and the third phalanx of the index finger, formerly paralysed, he could flex strongly. His left leg also continued to grow stronger he could stand alone upon it without support for a considerable time; the stiffness formerly felt at the top of the calf, when he attempted to extend it, was completely gone; he could hold up the fore part of the foot when the heel was on the ground as long as he liked; he could move the toes, especially upwards much more freely, and, as he said, he walked "much better" than formerly. I ordered the extensor muscles of the fore-arm, especially those of the thumb, to he galvanized frequently; the treatment in other respects to continue the same. The last record which I made of this case was July 28, and was as follows:-When the hand is in a passive state it is now quite straight in relation to the fore-arm, and its grasping power is notably increased. The patient can walk on either the heel or toes of the left foot, and in ascending stairs can bear all his weight so completely on his left toes, as to be able to go up by advancing each foot a step alternately. The bowels continue to be opened daily; the left side continues remarkably warm, and during the two months of treatment headache has never been felt.

As the radial side of the fore-arm has been turned inwards. ever since infancy, it is probably held in that position, not only by the pronator muscles, but by adherent tissue developed. between the immobile structures. Holding this opinion, I directed the boy to make continuous efforts forcibly to supinate the fore-arm, and already the rotating power has increased. If his left tendo-Achillis had not been divided, he would now walk I believe, with only such a slightly perceptible limp as would be due to the difference in length of the two legs; there is more unevenness in his gait than that difference will account for, and I ascribe it to the operation which he underwent. Indeed, he could walk better, he says, before the operation than afterwards; and he is probably right, for he also says that before the operation the muscles of the calf were fully developed, whereas afterwards they gradually wasted.

As in the treatment of cases of paralysis of long standing, medicines are, notoriously, of slight avail, and as any merely theoretical considerations which I may advance in favour of the method I am advocating will not be likely to exert much influence, I shall, I hope, be permitted to adduce, as evidence in support of that method, the reports of two other cases which were published in the Journal of Mental Science.

Case of Hemeplegia, with persistent headache; impairment of intelligence and vision; obstinate constipation; and deficient expulsive power of the bladder.-H. D. J., suffering from hemiplegia, consulted me, August 12th, 1863. He can lift the right elbow

nearly as high as the shoulder, when the arm is flexed; but when extended, only as high as the mamma. The supra-spinatus muscle of the right side is considerably wasted. Can flex the fore-arm vigorously, but can extend it only inperfectly and feebly. Can flex the fingers and thumb closely, but not powerfully; cannot extend the fingers beyond a right angle with the palin; cannot extend the thumb. Cannot stand on the right leg without support; it is not wasted. Cannot extend the toes except very slightly; can flex them better, but much less than he can the toes of the left foot. The right foot and leg, as high as the knee inclusive, are habitually cold; so cold that even now he has a fire every night to warm them before going to bed. Drags his left foot, and wears the toe of his shoe out in consequence.

Has continuous pain on the right side of the head round the ear, sometimes extending to the back and front of the same side. Has constant singing in the right ear. Has paralysis of the sixth nerve of the left side. Has a little pain in the left eye; cannot read test-type "12" with it; with the right eye can read test-type "3" with difficulty. Tongue deviates strongly to the right side; tactile power of tongue and of cheeks on each side the same. In the palm of the hand feels two points six lines apart on right side, four on left. Intelligence considerably impaired. Pulse 120, the same strength on both sides. Bowels so constipated as to be confined for a week together if no medicine be taken, the stools being very hard. Even with several strong doses of purgative medicine in succession, very often no action of the bowels is effected. The expulsive power of the bladder is "greatly impaired." He sometimes passes twenty-four hours without making water. The patient is generally very impatient and irritable.

After the treatment, consisting chiefly of ice to the spinal region, varied from time to time according to the requirements of the case, had continued until September 24th, the following was the condition of the patient :—

He can now raise his right arm vertically above his head ; can extend his fore-arm vigorously, and all the fingers and the thumb completely. Can balance himself on the right leg without support. Can extend and flex the toes of the right foot very considerably, much more than formerly. The right leg decidedly warmer than before using the ice. In walking be can now put his left foot flat, there being no dragging of it as formerly. The pain of the right side of the head and the singing of the right ear, though not quite gone, are markedly lessened. The pain in the left eye is still felt at times but it is also much lessened. The paralysis of the sixth nerve of this eye continues about the Can now read test-type "1" with the right eye, and

same.

"8" with the left. Feels two points at five lines apart in each palm. Intelligence very greatly improved. The bowels are now easily acted on by a slight dose of aperient medicine, and are thus open at least every other day. The expulsive power of the bladder is much greater than before treatment; in fact, quite normal. Urine is now voided about three times

in the twenty-four hours.

6

Case of Paralysis of the muscles of the tongue and throat.September 13, 1863, I was consulted by Mrs. who, about four years ago, lost the power of her right hand for a time, but recovered it. A year later she had an attack of paralysis of the right arm, lasting only for a few days. The face was drawn to the right side, and the speech became "thick." She has never walked so strongly since this attack as she did before it. She had a third attack about thirteen months ago, when, having gone to bed well, she rose in the morning, and went to call her daughter, but found herself unable to speak. arm was not affected at all this time. Both legs are now very

weak, the right one being much the worst.

The

The tongue is still paralyzed, but its sensibility is normal. She can now protrude it slightly, and move it from side to side, but cannot speak at all. Formerly the tongue was stiff, and could not be protruded.

During the last two months she has become able to swallow fluids with difficulty, only a teaspoonful at a time. Has all her food minced, being unable to chew it, because she cannot guide it in her mouth. Uvula straight. Pupils equal, and sight fairly good. Forehead, face, submaxmillary region, decidedly cool; upper extremities habitually cold. Sleeps well; appetite good; bowels regular. Goes out daily to walk, but feels a great stiffness in the limbs, particularly in the right leg and arm. The patient writes on a slate "My nerves are greatly shaken; the most trifling thing makes me laugh or cry without any cause. I cannot account for this attack in any way. I have tried blisters, strychnine, galvanism, and homoeopathy, without any effect. I have no headache nor pain of any kind, but often feel as if a band were bound round my head and throat (more round the throat than the head); and going up or down a single step, I fancy I must fall, though I know it is only a nervous feeling." I requested her to apply ice, until it melts, along the upper half of the spine twice a day.

September 20th. The patient looks better; the hands have been always warm since the treatment began, becoming so in three minutes after the use of the ice. Her expression is improved; she looks healthier, stronger. Pulse 92; tongue clean, bowels regular. B. Ammonii bromidii gr. v.; potassii iodidi gr. iiss, ter die.

September 27th. Feels very well; arms, but not hands, warm; bowels regular. Face often flushes while the ice is on. Can eat better, and can say "Helen" and "No." To make the hands warm by putting them in hot water, by friction, and by warm gloves. To continue the medicine already prescribed, once daily, and to take of ferri carbonatis cum saccharo gr. x, bis die.

October 3rd. Much the same, but has a little more power in the tongue. Can say "nothing." Bowels regular. Pulse 104. Continue the ice and the pills, and keep a roll of cotton wool beneath the lower jaw.

Is

11th. Is generally better. Can say "Yes" and "Fire" and all the letters of the alphabet except "w" and "y." The wool beneath the jaw has much increased the temperature there. always warm, except just after dinner; she has not the ice on then. To continue the pills, to put the ice-bag next the skin, and to suck jujubes in order to exercise the tongue.

66

17th. Can now say Bacon, finger, apple, paper, Mary, box." Hands warm, feet also. Pulse 100. Bowels regular. Tongue deviates to the right. Swallowing improved; takes a wine-glassful of porter daily. B. Potassii iodidi gr. iij, bis die. Continue the ice and the jujubes, and make continual efforts to speak.

I never saw this patient again.

Case of Chronic Hemiplegia, with extreme constipation and coldness of the paralysed side.-F. J., aged 27, consulted me Nov. 6th, 1863. He had to be carried into my room. Became paralysed seven years previously. The elbow is immovably flexed, the fore-arm is pronated, the fingers and thumb are powerfully flexed into the palm of the hand. Can raise the right leg a little, but cannot flex it at all, the foot is drawn inwards, cannot move the toes in any way. The tongue can be only so far protruded as to get its tip over the teeth, can drink with great difficulty, and only very slowly, can bite, but cannot grind his food. Has wholly lost the power of speech. Breathes stertorously, and is often afflicted with an uncontrollable sardonic laugh.

Temperature of right hand 83° Fahr., of left 87°, of right

leg 84, of left 89°. Bowels habitually costive, open about

twice a week, sometimes only once if aperient medicine is not taken; makes water with distressing frequency.

The patient came to me from Ireland, whither he returned after visiting me once. I ordered ice to be applied along the whole spine three times a day. Owing to his adverse circumstances the treatment was continued only a short time. May 18th, 1864, he wrote to me as follows:-" When three weeks had elapsed [after the date the treatment began] an obstinate

constipation, from which I had suffered for years, seemed cured. The temperature of my paralysed band rose considerably, and for the first time for six years I hobbled about with a walking cane, and continue to improve.'

In answer to an enquiry concerning his condition, which I subsequently addressed to him, this patient wrote to me, May 7th, 1866, that "since the very imperfect trial of the ice treatment" immediately after he first consulted me, he had "failed in procuring ice except for a day or two," when, as he said, "we had frost here;" that, nevertheless, his improvement had continued; that he had begun to "mumble a few words;" that, "under favourable circumstances the palsied side is as warm as the other" that "the bowels act very regularly;" and that, in respect to the excessive micturation with which he was troubled, "there is a grand improvement; for the last few weeks that failing has all but vanished, though it was nearly nine years old."

I regret extremely that this patient could not continue the treatment I advised; it is evident that it was doing him great good; and, to the extent of the benefit derived from it, the case would have afforded a still more decisive illustration than it is already of the remedial efficacy of the method in question, as well as an answer to an eminent London physician who saw the patient with me, and who then said to me, Well, you don't expect anything can be done here, do you?"-Medical Press and Circular, May 29, 1867, p. 502.

DISEASES OF THE ORGANS OF CIRCULATION.

30.-DIGITALIS IN DISEASE OF THE HEART.

By Dr. J. MILNER FOTHERGILL, Morland, Westmoreland. Both the experiments of Handfield Jones and Fuller show conclusively that in digitalis-poisoning the heart is found in a state of tonic contraction. Clinical observations, which of course, are much more numerous than physiological experiments, show also that under digitalis, in many cases an irregular pulse becomes much steadier, the beats becoming more equal and regular; clinical observation will show, too, yet another fact, not by any means so well known, that where a heart, with or without valvular disease, is beating so feebly that its apex-beat cannot be felt, that its sounds are inaudible almost, certainly undistinguishable, and the pulse almost imperceptible, under digitalis it becomes so altered that its apex-beat becomes perceptible; not only can the natural sounds, but, where present, the abnor