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the classical symptoms of tumour and on account of thefact that the onset of symptoms had been acute, thoughtthat the cause of the symptoms was encephalitis ratherthan tumour ; but as no improvement took place an

operation was decided upon. The cortex of the central

convolutions was healthy. The foot centre-there had been

cramps starting in the right foot-was then determinedelectrically, and an incision made. A tumour was at once

evident, and this was removed, together with some brainsubstance. In the evening and on the next day there wasno increase in weakness or impairment of ordinary or ofmuscle sensibility. The patient unfortunately died from septicmeningitis, and the necropsy showed that the rest of thebrain was quite healthy. The interesting points in the caseare that it was one of tumour without any of the usual

symptoms and with quite a sudden onset. The conditionafter operation, in which presumably there had been removalof a certain part of the cortex, is also interesting because ofthe absence of any sensory disturbance as a result of this.

TRIONAL.

AN abstract of an important contribution on the action oftrional by Dr. K. Rychlinski appears in a recent number ofthe Neurologisches Centralblatt. Fourteen cases of sleep-lessness due to various causes, chiefly psychical conditions,were treated with this drug, and at different times sulphonal,chloral hydrate, and daboisin were substituted, and theireffect compared with that of trional. He found that incertain cases of long-continued insomnia trional in doses offrom one-half to one gramme was efficacious without pro-ducing any headache ; whereas in the same cases ordinarydoses of chloral hydrate or sulphonal were inefficacious andlarger doses only procured a short sleep. In certain casesthe dose was limited to one gramme, but in only two of thefourteen cases were large doses of four grammes necessaryin order to procure unbroken sleep for eight or ten hours, andin those cases chloral hydrate and sulphonal were moreefficacious in smaller doses of two or three grammes. Trionalin hot milk or tea procured eight hours’ sleep usuallywithin half an hour. Sometimes, however, its effect was notproduced until two hours after administration. Several timesdose took effect also on the second night, but only when a

large dose was administered. In a case of mitral regurgita-tion there was no evidence of any bad effect produced on theheart, and this was confirmed by sphygmographic tracings.Although further experience of this drug is still requisite itcannot be denied that experiences such as those recorded inthis paper suggest that in trional we may find a safe, efficient,and reliable hypnotic. -

MEDICAL WITNESS AND JUDGE.

ON Feb. 8th, at the Winchester Assize, before Mr. JusticeCave, a labourer named Cousins was indicted with havingattempted to carnally know a girl aged ten years. The juryfound the prisoner guilty, and he was sentenced to eighteenmonths’ hard labour. The case is of interest to the medical

profession on account of the severe strictures passed on themedical testimony by the judge. Dr. L. Maybury and Mr.Colt gave it as their opinion that " there was no evidencethat penetration had occurred," whereupon Mr. Justice Caveremarked that the witnesses were attempting to decide thecase and so usurping the province of the jury. It seems to us

that the conflict between the judge and the medical witnessesunfortunately arose through the latter-no doubt uninten-tionally-stating there was no evidence of penetration.What they intended to say was that the evidence as obtainedfrom an examination of the prosecutrix was not conclusive,since the hymen was not ruptured and there was no lacerationor bruising of the parts. At the same time there was pre-sumptive evidence of the act, for the vulva were inflamed

and there was a purulent discharge, and on the shirt of theprisoner the microscope revealed semen, pus, and epithelialscales. We regret that the learned judge did not take a moregenerous view of the medical evidence, instead of practicallyascribing an interested motive. Nevertheless, the incidentshould form a valuable object-lesson of the importance,especially in criminal cases, of using correct phrases and ofdrawing logical inferences. -

PSEUDO-BULBAR PARALYSIS.

DR. SACAZE of Montpellier records in the Revue de Médecinethe case of a patient who in consequence of two separateattacks suffered from left hemiplegia, hemi-chorea, aphasia,and aphonia, with great difficulty in swallowing, and paresisof the tongue and of the soft palate. The necropsy revealedareas of softening in both hemispheres, the internal capsule,the lenticular nuclei, and the caudate nuclei being destroyedon both sides. The pons and medulla, apart from com-mencing secondary degeneration of the pyramids, were

quite normal. This case illustrates the fact, whichhas now frequently been pointed out, especially byDr. Barlow and Drs. Hughlings Jackson and James

Taylor in this country, that a lesion on each sideof the cerebrum gives rise to symptoms which so closelyresemble those of bulbar paralysis as to be clinically almostindistinguishable from these. The reason of this seems to bethat whereas a unilateral lesion in the brain gives rise to onlytransitory and slight affection of the bilaterally associatedmovements, the occurrence of a second lesion on the oppositeside of the brain so weakens those movements as to cause

very distinct impairment of the cesophageal, laryngeal,palatal, and tongue movements, thus giving rise to symptomswhich closely simulate those of bulbar paralysis.

THE DIFFUSION OF SMALL-POX.

THE new cases of small-pox notified in London last weekwere 11 in number, and the admissions to institutions of theMetropolitan Asylums Board were 18, against 6, 8, and 21 in thepreceding three weeks respectively. The disease continues toprevail in the parish of Marylebone, to which belonged the 3deaths from small-pox registered in London during the week.On Saturday last there remained 56 cases of small-pox undertreatment, an increase of 5 on the total on the precedingSaturday. Last week witnessed an increase of fresh casesin West Ham, where over 6 attacks were chronicled. One ortwo cases came to light in other suburban districts. A dozenattacks at Birmingham show that the disease is getting undercontrol there ; and, moreover, no death was registered,Generally the midland districts were free, as comparedwith recent weeks. In Scotland small-pox continues to

spread in Glasgow. A death occurred on Wednesday of lastweek in the person of a sailor from London, and 4 fresh casescame to light, followed by 2 more the next day; when alsotwo persons were dismissed from the infirmary, having beenadmitted under a mistaken diagnosis. The total cases in the

city were then 39 in number. In Edinburgh there were 25patients known to be under treatment in the middle of lastweek, 7 cases having been notified since Jan. 27th. In

Govan and Auchterarder stray cases have recently been dis-covered. In Dublin in the week ended the 2nd inst. 69cases were admitted to hospital, 64 discharges took place,and 171 patients were left under treatment, 131 ad-ditional convalescent cases being under isolation at EI-mainham. Five deaths occurred, including 2 in vaccinatedpersons (aged nine and fifty years respectively) and 2 in un-vaccinated persons, both under ten years of age. A total of106 deaths had been reached up to the date in question. Muchgood will, it is hoped, be effected by the very stringent orderof Archbishop Walsh as to the disabilities of persons in the

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matters of school attendance and confirmation if not vacci-nated or revaccinated as their age may require. In December.jio fewer than 127 streets were invaded by small-pox-30 onthe north side and 97 onthe south side of the Liffey. The

admissions to hospital were 262 in number, the notified cases..310, and 26 deaths were registered. All possible steps arebeing taken to prevent the spread of the disease, and 56.persons were at the close of the year occupied in the removalof patients and in the necessary processes of disinfection.In the fourth quarter of 1894 the admissions to hospitalnumbered 466 and the deaths registered 51, including 27unvaccinated sufferers, of whom 9 were under five years ofage, and 21 vaccinated persons all over that age.

THE NATURE OF GASTRO-ENTERITIS IN INFANTS.

FROM examinations of the blood of infants suffering from.gastro-enteritis, conducted in Professor Epstein’s clinic at

- Prague, A. Czerny and P. Moser think that this affection is tobe regarded as a general infection of intestinal origin.1 It

.is, therefore. different from dyspepsia, in which the diseaseremains limited to the gastro-intestinal tract. Thus, out offifteen cases of gastro-enteritis in which the blood was- examined during life, in twelve the presence of micro-

organisms was ascertained. On the other hand, in onlytwo out of thirty healthy children were cultures obtained’from the blood, and of eleven infants suffering from dyspepsiaonly one yielded that result. The microbes found circulatingin the blood in the subjects of gastro-enteritis comprisedstaphylococci, streptococci, bacterium coli commune, bacilluspyocyaneus, and bacterium lactis aerogenes, all of which are’known to occur in the intestinal contents. It is pointed outthat this variety in organisms concords with the multifa-riousness of the symptoms of gastro-enteritis, whilst it showsthat prophylactic measures are more hopeful than thera-peutical, the value of which latter must depend on the kindand intensity of the general infection.

THE ROWLANDSON EXHIBITION.

DID the comic portrait painter of the eighteenth centurysee all whom he intended to bring into ridicule as the victimsof advanced acromegaly 7 Acromegaly is still of sufficientlyunusual occurrence, yet to the eyes of Rowlandson, Bunbury,.and Gillray mankind could best be brought into contempt bydepicting them with the facies of the disease as they hadevolved it from their imagination. The immensely lengthenedlace, the projection of the under jaw and lip, the low fore-head, the sunken eyes, the large ears, the swollen face areall there, and placed on paper a hundred years before thepathological condition was known to our profession. Andthis becomes more astonishing when we remember that theartists of those days were not idealists, but that withoutany modern pretensions to realism they painted what theythought they saw. And that they really saw the humanface, whether wrung into distortion for purposes of cari-cature or graciously smoothed out for purposes of flattery,to be different from what we see it, is proved to our mindsby the fact that Reynolds’s and Gainsborough’s courtlycreations have the same similarity to Each other that we havedescribed as being present in the work of the caricaturists.Except to a connoisseur, who may be guided by some trickin brnsh-work, it is often difficult to see the differencebetween the Dachess of Dashire with hoop by Reynoldsand the Marchioness of Blankaster with dog by Gains-borough. Those interested in Rowlandson’s work hadan excellent opportunity recently of seeing a collectioncf his drawings at the Fine Art Society in Bond-street.

1 Jahrbuch fur Kinderheilkunde, 1894. Abstract in Fortschritte der Medicin, 1895, No. 3.

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Famous as a caricaturist, he was there seen in his lessknown character of a graceful portrait painter, but thecharacteristic countenances were not without numerous

examples. __

PYLOROPLASTY.

IN THE LANCET of July 9th, 1892, Dr. Limont andMr. Page published an account of the first case of

pyloroplasty performed in this country. In the followingMay Mr. Pearce Gould published also in this journalan account of a case in which he had repeatedMikulicz’s operation and entered more fully into its detailsand advantages. He also collected a series of twenty-two other cases by various American and Continental

surgeons. In a recent brochure Dr. Corazza of Veronarecords a successful case of his own, and adds a series of

twenty-seven other cases by Continental surgeons. Togetherwith Mr. Miller’s case recorded in THE LANCET of Dec. lst,1894, and Mr. Morison’s case published in our columns to-day, we obtain a total of fifty-three cases in which

pyloroplasty has been carried out for pyloric stenosis. Of

these, six have proved fatal-two from collapse, three fromsepsis, and one from internal haemorrhage consecutive to theoperation. These figures show an exceedingly satisfactoryresult, and there is reason to look for a still further

improvement if the patients are submitted to operationat an earlier period of the affection and with more perfectobservance of complete asepsis. The restoration of thefunction of the stomach is a different matter from mere

recovery from the operation, and the published reports of thecases are not in all cases complete in this respect, nor havethey been made sufficiently long after the operation to

permit of a full statement on this head. But here, too, earlyoperation is likely to yield far better results than when thedisease has been allowed to progress almost to a lethal pointbefore operation is resorted to.

DIPHTHERIA AT MITCHAM.

Ds. MAIR, the medical officer of health to the CroydonRural District Council, has presented a report to his healthcommittee upon the prevalence of diphtheria in Mitcham

during 1894, which contains some instructive facts. Out ofa total of 64 cases notified in the whole district during theyear, no fewer than 53 occurred in Mitcham and the adjoiningpart of Merton, the number of houses invaded being respec-tively thirty-seven and twenty-seven for the same areas.Dr. Mair very properly points to the disparity betweeninvaded households and cases as a pressing need for an

isolation hospital. As regards the disproportionate incidencein Mitcham and its vicinity the facts point clearly to schoolinfection, children attending one particular school in thedistrict from twenty-one out of the twenty-seven invadedhouses, yet in eleven of these the child first attacked did notattend school. Dr. Mair thinks, therefore, that a widerexplanation is to be found in the drainage conditions, notonly of the school, but of the whole of the affected portionof Mitcham. Owing to the defects in gradients and con-nexions there is an actual influx of sewage from the mainsewer into the drains during flood times. His advicethat everything should be done to remedy this headingback " of the sewage at all costs is therefore thoroughlywarranted; and in further proof of the unhealthinessof the area it may be remarked that an inspection of318 children attending the school in question resulted inthe discovery that 243, or nearly 47 per cent., had "unhealthythroats." Chronic tonsillitis and a certain proportion ofgranular throats were the prevailing conditions. It is not

surprising then that diphtheria should have found a footing1 THE LANCET, May 20th, 1893.