degree of irritation. All have recovered under the use of hemlock, and the slighter cases with great rapidity. The following are examples of two of the severer cases :—

1. Stephen S., aged 13 years, came under my care March 1867. His mother gave the following history:-During the time she was carrying the child, she was attending the deathbed of a near relative, and was weak, nervous, and depressed. On one occasion she was much startled by the unexpected striking of a large bell overhead as she passed under a gateway. At his birth the child was emaciated, but he made flesh rapidly, and at the end of a month was quite plump. For the first four months he screamed almost constantly. When only three weeks old he was seized with violent convulsions, recurring at intervals for several days in succession. These fits were of an epileptic character, each lasting three or four hours, and attended with unconsciousness. The convulsions chiefly affected the left limbs. Between the second and third month he had a second series of fits. A month afterwards, he had whooping cough badly and the fits were again renewed. Since then he has been liable to frequent attacks of Laryngismus stridulus, and a recurrence of the fits every three or four weeks. Dentition began at the eighth month, and at this time the fits were very violent; on one occasion he was unconscious for five hours, and leeches were applied to the temples. From this time to the present, the fits have increased in frequency and severity, and the attacks of laryngismus stridulus are induced by the least excitement. As yet only five teeth (incisors) have appeared, but there are indications of the eruption of a sixth. The child has never walked, the left leg cannot be straightened on account of contraction of the hamstring muscles; the left arm is nearly useless and drawn backwards; there is internal strabismus of the right eye, congenital, but much increased since birth. The patient is a florid, healthy-looking, remarkably large and powerful child. He is noisy, restless, and unmanageable beyond description; his temper is so violent that, upon the slightest provocation, he becomes furious, screaming incessantly, and in his struggles striking his head against objects in the way, alike indifferent to restraint and

to pain. Has startings in his sleep, and frequently wakes up with a scream. His appetite is voracious, and thirst insatiable. On putting my finger into the mouth to examine his gums, I immediately brought on a violent attack of spasmodic coughing interrupted by prolonged stridulous inspiration, the face became congested, the tongue was protruded, swollen, and of a dark colour, and he struggled desperately. The poor mother was well-nigh worn out with her unremitting attentions to the child, and she stated that he is wickedly disposed, and that he strikes her upon the slightest provocation. The treatment of this case extended over a year, and consisted in the administration of hemlock alone. Beginning with mxv. of the succus, I gradually increased the dose to 3ivss. taken once every day. The beneficial effect of the drug was decided and immediate. During the first five weeks the patient had only one fit, and this was associated with the cutting of the sixth tooth. At the end of this time the laryngismus stridulus had finally disappeared; the left arm was no longer drawn backwards and he had begun to use the hand; the left leg could be farther extended. From this time his progress was rapid and uniform; and with the exception of occasional twitchings and grinding of the teeth during sleep, and a single fit to be mentioned hereafter, all convulsive movements ceased. At the sixth month of treatment he was able to walk with the help of a hand; five more teeth had appeared, making twelve in all; he was much more quiet and tractable, and was improving in intelligence. Dentition progressed favourably, and at the end of the ninth month all the temporary teeth were cut but two; he walked well with the help of a hand, and used the left limbs almost as well as the right; the strabismus was less; and he began now to articulate a few words; he was constantly on the move, and still very rough and boisterous, and his appetite for food and drink remained as insatiable as ever; the nocturnal twitchings had ceased. A fortnight afterwards he was able to walk alone, and now began to run about all day long. Two weeks later on he awoke in the night with a start, and his mother apprehending that he was about to have a fit poured cold water upon his head.

In the evening of the next day he had a fit which lasted twenty minutes. This was his last convulsive attack; it weakened the left leg for a few days, but under the influence of increased doses of the medicine he speedily regained his former improved condition, cut the remaining two teeth without difficulty, and has continued well up to the present time.

The effect of the medicine upon this young patient was very marked. Twenty minutes after taking it the eyes had a heavy, stiff, dreamy appearance, and he seemed often incapable of raising the lids. He would then stop suddenly in the middle of his play, lay his head upon the carpet, and remain perfectly quiet and motionless for a period varying from half an hour to two hours. On one occasion he lay still and apparently torpid with the eyes closed for four hours, when his mother being somewhat alarmed roused him. This condition was induced by an increased dose of 3ij. The effect of the hemlock upon the contracted muscles was very decided. The left leg, which before the dose was slightly bent, and moved stiffly in walking, would become released during the action of the medicine, and as he walked, the heel could be fairly brought upon the ground.

At the time that he began to run about without assistance he was taking 3ij.; of the succus daily, and it produced the usual effects of arresting him in his play, causing the eyes to look dull and heavy, and inducing a state of repose lasting from half an hour to an hour and a half. But five or six days afterwards his mother, who had watched him with the most anxious care, observed that the medicine had all at once lost its effect. On mentioning this to me I increased the dose to 3ijss.; but after the first two or three doses no effect followed, and nine days afterwards the last fit occurred. I then increased the dose rapidly, and soon found it necessary to give the patient more than double the quantity that he was taking at the time he began to walk without assistance, in order to produce equal physiological effects-viz. 3ivss.

This is a very remarkable and interesting observation. It would appear therefrom, that simultaneously with the

acquirement of the power requisite for running and freely exercising the body in the erect posture, a rapid development of motor force takes place.

If we can trust this single observation-and I think we may safely use conium for our measure-it appears that the motor force may be more than doubled during the short period of a fortnight. Nor is the above a very uncommon case, for although the child ran about from morning till night as soon as he could walk alone, many children attain an equal degree of activity in the same space of time.

2. John C., aged 23 years, a pallid slightly-developed child, had always enjoyed good health up to the seventh month, when he suffered from an attack of measles, and the irritation attending the eruption of two incisor teeth. These left him very weak, and at the ninth month he was attacked with fits which have recurred at variable intervals ever since. These attacks were preceded by a violent start and screaming, then followed rolling of the eyes, loss of consciousness, and strong contractions of the flexor muscles, lasting usually twenty minutes. At first the fits occurred every day, sometimes he had four fits in the day, and occasionally as many as ten or thirteen in the week.

During the last five months the character of the fits has somewhat changed. There is now no loss of consciousness, the attack is preceded by a cry of pain, and accompanied by a feeling of dread. The trunk and limbs are affected with tetanic spasm, the body being arched backwards and slightly curved to the left, the left arm pulled backwards and the right forwards over the body to the left side, the mouth drawn to the left, the legs rigidly extended with a slight curve backwards, and the feet strongly flexed. This state continues, sometimes for only five or ten minutes, sometimes with short interruptions for several hours, and the little patient cries out with pain, frequently exclaiming, 'aches so bad, make me better, make me better.' He came under my care April 3, 1867. During the whole of the time he was waiting in the out-patients' department at the Hospital, he was in an alternate state of cramp and partial relaxation, and when his mother brought him into the prescribing room

he was fully extended in her lap, the thumbs were drawn into the palms of the hands, and firmly grasped by the fingers; the toes firmly flexed, the feet rigidly arched backwards, and the muscles of the calves firmly contracted. He complained of aching pains chiefly in the feet and legs, and manifested great dread lest anyone should touch his feet in passing. The head was rather large but quite cool, the fontanelle firmly closed. A slight internal strabismus (congenital) affected both eyes. The functions were naturally performed, and the child was remarkably intelligent and patient. Dentition was completed three months previously, and two months ago he began to walk. Soon, however, the abovementioned attacks supervened and prevented all further attempts, and for the last few weeks he has been unable to set a foot upon the ground or even to bear the pressure of shoes. The cramps distress him by day and take away all appetite for food, and interfere with sleep by night, and the poor little patient is much exhausted. The mother stated that three of her other children had suffered from convulsions during dentition, and one had died in consequence, at the age of seventeen months. Under the influence of conium an improvement was observable in a few days; the contractions of the fingers and toes relaxed, and with the diminution of muscular tension the pain decreased. He was rapidly improving when his mother was called to her father's deathbed, and the treatment was suspended for a fortnight. At the end of this time he had a violent tetanic attack with opisthotonos, lasting 1 hour, and he was lapsing into his former condition of continuous cramp. Upon resuming the hemlock in increased doses he rapidly improved; the muscles of the calf relaxed, the foot could be extended at right angles with the leg, and he was able to wear boots, and began to walk again. The improvement continued, and within three months from the time I first saw him he was able to walk well. The attacks had totally disappeared, and he was greatly improved in health and strength. The hemlock was now suspended. Since this time he has not manifested the slightest tendency to spasm, and has become a healthy and active child.