and amount, it is still desirable to give for a short time, before each monthly period, a few doses of the medicine. This remedy has been recommended by Dr. Begbie in nymphomania and puerperal mania. It is also employed to stay the unnatural discharge from persons who suffer from frequent seminal emissions. I have no doubt, from my own experience, that the drug does possess, in a high degree, this power. Its employment should be supplemented by cold sponging of the scrotum and perinæum, and the suspension of the testicle in cold water for some minutes night and morning.

It is useful in allaying various forms of hyperæsthesia; and sometimes eases the severe pain of chronic arthritis.

If the medicine be continued for a long time, as sometimes happens in the treatment of epilepsy, its physiological effects become apparent. "Diminished sensibility, followed by complete anesthesia, of the soft palate, uvula, and upper part of the pharynx, is the first symptom that the patient is getting under the influence of the drug. The sexual organs are among the first to be influenced; for there is soon produced failure of sexual vigor, and, after a time, marked diminution of the sexual appetite itself. Another frequent, if not constant, result of the prolonged administration of the bromide is an eruption of small boils, in successive crops, chiefly over the face and trunk, and accompanied with troublesome itching." (Bazire.) It also produces bodily and mental depression, and the patients become low-spirited and subject to gloomy ideas, and are soon fatigued and unfitted for work. On the suspension of the medicine, all these symptoms and appearances soon subside.-Lancet.

Extract from a Paper entitled "Remarks on the Pathology of Chorea." By W. H. BROADBENT, M. D., M. R. C. P., Senior Assistant-Physician to St. Mary's Hospital and the Fever Hospital.

In the session of 1865-'66, I read at the Medical Society a paper on chorea, which I withheld from publication at the time, in order that, by further reflection, I might mature the opinions I advanced, and obtain a greater amount of clinical evidence than I then possessed on some of the points bearing on the questions raised.

The chief object of this communication was to show that chorea was not the manifestation of a general condition, whether of the nervous system, as is still commonly held, or of the blood and tissues generally; but an affection of the sensori-motor ganglia at the base of the brain, the corpora striata, and the optic thalami. Dr. Russell Reynolds had already

enunciated and ably maintained this view in his work on the Diagnosis of the Diseases of the Nervous System; and Dr. Hughlings Jackson, who was present at the meeting of the Society, had independently arrived at a similar conclusion, and had, moreover, assigned a precise character to the lesion of the ganglia by applying the theory of Dr. Kirkes as to the causation of chorea-i. e., embolism of their vessels. These views he has recently developed more fully in an able paper in the Edinburgh Medical Journal. It appears to me that chorea is to be regarded as a symptom rather than as a disease, and that it cannot be referred to any single pathological condition. This is what I now endeavor to establish.

It is not necessary here to employ arguments against the opinion that chorea is the expression of a special "diathesis," as described by the late Professor Trousseau, although an hypothesis equivalent to this seems to be extensively held-i. e., that it is due to functional irritation of the nervous system by blood containing some morbid element. If it can be shown that the sensori-motor ganglia alone are affected, this supposition is excluded, without the need of direct disproof.

The considerations which form the basis of the conclusion, that the seat of the morbid changes to which the symptoms of chorea are due is the corpora striata and optic thalami, are as follows:

1. The cerebral hemispheres are not involved, as is seen by the fact that, in a typical case, there is primarily no affection of the intelligence. It is true that, in some cases, the mental faculties are obviously enfeebled, and sometimes there is acute delirium; but in these instances we have chorea plus impairment of intelligence-an affection of the hemispherical ganglia, in addition to the affection of the sensori-motor ganglia. It is true, again, that we may have considerable structural damage in the hemispheres without apparent loss of any of the intellectual faculties; and this weakens in some degree the conclusion that absence of intellectual derangement in chorea implies absence of lesion in the hemispheres. It would not be easy to show positively that the cerebellum is not involved; and, as the attempt would necessitate some discussion of the functions assigned to the cerebellum, it will not here be made.

A point of greater importance is to show that chorea does not arise from any morbid condition of the cord. The following considerations on this question are advanced by Dr. Russell Reynolds:

1. "Clonic spasm of the incessantly-repeated character is not a phenomenon of persistent spinal irritation. (Tonic spasm is a mark of such a condition.)

2. The movements (unless very severe, and even then to some extent) are generally controlled by the will; and it is certain that the purely (asensuous) reflections are not amenable to volition, or, at all events, to the same extent.

3. "The spasmodic movements cease during sleep, whereas the phenomena of excito-motor character are increased by this removal of volition. The direction of attention to some other object likewise diminishes the intensity of choreic movements.

4. "The special occasion of increase or of induction of choreic movements are the attempts at volitional action and the emotional changes."

These arguments are open to criticism, and could not be accepted as conclusive. They have, however, considerable weight, especially when taken in connection with the following, which I have added:

5. Tickling the palm of the hand or the sole of the foot does not excite exaggerated reflex action. If the choreic movements were due to abnormal excitability of the cord, or an undue readiness to respond to impressions, tickling is the kind of stimulation which would, of all others, render this manifest. I have now tried the experiment in a great number of cases. Not uncommonly it causes some amusement to the patient, and there are grimaces and movements due to this emotional state; but, when the smile or laugh has passed off, the tickling is borne without any difficulty, and there seems frequently to be less difficulty in controlling the tendency to reflex actions than in health. Sometimes the tickling is not felt, as such, at all.

6. The most conclusive evidence, however, that the phenomena of chorea are not of spinal origin, is furnished by their unilateral character. Almost invariably, the twitchings come on first in one arm and leg, and often last for some time in the limbs of one side before extending to those of the other. (See Dr. Russell's paper in the Medical Times and Gazette for May 31, 1868.) Throughout the affection, again, they usually predominate on one side or the other; and cases are not uncommon in which the chorea is unilateral from first to last-unilateral, that is, so far as the limbs are concerned, though more or less bilateral in the muscles of the eyes, chest, and abdomen.—British Medical Journal.

On a Case of Disease of the Pons Varolii. By Dr. R. BEVERIDGE, Physician to the Royal Infirmary, Aberdeen. In endeavoring to determine the functions of the various parts of the nervous system, no more reliable observations can be made in man than those where disease is localized in one

limited spot, inasmuch as the functions so deranged point to those naturally carried on there; and, as a contribution to our knowledge of this subject, the following case is submitted:

J. T., a laborer, aged twenty-three, enjoyed perfect health up to the middle of September, 1864, when he began to see double, and to stagger in walking. These symptoms becoming aggravated, he was soon incapacitated from work, and was admitted into the Royal Infirmary, September 28th. After admission, the partial paralysis rapidly increased, and in the middle of October the symptoms might be thus described: Cannot walk without assistance; cannot articulate distinctly; swallows with considerable difficulty; voluntary power over the left side of the body and face not abolished altogether, but very considerably impaired; voluntary power over the right side of the body slightly enfeebled; marked internal squint of the left eye, which can with difficulty be brought so as to look straight forward, but cannot by any effort be made to look outward. Vision perfectly distinct and accurate with either eye, but the internal squint caused at first double vision, which for a time was felt to be very embarrassing. Touching lightly with the hand and pinching are felt everywhere, but less distinctly on the right side than on the left; and he states that the right side both of the body and face feels numb. Mental faculties unimpaired. The state of the hearing was not examined till November 20th, when he was found to be deaf in the right ear, and he stated that he had noticed deafness on that side coming gradually on for some months. In the end of November, the symptoms were increased in intensity, but unaltered in character. Voluntary power over the muscles was nowhere completely lost, but was much more impaired on the left than on the right side, while the loss of sensation was more marked on the right side. Breathing went on regularly, but he could not increase the depth of respiration by a forced effort when asked to do so. He gradually sank and died on December 1st.

Autopsy, December 2d.-Brain weighing 54 oz.; veins of cerebrum slightly congested; arachnoid in spots slightly opalescent; substance of hemispheres healthy; ventricles containing, but not distended with, clear serum; choroid plexus finely injected-this appearance most marked in the inferior horn of the ventricle. Medullary bands, corpus callosum, fornix, hippocampi, corpus fimbriatum, and tænia semicircularis firm and strongly marked. Corpus striatum, optic thalamus, corpora quadrigemina, and pineal gland natural. Cerebellum healthy. Pons larger than usual, somewhat lobulated on the anterior surface, the lower part of which, down to the medulla oblongata,

presented a gelatinous appearance. On making a section, the fibres of the lower part appeared very indistinct, and in a great measure replaced by a soft semi-gelatinous-looking mass (soft cancer) without any defined border, much more abundant on the right than on the left side, but present on both sides, not extending down into the medulla oblongata, most marked in the lower half of the pons, extending nearly through the pons from front to back on the right side, but limited to the front of it on the left side, replacing entirely the transverse and to a great extent also (although not completely on either side) the vertical fibres; presenting under the microscope the appearance of a mass of minute, mostly oval, nucleated cells, intermixed with a (very) few nerve-tubes, no exudation corpuscles, and no nerve-cells; not forming a defined tumor, but infiltrated, as it were, into the tissue. The origin of the right fifth nerve in the pons was involved, as was also that of the right auditory. Medulla oblongata healthy. Lungs congested, oedematous, especially behind, large, voluminous, filling entirely the sides of the chest, and not collapsing on its being opened; the right weighing 34 oz., the left 25 oz. Heart somewhat enlarged, weighing 12 oz. Pericardium adherent by loose bands along a narrow line in front of the right ventricle, extending from near the apex to the origin of the pulmonary artery. Left ventricle with its walls thickened; endocardium of the left auricle thick and opaque; that of ventricles white in small patches; aortic and mitral valves thickened, but pliable and apparently competent; commencing fibrinous vegetations on the inner surface of the mitral valve near its base. Abdominal viscera healthy.

This case is of considerable interest in a physiological point of view-the more so that, the disease being a slowly progressive one, the symptoms were limited to impaired function of the pons itself, and there was not present the complication of shock with its consequences such as occurs in the case of apoplexy or the like. Standing as the pons does, as it were, in the great highway of impressions passing both to and from the great nervous centres of the cerebrum, affections of it may be expected mainly to show the results of severance of the centres from the cord and its nerves below. Accordingly, in this case, every thing seemed to show that the cord below and the cerebrum above were both intact-the continuance unhampered of ordinary respiration and of the muscular action of the thoracic and abdominal walls, and viscera, showing the integrity of the medulla oblongata and cord, while the full preservation of the mental faculties proved the unimpaired action of the cerebrum; but the partial loss of sensation and voluntary