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provement upon it has failed! We are ready to admit that Dr. Jones may have led to this error by assuming that the obliteration of the artery is the mere effect of the adhesive inflammation excited by the rupture of the internal coat. Still, however, the experiment should have been correctly conducted, and without any fancied improvements.
Let us remark, that the permeability of the artery, after the application of the ligature, is insisted on as absolutely „necessary for the success of the operation. How can this be the case, if adhesion is the only process we are inducing? Next we have seen that the bare exposure of an artery, without the application of any ligature, is enough to induce its contraction. Are we not, then, authorised to conclude that the less injury we do to an artery, provided we excito the stimulus for contraction, the better is the vessel enabled to complete this salutary process? And is it not at least probable that by the continuance of the ligature for six hours, the injury may be such as to incapacitate the artery from a process which must require a degree of power scarcely to be expected after so much violence?
We therefore consider the experiment as unfairly conducted, though with the best intentions, and are even ready to admit that Dr. Jones, by his premature analogical reasoning, may have given rise to this error. Again we repeat it, let us learn what the powers of the arteries are in health and under disease, and not impute actions to causes altogether 'unsatisfactory, if not insufficient. If the reader has taken the trouble to examine our remarks on Dr. Jones's book, he may comprehend us still better.
There are several other passages in the history of this case which are well worth notice. On the first examination of the diseased limb, it was remarked that “the pulsations were strong, with considerable pain in the surrounding parts, extending to the limb beneath; and the circulation in the saphena vein seemed sluggish.” This confirms an observation to be met with in the case of spurious aneurism cured by pressure above the injury, the relater of which suspects that there is a kind of sympathy between arteries and their corresponding veins.* in another passage Mr. H. asks,
“May we not infer from this circumstance, in opposition to the opinion of modern physiologists, that there is a contractile power inherent in the coats of arteries independent of their elastic one?"
* See London Medical Journal, vol. vi. p. 541.
“ + Dr. Jones eertainly leared to this latter opinion, as may be seen by a reference to the Preface of his book, page 4."
This contractile power is proved by Mr. Hunter in more experiments than it would be convenient even to count.*
The last remark we shall make is on the different result of operations on man or on brutes. The various causes of this need hardly be explained. In proportion as the machine is the more complicated, every new operation must be more uncertain: and, when the action of all the restorative powers is required, there cannot be a doubt that despondence and terror must considerably "counteract the calm and uniform progress of nature.'
We shall here close our remarks on securing arteries for the present. It has already led us so far, that we can only, notice the introductory paragraph to the chapter on nem. crosis.
“ As the accompanying plate (says Mr. H.) represents the new osseous shell and sequestra of the most complete and interesting case of necrosis, that, I believe, is to be met with on record: Í have thought that a brief statement of its leading points, with a few remarks on the formation of new bone in this disease, might not be deemed unwortby of consideration, the more especially so, as it is a subject upon which much contrariety of opinion has existed.”
On reading this as the “ best case on record,” and on comparing " ihe plate" with the explanation, it was impossible not to recollect the late Mr. Hunter's lectures on the various diseases of the bones, or the number of specimens he exhibited in illustration of his doctrine. We shall, however, conclude with a most sincere wish-Oh! si tantum ipsum audisses.
An Essay on the Shaking Palsy; by JAMES PARKINSON, Member of the Royal College of Surgeons. 8vo. pp. 66. Sherwood and Co. 1817.
The following apology of the author, contained in his preface, is transcribed on his account, and as a reason for our early notice of the tract.
“ The advantages which have been derived from the caution with which hypothetical statements are admitted, are in po instance more obvious than in those sciences which more particularly belong to the healing art. It, therefore, is necessary, that some conciliatory explanation should be offered for the present publication: in which, it is acknowledged, that mere coujecture takes the place of experiment; and, that analogy is the substitute for anatomical examination, the only sure foundation for pathological knowledge.
“When, however, the nature of the subject, and the circumstances
* See Treatise on the Blood, &c. part i. passim..
under which it has been bere taken up, are considered, it is hoped that the offering of the following pages to the attention of the medie cal public, will not be severely censured. The disease, respecting which the present enquiry is made, is of a nature highly afflictive. Notwithstanding which, it has not yet obtained a place in the classification of posologists ; sowe have regarded its characteristic symptoms as distinct and different diseases, and others have given its name to diseases differing essentially from it; whilst the unhappy sufferer has considered it as an evil, from the domination of which hé bad no prospect of escape.
“ The disease is of long duratiou: to connect, therefore, the symptoms which occur in its later stages with those which mark its commencement, requires a continuance of observation of the same case, or at least a correct history of its symptoms, even for several years. Of both these advantages the writer has had the opportu- i nities of availing himself; and has hence been led particularly to observe several other cases in which the disease existed in different stages of its progress. By these repeated observations, he hoped that he had been led to a probable conjecture as to the nature of the malady, and that analogy had suggested such means as might bę produetive of relief, and perhaps even of cure, if employed before the disease had been too long established. He, therefore, considered it to be a duty to submit his opinions to the examination of others, even in their present state of immaturity and imperfection."
- After this, the reader will consider himself as perusing a few hints which the author is anxious to communicate, in order to learn the opinions of others, and particularly that such practitioners as have an opportunity of inspecting the body of a person dying under the disease may not fail to... communicate the result of his observations.
We shall omit all that is said concerning nosological definition, and at once present our readers with the history of the disease and a case.
“ So slight and vearly imperceptible are the first inroads of tlris malady, and so extremely slow is its progress, that it rarely happens, that the patient can form any recollection of the precise period of its commencement. The first symptoms perceived are, a slight sense of weakness, with a proneness to trembling in some particular part; sometimes in the head, but most commonly in one of the hauds and arms. These symptoms gradually increase in the part first affected; and, at an uncertain period, but seldom in less than twelvemonths or more, the morbid influence is felt in sonie other part. Thus, assuming one of the hands and arms to be first attacked, the other, at this period, becomes similarly affected. After a few more months the patient is found to be less strict than usual in preserving an upright posture: this being most observable whilst walking, but sometimes whilst sitting or standing. Sometime after theappearance of this symptom, and during its slow increase, oner of the legs is discovered slightly to tremble, and is also found to
suffer fatigue sooner than the leg of the other side: and, in a few months, this limb becomes agitated by similar tremblings, and suffers a similar loss of power.
“ Hitherto, the patient will have experienced but little inconvenience; and, befriended by the strong influence of habitual endurance, would, perhaps, seldon think of his being the subject of disease, except when reminded of it by the unsteadiness of his hand, whilst writing or employing himself in any nicer kind of manipulation. But as the disease proceeds, similar employments are accomplished with considerable difficulty, the hand failing to answer with exactness to the dictates of the will. Walking becomes a task which cannot be performed without considerable attention. The legs are not raised to that height, or with that promptitude which the will directs, so that the utinost care is necessary to prevent frequent falls.
“At this period, the patient experiences nuch inconvenience, which unhappily is found daily to increase. The submission of the limbs to the directions of the will can hardly ever be obtained in the performance of the most ordinary offices of life. The fingers cannot be disposed of in the proposed directions, and applied with certainty to any proposed point. As time and the disease proceed, difficulties increase: writing can now be hardly at all accomplished; and reading, from the tremulous motion, is accomplished with some difficulty. Whilst at meals the fork, not being duly directed, frequently fails to raise the morsel from the plate: which, when seized, is with much difficulty conveyed to the mouth. At this period the patient seldom experiences a suspension of the agitation of his limbs. Commencing, for instance, in one arm, the wearisome agitation is borne until beyond sufferance, when, by suddenly changing the posture, it is for a time stopped in that limb, to commence, generally, ių less than a minute in one of the legs, or in the arm of the other side. Harrassed by this tormenting round, the patient has recourse to walking, a mode of exercise to which the sufferers from this malady are in general partial; owing to their attention being thereby somewhat diverted from their unpleasant feelings, by the care and exertion required to ensure its safe performance.
But, as the malady proceeds, even this temporary mitigation of suffering from the agitation of the limbs is denied. The propensity to lean forward becomes invincible, and the patient is thereby forced to step on the toes and fore part of the feet, whilst the upper part of the body is thrown so far forward as to render it difficult to avoid falling on the face. In some cases, when this state of the malady is attained, the patient can no longer exercise himself by walking in his usual manner, but is thrown on the toes and fore part of the feet; being, at the same time, irresistibly impelled to take much quicker and shorter steps, and thereby to adopt unwillingly a running pace. In some cases it is found necessary entirely to substitute ruming for walking; since otherwise the patient, on proceeding only a very few paçes, would inevitably fall.
“In this stage, the sleep becomes much disturbed. The tremulous motion of the limbs occur during sleep, and augment until they (NO. 221.
awaken the patient, and frequently with much agitation and alarm. The power of conveying the food io the mouth is at length so much impeded that he is obliged to consent to be fed by others. The bowels, which bad been all along torpid, now, in most cases, demand stimulating medicines of very considerable power: the expulsion of the fæces from the rectum sometimes requiring mechanical aid. As the disease proceeds towards its last stage, the trunk is almost permanently bowed, the muscular power is more decidedly diminished, and the tremulous agitation becomes violent. The patient walks now with great ditficulty, and, unable any longer to support himself with his stick, he dares not venture on this exercise, unless assisted by an attendant, who, walking backwards before him, prevents bis fàlling forwards, by the pressure of his hands against the fore part of his shoulders. His words are now scarcely intelligible; and be is not only no longer able to feed himself, but, when the food is conveyed to the mouth, so much are the actions of the muscles of the tongue, pharynx, &c. impeded by impaired action and perpetual agitation, that the food is with difficulty retained in the mouth until masticated; and then as difficultly swallowed. Now also, from the same cause, another very unpleasant circumstance occurs: the saliva fails of being directed to the back part of the fauces, and hence is continually draining from the mouth, mixed with the particles of food which he is no longer able to clear from the inside of the mouth.
“ As the debility increases and the influence of the will over the muscles fades away, the tremulous agitation becomes more vehe, ment. It now seldom leaves him for a moment; but even when exhausted, Nature seizes a small portion of sleep, the motion beconies so violent as not only to shake the bed-hangings, but even the floor and sashes of the room. The chin is now almost immoveably bent down upon the sternum. The slops with which he is attempted to be fed, with the saliva, are continually trickling from the mouib. The power of articulation is lost.' The urine and fæces are passed involuntarily; and, at the last, constant sleepiness, with slight delirium, and other marks of extreme exhaustion, announced the wished-for release.
“ CASE 1.- Almost every circumstance noted in the preceding description, was observed in a case which occurred several years back, and which, from the particular symptoms which manifested themselves in its progress; from the little knowledge of its nature, acknowledged to be possessed by the physician who attended; and, from the mode of its termination; excited an eager wish to acquire some further knowledge of its nature and cause.
“ The subject of this case was a man rather more than fifty years of age, who had industriously followed the business of a gardener, leading a life of remarkable temperance and sobriety. The commencement of the malady was first inanifested by a slight trembling of the left hand and arnı, a circunstance which he was disposed to attribute to his having been engaged for several days in a kind of employment requiring considerable exertion of that limb. Although