eertainty to any proposed point. As time and the disease proceed, difficulties increase: writing can now be hardly at all accomplished; and reading, from the tremulous motion, is accomplished with some difficulty. Whilst at meals the fork, not being duly directed, frequently fails to raise the morsel from the plate which, when seized, is with much difficulty conveyed to the mouth. At this stage the patient seldom experiences a suspension of the agitation of his limbs. Commencing, for instance, in one arm, the wearisome agitation is borne until beyond sufferance, when, by suddenly changing the posture, it is for a time stopped in that limb, to commence, generally, in less than a minute in one of the legs, or in the arm of the other side. Harassed by this tormenting round, the patient has recourse to walking, a mode of exercise to which the sufferers from this malady are in general partial; owing to their attention being thereby somewhat diverted from their unpleasant feelings, by the care and exertion required to ensure its safe performance.

"But, as the malady proceeds, even this temporary mitigation of suffering from the agitation of the limbs. is denied. The propensity to lean forward becomes invincible, and the patient is thereby forced to step on the toes and fore part of the feet, whilst the upper part of the body is thrown so far forward as to render it difficult to avoid falling on the face. In some cases, when this state of the malady is attained, the patient can no longer exercise himself by walking in his usual manner, but is thrown on the toes and fore part of the feet; being, at the same time, irresistibly impelled to take much quicker and shorter steps, and thereby to adopt unwillingly a running pace. In some cases it is found necessary entirely to substitute running for walking; since otherwise the patient, on proceeding only a very few paces, would inevitably fall.

"The tees now becomes much faried. The tremzlona motions of the limbs cean furing deep, and ang mens until they awaken the patient, and frequently with much agitation and alarm. The power of conveying the food to the month is at length so much impeded that he la do get to consent to be fed by others. The bowels, which had been all along torpid, now in most cases demand stimulating medicines of very considerable power: the expation of matter from the rectum sometimes requiring mechanical ail As the disease pro

ceeds towards its last stage, the trunk is almost permanently bowed, the muscular power is more decidedly diminished, and tremulous agitation becomes violent.

"The patient walks now with great difficulty, and unable any longer to support himself with his stick, he dares not venture on this exercise unless assisted by an attendant, who, walking backwards before him, prevents him falling forwards by the pressure of his hands against the fore part of his shoulders. His words are now scarcely intelligible, and he is not only no longer able to feed himself, but when the food is conveyed to the mouth, so much are the actions of the muscles of the tongue, pharynx, &c., impeded by impaired action and perpetual agitation, that the food is with difficulty retained in the mouth until masticated, and then as difficultly swallowed. Now also, from the same cause, another very unpleasant circumstance occurs; the saliva fails of being directed to the back part of the fauces, and hence is continually draining from the mouth mixed with the particles of food which he is no longer able to clear from the inside of the mouth.

"As the debility increases, and the influence of the will over the muscles fades away, the tremulous agitation. becomes more vehement. It now suddenly leaves him for a moment; but even when exhausted, nature seizes a small portion of sleep, the motion becomes so violent

as not only to shake the bed-hangings, but even the floor and sashes of the room.

"The chin is now almost immovably bent down upon the sternum. The fluids with which he is attempted to be fed, with the saliva, are continually trickling from the mouth.

"The power of articulation is lost. The evacuations are passed involuntarily; and at the last, constant sleepiness, with slight delirium, and other marks of extreme exhaustion, announce the fatal result."

AFFECTIONS OF THE SPINAL CORD.-As a general rule, the motor power is affected in all cases of softening of the spinal marrow, but there are exceptional cases on record.

Dr. Janson, of Lyons, has published the particulars of a case in which the spinal marrow was, for the most part, in a state of bouillie, yet the patient had no impediment in the power of motion. M. Velpeau cites a case in which the cervical portion of the spinal cord was morbidly softened without impairing the motor power. In animals the spinal cord has been damaged without interfering with the movements. Andral, when addressing himself to this subject, observes: "do all not know that the foetus, during uterine life, has free power of motion, although its spinal cord at that period is far from having that consistence which it acquires subsequently." M. Rullier relates a case where there was considerable softening of the spinal cord, but communication was maintained between the upper and lower portions of the cord merely by a slight though firm slip; there was no relation between the part of the cord affected and the parts of the body capable of being moved; the patient could walk, but his arms were paralysed and contracted.

There is a form of acute softening of the spinal marrow which developes itself very suddenly, progresses with great rapidity, and speedily terminates in death.

These cases of acute ramollissement of the spinal cord resemble, in many of their features, those of cerebral hemorrhage. The patient, in the first instance, appears to have an attack of lumbago, this is succeeded by great muscular debility in the spinal column, as well as in the lower extremities. Coma then speedily supervenes, the limbs become forcibly contracted, and the patient dies in a state of tetanic spasm. In many cases, however, even in acute softening of the spinal cord, the mind often continues unclouded until the moment of death.

PERIPHERAL PARALYSIS.-I have not yet spoken of those lesions of the motor and sensorial power which commence in the peripheral extremities of the nerves, and which are occasionally seen to progress upwards from the lower limbs, and ultimately involve the great nervous ganglia, and eventually the brain itself.

I have seen several remarkable cases of this kind. The early symptoms of this affection are occasionally altogether overlooked in consequence of their great obscurity. A patient complains of a general failure in the muscular tone of his feet and legs. He (if accustomed to active walking) is conscious of his inability to take his usual amount of exercise. He notices for some time no other alteration in the motor power. The loss of muscular strength is confined to the foot and leg. This state of local partial paralysis may exist for years before the patient has any apprehension of danger, or feels under the necessity of obtaining medical advice. In one remarkable case that came under my notice, I was informed that this failure of muscular power had been progressing gradually for six years. It was first observed in the foot, it then extended to the legs and arms, and it was not until the expiration of seven years that the brain became involved! Occasionally the paralysis is confined to the legs, and appears to be arrested there, in the course of its progress upwards towards the brain.

CHAPTER XIX.

Morbid Phenomena of Speech.

THIS division of the subject will be considered in the following order :

1. Cerebral Localization of Speech. 2. Irregular Action of Articulation. 3. Impairment and Loss of Speech. 4. Morbid Imitative Movements of Articulation. Involuntary Articulation.

Various attempts have been made to localize the organs of speech, and to ascertain by carefully executed post mortem examinations, as well as by accurately observed physiological experiments made upon animals during life, the precise portion of the brain influencing and regulating this faculty.

The following distinguished physiologists, Gall, Serres, Pinel, Grandchamp, Belhomme, and Bouillard, maintain that the anterior lobes of the brain preside over the organ of speech, and a number of cases of total and partial loss of this function have been cited, in which this portion of the encephalon has been discovered, after death, to be in a state of organic disease.

In 1845, at l'Académie Royale de Médecine, M. Belhomme read a memoir, "On the Localization of Speech in the anterior lobes of the Brain," in which, by a reference

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