rarely audible before the completion of four, or four and a half, months of pregnancy. Changes in the Cervix Uteri.-It has been asserted by some obstetrical writers, that the diminution in the length of the servix is gradual and regularly progressive during pregnancy; thus, that by the end of the fourth month, it has lost about one-third of its length; by the end of the fifth month, onehalf; by the end of the sixth, three-fourths; and by the end of the eighth, it is not more than about two lines long. It must not, however, be imagined that in all cases this diminution of the neck of the womb is so uniform as to enable the accoucheur to predict the period of pregnancy. M. Dubois mentions a case in which he had an opportunity of examining the uterus in a woman who died in the eighth month, and in whom the servix uteri was found to be as long as it usually is during the first months; and he cites another instance where a woman stated that she was near the period of her confinement, but her accoucheur, finding that the servix uteri was not at all shortened, expressed his disbelief that such could be the case; the result however, soon proved the inaccuracy of his opinion. In many cases, the outline of the distended uterus may be felt through the abdominal parietes: this examination is always best made when the woman is in bed and early in the morning before food is taken if the bladder and bowels have previously been emptied, the examination will be more easy and satisfactory. M. Dubois cites two or three curious cases, in which the pains of seeming labour came on with all the other usual accompaniments at the time expected by the woman, although it afterwards proved that she was not even pregnant.Gazette des Hôpitaux. NUMBER OF SUICIDES IN FRANCE IN 1839. During the course of this year 2,717 cases of self-destruction have been reported by the authorities of the different departments; of this number, 698 were committed by females; and 486 occurred in Paris alone. We cannot, however, regard this as the entire number of suicides perpetrated throughout France, during the year; for very many undoubted cases, says the reporter, are, either from insufficient data or at the importunity of relatives, registered as deaths from accident. The following table shows that the dreadful crime of self-destruction has been yearly increasing during the last four years:1836.. 1837 1838 1839 2,310 2,413 2,556 2,717 (A lamentable picture of human depravity!)-Gazette Medicale. maintained that the pulse of the child in utero, and also after birth until breathing commenced, seldom exceeded 60 or 70 pulsations in the minute. In our notice of his last work, in the number of the Medico-Chirurgical Review for July 1836, we questioned the accuracy of the Doctor's assertions, and incurred in consequence his wrathful criticism. Our readers may find it worth their while to revert to his pamphlet, and our rejoinder, in the number of this Review for January 1837.-Rev. CASE OF PALSY OF BOTH FACIAL (7TH PAIR) NERVES. The following very curious and rare case is well deserving of being recorded. A young lady, 22 years of age, consulted M. Magendie, in April, 1840, in consequence of the following symptoms which had made their appearance about a fortnight previously. The earliest symptom was a slight embarrassment in the movements of the left eyelid; this was soon accompanied with an inability to contract the left temple and left half of the forehead. The next symptoms were sensation of numbness in the left side of the tongue, but without any impediment in its movements, and an increased sensitiveness of hearing, so that the gentlest sounds caused a painful resonance in the left ear. These two last symptoms did not last above 24 hours; but the paralysis was permanent. At the period of her consulting M. Magendie, there was considerable distortion of the features on the right side, especially of the mouth and chin; also an inability to contract the forehead and to close the left eyelids. The left side of the upper lip hung down below the level of the other side, and the left side of the lower one was equally paralysed; the saliva flowed involuntarily from the left angle of the mouth. The left cheek was drawn to the right side, and was stretched and firmly applied to the gums and teeth; it swelled somewhat during the act of expiration, and fell down during that of inspiration. While eating, the food was apt to collect in the left side; and while speaking, laughing, &c. the deformity of the features was always greater. M. Magendie recommended a trial of galvanism with acupuncturation; one needle was to be inserted over the parotid gland and another over the supraorbital, the infra-orbital, and the mental foramina successively. These needles were then brought in connection with the conductors of Clarke's machine the wheel of which was at first turned round slowly and afterwards more quickly. Each galvanic shock produced painful dartings over the whole of the affected side of the face; but it was observed that the muscles contracted but feebly. This treatment was ordered to be repeated every day. For the first five days it seemed to have little effect, and on the sixth, a new set of symptoms made their appearance; the right side of the face now becoming affected in a similar manner. The right eye could with difficulty be closed, and the right side of the forehead could not be moved; the distortion of the left side was at the same time considerably less than it had been before. On one day the patient experienced a numbness in the right half of the tongue, and a painful sensitiveness to sounds in the right ear. M. Magendie ordered that both sides of the face should be galvanised daily in the manner that we have explained: the contraction of the muscles under the influence of the shocks was observed to be much less than in health. Little benefit however seemed to be derived from the treatment, and on the 15th of April, (13 days after her first visit to M. Magendie,) the following report was made of her case. There is now no longer any distortion of the features; they are regular, but motionless and impassable, so that they do not express by any change, except in the colour of the face, the emotions of the patient. The eyeballs seem to be unusually large, in consequence of the inability to close the lids; and the hanging down of the eyebrows gives a most unpleasing character to the physiognomy: the tears are constantly flowing down the cheeks. The patient cannot contract any part of the forehead; the alæ of the nose are much flattened, and inclined in towards the septum. The lips have lost all their contractility, so that the speech is much embarrassed, and the pronunciation of labial sounds is impracticable. Mastication is equally difficult; for the food is always getting between the gums and the cheeks, and the patient is obliged to use her fingers to displace it. The cheeks are flat and hang down, so that the face looks lengthened and much older than in health. From the phenomena now mentioned, it is obvious that the muscles under the influence of the facial nerves of the 7th pairs have lost almost entirely their contractile powers. The general health has however remained perfectly good; the appetite being regular, sleep undisturbed, &c. After a few days' longer continuance of the galvanism, the face was observed to be somewhat drawn to the left side—a good sign; for it implied that the muscles on this side were recovering their motility. At the same time the patient found that she could move a little the left angle of the mouth, close the left eyelid, and contract somewhat the left side of the forehead. The galvanism being persevered with, the muscles of the right side soon began to contract more forcibly under its influence, and to be also more obedient to the will. In the first week of May (25th seance,) the features had nearly recovered their perfect regularity;-not indeed as in the second stage of the case, when the absence of distortion was owing to a double paralysis, but in consequence of a double cure-which was only slightly disturbed when the patient spoke or laughed. The tears and the saliva were no longer excreted involuntarily; the sides of the nose were not pinched in as before, and the patient could now masticate her food without being obliged to be every now and then putting her finger in her mouth. M. Magendie recommended that the needles should now be implanted only into the substance of those muscles whose motility seemed to be not quite so perfectly recovered as that of the others. In the course of a week or two more, the cure was pronounced to be complete in every respect. In concluding the report of this curious case, it should especially be kept in mind that the sensory twigs of the portio dura on either side were not at all affected; the sensibility of the face remaining as perfect as in health throughout the continuance of the muscular paralysis. It may be objected by some that the continuance of the sensibility unimpaired might be owing rather to the integrity of the fifth pairs, than of the sensory twigs of the seventh pairs. But the following fact, which was repeatedly observed by M. Magendie and pointed out by him to several pupils, disproves this idea. If, when a needle was inserted into the parotid gland, it reached directly a twig of the portio dura, that moment the pain radiated along all the ramifications of the pricked nerve. The sensory filaments of the nerve were therefore not paralysed as its motory were. We can readily understand how the seventh pair should have retained its sensibility under such circumstances; seeing that this is supplied or communicated to it by the fifth pair; for, if we divide the portio dura between the stylo-mastoid foramen and the anastomosis with the auriculo-temporal branch, the extremity of the nerve which corresponds to the face does not lose its sensibility, although all power of motion in the parts is abolished.* It thus appears that the portio dura does not derive its sensibility directly from the encephalon, but indirectly and by the way of anastomosis, beyond the point where we have made the section. This circumstance explains why palsy of the fifth pair induces a loss of sensibility in the seventh pair also; the sensory filaments of the latter emanating, so to speak, from the former. In the patient, whose case we have given above, both nerves of the seventh pair were paralysed, while the fifth pair remained quite intact. General Considerations on Paralysis of the Seventh Pair. This pair of cerebral nerves is much more frequently affected with palsy than the fifth pair; moreover, the disease in the one case is much less serious than when the latter nerves are implicated. In the first case, the motility only * For an account of the experiments which prove this, consult the two volumes of Magendie, Leçons sur le System Nerveux. is impaired or lost; in the second, the general sensibility of the face and the special sensibilities of sight, hearing, smell, and taste, are more or less compromised, with or without a loss of motion in the lower jaw at the same time. Palsy of the seventh pair is not accompanied with any lesion in the nutrition of the parts which it supplies; while that of the fifth pair is often attended with most serious changes, amounting sometimes to gangrene in different parts. Palsy of the seventh pair on one side is not unfrequent; but it is exceedingly rare that both nerves are affected at the same time. The preceding case is almost unique it confirms what experiments had previously taught us, that the division of both nerves causes a complete immobility of the whole of the face. The most important point to determine in cases of palsy of the portio dura is, whether the disease be simply local, or whether it is connected with, and dependent on, disease within the cranium. Of all diseases of the brain, hæmorrhage is that which is most frequently accompanied with paralysis of the face. If there be palsy of the limbs of the same side, the diagnosis cannot be doubtful. But the latter symptom may be absent, although there is hæmorrhage; as was shown in the case of the late Baron Dupuytren We must therefore be on our guard not at once to pronounce a case free from danger, because the face alone and not the limbs at the same time are affected with paralysis. M. Andral lays much stress on the following circumstances to guide our diagnosis. In cerebral hemorrhage the features are much less distorted, and the muscles of the face continue to have some power of motion: the patients can readily, on the palsied side, close the eyelids and contract the forehead. On the contrary, when there is a lesion of the nerve without cerebral mischief, the distortion of the features is much more considerable, and all muscular contractility is usually gone: the patient cannot close his eyelids, or contract the forehead. When we have reason to believe that the paralysis of the seventh pair is connected with any recent lesion of the brain, we must carefully avoid any stimulating remedies, and galvanism among the number. But when the paralysis is of local origin, there is no remedy so efficacious as galvanism to excite the dormant powers of the nerve. M. Magendie recommends that we should act on the fifth pair as well as on the seventh, in consequence of the influence which the former has on the functions of the latter nerve. For this purpose, one needle should be inserted into the parotid gland, and another immediately over either the supra-orbital, the sub-orbital, or the mental foramen; or, what is better, over each of the foramina in succession. If during the treatment any muscle or muscles are more refractory than the rest, a needle should be inserted into it, and the galvanic stream be sent directly through it. Some patients object to the use of the needles, although the operation is attended with scarcely any pain. When such is the case, we must be satisfied with merely applying the conductors: one of these should terminate in a flat surface, and be applied in front of the ear; and the other in a lengthened globular end which can be drawn along the internal surface of the cheek and lips. In this way the galvanism may be made to act on the palsied nerves; but its action is much less efficacious than when the needles are employed at the same time. The average duration of the cure of paralysis of the portio dura by galvanism may be stated at about twenty seances. The machine which M. Magendie has exclusively used for some years past is the electromagnetic instrument of Clarke. He very rarely prescribes any medicine either for internal or for external use.-Gazette Medicale. Remark. The preceding case we should pronounce to be one of hysterical paralysis. The suddenness of the attack, while the general health was and continued to be good, and its transference to the fellow nerve on the opposite side lead us to this conclusion. The comments however, which the author makes, and his account of Magendie's treatment of such cases, are highly interesting.— (Rev.) IODURETTED MERCURIAL SYRUP FOR THE TREATMENT OF SECONDARY SYPHILIS. Dr. Gibert has for some time been using the following syrup in many cases of obstinate secondary venereal affections. Take of Very clear syrup . 2400 parts. The usual dose is a table spoonfull, which may be said to contain one centigramme of the bi-ioduret of mercury, and 50 centigrammes of the ioduret of potassium. The syrup has no unpleasant taste and possesses the great advantage of remaining unchanged for a great length of time. The proportion of the ioduret of potassium in the syrup is more than sufficient to hold the mercurial bi-ioduret in solution; but, besides that it serves to counteract the tendency of the latter to decomposition, it is in itself a useful remedy; whence the excess is rather an advantage than otherwise. M. Gibert also occasionally orders the bi-ioduret in the form of pills; thus:Take of Bi-ioduret of mercury Ioduret of potassium Make a mass to be divided into 20 pills, of which two or more may be taken daily. By means of these formulæ, M. Gibert tells us that he has succeeded in curing several cases of inveterate syphilis and scrofulous cutaneous disease, which had long resisted every other remedy. BARON LARREY; HIS MEMORABLE CAREER. The great captains of former times have set the example of devoting the leisure of their old age to the recounting, for the benefit of their successors, the history of their campaigns and military labours. Some of the masters of our art too have followed this most useful plan, blending the impressions of their army life with the results of their professional practice, and thus dramatising science by bringing it in contact with the events of the age. The works of Ambrose Paré for example, not only constitute a venerable portion of the records of surgery, but at the same time shed much light on the state of French society at the period; they combine the interest of a chronicle and the historical value of a scientific treastise. Following the example of the father of French surgery, Baron Larrey has communicated to the public, in a series of admirable works, the results of an active life, which, next to that of the immortal Huguenot (Duke de Sully), is assuredly one of the most remarkable on record for its duration and its varied interest. Like his great model he has taken up the pen only to narrate what he has seen and what he has done: a literary proceeding that, for a length of time, seems to have fallen into desuetude. He commenced active service in 1787, |