cases are met with in which active interference is requisite. He particularly dwelt upon the ruinous consequences which follow a meddling midwifery, and entreated his junior auditors to be cautious how they allow themselves, by their anxiety for the welfare of their patients, to be betrayed into rash and unsuccessful interference with the operations of nature. The meeting then separated. Delirium Tremens. Our readers must all remember a very unseemly TRIAL of a septuagenarian surgeon of a public institution, for mistaking delirium tremens, or delirium traumaticum, for mania Now we would ask the hypercritics in such cases, whether mania does or does not exist in fully-formed delirium tremens? No man who ever saw the disease would attempt to deny the existence of mental derangement in the case under consideration. Why, in the United States, where the disease is ten times more prevalent than in this country, it is termed "MANIA A POTU." But the sticklers for a definite mark of diagnosis, say, "Oh we can tell delirium tremens from common mania by its cause, not by its SYMPTOMS." Indeed! This is rather an unscientific procedure as well as a very unsafe one. We are called to a patient, and asked to examine him and give the name of his malady. But after a close investigation, we say “Oh you must tell us the cause of his complaint, otherwise we cannot tell you its name." This is a precious piece of diagnosis! Then let us observe that, in the first place, delirium tremens does not always acknowledge intemperance for its cause-and that the ordinary cases of acknowledged mania do very frequently result from habits of intoxication. Thus a man who lives well, but not intemperately, meets with a compound fracture of the leg, and consequently is debarred from animal food and wine. He gets delirium tremens or traumaticum, and presents the same phenomena as the man who has been drunk every day. An internal inflammation, as pneumonia, will sometimes occasion all the symptoms of delirium tremens, in good constitutions, but where food and wine are withdrawn, and the lancet and purgation employed. Thus, then, in a majority of cases, the symptoms are precisely those of a sudden burst of mania—often taking on the character even of monomania-and the causes are often those of common mania, and by no means universally intemperance in spirituous or vinous potations. We have seen several instances of temporary mania assuming the character of delirium tremens so exactly, that nothing but the history of the cases undeceived us. We may mention a recent case. A young medical gentleman was suddenly taken with symptoms of delirium tremens, and we were sent for to visit him. He had red ferrety eyes-cold clammy skin-dry tongue -incessant jactitation-quick small pulse-no sleep for some nights -violent gesticulations-rapid talking-aberration of intellect. He averred that the devil and a coati mondi were under the bed, and that conspiracies were formed against his life. There was tremor of the hands and agitation of the limbs. In short, a more complete picture of delirium tremens we had never seen; and this we mentioned to one of his friends, while we inquired whether or not he had been lately indulging in drink. We were informed that he was a "Teetotaller" —a young man of the most temperate habits-but that some moral causes, of a very exciting nature, had lately been in active operation, the precise nature of which we do not deem it necessary to mention. This information modified our treatment, or rather our prognosis. We did not exhibit opium or stimulants, but prescribed soothing or sedative remedies-few of which, however, were taken. In ten or fourteen days he was well. A remarkable occurrence took place during our attendance on this gentleman. A female acquaintance, much interested in his fate, visited him and remained several hours at his bed-side. The state of her friend's case made such an impression on her nervous system, that, soon after her return home, she presented a train of symptoms resembling those already described -merely from sympathy. We did not ourselves see the lady after she left our patient's bed-side; but were credibly assured of the above occurrence. Here then we see the effects of purely moral causesnamely, the symptoms of delirium tremens. The advocates of a definite line between delirium tremens and a sudden outburst of mania have still a stronghold to retreat to, if beaten from the outworks. The treatment, they say, is different in the one case from that which is proper in the other. On this point we have no fear of joining issue with them. In the first place, what line of distinction can be drawn in the treatment, where, as is often the case, the mental derangement, acknowledged as such, results from habits of intemperance? None. But whatever be the cause of the mental aberration, the essential moral treatment is in all cases the same. The patient must be kept under surveillance, or even under restraint if necessary. In a delirium a potu, the tendency to self-destruction is often as strong as in mania from any other cause. The utility and necessity, therefore, of personal restraint is as necessary in the one case as in the other, whenever the aberration is considerable, and violence is manifested. Thus, then, we find an identity of symptoms-often an identity of cause-and frequently a similarity of treatment in mania" a potu," and mania from any other cause. It is hardly necessary to observe that the adjunct" tremens" is obviously improper, since it is by no means a necessary accompaniment of mania "a potu." It is often present in other complaints, or even where no complaint is made by the patient, but where habits of intemperance are established. If the above observations are correct, or founded on observation, (and we believe they are)-if mania a potu cannot always be distinguished by its symptoms or its causes from any other case of mania— and if the moral treatment, as far as restraint is concerned, be the same in both, then we say that Sir Anthony Carlisle has been hardly treated for mistaking a case of delirium tremens or traumaticum for one of mental derangement. The great ground of complaint against Sir A. has been the order to remove the patient from the ward of an hospital to an asylum. Now we confess that we do not see clearly VOL. XV. NO. 44. 2 T the justice of this complaint. We conceive that, during the existence of the delirium or mental aberration, no place can be worse, either for the patient himself, or the other inmates of the institution, than the ward of an hospital. The room, or even the dark cell of an asylum is infinitely preferable during the temporary insanity. We allude only to the diagnosis of delirium tremens and temporary mental derangement, in this case. If the medical officer was guilty of negligence in his duty, the charge should have been placed on its proper basis, and no side wind ought to have been taken advantage of, to bring forward an accusation of ignorance.-Medico-Chirurgical Review, April, 1839. Rheumatism terminated by Ossification of the Muscles, a Case followed by Observations, communicated by Drs. Testdin and Charles Danbresse, physicians, at Lille.-CASE. Wilmart (John Baptist) a bachelor, formerly a brushmaker, born of parents who died old, and one of which (the mother) was subject to rheumatic pains, has enjoyed good health to his eighteenth year; he always dwelled in one of the most unhealthy streets in the city, and continually was working in a damp cellar; he used the ordinary diet of workmen, and seemed always to be of temperate habits. At the age of eighteen he got a fall, by which he hurt his right thigh; in consequence of this accident he suffered some pains, and became lame, which made him, after a lapse of two months, consult a surgeon who diagnosticated a dislocation, but considering the time which had already passed, thought it to be incurable, and did not prescribe any treatment. The pains gradually disappeared, but the lameness continued. He worked at his trade for eight years longer; when he was seized with pains in all the extremities, accompanied by intense febrile movements. From thence the motions begun to be embarrassed, especially those of tho scapulo-humeral articulations. Nevertheless, he continued to work and to walk during seven years; motion then begun to be more and more embarrassed; it was almost impossible for him to walk, the forearms alone continued to move freely. At last the arms and the thighs became completely immovable, as also the lower jaw, the motions of which began to be embarrassed, but a long time after those of both the thoracic and abdominal extremities. In this state he entered, on the 3rd of February, 1834, the hospital of Saint Sauveur, where he stayed for two years and a-half without undergoing any treatment, except a bleeding at the time of his admission, which was performed with the view of influencing the intense febrile movements which continued for a long time. On the the 15th of April, 1836, he was placed in the general hospital, in the ward of incurables. It was not till the end of December, 1837, that he attracted our attention, when he was found in the following condition : Both the jaws were much approximated to each other, and could not be separated; the motions of the lips were free; the nourishment, which consisted of broth, eggs, bread, and other soft aliments, was introduced through a breach caused by a loss of two teeth; the deglutition was not difficult, and the voice but little altered; the motions of flexion and extension of the neck were 'impossible; he only could move his head a little to the right, otherwise it was not inclined to either side; both sterno-cleido-mastoid muscles were stretched and prominent under the skin; both scapulohumeral articulations were completely motionless; the pectoral muscles of each side were equally stretched and prominent, and also presented, in the greatest part of their extent, such a hardness, that their transformation into an osseous tissue was immediately diagnosticated, which was also confirmed by percussion. It was easy to see that only a portion of those muscles were altered, and also one could see that this sensation of hardness of the muscles was not produced by the contraction of their fibres, because the ossified parts appeared in a form of prominent ribs, separated by the intervals, while the muscular tissue preserved its ordinary consistence; the inner edge of the left deltoid, as also the right biceps, were in the like condition; the right forearm could be approached to the trunk, but the extension could not take place but by half; the left forearm could perform the same motion, but less extensively; yet no hardness could be felt in the muscles of this arm; the motions of the frame were completely arrested, as also those of the coxo-femoral articulations; one could feel also round these articulations a hardness analogous to those of the pectoral muscles; the femoro- tibial articulations performed still some slight motions. Otherwise the patient did not complain of anything, and all his functions appeared to be performed regularly, excepting nutrition, for he was in a state of great emaciation; the skin had preserved all its sensibility in the ossified regions. He died at the age of thirty-nine, on the 23rd September, 1838, after having shown symptoms of pulmonary congestion and of enteritis. Necroscopy. Chest.-The lungs were filled with tubercles, and their tissue gorged with blood; the heart presented nothing particular, nor any of the large vessels. Abdomen. The digestive tube showed traces of a chronic enteritis; none of the other viscera of this cavity, nor the vessels, both arterial and venous, presented anything worth notice. Examination of the Muscular System.-The muscles which, during life, were observed to be ossified were found really so, as also a great number of others which we shall enumerate and describe. 1. A portion of the right temporal, about an inch long, and two lines broad, consolidated on one end with the coronoid apophysis of the inferior maxillary bone, on the other, with the external aspect of the great wing of the sphenoid bone, a portion of the left pterigoidean which unites the pterigoid apophysis with the angle of the jaw; this accounts sufficiently for the want of motion of the jaws. 2. A portion of the great complexus, of the left side, two inches long. The sterno-cleido-mastoid of the same side was transformed in a fibrous tissue. 3. The inner third of the left deltoid continued without any line of demarcation, superiorly with the clavicle, and inferiorly with the humerus. 4. A considerable portion of the great pectoral, and almost the entire of the lesser of the left side. 5. The greatest part of the right great pectoral. The ossified portions have the form of three large bands separated by intervals, in which the muscular tissue is in its normal state, they run (en dehors) outwards, and unite with the coraco-brachialis, and the short portion of the biceps, which have undergone the same change in all their extent, except the long portion of the biceps, and the tendon of insertion to the radius, which are in a normal state. 6. The long portion of the right biceps at its upper attachment, to the extent of two inches; this portion is more bulky than usual, and has two separate insertions, one, as usual, under the glenoid cavity, the other to the axillary ridge of the scapula, to the extent of about six lines. The inferior extremity of the same muscle in its entire length, and to the extent of three inches, is attached to the olecranon, and is healthy. 7. The inferior extremity of the left biceps and of the triceps of the same side. 8. Portions of a considerable extent of the great right dorsalis ; they represent ribs in a direction the reverse of the natural ones. 9. The muscles of the vertebral column in almost all their length, but more on the right than on the left. The sacral portions of these muscles is in a natural state. 19. The middle gluteus muscle is represented by long and broad ossific stalactiform needles. 11. The right adductors, as far as the middle of the thigh, are transformed into an irregular mass, uniting the femur with the pubis, and representing an abdominal clavicle, if one may use such an expression. 12. That portion of the anterior crural which is inserted into the anterior and inferior spine of the ilium. ceps. 13. All the inferior and internal parts of the right crural tri 14. The lesser and middle left glutai, and the posterior edge of the great. 15. The greatest part of the tensor vaginæ femoris of the left side. 16. An osseous mass which is united to the preceding; but which one does not know to what muscle to refer. 17. The internal and inferior portion of the biceps of the same side. The appearance of this newly formed osseous tissue was not every where the same. The portion of the deltoid which consolidated with |