of the memory has been the first mental States, who is now one of the most res symptoms observed. The failure of memory is, perhaps sometimes considered the only impairment of the mind, where in fact its other powers are likewise injured, inasmuch as an alteration is much more readily detected in the memory than in any other faculty. It is possible likewise, that in many instances it is more properly the recollection than the memory which suffers; the remembrance is not lost, but the facility of finding it in the mind: so that the change would be more justly stated to be in an impairment of the liveliness and rapidity of association. I have heard it observed of old men, that their memory has become impaired, but that their understanding has remained as strong as formerly, only slower in its operations. A supervening slowness of association would account in these instances for all the phenomena observed. How much we may remember, which we cannot recollect, is shown by a curious class of cases, several of which have been collected by Dr. Prichard, in his work upon the nervous system, from which I shall extract the following. "A man was brought into St. Thomas's Hospital, who had received a considerable injury of the head, but from which he ultimately recovered. When he became convalescent, he spoke a language which no one about him could comprehend. However, a Welsh milk woman came one day into the ward, and immediately understood what he said. It appeared that the patient was a Welshman and had been absent from his native country about thirty years. In the course of that period he had entirely forgotten his native tongue, and acquired the English language. But when he recovered from his accident, he forgot the language he had been so recently in the habit of speaking, and regained the knowledge of that which he had originally acquired and lost."* "A student at an university in the United pectable clergymen in that country, possessed a tolerable share of classical knowledge, when the consequences of a fever, which affected his brain, deprived him entirely of his former acquisitions. In fact, he had now become so ignorant, that he was not only unable to read a Latin book, but even knew nothing of the grammar. When he had regained his bodily health, being of a persevering disposition, he began again the first rudiments: every thing was quite new to him: he passed through the accidence and syntax in his grammar, and was learning to construe, when one day, as he was making a strong effort to recollect a part of his daily lesson, the whole assemblage of the ideas which he had formerly acquired and lost, suddenly re-appeared to his mind, and he found himself able to read and understand the Latin authors as he had done before his illness." The first thing to be satisfied of in all questions of this nature is the precise accuracy of the particular facts. We will suppose these facts to be not merely generally but altogether accurate. We do not think that Mr. Mayo has exactly stated the case. When an old man begins to lose his memory, it is well known, that it is the memory of recent events that is impaired. He remembers full well the scenes of his boyhood. In the case of the Welshman it was the language recently acquired that was forgotten; and this we believe to be usually the case after injuries of the head. Patients do not so well recollect what occured about the period of the accident, or subsequently, as that which took place at a time antecedent to it. Mr. Brodie mentions an instance of this in his paper on Injuries of the Brain. These facts seem to prove that events which have occurred, or ideas that have been formed at an early period of life, have a stronger hold upon the memory, that is, have made a more lasting impression on the mind, than those presented to it in later years. But, in reasonings of this kind, we must *Dr. Tupper's Inquiry into Gall's System always be careful not to erect words into of Craniology. things, nor reason on nonentities as if they were things which have existence. What is memory? We should say it is the preservation of ideas that have been received through the medium of the senses from without, or of impressions made on the sensorium by the organic sympathies within. Now as early life is that in which the senses are most acute, and the sensorium most apt in the reception of impressions, it is not difficult to conceive that it must be more affected by those impressions, and more lastingly influenced by them, than in later years when the senses are more obtuse, and the impressions which they convey are consequently more feeble. But this mode of reasoning is inapplicable to the case of the gentleman who forgot the Latin language, after having suffered from a fever affecting the brain, and suddenly regained the recollection of it. This, by the way, seems to us rather favourable to phrenology than to metaphysics, rather favourable, to the theory that the brain is an assemblage of organs, than a whole, which, as a whole, must be affected. It is more easy to explain the case on the supposition that a particular portion of the brain was organically affected, that a slight effusion, or some other partial lesion, occurred, than on the supposition that the brain is " one and indivisible," the organ of thought, and that being affected in totality, the power of recollecting one language was lost. Mr. We will, however, look at the case in a more metaphysical point of view. Mayo adverts to the distinction between remembrance and recollection; the former appears to be the endurance of the idea in the mind; the latter, the power of obtaining it from the mind. He explains then the case of the clergyman, by saying that, after the fever, the remembrance of the Latinity was still present in his mind, but that he temporarily lost the recollection of it. Analyse this and it explains nothing. Remembrance and recollection are arbitrary terms, and are merely representatives of certain facts. To say then that the clergyman remembered the Latin language, but did not recollect it, is simply to express the fact, is merely to affirm, in conventional language, that the case was such as it was. It is obvious that this is a sort of algebraic expression of facts, but not an explanation of them. Neither do we think that a slowness of association is an explanation of these phenomena. What does slowness of association imply? It is a nonentity; it is merely the expression of certain phenomena; it is a relative term; which means no more than that one idea presented to the mind does not call up another idea in some degree, or in some manner linked with it, as speedily or as fully in one case as in another. To say then that the clergyman did not recollect his latinity, because he was laboring under a slowness of association, is simply to say, when the term is resolved into its elements, that he did not recollect his Latin. It drives the difficulty a little farther off, but it does no more, at least it appears so to us. For instance. The clergyman did not recollect the Latin language, because certain of the associations connected with that language did not, as under ordinary circumstances they would do, call up the ideas which constitute that language. Does this explain the matter? The memory is made to halt at one point rather than another, but after all it is made to halt, and we know no more of the wherefore or the how, than we did before. We make these remarks, not from disrespect to metaphysics, but merely to put in a prominent point of view the truth which most men, we believe, acknowledge, that when we express facts metaphysically, we simplify their expression, or we generalize it, but we do not usually explain the facts themselves. Mr. Mayo we know to be a good metaphysician, and perhaps he may smile at the imperfect manner in which we have put the case. In our next we shall take some notice of Mr. Mayo's very interesting and useful work. LXXXIII. APHONIA. DR. WEBSTER. SOME Curious cases of this affection are related by Dr. Webster in our esteemed cotemporary the Medical and Physical Journal, for September last. They occurred in the practice of Dr. W. in the St. George's and St. James's Dispensary. In these individuals, there was principally observed a peculiar affection, amounting almost to a total loss of voice, without any decided proof of disease in the larynx or glottis. From these and other cases, which Dr. W. has observed, he comes to the conclusion, that the complaint is occasioned by a paralytic state of the nerves distributed to the larynx and glottis, from pressure or some diseased condition in the cerebrum. We can only make room for one of the four cases related by this intelligent physician. "Case 1. George Wright, æt. 16, groom. When first seen, this patient had an attack of bronchitis, which was, however, soon removed by the exhibition of demulcent and aperient medicines, and the application of a blister to the chest: on the 14th of January last, he was considered free from all pectoral complaints. Nevertheless, at this period, an affection or weakness of voice showed itself; and, on the 16th, it became so remarkable that Wright could only, with the greatest difficulty make himself heard by the bystanders, being scarcely able to speak, even in the lowest whisper. Notwithstanding the presence of this symptom, he did not complain of any pain in the throat or chest, nor was there any dyspnea; but the patient now for the first time mentioned that he had a severe headach, accompanied by drowsiness and deafness; and, on examining the pupils of both eyes, they were observed to be very much dilated, and almost insensible to the influence of light. It was from these circumstances that attention was especially directed to the cerebral symptoms, which ultimately led me to consider this affection of the head to be, in reality, a principal cause in producing loss of voice in this individual; and subsequent investigation, confirmed by the successful treatment adopted, demonstrated the correctness of the pathological views then entertained. Five grains of the extract of conium were given at night, followed by an aperient in the morning; and a demulcent medicine was also ordered to be taken twice or three times a day. Little or no benefit, as might be expected, followed this mode of treatment: on the contrary, the loss of voice still continued, and it was latterly even so much affected that the patient sometimes could not articulate a single word; the air during these efforts to speak appearing to pass through the rima glottidis, as if he were blowing a musical instrument, without a note being produced. It also merits observation, that if any alleviation of the pain in the head occurred, and especially if, at the same time, the pupils became less dilated, and were sensible to the impression of light, the voice invariably became stronger and more distinct, thus showing that the condition of the brain, and consequently the function of the nerves distributed on the larynx and glottis, was materially concerned in the disease; and, therefore, it appeared this affection of the head must first be removed, in order to restore the natural tone and strength of the voice. In accordance with the above reasoning, a blister was applied to each temple on the 24th, which discharged freely, and the patient, when seen on the 26th, was found to have materially improved; the headach was almost gone, excepting over the right eye; the pupils appeared less dilated, and sensible to light, and the words, when speaking, could now be more distinctly articulated, although still in a low tone: the countenance likewise looked clearer, was not so anxious, and, to use the patient's expression, he felt almost quite well,' excepting the continued weakness of his voice. Extract of conium, which had been taken for the last two nights, was continued, and an aperient mixture prescribed in the morning; at the same time more nourishment was allowed, as the appetite and digestion had improved. On the 18th, the patient felt considerably better; the pupils contracted when exposed to a strong light, and the deafness and headach were almost removed; whilst the tone of the voice was nearly natural, and he articulated words correctly, although not strongly. A week afterwards, he had almost recovered his usual voice, had no head affection; and, when seen for the last time, in the middle of February, he was convalescent." The other cases are equally satisfactory, and we recommend the subject to the attention of practitioners in general. LXXXIV. OF THE ORGANS OF THE HUMAN VOICE. By Sir CHARLES BELL, KGH. FRS., &c. &c. SIR CHARLES BELL is always sure of being favourably received when he appears before the public as an author. We are not surprised therefore that the present Essay in the Philosophical Transactions should have attracted the notice of most of our contemporaries. We will lay an abstract of it before our readers. Sir Charles observes, that the subject has been negligently treated, that physiologists have been too much accustomed to the consideration of parts with the view to one function only, that the human vocal organs are remarkable for their complications and combinations, and, finally, that although there is one question to which he would direct particular attention, namely, articulate language, still he thinks it best to consider all the parts of the subject systematically. He accordingly divides the inquiry into three heads; the trachea, the larynx, the pharynx. And first of the trachea. "We read that the trachea is formed of imperfect hoops of cartilages, joined by membranes, and that it is flat on the back part, for these reasons: that it may be a rigid and free tube for respiring the air, that it may accommodate itself to the motions of the head and neck, and that it may yield, in the act of swallowing to the distended esophagus, and permit the morsel to descend. This is perfectly correct; but there is a grand omission. Whilst all admit that a copious secretion is poured into this passage, it is not shown how the mucus is thrown off. There is a fine and very regular layer of muscular fibres on the back part of the trachea, exterior to the mucous coat, and which runs from the extremities of the cartilages of one side to those of the other. This transverse muscle is beautifully distinct in the horse. When a portion of the trachea is taken out, and every thing is dissected off but this muscle, the cartilages are preserved in their natural state; but the moment that the muscular fibres are cut across, the cartilages fly open. This muscle, then, is opposed to the elasticity of the cartilages of the trachea. By its action it diminishes the calibre of the tube, and by its relaxation the canal widens without the operation of an opponent muscle. The whole extent of the air passages opens or expands during inspiration; and then the trachea is also more free; but in expiration, and especially in forcible expectoration and coughing, the trachea is diminished in width. The effect of this simple expedient is to force the passage of the accumulated secretion; which, without this, would be drawn in and gravitate towards the lungs. When the air is inspired, the trachea is wide, and the mucus is not urged downwards; when the air is expelled, the transverse muscle is in action, the calibre of the tube is diminished, the mucus occupies a large proportion of the canal, the air is sent forth with a greater impetus than that with which it was inhaled, and the consequence is a gradual tendency to sputa towards the top of the trachea. In the larynx, the same principle holds; for as the opening of the glottis enlarges in inspiration, and is straitened in expiration, the sensible glottis, by inducing coughing, gets rid of its incumbrance. Without this change of the calibre of the trachea, the secretions could not reach the tion on the skin does not in itself constitute the exanthematous disease; that the eruption is merely one of the elements or phenomena of it, and that without denying the existence of other simultaneous complications, such as changes of the blood, direct affections of the nervous system, &c. by far the most common and most important is an inflammatory congestion of the encephalic, respiratory, or digestive organs. Now it is proper to observe that the internal phleg masiæ, which so very frequently accompany eruptive fevers, assume sometimes a special or particular character; thus, the angina in scarlet fever is ordinarily of the diptheritic kind; but yet it would be a most serious error, if we supposed, with some able physicians, that these specialities forbid the employment of anti-inflammatory remedies. In the 13th bed of the ward, St. Jean de Dieu, you saw a young man in whom scarlatina was accompanied by an intense diptheritic angina, extreme exhaustion, intermittent pulse, and great dryness of the skin; the prognosis was certainly, to all appearance, most unfavourable. He was bled, and had leeches applied several times to the throat, and all the worst symptoms speedily vanished. Certainly we are not to overlook the various forms which inflammations may assume; but we must be always careful not to lose sight of the very foundation of the disease; the old adage is generally a true one "la forme emporte le fond." In the disease which has been called typhus, or typhoid fever, entero-mesenteric fever, dothinenteritis exanthema intestinalis, and which we have designated entero-mesenteritis, because, in reality, the inflammation of the small intestines and of the adjoining mesenteric glands is the fundamental element and starting-point of the disease, the antiphlogistic treatment has been uniformly and most successfully adopted. We have very seldom employed the chlorurets at the same time; these remedies, however, form excellent adjuvants, in many cases of those fevers which are termed "essential." They were first recommended in the treatise which I published in 1826. In "erysipelas," the treatment has con sisted in bleeding, when the disease was severe, and in the exhibition of ipecacuan and the employment of the antiphlogistic regimen when it was mild. The progress of "tubercular bronchitis" was very sensibly arrested, in many instances, by means of a low diet and the occasional application of a few leeches, of the cupping-glasses, and of revulsives. There was one case of partial phthisis (a cavern at the summit of the right lung), which was completely cured in this manner. "Partial Dropsy." Many examples of this affection have been witnessed by our students; they have been almost all traced to some impediment to the venous circulation, arising from obliteration of the vessels by fibrous concretions in their cavities. Professor Chomel (Lancette Française, No. 81) mentions a case, in which the adema was confined to the upper half of the body; see, also, a paper "on the Obliteration of the Veins, and its Influence in producing Partial Passive Dropsies," in the Archives Générales de Médécine, 1824. Several cases of diseased heart, of peripneumony, of effusion into the chest after pleuritis, of hæmoptysis, of typhus fever, of colica pictonum, of jaundice, are detailed; the same general therapeutic means were employed, namely, bleeding, general or local, varying in quantity according to the symptoms, and the other parts of the antiphlogistic regimen, with very striking advantage. "Tis most gratifying that the indications of cure, in very many diseases, are now so simple and well understood, and that the practice of medicine is becoming every day less and less empirical, and acquiring a more rational and satisfactory character. This change of things we owe to the great mind of M. Broussais, the father of reformed medicine. M. Bouillaud has used the antiphlogistic treatment in cholera with certainly as great success as can be fairly claimed for any other method proposed. In 34 cases, lately under his care, only 9 died, although 14 were in the last stage of the disease. Numerous cutaneous diseases have been cured, nay, we might rather say strangled, by the repeated |