like pain, increased by moving or bending them. The trunk was insensible as high as the nipples. Breathing greatly oppressed, and the arms felt benumbed, although the sensation was nearly intact. The bladder was distended, and no urine had been passed for 24 hours, bowels confined. The whole spine was the seat of pain, but it was free from rigidity or tenderness on pressure, although the muscles on both sides of the spinous processes were painfully tender. If he attempted to move his lower extremities the pain was increased and painful shocks were excited, which shot up to the head. Raising him to the sitting position, caused these shocks to shoot along the sides of the chest and down the legs. The moment he fell asleep he was awoke by them, their severity causing him to utter loud groans. They seemed to arise suddenly in the spine, and shoot from thence over the body. His easiest position was with the head and shoulders somewhat raised, and avoiding the slightest movement; even speaking excited pain.

Blood to the amount of 30 ounces was taken from the arm, and with marked relief to the symptoms, and 2 grains of calomel and a of a grain of tartarised antimony given every two hours. The urine was drawn off.

26th. He had obtained some sleep after the bleeding. The first dose of the antimony had excited considerable nausea. The painful shocks had ceased to occur with the same severity, except on motion. They seemed to have passed into a state of tremor, which, like the shocks, was transient. The pulse being good, the bandage was removed, and the adhesions at the opening of the vein destroyed, and blood to the amount of 10 or 12 ounces allowed to flow. From this time the improvement became manifest, the bowels acted without medicine, a large quantity of green fæces being passed. The mouth became sore on the fourth day of the exhibition of the calomel; it was then discontinued. On the twelfth day he was able to get up.

The symptoms subsided in the following manner:-first the shocks of pain, then the oppression of the chest, and the numbness of the arms, accompanied by a return of the sensation of the body as low as the pelvis, then the power of evacuating the contents of the bladder, and lastly, of the voluntary power and sensation of the legs.

2. Of the Pia Mater.-This membrane is rarely affected with inflammation, without the arachnoid being at the same time implicated.

The most characteristic symptoms of inflammatory congestion or inflammation of the pia mater, are, rigidity of the muscles supplied by nerves derived from that part of the cord where the membrane is affected, followed by contraction, which is generally aggravated by shocks. The voluntary power and sensation of the parts affected with rigidity are but little affected in those cases where the substance of the cord or the nerves remain unimplicated. The first will, however, be interfered with from the rigidity of the muscles, and when severe it will be altogether impossible. The patient will, even when the rigidity is not severe, guard as much as possible against exerting the power of the will from the great increase of pain which motion excites, and the tendency which it has to induce. convulsive shocks, or aggravate the state of contraction. But after the disease has been established and fluid poured out from the pressure which it excites, both will be more or less destroyed. In inflammation of the upper part of the canal, particularly when the arachnoid is also affected, the gravitation of the fluid effused may induce paralysis of motion and of sensation of the lower extremities,

the muscles of the upper extremities, the neck, and back, being rigid, and more or less contracted. This state of paralysis may also be induced by the matters effused into the cellular tissue covering the pia mater, from the pressure which they exert on the cord.

The cutaneous sensibility is sometimes increased, either from the substance of the cord becoming implicated, or from irritation of the nerves of sensation. The transient shocks or convulsions sometimes present in arachnitis, are very severe in inflammation of this membrane; its intimate connection with the cord and nerves may account for this, and for the state of increased cutaneous sensibility sometimes observed. Attempts at motion will induce these transient shocks and convulsions, and when contraction exists they will increase it. Tickling the soles of the feet or the palms of the hands when the corresponding extremities are affected, will induce them. They will also occur spontaneously, and add greatly to the severe pain already existing. They may sometimes become so severe as to assume a clonic form, the parts affected being alone convulsed, or from irritation or inflammation of the cerebellum ensuing, all the muscles of voluntary motion may participate.

In tracing the influence which the implication of certain parts of the pia mater exerts on the muscles, which receive their nerves from that part of the cord where the membrane is affected, it will be found,

1st, That when the membrane of the upper part of the cervical region is implicated the muscles of the face and jaws are affected, first with stiffness, which rapidly passes into a state of complete rigidity, rendering the jaws immoveable, and the features distorted. Sometimes the muscles are convulsed, and pain, more or less severe, exists, which is greatly aggravated by any attempt to move the jaws. The head will be also, more or less drawn back, from the muscles of the upper part of the back of the neck being stiff and contracted, and the eyes will be, from their muscles sometimes being similarly affected, either fixed or distorted.

2d, When the inflammation extends to, or is seated lower down in the cervical region, then the muscles of the neck will present first a state of stiffness, then rigidity followed by contraction, by which the head will be drawn back or to one side, according as to whether one side is alone or more affected than the other, and both deglutition and respiration will be more or less interfered with.

3d, Implication of the membrane of the brachial portion of the cord will be attended by rigidity and contraction of the muscles of the arms, and of the dorsal and lumbar portions, by the same state of the muscles of the chest, abdomen, back, and lower extremities. This state of rigidity and contraction will, as has been before observed, be greatly aggravated by the convulsive pains or jerks which

occur.

'ASE III.—A farm labourer, æt. 29, of moderate stature and strength, after

exposure to wet while mowing, was taken in the evening with pain in the back. The next, and succeeding days, the pain was very severe, and prevented him from going to work; he took some turpentine and his back was rubbed with it, with some slight relief. On the morning of the 3d day he came under my notice as a parochial patient, suffering from what appeared to be severe lumbago. He had slight fever and thirst, bowels confined, urine scanty and high coloured. A mustard poultice was ordered to be applied to the back, and some saline purgative medicine with colchicum, with a dose of calomel and opium at bed time, given.

4th. He had passed a very restless night, the pain in the back had increased. It was referred to the vicinity of the lower dorsal vertebræ, and was aggravated by bending the back and striking the spinous processes with the knuckles. This led me to question him as to whether he had received any injury to the back. All that could be learnt was, that in a quarrel with one of his fellowlabourers he had received a blow, the day before he complained, which had knocked him down, and he had rolled off a hay stack; but the height from which he had fallen was not great, and he had received no injury. There was an expression of intense anxiety about his face, which made me feel very anxious for the result of the case. He could walk, but said that it was difficult, from the pain in the back; and when he was in the erect position he kept his hands firmly pressed on his back. His bowels had not been opened, and no urine had been passed since the day before, but the bladder was not distended. As the state of the pulse, which was quick, but without much power, did not seem to admit of the abstraction of blood from the arm, he was cupped to 8 or 10 oz. from the seat of pain, with relief. A dose of croton oil was given, followed by some saline sedative medicine. The croton oil opened his bowels, and at the same time he passed about a pint of urine. In the evening he seemed somewhat better.

5th. The night had been unusually restless. The pain had greatly extended, the lower half of the chest felt as if tightly surrounded by a band of iron, which rendered the breathing oppressed. The muscles of the back felt stiff, as did those of the abdomen; the lower extremities were somewhat rigid. The parts thus affected were the seat of severe pain, which was from time to time aggravated, particularly on attempting to move, by shocks or jerks. This pain was also greatly increased by motion. The power of moving the legs seemed much restricted; the cutaneous sensibility was intact, although deep pressure was painful. Heart's action tumultuous, pulse rapid and jerking. Blood to 15 oz. was taken from the arm, with temporary relief to the symptoms, and it was repeated to 10 oz. in the evening with a like result; calomel and opium were also given.

6th. This morning the symptoms were much aggravated, the whole spine was rigid and curved, the legs were retracted, but they could be extended although it excited severe pain; the upper extremities were stiff, as was also the neck; breathing greatly oppressed, and great difficulty was experienced in swallowing; the pulse was very rapid; heart's action very tumultuous. The blood drawn presented but a very slight buffy coat. This morning a motion was passed involuntarily, but no urine had been passed since the action of the croton oil. The bladder did not feel greatly distended; a catheter was, however, passed, and about a pint of urine drawn off.

From time to time the back, neck, and extremities were affected with contractions lasting for three or four minutes, causing him to utter loud groans, from the severe aggravation of the pain which they induced, and the perspiration to ooze out in large drops on his face and body.

The tobacco enema was tried, but although not more than 15 grs. were used in the infusion, the symptoms which it induced were most alarming, the pulse became almost imperceptible, the heart's action feeble and tumultuous, and the surface of the body pallid. This state continued for twenty minutes after NEW SERIES.-NO. VI. JUNE 1855.

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the enema had been evacuated by pressing on the lower part of the colon. It did not seem to exert any influence on the disease further than to prevent the occurrence of the convulsive shocks. The same results followed the use of chloroform on the next day.

7th.—The muscles of the face and jaws were now affected, the utterance of words difficult, although they were quite appropriate.

8th.-Breathing was still more oppressed, and rather noisy. Towards the evening a state of coma set in, and he died early in the morning of the 9th day. The body was examined 24 hours after death. The vessels of the brain and the substance of the brain were loaded with blood, the lateral ventricles contained a small quantity of serum, as did also the pia mater at the base of the brain.

The vessels of the spinal canal were loaded with blood, the cellular tissue between the dura mater and the walls of the spine was of a deep red. A large quantity of serum escaped from the canal, it was slightly turbid. In the lower part of the dorsal region the arachnoid membrane was somewhat thickened and opaque; between it and the pia mater gelatinous exudation existed, which extended up as high as the medulla oblongata, but its consistence was much less marked above the 6th dorsal vertebra than below. The pia mater was deeply injected throughout, but this state was more marked below than above the 6th dorsal vertebra.

The cord was more vascular than usual, but no other change could be observed, although it was carefully examined. The vertebræ were quite healthy. (To be continued.)

ARTICLE IV.-On the Peculiarities of Dentition in Man, and its Influence on Infantile Mortality. By J. SMITH, M.D., Dentist, Edinburgh.

THIS is a subject in which, notwithstanding the researches of previous enquirers, much room still remains for investigation, and regarding which, both as to its nature and consequences, the most vague and contradictory ideas are entertained-some of them, like most other errors once established in medicine, being apparently as difficult to remove, as they are certain to exert an injurious tendency in their practical application.

Dentition, in the most common acceptation of the word, appears to be too frequently confined to that period at which the temporary teeth make their appearance above the gum; and in this restricted sense of the term, we have constant reference made to a number of affections occurring during infancy, and attributed to the morbid influence of, exclusively, the eruptive stage of this process, under the various names of teething, cutting the teeth, etc. etc., all having regard to the penetration of the tissue enclosing the tooth-as if this were effected, not according to a vital process, but by mechanical force--while the other stages, exhibiting less obvious phenomena, are never taken into account at all. It is of importance, in the consideration of this subject, to bear in mind that the process of dentition, being in all its st ges a natural one, regulated by relatively the same physiological laws as other healthy actions, ought to proceed without constitutional disturbance; that it does so in all animals, so far as

we know, with the exception of man; and that, in his case, when disturbance does take place, it is to be regarded as arising from some peculiar abnormal condition of the parts concerned in, and not all as an inherent effect of the process itself.

The structures concerned in dentition are originally adapted for its occurrence, and it is inconsistent with what we know to be the case in analogous instances of development, that any of the steps essentially necessary in the process, such as the penetration of the gum, should occasion a great amount of distress. But an important source of error, and one calculated to lead to much misapprehension on this subject, exists in the fact, that from the greater susceptibility at this age to impressions of any kind, sometimes to those of a very slight nature, considerable constitutional disturbance, altogether apart from this cause, is of very common occurrence; and, although certainly not in every case due to this process, yet the eruptive stage of dentition offering something like a plausible explanation of suffering, an unfavourable impression generally prevails regarding it, and affections are imputed to its agency, which might, in many cases, be traced to an entirely different origin. However, attention being arrested by what appears to be so evident a cause of uneasiness, all treatment is at once turned in that direction, and the true cause of the disorder probably overlooked.

The opinions entertained of dentition being the source of such serious results as are generally ascribed to it, appear in a great measure owing to this unfavourable prejudice existing in the minds of medical men; and while the works of the more early authors on this subject, contain statements involving such misconception and inaccuracy, as to render their confutation unnecessary, we find, at the present day, that the same inclination towards exaggerated ideas of the pernicious tendency of this process, prevails to a very considerable degree.

As an illustration of what we here state in reference to this question, we find in the "Gazette des Hôpitaux," for March 3, 1855, the following remarks: "One sixth of all infants born perish annually at the period of dentition. Already, in 1781, the Royal Society of Medicine, struck by this alarming proportion, offered a prize for the best essay on the following subject, What are the best means to be employed for the prevention of the accidents of dentition, common to infants at the breast, and for their successful treatment when they occur?' The question, hitherto ill-studied, has not as yet been solved, for, as the mortality tables substantiate, the proportion of infants lost by dentition, is exactly the same at the present day as it was in 1781."

Not to mention the fact of the rate of infantile mortality having diminished in every way since 1781, it need only be remarked with regard to the assertion that "one-sixth of infants born perish annually at the period of dentition," that, according to the latest statistics, the total number of deaths from all causes whatever,