plished its decussation, the paralysis is direct for the face, while it is crossed for the parts supplied with nerve-influence by the columns of the cord, the decussation of which is only accomplished in the anterior pyramids-that is to say, below the annular protuberance." (p. 281)

For several reasons, stated somewhat at length, M. Trousseau does not agree with the reasoning brought forward.

Cerebral Fever, or, as with ourselves, Acute Hydrocephalus, occupies Chap. LV.

Among the symptoms referred to, some stress is laid on the existence of meningitic staining-"la tache méningitique ou cérébrale"-to be explained on the supposition of a material alteration in the vascular supply of the skin. It is described as a well-marked redness, rapidly developing itself upon a slight rubbing of the skin with any hard body, and remaining evident from ten to fifteen minutes. The redness is deeper and of more prolonged duration than that which follows on the same or even on more severe mechanical friction in ordinary febrile affections. It is specially found to exist on the anterior part of the abdomen, the thighs, and the face.

The three stages of the disease are recognised much in the order and as possessing the characters ascribed to them by English writers, the precursory conditions of the first stage being rather indicative of a deeply-implanted tendency to brain mischief, usually tubercular in origin, than as positively shadowing out the necessary sequence of acute hydrocephalus. Vomiting more or less persistent, and constipation, attended with headache of varying intensity, are the symptoms specially to be noted in this early stage.

The accession of the non-feverish period, with its singularly slow pulse, falling from 90 or 100 to 50 beats in the minute, gives rise to hopes of recovery. The repose contrasting so favourably with the previous restlessness makes the attendants on the child believe in the certainty of improvement. On this, however, follows deep somnolence, with a total disregard of external impressions, broken only by the mournful "cri hydrencephalique."

Retraction of the abdominal walls is a condition of especial value when the diagnosis between the disease before us and typhoid fever is in question, since it is so strongly contrasted with the tumid and prominent abdomen of the latter affection. Peculiar to this form of encephalic seizure is mentioned the irregularity of the respiration, frequent inspirations, with a subsequent arrest of movement of the chest walls, not connected with the circulation, for it is coincident equally with the extremely slow pulse of the second as with the hurried heart-action of the third stage.

This third period is marked by a return of the feverish symptoms; the stupor becomes more profound; paralytic phenomena declare themselves; strabismus, dilatation of the pupil, and loss of power over the levator palpebræ are mentioned. Hemiplegia, more or less complete, may be found to exist, appearing sometimes to change its seat; for the limb sensitive to irritation one day is on the next visit uninfluenced by the same means the explanation, however, being that

both limbs are paralysed, the healthy limb of yesterday being the most thoroughly palsied to-day.

Convulsions declare themselves, and death closes the scene after, it may be, an apparent relief of all the symptoms. The older medical works contain published cases of cure. Since, however, the pathology and diagnosis of the disease have been more thoroughly cleared up they are no longer met with. In these touching lines M. Trousseau enunciates his opinion of the value of treatment:

"Nevertheless, convinced as I am of my own impotence, I cannot decide to remain absolutely inactive; although, taught by long experience, I know that my efforts will be useless, I still try to contend with the discase. My intervention will, at least, have as its result that I do not ruthlessly snatch away all hope from those who surround the sick child, but that I sustain their courage, and do not leave to them the regret that I have done nothing to save him whom they confide to my care. But convinced, also, that too energetic plans of treatment weary out more rapidly the source of life, I endeavour to do the least possible ill, since I am powerless to do actual good." (p. 323.)

Chap. LVI. Cases of vertigo from stomach derangement are apt to be mistaken for those dependent on cerebral disturbance. They have this characteristic, that, throughout, the intelligence is neither impaired nor lost. The treatment should be suited to the relief of the coincident dyspepsia; on no account must it include any resort to low diet and depressing agencies.

Physicians, in treating disorders of the digestive organs, far too often fall into the error of dictating for their whole circle of dyspeptic patients that very régime which they have by experience learned to be best for their own requirements. The only sure guide to a correct diet scale must be found in the liking and the general condition of each separate patient.

For chemists and chemical theories the author has small reverence; the experiments of the laboratory and the experience of the bedside have little in common: "I know not how too thoroughly to put you on your guard against chemistry, which, principally in its application to therapeutics, leads to deplorable errors." (p. 378.)

To affections of the stomach and intestinal canal, including chronic gastritis, simple ulcer of the stomach, diarrhoea, &c., several chapters are devoted. The various plans of treatment found most satisfactory in the author's experience are noted in turn.

In Chap. LXII. attention is directed to the nursing and the weaning of children, and the bearing of the first series of teeth on these two physiological processes. The first teeth appear in groups, with a distinct interval of rest between the separate manifestations, and three or four even of these groups should be present before the child is weaned: "My rule is this-I wait for the complete evolution of the canine teeth before the children are weaned; I wait, then, until the child has sixteen teeth, without taking account of the age at which it has arrived." (p. 469.)

Chap. LXVI. Occlusions of the intestine-comprehending under this title those cases to which the terms of ileus, volvulus, iliac pas

sion, &c., have been given-are due to external or internal causes. The causes external to the intestine are tumours, displaced viscera, and especially organized bridles of lymph, owing their existence to past peritonitis. Internal conditions, giving rise to obstructions, are, narrowing of the calibre of the gut from local disease, invagination, the lodgment of foreign bodies, &c. &c.

Out of four cases in which the author has, after the failure of other means, suggested the operation for artificial anus, two are stated to have recovered. The operation described is that practised by M. Nelaton, opening the lower end of the small intestine by an incision in the right iliac fossa. No reference is made to the procedure of opening the colon either by Littre's or Amussat's operation.

Hydatid cysts of the liver, Chap. LXVIII., are only to be opened surgically when adhesions exist between the hepatic substance and the internal surface of the abdominal walls. To induce these adhesions, M. Trousseau has recourse to "multiple acupuncture;" thirty or forty needles arranged in a frame are pushed through the integuments and subjacent tissues, so as to give rise to a localized peritoneal inflammation. Subsequently the requisite opening may be practised.

Chap. LXIX. Hydatid cysts of the lung have their primary seat in the pulmonary tissue. Secondary implication of the pleura may occur as the disease advances. As yet, the weight of experience is against any surgical interfererce in such cases. Chapters LXX. and LXXI. are devoted to the consideration of diabetes in its two forms. The late researches of M. Bernard and M. Schiff are specially referred to. Our limited space forbids any attempt at the lengthened notice which these exhaustive papers so well deserve. Chap. LXXII. entertains the strange disease, exophthalmic goître. In this affection, when fully developed, three well-marked morbid conditions are present:

1. Protrusion of the Eyeballs, more or less slowly increasing until the eyelids fail to cover them. Some disturbance of vision may be present; it is not, however, a necessary coincidence. Ophthalmoscopic examination in the hands of M. Wilhuisen has shown hyperæmia of the retina and pigment deposits, consequent probably on some change in nutrition.

2. Enlargement of the Thyroid Body.-Of the two lobes the right is usually most affected, but the whole body, isthmus included, may become the seat of enlargement. The gland elements undergo a distinct hypertrophy, and the blood vessels are also much enlarged. Two cases, indeed, have been reported where the thyroïd tumour was, from its expansion, supposed to be an aneurismal sac.

3. Disturbance of Heart Action.-Palpitations are much complained of; they form, indeed, a prominent symptom of the disorder; the heart acts regularly, but with much violence, and the beating is transmitted along the line of the large vessels; bruits de soufflet are not uncommon; but there is no necessary coincidence either of positive hypertrophy or of valvular disease. In the existence of a temporary hypertrophy, analogous to that of the organ in pregnant women, some belief is entertained.

The disease may exist even though there be no protrusion of the eyeballs; and the absence, also, of the thyroïd enlargement for a time will not invalidate the diagnosis. Sooner or later, the three distinctive characters will be manifested.

"In our opinion, the disease is a neurosis, with local congestions, having its immediate cause in a modification of the vaso-motor set of nerves." (p. 645.)

With reference to the treatment it is stated that iodine and its preparations, at first universally tried, have as generally been rejected. Pallor and oedema are constant attendants on the course of the disease, yet ferruginous preparations are not desirable. M. Trousseau recommends general bloodletting, the local application of cold, and the administration of digitalis, pushed to the verge of its poisonous action. In females, especial care should be paid to the soliciting a due menstrual discharge.

In the most severe accessions of dyspnoea, tracheotomy will probably seem to be the only means of saving life. If it is attempted, the operator must bear in mind the certainty and the dangers of an excessive hæmorrhage. M.Chassaignac's écraseur might be found available. The affection of the supra-renal capsules, attended by discoloration of the skin, Addison's disease, is referred to in Chap. LXXIV.

Only two cases have come under M. Trousseau's care. The employment of tonic and supporting treatment affords the only hope of benefit, rarely hitherto realized.

After a notice, Chap. LXXV., of the white-cell blood leucocythemia, the next section is devoted to that interminable medical puzzle-gout, in its various forms.

Both in local manifestation and in general symptoms the peculiar and specific characters of the disease are well marked. Analogies exist between gouty and rheumatic arthritis; but the differences are found in every direction-the mode of access, the parts affected with their subsequent local changes, and in the duration of the whole disease.

Several pages are given to acute and chronic gout. The deposits of chalk-stones are formed not during the attack of gout, as frequently supposed, but during the intervals of comparative ease. No necessary health-disturbance attends on these local changes.

Masked gout (goutte larvée) may be the determining cause of angina pectoris, or may show itself under the form of severe asthma. Attacks of these affections will frequently alternate with the ordinary arthritic mischief.

Visceral or anomalous gout not unfrequently results on the treatment of the ordinary articular affection by too severe or too prolonged using of remedies. Pulmonary or nephritic disorders are among the most common forms. It is of the most serious moment, since the organs affected are those whose functions are essential to the very existence of the sufferer.

Is active medical intervention during the acute access of gout necessary, or even advisable ?

In accordance with the opinions of our great authority, Sydenham, the author deprecates active interference, and in these words:

"At the commencement of my practice I have endeavoured, like many others, to contend against the malady; now I stand with my arms folded. I do nothing, absolutely nothing, against the attacks of acute gout, especially when they seize an individual in the prime of life. More than once I have had to repent a departure from this inaction, and have learnt how perilous active intervention might become." (p. 739.)

Acute gout, heroically treated, will, in many instances, merge into the atonic cold and persistent form. If remedies are imperatively called for, then they should be used carefully and methodically. Colchicum with quinine is a valuable form of remedy, given in small doses towards the close of an attack, so as to moderate, not to extinguish the pain.

Of local applications, as generally employed, M. Trousseau says nothing. He has derived benefit from the subjecting of the parts affected to the influence of tobacco fumigation-employing the process in the absence of severe pain. Most probably the remedy acts by diminishing the increased local susceptibility.

The remaining chapters take cognizance of intermittent fevers and of rickets.

It would seem that not only does scrofula not entail rickets, but that the two diseases tend mutually to exclude one another. MM. Rufz and Guérin have deduced a similar law from their researches.

The whole work, in reflecting the daily teaching of its distinguished author, bears ample testimony to his unwearied zeal and assiduity. It will be heartily welcomed by those who embrace advances in medical knowledge as means

Ricerche sull' Anatomia Normale e Patologica delle Cassule Soprarrenali e Considerazioni sull' Apoplessia di questi Organi e sulla Malattia dell' Addison. Per RAFFAELLO MATTEI, Professore di Patologia Generale alla R. Universita di Siena.

Researches, Anatomical and Pathological, on the Supra-renal Capsules, with Remarks on Apoplexy in these Organs, and also on Addison's Disease. By RAFFAELLO MATTEI, Professor of Pathology in the Royal University of Siena. (From the Sperimentale,' 1863, pp. 28.)

THE charm of novelty attaching to minute investigations into the anatomy and pathology of these organs is not yet so far dispelled as to lead us to regard with an ordinary degree of interest observations so original as those which lie before us. As they are seldom found to be affected by disease, the obscurity which surrounds the function of these secondary viscera, and, perhaps also a certain preconception as regards their importance and activity, long led to their unmerited neglect, and, in the minds of most observers, to a partial indifference