of the whole number of cases; and in improving only more or less 11-14ths so far that the suppuration was moderated, seldom quite removed, and not unfrequently the hearing somewhat improved. Two fourteenths of all the cases remained uncured.

Stricture of the Eustachian tube. The figure of the curability of this affection is still more unfavorable than that of the curability of chronic inflammation of the membrana tympani.

Nervous deafness. "As the little success of treatment," says our author, "in chronic inflammation of the membrana tympani and in stricture of the Eustachian tube is essentially owing to the invariable obstinacy of the organic changes of the affected parts, so in nervous deafness the results of treatment have been equally unfavorable in consequence of the too far advanced state of depression of the vital energy of the auditory nerves. They, in fact, not only are affected with simple diminished susceptibility for sound, even to complete deafness, but at the same time with a morbid susceptibility for impressions of every kind, increasing with the deafness. The consequence of this is, that the mildest applications only can be borne. Indeed in cases of much developed nervous deafness, the impossibility of any improvement depends principally on the impossibility of finding remedies which will operate gently enough on the auditory nerves and not overirritate them." (pp. 179-80.)

It will be seen that these therapeutical speculations of our author are dictated by the pathological views he entertains regarding the cases he calls cases of nervous deafness, but from which views we have above altogether dissented. Practically, however, we equally admit the hitherto little curability of the affections referred to.

Besides these extremely unfavorable circumstances, Dr. Kramer encountered still another, viz., that 3-5ths of his patients labouring under nervous deafness had already passed their 30th year before consulting him, and that in more than half, the complaint had already existed longer than 10 years; and lastly, that in 2-7ths the deafness had already attained the highest degree-viz., either total deafness or incapacity to hear the watch on application.

Dr. Kramer either did not at all undertake the treatment, or, having undertaken it, soon relinquished it as hopeless in 5-20th, i. e. 271 of his patients, in consequence of their not bearing the mildest applications, although the circumstances of the case were otherwise favorable, such as youth and a moderate degree of deafness.

On the other hand, he succeeded in benefiting, both in regard to hearing and tinnitus, 14-20ths of his patients, i. e. 703, though in very different degrees, according to the age of the patient, the length of time the disease had existed, the degree of its development, and to the length of the treatment.

In 1-20th, or 54 of the cases only, was a perfect cure effected, but the attending circumstances were of the most favorable kind, such as inconsiderable development of the disease and youth of the patient.

In regard to his mode of treating nervous deafness, Dr. Kramer tells us that it is still essentially the same as that described in his treatise on the Nature and Treatment of the Diseases of the Ear, viz. the introduction into the cavity of the tympanum of stimulating vapours. Instead of the vapour of acetic ether, however, which he formerly recommended, but which he has of late years found too stimulating, and therefore not so

well borne, he recommends the vapour of aqua assafœtidæ simplex, of musk, of aqua amygd. amar. sine spiritu parata, and the like.

General treatment, in addition to this local treatment, he had recourse to only for other attendant complaints, the occurrence of which was on the whole rare. But he remarks, that although such concomitant complaints be removed by the general treatment, the nervous deafness may be little or not at all benefited. It is, however, he continues, always quite proper, before the commencement of the local treatment of the auditory nerve, to bring the general health into as good a state as possible.

3. Diseases incapable of cure, but under peculiarly favorable circumstances admitting of amelioration. Under this head Dr. Kramer places otitis interna. In otitis interna resolution sometimes takes place, but seldom. In most cases, besides destruction of the organ, there is danger of life.

4. Unconditionally incurable diseases. Under this head Dr. Kramer places obliteration of the Eustachian tube and deaf-dumbness.

Besides the "Statistics," of which we have now given a very full abstract, the work before us contains three other contributions, viz. on the Acoustics of the human ear, on Electro-magnetism as a remedy for dullness of hearing and tinnitus aurium, and on Otorrhoea cerebralis. The first and the last of these we pass over, but pause to give the following results of the experience of Dr. Kramer and others as to the value of electromagnetism as a remedy in deafness and tinnitus aurium.

1. The magneto-electric or electro-magnetic current acts decidedly as an excitant on the organ of hearing.

2. This action is strongest when there is an affection of one or both auditory nerves, and the magneto-electric current is conveyed from the mouth of the Eustachian tube to the external auditory passage of the same ear, instead of from one auditory passage to the other.

3. The exciting action of megneto-electricity is manifested by convulsive twitchings, pains in the ear, momentary increase of the hearing distance (which, however, very soon diminishes again, or, though it continues some time, it does not amount to any great degree), and by aggravation of the tinnitus, either at the moment or some time after the sitting.

4. Magneto-electricity or electro-magnetism does not thus appear to possess any peculiar strengthening action on the auditory nerves. On the contrary, great care is necessary in the employment of the remedy not to over-excite the affected auditory nerves.

5. Hitherto the results of experience as to the use of the rotation apparatus in diseases of the ear are not encouraging. If, however, for any reason it be had recourse to, nervous deafness is the complaint for which it is most adapted; but that the complaint is nervous deafness ought to be first determined by careful instrumental exploration of the outer and middle ear.

6. The application of magneto-electricity ought always to be made with the greatest precaution and in the mildest manner, and always given up whenever, notwithstanding every precaution, decided aggravation of tinnitus takes place, and improvement of the hearing distance is not effected, or, when effected, it is again lost.

ART. III.

Klinische Ergebnisse gesammelt in dem Königlichen Policlinischen Institut der Universität, von dessen Assistenarzte Dr. EDUARD HENOCH, und herausgegeben von Dr. M. H. ROMBERG, &c. &c.—Berlin, 1846. Results of Clinical Observation in the Royal Polyclinical Institute of the University of Berlin. Recorded by Dr. E. HENOCH, and edited by Dr. RoMBERG.––Berlin, 1846. 8vo. pp. 282.

THE results of medical art, as delineated in the present volume, presents points of interest. The name of the editor is a guarantee for the accuracy of the details, and stamps a value upon the clinical and practical information imparted. A field of action, such as the policlinic of a large city like Berlin, must present ample scope for therapeutical experience and experiment, and the practised eye of Dr. Romberg would not fail to view it aright. Further, the preface of the editor contains proofs, that he rightly appreciates the importance of his position as clinical instructor and the value of dispensary practice as a means of instruction.

The cases treated in the dispensary are arranged methodically. First come diseases of the nervous system, according to the neurology adopted by Dr. Romberg, (vide our review of his work in vol. XVII of this Journal): then follow in succession, diseases of the blood, of the alimentary canal, of the sexual and urinary organs, of the thoracic viscera and of the skin.

Cardiac neuralgia, or angina pectoris, was observed only once; it occurred in a tailor aged 40, and was complicated with disease of the aortal valves: death occurred suddenly. The pain was much relieved by

small doses of nitrate of silver.

Hemicrania was also successfully treated by the same remedy.

Cases of chorea St. Viti were frequent. Nine girls, one boy, and two women, aged 24 and 48 respectively, were treated. The left side only was affected in one case; the right side only in three; and in the eight remaining, both sides. The treatment of the cases, in which intestinal worms were the apparent cause of the disease, consisted in the administration of calomel and jalap: when no causal indication was manifest, the infusion of senna was given first to operate on the bowels, and then chalybeates. The hydrochlorate of iron was found to be the most successful, and was prescribed for children in three-grain doses thrice a day, combined with powdered rhubarb. The arseniate of potass was however found to be the most efficacious remedy: a case of eight years' duration in a girl aged 11 years, and another of 3 years, are reported as recovering under its use. Dr. Romberg began with a dose of two drops of the arsenical solution, gradually increasing to six drops.

Infantile meningitis was ushered in by various symptoms. Convulsions, not unlike eclampsia or epilepsy, was one of these. A boy, aged 4 years, had convulsive paroxysms for three days, with intervals of perfect health. On the fourth and fifth days, he did not suffer at all; on the sixth, the convulsions reappeared, accompanied by the usual symptoms of meningitis. A girl, aged 8 years, in perfect health, was attacked with such violent convulsions, that they were pronounced to be epileptic by the practitioner

called in; she recovered perfectly, but in twelve hours meningitis set in, and proved fatal in six and thirty hours. In another case, the convulsions preceded the attack of meningitis fourteen days. Dr. Romberg observes, that the condition of the nasal mucous membrane constitutes a good diagnostic sign in these cases. If the secretion be arrested, and the nose be dry, then meningitis is impending. Other signs of meningitis in infants are, the continual attempt to bury the occiput in the pillow, and a frequent change of colour in the cheeks, and especially in one cheek only. Vomiting was often observed, but with these peculiarities, that it occurred when the stomach was empty, without nausea, without straining, and was brought on by moving or shaking the head. The expression of the eyes was noticeable. Children usually follow with their eyes the eyes of their attendants; in meningitis, they cease to do this.

In the majority of cases, the disease was tuberculous meningitis, and was accompanied by deposit of tubercle in other organs, particularly the lungs, bronchial glands, liver, spleen, and mesentery. In the brain, the deposit usually occupied the sulcous folds of the pia mater.

The cases of meningitis infantum were treated after a rigorous antiphlogistic method. Leeches were applied behind the ears, and large doses of calomel given so as to act briskly on the bowels. Cold was applied to the head after the plan recommended by Heim. The child's head is wrapped round the temples with woollen, so that the water may vented running over the face, and then cold water is poured upon the head, from the height of one or two feet, for a quarter of an hour. After an interval, the process is repeated.

be

pre

Several cases of epilepsy were treated. Some of these displayed remarkable periodic phenomena. A boy at the age of 9 years, had an attack of epilepsy brought on by fright, the fit recurring every evening at a certain hour. It disappeared without any treatment being adopted. In his twelfth year, he fell on the ice while skating, having a headache and other cerebral symptoms at the time; and immediately he was again subject to periodic epileptic fits, recurring every night at ten or eleven o'clock. In another case, a young woman, the fits recurred every evening about five o'clock. In another case, the paroxysm recurred every month, about the time of the new moon; the whole paroxysm or attack continued twentyfour hours, and was made up of twelve fits, having an interval of coma of two hours' duration between each. In a note Dr. Henoch mentions the case of a young gentleman who had a fit with the greatest regularity every seventh day, from eight to half-past eight o'clock in the morning.

Paraplegia. The suppression of the perspiration of the feet is mentioned by Romberg as a cause of this disease. We are inclined to doubt the accuracy of the etiological views given by him, as it seems more probable that the suppression of the perspiration was rather a coincident than an antecedent. A healthy man, aged 46, who had been troubled from his youth with profuse perspiration of the feet, had suffered for two years past from frequent pains in the limbs, which were worse towards night, were evidently of a rheumatic character, and had followed his getting cold and wet in the feet. The perspirations at last were suddenly suppressed, and immediately after the patient experienced a feeling of weakness and loss of sensibility in the lower extremities. At first, these phenomena

were confined to the leg, but extended subsequently to the thigh and lower abdomen, and were accompanied by eneuresis and constipation. Totally unable to walk, he was able to move about on crutches, dragging the lower half of his body after him; but when seated, he could move his legs in any direction. Perspiration was limited to the upper half of his body, ending just below the umbilicus. The lower half was dry, and desquamated continually. Sexual power was lost. The most careful exploration of the spinal column was instituted, but nothing could be discovered to account for the paraplegia. Dr. Romberg then conceived, that the suppression of the habitual perspiration from the feet at least indicated the therapeia in the case, and he prescribed the foot-bath, with half an ounce of "aqua regia" (nitro-muriatic acid) thrice a week. In a fortnight, the gait became steadier, the patient was able to stand, the feet hitherto cold and dry, became warm and moist. From gr. to gr. of the spirituous extract of nux vomica was then administered, and in fourteen days the urinary bladder recovered its tone, and sensation returned to the lower extremities. After a few months' perseverance in the treatment, the patient recovered perfectly, except a slight tottering in his gait.

Another case, somewhat similar, was observed in the person of a drunkard. In this, the bladder and rectum were not paralysed, nor was sensation lost, and the patient could move his legs when seated, as in the preceding case. Upon inquiry it was found, that a profuse habitual perspiration from the feet disappeared immediately previously to the accession of the paralysis. Foot-baths, thrice a week, medicated with caustic potass instead of acid, and continued for a month, effected a cure without the use of any other remedies.

A new form of atrophy of the face. This case is interesting, as an example of hemiplegic atrophy only. A woman, aged 28, had, at the age of 13, an attack of tertian ague. Three years afterwards, she made a journey on foot through a very heavy rain, and very soon after was attacked by what was probably scarlet fever. In particular, the mucous membrane of the pharynx was inflamed, the voice was hoarse, deglutition painful, the uvula enlarged, and an abscess formed in the left tonsil. Externally, the cervical glands were swollen. The general health was shortly re-established, but it was found, that the right side of the face appeared full, plump, and blooming, as it should be in a female of eight. and twenty, while the left side was shrivelled and wrinkled like that of an old woman. The median line of the face constituted a sharp and distinct boundary between youth on the one side of the face and age on the other. On the wrinkled side, the hair was scanty, and the forehead less convex ; but from the want of muscle and fat, the superciliary arch on that side was more strongly marked than on the right. Further, the eyebrow was nearly all gone, the eyelashes scanty, the caruncula small and pale, the eyelids large and thin, as compared with the right. The left side of the nose presented a curiously atrophied appearance, as also the left side of the mouth and chin; and the morbid change could be traced down the same side of the neck to about the middle. Dr. Romberg gives nine comparative measurements of the two sides: those on the left were less than the corresponding on the right, in proportions varying from a fourth to a tenth. The atrophy also implicated the left tonsil, left side of the uvula, &c.