marked coolness of left side; consciousness gradually returned that evening. Paralysis more marked on the third day, with involuntary discharges of urine and fæces. On the fourth day he was occasionally delirious, much headache, which continued for three subsequent days, when the power of motion in leg was restored, the left arm still powerless.

On the 26th day he was discharged much improved, the pulse gradually increasing until it reached 70 beats.

Treatment, absolute rest, purgatives, mild diet, and ice to head.

In the same series of reports, are included one case of fracture of base of the skull, with extensive lesions, under the care of Mr. Moore, in which death occurred on the thirty-first day, consciousness never having returned; and another case, under the care of Mr. Hulke, of comminuted depressed fracture, in which the trephine was employed; death followed in ten hours. The use of the trephine, in this case, proved to be justifiable by the fact that the pulse and respiration, which were respectively 40 and 24 before the operation, immediately rose to 80 and 32 as soon as the bone was raised.

In the Times and Gazette, April 17, 1869, Mr. Hutchinson reports eight additional cases of herpes zoster, at the Hospital for Skin Diseases, occurring after the continuous administration of arsenic. He had in a former number of the Journal, reported a similar number, the majority of the whole having been observed in his own practice. He is disposed to conclude from this clinical experience that there must be some connection between the use of this drug and the supervention of shingles.

CLINICAL RECORDS.

"Ex Principiis, nascitur probabilitas: ex factis, vero veritas."

ART. I.-EPILEPSY TREATED WITH THE TREPHINE-RECOVERY. By A. F. Magruder, M.D., Sharon, Miss.

Miss M., the subject of this report, is a young lady of good family, the daughter of a respectable planter of Leake county, Miss. Is aged 19 years and 4 months, of

medium height, pretty well developed, and weighs ordinarily one hundred and fifteen to one hundred and twenty pounds.

During the past year her brother, in whose family I practiced, mentioned her condition to me, and expressed a desire that I should see her. Subsequently, while visiting his father, Miss M. was attacked with epileptic convulsions of unusual severity. At his suggestion I was called to see her on the 31st of Janunary ult. The roads being heavy and the distance twenty miles, I did not reach her till evening, when I found her with violent spasmodic action, more marked in the left side and attended with delirium. She was being held in bed by several lady attendants, and when released would spring to the floor, but would fall in consequence of spasm of the extremities.

I summoned Dr. Morris, the attending physician, and proceeded to examine the patient. The history of the case, as derived from the family, was as follows:

When four years old she "began having fits," which varying in violence, and occurring at irregular intervals, continued until she arrived at puberty, when (as might have been expected) they became periodic, a characteris, tic which continued for several years. Within the past twelve months, however, this peculiarity seems to have disappeared, the spasms occurring more frequently, some times only a few days intervening. The patient usually has a good appetite, some gastric disturbance, but bowels regular. Catamenia said to be normal, though somewhat scant, usually continuing five days, unattended with much pain.

Patient states that unusual tingling of the left hand and foot, with headache, is uniformly regarded as a premonition of attack. Aphasia generally preceding the spasms, which has created a habit of rolling the tongue

and presenting the fingers of the left hand grasped firmly in the right, as a sign to the family of distress.

It was ascertained that when four years old she was struck on the head, accidentally, with a piece of iron, thrown from the hand of a nurse. The wound produced

was serious, but not such as to excite the alarm of her parents. It continued to discharge for several months, and when cicatrization was complete, the patient began. to have fits; yet the injury was overlooked by her attendants, and no serious consideration given to it as a cause of the disturbance.

The spasmodic action continuing with greater or less violence during the night of my first visit, the examination was not as thorough as it might otherwise have been, but I present the following outline as the result of that and subsequent examinations:

A short but deep indentation was observed in the upper posterior portion of the right parietal bone, (the missile having been thrown from behind), extending obliquely upward and forward nearly to the sagittal suture; attended with hemiplegia, affecting the limbs and the left palpebra. It was noticed that on starting to walk, the left foot was lifted with a spasmodic jerk, stepping much higher than with the opposite limb. The left hand smaller than the right, exhibited a want of muscular development and dificient circulation, the radial pulsation being imperceptible. Both hand and foot were represented as subject to cold and numbness, and prickling sensations as if asleep. The left eye presented a heavy dull appearance, and the lid drooped, never disclosing more than half of the orb. It was also observed that the patient slept with the right eye open and the left closed, and that, on awaking, the left lid remained closed for some minutes, and then was slowly and partially elevated. Another system which was remarked as uniform, was

habitual spitting, much aggravated during her paroxysms, and persistent while sleeping.

How far the rational signs enumerated may have been. the result of hysteria or of pressure on the nervous centres, I have not been able to decide, nor is the decision a matter of material consequence, since we have the depression of the cranium over the right hemisphere and corresponding hemiplegia, with epileptic convulsions, unattended with other important functional derangement. Circumstances, which I think fully justify an operation, especially when it is considered that the symptoms, should they continue after the operation, would not be the less amenable to treatment, but on the contrary the treatment might be much assisted by the moral force resulting therefrom.

After the most patient etiological investigation it was so obvious to my mind that the whole train of symptoms originated in the injury to the cranium, producing compression, and to be relieved only by surgical treatment, that I advised trephining, which was readily assented to by the patient. Having placed her on alterative treatment I left her, and saw no more of her till the 12th of March, six weeks after my first visit, when I was notified that she was at her brother's, ten miles distant, and wished to see me. Visiting her, I found her quiet, her intellect clear, but the physicial signs unchanged. A few days after, by invitation, my friends Dr. James Galloway and Dr. C. B. Galloway, of Canton, saw the case with me, and these gentlemen agreeing as to the propriety of trephining, it was determined to operate on the 25th of the same month. At that time, however, she was seized with a violent paroxysm, from which she did not recover fully for ten days. As soon as she was able to travel I took her into my family, and treated her fourteen days. During this time, being frightened, she was

again seized with spasms, which continued at irregular intervals for eight days, the intermission never being attended with consciousness for any considerable period.

On the 19th of April her condition being much improved, she returned to her brother, and I visited her on the 21st, determined to operate. Her aversion to anæsthetics being great, I yielded to her wish, and consented to operate without them, depending simply upon suitable persons to hold her. She stated that she appreciated her condition, and could bear anything for relief. With remarkable fortitude, she placed herself upon the table, requesting attendants not to touch her, except one to to steady her head, which was done with nice address by Mr. John Beall, and the operation completed without difficulty, the T incision being adopted.

The portion of the cranium removed, one and one eighth of an inch in diameter, embraced nearly or quite all the depression, though the indentation could not he made to occupy the middle of the trephine, in consequence of its proximity to the sagittal suture, and came away smoothly, there being no adhesion of the dura mater, but a prominent ridge on the internal table, along the line of the injury. The integument was brought together with four interrupted sutures, which were removed in a few day, the union being complete. In the meantime, however, a little puffiness was observed and an opening made, which admitted the escape of a small amount of bloody serum. This operation was repeated from day to day, the discharge assuming a healthy purulent character, which gradually ceased, leaving a smooth cicatrix.

During the treatment there was no febrile or inflammatory action, the pulse being regular, and varying from seventy-two to eighty-two per minute. It was remarked, however, that whenever there was any accumulation be