The morning after his attack I stained four of the nails of the palsied right hand, down to the lower edge, with nitric acid, which tints these parts of a deep and quite lasting yellow, hoping thus to learn whether they would grow as fast as those of the other hand. To my surprise, while the left healthy nails grew as usual, the right nails did not grow at all during three weeks. Then, and throughout while the arm was still motionless, the nails began to grow, as was shown by a narrow line of white below the tinted portions. Within a week after this the fingers became controllable by the will, and gradually the whole hand and then the arm was restored, so as to perform any except the most delicate tasks required of it.

October 16, I attended Mr. C., aged forty-six, who was suffering from great mental excitement concerning an election in which he was interested. His previous health was perfect. While lying in bed in the evening, somewhat drowsy from a small dose of morphia, he felt his right thumb drawn into the palm; then the forearm flexed strongly on the arm, while the right face twitched slightly, and in a few moments the right arm and leg became entirely paralyzed, as to motion only. There was no deviation of tongue or face, but he could not carry either eye fully to the right side. With these symptoms there was nearly complete aphasia, his only word being "yes." On the 17th he could make negative signs with his head, although still saying "yes," to every question. On the 18th he was able to say "yes," "no," and "certainly," and could repeat after me many simple words. October 20th; his right hand slightly cedematous, and he now for the first time moves his toes. His vocabulary is enlarging, but he makes the usual curious blunders, and when trying to read aloud, frequently stops at long words and miscalls them; says he understands what he hears and reads.

The temperature of the right palm was at this time 95 4-5°, left 97 2-5° F. Ever since the attack he complained of pain in the right shoulder, and of the occasional spasmodic flexion of the thumb and fingers. At this time, the fourth day, the

hand being moveless, I stained the nails, except that of the little finger, on both hands. Not the slightest growth took place on the palsied side until November 2d, when, seeing a line of white above the quick, I risked the prediction to his wife that in a week he would begin to move the limb. On the fourth day after the thumb recovered some slight power, and the rest of the limb rapidly followed it, so that every muscle was under control on November 9th, although for some time the extensors of the fingers moved with difficulty, because of the continued but lessening spasm of the flexors.

The whole history of these cases I have not given, thinking it enough to relate so much of them as is sufficient for my present purpose.

Perhaps, also, I ought to excuse myself for reporting but two distinct cases, in place of waiting until numerous opportunities enable me to be more sure of the constancy of the facts related. Cases of this kind, however, seen early, may not recur very often under my own eyes, and I shall probably increase the chance of studying this curious symptom by making it public.

Even now it suggests some reflections which I must be pardoned for intruding, because they will to some extent guide any future observer.

I have been unable to find that this observation has been made before. In old cerebral palsies the nails very often become deformed, and even the muscles may undergo changes which are possibly due to the neural sclerotic alterations which sometimes come on after the part has been long disused. They are then the direct result of isolation from the spinal trophic influence. In recent cerebral palsies there is often cedema, but no muscular atrophy; and it is, therefore, remarkable, that the nails should ever suffer in their nutrition. It is still more curious, when we reflect that even in parts whose nerves are severed, the nails grow as usual, and that chiefly in partial nervewounds do we meet with clubbing or serration.

It seems as if the injury to the brain must have exerted an inhibitory influence, and the fact aids, to my mind, the view

which I hold with many, that there are nutritive nerves. Theorists who follow Brown-Séquard, would probably regard the checked growth as due to spastic contraction of the vessels feeding the nail, and as a vaso-motor nerve impression.

I cannot admit this, because no conceivable amount of such spasm could last long enough or be complete enough to cause the result without making a visible difference in the tint of the nail and the thin parts at its matrix; and these remained mnch as usual, perhaps a little redder than common. To test this view, I faradized with a secondary current and dry wire brush two of the nails daily, giving great pain and intensely flushing them. They were also kept thrice a day, for half an hour, in hot water, so as to flush them as much as possible. My patient, an intelligent person, being much interested in the question, submitted readily to this treatment, but no more growth took place in these nails than in the others. I have noted the lower temperature in the last case; but in hands cut off from all nerve connection it is still slower, and yet the nails grow. It does look, therefore, in this case, as if some influence was at work here which did not act through a change in the vascular supplies. It is a point in favor of trophic nerves.

Other and most interesting questions also present themselves. The re-growth preceded the return of will power. If this should prove constant or common, it will certainly help us to answer the inevitable query as to whether the arm will recover at all, and how soon.

It is, of course, desirable to learn how often this check of nail growth occurs-whether in all cerebral palsies, or only in certain ones-whether, in a word, it relates itself to particular brain regions, and is a direct effect, or arises from a spinal shock which these brain injuries occasion.

I trust that I have been able to show, therefore, that this apparently trifling symptom may open the way to the solution of very important questions, and is certainly not devoid of interest for the most purely practical amongst us.-Ex.

ANALYTICAL DEPARTMENT.

"Qui e nuce nucleum esse vult, frangit nucem."-Plautus.

Results of Revaccination in Five Hundred Cases.—Dr. J. Halton states that out of this number 179 had scars that were mostly circular, and did not seem to go deeper than the true skin; 106 had scars so slight that they had often to be carefully looked for; and 66 had deep scars of irregular form. In 24 there were no scar, though they stated they had been vaccinated; and 50 stated they had never been vaccinated. In 75 cases the state of the arm was not noted accurately. Of the 179 with circular scars, 10 presented perfect vaccine vesicles. All the others presented the vesicle in a modified form, as a blister, a tubercle, or a scab. There was usually considerable inflammatory redness. Of the 106 who presented slight puckered marks, 9 had on the eighth day perfect vaccine vesicles. The remainder presented irregular vesicles. Of the 66 who had deep scars, 6 showed the perfect vaccine vesicle. Of the 24 with no sign of vaccination, 16 presented the perfect vaccine vesicle, 2 the imperfect vesicle, and 6 failed to present themselves. Eighteen of all the cases failed on the first occasion of revaccination, but on the repetition of the operation it was in nearly all instances successful. In no instance did he succeed in obtaining an approach to a perfect vesicle in a vaccinated child under seven years old. The lymph was in all cases carefully selected, and perfect repose of the arm was enjoined. The conclusions which he thinks may be drawn from his experience are, first, that a large proportion of the population are utterly unprotected by vaccination; second, that vaccination scars, no matter how deep, are no guarantee that the possessor is protected by vaccination; third, that in some constitutions the vaccine influence wears out, as is clearly shown on revaccination, when a perfect vesicle will be produced; fourth, that the operation of revaccination, when properly performed with lymph taken from the summit of a vaccine vesicle without areola on

the eighth day from a healthy child, is entirely unattended with danger, and in the majority of cases with very slight inconvenience; fifth, that there are reasonable grounds for believing that revaccination is to a considerable extent at least an efficient protection against small-pox.-Dublin Journal of Med. Science, March 1, 1872.

On Gonorrheal or Urethral Rheumatism.* By Thos. Bond, R.S., London, F.R.C.S., Surgeon to the Lock Infirmary of St. George's Union, Westminster.—The pathology and treatment of some so-called rheumatic diseases of the joints have been much misunderstood, and particularly so gonorrhoeal rheumatism, or, as I think it might more correctly be called, urethral rheumatism.

The disease is not, in my opinion, rheumatism at all in the proper application of the word, nor is it the effect of any specific poison or constitutional diathesis. It often occurs quite independently of the acute urethral inflammation called gonorrhoea, as well as of any gouty or rheumatic predisposition; but it is dependent on a local condition of the urethra which I shall presently describe. Nevertheless, I shall continue to use the name urethral rheumatism as being most convenient.

This affection is more frequent than is generally supposed, and occurs commonly in men of an anæmic and weakly condition, whose habits and occupations are sedentary and unhealthy, and particularly does it occur in those cases in which a gonorrhoea has been treated by a long course of antiphlogistic medicine, or by an excessive and indiscriminate use of copaiba.

men.

In my experience, it very rarely occurs in florid and healthy Out of upwards of fifty cases of gonorrhoea among the well-to-do classes which I have treated within the last year, I have had one case only of urethral rheumatism; while in the Lock Infirmary of St. George's Union at Wesminster, where I treat over 300 cases of venereal disease yearly as in-patients, I

* Abstract of a paper read before the Medical Society of London, Nov. 6th, 1871.