viscera were found to be healthy. The heart was large, the left ventricle being especially hypertrophied; several fibroid nodules were found in its walls, one of which projected both inside and outside-they were of a dense white appearance. Microscopically these fibroid nodules were composed of fibronucleated tissue, of small round cells with some intercellular substance, and some yellowish spots. Dr. Cayley referred to the specimens of fibroid disease of the heart exhibited last session by Dr. Hilton Fagge. In the present case the aorta was healthy; the muscular fibres of the heart around the nodules were not fatty. CONGENITAL DISEASE OF THE AORTIC VALVES. Dr. CAYLEY also exhibited a specimen of Congenital Disease of the Aortic Valves. A child died at the age of nine months, after having suffered from dyspnoea from birth. There was a loud general systolic murmur, but no actual cyanosis. The left ventricle was greatly enlarged; the aortic orifice covered with vegetations; the septum ventriculorum and foramen ovale were perfectly closed. The disease was considered congenital by Dr. Cayley because there had been dyspnoea from birth; but, as the orifices were closed, the condition could not have dated far back into intra-uterine life. The PRESIDENT remarked that one could scarcely conceive so much intra-uterine change accompanied with closure of the foramen ovale. OBITUARY. EDWIN LANKESTER, M.D., F.R.S., etc. WE last week noticed the death of Dr. Lankester, a man who for many years has occupied a prominent position amongst us as Coroner for Central Middlesex and Medical Officer of Health for the Parish of St. James's, Westminster, and as the author of many works on sanitary reform, botany, and food. He was born on April 23, 1814, at Melton, Suffolk, and was educated at Woodbridge, where he was articled to the late Mr. Samuel Gissing, surgeon. He pursued his medical studies at University College, at which institution he greatly distinguished himself as a student of botany, to which science he had an earnest attachment from his earliest years. At the conclusion of his studies he passed his examinations at the College of Surgeons and the Society of Apothecaries. He afterwards studied on the Continent, took his degree at the University of Heidelberg, and subsequently received the degree of LL.D. from Amherst, United States. He was appointed Medical Officer of Health for the important parish of St. James's, Westminster, in 1862. In the same year, after a fierce contest with a solicitor, he was elected Coroner for Central Middlesex by a majority of about fifty votes. In both these offices he acquitted himself to the satisfaction of most, though some of the Middlesex magistrates found great fault with him for ordering what they called "unnecessary" post-mortem examinations. We alluded to this subject in our last issue, and it is unnecessary to refer to it further. Whatever may have been the shortcomings of Dr. Lankester in his office of Coroner, it is certain that he did his utmost to maintain the dignity and usefulness of that ancient tribunal. In proof of the services which Dr. Lankester rendered to the cause of public health, as physician, author, and lecturer, we cannot do better than give the following short and very imperfect list of his works:-"Twelve Lectures on Food," 1861. "Twelve Lectures on Animals useful to Man," 1862. Translation from German of "Principles of Scientific Botany, by Dr. M. J. Schleiden," 1849; and of "Küchenmeister's Animal and Vegetable Parasites inhabiting the Human Body." "Guide to the Food Museum, South Kensington." "A School Manual of Health," 1868. Second, Third, Fourth, Fifth, and Sixth Annual Reports of the Coroner for Central Middlesex; as well as numerous contributions to medical and scientific journals, and popular works in medicine and science. He succumbed at the really premature age of sixty to carbuncular disease and diabetes. He died at Margate on October 31, and was buried at Hampstead the following week. MEDICAL NEWS. First, UNIVERSITY OF LONDON.-The following is a list of the candidates who have passed the recent Second M.B. Examination: First Division.-Branfoot, Henry Seymour, Guy's Hospital; Crocker, Henry Radcliffe, University College; Duncan, Andrew, King's College; Duncan, Peter Thomas, University College; Eastes, Thomas, Guy's Hospital; Gould, Alfred Pearce, University College; Harris, Vincent Dormer, St. Bartholomew's Hospital; Nicholson, Arthur, King's College; Rigby, James Arthur, Guy's Hospital; Sturge, William Allen, University College; Whittle, Edward George, University College. Second Division.-Ashby, Henry, Guy's Hospital; Beach, Fletcher, King's College; Briggs, George Chapman, King's College; Davies, David Arthur, University College; Houghton, Walter Benoni, University Col lege; Morley, Thomas Simmons, Guy's Hospital; Moss, Herbert Campbell, King's College; Percival, George Henry, Guy's Hospital. ROYAL COLLEGES OF PHYSICIANS AND SURGEONS, EDINBURGH.-DOUBLE QUALIFICATION.-The following gentlemen passed their first professional examination during the recent sittings of the examiners : Birtwell, Daniel, Clayton-le-Moors. Boulton, William Thomas Livingstone, St. John's, New Brunswick. Rodman, John, Kilmarnock. Shand, Henry Miller, Aberdeenshire. Worswick, Frederick Henry, Manchester. The following gentlemen passed their final examination, and were admitted L.R.C.P. Edin. and L.R.C.S. Edin. : Aitchison, James, Newcastle-on-Tyne. Anderson, James Fisher, County Armagh. Atkinson, William Joseph, County Kildare. Clark, Harry Foord, Farnham. Daly, Timothy, Crookstown. Gallimore, Thomas, Ashwood, Longton. Gowland, George Robert, Sunderland. Grant, James, Caithness. Gray, James Campbell, Finvoy. Grevile, Frank Angiere, Clifton, Bristol. Large, Brisbane Warren, Cork. Maclean, John Hugh, Edinburgh. MacAuliffe, Alexis, Cork. M'Intyre, William, St. Andrews. O'Dea, Patrick S. Lawrence, County Galway. Pollard, Clement, Taunton. Williams, Theobald Wolfe Tone, London. ROYAL COLLEGE OF SURGEONS OF ENGLAND.-The following gentlemen passed their primary examination in Anatomy and Physiology at a meeting of the Court of Examiners on the 11th inst., and when eligible will be admitted to the pass examination: Anderson, William Stirling, student of the Glasgow School. Coates, Harcourt, of University College. Collingridge, William, of St. Bartholomew's Hospital. Elsmere, Edward, B.A. Cantab., of the Cambridge and St. George's Ewen, Harry Walter, of Guy's Hospital. Farrant, William, of Guy's Hospital. Foster, Henry, of the Leeds School. Guillemard, Francis H. H., B.A. Cantab., of the Cambridge School. Ingram, Ernest Fortescue, of Guy's Hospital. Irvin, Joseph Henry, of the Manchester School. Kains, Robert, of the Toronto School. Liosey, Alfred Edwin, of the Liverpool School. Phelps, Arthur Martin, B.A. Cantab., of the Cambridge and St. Thomas's Price, Ebenezer E., of the Middlesex Hospital. Vaillant, Marie Edouard, of the Heidelberg and Vienna Schools. Wartenberg, Victor Adolph, of the Manchester School. Only six candidates out of the thirty-eight examined failed to acquit themselves to the satisfaction of the Court of Examiners, and were therefore referred to their anatomical studies for three months. ROYAL COLLEGE OF SURGEONS, EDINBURGH.-The following gentlemen passed their first professional examination during the recent sittings of the examiners: Fearnley, William, West Hardwick, Pontefract. Kiermander, H. B., Calcutta. Pyper, Andrew, Edinburgh. APOTHECARIES' HALL.-The following gentlemen passed their examination in the Science and Practice of Medicine, and received certificates to practise, on Thursday, November 5:— Kershaw, Joseph, Byrom-street, Manchester. Newton, Edward Shackfield, Canonbury-park. Strugnell, Frederick William, Carlton-road, Kilburn. The following gentlemen also on the same day passed their primary professional examination : Henwood, John Davey, Charing-cross Hospital. ALDERTON, T. G., L.R.C.P. Lond., M.R.C.S.-House-Surgeon at the West London Hospital, vice W. L. Webber, L.R.C.P., M.R.C.S., resigned. DAVIES, ROBERT, jun., L.R.C.P., L.F.P.S.-House-Surgeon to the Carnarvonshire and Anglesea Infirmary, Bangor. FULSHAW, RALPH, M.R.C.S., L.S.A.-Medical Officer for the Earl Shilton District of Hinckley Union, Leicestershire. HUBBARD, THOMAS COATH, L.R.C.P., L.R.C.S. and L.M. Edin.-Medical Officer for the Borough District of Walsall Union. LLOYD, ROBERT HODGENS, M.R.C.S. Eng., L.S.A.-Medical Officer for the Infirmary of the Parish of Lambeth. MACLACHLAN, JAMES, M.D.-Medical Officer for the Workhouse of Walsall NESHAM, T. C., M.D., M.R.C.S. Eng., L.S.A.-Lecturer on Midwifery in NAVAL APPOINTMENTS. ADMIRALTY.-Richard Denton Mason, Esq., C.B., has been promoted to the rank of Inspector-General of Hospitals and Fleets in Her Majesty's Fleet, with seniority of November 3, 1874. BIRTHS. BOND.-On November 2, at 50, Parliament-street, Westminster, the wife of WRIGHT.-On November 5, at Wellingborough, the wife of J. Brampton MARRIAGES. CASSIRER-HULL.-On November 3, at Kensington, Hugo Cassirer, of MANN-SHARMAN.-On November 4, at St. Paul's, New Wandsworth, TIMMINS-BUCKLEY.-On November 3, at All Saints Church, Llanelly, I. A. J. Timmins, M.D., of Carmarthen, son of I. A. Timmins, Esq., of Mount Hill, Carmarthen, to Mary Anne, third daughter of James Buckley, Esq., of Penfai and Castell-Gorfod, Carmarthenshire. WILSON-BUCHANAN.-On November 4, at 2, Sandyford-place, Glasgow, J. G. Wilson, M.D., F.R.S.E., of Glasgow, to Edith Gray, youngest daughter of the Rev. Robert Buchanan, D.D., of Glasgow. CAMPBELL, ARCHIBALD, M.D., Ardmore Islay, late Superintendent of Darjeeling, Bengal, at Denmark House, Slough, on November 5, in his 70th year. CRONIN, ELIZA, wife of William James Cronin, F.R.C.S., at Queenstown, Ireland, on October 20. LANKESTER, EDWIN, M.D., F.R.S., Coroner for Central Middlesex, at Margate, on October 30, in his sixty-first year. LEGRAND, WILLIAM, M.D., F.R.C.S., Deputy Inspector-General of Fleets and Hospitals, Royal Navy, at 22, Manor-road, New-cross, on November 4, aged 69. MACKERN, THOMAS, M.D., of Eliot-place, Blackheath, at Eastbourne, Sussex, after a few days' illness, on November 7. O'FLAHERTY, MARY, eldest daughter of T. A. O'Flaherty, M.D., of Ardagh House, Killarney, late of 2, Baker-street, Portman-square, London, of low fever, at Salvator Kloster, Münstereifel, Germany, where she was finishing her education, on October 31, aged 19. ROBERTS, ELIZABETH, beloved wife of William Roberts, M.D,, of Mosleystreet, Manchester, at Woodlands Park, Timperley, on November 7, aged 30. SAUNDERS, ALICE ANN, beloved wife of H. W. C. Saunders, Esq., eldest daughter of the late Dr. Alexander Leigh (60th Royal Rifles), at St. Helier's, Jersey, on October 22, aged 28. SAVERY, JOHN, M.D., at Roselands, Hollington, near Hastings, on November 2, aged 76. VACANCIES. In the following list the nature of the office vacant, the qualifications required in the Candidate, the person to whom application should be made, and the day of election (as far as known) are stated in succession. DERBYSHIRE GENERAL INFIRMARY.-Assistant House-Surgeon. Applications, with testimonials, to the Secretary, Mr. Samuel Whitaker, 4, Victoria-street, Derby, on or before November 21. DERBY AMALGAMATED FRIENDLY SOCIETIES' MEDICAL ASSOCIATION.Resident Medical Officer. Candidates must be M.R.C.S., and registered under the Medical Act. Applications, with testimonials, to Mr. J. Bullivant, 58, Abbey-street, Derby, on or before November 16. DISTRICT INFIRMARY, ASHTON-UNDER-LYNE.-House-Surgeon. Candidates must possess a recognised medical and surgical diploma. Applications, with testimonials, to Hugh Mason, Esq., Ashton-under-Lyne, on or before December 14. EVELINA HOSPITAL, SOUTHWARK-BRIDGE-ROAD, S.E.-House-Surgeon. Candidates must possess a recognised qualification. Applications, with testimonials, to the Committee of Management, on or before Nov. 20. HUDDERSFIELD INFIRMARY.-House-Surgeon. Candidates must be fully qualified, and unmarried. Applications, with testimonials, to the Secretary, on or before November 23. QUEEN'S HOSPITAL, BIRMINGHAM.-Resident Secretary and General Superintendent. Candidates must be unmarried. Applications, with testimonials, to the Chairman of the House-Committee, at the Hospital, on or before November 25. TRINITY COLLEGE, DUBLIN.-Professor of Chemistry. Applications and testimonials to the Registrar, on or before January 23, 1875. Further particulars may be obtained from the Rev. Dr. Haughton, Medical Registrar, Trinity College, Dublin. UNIVERSITY OF DURHAM COLLEGE OF MEDICINE, NEWCASTLE-ON-TYNE.Lecturer on Anatomy, Lecturer on Medical Jurisprudence, Lecturer on Botany, and Demonstrators of Anatomy. Applications, with testimonials, to the Secretary, on or before November 21. GERMAN MEDICAL STUDENTS IN 1874.-It is stated in the German University Calendar that in the summer session of 1874 the number of medical students at the different universities were as follows:-Vienna, 963; Würzburg, 518: Leipzig, 502; Munich, 310; Berlin, 299 (exclusive of 160 pupils of the Friedrich-Wilhelm Institute and of the MedicoChirurgical Academy); Dorpat, 283; Greifswald, 281; Graz, 275; Strasburg, 184; Zurich, 183; Bern, 174; Breslau, 170; Halle, 163; Königsberg, 161; Tübingen, 158; Erlangen, 151; Göttingen, 135; Marburg, 132; Bonn, 126; Freiburg, 117; Innsbruck, 99; Heidelberg, 83; Jena, 78; Basel, 69; Giessen, 65; Kiel, 55; Rostock, 29.-Berliner Klin. Woch., October 19. IMAGINATIVE LIBELS.-Dr. Baird, of Daylesford, sued Mr. Izett, the Town Clerk, for £100 damages for having characterised him as a "bounding medical kangaroo." His Honour, in nonsuiting the plaintiff, ridiculed the notion of the words being in any respect libellous-the doctor, in fact, might have appropriated them in a complimentary sense. Had the parties been in England, and Izett had called the doctor a "British lion," or in Calcutta and the name chosen was Royal Bengal tiger," there could be no possible damage to his income or reputation, and the doctor could take the term as synonymous with "redoubtable" or "indomitable." Here the kangaroo is the national animal, and to be likened to it was rather a compliment than otherwise. Nonsuit, with costs.-Australian Medical Journal, July. HEALTH OF THE PUNJAUB.-The Sanitary Commissioner of the Punjaub, in his return for the week ending August 29 last, reports that the death-rate of the province continues to rise. The total deaths for the three weeks ending August 15, 22, and 29 were 5716, 5965, and 6301 respectively. There were two deaths registered under the head of cholera; they occurred in the town of Soucpat, in the Delhi district. More recent information shows that there had been altogether about thirty cases of cholera in that town up to September 13 last, of which twelve proved fatal. Small-pox mortality is nearly stationary; the deaths registered from this disease were 119, as compared with 126 in the previous week. Fiftyfive, or very nearly one-half, of the total small-pox deaths occurred in the district of Ambálah alone. NOTES, QUERIES, AND REPLIES. Se that questioneth much shall learn much.—Bacon. M. A. C. is thanked. Nemo.-There is such a work published by Messrs. Churchill. Sir J. R. Cormack.-The paper shall be inserted next week, if possible. B.A. Cantab., Cottenham.-The numbers of students registered as pursuing their studies at provincial schools in the decades mentioned were as follows:-1844, 229; 1854, 235; 1864, 247; and in the present year 1874 they have in creased to 253. M.D., St. James's.-The following is a copy of the inscription on the brass tablet inlaid in granite which is placed over the remains of Hunter in Westminster Abbey:-" Beneath are deposited the remains of John Hunter, born at Long Calderwood, Lanarkshire, N.B., on the 13th of February, 1728. Died in London on the 16th of October, 1793. His remains were removed from the Church of St. Martin's-in-the-Fields to this Abbey on the 28th of March, 1859. The Royal College of Surgeons of England have placed this tablet over the grave of Hunter to record their admiration of his genius as a gifted interpreter of the Divine Power and Wisdom at work in the laws of organic life and their grateful veneration for his services to mankind as the founder of scientific surgery. 'O Lord, how manifold are Thy works; in wisdom hast Thou made them all.'-Psalm civ. 24." An Old Surgeon Superintendent inquires whether the Government Emigration Commissioners knowingly employ homoeopathic practitioners to take medical charge of emigrants to Australia, and points to the mortality amongst them on a recent occasion. Fellowship.-You will find the desired information in our advertising columns. Write to the secretary. Tyssen.-William Hey died on March 23, 1819 "Those means which med'cine and the gospel give C. E. A.-It was the late Dr. Gregory who said of the celebrated Dr. Radcliffe that "he was at least no fool; and we may depend upon it he would not have allowed a hundred ounces of blood to be taken from him in one day without good reason for it.' W. P., Southsea.-Dr. Stewart, of Edinburgh, records twenty cases and nine dissections in cases of Bright's disease, where he considered lardaceous disease to have been present. Edinburgh Medical Journal for February, 1861. Alfred P. P.-In 1858 the number of known lepers in Norway was 2087. See report of International Congress of 1862. Dr. McM., Devonport.-It is an old Hebrew proverb that "when the sun rises the disease will abate"; it originated from a tradition that Abraham wore a precious stone round his neck, which preserved him from disease, and which cured sickness when looked upon. When Abraham died God placed this stone in the sun. H. M., Borough.-The engraved portrait of the late Bransby Cooper is scarce, as only 300 were struck off when the plate was destroyed: 225 were distributed to the subscribers, and the remaining seventy-five were presented to the Society for the Relief of Widows and Orphans of Medical Men, to increase the funds of the institution. Tuffnell.-British and Foreign Medical Review, January, 1837, and January, 1838. A Foreigner.-Laurence Bellini, an Italian physician, was born at Florence in 1643. He graduated at Padua, and afterwards became professor of philosophy at Pisa, which chair he exchanged for that of anatomy. He died in 1703. Leno. "Early, bright, transient, chaste, as morning dew, He sparkled and exhaled, and went to Heaven." Gilbert N.-A medical school was established in the Columbia College, New York, in August, 1767, but in consequence of the establishment of the College of Physicians and Surgeons in New York, the medical school of the former college was in November, 1813, discontinued. P. C. F.-Sir Robert John Kane, M.D., was born in Dublin in 1810, and was knighted by the Lord Lieutenant of Ireland in 1846. M. S.-The nomination of candidates for the Middlesex Coronership will take place on the 17th instant. Thomas Guy.-The essays for the next triennial prize of £300, under the will of the late Sir Astley Paston Cooper, Bart., must be sent in on or before January 1, 1877. The subject for it is "the Anatomy, Physiology, and Pathology of the Sympathetic Nervous System." No official of Guy's Hospital can compete for it. Quinine. It is stated by John Evelyn, in his "Diary," vol. ii., p. 332, that "on visiting the Marquis of Normanby, November 29, 1694, he had much discourse with him concerning Charles II. being poisoned; also concerning the quinquina, which the physicians would not give to the King at a time when, in a dangerous ague, it was the only thing that could cure him (out of envy because it had been brought into vogue by Mr. Tudor, an apothecary), till Dr. Short, to whom the King sent privately to know his opinion of it, he being reported a Papist (but who was in truth a very honest good Christian), sent word to the King that it was the only thing which could save his life; and then his Majesty enjoined his physicians to give it to him, which they did, and he recovered. Being asked by Lord Normanby why they would not prescribe it, Dr. Lower said it would spoil their practice, or some such expression, and at last confessed it was a remedy fit only for kings." Coffee.-According to Wanklyn, raw coffee contains 6 to 8 per cent. of sugar, which after roasting is reduced to 1 per cent., or even zero. The fat, on the other hand, seems to be increased by roasting from 4 or 5 per cent. to double that quantity, although perhaps the fat is not actually increased, but merely laid open by heat to the action of solvents. Roasted coffee is rich in nitrogen, but only half as rich as tea. Raw coffee is said to yield 25 per cent. to boiling water, but roasted coffee as much as 39 per cent., which last figure is perhaps excessive. PERFUMES AS DISINFECTANTS. TO THE EDITOR OF THE MEDICAL TIMES AND GAZETTE. SIR,-My attention having been drawn to a letter you published from "An Afflicted Sanitarian" in your number of October 24, you will perhaps allow me to offer a few practical remarks respecting the use of perfumes as disinfectants. Whether malaria and miasma arise from noxious gases or from invisible particles of matter I shall leave to scientific men to discuss and decide; but in either case I believe perfumes would act as antidotes. If they are noxious. gases they probably contain sulphur or phosphorus, and both are dissolved and consequently neutralised by the essential oils forming the basis of all perfumes, which, being strongly ozonised, would also militate against the effluvia of organic decomposition. If they are particles of living matter, perfumes are a deadly poison for them, and will not fail to destroy them; hence the ancient custom of embalming-the object of which was to prevent the flesh from being devoured by its post-mortem aggressors,-and the modern custom of preserving furs from moths by means of aromatics. I may quote, as a well-known fact to back my opinion, the immunity from cholera enjoyed, both in Paris and London, by people employed in perfume factories or in tan-yards; for tan is also a perfume, sui generis. I may add that the perfume vaporiser mentioned in the notes of your last number was once employed on board of the West India mail-steamer Tamar in fumigating the vessel, which was infected with small-pox, and that it succeeded in checking completely the disease at the end of three days, as I can show by a letter received from the captain. The perfumes I used there, and would recommend in similar cases, were all derived from plants of the labiate order, such as lavender, rosemary, thyme, peppermint, etc. The Eucalyptus globulus and other trees of the same family, very rich in essential oil, have also the remarkable property of destroying malaria in marshy districts, and I can refer your readers to a very interesting lecturedelivered on this subject in March last by Professor Bentley at the Royal Botanic Society, which is greatly in favour of my theory. I shall be very happy to see this question become the subject of serious investigation in this country, as it has already been in France and Italy, among the authorities of science; and I have every hope that the result will confirm my humble opinion. I am, &c., 96, Strand, November 5. EUGENE RIMMEL. PERIODICALS AND NEWSPAPERS RECEIVED— Lancet-British Medical Journal-Medical Press and Circular-NaturePharmaceutical Journal-Allgemeine Wiener Medizinische ZeitungBerliner Klinische Wochenschrift-Centralblatt für Chirurgie-Gazette des Hôpitaux-Gazette Médicale-Gazette Hebdomadaire-La Tribune Médicale-Le Mouvement Médical-La France Médicale - Le Progrès Médical-Bulletin de l'Académie de Médecine-Students' Journal and Hospital Gazette-Sussex Coast Mercury-The Central News Circular of Coming Events-Northampton Mercury-Lincoln Gazette-The Standard -The Evening News and Hull Daily Express-Liverpool Daily PostJournal de Médecine et de Chirurgie-Transactions of the Pathological Society, vol. xxv. BOOKS AND PAMPHLETS RECEIVEDExcision of Three Inches of the Median Nerve after an Old Gunshot Wound of the Left Elbow, by J. L. Stewart, M.D.-Lee on Whooping Cough as a Cause of Spinal Caries-Report of the Committee of Meteorology and Epidemics of the Philadelphia County Medical Society-Turnbull on Deaf-Mutism and the Method of Educating the Deaf and Dumb-Turnbull on Tinnitus Aurium, or Noises in the Ears-Weir Mitchell on PostParalytic Chorea-Da Costa on Strain and Overaction of the Heart (being the Third Toner Lecture)-Buckingham on the Mutual Relations of Druggists and Physicians-Report of the Sanitary Administration of the Punjaub-17 Jahres-Bericht des Schmedischen Heilgymnastichen Institutes in Bremen, von Prof. Dr. A. S. Ulrich-Ninth Report of the Quekett Microscopical Club-Hill's Health Report of the Borough of Birmingham-An Investigation into the Action of Veratrum Viride upon the Circulation, by H. C. Wood, jun., and J. Berens, M.D.-Clark on Public Health Administration-Rutherford on the Present Aspects of Physiology-Bakewell's Observations on the Growth and Reproduction of the Red Corpuscles of the Blood-Jardine's Elements of PsychologyRoss on Protoplasm-Hartshorne's Essentials of the Principles and Practice of Medicine, fourth edition -Steiner's Compendium of Children's Diseases, translated by Lawson Tait, F.R.C.S.-Michôd's Guide to Athletic Training-Talks about Health, by Mrs. Lankester. COMMUNICATIONS have been received from Dr. G. HAYDEN, Dublin; Mr. G. F. SAVAGE, London; Mr. W. MARRIOTT, London; THE REGISTRAR OF APOTHECARIES' HALL, London; NEMO; Mr. R. J. GODLEE, London; Dr. ALCOCK, New Ross; Mr. S. WREFORD, London; Mr. E. RIMMEL, London; Mr. S. PRESTON, Hinckley; THE REGISTRAR-GENERAL, Edinburgh; Dr. C. BELL TAYLOR, Nottingham; THE SECRETARY OF THE ASTLEY COOPER PRIZE TRUST, London; Mrs. THEOBALD, Leicester; Dr. HANDFIELD JONES, London; Dr. EDWARDSCRISP, London; Sir JoHN ROSE CORMACK, London; The Rev. Professor HAUGHTON, Dublin; Dr. GEORGE JOHNSON, London; Mr. F. LEGRAND, London; Dr. REES PHILLIPS, Cheltenham; Mr. G. EASTES, London; Messrs. J. SMITH and Co., London; Dr. EDIS, London; Dr. FARQUHARSON, London; Mr. J. W. GROVES, London; Mr. GEORGE GASKOIN, London; Dr. SPARKS, London; Dr. EUSTACE SMITH, London; Mr. J. CHATTO, London. APPOINTMENTS FOR THE WEEK. November 14. Saturday (this day). Operations at St. Bartholomew's, 14 p.m.; King's College, 2 p.m.; Charingcross, 2 p.m.; Royal Free, 9 a.m. and 2 p.m.; Hospital for Women, 9 a.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic, 14 p.m.; St. Thomas's, 94 a.m. 16. Monday. Operations at the Metropolitan Free, 2 p.m.; St. Mark's Hospital for Diseases of the Rectum, 2 p.m.; St. Peter's Hospital for Stone, 3 p.m.; Royal London Ophthalmic, 11 a.m.; Royal Westminster Ophthalmic 14 p.m. MEDICAL SOCIETY OF LONDON, 8 p.m. Mr. Braine will exhibit a living Specimen of Abnormal Growth of Lip. Dr. Cleveland, a Specimen of Warty Tumour. Mr. Napier, "Something New (or believed to be so) in the Science of Dental Surgery." Dr. R. J. Lee, "On Maternal Impressions." 17. Tuesday. Operations at Guy's, 14 p.m.; Westminster, 2 p.m.; National Orthopedic, 19. Thursday. Operations at St. George's, 1 p.m.; Central London Ophthalmic, 1 p.m.; 20. Friday. Operations at Central London Ophthalmic, 2 p.m.; Royal London Ophthalmic, 11 a.m.; South London Ophthalmic, 2 p.m.; Royal Westminster Ophthalmic, 14 p.m.; St. George's (ophthalmic operations), 1 p.m. MEDICAL MICROSCOPICAL SOCIETY, 8 p.m. Dr. Goodhart, "On Buccal Psoriasis or Ichthyosis of Tongue." 9.72 0.00 0.00 0-07 0-18 31 58.8 41.0 48-3 9:05 0.00 0.00 82 60 2 35 7 48-7 9-28 0-10 0-25 27 56 7 39-5 48-1 8.94 0.28 071 196 57 6 40 3 48'5 9-16 012 0:30 47 56 5 37 2 48'0 8-89 0-18 0'46 35 58 1 37 3 49'0 9.44 0.20 051 339 59-7 38 6 49-1 9.50 0.81 0.79 170 60 8 37 0 49 4 9-66 0 32 0-81 63 60 2 35 8 49'0 9.44 0.27 0.69 35 81 58.5 42.9 49-5 278798 12.9 272 155 59'0 41-0 49-1 in United Kingdm 7618655 36 65957 3669 68 0 31-6 49-1 9-50 0-220-56 At the Royal Observatory, Greenwich, the mean reading of the barometer last week was 30'03 in. The lowest was 29'90 in. on Monday afternoon, and the highest 30:33 in. at the end of the week. The figures for the English and Scottish towns are the numbers enumerated in April, 1871, raised to the middle of 1874 by the addition of three years and a quarter's increase, calculated on the rate which prevailed between 1861 and 1871. The population of Dublin is taken as stationary at the number enumerated in April, 1871. THE morbid picture which progressive bulbar paralysis presents, is one which, if once seen, is never likely to be forgotten. Considering how sharply defined are the characters of this disease, it is very remarkable that it should only have been first discovered and described by Duchenne in the year 1860. This is not to be accounted for by its great rarity. More than fifty cases of it have been reported already, and I have myself been consulted five times in eight years by persons suffering from it. It is quite certain that the affection had been observed by others before Duchenne-for instance, by Trousseau and Duménil,-but he was the first who referred its symptoms to their anatomical cause, and comprehended the disease as a whole instead of laying undue weight on certain symptoms to the neglect of the rest. To-day the group of symptoms of progressive paralysis of articulation and deglutition, such as Duchenne described it, is universally recognised as a typical form of disease and as a special variety of paralysis. The French have hitherto adopted for it Trousseau's name, "paralysie labio-glosso laryngée," or more shortly "paralysie glosso laryngée progressive"; while we in Germany have followed Wachsmuth in giving it the more appropriate title of "progressive bulbar paralysis." (b) Let us now consider more closely what light is thrown on the symptoms and course of this remarkable disease by the numerous observations which have been made on it since 1860. The persons who are attacked by progressive bulbar paralysis in its typical primary form have, with rare exceptions, passed their thirtieth year, and the predisposition to the disease appears to increase with advancing age. If we exclude two -cases which differ from the ordinary form in important particulars, out of 43 patients whose age is given only I was between 20 and 29 years of age; from 30 to 39 there were 6 patients; from 40 to 49, 8; from 50 to 59, 11; from 60 to 69, 14; and 3 from 70 to 72. Of 53 persons whose sex was noted, 34 were men and 19 women. The disease has been observed amongst the highest and lowest classes of society, and seems to be, if anything, rather more common among well-to-do people than among the poor. As yet it is not known to have been hereditary in any instance. In most of the cases the exciting cause was obscure, and, as a rule, the patients had been previously strong and healthy. Catching cold and mental disturbances were the most frequent assigned causes of its origin. One case appeared to have followed a fall on the head, and another excessive tobacco-smoking, and the disease was often found associated with syphilis. In one case it certainly appears to have been due to severe muscular over-exertion. The symptoms of the disease at its commencement are generally so trifling that the patients do not seek advice for them, and they have no suspicion of the fearful fate which awaits them in the future. What is first noticed is a slight alteration in the speech, which is soon followed or simultaneously accompanied by slight difficulty in swallowing. The general health of the patients remains excellent; they only find that their tongue feels heavier, and that they must exert more force to move it in speaking or eating, while it soon gets fatigued in doing either. Certain letters, especially R, become peculiarly difficult to pronounce. The patients' friends soon find that there is an alteration in their speech, and that it is not so distinct as it formerly was. The rule is for the tongue to be first attacked, and it is not till later that the lips, the larynx, the gullet, and the palate suffer in their turn. It is rare to find exceptions to this rule; yet Duchenne described one of his earliest cases as beginning by paralysis of the palate and lips. Duchenne speaks of the early affection of the lips as (a) This lecture is partly a translation and partly an abstract of No. 54 in Volkmann's admirable "Sammlung Klinischer Vorträge." (b) Throughout this lecture the term bulbar paralysis will be used instead of the ordinary English one of glosso-labial paralysis. The German name is not only shorter, but has also the advantage of directing attention to the pathological seat of the disease in the nervous system. VOL. II. 1874. No. 1273. occasionally giving rise to a feeling of slight stiffness in them, as if from cold. When deglutition becomes implicated, most distressing salivation usually soon follows, but in exceptional cases the salivation has preceded the impairment of swallowing, so that that symptom represented something more than a simple retention of mucus and saliva in the mouth, in consequence of dysphagia. In rare cases the trifling symptoms of paralysis which we have described remain for months, and even for years, unaltered; and then after some violent chill, or without any assignable cause, become rapidly worse. It is only exceptionally that the premonitory symptoms are first noticed during recovery from any sort of fever. It has been asserted that the disease may begin suddenly, in the form of an apoplectic attack; and Dr. Wilks has related several instances of the kind, some of which were accompanied with hemiplegia and paraplegia, and in which the symptoms of bulbar paralysis persisted after those of hemiplegia had disappeared. These cases, however, differ from those of true bulbar paralysis in the paralytic symptoms being complete from the first, and not of a progressive character. One, however, of my patients was attacked by the disease in a way which might be called "apoplectiform.' He was a Catholic priest, aged sixty, of regular habits, and who had always enjoyed good health previously. After suffering from pains in the back for eight days without any assignable cause for them, he one day found, while he was preaching, that his mouth was somewhat drawn, and that speaking was difficult, but he was not prevented from finishing his sermon. He did not feel giddy at the time nor at any after period; but from that time forward (March, 1868) he always had a feeling of weight in the tongue. After he had suffered many weeks from catarrh, severe cough, and abundant expectoration, which only very gradually improved, there was a rapid exacerbation of the paralytic symptoms. He stammered when he spoke, and had great difficulty in swallowing. Both arms became weak, and at night he had attacks of prostration which almost amounted to total unconsciousness. As early as September, 1868, this patient presented the mournful picture of a well-marked bulbar paralysis, with paralysis of hoth arme and atrophy of the small muscles of the hand. He died on September 18, 1869. There were no naked-eye appearances of an apoplectic clot to be found postmortem either in the medulla oblongata or in the pons, but the anterior and lateral white and grey regions of the spinal cord were the seat of a degenerative myelitis. The medulla oblongata was not examined microscopically. Occasionally the initial symptoms of bulbar paralysis may consist of headache, of pains and a feeling of constriction in the neck, and of tightness in the chest, which may probably be considered as irritative phenomena due to hyperemia of the medulla oblongata. In the further development of the disease the order in which the power of pronouncing the various letters of the alphabet is lost is not the same in all cases, since it depends on the order in which the various provinces of muscles in the territory of articulation become paralysed. If the movements of the lips are the first to suffer, (c) O and U will be the first letters that the patient cannot articulate, then I and and E, but A remains generally as long as the patient can speak at all. Where the tongue loses the power of raising itself from the floor of the mouth before the lips are paralysed, it is the letter I which first becomes impossible to pronounce. The loss of the movements of the tongue first robs the patient of R and Sch, then of S, L, K, G, T, and later of D and N. The paralysis of the lips at first makes the consonants P and F difficult to pronounce, then B and M, and lastly V. The paralysis of the palate not only makes the speech nasal, but also, as soon as it has reached such a degree that the quantity of air which escapes through the nose is excessive, prevents the formation of the labials B and P, which now sound like "Me," "We," or "Fe," because, as Duchenne has remarked, the force of the stream of air which must pass through the mouth and lips for their production is insufficient to overcome the contractile tension of the lips. The correctness of Duchenne's view is shown by the fact that if the lips still retain the power of contraction these patients can say B and P when their nose is held. If the speech becomes entirely lost, nothing remains at last but the (c) The letters here given are as they stand in the original, according to the German pronunciation: U therefore corresponds to Ooh in English, I to e, and E to a. A sounds like ah, and P, B, G, and T like pay, bay, gay, and tay. |