any thing unusual about his face, but the moment he smiles it is drawn to one side. When he laughs or sneezes, the distortion is very remarkable. In sneezing, particularly, the muscles of the nose, mouth, and even eyelids, of the right side, were passive, at the time all the muscles of the other side were acting strongly. The right buccinator did not correspond in action with the left, so that, when he attempted to whistle, the air escaped by the right angle of the mouth; but the pa. tient could bring the orbicularis oris into action, and could hold a pencil with it; and he could shut his jaws with equal force on either side. The sensibility of the paralyzed cheek was also equal to that of the other. In short, all those actions which have been proved to depend on the influence of the fifth pair of nerves remained perfect. This, it will be at once observed, is just the reverse of what generally holds good with regard to paralysis following apoplexy, in which those actions enumerated as perfect in the foregoing example are deficient, and those connected with the portio dura are little, if at all, affected. In Richardson's case, the previous history agrees well with the views of Mr. Shaw; for he had suffered a very severe attack of cynanche parotidea, having his face so much distorted as to lead the people, in whose house he lodged, to the belief that he was mad.

Several cases of a similar nature are detailed, and the various inconveniences arising from this cause are illustrated: among these, the most distressing seems to be the loss of power in the eyelids of the paralyzed side: the eye being thus deprived of its natural covering, and constantly exposed to the light, becomes destroyed by repeated attacks of inflammation. This consequence is particularly striking in the case of a porter named Garrity, as described by Mr. Shaw. About nineteen years ago, he was affected with violent pain in the right ear, accompanied with discharge: the face became paralyzed on the same side; since which time he has never been able to close the right eyelid, in consequence of which he has suffered repeated attacks of inflammation; the cornea has become opaque, and the sight is nearly destroyed. remarkable appearance presented by this patient is the extreme thinness of the cheek, owing to the muscles having been so long unemployed; while the masseter and temporalis muscles of the same side are not at all diminished in size. "During the course of last winter, a surgeon in town was much distressed by receiving intelligence that one of his relations in the country was attacked with symptoms of paralysis of the face; but, in the course of a short time, he was not less surprised than pleased to hear that his friend had been suddenly relieved of all the symptoms by the bursting of an abscess in his ear. The progress of this case puzzled my friend not a little, until he read the account of the inquiries in which we had been engaged in Windmill-street."

Another

The views of the ingenious author of this paper are not confined to those cases of partial paralysis in which some local pressure, or other injury, affects the portio dura, but he proceeds to illustrate the connexion between this form of paralysis and that depending on mischief within the head. A woman was attacked with pain in the right ear, accompanied with discharge, and paralysis of the side of the face: the discharge stopped, and she was seized with pain in the head, vertigo, and some degree of stupor. From these she recovered by active treatment.—A

child was affected with discharge from the ear: some time after this had ceased, she was seized with a fit, and fell down; there was total paralysis of the face, leg, and arm of the same side. These cases show the propriety of examining the state of the ear in partial paralysis of the face, accompanied with pain or other unpleasant symptoms about the head.

Another cause of this local palsy seems to be exposure to cold, commonly called a blight. Such instances are said to be common in India during the prevalence of cold winds; and Mr. Shaw informs us, that it is sometimes to be observed in those unfortunate females who walk the streets during the night." In such cases it, for the most part, gradually subsides; while the palsy accompanied with inflammation and suppuration is extremely difficult of cure. In order to attempt this, however, Mr. Shaw suggests leeches and blistering,-it would appear from analogy, as he gives no example of his having employed it himself.

Injuries of the head likewise give rise occasionally to partial paralysis of this kind, one of the most interesting examples of which is thus related. "While accompanying M. Cloquet, one of the most ingenious and learned surgeons in Paris, in his morning-visit to the Hospital St. Louis, he drew my attention to the case of a woman who had some unusual symptoms, produced apparently by a fracture of the clavicle. Ou examining her, I discovered all the appearances of paralysis of the portio dura; and, on further inquiry, I found that, at the time the clavicle was broken, she had received a blow on the temporal bone of the same side."

Exactly analogous is the effect of dividing the nerve in operations; and it becomes a question of great importance to surgeons, whether greater inconvenience may not result from such division, than from allowing any tumor of moderate size to remain. The restoration of continuity following the division of other nerves, and the return of power, is sufficiently ascertained; but more extensive observations and experi ments are required to settle this question with regard to the portio dura. The evidence at present is rather against its restoration.

M. SERRES has given an account of several cases of inflammation, or apoplexy, of the cerebellum,* attended with symptoms so peculiar as to lead to the detection of the seat of disease even before death.The first of these occurred in 1814. A man, aged thirty-two years, was brought to the Hôtel Dieu in a state of insensibility, with his face red, his head hot, his pulse strong, his breathing slow and interrupted, with occasional convulsions and tonic spasms; and with the penis in a state of permanent erection, which remained until within four hours of his death. He died on the twelfth day. The hemispheres of the brain presented no mark of disease, but the cerebellum was much injected with blood; the superior vermicular process, and the processus cerebelli ad testes, being of a deep red colour, and containing several small foyers. The opinions of Drs. Gall and Spurzheim regarding a connexion between the genital organs and cerebellum, naturally suggested * Journal de Physiologie, Août 1822.

itself, and directed the author to further observation, and several analogous cases, of subsequent occurrence, are related. Among these, one of the most remarkable is that of Marie-Jeanne-Josephine Dubourg, who died at the age of thirty-three, in consequence of habitual and excessive indulgence in venery. Connexion with the other sex not satiating her desires, she became addicted to masturbation, which was followed by stupor, and at length, tired of habitual gratification, she submitted to have the clitoris burnt. This operation failed to deaden her passions, and she returned to the same method of satisfying them, till at the age of thirty-two, she suffered from violent head-aches, and became suddenly imbecile. The vermiform processes were indurated, and the surrounding part of the cerebellum inflamed; but its general texture was softened, resembling that of a fœtus of the second month; the arteries of the cerebellum were unusually large. The body had been injected, with a view to ascertain the state of the vascular system, and the uterine, vaginal, vesical, and hemorrhoidal arteries were found very much dilated.

A case of a similar description, and appearing to coincide with the views of the French pathologist, is given by Mr. DUNGLISON, in the London Medical Repository for October. A boy, aged five years, was attacked with increased action in the head, evinced by convulsions, strabismus, coma, &c. with convulsive motions of the right side, and palsy of the left: these symptoms proved fatal at the end of eleven days. The penis had been observed, at different times, in a state of complete erection, and diseased appearances were found, by dissection, in the cerebellum and its membranes.

The great extent to which the brain may sometimes be injured, without producing immediate death or any mental derangement, is well known to pathologists, and especially familiar to military surgeons. The fact is well illustrated by a case which recently occurred in Paris, and which is recorded by Dr. DU PONCHEL.* A dragoon was wounded in

a duel, the sword of his opponent entering the skull through the orbit, and beneath the ball of the eye. The degree of injury could not, of course, be ascertained at the time; but, on dissection, the sabre was found to have divided the optic nerve and the ophthalmic artery, and passed completely through the substance of the middle lobe of the right side, penetrating even to the calvarium, but leaving the ventricle untouched. A portion of cerebral matter was found in the orbit, having been brought there in forcibly withdrawing the instrument by which the wound was inflicted. Slight effusion, with some partial adhesions, were found about the right hemisphere, but there was no appearance of suppuration in any part of the brain. The patient lived sixteen days; the symptoms being paralysis of the left side of the body, dilated pupil, disposition to coma, and difficulty of speech, but with the mental faculties unimpaired till a few hours before death.

M. VALENTIN, in the work already alluded to, mentions having seen at Rome a preparation of the brain, in which a hair-pin was found, about two inches long, which had been thrust perpendicularly into the

* Bulletin de la Société d'Emulation de Paris, Mai 1822.

fontanelle, and passed down between the hemispheres as far as the corpus callosum, which, however, it did not touch. It was situated on the left side of the falx, and had not wounded the longitudinal sinus. The head of the pin was in contact with the dura mater, but had left no mark on the bone. This singular circumstance is related of a Russian soldier, who lived to the age of thirty-six, and had served in the Roman army: he died of inflammation of the lungs, and was opened by S. FLAJANI. As this plan of pushing pins into the head is said to be common in Russia as a means of infanticide, it is conjectured that the foreign body had remained in this instance from the period of very early infancy. If this be correct, it is probable that the pin must, when introduced, have transfixed the corpus callosum, as it is stated that, when the head was examined after its full development, it reached down to that body.

It is singular that, in the various treatises upon Diseases of the Eye, we hear so little of the Lachrymal Gland: connected as it is with our mental and bodily sympathies, we should, a priori, have expected it to be particularly subject to morbid actions, but this does not seem to be the case. BOYER remarks, that the maladies of this gland are little known, because its situation both protects it from external injury, and prevents our being able to examine it during life. He states that he has never known an instance of its being inflamed; nor does he seem to have been aware of any other instance of disease, except that an instance of scirrhous enlargement of the gland, in which extirpation was performed, bad been presented to the Royal Academy of Surgery in France. Mr. TODD,* however, informs us that he has met with many instances of disease of this organ, and that such affections are therefore less rare than occulists have been inclined to suppose.

The author first treats of acute inflammation of the lachrymal gland, which he states to be sometimes idiopathic, but more frequently succeeding to some form of ophthalmia. He has likewise known it to accompany the psorophthalmia of children, when it was severe or ag gravated by adventitious circumstances. The symptoms which he regards as characteristic of this disease are intense pain "under the temporal extremity of the eyebrow," extending to the neighbouring parts, sometimes into the cranium, with profuse or defective secretion of tears: when the latter is the case, the palpebræ and cheek become excoriated to some extent; both eyelids, but particularly the upper, are tense and swollen; and, lastly, the inflammation, spreading to the conjunctiva, gives rise to a severe and obstinate form of ophthalmia. "When inflammation of this kind is at its height, there are much symptomatic fever and restlessness; flushing of the face, particularly at the affected side; acute pains darting through the orbit and head; and, as it is stated (by Waller), more or less delirium, with strabismus, and impaired vision and protrusion of the globe, proportionate to the size of the swelling."

Chronic inflammation of the lachrymal gland is regarded as, for the most part, of strumous origin; it is marked by an obvious enlargement

On Diseases of the Lachrymal Gland, by C. TovD, &c. &c.-Dublin Hospital Reports, vol. iii.

at the outer part of the orbit, frequently causing an oedematous swelling of the upper eyelid, and difficulty in moving the eye towards that side; and is to be remedied by leeches, blisters, and the usual means employed in struma. Scrofulous enlargement is an affection of the lachrymal gland, which Mr. Todd regards as well marked; it is distinguished by the tumor presenting a surface "more or less lobulated," by the absence of pain, and the slowness of its progress; sometimes continuing stationary for many months, and in others running on to strumous suppuration.

Abscess is said frequently to succeed to acute inflammation, occasioning much pain and tension. Mr. TRAVERS, in his Synopsis of the Diseases of the Eye, mentions suppuration of the lachrymal gland as a frequent occurrence in children, and recommends evacuating the matter from the inner surface of the eyelid,-probably in order to avoid disfiguring the parts by leaving a cicatrix. To this, however, Mr. Todd objects, that deformity seldom succeeds, unless from delaying the operation till the integuments become diseased; and therefore recommends that incisions should early be made parallel to the superior margin of the orbit, by which means few fibres of the orbicularis will be cut, and the cicatrix, "being in the direction of the natural folds of the eyelid, will be concealed by them."

Schirrus of the lachrymal gland has chiefly been regarded as accompanying a general cancerous or carcinomatous state of the eye; but the author shows, by a case given at length, that it may exist as a distinct disease. The gland was extirpated: it was much larger than a walnut; presented considerable eminences, with fissures between them; and was nearly as hard, but more elastic, than cartilage. On being cut into, several small cysts were discovered, containing a glairy fluid, the interstices consisting of fatty substance, with transverse membranous bands. Much coagulated blood filled the cavity after the operation, and gave to the eye the appearance of being in a gangrenous state. The patient, however, did well; and," although vision was totally extinct in that eye, yet the orbit was perfectly sound, and its position almost natural." Another case is given, in which Mr. O'BEIRNE extirpated this gland, although without discovering what the tumor was, till it was laid bare by the incision: vision remained unimpaired, and the patient suffered "no inconvenience whatsoever from the loss of the gland." This operation has likewise been successfully performed by Mr. Warner and Mr. Travers.

A disease of the Cellular Membrane of the Throat, which would seem to be of rare occurrence, has been described by Dr. GEORGE GREGORY.* The patient complained of pain and tenderness of the external parts of the throat, extending round the neck, and being particularly felt at the junction of the clavicles with the sternum. She had considerable fever, with much difficulty of swallowing, but no diseased appearance could be perceived on examining the fauces. There was neither hoarseness nor any considerable difficulty of breathing. She was bled and purged, without any effect in arresting the progress of the disease, which, conti

*London Med, and Phys. Journal, October.