650

aneurisms in the arteries, and varices in theveins. 3dly. The internal organs alwayssuffer more or less in their functions, whenthe spine is distorted. The viscera, obligedto follow the irregular movements of thespine, are forced out of their natural situa-tions, and, withiti the chest especially, areunduly squeezed and compressed againstthe bony covering. These several causes

lay the foundation of numerous disorders,which operating’ at all times, generallydestroy their victims prematurely.

Various and distressing as these maladiesreally are, they constitute only part of theheavy afflictions, which the miserable suffer-ers are doomed to endure. From irregula-rities in the vertebral pillar, the cord andnerves issuing out of it, becoming undulystretched, and pressed against the bonytubes, are rendered unfit, properly, to con-vey the nervous power, to its ultimate desti-nation. Many obstinate disorders owe theirformation to the partial, or entire inter-

ruption, of the accustomed nervous supply.Their origin from this cause, and the reme-dies indicated, have, I conceive, been toogenerally mistaken, both by pathologistsand practising physicians. They have beenaccustomed to trace its source to the brninas the fountain, whereas, in fact, it motecommonly proceeds from the spine alone.So long as no efforts were made to relievethe defective arrangement of the vertebrae,the offices of the spinal nerves could not be Iat all understood, and were, therefore,usually overlooked. Now that we have ac-quired the power of restoring the misshapencolumn to its primitive figure, these mala-dies are not only brought under review, butare subjected to a strict surveillance. No

longer concealed from observation, theyhave, as already observed, been found in

many instances to commence in the verte-bral structure, and to abate as its derange.ment receded.The power which I have successfully

exercised over the spinal column for morethan ten years, and which I challenge themost incredulous and prejudiced to contra- fdict, has established a new era in medi-cine—an era which will soon lead to themost unexpected and useful results inpractice. The authority of great names,and the influence of high medical stations,may for a time retard, but cannot whollyarrest, its progress: it will, ultimately. sur-mount every obstacle, and triumph iu den-ance of all opposition—magna est veritus, etprevalebit. Nay, I venture fmther to assert, Ithat this power over the spinal joints hasalready enabled me to cure several dis-orders deemed irremediable, and to cast aray of light upon the most abstruse

anddifficult pathological questions. Equallymisinformed are those medical practition-

’ ers, whatever mav be their authority ori merit in other respects, who declare thatrecumbency, as now conducted in spinalcomplaints, tends to encourage bad health.These assertions are in direct opposition 10multiplied experience. So great is our

predilection for received tenets, and our

. obstinate attachment to current admissions,, ; however erroneous, that several of themost violent declaimers against my prac.tice have actually attended patients to nogood purpose, and, who remained for sixor eight years, constantly lying, andyetcon.tinued in good health during the whole time.The first and eighth cases in my treatise,’’.;esides that of Miss Goulding, published inThe Gazette of Health, may be referred to,as confirmatorv of this statement. So far

then is recumbency from hurting the health,as mere theorists affect to believe, that, inthese particular cases, it really conducesto its improvement, and frequently enablespatients to subdue a phthisical habit, andother constitutional ailments. ’

According to the order laid down for pub.lishing my " Observations on Spinal Com-plaints," several cases, which I am anxiousto make known early, would probably be de.ferred for several years. With a view to ob.viate this delay, I am desirous to print a se.lect portion of them without further loss oftime, that they may come under the imme.diate notice of my professional brethren.The- accompanying case will be succeeded,at short intervals, by others, if it be deemedproper for insertion in your valuable pe-riodical.

I am, Sir, yours, &c.,- EDWARD HARRISON.

Holles Street, Cavendish Square,Jan. 20, 1829.

EDWARD HARRISON,

A CASE OF PARAPLEGIA, COMPLICATED

WITH FPILEPSY, CURED BY APPLICA-

TIONS TO THE SPIRAL COLUMN.

Sarah Tribet, in the twenty-second year ofher age, of the sanguine temperament, andin good bodily health, had the misfortune to1038 the feeling and motion of her lower ex.tremities, upwards of three years and a

half since. Sensibility of the limbs returnedpartially in six weeks, but they recoverednone of their activity, and the feeling wasagain lost after a short time. She sars thather back and left side. a little below thefalse ribs, have been very tender, and in-capable of motion for nearly the same

period. Pulse, bowels, and appetite, are

tolerably regular. The menses observetheir natural periods, and low in moderatequantities, but are very dark-coloured, andhighly offensive.She traces her sufferings to having exert-

d all her force to raise from the ground a

651

large bucket filled with water ; she in.

atantly felt as if something had given way inthe small of her back, and fainted a fewminutes afterwards. From that time her

strenth, the activity of her legs and feet,began sensibly to fail. In six weeks she

bad a second fainting fit, which left her inher present helpless condition, both as tothe sensibility and power of moving her in.ferior extremities. She was admitted intoa large provincial hospital three monthsafter her accident, and remained there alto-gether two years. While in the hospital,sbe was frequently bled with leeches andscarificators. She had also several blisters

applied, and large caustic issues inserted indifferent parts of the back. The tartarisedantimonial ointment was rubbed upon herloins, and electricity used to the paraplegiclimbs.Finding no relief from the means pursued,

she returned home, in a more deplorablestate than she left it. The assistance ofmedical men in her own neighbourhoodbeing equally unavailing, she was at lengthbrought to London, and placed under mycare. She was seized with epileptic fits, forthe first time in her life, during her -resi-dence in the hospital, and they continuedto afliict her some time after her returntfome. These fits generally left hpr insen.sible for a day or two. After one attack,she remained in this deplorable condition

upwards of a whole week. On recoveringher faculties, she found herself in a copioussalivation. In answer to her inquiries onthis point, the m:dical gentleman replied,that she was wholly indebted to the saliva-tion for her recovery. As tha fits alwaysproduced a temporary loss of understandingand memory, she cannot venture to say how

many of them she has had in all, but she iscertain they exceed ten.On examining the course of the spinal co-

lumn carefully, I found it every where ex-

tremely tender, and painful to the touch. Itwas more particularly sensitive in the smallof the back, where she first received thestrain. On looking at the back, I could per-ceive no deformity. The only imperfectionthat I saw in it was, that the lumbar hollowhad almost disappeared. On drawing my fin-gers along’ the spine, in that part, I found thevertebras placed in regard to each other alittle zigzag, or chequer-wise, and at equaldistances. The pains were almost whollyconfined to the lower part of the spinalregion. She has no power to move any partof her back, and the inferior extremities areentirely helpless. She can stir neither ofthem, nor any of their joints. Though shefelt nothing in the part touched, 1 was sur-prised to find that, on pressing the soles oiher feet with my hand, she was immediatelyseized with the most tormenting anguish

in her loins, which obliged her to cry out,and desire me to desist. She was this after-noon placed flat upon a firm crib, and afterbeing well rubbed with an emollient ointment,the usual shield* was fixed -to her back, soconstructed as to make firm pressure upon.the dorsal and lumbar vertebra;. It was keptin its proper situation by means of a tightbandage applied all over her back and chest.

Nov. 5, 1823. The means recommendedhave been carefully pursued. The back is

considerably easier, and less sensible to thetouch. She can already move the toes ofboth feet.

15. The only pain of which the patientnow complains, is confined to the small ofher back. Aloderate pressure on the solesof her feet is no longer perceived in theloins, but she can feel it m the part touched.She is able, with considerable difficulty, todraw, in a slight degree, her legs upwards,and also to bend her knees. The lumbarhollow is entirely regained, and the vertebraehave recovered their proper places.

30. She has suifered no inconvenience oruneasiness in her back since the last report.She can raise herself from the crib, andmove every pait of the spine with greatease. She can also cross her legs backwardsand forwards, several times in quick succes·sion, without much effort. She thinks herback and limbs have acquired strengthenough to bear her weight upon them. Thenatural feeling of her back and limbs, iswholly restored. The menses return attheir usual periods, they are of a brightercolour, and no longer emit a disagreeablesmell. Continue.

’

Dec.15. Shemovesher legs and backwiththe greatest freedom. The recumbent pos-ture has been strictly observed from thefirst. She thinks herself strong enough towalk alone, if she might be permitted tomake the experiment.

31. The patient was suffered this after-noon to get up, at her own urgent re-

quest, and try how far she had the use ofher limbs. The moment she left the couch,she was able to stand erect, and alone. Soonafterwards she walked about in the room

supported between two persons, for aboutfive minutes. Finding herself fatigued bythe exeition, she desired to be replacedupon the crib. The moment she was putupon it, she declared that she had not feltthe smallest pain or inconvenience, either inher back or limbs. The menses continue

regular, and preserve their natural appear-ance. She is perfectly weil in health.

Feb. 29, 1824. She has been snifered to

walk about in her room, a quarter of anhour-every other day, since the last report.

* See case 4th, in Dr. Harrison’s Essayon Spipal Diseases.

652

The exercise she finds very pleasant, and itoccasions no fatigue. She often petitions tohave the period enlarged.March 17. The improvement in her limbs

has been regular and progressive ; she haslately been suffered to walk two miles everysecond day. Finding neither pain nor

weakness from the exertion, she solicits

permission to increase the distance.I have been induced to comply with her

application to leave London for Sidmouth,under particular restrictions. ’May 10. In a letter received from Sarab i

Tribet, dated Sidmouth, Dec. 30, 1824, she lisays,

" I continue your advice, as far as in

my power, and I still feel myself mending.Sir, when I returned to Sidmouth, the ladiesand gentlemen, and even the clergymanstared at seeing me walk, and well theymight, after witnessing the helpless state inwhich I left them."

In a second letter, dated Sidmouth, Oct.9th, 1825, she observes," I am sorry to say Ihave been very ill. I kept my bed threeweeks, and I was very much afraid I shouldbe crippled; but, with the blessing of God,I am able to walk again, without any sup-port."

I received a third letter from Sarah, inOctober, 1826. She enjoyed good health,and had undertaken the management of aschool for young children.In her last letter, dated April 23, 1827,

she observes, " You cannot imagine howwell I am able to walk, and even to run,without feeling the least effect in my back.I never felt better in my life."

REMARKS.

The paraplegia, with this’patient, followedso closely upon her accident, that I think,whatever difficulties we may find in ex-

plaining the loss of sensibility and motion,in the lower limbs, we shall have no hesi-tation in referring it immediately to an af-fection of the back. We are more favourableto this conclusion, because she never ex-perienced any disorder of the head, throughthe whole course of her indisposition, exceptwhen under the influence of her epilepticfits. Moreover, the curative means, whichproved efficacious, were wholly dixected tothe spine. Although this organ, when firstexamined, manifested very little irregularityto the sigltt, the lumbar cavity was nearlyobliterated. The vertebrae, too, were found,on close examination, to have lost their rela-tive distances, as well as their properstations in the column. I am of opinion,that this dpfective arrangement in the im-

plicated vertebra was produced by therupture, or undue stretching, of some of thearticular ligaments, at the time when sheexerted herself to raise the bucket. The

displaced, or subluxated, vertebrae, bp oc;casioning pressure upon the spinal chord iuthe theca, and irritating the nervous trunks,in their passage through the foramina ver-tebrarum, effected both the loss of feelingand of motion in the limbs.The suffering spot, whenever the back

becomes afflicted with pain, has not, accord-ing to my own observations, in a single in-stance, been traceable to the theca. Greatexternal tenderness is felt on pressure nearthe spine, and especially among the con-tiguous muscles; the uneasiness is, there.fore, superficial, and confined to the softparts ; the symptoms and sufferings may, insuch cases, be easily discovered, and theirtrue nature ascertained, as far as they be-come objects of the touch. When the ma.

lady is stationed within the bony tube,things are widely different ; it must then be

very difficult to detect the deep-seated mis-chief. The symptoms denoting it are ne.cessarily obscure, and indistinct, on accountof their remote situation, and the interpo.sition of a bony case.

In confirmation of the preceding remarks,we may observe, that the spinal nerves, intheir way out of the back bone, to theirultimate determination, have to traverse thevertebral holes. These are formed of notches,in the upper and lower edges of the lateralbridges ; they are constructed to make around hole, between the adjacent vertebræ.The nerves proceeding from the spinal mar-row, and the blood-vessels, pass throughthese holes ; when the arrangement is per-fect, the two portions of the notch fit’ex.actly. In this happy state of things, thenervous bundles connected with them, ingliding along the holes, encounter no im-pediment ; the muscles and organs, to whichthey run, receiving their full supply ofner-vous influence, perform their offices easilyand well; but whenever the spinal columnbecomes distorted and misshapen, the cor.responding notches, losing their proper ad.justment, cease to fit correctly. This changein the conformation of the vertebral pillar,leads to numberless evils in the animal

economy. The nerves, in their progressthrough these irregular apertures, becomeimpeded, interrnpted, and squeezed againstthe bony sides of the canal ; hence the ner-vous power has to surmount many difficul-ties in its journey. From the contortedfigure of the column, the spinal cord isforced into an unfavourable posture in thetheca. The anterior and posterior nervousfasciculi are driven from their usual course,and cannot, therefore, emerge in a properdirection. As they proceed, and incline to.wards each other, to be enveloped in thesame sheath, they enter the vertebral holesat an unfavourable angle. In consequenceof this defective arrangement, the nervous

653

influence is either wholly or partially ar-rested in its course, by the impediments ithas to surmount. The organs, dependentupon its regular supply, being imperfectlyprovided, exhibit the different phenomenawhich have been described in this and myother cases. In accordance with these ob-servations we may remark, that when anerve is wounded, or bruised, the musclein which it terminates is thrown into spas-modic contractions ; after its entire section,the muscle becomes insensible to the strong-est stimuli. It is, moreover, experimentallytrue, that whether we irritate the muscleitself, or the nerve leading to it, the musclewill equally contract; it follows, there-fore, that the excitation of either end of anerve will influence the muscle which itanimates.

13y applying this doctrine to the nervousbudles, in their passage along the displacedvertebral notches, we shall be able to un-

derstand how slight pressure upon them in-duces pains and cramps, while a greaterdegree of it produces insensibility and entireloss of motion.

I am the more inclined to favour theseopinions, because we scarcely ever meetwith a patient suffering from a distortedspine, who has not some paraplegic symp-toms. It follows from these premises, thatboth feeling and motion, in the inferior ex-tremities, are functions dependent upon thespinal nerves.The patient endured several severe pa-

roxysms of epilepsy, while she was afflictedwith paraplegia. The sources of this dis-

tressing and obstinate complaint are oftenso much concealed, that it is impossible todiscover them. We know enough to say,that the exciting cause is sometimes placedwithin the skull, and, at other times, re- !,mote from the brain ; for example, the pre-sence of intestinal worms, and of sordes inthe bowels, are common causes of epilepsy.These act primarily upon the nervous fila-ments of the intestines, and the irritationbeing conveyed, by some unknown commu-nication, to the spinal cord, the voluntarymuscles are forced into violent and irregu-lar contractions. For the same reason Iventure to assert, that irritations applied,in the first instance, to the spinal cord, ornervous trunks near it, will occasionallylead to the same train of symptoms as if

they had been directed to the minute ner-

vous fibrils. I have already recorded an

example of hysteria t originating in the spi-nal column, and I shall hereafter introducean instance of chorea sancti viti, commenc-

* Dr. Monro’s Observations on the Ner-vous System.

t See the case of hIary Rafter, in myEssay on Spinal Diseases.

ing in the same organ. These, as well asepilepsy, being accompanied with spasmo-dic contractions of the voluntary muscles,make it highly probable, that, in all similarcases, an impression upon the spinal cordmay be the originating cause.The patient had complained of pain, and

tenderness in the spinal column, from thecommencement of her malady, but its great-est severity was about the loins. Manypractitioners do not hesitate to refer symp-toms of this kind, in every instance, to in-flammation of the spinal cord, or its invest.ing membranes. That they sometimes in-dicate an inflammatory diathesis, or, as ithas been called, a sub-acute inflammationI am ready to admit, though I am enabledto say, from multiplied experience, that itis a rare occurrence.- We ought, however,to recollect, that whenever the disorder isinflammatory, or accompanied with increas-ed vascular action, the complaint will eitherbe speedily subdued, or it will terminate ineffusion, suppuration, or gangrene. Inflam-

matory complaiuts are never stationary ;they are always progressive, and run theircourse in a few days or weeks. The achesand pains, which, as in this case, continueunabated for months and years, without

leading to structural changes, are neither ofan inflammatory character, nor are theyseated in the vascular system ; they proceedfrom some malady in the nervous composi-tion, belonging to the suffering part, andare chiefly to be relieved by applicationsdirected to it. In order to act with effect,we must endeavour to find out the natureand exact seat of the complaint before weproceed to the treatment. This discrimin-ation is especially necessary, because theremedies best adapted to moderate in flam-

matory action, exert little power over a dis-tracted state of the nerves. So many ex-

amples of chronic pains, arising from neural-gia, have lately come under my own cog-nizance, and been cured by the treatmentso often explained, as to lead to a convic-tion, that they are much more common thanis generally admitted.

In cases originating from nervous irrita-tion, undeviating rest, and perfect quiet, solong as they are submitted to, will mitigatethe symptoms ; but the miserable sufferersno sooner return to their usual occupations,than the old pains reappear, with their for-mer severity. In this way invalids drag ona miserable existence for the rest of life,because, until the offending cause is dis-covered and subdued, the disorder will re-main unabated.As I employed no remedies with this

patient, to overcome increased vascular ac-tion, it is clear, from the result, that she did

, not suffer from that cause. She became free

) from pain, after assuming dorsal recumbency,t

654

which is t convincing proof that her afflic-tions were not in the circulating system ;that they were of a different complexion, andrequired other measures for their removal.She had been ineffectually subjected to

long and repeated courses of the usual treat-ment, both in hospital and private practice ;that they afforded her no relief is evidentfrom her own statement, and the helplesscondition in which she applied to me. Themeans on which I relied were entirelv con-fined to the spinal region. As the verte-bra3 approached their native beds, the spinalcord, and nerves issuing out of them, gra.dually recovered their healthy tone and abi-lity. The nervous influence being at lengthfreed from ail irritations, and being more-over regularly distributed to the muscles,they entirely recovered their lost strengthand former activity. The patient, thus in-vigorated, was happily restored to the fulluse of her limbs, and the enjoyment of asound constitution.

It follows, as a consequence of the indi-cations and practice, successfully employedfor the cure of Sarah’1’iibet, that her dis-order was wholly confined to the spinalcord, and its nervous trunks, at their origin.It was in accordance with this pathology,that I determined to restore the natural

figure of the back, in order to relieve the

spinal nerves from injurious pressure. Inthis I completely succeeded, and, as a con-sequence of it, I had the gratification to

witness a full confirmation of my doctrines,in the recovery of my patient, to the bless-ing- of vigorous health.The conclusions deducible from the pre-

ceding and former cases are,-1st. That paralvleaia is a disorder of the

spinal cord. Many examples of this dis-

tressing complaint have come un dermy-.°are,at different times. Several of them havebeen permanently cured, by removing verte-bral deformity. This success enables me toassert, that paraplegia was, in every in-stance which has occurred to me, an affec-tion of the back-bone.ndly. The epilepsy, likewise, originated

from the back. We are warranted in thisopinion, because it appeared, for the first Itime, after the injury, and went away onher adopting’ quietness and rest.

3dlv. The extreme tenderness, in this s

case, was not of un inflammatory character ;Had it either originated in a phlogistic stateof the parts, or been accompanied with in-flammatory action in them, the disorderwould not have remained stationary for solong a time. By referring it to neuralgia,or irritation of the spinat cord and its ner-vous trunks, we can both understand itslong continuance, without producing

struc-tural change, and its final disappearance on Irectifying the vertebræ.

RICHMOND SCHOOL OF ANATOMY,

To the Editol’ of THE LANCET.

SIR,—I am most anxious to completemy notices of the ltichmond School of Ana-

tomy, and I will not occupy many more ofyour pages with my critiques on its pio-fessors.

My former letters have been noticed insome late numbers, and, (since my repty toa writer styling himself " Richmoud,") by acorrespondent who affixes the signature of" Phiifdethes " to his production, and by anameless author, who concludes his per-formance, by professing himself your obe.dient servant, Mr. Editor.With respect to the first of these letters,

to so solemn an appeal to our Irish hearts,I may observe, that my awfully indignantfriend, in his admiration of anonymous pro-ductions, proceeding from the pens of Ju.nius," "J. K. L.," or " Erinensis ;" and, inhis condemnation of the remarks of a minorscribe, who has sought the same protectionas these distinguished writers have foundshelter under, seems to have forgotten thatthe principal, perhaps the only, use in ano.nymous correspondence, is to enable theworkman who labours in the lowest story,to reach the artificer employed at the sum.mit, with his voice, since he cannot touchhim with his hand ;-in plainer language, to

permit the approach of truth to the mantleof authority." Junius," " J. K. L.," and "Erinensis,"

have sung nobie strains, and 11 Pljilaletbes"is musical enough to admire them; my lay,hallad like, has had nothing but truth andsimplicity to recommend it; and hence itdisgusts the ear accustomed to a highermelody. Heu! me miserum! like "Ju.nius’s" correspondent, Sir William Draper,my opponent possesses the weapon of lan-guage, and assails me, right and left, withthe vituperations of fiction. I honour himfor the solemnity of the details of my scan-dal, my inconsistency, and my falsehood,but I will dismis3 him with my forgiveness,in his supply of a quotation that enables meto return his arrows, pointless and weakly,propelled as they are. "Anonymous writ-ing’ has afforded a shelter to impartial state-ments ; it has enabled the satirist to directhis shaft against a manifest abuse." Ifthis, Sir, be the (.ase, little does it signifywhat talent is displayed in the satire; sothat the desired object is gained, it matterslittle whether the nobler quill of " Junius,"or the humbler pen of

" Lennox" be em-

ployed. Whatever Mr. Carmichael’s or

Dr. M’Dowel’s conduct may have been,they are undefended by such writers as