a thousand, in a questionable attempt to abrogate one of the general conditions of man?

As to the uses of chloroform in the medical or therapeutical treatment of pain, the question changes. There is no reasonable therapia of health. Hygienical processes are good and valid. The sick need a physician, not they that are well. To be in natural labor, is the culminating point of the female somatic forces. There is, in natural labor no element of disease-and therefore, the good old writers have said nothing truer nor wiser than their old saying, that "a meddlesome midwifery is bad." Is chloroform meddlesome?

Your countryman, old Thomas Rainold, in "Woman's Booke, or The byrthe of Mankynde," at fol. LIII. says, "Very many be the perilles, daungers, and thronges, which chaunce to woman in theyr labour." These are the cases requiring our therapeutical and chirurgical intervention. You will, my dear sir, think me a hopeless recusant, if I decline the anæsthesia here also. I pray you, therefore, allow me to state my reasons for such recusancy.

If I were amputating a limb, or extirpating a tumor, I should see all the steps of my incisions, ligations, &c. But if I apply my forceps in a right occipito-posterior, (fourth of Baudeloque) I know I thrust the blade of the male branch, far upwards betwixt the face of the child and the upper third of the vagina, which, in this case, is already greatly expanded, and that the extremity of the blade is separated from the peritoneum, only by the mucous and condensed cellular coat of the tube. Now, no man can absolutely know the precise degree of inclination his patient will give to the plane of her superior straight, while in pain; an inclination to be modified by every movement of her body and limbs. Under such absolute uncertainty, the best guide of the accoucheur is the reply of the patient to his interrogatory, "Does it hurt you?" The patient's reply, "Yes and no," are worth a thousand dogmas and precepts, as to planes and axes, and curves of Carus. I cannot, therefore, deem myself justified in casting away my safest and most trust-worthy diagnosis, for the questionable equivalent of ten minutes exemption from a pain, which, even in this case, is a physiological pain.

Having thus, in my own defence, and not as attacking your opinion, set forth the motives that have hitherto served to restrain me from the administration of chloroform, I desist from giving you any further trouble in this line of thought. I have, sir, a far more pleasing duty to perform, in saying that your name is as well known, perhaps, in America as in your native land, and to congratulate you on the extension of your fame. I had the pleasure to read your interesting letter to

my class, consisting of several hundred young gentleman, who listened to your words with the same respect, as they would have paid to you, had they been pronounced by your own lips. They will disperse themselves in a few days hence, over all the States in the Union, and thus will have it in their power to report the latest dates of your opinions as to chloroform. I shall also allow it to be published on the first proximo, in a medical journal of extensive circulation. You will herein perceive the readiness with which I assist in disseminating your views. It is not without regret that I find myself opposed to your opinions in the case. That difference ought not, however, in the least degree to affect those sentiments of respectful consideration and real esteem with which I am, dear sir, very faithfully, your obedient servant, CH. D. MEIGS.

Professor Simpson, &c.

[Medical Examiner.

ARTICLE III.

Interesting Cases by JAMES BLAKE, M.D., Professor of Anatomy in the St. Louis University - Abnormal distribution of the Thyroid Arteries.

The following case of abnormal distribution of the thyroid arteries, is, I think, of sufficient interest to render it worthy of the attention of the profession; as, in the subject in which it occurred, neither in the operation of tracheotomy or laryngotomy could have been performed without great danger of sacrificing the life of the individual. The subject in which it occurred was a male about forty years of age, brought into the dissecting room of the St. Louis University during the past session. The first anomaly that presented itself on dissecting the arteries going to the head and neck, was of a considerable artery about the size of a quill, arising from the anterior and superior of the innomminata, passing upwards and crossing the trachea about three-quarters of an inch above the sternum. After proceeding about two lines beyond the mesial line, it again turned to the right and crossed the mesial line about a quarter of an inch before the isthmus of the thyroid body, and proceeded to divide into branches along its lower edge on the right side.

On dissecting the superior thyroid arteries, it was found that the artery of the right side was subject to an abnormal distribution, perhaps more dangerous to the operator than was the artery coming from the innominata; for whilst the latter has been noticed as not of very unfrequent occurrence, this abnormal distribution of the superior thyroid must, I think, be extremely rare, as I see no notice of it in those anatomical and surgical works which I have referred to. The artery arose from the external carotid, at the place where it is generally found; but here it was seen to be much larger than usual; it proceeded downwards to the upper and outer angle of the thyroid body, but instead of dividing into its terminal branches, as it generally does, it turned forwards to the left, running along the upper edge of the cricoid cartilage, or between it and the thyroid cartilage, and lying on the cricothyroid muscle; it continued this course until it passed rather beyond the mesial line, crossing the crico-thyroid ligament. During its course, it sent branches downwards to the upper edge of the right side of the thyroid boby, and the isthmus and its terminal branches were distributed to the left lake of the thyroid body. The artery where it crossed the crico-thyroid ligament was as large as a crow quill; there was no large anastomiotic branch uniting with the superior thyroid artery of the opposite side, which was rather smaller than natural. The inferior thyroid arteries were natural, but that of the right side rather larger. The thyroid body was rather above the natural size, and somewhat more dense in its structure, and less red than is generally found-the isthmus was broad, extending as far as the lower edge of the cricoid cartilage. From the above description it is evident that neither the operation of tracheatomy or laryngotomy could have been performed in this subject without incurring the greatest risk of wounding an artery, the bleeding from which might under the circumstances, even had led to a fatal result.

The

Case of Entozoa in the heart.-On opening the heart of a dog which had been the subject of a physiological experiment, the right auricle was found to contain a number of entozoa, between twenty or thirty, they were situated principally in the auriclar appendage, forming an intricate mass. worms appeared to be a species of ascaris, they were smaller in character than the ascaris lumbricoides, and varied in length from four to eight inches-they were so completely twisted one with the other, as to form an intricate mass, which more than filled the anicular appendage. The animal did not appear to have at all suffered from the presence of these parasites, for it seemed perfectly healthy. The occurrence of entozoa in the heart has, I find, been noticed by two or three

Vol. I, No. 2.-9.

writers, but it would appear that their occurrence is extremely rare. Besides the interesting question, as to how these animals would find their way into their extraordinary habitation, another still more serious appears to me to be, how they became enveloped in a part which is constantly being washed out as it were by the blood, and from which, it would seem, that they must be expelled, as each contraction of the ventricle propelled forwards the fluid in which they existed. I regret that in consequence of the preparation having been destroyed by the rats, I was unable to examine it as minutely as I could have wished.-St. Louis Med. and Surg. Jour.

ARTICLE IV.

On the Theory of Spasmo-paralysis in Infants and Adults. By MARSHALL HALL, M.D., F.R.S., &c., London.

Paralysis may depend on the exclusion of the influence either of the cerebrum; or the spinal marrow-that is, of both cerebrum and spinal marrow. Spasm can only arise from irritation of some part of the spinal system; but this irritation may effect the incident excitor nerves, the spinal centre, or the muscular nerves. Spasmo-paralysis is a term which I have adopted to express the varied combinations of spasm and paralysis, which occur so frequently in practice. How shall we find our way through this labyrinth?

It may, indeed, be said that the diseases of the nervous system constitute one-third part of medicine, and that their accurate diagnosis was impossible, previous to the distinction of the three divisions of that system from each other. Now, this distinction depended, in its turn, on the detection and separation of one of these-the reflex spinal system-from the other two-viz.: the cerebral and ganglionic; and this again, in its turn, affords the diagnostic of the diseases of the entire nervous system.

Such is the important practical object to which I wish to devote myself, while I leave the mean and ignoble caviller at the threshold of this true temple of medical science.

Infants are often born with distortion of the foot or feet, and during growth a paralytic weakness and atrophy are conjoined with the spasmodic action of the deforming muscle. A similar effect is sometimes seen to take place during infancy. I have once seen a case in an adult in which

the tendo Achillis became so drawn that the patient could no longer put the heel to the ground. In some cases of hemiplegia, spasmodic contraction of the hand and arm accompanies the paralytic attack. In other cases, a spasmodic contraction of the hand gradually takes place more remotely after the attack. I have seen various cases of paralysis, or spasm, distinctly, and of the two either variously combined or following each other. Now what is the just rationale-what the theory of these spasmo-paralytic cases?

These questions could not be answered before the appearance of the remarkable work of M. Flourens, or before the detection of the reflex spinal system. The due limitation of the excitor and in-excitor portions of the nervous system, which we owe to M. Flourens, and the just appreciation of the incident and reflex forms of action, of their excitomotor powers, which has flowed from my own investigations, are the essential preliminaries to an investigation of the theory of spasm, of paralysis, and of spasmo-paralysis. To this very day I observe these things confounded together, and that even by teachers of our pupils and critics of our literature.

Intra-uterine Spasmo-paralysis.

How interesting and how valuable would be a series of accurate cases and post-mortem examinations of the various congential spasmodic and spasmo-paralytic affections! of cheirismus, and especially of podrismus, in the varied forms, or rather deformities, of club-foot.

Is the cause of this calamity always of centric origin? or is it sometimes the reflex action of external cold, injury, &c ? The class of intra-uterine diseases still requires renewed investigation, and no part of it more than affections of the nervous system.

Effusion over the hemispheres, and at the base of the encephalon, and along the spinal canal, is too frequently the cause of irritation-pressure or counter-pressure-on the spinal system, that division of the nervous system endowed with the excito-motor power. This irritation is the source of various congenital, convulsive or spasmodic affections; it may be the cause of strabismus, laryngismus, &c., of the various distortions of the hands, and especially of the feet. In the case of two brothers, similarly affected, the tendo Achillis was permanently contracted with spasmo-paralysis of both legs; on the death of one, aged twelve, effusion on the cerebral hemispheres, at the base of the brain, and along the spinal canal, was found in considerable quantity; the