before, could be distinctly enunciated, and with a daily decreasing amount of hesitation. For the second case, Mr. Bates has contrived, as you here see, a small plate, fitting closely to the palate, and affording attachment to a light narrow tube, the posterior end of which opens into the mouth, looking towards the fauces, whilst the anterior projects between the lips. By this contrivance the current of air is made to be in part continuous, and the patient finds, to his surprise and delight, that he can produce the sound without any limitation other than his will. The subject of the third case has been materially benefited, and is, indeed, in a fair way to be entirely cured of his unfortunate habit, by means of a neckerchief or cravat, in which is a little spring, pressingas you observe directly upon the projection of the thyroid cartilage, in such a manner as to relax the rima glottidis, by approximating the thyroid to the arytenoid cartilages; thus permitting the exit of air and preventing the spasmodic action of the muscles that close the glottis. The spring is so regulated, that the amount of pressure upon the thyroid cartilage can be increased or diminished, as occasion may require. [The effects of these different forms of apparatus were exhibited on the stammerers before the glass; and the action of each was clearly manifested.] By such contrivances, which are simple, and adapted to the accomplishment of the object in view, Mr. Bates succeeds in effecting a great desideratum,the restoration of self-confidence,—the want of which is a main obstacle to improvement in all such cases; for as soon as the patient becomes thoroughly and practically convinced that there is no difference between his vocal organs and those of his friends, whom he hears speak without difficulty or hesitation, he becomes inspired with confidence in himself, and his exertions are thenceforth the commencement of his restoration, Let it be, however, distinctly understoodand no one is more convinced of this truth than Mr. Bates himselfthat no apparatus of this, or any kind, can, of itself, accomplish a cure. Nothing but a thorough system of practice and discipline, persevered in for a considerable period, can effect the work of restoration. The instrument merely infuses confidence. Withdraw it, and the case is left in the same condition as before. I can have no doubt, however, that with such a system, the stammerer may be amazingly benefited by the course pursued by Mr. Bates; but he must be thoroughly impressed with the fact, that time is one of the elements that must enter into his calculations, and that no plan can succeed without it.-Philadelphia Medical Examiner, July, 1852, p. 430. 15.-ON THE RELATION OF LARYNGISMUS TO EPILEPSY. By DR. E. WATSON, A.M., Glasgow. [After commenting on Dr. Marshall Hall's treatment of epilepsy by tracheotomy, Dr. Watson proposes, instead, the application of a solution of nitrate of silver (varying in strength with the requirements of the case) to the glottis of the epileptic patient, for the same reason as he would apply it in a severe attack of spasmodic croup,-viz., to allay the nervous excitability of the part in question. Dr. Watson proceeds to relate the following case.] Early in January of this year (1852), I was called to a young lady, who had for several years suffered very frequent attacks of epilepsy, and when I first saw her, she had but very short and uncertain intervals between the fits. These were very severe, and presented the usual characters of the disease in its most marked form. Her bowels were thoroughly cleared out with croton-oil, and the cold bath was used with good effect. The fits became less frequent, though almost equally severe when they did occur. The valerianate of zinc and galvanism were then added to the cold bath, and due regulation of the bowels. I now, moreover, began to touch the glottis with a solution of one scruple of nitrate of silver in an ounce of water. This was continued regularly every day for a fortnight, and afterwards for some weeks with longer intervals between the applications. By the middle of February, the fits had quite changed their character, being more like short faints than the regular convulsive paroxysms; and they have since then occurred very much less frequently. The patient has greatly improved in general health, and in activity of mind; and she has lost much of that dread of the disease which formerly rendered her existence miserable. It is true that this is but a single instance, and that the present favourable state of the patient may not be permanent. Yet seeing that the remedy has, even in one case, been followed by such admirable results, that it is in itself most innocent, and so reasonable in theory, surely I am warranted in suggesting it for trial by my fellow practitioners. Nor ought it to be forgotten that, although I can only at present furnish one instance of its efficacy in curing epileptic laryngismus, abundance of proof might be adduced, to show its power to subdue laryngismus in other cases. In those of hooping cough alone, since I first proposed this plan in the Edinburgh Monthly Journal of Medical Science' for 1849, I have treated to a conclusion some fifty-seven cases; and M. Joubert, of Cherion, has treated sixty-eight. Now, in all these hundred and twenty-five cases of hooping cough, the laryngismus was speedily cured, except in eight cases, which resisted the treatment, but were none the worse for it; for not one death occurred among them.-London Journal of Medicine, July, 1852, p. 642. 16.-Chloroform in Delirium Tremens. By W. ROGAN, Esq., M.B., Londonderry. [On the 13th of June last, this gentleman was called to visit a well-marked case of delirium tremens. He says] I immediately gave him a drachm of laudanum in half a glass of brandy and directed it to be repeated every hour till he slept; he was also to be well supplied with strong beef tea. He took three doses of the medicine without its causing any tendency to sleep or abatement of the delirium. His pupils were now so much contracted, that I hesitated to give more opium, and determined to try chloroform. I administered it on a hand kerchief, without any opposition from the patient, who seemed amused by the process. In a short time he was under its influence, lying quiet, and breathing naturally. I kept up its effects for about three quarters of an hour, and then withdrew it. He roused up shortly after, quiet in manner, and evidently better. In about ten minutes, he fell asleep, and slept for seven hours without intermission. When he awoke he was quite sensible, and much refreshed. He took some food, and again slept for some hours longer, and awoke quiet well, and able to return to his work. The above is a good example of the benefit of chloroform after opium has been pushed as far as seems compatible with safety.-Med. Times and Gazette, Aug. 14, 1852, p. 174. 17.-On the Treatment of Facial Neuralgia.-M. CAZENAVE informs us (Revue Medico-Chirurgicale) that he has had marked success in removing the pains of hemicrania and facial neuralgia by means of the following pomade: Pure chloroform, dr. iv. Cyanide of potassium, dr. iijss. Wax sufficient to give consistence. M. Cazenave professes to have tried the cyanide of potassium alone, without any benefit, and therefore concludes that it is this particular combination which is so valuable. The mode of using it is to rub ointment, the size of a pigeon's egg, into the scalp, after which the head is to be covered with an oiled-skin cap. The inunction is to be repeated according to circumstances. In facial neuralgia it is rubbed in over the affected nerve.-Provincial Medical and Surgical Journal, July 21, 1852, p. 380. DISEASES OF THE ORGANS OF CIRCULATION. 18.-ON SOME OF THE PRINCIPAL EFFECTS RESULTING FROM THE DETACHMENT OF FIBRINOUS DEPOSITS FROM THE INTERIOR OF THE HEART, AND THEIR MIXTURE WITH THE CIRCULATING BLOOD. By DR. WILLIAM SENHOUSE KIRKES. [The following observations on the above subject were communicated by Dr. Burrows, to the Royal Medical and Chirurgical Society.] As an introduction to the subject, the author observed that it was a a clearly established fact, that the fibrinous principle of the blood might, under certain circumstances, separate from the circulating fluid, and be deposited within the vascular system, especially on the valves of the heart. The forms of fibrinous concretions to which the following observations especially applied, were, first the masses usually described as Laennec's globular excrescences; and secondly, the granular or warty growths adhering to the valves, and presenting innumerable varieties, from mere granules to large irregular fungous or cauliflower excrescences projecting into the cavities of the heart. These growths, when once formed, whatever might be their origin, were full of peril, and would often remain so, long after the circumstances which gave rise to them had passed away. When of large size, or loosely adherent, they might at any time be detached from the valves, and conveyed with the circulating blood, until arrested within some arterial canal, which might thus become completely plugged up, and the supply of blood to an important part be suddenly cut off, from which serious, if not fatal results would ensue; or, smaller masses might be detached, and pass on into arteries of much less size, or even into the capillaries, whence congestion, followed by stagnation and coagulation of the blood, and all the consequent changes such coagulated blood is liable to undergo in the living body, would necessarily follow. Many singular morbid appearances observed in internal organs, and not well accounted for, were probably brought about in this manner. Again, the masses of fibrine might soften, break up, and discharge the finely granular material resulting from their disintegration into the circulating blood, and, contaminating this fluid, might excite symptoms very similar to those observed in phlebitis, typhus, and other analogous blood diseases. Thus the fibrinous material detached from the valves, or any other part of the interior of the heart, might be the cause of serious secondary mischief. The parts of the vascular system in which these transmitted masses of fibrine might be found, would in great measure depend upon whether they were detached from the right or left cavities of the heart. Thus, if from the left, they would pass into the aorta and its subdivisions, and would be arrested in any of the systemic arteries or their ramifications, and especially into those organs which receive large quantities of blood direct from the left side of the heart, as the brain, spleen, and kidneys: on the contrary, if escaping from the right cavities, the lungs would necessarily become the primary, if not the exclusive, seat of their ultimate deposition. A division of the subject being thus naturally formed, the author proposes to consider the subject, first, as to the remote effects resulting from the separation of fibrinous deposits from the valves or cavities of the left side, and secondly, as to the corresponding effects produced by the detachment of like deposits from the valves or cavities of the right side of the heart. The author then proceeded to elucidate the first branch of the subject, in whch masses of some magnitude were detached from the left side, and arrested in an arterial channel of notable size. This pathological fact was illustrated by three cases, in many respects identical; for, in each, death appeared to ensue from softening of the brain consequent on obstruction in one of the principal cerebral arteries by a mass of fibrinous material, apparently detached from growths on the left valves. The first case was that of a female, aged thirty-four, of pale and delicate aspect. She had suffered from rheumatic pains, and there was a loud systolic murmur heard over the entire cardiac region. While under treatment for these symptoms she suddenly fell back as if fainting. She was found speechless, with partial hemiplegia of the left side, The but there was no loss of consciousness; the hemiplegia increased, involved the face and limbs, and gradually became complete in regard to motion; but sensation remained unimpaired. These symptoms lasted five days, when she quietly died. The post-mortem examination developed much congestion of the pia mater, amounting in some places, to ecchymosis. The right corpus striatum was softened to an extreme degree-being reduced to a dirty, greyish-white pulp. In the posterior lobe of the right cerebral hemisphere was a similar spot of pale softening. The right middle cerebral artery, just at its commencement, was plugged up by a small nodule of firm whitish, fibrinous-looking substance, not adhering to the wall, but rendering the canal almost impervious. The vessels of the brain were generally healthy, except a yellow spot or two in the coats of those at the base of the brain. The heart was enlarged; several broad white patches externally. The right valves were healthy, so also were the aorta; but the mitral valve was much diseased, the auricular surface being beset with large warty excrescences of adherent blood-stained fibrine. The right common iliac artery, about an inch above the origin of its internal branch, was blocked up by a firm, pale, laminated coagulum, which extended into the internal iliac. pleure were adherent in places; liver and intestinal canal healthy; spleen large, pale, and soft, and contained a yellowish-white, cheesy substance. The kidneys were pale, rough, and granular; within the cortex of the right were several large masses of yellow deposit, surrounded by patches of redness. Death had resulted in this case from the softening of a large portion of the right side of the brain, which the author considered to have arisen from an imperfect supply of blood, consequent on the middle cerebral artery of the same side being obstructed by a plug of fibrine. The author then discussed the sufficiency of such an obstruction to produce the effects ascribed to it, and he brought forward many examples showing that atrophy and disorganization usually resulted from any circumstance which materially impeded, or entirely cut off, the supply of blood to a part. The author then directed attention to the proba ble source of the fibrinous plug found in the middle cerebral artery. The suddenness of the cerebral symptoms rendered it probable that the blocking up of the artery was equally sudden, and not the result of gradual coagulation of the blood within the vessel. The absence of all local mischief in the coats of the artery at the point of obstruction, as well as elsewhere, pointed to some other than local origin for the clot; and the author, at the time of the examination, formed the opinion, that a part of the fibrinous deposit on the mitral valve had become detached, and carried by the stream of blood, until arrested at the angle whence the middle cerebral proceeded. This explanation suited equally for the plug found in the common iliac; for it was quite conceivable that portions of the loosely adherent fibrine might be easily detached by the stream of blood washing over the mitral valve, and when once admitted into the circulating current, they would only be arrested by arriving at a vessel too small to allow their transit along its canal. Two other cases were described by the author, possessing many interesting points of resemblance: one, a female, aged twenty-four; the other, a male of the same age. Both were admitted into the hospital with hemiplegia of the |