town in the beginning of October, much improved in every respect, and having exhausted his stock of pills. He now took other four dozen, when he dropped them altogether, having no further occasion for medicine.

I will not say, that in this instance nitrate of silver cured phthisis; but from the authority of the patient, and the testimony of my own senses, I affirm, that the quantity of sputum was diminished, and its qualities improved; and that a tone and vigour was communicated to the constitution, which no other medicine with which I am acquainted could have imparted.

CASE 7. Mrs. Simpson, aged about 30, of an extremely fine complexion, and delicate frame, consulted me in November last, with regard to her general health, which was much impaired. She exhibited, indeed, the appearance of being far advanced in phthisis. I found she had laboured for some time under fluor albus; and that the discharge was copious, extremely acrid, and accompanied with distressing pain in the region of the uterus. I immediately put her on the nitrate of silver pill, with immediate and great good effect. The pain went off in three days, and the discharge was lessened in proportion. In less than a fortnight she felt her strength considerably improved, and in every respect much mended. She continued the medicine about a month, at the end of which she was perfectly free from complaint. I cannot, indeed, convey an adequate idea of the change, for the better, produced on this interesting and delicate female.

CASE 8. Mrs. M. who had been married several years, but had no children, tall, slender, had constantly an eruption all over her face of a fiery red, and who had not menstruated for several years, became subject to an abscess in a particular spot, within the left labium pudendi, of frequent recurrence. She underwent three courses of mercury, but the complaint perpetually recurred. At length, I prescribed nitrate of silver with the happiest effects. Not only did the discharge disappear, and the ulcer heal up kindly, but the whole habit of the patient seemed to undergo a revolution; her face even became less fiery and red, symptoms of the return of the catamenia began

to manifest themselves, and she felt herself better than she had been for several vears before. It was with some difficulty I could persuade this patient to drop a medicine from which she had experienced so much benefit.

CASE 9. A lady, advanced in life, was seized with a pneumonic affection, accompanied with colliquative perspiration. As soon as the pain of the chest was subdued, which was effected without blood-letting, and that the patient could make a full inspiration, nitrate of silver was exhibited. The perspirations were immediately checked, and the strength of the patient was quite restored in a short time.

CASE 10. A young man was attacked with slight, obtuse pain in his chest, for which he took advice, but of what nature I know not. When I was consulted I found him much reduced by colliquative perspiration. This was, indeed, his only complaint: and the nitrate of silver removed it entirely in a very few days.

I have exhibited nitrate of silver in obstinate gleets from gonorrhea; and in many instances with perfect success, after all the usual remedies had been tried in vain. I have likewise failed in some cases; but believe it was more owing to the medicine not being carried a proper length, than to its inefficacy. In some cases I have made a cure in a very few days; in others, a considerable time elapsed before much effect was produced. One gentleman had been repeatedly under my care for gonorrhoea, which in every instance was difficult of cure. The patient had a cadaverous, unhealthy appearance. The last time he consulted me, I prescribed nitrate of silver, after the inflammatory symptoms were subdued; and with immediate good effect. Not only was the discharge quickly dried up, but the patient described himself as having acquired a tone and vigour to which he was formerly a stranger. It was with difficulty also that this patient was persuaded to give over the medicine.

Such are some of the effects I have observed from the internal use of nitrate of silver-effects which entitle it to more attention than has yet been bestowed on it. From the preceding statements, it is evident, that it possesses anti-purulent

powers in no common degree; and, that in depraved and relaxed habits, it is a remedy that has no rival.

W. BALFOUR, M. D.

A Memoir on Stuttering:-oμos or gavrioμos, of the Greeks, balbuties, hæsitatio linguæ, of the Romans. By M. ITARD, Physician to the Deaf and Dumb Institution of Paris. [Translated from the Journal des Sciences Medicales.]

[From the London Medical and Physical Journal, for May 1818.] STUTTERING is one of those impediments of the functions, which, placed among our infirmities on the borders of the medical domain, has never seriously engaged the attention of physicians. The rich productions of ancient medicine are barren on this point. What Hippocrates, Aristotle, and Galen have said on it, is hardly worth quoting, and their silence on the treatment of psellism, seems to have devoted it to absolute incurability. This is the more surprising, as this defect must have been much more distressing among a people, where the art of speaking in public was intimately connected with the form of their government, and opened the road to the first honours and dignities of the state. Thus, we may remark, that those who were afflicted with this misfortune, consulted their own genius much more than the opinion of the faculty, as we learn from the manner in which Demosthenes, according to Plutarch, improved his pronunciation. Sometimes they had recourse to the gods. We read in Herodotus, that Battus, chief of a colony of Thereans, went to consult the oracle of Delphos on his stuttering, and that the advice he received was, to transport his penates under the burning sun of Lybia.

Our therapeutic of stuttering is hardly more enlightened than that of the Pythonissa was two thousand years ago. Some observations of pathological anatomy, collected by modern authors, far from throwing any light on this affection, would rather turn us aside from its real treatment, by making us consider stuttering as occasioned by some organic lesions; such, for example, as the two accidental conduits, which, according

to Sanctorius, were found in the middle of the roof of the palate, or the separation of the uvula, seen by Delius, (Act. Nat. Curios. t. 8.) or some defect of conformation in the os hyoides, if we may believe Hahn (Commerc. Liter. for 1736.) Morgagni has devoted some paragraphs of his letters X. XI. and LI. to the etiology of stuttering, but not precisely to that which we are now considering. He only notices those embarrassments of the tongue, which are the usual remains of apoplexy, or the frequent preludes of that overwelming disease. We are indebted to Dehaën for five or six histories of stuttering, also symptomatic, produced by congestions in the lungs, particularly by the formation of a vomica, and attended with symptoms of hemiplegia owing to the same cause. Unfortunately, these observations, related in the Opuscules inédits of this illustrious practitioner, are very incomplete, and badly drawn up. Still there is a fact which deserves to be remarked. In three of these patients, the expectoration of the vomica was followed by the cessation of stuttering, and of the hemiplegia.

Menjot, Fick, and Bergen, who have published dissertations on stuttering, have multiplied their divisions, and have confounded this defect of speech with other imperfections of the same organ, without indicating any rational mode of cure. Sauvages, who, in his Nosology, has copied Menjot, deserves the same reproach. It must be acknowleged, however, that he formed a true judgment of the nature of this defect, by considering it as a weakness, and by placing it consequently in the class of dyscinesias. It is astonishing, that he should afterwards have placed in the same class, as species of the same affection,-lallation, mogilalism, iotacism, and other faults of pronunciation, which are owing to quite different causes.

Such is the actual state of science on this subject. Let us see what my reflections and experience have been able to add to it.

Stuttering is, as every body knows, a hesitation of the vocal organs, by which certain syllables, that require a more or less marked action of the organs of the voice and speech, are pronounced with difficulty, and with a stammering repetition of certain sounds. This defect of pronunciation is not observed in children, till having attained the age when their speech

of

should be clear and easy, they continue to show hesitation and embarrassment in the articulation of sounds. Not but that with some attention we may perceive it, even in the first years life, and may distinguish that imperfect articulation of sounds, those half-formed words, which mark the language of childhood from those defective repetitions of a monosyllable which constitute stuttering; but, whether from mistakes on the nature of this defect, or from hopes that it will disappear, no serious attention is paid to it till towards the seventh or eighth year; when this inconvenience, far from diminishing, becomes more apparent from the timidity of the child, and increases till beyond the age of puberty. As manhood advances, it generally diminishes remarkably, and often disappears at the ap proach of old age. It has sometimes been completely dispelled by an acute disorder. Timée (Casus Medicinales) gives the history of a stuttering child, who recovered the free use of speech about the age of eleven, in consequence of a quotidian fever. What is very remarkable, stuttering is very rare in women; and, were I to judge from my own observations, I should pronounce them totally free from it, never having seen one afflicted with it.*

To determine the cause of stuttering, we need only examine for an instant the principal phenomena which attend it. We may remark particularly, that what distinguishes this impediment of the vocal functions from all others, is, that it is subject to variations of intensity depending on the moral state, which form the principal characters of nervous debilities. We may add, that among all our organs, there are none which are so completely dependent on the emotions of the mind as the organs of the voice and speech, and that, therefore, their spasmodic affections must be excited by the least agitation of the internal senses. This is precisely what happens in stuttering. Persons affected with it feel it much more in society, before a large assembly, in anger, impatience, and even in a transport of joy. In the bosom of their family, or in the calm of solitude,

• The English Editor knew a case in a lady not less than fifty years of age. The impediment in speaking was considerable; but the lady could read with great propriety, and without difficulty.

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