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AN ESSAY ON THE PHYSIOLOGY OF THE NERVOUS SYSTEM.
716 distance, or near the seat of mischief, does not succeed, from the incision being soon attacked with disease, unless it has been arrested in the individual part first affected, and the patient has been separated from all others affected by it. Tenth-The local disease is to be arrested by the application of the actual or potential cautery. An iron heated redhot, or the mineral acids pure, or a solution of arsenic or of the chloride of zinc, or other caustic which shall penetrate the sloughing parts, and destroy a thin layer of the unaffected part beneath them. Eleventh. After the diseased parts have been destroyed by the actual or potential cautery, they cease in a great mea- ’, sure to be contagious, and the disease incurs less chance of being propagated to persons having open wounds or ulcerated surfaces. A number of wounded thus treated are less likely to disseminate the disease than one person in whom constitutional treatment alone has been tried. Twelfth. - The pain and constitutional symptoms occasioned by the disease, and considered as distinct from these symptoms which may be dependent on disease endemic in the country, are all relieved, and sometimes entirely removed, by the destruction of the diseased surface; which must however, be carefully and accurately followed to whatever distance and into whatever parts it may extend, if the salutary effect of the remedies is to be obtained. Thirteenth.—On the separation of the sloughs, the ulcerated surfaces are to be treated according to the ordinary principles of surgery. They cease to eliminate the contagious
a
-
principle, and do
not
require a specific
treatment.
The constitutional or febrile symptoms, Fourteenth. whenever or at whatever time they occur, are to be treated according to the nature of the fever they are supposed to represent, and especially by emetics, purgatives, and the early abstraction of blood if purely inflammatory, and by less vigorous means if the fever prevailing in the country is of a different character. Fifteenth.-The essential preventive remedies are separation, cleanliness, and exposure to the open air-the first steps towards that cure which cauterization will afterwards in -
general accomplish. AN ESSAY ON THE
PHYSIOLOGY OF THE NERVOUS SYSTEM. WITH AN EXPOSITION OF CLAIMS TO PRIORITY OF
BY ALEXANDER AUTHOR
OF,
WALKER,
"NERVOUS SYSTEM," WOMAN," "INTERMARRIAGE," &c.
WORKS ON THE "
DISCOVERY, &c. "BEAUTY,"
(Continued from page 691.)
CASE 4.--Destruction of a great par°t of the Spinal Marraw, (the Postcrior Columns of the Cord,) with Cont2-action of the Arms, and Perfect _Mobility cf the Lower Lirrzbs. By M. RULLIER, M.D. From the Journ. de Physiol, Expé-r.," t. iii.,Avril,1823. -Of this, M. Magendie says, " The case which we are about to give 4s one of the most remarkable furnished by pathological anatomy." At about thirty-four years of age, the patient, Mr. L-, began to feel difficulty in the movement of his arms, soon requiring some help in putting on or off his coat, and he was not long in suffering pain and numbness in a slight deviation, which had appeared in the dorsal region of his vertebral column, and which had previously led to the elevation of his right shoulder. That affection, after some long remissions, made rapid progress, and the patient suddenly lost the use of his arms. Falling by accident with his face towards the ground, he remained in that position without being able by his arms to raise himself till some one came to his assistance. His hands, especially since that time, stiff, bent involuntarily, and
turned so that their palms were directed outwards and Lacl:wards. From the time of that fall, the patient, reduced to absolufe impotence as to both arms, did not enjoy a moment of health. from the tumour formed by the spine; that tumour increased insensibly; the shoulders, principally the right, were raised, and the head sank between them. The patient, who could not in walking prevent the balancing of his arms, speedily presented the double appearance of hump-back and a puppet. Medical treatment was to no purpose; though, with the exception of the arms regarded as a whole from the shoulders to the hand, all the parts enjoyed their voluntary motion. The patient walked about on foot. He could even, a short while before his death, go out without fatigue, and cause himself to
permanently contracted, were
He suffered
be conducted, at different times, to the outer Boulevards for little promenade. The contracted parts preserved all their tactile sensibility. The hands ceased to touch only because they were deprived of motion, but they were, as well as the rest of the limb, sensible to all the differences of external temperature, and to the slightest contact. It was on the 5th of October, 1822, that M. Rullier was called to this patient. The voluntary motions continued in the lower limbs. (There is no mention of the state of sensibility in these parts.) The patient placed on his legs coulcl walk and make little excursions a short while before his death, which took place on the 31st of the same month. The fibrous canal of the spine was laid open in all its extent by MM. Piedaguel and Leconteux, in the presence of M. Magendie, thirty hours after death, by raising from it the spinous apophyses and laminæ of the vertebræ; the spinal marrow did not undergo in its canal any sort of compression, it turned only like the spine itself in the dorsal region. The spinal marrow, examined -%Nitli care, in its place, and on its posterior surface, appeared in the natural state at its upper extremity, from its origin to the fourth pair of cervical nervesThe two inferior thirds of its dorsal part were equally in a sound state, but between these two portions—that is, to the extent of about six or seven inches, comprised between the two inferior thirds of the cervical region and the superior third of the dorsal region inclusively, and corresponding to eight or nine pairs of nerves, that part presented the most remarkable alteration: It was of drffluent softness, so that the canal formed by the dura mater seemed filled by a real liquid, which was directed in obedience to its weight, sometimes upwards, sometimes downwards, according to the direction in which the body was inclined; but that flow which swelled in both these directions the envelope of the spinal marrow stopped precisely at the parts of that organ which preserved their natural state. A little opening effected in the dura ma.ter permitted immediately to now out a great quantity of the liquid; when we had divided that membrane, we saw the spinal marrow, covered with its proper membrane; it was of a reddish grey, very soft; it presented a sensible fluctuation, and the opening of its membrane permitted to flow out a liquid mixed flakes of medullary matter. We afterwards opened with littleand largely, by a longitudinal incision, that part of the marrow which presented an oblong cavity filled with a sort of fluid of reddish-grey colour, in which were disseminated a, great number of bloodvessels of great tenuity. Ve scarcely saw in the anterior part of that altered portion the medullary cords in connexion with the corresponding roots of the spinal nerves. On the left side, the interrupted column was no longer marked for about an inch and a half,but by lenticular portions of medullary matter, placed in succession of each other in the line of its direction; that disposition appeared to us always toresult from the flow of matter which took place in the same situation by means of a little accidental opening effected in the middle part of the membrane, or by pulling the marrow. The spinal marrow, detached and raised from its canal,. could be examined on its anterior region, Here the alteration which we have been describing was much less sensible; the diffluence was not superficial, was not to be seen externally,. and the flow of the matter by the opening made had diminished the volume and removed the appearance of fluctuation; the medullary cords, corresponding to the fillets of origin of £ the anterior branches of the spinal nerves, were apparent, and presented no interruption in their continuity, with the exception of the left, which was altered, as we have said. We traced them on the whole extent of the spinal marrowy even. into the medullary tissue from which they arise.* Attentive dissection showed that the disposition and the structure of the origin of the spinal marrow, and of its superior part to the fourth pair of cervical nerves, presented nothing particular. Backwards, the inferior portion of the fourth ventricle, and the posterior pyramids, before the pyramidal and olivary eminences, presented their well-known configuration.In seeking with care for the origin of the spinal nerve, we convinced ourselves that its most inferior originating fillets evidently corresponded to the destroyed portion of the spinal. marrow.
The structure of the whole of the part situated above the pair of cervical nerves was sound; the medullary sub-
fourth
* The aspect of that part of the spinal marrow was such that all the assistants exclaimed that there was a dropsy of the spinal marrow; in the proper colour of that part had disappeared, and was replaced byr reality, an almost colourless liquid, in which floated to and fro small flakes of the medullary matter.
717 its
ordinary whiteness and consistence; but that consistence and whiteness changed suddenly. It seemed as if the spinal marrow were converted into a ccllulosity, infiltrated with a rose-coloured, pale serosity to the sixth cervical pair, a place in which there existed only a large cavity, whose walls were formed only by the muscular and serous membranes of the spinal marrow, and the remains of the medullary matter. That disorganization was remarked to the fourth pair of dorsal nerves, but the alteration plunged ’ in the manner of a cone in the middle of the medullary substance, which reappeared there with its natural properties. The eight inferior inches of the organ presented no alteration. Some nerves were dissected and traced, those of the brachial plexus in particular, as corresponding to the disorganization ; they were found without alteration, as well as their ganglia. ’ The brain in this case, saysM. Longet, was sound. The spincal marrow had not undergone any sort of compression; it turned only like the spine itself in the dorsal region. In an extent of about six to seven inches, (posterio2, part,) comprised between the two inferior thirds of the cervical region, and the superior third of the dorsal region, inclusively, and corresponding to eight or nine pairs of nerves, the spinal marrow We scarcely saw, at the anterior was softened and diffluent. part of that altered portion of the spinal marrow, the medullary cords in connexion with the corresponding or anterior roots. On the left, the anterior column was no longer marked to the extent of about an inch and a half, but by lenticular portions of the medullary matter placed in sequence of each other in the line of its direction. That alteration was much less sensible when we looked at the spinal marrow on its anterior side. The medullary cords corresponding to the anterior roots of the spina.l nerves were apparent, and presented no interruption in their continuity, with the exception of the left, which was altered as we have just said. The structure of all the part situated above the fourth cervical pair was untouched ; the eight inferior inches of the organ presented no
stance
possessed
below that
point,
and the sensitive functions to amount of morbid structure.
an
extent
proportionate
to the
" Pathological observations, then, appear to warrant the conclusion that the antero-lateral columns are compound in function, both sensitive and motor, (by which they would have directly opposed motions going on in the same fibres!) but they do no not justify us in attributing sensitive power to the posterior columns. " We think that the phenomena of disease may be referred in support of our view. 7M nzany cases where the _principal symptom has been a gradually increasing difficulty of walking, the posterior columns have been the seat of disease. We may notice two kinds of paralysis of motion, distinguished respectively by impairment or loss of voluntary motion, and of the power of co-ordinating movements. In the latter form, while the voluntary powers are considerable, tli,-. patient walks with great difficulty and a gait so tottering, that the centre of gravity is
to
I
easily displaced. "All
cases on
record which
principles.
have had the
opportunity of
is the following:—That the antei,o-late2-al columns of the spinal co2-d with the grey matter, are, in connexion with the brain, the recipients qf sensitive impressions and volitional impulses, and that they are the centres of the independent our physical nervous actions of the cord, and that the posterior columns propagate the influence of that part of the encephalon (the cerebellum) which combines with the nerves of vo’ition to regulate the locomotive power·s," (this I stated even so far back as 1809, and repeatedly since that period,)" and serveas connnissures in harmonizing the actions of the several segments of the cord." Seafield, Leith, 1848.
alteration.
Remarks on this case by M.Magendie.—There was here, then, an almost complete isolation of the upper and lower parts of the spinal marrow, and this to an extent of six or seven inches; nevertheless, the will exercised its influence on the lower limbs. The contraction of the upper limbs, with the continuance of sensibility, deserves also to be borne in mind; for the posterior columns of the spinal marrow, or the seat particularly of sensibility, had disappeared, for all the pains which furnish the brachial plexus. Thus the sensibility of the arms could not have had its ordinary source-that is to say, that which is in relation with the posterior roots. To resume, we may repeat that the case of M. Pullier shows us that we have much to learn respecting the functions of the spinal marrow; and that ought to interest the persons who study pathological anatomy not to omit the opportunity of examining that part, and even of preserving it, when it shows any lesion. Note by -zlrr. Walker.—There are filaments communicated between the contiguous posterior roots of the spinal nerves; and this explains the only difficulty in the preceding case of M. Rullier, which would be inexplicable on M. Magendie’s
we
examirzing, in which the posterior columns were the seat of disease, began by evincing more or less disturbance of the locomotive powers, and it seems to us that the degree to which sensibility may become affected will greatly depend upon the extent to which the posterior roots of the nerves are involved in the disease. " The hypothesis, then, which we are most disposed to adopt,
ON THE
TREATMENT OF REMITTENT AND INTERMITTENT FEVERS IN THE WEST INDIES.
(IN
A
SERIES
OF
PAPERS.)
III.—On Some Points of Treatment in Late Stages of Fever. BY DANIEL BLAIR, M.D., George Town, Demerara. IN remittents or continuous intermittents, wherein the paroxysms are imperfect, and occur so closely on each other as scarce to leave an interval, and where the period for the administration of the quinine or quinine and calomel has gone by, other remedies of much efficacy come into use. The continuous intermittents referred to generally occur among those of irregular and intemperate habits or of feeble constitution; and during the warm, close, humid weather of the great rainy season and the succeeding month, the disease is most liable to become congestive or typhoid. The whites are more subject to this form of disease than the blacks, and the coolies than the negroes. When the eyes are heavy, sunken, and hazy with muscosities, the skin warm and dry, and the pulse tolerably developed, sordes on the teeth, and the tongue (whether clean or sordid, rough, glabrous, or spinous) dry and baked in appearance, with or without torpor or typhonrania, one grain of camphor, with ten grains of nitrate of potash, hourly, will generally in twenty-four hours improve all the symptoms, but most markedly the tongue, rendering it moist. Green tea forms a good article of aliment in these cases. If, notwithstanding the moisture of the tongue, the other symptoms remain stationary, half an ounce each of the old spirit of Mendererius and camphorated water should be substituted for the nitre and camphor till the skin becomes cool and moist. If the skin be shrivelled, cool, and moist, and the pulse weak, and the rest of the symptoms are simply adynamic rather than typhoid, striking advantage results from the combination of musk with ammonia, two or three grains of each
General Remark on these four Cases,—Thus, all the four preceding cases, collected from different sources, and by different individuals, show the effects of the destruction of the posterior columns in loss of motive power, while sensibility remained perfectly intact-circumstances which are quite consistent with the anatomical fact and its physiological consequences, that the motor nerve, the nervus accessorius, arises from the posterior columns, and with the motor muscles of the eye, being supplied by nerves similarly derived. All tends to prove that the posterior columns are motor, as clearly as it is already shown that the anterior are sensor, and are alone capable of exciting the posterior to act. Thus, as I said in 1809, the anterior columns and nerves are sensor, and the columns and nerves are motor ones; and all delay posterior in acknowledging this discredits only the person sp delaying. hourly.
Occasionally, symptoms indicating the camphor and nitre associated with an affection of the membranes of the brain, which, if unrelieved, may end fatally by effusion under the
are " We are not aware," say Todd and Bowman, " of any well-observed case, in which the motor power persisted after extensive lesion of the antero-lateral columns; on the contrary, we believe it may be laid down as the general rule, that lesion of those columns always impairs both the motor
arachnoid. The patient may make no complaint, and marked manifestations of this condition may be absent; but its presence is to be suspected when there is unusual heat of head, pain in it, excited by rotation, sottishness of countenance
a
-
principle, and do
not
require a specific
treatment.
The constitutional or febrile symptoms, Fourteenth. whenever or at whatever time they occur, are to be treated according to the nature of the fever they are supposed to represent, and especially by emetics, purgatives, and the early abstraction of blood if purely inflammatory, and by less vigorous means if the fever prevailing in the country is of a different character. Fifteenth.-The essential preventive remedies are separation, cleanliness, and exposure to the open air-the first steps towards that cure which cauterization will afterwards in -
general accomplish. AN ESSAY ON THE
PHYSIOLOGY OF THE NERVOUS SYSTEM. WITH AN EXPOSITION OF CLAIMS TO PRIORITY OF
BY ALEXANDER AUTHOR
OF,
WALKER,
"NERVOUS SYSTEM," WOMAN," "INTERMARRIAGE," &c.
WORKS ON THE "
DISCOVERY, &c. "BEAUTY,"
(Continued from page 691.)
CASE 4.--Destruction of a great par°t of the Spinal Marraw, (the Postcrior Columns of the Cord,) with Cont2-action of the Arms, and Perfect _Mobility cf the Lower Lirrzbs. By M. RULLIER, M.D. From the Journ. de Physiol, Expé-r.," t. iii.,Avril,1823. -Of this, M. Magendie says, " The case which we are about to give 4s one of the most remarkable furnished by pathological anatomy." At about thirty-four years of age, the patient, Mr. L-, began to feel difficulty in the movement of his arms, soon requiring some help in putting on or off his coat, and he was not long in suffering pain and numbness in a slight deviation, which had appeared in the dorsal region of his vertebral column, and which had previously led to the elevation of his right shoulder. That affection, after some long remissions, made rapid progress, and the patient suddenly lost the use of his arms. Falling by accident with his face towards the ground, he remained in that position without being able by his arms to raise himself till some one came to his assistance. His hands, especially since that time, stiff, bent involuntarily, and
turned so that their palms were directed outwards and Lacl:wards. From the time of that fall, the patient, reduced to absolufe impotence as to both arms, did not enjoy a moment of health. from the tumour formed by the spine; that tumour increased insensibly; the shoulders, principally the right, were raised, and the head sank between them. The patient, who could not in walking prevent the balancing of his arms, speedily presented the double appearance of hump-back and a puppet. Medical treatment was to no purpose; though, with the exception of the arms regarded as a whole from the shoulders to the hand, all the parts enjoyed their voluntary motion. The patient walked about on foot. He could even, a short while before his death, go out without fatigue, and cause himself to
permanently contracted, were
He suffered
be conducted, at different times, to the outer Boulevards for little promenade. The contracted parts preserved all their tactile sensibility. The hands ceased to touch only because they were deprived of motion, but they were, as well as the rest of the limb, sensible to all the differences of external temperature, and to the slightest contact. It was on the 5th of October, 1822, that M. Rullier was called to this patient. The voluntary motions continued in the lower limbs. (There is no mention of the state of sensibility in these parts.) The patient placed on his legs coulcl walk and make little excursions a short while before his death, which took place on the 31st of the same month. The fibrous canal of the spine was laid open in all its extent by MM. Piedaguel and Leconteux, in the presence of M. Magendie, thirty hours after death, by raising from it the spinous apophyses and laminæ of the vertebræ; the spinal marrow did not undergo in its canal any sort of compression, it turned only like the spine itself in the dorsal region. The spinal marrow, examined -%Nitli care, in its place, and on its posterior surface, appeared in the natural state at its upper extremity, from its origin to the fourth pair of cervical nervesThe two inferior thirds of its dorsal part were equally in a sound state, but between these two portions—that is, to the extent of about six or seven inches, comprised between the two inferior thirds of the cervical region and the superior third of the dorsal region inclusively, and corresponding to eight or nine pairs of nerves, that part presented the most remarkable alteration: It was of drffluent softness, so that the canal formed by the dura mater seemed filled by a real liquid, which was directed in obedience to its weight, sometimes upwards, sometimes downwards, according to the direction in which the body was inclined; but that flow which swelled in both these directions the envelope of the spinal marrow stopped precisely at the parts of that organ which preserved their natural state. A little opening effected in the dura ma.ter permitted immediately to now out a great quantity of the liquid; when we had divided that membrane, we saw the spinal marrow, covered with its proper membrane; it was of a reddish grey, very soft; it presented a sensible fluctuation, and the opening of its membrane permitted to flow out a liquid mixed flakes of medullary matter. We afterwards opened with littleand largely, by a longitudinal incision, that part of the marrow which presented an oblong cavity filled with a sort of fluid of reddish-grey colour, in which were disseminated a, great number of bloodvessels of great tenuity. Ve scarcely saw in the anterior part of that altered portion the medullary cords in connexion with the corresponding roots of the spinal nerves. On the left side, the interrupted column was no longer marked for about an inch and a half,but by lenticular portions of medullary matter, placed in succession of each other in the line of its direction; that disposition appeared to us always toresult from the flow of matter which took place in the same situation by means of a little accidental opening effected in the middle part of the membrane, or by pulling the marrow. The spinal marrow, detached and raised from its canal,. could be examined on its anterior region, Here the alteration which we have been describing was much less sensible; the diffluence was not superficial, was not to be seen externally,. and the flow of the matter by the opening made had diminished the volume and removed the appearance of fluctuation; the medullary cords, corresponding to the fillets of origin of £ the anterior branches of the spinal nerves, were apparent, and presented no interruption in their continuity, with the exception of the left, which was altered, as we have said. We traced them on the whole extent of the spinal marrowy even. into the medullary tissue from which they arise.* Attentive dissection showed that the disposition and the structure of the origin of the spinal marrow, and of its superior part to the fourth pair of cervical nerves, presented nothing particular. Backwards, the inferior portion of the fourth ventricle, and the posterior pyramids, before the pyramidal and olivary eminences, presented their well-known configuration.In seeking with care for the origin of the spinal nerve, we convinced ourselves that its most inferior originating fillets evidently corresponded to the destroyed portion of the spinal. marrow.
The structure of the whole of the part situated above the pair of cervical nerves was sound; the medullary sub-
fourth
* The aspect of that part of the spinal marrow was such that all the assistants exclaimed that there was a dropsy of the spinal marrow; in the proper colour of that part had disappeared, and was replaced byr reality, an almost colourless liquid, in which floated to and fro small flakes of the medullary matter.
717 its
ordinary whiteness and consistence; but that consistence and whiteness changed suddenly. It seemed as if the spinal marrow were converted into a ccllulosity, infiltrated with a rose-coloured, pale serosity to the sixth cervical pair, a place in which there existed only a large cavity, whose walls were formed only by the muscular and serous membranes of the spinal marrow, and the remains of the medullary matter. That disorganization was remarked to the fourth pair of dorsal nerves, but the alteration plunged ’ in the manner of a cone in the middle of the medullary substance, which reappeared there with its natural properties. The eight inferior inches of the organ presented no alteration. Some nerves were dissected and traced, those of the brachial plexus in particular, as corresponding to the disorganization ; they were found without alteration, as well as their ganglia. ’ The brain in this case, saysM. Longet, was sound. The spincal marrow had not undergone any sort of compression; it turned only like the spine itself in the dorsal region. In an extent of about six to seven inches, (posterio2, part,) comprised between the two inferior thirds of the cervical region, and the superior third of the dorsal region, inclusively, and corresponding to eight or nine pairs of nerves, the spinal marrow We scarcely saw, at the anterior was softened and diffluent. part of that altered portion of the spinal marrow, the medullary cords in connexion with the corresponding or anterior roots. On the left, the anterior column was no longer marked to the extent of about an inch and a half, but by lenticular portions of the medullary matter placed in sequence of each other in the line of its direction. That alteration was much less sensible when we looked at the spinal marrow on its anterior side. The medullary cords corresponding to the anterior roots of the spina.l nerves were apparent, and presented no interruption in their continuity, with the exception of the left, which was altered as we have just said. The structure of all the part situated above the fourth cervical pair was untouched ; the eight inferior inches of the organ presented no
stance
possessed
below that
point,
and the sensitive functions to amount of morbid structure.
an
extent
proportionate
to the
" Pathological observations, then, appear to warrant the conclusion that the antero-lateral columns are compound in function, both sensitive and motor, (by which they would have directly opposed motions going on in the same fibres!) but they do no not justify us in attributing sensitive power to the posterior columns. " We think that the phenomena of disease may be referred in support of our view. 7M nzany cases where the _principal symptom has been a gradually increasing difficulty of walking, the posterior columns have been the seat of disease. We may notice two kinds of paralysis of motion, distinguished respectively by impairment or loss of voluntary motion, and of the power of co-ordinating movements. In the latter form, while the voluntary powers are considerable, tli,-. patient walks with great difficulty and a gait so tottering, that the centre of gravity is
to
I
easily displaced. "All
cases on
record which
principles.
have had the
opportunity of
is the following:—That the antei,o-late2-al columns of the spinal co2-d with the grey matter, are, in connexion with the brain, the recipients qf sensitive impressions and volitional impulses, and that they are the centres of the independent our physical nervous actions of the cord, and that the posterior columns propagate the influence of that part of the encephalon (the cerebellum) which combines with the nerves of vo’ition to regulate the locomotive power·s," (this I stated even so far back as 1809, and repeatedly since that period,)" and serveas connnissures in harmonizing the actions of the several segments of the cord." Seafield, Leith, 1848.
alteration.
Remarks on this case by M.Magendie.—There was here, then, an almost complete isolation of the upper and lower parts of the spinal marrow, and this to an extent of six or seven inches; nevertheless, the will exercised its influence on the lower limbs. The contraction of the upper limbs, with the continuance of sensibility, deserves also to be borne in mind; for the posterior columns of the spinal marrow, or the seat particularly of sensibility, had disappeared, for all the pains which furnish the brachial plexus. Thus the sensibility of the arms could not have had its ordinary source-that is to say, that which is in relation with the posterior roots. To resume, we may repeat that the case of M. Pullier shows us that we have much to learn respecting the functions of the spinal marrow; and that ought to interest the persons who study pathological anatomy not to omit the opportunity of examining that part, and even of preserving it, when it shows any lesion. Note by -zlrr. Walker.—There are filaments communicated between the contiguous posterior roots of the spinal nerves; and this explains the only difficulty in the preceding case of M. Rullier, which would be inexplicable on M. Magendie’s
we
examirzing, in which the posterior columns were the seat of disease, began by evincing more or less disturbance of the locomotive powers, and it seems to us that the degree to which sensibility may become affected will greatly depend upon the extent to which the posterior roots of the nerves are involved in the disease. " The hypothesis, then, which we are most disposed to adopt,
ON THE
TREATMENT OF REMITTENT AND INTERMITTENT FEVERS IN THE WEST INDIES.
(IN
A
SERIES
OF
PAPERS.)
III.—On Some Points of Treatment in Late Stages of Fever. BY DANIEL BLAIR, M.D., George Town, Demerara. IN remittents or continuous intermittents, wherein the paroxysms are imperfect, and occur so closely on each other as scarce to leave an interval, and where the period for the administration of the quinine or quinine and calomel has gone by, other remedies of much efficacy come into use. The continuous intermittents referred to generally occur among those of irregular and intemperate habits or of feeble constitution; and during the warm, close, humid weather of the great rainy season and the succeeding month, the disease is most liable to become congestive or typhoid. The whites are more subject to this form of disease than the blacks, and the coolies than the negroes. When the eyes are heavy, sunken, and hazy with muscosities, the skin warm and dry, and the pulse tolerably developed, sordes on the teeth, and the tongue (whether clean or sordid, rough, glabrous, or spinous) dry and baked in appearance, with or without torpor or typhonrania, one grain of camphor, with ten grains of nitrate of potash, hourly, will generally in twenty-four hours improve all the symptoms, but most markedly the tongue, rendering it moist. Green tea forms a good article of aliment in these cases. If, notwithstanding the moisture of the tongue, the other symptoms remain stationary, half an ounce each of the old spirit of Mendererius and camphorated water should be substituted for the nitre and camphor till the skin becomes cool and moist. If the skin be shrivelled, cool, and moist, and the pulse weak, and the rest of the symptoms are simply adynamic rather than typhoid, striking advantage results from the combination of musk with ammonia, two or three grains of each
General Remark on these four Cases,—Thus, all the four preceding cases, collected from different sources, and by different individuals, show the effects of the destruction of the posterior columns in loss of motive power, while sensibility remained perfectly intact-circumstances which are quite consistent with the anatomical fact and its physiological consequences, that the motor nerve, the nervus accessorius, arises from the posterior columns, and with the motor muscles of the eye, being supplied by nerves similarly derived. All tends to prove that the posterior columns are motor, as clearly as it is already shown that the anterior are sensor, and are alone capable of exciting the posterior to act. Thus, as I said in 1809, the anterior columns and nerves are sensor, and the columns and nerves are motor ones; and all delay posterior in acknowledging this discredits only the person sp delaying. hourly.
Occasionally, symptoms indicating the camphor and nitre associated with an affection of the membranes of the brain, which, if unrelieved, may end fatally by effusion under the
are " We are not aware," say Todd and Bowman, " of any well-observed case, in which the motor power persisted after extensive lesion of the antero-lateral columns; on the contrary, we believe it may be laid down as the general rule, that lesion of those columns always impairs both the motor
arachnoid. The patient may make no complaint, and marked manifestations of this condition may be absent; but its presence is to be suspected when there is unusual heat of head, pain in it, excited by rotation, sottishness of countenance