young man, twenty years of age, who had for some time been annoyed with a papular eruption on the skin of the arm, for which he had been treated by a chemist in town, without applying to his medical attendant. I therefore inquired of this chemist what drugs had been used by him, but found that they were sufficiently safe and simple. Some of the papules were suppurating when I looked at them. The patient had also received a slight cut with a piece of copper on the same arm, but the wound was quite healed. When I visited the patient his back and extremities were very rigid, and he was taking frequent fits of opisthotonos, but his face was less affected than usual, and he could swallow well. I therefore commenced the treatment with good hope of the result.

At first he took the tincture of the bean made by percolation, but as soon as possible it was changed for the following tincture, in using which one can be more precise as to the doses administered :

B. Ext. physostigmatis venenosi, grs. viij.; aquæ bullientis, ss.; sp. vini rectificati, iss. M.

The extract is dissolved in the water at a boiling temperature, and the spirit is gradually added. The fluid is then filtered, when a clear sherrycoloured tincture is obtained. I have kept this tincture for three months without any turbidity or other change taking place in it, and I believe that it is sufficiently stable for all practical purposes. Every ten minims contain one-twelfth part of a grain of the extract, which is a good dose to begin with in an adult.

Such a dose was given every hour at first, with the effect of greatly relaxing the stiffened muscles of the back and extremities. His bowels were likewise freely moved on the 26th, by a dose of castor oil, with a drop of croton oil mixed with it. He had short sleeps during the night, but next morning the spasms could still be excited, though neither so readily nor so severely as formerly.

During the first part of the 27th he had his doses of the tincture every half hour, and felt so much the better of each dose that he constantly asked for them himself, and would have taken them even oftener. By mid day his body was more relaxed than ever, so that he could move himself in bed, and raise his head from the pillow. I therefore left him in the care of Dr. Fergus, with particular instructions how to proceed. These were carefully carried out by him, and the case went on most favourably. The patient's hopes were coinpletely restored, and he spoke of soon being at business again. The administration of the bean was continued every two hours during the night, and in the morning (28th) Dr. Fergus found that it had considerably affected his patient with its depressing action. In fact, the patient fell into a syncope when Dr. Fergus was present, but by admitting fresh air and rubbing the chest he recovered and seemed much improved. Unfortunately, however, after Dr. Fergus had left, he again fell into a similar state, and, as there was some loose mucus in the throat his friends turned him round to allow it to fall out; on their doing this, he was seized with a violent and universal paroxysm, in which he died about ten a.m.

On returning to Glasgow, which I did on the following morning, I was greatly mortified at learning the result of this case. It is the first and only fatal case which has occurred to myself in which the bean has been fairly tried. I did regret that the patient had been perhaps roughly, because hurriedly, turned round upon his face, for no doubt that was the exciting cause of the fatal convulsion. Had the milder, and sufficiently effective means, adopted by Dr. Fergus, been again employed, I think the issue might have been different. But whether this be so or not, I think we may learn from this case the following lessons::

1. That in the most violent cases of tetanus the bean may be so administered as to diminish the force and duration of the convulsions.

2. That the bean does not rapidly counteract, far less change the morbid lesion in which the proximate cause of tetanus consists. In the preceding case the spasms were greatly mitigated, and yet the disease still existed, in

a latent state no doubt, but yet capable of being roused into great and even fatal activity.

3. That it is, therefore, of great importance to commence the use of the bean early in all cases of tetanus, so as to give it time to act before the disease has become matured. In the preceding case the disease had reached its greatest violence before the medicine was begun at all.

4. That in the state of depression, which is one of the physiological effects of the bean, the patient can very ill bear the renewal of the convulsions. The case is an example of this, and I have often witnessed the same thing in my experiments on the lower animals with strychnia and Calabar bean. The gentlest means for restoring the feeble respiration of the patient when so affected, should alone be employed, and the mouth or throat should be cleared by means of the finger, or by any suitable substitute for it that comes first to hand.

The cases of tetanus treated by the Calabar bean, as I have recommended it, now amount to the following numbers:

No.

Recovered.

Died.

My Infirmary cases.

4

Case treated by Dr. Fergus and myself
Dr. Alexander's cases

Dr. Campbell's case

These were all acute traumatic cases of tetanus, some of them very severe, and all of them warranting the most unfavourable prognosis. Indeed I be lieve that a similar good result could not be shown in such cases by any other kind of treatment. It ought to be remarked, likewise, that one of my fatal cases (Lancet, 1868) was really not treated at all, as the man was dying when I saw him, and he only doubtfully swallowed one dose of the remedy.-Glasgow Mea. Journal, Nov. 1868, p. 51.

27.-CASE OF STRYCHNIA POISONING.

By Dr. JOHN W. KEYWORTH, Birmingham.

On the 23rd of July, 1867, at 7 a.m., I was sent for to a female patient of slight suicidal tendency, who had taken at 11 o'clock the night before, a packet of Battle's Vermin Killer (containing it is stated. 3 grs. of strychnia). The body and limbs were perfectly rigid with spasms, which, when occasionally relaxed, was excited by merely blowing in her face, or by the shaking of the floor in walking. She had been in this condition since 2 a.m., gradually becoming worse. She was speechless, but conscious, and her pulse very rapid and feeble. Her face was livid. The jaws were constantly fixed. Having recently read your paper, and seeing also that the case was almost hopeless, I sent up to the Eye Infirmary for some of the wafers. Failing there, I obtained from Messrs. Southall of this town, pharmaceutists of the first order, some tincture of Calabar bean. They could not give me any information as to the dose. I gave 30 drops every half hour till two drachms had been taken, pouring it into the mouth where a tooth was absent. The effort of swallowing produced violent spasm. After each dose the attack grew less frequent and strong, and I then gave two half drachms at intervals of an hour, then 15 drops every two hours. Altogether half an ounce was taken. The pulse then became extremely weak, the spasms almost ceased, but the woman could scarcely speak or swallow. At the end of some hours she remained very feeble, quiet, but sleepless, and her legs and arms" felt like lead," and were utterly immovable. This gradually subsided, but she could not stand or walk for four or five days, and was three weeks before she fully recovered. The poison was taken in gin, and appeared, from the inspection of the cup, to have been wholly taken. An hour and a half afterwards she appeared, her friends said, "to be in a fit," and

shortly afterwards became "convulsed." The effect of the Calabar bean in relaxing the spasms was apparent in about twenty minutes after taking the first dose, and became more apparent and decided after each repetition.

This is the only case in which I have as yet had an oppertunity of trying the antidote, and of course it proves little; but I shall certainly be disposed to repeat it in any analogous case. The instance was favourable, inasmuch as from the time the poison had been taken, and the condition of the patient, emetics and the stomach-pump were out of the question. And as strychnia appears to destroy life chiefly, if not entirely, by its action on the muscles, there would seem every reason why with it, as well as tetanus, this antidote should be effectual.-Glasgow Medical Journal, Nov. 1868, p. 54.

28.-CONTRIBUTIONS TO THE ELECTRICAL TREATMENT OF

PROGRESSIVE MUSCULAR ATROPHY.

By Dr. C. HILTON FAGGE, Assistant Physician and Medical Registrar to Guy's Hospital.

[Progressive muscular atrophy" is also known as " Wasting palsy" and Cruveilhier's paralysis." It always occurs in the muscles of the upper extremity, but is quite distinct from scrivener's palsy. Within the last few years Duchenne has described a form of paralysis resembling true Cruveilbier's paralysis, but really a different affection. The characteristic points in Duchenne's paralysis, is that the disease is hereditary and attacks in succession all the males of the family. During the last two years ten cases of Cruveilhier's paralysis have been admitted into Guy's Hospital.]

In giving brief notes of these cases, I will first mention those which have been treated by the continuous current alone, after the method introduced by Remak. This consists in the employment of a "constant" battery, having 100 cells, of which a variable number are used, according to circumstances. One pole, the positive, is applied to the back of the head or neck, generally to the mastoid process; the other, or negative pole, is placed over the spine, not higher than the fifth cervical vertebra. When this is done, contractions are sometimes observed in the fingers, or in other paralysed parts,-which contractions Remak has termed "diplegic." The current is allowed to pass for a quarter of an hour at a time, and its application is repeated daily. This method appears to be entirely empirical, having no theoretical foundation whatever; but it must be admitted that in some cases success justifies its

use.

CASES TREATED BY THE CONTINUOUS CURRENT.

Case 1.-(Reported by my clinical clerk, Mr. Bransford Edwards.)—G. P. H., age 27, admitted into clinical ward, under my care, June 12th, 1867. He is a harness maker. About eight weeks ago he began to feel weakness in his arms, and became unable to grasp firmly with his hands. He also had tingling sensations in his arms. The muscles of the fore-arms, except the supinator longus, were considerably atrophied; and the interossei, and other muscles of the hand, were also much wasted. The movements of the hands were very imperfect; for instance, he had great difficulty in unbuttoning his shirt. Tremor was not present in any marked degree; I think I observed it slightly in one of the muscles of the left fore-arm. On testing the muscles with the continuous current, it was found that thirty-five to forty cells were required to produce contractions in the extensors of the fore-arm; whereas the biceps reacted to twenty cells. The medicine which was prescribed for him, besides an occasional purgative, was a mixture containing three grains of iodide of potassium, which he took three times a day for seven days, when it was discontinued, in order that the value of the electrical treatment might be more surely tested. This treatment consisted in the application of the continuous current to the spine (according to Remak's method) every day, for fifteen minutes at a time. It produced a strong galvanic taste, and a tingling sen

sation in the right arm (the electrode was applied beneath the right auricle). The fore-arms were wrapped in cotton wool, and placed upon splints. After seven days of the treatment the splints were removed, and it was then found that there was decidedly more power in the grasp. At the end of sixteen days he could dress himself with ease, and could write tolerably well. He could not bear so strong a current as at first; twenty-five cells now produced distinct contractions in the arms and legs simultaneously. The muscles were fast regaining their firmness and tone. He continued to improve. On August 22, it is noted that he could write several letters in a day. He went out nearly well, on September 21, 1867. I have since heard (Oct. 1868) that he has remained free from any further symptoms of the disease. Besides the affection of the arms,, this man had likewise weakness of the lower limbs; from this he recovered at the same tine.

Case 2.-(Reported by Mr. Colson.)—J. H., aged 27. The disease had begun two years before, with numbness and coldness in the thumb of the right hand, gradually extending to the other fingers, and to the fore arm. Subsequently the left hand became affected, but to a less degree. He was in the army, and therefore was not called on to use his hands unduly. On his admission the affected muscles were found to be greatly wasted, the thenar and hypothenar eminences being quite hollowed out. He had more loss of power

on getting out of bed in the morning than at any other time. He was ordered to take julep. iodinii comp., and to use the continuous current; no marked improvement, however, took place, and he went out on Dec. 31, 1867. He continued to attend as an out-patient, but without result, and when I last saw him he was still in statu quo.

Case 3.-(Reported by Mr. H. K. King.)—W. R., age 49, a saddler, adInitted into the clinical ward, under Dr. Moxon's care, July 2, 1867. For about twelve months he had noticed his thumb to be getting weak; and for six months he had found that he had difficulty in holding a pen. There was much wasting of the flexors of the fore-arms, and of the thumb muscles. He could not grasp with the thumb, nor could he extend the last two joints of the fingers. The case, in fact, was a well-marked example of Cruveilhier's paralysis. Treatment with the continuous current was commenced on July 8. It led to no very decided improvement. He went out on Sept. 9th.

CASES TREATED BY INDUCED CURRENTS.

Case 6.-(From notes by Mr. Barry.)—G. L—, age 53, admitted under my care, Feb. 6, 1867, with very advanced progressive muscular atrophy of the upper limbs, and a similar affection commencing in the thighs, as was shown by muscular tremors and shooting pains. The disease had begun four months before. When this patient was in the hospital, the continuous_current apparatus was not available, and therefore the affected parts were Faradized as regularly as possible. The biceps was the only muscle of the upper limb in which distinct contractions were produced by the induced current. He went out on June 4, unrelieved. After returning home he improved considerably, so far as the lower limbs were concerned. I went to see him at Orpington in the course of the summer; and he walked with me for a mile, or a mile and a half. His arms were still in statu quo. I have since heard that he is dead.

This man was a plumber, and had a well-marked blue line on the gums. I at first regarded his case as one of lead paralysis, but I think there is little doubt that this view was incorrect. He had had very little to do with lead for two years before; he had never had colic; there was not the usual dropping of the wrists, flexion and extension being impaired more equally than is the case in lead paralysis; he had taken iodide of potassium as an out-patient without benefit; and the intractability of the symptoms is quite unlike what one sees in lead paralysis. It is to be regretted that we could not test the action of continuous currents on the affected limbs; their effects are supposed to afford a critical distinction between the two diseases.

Case 7.-(From notes by Mr. Chapman.)-G. M-, age 47, admitted under my care March 13, 1867. He was affected with well-marked pro

gressive muscular atrophy of seven months' duration. The muscles of the shoulders were much wasted, and affected with marked twitchings. He was ordered to take mist. quiniæ c. tint. nucis vomicæ iij, ter die, and to be galvanized every other day. He improved slightly, being able to raise his arms better. But there was no very decided benefit. He went out on

June 4.

66

66

Case 8.-A. C- -, age 24, admitted under Dr. Wilks' care into the Clinical Ward, July 4, 1866. She said that she had never been very strong, and that since the death of her mother, five years before, she had had bad health. Her existing symptoms, however, dated from two years back, when she entirely lost the use of her hands, and ultimately of her legs also." The fingers and toes became firmly flexed. On her admission they could not be extended, even by force, and they presented a well-marked griffin'sclaw" appearance. The muscles of the extremities were wasted to an extraordinary degree, the interossei of the hands having almost disappeared, so that the finger and the thumb seemed to meet between the metacarpal bones. She had, in fact, the appearance of a mere skeleton covered by skin. She lay on her back in an utterly prostrate condition, and could only raise her hand a few inches from her bed. There was a distinct blue line" on the gums. The water which she had been drinking was analysed by Dr. Stevenson, who found it to contain half a grain of lead in the gallon. She was, in the first instance, ordered to take iodide of potassium, and after three weeks Faradisation was commenced. She began to improve gradually but surely; and on October 2, when she was transferred into Lydia Ward, she could extend her fingers, and feed herself tolerably well with a knife and fork. The nutrition of the muscles had gradually improved. On October 20, she tried to walk with a chair, but could manage only a few steps at a time. On November 8, she walked across the ward. On December 3, she menstruated for the first time during her illness. On January 7, 1867, she went out well.

This patient has since visited Guy's Hospital, and was then well nourished, healthy-looking, and able to walk as well as ever. Dr. Wilks speaks of the case as perhaps the most remarkable cure (or recovery) that has ever come under his observation.-Practitioner, Dec. 1868, p. 345.

29.-CASES ILLUSTRATIVE OF THE TREATMENT OF PARALYSIS BY THE APPLICATION OF COLD OR HEAT ALONG THE SPINE.

By Dr. JOHN CHAPMAN, Physician to the Farringdon General Dispensary.

Case of Apoplexy with Hemiplegia.-On December 3, 1864, I was called to see a gentleman, aged 55, whom I found in a state of profound stupor; he could not be roused, the right arm and leg were paralysed, the leg less completely so than the arm. When the hand was pinched severely there was no evidence of sensibility; the left hand was of a markedly dusky hue, the nails being slightly purple; the temperature of the left side was considerably lower than that of the right, and the pulse which was 82, was much feebler at the left than at the right wrist; the head was hot; both eyes were closed, the left one being protruded abnormally and slightly lachrymose; the face was drawn to the left side.

I applied an 8 inch spinal water-bag, containing water at 120° Fahrenheit, to the cervical and upper dorsal region of the spine. This bag was ordered to be refilled at frequent intervals, so that the application of heat might be continuous during the day or whenever the head should be found hotter than natural. A spinal ice-bag was also ordered to be applied at once during three-quarters of an hour to the lower third of the spine, and to be repeated the same afternoon. In less than twenty minutes after the hot-water bag was first applied, the head had become much cooler than before, and within twelve hours some degree of returning consciousness was evinced. The