On some Peculiar Cerebral Affections, and a Case of Hemiplegic Anœsthesia.

365 ere he had proceeded far, he was suddenly seized with a violent pain over the right eyebrow, as if some immense weight were pressing on that part of the brain. This, as far as he himself was able to judge, was unattended with any impairment of the intellect, though naturally with great depression of the spirits. It was speedily succeeded by a numbness and a tingling of the same side of the face and left extremities; and on touching these parts with the hand of the opposite side, they felt somewhat colder. Sensation was soon almost entirely gone; for he could not feel a hard bite on the right side of the tongue or right cheek, nor did pinching the same side of the body cause any pain. VolunIsles. tary motion was not in the least impaired, though the right "One disease, indigestion, holds a particularly prominent hand, owing to its want of sensibility, afforded little assistplace; its prevalence in some one of its Protean forms is so ance in groping along the narrow passages. The difficulty in great, that American patent-medicine vendors never forget it in progression, which might have attended walking in an open their puffs, well knowing that almost every family feels more space, was not remarked in the cave, where, from the character of the place, the steps were short and irregular. That or less interested in procuring the new sovereign remedy. As this disease presents such various forms, it is obvious that the there was no distortion of the face or lameness was manifest ’ universal’ method of treating all its varieties must necessarily, from the fact, that he was able so to govern his movements, in many cases, prove highly injurious. Hence, without doubt, that no person perceived how he was affected; although it it is often aggravated, or even induced, when previously it caused him not a little alarm, both from the strangeness ofexisted only in imagination. In the table, about one-third of the symptoms, and from an apprehension that they might the cases were recent and temporary, arising from ir- result from effusion of pus on the surface of the right hemisphere from the carious temporal bone. The symptoms regularities in diet, &c. " Sporadic cholera occurs more frequently, and in a more detailed lasted for upwards of twenty minutes, until the party aggravated form, than in Britain, whether attacking the left the cave, was again exposed to the warmth of the sun, adult or infant; yet its severity is not so much increased as and began to take active exercise, when sensation entirely might be anticipated from the much greater difference in returned; but the violent headach remained during that and temperature between the day and night in Nova Scotia. I the following clay. The same person subsequentlv, and under have occasionally witnessed as decided rice-water evacua- similar circumstances, had attacks very like that just detions as in the epidemic disease. It is, however, seldom fatal, tailed ; but the symptoms were less marked, and the an2esexcept among infants. Skin diseases, apartfrom the exanthe- thesia was on the opposite side of the body; so also the pain mata, are not of very great importance ; after scabies, I in the head, which was as completely localized over the left psoriasis is the most common, and, together with various other eyebrow, as on the former occasion it had been over the eruptions, is popularly designatedsalt rheum.’ A few cases right. " It is curious to observe, in these cases of anaesthesia, that of lepra recorded were easily cured. Of purpura only two ’, cases have been met with, and both were readily cured by ’, not only does the skin lose sensation, but the mucous memalteratives, aperients, and restoratives." j brane, the muscles, and other part do the same. The mucous membrane of the bladder, insensible to the urine which it contains, does not influence the muscular coat to On some Peculiar Cerebral Affections, and a Case of contraction: hence the urine dribbles away, and a catheter Hemiplegic Anœsthesia. may be introduced into the urethra,, a finger into the rectum, or irritating particles into the eye, without the patient’s By SAMUEL GRIFFITH, Esq., M.R.C.S.E. Lond. IN the first part of his paper, the author gives an account knowledge. The mouth and nose, though they remain susof a series of cases of cerebral affection, which occurred, ceptible to taste and smell, yet do not perceive the stimuli of pungent substances, as ammonia: and a case is related of a during the spring of 1844, at Herne Day, having all the man who, falling with his spade, broke his arm; he heard the characteristics of an epidemic. Not less than fifteen adults but thought it was his spade only that was broken ! in the practice of one gentleman, in a population under 2000, crash, " The causes of anaesthesia may be-1. Sudden exposure and during the space of two or three months, were attacked with various degrees of vertigo, headach, and affections of the to cold, when heated, the susceptibility being increased by debility. 2. The influence of noxious vapours, as sight; several were seized with paralysis more or less com- previous loaded with carbonic acid. 3. Sanguineous effusion. 4. plete, and two with apoplexy. Not one of the whole number air effusion. 5. Effusion of pus on the brain, as from a died; no more than one or two of the whole number required, Serous There were no atmo- carious temporal bone. or could bear, depletory measures. "The three causes last mentioned will not (says the author) spheric phenomena to account for the epidemic, and it was account for the case which has been related, the symptoms of the first time that it had appeared in that locality. The author then adverts to other instances of epidemic cerebral which were too evanescent to be so explained. The two former which would both cause venous congestion, might paraffections-viz., that occurring in Paris in the autumn of causes,account for the attack, but even these do not serve to tially 1828. The second part of the paper is taken up with the conside- explain its hemiplegic character, and the absence of paralysis ration of anaesthesia, which may be either simple, or combined of "motion. with want of power. Simple anaesthesia may be either very Pathology.—Cases of simple anaesthesia are rarely if ever local or general : thus, in some cases, small patches only of fatal: hence no opportunities of making examinations are so interintegument are wanting in their sensibility, while in others, afforded; but the different cerebral affections are woven one with the other, that the pathology of one class as in a case related by Andral, sensation is lost over almost the entire surface of the body. Sauvages relates a case will go far to explain that of another. Apoplexy presents to the case under consideration. involving the whole of the body. At other times, it assumes many points of similarityfrom When this does not result a paraplegic or hemiplegic character; and Mr. Broughton serous, sanguineous, or purudetails a case in which it succeeded to complete paraplegia of lent effusion or softening, which are by no means invariably the lower extremities. Other cases are also related; but its present, congestion is the only morbid appearance visible. most interesting as well as curious form is that in which it This may be either arterial or venous: when the former, the assumes a hemiplegic character. The following are notes of patient has usually been strong and hearty, with vigorous action of the heart, while the symptoms lasted; when the a case of this kind which occurred under the author’s own observation :latter, there is feeble action of the heart, coldness, and an " The patient, about twenty-two years of age, had pre- exsanguined state of the surface, debility, and faintness. viously enjoyed comparatively good health, with the excep- These symptoms were all present in the case above narrated. tion of some severe attacks, when young, of otitis in the right ’, How this venous congestion produces the further symptoms ear, which were followed by caries of the temporal bone, and of anaesthesia, &c., whether by pressure, or by the presence total loss of hearing on that side. At the time of which we of the highly carbonized blood in contact with the brain, now begin to treat, he was somewhat out of health, owing to space will not allow us here to consider." close application to his profession in town. He stated, that The author next dwells on the analogy which exists beafter violent exercise in climbing the Cheddar cliffs, on a tween simple anaesthesia, anaesthesia combined with paralysis warm day at the end of last August, while somewhat heated, of motion, and apoplexy, and the different stages through he went into the cold and damp caves. He felt no chill or which a person passes whilst inhaling ether &c. The treat-

bronchitis, fifty-two cases; pneumonia, forty; while tubercular phthisis stands in the table at fifteen. The last is probably a lower figure than would have occurred in Great Britain, so far as practical knowledge has enabled me to form an estimate. The explanation (allowing it to be the case) does not seem very obvious. It can be hardly accounted for on the supposition that the strumous diathesis is less prevalent here, as that could scarcely be maintained, unless in reference to the large manufacturing towns at home, and among weavers and miners, &c. Probably it depends on the comparative dryness of the atmosphere, which is more agreeable (though in the winter much colder) than the damp rawness of the British

shivering; but

366 ment of a person rendered insensible by ether he considers would be similar to that of a patient labouring under pa-

ralysis from venous congestion.

The paper which is the subject of this analysis was read time ago before King’s College Medical Society, when Mr. G. SMITH narrated a case similar to those mentioned by Mr. Griffith, of a lady who also entered into the cave at Cheddar, in Somersetshire, and after having been a short time there, was seized with vertigo and loss of voluntary motion, and was obliged to be assisted out. Mr. WOOD suggested that therewas an analogy in the of paralysis mentioned by Mr. Griffith, epidemic and the recorded epidemics of chorea. He thought that the existence of disease in the temporal bone might have caused the symptoms, either directly, by extension to the brain, or indirectly, by favouring congestion about it. Mr. GRIFFITH, in reply, stated that only in the one attack at Cheddar was the side affected on which the diseased bone existed; the two subsequent attacks, slighter, however, affected the opposite side. Mr. SALTER believed the symptoms to be attributable to the effect of carbonic acid. He believed that there were at least four epidemics of cerebral disease on record: one happening at the siege of Vienna, when twenty out of twenty-five children were seized with hydrocephalus. In some parts of Germany, more recently, an epidemy of arachnitis had been noticed. Mr. G. SMITH made known, as connected with the subject under discussion, a fact which fell under his observation during the last summer-viz., an epidemic amongst horses in Somersetshire. In one place he knew that three horses, grazing together, were equally attacked with hemiplegia of the left side, but recovered under treatment by bleeding, &c. ’, some

the process, is often a great nervous shock to the system, which, may, in a weak person, prevent the necessary of the uterus or abdominal muscles."

exhaustion, by contraction

Instance of Malposition of the Testicle. Communicated by D. TOD, Esq., London. MR. TOD has forwarded to us the report of this case, in the

words of the individual who was the subject of the anomaly. It appears that when the patient had attained the age of five or six years, he was found to have a tumour in the right groin. This, in the opinion of a physician who attended him, was of a hernial kind, and he was made to wear a truss, and remain in a recumbent position during the period of ten days. Up to that time he had been in the habit of joining in all the plays and games of his age, without experiencing the least pain or inconvenience in the groin; and had the swelling not been detected by his nurse, he considers that probably some time might yet have passed before his own observation would have been called to its presence. From that period to the present, the patient had always worn a truss. At one time he remembers that the tumour invariably descended during the day, and was compressed by the pad. By degrees, however, the swelling kept within the abdomen, and was only forced outwards under great exertion; whilst external, was always very painful. After athletic exertion in particular, to which the subject of the case was addicted, the tumour has descended, and remained in the groin some hours, giving an acute aching pain; but it receded easily into the abdomen upon removal of the truss, and by lying down. During some days, on which the use of the truss was discontinued altogether, the tumour in the groin swelled larger than a pigeon’s egg during the day, receding at night, and producing that aching sensation before named. The circumstance of only one testicle being present in the scrotum had been detected by the patient in youth, and Report of a Case of Placenta Prœvia, and Remarks. he then entertained a suspicion that the tumour consisted of By T. STOKES, Esq., M.R.C.S., Nailsworth, Gloucestershire. the missing organ. He says: "I am now in my thirty-fourth and was married about seven years ago, since which "ON March llth, at three A.M., I was summoned to a young year, I have not experienced the same freedom from annoyperiod in woman labour with her first child. She was attended by a ance so as previously whilst taking severe exercise, completely midwife, and had undergone uterine haemorrhage from ten and have been obliged to increase the force of the truss, in I found my patient deathly cold, and pale, and with r;M. of a greater disposition in the tumour, or, as I consequence no perceptible pulse. The os uteri was dilated but little, and now believe, the testicle, to descend, and of a feeling of inathe placenta implanted over it and the cervix uteri, the bulk to go through hard exertion as formerly. And when it bility of the placenta being over the right lateral portion of the does-come down now, it is considerably longer in passing back uterus. My first effort was to separate the placenta from its to the as well as more painful:’ At a professional abdomen, attachment all around the lower part of this body. I then visit to Mr. Tod, the tumour and failing in his descended, the patient to swallow, by degrees, four ounces of brandy, efforts to return it as got quickly and easily as an ordinary rupture with four eggs beat up and mixed with sugar and gruel. be reduced, and upon the foregoing history being detailed, may Before the nourishment or the stimulus had been given, it ap- the nature of the case became evident. Mr. Tod proposed a peared to me that collapse would be the sure effect of attempt- further opinion as to whether it would be advisable to pass the ing to deliver. I had the hands and feet well rubbed, and by operation, into the scrotum; or whether, by keepwarmth applied to the chest and back; but still a deathly testicle, it in the groin, there would be a likelihood of its eventually ing and with no On a coldness appearance, perceptible pulse. passing thither. A consultation accordingly took place, but second examination, I found a little bleeding still going on. no operation was determined on. There appears to be no disI then ruptured the membranes, though fearful of emptying of intestine; the patient can bear pressure upon placement the uterus, being assured that a state of collapse would follow the internal ring whilst the testicle is down. Mr. Tod states this interference. After examining from time to time, I was in this, and two other instances, he recommended the that agreeably impressed that no more blood was effusing, andIhoped, testicle to be kept down, and prevented from returning to the by attending to the stomach, and by external warmth, that abdominal cavity, and for the following reasons :-The testicle Nature would rally, and the labour go on naturally. The pains, in each case was sound, and had no adhesion with any part of I was glad to find, gradually increased; but still I could find the abdominal viscera. no pulse, and the patient, in a slow whisper, gave me to understand that the pains were exhausting her,and she could not live. I thought so too, and commenced the business of slowly dilating Reviews. the parts, and getting the hand in utero, and drawing down the feet of the child, which I slowly withdrew from the mother. Having done this, I made good pressure over the uterus, and Deafness Practically Illustrated: being an Exposition of Original continued for some time the means of warmth and nourishViews as to the Causes and Treatment of Diseases of the Ear. ment, but the small quantity of blood effusing from the empBy JAMES YEARSLEY, M.R.C.S.E., Surgeon to the Metrotied uterus appeared, for some time, to place life in a hopeless politan Institution for Diseases of the Ear, to the Royal London : Churchill; and condition, especially as even now there was no pulse to be felt. ’ Society of Musicians, &c. &c. Some reaction having returned, however, I left my patient, Highley. 1847. Post 8vo, pp. 181. under suitable directions; and on this day, March 14th, I fiud THE author supplies the following reasons for presenting his her as well as can be expected. She vomited, I understand, views in the form of a book, to public notice :after my departure, and this I have commonly found to be the " I have over and over again enunciated my views and case when I have given much brandy or wine to patients apparently sinking under uterine haemorrhage, when the nervous illustrated my practice before hundreds of my professional and vascular functions begin to return. Having had some- brethren, who have honoured my Practical Demonstrations what about two thousand cases of midwifery in my own expe- with their presence. Nevertheless, every day’s experience rience, I claim no merit or novelty in the treatment of this makes it evident to me that much remains to be done for patient, but if I have learnt anything worth impartin,g to young the more effectual subversion of error in the treatment of practitioners, it is, not to be hasty in proceeding to delivery in deafness. Indiscriminate syringing, and acrid and stimulating dangerous cases, urged by the fears of bystanders. The empty- drops applied to the outer passages of the ear, still have their ing of the uterus per manum, without the loss of any blood in advocates, though by such treatment, in the great majority

prevalence