the deaths from these causes, over and above what might be expected from increase of population. These deaths are also more frequent in the winter and autumn quarters than in the spring and summer seasons. These statistical results resemble, Dr. Granville points out, those given in a former number of the British and Foreign Quarterly Medical Review,' as observed in Italy. It appears that the middle ages-i. e., from twenty-five to sixty, affords the greatest number of deaths from apoplexy. As regards sex, Dr. Granville is of opinion that sudden death from apoplexy is as frequent in females as in males, while paralysis is more frequently the cause of death in the former. The general result of Dr. Granville's investigations under the two last heads, is that from infancy to manhood, or mature age, the deaths from these causes are fewest in number; that nearly double the number of men die suddenly from apoplexy at mature than at old age; that women and men die in almost equal numbers from these causes in the periods of mature and old age; and, that the only difference regards paralysis, which is more destructive to females, after sixty years of age, than to males.

Among other interesting deductions from the tables prepared by Dr. Granville, we find that there exist peculiarities belonging to locality, thus: apoplexy and paralysis are more frequent in counties than in cities, and sudden deaths more frequent in cities than in counties. Of the status or condition in life of those who have died from these three causes, it appears that the greatest number have occurred among the wives or widows of the industrial classes; next amongst domestic servants, cabmen, coachmen, porters, &c.; then among labourers, as house painters, plumbers, stonemasons, bricklayers, &c. Noblemen. and independent gentlemen, it seems, are about level with tailors, bootmakers, hatters, &c. Many more facts equally important and instructive are contained in this section.

The "Early destruction of life in England," or, as we should phrase it, the destruction of life at an early age, is a fact well known to the medical profession, and here extensively illustrated by Dr. Granville. The returns in the registrar's office give the proportions of deaths as one-fourth for males and one-fifth for females, within the first year of life, excluding still-born and premature births. The proportions of births being 100 females to 105 males, the cause of this exemption in favour of female infants remains to be discovered. Infantile deaths occur in much greater number during the first thirty days of life, gradually decreasing as the first year approaches completion. The early destruction of life is greater in certain manufacturing than in purely agricultural districts, and in the latter than in the metropolis; and again, it is greater in sea-ports than in other towns. The causes of these early deaths are unsatisfactorily explained in the coroner's verdicts appended to the registry, in a large number of instances. In a vast number, the children, as Dr. Granville observes, have been illegitimate. So frequent are these cases, that the coroners, the author remarks, appear compelled to employ some set expressions, without attempting to explain the causes in the description of death under consideration.

That the crime of infanticide has greatly increased of late years, the records of coroners' courts, assizes, and criminal courts, only too amply testify. We have ourselves endeavoured to learn, from the records of the metropolitan police-courts, the exact amount of increase in this crime; owing, however, to absence of a classification of this from allied offences, we have not succeeded. Much of the increase in question may doubtless be traced to the absurd and unscientific state of our law of infanticide, which requires proof of the commission of the crime after entire birth and separation of the infant from its mother. Under these conditions, it is well known to coroners that cases in which all evidence brings home the perpetration of the crime to the real culprit will, nevertheless, in the criminal courts, obtain acquittal. Hence often the indefinite character of the verdicts of coroners' juries. The causes assigned for infantile death are, we agree with Dr. Granville, often ridiculously insufficient.

Still-births are omitted from the registration returns. The number of deaths occurring at each of the first three months are not specially noted, but included in one general enumeration. Dr. Granville follows the number of early deaths through the variations attending locality, status of inhabitants, &c.; and a painful impression is left upon the mind by the perusal of the details adduced, as to the fearful demoralization and indifference to human life manifestly prevailing among the inhabitants of some districts in Great

Britain-not in China, but in the British metropolis. The infantile mortality of Bethnal Green is to that of St. George's, Hanover-square, as 61 to 1 !! Is comment needed? Still more solemn is the lesson inculcated by the state of things in Preston, up to a very recent date, as set forth by Dr. Granville.

In this section, the author has taken the opportunity of offering suggestions with regard to the registration of deaths, more particularly of those under one year, which, if acted upon, would tend to the enhancement of the value of the already highly-valued documents of the Registrar-General's office.

"Frequency of sudden death."-In order to impress his readers with the truth of his statements, and to fix their attention upon the subject, Dr. Granville has brought together a series of "Facts." These facts, however, consist of what appear to us to be newspaper paragraphs and obituaries, recording sudden deaths; and which, by dint of scissors and paste, might have been almost indefinitely added to, including other equally impressive and striking occurrences.

"What is sudden death?"-To give the answer to his question imposes upon the author the necessity of discussing the preliminary question, "What is life?" In so doing, Dr. Granville criticises the principal doctrines of vitality, the definition adopted by himself being that "Life is the communication of an immaterial principle to the organized being, forming no part of it, but simply using it as a machine subordinate to its will."

The answer to the first question, "What is sudden death?" is promised to be more fully given in a future work, which shall treat practically of the causes, and their treatment, and the prevention of sudden death. For the present, Dr. Granville is content with the statement that there is no such thing as sudden death, except as the closing scene of a series of pathological changes going on for a longer or shorter period of time. The conclusion of the present volume consists of a summary of what is contained therein, for the purpose of putting on their guard those individuals who are "likely to be the designated next victims, by showing, 1st, That in our days apoplectic seizures, &c., are more common than in former times. 2ndly, That neither youth nor manhood goes free, but rather the contrary, from such calamities. 3rdly, That these are not confined to the larger masses, but reach the home of the better and most exalted. Lastly, That circumstances attending the sudden deaths of infants are brought to light which demand further investigation."

REVIEW XII.

1. Bericht über die elektro-physiologische Arbeiten des Dr. DUCHENNE, de Boulogne, zu Paris. Von Dr. HERMANN EBERHARD RICHTER. (Schmidt's Jahrbuch,' No. 11, 1853.)

Report upon the Electro-physiological Researches of Dr. DUCHENNE. By Dr. H. E. RICHTER. (Schmidt's Jahrbuch' for October, 1853.)

2. Die Electrecität in ihrer Anwendung auf practische Medicin. Von Dr. MORITZ MEYER, arzt in Berlin. 1854.

Electricity in its Application to Practical Medicine. By Dr. MORITZ MEYER, of Berlin. 1854.

3. Histoire de l'Electricité Médicale. Par M. J. GUITARD, M.D., Président de la Société Medicale d'Emulation de Toulouse. 1854.

History of Medical Electricity. By M. J. GUITARD, M.D., Toulouse. 1854.

4. De l'Action Thérapeutique de l'Electrisation Localisée dans le Traitement des Paralysies Consécutives à l'Hémorrhagie Cérébrale. Par M. le Dr. DUCHENNE, de Boulogne. (Bulletin Général de Thérapeutique Médicale et Chirurgicale,' Mars et Avril, 1854.)

On the Therapeutic Action of Topical Electrisation in the Treatment of Paralysis, consecutive to Cerebral Hæmorrhage, By Dr. DUCHENNE.

5. Heilung der Impotentia virilis, mittels Electricität. Von Dr. B. SCHULZ, in Wien. ('Wien Wochenschrift,' 10-12.

1854.)

On the Cure of Impotence by means of Electricity. By Dr. B. SCHULZ, of Vienna. (Schmidt's Jahrbuch,' August, 1854.)

ALTHOUGH Scribonius Largus attempted the cure of gout and headache by placing the feet of his patients in a bucket of torpedos, and Paracelsus recognised some therapeutic properties in the magnetic bar, it was not until the middle of the last century that electricity was employed with any zeal for the cure of disease. The discovery of the Leyden phial at this time gave fresh impetus to the application; by its aid success was obtained beyond the most sanguine hopes; anticipations were raised; great pretensions made, and followed by still greater failures; until what was wanting in fact had to be supplied from fiction; and electricity, in its therapeutic relations, passed from the earnest inquirer after truth, through the hands of the enthusiast, into those of the most heartless charla

tans.

Falling into the same category of disgrace with the talisman, amulets and sympathetic cures, its scientific history was for some time lost; and nothing was heard of it, beyond vague rumours of miraculous cures from the shady regions lying outside the circle of sincere investigation and legitimate therapeutics.

In an earlier number of this review,* attention was directed to the researches of Mr. Donovan, Dr. Golding Bird, and others, who had submitted the claims of electricity to renewed examination. It was then shown that many cases of chorea, paralysis, and of amenorrhoea were amenable to this form of treatment, when others had proved unsuc

cessful.

Since that time, scarcely anything of importance has been added by the phyiscians of our own country; but in France and Germany there has been great attention bestowed upon the subject; and if no new facts have been added, the real use of electricity has been established, the several methods for its application have been tested, and their relative value pointed out. M. Duchenne (of Boulogne) has been the most vigorous labourer in this field, and it is our special object at the present time to present the results of his inquiries. Before doing so, we have to speak highly of the history furnished by M. Guitard, to which we are indebted for some of the following information.

After the discovery of the Leyden phial, and before the time of Volta, i. e., from the year 1745 until the commencement of the present century, friction-electricity was the only form used in medicine. Sparks drawn from the "prime-conductor," or from the individual, placed upon an insulated stool; shocks from the Leyden-jar; the "electric aura," from a pointed wire; and the so-called "electric bath," were the methods employed. M. Jallabert (1748) published a cure of paralysis with atrophic muscles, affecting the right arm. He recognised as results of electric stimulation-acceleration of the pulse, increase of temperature, involuntary contraction of the muscles, and emmenagogue properties.

M.

M. Jallabert's method was the application of sparks to points of the skin corresponding to the attachment of muscles; and in the Encyclopædia of Diderot and d'Alembert (1777) this mode of exhibition is considered to account for Jallabert's success. l'Abbé Sans (1772) related several cases of hemiplegia, and considered electricity the only means calculated to effect a cure in paralysis of long duration.

In 1780, M. l'Abbé Bertholon published an elaborate treatise upon the electricity of the body in health and disease, in which those conditions are referred to its equilibrium on the one hand, or to some variable kind of inequality on the other. Every sort of malady is, according to this learned Abbé, amenable to electric treatment, if the physician would only find out the form of electricity required.

We view with irresistible distrust the statements of a man, who treats successfully with the same remedy all classes of disease; and finding that the Abbé Bertholon cured affections of the skin, fevers, inflammations, cachexia, convulsions and paralyses with almost equal rapidity and ease, we pass on to the less ambitious but more careful memoir of M. Mazars de Cazèles. In this are related the cures of twenty cases, consisting of

Vol. iii. p. 373. 1849.

chronic rheumatic affections, hemiplegia, general paralyses, and neuralgia. In a second memoir by the same author, similar reports are furnished of forty-six cases; and M. Sigaud de la Fond confirms their general truthfulness by the detail of his own success in analogous affections. The latter author sums up the modus operandi of electricity by affirming that it augments transpiration, saliva, and the alvine secretions, causes abundant deposit in the urine, increases the temperature of the body, and improves its nutrition. In 1785, Cavallo published a general treatise, collecting the observations of previous experimentalists, and bearing his own testimony to the value of electrical applications for the increase of secretion generally, and in the treatment of skin diseases. After the discoveries of Galvany and Volta, Valli was the first to apply the new form of electricity (galvanism, or contact electricity), for the restoration of those who were in trance, or apparently dead from other causes. Sömmering pointed out the region of the phrenic nerve as the most advantageous spot for its application with this end in view. Pfaff, Reil, Humboldt, Aldini, and others announced the utility of galvanism in the treatment of paralyses of motility; Schaub, Eschke, and others, in loss of sensibility; and Sarlandière, by means of electro-puncture, made its application possible to deeper organs. Since Professor Faraday's discovery of induction-electricity, the older methods of electrifying have been almost entirely discarded, and it is with this mode of operation, now commonly called "Faradisation," that Duchenne and others have accomplished their results. There are, then, three generic forms of electricity, which may each be applied in different manners; and Duchenne has the following comments upon their relative value.

The

The action of electricity by sparks is always limited to the skin, or to some superficial muscle. The Leyden phial causes energetic contraction of the muscles, and some commotion of the nervous centres, with a painful feeling of shock, or of contused nerve. galvanic current may be either interrupted or continuous; the latter acting only upon the skin, and producing, in proportion to its strength, either simple erythema, or an eschar. The induction current is, from its very nature, of momentary existence only, and, although the rapidity with which its intermittences take place may be increased or diminished at will, a continuous stream is impossible. A current of the first order acts directly upon the muscular contractility; the secondary current excites powerfully the retina and cutaneous sensibility.

The therapeutic value of these three forms is various. Electric sparks afford a convenient mode of stimulating the skin. They are too feeble for action upon the muscles, and the Leyden phial produces too great commotion of the central organs. The continuous current from galvanism is of service when it is desirable to obtain thermic or chemical effects; and it is the best form of application to the retina. For action upon the muscles, the induction-apparatus is the best. Its special value appears to be, that its intensity can be regulated with great precision; that it can be directed upon any organ, and limited to that organ; that it exerts no appreciable chemical action on the tissues, and leaves no textural change; that it causes less burning sensation on the skin, causes and leaves less pain in the muscles, and rarely induces disturbance of the nervous centres. Duchenne's apparatus consists of an induction-machine attached to one of Bunsen's carbon-batteries; and his special improvements are the "Graduator," a welladjusted arrangement, by which the force of the current may be increased or diminished at will; the "Rheometer," which enables the operator to measure the force he is employing, and consequently to enhance the value of the Graduator; and the "Rheophors," or handles for applying the current. The whole apparatus is neatly arranged in a case, and may be procured of Charrière, Rue de l'Ecole de Médecine, No. 6, for

160 francs.

With regard to the mode of applying the conductors, Duchenne has made some important observations. If thay are dried and placed upon the dry cuticle, not far from one another, the action is confined to the surface. If both cuticle and conductor are well moistened (his own method being the attachment of wet sponge to the ends of the conductors) there is no action upon the skin, but marked contraction of the underlying muscles, accompanied by a very peculiar sensation like that caused by placing the nductors (through a wound in the cutis) upon the muscles themselves. The muscles

may be reached, directly, by placing the moistened conductors over them; or indirectly, by placing the conductors over the trunk of their nerve. The latter method is not so precise as the former, but is of use when anesthesia is to be combated. The sensitiveness of the skin varies widely in different situations, and the same is true not only of the sensibility, but also of the contractility of the muscles. Hence, Duchenne observes, it is necessary to become acquainted with these differences in order to administer the proper dose to a particular muscle, or group of muscles.

Some individuals are much more influenced than others, and unpleasant disturbance of the nervous centres may be induced, such as vertigo, confusion of thought, &c., without any local sensations from the application.

The purposes for which Faradisation may be employed are the advance of physiology, pathology, and therapeutics. The great utility of this agent in physiology is in establishing the functions of particular muscles and nerves. Every voluntary movement of a muscle, or a group of muscles, is complicated by the involuntary contraction of their antagonists, a provisional association to insure firmness and stability in the limb; and farther, it is impossible to determine the contraction of any particular muscle by a direct effort of the will; we can determine only the kind of movement, which shall be the "end" or resultant of muscular combinations; and the production of these combinations is the function of some part of the nervous system independent of volition. Duchenne imagines that by accurate local Faradisation many errors in our ideas with regard to the mechanical uses of particular muscles may be corrected; and this may be the case, but it must require the practised hand of M. Duchenne himself to single out deeply situated muscles, and determine their special contraction apart from those which closely surround them. Richter gives an interesting account of some conclusions to which Duchenne arrived, and the aid which he received therefrom in directing his local Faradisation for the treatment of certain local spasms and paralyses.

Some of the most interesting conclusions relate to the complicated movements of the scapula, which cannot be described without much detail, or the aid of plates. With regard to results more readily appreciable, we may mention that Duchenne considers the zygomaticus major the muscle which gives the special expression of laughing; the zygomaticus minor, that which gives the appearance of crying; that the musculus extensor digitorum communis, musculus extensor pollicis longus, and the musculus extensor digiti minimi, extend only the first phalanges of the fingers and thumb, while abductors, interossi, and lumbricales effect extension of the second phalanx of the thumb, and of the second and third phalanges of the fingers; that the musculus flexor pollicis brevis is a flexor of the first phalanx of the thumb, but to a higher degree an extensor of its second phalanx; and that the musculus supinator radii longus is not a supinator, but a pronator of the forearm. As to nerves, Duchenne thinks that he has made out satisfactorily the function of the corda tympani-viz., that of conferring sensibility, and the sense of taste, upon the interior two-thirds of the tongue.

In its relation to pathology, electricity appears to be of service in diagnosis and therapeutics. Neither Duchenne, Meyer, nor Guitard add anything of importance with regard to the former, although they speak very confidently, and, it must be added, somewhat contradictorily upon the subject. Dr. Marshall Hall pointed out, many years ago, that when paralysis was of such a kind as to sever muscles from the influence of the spinal cord, their irritability to stimulation from the galvanic trough was less than the irritability of muscles still in functional connexion with the cord. The use of the term "spinal" to denote this kind of paralysis led to misapprehension, and was supposed to imply disease of the cord itself; consequently, cases of ordinary paraplegia became the field for experiment. Duchenne and Meyer use the words spinal paralysis in this sense, and hence modify or contradict what they suppose to be the meaning of Dr. Hall. It is at once obvious that, although muscles may be cut off from the influence of the brain, and thus paralysed in respect of volition, by many diseases of the medulla, some portion of the cord below the seat of lesion may remain intact (or even in a state of exalted reflex activity), and that these cases are not examples of "spinal paralysis," using that term in the sense clearly defined by Dr. Hall.*

See Medico-Chir. Trans. vol. xxx. p. 207.