blow as the cause of both the exo-cranial and endo-cranial disease, consists in the facts that its occurrence was so long prior to the date of attack, and that the health of the patient during the intervening period of three years is not spoken of as having been impaired, and was, at all events, sufficiently satisfactory to admit of her marriage. This point will be again referred to, and our object in merely broaching the discussion in the preceding sentence is to afford explanation of the surgical procedures resorted to in the treatment of the case.

A dark, muddy colored cicatrix covered the seat of an old ulcer on the inner aspect and about the middle of the right leg. One or more slight elevations was found upon each tibia. There were no scars about the labia or inguinal regions, or any other indications of syphilis sufficiently well-marked to justify settled conclusions in regard to its presence. The husband very pointedly and positively denied that either he or the patient had ever been affected with this disease.

The aphasia was complete. The answer she gave to all inquiries or conversation was uniformly "day, day." If expostulated with and forced in an imperative manner to give some reply to questions addressed to her, she ut tered this word with more energy-repeated it oftener and gave it an additional emphasis by terminating it with "O" thus, "day-o, day-o." When a pencil was placed in her hand and a sheet of paper in position before her and she was told to write, she made a bold dash and rapid movements over the paper, but none of the lines which she produced bore the least resemblance to a letter. She had been right-handed, and it was affirmed, had once written rapidly and legibly.

The only known disorder of spinal sense consisted of the extraordinary state of her perr-æsthesia, previously described; but there was presumable impairment of sight

in the left eye. It was impossible to learn what degree of injury the function of this eye had suffered, but the sense of vision was so well preserved to the patient that she could recognize her husband, or the nurse, at the end of the long ward, and, as her husband asserted, sufficiently well to enable her to read letters which a female friend occasionally wrote to her. Hearing did not seem to be abnormal, although the husband suspected deafness in the left ear. Taste was unquestionably retained and apparently in a normal state. The testimony, in reference to smell, is somewhat contradictory. The husband affirms that it was not lost, but his opinions are principally founded upon the effects following the inhalation of camphor, ammonia, etc., a failure to distinguish between the function of smell and mere excitement of the nerves of general sensation distributed to the schneiderian membrane, not always confined to the non-professional. On the other hand, the patient, on one occasion accidentally smeared her hand and face with fæcal matter and evinced such an absence of any indication of disagreeable smell that the conclusion is a very reasonable one, that the power of perceiving odors was greatly impaired, if not totally lost. The patient's urine and stools were passed in bed, but regularly, both in respect to amounts and periods.

The treatment ordered was sustaining and alterative Liberal supplies of nutritive and easily digested diet were directed. She was permitted a glass of milk punch daily and three table-spoonsful of cod-liver oil. After a few days, five grains of iodide of potash were added thrice daily to the list of her remedies. In view of the knowledge obtained in reference to the patient's habitual use of opium, and to mitigate the intense suffering occasioned by every attempt to change her position, she was, on the day of her admission, ordered one-third of a grain

of morphia to be repeated regularly three times a day. Whatever points of clinical history, or theories might be looked to, to account for the existence of the external ulcer, its presence upon the coverings of the left hemisphere in a case of aphasia indicated a relation between it and the more important lesions within the cranium. What these lesions were was a matter of conjecture purely, but there was a possibility that the trephine might remove pressure or permit the escape of matter. Accordingly, the advice of Prof. Richardson was requested, who at once concurred with us in justifying the operation and consented to perform it.

At this visit of consultation, Prof. Richardson forced the blade of a pair of dressing forceps into the margin of the ulcer upon the forehead and removed a circular disk of the necrosed outer table equal to a dime in size.

Prof. R. trephined the patient on the 17th of June, in the presence of a large number of medical gentlemen and students.

The bit of the trephine was placed in the centre of the circle of necrosed bone so as to include within the crown the whole of the diseased surface. The bone was found very much thickened, the diploe absent, the inner table looking perfectly healthy. The dura-mater was highly vascular, but not distended or otherwise unhealthy. Pulsation of the cerebral mass, both cardiac and respiratory, absent or inappreciable. The patient was freely narcotised with chloroform and both the radial pulse and respiratory acts were feeble. Pressure upon the membranes gave impression to the junior writer of an underlying substance more resisting than normal cerebral

matter.

On the 18th the patient's condition was as good as it had been previous to the operation. Indeed no difference could be noted as to her general state. The cardiac pul

sations of the brain were strongly marked; the respiratory pulsations could not be made out. We mention here the clinical fact, (leaving its discussion for a future page,) that neither upon this nor upon any subsequent occasion, were we able to note pulsations of the brain corresponding with the respiratory function, and, also, that at certain times, all cerebral movement whatever was apparently absent, and yet no alteration in the patient's condition could be observed by which we might explain the difference thus observed.

On the 20th, the patient's condition was decidedly less favorable. Her countenance was more dull and she showed a disposition to sleep continually. Opium omitted.

On the 21st, the patient was still more soporose; could with difficulty arouse her to take her food. No longer seems to recognize persons. Membranes rather more prominent. On the succeeding day, Prof. Richardson punctured the dura-mater. No fluid normal or abnormal escaped through the puncture and only a small amount of blood flowed from the severed vessels of the duramater. It was found, upon to-day's visit, that her pulse had arisen in frequency to 108. From this period until the 28th, there was no very marked change in the patient's condition, although, as obvious to all, she was gradually failing.

On the 28th, difficulty in swallowing and very nearly complete coma were manifested. The patient was supported by nutritive enemata until the 30th, when death occurred at 5 P. M.

ART. III.-A CASE OF VARICELLA, WITH SOME COMMENTARIES ON THE IDENTITY OF VARICELLA AND VARIOLA. [Read before the Boyle County Medical Society, July 28, 1868.] By JOHN D. JACKSON, M.D., of Danville, Kentucky.

Thursday, July 2, 1868, Mr. H. E. S., æt. 32, consulted me at my office, complaining of feeling generally indisposed and having a sensation of slight chilliness, together with a good deal of pain in the small of the back. He said he had been abroad fishing, a few days previously, and during the time slept upon the river bank, and to this he attributed his illness. Pulse scarcely accelerated, 'tongue clean, skin natural in temperature, pliancy and moisture, bowels regular, no nausea. A moderate amount of pressure over the lumbar muscles elicited pain. Was inclined to the opinion that he was suffering with a simple attack of lumbago, which opinion, the painfulness of the lumbar region on pressure tended especially to confirm me in.

Advised quietude and no medicine for the present. Before leaving he attracted my attention to what looked like a small commencing furuncle, situated upon the manubrium of the sternum and said that he had another just like it upon his hip; each of which he declared was quite painful.

Friday, 3. Saw him at his house. Found him pretty much as on yesterday. He said that in the morning before sending for me he had felt chilly, and had high fever for an hour or two, but found him at the time of my visit perspiring. Advised quietude within doors; no medicine.

Saturday, 4. Was chilly in the morning, as on yesterday. His chest and back are covered with papules, and on his right hip are several vesicles or blebs covered with a very thin cuticle; some are filled with a transparent