mated, expression of countenance. There was no sign of paralysis to be noted, and his mental condition was surprisingly changed from what it was when he came under treatment. The case is an interesting one, both as showing the value of specific treatment and as a lesson in the fact, often unrecognized, that unusually great patience is necessary in the treatment of syphilitic diseases of the nervous system, improvement being often much delayed. The man has been attending the hospital regularly for fourteen months, and with constantlyincreasing advantage. On the Treatment of the Paralytic Forms of Strabismus. By ROBERT B. CARTER, F. R. C. S., Consulting Surgeon to the Gloucestershire Eye Institution. The forms of strabismus that depend not only upon contraction of one rectus muscle, but also upon paralysis of its opponent, have been long recognized as sources of much embarrassment to the surgeon. The paralysis is sometimes the primary affection, and sometimes, I believe, it is merely a secondary one, due to the enforced inactivity of a muscle that has been long overpowered by its antagonist. In the former case, the paralysis itself being often traceable to some rheumatic or syphilitic cause of pressure upon the motor nerve, and vision being unaffected, there will usually be much diplopia as well as much disfigurement. In the latter case, where the strabismus was originally caused by hypermetropia, and where vision is much impaired, disfigurement alone will be present. In both, after the lapse of a certain time, we may find the eye almost fixed in an abnormal position; one muscle contracted and perhaps structurally shortened, and its antagonist so far paralyzed that it will not respond at all to the influence of the will. However successfully we may then address remedies to the removal of the original cause of the paralysis, our success will be fruitless, because the natural balance of power between the opponents is too much disturbed for the weaker muscle to have any chance of reasserting itself; and, if we divide the tendon of the contracted muscle, the paralyzed one will yet be too feeble to bring back the eyeball to its proper position. Surgical ingenuity has been taxed to devise compound operations, by which the weakened muscle has been brought forward or shortened, and the contracted one divided or put back; but the results have seldom been satisfactory, and the last state of the patient has often been worse than the first. Some two or three years ago, Professor Moritz Benedikt, of Vienna, published on the effects of the direct galvanic current in paralysis of the ocular muscles; and my very rough translation of his paper appeared almost by accident, and without my having any opportunity of revising it, in the second volume of the Ophthalmic Review. Benedikt's results seemed to me capable of being improved upon, and I determined in the first suitable case to try a combination of tenotomy with faradization. A patient soon afterward presented herself with complete paralysis of the right superior rectus. She was a respectable, middle-aged woman, the affection was of many years' standing, and I could not ascertain its cause. The inferior rectus was strongly contracted, the cornea rolled down, the supra-corneal region of the sclerotic bulging forward from the loss of support, the diplopia very distressing, and the deformity extreme. Voluntary power of upward rotation was wholly lost. In order, in the first place, to test the electric contractility of the paralyzed muscle, I obtained a pair of small rheophores, terminating in disks of not more than a line in diameter. These disks were covered with very fine white leather, well wetted. The upper lid being lifted, and completely controlled by a large retractor, governed by the left hand, the disks were applied to the supra-corneal region of the conjunctiva, as far back as possible, with the right hand, and about a line apart. When fairly placed, they were connected with the primary current of a Stöhrer's battery, in very feeble action. At first, the only effect produced was irritation of the fifth nerve, as shown by pain, lachrymation, and redness; but, after three or four applications of the current on successive days, some very slight effort of contraction in the weakened superior rectus became manifest. I then divided the tendon of the inferior rectus; and continued the use of the current daily. Day by day the paralyzed muscle recovered strength; and, in about three weeks from the commencement of the treatment, the cure was complete, as well of the diplopia as of the deformity. The second case that came under my notice was one of hypermetropia, with extreme convergent strabismus of the right eye, the vision of which was so much impaired that there was no diplopia. The patient was a young man of nineteen, a domestic servant; and his squint was a serious hinderance to his prospects in life. Paralysis of the external rectus appeared to be absolute; and the most complete possible tenotomy of the internal rectus, by Liebreich's method, was followed by little, if any, improvement in the position of the eye. The eye lids were then held apart as widely as possible, and the rheophores used for the former case were applied in the same manner to the conjunctiva covering the external rectus. Little by little, the weakened muscle responded to the current; and after a short period of treatment the squint was entirely re moved. The patient was then instructed to exercise the eye daily by reading through a lens of short focal length; and it seems probable that he will ultimately regain useful vision. I have taken these two cases as types of different forms of paralytic strabismus; and the results obtained in them, and in others of a less-marked character, induce me to believe that paralysis of a rectus muscle, due to any of its more frequent causes, is seldom beyond the reach of recovery by electric treatment. But in such paralysis, as indeed in some other forms, the contraction of the opponent is a formidable impediment to the functional restoration of the muscle that is weakened; and the anatomical relations of the recti tendons to the capsule of Tenon are fortunately such that an effectual tenotomy, if carefully performed, will not involve any loss of power likely to produce displacement in an opposite direction. It is always satisfactory to obtain some evidence of reaction to the current before the tenotomy is performed, because then, eventual success may be considered certain; but there will be some cases in which the paralyzed muscle will be too feeble to react until released from the tension of its antagonist. I am disposed to attach importance to the small rheophores, and to their application on the conjunctival surface, immediately over the affected muscle; so that "localized electrization" may be practised after the manner of Duchenne. There can be no doubt that an induced or faradaic current is more generally applicable than the direct current to the cases under consideration, because less potent in its effects upon the optic nerve and retina; and, as a rule, for the same reason, I should use the primary induced current before having recourse to the secondary. The latter, as the more penetrating, may be used if the former should fail; but, on account of the very superficial situation of the recti, only a small power of penetration will usually be required. Furthermore, since it has been shown that in some cases paralyzed muscles will react to the direct current when they are insensitive to the induced, the former should in all cases be tried, but with due caution, as a last electrical resource, and prior to the performance of any operation for shortening the weakened muscle.-The Lancet. Epilepsy.-Dr. Beigel, in a paper, founded on one hundred and fifty-two cases of epilepsy, read before the Clinical Society of London, inferred that, although unconsciousness and convulsion are so frequent as phenomena of the epileptic paroxysm that most writers regard them as characteristic, there are many cases undoubtedly of epileptic nature in which these symptoms are absent. He considered that the only invariable pathognomonic signs of epilepsy were those which arose from disturbances of the circulation, and set forth various facts and observations which had led him to localize these disturbances in the vaso-motor nerves. As regards the treatment of epilepsy, Dr. Beigel believed that the most important remedy for continuous administration was the bromide of potassium. He further strongly recommended the subcutaneous injection of morphia, guarded by atropine in the manner suggested by Dr. John Harley, immediately before an apprehended attack, as a means of warding it off, or at least of modifying its violence. -The Lancet. Case of Hysteria, in a Male. By Dr. MOURETTE.-A young boy, aged thirteen, of a delicate complexion and feminine appearance, had for several weeks suffered at intervals from a nervous affection, and which M. Mourette thought was hysterical in its character. After a general feeling of discomfort, attended with coughing and eructations, he passed into a kind of convulsive seizure, during which his limbs were agitated, incoherent words uttered, and a feeling experienced as if there was a ball in the throat. At the end of a variable period the access terminated with yawning, tears, and nervous cries. At no time was consciousness lost. He understood all that was passing around him, but was unable to eat any thing. The urine and fæces were not passed involuntarily. Neither antispasmodics, sulphate of quinine, nor revulsives, gave any relief.-Bulletin Médical de l'Aisne and Annales Médico-Psychologiques. Cerebral Embolism. By ERLENMEYER.-According to Erlenmeyer, the principal causes of cerebral emboli, in addition to divers affections of the circulatory organs such as atherome, endocarditis, etc., are rheumatism, gout, syphilis, cancers, and puerperal phlebitis. The abuse of spirituous liquors is also a powerful cause; sex is without influence. The period of life between thirty and forty years furnishes the greatest number of cases. Symptoms: no prodromata; sudden loss of consciousness, with paralysis of various parts of the body. The facial and hypoglossal nerves, and the extremities, are almost always attacked; sensibility is abolished in the conjunctiva while it remains intact in the cornea, the last fact being due to the influence of the sympathetic nerve. Pupils normal, reacting well. No symptoms of compression or of irritation of the brain. No vomiting, or contractions, or grinding of the teeth. The pulse is weak and small, the temperature rather below the normal standard. Sometimes there are epileptiform seizures, more severe in their character according as the extent of brain rendered anæmic is more considerable. Psychical troubles do not appear till late, when the collateral circulation, not being established, the cerebral substance begins to undergo degeneration or transformation. If, then, psychical troubles are due to a cicatricial transformation, or to the formation of cysts, a cure is not possible. The mental affection often assumes the form of general paralysis, from which it is not always easy to distinguish it. Lesions of the corpora striata and of the optic thalami are more apt to lead to this false paralysis. The emboli may exist on both sides, in which case the resemblance to general paralysis is.very striking.-Prager Vierteljahrschrift. II. MEDICAL JURISPRUDENCE. On Medico-Legal Uncertainties. By J. W. EASTWOOD, M.D., Edin. (Read at the Annual Meeting of the Northern Branch of the British Medical Association, held at Darlington, July 1, 1868.) To wander over the whole field of medico-legal uncertainties would lead us among railway injuries, criminal cases of every kind, disputed wills, and various subjects, psychological and non-psychological. Such a wide scope is not the object of this paper, but I wish to place before you some facts of an important department, which I trust will, sooner or later, be brought seriously before the profession and the legislature. The uncertainties to which I wish to draw your attention are produced by several causes, conveniently divided into medical and legal: 1. Medical difficulties, inherent in the subject itself, from the nature of the human mind; and those arising from the variety of medical evidence. 2. Legal difficulties, caused by the state of the law, and the uncertainties of its administration. In a court of law it is entirely overlooked that, in trials of psychological interest, it is the human mind, with all its complex workings, that has to be considered, and that no subject is more difficult to comprehend. There is no accurate definition of insanity, either medical or legal; and there is no standard of sanity, except that which a man makes for himself. The mens sana in corpore sano exists only in words, as an ideal standard, for who has ever successfully defined |