wasting palsy; and with Duchenne, Aran, Oppenheimer, Wachsmuth, and Dr. Meryon, we have to look for the primordial phenomena of the affection in the muscles themselves-probably in a fatty and granular degeneration of the fibre. It is fully admitted, however, that the nervous and muscular systems will sympathize with and react upon each other in this diseased state. We may look, our author says, for three orders of phenomena :

"1. Primary or direct.―These are, destruction of muscle and consequent loss of power. They are necessarily always present, and in the simple cases are the sole factors in the problem.

"2. Secondary or reversed.-These include atrophy and fatty degeneration of the motor nerves, together with softening or other change in the spinal cord. These are not invariably present. Probably some of the neuralgic pains should find a place here; the nervous filaments ministering to the muscular sense, being involved in the general devastation, may be the source of those severe pains sometimes experienced in the substance of the affected muscles; but I am disposed to believe that most of the abnormal sensations and movements are the expression of the next order.

"3. Tertiary or reflected.-These may be produced through irradiation of impressions conveyed to the spinal centre by the nerves of the special muscular sense; or they may be the direct consequences of the secondary organic changes just described as going on in the part of the cord where the nerves of the decaying muscles originate, whereby the contiguous sound portions are irritated. In both these ways abnormal movements and feelings are provoked-undue sensitiveness to cold, neuralgic pains along the nervous trunks or in the joints, twitches, cramps, contractions, and fibrillary tremors."

The treatment advocated divides itself into two lines of indication. "The object of the first is to arrest or cure the atrophy of the muscles, and that of the second to combat the secondary phenomena. In dealing with the primary disease, our first endeavor must be to seek out the exciting cause, and obviate, if that be practicable, its continued operation. The handicraftsman must immediately renounce the practice of his mechanical art; the laborer must take off the strain from the overworked members. If cold and damp be the original excitant, they must be sedulously avoided in future, to escape the risk of a recrudescence or relapse. The direct treatment must have for its end, in the active stage of the malady, to restore the nutritive operations from their depraved estate to their original healthy tenor. This is accomplished by a judicious combination of perfect repose and regular stimulation. Experience has shown that for the latter purpose no remedy approaches galvanism, which should be applied to the muscles daily, or every other day, in the manner above directed. With galvanism may be combined gentle frictions of the parts affected, with some stimulating liniment; and, if the means be at hand, warm sulphuretted or saline baths may be employed occasionally, as adjuvants to the local applications. When the disease has become stationary, more violent stimulation by electricity and friction must be resorted to, and cold bathing, with enforced exercise of the muscles, may be tried, if other means fail of effect. Remedies should be applied without loss of time, for when the atrophy has extensively affected the muscles of the trunk, or has remained stationary for a lengthened period, the chance of recovery diminishes in an accelerated ratio.

The secondary phenomena, neuralgic pains, spasms, &c., are most effectually subdued by warm baths and inunctions; or, if they obstinately persist, by morphia-dressed blisters over the painful tracks. Any ailment of the general system, or concurrent and independent disease, must be dealt with, in accordance with the recognized canons of therapeutics."

On Cerebellar Hemorrhage. By Dr. J. R. HILLAIRET, Physician to the Hospital for Incurables in Paris. (Archiv. Gén. de Méd.,' February, March, April,

May, 1858.)

This very elaborate and valuable memoir is divided into two parts; one part containing eight cases, six of them original; the other part containing a general description of the two principal forms of the malady, an examination of

each of the more important symptoms, and a comparison between cerebellar and cerebral hemorrhage.

Cerebellar hemorrhage, according to M. Hillairet, occurs under two forms; one slow, and progressing regularly from the attack until death; the other sudden, and almost immediately fatal. The last is the most frequent of the two.

In the first form the consciousness is preserved at the moment of the attack; in the second form the consciousness may be lost at the moment of the attack, but only momentarily.

In both forms, but particularly in the first, the attack is followed by vomitings, which recur frequently during the course of the malady, and will not be stayed. M. Hillairet considers that vomiting is a symptom which has some special relation to cerebellar hemorrhage, or to some lesion which may bring about an augmentation in the volume of the cerebellum, and he differs with those who think that it is a symptom of cerebral hemorrhage. In some cases the vomiting has coincided with laceration of the gray substance of the periphery, but in all cases the author refers this phenomenon to some slight compression or irritation of the pneumogastric nerves, which compression or irritation is brought about by the pressure of the blood effused within or upon the cerebellum. Vomiting is also observed in other affections of the cerebellum, which are attended by augmentation in the volume of this organ, such as abscess, cysts, tubercles, and, but very rarely, in cases of softening where the volume of the organ is not sensibly increased, and where, consequently, the pneumogastrics are not subjected to the irritation of pressure. In a word, M. Hillairet differs from the majority of writers on this subject, and considers that vomiting is of very rare occurrence in cerebral hemorrhage, unless the cerebellum is implicated. Thus, according to his experience, there was vomiting only in 1 case in 30 where the hemorrhage was cerebral, but as much as 1 in 2.30 where it was cerebellar.

In sudden and severe cerebral apoplexy the patient falls without sense and consciousness, breathes stertorously, and, as a rule, death does not happen until after an interval of some hours; in sudden and severe cerebellar apoplexy, on the contrary, the patient is often able to give expression to his suffering at the moment of attack by a cry, a gesture, or in actual words, and except for a short time before death, which happens speedily, the intelligence is not completely abolished.

Hemiplegia is not so frequent a symptom of cerebellar apoplexy as has been supposed. It has been said to be present in a third of the cases; in the cases recorded in the present memoir it was not met with. The paralysis has been always on the opposite side of the body; at the same time it is possible, as M. Longet has shown, that in some cases a want of decussation may lead to paralysis on the same side. In no instance would there appear to be conclusive proof that the paralysis was either general or confined to the lower part of the body. In many cases the paralysis is incomplete, and the limbs relaxed rather than palsied. Thus, the patient will be unable to preserve his equilibrium if he attempts to stand; but if he lies down, he is able to move his legs about, or even to raise them from the bed and maintain them in an elevated position.

There was no tendency to move backwards or to turn round and round in any of the cases contained in M. Hillairet's memoir; but in one of them the patient, before the attack complained of being pushed by some irresistible force towards the left side.

Paralysis on the oposite side of the face, which is habitual in cerebral hemorrhage, is not only met with in exceptional instances in cases of cerebellar hemorrhage. In the latter cases, also, deviation of the tongue is quite exceptional; but notwithstanding this, the speech, as a rule, is dull and drawling. Only once in 26 cases was there any deviation of the commissures of the lips. M. Hillairet also directs attention to a silly astonished expression of countenance, accompanied by a fixed stare, as being present at the time of the attack; but this phenomenon may easily be overlooked, for it soon passes off. In severe cerebellar apoplexy the sensibility would at first seem to remain uninjured. Once, about the middle of the course of the disorder, M. Hillairet

observed a momentary state of hyperesthesia. Once only was the sensibility lost from the beginning. Afterwards, as a matter of course, the sensibility disappears as the state of coma gains ground.

The special senses are affected the same way as common sensibility. At the beginning it is quite exceptional for the sense of hearing, smelling, or tasting, to be at all impaired. Sometimes, when the processus cerebelli ad testes are injured or destroyed, sight may be enfeebled or abolished. It would seem also that contraction and immobility of the pupils are the rule, dilatation the exception.

Convulsions are not met with in cerebellar hemorrhage, if the mischief be confined to the organ, or in cases where the effused blood has set up an inflammatory action in the surrounding cerebellar structures.

Most generally the bowels do not act, but sometimes there age involuntary evacuations. In the form of apoplexy which is slow and progressive, the power of passing water is preserved at first; in the sudden form it is lost from the beginning.

The mean duration of cerebellar apoplexy, not including "les cas foudroyants," is a day and a half.

In a word, there are certain common symptoms, which belong equally to cerebral and cerebellar apoplexy, such as general headache, vertigo, dimness of sight, ringing in the ears, hemiplegia, and so on; but there are also certain differences which may help us to a diagnosis, and M. Hillairet's memoir is an important contribution to the knowledge of these differences.

The Physiology and Pathology of the Central Nervous System. By E. BROWNSéquard, M. D. (Lancet,' various Nos. from July 3d to December 18th, 1858.)

The following lectures, which contain the most recent statement of the views of this distinguished physiologist upon this subject, were delivered before the Royal College of Surgeons of England, in May, 1858.

Lecture 1-This is devoted chiefly to the setting forth of the truth of Sir Charles Bell's theory as regards the existence of two distinct sets of nervous conductors-the sensitive and the motor. With respect to the pain produced by the irritation of the anterior roots of nerves (the "recurring sensibility" of Magendie)-a phenomenon which has been urged as an objection to the purely motor character of these roots-the explanation given by Dr. Brown-Séquard is, that the irritation gives rise to cramp, which cramp is the cause of the pain, and his conclusion is, that there is no sensibility of any kind in the anterior roots, and that it is because they are motor, and not because they are sensitive, that they cause pain when they are irritated.

Lecture II.-In this lecture Dr. Brown-Séquard relates certain experiments which show that the transmission of the sensitive impressions along the spinal cord is chiefly in the gray matter. After refuting the views of Longet, and exposing some principal causes of error in experimenting, he relates certain experiments to show that the part, though not itself endowed with sensibility, may be a conductor of sensitive impressions. After this he relates experiments which prove, 1st, that a transversal section of the posterior columns of the spinal cord, instead of causing anesthesia, is followed by hyperesthesia; and, 2dly, that a transversal section of the whole spinal cord, except the posterior columns, is followed by complete anesthesia. As a general conclusion, it would seem that the conductors of sensitive impressions, at their arrival in the spinal cord, either enter directly into the central gray matter, or go up or down a little way in the posterior columns also, most likely in the posterior gray cornua, and in the posterior part of the lateral columns, and entering afterwards the central gray matter, by, or in which, the two sets ascend towards the encephalon. It would seem, also, that the posterior columns of the spinal cord are not, as has been imagined, a bundle of fibres, from the posterior roots of the spinal nerves; and that the restiform bodies, which are the continuations of the posterior columns, are not a place of passage of any of the conductors of the sensitive impressions of either the various parts of the trunk and limbs, or of the head;

and that, therefore, the cerebellum, with which the restiform bodies are connected, does not receive from them any of such conductors.

Lecture III.-In this lecture, Dr. Brown-Séquard shows that the celebrated experiments of Galen, which have been always thought to prove that there is no decussation of the conductors of sensitive impressions in the spinal cord, do not prove anything in this respect; and after this he proves, we think conclusively, that the conductors of sensitive impressions make their decussation in the neighborhood of the place of insertion of the sensitive nerves or roots of nerves, in the cerebro-spinal axis. As regards the sensitive fibres of the trunk and limbs, the following experiments show that their decussation takes place in the spinal cord.

"1st. In a mammal the spinal cord is laid bare at the level of the two or three last dorsal vertebræ, and a lateral half of this organ (including the posterior, the lateral, and the anterior columns, and all the gray matter, on one side) is divided transversely. The animal is left at rest for a little while, and then it is ascertained that sensibility seems to be much increased in the pos terior limb on the side of the section, while it seems to be lost, or extremely diminished, in the posterior limb on the opposite side. There seems to be, therefore, hyperesthesia behind and on the side of a transversal section of a complete lateral half of the spinal cord; while, on the contrary, there seems to be anaesthesia behind the section, and on the opposite side.

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This experiment is one of the two made by Galen; but he seems not to have looked at all the condition of sensibility, and he simply states that there is a paralysis on the side of the section, and no paralysis on the opposite side. "Schoeps, Van Dean, and Stilling have observed that sensibility is not lost in the limb or limbs behind and on the side of the section of a lateral half of the spinal cord; but they have not remarked the most important fact, that on the opposite side there is anæsthesia. They also do not mention this curious result of this experiment, the existence of hyperæsthesia on the side of the injury.

"2d. If, after having made a first section of a lateral half of the spinal cord in the dorsal region, on the right side, for instance, and after having ascertained that the right posterior limb is hyperæsthetic, or at least extremely sensitive, we divide the left lateral half of the spinal cord in the cervical region, we find then that the right posterior limb loses entirely, or almost entirely, its sensibility. This experiment shows clearly that the sensitive impressions coming from the right posterior limb, after the first section, passed across the spinal cord from the right into the left side, along which they were transmitted to the encephalon.

"3d. To obtain a very striking result from the experiment, which consists in only one section of a lateral half of the spinal cord, it is better to make it after the posterior columns have been divided. We know that after this division there is hyperesthesia in the parts of the body which are behind the section; if, after having ascertained this fact, the section of a lateral half is completed where the posterior columns have been divided, we find that the hyperæsthesia seems to increase in the side of the second operation, while, in the opposite side, not only the hyperesthesia, but sensibility entirely disap

pears.

"4th.-There is another mode of proving that the conductors of the sensitive impressions decussate in the spinal cord. In several points of view this mode of proving is superior to the preceding. It consists in a longitudinal section of the spinal cord, an experiment already made by Galen, but the results of which, as regards sensibility, have been overlooked by him.

"The spinal cord is laid bare in the whole lumbar region, and a careful division of the entire extent of the part of the organ giving origin to the nerves of the posterior limbs, is made so as to separate the two lateral halves of the organ, one from the other. If this experiment could be executed perfectly well, nothing would be divided in the cord except the commissures, which unite the right side with the left side of the cord, and all the longitudinal elements of this nervous centre would be left uniniured; but it is impossible not to cut more or less on either side. Howeve the operation has succeeded

well, i. e., when the two separated halves have been very little injured, a striking result is obtained. The voluntary movements still exist in the posterior limbs (though diminished on account of the injury to the muscles of the lumbar region), but sensibility is entirely lost in them. For persons who know that injuries to the spinal cord, which cause a diminution of sensibility, always produce a greater diminution of voluntary movements, this fact will not be explained by the supposition that some injury has, then, been made to the two halves of the cord, and that it is in consequence of this supposed injury that the loss of sensibility is due. At least it will, I think, be easily admitted that if the two lateral halves of the cord had been injured enough to produce a complete and a lasting anæsthesia, there would be a notable degree of paralysis of voluntary movements. We repeat that such is not the case; the animal has the use of his two limbs; he moves about pretty freely, as Galen had already said. The loss of sensibility, therefore, must depend on the section of the commissures of the spinal cord, or, in other words, on elements of this organ which cross each other in the median line, or, rather, in the median plane.

"If now we compare the results of this experiment with those of a transversal section of a lateral half of the spinal cord, we find that they agree perfectly in showing that the conductors of the sensitive impressions decussate in this organ.

"5th. Another experiment, which is a combination of two of the preceding, gives a still better proof of the decussation of the conductors of sensitive impressions in the spinal cord. A longitudinal section is made on the cervicobrachial enlargement of the spinal cord, so as to separate it in two lateral halves. I ascertain then that sensibility is lost in the two anterior limbs, while it remains, and even seems to be increased, in the two posterior limbs. Of course, if the loss of sensibility in the two anterior limbs depended upon an injury to the two sides of the cord, and not upon a section of the decussating conductors of sensitive impressions, there would be a loss of sensibility, or, at least, a diminution of it in the posterior limbs. The admission of a decussation explains the two facts-loss of sensibility in one set of limbs, and conservation of it in the other set. If we divide transversely, in the same animal, the right lateral half of the spinal cord, we find then that the posterior limb on the same side becomes more evidently hyperesthetic than before, and that the left posterior limb loses its sensibility. The transmission for this last limb, therefore, took place by the right half of the cord, while that for the right posterior limb continues to take place by the left half of the cord."

As far as experiments go, it is very difficult to decide whether the decussation of the conductors of sensitive impressions is absolutely complete or not, but it seems to be very nearly, if not absolutely, complete. In reptiles and birds the decussation is not so complete and immediate as in mammals; in man (judging from certain pathological cases which will be considered afterwards) it would seem to be complete.

Lecture IV.-One question discussed in this lecture is-how is it that sensibility is not lost, but only more or less diminished, although the spinal cord is deeply altered? This question seems to have its solution in the following experiment:

If we divide transversely the posterior columns in the upper part of the lumbar region in a mammal, we find that there is hyperesthesia everywhere behind the section; if, then, we divide the posterior parts of the lateral columns and the posterior gray horns, we find that the hyperesthesia increases also everywhere behind the section. If the section is carried further, so as to have the whole posterior half divided transversely, the posterior part of the gray matter, behind the central canal, being cut, the hyperesthesia remains excessive everywhere behind the section. When another section is made, cutting a little more of the central gray matter, the hyperesthesia disappears from everywhere at once, and a certain degree of anesthesia appears everywhere behind the section. At last, if the whole of the central gray matter be divided, with also a good part of the basis of the anterior horns, sensibility is very much diminished everywhere behind the division, and it disappears entirely everywhere at the same time when the section has left only the anterior parts of the ante