fit, blue in the face, cries plaintively, and foams at the mouth. Death usually ensued on the third or fourth day. Shortly before death the convulsions ceased, the respiration, which had always been regular, became shorter and at length ceased without signs of dyspnoea. The rigor mortis was very strong, but did not last long. Dr. Busch never observed inflammation of the navel or of its vessels.

The practice of the midwife in the conduct of the labour and the management of the child was minutely observed. The conclusion formed was that she washed the child in water that was unusually hot. She was cautioned to use a thermometer, and not to exceed a temperature of 28^ C.

Whether this was followed by the disappearance of tetanus is not reported.-Monats. f. Geb., June, 1868.

The following memoirs, for want of space, are referred to by title only, or very briefly:

On the Postural Treatment of Prolapse of the Funis. By Dr. C. H. KIDD. Dr. Kidd narrates a successful case in illustration.Dublin Quart. Journ., August, 1868.

By Dr.

Case of Enormous Fibro-cellular Tumour of the Vagina. BEATTY. The tumour was successfully removed by ligature.Dublin Quart. Journ., August, 1868.

On Recurrent Typhus in Pregnant Women. By Dr. ZUELZER. Dr. Zuelzer cites the observations of various authors upon the relations of fevers to pregnancy.-Mon. f. Geburtsk, June, 1868.

Two Cases of Anterior Encephalocele. By Drs. HECKER and BUHL. -Mon. f. Geburtsk., June, 1868.

A Case of Quintuple Birth. By Dr. GALOPIN. (The children were all male, of about five and a half months' development. Five umbilical cords were inserted into two placentas.)—Journ. de Bruxelles, 1867.

Eighty-four Observations on the Bodies of New-born Infants in reference to Breslau's Respiration-test. By Dr. LIMAN.-Vierteljahrschr. f. Gerichtl. Med., 1868.

Version in Contracted Pelvis. Dr. Ringland relates an interesting case illustrating the value of this operation.-Dublin Quart. Journ., August, 1868.

A Pelvimeter for Internal and External Measurement and Simultaneous Estimation of the Inclination of the Pelvis. By Dr. LAZAREWITSCH.-Monats. f. Geb., May, 1868.

A Fibrous Tumour of the Uterus eliminated by Softening in a Female who had Disease of the Heart. By F. OPPERT, M.D.-Med. Times and Gaz., August, 1868.

Labour Obstructed by Enlarged Kidneys. By Dr. WOLFF. Berlin Klin. Wehnschr., 1867.

A Case of Vesico-Vaginal Fistula following the Passage of a Vesical Calculus. By Dr. Mendel.-Monats. f. Geb., June, 1868.

REPORT ON PATHOLOGY AND PRINCIPLES AND

PRACTICE OF MEDICINE.

BY FRANCIS C. WEBB, M.D., F.L.S.,

Member of the Royal College of Physicians, Physician to the Great Northern Hospital.

The Diagnosis of Diseases of the Nervous System by Means of the Ophthalmoscope.-In a memoir presented to the Academy of Sciences, Mr. E. Bouchut draws the following conclusions:-1. The ophthalmoscope enables us often to discover in the interior of the eye lesions of circulation, secretion, and nutrition which indicate organic disease of the cerebro-spinal system. 2. Optic neuritis, neuro-retinitis, choroïditis and papillary atrophy accompany the greater part of acute and chronic diseases of the brain and of the cord. 3. By the anatomical and physiological relations of the eye with the brain and cord we can explain the law of coincidence of optical neuritis with organic lesions of the nervous system. 4. When a chronic or acute inflammation has its seat in the brain, that inflammation, through the medium of the optic nerve, may be propagated to the eye. 5. Diseases of the anterior pillars of the cord may, through the medium of the sympathetic, produce in the eye the phenomena of papillary hyperæmia which will later give rise to atrophy of the optic nerve. 6. Optic neuritis and neuro-retinitis produced by acute or chronic diseases of the nervous system are generally observed in both eyes. 7. In lesions of the encephalon or its meninges optic neuritis is in general more marked in the eye corresponding to the hemisphere which is most gravely affected. 8. Alterations of the optic nerve and of the retina complicated by nervous troubles of sensation, intelligence or movement, always indicate an organic disease of the brain. 9. Alterations of the optic nerve and of the retina must not be isolated from other morbid symptoms, whilst their establishment adds to diagnosis an element of incontestable certitude. The diseases of the nervous system in which optic neuritis and neuro-retinitis may be observed are Phlebitis of the sinuses, acute and chronic meningitis, chronic encephalitis, cerebral hæmorrhage, tumours of the brain, cerebral contusion and compression, chronic hydrocephalus, abscess of the brain, acute myelitis, locomotive ataxia, the contraction known as essential, and certain forms of epilepsy, paralysis or neurosis connected with organic lesion of the nervous substance.

Tumours of the Brain.-Dr. R. Bartholow relates three cases in which tumour of the brain was diagnosed. In one only, however, did circumstances permit the verification of the diagnosis after death. After a résumé of the observations of previous writers, he thus sums up the combinations of symptoms which, he thinks, may indicate the situation of the morbid growth. "In cases of tumour of the cerebrum, the following symptoms are observed:-Headache, not, how

ever, confined to the seat of the morbid growth, and thus indicating its position, but limited to one side of the head, or deep-seated and diffused; epileptiform convulsions and mental derangement. Alterations of sensibility and of the special senses do not usually occur. Paralysis is not generally present in tumours of the posterior lobes, but is common in tumours of the middle and anterior lobes. Alterations in the special senses occur more frequently in tumour of the middle lobe, except the sense of smell, which is more usually affected by tumour in the anterior lobe. Tumours of the corpus striatum and optic thalamus are accompanied by the following symptoms:Hemiplegia, partial or complete, on the side opposite the tumour, and convulsions; common sensation and the special senses are not frequently affected, and the mind is not often impaired. In tumour involving the crura cerebri, lesions of sensation and paralysis of the face and of the limbs on the opposite side, giddiness and paralysis of the motor oculi have been observed. In tumour of the pituitary gland the symptoms are frontal headache, amaurosis, first in one eye, then extending to the other. The mental powers are generally unimpaired, and there are no alterations of speech, sensation, or motion. In a case which has been brought to my notice, nonsaccharine diuresis and epileptic convulsions were prominent symptoms. The symptoms are more complex in tumour of the pons. We find here crossed paralysis; face paralysed on the same and limbs on the opposite side; pain or anæsthesia in the paralysed parts, disorders of the special senses; dysphagia and mental derangement. Convulsions are so uncommon in tumours of the pons that Ladame lays down the following rule:-'If a tumour has attained sufficient size to allow of its presence being diagnosed, and if convulsions be present, the probability is that the seat of the tumour is not in the pons Varolii.' He also considers, and no doubt justly, that the simultaneous affection of several of the organs of sense is indicative of tumour of the pons. In tumours of the medulla oblongata, pains in the limbs, anæsthesia, convulsions, and sometimes partial or complete paraplegia, giddiness, vomiting, staggering gait, pains in lower extremities, amaurosis, dulness of intellect, hallucination, delirium, &c., have been observed. The following symptoms have been observed in tumour of the cerebellum: occipital headache, convulsive attacks, defect in the power of co-ordination, whence walking or standing are difficult or impossible, convergent strabismus, amaurosis; usually no disturbance of sensation except headache; no paralysis; no lesions of speech; no mental derangement. Mental derangement, however, does occur sometimes in cases of tumour of the cerebellum, as a result of the changes in the circulation of the brain produced by the new growth."-Dr. R. Bartholow, American Journal Medical Sciences, April, 1868.

Fatal general Emphysema supervening on Chronic Pleurisy and Hydrothorax.-Dr. J. R. Thomson relates the case of a bricklayer's labourer, æt. 31, who having apparently been in good health (except that he had complained of palpitation and dyspnoea on exertion), and

engaged in his work, became suddenly sick, and, whilst vomiting felt something give way in his chest. Shortly afterwards he brought up a little blood; great difficulty of breathing followed. Emphysema showed itself in the cellular tissue of the neck, and rapidly spread, especially on the right side. On percussion there was hyper-resonance over the right apex, and as low as the level of the third rib. Below that there was relative dulness. On the left side percussion was natural. On auscultation over the right apex the respiratory murmur was harsh, but there were no moist sounds or friction murmur. On the left side the breathing was slightly harsh. A systolic bruit was audible at the ensiform cartilage. The emphysema rapidly increased, the respirations rose to sixty, the pulse could not be counted, and he sank rapidly.

Post mortem twenty-five hours after death.-One of the cusps of the mitral valve was converted into a small hard nodule. The right pleural cavity contained several quarts of a brown fluid. The lung was compressed against the vertebral column and bound down by adhesions which were most dense at the apex. The pleura over the lower part of the lung and diaphragm was covered with lymph. There were no traces of emphysema beneath the costal pleura. The lower and middle lobes of the right lung were solidified and friable. The apex contained cretaceous tubercle. The left lung and pleura were healthy except some interlobular emphysema over the anterior aspect of the former. The right bronchi contained a little blood. The posterior mediastrum contained no air, but air was present in large quantity in the anterior. The author supposes that rupture took place in the anterior part of the right lung.-Dr. J. Roberts Thomson, Edin. Med. Journ., June, 1868.

Thoracic Aneurysm and Dementia.-Dr. W. Moore relates three cases of thoracic aneurism in which dementia was a prominent symptom. In the first there was aneurysm of the transverse portion of the aorta probably interfering with the carotid supply; in the second there was a large aneurysm springing from the upper part of the transverse portion of the aorta, with the left carotid impervious from its origin to its bifurcation and atrophy of the left hemisphere of the brain; in the third there was an enormous aneurysm springing from the front of the ascending portion of the arch, the carotids and large arteries of the brain were found after death well-nigh empty, and there was general atrophy of the brain. The author's object in adducing these cases is, he writes, to show that "mental diseases," so called, may be entailed by comparatively remote physical conditions, and hence arises the importance of taking the widest range in the consideration of these affections. If in a case of dementia we can detect a latent aneurysm or intrathoracic tumour which from its situation, it is to be presumed, would cause obstruction of the cerebral supply and consequent atrophy of the brain, it is clear that the prognosis and treatment of the case would be materially affected.-Dr. W. Moore, Dub. Quart. Journ., May, 1868.

Ascending and Descending Breathing: its Value as a Symptom and its Mechanism.-The peculiar irregularity of breathing referred to in this paper was first described by Dr. Cheyne. The early cases in which the symptom was observed were all cases of fatty degeneration of the heart, and it was supposed to be a symptom pathognomonic of that disease. It was thus described by Dr. Stokes. Among the indications of the malady he says there sometimes occurs "a form of respiratory distress peculiar to this affection, consisting of a period of apparently perfect apnoea, succeeded by feeble and short inspirations, which gradually increase in strength and depth until the respiratory act is carried to the highest pitch of which it seems capable, when the inspirations, pursuing a descending scale, regularly diminish until the commencement of another apnoeal period." Other cases where this symptom was observed, however, occurred in which the heart was found to be free from fatty degeneration, but the left ventricle was found hypertrophied in consequence of valvular or arterial disease. This condition has hitherto generally been associated by writers with a weak state of the right ventricle, or attributed to some perverted action of the nervous centres. Dr. Little offers a new explanation:-" In health the right and left ventricles, though differing so much in the thickness of their walls, are equally competent for their duties; the right ventricle is able to fill the pulmonary capillaries as thoroughly as the left one, with the aid of the other forces which contribute to the circulation, fills the systemic. But if an abnormal burden is imposed on the left, if rigid valves narrow its outlet, or permit the blood it discharges at each systole to fall back into its cavity, or if the arterial coats, their elasticity destroyed by disease, no longer help the heart; if the aorta, instead of taking charge of each wave of blood as it leaves the ventricle, and propelling it onward by the steady recoil of its walls, is permanently dilated, and allows each portion of blood to remain in its ascending trunk, and so to impede the entrance of that which follows-under any of these conditions the left heart, however hypertrophied, may be quite unable to rid itself of the blood as rapidly as it is supplied to it by the right ventricle. Blood would, therefore, accumulate in the left auricle, in the pulmonary veins, and in the capillaries of the lungs. That blood having already absorbed as much oxygen as it required, would fail to produce that impression on the ultimate filaments of the pneumogastric which black blood does, and which impression is converted by the nervous centres into the motor impulse which produces breathing. Breathing would, therefore, cease; and inasmuch as the respiratory act seems to assist in carrying the blood to the left side of the heart, it would no longer be so over-stimulated by fresh supplies, and its contractions would become less frequent and more regular. After a few systoles, however, it would succeed in discharging the red blood collected in its cavities to such an extent that they could receive some of that which lay in the pulmonary veins and lungs. Space being thus gained, the black blood which the pulmonary artery contained would reach the capillaries of the lung in amount proportionate to that of