Before entering on the consideration of the experiments on the nerves of the face, or the conclusions to be derived from them, the following account of the origin of the opinion which the essay supports, is first given :-"Some years ago there occurred to me, during my dissections, a very unusual arrangement of the nerves of the face ;-all that part of the facial of the right side which is distributed to the side of the face and temples, was wanting, and its place supplied by a trunk from the second division of the trifacial, which trunk turned round the posterior edge of the ramus of the jaw, and emerged through the parotid, having an appearance extremely like the facial, in ordinary circumstances. I had fortunately known the individual when alive, and there was not any thing remarkable in the expression of his countenance. The conclusion to which I was, of course, irresistibly led by this lusus, was, that these nerves must be possessed of exactly the same properties and structure, or the one could not supply the place of the other. Such an opinion was also, on consideration, greatly supported by the well-known similarity of arrangement, and intimacy of connection, which these nerves have in their natural distribution. I am now extremely glad, as the subject of these nerves has become of importance, that I mentioned the occurrence, immediately after it happened, to several scientific friends, and, among others, to Dr. Spurzheim, who, in his lectures in this city, alluded to the fact.

"When the occurrence happened, I had neither opportunity por leisure to follow up the inquiry. I, however, held the subject in recollection, and when I began, in 1817, to lecture on anatomy, I directed my attention particularly to the consideration of the consequences to which such a view of these nerves would lead; but before I permitted myself to believe in the truth of an opinion so much opposed to that generally received, I felt it incumbent on me to inquire more particularly into the simple anatomical question. I was naturally led to suppose, that if these nerves were in reality possessed of the same structure and function, they would arise, or hold connection with the same or analogous parts of the brain. I consequently took every opportunity of examining this point, and I was, at last, fortunately able to trace these nerves to the same part in the brain, and to shew that they in reality spring from precisely the same source; and moreover, that the reason why they were ever considered distinct, must have arisen from their union in the substance of the brain being concealed by the commissure of the cerebellum, or Pons Varolii. Ever since this period, I have

been in the habit of demonstrating these nerves as different divisions of the same pair. The many additional reasons for supporting this opinion, derived from comparative anatomy, and from experiments on animals, I will now proceed to mention; but first shall say a word respecting the mode of dissecting the roots of these nerves, so as to shew their junction in the substance of the brain.

"When we look at the part of the brain from which the facial and trifacial, emerge, the latter has evidently the aspect of passing downwards, outwards, and backwards, through the substance of the commissure of the cerebellum; and the former, by the manner in which it turns round the lower border of this commissure, has evidently a direction upwards, outwards, and forwards, so that they appear to penetrate the surface of the brain in such a manner as will enable them to run towards each other. The facial, at the point where it leaves the brain, corresponds to the interval or groove which separates the corporia olivaria from the corpora retiformia of Ridley, and the trifacial to the point of junction of the Pons Varolii with the crura cerebelli. If the brain be tolerably firm, the union of these nerves in its substance may be most easily shewn by making an incision of two or three lines in depth through the pons, bounded on the outside by the nerves mentioned, and then, by scraping with the end of the handle of a knife made smooth, the transverse fibres of the pons on the inner side of the incision, or, in other words, from without inwards. We must take care not to disturb the nerves when they are connected with the surface, but use them as our guide in searching for their continuation in the pons, and we shall clearly observe the two nerves united in one at their origin. It may be proper to mention that there are sometimes a few fibres belonging to the trifacial, which cannot be distinctly traced through the pons.†

[Mr. Wallace has very kindly promised to send us the remaining part of his interesting paper, with additional experiments.-EDITOR.]

.: The Commissure of the Cerebellum, is the name given by Gall and Apurzheim to the Pons Varolii,

+Gall and Spurzheim. Ir C. Page 106, and Santorini.

REMARKS ON NEVUS MATERNUS, WITH A CASE, BY GEORGE LANGSTAFF, Esq.

To the Editor of the Quarterly Journal.

SIR. Should the following additional practical observations to those I gave on Nævi Materni in your last Journal, be considered worthy of publication, you will perhaps give them a place in your next number.-I am, your's respectfully,

GEO. LANGSTAFF.

My motive for publishing the case and dissection above alluded to, was with a view of making known some of the varieties of the disease, more especially of the difficulty of ascertaining by examination, during the child's life, the depth of the diseased growth, in consequence of its very intimate connexion with the parts seated remotely from the integuments, which fact, in other instances of the kind that may be met with, would, in all probability, make an operative surgeon cautious in deciding on the propriety of the extirpation of such nævi.

I have removed at different times, and from different patients, a great number of subcutaneous, nævi, some of which were very large; but their extent and depth would be nearly as accurately ascertained by the touch, as we find to be the case in moderate sized encysted tumors. In all the operations the hæmorrhage was considerable, and in some rather alarming, although the healthy skin was removed as far from the diseased, as prudence dictated, and the situation of the parts allowed.

Lately, I removed the principal part of the upper lip, affected with nævus, from a child, three months old, which, from its magnitude and discoloration, gave the child such a hideous appearance, as to make the parents very anxious to have an operation performed to lessen the deformity, even at the risk of its life. The labial artery, which was very large, bled freely; but the principal divided trunks and main branches were easily secured. Long, firm, but very slender, silver pins were employed to bring the divided parts together, which were allowed to remain in five days. The incised parts at this period from the performance of the operation had united, except where the very small silk ligatures, which secured the arteries, remained, which in the course of a week were removed. The operation succeeded beyond expectation, and there will be scarcely more unsightliness than is seen after the common operation for hare-lip. I have mentioned this case to shew, that the operation för hare-lip may be performed successfully at an early period after the birth of the child,

and from what I have seen, I am induced to think, that in all cases of hare-lip, not connected with a bifid state of the palate, &c., that the operation ought not to be deferred the period it has been recommended, even by several eminent surgeons, which does not appear necessary, and keeps the parents in a state of painful anxiety.

To conclude, I think it right to state, that I have been fortunate enough to destroy, by the application of potassa fusa, some of the smaller kind of elevated subcutaneous nævi, such as appeared disposed to increase, situated on parts of the body likely to cause disfiguration, and to require at some period to be removed by excision. The sloughs produced by the caustic were thrown off in the same manner we see them, when this agent is made use of for the formation of an issue, and in no instance attended with hemorrhage. But I do not wish it to be supposed, that I should recommend this treatment to nævi of a large kind. The largest in which I have employed the caustic did not exceed externally the section of a large cherry. In removing nævi from the tip of the nose, a case not unfrequently met with, which gives the face of the child a very whimsical appearance, I have been more perplexed with suppressing the hæmorrhage than in any other, the part being so well supplied with arteries, and not allowing of the removal of a necessary quan-, tity of sound integuments.

T

I purpose trying caustic, in the next case of the kind that may come under my care.

G. L.

CONTINUATION OF MR. LLOYD'S PAPER ON VARICOSE VEINS.

The preceding cases are interesting not only so far as they demonstrate the safety of dividing varicose veins, but also by shewing, that ulcers of the legs, connected with a general varicose state of the veins, will speedily heal, notwithstanding they have previously resisted every other mode of treatment, if merely the varices which are immediately adjoining them, and tender to the touch, be divided. The first case also proves, that although ulcers dependent on varices have existed for many years, they may be as certainly and as speedily healed, as those which have existed only for a much shorter time. The same points are further confirmed by the following case; and it moreover shews, that an ulcer of nearly twenty years standing may

be healed in an old person, without any injurious effects ensuing, if at the same time a proper regimen be observed.

Early in the spring of 1813, I was consulted by an old lady, between sixty and seventy years of age, on account of a painful ulcer on the small of the right leg, which occasioned her to be so lame that she could hardly walk about the house. The ulcer, she informed me, had existed for nearly twenty years; it was about an inch and a half in length, and an inch and a quarter in breadth; its edges were hard and elevated; its surface was of a variegated and glossy appearance, and it discharged copiously an offensive oily kind of matter. The skin surrounding the lower part of the leg was of a dark reddish purple colour, seemed tightly stretched over the other integuments, and had that peculiar shiny appearance which so commonly attends old standing ulcers of the leg. The veins of the leg were not much elevated except at the upper part of the calf, but still they were much dilated; and upon examining the parts about the wound with my hand, I distinctly felt a large Varix, with hardened edges, and tender to the tolich, 'situated between the tibia and fibula. This varix therefore was selected to be divided, for although there were, in the neighbourhood of the ulcer other varices to be felt, still there were none of them either inflamed or tender. In a few days before the operation was performed, the patient was con'fined to vegetable diet, and all stimulating drinks were abstained from; her bowels were freely opened, and the limb was kept constantly in an horizontal position. The operation was performed in the same manner as in the preceding cases-about twelve ounces of blood were abstracted at the time, and no bad symptom ensued. The wound occasioned by the operation healed by the first intention; and on the third day, when the dressings were removed, the edges of the old wound were found white, and fibres of skin were seen shooting from the whole circumference,, The process of cicatrization, moreover, went on so rapidly, that the old ulcer, which had previously for so many years resisted every attempt to cure it, was, by the nineteenth day, completely healed. The pain, too, which had before been a source of constant trouble, wholly ceased; and indeed the success of the operation was altogether so complete, 'that the leg remained perfectly well to the time of her death, which happened about three years and a half afterwards. The bandage was worn for several months after the ulcer had healed, but subsequently it was left off. As the ulcer in this case had existed for so many years, I considered it right to direct the patient, always to take some opening medicine two or three

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