be, which induces it, exerts its action first upon the nervous centres, and from thence upon the other organic apparatuses, especially upon that of digestion."

In slight cases of intermittent fever, Dr. Broussais has found, both at Paris and Algiers, the administration of cold lavements, either with or without the use of quinine, an excellent means. They seem even to have the effect of preventing an access of fever, which the heat of skin, especially of the abdomen, headache, uneasiness, and loss of appetite, proved to have been imminent. For such patients it has often sufficed to diminish the amount of their food, and administer a few cold injections, to entirely restore their health in a few days.

In respect of the treatment of the worst forms of remittent or pernicious fever, we have the following remarks:

"According to what I have seen and heard in Algeria, most of the French practitioners have recourse to general and local bleeding; some, however, employing it with confidence, and relying much upon its association with an antiperiodic medication, and others resorting to it with reluctance, and with much doubt as to its utility. It soon became evident to me, upon my arrival in Africa, that not only is bleeding useful in intermittent, and especially remittent fever, but that there is no disease or country in which it is of such efficacy as in these Algerian fevers. It, so to say, relieves the disease in a few hours, save where there is serious inflammation or changes of structure, and it forms an admirable preparative for quinine. I have frequently seen this drug quite inoperative until some leeches or a bleeding have removed the complication which proved an obstacle to success. Notwithstanding the great efficacy of bleeding, I have not resorted to it in all cases; but when the patient has presented a weak faltering pulse, and other signs of collapse, I have at once ordered him a large dose of quinine, often with æther, employing revulsives at the same time. These last are highly useful in the comatose and algid forms of the disease, but only as adjuncts to other measures. As to quinine, it has operated wonders, whether given alone or in combination with bleeding. When an inflammatory complication has existed, I have administered it immediately after the depletion, without waiting for the moistness and natural colour of the tongue being restored. The loss of blood seemed to enable the patient to pass at once from a state of disease to one of comparative convalescence; and the quinine prevented or moderated the violence of the symptoms, which always manifested their tendency to return. Upon these points I may refer to the practice of Johnson and Twining in India, and the success which followed their free use of the lancet."

Sporadic Affections.-The only one of these Dr. C. Broussais dwells upon is phthisis pulmonalis. In 930 patients admitted from the 1st January to the 1st November, only eight cases of pulmonary tubercles presented themselves, giving one for 116 patients; a proportion small indeed, compared with that observed in the military hospitals of France, where a case of consumption showed itself in every 41 patients, during 1831-44. Again, in 41 deaths, 2 only from phthisis are met with, or 1 in 20; while the proportion in Paris is 1 in 5.

"This disease is then, without any doubt, much less frequent in our African possessions than in France, and so great is the difference, that it evidently depends on the climate, no secondary circumstance being capable of producing it. But to render the difference still more striking, we must take into account the autopsies at which the patients, having sank under different diseases foreign to those

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of the chest, tubercles are nevertheless met with. Common as is this case at Paris, we only met with three examples in Algeria. Still, rare as is phthisis, it does occur in Algeria, and may originate there. And not only may it do so, but also, in spite of a prolonged residence, the vicinity of marshy emanations, or the occurrence of numerous attacks of fever. The antagonism announced by Dr. Boudin is, in our eyes, an ingenious hypothesis, but, being destitute of foundation, it crumbles before exact observation. To complete this subject, we have to state the influence of the climate of Algeria upon the progress and cure of phthisis. Is its progress more rapid in Algeria? Certainly not, according to our documents. Is there a greater chance of cure than in France? The same documents reply affirmatively; for we have observed cures of circumscribed tubercle, and extraordinary amelioration in suppurating tubercle."

RESEARCHES ON THE CONDITION OF THE BLOOD IN THE ENDEMIC DISEASES OF ALGERIA. By MM. Leonard and Foley.

This forms an interesting complement to the paper just considered, and consists in a detailed account of numerous analyses of the blood in the febrile diseases of Africa, conducted in the same manner as those of MM. Andral and Gavarret were performed. Comprehensive tables, exhibiting the amount of the various component parts of the fluid, are given; but we can only find space for the general recapitulation of results.

"1. The fibrine is found in its natural proportions at the commencement of the fever. 2. It is diminished by the influence of duration and relapse of fever. 3. The passage from intermittence to remittence, from the continuous to the pernicious form, does not produce an increase or diminution of the quantity in any constant manner. 4. The amount is somewhat increased if there be complications, leading to the conclusion that these are of an inflammatory character. 5. The congestion of organs, which takes place under the influence of fever, may in some few cases proceed to the extent of inflammation, and in this way give rise to an increase of fibrine. 6. The engorgement of the spleen, which is observed in intermittent fever, is only exceptionably coincident with a defibrinated state of the blood, contrary to what is met with in the typhoid state. 7. The proportion of globules is only exceptionably increased, its tendency being to remain stationary or diminish. 8. The diminution only takes place under the influence of the prolongations of the disease, relapses, and an enfeeblement of the constitution. 9. Although the instances of increase usually occur in the severe forms of the disease, we cannot establish a relationship between these two circumstances. 10. The solid matters of the serum have a tendency to diminish in quantity, and this equally with the organic and inorganic materials. 11. The diminution of the proportion of albumen is very marked; but does not take place to the profit of the fibrine or the globules. 12. The proportion of water is diminished only in some very rare cases. It generally is increased, and often very markedly so. It is so almost always at the expense of the globules.

"To what reflections do our researches give rise? It cannot be denied that the blood is submitted to modifications in its crasis during the course of these fevers. These modifications are such, that, interpreted as by pathologists who have preceded us in the examination of other diseases, they will explain the morbid phenomena observed at a certain period of the pyrexia, (viz. those which succeed to the acute stage, preserving only the febrile periodicity, which indeed may also have ceased,) and are exhibited in chloro-anemia, anasarca, ascites, scorbutus, nasal hæmorrhage, &c. The impoverishment of the elements of the blood, considered separately as to the effects each exerts upon the organism, ex

hibits itself as regards the globules, by the general debility, the decolouration of the skin and mucous membranes, and certain disorders, of the circulation; the fibrine, by the violet spots of the skin, the epistaxis, the scorbutic bleeding from, and sometimes the gangrene of, the mouth, and the muscular pains of the limbs: the albumen, in puffiness, serous infiltration, ascites, and perhaps that serous diarrhoea which, in persons exhausted by fevers, almost always terminates the above-named disorders of the economy. *

*

**

*

*

*

*

*

*

*

*

* We must admit as conclusions-1. That the vitiation of the blood, such at least as it has been exhibited in our researches, can only be looked upon as consecutive, and as an effect of the disease. 2. That this vitiation, which is also manifested in other diseases as a consequence of their duration, as the beautiful researches of MM. Andral, Gavarret, Becquerel, and Rodier have taught us, presents no peculiarity in this description of affection, only inasmuch as it implicates, at the same time, a greater number of the elements of the fluid. 3. That if the development of the fever is the result of the poisoning of the blood, which we do not absolutely deny it may be, the presence of the principle causing it is yet to find, and we may just as reasonably attribute, in the mean time, the earliest symptoms indicating the existence of the disease, to a morbid modification of some of the apparatus of the nervous system. 4. That to a certain degree the same reproaches may be addressed to the humoral pathology as to the anatomical pathology of the solids; that it fails to entirely raise the veil which conceals the essence of the disease from our view. 5. That notwithstanding this, the knowledge of the change or the proportion of several of the elements of the blood, operated by the influence of diseases, should be looked upon as a real addition to that of the lesions which the solids undergo; for it serves in some cases to clear up and explain the pathology of these latter. That after the study of the fluids of the animal organism should come another, that of the laws by which that power which governs all the other systems of the economy acts. Little does it matter whether we call it vital power, innervation, plastic force or vital dynamism, provided it be examined by the procedures of philosophical experiment. The following sentence of Hippocrates will then receive its confirmation: 'We must consider in man not only the containing parts or solids, and the contained parts or liquids, but especially the active powers or the cause of vital movement.'

6.

CASES OF WOUNDS AND DISEASES OF THE BRAIN, WHICH TEND TO PROVE THAT THE FACULTY OF LANGUAGE IS PLACED IN THE ANTERIOR LOBES OF THAT ORGAN. By M. Bonnafont.

In the first of these, a musket-ball entered the anterior portion of the left temple, and passed out at the same point on the opposite side, having traversed the anterior lobes of the brain. Some of the cerebral substance passed out at the apertures. The soldier, at first insensible, soon recovered his faculties, except that of smell, and the power of articulation. He preserved his memory of things and facts, as well as his hearing, as was manifested by the signs he made upon various questions being asked him. Five hours after he became comatose, and died 18 hours after the receipt of the wound. In the second case the ball traversed the right anterior lobe from below upwards, as well as the upper portion of the opposite lobe. The wounded man heard what was addressed to him, and at every question made a kind of groan, but he had entirely lost the power of speech. He died the next day. Case 3.-A man about 50 years of age was admitted into the Nantes hospital as insane, and, although speaking

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with difficulty, he could make himself understood, but his embarrassment of pronunciation increased, so that for 18 months before his death he was obliged, excepting two or three words, to express everything by signs. At the autopsy, an osseous tumour, the size of a large nut, was found in the left coronal fossa, which by its pressure had caused the disappearance of nearly the entire corresponding lobe of the brain, and a strong depression in the opposite one. The fourth case was that of a woman (æt. 55), who for several years had lost the power of speech, except for one word, which she incessantly repeated. At the autopsy, the two anterior lobes were found nearly atrophied and surrounded by a large quantity of fluid. The fifth case relates to the loss of memory properly so called, and not to the loss of the faculty of language. A sergeant was struck by a ball on the right parietal bone, its course seeming afterwards to be downwards and forwards towards the base of the brain. The attendants were surprised at hearing the wounded man reply at random to questions which were addressed to him. The reporter found he answered correctly enough when the question required no exercise of memory; but, in regard to anything which had happened, even a few days before, he made vain efforts to recollect himself. He continually exclaimed, "How strange it is that I should have lost my memory. He died the next day but the urgency of affairs prevented an autopsy being made. Case 6.-A soldier (æt. 22,) was struck on the right temporo-parietal region by some fragments of rock during the explosion of a mine, which drove the bone in upon the contents of the cranium. He remained some days unconscious; and on coming to himself he was deaf and partially blind, and had lost his memory to such an extent as scarcely to recollect the cause of his accident. The sight was gradually restored, as also, by the aid of galvanism, the hearing; but his memory, which was once very excellent, so as to enable him to commit long passages to it, and though now (eight months) somewhat improved, continues very defective, so that he is obliged to make great efforts to recall any event which but the evening before had made a great impression upon him. Oftentimes he cannot recollect for very short periods what has been said to him, however great the efforts to this end he may make. His speech is fluent, but certain words, which he pronounced well prior to his accident, are now articulated with difficulty. The consciousness of his state much annoys this patient, for he can write words correctly which he cannot pronounce without great difficulty.

ON FOREIGN BODIES IN THE EAR. By M. Latour.

These are numerous, and are naturally divided into two classes, those which are developed in, and those which are introduced into, the meatus. The latter class may be subdivided into bodies possessing spontaneous movements (insects): 2, bodies susceptible of swelling or even germinating in the ear (peas, &c.): 3, bodies of an invariable size (leaden balls, &c.): 4, liquid substances, capable of exerting chemical action on the parietes of the meatus (acids, &c.) These divisions are not useless, and are much the same as those adopted by Paulus Ægineta and Ambrose Paré.

The symptoms are too obvious for transcription, in spite of which, however, the diagnosis is not always correctly made. A case is cited in which a fruit-stone has been mistaken for a sequestrum of the temporal bone; while at other times the canal has been needlessly irritated in searching for a foreign body which it did not contain. M. Velpeau relates a case in which the worst consequences resulted from this. Such occurrences will seem less strange when we recollect that few medical men habituate themselves to the exploration of the meatus. This would be unpardonable neglect in the military surgeon, seeing the frequency with which this part is made the seat of fraudulent attempts. The usual directions given for inspecting the ear are valueless, and nothing but the speculum will suffice in most cases. Its utility has been long recognized: for Fabricius Hildamus gives us a figure of one little differing from that now in use. M. Latour, however, considers the latter as too voluminous, and has contrived a simpler, smaller, and less expensive one, which can be put into an ordinary pocket-case. The sitting position is the best for its employment. The pavilion of the ear is to be drawn backwards, upwards, and outwards by the left hand, and the speculum gently introduced to the depth of from five to seven lines by the other, according to the length of the cartilaginous portion, the valves of the instrument rarely penetrating so far as the osseous portion. These are then expanded as much as possible and the direct rays of the sun, if obtainable, admitted. If not, we must have recourse to artificial light, employing reflecting lamps, or a silver spoon to concentrate the light. The author has frequently concentrated the rays of a candle or lamp by means of a lens. However obtained, the light should always be directed obliquely on the valve of the speculum, for the eye cannot otherwise explore the canal. If the wax is sufficiently abundant to intercept the rays of light it must be removed by the aid of sweet-oil and warm-water injections, or, if it is solid, by means of long thin forceps, having a piece of cotton on their extremities. When we find the canal obstructed by a foreign body, its nature may be often ascertained by catheterism of the meatus, which indeed is the only procedure admissible when the canal is anormally narrow, or its mucous membrane much swollen. In this last case, leeches, emollients, or prepared sponge, must be employed for the dilatation of the passage, according to circumstances.

Prognosis. The presence of a foreign body in the ear is always a serious circumstance. The present disorder of hearing may become permanent. Besides the local symptoms which, and especially the pain, sometimes put on an alarming character, we have always to fear those dreadful effects of sympathy producing encephalic complications, of which so many examples are on record. These complications are of different kinds. Sometimes there is inflammation of the brain or its membranes; sometimes the accidents are of a nervous character, inducing epilepsy or convulsions; and at others, an unusual stimulus is imparted to the salivary glands and a profuse ptyalism brings on a state of marasmus. M. Lallemand believes the affection of the ear induces that of the brain, not only by propagating the diseased action by contiguity, but by maintaining a constant state of congestion near the cranium. In stating an opinion a number of circumstances must be taken into consideration, such as the irritability of the