points, along the so-called line of contact of the valves was a clearly marked row of smaller vegetations. The vegetations were most abundant on those segments of the valves which are opposite the point of origin of the coronary arteries. There were a few very small patches of fibrous tissue at the base of the aorta. The anterior segment of the mitral valve was markedly thickened throughout its extent, and it was also moderately contracted. The posterior segment was similarly thickened and so adherent to the contiguous ventricular wall that only about one-fourth of an inch of its lower border was free. The edges of both segments were about one-eighth inch thick and studded with vegetations which had a distinctly granular appearance and feeling. The result of the contraction of the segments was a moderate stenosis of the orifice. The left auricle was greatly dilated and its endocardium thickened and studded with small irregularly shaped fibrous patches. Its color was a turbid yellowish gray. The muscular tissue of the heart was dull, pale and flaccid. The thickness of the wall of the left ventricle (muscular tissue alone) was one-half inch. The heart measured 54 by 5 inches, and weighed 1 pound 2 ounces (avoirdupois). There was a moderate dilatation of the ventricles, but the enlargement of the organ was more of the nature of an hypertrophy than a dilatation. Except as mentioned the changes in the heart were not of special pathological interest. amined, was: chronic pericarditis, sero fibrosa and endocarditis with recent acute exacerbations of both, with effusion, chronic myocarditis, and chronic and acute circumscribed pleuritis of the left side with effusion and pulmonary hyperemia and edema; chronic pleuritis of this right side; circumscribed peritonitis (diaphragmatic), subacute splenitis passive hyperemia of the liver. DR. JOHN A. ROBISON.-I think Dr. Babcock was perfectly excusable in not detecting the pleurisy because oftentimes when there is not more than eight or ten ounces in the pleural cavity and no complicating disease, if the respiratory sounds are very intense, or if the lung has not been pressed upon to any great extent there will be still a sufficient amount of resonance on that side to overcome any dulness the small amount of effusion will cause. I know in a great many cases it is a very puzzling question to a person making an examination to tell whether there is any fluid in the cavity or not by the physical signs. SELECTION. THE TWO ASPECTS OF PHTHISIS. In dealing with phthisis, we are always prone to regard it mainly either as a true lungdisease or as a constitutional malady, with a pulmonary lesion as its most constant, and usually most important, local expression. The former is the tendency of the student and young practitioner, who are apt to think that through the stethoscope may be learnt most of what is worth knowing about the disease: the latter becomes more and more the view which arises from a wide experience of phthisis, and gradually impresses itself upon us as vitally important, esespecially with regard to prognosis and treatment. Dr. H. G. Sutton puts this strikingly in his recently published and profoundly suggestive lectures on Medical Pathology. He says: "In considering phthisis and the treatment of phthisis, do not think of the lungs so much, for it is simply harassing to one's self, and leads to the death of the patient, and no one benefits by it. How can a lung be repaired if there is not sufficient blood going through it? The one object in the treatment The diagnosis, limited to the organs ex. of phthisis is to get more blood through the LUNGS.-There is fluid in the left pleural cavity reaching, as the body lies in the dorsal decubitus, to the anterior axillary line. This fluid was not measured but was approximately eight to ten ounces, clear and slightly reddish. The lower border of the upper lobe of the left lung corresponded anteriorly to the third rib and was adherent. This line of adhesion, as well as a few others over the surface of the lung, was not of very recent origin, but yet easily broken down. That part of the pleural surfaces, however, immediately next the base of the heart was very firinly adherent. In this lower part of the left lung there was a moderate degree and amount of hypostatic hyperemia and edema. There were a few old and moderately firm adhesions over the right lung. The spleen was of less normal size and soft and degenerated. The liver was rather pale but in a state of moderate passive hyperemia. There were a few very thin and not very recent bands of adhesion between its left lobe and the diaphragm. The other organs were not examined. lung to repair it; hence the importance of dynes, but it seems doubtful whether they rest, food, and fresh air." All the main principles in the treatment of phthisis now generally adopted, namely, liberal dietary, tonics, open-air life, change of climate, etc., aim at the improvement of the constitutional condition, the assumption underlying these measures being either that the local condition is inaccessible to therapeutics, or else that it may be confidently expected to improve with the improvement in the organism generally. No doubt since the discoveries of Koch, patient and enterprising efforts have been made to strike at the real origin of the disease by measures directed to the destruction of the tubercle-bacillus. Hence has arisen the wide adoption of antiseptic inhalations, and more recently the injection of sulphuretted hydrogen, carbonic acid gas, etc. Without seeking to prejudge the results of experiments still in progress, it must, we think, be owned that the net result of this local therapeusis in phthisis has hitherto been very small. Inhalations do good unquestionably, but in what class of cases? Chiefly in old cavities filled with putrid secretion, where the rationale of their action is too obvious to require demonstration; but we are still without evidence of their utility in incipient phthisis; in other words, their influence in checking the development or limiting the activity of the bacillus is still an unproved hypothesis. It is to feared that Koch's discovery, whatever may prove its ultimate value, has done mischief in the department of therapeutics, by tending to obscure the view put forward so bluntly and yet so truly by Dr. Sutton, that in the treatment of phthisis we should think of the organism, and not of a single organ. Local measures of another kind have had a wide popularity and a certain utility in phthisis. We refer to counter-irritants, the efficacy of which has been particularly insisted upon by Professor Jaccoud. No one can try them patiently without being convinced of the resulting benefit. They relieve cough, and enable us to dispense with ano have any other beneficial action whatever. Many years ago it was proposed to treat early cases of phthisis by strapping the apex, the fashion adopted so usefully in pleurisy. It may be doubted whether this practice is now ever adopted, and there can hardly be a doubt that the proposal was based upon a radical misconception of the nature and requirements of the disease. All our knowl edge now tends to show that phthisis arises from inactivity, and not from over-action of the lungs; and, so far from endeavoring to limit the play of pulmonary function, one of our chief aims, apart from the actual presence of hemorrhage, is to promote it. While the constitutional view of phthisis is, for the present at least, much the more useful with a view to treatment, Dr. Sutton would no doubt, be the last to deny the indispensible value of a correct estimate of the local signs. Especially is this so in diagnosis. We may strongly suspect the existence of phthisis before the lungs yield any sign, but we can hardly get beyond the point of mere suspicion. Asthenia,emaciation, night sweats and febrile disturbance may combine, with a bad family history, to make us view a case with the gravest anxiety, although the stethoscope yield no abnormal indications; but, while the lungs remain free, we always continue to hope that our suspicions may prove unfounded. Again, the extent of the local with a cavity in one apex, while the rest of lesion is always a very vital point. A patient his lungs is sound, is in a very different position from one in whom we find evidence of disseminated tubercle throughout a large area of the local lesion, which only local investiof the pulmonary substance. The progress gation can determine, is also a point of cardinal importance. There is the most radical difference between a case of phthisis in which the local signs remain quiescent for months or years, and one in which they creep steadily onwards. The former case allows an opportunity for treatment, and permits a more or less favorable prognosis; the latter case is sure soon to terminate fatally. It is evident that in phthisis it is essential that the relation of the local and the constitu tional condition be correctly estimated and steadily kept in view.-British Med. Jour. II. THE CORPUS STRIATUM.-N. Y. Med. with the experiments of disease upon the Jour. human being. The individual facts of the III FUNCTION OF THE THYROID IN DOGS. latter kind, upon which my conclusions are -Brit. Med. Jour. Dr. Landon Carter Gray, in a review of the knowledge acquired concerning cerebral localization, after speaking at some length of the great confusion resulting from the advancement of theories from many sources, speaks as follows of our present knowledge of it. based, are too numerous to be considered in a work of this kind. Regarding the human brain, there are two sets of facts-one set that is indisputable, another that is still under discussion. Let us first consider the former. The ascending frontal and parietal convolutions are divided into three parts. Of these, the upper third, with the adjacent portion of the base of the first and second frontal convolutions, contains the center for the lower extremities; the middle third, with But the continuance of the study upon hu- the adjacent base of the second frontal man beings has been rewarded by more per- convolution, contains the center for the upper manent conclusions. Pathology has gone extremities; the lower third, with the third hand in hand with physiology. Each has its ad- frontal convolution, contains the centers for vantages. The skull of a dog or an ape can the face, neck, and speech muscles. The sobe trephined at will,and just as much removed called "paracentral lobule" is the medial surof the cerebrum as the operator desires; the face of the upper part of the ascending parieanimal can be kept constantly under observa- tal and frontal convolutions, and therefore, tion, and often, when there are no fatal re- contains the center for the lower extremities, sults, for a considerable length of time, the although lesions of this medial surface are operation can be repeated. Focal alterations comparatively rare. This area upon the conof the human brain are rarely so localized, vex and medial surfaces is that of what may and cannot, of course, be produced at will, or be called the "facio-phonetic-skeletal region." kept so well under observations; so that con- Lesions of it produce impairment, in the manclusions which may rest upon a few months ner indicated, of the upper and lower extremof physiological experiment cannot be con-ities, of the facial and neck muscles, and of tradicted or verified except by years of widespread and isolated observations upon the human subject. On the other hand, human the motor mechanism of speech. It may justly be regarded as proved that the paralysis of the limbs and the face is both motor and sensory,and that the motor and sensory paralysis are not always of equal intensity, that the one may occur without the other, and that the area within which sensory paralysis may be produced is of a larger extent than the motor area, inasmuch as the former embraces the two parietal convolutions. In matters of this kind one is greatly tempted to draw precise circles for each center, and, doubtless, positivism of this kind saves much trouble to those of great faith; but I cannot reconcile facts to such sharp delimitation. In truth, the areas overlap one another, just as the convolutions pass imperceptibly into one another, and the time will never come when a man will be able to mark a line on a convolution and say that it is a precise boundary-line between two centers, so that at one one-hundredth part of on inch to one side there will be certain symptoms, and totally different ones at one one-hundredth part of an inch to the other side. The centers can only be approximately demarkated, not absolutely. There are also good clinical reasons for believing that each different kind of sensation-the tactile, pain, temperature, and muscular senses has a cortical center of its own; but it has as yet only been determined that the muscular sense has probably its center in the parietal convolutions. The center of hearing may be located in the first and second temporal convolutions, although this area does not seem to be so constant a center as some others in the cortex, for the writer and Kussmaul, perhaps also Westphal, have reported cases in which a lesion was located here without the expected auditory symptoms. It is curious, however, that the left lobe seems to be mainly affected, the right side seeming to be of greatly subsidiary importance, Luciani and Seppilli stating that it is never affected alone, while the lesion is very seldom in both temporal lobes. It is curious, too, that the cases have so far always presented the symptom of mental deafness analogous to the mental blindness, as described above, and never any absolute deaf ness. The cases of cortical production of loss of smell or loss of taste have been too scanty to define the centers of those two special senses, although it is probable that the olfactory center is in the hippocampal convolution. In conclusion he says: From this review we perceive that the doctrine of cortical localization is far too well grounded upon facts of eternal verity to be flippantly sneered at, although much remains to be done in the way that has been hewn out of primeval ignorance and acquired obstinacy. Like all truths that have lurked undiscovered for centuries, except those that do not require skilled experimentation or trained observation, it has had to rely upon the testimony of a cloud of witnesses, each one varying in competency or bias, and the result has been the ordinary one of a long trial of issues of fact before an ordinary jury—a fail The center of sight is to be found in the occipital lobe and the angular gyrus. There has been a fierce discussion regarding this center between the followers of Munk and those of Ferrier; the former denying that the angular gyrus had any part in this center, the latter affinming that any visual impairment must implicate both angular gyrus and occip-ure to convince every one. But the jurors of ital lobe. But the experiments of Luciani and Seppilli, and the cases collected by these gentlemen, warrant the assertion that the center embraces both angular gyrus and occipital lobe, although with this distinction, that lesions of the angular gyrus alone produces mental blindness, while lesion of the occipital lobe produces absolute blindness of the same half of the two retina (lateral hemiopia). science can wait for all time, the trial is never closed, and no verdict, however conclusive it may seem at the time it is given, will stand for one hour in the face of a newly discovered fact. In spite, therefore, of uncertainties about minor points of detail, we must admit that we have localized the cortical centers for the motor and sensory nerves of the limbs and face, for the mechanism of speech, for the optic nerves, and probably also for the audi- line, and quite distinct from each other. tory nerves. CONTRIBUTION TO THE PHYSIOLOGY OF THE CORPUS STRIATUM. In Baginsky and Lehmann (Virchow's "Archiv fuer pathologisehe Anatomie") have conducted an interesting series of experiments with a view to the more exact determination of the functional significance of this important structure. The technique resorted to would seem to possess many advantages. In brief, the process employed was the following: A fine glass canula was connected with an ordinary water air-pump and those portions of the brain to be extirpated were removed by suction. By gradually removing in this way the greater part of the nucleus caudatus, these investigators ascertained that the consequent modifications in function were merely. quantitative in character. The principal phenomena observed were the following: creased susceptibility of the animals to sensory impressions; tendency to run away with precipitancy, if attempts were made to catch them, but without evidence of any internal motion; a peculiar derangement manifesting itself in anomalous attitudes of the extremities, particularly of the forelegs. When se verely irritated, the extremities resumed their normal attitudes. This phenomenon has already been described by Schiff and Nothnagel, and is ascribed by Nothnagel to partial paralysis of the muscular sense. All the phe nomena retroceded, but it was observed that the greater the amount of the nucleus removed, the longer the time which elapsed before function was again restored. It was also observed that whenever the anterior portion of the nucleus caudatus was irritated (not destroyed) a rise in temperature took place. A resumption of the normal temperature took place, however, with great rapidity. Of Schiff has made careful observations, which show that, while the removal of one of these bodies has no effect, a train of remarkable phenoma ensues if both be removed. these, one of the most singular is the series of rapid muscular contractions which is set up, chiefly in the temporal muscles. There are usually two or three contractions in a second, but the muscles of opposite sides do not contract synchronously. Another result is the vermicular movements of the lingual muscles, which, like the preceding, may begin even two days after the operation. A third characteristic is the apathetic condition of the animal; this begins the day after the operation, but takes some time to reach its maximum. Ewald, after confirming Schiff's statements on the above points, mentions another symptom-namely, a peculiar odor ge erated by the animal; it is possible, however that change of diet may account for this. Ewald's results differ from Schiff's in a more important particular-namely, as regards the fate of the animal operated on. Schiff found that if an interval of twenty-five or thirty days were allowed between the operations on the right and left glands, the animal survived; whereas, in Ewald's experiments the dog always died, although in one case thirty-nine, and in another fifty, days intervened. Death was preceeded by dysphagia; the wounds had perfectly healed. Schiff's most remarkable discovery, however, was this: If the thyroid of one dog were inserted into the abdominal cavity of another, through a small wound in the integuments, the latter animal could then bear extirpation of both thyroids; hence it was concluded, that some material necessary to the nervous system is elaborated by the thyroid body. Evidently this material may be vicariously elaborated by some other organ or organs, if only sufficient time be afforded, as when one gland is removed some time before the other, or the prodedure just men THE FUNCTION OF THE THYROID IN DOGS. tioned is adopted. Accordingly, the idea The dog has two thyroid bodies, one on the right and the other on the left of the median suggested itself to Ewald to make injections of the thyroid juice of a dog into other dogs, in order to see what immediate effects upon |