stimulate these nerves? On dissection, there was found hydrocephalus to a considerable extent, and the whole of the pia mater was studded with tubercles. The cervical portion only of the spinal marrow was examined, and no disease was found there, except an increase of fluid.

In the second case, that of a young woman, there was loss of sense, but not of motion, in her hands. Some time before death she had an apoplectic fit, succeeded by hemiplegia. Three scrofulous tubercles and other derangements were found in the brain, and one in the cerebellum softened down. No disease could be detected in the spinal marrow; but the cancellous structure of the bodies of the vertebræ was filled with cheesy deposit, so that they could be easily cut with a knife.

In the third case, the patient had been thrown from his horse and hurt his back. Six weeks afterwards he became affected with some loss of muscular power about the mouth and pharynx, succeeded by numbness about his feet, and a sense of weakness in his legs. This last symptom extended upwards until the lower half of the body was paralysed. The same state took place in the upper extremities. When he came under our author's care, he was in a very deplorable condition. The bladder and rectum were paralysed, and he had hardly any power of deglutition. By directing remedial measures to the head, under the impression that there was inflammatory action in its membranes, the patient slowly and partially recovered. It is evident that this case is not satisfactory, in respect to the precise seat of the organic lesion. The fourth case was that of a man, who came into Bartholomew's Hospital with paraplegia, including paralysis of the rectum and bladder. He walked like a drunken man. On examination, no disease of the spinal column could be detected. But, as there was something about his eyes which led Mr. Earle to suspect disease of the brain, he was treated accordingly, and, under this treatment, he improved. It afterwards came out that he had received a severe blow on the temple, several months previously, against which he took no precautions. Two months after this accident, he felt a stiffness in his feet and ankles, which gradually spread upwards, as high as his loins, accompanied by defect of sensation. He had suffered a good deal in his head after the blow. Repeated small bleedings from the head-an active seton-low diet-mild aperients, constituted the remedies; and, under this plan, he slowly improved. This case goes to the support of PROBABILITY in Mr. Earle's views, but no farther.

The fifth case, was that of a youth of 15, who came into Bartholomew's Hospital for paralytic affection of the lower extremities. Five years previously he had been operated on for cataract in both eyes, and, by the subsequent inflammation, one eye was destroyed. The other experienced a similar fate about a year afterwards. Severe head-achs attended and followed this last catastrophe, and his lower extremities became weak, with shooting pains, and some involuntary contractions of those members. The

...probable and, indeed, it canisease may produce paralysis of thest cases are very far from provLunder each case. Neither do they intna, that local paralysis may depend pient of any disease in the brain or ......gonal injury is sustained by one or other -say paralysis of the feet and legs Dat the nerves of those parts paralysed, change not cognizable by our senses. If and none in the leg, is it not evident that the Susibility of the leg must be in the portion of Le snee?

gia dependent evidently on disease of the spine,

man who was thrown from his horse, and fell on the nconvenience was experienced at the time; and it y months, that he felt a difficulty in throwing his leg this was followed by disposition to trip, and inability to measure correct distances. These symptoms gradually ne motive powers of the lower extremities were entirely scans, depletory and counter-excitant, had been used under the disease was in the spinal cord, but the paralysis advanced a length the superior extremities lost their muscular power. d bladder escaped paralysis. During all this time (nearly two s gederal health was good-his mental faculties clear. Sensation ed perfect to the last in all the parts deprived of motive power. hed at length, apparently from want of muscular power to breathe. ntellect was unimpaired within ten minutes of his dissolution. Vari... medical men were consulted during this patient's illness-and various opinions were entertained, as a matter of course. The more general opinion was, that this was one of those cases descri Dr. Baillie. Our author was led to impute the cause to affection

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Ulceration of the posterior surfaces of the bodies had commenced at several points in the lumbar and dorsal spine, with a thick yellowish deposit covering the ulcerated parts. There was more fluid than usual between the dura and pia mater. The latter was very vascular. The medulla itself was very hard, as was the cellular texture of the bodies of the vertebra. In the head, a small quantity of fluid was found in the ventricles-and the arachnoid, at the basis of the brain, was slightly milky.

There cannot be a doubt that, in this case, the paralysis was owing to chronic inflammation of the spinal column, affecting both the osseous and the soft structures.

The cases where both head and spine were found involved in disease, we must pass over. Some of our mercurial brethren, in the noble art of reviewing, will doubtless think us extremely clumsy in occupying four or five pages of close type with an article of fifty octavo pages, the analysis of which they would have compressed into one or two pages of large type. We much doubt whether such analytical reviews can give satisfaction to either the author or the public. We shall certainly continue our usual practice of giving a complete analysis of all articles on which we enter, and where the matter is of a practical nature. Where criticism merely is wanted, we shall probably be as brief and to the point as our neighbours.

There are three distinct kinds of reviews-the analytical, the critical, and what might be termed the TOM-TIT-ICAL. This last species is of modern invention. Thus, in a recent number of a celebrated cotemporary, Dr. Abercrombie's whole work was despatched in three or four columns, although a single division of it cost us many days labour, and has occupied fourteen or fifteen pages of our present Fasciculus !

2. Rupture of the Uterus not fatal. By Dr. SMITH.

The utility of registering cases where rupture of the uterus has not terminated in death cannot be disputed, as such cases fortify the mind in the prognosis which, we all know, is imperiously demanded from the medical practitioner, on such trying occasions. It is the duty of Journalists, however, to divest such registry of all unimportant details, as greatly abridging their diffusion through medical society at large.

Case. Mrs. H. aged 40 years, the mother of nine children, was taken in labour in the seventh month; the membranes broke; the pains were sharp; the presentation natural. In consequence of symptoms which justified venesection, this was directed, but could not be effected, in consequence of the fatness of the arm. Eight or ten hours after the rupture of the membranes, the patient complained of severe pain in her back, and through the abdo

men, as if a sword had been thrust through her," followed by a considerable discharge of blood from the vagina, faintness, and sickness. The labour-pains ceased--the countenance sank--the pulse rose to 130, extremely feeble--the abdomen became irregular in shape, and tender on pressure. On examination, no part of the foetus could be felt. In a subsequent examination, Dr. Smith distinctly felt a rent, about two inches from the os uteri, across the posterior part of the uterus, nearly three inches in length, through which two fingers could be readily passed. The edges of the rupture were extremely thin. A consultation was proposed, but Dr. W. and the attendant surgeon, Mr. Whatman, were obliged to act. Mr. W. endeavoured to introduce his hand into the uterus, but found a resistance which he could not overcome. The attempt was made by Dr. W. and Mr. Charles, (who had just arrived) without success, in consequence of an adhesion of the os uteri to the vagina under the pubis, the effect of inflammation in a former labour. The most formidable symptoms now supervened, and it was determined to dilate the os uteri by a slight incision through the hardened part, so as to allow the hand to pass. This was performed dexterously by Mr. Whatman, and the hand was introduced into the uterus, the feet brought down, and the body of the child delivered. There was difficulty with the head, and, therefore, it was perforated through the lambdoidal suture, when the delivery was readily effected, the placenta soon following. Very little hæmorrhage succeeded. During these operations, the patient was often on the brink of death, but was supported by wine, brandy, and other stimulants. A large opiate was properly administered after the delivery was completed. The patient continued in a very alarming state for two hours, when she gradually recruited. Abdominal inflammation followed, with its usual phenomena, and was treated in a very masterly manner. This treatment we need not detail. The patient perfectly recovered, and lives a monument of the triumph of art over an otherwise inevitably fatal accident. We would ask Sir Anthony Carlisle what his female accoucheurs would have done in such a case--and what chance there would be of effectual chirurgical aid being given, if the practice of midwifery were confined to females? Why is the Westminster Hospital not left to the nurses, except when a surgical operation is to be performed? In midwifery, as in surgery generally, it is necessary to be practically acquainted with the efforts of Nature, in order to know when and how art is to interfere. If, therefore, you leave all natural and difficult labours to females, it will be nearly useless to call in surgeons or physicians when the case requires an operation of manual dexterity. But the question is absurd, and we are almost ashamed of alluding to it. It is the veriest chimera of a disturbed sensorium.

Medico-Chirurgical Review,

No. XVI.

[FASCICULUS IV.]

FEBRUARY 23, 1828.

ART. X.

An Inquiry into the healthy and diseased Appearances of the Mucous Membrane of the Stomach and Intestines. By W. E. HORNER, M. D. Professor of Anatomy in the University of Pennsylvania.

[American Journal of the Medical Sciences, No. I.]

THE disputes which have obtained respecting the natural and the morbid

appearances of the gastro-intestinal mucous membrane, sufficiently attest the great importance of settling these mooted points by some acknowledged standard. Like Dr. Horner, we have frequently seen the most opposite conclusions drawn from identical appearances in the organs under consideration, without having any available experience or authority, by which the correctness of these conclusions could be determined.* These circumstances induced Dr. Horner to institute a series of observations on the mucous membrane of the stomach and bowels; and, by coincidences purely accidental, he was so fortunate as to obtain that description of information, in a few months, which, in the ordinary current of events, might not have been acquired in years.

"Three unsettled points present themselves in this inquiry:-1st. What is the healthy condition and appearance of the gastro intestinal mucous membrane? 2d. What is its appearance in congestion from the agonies of dying? 3d. What is its appearance in genuine red inflammation?"

So much ambiguity and vagueness have obtained respecting the meaning of certain terms, especially inflammation and congestion, that our author thinks it necessary to state that, "by congestion, he means an accumulation of red blood in any part or organ of the body, without irritation or mechanical violence; and, by red inflammation, the accumulation of red blood which follows any local irritation."

"1. Of the Natural Colour of Mucous Membranes. "When an animal is bled to death, the stomach being empty, the mucous mem

*See our review of Mr. Annesley's work on the effects of Calomel on the Mucous Membrane, in the 4th volume of this Series, p. 333, et seq.

VOL. VIII. No. 16.

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