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Its massive courses, circling as they rise,
Swell from the waves to mingle with the skies :
There every quarry lends its marble spoil,
And clustering ages blend their common toil:
The Greek, the Roman, reared its ancient walls ;
The silent Arab arched its mystic halls.
In that fair niche by countless billows laved
Trace the deep line that Sydenham engraved,
On yon broad front that breasts the changing swell,
Mark where the ponderous sledge of Hunter fell.
By that square buttress, look where Velpeau stands,
The stone yet warm from his uplifted hands."
There where the western sun pours down his rays,
And gilds the efforts of more recent days,
Mark that proud column-our eyes its splendor dims-
Quarried by Rush, and reared by Sayre and Sims.
"And say, 0 Science, shall thy life-blood freeze
When fluttering folly flaps on walls like these ?
No! they will stand through all revolving time
Firm, imperishable, and sublime."

CASE OF RECOVERY FROM OCCLUSION OF ONE OR

MORE OF THE CEREBRAL SINUSES.

By M. O'HARA, M.D.,

PHILADELPHIA, PA.

Os March 1, 1880, I was called to see Miss M., a robust white person, twenty-two years of age. She had been complaining since February 22d of general and local pains which she called neuralgia, but now her complaint was especially of ædematous swelling about the eyes and face and atrocious pains in the head; the pain was constant and tensile, but with exacerbations of severity. The pains and swelling were most marked in the face, temporal and frontal regions, and more manifest on the right side. The pains in the temporal region seemed to alternate in severity with the changing appearance of venous distension in the forehead, nose, eyes, temples, and the whole orbital region. There was internal strabismus of the right eye; the pupils were normal; the eyes were protruiled, the right eye more than the left; there was ecchymosis of both conjunctive.

Negative points were the absence of sweats and vomiting, though nausea was present. No definite motor paralysis could be made out, but the grip of the right hand seemed weaker than the left.

On having her to stand and walk a few feet with eyes shut, she fell unless supported. There was hy perästhesia of the left cutaneous surface, and anæsthesia of the right. The recognition of impressions on either side was uncertain. Vision was not impaired. The hearing was defective on the left side, but this she stated to have been the case for years. The tendon reflexes were normal. IIer mental condition was unaffected. There was general fever, pulse 100, and respiration more frequent than normal.

The only history afforded as to causation was that she had fallen eighteen months previously, and had struck upon her right knee; since, she had pains and swelling in the right and

left knees and ankles, and pains in the leg bones, which remained continuously in the right tibia. There were present periosteal inflammation and thickening of the right tibia.

The diagnosis was made of complete or nearly complete occlusion of one or more of the basal cerebral sinuses either from internal or external causes, and was based on the local appearances and the history given by the patient; the circulation being so obstructed as to cause a damming backward of the blood in the ophthalmic veins into the facial veins, which ought to have been emptied into the cavernous sinuses.

The treatment ordered was cupping, free purging, the use of bromides and ergot in large quantities, morphia to relieve pain and procure sleep.

On March 2d Dr. C. K. Mills met me in consultation, and concurred in the diagnosis. He co-operated with me afterwards in the management of the case. The pain was greater and more diffuse over all the region before mentioned; the conjunctiva was more ecchymosed; the strabismus was decided; there was very marked collateral venous distension over the whole face, nose, and temples. Urination was less free.

The same treatment was continued, and it was deemed prudent, lest there be some blood contamination, to add the use of iodide of potassium and bichloride of mercury.

On the third, there was an amelioration of all the head symptoms. She required morphia for sleep, as the insomnia was distressing without it. No change was made in the treatment. Severe purging by senna and salts appeared to bave a happy effect.

On the fourth, she complained of a throbbing pain in the right side of the head, with each beat of the heart; the headache was very distressing, but was relieved by morphia frequently given. She had annoying pruritus and formication over the whole body, which was palliated somewhat by washes of borax and muriate of ammonia.

On the fifth, she had very much pain, as if the head would burst; she was delirious, and had illusions, but no permanent hallucinations. The squint had disappeared. Her pulse was 108, and her temperature 103°. Her local head temperatures were taken at three stations—a central frontal in the middle of the forehead, and a lateral frontal just above and behind each external angular process of the frontal bone. The results were

98

.

1020

.

Central frontal

993
Right lateral frontal
Left lateral frontal.

96} Her right knee was painful and swollen; the left was also pain. ful. Her grip was equal in both hands.

On the sixth, she showed a remarkable improvement which came on in the course of a few hours. She slept well and without any narcotic for four hours, and made no complaints until later in the day, when swelling and pains in the left knee and scattered pains over the body appeared. She was now kept on bromide and reduced quantities of the io lide, with mercury.

On the seventh, she slept tolerably well and continued better. The superficial sensibility of the body was normal. The knee was less swollen. The ecchymotic condition of the eyes was disappearing. The temperature record was

General temperature (axilla)
Central frontal

981
Right frontal .

983 Left frontal

985 She complained of a beating sensation on the right side of the head anteriorly. There was a purplish blotch on the right molar bone, one and a balf inches in diameter, of irregular outline between the eye and ear. The conjunctival ecchymosis, the ocular protrusions and nasal swelling, present the day before, had all left.

On the eighth, she was doing well, but had some slight delirium. The pulse was 82 and temperature 1001o.

On the tenth, she vomited occasionally, was melancholy and complained of flying pains.

Up to the twentieth she steadily improved, but on this day she complained of gastric distress and a smothering feeling in breathing

On the twenty-third, she had neuralgic pains in the left side of the body and a rectal abscess was opened.

On the twenty-fourth, she felt quite stupid; the left side of the body, particularly the leg and foot, felt weak. The rectal abscess was discharging.

On the twenty-ninth, she had much pain in various joints, and felt mentally enfeebled. Her left arm and fingers felt weak. She could not cut with the scissors (her usual occupation).

On April 30, the last day she was seen, the symptoms noted

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