About seven in the evening, and about one hour after passing normal urine, without any warning, his attention was called to a warm trickling down his thigh.

Investigation showed blood spurting from his penis in alarming quantities. It could be controlled only by grasping the organ tightly in the hand, release of the constriction being at once followed by the hemorrhage. A large bath-towel was saturated and the carpet showed two spots covered with clotted blood, not smaller than dinner plates. He believes he lost more than a pint of blood, and I think this is a small estimate.

He was much exhausted, and went to bed, though he slept but little, having occasional erections which renewed the hemorrhage. In the early morning he passed clear urine, which scalded one portion of his urethra and was followed by slight bleeding. He "milked" a clot from his urethra, which brought on hemorrhage again.

At noon he passed normal urine in my presence with no scalding, and but a slight trace of blood followed his milking process. He rapidly recovered his usual health.

I regret that I was unable to make an endoscopic examination. There was no infiltration into the tissues of the penis, and no pain except at one point near the scrotal junction, where there was slight tenderness, probably the source of the trouble. His abdominal uneasiness and the other symptoms first led me to think of renal trouble, which may indeed exist, but the hemorrhage was undoubtedly urethral.

Since childhood he has noticed a tendency to bleed profusely after slight injuries; nose bleed has many times given him much alarm; the hemorrhage from slight cuts, pin-pricks, scratches, etc., is controlled with difficulty, and a few years ago, while absent-mindedly biting his lips, he caused a slight abrasion from which blood spurted in alarming quantity. No other members of his family are bleeders, so far as known. While urethral hemorrhage may not be rare, I am unable to find in the works at hand any reference to bleeding similar to that which occurred in this patient.

CLINICAL LECTURE.

THE MEDICO-LEGAL ASPECT OF APHASIA. BY DR. C. K. MILLS.

A Clinical Lecture delivered at the Philadelphia Hospital. REPORTED BY M. V. BALL.

APHASIA has an important place in legal medicine not only from the fact that it is often combined with insanity, but because questions often arise as to the responsibility of the afflicted person or his testamentary capacity. In every case we must find out how far the patient is able to speak, how far he can make himself understood by speech, and how far he can explain himself by means of pantomime.

By pantomime we mean the use of signs for definite purposes, and it may be present with speech, and on the other hand it may be lacking, while speech is preserved. In bringing these patients before you, illustrating as they do various kinds of aphasia, I will dwell mainly on the medico-legal aspect of the subject.

In CASE I. we have an old hemiplegic woman, who answers every question with a single recurring utterance, namely, "la la," she is paralyzed on the right side, and

has been in the hospital many years; she understands everything that is spoken to her; she puts out her tongue when told. She plainly evinces her disgust by pantomime, when asked if she wants medicine, and yet the full extent of her vocabulary is “la-la.”

CASE II. is a man who replies to all questions with the two words, "any one." Here we see that the man likewise understands all that is spoken to him, but has only these two words to make his wants known. CASE III. says (6 no" to all questions, even when he means yes. Occasionally he utters an oath, but this utterance is involuntary and he is not responsible for it. CASE IV. is a man who cannot talk at all; when questioned he shakes his head. He understands what is said, but is unable to utter a syllable, although able to make his wants known in writing. There is no paralysis present, but as his trouble came on suddenly, and as the result of an accident, there was probably a hemorrhage.

CASE V. is a woman, who, when asked her name, answered promptly, " B. Doyle;" when asked whether it was Bridget, she made some incoherent remark; when shown a penknife and told to name it, she replied that "she knew what it was, but could not tell the name of it;" when shown a key, she said it was for hiding things; a watch was called "money;" she said "she was going to say hammer, but she knew that is not right." After some effort she exclaims, "gold,” and when asked if it is not a watch, she says, "yes, a hatchet." She is able to name correctly her hand and foot. This woman, like the others, is able to understand everything that is told her and has an extensive vocabulary, but certain words she cannot speak. She has a form of verbal amnesia. She is neither wordblind nor mind-blind, she recognizes objects and their uses; she can even recall the names of such familiar things as her hands and feet, but many other concrete nouns she cannot name.

CASE VI. is a young woman who has been paralyzed for one and a half years. After the attack she had slight trouble with speech; she is an example of left hemiplegia. As a rule, only right-sided hemiplegia is accompanied by persistent aphasia, but when the person is left-handed, aphasia may be present in left hemiplegics.

CASE VII. is a man who, when asked a question, responds, but in a very imperfect manner. He is neither demented nor word-deaf; he is able to make known his wants, but there is a paralytic condition of the muscles of articulation. The man has the power to propositionize, that is, to construct sentences properly and speak them.

CASE VIII., an old man who is unable to stand without support, a complete hemiplegic, when asked his age, showed with his fingers that he was forty, but he looks at least sixty. He can only make a moaning sound, and, although understanding what is told him, is deficient in pantomime and resembles a demented person in his appearance.

CASE IX. is a woman with verbal incoherency; she will start out well and then will come a word or phrase which has no connection with what has gone before it. Her language is a form of jargon. The patient is able to understand all that is spoken to her, and has a large vocabulary, but the speech is broken up by putting in words that do not fit; her reading is much like her

speech. Some patients read rapidly and fluently what is a jargon to others, the person reading understanding all the time what he is reading, but may not be understood by his hearers.

Having shown you these patients we will now test them in a medico-legal way as to their responsibility, The cases in which aphasics become involved are more often civil than criminal.

Aphasia, like deafness, tends to make a person emotional, impatient, quick to anger, and so occasionally crimes of violence may be committed in moments of passion that are clearly attributable to the infirmity. Insanity itself may be present. The insane wards of a hospital contain some aphasics, and so the same questions that apply to the insane in any court case may arise in connection with this disease. In examining an aphasic the question to be answered is not, is an aphasic responsible, but is this or that aphasic responsible. Hughlings Jackson illustrates the matter well when he says that the question at issue is not whether a piece of string will reach across a floor, but if this or that piece will.

One of the questions that may arise in a civil case is the one in reference to testamentary capacity, Can the aphasic make a will? Can he be held responsible for a note or any other piece of writing to which he has affixed his signature or mark?

Some years ago I was called to see a man who had been stricken with an attack of apoplexy, and who was living with a woman not his wife; after the attack he married the woman, and then dying left his money to her. An attempt was made to set aside the will on the ground that the man, being an aphasic, was not responsible. I could testify that he was able to understand everything I said to him when I saw him, and the will was allowed to stand.

Starr gives the following list of questions useful in examining cases of aphasia :

1. Has the patient the power to recall the spoken or written names of objects seen, heard, tasted, or touched? 2. Has the patient the power to understand speech and musical sounds?

3. Has the patient the power to understand written or printed words?

4. If he speaks voluntarily, does he talk clearly, does he mispronounce, does he misplace, or talk jargon ?

5. Has he power to repeat a word after hearing it? 6. Is he able to read aloud, and, if so, does he understand what he reads?

out his tongue. This is probably mere confusion from the examination, though it should be noted, as it may have some bearing in the matter. I ask him if the word on this paper is New York; he shakes his head in a negative manner. Is it Philadelphia? He moves his head in assent, it being correct. So we see he has the power to understand printed words. Further testing shows that he also understands writing. He can talk voluntarily only to a very limited extent, and only in monosyllables, as "no" and "no, sir." He cannot repeat words or letters, but, strange to say, he can count up to sixteen without any effort. Sometimes he talks a little jargon. This man knows what he wants to say, and understands what is spoken to him, but he will say "no" when he means "yes," and he is easily confused. He will not write to-day, although he has written a word or two on another occasion. He can make his wants known only with great difficulty, and therefore might be understood as meaning one thing when he meant another. The man has a motor aphasia, probably due to a lesion in and around Broca's convolution, with destruction of tissue in the neighborhood. He has a motor aphasia, a motor agraphia, and a loss of pantomime almost equal to his loss of speech, becoming very much confused when he attempts to use his head or hands except in counting.

Testing Case VII. we find that he understands what is said; that he can read written and printed words; that he has the power of voluntary speech; that he can repeat after others; and that he can write and recognize objects. His articulation, however, is very bad; he is not easily confused, and when I ask him to sign this note he does so, but he tells me he would not do it if it meant anything; he is in every way responsible and competent.

"

Examining Case V. we have a different state of affairs. You remember she understands what is told her, but when I ask her how old she is she replies, "five cents." When I ask her to count five on her fingers, she says 'three;" therefore she cannot repeat after me, and her pantomime is bad. She knows the use of objects, but mixes up the names. She is not letter-blind—that is, she can voluntarily read individual letters, and she can read her own signature; but she might be cheated because, although she can speak and can understand, yet she cannot make her wants clearly known, for the reason that she may have intended one thing and said another. In getting the mark of this person to an IO U she places it far away from the proper position. A case

8. Has he the power to write at dictation?

9. Has he the power to copy?

much money he wanted to leave to another, but he made his mark in the body of the will instead of at the end, and the will was not considered legal. It is dan

The following is a subdivision: Has the patient the power to communicate his thoughts by pantomime? The power to understand signs, as well as expressing them, may be lost in some cases.

Let us test Case III. You remember his vocabulary consists of one word, "no." I hold a pen before him, and ask him if he knows what it is; he has not the power to name the object. When told to put out his tongue he does so, therefore he understands what I tell him; but when I ask him his age, he continues to put

be construed as a form of compulsion, and the document would not hold in the law.

I have thus been able to show you a few of the kind of cases commonly met with, and to indicate the way in which questions of a medico-legal nature may arise. The subject is of interest, and could be more fully treated had we sufficient time at our disposal.

MEDICAL PROGRESS.

Multiple Bacterial Infection in Certain Forms of Diphtheria. -DR. WM. ROYAL STOKES (Boston Med. and Surg. Journ., Dec. 12, 1895), in reporting the bacteriological examination of nine autopsies on cases of diphtheria treated with antitoxin, says: "In eight of the nine cases of uncomplicated diphtheria to which antitoxin had been given the bacteriological examination at the autopsy showed a more or less well-marked invasion of the blood by the pyogenic cocci. In five cases the streptococcus was found in the liver, spleen, kidney, and blood

of the heart." The same or other cocci were discovered

in one or more of the other organs in the remaining cases, while "in the lungs of all these cases were found the bacillus diphtheria, streptococci, pneumococci, and the staphylococcus pyogenes aureus, either alone or in various combinations."

The recent demonstration of the comparative frequency of this poly-infection in diphtheria is a matter of very considerable interest. Barbier and others, basing their conclusions upon the bacterial examinations of the throats alone, together with clinical observations, were able to point out the existence of two distinct forms of diphtheria as early as 1891; one the simple infection by the bacillus diphtheria, the other a mixed infection with one or more of the pyogenic cocci as well. Two years later the general belief that the bacillus of diphtheria was only to be found in the local lesion was disproven by investigations which demonstrated its presence in the

blood and material taken from the various internal organs of individuals dead of diphtheria. And still more recently, Wright and Stokes have been able to discover it present in the lungs of thirty out of thirty-one cases, while the various other internal organs showed it less constantly, but in a considerable per cent. of that

number.

So far as statistics of the double or multiple infection have been collected, they indicate that from fifty to seventy per cent. of the diphtheria cases are of this nature, at all events; a clear majority. And since antidiphtheritic serum is known to have no specific influence in controlling germs other than the bacillus diphtheria, we must not expect its full curative effect in these instances, but should be content to obviate the dangers of a secondary infection in any case by an early and thorough administration of the remedy.

The Etiology of Obstetrical Paralysis. -In a recent paper upon this rather obscure subject DR. G. L. WALTON, of Boston (Journ. Ment. and Nerv. Dis., November, 1895), offered the following explanation of its causation : That the brachial plexus already being brought up against the clavicle by rotation of the head away from the affected side, which also places the suprascapular nerve upon the stretch, exposes these trunks to excessive bruising and stretching during the separation of the head from the shoulder, that follows rotation in the strait, the shoulders being naturally restrained by the brim of the pelvis at this stage of delivery. Under the head of obstetrical paralysis Dr. Walton did not wish to include any except those occurring with natural labors, i. e., without instruments, or even the use of traction by hands or fingers of the attendant.

Dr. Starr, in discussion, expressed the belief that the prognosis was uniformly favorable, as he had observed no adults with such paralysis. Exclusive of those instances where there is dislocation of the shoulder-joint, Dr. Walton concurred in this opinion, while Drs. Taylor and Leszynsky had observed cases that caused them to doubt if a perfect recovery was the invariable rule.

A Case of Congenital Aphasia (Aphemia).-HERZEN (Revue Médicale de la Suisse Romande, 1895, No. 11, p. 600) has reported the case of a boy, five years old, otherwise apparently in good physical and mental condition, who was able to speak only a few words. The family history was good, and there had been no difficulty in the labor or in the pregnancy. The child had escaped the usual infectious diseases. When three years old he could pronounce correctly only three or four words, which formed his entire vocabulary. At this time he fell from a table about three feet high, striking upon his head, but not suffering any permanent disturbance. Consciousness was lost, and it was feared that death would result, but recovery finally ensued, without paralysis or convulsion. Subsequently the little patient acquired a few new words, whose number and pronunciation, however, were below those of a child of his age. Examination disclosed a symmetrical head, free from fissure or depression. The organs of phonation were perfectly normal. The child could open its mouth and move its tongue freely; also emit sounds, and articulate several words more or less intelligibly; but it was unable to formulate any phrase whatever. Its hearing and its intelligence were good. There was no trace of paralysis or of tion of the condition present in the case related is reatrophy. The child was right-handed. The explanaferred to a congenital malformation of the speech centers in both central hemispheres.

Death under Chloroform.-DR. MURRAY-AYNSLEY (New Zealand Med. Journ., vol. viii, p. 259) reports this unfortunate accident having occurred to a healthy female who was admitted to Christ Church Hospital, May 6, 1895. She gave a good family history, but was a little anæmic and had a slight goitre. For the removal of a ganglion on the back of the left wrist she was placed under chloroform at 9.45 on the following morning, and was well under before the operation was begun by Dr. Nedwill. The excision had been completed and the chloroform suspended, when the patient began to move a little and vomited a little bile-stained mucus. A few seconds later it was noted that she was cyanosed, but still breathing naturally and the lungs expanding. She was inverted, the throat sponged, and the tongue drawn out. The pulse, however, could not be felt. She was replaced on the table, took several gasping breaths, and after a few moments ceased to respire. Nitrite of amyl, ammonia, and strychnine were administered, and artificial respiration kept up for an hour, air entering the lungs freely during this time. For the first halfhour slight and irregular sounds were thought to have been heard over the region of the heart, but none during the latter half of the time. No autopsy was permitted.

warming in the new metropolitan home, where you

THE MEDICAL NEWS BECOMES A NEW YORK WEEKLY JOURNAL.

WITH this issue THE MEDICAL NEWS removes its home from Philadelphia to New York and passes into the hands of a new editor. No other radical change has been made or is contemplated. The same familiar face will greet its readers every week, bearing its messages of scientific facts, of personal experiences, of recent discoveries, and of medical news. Messrs. Lea Brothers & Company, now of New York and Philadelphia, will continue as its proprietors and publishers. The editorial and publication offices are permanently established in New York. Dr. J. Riddle Goffe becomes the editor, and in so doing desires to express, in behalf of THE NEWS, a warm esteem for the retiring editora high appreciation of his unwearied and able services in the past.

THE MEDICAL NEWS, therefore, takes its place as one of the regular weekly medical journals of this city.

To you, our host of contributors and readers in every land, no new introduction is deemed necessary; but rather would we invite you, as tried and loyal friends, to join with us in a cordial house

same unwavering support in your efforts to advance the science and the art of medicine.

As an exponent and leader of what is highest and best in medical literature, THE NEWS will continue to advance the standard of hygienic and sanitary science, to voice the latest discoveries in every field of scientific investigation, and advocate all public measures that will redound to the health of communities and the public welfare. Its columns will be always open to the free and candid discussion of all questions pertaining to the advancement of medicine in its widest interpretation-to questions of interest and importance to the profession itself and to personal matters of individual right and justice. It does not represent any individual interest, nor school, nor clique, but aims to be an exponent of the highest and broadest interests of science and the medical profession.

The Science of Medicine is being rapidly revolutionized and rewritten, on what gives promise of being an enduring basis of scientific fact. The veil that has hidden from our view the mystery of diseased processes is being rent in twain, and a flood of sunlight is converting the workers of disease into manufacturers of antidotes against their own destructive powers.

It is the proud boast of the physical sciences that they have chained the great material forces of Nature and trained them to man's service. But the silent, secret microscopical forces working against man himself are the last to yield to his intellectual power. The triumph, however, is the greater and the glory is with us of the medical profession. It is a privilege to be in at the birth of what promises to become the crowning achievement of medical science and an unspeakable boon to humanity.

To test and extend the application of the new therapeusis is the work of the immediate future, demanding the accurate application of exact scientific methods. To the general practitioner is committed the trust, to him the scientific world looks. for the account of his stewardship; and it is to him especially that the columns of THE MEDICAL NEWS are cordially opened as the most appropriate place for recording his triumphs, deductions, and conclusions.

Yet, after all, this is but one of many fields in which the physician and surgeon are constantly at work to relieve the sufferings of humanity. THE

MEDICAL NEWS will, as heretofore, be ever on the watch to present to the profession all the discoveries and improvements which may be made in all the departments of the science. It can point to fiftytwo years of earnest service rendered to all the highest interests of the medical profession, and it will be the unswerving purpose of the new editors to surpass, if possible, this honorable record by the diligent utilization of the superior advantages of their metropolitan position.

THE STATE COMMISSIONER OF LUNACY. THE Commissioner of Lunacy as an expert was editorially noticed by the Record recently, which goes on to say that "attention has been called more than once to the reprehensible conduct of the medical member of the State Commission in going upon the witness-stand for pay. That he has no right to do so in this State cannot be disputed, for his testimony in court, when it is given by him as an 'expert,' may send the prisoner to an asylum or a prison. As the doctor and his associates are bound by law to recommend the discharge of improper subjects from the former, it can be seen how dangerous must be his position if he has given testimony in a particular case." Just so. And see what has happened within less than a month. He took the stand and declared Hannigan insane. Within two weeks, so remarkable was recovery, the Commission was asked to discharge the man. Yet how could it do so in the face of the testimony so recently given. The courts were appealed to.

Judge Barnard refused to order the discharge of the prisoner from the State Hospital, and insisted that the indorsement of the State Lunacy Commission to the certificate of sanity given by the superintendent of the hospital is needed to make Hannigan's discharge legal.

He says that when a man is acquitted of the crime of murder on the ground of insanity, and then committed to an asylum, three processes are needed to secure his discharge-viz., first, the certificate of the superintendent of the asylum; second, the indorsement of the State Lunacy Commission; and, third, an inquiry by a Supreme Court Justice as to the man's sanity. He could not understand, he said, why the Lunacy Commission refused to indorse the certificates of Dr. Pilgrim. He remanded Hannigan back to the asylum. Immediately after Judge Barnard declined to discharge Hannigan from the hospital his lawyers

went to Newburg. went to Newburg. There they found Justice Brown, and renewed their application for a writ of habeas corpus for their client. Judge Brown signed the writ. He was unwilling, however, to hear arguments on the case that day, though the officials of the hospital had taken Hannigan to Newburg immediately.

The Commission was appointed to save the taxpayers of the State, not to furnish means for useless expenditures. The detention of the superintendent, the various keepers and attachés in attendance at court-first in Poughkeepsie, then to Newburg-was a waste of public moneys and a perversion of principles. The Legislature should speedily amend this section, for what was a few days ago only a theory, to-day becomes a burning shame.

WHICH DOES IT ADVERTISE?

THE above question is irresistibly suggested by a glance through a bulky pamphlet recently issued in Chicago by the manufacturer of one of the many concentrated foods which glut the market. It is the stale and familiar compound of "original research," reports by the hired chemist of the firm or by similarly "influenced M.D.'s," who usually sign themselves as third or fourth assistants to some distinguished hospital or clinic, with testimonials from various physicians and "professors," deftly interspersed with insinuating and laudatory remarks by the head-salesman. All of which has the impudence to call itself "scientific matter," and claim to be latest views upon the problems of nutrition, "condensed for the benefit of the busy practitioner,” who is expected to be duly grateful therefor. And the agents who distribute these actually assume the airs of benefactors and enlighteners of a poor, benighted profession. A very brief inspection of this particular hodge-podge, however, reveals the fact that, like a "double" Uncle Tom's Cabin, it exploits "two Topsies," and that the burden of its song seems to be divided between "the product" and its "developer," a certain doctor of our own city (to our shame be it said) whose name and titles adorn its columns in reckless profusion, occurring ten times in the first twenty pages. This apotheosis begins in the introductory chapter, where he is hailed as the genius who developed new methods of application of this power "up to the marvellous scope and efficacy now exhibited by his reports, which make up the marrow of these pages." Not