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the alleviation of Mr. G.'s lingering malady, it will suffice to state generally, that having the advantage of being frequently seen by Dr. Chambers, Dr. Seymour, Sir Benjamin Brodie, and Mr. Tatum, who' repeatedly met me in consultation, every remedy likely to mitigate the symptoms, when even no hope existed of curing the disease, was had recourse to; but all proved either inefficient, or produced only temporary benefit. Among the remedies employed, purgatives with strong enemata were found to be most beneficial, especially when the latter contained confection of rue. The tincture of cantharides, given as a diuretic, seemed likewise of considerable efficacy, at the same time that leeches were applied near the spot on the nape of the neck, where pain was felt on moving the head backwards ; their application being followed by blisters. Subsequently, a constant discharge was maintained from two issues, about four square inches in size, on each side of the spinal column, which were kept open for many months, by a mixture of mercurial and blistering ointments. The drain thus produced was considerable, and at one time it seemed to be rather advantageous; but the relief obtained from it, or indeed from any remedy, was only transitory, and never very decided
Besides the above plan of treatment, mercury, sarsaparilla, hydriodate of potassa, strychnia, hydrocyanic acid, morphia, and various other medicines, which it would be superfluous to detail, were likewise tried, but without any beneficial or permanent
result. Respecting one of the remedies just named, it deserves to be noticed as a peculiar feature in the present case, that although mercury was administered internally in very large doses, and rubbed in to an unusual extent, for some months consecutively, whilst both the issues were constantly dressed with mercurial and blistering ointments, this powerful mineral scarcely produced any apparent effect, either upon the patient's mouth, or his system generally.
During the last months of Mr. G.'s existence, notwithstanding the treatment seemed to have very little power over the disease, and although an unfavourable prognosis was for a long time entertained, nevertheless to alleviate the almost tetanic symptoms, to procure sleep, and, if possible, to give temporary ease to the afflicted patient, morphia was frequently administered, and in large doses ; indeed, towards the fatal termination of the case, this excellent anodyne was the chief remedy trusted to for relief; and however hopeless of curing the patient, its use certainly diminished the severe sufferings, and tended to soothe the acute pain of his latter moments.
Autopsy.—About eighteen hours after death, the examination was very carefully made by Mr. Hewett, in the presence of Dr. Nairne, Mr. Tatum, Mr. Charles Hawkins, Mr. Powell and myself. From notes made at the time, I have since drawn up the following Report of the pathological appearances met with :-
The body appeared considerably emaciated, but was not discoloured. Having removed the skull cap, some effusion of lymph was found under the arachnoid membrane covering the left side of the brain, along with turgescence of that, and the other hemisphere ; both divisions being pale, and exhibiting a watery aspect, although their texture was firm and compacted. The ventricles of the brain seemed large, particularly the left; and about two ounces of serum were effused in these cavities; the foramen commune being at the same time larger than natural. The arachnoid tissue extending over the pons Varolii adhered to the parietal layer of that membrane; but no tumour, or any other change of structure was found either in the brain or cerebellum, excepting that the latter organ appeared anemic, and rather softer in texture than ordinary.
On opening the thorax, every part seemed quite healthy, although the pleura pulmonalis on the left side of the chest, adhered firmly to the pleura costalis, by a few strong bands, some of which were apparently of considerable standing. The abdominal viscera likewise appeared very little changed from their natural condition, the liver, stomach and intestines being free from disease: with the exception of the kidneys, which were somewhat enlarged, anemic, and exhibited marks of chronic inflammation on the internal membrane of the pelvis and infundibula. The omentum and some of the small intestines also adhered to the bladder by strong bands, whilst that viscus was much diminished in magnitude, felt very hard to the touch, and on cutting into its cavity, it actually appeared not larger than the interior of an ordinary sized walnut, its muscular coat being unusually thickened. The mucous membrane was dark-coloured and rugous on the surface.
Having carefully laid open the vertebral column, throughout its whole length, the theca, corresponding to the three or four lower cervical vertebræ, was found to be much distended ; and on being cut into, the arachnoid cavity, with the sub-arachnoid tissue, appeared filled with lymph, which evidently had been some time effused ; as the membranes were thereby united to each other, and also to the cord. On making a more minute examination of the parts, the adhesions of the membranes to the cord were discovered to be much firmer at its anterior, than posterior portion; indeed, they were actually so strong, as to be inseparable from the medulla without rupture. At this particular part, the medulla also appeared larger than usual, felt soft and pulpy to the touch, and on being divided by the knife, its substance seemed to be in an almost diffluent state, infiltrated with serum, but exhibiting a natural colour. For the extent of half an inch above the point just described, the cord had a dusky red tinge, appearing however, of the ordinary consistence. In the anterior and posterior columns, not much difference was observable to the naked eye, at the first superficial examination of the diseased part of the medulla; although both divisions of the cord seemed considerably softened, infiltrated and disorganised, particularly in the posterior columns; whilst as well above, as below the affected portion, the medulla was healthy, and quite natural in appearance.
Since it is often very difficult by the ordinary means of investigation, to describe accurately all the minute alterations of structure, which disease may induce in so delicate a texture as the spinal cord, the microscope becomes an important auxiliary to scientific anatomists. Indeed, without the aid of that useful instrument, it would in many cases be difficult, if not impossible, to ascertain correctly the actual pathological changes of structure, which have taken place in that organ, so as to be able to explain the phenomena and symptoms characterising cases like the one now under consideration.
Fortunately on the present occasion, such a desideratum has been supplied; as I am enabled to exhibit to the Fellows of the Society, not only the diseased portion of the cord, but likewise to add a minute and valuable account of its microscopical examination, which that able physiologist, Professor Todd, of King's College, has had the kindness to make, for the express purpose of being appended to the present communication. In the letter that gentleman did me the honour to write, after examining the diseased part of the medulla transmitted to him for investigation, he says, “ The portion of spinal cord submitted to me by Dr. Webster, appears to consist of the greater part of the cervical segment. I find great destruction (from softening) of the medullary substance of the posterior columns, especially