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some curious particulars respecting the artificial means that have been resorted to by surgeons in former, as well as in present, times, for the cure or alleviation of this class of afflictions.

To describe a tenth part of the machinery invented for human distortions would require a large volume. Before the knowledge of anatomy was much diffused, the spine was considered by many as a single bone, and its curvatures were treated in the same way that a bent stick would be treated, when the object was to make it straight. Force was applied to the two extremities, to draw them into their proper position, and pressure was made on the prominent part. In our own days, a learned doctor, of manipulating celebrity, insisted that projections of the spine depended on dislocation of the vertebræ, and then the thumbing, stretching, and humbugging process came into vogue. The following woodcut, taken from Ambrose Parée, will shew that there is "nothing new under the sun." The centre figure is a rather flattering likeness of a modern spinewright, in the act of thumbing the dislocated vertebræ back into their places.

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"It is fit to lay and stretch forth the patient upon a table, with his face downwards, and straitly to bind him about with towels under his arm-pits, and about the flanks and thighs. And then to draw and extend as much as we can, upwards and downwards, yet without violence; for unless such extension be made, restitution is not to be hoped for, by reason of the processes and hollowed cavivities of the vertebræ, whereby, for the faster knitting, they mutually receive each other. Then must you lie with your hands on the extuberancies, and force in the prominent vertebræ. But if it cannot be thus restored, then it will be convenient to wrap two pieces of wood, of four fingers long, and one thick, more or less, in linen cloth, and so to apply one on each side of the dislocated vertebræ, and so with your hand to press them against the bunching forth vertebræ, until you force them back into their seats, just after the manner you see before delineated." 232.

We may readily conceive the dreadful consequences which must have Occasionally ensued, in tearing asunder newly-formed anchyloses, by these dangerous extensions and endeavours to reduce supposed displacements of the vertebræ! During the last century all spinal distortions were mechanically treated, and collars, backboards, stays, spine-supporters, &c. were multiplied

ad infinitum. In France, the celebrated Madame de Montmorenci lost her life by the stretching and screwing process employed to make her straight. "The ill consequences of the mechanical treatment of deformities of the spine, frequently presented themselves. Slight distortions were rendered worse, and bad ones were not mended, and on the recommendation of Mr. Baynton it became the fashion to condemn all persons, who either had, or were threatened with spinal deformity, to an undeviating horizontal posture for months and years. This is excellent practice in many cases of diseased bone and cartilage, but in debilitated states of the muscular system, the evil will be increased by such total inaction. Frequent failures threw this system and the inclined plane, which was a modification of it, out of fashion." 234.

From the universal application of machinery in former times, we are now, Mr. Beale thinks, in danger of running into the opposite extreme-" of neglecting mechanical means and repose, and trusting too much to muscular exercise, gymnastics, and calisthenics." All the means enumerated are beneficial, when applied to the proper cases:―

"Various exercises in muscular debility, and in convalescence from diseases of the cartilages and bones: with the occasional use of spine-supporters in the intervals of repose and exercise: friction, manipulation and even pressure to lateral curvatures and projecting ribs and undeviating rest in cases of caries.” 235.

Machinery is used in the treatment of deformities on two principles-1st, to take off the superincumbent weight from bones, cartilages and ligaments, when these are diseased-2dly. to act on shortened, contracted, or rigid parts, ard by extension to elongate them, or to bring them to their natural positions.

"Crutches are the simplest contrivances used on the first principle, when the lower limbs lose the power of supporting the weight of the body. The various backboards, collars, &c. used in curvatures of the spine are employed with the same view. Crutches have some advantage over corsets, and collars, inasmuch as they support the weight of the upper part of the body, without confining the muscles to total inaction. In walking, crutches should be of sufficient length to allow the extremity of the foot alone to touch the ground, and when attached to a seat, they should be high enough to raise the shoulders in the same manner as in the common mode of using them. The corsets employed in cases of distorted spine are occasionally useful, but much mischief has accrued from their indiscriminate employment. It must be obvious to every one, that where the primary source of distortion, is a debilitated state of the muscles, instruments which are employed to support the spine, to do, in fact, what the muscles should of themselves effect, so far from removing the deformity, will tend to the aggravation of the malady, they may conceal the defect but they never can cure it. Instruments of this kind are useful in slight cases of lateral curvature, and in convalescence from disease of the fibro-cartilages, in the intervals of exercise, during meals, and to relieve the irksomeness occasioned by long-continued recumbency." 236.

Our Gallic neighbours are almost mad, at the present period, in pursuit of machinery for the cure of distortions. Their MAISONS ORTHOPEDIQUes, vie with each other in the complexity of these machines. They not only stretch the spine, but apply mechanical means to act on the lateral contortions and inflections of the column. They keep up extension day and night, and their beds remind us of the bed of Procrustes, or the racks of the Inquisition. Here follows a specimen.

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The above is taken from M. Delpech, a highly talented surgeon, who has great experience in the treatment of distortions. The essential purpose, Mr. B. observes, of all the complex machinery of the French, may be effected by a screw, similar to that of the tourniquet, acting on a bandage round the pelvis, the head being fixed in one of the common head-pieces of the inclined plane, by an apparatus similar to that seen in the above sketch.

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The preceding wood-cut is copied from Delpech, and represents a contrivance by which exercise can be employed by convalescents from spinal diseases, as also in all cases where it is not yet proper to allow the weight of the body to press on the spine. By this apparatus a person can take exercise while in the recumbent position.

"The machine is supported on a basis, which moves on four rollers, in a grooved platform. The frame on which the cord is stretched, is connected with this basis by a pivot, by which the angle formed with the horizon may be altered. Below the axis there is a windlass in the frame which increases the tension of the cord. The car is mounted on the tense cord by two pullies, one anterior and one posterior: its sides cannot be supported on the sides of the frame, without impeding motion, which renders it necessary to maintain the equilibrium, by the action of the lower extremities." 242.

Below is a figure practising this exercise, and in the act of ascending. The cord is borne down by the weight of the body, the knees are pressed against the sides of the frame to maintain the equilibrium of the car, the body is raised by the exertion of the arms pulling at the side rails. This exercise obviously calls into play most of the muscles of the arms, chest, and spine, together with many of those of the lower limbs.

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We are unable to pursue the subject any farther--the foregoing being indeed only a specimen of the ingenious author's work, which we recommend as a very useful epitome and compilation, in all orthopedic pursuits.

VIII.

RESEARCHES PRINCIPALLY RELATIVE TO THE MORBID AND CURATIVE EFFECTS OF LOSS OF BLOOD. By Marshall Hall, M.D. 8vo. 1830.

ONE object of Dr. Hall's researches is to shew the remarkable difference in the degree of tolerance or intolerance of loss of blood in different diseases another object, and a very important one, is to establish the distinction between inflammations and irritations. Some observations on these subjects were published by our author ten years ago; but he has now enlarged on these topics, and added the testimonies of several living practitioners, in support of his conclusions.

The morbid effects of blood-letting have certainly not been studied so well as the curative, though they are not less interesting-syncope, delirium, convulsions, coma, and subsequent excessive reaction, are among the most conspicuous features of these bad effects of bleeding.

1. Syncope. It would appear that the primary cause of this phenomenon is defect of circulation in the brain, since posture alone relieves it; but then the deficiency of power in the heart must precede the affection of the brain. The respiration, the state of the stomach and bowels become secondarily affected. The efforts to vomit are succeeded by an amelioration of the syncope. The reaction which next takes place, may be excessive or defective or it may be wanting altogether, and yield to an opposite conditionsinking.

2. Convulsion. Next, after syncope, the most familiar of the immediate effects of blood-letting, is convulsion. It is more apt to occur in children, and in cases of slow and excessive detraction of blood. This is evidently dependent on affection of the brain-it is a phenomenon which shews that the brain may be "similarly affected by opposite states of the general system -an observation as old as Hippocrates. It is evident that the constitutional treatment must be diametrically opposite in the two cases of repletion and exhaustion. Dr. H. conceives that convulsion occurring after bloodletting, usually denotes that too much has been taken away, often in the recumbent position, when a great deal of blood flows before deliquium is induced.

Case. "A physician, aged thirty-four, became affected with inflammation of the larynx. He was bled freely on two successive mornings at his own instance. In the afternoon of the second day, the disease being unsubdued, he was bled a third time, placed in a rather inclined position upon a sofa. The blood was allowed to flow until thirty-four ounces were taken. He then suddenly fell upon the floor violently convulsed; and he remained for some time afterwards in such a state of syncope as to render his recovery very doubtful; being carried to bed, however, and cordials being administered, he slowly recovered. He did not afterwards suffer from the secondary effects of loss of blood.

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"A similar case is given by Mr. Travers. This gentleman observes, Some

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