Mr. Partridge declined to do so, and told Dr. Roberts that if he thought proper he might apply to the Court of Queen's Bench himself. Over-Laying and Death Certificates. AN inquest held last week on the bodies of two infants, gives us a double text-public and professional-for the discussion of the matter. The mothers of the two little victims excused themselves for the deaths of their children on the ground that they were accidentally suffocated by lying on them, and in the same breath they confessed that they had insured the lives, or rather the deaths, of the infants a short time before. The only evidence besides the statement of the mothers themselves, was the certificate of a surgeon who had never seen either body after death, and yet legally declared that they died of suffocation. The mothers were dismissed to the enjoyment of their gains by the death of the babies, and the surgeon was severely taken to task by the Coroner for certifying that of which he knew nothing. Medical Capacity for Coronerships. DR. LANKESTER, the coroner for Central Middlesex, has, in the discussion of Dr. Tindal Robertson's late paper at the meeting of the Association, debated the special qualifications of the doctor for the office of coroner in a tone which, though by no means enthusiastic as regards the claims of the profession, is impartial and argumentative. He considers that a medical practitioner is, by his habit of deduction from theory as much as from fact, rather the worse than the better as an investigator of simple occurrences, and he declares that the medical man owes his superiority to his study of the natural sciences. This we believe to be an accurate enunciation of the doctors special qualification, and one which ought not to be overlooked by the public. A medical coroner is an embodiement, in cases in which it is considered unnecessary to hold post-mortem investigations, of the judge and the expert. He is in the position which no lawyer can enjoy, of checking each enquiry by his medico-legal knowledge, and under his supervision it becomes improbable that in any case whatever, suspicious circumstances and pathological appearances could be overlooked. Thus, the public has an extra guarantee for the reliability of a medical coroner's enquiry, which they cannot have at the hands of any other functionary, however astute he may be. The Medical Act against Quacks. Ar last it would appear that the powers of the Medical Act against quacks are discovered to be sufficient for their object, and the action of the profession which was discouraged in the first instance by some very paradoxical legal judgments, is being revived against illegal practitioners. A druggist in Wales has been successfully prosecuted by the North Wales Registration Society, for using the title of Surgeon in a death certificate. The culprit endeavoured to save himself by attaching the letters n. r. to his falsely claimed qualification, which he explained to mean not registered." The fraud was too manifest for such a ridiculous defence, and the practising druggist has had the option of paying £10 or going to prison for a fortnight. The judgment of a member of the English Bench to the effect that the use of any title was not illegal so long as the culprit did not represent himself to be registered-a decision which has mainly deterred the profession from availing themselves of the provisions of the Act-would thus appear to be incorrect, as it is manifestly at variance with the spirit of the law. It is justly held that a person who uses the title of a medical qualification, thereby implies that he is or might be registered for it, and he should be punished accordingly. It is satisfactory to find that justice seems likely to overcome the ridiculous legal quiddits which have hitherto rendered the Medical Act nugatory. Qualification of Medical Assistants. THE Privy Council has had before it a series of new regulations for the examination of assistants, framed in accordance with the recent Pharmacy Act. We understand that the proposed examination combines Materia Medica, Pharmacy, Translation of Prescriptions, and the details of ordinary Dispensing Manipulation. The Materia Medica test will be principally on the identification of chemicals and pharmaceutical agents, both in the officinal condition and in the plant itself, and to pronounce on the quality and adulteration of each article, the candidates will be required to recognise the manufactured preparations, such as tinctures, infusions, and extracts, and to know the relative proportions of the various ingredients. Their capacity for the manipulation part of their duty will be tested by requiring them to translate prescriptions, to point out excessive or insufficient doses in faulty trial prescriptions, and to weigh, make up, and turn out neatly given prescriptions. Scottish Longevity. WHETHER from their occupations, the strength of their constitution, their climate, their diet; whether from all these combined, or from some other hidden and mysterious agency, the Scotch can boast of far more instances of longevity than occur in any other equal portion of the population in the United Kingdom, the returns recently issued by the Registrar-General for Scotland for the ten years 1855-64 show that in that country as many as 6910 of the 651,295 deaths in those ten years were of persons above 90 years of age. The mean population of the period is estimated at not quite 3,050,000. The following notes from Scottish local registrars' returns for the second or spring quarter of 1868, just published, are remarkable :— Stromness, Orkney.-Of the nine deaths registered in the quarter, two were of persons aged 94. Watten, Caithness.- -Of the nine deaths, six were of persons above 70; the average age of the six was 80 years. Gairloch, Ross.-Of the 15 deaths in the southern district, eight were of persons above 70, their ages averaging 81. Stornoway.-Of the 37 deaths, 13 were of persons above 70; one was 100. Rafford, Elgin.-Of the three deaths, two were of persons aged 84 and 86. Huntly, Aberdeen. Of the deaths, eight were of persons above 70, their average being 77. Blanchory-Devenick, Kincardine. Of the eight deaths, four were of old persons whose ages averaged 78 years. Largo, Fife. Of the eight deaths, five were of persons aged 78, 82, 83, 84, 85. Kilmore and Kilbride, Argyll.—Of the 19 deaths, nine were of persons above 70. Portobello.—Of the 30 deaths, seven were of persons above 70. MidCalder, Edinburgh, population about 1400.-Only two deaths, one of a person of 85 and one of 89. Dunscore, Dumfries.--Of the nine deaths, five were of old people whose united ages amounted to 387 years. Kirkcowan, Wigtown.-Of the eight deaths recorded, six were of per sons who had reached the respective ages of 68, 75, 79, 82, 84, 86 years. At Girvan, Ayrshire, a death at 101 was registered in the quarter; at Inverallan, Inverness, the death of a woman of 103; at Abbey, Renfrew, the death of a very old Highland woman, said to be 109. Professional Appeal. WE deeply regret that adverse circumstances, arising out of illness, make it necessary to appeal in our advertising columns to our brethren on behalf of a well-known and highly esteemed member of the profession in Dublin. We beg to refer our readers to that appeal, which we are confident will not be made in vain. The res angusta domi is a possibility in every case, and a fact in many; but we can say of our brother in this instance-" In prosperis magnus, in adversis major.” ANTOINE CLOT-BEY, an eminent physician, died lately at Marseilles, aged 73. He was induced to visit Egypt many years ago by an agent of Mehemet-Ali, for the purpose of organizing some medical establishments there. He also founded a medical school at Alexandria, and was chief agent in the erection of Abou-Zabel's Hospital, twelve miles from Cairo. He received the title of Bey from the Egyptian Government, and by that of France he was made a Commander of the Legion of Honour. DR. SAMUEL FENWICK and Mr. J. E. Adams have been appointed Assistant-Physician and Assistant-Surgeon to the London Hospital. Lecture. regards measures of simple hygiene, and next as regards that method which is generally spoken of as specific treat ment. before you some of the conclusions lately arrived at on the Let me, however, before entering on these topics, lay subject of syphilisation. In the last volume of the "Transactions of the MedicoChirurgical Society of London" you will find a very valuable contribution to our knowledge on this subject by Messrs. Lane and Gascoyen, surgeons to the London Lock Hospital. These gentlemen give a report of cases treated by syphilisation, or the repeated inoculation of syphilitic matter in persons already the subject of constitutional disease. It is true their own opinions do not agree as to the curative influence of syphilisation; the facts, however, which they record are not the less interesting and instructing. Pro Syphilisation. This peculiar method of treatment originated with M. Auzias-Turenne about 1845; owing to the opposition of the French Academy of Medicine, it can scarcely be said to have been tested in France, except by the late M. Melchior Robert of Marseilles. M. Sperino, fessor Boeck, of Christiania, however, is at this moment the of Turin, tried it in a considerable number of cases. champion of syphilisation; he has developed the system on a large scale, and the publications of himself and his pupil, Dr. Bidenkap, have revived the interest in this subject. The strange idea of curing syphilis by repeated syphilitic inoculations had its birth in France. It took its origin in this way-M. Auzias-Turenne, when studying the effects of syphilitic virus upon animals, perceived that after a certain number of inoculations, the inoculated animal gained a power of resisting the chancrous virus. To their immunity from the disease thus established, or rather to the peculiar modification of the organism thus induced, Auzias-Turenne gave the name of syphilisation. In November, 1850, he announced the result to the Academie des Sciences. He naturally conceived that it would not be impossible to reproduce in man the effects which he had observed on the lower animals; some patients voluntarily LECTURES ON VENEREAL DISEASES submitted themselves to his inoculations; in these cases a DELIVERED IN DR. STEEVENS' HOSPITAL. LECTURE IV. BY ROBERT MCDONNELL, M.D., F.R.S., ONE OF THE SURGEONS TO STEEVENS' HOSPITAL. GENTLEMEN, I do not mean to trouble you with any very lengthened observations on the treatment of syphilis. I have already said that the details of treatment must be pointed out at the bed-side, yet I feel that my lectures would very incompletely answer the purpose for which they were intended if I did not briefly touch on some points connected with the therapeutics of syphilis. As students of the Irish School of Medicine you may look, gentlemen, with very just pride to what has been done in this department by practitioners of Dublin. To Wallace we owe the introduction of iodide of potassium as an anti-syphilitic agent-an agent now universally admitted to be one of the most potent weapons which human skill can wield against this disease in many of its forms; to Carmichael we are indebted for having led the van in opposition to that free and reckless use of mercurials, which has done, and indeed still does so much mischief. He may almost be said to have inaugurated the all-important scientific study of the natural history of syphilis ; while Colles, Abraham Colles (whose memory is so highly revered within the walls of this great hospital), has, in his work on "Venereal Diseases and the Use of Mercury," given the most masterly sketch with which I am acquainted as to how we should handle the claymore against syphilis, should it become necessary to draw it from its scabbard. I shall speak now of the treatment of syphilis, first, as complete immunity was obtained; and so the ideas of Auzias-Turenne became admitted within the domain of therapeutics. The practice of syphilisation evoked extreme hostility in England, in fact it was never fairly tried until undertaken by Messrs Lane and Gascoyen, who commenced their series of observations under the direction of Dr. Böeck himself. These gentlemen pursued the method recommended by Dr. Boeck, which is as follows:-At the commencement three punctures are made on each side of the chest, and matter is inserted derived either from a person who has a primary syphilitic ulcer or from the artificial sores of a patient who is undergoing syphilisation. After an interval of three days, if the punctures have developed pustules, three other inoculations are made from them in the same region of the body, and this process is repeated so long as pustules are produced; the inoculations being made at intervals of three days, and the matter being always taken from the last-formed pustules. When at length these are not inoculable, fresh matter is employed, and the above process is repeated until a positive result can no longer be obtained on the trunk. The same practice is then commenced on the arms and continued there until the punctures fail, when a similar process is pursued on the thighs until no more pustules result, and a condition of immunity, more or less perfect, is arrived at. In the ordinary run of cases this occurs in from three to four months. The average period during which Messrs. Lane and Gascoyen's cases were under treatment in hospital, was five months and sixteen days. The average number of inoculations practised in each case was 259, of which 145 produced chancres, and 114 were sterile. A method of treatment which entails the production of some 150 chancres over the body can never, I think, be a R Ferri perchloridi liquoris fortioris. M. Fiat lotio. How long after contamination the use of such appliances may serve to neutralize a poison remains doubtful. All we can say for certain is that the sooner any poison is washed away or destroyed the better. popular mode of treating syphilis. From a very careful perusal of the valuable memoir of Messrs. Lane and Gascoyen, I most fully concur in the justice of the conclusion at which they arrive as to the therapeutic value of syphilisation. Differing," they say, "as we do on the scientific aspect of the question, we are entirely in accord as to its practical bearings, and we are decidedly of opinion that syphilisation is not a treatment which can be recommended for adoption. We consider that even if it could be admitted to possess all the advantages claimed for it by its When it is once admitted that syphilis is a true toxæadvocates over other modes of treatment, or in many in- mic disease, that it is a malady in fact depending upon the stances over no treatment at all, it would not sufficiently admission into the system of a poison, which, under favourcompensate for its tediousness, its painfulness, and the life-able circumstances, is capable of spontaneous elimination, long marking which it entails upon the patient." then it follows that hygienic measures must play a capital part in its treatment. If, as I have said in a former lecture, a struggle is going on between the constitution of the patient and a disease which has made an inroad into his system, it is of course of prime consequence that the constitution should be well backed up in the conflict. To maintain the general health, to uphold the natural vigour of the constitution, to keep the powers of the organism up to that level which is best adapted to accomplish the elimination of the virus-this is the object of the hygienic treatment. When to this we add the use of those simple medicaments which, acting on the skin, bowels, and kidneys, tend to keep their functions in healthy play, yet are not supposed to exercise any specific action, we then have that plan of treatment which has been called the rational or methodic treatment of syphilis. Has syphilisation any curative effect whatever? It seems strange, indeed, that at this period of the world's history we should not be able at once, and with certainty, to answer this question. Yet, to our shame be it confessed, we cannot. We do not as yet know enough about the simple and undisturbed progress of syphilis to say whether fifty cases of the complaint, with no other treatment than the dietary, rest, regular hours, &c., of an hospital, would take longer to get well than fifty similar cases submitted to syphilisation. Mr. Lane believes that it does exercise some beneficial and specific influence over the progress of the disease. Mr. Gascoyen, on the other hand, thinks that the natural tendency to recovery, which an early and uncomplicated constitutional syphilis exhibits with the lapse of time, and under circumstances favourable to the general habit, is sufficient to account for the subsidence of the secondary symptoms during syphilisation. It is gratifying to find so competent an authority as Mr. Gascoyen so deeply imbued with the belief that "an early and uncomplicated syphilis" has so great a natural tendency to recovery. For my part I should certainly agree with him. If the possibility of the spontaneous cure of syphilis be no longer contested, from that moment it becomes difficult, if not impossible, to assign its true therapeutic value to any mode of treatment-syphilisation among the rest. In order to determine whether the cases of cure attributed to syphilisation are not in reality due to the natural progress of the malady, there must be some definite standard of comparison. Hence, the extreme value of cases carefully noted and accurately observed for years, and which have undergone no other than treatment by hygienic measures. Prophylaxis and Hygiene of Syphilis.-The prevention of syphilis, or at least the attempt to check its ravages, is one of the greatest objects connected with State medicine. The rude machinery for this purpose adopted in Great Britain has until quite recently contrasted most unfavourably with the schemes of our continental neighbours. The Englishman's respect for personal liberty, as well as a sort of moral instinct which made him unwilling to handle an unclean thing, caused us as a nation to shrink from legislation on such a subject as the control of prostitution. Our soldiers, our naval and mercantile marine, and of course the public, have in consequence suffered to an extent quite incredible. We are, however, commencing a better system. Of this aspect of the prophylaxis of syphilis I do not speak at present. Various plans have been devised in order to prevent the occurrence of venereal disease in an individual after a suspicious connection. These may almost all be summed up in a few words:-strict attention to cleanliness, thorough washing. There can be little doubt that proper attention to this simple preventive measure would greatly lessen the evils arising from venereal disease of different kinds. A number of practitioners have recommended various lotions with the design of adding to the wash such ingredients as may destroy any venereal virus lurking in the folds, or coming in contact with slight fissures or excoriations around the corona or about the frenum. Lotions containing acids, alkalies, alcohol, wine, sulphate of zinc, lead, &c., have been thus ordered. Langlebert recommends a mixture of soft soap, potass, and alcohol. Rodet of Lyons, a lotion somewhat more caustic, viz.:— As regards diet the syphilitic patient should, as a rule, live generously. He should live on simple and nutritious food, taking as much as his appetite indicates to be sufficient-neither weakening his frame by taking less, nor striving to take more than his stomach can readily deal with. In prescribing a dietary attention should always be paid to the patient's usual mode of living; yet, believe me, you will generally find it necessary to insist on your syphilitic patients living tolerably well, many of them are so imbued with the idea that abstinence is necessary for their cure. Next, probably, in importance to diet is good air, a wellventilated sleeping apartment free from damp. The damp and crowded dwellings of the poor exercise a most baneful influence over the complaint. Let your patient have seven or eight hours sleep of a night; let him give up theatres, balls, card and supper parties; let him have such moderate exercise every day that, without being exhausted or absolutely fatigued, he may be well satisfied to go to bed each night at ten o'clock. If you have influence enough over your patient to induce him to adhere to such directions; to shun those selfish indulgences which tend to debilitate the frame; and if he has youth and a tolerably good constitution on his side, you may look forward to his case running its course favourably as one of "vérole faible." If he is one of a delicate family, of a scrofulous or gouty diathesis-then it is all the more necessary for him to leave nothing undone to keep up his general health. But if, on the other hand, you have a patient to deal with who will not forego his selfish pleasures; who haunts the tavern and the billiard-room, smoking and drinking, breathing foul air vitiated by gas and reeking with tobaccosmoke, during the hours which he should give to repose, let him expect that to him syphilis will come in "all her Gorgon-terrors clad." As adjuncts to hygiene, such simple medications as cod liver oil, chalybeate tonics, and warm baths play an important part. The first is specially indicated when any strumous tendency exists; the second class of remedies, useful through the whole course of the disease, is particularly called for during those periods of syphilitic chlorosis (chloro-anæmia), so usually the forerunner of an outburst of eruption. Warm baths or vapour baths are the most effective means of keeping the skin in action. Medicated baths of various kinds are eminently useful; baths corresponding with those of the bromated and iodated waters of Kreuznach, the waters of Schlangenbad, Harrogate, Baréges, can be readily obtained in all our cities. Tonic and exciting medicated baths are of great service in syphilitic as well as other affections of the skin; baths containing iodide or sulphuret of potassium, or arseniate of soda are eminently useful in the anæmia, chlorosis, or rheumatism connected with syphilis. Dr. Noël Guéneau de Mussy recommends three and ahalf ounces of subcarbonate of soda, with twenty grains of the arseniate, in a bath. No unprejudiced practitioner will deny the benefit of the Turkish and Russian baths. We have no means of inducing diaphoresis comparable to these. Such a bath as the following: M. B Ferri sulphatis, 3ij. Soda sulphatis, 3vi. Dissolve in thirty gallons of soft water at 98° Fahrenheit for a bath-can be readily obtained even at the patient's home; and thus the advantage of the chalybeate and the bath combined. The bowels should be kept in action once or twice every day for this purpose, nothing answers better than some of the sulphurous mineral waters made artificially; those of Bagnères-du-Luchon, of Baréges, of Aix les Bains, in Savoy, of Aix-la-Chapelle, have gained a well-deserved reputation. The waters of Kreuznach are greatly praised against the intractable combination of syphilis and scrofula. I very commonly order the following imitation of the Harrogate sulphur water— R Sulphatis potassæ, cum. sulphure, Ziv. Sulphatis magnesiæ, Ziij. M. Fiat pulvis. one teaspoonful of this powder to be taken in a tumbler of water every morning, or every second morning upon first getting up. The dose should be increased or diminished according to its effects. The patient should take a short walk before breakfast, and by increasing the quantity of fluid which he consumes daily, he should keep the kidneys in good action. Syphilitic patients are themselves sometimes aware of a peculiar, faint, yet disagreeable, odour emitted from the urine; this is observed at intervals, and after each has passed away the patient finds himself better. It seems to resemble the odour which patients labouring under ague know as indicating the approach of an attack of fever; and certainly points to the necessity of keeping these organs in good working order. Some patients object to the large quantity of liquid necessarily taken in consuming mineral waters, and although this is one of the great advantages attending their use, you may have to direct something else; equal parts of syrup of senna and fluid extract of sarsaparilla: a teaspoonful once or twice a-day in half a cup of hot water, acts well as an aperient, and suits those persons, not a few, who still retain an unbounded faith in sarsaparilla. Chlorate of potash used internally, as well as a gargle and mouth wash, is a great favourite with some. For the slighter forms of sore throat, I often order the following: R Potassæ chloratis, Zii. M. days with creasote ointment, healed rapidly, far outstripping those less energetically treated. You have often seen the almost magical effect of a large blister upon the hideous lupoid ulcerations of tertiary syphilis. I have seen some cases in which the local action of an accidental attack of erysipelas has entirely altered the appearance of the ulcer and brought about rapid cicatrization. In short, whether in the genitals, the mouth and fauces, or the skin, the local applications to venereal affections, forms a chief part of the therapeutics of syphilis. Prohibit tobacco-smoking, and the source of irritation once removed, "mucous patches" and ulcerations on the tongue, &c., for a long time recurring, will get well. Wash the surface, attend to cleanliness, and simply dust the part over with finely powdered starch, and you will quickly get rid of troublesome condylomata. Learn to overcome the more frequent and troublesome symptoms of syphilis, let your patient know that in the natural course of things he must expect recurrences; do not make promises that relapses are at an end: by so doing you are pretty certain to get a disappointment, and to lose the confidence of your patient, and that equally whether you adopt a specific treatment or not. The beneficial action of iodine in the treatment of syphilis is beyond doubt; in some eruptions, in severe syphilitic rheumatism and most forms of tertiary syphilis, its efficacy is unquestioned. In 1831, Lugol published his observations on tertiary symptoms cured by iodides without the combined use of mercurials. This led the way to what must be considered the greatest discovery in syphilitic therapeutics of modern times-namely, the introduction of iodide of potassium as a remedy against syphilis. I have already said that it is to Wallace of this city that mankind is indebted for this boon. I am glad to find that Lancereaux, one of the most learned and accomplished writers who has treated of the subject of syphilis, gives, in his exhaustive work, full credit to Wallace for being the first to introduce in practice this agent. Lancereaux says:- "Wallace, of Dublin, has the merit of having first employed iodide of potassium, of having fixed the doses of it, specified the indications for its use, and thereby of having definitely introduced the iodide into the therapeutics of syphilis, placing this medicament almost upon the same level with mercury. He commenced his experiments in 1832, and gave the results four years later in the form of four lectures.1 "One hundred and thirty-nine patients were observed, of whom six were affected with iritis, six with affections of the testicle, ten with divers diseases of the bones and articulations, ninety-seven with syphilitic skin affections, twenty with lesions of the mucous membrane of the mouth, nose, and throat; finally, three pregnant women were also submitted to the same treatment with the object of preserving the foetus from syphilitic infection. The preparation employed mistura hydriodatis potassa (as it was then called), contained 3ij. of iodide of potassium in 3viii. of distilled water. Adults took half an ounce of this mixture four times a-day-that is to say, thirty grains of the iodide per diem." Lancereaux adds, "The happy effects of this remedy are so generally recognised, that we cannot refuse to it, in the present day, a place alongside of mercury itself." to be used as a gargle several times a day, and one ounce to be swallowed three times a day. The doses ordered to be taken internally should be swal-physicians. lowed slowly, in fact, taken in sips, so as to be brought well in contact, in the act of swallowing, with those parts of throat and fauces not reached in gargling. The importance of the local treatment of all kinds of venereal sores, whether primary, secondary, or tertiary, cannot be over-rated. You have seen abundant proof of this in the terrible case of rupia, lately in No. 9 ward. The ulcers were so extensive that it was impossible to deal with all at the same time. You saw those which were touched with nitric acid, and afterwards dressed for some Wallace's success soon attracted the attention of other In England, Judd, Savile, Winslow, Williams; in France, Trousseau, Ricord, Gauthier; in Italy, Brera, Sperino, Pellizzari; in Germany, Guzman made trial of it and proved its good effects. The acute observation of the illustrious Ricord soon detected that it is an agent which exercises more influence over tertiary than secondary symptoms. The deeper affections of the skin and mucous membranes, the gummy tumours of the cellular tissue, the lesions of the bonessuch are the conditions which yield most readily to the use 1 See Lancet, March, 1836. of iodide of potassium. It has been likewise recognised that it may advantageously be employed even in larger doses than those at first recommended by Wallace; by degrees it may be increased from 15 grains to one drachm or even more daily. You have lately seen in No. 8 Ward a remarkable instance of the efficiency of this medicine in the case of a woman named Looney suffering from nodes and very distracting osteocopic pains. She was ordered 10 grains three times a-day, but by mistake took double that dose, taking 60 grains in the day; she was relieved almost as by magic. Although less prompt in its action, you saw the large nodes on the forehead of Williams in No. 2 Ward gradually vanish under its use. Wallace made some amends for the grievous offence he was guilty of in inoculating healthy subjects with the poison of syphilis. (To be continued.) Emotional language is conserved throughout, not only in its most striking manifestation, by (a) variations of voice, but in (b) smiles, &c.; and in its most simple manifestation by (c) gesticulation. Although thus circumscribed by the term defects of intellectual language, there are within this limit many varieties of defects met with in actual experience. It is easiest to say what they are not. 1. They are not defects of voice.-The patient who cannot say anything will vary the tone of his stock phrase or jargon and may be able to sing. 2. They are not defects due to mere paralysis of the tongue and other articulatory muscles.-Nevertheless the defect may be when most rudimentary a disorder of articulation (Ataxy); but this differs very widely from paralytic articulation. The tongue is not paralysed even when the patient may not be able to put it out voluntarily. 3. They are not owing to any fault in the outward organs of reception.-The patients are not deaf mutes. [Abstract of a Paper read before the British Association for the Speech has been lost suddenly after being fully acquired. Advancement of Science, at the meeting at Norwich, August, 1868.] THE PHYSIOLOGY OF LANGUAGE. BY J. HUGHLINGS JACKSON, M.D., F.R.C.P. DEFECTS of language nearly always occur with a certain form of paralysis on one side, called hemiplegia, and the right is usually the side paralysed. Hemiplegia is paralysis of those muscles which can move independently of those of the other side-i.e., of certain muscles of the face, tongue, arm, and leg; not of the muscles which act bilaterally. Or, in technical terms It is a paralysis of the muscles engaged in chief voluntary operations. The bilateral muscles used in all (physically) involuntary, semi-involuntary, reflex, automatic, &c., processes escape." This kind of paralysis depends on damage to the very highest parts of the motor tract-viz., the corpus striatum, or thalamus opticus (in cases complicated with defects of language usually, probably always, the corpus striatum). In other words it shows loss of function of a motor centre, which is embedded in the cerebral hemisphere; or, to speak metaphorically, which lies close upon mind. In loose language, the corpus striatum is the way out" from the chief organ of mind-through series of centres-to muscles which serve in intellectual and voluntary actions. Damage to the hemisphere near the corpus striatum produces those defects which have been called aphasia, alalia, aphemia, aphrasia, asphrasia, aphthenxis, defects of intellectual language, cerebral loss of speech, &c. TWO KINDS OF LANGUAGE. Healthy language is of two inseparable yet distinct forms: I. Intellectual-i.e., the power to convey propositions. II. Emotional-i.e., the ability to exhibit states of feeling. THE SPECIAL NATURE OF THE DEFECTS OF INTEL LECTUAL LANGUAGE. The author arranges the cases he has to mention for convenience of exposition in two classes. In the first class the author supposes that the sensori-motor processes for speech are more or less destroyed; in the second that they are unstable. Class I.-Severe cases in which the patient is speechless or nearly so, or in which speech is very much damaged. In the worst of these eases the patient can only utter some one unvarying word or two words, or some jargon. He relates several cases varying in severity. In these cases power to read write and make simple signs is impaired, but the facts bearing on reading, writing, and sign-making in the cases related will be more conveniently considered after Class II. Class II.-Cases in which there are plentiful movements but wrong movements, or plenty of words but mistakes in words. Under Class II. he points out that taking the phenomena of many cases, we find evidences of damage to sensorimotor processes, higher or lower in evolution according to (a) Complexity of movements. (b) Width of interrelation. (c) Number of associations from ataxy of the grosser movements of articulation to an "ataxy" of movements embodying ideas. He is obliged, however, to speak of sounds, taking it for granted that in the following phenomena (1), (2), (3), &c., the disorder is of evolutions of movement and sensation in the triply-compound ascent just mentioned. 1. Ataxy of articulation-often an unintelligible gabble. 2. Alterations of words, as "sift for "stiff." 3. Alterations of syllables, as "gippin" for "pigeon." 4. Mistakes in words-recognisable symbols-(a) Related more or less in general idea, as "dinner" for "breakfast," "smell" for taste." (b) Related in sound, as "Dustman" for "Busman." (c) No traceable relation, as "Where is the wind?" for "Where is the ink?" The two are separated by disease. It is intellectual language alone which suffers in most of the cases to be 5. Mistakes in compound symbols. (a) Related clearly described. Emotional language usually escapes altogether. in idea-"What am I to say it is o'clock?" for "What Intellectual language suffers throughout-not only in its day of the month am I to put down?" or (b) obscurely most striking manifestation in (a) words, but in (b) writ-related, as "When the warm water comes all the weather ing, and (e) sign-making. will go away!" for "When the sun comes out all the fog will go away." It is the power of intellectual expression by " movements" of any kind which is impaired-those most special, as of speech, suffering most; those of simple sign-making least, or not at all. 1 It is pointed out later in the paper that the fact that the unilateral muscles of one side only suffer when part of one of the corpora striata is destroyed, does not imply that the bilateral muscles (or the centre or centres for rudimentary bilateral) movements are not represented in the corpora striata. This is an exposition of Broadbent's hypothesis. "An Attempt to remove the Difficulties attending the Application of Dr. Carpenter's Theory of the Function of the Sensori-motor Ganglia to the common form of Hemiplegia." By W. H. Broadbent, M.D. Med. Chir. Review, April, 1866. When the defect is of processes so high in complexity, (interrelation and association) there is usually a traceable similarity, although it may be vague and deformed, betwixt the phrase used and the one intended. 6. Probably such defects as the following are of processes higher still, "Light the fire up there" for "Light the gas." He then considers very generally, and with regard to all varieties of cases, the defects in complimentary modes of intercommunication which accompany defects of speech, and |