author observed the formation of several granules in the nucleus, which united to form the nucleolus.

2. After reviewing the statements of previous writers, as those of Kölliker, Lenhossek, Schroeder van der Kolk, Lockhart Clarke, Dean and Deiters, Gerlach remarks that even superficial observation of preparations carefully stained with chloride of gold shows that two sets of fibres traverse the median line, and consequently decussate. These are clearly distinct from one another, both as regards their size, their place, and their mode of decussation. The smaller set are posterior in position, and running directly across the median line constitute true commissural fibres between the two hypoglossal nuclei. The broader set proceed, like the former, from the hypoglossal nuclei, but before decussating penetrate the white substance of the brain, and occupying the most posterior part of the raphi, cross the median line and pursue their further course in the hypoglossus of the opposite side. Gerlach then proceeds to describe the hypoglossal nuclei in nearly the same terms as those employed by Dr. Clarke. Their finer structure, he states, consists of stroma or neuroglia, the nerve-cells, and nerve-fibres. The stroma belongs to the category of connective tissues, and in hardened specimens presents a finely granular aspect, comparable with that of hyaline cartilage, but when perfectly fresh it is transparent and homogeneous. That it is closely connected with the connective tissues is shown by the fact that it is continuous with the ependyma fibres of the central canal, and also with that process of the pia mater which entering the posterior furrow of the spinal cord extends to the posterior grey commissure of the spinal cord, with which it becomes directly continuous. Scattered through the neuroglia, and belonging to it, are cell-like bodies composed of a nucleus and a small quantity of investing protoplasm. The nerve-cells of the hypoglossal nucleus are large, resemble those of the anterior nerves of the grey matter of the spinal cord, have no investing membrane, but possess several processes of which one, the chief, is continuous with a nerve-fibre. In the calf, but not in man, the cells are accumulated into three heaps on each side; a median, and an anterior and posterior lateral. The nerve-fibres are similar to those of the nerve-centres generally. Some are finer, some broader; the former form an entangled network in which the finest branches are, stated by Gerlach to divide and reunite! These chiefly form the commissural fibres, the broader fibres run a straighter course and proceed to the periphery, partly by crossing to the opposite side of the median line, but chiefly by passing straight forwards and outwards on their own side. These last, though they may easily be traced back in the form of two fasciculi to the hypoglossal nucleus, he has failed to discover terminating in the cells of the nucleus. On the whole, no remarkable analogy is observable between the decussation of the hypoglossal nerves in the medulla oblongata and that of the spinal nerves in the cord.

3. M. E. Cyon, partly at the suggestion of M. Schweigger-Seidel,

undertook the examination of the peritoneum with the special view of solving certain points in connection with the nervous system, and the part which he found most appropriate for the purpose was that which extends in the frog between the abdominal parietes and the cysterna magna of the lymphatic system, since this is extremely delicate, and contains no blood-vessels, whilst it is remarkably freely supplied with nerves. This part has also the advantage of containing a few stellate pigment-cells, and in some instances, or in certain parts, ciliated epithelium, the relations of which to the nerves were thus capable of investigation. He also examined the peritoneum of rabbits and guinea-pigs. The confusion resulting from the presence of connective tissue fibres was avoided by maceration for twenty-four hours in a diluted solution (1-400) of acetic acid. The preparation was then placed for fifteen or twenty minutes in a solution of acetic acid of 1 part to 200 of water, to which 1 part of chloride of gold in 1000 of water was added, then washed with the dilute acetic acid, and finally coloured with carmine and placed in glycerine.

He found chloride of palladium and osmic acid of comparatively little value, but nitrate of silver proved serviceable, especially when the epithelium had previously been removed.

The nerve-fibres of this part of the peritoneum are doubly contoured, united in twos or threes in a special sheath. These divide, and ultimately break up into fine non-medullated fibres, which are interrupted at intervals by nuclei that produce spindle-shaped enlargements. Broad nucleated fibres are also present, which exhibit a fibrillated structure, and appear to consist of bundles of fine fibres, as is well shown in parts where the fibres are flattened out from one another, and also when one fibre becomes detached and forming a loop re-enters the primary trunk. The splitting up of an apparently simple nerve-fibre is well seen, the branches presenting spindle-shaped dilatations which must be regarded as accumulations or enlargements of the medullary sheath, and these again must be regarded as bundles of still finer fibres, or rather of fibrils. Cyon was at first inclined to believe that these primitive fibrils invariably formed loops and plexuses, since he was unable to observe any connection of the nerve-fibres with cellular elements, nor any peculiar terminal organs, but further examination taught him that there were also free extremities, though he admits the fibres were sometimes only apparently lost, and then reappeared, whilst in other cases they may have been torn across in the unavoidable stretching of the tissue in preparing it for the microscope. Still he thinks that the free extremities of the nerves play a physiologically subordinate rôle, whilst the loops are more important. Similar appearances may be seen in the peritoneum of the rabbit and guinea-pig, except that the nerve distribution is simpler and the primitive fibrils leaving the trunks are few and form wide meshed loops.

REPORT ON SURGERY.

By JOHN CHATTO, M.R.C.S.E.

On some Points relating to the Treatment of Strangulated Hernia. -M. Tillaux, of the St. Antoine Hospital, on the whole, approves of Prof. Gosselin's decided practice in relation to strangulated hernia, viz., after performing the taxis first without and then with chloroform, without success, to immediately resort to the operation. He especially opposes Malgaigne's theory, which, by attributing so much importance to inflammation, leads to a dangerous temporisation in endeavouring to treat this. Still, M. Tillaux cannot consent to entirely overlook the old theory of obstruction or the modern one of inflammation, having so often observed, at the Bicêtre, large and old hernias partly or wholly irreducible, which had become the subjects of this obstruction, inflammation, or slight strangulation, whichever it may be, insensibly yielding to the effects of rest and cataplasms. Still, for recent hernias of moderate size and usually reducible, which have become strangulated, M. Gosselin's rule is the proper one.

The taxis, when it succeeds, acts as if by enchantment in the relief of symptoms; but numerous questions arise in its application, such as whether it should be moderate or forcible, how long it should be continued, and at what stage of the strangulation it ceases to be practicable. Thus, while M. Gosselin employs all the force that can be excited by two, four, or even six hands, most surgeons think a more moderate procedure preferable; and few would carry their enthusiasm for it so far as M. Thiry, of Brussels, who perseveres with it for twelve or fifteen successive hours. M. Tillaux is of opinion that, when it has been properly applied for a quarter of an hour upon a patient in a state of anesthesia, and does not succeed, the operation should be resorted to. The surgeon is not in possession of any positive sign that the taxis will prove harmless, and M. Tillaux cites a recent case in proof of this. In a patient who presented an inguinal hernia of twenty-four hours' duration, with the skin tense over it, and sound in appearance, and unaccompanied by any sign of local reaction, he performed a moderate taxis for a few minutes, the hernia being reduced. Two hours after the patient died in intense pain, and the autopsy revealed intestinal perforation. How little the mere duration of the strangulation can provide a rule may be seen from another case, in which a femoral hernia had been strangulated for eight days, and yet the intestine was found perfectly healthy.

After adverting to the ordinary rules for the operation, according to the condition in which the intestine is found, M. Tillaux adverts to the rarer case in which the lesion of the intestine is limited to its serous membrane. In a femoral hernia, in which strangulation had

continued sixteen hours, he found the peritoneum detached from the intestine to about the extent of four square centimètres, just as the epidermis is in a burn. As the muscular coat appeared healthy, he returned the intestine, and the patient recovered after some slight symptoms of localised peritonitis.

Besides the ordinary mode of strangulation by the rings and the orifices of the cribriform fascia, M. Chassaignac has pointed out one due to the inflexion of a noose of the intestine over a sharp edge, as, for example, Gimbernat's ligament. In this case the taxis only increases the inflexion of the hernia, instead of reducing it, all pressure acting, in fact, directly on the hernia. In a case here selected, in which the taxis had been freely employed prior to admission, the noose of intestine, lying with its convexity inwards, was strangulated by the external edge of Gimbernat's ligament. It was healthy, and having been straightened in order to be returned, it spontaneously re-entered the abdomen without any pressure whatever having been exerted upon it. The patient died of peritonitis.

M. Tillaux protests against the adoption of the practice recently advocated by M. Girard of performing the operation, and leaving the hernia unreduced, under the idea that the reduction of the inflamed intestine is the cause of the peritonitis that so often ensues. M. Girard bases his recommendation chiefly on two cases, in which, owing to gangrene in adhesions, reduction had not taken place, and yet the patient recovered. This, M. Tillaux observes, is the old story of their recovery, in spite of, and not in consequence of non-reduction; and he cannot treat the proposal as serious until cases have been treated by intentional non-reduction. He observes the return of the intestine is not the source of danger in herniotomy, but the peritoneal wound; and he believes that ovariotomy may teach us one reason why operations for hernia are so fatal. In it the surgeon, above all things, is assiduous in preventing the sojourn of a drop of blood or other fluid in the cavity of the peritoneum, for it is from the subsequent decomposition of this that peritonitis is to be feared. In hernia it is obvious that the blood from the bleeding surfaces easily may gain access to the cavity. This is a mere hypothesis, but it is desirable that the attention of surgeons should be turned in this direction.-Bull. de Thérapeutique, June 30th.

On Internal Otitis in New-born and Young Infants.-A short time since (vide Medical Times,' June 5) M. Parrot, surgeon to the Hôspice des Enfants, Trouvés, read an interesting paper to the Paris Hospital Medical Society on this subject, drawing attention to the great frequency with which the affection is met in autopsies of infants. In the present communication, MM. Baréty and Renaut, two of his pupils, furnish a complete macroscopic and microscopic account of the lesion. They observe that prior to M. Parrot's communication internal otitis of infants had been unnoticed in France and England, except, and then very imperfectly, as due to an exanthematic origin. In fact, Prof. von Tröltsch and his American translator, St. John Roosa, are the only writers who have noticed

the existence and frequency of purulent catarrh of the tympanum in children, together with the influence attributable to it in the production of deaf-dumbness. According to their own experience, derived from the performance of a large number of autopsies in 1868 and 1869, the lesion is one of very frequent occurrence. Indeed, the absence of some of the different stages of otitis was quite exceptional, a fact somewhat explained by M. Parrot's observation, that the subjects of the lesion had usually suffered from disturbance of nutrition, owing to insufficient or faulty food. Whatever their cause, MM. Baréty and Renaut describe minutely the various appearances of which Von Tröltsch had only as yet given a rough account, as witnessed by the naked eye. This description, which is illustrated by drawings, we have no space to follow, and can only refer to it those interested in a good anatomical account of internal otitis. The authors, from their clinical observation of these cases, quite agree with Parrot and Von Tröltsch, but the lesions are only one out of numerous other signs of an intense impoverishment of the economy which are met with, especially during the two first months of life, its subjects also often being born prematurely.-Archives de Physiologie, May.

On Reduction of Dislocation of the Humerus.-Professor Podratzki observes that, while as a general rule recent dislocations are reduced without difficulty, cases are met with which resist the usual methods, however skilfully employed. In old dislocations, especially when the use of chloroform is contraindicated, such resistance is, of course, much more frequently met with. He wishes to direct attention to the two methods of reduction which have been recently introduced, having himself derived great advantage from their employment. The first is the "pendulum" method, described by Professor Simon, of Rostock ('Brit. and For. Med.-Chir. Rev.,' Jan., 1867, p. 269), which he has found to succeed with an ease and rapidity that has surprised him. It consists essentially in raising the patient by the dislocated arm, converting his body, in fact, into an agent of extension. This is done by an assistant employing a towel, or, in obstinate cases, a pulley, while the operator directs the head of the bone into its cavity. In a case in which the dislocation had taken place eight weeks before, reduction was thus effected immediately, without the employment of chloroform. The other method is that of Schinzinger, and consists in forcibly rotating the humerus outwards, the shoulder-blade being fixed by an assistant. Such an amount of force may be exerted by the forearm converted into a lever, that there is some danger of breaking the bone. Rotation has been employed by Syme, Dumreicher, and others, but not so methodically as by Schinzinger. In the three recent cases in which Prof. Podratzki has resorted to it the success was remarkable for its rapidity, although in two of these no chloroform was given. He believes the plan unsuited for old dislocations, which can be more efficaciously and safely treated by the pendulum method.-Wochenblatt der Gesell. der Aerzte in Wien, May 26th and June 9th.