other times falling much below it. Inttances of this we have in different difeafes, and even in the fame difeafe, in very short intervals of time. A very remarkable one fell under my own obfervation, in a gentleman who was taken with an apoplectic fit; while he lay infenfible in bed, and covered with blankets, found that his whole body would, in an inftant, become extremely cold in every part; continue fo for fome time; and, in as fhort a time, he would become extremely hot. While this was going on for feveral hous alternately, there was no fenfible altera. tion in his pulfe. pared from them, allowed him a glass of wine or a little beer occafonally, but chiefly to confine himfelf to water. He pursued the plan very fcrupulously, loft his redundant fat, grew active as ufual in about fix months. I recommended a perfeverance for a few months longer; then to allow himself light animal food once or twice a week, and gradually to fall into his usual way of living. He grew well, and continued fo. A young unmarried woman, about twenty-three years of age, of a low ftature, and very fat, applied to me for affiftance in a great difficulty of breathing, fomnolency, and incapacity for any exercife. It was a harcfhip to her to be obliged to go up stairs, and at laft to cross the floor of her apartment. It seemed to me that mere obefity was her principal malady; indeed the had no other complaint but fuch as apparently might be accounted for from this fuppofition. She was ordered to pursue a vegetable diet, and in the fummer to drink the waters at Scarborough: She conformed to thefe directions, became more agile, lefs fleepy, lefs averfe to exercife. She walked up the fteps at Scarborough from the fpaw, a task of no little difficulty to people much lets encumbered. I urged a continuance of the fame diet: he was diffuaded from it by her friends, and died of fat in the twenty-feventh year, of her age. She left permiffion with her fitter, to be opened, if it was defired: the cafe was too fingular to be neglected: all the vifcera were perfectly found, but larded with fat beyond apprehenfion. In dividing the external teguments, we we cut through 24 inches of fat. high, enjoyed a good fate of She died fuddenly. Some inftances of a fimilar nature, in which a vegetable diet has fafely contributed to reduce immoderate corpulency, induces me to think that a prudent trial in the cafe I am treating of (an Angina Pedoris) would be advifable. Perhaps a reasonable ufe of wine, not a generous one, fhould be here allowed, left the ftrength fhould be diminished too much in proportion; and if the power of abforption fhould by this means fail, we may probably lofe more ground, by the increase of the ferefa colluvies in the cavity of the thorax, than what we gain by fubtracting the fat. All the means of increafing the thinner fecretions are evidently pointed out as neceffary, from this diffection; and if to thefe we join mall dofes of chalybeates, or other medicines, and an abilinence from animal food, fo far as the patient's health, fituation, and manner of life will admit of it, we are perbaps rendering all the reasonable affiftance we can, till future difcoveries make us better acquainted with the real causes of this fingular diftemper. Some Account of a very remarkable Medical Cafe, in which all the Bones, particularly thofe of the Thighs and Legs, left their Solidity; by Mr. Henry Thomson, Surgeon to the London - Hofpital. From Medical Obfervations and Inquiries by a Society of Phyficians in London. AMES Stevenson, a JAMES'Stevenfon fhoe Wapping, aged thirty-three, five feet feven inches health till about the year 1766, pains in his knees and feet, and when he was feized with violent was tormented with a head-ach, riods; thefe pains he fuppofed to which came on at irregular pebe rheumatic, and had recourse to a variety of medicines, and to empirical aid, without finding any alleviation whatever of his complaints. In the month of November of the fame year, he injured his left fhoulder by a fall, which occafioned him confiderable pain; and he was unable to move it for several months afterwards. In November 1768, he flipped had fprained his right thigh; this down in his fhop, and fancied he injury confined him to his bed about a week; and he was afterwards unable to walk without the fupport of a perfon's arm and a crutch-ftick. of December following, as he was On the twenty-first endeavouring to go up ftairs to bed, fupported by his wife, he ftruck the toe of his right foot upon the edge of the ftep, and inftantly cried out that his thigh was broke. He was put to bed, and an apothecary being fent for the next morning, who, paying thigh, attributed the great pain he little attention to the injured fuffered to an increafe of his rheumatic complaints, and gave him medicines accordingly. In this fituation he continued upwards of a fortnight, when Dr. Dickfon, phyfician to the London Hospital, was called in. Upon his viewing the thigh fo much complained of, he found it crooked and much fhorter than the other, and therefore advifed a furgeon to be fent for. I faw him the following day, and and on examination, found a fracture of the thigh-bone near its upper extremity. I effected the reduction as well as I could, by means of very little extenfion, and had reafon to fuppofe that the ends of the bone were in due contact, by the limb being of an equal length with the other. It was fecured in this pofition with the ufual apparatus; and I was in hopes that his pain would now ceafe: the event however proved different; his pains continued, though not fo violent. This circumftance obliged me frequently to unbind the plints, and to reaccommodate the bandage, judg. ing that either the puckering of the bandage, or tightness of the fplints, might occafion in fome measure the uneafinefs which he felt. About the end of five weeks from the time I had replaced the thigh-bone, defirous of knowing how far the union was completed, I undid the whole apparatus, and requested his wife to lift up the leg, by placing one hand under the ham, and the other to embrace the leg above the ancle, whilft I examined the degree of firmness where the fracture had been. In doing this, I was furprized to find the thigh-bone yield and fall in, about a hand's-breadth above the knee, fimilar to that of a fracture, excepting that in this cafe, there was no fenfation of grating, as is ufual, where the broken bone is of a folid texture. Upon turning my head about to give his wife directions to lower the leg upon the pillow, I became more aftonished, for I found the leg almost doubled in her hands; a fimilar feparation of the tibia and fibula (the two bones of the leg) had taken place about a hand's breadth below the tuberofity, as has been just before noticed, in the os femoris (the thigh bone). Both thefe feparations were unaccompanied with any remarkable figns of additional pain to the patient. This deplorable fituation of the patient urged me to a particular inquiry into the caufe of fo uncommon a calamity. I could however learn nothing fatisfactory, further than concerning the rheumatic complaints before mentioned, which gave me fome fufpicion that a venereal virus might poffibly have laid the foundation for the fufferings he had undergone. I queftioned him upon this head; he acknowledged that he had had a venereal complaint between two and three years before he married; that he never thought himself cured of it, though he had then been married about fix years; that he had fcorbutic blotches upon him for fome years, and declared he had then a gleet. Upon viewing the eruption, I was confirmed in my opinion, that it was venereal; I therefore refolved that he fhould begin a mercurial courfe, and accordingly directed a drachm of the ftrong mercurial ointment to be rubbed in every night, under the ham of the found limb. Previous to my dreffing up the miferable leg and thigh, I examined the feparation (for I could not call it fracture) which had been produced in the tibia (the great bone of the leg). The kin being very thin, from the emaciated condition of the patient, I could perceive by the finger a regular tranfverfe cleft in the tibia; there was no appearance of ecchymofis (livid pots or blotches in the twenty-four hours, when it arrived to its height. The wound of the leg fuppurated in the most kindly manner, and healed in a fhort time. The spitting alleviated the pains in his limbs, the eruption upon the skin gradually dif appeared, and upon the whole, his health feemed much amended. blotches in the skin) nor tumefaction, nor did any appear afterwards; upon tracing the furface of the tibia with my fingers, below the fiffure, I found a remarkable foftnefs and yielding of the bone down to its lower extremity, fimilar to a fluid being contained therein. So extraordinary a circumftance excited my curiofity, and 1 deter- The right leg and thigh began mined to explore the nature of fo to fhorten, and acquired foon a uncommon a feel, by laying it confiderable degree of deformity. open. The following day I made The bandage and fplints were dif an incifion, about five inches in continued, as being no longer ferlength, with a fcalpel, through viceable; and finding the left i the fkin, along the fpine of the tibia become foftened in the manner bia, and turning the knife about an which had been obferved in that inch across upon the furface of the of the right, I lamented his fate, bone, I made a fecond incifion pa- as judging him paft all hope of rerallel with the first, and then re- lief. However, his cafe being. moved this incifed portion clear made known to the Medical Sofrom the periosteum (the skin cover- ciety, who from time to time affifting the bone), which was remark- ed him with money, feveral of its ably thin. Finding upon examin- members vifited and directed the ation by my fingers, that the ex- ufe of various things. He drank ternal part of the bone was ex- wort for a confiderable time, and tremely pliant, and yielding, I likewife the antifcorbutic juices, paffed my knife through it, and re- and for a great while took a decocmoved all that had been denuded tion of the bark with elixir of viwith the greatest eafe, its texture triol, by the order of Dr. Dickson, being only about the folidity and who frequently faw him; but nothickness of the rind of cheefe. thing which was tried having any effect in checking the progrefs of this deplorable difeafe, the poor man grew tired of medicines, and calmly expected his diffolution. This being done, I found a dufky red, or liver-coloured flesh, occupying the whole internal part of the bone, devoid of fenfibility, and from which the offeous covering had been removed, without the leaft hæmorrhage: in fhort, it appeared to me an unorganized mafs, fimilar to the flesh-like fubflance or coagulum which may be formed upon a flick or feather, by ftirring fresh drawn blood in a bafon. The mercurial unction was continued every night for the fpace of a fortnight: the ptyalifm gradually advanced, and he fpat about a pint From the time of my first at tendance upon him, to the day of his death, he was never able to be removed out of his bed; he lay upon his back, nor could he ever bear to be turned upon his fide. The left leg and thigh loft its ftraitnefs, and became deformed in like manner with the right; and in proportion as the contraction and deformity took place, he gra dually loft all fenfe of mufcular action; His appetite remained good the whole time of his confinement, till within three weeks of his death; he was fometimes coftive, and had recourse to a laxative electuary at these times: his urine for the first two years generally depofited a whitish fediment, which upon evaporation became like mortar; and he voided three or four fmall jagged ftones fome time after a complaint in his loins. He was at laft feized with a lientery, which put an end to a miferable existence, on the 18th of February 1775, after a confinement to his bed of above fix years. Dr. Hunter did me the favour of affifting in the examination of the body. Upon opening the thorax (cheft), we found the ribs and fernum (the breaft-bone) had loft all their folidity, being eafily cut through with a common fcalpel; the cartilages of the ribs were unaltered; the contents of the thorax and abdomen (belly) appeared in a healthy ftate, and were no otherwife affected than by fituation, owing to the deformity of what originally formed the bony fupports of the thorax, the fpine, and pelvis (hips). The gall-bladder however was deftitute of bile, greatly contracted, and contained a confiderable number of very fmall, black, jagged ftones, resembling coal duft. We next proceeded to examine the ftate of every bone in the body; the refult was, that we could easily pafs the knife through thofe of the VOL. XIX. cranium (skull), fternum, ribs, vertebra (joints of the back-bone), pelvis, and all the cylindrical bones which formed the extremities; and the phalanges of the fingers were even fo much altered, that they were capable of being flit through longitudinally. All thefe originally bony parts confifted of a mere cortical or outfide offeous covering, of the thickness of rind of cheese, and of an infide fleshcoloured mafs. The cartilaginous coverings of the epiphyses of the bones of the extremities appeared to have loft much of their original thickness: in many parts of the epiphyses it appeared as if this cartilaginous covering was in a manner annihilated, whilft in other parts it appeared prominent and full of bumps. The epiphyfes were equally compreffible and fpringy to the touch as the diaphyfes of the fame bones; and though there was an apparent diminution of cartilaginous covering, yet it by no means appeared to be abraded, fince what remained preferved its pearly colour and fmooth polish; and it is remarkable, that though the joints of the lower extremities, in particular, had been deftitute of motion above fix years, the finovia was perfectly good, and in great quantity. I have only to add, that the mufcular parts in general, but more particularly of the lower extremities, were exceedingly pale, having loft the appearance of flesh; and it would fcarcely have been poffible to have traced them by diffection, from their contortion and adhesion to each other. |