curious noise, which kept upon her almost continually, so that there was but a very short time between for conversation. Before it came on again, she always complained of her chest, but could not describe how it felt. Her speech gradually left her, but about an hour in the day this noise would leave her, so that she could talk; from this time it got to half an hour, quarter of an hour, five minutes, and three minutes. After this the noise never left her except when sleeping, but as soon as she awoke it used to come on immediately, and so it continued for some time; a very low noise at times, then louder. After a time the noise was changed to very loud, but it used to cease several times in the course of the day. So it continued for some time. Then it used to come on only once in the day, and that was of a morning. At first waking, she used to shriek for about five or ten minutes; it could not be compared to anything else but a shrieking fit. This continued for three or four years every morning, and at last left her entirely. Not less than five different noises I have heard during her affliction. It is about five years since this noise left her entirely. Since she began to be regular, which was about the age of seventeen, she has gradually gained her speech so far as to be able to talk a little, but for the last three years there seemed not to have been any improvement. She cannot mention the name of any person or thing, if it be ever so easy, which is very remarkable; and cannot try to say a word, as children do when learning to talk; nor can she enter into conversation at all, unless persons ask her questions, and then she can answer in very simple words, but never can say a long word. She had her natural speech up to eight years of age, and was a very active child. I have never heard her read out since that time. She has had medical attendance several times. At one time it was thought that the spine of her back was affected: she lay on boards for several weeks, but was not benefited by it. It was then thought that the windpipe was affected, but nothing for this did her any good. She was electrified, but it did not produce any effect. She is very nervous at times, and very lowspirited; and if she walks fast, short of breath. She has not been regular for six months. She had never passed any worms.'

When first seen by Dr. Ramskill, she could not say the name of any person or thing. She could utter one or two words. She was, however, fairly intelligent, but nervous, and her memory was bad. When she wanted anything, she made signs for it, pointing, and saying, "I want that." The first new word she was taught (by the nurse, who took great pains with her) was "good-night." Whilst being taught, the nurse said her heart would beat violently, and she seemed hysterical; and for this reason she was generally taught at night, after the other patients had gone to bed. The improvement was, on the whole, gradual, except one rather sudden step on November 26.

December 20.-She has now been well for several weeks, and can speak well. On one occasion, however, after having been annoyed, she did not speak for five days. During the first week or two of her stay in the hospital, she had attacks of coughing-a hard, barking, clattering cough. It was worse when she was excited and when her speech was worse. The medicines taken were small, repeated doses of blue pill and strychnine (gr.).

This case, Dr. Ramskill said, might lately have been complicated with hysteria, but it could not have been altogether due to it, as it began when the patient was a child only eight years of age. It was, he thought, rather of reflex origin.

ART. 54.-Loss of Sight from Decayed Teeth.

By Mr. H. T. KEMPTON.

(The Dental Review, January, 1863.)

CASE. The patient was a gentleman, aged forty-two, of a highly nervous temperament. At the time he first visited me he was suffering from pain extending over both sides of the head and face, incapacitating him from attending to his profession, and depriving him of rest at night. The sight of both eyes was affected, but more particularly that of the right. The patient had been under treatment since June last. On examining the mouth I found there was extensive inflammation on both sides of the lower jaw, owing to the presence of two decayed teeth. On the right side the first molar was considerably decayed and the pulp cavity exposed, so that on introducing a small instrument it gave rise to a violent paroxysm of pain. The tooth was somewhat loose in its socket, owing to the inflammation having extended to the periosteum. Subsequently, upon extracting this tooth I found a small sack filled with pus attached to the fangs. On the opposite side, the second molar was in much the same state, but the inflammation not so acute.

In the upper jaw all the teeth were sound.

In consequence of the pains about the head and face, I extracted the two decayed molar teeth in the lower jaw. This proceeding not only afforded relief to the patient's sufferings, but was afterwards attended by such a marked improvement in the power of vision, that there can be no reasonable doubt that the teeth had been the primary source of the eye affection. The history of the case will, however, be best understood from the following account given me by the patient himself:

"It may be necessary to remark that for some months previous to becoming a sufferer from toothache, I had worked hard at mental employment, and my nervous system was in a very sensitive and excitable state. My lower limbs particularly felt as if they were partially paralysed, or rather I should say that when at all tired I was to some extent unable to control them.

"In May last I visited the North of England, and while there suffered severely from what I then believed to be ticdoloureux, but now concluded to have been toothache. It commenced on the left side of the lower jaw, doubtless from the pressure of the wisdom tooth upon the decayed tooth lately extracted. The pain I endured was excruciating, and was not confined to the lower jaw, but spread entirely round the face, and was at times acute in the ears and about the temples.

"On returning to London, I suffered greatly from pains in the teeth on both sides of the lower jaw, but found that the right ear and temple were more affected thereby than those on the opposite side.

"At length, about October 14th, I suddenly found that the sight of my right eye was all but gone. Attributing this to cold, I, as I now believe, very improperly, applied a warm poultice overnight. On the following morning I found my sight by no means better, and after foolishly dallying for a week or more, was advised by a friend to go to the Ophthalmic Hospital, which I did, and explained to the surgeon, Mr. Jabez Hogg, that I had been suffering from toothache as I have previously described. He at once prescribed for me, and said that if I valued the sight of my eye, the offending tooth must come out. I accordingly went to a dentist to whom I had been recommended, and told him that I must leave him to judge which

tooth it was, as owing to the general pain in the teeth in the locality (the right side of the lower jaw) I really could not fix upon it. He selected the wisdom tooth, which Mr. Hogg subsequently told me was the wrong one, and pointed out the tooth afterwards extracted by yourself, as the source of my sufferings. Under the skilful treatment of Mr. Hogg, the sight of my eye has been and is gradually improving; but there are one or two points, which, although doubtless well understood by ophthalmic surgeons, have seemed to me very curious.

"I observed that while, by the improvement of the sight of the affected eye, I was enabled dimly to distinguish the furniture and windows of a room-the fire, which I should have thought would have been the clearest object of all, was quite invisible, and simply conveyed the impression of a black space. While this was the case, I could nevertheless faintly distinguish the smoke ascending the chimney. As the vision continued to improve, I was gradually enabled to see the light proceeding from the fire-although the absolute heated coals and flame were still invisible to me. These, together with gas-lights and the flames of candles, are now becoming distinguishable.

"I may further observe, that on closing the eye, while it was yet all but insensible to external objects, I could see various beautiful patterns consisting of numerous combinations of gold or orange-coloured carved lines on a dark ground.

"As the sight gradually improved, these patterns became replaced by stars of a like colour on a similar dark ground-and finally both patterns and stars disappeared."

ART. 55.-A Case in which there was a Remarkable

Enlargement of the Nerves.

By Dr. WALTER MOXON.

(Guy's Hospital Reports, 3rd Series, Vol. VIII. 1862.)

During the winter session of 1860-61, Dr. Moxon chanced to observe that the nerves in a subject which was then undergoing dissection were of a very unusually large size. It happened, unfortunately, that this subject had been allotted to the use of first-year students, who at the school of Guy's are instructed to dissect the muscles of the body without regard to the vessels and nerves; in this manner it came to pass that the dissection was already advanced before the extraordinary condition of the nervous system was noticed; the brain had in the meantime been removed and destroyed, and the opportunity for making many interesting observations had passed by. Enough was left to establish the case as one of the most extraordinary upon record, for when the remainder of the nervous system was surveyed, the nerves which composed it were found to be uniformly increased in size throughout their entire extent in such a way that they had nearly three times their usual diameter; they were all enlarged in just proportion to their proper size, and there were no irregular swellings or tumours of them, or connected with them at any part; the fasciculi of which they were composed were individually larger than usual, so that these nerves looked coarse in texture; when one of the larger of them was cut across, the great size

900

of the fasciculi was plainly seen; there was no increase of the interstitial neurilemma, but rather a proportional decrease, so that the coarse component fasciculi were more than ordinarily independent of, and moveable upon each other. The nerves were enlarged in this extraordinary manner as far as the naked eye could trace them, and were not easily broken, so that branches usually so small as to be very difficult of manipulation could with great facility be followed close up to their ultimate distribution. In the microscopic examination of the state of these nerves we obtained the valuable assistance of Dr. Gull, also of the late Professor Quekett, and of Mr. Bader; careful measurements of the size of the nerve-tubules were made, and always with the same result, showing that the average diameter of the ultimate fibrils wasth toth inch, some as large asth inch were measured, and in repeated observations upon portions of the median nerve we did not find any smaller than 1000th, the main proportion being much larger. It is this enormous size of the elementary fibrils which renders the case so remarkable; if the great size of the nerve-trunks had depended upon an unusually large number of these elements, the case would have been worthy of note, but we should have had some analogy for it in the large muscles of an unusually muscular man, or even, more distantly, in the numerous blood-corpuscles of one who is plethoric, or in the multiplied adipose vesicles of a very fat person; as the case stands, however, we must wait for a parallel instance, until some observer shall find a subject whose red blood-corpuscles are th inch in diameter, and capillaries universally varicose, or his muscular fibres Tth inch. It is well established that the size of the elementary nerve-tubules is generally constant in man and mammalia, being aboutth toth inch, rarely a little larger, often much smaller; we are disposed to think, however, that the number of distinct observations, in the way of comparative measurement, is not large, and that there may be considerable variations in the size of the tubules in different subjects. If this be true, this case will be an extreme one, but one of a natural class.

The subject whose peripheral nerves are described in this article was the body of a female who died in Guy's Hospital of a chest affection. None but negative information could be obtained regarding the phenomena of her nervous system during life.

ART.56.-Cases of Nervous Affections treated by Faradaization. By Dr. JULIUS ALTHAUS.

(Pamphlet Trübner: London. 1863. Second Edition. Pp. 16.) The cases related in this pamphlet illustrate very plainly the efficacy of a mode of treatment which is yet very far from being appreciated at its true value. They form a fit sequel to those related in Dr. Althaus' excellent " Treatise on Medical Electricity, theoretical and practical."

(B) CONCERNING THE RESPIRATORY SYSTEM.

ART. 57. On the Treatment of Pneumonia, with the Results of 105 carefully recorded Cases.

By Dr. J. HUGHES BENNETT, of Edinburgh.

(Lancet, August 16, 1862.)

Pneumonia, like most other inflammations, when acute, was for. merly treated by so-called antiphlogistics-that is to say, bloodletting, purgatives, antimonials, low diet, and other methods of lowering the strength of the patient. It was about eighteen years ago, in consequence of investigating the pathology of inflammation, that Dr. Bennett began to doubt the propriety of such a treatment, and this for the following reasons:

In the first place, the cause of the inflammation is an irritation of the textures, of the ultimate molecules, of the part; in consequence of which their vital power of selection is destroyed, and that of their attraction is increased. The removal of blood by venesection cannot alter this state of matters, neither can other lowering remedies. If the inflammation be superficial and limited, local bleeding may diminish the congestion, as in conjunctivitis; but if exudation has occurred, it cannot remove that.

In the second place, an exudation or true inflammation having occurred, it can only be absorbed by undergoing cell-transformation. Now this demands vital force or strength, and is arrested by weakness. Inflammations in healthy men rapidly go through their natural progress. In weak persons they are delayed or arrested: hence their fatality.

In the third place, the strong pulse, fever, and increased flow of blood in the neighbourhood of inflamed parts have been wrongly interpreted by practitioners. They are the results, and not the causes, of inflammation; and show that the economy is actively at work repairing the injury. So far, therefore, from being interfered with and interrupted, they should be supported by nutrients.

It follows, fourthly, that if these views be correct, the true treatment of inflammation, should be directed towards bringing the disease to a favourable conclusion by supporting, rather than by diminishing, the vital strength of the economy; and this, not by over-stimulation, as was done by Dr. Todd, but simply by attending to all those circumstances which restore the nutritive processes to a healthy condition.

In support of the soundness of these views, Dr. Bennett offers an analysis of 105 cases of pneumonia publicly treated in his clinical wards in the Royal Infirmary of Edinburgh, and carefully recorded by his various clinical clerks. In all these cases the treatment was directed to the support of the economy, never to weaken it by antiphlogistics. At the same time, if dyspnoea be urgent, cupping or a small bleeding (from four to eight ounces) may be practised as a palliative, more especially in bronchial or cardiac complicationalthough in none of these cases was such bleeding ever found neces