and practised by M. Jourdant, has, with the permission of the latter gentleman, published an account of the mode in which he has been relieved of his distressing infirmity. The readiness with which M. Jourdant-although described, in one of the French journals, as an obscure mechanic-granted permission to reveal the nature of his secret, is highly honorable to him, and deserves the thanks of the medical profession.

What is the nature and primary cause of stammering? According to MM. Rullier, Voisin, Colombat, Bell, &c., it arises from an inability on the part of the patient to co-ordinate and combine together the various actions of the vocal organs, and especially those of articulation. The 'point de depart' of this lesion of the vocal functions is unquestionably seated in the nervous system. A clever writer has defined it to be a Neurosis, consisting in a choreic spasm of the expiratory muscles, and a tetanic rigidity of those which regulate the production of the voice. We need scarcely say that the idea of there being any actual shortening in the dimensions of the tongue-an idea, by-the-bye, which gave rise to the 'funeste' proposal of cutting the genio-glossi muscles for the cure of stammering is utterly without foundation.

M. Jourdaut is of opinion that the cause of Stammering consists in the precipitate emission or escape of the inspired air and of the speech at one and the same time; the stammerer expends in blowing, and not in sound, the air which he has received into his chest. Let us for a moment consider the series of phenomena, which take place in the natural and healthy condition of the organs. Whenever we wish to produce any vocal sound, we first of all make a deep inspiration and dilate the chest; then, at the moment when the act of expiration commences, the air during its escape through the rima glottidis produces the sound desired, and this is continued until all the inspired air has been expended. When this is the case, the person either ceases to speak, or, if he wishes to continue to do so, he makes a new inspiration, and the same succession of phenomena is reproduced and repeated. From the moment when the act of expiration begins, the chest returns to its normal condition_slowly and gradually, in proportion as the sound is emitted; and the inspired air is so managed, that it escapes the more slowly as the sound is the more intense and prolonged. In the case of the stammerer however, no sooner has the air been inspired into the chest, than its parietes begin to contract too soon, in order to expel any excess received. The sudden contraction expels a greater quantity of air than is necessary for the production of speech; and then this large volume of air, coming into the mouth at the moment when the tongue, the lips, and the cheeks are contracting for the purpose of articulating the sound, opposes the regular action of these organs in this manner the confusion of the speech is induced.

The primary Cause therefore of Stammering consists, if this view of the case be correct, in a disturbance of the actions rather of the thoracic muscles, than of those which serve for articulating the vocal sounds; the latter lesion being only secondary and consecutive.

By the hurried and precipitate expulsion of the air in too large quantity from the chest, the sonorous waves, which serve for the formation of the voice, and which are about to be modified by the peculiar configuration that_the_buccal cavity must assume for each letter, are deranged and become confused. The muscles of articulation do not contract with readiness and ease, but are 'genés' in their movements; hence the great difficulty of pronouncing certain syllables, the more or less frequent repetition of certain others, and so forth.

From this theory of the production of Stammering springs a very obvious indication for the treatment of it; viz. to prevent the expulsion of the air en pure perte' from the chest during the act of speaking. The chief difficulty experienced by the stammerer consists in detaining the air in the chest, and in allowing it to escape only very slowly and gradually. To effect this object, it is especially necessary to attend to the following rules in speaking: first of all, to

make a gentle inspiration, as in the healthy state; then to make a very slight pause; then to begin to talk, taking especial care to keep the chest_continually somewhat dilated, and the abdomen slightly protruded, giving out, all the while, as little air from the chest as possible; and lastly, before recommencing the same series of movements, to expel the air that remains behind by a powerful expiration. The most important point for the stammerer to attend to is to keep his abdomen slightly saillant-a position which, by causing the descension of the diaphragm, forces the chest to remain expanded. M. Becquerel always observed the necessity of attending to this injunction in his own case.

M. Jourdant generally advises his patients to mark with their thumb the three several acts which he wishes them to attend to-viz: 1, the inspiration and the rest; 2, the articulation, while the diaphragm has descended, and the chest is dilated; and 3, the expulsion of the air, that remains behind in the lungs, by a strong and forcible expiration. The greater the quantity of the air that remains in the chest for the final expiration, the better. If these simple rules be strictly attended to, it will be found that no stammering can take place, even if the person tries to do so. It requires indeed assiduous efforts on the part of the stammerer, and these too continued for several days, before he can hope to overcome the difficulties in question. Once however that he succeeds in fully understanding and reducing to practice the mechanism of the treatment, he can pursue the plan now recommended at his leisure with increasing facility and effect; for the respiration gradually becomes less and less embarrassed, and the muscles, both of the chest and the vocal organs, become more obedient to the dictates of the will. As a matter of course, we cannot anticipate much benefit from this, or indeed from any other, method of cure, till the individual is old enough to have due command over his feelings and resolutions.—Traité de Begayement, &c. par Dr. Becquerel.

ON THE CAUSE OF THE LASSITUDE AND PANTING IN ASCENDING HIGH MOUNTAINS.

It has invariably been found by all travellers, who have ascended very lofty mountains, that, at a certain elevation, any muscular exertion brings on very speedily a suffocative panting of the breath, and so complete a prostration of the muscular strength as baffles the stoutest heart to overcome. For example, we learn that Saussure, on the top of Mont Blanc, could not advance more than 12 or 15 paces at a time, before he was obliged to stand still and even to sit down, in order to take his breath and recover his strength. When he was at rest, the only inconvenience that he experienced was a sense of slight oppression in the region of the heart-which the moment before had been beating_with_great rapidity, but was now tolerably quiet. On the slightest movement however he was forced again to stand still, and pant for some minutes, with his face turned to the wind. The guides, who attended the philosopher, were similarly affected. Now, the question comes to be, how are we to account for this extreme embarrassment of the breathing and this utter powerlessness upon exertion? Hitherto no very satisfactory explanation has been given of these physiological facts. M. Brachet of Lyons has recently suggested the following hypothesis. "It is not," says he, "the mere rarefaction of the air that occasions the lassitude and anhelation in the circumstances mentioned, since these phenomena are, without changing the air, either not produced at all, or quickly cease to exist, when the person is at rest. Neither can it be any real fatigue that occasions them; as they are experienced the very moment that the traveller re-attempts to walk, after he has rested for a length of time, and when he seems to have quite recovered his expended strength, so that he perhaps fancies himself able to make a considerable advance.

"Assuming the principle that the arterial blood becomes of a darker and darker colour, while traversing the muscles, in proportion as these are in a state of more powerful contraction, we are readily led to the following satisfactory explanation. During the state of rest, the venous blood returns to the heart less disoxygenated than usual, and consequently it requires a less quantity of oxygen, in its passage through the lungs, to give it a vermilion colour, and the necessary amount of stimulus. On any muscular exertion however taking place, the returning blood, being then of a darker colour, has need of a larger quantity of oxygen than before. Now as the air, being in a state of very great rarefaction, cannot afford a large supply of the vital gas at once, it is necessary to make up for this deficiency by an increased frequency in the acts of respiration: hence the panting and dyspnoea that are felt. As to the lassitude that is experienced, it is only, so to speak, the phenomenon inverted, the effect become the cause. It is well known that, if the arterial blood is rendered dark, the muscles, to which it is sent, will then not receive the full amount of stimulation required, and their power of contraction will be proportionately feeble. This is exactly what takes place in persons on the top of a high mountain; the blood, made black by its passage through the contracted muscles, no longer meets with a sufficient quantity of air, in the vesicles of the lungs, to restore to it its necessary vivifying stimulus. It therefore returns to the muscles, as well as to all the other organs of the body, less and less highly oxygenated: the results of which condition are the atony of the muscular energies, and the extreme lassitude of the body.”— Journal de Medecine de Lyon.

Remarks. The interpretation given by M. Brachet is ingenious; but let it be observed that it does nothing more than simply afford a very plausible explanation of the mode, in which the extreme rarefaction of the air at high altitudes-the essential cause of all the distress experienced-may be supposed to act on the state of the breathing and of the circulation. The observations of Aeronauts have abundantly shewn that, when the body is in a state of perfect quietude, the respiratory process is but very little disturbed. It is only when any muscular effort is made-for then there is obviously a greater consumption of oxygen-that fatigue and breathlessness are experienced. We see an illustration of the same fact, wherever the breathing is from any cause embarrassed or impeded, as in Asthma, threatened Suffocation, &c. The greater the struggles that are made with the limbs, the greater is the distress and the danger: safety under such circumstances consists in the quiescence of the body, and in the moderated action of the lungs.

HYGIENIC EFFECTS OF SWIMMING.

There is very little doubt but this most healthful and invigorating exercise is far too much overlooked, in the present day, as a most useful and potent means of hygienic and therapeutic treatment. In not a few chronic maladies, a cure is to be expected, not so much from the administration of any drugs or medicines, as from a regulated regime in reference to diet and exercise. It is always better to evoke, so to speak, the restorative and healing energies of Nature-that may have become, as it were, dormant from want of being called into play-than to trust to the foreign and extraneous operation of man's interference, in our attempts to restore the body when feeble, and animate the mind when sickly or oppressed. Now, in no manner can this be so effectually done as by the steady and regular employment of gymnastic exercises; and of these, perhaps, none is on the whole equal to that of Swimming. All hardy and simply-living nations have borne testimony to the truth of this observation.

The Greeks and Romans fully appreciated the advantages of regular swimming exercise. In the time of Augustus, a man, that could not swim, was held in contempt. This Emperor ordered that as much attention should be paid to instruct his nephew in swimming, as in teaching him to read. The Spartans were obliged, by their military laws, to exercise themselves every day in the Eurotas, and the Roman soldiers were enjoined to do the same in the Tiber. These nations attached a very prominent importance to swimming, among the gymnastic exercises of the state, being well aware how admirably calculated it is to give strength and tone to the limbs, and to impart pliancy and facility of movement to the body. In this they were right; for in truth the act of natation calls into energetic play almost every muscle of the frame, without being liable to induce the troublesome consequences that not unfrequently accompany the exercises of running, leaping, riding, dancing, &c. All these latter exercises are apt to induce a more or less copious amount of perspiration-thus a considerable loss of animal matter takes place, and may expose the person to a retropulsion of the fluids, and consequently to the risk of serious accidents. In swimming, however, there is no such liability; and, if the natatory movements are moderately and regularly performed, the play of muscular action is effected without distress; whereas, in other exercises, the movements are almost always apt to be excessive in certain muscles, while the rest are in a state of nearly perfect repose. Medical men will do well to impress very forcibly on the attention of parents the excellent advantages of swimming to children, after the sixth or seventh year of their age. Independently of the moral benefit young people derive from the exercise, by diminishing their natural timidity, their physical health is thereby much strengthened and improved, and their body and limbs become more agile and graceful in all their movements. Fortunately, the Italian people have of late years began to appreciate the truth of this remark; for now we see the children of both sexes accustomed, in early life, to practise the healthful exercise of swimming. It is especially useful to such children as are of a lax fibre and scrofulous constitution; often have we had occasion to observe the gradual dispersion of abdominal fulness in such habits, under the steady use of swimming exercise. Sea-bathing is unquestionably to be preferred, more especially in such cases; but, if this cannot be obtained, let not the exercise be neglected, when a freshwater bath can be procured.-Guastalla, Studii Medici sull' Acqua di Mare, 1843.

Remarks. It is almost quite unnecessary to add a single word in commendation of Swimming, especially in salt water, as an important part of hygienic regime. Every young person ought to be taught to swim; and well would it be for many delicate girls, if false and foolish notions of decorum, on the part of their parents, did not too often debar them from using this most invigorating exercise. It should be more especially recommended, when there is any tendency to spinal weakness or lateral incurvation. The regular and equipoised exertion of the muscles on both sides of the back cannot but be beneficial in rectifying the incipient infirmity.

ON THE POST-NATAL DESCENT OF THE TESTICLES, AND THE ACCI

DENTS THEREBY OCCASIONED.

The subject of the following remarks is but little known or understood by the majority of medical men. Hevin and Hunter are the only writers, who have endeavoured to determine the age at which the testicles usually descend into the scrotum, in cases where they were still within the abdominal ring at the time of birth: the former asserting that this evolution generally takes place about the period of adolescence, and the latter, at some time between the 2nd and 6th years

of life. Though there may be some difference of opinion on this head, the main fact, however, that the testicles do descend at some time or another subsequent to birth, is admitted without hesitation by both these observers. Now this is the very position that M. Oustalet has undertaken to disprove. Resting his opinion on the results of his own experience-which too has been enriched not a little by analogous observations collected by his father-this gentleman maintains that, in a very large majority of cases, the testicles, when arrested within the abdomen at the time of birth, do not descend at all, at any subsequent period,

into the scrotum.

In support of this assertion, the author relates 16 cases, as examples of the accidents occasionally grave and severe-which are apt to be induced by this state of things in almost every one of these cases, the patients had passed the period of adolescence. The symptoms and effects observed were stiffness and embarrassment in the movements of the limbs and body, engorgement and sometimes a veritable strangulation of the testicles, scirrhous degeneration of the seminal glands, and tendency to the descent of the bowels along the inguinal canal.

After comparing the inconveniences and dangers of these accidents on the one hand, and of the persistence of the testicles within the abdomen on the other, M. Oustalet comes to the practical conclusion that, "when we discover at birth that one or both testicles are still within the ring, a bandage should be at once applied, and every means employed to induce a speedy obliteration of the abdominal aperture."-Gazette Medicale de Strasbourg.

Remarks. It is objected, by a French reviewer of this memoir, that M. Oustalet has not very satisfactorily established the propriety of the practice he recommends, because he has failed to shew that the number of patients, in whom the arrest of the testicles does really induce troublesome consequences, much exceeds that of those in whom this anomaly causes little or no inconvenience. Let us see how the truth stands in reference to this matter. Wrisberg has calculated that, of every 102 fœtuses at the full term, there are not fewer than 12 in whom the testicles have not yet come down. Now, if every medical man will consult his recollections of practice, it will readily be admitted that the number of cases, in which the accidents described by M. Oustalet have been observed, is very far short of the ratio of 12 to 102: and yet this would necessarily be the case, to justify the apprehensions and consequently the practice of this gentleman.

ON THE UTILITY OF SURGICAL OPERATIONS IN CANCEROUS DISEASES.

The grand points of this most important surgical question are to determine— 1, if it be really true that Cancerous disease is primarily of a local nature, and subsequently degenerates into a constitutional malady; and 2, if extirpation, performed at an early period, prevents the occurrence of this degeneration. With the view of elucidating these matters, M. Leroy d'Etiolles has collected the following statistical observations. Of 801 operations, 117 were performed within a twelvemonth after the first manifestation of the disease.

Of these 117 cases, there were 61 in which the disease had returned at the time when the reports reached me. It is more than probable that this proportion would be found to be still higher, if we knew the actually present state of these cases.

The results of operations for Cancer of the Lip are curious and worthy of notice, in consequence of the difference in this respect observed in the two sexes. Of 633 cases of Cancer in the male subject, 165 were examples of Cancer of the Lip: of these 114 were treated with the knife-12 with caustics. There were