I then went, at some length, into detail on the applica-de-generation puts a limit to the time during which any tion of these observations both to muscular fibre and to the ganglionic centres of nerves.

of nerves are capable of developing only a given or definite amount of nervous influence or force during a given or definite period of time."

And further on, observing in relation to the ganglionic nerves:-"They, too, as I regard it, can develop but a limited amount of nervous influence or force during the definite period of time I refer to; that is, during the period of time which is defined by the de-generation of individual ganglia, irrespective of new or re-generated ganglia."

And adding "Hence the process of de-generation (as in the case of an individual muscle) puts a limit to the time during which any individual ganglion can develop nervous influence or force. Hence, too, it is obvious (in like manner as in the case of muscular fibre) that the duration of that time will be longer or shorter, according to the degree of activity with which the process of degeneration takes place in that ganglion; or which amounts to the same thing, according to the degree of activity with which that ganglion has discharged its physiological function of developing nervous influence or force."

Thus, then, it is obvious that when once any given ganglionic centre has expended, or exhausted, its entire nerve force, say in the production of convulsions, there must be a pause, intermission, or rest, before a similar expenditure of nervous force can take place-namely, until a new ganglionic centre has been developed by the process of nutrition.

I might introduce many more quotations to the same effect, but it is needless. I may, however, be permitted to add, that throughout the papers referred to, which extended over a period of upwards of two years, I had gone at great length into the subject of nutrition. I had remarked extensively on the nature of that process, how it took place, and what it accomplished. I had pointed out at considerable length how, after the complete expenditure of muscular force by a muscle, or of nervous force by a ganglionic centre, a new muscle, or a new ganglionic centre must be developed by the nutritive process. And I had further extensively entered into detail as to the manner in which those results were brought about by that process. It is unnecessary to add more on this subject, but what I desire to impress on the reader is this-namely, that in 1853 I pointed out in as simple, clear, and intelligible language as could be employed for that purpose, the following physiological principles, viz.:

That in the discharge or performance of their respective physiological functions, by muscular fibre, by ganglionic nerve centres, and by animal organic tissues universally, "time defined" manifestations of function must necessarily be followed by "definite intervals of rest," during which rest a re-development, or renewal of the tissue employed, must be effected by the process of nutrition before a repetition of that function can take place.

EPILEPSY.

CASE OF SPINAL ORIGIN: OBSERVATIONS UPON ITS PATHO

for any considerable time; giddiness on prolonged mental or physical exertion; noise in the head, flushing of face, congestion of hands, muscular tremors, irritability of mind; frequently dislike of conversation or company; insatiable appetite, unrefreshing sleep, hideous dreams, drowsiness and increased discomfort at noon.

His features appear pretty healthy; eyes dull, watery; pupils slightly contracted, conjunctivæ bloodshot; gait inclined forward; hands blue, cold; pulse 78, small, nervous. The chest presents a striking appearance. It is very lean, flat anteriorily, contracted, and almost of the same circumference from clavicles to false ribs. Below the latter is a notable dilatation reaching to the hips. Respiration, 14 per minute, is diaphragmatic and abdominal; inspiration prolonged and laborious, expiration short and bellows-like. The thoracic respiratory muscles are almost quiescent and poorly developed, excepting serratus magnus; those of the abdomen are active, large, and welldefined. Support around the diaphragm affords comfort, and facilitates breathing. The heart and lungs are healthy, the vesicular murmur feeble. The spine is red, congested, and hot; deep pressure upon either side of seventh and eighth dorsal vertebræ creates much pain.

The patient dates his malady ten years back, when he over-heated himself at play, and caught cold. Vertigo and uneasiness about the stomach thenceforth became

the prominent symptoms. About two years passed, he fell in a fit in the street, lost consciousness, was convulsed, foamed at the mouth, and so continued for nearly a quarter of an hour. Five weeks ago, he sustained "a fearful nervous shock in the back," so enervating that he was obliged to keep his bed for several days, has been since incapacitated for mental labour, and dreads every moment a similar visitation. He lives regularly, but in earlier days applied himself too constantly to literary pursuits. One of his parents inherits consumption; the other, in years gone by, was subject to fits, and has yet many epileptic conditions.

The following was my general line of treatment:-I prescribed bromide of potassium, in doses of 3ss. to 3i. ter in die, in a tonic mixture; counter-irritation to the spine, by vessicating collodion; a wide belt around lower ribs, as a support to the diaphragm; bland, nourishing food; gentle outdoor exercise, and quiet of mind.

Under this course he improved for the first fortnight, after which he failed so much in strength and nervous energy, appetite and taste for food, that, at the end of the month, he thought himself "worse than ever." I therefore discontinued the potash, and gave, instead, bichloride of mercury (1-12th gr. ter in die) in bark. By gentle perseverance in this alterative and tonic treatment for about three weeks, his distressing symptoms gradually disappeared; and by a change of air and scene, a short sojourn at a distant seaside, his long-impaired health was re-established.

This case manifests important epileptic symptoms, especially affecting the respiratory functions. Pulmonary disturbance is characteristic of this disease, and is best exemplified in a typical case. A fit is ushered in with a strong contraction of respiratory muscles, "the epileptic cry,

LOGY AND TREATMENT: BROMIDE OF POTASSIUM AND closure of the glottis, and cessation of breathing. Convul

BICHLORIDE OF MERCURY.

BY P. C. LITTLE, F.R.C.S.I., &c.

IN continuation of my remarks upon epilepsy in Vol. III.,
No. 25, of your journal, I beg to contribute the following
case of spinal origin, which manifests some remarkable
epileptic phenomena not noticed in my former paper.
June 20, 1867.-A. B., aged 23, a professional gentle-
man of ability and studious disposition, consulted me for
those conditions:-A constant irritation and painful weari-
ness at pit of stomach, occasionally relieved by the falling
down, as it were, of something from the chest, followed by a
tickling sensation about the stomach; has "always a wish to
breathe," much difficulty in that act, mitigated by bending
forward; habitual sighing and yawning; pain down the
spine and around the lions; great distress in sitting erect

sive and irregular pulmonic efforts follow, which end in slow, laborious breathing, and recovery. In the interparoxysmal periods the respiration is frequently obstructed, inspiration usually difficult. Those abnormal conditions find a general explanation in widely-accepted principles regarding the medulla oblongata.

The co-relation of this structure with other cerebro-spinal centres is thus laconically described by Flourens:-"The cerebrum feels and wills, the medulla oblongata executes, and the cerebellum co-ordinates." The oblong medulla is, therefore, the starting-point of all convulsive movements of epilepsy, it also embraces the respiratory tract,2 is the centre of the reflex motor system,3 and I am

1 Admirably elucidated by Van der Kölk in his work on "The Spinal Cord, Medulla Oblongata, and on Epilepsy." 2 Sir Charles Bell.

3 Dr. Marshall Hall on "The Nervous System."

tempted to add, appears to be the organ (if there be any special one) through which the mind directly communicates with matter. Speculators upon the latter intricate question may find that, the medulla oblongata has stronger claims to this eminent position than either the heart, cerebral hemispheres, or pineal gland. Extirpate the brain, spinal cord, or heart, and may not phenomena of life still be produced? Isolate from other nervous centres the medulla oblongata-nay, injure slightly its lethal point, calamus scriptorius, and will not all vitality at once cease? The part which the oblong medulla acts in the production of epilepsy seems to be clearly, though indirectly, demons-lation of a great principle of the "circulation "—the avoidtrated by one of our learned transatlantic brethren. In 1862, Professor Josh. Jones, University of Nashville, U.S., wishing to ascertain the therapeutic action of prussic acid, performed upon alligators very many experiments, which conclusively proved that the poison only produces its fatal effects when carried by absorption or directly applied to the medulla oblongata, and that the first and most marked phenomena (the spasms) and the respiratory disturbance which rapidly extinguish life are the immediate effects of the poison upon the medulla oblongata.1

ingly apparent after death from gun-shot wounds of the heart, or from bursting of aortic aneurisms. Kussmaul and Tenner have endeavoured to prove their theory by tying the arteries which supply the brain in animals, whereby epileptic symptoms were produced. Are we, therefore, to refer those conditions solely to anæmia! Certainly not. They may, and often do, arise from hyperæmia, as in some forms of apoplexy and laceration of the brain. Ligature of the arteries to that organ arrests its circulation, but how such results in anæmia and epilepsy is not evident. Such conditions, could we conceive them to exist, would be in vioance of a vacuum in the heart and great vessels-so admirably provided against by contractility and elasticity, molecular attraction, and vis à tergo. This anæmic theory is also opposed to a generally accepted opinion, endorsed by Brown-Sequard, that, in a fit the pulmonary functions are interrupted, the right side of the heart engorged, and the venous blood reflected upon the brain. It is unnecessary to pursue those theories any further. The sum of the labours of many great minds engaged upon this subject, has afforded a simple and rational explanation of epileptic phenomena, and has been announced by the persevering Van der Kölk, who fixes the starting point of the malady in the medulla oblongata-an impulse from which is communicated on the one side to the muscles of the extremities, causing convulsions, and on the other to the cerebral lobes, inducing loss of consciousness. In his pathological investigations of epilepsy, Van der Kölk found enlargement of the capillary vessels, and granular degeneration of medulla oblongata; and M. Hall remarks that, "every function of the nervous system is involved in the pathology of epilepsy." Hence, a slight increase of tonic condition of the sympathetic nerves will diminish the vascular supply, and may so suspend consciousness.

It is chiefly in its relation to respiration that we have at present to regard this structure. To it is specially ascribed inspiration, while to a yet undetermined segment of the spinal cord expiration is referred. Analogy supports this view. Observe the compensating organic and functional forces of the system, and the character of respiration, which in a manner resembles the alternate rising and falling of the scales of a balance. The muscular mechanism by which this twofold movement is carried on is so directly controlled by the medulla oblongata that, excitement of the latter, whether arising from a nervous centre, or periphery, increases the respiratory function, and is reflected in spasmodic or convulsive actions of the muscles of respiration, which destroys their harmony of action. Viewing respira- Viewed under those aspects, we find a gratifying tion as an automatic movement, its regularity depends solution to the many difficulties of the present case. proximately upon the faithful discharge by the inspiratory Here the disease assumed a chronic character. It wanted and expiratory organs of their reciprocal functions. In the frequent repetition of fits and insensibility, which epilepsy, the effects of the undue action of the medulla usually characterize acute epilepsy. It was, nevertheless, oblongata are more strongly marked in the inspiratory serious, perhaps rare, in its presenting permanent epileptic apparatus, which is more directly opposed by a counteract- symptoms which, under certain circumstances, might end ing force than the expiratory. This force originates in the in the more lamentable type of the disease. A careful inanatomical and physiological relations of the thoracic respi-vestigation of the case rendered pretty certain the diagnosis, ratory muscles. For instance, the internal intercostals which would have been doubtful had examination of the which proceed upwards and inwards act in pulling down spinal region been neglected. The history of the case the ribs, and so assist in expiration, in opposition to exter- appeared to point to hereditary taint, rather than to cold nal intercostals, which go downwards and outwards, and caught after violent exercise, in youth, as predisposing to the elevate the ribs in inspiration. The result of such imme- malady. If it originated in the former, according to Dr. diate antagonism is a comparatively fixed state of the Russell Reynolds, and other high authorities, the attacks thorax. On the other hand, where such counteracting should assume the more grave form, the haut mal. Such forces are less evenly balanced, or where the usual action was not the case. Whatever may have remotely led to this of a certain set of muscles is less disturbed, their function is illness, there can be little doubt that the proximate cause more natural, as, I think, is exemplified in this disease in was chronic congestion, or a low inflammatory condition of expiration, which is carried on so strongly by the diaphragm, a portion of the cord, as above indicated. The grounds, the abdominal muscles, and perhaps by serratus magnus, a priori, which sustained this opinion were-the tenderness acting from a fixed scapula. and other abnormal conditions of the spine, and the constitutional symptoms referrible to derangement in that region. The result of my alterative, and counter-irritant treatment has, I believe, confirmed the diagnosis.

Thus, in epilepsy, the spinal manifestations of functional derangement of medulla oblongata appear to find an explanation. In the same way the cerebral disturbance may be accounted for. Drs. Kussmaul and Tenner are of opinion "that both the loss of consciousness and the convulsions of epilepsy, are the result of sudden and extreme anæmia of the brain."2 I cannot reconcile that conclusion, with more widely known facts. The most fearful bleeding, as from wounds of large arteries, or from rupture of aneurisms, or of the heart by a shell in war; the appalling flooding occasionally met with in the puerperal state, the profuse and rapid hæmoptysis which sometimes ushers in pulmonary phthisis, are not necessarily attended with convulsions and insensibility. On the contrary, such cases are more frequently marked by mental acuteness, and physical relaxation, or composure. The latter condition is often affect

1 The American Medical Record, December 16, 1867. Bociety, 1859.

2.On Epileptic Convulsions from Hemorrhage, New Sydenham

No

The pathological view which I had taken of the case, suggested the much-extolled bromide of potassium, for its alterative and hypnotic qualities, as the most suitable remedy. After having given it, in large doses for about a month without benefit, I discontinued it, and resorted to the less fashionable, but more venerable bichloride of mercury, which here and in similar cases proved so satisfactory to me. doubt there are instances, as from nervous irritability, in which this salt may effect a cure. But to hold, as some do, that it is always a specific in a disease so variable in its causation and pathology is unreasonable. As well may we say, the same medicine will remove every pain, or the same hat fit every head. In my former paper, I mentioned a case of the petit mal, then under my observation, which has since completely recovered by the use of quinine and iron, with hygienic and tonic adjuvants. It originated

mission tongue furred. Pulse 106. Rhonchus over lungs; slight dulness at right posterior base; 2 days later pleuritic rub at right scapular angle; 3 days later free from pain, no rub. Pulse 80.

Chloric ether and liq. ammon. acetatis (7 days); quinine and iron.

quinine and dilute hydrochloric acid. Blisters. Aperients.

Ad

PNEUMONIA. Henry M., æt. 17, no occupation. mitted March 28; discharged May 28. In hospital 61 days. Recovery. Has lived badly of late. Previously ill 1 week. Shivering and lassitude; deafness and PLEURISY.-Harriet T., æt. 27, draper's assistant. Ad- drowsiness. On admission, face flushed; skin hot and mitted February 26; discharged April 2. In hospital 36 dry. Pulse 120; respiration 40. Expectoration more or days. Recovery. Previously ill 14 days. Pain in right less rusty till 37th day after admission; deeply tinged side; paroxysms of dyspnoea; occasional vomiting; ex- with blood on 17th day after admission. Dulness; fine pectoration sometimes streaked with blood. On admission crepitation, and increased vocal resonance over right base; pallid; frequent cough; greenish expectoration. Pulse 10 days later bronchial breathing and crepitation below sca108, respiration 36. Dulness, feeble bruit, and faint cre- pula; 19 days later lower two-thirds of right lung dull; bronpitation below angle of right scapula; 3 days later no chial breathing and fine crepitation at scapula angle; dulvesicular bruit below right scapula; pleuritic rub at rightness and harsh breathing at left base; 17 days later breathanterior base; 10 days later no crepitation or rub. ing everywhere vesicular.

Liq. ammon. acetatis and chloric ether. Afterwards quinine and iron. Cod-liver oil.

PLEURISY. Benjamin B., beggar. Admitted June 27; discharged July 20; In hospital 23 days. Recovery. Four attacks of pleurisy (right side) in last five years, the last 18 months ago. Previously ill 6 weeks; shivering; pain in right hypochondrium; dyspepsia; thirst; loss of appetite; dry cough. On admission weak and drowsy ; sordes on lips and teeth; tongue dry and brown. Pulse 108; respiration 36; dim-expansion of right side; dulness and absent vocal vibration over lower part of right lung; breathing absent at base; distant above; crepitation over upper part of posterior lobe; line of dulness extending to 1 inch above angle of scapula, and 1 inch below nipple; chest free from abnormal sounds on July 16th. Carbonate of ammonia and chloric ether (8 days). Then quinine and dilute hydrochloric acid.

PLEURISY.-A. A. T., æt. 21, porter. Admitted February 13; discharged March 19. In hospital 35 days. Recovery. Previously ill 3 weeks; shivering; headache; vomiting; dyspnoea; pain in right side. On 3rd day after admission slight dry cough; pulse 92; respiration 32; dulness and absence of breathing and vocal vibration below 3rd rib in front, and 1 inch above scapular angle behind; tongue dry and red; appetite bad; bowels confined; urine one-half albumen (free from albumen 3 days later). 23 days later, dulness over whole of right lung; friction sound below right nipple.

Liquor ammon. acetatis, arom. spts. of ammonia and squills; afterwards dilute muriatic acid, squills, chloric ether, and liq. cinchona; cod-liver oil. Aperients. Brandy 12 oz.

Literature.

THE RECONSTRUCTION OF THE ARMY.

THAT the entire system under which our army is at present recruited, officered, and administered will at an early date be subjected to a more severe criticism than it has yet undergone, House of Commons for what promises to be a successful_onis now evident. Mr. Trevelyan has already prepared the Treasury and a large portion of the press have condemned the slaught against the disposal of commissions by purchase. The double government under which this branch of the public service is administered; and now Sir Charles Trevelyan' has published an excellent treatise, in which he clearly points out the existing defects and their remedies, having in view nothing short of the reconstruction of the entire military machine.

the army

In no other state of society than the army of this country do the old usages of feudalism still remain in force. Between the officer and the private a great gulf exists. The distinction is essentially one of caste; but like many other usages of mediæval times, it must give way with the advance of opinion. That nation; that it should be either more aristocratic or more should be anything else than a representation of the democratic than the rest of English society, seems monLiquor ammon. acetatis, sp. ammon. arom., and tinct. strous; and that perseverance and proved worth should camph. co. (12 days). Then dilute muriatic acid, quinine not obtain the same position of fortune and distinction in the and chloric ether. ol. morrhuæ. E. L. to right side. military service that they command in other positions in life, PNEUMONIA. E. N., æt. 62, carpenter. Admitted is a principle far behind the spirit of the present time. The January 29; discharged February 20. In hospital 22 question comes to be, how are these conditions to be improved? days. Recovery. Three weeks ago, after rigors, was laid The answer immediately follows, abolish purchase, and inup for a few days. Four days ago, vertigo, nausea, dysp- crease the pay of all ranks sufficiently to enable them to live nea, cough, and rusty sputa. On admission, cheeks upon it in a suitable manner; or, in other words, make the flushed; skin hot and dry; headache; shortness of breath; infantry and cavalry branches of the service what the artillery, pain in upper part of abdomen. Pulse 104; respiration Royal engineers, and several departmental corps are, a life 32. Dulness and medium crepitation over right lung, be-long profession for the officers who join them. Another innovation, in regard to present usages, would be the promotion low 4th rib in front, and scapular angle behind; bronchial of an increased proportion of non-commissioned officers to combreathing and bronchophony behind, pleuritic rub in front; 3 missions, a measure which, probably more than anything else, days later crepitation up to scapular spine behind, and would serve to induce the yeomen class of our countrymen to 2nd rib in front; 9 days later crepitation to 1 inch below enter the army, and thus indirectly undermine much of that spirit scapular angle; 7 days later breathing clear; appetite of restlessness, to call it by no harsher name, which, it is to be good. feared, is sown somewhat freely among the partially educated of our population.

Liquor ammon. acetatis, chloric ether, sp. ammon. arom. and tinct. scillæ. Afterwards quinine and dilute muriatic acid. Brandy 12 oz. Turpentine stupes.

PNEUMONIA.-H. H., æt. 17, groom. Admitted December 1; discharged December 31. In hospital 30 days. Recovery. Subject to cough. Previously ill 3 days. Pain in limbs and left side of chest ; cough; expectoration; loss of appetite, and feverishness. On admission, skin hot; headache; tongue coated. Pulse 116. Dulness; diminished vocal resonance, and thrill; fine crepitation, and some bronchial breathing below left scapular; blood streaks in expectoration. Much epistasis after admission. Lung normal on 15th day.

Liq. ammon. acetatis (7 days); aromatic spts. of ammonia, chloric ether, and liq. cinchone (9 days); then

As to the question of retirement, there need be no greater difficulty than now exists in regard to the corps and departments in which promotion by purchase is not now observed; and it may be assumed that as with them the applications are few to retire, or for leave of absence, in times of active service, the country would considerably gain by the substitution of such a state for that which was attributed to purchase officers during the Crimean war and the Indian mutiny.

That the volunteers and militia are, in their present condi tion, utterly useless as a means of defence seems to be all but universally acknowledged, and that our regular army is hampered and burthened instead of strengthened, by the numbers of old soldiers in its ranks, is a fact which has, perhaps, become more apparent than it was before, since General Trochix called 1 "The British Army in 1868." London: Longmans, Green, and Co.