publishing as the excellent Pott did. I may also, without presumption, adopt the words of that great man in another respect, viz. that this form of the disease has hitherto been regarded too superficially; that we have been too prone to be satisfied with observing its external appearance only, without inquiring into its real nature; that there may exist external spinal curvature, and much consequent mischief, without caries, is well known; that there can be internal curvature without caries to any considerable extent, yet life be destroyed, is no less true.

I rest all I have said upon what he advanced: "A morbid state of parts previous to deformity must be allowed; every complaint of the living, and every appearance in the dead, prove it beyond contradiction or doubt. These complaints increase with the deformity, and decrease by early means used for relief; but, when used too late, or, from the inveteracy of the disease, the issues are found to be unequal to the wished-for effect, the general complaints receive no amendment, but increase until the patient sinks under them.' P. 479. It could not escape the vigilant attention of Mr. P. that the disease was liable to shew itself under a variety of symptoms during life, and appearances after death; but, as before observed, all his subjects were young, and there is no account of any case in his work analogous to those I have related. The variety now spoken of differs from that treated by him in the particulars mentioned at p. 3.

From all which has been now said, I think no impartial judge will hesitate in allowing, that, if the sufferer, whose internal state was explored by dissection, had applied, in the outset of his malady, for relief from our art; and if, when he began to lose the power of walking steadily, the caustic issues had been formed, he would have stood a fair chance of recovery. I do not, by any means, presume to say that this form of spinal affection was wholly unnoticed by Mr. P. but it was only so in a general way, as, where he says, "Sometimes each of the distempered states of these parts is accompanied by a greater or less degree of deformity, with out any apparent disease of the bones composing it;" and "sometimes the same bones are found to be carious, without any crookedness or alteration of figure." P. 468. He illustrated this truth by a drawing, and it is remarkable that the destruction shewn, without external deformity, was of the lumbar vertebræ. He laid great stress on the altered figure of the spine, as is evident from his 3d Axiom, p. 470, "That, when these complaints are not attended with an alteration of the figure of the back-bone, neither the real seat nor true nature of such distemper are pointed out by the general NO. 169. symptoms,

сс

symptoms, and, consequently, that they frequently are unknown, at least while the patient lives."

I think the whole six cases now related afford sufficient evidence of the existence of general symptoms decidedly authorising the early application of the caustics; and that, when, through oversight, inattention, mistaken diagnostic, or pre-conceived theory, this remedy is not employed until the disease has become an "over-match" for it, surgery has failed in effecting all it is capable of effecting. In cases of external curvature, such unfortunate practice rarely happens: I say rarely, because I know it still does occasionally. But, in the cases now attempted to be described, no deviation from healthy shape in the bones is found, till very late in the journey of the disease to a fatal termination, and then may be easily overlooked. The whole existing symptoms, though so clearly described by Mr. P. and being always present in a greater or less degree, are deemed, as they were in the master stone-mason's case, a mortal nervous disease of the spinal marrow, which nothing could even arrest, much less cure. If, then, the form of the disease with external curvature may be mistaken for lumbago, rheumatism, &c. as was the case with a milliner at thirty years of age, in this city, how readily may the more obscure form of the same malady be wholly unascertained?

expe

Remarks on the excellence of Mr. Pott's work would lead to great prolixity, if indulged, but one more observation may be permitted. He says, "Some predisposing cause must be looked for, in which (in my opinion) consists the very essence of the disease." P. 399. Of the correctness of this statement there can be no manner of doubt: the rience of half a century has confirmed it. The young woman mentioned above was cured, by the caustics, of the spinal disease, and enjoyed good health thirteen years; she was then gradually seized with the symptoms of hip enlargement, so well described by Mr. Edward Ford, and this the caustics removed, though, in consequence of the late application of the appropriate remedy, she had more lameness after than would have remained had it been earlier applied. The cure of the back-bone remained steady. It cannot be considered irrelevant to observe, that the caustic issue placed behind the great trochanter, has apparently been the means of removing the long-continued lameness in the hip joint, following a blow or fall, which, from its ambiguous nature, is indefinable, yet sufficiently mischievous to fix a painful impediment to free motion for years, or a long life.

From the whole then that has now been advanced on this

interesting

interesting subject, may not the following conclusions be fairly drawn:

1. That a useless state of the lower limbs, with a greater or less degree of concomitant symptoms, may be connected with internal deformity of the lumbar vertebræ, independant of any or very little external spinal deranged appearance.

2. That this affection of the lumbar vertebræ is more commonly met with after than before the meridian of life is attained; and, from this circumstance, and that of expecting always to find more or less of external spinal curvature in cases of useless lower limbs, medical men have overlooked the source of this form of disease.

3. That, although in this form of the disease no external curvature of the spine be present, yet it is attended with all the symptoms enumerated by Mr. Pott as accompanying the more common external curvature, that of the stricture at the stomach excepted; but that they are all milder in degree, and longer in producing a fatal effect, though ultimately as certainly destructive, if pre-disposition continue, as where the cervical or dorsal vertebræ are the immediate seats of the local mischief.

4. That, in all cases of a useless state of the lower limbs, where the general symptoms, so accurately described by Mr. Pott, are found to exist, let the age of the subject be what it may; yet, notwithstanding that the particular external curvature be wanting, the use of the remedies he has recommended are indispensably necessary.

5. That the chance of recovery in the lumbar spinous affection is nearly in exact proportion to the early or late application of the proper remedies, allowing for the difference of age; the younger having more chance of ultimate restoration after long delay than the older.

6. That, however long the disease may have existed, if the digestive organ have not absolutely failed, if hectic fever be not severe and constant, respiration laborious, and debility great, nor any additional disease present, it is proper practice to afford the patient a chance by the application of caustic issues, and the use of mild aperients and tonics. G. N. HILL.

Chester, Nov. 16, 1812.

F

To the Editors of the Medical and Physical Journal.

GENTLEMEN,

you think the following case of burn, treated agreeably to Dr. Kentish's method, worthy of a place in your ex

tensively

tensively-circulated Journal, you will favor me by inserti I am, Gentlemen,

ing it.

Your obedient Servant,

J. A. BRADLEY, Surgeon, Member of the Royal College of Surgeons, London. Liverpool, Jan. 9, 1813.

Mary Taylor, aged seven years, (Monday, Sept. 14, 1812,) was dreadfully burnt by her clothes catching fire. Three large and deep eschars occupied the whole of the left side of the back, from the shoulder to the nates; another, equally deep, extended from the top of the left shoulder to the bend of the arm. I arrived at the house about half an hour after the accident had happened, and immediately applied the warm Ol. Terebinthine, after the manner recommended by Dr. Kentish. The little patient being put to bed, the Liniment. Terebinth. was spread thick upon old linen, and immediately applied to the injured surfaces. Upon leaving the house, I requested two drops of Tinct. Opii to be given in a glass of warm wine and water.

Tuesday, 15th. Visited her about ten o'clock a. m. and found her pretty free from pain. She had had a little sleep during the night; pulse quick; tongue furred; prescribed 12 grs. pulv. Jalapii, with 2 of calomel, to be taken directly in a little treacle. The Liniment. Terebinthine to be continued.

Wednesday, 16th. Visited at eleven o'clock a. m. Suppuration established; the powder had purged twice; fever considerably abated; had slept soundly all night. The Liniment. Terebinthine to be discontinued, and the Ung. e Lap, Cal. to be substituted in its place.

Thursday, 17th. Suppuration going on kindly; bowels costive; prescribed the powder as before, to be taken directly; but, as it had not remained upon the stomach, gave a bolus with 4 grs. of calomel at bed-time.

Friday, 18th. Found her free from fever; the bolus had operated well; slept soundly during the night, but great pain this morning of the arm. Prescribed ten drops of

Tinct. Opii. Dressings as before.

Saturday, 19th. Profuse suppuration; sloughs separating; appetite good; free from fever.

Sunday, 20th. Visited at ten o'clock a. m.; found the sloughs throwing off, leaving deep ulcerations, particularly in the arm. Continue the Ung. e Lap. Cal.

Monday, 21st. Suppuration lessened, and the parts looking healthy. Dressings as before.

Tuesday, 22d. Tongue furred; pulse quick; skin very

hot