found in every general respect healthy, There was, however, still some difficulty in breathing, dependent evidently on an obstruction about the larynx. The complaint was much better in clear and dry, than in close and moist weather; and, on inquiry, I found that affections of mind, particularly anger and passion, never failed to aggravate it most materially; and, that if the child was contradicted, or corrected, the dyspnea became invariably so much worse, that he would quickly become black in the face, and frequently remained in that state for an hour, or more.

"Under the impression that the affection was purely spasmodic, I prescribed a mixture with bark, opium, and æther, in a light form, to be regularly given. By this plan, the complaint, in a few days, became evidently better, and in the course of a fortnight was completely and permanently removed."

We have some suspicion, that the first of these cases was the effect of cynanche maligna; at least, we have seen all these symptoms in a subject where the rest of the family had scarlatina. Dr. Heberden, in his Commentaries, has a similar remark.

As to the second, we confess ourselves not easily satisfied with the hackneyed expression of spasm or spasmodic affec tion, we should rather impute the symptoms to a slighter inflammation, which had become chronic, or was readily excited from very slight causes. Under such circumstances, inflammation is kept up by debility, and the remedies prescribed were very likely to relieve it, as we often find in chronic ophthalmia. Two cases follow of croup, or inflame mation in the trachea in grown people of cases similar to these, we have lately said so much, that, we shall detain our readers only to express our satisfaction at the following remark of Mr. Howship.

"From observation, I should say that, in all probability, spasm of the muscles of the glottis, is much less frequently concerned in the fatal event of these complaints, than was supposed by Dr. Cullen; although, with a candor worthy of so great a man, he admits, that he never succeeded in relieving the symptoms by the use of antispasmodic remedies."

Cases of abscess in these parts follow; such, also, have lately come under our consideration. Two cases of enlarge ment of the lymphatic glands of the neck, are related as the

effect

effect of mercury; the first suppurated, and was rather the consequence of an irritable habit, induced by mercury and an irregular mode of life. The author remarks, that the thyroid gland is rarely affected with acute inflammation. Two instances are, however, related; one of which advanced to suppuration and the patient recovered. Some affections of the external parts of the chest follow; among the rest, a very painful condition of the sternum is detailed with much interest. We should suspect the whole was inflammation seated in the cartilaginous part, as it is well known, that cartilage is a substance which will bear very considerable inflammation without suppuration. When the disease is seated in the bone, abscess is likely to follow; such is the second case referred to by Mr. Howship. We are surprised to meet with so few instances of inflammation of the heart, and still more at the author's scepticism relative to the frequency of the disease. That palpitations often occur, and even pains described by the patient as seated in that organ, without any real disease, cannot be questioned; but, if we were to give our opinion, we should consider carditis and its consequences as more frequent than is generally suspected. Mr. Howship remarks, that he has dissected only three instances of malformation in the heart: these were, however, all of them somewhat similar, yet by no means common occurrences. In all three the aorta communicated with both the ventricles; this produced the usual consequences of irregular circulation-dyspnoea and purple skin. In two, the author remarks, that the heat of the body varied with the complexion of the skin. It is much to be regretted that this was unnoticed in the third subject, who lived to the age of sixteen years.

The remarks on the diseases in the pulmonary system are well digested and judiciously related; some of the cases are, as the author calls them, singular; but, as these could neither be suspected, nor relieved if known, we shall confine our extracts to such as are more frequent, more easily detected, and capable of relief.

"Inflammatory action in the lungs, as in other parts of the body, varies in intensity, and, as it becomes less acute, or more local, its characters change; and that which was originally a gene ral affection of the lungs, may become new modelled, assuming the characters of a local affection only, perhaps without pain, or other constitutional sympathy.

"Dr. Cullen mentions an effusion of blood into the general cellular texture of the lungs, as one of the occasional consequences of acute inflammation. I have examined the lungs after death in many cases of inflammation, but have never found this appearance. In

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