the arm or leg. We have surmised whether in such cases the paralysis may not have been purely local, and due simply to pressure on the nerve of the limb, or possibly sometimes to cold applied to the surface, in the same way as facial paralysis may arise from a coup de vent. We have thought this, because in many cases we have been unable to trace any cause whatever for the attack; and we know, indeed, one instance where a child in good health, having sat for a considerable period at a window with his leg doubled under him, had the limb quite benumbed and rendered helpless in consequence, so that he was obliged to be carried to bed by the nurse. On the following morning the leg was found still paralyzed, preventing the child from standing. He gradually recovered by sea-bathing in the course of two or three weeks. If the occurrence had not been observed by the nurse, the cause would have remained altogether unknown to the parents of the child. We see no reason, therefore, why the paralysis may not in some cases have no more deep-seated cause than accidental pressure. In others a blow may, we think, be the starting point of the disease.

It has been said that this affection is connected with club-foot, and some have described them together; owing, however, to the divided practice of the physician and surgeon. perhaps neither the one nor the other is the fittest person to decide the question. But, for our own part, we have never been of opinion that the two diseases are pathologically associated. Talipes we have regarded as a result of spasm of the muscles, connected often with general convulsions, and arising from nervous irritation during either intra or extra uterine life; whereas infantile paralysis, if not cured, does not, so far as our experience goes, terminate in spasm, but in atrophy of the limb: the muscles waste, and the whole extremity becomes smaller or ceases to grow with the rest of the body; the consequence being that the limb hangs helplessly at the side, and in the case of the leg often obliging the patient to use a crutch, as the enfeebled limb does not reach the ground. Without examining the limb, the impression might be that such a patient had suffered from hip-joint disease in infancy. If a child with club-foot be brought to a surgeon, and a history of convulsions followed by a contraction of the leg be related, we should not regard this as a case of infantile paralysis; we believe the pathology of the two is different, and a different treatment is required.

A certain proportion of cases recover, although we cannot state what that number is, for reasons already given. We have never found any particular medicine which can be styled a remedy; but tonics, and all means which will stimulate the limb, are good-as rubbing it, exercising it as much as possible, and galvanism. The latter we have seen very serviceable; for if it acts in no more direct manner on the inert functions, it stimulates the muscles and prevents their waste. The only drawback to this remedy is the dread experienced by the child, which is sometimes so great that it cannot be persevered with. Of course, if there appear to be any special cause for the paralysis in the nervous centres, in the bowels or teeth, appropriate remedies will be given.

CASE I.-Jane F, aged twenty months. Well up to six months ago, when she had convulsions, and very soon afterwards it was observed that the right arm was weak. There was now almost total paralysis of motion in this arm; child otherwise quite well. Occasional alterative powders of the soda-with-mercury powder, embrocations, and galvanism, were prescribed. The child left at the end of a month, when the arm had made a decided improvement.

CASE II-Nelly S―, aged seven months. A month ago the mother noticed that the child had quite lost the use of the right leg. Now it was found perfectly paralyzed, and dangled about just as it was moved. The child was very well, and the mother said it had never had any illness whatever, nor any trouble with the teeth. Ordered the same remedies as in the case above. Improvement slight. This child was seen a year afterwards, and the right leg was still weaker than the other.

CASE III.-James H--, aged a year and a half. Two weeks ago, when taken from his bed, the mother noticed that he could not stand on his right leg. Had no other symptoms; health good, and always had been so. Leg to be rubbed, and electricity used. Improving when Ïeft.

CASE IV.-Henry B-, aged three years and a half. This child had been at the infirmary various times during the previous two years, and exemplified very well the consequences resulting from this affection if not cured. The left leg during this period had been partially paralyzed; the limb was much smaller than the other, and so weak that the child could with difficulty bear his weight upon it. He could, however, just walk. As galvanism had never been used, it was ordered; but the patient was so alarmed by it that it was obliged to be discontinued. He was under notice for some weeks, but had not much improved.

CASE V.-Sarah B——, aged a year and a half. The mother noticed that the child was unable to move her arm for the last few days. The child was in perfect health, and no local cause (as injury) could be discovered. She remained until the card had expired, when the arm had slightly improved in strength, but not to any great degree. The child's health in other respects was excellent.

CASE VI.-Thomas M, aged two years and a half. Paralysed in the left leg; could move it slightly when in the mother's arms, but could not stand upon it. The history was remarkable, it being stated that the child fell and struck his leg, and on the following day it was perfectly helpless. On careful examination, no signs of any injury could be discovered, but the case presented the features simply of infantile paralysis. At the end of a month the child had improved considerably.

CASE VII.-Henry S- aged eleven months.

Three months before,

he was taken unwell and had slight convulsions. It was afterwards noticed that the right leg was weak, and this has been quite paralyzed since. Galvanism, &c. At the end of six weeks he left in much the same state. CASE VIII.-George P. aged fifteen months. Two months ago the child was weaned, and soon afterwards became ill, but had no convulsions or symptoms of head affection. It was soon discovered that the right leg was paralyzed. Before this he could walk alone. Galvanized. Left at the end of the month no better.

CASE IX.-George L, aged three years. Eight months ago was ill, and under medical care for his head, but had no convulsions. He was a long time ill, and the mother was unaware whether the leg was affected then or not, but only on recovery four months ago did she discover that he was unable to walk on account of weakness of the right leg. Has been unable to walk since. Child only came twice.

CASE X.-William C, aged twenty months.

Three weeks ago the child was ailing, which the mother supposed was due to the teeth. Had no fits. Soon afterwards it was observed that the left arm was utterly powerless. The child is delicate, with a large head. Ordered embrocation, use of arm as much as possible, and afterwards galvanism. At the end of a month the arm was much stronger, the child could grasp with it, and the case was evidently doing well.

CASE XI.-Charles F--, aged two years. Been paralyzed several weeks in the right leg. No cause could be discovered for it. Galvanism, &c. In the course of six weeks the leg had so far improved that the boy could stand upon it, but he could not yet walk.

aged one year and a half.

CASE XII.-Anne F. Four months ago she had an illness, the nature of which the mother is not aware of; but when she had recovered, it was found that the child had lost the use of her right leg. The limb is now quite powerless, dangles about as moved, and muscles wasted. Galvanism, &c., ordered. At the end of two months,

when left, some improvement had taken place.

Since this form of paralysis is usually met with in young children, it has been considered to have a special pathology. It may be only true, however, that patients at this time of life are more liable to a morbid condition, which may occasionally occur at any age.

CASE XIII.-James R-, aged fifteen. Three months ago he was unwell. Slightly feverish, and kept his bed a week. On getting up he found his right arm so feeble that he was scarcely able to use it. He now cannot raise his arm from his shoulder; but when resting it on a table can use the muscles of forearm and fingers. Can discover no local cause for the paralysis, and the boy is in excellent health. Galvanism ordered.

he left at the end of six weeks he was considerably better.

When

The above cases do not, unfortunately, throw much light upon the pathology of the disease; but some of them do show that the statement of the necessary existence of a cerebral lesion is an assumption. In none of them, whilst under treatment, was there any contraction of the tendons commencing to take place.

ART. 48.-Case of Progressive Muscular Atrophy of the Hands, with Enlargement of the Ventricle of the Cord in the Cervical Region (Hydromyelus), and Atrophy of the neighbouring Grey Matter.

By Dr. GULL.

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

This case is given as a contribution to the pathology of progressive muscular atrophy, and as suggesting a doubt respecting the validity of the present theories of the function of the grey matter of the cord. Although there were no other remains of the grey matter in certain parts of the cervical region but the inferior cornua, the patient was still able to walk perfectly well, and to move the arms freely in all directions, and the sphincters acted properly; nor was there any affection of sensation in any part, except a feeling of numbness in the right hand. The case, which seemed to be a chronic

hydromyelus, comparable to a chronic hydrocephalus, is illustrated by drawings.

CASE.-G. B., æt. 44, a journeyman tailor, of sober habits, was admitted into the clinical ward, February 5th, 1862. States that he has always been healthy and strong. Never had any injury to his back. Thirteen months ago, when working in London, the fourth and little finger of the right hand became weak and flexed, without any assignable cause. The hand was cold, and there was a feeling of numbness in the fingers, but no pain. This gave rise to a good deal of inconvenience, but he was able to continue working at his trade. Two months ago, the middle finger of the same hand became suddenly affected, and three weeks ago the three inner fingers of the left hand became weak and flexed in the same way, but without any numbness. The hands gradually wasted. The arms are not affected. Seven weeks ago he had pains through his chest, and a feeling of tightness across the upper part. He is pale, complains only of wasting and weakness of the hands; has no pain in them, but the right is cold, with a feeling of numbness. The left hand is not so cold, and the sensation in it is perfect. He can move both thumbs and index fingers freely; he can also extend the first phalanges of the other fingers of both hands, but not in the least degree the second and third phalanges, which are gently flexed towards the palm. The interosseous spaces on the backs of the hands are sunken from the wasting of the muscles. The palms of the hands are hollow, and the flexor tendons very prominent. The thenar eminences are wasted, and the hypothenar almost entirely gone, particularly on the right side. The motion of the wrist joints is unaffected. He can move the arms freely in all directions. Can walk perfectly well.

At the upper part of the dorsal region there is a slight flattening of the natural curve of the spine, from the long muscles of the back being at this part wasted. Pressure on the fourth dorsal spinous process causes a sharp, pricking pain, as of a knife running into the part, but when the part is not touched he has no pain. No pain on pressing the other spinous processes; no affection of sensation in any part, except the feeling of numbness in the right hand; sphincters good; urine normal; appetite and digestion good. He was put upon a full diet, and the wasted muscles were daily galvanized by an intermittent current. A fortnight after admission he had gained power in the hands. He said he felt them stronger and more pliable after each application of the galvanism. It was noted that, with a moderate current, the contractility of the muscles of both hands was good, but more particularly in the short muscles of the thumb, which were least wasted. Sensibility not so acute in the right hand as in the left, but no marked anæsthesia of either. Both hands were rather cold. A few days after this report the patient sickened with typhus fever, and died on the 8th of March.

A post-mortem examination was not permitted at the hospital, and it was only after much difficulty that the cord could be obtained. The bones and ligaments of the spine were healthy; the membranes of the cord healthy; the exterior of the cord presented nothing abnormal, except that the cervical enlargement appeared broader and somewhat flattened. On making transverse sections, the white columns had their normal consistence and texture, but the centre of the cord had a large cavity, beginning at the fifth cervical, enlarging downwards to the seventh, and ending at the fourth dorsal. The only remains of the grey matter were at the anterior part of the cavity behind the anterior columns. Here the caudate vesicles had their normal size and structure; the pigment, nucleus, and nucleolus being well marked, and the tubular structure unaltered. The cavity in the cord was bounded

by a layer of condensed grey substance, which could be separated as a distinct membrane. On its interior surface, forming the lining of the cavity, were a number of delicate, elongated, nuclear bodies, apparently epithelium. One or two granule cells were found scattered amongst the white columns, but no further traces of any active tissue change. The roots of the nerves appeared normal, and contained healthy tubules. The character of the fluid filling the cavity could not be ascertained, as it escaped in the removal of the cord from the spinal canal.

ART. 49.-Progressive Muscular Paralysis of the Tongue, the Curtain of the Palate, and the Lips.

By M. TOMMASI.

(La Sperimentale, t. x., 1862; and Gazette Hebdomadaire, Nov. 14, 1862.)

Dr. Tommasi relates a well-marked case of this disorder which occurred in the wards of Prof. Pellizzari, of Florence, and which formed the subject of an excellent monograph read at a meeting of the Medico-fisica Society of that place. The importance of the case induces us to give it at some length.

CASE. On the 30th April, 1862, a countrywoman, named Annonziata Maffaio, aged 48, entered the hospital of Santa Maria Nuova, representing herself as suffering from a tumour of the pharynx. Having previously enjoyed good health, she suddenly perceived, in the beginning of September, 1861, that certain movements of the tongue had become difficult, especially those which in the pronunciation of certain words involved the contact of the tongue with the palate or teeth. At the end of the same month, she had an attack of rheumatism in the muscles of the right side of the neck and over the scapula, which was cured by the application of blisters. During this attack, the difficulty and imperfection of the movements of the tongue increased. Soon after, deglutition became difficult, and later still the movements of the lips began to be slow and uncertain.

The 5th May, 1862, the following was the state of the patient :

The lips were of ordinary size and colour. When the mouth was closed, there was a little irregularity towards the free edge of the upper lip. The opening of the mouth was accompanied by an irregular and oscillating movement of the lips.

In the movements occasioned by talking, sucking, whistling, kissing, the contractions were slow, difficult, and always incomplete. If a piece of solid food penetrated between the lips and the teeth, it could not be removed without the assistance of the finger. The mucous membrane of the mouth was of norinal colour and appearance. The tongue was of ordinary size; it had lost its convex form, and was soft, depressed on the median line, and raised towards the edges. The movements of the tongue were tolerably quick and easy. It could not, however, be put out freely, and was agitated by a slight tremulousness.

The curtain of the palate was relaxed and descended lower than usual, and the concavity of its anterior surface was diminished. The uvula came in contact with the base of the tongue; the contact of an irritant body occasioned only a slow and uncertain movement. During deglutition, morsels of food frequently intruded into the posterior cavity of the nostrils. The pharynx, on the contrary, had lost none of its contractility.

This irregularity of movement occasioned difficulty in the pronunciation