- Email: [email protected]
OBSERVATIONS ON CHOREA.
LONDON, SATURDAY, MAY OBSERVATIONS ON CHOREA.
By EDWARD HARRISON, M.D., F.R.A.S., ED.
[1828-9.
30.
symptoms, are both traceable to this allpowerful organ. After the morbid actions have subsisted long enough to produce structural new
changes,
the
complaint assumes a
character, and requires different
treat-
The former state is exclusively medical, and the latter as entirely surgical. This is the only proper subdivision of the medical profession, and in a science too extensive for the grasp of any human mind, it would conduce to the interests of the sick, and advantage of medical knowledge, to pre. serve the distinction inviolable. With these introductory remarks, I return to the further consideration of chorea. The pathology of this distressing complaint is encompassed with extraordinary difficulties, because all our inquiries into the physical properties of living matter, are of necessity limited in their scope. While the actions are obvious to the senses, the moving power is unseen and often inscrutable. The finest instruments, and most powment.
I HAVE lately published four cases oj chorea in your useful and widely circulating periodical. Each of them was ushered into notice, with a few supplementary remarks, These were intended to prepare the way for what I have to communicate on the subject of spasmodic diseases, and more especially to establish the paramount influence of the spinal nerves over all the functions and operations of living beings. It will, I conceive, be unnecessary, after detailing the cases, and calling the reader’s attention to the new lights which have lately illumined the medical horizon in this department, to employ many words to convince the faculty, that this order of nerves has been too much overlooked in our physiological researches. So far from being reduced erful lenses, are insufficient auxiliaries. to discharge the inferior and subordinate Hence our researches are necessarily imoffices usually assigned to them, we may perfect and discordant. Still, although we with truth aver, that the most important and may be unable to remove the veil, and unfold complicated are under their immediate con- the mysteries of animated nature, we can trol and management. The extensive range, make approaches, and establish some fun. or rather ubiquity of the spinal nerves, is damental truths for our guidance and direc.. well known to anatomists. Even the hard- tion. There is an established principle of the est bones offer no insuperable resistance, because we can not only trace them into nervous system, which will help us to lessen that structure, but perceive, that whenever the obscurity of chorea, and to account for they are hurt, pain, tenderness, and inflam- the remote separation between the seat of mation ensue, from which it is manifest primary irritation, and the muscular spasms, that nerves are spread through them. But which constitute, perhaps, its most embarif nerves are found in the most solid and rassing feature. This principle actuates the series of organs engaged in a common compact substances, their presence is easily detected in soft and vascular parts. Since, and is, more especially, observed then, all our functions, whether we be in the at its extreme points. In whatever part of enjoyment of sound health, or afflicted with the chain the morbid action commences, illness, are dependent upon the nervous sys- the chief sufferingis in the extremities. I tem, it is, in fact, the great regulator of have several times noticed this law of the life. While it remains in good order, the animal economy, when treating of the sympcorporeal functions are duly exercised. ’ toms in particular cases. When it languishes, the body suffers ; and We see a foundatioii laid in the anatomiwhen it fails, death ensues. We must, cal structure of the nervous fabric, for an intherefore, look to the nervous power alone timate communication between the most for the seat of disease, and for the operas remote parts, though we may not be able to tion of all remedies. Whatever may be trace the particular course by which the imthe exciting cause, or however various the pulse i, conveyed, or to dispntanalp it from
, whole
,function,
No. 300.
258 others with which it is inseparably con- the mind. With boys, the tone and modulaDPctèd. I have already drawn largely upon tion of the voice undergo an extraordinary this principle, and slall take occasion to re- change. A down covn’s the chin, which fer to it again and again, in prosecuting the becomes at length a thick and bristly beard, The personal form is more robust. In girls subject of spinal deformity. History of Chorea.—Chorea seizes indis- the mammæ enlarge, and the menses burst criminattly upon the youth of both sexes, forth. In both sexes, the pudenda are clotLed usually between the tenth and fourteenth with hair; the propenstties are no longer year, and harasses them with convulsive the same ; the amusements of the child motions; they are partly voluntary, and are cease to please the youth ; other employ. generally confined to one side of the body, ments and pu;suits are substituted fr them, displaying themselves in ridiculous gesticu- The full development of the genital organs latious of the arms and hands, as well as in usually occupies a series of years. The the patient, rather dragging than lifting up testes iu men, and ovaria in females, gra. The mental dually increase, and, at a certain lrerml of one of his feet in walking. faculties are cccasionalty affected in a expansion, become capable of forming apeI’hts secretion, so necessary , culrar. fluid. slight degree. Diagnosis.—The muscular exiiibitions in to the continuation of the species, produces chorea are conspicuous and apparent at the very important effects upon the individuals first glance. The absence of fever, of coma, who furnish it. Severa,l complaints disap. or delirium, and of muscular debility, will pear under its influence, and others are sub. always show the real character of the malady,atituted. In delicate habits, nervous dis. and prevent our confounding it with pri- eases often commence at this period, being mary affections of the brain. We must roused into action by the irritation of anew carefully distinguish it from the convulsive excitant. After the constitution is fully ’agitations of the head in old people, from displayed, and the habit has been sometime ’the tremors which follow certain complaints accustomed to the impulse, its nerves are of the brain, and such as proceed from ex- rendered less sensitive, and the diseases so ’cess in venery. Nor must it be mistaken produced gradually disappear. Of these, for the tremulous motions of dram-diinkers, chorea is one of the most common and reor workers in lead, and mercury. markable. It is evident, from many cir. The circumstances most favourable to the cumstances, that the evolution of the geni. display of chorea, are infancy, the female tals, and formation of an unusual irtitatien, sex, a delicate and irritable frame, also an operate powerfully upon the nervous fibrils. hereditary or acquired predisposition to The impressions made upon the nervous fibrils, from this and other causes,-being ’spasmodic emotions. The occasional causes are, 1st. Such as carried to the spinal chord, and from it, along act upon the sensonum commune. Of these other nervous branches, to particular musa sudden fright is o’ne of the most common. cles, they are forced to display those spasGusts of passion will frequently induce it; modic actions which we denominate chorea. as do great disappointments, &c. 3dly. Besides impressions directed to the Impressions thus made upon the brain, hav. brain, and nervous expansions, it woulti - iug been conveyed along the meduttaob- seem, that another set of exciting causes, longata to the spinal chord, rouse cettain acting directly upon the spinal chord, or its nervous trunks, and throw their particular nervous trunks in the lumbar region, ocicamuscles, into those extraordmaty gesticula- sionally produces chorea. The first and third cases are, examples of this disease in tions, which are characteristic of chorea. 2d!y. Such as ct upon the minute ner- its perfect form. In both, the chorea mani’vous expansions. Among these may be fested its dependence upon the spinal coenumerated derangements in the stomach lumn. However long the first patient reand bowels, excess in venereal enjoyments, posed upon a flat surface, she continued the odious vice of masturpation. Intestinal well, but after she had remained updght worms likewise occasion it, and, according only a few hours, the chorea returned with to some, the irritation of teething-. Chorea unabated severity. The anxious wotl,er is also the sequel of many disorders, parti- was so fully convinced of its connexion w.th cularly epilepsy and hysteria. In aduition the back, that she expected to remove the ^
jealunsy,
to the causes already mentioned, we ought, predisposition by lengthened recnmbency. I thick, to include a new stimulus formed in After she had made the trial, and been disthe generative organs. At a certain age, appointed in her expectations, she had revaryij,gcoyisiderably in din’c-rent iiidividuals course to my assistance. As a proof of the and countries, a striking alteration com- correctness of her opiniou, the vertebræ mences in both sexc-s, which elll ploys seve- were no sooner replaced than the elserea ral years to comi,l,,te its entire maturation. entirely disappeared, and has never return d. This change is distinguished by obvious In the other instance, its relation to the bodily signs, as well as iu the disposition of spinal chord was equally striking; the chorea
259 had tormented the delicate sufferer for such period before suppuration was esta.
a short
we must, I think, impute its the ir.flammatory action of some tissue within the lumbar theca, or sacram. The phlogistic diathesis irrituting the spinal chord, produced all the distressing symptoms under which she laboured, till the pus burst through one of the sacral holes :* she was then speedily and effectually relieved from all her severe afflictions. That the chorea really proceeded from confined pus, does not, I think, admit of any doubt, because the enclosed fluid was scarcely eva. cuated, before the disease left her, and convalescence became apparent. The suddenness of the transition leads to a conviction of the cause, and justices the opinion I have embraced. Could no further evidence be adduced in favour of the above doctrine, I think these two cases fully warrant the conclusion, that irritations applied directly to the spinal chord and nervous trunks in the ’foramina vertibrarum will, like excitants operating upon the brain and minute ner-
blished, that
origin
to
with more certainty the seat of diswell as to understand the ravages committed upon the frame, and the alterations of structure produced by particular complaints. This is the chief of what we have learned by dissections, and the knowledge thus acquired is of such limited use, that no curative indications can be safely drawn from them alone ; nor can we, wholly ignorant as we are of the composition of the nervous energy in a state of health, presume to point out the alterations which it undergoes, or the functional changes which take place during the choroid manifestations. Inasmuch, then, as we can neither discover the proximate cause of any complaint, by the most attentive dissection, nor penetrate into the laboratory of the nerves, or bring the fabricated material under review, we must be content to study the laws of animated nature, and regulate its aberrations by reiterated experience and attentive observation.
tinguish eases,
as
Tlte indications of cure- are.. 1st. To subthe phlogistic diathesis, if it be present. vous fibrils, sometimes produce genuine learn from the third case, that inflamchorea. action is sometimes the exciting matory Proximate Cause.— Whatever may be cause. When it occurs, it must be comthe primary or exciting cause of chorea, bated with the general and local remedies the altered function, the morbid lesion, or for that purpose. usually employed proximate cause, is always fixed in the spinal 2dly. To remove particular irritations. or of motion. In this subchnrd, organ In order to give full effect to this indicastance, all the remote causes meet, and from tion, we should endeavour to discover the it the symptoms proceed. and the exact spot where it A careful observance of the laws of the exciting cause, is situated, and upon which it chiefly opelivingframe is not only necessary in chorea, rates. Having gained this double but is far superior to the most finished distion, we must proceed accordingly. Mental sections, valuable as they undoubtedly are causes are to be overcome by suitable treatin many respects. They show us, among ment and corporeal irritants, require their other things, how variously we are affected, remedies. The various means and how much we are capable of enduring. appropriate best calculated to effect these different purFurther we cannot advance, because, in poses Ytill occur to practitioners, as the ex* every attempt to trace a regular connexion between symptoms and appearances after amples present themselves. death, many Imks remain conceal-ed, which Sdly. To obviate particular symptoms. our limited faculties are unable to discern. Besides the medicines above recommended, For example, dissection has hitherto reflect- the .state of the intestinal canal should be ed no light upon the essence of fever, though i carefully regulated through the whole disit constitutes the chief part of so many dis- ease. All lodgements must be prevented, eases, and has occupied the attention of and excrementitious matters removed as physicians from the most remote periods to they are formed. This precaution is more the present time. Nor has it led us to a especially necessary when the disorder is better acquaillfance with the nature of erup- situated in the bowels, the generative memtive complaints, of contagions, or of the iu- bers, or other contiguous organs. I have, numerable ailments to which human beings on many occasions, found the happiest efare exposed. It has only taught us to dis- fects to arise from the soothing influence of the warm bath, after other expedients had * In repiy to my inquiries, 1 received failed. It is to he repeated every second or the following answer," 1 cannot venture, at third day, for a few minutes at a time, and the distauce of twelve years, to fix posi- of the temperature most agreeable to tue tively upon the exact spot out of which the patient. In delicate or relaxed constitutions, I pus was disrharbed. llceom:inb to the best of my recollection, it came through the sa- ’., have known the bark and cold bath produce crum from one of its foramina, situated on I the Lest consequences; these, with change the right side." ! f a!r ;nd of temperatule, often effect a cure,
due iWe
-
Informa-
260
when other remedies have been tried and ! much altered in structure ; the other side of the cerebrum, and the whole of the cere. proved inefficacious. Having, for the present, concluded my bellum, were healthy. The spinal chord observations on chorea and puerperal con- was not examined. The fact of the cranium vulsions, I think I am warranted in main- being equally developed on both sides, taining, that the spinal chord and nerves renders it probable that the disease was not possess a greater range of inherent facul- congenital ; and it is very remarkable, that ties than has hitherto been assigned to them. ’, notwithstanding the condition of the brain Whoever will give himself the trouble to afore described, the patient was able to see examine into the truth of my several cases with both eyes, and had some degree of published in your Journal, (and especially in muscular power on the paralysed side.myEssay on Spinal Diseases,") must, as Journ. de Physiologie. to me, arrive at the same conclu- I OF LATERAL CURVATURE OF sion. It is quite apparent, from anatomy THE SPINE. and multiplied experience, that the tary muscles are entirely, and all other parts A French writer, Ur. Verniere, in a short of the body in a great measure, under the treatise lately published on this subject, direction and management of the spinal apreprehends the orthopedic plan, strongly paratus. But if we are once led to admit at present so much in vogue in France that the seat of chorea and of puerperal con- and which consists in keeping vulsions is in this organ, we may find, on the Germany, on an inclined patient lying plane, and pursuing the inquiry, that other convulsive making permanent extension of the spine: disorders referred to the brain, are really this method, he says, even in those few cases affectiots of the spinal column. where an apparent cure is produced, causes such a relaxation of the ligaments, and weakening of the muscles, that the curvature quickly returns, when the patient begins to stand and walk ; he therefore proposes anew FOREIGN DEPARTMENT. method of treatment, viz. that of making tbe patient remain, for the greater part of the day, upon the hands and knees, moving about as ATROPHY OF THE RIGHT HEMISPHERE much as possible ; he admits that this will, at THE BRAIN. first, appear absurd and ridiculous, but mainPIERRE V., aetat. 29, and of middle sta- tains, though his theory is as yet unsupportture, who had been for seven years in the ed by experience, that the weightbeing com. Hospice de Bicêtre, on account of incom- pletely taken off the spine, and the muscles plete hemiplegia of the left side, which was of the back being exercised, both in loco. either congenital, or had come on duringI motion, and in supporting the head, while his infancy, a point which could not be the health is not injured, as it must general ascertained, died there in Feb. 1828, of pul- I necessarily be, by a continued recumbent monary pthisis. There was nothing un- posture, that a permanent cure is more likely usual in the course of the disease, and the to be produced by this method than by any intellectual faculties were uninjured till other that has hitherto been employed or within a few minutes of his dissolution. On proposed. examination of the body, (which was much I However absurd this method may appear emaciated, so that the left leg and arm, at first sight, there is certainly some justice which had been atrophic, were of the same in Dr. Verniere’s remarks, and the experisize as the right,) the lungs were found full ment is well worth we doubt of tubercles and vomicae, and there was hy- whether it would betrying, though to induce any possible pertrophy of the right side of the heart, and person, especially an adult, to remain in enlargement of the liver. The bones of the such a posture for the requisite period. skull had their usual thickness and ccnformation ; on opening the dura mater, a very TREATMENT OF RANULA BY SETON. large quantity of serum escaped, and, on The above remedy has been lately enifurther examination, was found to have ocin this troublesome affection by cupied the situation of the right hemisphere, all that existed of which was a very M. Langier, not with the object of exciting thin layer of greyish pulpy tissue, totally inflammation of the sides of the cyst, but of two permanent openings, which unlike the natural structure of the brain ; the corpus striatum, thalamus opticus, cor- might give free passage to the saliva, and pora quadrigemina, optic end olfactory thus induce its contraction. The seton,a si1k cord, a line in diameter, was innerves, and corpora olivaria and pyramidalia of the right side, were all much smaller troduced with little pain to the patient, and been loosely tied under the tongue, thau on the left, the two first so bard, as to offer some resistance to the scalpel, and worn without causing the least incon.
it appears
volun- TREATMENT
I
OFI
i I
ployed
producing
’single , having; was
By EDWARD HARRISON, M.D., F.R.A.S., ED.
[1828-9.
30.
symptoms, are both traceable to this allpowerful organ. After the morbid actions have subsisted long enough to produce structural new
changes,
the
complaint assumes a
character, and requires different
treat-
The former state is exclusively medical, and the latter as entirely surgical. This is the only proper subdivision of the medical profession, and in a science too extensive for the grasp of any human mind, it would conduce to the interests of the sick, and advantage of medical knowledge, to pre. serve the distinction inviolable. With these introductory remarks, I return to the further consideration of chorea. The pathology of this distressing complaint is encompassed with extraordinary difficulties, because all our inquiries into the physical properties of living matter, are of necessity limited in their scope. While the actions are obvious to the senses, the moving power is unseen and often inscrutable. The finest instruments, and most powment.
I HAVE lately published four cases oj chorea in your useful and widely circulating periodical. Each of them was ushered into notice, with a few supplementary remarks, These were intended to prepare the way for what I have to communicate on the subject of spasmodic diseases, and more especially to establish the paramount influence of the spinal nerves over all the functions and operations of living beings. It will, I conceive, be unnecessary, after detailing the cases, and calling the reader’s attention to the new lights which have lately illumined the medical horizon in this department, to employ many words to convince the faculty, that this order of nerves has been too much overlooked in our physiological researches. So far from being reduced erful lenses, are insufficient auxiliaries. to discharge the inferior and subordinate Hence our researches are necessarily imoffices usually assigned to them, we may perfect and discordant. Still, although we with truth aver, that the most important and may be unable to remove the veil, and unfold complicated are under their immediate con- the mysteries of animated nature, we can trol and management. The extensive range, make approaches, and establish some fun. or rather ubiquity of the spinal nerves, is damental truths for our guidance and direc.. well known to anatomists. Even the hard- tion. There is an established principle of the est bones offer no insuperable resistance, because we can not only trace them into nervous system, which will help us to lessen that structure, but perceive, that whenever the obscurity of chorea, and to account for they are hurt, pain, tenderness, and inflam- the remote separation between the seat of mation ensue, from which it is manifest primary irritation, and the muscular spasms, that nerves are spread through them. But which constitute, perhaps, its most embarif nerves are found in the most solid and rassing feature. This principle actuates the series of organs engaged in a common compact substances, their presence is easily detected in soft and vascular parts. Since, and is, more especially, observed then, all our functions, whether we be in the at its extreme points. In whatever part of enjoyment of sound health, or afflicted with the chain the morbid action commences, illness, are dependent upon the nervous sys- the chief sufferingis in the extremities. I tem, it is, in fact, the great regulator of have several times noticed this law of the life. While it remains in good order, the animal economy, when treating of the sympcorporeal functions are duly exercised. ’ toms in particular cases. When it languishes, the body suffers ; and We see a foundatioii laid in the anatomiwhen it fails, death ensues. We must, cal structure of the nervous fabric, for an intherefore, look to the nervous power alone timate communication between the most for the seat of disease, and for the operas remote parts, though we may not be able to tion of all remedies. Whatever may be trace the particular course by which the imthe exciting cause, or however various the pulse i, conveyed, or to dispntanalp it from
, whole
,function,
No. 300.
258 others with which it is inseparably con- the mind. With boys, the tone and modulaDPctèd. I have already drawn largely upon tion of the voice undergo an extraordinary this principle, and slall take occasion to re- change. A down covn’s the chin, which fer to it again and again, in prosecuting the becomes at length a thick and bristly beard, The personal form is more robust. In girls subject of spinal deformity. History of Chorea.—Chorea seizes indis- the mammæ enlarge, and the menses burst criminattly upon the youth of both sexes, forth. In both sexes, the pudenda are clotLed usually between the tenth and fourteenth with hair; the propenstties are no longer year, and harasses them with convulsive the same ; the amusements of the child motions; they are partly voluntary, and are cease to please the youth ; other employ. generally confined to one side of the body, ments and pu;suits are substituted fr them, displaying themselves in ridiculous gesticu- The full development of the genital organs latious of the arms and hands, as well as in usually occupies a series of years. The the patient, rather dragging than lifting up testes iu men, and ovaria in females, gra. The mental dually increase, and, at a certain lrerml of one of his feet in walking. faculties are cccasionalty affected in a expansion, become capable of forming apeI’hts secretion, so necessary , culrar. fluid. slight degree. Diagnosis.—The muscular exiiibitions in to the continuation of the species, produces chorea are conspicuous and apparent at the very important effects upon the individuals first glance. The absence of fever, of coma, who furnish it. Severa,l complaints disap. or delirium, and of muscular debility, will pear under its influence, and others are sub. always show the real character of the malady,atituted. In delicate habits, nervous dis. and prevent our confounding it with pri- eases often commence at this period, being mary affections of the brain. We must roused into action by the irritation of anew carefully distinguish it from the convulsive excitant. After the constitution is fully ’agitations of the head in old people, from displayed, and the habit has been sometime ’the tremors which follow certain complaints accustomed to the impulse, its nerves are of the brain, and such as proceed from ex- rendered less sensitive, and the diseases so ’cess in venery. Nor must it be mistaken produced gradually disappear. Of these, for the tremulous motions of dram-diinkers, chorea is one of the most common and reor workers in lead, and mercury. markable. It is evident, from many cir. The circumstances most favourable to the cumstances, that the evolution of the geni. display of chorea, are infancy, the female tals, and formation of an unusual irtitatien, sex, a delicate and irritable frame, also an operate powerfully upon the nervous fibrils. hereditary or acquired predisposition to The impressions made upon the nervous fibrils, from this and other causes,-being ’spasmodic emotions. The occasional causes are, 1st. Such as carried to the spinal chord, and from it, along act upon the sensonum commune. Of these other nervous branches, to particular musa sudden fright is o’ne of the most common. cles, they are forced to display those spasGusts of passion will frequently induce it; modic actions which we denominate chorea. as do great disappointments, &c. 3dly. Besides impressions directed to the Impressions thus made upon the brain, hav. brain, and nervous expansions, it woulti - iug been conveyed along the meduttaob- seem, that another set of exciting causes, longata to the spinal chord, rouse cettain acting directly upon the spinal chord, or its nervous trunks, and throw their particular nervous trunks in the lumbar region, ocicamuscles, into those extraordmaty gesticula- sionally produces chorea. The first and third cases are, examples of this disease in tions, which are characteristic of chorea. 2d!y. Such as ct upon the minute ner- its perfect form. In both, the chorea mani’vous expansions. Among these may be fested its dependence upon the spinal coenumerated derangements in the stomach lumn. However long the first patient reand bowels, excess in venereal enjoyments, posed upon a flat surface, she continued the odious vice of masturpation. Intestinal well, but after she had remained updght worms likewise occasion it, and, according only a few hours, the chorea returned with to some, the irritation of teething-. Chorea unabated severity. The anxious wotl,er is also the sequel of many disorders, parti- was so fully convinced of its connexion w.th cularly epilepsy and hysteria. In aduition the back, that she expected to remove the ^
jealunsy,
to the causes already mentioned, we ought, predisposition by lengthened recnmbency. I thick, to include a new stimulus formed in After she had made the trial, and been disthe generative organs. At a certain age, appointed in her expectations, she had revaryij,gcoyisiderably in din’c-rent iiidividuals course to my assistance. As a proof of the and countries, a striking alteration com- correctness of her opiniou, the vertebræ mences in both sexc-s, which elll ploys seve- were no sooner replaced than the elserea ral years to comi,l,,te its entire maturation. entirely disappeared, and has never return d. This change is distinguished by obvious In the other instance, its relation to the bodily signs, as well as iu the disposition of spinal chord was equally striking; the chorea
259 had tormented the delicate sufferer for such period before suppuration was esta.
a short
we must, I think, impute its the ir.flammatory action of some tissue within the lumbar theca, or sacram. The phlogistic diathesis irrituting the spinal chord, produced all the distressing symptoms under which she laboured, till the pus burst through one of the sacral holes :* she was then speedily and effectually relieved from all her severe afflictions. That the chorea really proceeded from confined pus, does not, I think, admit of any doubt, because the enclosed fluid was scarcely eva. cuated, before the disease left her, and convalescence became apparent. The suddenness of the transition leads to a conviction of the cause, and justices the opinion I have embraced. Could no further evidence be adduced in favour of the above doctrine, I think these two cases fully warrant the conclusion, that irritations applied directly to the spinal chord and nervous trunks in the ’foramina vertibrarum will, like excitants operating upon the brain and minute ner-
blished, that
origin
to
with more certainty the seat of diswell as to understand the ravages committed upon the frame, and the alterations of structure produced by particular complaints. This is the chief of what we have learned by dissections, and the knowledge thus acquired is of such limited use, that no curative indications can be safely drawn from them alone ; nor can we, wholly ignorant as we are of the composition of the nervous energy in a state of health, presume to point out the alterations which it undergoes, or the functional changes which take place during the choroid manifestations. Inasmuch, then, as we can neither discover the proximate cause of any complaint, by the most attentive dissection, nor penetrate into the laboratory of the nerves, or bring the fabricated material under review, we must be content to study the laws of animated nature, and regulate its aberrations by reiterated experience and attentive observation.
tinguish eases,
as
Tlte indications of cure- are.. 1st. To subthe phlogistic diathesis, if it be present. vous fibrils, sometimes produce genuine learn from the third case, that inflamchorea. action is sometimes the exciting matory Proximate Cause.— Whatever may be cause. When it occurs, it must be comthe primary or exciting cause of chorea, bated with the general and local remedies the altered function, the morbid lesion, or for that purpose. usually employed proximate cause, is always fixed in the spinal 2dly. To remove particular irritations. or of motion. In this subchnrd, organ In order to give full effect to this indicastance, all the remote causes meet, and from tion, we should endeavour to discover the it the symptoms proceed. and the exact spot where it A careful observance of the laws of the exciting cause, is situated, and upon which it chiefly opelivingframe is not only necessary in chorea, rates. Having gained this double but is far superior to the most finished distion, we must proceed accordingly. Mental sections, valuable as they undoubtedly are causes are to be overcome by suitable treatin many respects. They show us, among ment and corporeal irritants, require their other things, how variously we are affected, remedies. The various means and how much we are capable of enduring. appropriate best calculated to effect these different purFurther we cannot advance, because, in poses Ytill occur to practitioners, as the ex* every attempt to trace a regular connexion between symptoms and appearances after amples present themselves. death, many Imks remain conceal-ed, which Sdly. To obviate particular symptoms. our limited faculties are unable to discern. Besides the medicines above recommended, For example, dissection has hitherto reflect- the .state of the intestinal canal should be ed no light upon the essence of fever, though i carefully regulated through the whole disit constitutes the chief part of so many dis- ease. All lodgements must be prevented, eases, and has occupied the attention of and excrementitious matters removed as physicians from the most remote periods to they are formed. This precaution is more the present time. Nor has it led us to a especially necessary when the disorder is better acquaillfance with the nature of erup- situated in the bowels, the generative memtive complaints, of contagions, or of the iu- bers, or other contiguous organs. I have, numerable ailments to which human beings on many occasions, found the happiest efare exposed. It has only taught us to dis- fects to arise from the soothing influence of the warm bath, after other expedients had * In repiy to my inquiries, 1 received failed. It is to he repeated every second or the following answer," 1 cannot venture, at third day, for a few minutes at a time, and the distauce of twelve years, to fix posi- of the temperature most agreeable to tue tively upon the exact spot out of which the patient. In delicate or relaxed constitutions, I pus was disrharbed. llceom:inb to the best of my recollection, it came through the sa- ’., have known the bark and cold bath produce crum from one of its foramina, situated on I the Lest consequences; these, with change the right side." ! f a!r ;nd of temperatule, often effect a cure,
due iWe
-
Informa-
260
when other remedies have been tried and ! much altered in structure ; the other side of the cerebrum, and the whole of the cere. proved inefficacious. Having, for the present, concluded my bellum, were healthy. The spinal chord observations on chorea and puerperal con- was not examined. The fact of the cranium vulsions, I think I am warranted in main- being equally developed on both sides, taining, that the spinal chord and nerves renders it probable that the disease was not possess a greater range of inherent facul- congenital ; and it is very remarkable, that ties than has hitherto been assigned to them. ’, notwithstanding the condition of the brain Whoever will give himself the trouble to afore described, the patient was able to see examine into the truth of my several cases with both eyes, and had some degree of published in your Journal, (and especially in muscular power on the paralysed side.myEssay on Spinal Diseases,") must, as Journ. de Physiologie. to me, arrive at the same conclu- I OF LATERAL CURVATURE OF sion. It is quite apparent, from anatomy THE SPINE. and multiplied experience, that the tary muscles are entirely, and all other parts A French writer, Ur. Verniere, in a short of the body in a great measure, under the treatise lately published on this subject, direction and management of the spinal apreprehends the orthopedic plan, strongly paratus. But if we are once led to admit at present so much in vogue in France that the seat of chorea and of puerperal con- and which consists in keeping vulsions is in this organ, we may find, on the Germany, on an inclined patient lying plane, and pursuing the inquiry, that other convulsive making permanent extension of the spine: disorders referred to the brain, are really this method, he says, even in those few cases affectiots of the spinal column. where an apparent cure is produced, causes such a relaxation of the ligaments, and weakening of the muscles, that the curvature quickly returns, when the patient begins to stand and walk ; he therefore proposes anew FOREIGN DEPARTMENT. method of treatment, viz. that of making tbe patient remain, for the greater part of the day, upon the hands and knees, moving about as ATROPHY OF THE RIGHT HEMISPHERE much as possible ; he admits that this will, at THE BRAIN. first, appear absurd and ridiculous, but mainPIERRE V., aetat. 29, and of middle sta- tains, though his theory is as yet unsupportture, who had been for seven years in the ed by experience, that the weightbeing com. Hospice de Bicêtre, on account of incom- pletely taken off the spine, and the muscles plete hemiplegia of the left side, which was of the back being exercised, both in loco. either congenital, or had come on duringI motion, and in supporting the head, while his infancy, a point which could not be the health is not injured, as it must general ascertained, died there in Feb. 1828, of pul- I necessarily be, by a continued recumbent monary pthisis. There was nothing un- posture, that a permanent cure is more likely usual in the course of the disease, and the to be produced by this method than by any intellectual faculties were uninjured till other that has hitherto been employed or within a few minutes of his dissolution. On proposed. examination of the body, (which was much I However absurd this method may appear emaciated, so that the left leg and arm, at first sight, there is certainly some justice which had been atrophic, were of the same in Dr. Verniere’s remarks, and the experisize as the right,) the lungs were found full ment is well worth we doubt of tubercles and vomicae, and there was hy- whether it would betrying, though to induce any possible pertrophy of the right side of the heart, and person, especially an adult, to remain in enlargement of the liver. The bones of the such a posture for the requisite period. skull had their usual thickness and ccnformation ; on opening the dura mater, a very TREATMENT OF RANULA BY SETON. large quantity of serum escaped, and, on The above remedy has been lately enifurther examination, was found to have ocin this troublesome affection by cupied the situation of the right hemisphere, all that existed of which was a very M. Langier, not with the object of exciting thin layer of greyish pulpy tissue, totally inflammation of the sides of the cyst, but of two permanent openings, which unlike the natural structure of the brain ; the corpus striatum, thalamus opticus, cor- might give free passage to the saliva, and pora quadrigemina, optic end olfactory thus induce its contraction. The seton,a si1k cord, a line in diameter, was innerves, and corpora olivaria and pyramidalia of the right side, were all much smaller troduced with little pain to the patient, and been loosely tied under the tongue, thau on the left, the two first so bard, as to offer some resistance to the scalpel, and worn without causing the least incon.
it appears
volun- TREATMENT
I
OFI
i I
ployed
producing
’single , having; was