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tigating the history, however, it appeared that many years agoshe suffered from symptoms referable to the kidney, whichwould seem to have led to the opinion of another of the staff,that it might be hydro-nephrosis. The tumour is howeverhard, somewhat rough (which may depend upon malignantgrowths), and is confined to a situation in which we have seenseveral tumours of the spleen. We have no doubt an oppor-tunity will soon be afforded to test the accuracy of the diagno-sis, although we regret to say treatment is proving of no availwhatsoever.

SCROFULOUS OSTEITIS.

THIS case seemed one of necrosis of the shaft of the humerusin a man about thirty years of age, with several fistulous open-ings leading down to the bone, into one of which the probepassed into its interior. This condition had been present foreleven months, and seemed to be strumous, as there were cica-trices in other parts of his body,-over his ribs and feet,-which showed former disease of the bones of a strumous cha-racter. When under the influence of chloroform, Mr. Curling,on the 7th of May, made an incision along the upper and inneraspect of the arm, and very carefully divided the parts down tothe bone. This was necessarv to avoid wounding any of theimportant vessels and nerves in’ this situation. The shaft pfthe bone was found enlarged; an opening was made into it bymeans of a small trephine, its diameter being increased bythe aid of a mallet and chisel. No sequestrum was found, butthe bone itself was in a softened condition, and a good deal ofit thus affected was removed. The cavity was then filled withlint, and the arm left to heal up by suppuration, which willbring on a healthy action, as in a former case of trephining ofthe tibia, mentioned in our "Clinical Records." " Under suchcircumstances, everything will properly heal up.

Medical Societies.ROYAL MEDICAL & CHIRURGICAL SOCIETY.

TUESDAY, MAY 11TH, 1857.

SIR C. LOCOCK, PRESIDENT, IN THE CHAIR.

ANALYSIS OF FIFTY-TWO CASES OF EPILEPSY OBSERVED BY THEAUTHOR.

BY EDWARD H. SIEVEKING, M.D., F.R.C.P.,PHYSICIAN TO THE LATE DUKE OF CAMBRIDGE, LECTURER ON MATERIA MEDICA

AT, AND ASSISTANT-PHYSICIAN TO, ST. MARY’S HOSPITAL.

THE 52 cases analyzed had occurred exclusively under theauthor’s own observation, and the conclusions were limited topoints with reference to which satisfactory evidence could beobtained.

<S’ex.&mdash;24 were females, 46*15 per cent.; 28 were males, 53’84per cent.

Age. --The following is the distribution of the cases through-out the different periods of life :-Under 10 years, 17; from 10to 20, 19; 20 to 30, 4; 30 to 40, 4; 40 to 50, 7; over 50, 1 ; orfrom infancy to the age of 20 years inclusive, 69’23 per cent.;from 21 to 40 years inolusive, 15’38 per cent.; from 41 to 55years inclusive, 15’38 per cent. Arranged according to sex,we find during the first decennium, 8 males and 9 females;during the second, 12 males and 7 females; during the third,2 males and 2 females; during the fourth, the same number ofeach; during the fifth, 2 males and 3 females; during thesixth, 1 female. The male sex during puberty, therefore,seems to exhibit a more marked proclivity to epilepsy than thefemale; at later periods the ratio returns to the equality shownto prevail during the first ten years of life.

(7aMe.&mdash;Hereditary tendency could be traced only in 6’cases, or 11 ’1 per cent. A definite cause was assigned by thepatient or the patient’s friends in 16 cases, or nearly one-thirdof the whole. Amongst these, otorrhcea is mentioned twice;fright, twice; injury to the head, twice. The cases differ inthe relation they bear to the occurrence of the seizure.

Premonitory S!fmptoms.-The occurrence of an "aura" is apoint on which observers have expressed different opinions.Comprising under this term all the premonitory symptoms in-dicating the approach of a fit, it is noted in 27 out of 52 cases;the most common was a sense of giddiness and impairment ofvision ; sometimes the patient suffered pain in a definite regionof the body, or, though unable to explain the sensation, is

aware of some change from which they know that a paroxysmis about to take place. The sensation was never described as apuff of wind or aura in its verbal sense.

Individual Symptoms.-Headache is a very frequent con-comitant of epilepsy. It was observed in 33 out of 52 cases, or63’42 per cent. The mode of its occurrence varies: the patienteither suffers habitually or very frequently from it, and thesymptom bears no immediate relation to the paroxysm; or theheadache occurs shortly before the fits, so as to usher them in;or again it affects the individual after they are over. It wasconstant or frequent in 36 ’5 per cent.; it occurred before thefits only in 7 ’7 per cent.; it occurred after the fits only in 17’3per cent. Biting the tongue is justly regarded as an importantcorroborative symptom; but it is by no means uniformly pre-sent, nor does it constantly occur in the different paroxysmsaffecting the same individual. The tongue was bitten in 17cases, or 32’7 per cent. The urine was tested for albumen in19 cases, and it was found temporarily present in one, perma--nently in one. It was also tested for sugar in 14 cases, andthis ingredient was not found once-a result which seems irre-concileable with the observations of Dr. Goolden.

Re8ult. of 7’i-eatme)it.-The author ventured to express a,

feeling of scepticism with regard to the positive certainty ofany cure of epilepsy. He believed that, in the majority, no.organic lesion, in the ordinary anatomical sense of the word,was present in the commencement of the disease, and that, ina large number, none seems to result from the recurrence of thefits. It appears that a diathesis is necessary to its occurrence,and that this may be suppressed or held in check; but whetherit may be eradicated, is a question which he would not ventureto answer in the affirmative. He was satisfied of the power ofwell-selected remedies in repressing, and often indefinitelypostponing, the paroxysm, and he particularly insisted on theimportance of dietetic and regiminal treatment. The numberof apparent cures was 15, or 28’85 percent.; in other instances,more or less benefit was obtained. The duration of the dis-ease before treatment is commenced, has an obvious influence,over its curability. Eight of the 15 (apparent) cures were

wrought in cases that had lasted one year or under, four wereof two years’ duration, one of three, one of six, and one of &pound;eight years. The treatment adopted had varied with thenature of the constitutional affection in each case; but he wasable to draw this general inference, that the main indicationswhich should guide us, are to remove local irritation by counter-irritants, to promote the healthy action of the secernent organs,.and to give a tone to the constitution by vegetable and metallicroborants. The author expressed his belief that there was nospecific for epilepsy; the salts of zinc certainly fail to removeit in many cases.

In a postscript he detailed the results of an analysis of theReturns of the Registrar-General with reference to sex in deathsfrom epilepsy during seven years; which gave 6729 males, and6149 females, or 52’26 of the one sex to 47’73 of the other.

Dr. WEBSTER remarked that epilepsy was on the increase, aswas proved by the fact, that in London, nearly double thenumber now died of that disease than did only twelve yearssince. Epilepsy was more frequent in London than in Scot-land ; for even in the town population of that part of the king-dom, the number of epileptic cases was only one in three ascompared with London. The disease was common in Franceand in the South, whilst insanity was more common in theNorth than the South. With respect to the comparative fre-quency of epilepsy in the sexes, it was more common in earlylife in women; about equal in the sexes at middle age, andmore frequent in men than women in advanced life. This

brought the number in the sexes to about equal. Amongst thefrequent causes of epilepsy in young people, fright and terrormight be mentioned. One of the worst cases he (Dr. Webster)had ever seen was in a young woman who had been frightenedby " a ghost." Amongst older persons, dissipated habits anddrunkenness were common causes of epilepsy. He thought itwas hereditary in more cases than stated by the author. In-stead of 11 per cent., as given by Dr. Sieveking, he thought itwas 35 per cent. at the least. In the last report of the NewYork Asylum, it was mentioned that during that year, in allthe epileptic patients admitted, the cause of the disease washereditary; or they were the children of drunkards. Withrespect to treatment he thought it was only in early life thatwe could expect much good from remedies. He had seen casescured in early life, but very rarely indeed afterwards. Theeffect of the much-vaunted mineral medicines was usually buttemporary. It was essential in these cases to regulate the diet,and to avoid mental excitement.

Dr. A. P. STEWART had been surprised to hear that in none

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of Dr. Sieveking’s cases was there disease of the kidney. He(Dr. Stewart) had had three cases under his care during thelast eighteen months, associated with disease of that organ.He could not then say how many other cases of a similar kindhad occurred to him, but some two or three years since he hadthree such cases. He should have been glad to have heardmore particularly what remedies had been employed by Dr.Sieveking. He (Dr. Stewart) had used most of the remediesrecommended for epilepsy, and had carried the dose of sulphateof zinc to the extent of twenty-five grains three times a day;in some instances it did good, in others it rather aggravated the ’disease. In two cases he had used nitro-muriatic acid exter-

nally and internally, as recommended by Dr. Hunt; it was ofuse in one case, but not in the other.

Dr. SNOW said that Mr. De la Rue had presented him withspecimens of two volatile hydrocarbons distilled from Rangoontar, which he (Dr. Snow) found to produce symptoms just likethose of epilepsy in animals which inhaled them. The guinea-pigs and white mice on which he had experimented with thesesubstances continued to walk about, and appeared quite con-scious up to a certain point, when they were suddenly attackedwith violent epileptic convulsions, and were insensible duringthe fit. If they were removed from the vapour, as soon as theconvulsions commenced, they recovered rapidly, without subse-quent ill effects of any kind; but if they were allowed to remainin the vapour, they died in half a minute or a minute. Heobserved that the white mice became rather livid just beforethe convulsions commenced.

Sir CHARLES LococK had noticed the omission in the paperof a very common cause of epilepsy-viz., dentition. He didnot quite agree with Dr. Ashburner, that all cases of thedisease could be cured by the removal of a tooth; but he hadcertainly seen the affection cured in more than one instance byremoving over-crowded teeth. A great number of cases of epi-lepsy, both in boys and girls, arose from the practice of onanism.This was a cause very frequently overlooked, and might accountfor the great increase in the disease of late years. There was aform also of hysterical epilepsy connected with the menstrualperiod, and as periodic as that function. This form of the dis-ease was very difficult to treat. The attacks only occurredduring the catamenial period, except under otherwise strongexciting causes. He had been baffled in every way in thetreatment of this affection. Some years since, however, he hadread in the British and Foreign Review, an account of someexperiments performed by a German on himself with bromideof potassium. The experimenter had found that when he tookten grains of the preparation three times a day for fourteendays, it produced temporary impotency, the virile powers re-turning after leaving off the medicine. He (Dr. Locock) deter-mined to try this remedy in cases of hysteria in young women,unaccompanied by epilepsy. He had found it, in doses of fromfive to ten grains, three times a day, of the greatest service.In a case of hysterical epilepsy which had occurred every monthfor nine years, and had resisted every kind of treatment, hehad administered the bromide of potassium. He commencedthis treatment about fourteen months since. For three monthshe gave ten grains of the potassium three times a day. Hethen gave the same dose three times a day for fourteen daysbefore the menstrual period, and latterly had only ordered itin the same dose, three times a day, for a week before the ex-pected catamenia. This patient had had no epilepsy since thecommencement of the use of the potassium. Out of fourteen orfifteen cases treated by this medicine, only one had remaineduncured.

Dr. WEBSTER remarked that onanism was, no doubt, a fre-quent cause of epilepsy, more particularly in southern climates.

Dr. SIEVEKING had not enumerated onanism amongst thecauses of epilepsy in his paper, because it was not the assignedcause in any instance by the patient. The difficulty really wasto arrive at the truth with respect to the influence of this causein the production of the disease, and he confessed he did notknow how to proceed to determine it in the case of females.

ON THE TREATMENT OF WOUNDS OF THE PALMAR ARCHESBY FORCED FLEXION OF THE ARM.

BY J. GILES, M.R.C.S.

(Communicated by T. B. CURLING, F.R.S., &c.)

After allusion to the various troublesome complications, andfrequent very serious consequences which attend wounds ofthe palm, when circumstances prevent the application of liga-tures at the seat of injury, the author remarked upon theadvantages of a method of treatment which should have theadvantage of checking the haemorrhage without either severe

local pressure or ligature of vessels remote from the wound;such advantages would seem to be afforded by the plan of flex-ing the forearm upon the arm with sufficient force to arrestthe bleeding, and maintaining it in that position so long as maybe necessary. The author related five cases of wound of the

palmar arch, and one of wound of the forearm, which werethus treated, and all with success, save one, in which, how-ever, the procedure was not had recourse to until a monthafter the accident. The merit of originating this mode oftreatment was given to M. Durwell, by whom it was proposedin L’ Union 111eclicczle, tome iii., p. 341.Mr. SPENCER WELLS had seen several gentlemen present

trying to stop the pulse at the wrist, by flexing the forearm onthe arm. He should like to know the result, as he had notsucceeded in stopping the circulation in his own wrist.

Mr. ARNOTT remarked that the fact announced in the paperhad been long known; the pulse, in many instances, could bearrested in the manner described; sometimes, however, it failed.He thought, however, the young gentleman who had sent thepaper to the Society was entitled to its thanks for bringingbefore them any means of treatment in a very troublesomeclass of cases. A case of Mr. Skey’s had been mentioned in thepaper, in whichthe ulnar, radial, and brachial arteries had been allsuccessively tied without arresting the hoemorrhage. Was therenot in this case, however, disease of the coats of the artery’?Mr. Arnott mentioned a case which had come under his care inUniversity College Hospital, in which the wound in the palmhad been received twelve days before the admission of thepatient. The haemorrhage had not ceased, and the house-sur-geon tied the artery upon the spot; bleeding recurred: thenpressure was applied, and subsequently the radial, ulnar, andbrachial arteries secured. Only temporary benefit ensued. Mr.Arnott now applied ligatures in the palm, and thus happilysucceeded in arresting the haemorrhage. In some cases, themode of treatment advocated by Mr. Giles was a good one; butit was desirable that a small solid compress should be appliedover the wound, in addition to the flexion of the forearm onthe arm. It was, however, very difficult in some cases to keepup this condition of flexion. It was not necessary, however,absolutely to arrest the flow of blood; if we interfered with thecurrent, as was done in the treatment of aneurism by pressure,it would in some cases be sufficient. The treatment, however,in wounds of the palmar arch, must be adapted to the exigen-cies of the case.

Mr. CIT11LING remarked, that in addition to flexion, Mr.Giles had advised the employment of local pressure in thesecases. Flexion would not always succeed in arresting the flowof blood, but by flexion he (Mr. Curling) could arrest the pulseat his own wrist. Usually, by this proceeding, the force of thecirculation could be sufficiently diminished to do good. Thismode of treatment was not applicable in all cases. An in-stance had lately occurred at the London Hospital, in whichlocal pressure could not from some cause be fully employed,and the current of blood could not be sufficiently interruptedby forcible flexion. The humeral artery was consequentlysecured, and with success. Enough had been said to show thedifficulties which surgeons occasionally encountered in cases ofwounds of the palmar arch ; and if the plan before themanswered only in a few cases, (though he himself believed itwould succeed in most,) it was a valuable accession to our sur-gical means of treatment.ANTEFLEXION OF THE UTERUS CONSIDERED AS A NORMAL

ANATOMICAL CONDITION.

BY J. H. BENNET, M.D.,PHYSICIAN ACCOUCHEUR TO THE ROYAL FREE HOSPITAL.

The author’s attention was attracted some years ago, duringa series of investigations into the condition of the os internumduring life, by the anatomical fact that the uterine cavitiesand the uterus itself, in women who have never borne children,are generally more or less anteflexed. He thinks it provedthat this was misunderstood because stem-pessaries are in-

variably made perfectly straight, and anteflexion has been uni-versally described as an abnormal or morbid condition. M.Huguier, however, published a memoir some years ago, de-scribing anteflexion as an occasional congenital condition, buthe described it as accidental and exceptional. The author’sresearches were begun with a view to determining the value ofcontraction of the os internum as a cause of sterility. Hefound that when the uterine sound met with resistance there,a small wax bougie could be passed, which, if allowed to re-main for a minute or two in the uterus of a woman who hadborne no children, presented when withdrawn a slight anterior