the third, aphonia with congenital idiocy from atrophy of the anterior lobes; the fourth, mania pellagrosa; and the fifth is a case of general paralysis.

The following is a brief account of the first case, viz., aphasia in an epileptic.

A woman, of sound parents and good constitution, lived till she was twenty-five in good health, when she had an epileptic attack while menstruating. She had no return of it for seven years, but her mind was rather dull. When she was thirty-three the epilepsy re-appeared, the attacks occurring every fifteen days, and being aggravated during menstruation. In one of these attacks she fell into the fire and burned her right hand. A curious fact connected with them was that, during the period of excitement, the urine diminished in quantity nearly half, its specific gravity rose ten degrees, it was loaded with urates and phosphates, and twice albumen was also found. Her mind was much impaired, and she had almost total loss of memory and of the use of words. She could not answer a question, sometimes would pronounce such words as bed, bread, &c., but had generally only one or two phrases which she would repeat.

At the autopsy the bones of the cranium were found much thicker than usual, and in the frontal region there was on the inner surface a remarkable deposit of calcareous substance. The skull measured only 18-8 inches in circumference, 7.2 in its longitudinal and 5-2 in its transverse diameter.

The weight of the brain, with the cerebellum and medulla, was 36 oz. avoirdupois, minus 16 grains. The author thinks that the small size of the head resulted from the unusual ossification of the sutures, and that this interfered with the nutrition of the brain. He also considers that this case is opposed to Broca's views as to the localisation in the brain of the faculty of speech, as both lobes of the brain were atrophied, and the right the most, while he mentions several writers who have related instances of disease in the brain with aphasia, far away from M. Broca's convolution. For instance, E. Cruveilhier found aphasia with disease of the left corpus striatum, Bennet found the same with atrophy of the convolutions of the right hemisphere, and Barthe had a case due to hydatids in the left ventricle.

The next case, the third, is also one of interest, and is abridged as follows:-M. B-, a male, æt. 38 at time of death, with this history-His parents were healthy, but from birth he showed a singular want of intellect, took the breast with difficulty and could not utter a cry. He could only succeed in learning to walk imperfectly. No change occurred at puberty; he never spoke, but made noises when it rained, walked with

very tottering

steps, and later only ate when forced, showing no dislike to the most nauseous substances. His hearing seemed pretty good, but not so his sight.

Autopsy. The measurements of the cranium were in circumference 19.4 inches, ant.-post. diameter 7.3, transverse ditto 5.6, and vertical height 4.6.

On the anterior surface of the petrous portion of the right temporal bone was a small pedunculated tumour, the left petrous bone was smaller than the right, and without the elevations corresponding to the semicircular canals, while the upper semicircular canal on this side was narrow and atrophied.

The left hypoglossal, the olfactory, and optic nerves (as well as the eighth, ninth, tenth, and eleventh, according to Italian anatomists) were atrophied and like threads of silk. The left meatus auditorius was quite filled with wax.

The weight of the cerebrum was 39 oz. avoird., that of the cerebellum 54. The cerebral substance was denser than usual and of a dull yellowish colour. But what was of the most importance the convolutions of both anterior lobes were smaller than the posterior, and the sulci hardly apparent. The microscope showed a deposit of pigment in the multipolar cells of the brain and medulla oblongata.

The author thinks that the primary disease was atrophy of the anterior lobes, and that the nerves were affected subsequently. The small volume and atrophied appearance of the anterior lobes are very remarkable in the engraving which illustrates the case.

We are glad to see such good fruits of the clinique on mental diseases as these cases afford, and can wish that a similar course were adopted in this country, where, though we possess far greater advantages in every way in the treatment of the insane, the student is debarred from any opportunity of watching the phenomena of diseases of the mind.

Dr. Lombroso, who has charge of the clinique for mental diseases at the famous University of Pavia, has evidently worked hard at his cases, and investigated them most industriously. The weight of his patients, the condition of their hair, teeth, and urine, the measurements of their skulls, their motor and sensory affections, intellectual state, and the etiology of their disease, all come under his notice in succession, and he has given the results of his labours to the public under the above title.

Work of this kind is very valuable for its own sake, though it is not sufficiently practical to be generally appreciated. We must be content to give an outline of the conclusions arrived at by the Italian professor, after his elaborate investigations.

The weight, he says, of an insane man is less than that of a sane one of the same stature and condition. Dementia, pellagra, and mania, diminish the weight of the body, and dementia the most. Patients in acute mania lose weight independently of the conditions of respiration and alimentation.

The hair of the insane often undergoes changes of colour, and they become prematurely grey or else bald. In an epileptic woman it was noticed that the hair stood erect on her head during paroxysms of fury,

The teeth are generally irregular or deficient, and more often so with the demented.

The attachment of the ear to the head and the form of the helix are often irregular in chronic mania and dementia.

The globe is often observed to have a continuous lateral movement.

The specific gravity of the urine is lower than usual in those suffering from pellagra and in melancholics; it is normal in cases of mania, and in the demented it rises to a remarkable degree, especially at the onset of attacks of excitement. In these cases the urine diminishes much in quantity, and the proportion of urea, phosphoric and sulphuric acids increases, while in some cases albumen is present. The urine is acid in most cases of mania, and very acid in those who are furious, but this acidity soon gives way to an alkaline condition. The most interesting of these observations, however, are the cranial measurements made in a considerable number of cases. From these the author concludes that the healthy individuals of each Italian province have certain special cranial characters which distinguish them from the inhabitants of the neighbouring provinces. These characters consist in certain proportions of the longitudinal as compared with the transverse diameters, which vary very slightly with the stature, and education of the individual, whilst they are subject to considerable differences under the influence of insanity. The demented and idiotic. have a tendency more especially to the "ultra-brachiocephalic" type, the male sufferers from mania to the "dolico-cephalic," while monomaniacs approach nearly to the moderate brachiocephalic. The capacity of the cranium varies in the several provinces, but more still according to individuals or intellectual culture. It is absolutely less in all the subjects of mania, more markedly still in the demented and idiotic, and especially in demented epileptics. These facts are amply illustrated by an elaborate table showing the relative measurements of the various diameters of the skull, and giving also the height of the individual and his place of birth, and these observations have been made on a series of sane as well as insane people for purposes

of comparison. Thus, for instance, a certain diameter is found to measure 771 millemètres in a native of the Abruzzi, while it is 767 in a Neapolitan, and 814 in a Milanese. There are many obvious objections to attaching much importance to such differences, but a series of careful observations conducted honestly and on a scientific basis are entitled to attention, and the more so when they are put forward simply on their own merits and not to support any favorite theory. There are other tables in this little work, dealing with statistics as to hereditary influence, causation, &c., and a chapter on criminal lunacy; but the points dwelt on have often been brought under notice in this country before.

ART. XIV. Reports and Papers of the Metropolitan Poor-law Medical Officers' Association. 1866 and 1867.

Reports and Papers of the Association for the Improvement of London Workhouse Infirmaries. 1866 and 1867.

It is our intention in our next number to consider at length the measures taken and contemplated for improving the management of the medical relief of the poor in London. The two associations, the published papers of which are before us, have done good service in the agitation which has happily terminated in the passing of the "Metropolitan Poor Act" of the present session. These associations, indeed, were not the first in the field. Much had been already effected by the inquiries of D. Stallard, and of the 'Lancet' Sanitary Commission, consisting of Mr. Ernest Hart, Dr. Anstie, and Dr. Carr. It will be our endeavour when discussing the history of this successful agitation to give their due share of praise to all concerned in it. The two associations above mentioned differed in this, that the one is a professional and the other essentially a non-professional organization. Both, however, dealt with similar facts and grievances, although, as respects the former, other objects, secondary to the common object of both, were necessarily held in view.

ART. XV.-The Restoration of Health; or, the Application of the Laws of Hygiene to the Recovery of Health: Forming a Manual for the Invalid, and a Guide in the Sick-room. By WILLIAM STRANGE, M.D., &c. London, 1865, pp. 434.

THIS work contains a good deal that is useful, and, as it

seems to us, not a little that is superfluous. The portion which is physiological and, we are disposed to add, that which is pathological, might, we think, have been omitted with advantage. A very superficial knowledge of each of these difficult and abstruse subjects is more likely to bewilder the mind of the general reader than to enlighten it. It is surely but a vain attempt to indoctrinate in the higher branches of medical science those, such as the general public, who have not had the preliminary education requisite for the understanding of the merest elements of them, and, if ignorant of anatomy-as the public must be presumed to be-of understanding even the greater number of the terms employed. As regards the junior members of the medical profession, to whom the author thinks his work may be useful, we are also not without our doubts. To answer the purpose designed in their case the information afforded is hardly sufficiently minute or exact; and defective indeed must be the condition, and limited the reading, of those practitioners who can from this volume derive much instruction.

The 2nd and 3rd parts, having for their titles, "Nature, Causes, and Prevention of Diseases," "Management of the Sickroom," and "Convalesence and Restoration of Health," these comprising nearly three fourths of the entire contents, have, we think, better claims to attention, and are likely to be of more service, especially to nurses, whether professional or nonprofessional, and to such invalids and convalescents as are in no danger of becoming hypochondriacal, and of being too observant of their feelings. The majority of the rules laid down are judicious, and display an accurate knowledge of the ordinary wants of the sick, and of the desiderata in nursing, such as might be expected from an experienced hospitalphysician.

The style adapted by the author is easy, flowing, and popular; perhaps occasionally too figurative, and also prolix, and too little idiomatic. Here is an example of the former. Adverting to the sympathy, which he calls universal, between the stomach and all other organs, he remarks:

"It both feels with them in distress, and it takes care to make them participate in its own troubles. It is not at all inclined to mourn in silence, and meekly put up with the wrongs' inflicted upon it; but it makes its lamentations heard by its neighbours far and near, and draws them all to participate in its quarrels, thus putting force upon the offending owner to compel him to alter his conduct."

Now, apart from the mode of expression, we might object to