one only with considerable difficulty. The common sensibility was but little affected in any part; the intellect was confused; he could not answer many questions successively. In the course of a few days all the unfavourable symptoms were aggravated; the trembling oscillation of the head and tongue was incessant; the trunk and limbs lay nearly still and motionless; the forearms were laid across the abdomen, the wrists were bent, and the thumbs drawn into the hollow of the hand, and almost constantly trembling. Every now and then there was a paroxysm of apparently epileptic convulsions, and the patient seemed to recover his sensibility and consciousness for a time, but he soon relapsed into his former stupor. On dissection, the attention of the physician was directed in a special manner to the encephalic contents; and it was found that a tumor, of the size of a small walnut, had formed on the tuber annulare, and adhered to the outer surface of the cerebellum. This tumor was formed of nacreous particles and layers, and belonged to that class of morbid deposits described by M. Cruveilhier as consisting of stearine and cholesterine;

they appear to be quite inorganic, presenting no traces of vessels, or of cellular tissue,-Archives Générales.

indulgence in the pleasures of the table;

in course of time the appetite became quite voracious. Her chief malady was a difficulty of breathing, which returned periodically every evening, and was accompanied with the sensation as if a heavy ball was rising from the lower part of the belly to the region of the heart, and there stopped, and obstructed the respiration. These symptoms lasted generally for about six or eight minutes, and then gradually subsided. Each attack became more severe; and at length they sometimes induced delirium. A general emaciation supervened, although the bulimia was not diminished. All the remedies tried to relieve her failed, and she died in the course of a few months from marasmus.

Autopsy. Thoracic organs healthy; omentum almost entirely awanting; liver, gall-bladder, and spleen natural. The stomach was puckered, and evidently much thickened, especially towards the pyloric orifice, and along the great curvature; its blood-vessels were empty; the mucous membrane, coated with a viscid deposit, was thin, transparent, but not softened; its surface was elevated into bold irregular projections, by the subjacent bundles of muscular fibres, extending from the great cul-de-sac towards the pylorus; between these projections were hollows, or depressions; and thus this stomach presented an appearance not unlike to

felt. The uterus could be felt distinctly with the hand placed on the hypogastrium; and if firm pressure was made, a sharp pain was produced. Gently soothing means and absolute rest were enjoined, and after a few days the patient seemed to be relieved, when suddenly the abdomen became enormously distended, and a fluctuation was distinctly perceptible. A sense of uneasiness and weight in the hypogastrium was complained of. Dr. O. was not at all surprised at this change in the symptoms, as he had, from the commencement, regarded the case as one of inflammation of the membranes of the ovum: and he therefore concluded, when the sudden swelling of the abdomen supervened, that the inflammatory process had terminated in effusion. The treatment which he adopted was of the simplest kind, as the general health of his patient was now moderately good. The coloured discharge became less and less, all tenderness of the abdomen ceased, and the movements of the child began to be felt. The pregnancy went on favourably to its full period, and the lady was safely delivered. Dr. O. was then able to verify the accuracy of his prognosis. It may be noticed, that during the labour, and before the head was protruded externally, there had escaped suddenly a tumor or pouch as large as a man's fist, formed apparently by the foetal membranes, but of the thickness and consistence of softened parchment.As labour advanced this pouch burst, and discharged the amniotic fluid.

On examination of the after-birth and membranes, he found that these last were, for about one-third of their extent, considerably thickened, opaque, and of a whitish colour, villous on their internal surface, and, in short, altogether like to parchment which had been long steeped in water. All the thickened portion was traversed by minute vessels, and these were more distinct as they approached the placenta.-Arch. Générales.

Dr. Bellingeri, with whose work on the functions of the nervous system our readers are made acquainted in a preceding part of the present number, is the narrator of the case. A country girl, thirteen years of age, whose health had been very generally good, in spite of a considerable bronchocele, began about the middle of last year to experience a pain in the left shoulder, which extended towards the neck, and was especially severe over the larynx; the neck became stiff, and occasionally she complained of pain in the occiput, and difficulty in moving the lower jaw.These symptoms she attributed to having slept in a damp chamber. Although troublesome, they did not seem to disturb her general health, as she eat and slept well, and was able to go about as usual. It deserves, however, to be noticed, that the act of swallowing was not quite easy;-she felt as if the food was partially obstructed in its descent. In the course of a day or two, she experienced sharp pains along the whole extent of the spine, and a sense of dragging in the lower extremities. Two days after, the lower extremities became rigidly drawn backwards; and in other 24 hours, the head, neck, and trunk were similarly affected. The sharp, darting pains in the occiput and along the spine were as severe as hitherto. Venesection and oily purgatives were employed, and leeches were applied to the back. For five days, the tetanic symptoms continued in all their seve rity; and so powerful was the opisthotonos, that the body of this poor sufferer formed a complete arch backwards. The rigidity of the spasm was strongest in the lower extremities;-so stiffly were they drawn backwards, that they could not be brought into a straight direction, even when considerable force was used. The power over the upper extremities was not completely lost, the patient being able to move them about in some directions; but the movements were limited and also painful. The pupils were observed to be con

stantly contracted, and seemed to be little or not at all affected by light; the sense of vision and the hearing were not however disturbed. The alæ nasi and the upper lip were drawn upwards, and the patient could only imperfectly close the mouth: indeed every muscle of the face seemed to be more or less affected with spasm. In no part was the common sensibility affected. The pulse was contracted, and beat about 104 times in the minute. The abdomen was so stretched that its surface was as flat as a board; for four days no alvine evacuations had been obtained; and it was found that considerable spasm of the sphincter ani and of the rectum existed, when attempts were made to throw up enemata. The urine was voided voluntarily and at intervals; but she had not the power of retaining it; for whenever the desire came on, she was obliged to yield at once to it. The heat of the body was rather higher than in health; and the skin was always gently moist.

Dr. B. saw her for the first time on the ninth day after the commencement of the disease, and found the symptoms then as we have described. He tried the effects of bleeding from the jugular vein, in consequence of the patient complaining of a distressing constriction in the throat. After about nine ounces had flown, a sense of suffocation came on, and the face became livid; the bleeding was immediately stopped, and in the course of a few minutes the breathing became more easy; but again the paroxysm returned with more alarming severity, and the patient died, apparently asphyxiated, from a spasmodic closure of the rima glottidis. A short time after death the left arm was drawn backwards. For twelve hours the rigidity and distortion of the head, neck, trunk, and lower extremities continued, although the body was then quite cold; in other twelve hours these appearances had ceased, and the joints were pliant.

Dissection. On the posterior surface of the spinal cord, between the third dorsal and the first lumbar vertebræ, and externally to the investing dura mater, there was a bloody exudation;

it was truly an exudation and not a mere congestion. When the dura mater was slit open, a state of very high injection of the minute capillary vessels on the pia mater, which invests the posterior surface of the medulla, extending from opposite the ninth dorsal vertebrae to the extremity of the cord, or cauda equina, was most strikingly apparent to all the medical men who attended the examination. The pia mater which invested the posterior surface of the rest of the spinal marrow was similarly, but in a less degree injected; the injection was most conspicuous at the medulla oblongata. It is to be observed that the appearance now alluded to was limited to the posterior surface of the medulla; it was not seen on the lateral surfaces. On the anterior surface the cellular tissue which lies between the vertebræ and the dura mater, and this membrane itself were very highly injected, (even more so than on the posterior surface) along the whole extent of the spine. When the dura mater was slit open, the arteria spinalis media was found engorged with red blood, and many of its branches, especially at the lumbar region, were in a similar state. The injection which existed on the posterior surface of the medulla was confined to the pia mater: the substance of the medulla itself throughout was altogether natural.

Cranium. There was a slight sanguineous transudation between the dura and the pia mater; this latter membrane seemed highly injected at several parts; the thalami optici, corpora striata, and corpora quadrigemina were healthy; but the choroid flexus was much engorged. The pia mater which invests the cerebellum, pons varoli, and medulla oblongata was highly injected over its whole extent; but the substance of those parts themselves appeared to have not been affected.

Abdomen. Several portions of the intestinal tube were of an unusually deep red colour; a number of lumbrici were found within.

Physiological Considerations. As in the preceding case, the engorgement affected chiefly the pia mater which in

vested the anterior surface of the tuber annulare, and the posterior surface of the spinal cord, we can at once understand why the spasm assumed the form of general opisthotonos, accompanied with trismus and dysphagia. The anterior surface of the tuber is formed by fibres issuing from the cerebellum; and when these fibres are irritated, they cause spasm of the extensors of the head and neck, trismus, and a spasmodic constriction of the fauces and pharynx. The rigidity of the arms, and the painful difficulty which the patient experienced in attempting to bend them, indicated a spasmodic irritation of the extensor muscles.

The opisthotonos of the trunk proceeded from the congested state of the posterior surface of the dorsal medulla spinalis; and the permanently rigid extension and retro-duction of the lower extremities were owing to the disease having extended to the lumbar portion of the medulla; and the reason of the cramps having been more violent in these than in the upper extremities, is no doubt to be sought for in the more highly congested state of the lumbar, than of the cervical portion. The phenomena of the case are quite in harmony, says Dr. Bellingeri, and indeed corroborate the doctrine, that the cerebellum and the posterior columns of the medulla spinalis preside over the extensor muscles of the body, and do not at all influence the flexors. The absence of any disturbance of the sensibility is to be attributed to the immunity of the substance of the medulla from disease. The history of the case shews that an irritation acting upon the white, or medullary substance, causes spasm, and does not affect the sense of touch; also, that the posterior column of the spinal cord, and the nerves which issue from it, are not to be considered as simply sensory organs, as Bell and Majendie suppose; indeed, the sensibility was little or not at all affected in this child.

Such are the speculations of M. Bellingeri. This is not the place, nor have we at present the disposition, to dispute them. We therefore let them pass for what they are his opinions.-Rev.

VOL. XXI. No. 42.

Pathological Considerations. The vermination is probably to be regarded as the occasional cause which had excited the latent, or masked enteritic affection. Broussais has very justly remarked that diseases of the encephalon and of the spinal marrow are often sympathetically or secondarily induced, by inflammatory or irritative affections of the alimentary tube; the reverse of this position also is equally true. Admitting the correctness of the opinion, that the nervous was consecutive to the enteritic disease, we are led to account for the more marked congestion which was found at the tuber and medulla oblongata, to the more intimate sympathy, and the more immediate connexion which exists between those parts and the abdominal viscera, by means of the great sympathetic nerve. We can also understand how the morbid action may be propagated to the posterior surface of the spinal cord; no doubt in consequence of the numerous communications between this (the sympathetic) nerve, and the posterior fasciculi of the spinal nerves. From these considerations, it must be apparent, how necessary in medical practice it is to have our attention most diligently directed to the state of the primæ viæ, in all affections either of the brain or of the spinal cord.-Annali Universali di Medicina.

CANCEROUS ULCERATION OF THE NOSE

TREATED WITH CREOSOTE.

ral small ulcers of a very unhealthy appearance. A variety of remedies had been tried by different surgeons; but the disease had baffled them all. M. G. considered the case as well adapted for a trial of the creosote; he touched the surfaces of the sores in the throat, as well as on the nose, with a pencil dipped in creosote water, and introduced into the right nostril a dossil of lint wet with it. The application caused a slight burning sensation. It was used once daily on the fourth day, the surface of the ulcer on the lip was observed to be quite dry, and to be covered with a reddish-brown crust. Upon removing this, a few drops of blood flowed from the raw surface. The creosote water was, however, immediately re-applied-the crust was again formed within 24 hours, and again removed. This treatment was continued for four days, and, at that period, the appearance of the sores was decidedly much improved; the surface was no longer fungous, but dry, and, as it were, mummified; the lower margin of the ala nasi exhibited a point of cicatrization, and this sanative process advanced gradually during the ensuing fortnight. M. G. now applied the pure creosote, in place of its solution in water; the pain caused by the application was very smart and pungent; but it did not last long. On the morrow, the crusts were found to be more strongly adherent, and considerable difficulty was experienced in attempting to remove them. The application of the pure oil was continued regularly once a day; and so satisfactory was the progress made under its use, that, in the course of another fortnight, almost the whole extent of the ulcer on the nose and lip was cicatrized. A very small portion remained in a state of suppuration at the date of the report.Journal fur die Chirurgie, &c.

The English reader will scarcely fail to notice, that this was an instance of lupus. Various stimulating and escharotic ointments or washes have sometimes succeeded, and more often failed, in healing this obstinate species of ulceration.

ON THE EMPLOYMENT OF Soot, as & SUBSTITUTE FOR CREOSOTE.

M. Bland, physician to the Hospital de Baucaire, was led, by analogical reasoning, to believe that soot might probably have similar effects, as an outward application, to the newly-discovered substance, creosote. The prepa ration of this (creosote) is not only very expensive, but is extremely uncertain and troublesome; it is obtained by the dry distillation of organic substances. Now it may be observed, that the combustion of fuel (wood), in our grates, is an every-day rude exemplification of the same process; the former, indeed, goes on in closed vessels, and the product is, therefore, more simple and pure; but there can be little doubt that the same constituents are present in the heterogeneous soot of our chimneys. M. Bland communicates the results of his practice in the following reports.

CASE 1. A boy, 14 years of age, had been affected, for eight months, with the "herpes squamosus lichenoides" on the chin and lower lip. This dartre presented the appearance of a large grey-coloured crust, hard, and very adherent to the skin, which was stretched, painful, and deeply chapped. The disease had resisted a variety of remedies. He was ordered to use a lotion (made by boiling two large handfuls of soot in a pint of water for half an hour, and then strained) four times a day. Within a fortnight, the cutaneous affection was cured, and the skin had recovered its natural colour and pliancy.

CASE 2. A younger brother of the former patient had, for a year and a half, laboured under a most troublesome "tinea favosa," or "favus vulgaris," which had spread over the whole of the hairy scalp. Thick, yellow, honeycomb crusts covered the diseased surface, and a most disgusting smell proceeded from it. He was ordered to have the hair cut close, and to apply bread and water poultices for a few days, in order that the crusts might be detached. When this was effected, the