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with the excito-motor power. This irritation is the source ofvarious congenital convulsive or spasmodic affections; it maybe the cause of strabismus, laryngismus, &c., of the variousdistortions of the hands, and especially of the feet. In thecase of two brothers, similarly affected, the tendo Achilliswas permanently contracted with spasmo-paralysis of bothlegs; on the death of one, aged twelve, effusion on thecerebral hemispheres, at the base of the brain, and alongthe spinal canal, was found in considerable quantity; thearachnoid was thickened, and, over the lateral portion of onehemisphere, converted into a thin layer of bone.

Of Spasmo-paralysis in Infants and Children-Spasmo-paralysis in infants and children is of centric and

of ex-centric origin-the prognosis of the former being, ofcourse, far more formidable than that of the latter.Teething, ahd gastric and intestinal irritation, and, I suspect,

exposure of the naked surface to the cold, are thé causes ofthe reflex or ex-centric forms of this malady. From suchcauses I have seen hemiplegia of the arm, or of the leg, or ofboth; and the proof that the affection was of reflex origin wasa very happy one-viz., speedy recovery.The event, however, is not always so fortunate.Sometimes both legs are affected, and this affection is

sometimes more observed in one leg than in the other; some-times the spasm, sometimes the paralysis, predominates; andsometimes one leg is affected with paralysis, whilst the otheris ,affected with spasmo-paralysis.

Spçr,smo-paralysÍ8 in the .A dult.But of all the cases which have come under my observa-

tion, none has been more replete with interest and anxietythan spasmo-rparalysis occurring in the adult period of humanlifa.

It is .well known that the epileptic convulsion sometimesle3v&bgr;fT one arm, one leg, or one side, paralytic or hemiplegic,Ïnta. greater or less degree. If the seizures were not to be

repeated, I imagine this paralysis would frequently subside,being the effect of shock, and of the common cause or causesof the convulsion and of the hemiplegia, which is thereforenot permanent. But if the shock be repeated, the paralysismay be. permanent, although the convulsion subsides.In one most interesting case, a lady, aged thirty-five, was

seized with violent convulsion of the left side of the face, andof the left arm, the leg being unaffected; when the convulsionceased, the face and arm were left extremely, if not perfectlyparalytic. A degree of amendment took place; but the con-vulsions returned, occupying the same seats as before, and,on ceasing, again left the face, arm, and hand, absolutelyparalytic.

This lady had once had phlegmasia dolens after parturition,and this leg again became swollen. But the cause of theattack of convulsions seemed to be discovered in the conditionof the intestines; for these convulsions were relieved by purga-tive medicines, but were excited if those medicines acted tooviolently.From the paralysis left by this serious attack or repetitionof attacks, the patient recovered completely,-an additionalproof that the affection had, like many cases of epilepticseizure, arisen from some cause ex-centric to the encephalonor- spinal marrow. And how invaluable is this fact, in refer-ence. both to our prognosis and treatment! I

- ...

Indeed, I may here observe, that spasmo-paralysis is inevery respect a disease of less hopeless character than pureparalysis, inasmuch as the’irritation of an organ is a lesssevere affection than its destruction. The diagnosis or detec-tion of the cause is the first great object of the physician, andespecially the determination of the question-Whether thatcause be seated centrically or ex-centrically.In one case, which occurred in a member of our own profes-

sion, after repeated threatenings supposed to be apoplectic,severe spasmo-paralysis supervened, and remained permanent.Bleeding had been resorted to constantly as the preventive. Itought, I believe, to have been decided, but not too severe,antacid aperients, with a strict attention to the diet, whichshould not have been of a mere vegetable, but of a light anddigestible character.There was, I believe, more of the epileptic than of the

apoplectic in those threatenings. Is there any physical lesion?Is the case, or was the case, one admitting of recovery ? Howdeeply interesting are all these questions ! t

It is plain that the new topic-new because now vieweddistinctly—of spasmo-paralysis, will assume an importantposition amongst the objects of the physician’s studies.

I have two patients under my care1 at this time, with po-

drismus, occurring at the ages, in one, of twenty-five, in theother, of forty-five. Both are females. In the first, tharight foot is drawn upwards and inwards, and so severely asto induce great tenderness and swelling of the outer ankle.Various symptoms of nervous origin are conjoined with thisdeformity of the foot. In the other, the tendo Achillis ineach leg is tense, and the toe only, and not the foot, muchless the heel, can be put to the ground. In this case almostevery article of food or medicine is rejected by vomiting.

I do not believe that either of these cases is hysteria.There is no other symptom of hysteric character, and thetemperament in both patients is staid and sedate.

Conclusion.

From the recent progress of the physiology of the nervoussystem, we are now enabled to conclude-

1. That paralysis, pure paralysis, may be an affection eitherof the cerebrum, the spinal marrow, or the nerves; but

2. That spasm must be an affection of some part of the true;spinal system; and

3. That spasmo-paralysis must at least involve in it an affec-tion of the true spinal system, either primarily or secondarily.There is only one exception to this last rule: it is the case

of severe hemiplegia, in which, from the mere facts of thesevering of the influence of volition, and the normal or phy-.siological action of the spinal marrow-the source at once ofthe irritability of muscular fibre and of tone-the affectedhand frequently becomes spasmodically flexed.Here I conclude this brief paper. I think I have clearly

shown in it, once more, how important, how essential, phy-siology is to the physician, and pointed out a distinction to:be carefully drawn between paralysis, and spasm, and spasmo.-paralysis, as.at once a guide to our prognosis and our treatment.

STRANGULATED UMBILICAL HERNIA SUC-CESSFULLY OPERATED UPON AFTER THEPLAN PROPOSED BY MR. GAY.

BY GEO. BORLASE CHILDS, Esq., F.R.C.S.E., London.

MR. OHILDS was requested by Mr. Clarke, of Queen-street,to see Mrs. T- on the 8th of March, a very corpulentperson, aged thirty-five, affected with a large umbilical herni4which had become strangulated in the course of the previousnight. Mrs. T- had been the subject of a hernial protru-!sion for two years, which, although irreducible, had given her.no inconvenience. On the occurrence of strangulation, theparts in the vicinity, as well as the contents of the hernial sac,became very tender, the abdomen tense and unyielding, whichsymptoms were speedily followed by a constant sense of nauseaand vomiting.

The- hernial tumour, at least eight inches in its longest dia.--meter, lay principally on the abdominal parietes to the left ofthe umbilicus, which it depressed to a depth that made thedistance between them and the integuments very considerable,and obviously consisted of a large mass of omentum as well as’y,intestine.An operation for its relief was immediately required, and on

determining upon the plan, a preference was given to that re-cently proposed by Mr. Gay, on the grounds, that from itsgreat size, the corpulency of the patient, and the extent ofwound necessary for its performance in the ordinary way,hardly any but a fatal result could be anticipated from it.In the presence of Mr. Coulson, Mr. Childs proceeded to

operate, assisted by Mr. Goude and Mr. Clarke, after thevapour of chloroform had been administered, so as to bringthe patient fully under its influence. A wound through theinteguments and superficial fascia, not more than an inch inlength, was made on the right side, just beyond the edge of.the hernial mass. The finger was directed through the wound,and after separating some few bands of cellular and other tis-sues, which feebly obstructed its course, the neck of the sacwas reached, at a depth of at least four inches. The umbi-lical ring forming the stricture was then felt gripping theneck of the sac, to which it was adherent, by means of somestrong bands. These were broken down with the point ofthe finger, but not without some difficulty, owing to the greatquantity of fat and consequent depth of the wound. A di-rector was then insinuated between the sac and the ring,guided by the finger, which still remained in the wound, andthe stricture divided. After breaking down some further ad-hesions, the parts were liberated, and the contents of the sac

immediately returned. The patient had her usual trass -

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applied at once,and no bad symptoms occurred to preventher .complete recovery.

: Mr. Childs felt desirous of giving publicity to this opera-ttO.n, bearing as it does upon the important discussion referredto in the pages of THE LANCET of last week, at the meeting ofthe Medico-Chirurgical Society, and on the advantages whichare obviously obtained by this mode of operating over thatwhich has been heretofore practised.The usual fatality attending operations for umbilical hernia

would, in the prognosis of the present case, have excitedgrave doubts as to the result, had the old operation beenadopted; and Mr. Childs cannot but think.that the simplicityof the principle upon which the new operation is based, thelittle difficulty, in ordinary cases, of practising it, and thelessened probability of its being followed by any severesymptoms, form very decided arguments in its favour., Fore-street, City, MArch, 1848.

REPORT OF A REMARKABLE CASE OFSOMNOLENCY.

BY JAMES EDWARD, M.D., L.R.C.S. Edin., Forfar.

’THERE lived in the parish of Cortachy, in the county ofForfar, between 1819 and 1834, a certain female, EuphemiaLindsay, commonly known through the most of Forfarshire bythe appellation of Sleeping Effie. Her peculiarities were as’remarkable as those of any one who has appeared in the annalsof human history. She was addicted to wandering, and com-..monly, left her home about the time when other people retired"two rest, and during the night would frequently wander fromtwelve to fifteen miles. It was remarked, that when she took’these nocturnal journeys, she was sure shortly afterwards to’fall into sleeping fits; and it was no unusual thing for her tosleep two or three weeks without awaking. In the winter;of 1820 she slept five weeks, and during the spring of 1825 she,slept six weeks and three days, which was the longest sleepshe had been known to take. This happened during theministry of the late Rev. John Gourlay, whose son Williamwas a surgeon, and frequently visited her during her som-niferous periods. Mr. William Shaw, private teacher, waspresent at some of Mr. Gourlay’s visitations, when he appliedsinged feathers to her nostrils; and at his request he appliedthem in such a manner, that the flame touched her nose andface during the time of burning, but she never showed the’least symptom of feeling; and to put suspicion beyond doubt,her neighbours frequently put private marks on her bedclothes.when or before they retired to rest, and in such a way, that ifshe had made the smallest stir in the course of the night, themarks must have been removed, but never in the morning,-when inspected, had they deviated frpm where they were’placed. ,’ During one of her sleeping fits, it was ascertained that shehad taken a drink of water during the night, it being placed:close to her bedside; but at no time could it be observed byany of the neighbours who from time to time frequentlyvisited her, that ever she had touched her store of provisionsduring the time she slept. The last sleeping fit she had cameon in the summer season of 1834, and lasted three weeks, andshe died of an exhausted constitution three days after sheawoke from it, at the age of fifty-six years.These facts can be authenticated by many respectable

people in the parish where she lived, iWho ,knew her well andare still in existence, several of them being relations of herown. During the winter of 1828, treated her for a neuralgicaffection in the region of the heart.. Forfar, Feb. 14th. 1848.

Analyses of Communications in MS.RECEIVED FOR PUBLICATION IN THE LANCET.

Contributions to Dietetics.—Use of Ligninin in the Animal Economy;Necessity for Non-Azotised Food.

By WILLIAM HENRY ROBERTSON, M.D.,PHYSICIAN TO THE BUXTON BATH CHARITY.

DR. BEDDOES, of Bewdley, Worcestershire, in a letter toDr. Robertson, after making reference to the three firstnumbers of the " Treatise on Diet," by the latter physician,and especially to the comparison of dietaries in the thirdnumber, remarks—" The calorific value of any particulararticle of food should be measured by the proportion of oxygenwith which its carbon and hydrogen will unite to form car-bonic acid and water. Thus, supposing fat to contain, perCent., 79 carbon, 11 hydrogen, and 1Q oxygen; its calorific

value may be calculated as follows :-6 : 16 :: 79 : 210.6,amount of oxygen which will combine with the carbon;.1 : 8 :: 11 : 88, amount of oxygen which will combine withthe hydrogen; total, 298.6. Subtract amount of oxygen infat, 10; amount of oxygen required to burn 100 parts of fat,288.6. 288.6 may, then, be taken as the calorific value of fat.Other non-azotised bodies may be treated in the same way.Thus, starch will have a value of about 116, grape-sugar, 96, &c.In r eckoning the value of compound aliments, I would ex-clude from the computation, lignin, as being an innutritioussubstance. This rule would of course reduce the calorificvalue of oats, peas, and most other vegetable substances.When you, Sir, state, in one of your tables, that peas contain80 per cent. of dry nutriment, do you not include the ligpin;and if so, do you not assign too high a value to peas in thescale of nutriment ? It seems to me that nitrogenous prin-ciples should have their calorific values computed in a similarmanner, seeing that after assimilation and deposition, in theforms of muscle, &c., they are finally decomposed, and ,yieldtheir carbon and hydrogen (in great part) to the lungs, thenitrogen passing ciff principally in the form of urea, and carry-ing with it a part of the carbon and hydrogen."

, In his reply to this communication, Dr. Robertspn submitte’d

that it would be premature " to assume that Iignin is not inany degree, or under any circumstances, assimilable by thehuman system;" and that"the questions of the various degreesof digestibility of the different articles of food, the relativeprobability of their being dissolved by the peptic secretions,or of their becoming excrementitious without having ministeredin any degree to the nutrition of the body, are matters, evenyet, far from having been correctly ascertained. A series ofanalyses of the faecal evacuations would be requisite to thefull determination of these questions.

’

,

11 It would be of no secondary importance to have thepositive and relative solubility of the different articles of foodthus determined, as well as their relative composition, andthe consequent degree to which, when digested and assimi-lated, they may minister azotised matter to the organic pro-cesses, and non-azotised matter to the respiratory wants ofthe jeconomy of the, body. There- may, indeed, be some riskthat the animal economy might come to be regarded in apoint of view much too exclusively chemical; that thepeculiar laws of organization and vitality, and the paramountinfluence of the mind itself, might be so far forgottpn orunconsidered, as to invalidate all or any of the conclusions.But this need not be the result of bringing the facts ofchemistry, the laws of the organization, and the phenomenaof the vital principle, to bear on one another, in forming

deductions for a system of soundest dietetics. It is quitetrue, at all events, that no system of dietetics can be worthyof any confidence, that is not based on chemical facts.. Sugar

and fat were considered to be highly nutrimentary in qha-racter, ,until chemists proved that non-azotised substances’ could not minister to the restoration or nutrition of the,

azotised tissues and organs. ’Nor is it a long time since itwas made a grave charge against the bread-bakers of one of

i the Transatlantic cities, by a medical writer, that they gur-’ chased and mixed their flour in such a way as to render the

dough as viscid as might be, and the bread, consequently, as’ light, and therefore as bulky and as deceptive in its appear-

ance as possible, instead of purchasing the flour with reference’ to its proportional quantity of starch, which, although net

viscid, and not ministering to the lightness and bulkiness ofthe bread made from it, was maintained to be by much themore nutritious part of the flour. The supply of non-azotisedaliment, however, is no less important than that of azotisedaliment to the human system: the respiration must evercontinue while life subsists; the oxygen of the air must bebrought into contact with the carbon of the blood, the animalheat maintained, and the chemical condition of the arterialblood secured, or death must speedily ensue; and if non-azotised aliment is not provided for the fulfilment of this

necessity, and the due supply of the carbon, a correspondingexpenditure of the azotised materials of the body, or ofazotised food, is rendered necessary, and so much needlesswaste is incurred, and so much evolved nitrogen, in variousconditions of combination, remains to be got rid of, at a

t, corresoondinsr expenditure and waste of organic power."

Remarks on a Case of Death from a Blow, related by Hayes Kyd,Esq., Surgeon, Harefield, (THE LANCET, 1847, vol. ii. p. 521.)

By C. R. BREE, Esq., M.R.C.S. &c., Stowmarket.Mr. Bree remarks that though the report of this case ishighly interesting as a contribution to pathology, "the exami-