be productive of the best results. A married woman of middle age was admitted with a most copious scaly and papular eruption. It covered her face, trunk and extremities, not any part escaping, and the profuse production of scale-crusts was a very remarkable feature. On the arms it might have been taken for common psoriasis, but on the face there could be no doubt as to the diagnosis. Mercurial baths were ordered, but after the third she became freely salivated. For a week or two she was confined to bed, and in a very feeble state from the profuse ptyalism. During this period the eruption vanished as if by magic. No more mercury was used in any form, and at the end of a month the woman left the hospital covered with stains, but having nothing whatever remaining but stains. She was charged to return in a month, that we might know if any relapse occurred.

I remarked in connection with this case that it was the most rapid cure of a severe secondary eruption which I had ever known. Although, on the whole, I prefer the long-continued treatment by small doses, yet it is well to bear in mind that in certain cases mercury appears to be far more efficient when pushed to its full physiological influence. We must avoid prejudging the question, and keep our minds open for the reception of all evidence that may be forthcoming. In some acute inflammatory affections, not syphilitic, benefit is observed immediately that salivation occurs, whilst none is witnessed before.

Interstitial Keratitis, with Deafness.

His deafness was symmetrical. It had come on during the last three months, and it had progressed to such an extent that the lad carried in his hand a slate and pencil for writing. He had not had any discharge or pain, but he complained bitterly of "such a ringing in my ears." I remarked that deafness of this kind and intensity, and at this age, was almost conclusive in itself as to inherited taint. We know of no other affection which in young persons can, without otorrhoea or any proof of inflammation, proceed in the course of a month or two to the entire loss of the function. Such cases are common enough in

those who inherit syphilis, and they occur in connection with no other cause. In this instance the lad suffers also from symmetrical keratitis, and of this disease precisely similar statements are true. Thus, although his physiognomy is scarcely peculiar, his teeth are well formed, and we know nothing of his family history, yet the simultaneous occurrence of two maladies, each of which is characteristically syphilitic, justifies us in a confident diagnosis.

Paralysis of both Six Nerves after Injury to the Head.

The man in whom this lesion is present has, in all probability, suffered a fracture through the base of the skull. He bled at both ears and from the nose. His portio dura is paralysed on the right side, and he is deaf in both ears, though not absolutely so, and in the right he was, he says, deaf before his fall. Both six nerves are absolutely paralysed, and the eyes converge. The man is quite free from brain symptoms, and he is doing well. In anticipation of arachnitis he was put under the influence of mercury during the first week, but as he is now wholly without symptoms, excepting the paralysis, it has been discontinued.

What the precise lesion may be which has caused complete paralysis of both abducentes it is somewhat difficult to conjecture. In all probability, the fracture crosses the right petrous bone, and it may cross the sella turcica. I mentioned at the bedside that I had seen several cases of paralysis of one sixth nerve after injury to the head, but that I did not remember one in which it was double. During the same week I had seen with Dr. Macpherson of Midmay-park, a little girl who had been knocked down in the street by a horse, and in whom, without any other cerebral symptoms, the right sixth nerve was quite paralysed.

Recovery from Paraplegia possibly of Syphilitic origin. We sometimes, in going over the past life-histories of our patients, come upon interesting fragments of evidence, always, however, to be taken with a certain amount of hesitation on account of the sources of fallacy. A gentleman who consulted me a few days ago for a syphilitic gumma in his tongue, told me that he

had formerly suffered from paralysis, and had wholly recovered. The facts were these. Fifteen years ago he had syphilis with eruption, &c., rather scverely, and took mercury. Almost as soon as his treatment was over, he began rather suddenly to lose the use of his legs. The weakness began at his heels, and crept upwards, and his lower extremities wholly failed. He was on the couch for three or four months His arms were weak, but not wholly paralysed. After four or five months' treatment he wholly recovered, and has never since had any reminder of it. He was married at the time, and married a second time some years afterwards. He has now enjoyed ten years of good health, and has, during that time had nothing of a specific character.

Intercarpal Dislocation.-(Under the care of Mr. C. E. RICHMOND, of the Warrington Infirmary and Dispensary).-Dennis S, aged forty-seven, miner, a muscular subject, with well defined anatomical points, was admitted March 14th, 1879. He was working at a thrashing-machine when the strap of the fly-wheel caught his arm and dragged him up to the top of the wheel (the height of which was stated to be about nine or ten feet), from whence he fell on his hand. He could

not state whether he fell on the back or palm of the hand. There were several skin lacerations (done by the strap) midway up the forearm, but no fracture of the radius and ulna was discoverable. There was, however, marked deformity at the left wrist. The length of the hand from the wrist to the knuckles was very noticeably shortened. There was a prominent transverse ridge on the dorsal aspect of the wrist beneath the ends of the radius and ulna; and below this ridge there was a marked depression. On the palmar aspect the base of the hand was unduly promiment, the general direction of the metacarpal bones being quite altered by their bases being pushed forward towards the palm. The diameter of the wrist, both laterally and anteroposteriorly, was much increased. There was not very much bruising or swelling of the soft tissues themselves, though the circumference of the wrist, taken round the extremities of the radius and ulna, was one inch and a quarter more on the injured

than on the sound hand, and below this point the difference was even more marked. He was unable to flex or extend his hand himself.

On examination the ends of the radius and ulna seemed separated from each other somewhat. The transverse dorsal ridge before mentioned could be demonstrated to be the first row of carpal bones, with the semilunar rather unduly prominent. Between this ridge and the ends of the radius and ulna the movements of flexion and extension, although restricted could be obtained with considerable ease and without any crepitus. Below the ridge the extensor tendons could be plainly felt stretching across the depression to the fingers.

The articulation between the thumb and the trapezium was not interfered with, nor had any of the articulations between the metacarpals and second row of carpals sustained any injury. On the palmar prominence before mentioned the trapezoid could be felt pushed more anteriorly than, and considerably above, the level of the trapezium, and nearer the ulnar side the head of the os magnum could be felt overlapping slightly the ends of the radius and ulna, which on the palmar surface were quite obscured; and on flexion and extension of the hand the os I could be felt to ride on their anterior surface. The dismagnum placement of the unciform, although distinct, was much less marked. Under no circumstances could any crepitus (other than that attributable to effusion) be detected, nor was there any sign of fracture whatever.

The result of examination showed that the second row of carpal bones was dislocated from the first forwards and upwards, the displacement was most marked in the case of the trapezoid and os magnum.-The Lancet.

Movements of the Eyelids.-A paper was read before the Royal Medical and Chirurgical Society on the "Movements of the Eyelids," by W. R. GOWERS, M.D., of which the following is an abstract: Under normal conditions the lids leave the cornea approximately uncovered in all positions of the eye-ball moving with it. For these movements, and

up

for the voluntary closure and opening of the lids, there are only two muscles, the orbicularis and the levator. These will not expain áll movements, and it is probable that the eyeball itself moves the lids, not by the conjunctival connection but by the pressure of the convexity of the sclerotic, and to a less extent of the cornea, the edges of the lids lying in or near the sclero-corneal sulcus. This effect is greatest on the upper lid, partly because the tarsal cartilages are attached, at their extremities below the transverse axis of the eye-ball. The eyelids are moulded on the globes, the shape of the palpebral fissure depending on the position of the eye-ball, and being curiously altered in some abnormal lateral positions. In closing the eye-lids gently the lower lid is raised by the palpebral orbicularis; in rotation of the globe the lower lid is raised, not by the orbicularis, but by the pressure of the globe, and the movement is slight if the globe is very prominent. Depression of the lower lid in looking down is by pressure of the cornea. The upper lid is maintained in position by the balance of tone between the levator and the orbicularis. If the latter is paralysed, the lid is a little higher than normal. The descent of the upper lid in looking down is not by contraction of the orbicularis (for it is unaffected in facial palsy), but is by the pressure of the sclerotic against the tarsal cartilage. The lid is raised on upward rotation of the globe by the levator, the contraction of which, if sudden, is excessive. With this is associated a synergic action of the frontalis; the latter is sometimes habitual, and then is relaxed with the levator on looking down. The action of the levator, associated with that of the superior rectus, is beyond voluntary control, and, in the simulated ptosis of hysteria, necessitates a strong contraction of the orbicularis to keep the lid down, if the patient is made to look up. The associated relaxation on looking down prevents almost all voluntary contraction of the levator in that position. Gentle closure of the lids, as in sleep, is by the palpebral orbicularis; the levator being relaxed, the recti passive. Forcible closure is by the whole orbicularis, the levator being released and dissociated from the superior rectus, which contracts, rolling the globe up. Hence, probably,