Corrtirzaccctiorz of cases of fracture of the base of the skull; erroneous notions on this subject. Case of recovery after fractured base of the skull, with facial paralysis. Symptoms of partial paralysis 0;) <t)!fBtAeM:. Blood and sero-sangwineous discharge from the eal"; disappearance of all the symptom after treatment, except the facial paralysis. Partial recovery of muscular power on the a f&middot;ected side of the face by electricity. Review of the treatment. Rapid &Ugrave;npro'rement

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... wing doubt over the natul'e of the lesion. tH'y<C< OpeyaMM ztpon another patient affected with paralysis of the face,' re-establisament of the harmony of features. Many persons thus affected might be benefitted by a surgical operation. Second case of fracture of the base of the skull recently in hospital; discharge of a small quantity of blood and much cerebra. spinal fluid fa'oan tl.e ear; death from arachnitis after apparent improvement. Very slight symptoms soon after the blow on the head. Influence of previous habits on the issue of these cases. Influence of the recumbent posture on the action of the cerebrum. Escape of cereboo-spinal fluid fl'om the ean in considerable quantity; explanation of the pathological changes which allow of the manifestation oJthis symptom. Trifling d-istul,bance of the symptonz at the outset. Thirst sometimes a prominent symptom in these cases. Thirst may be satisfied by fluids being thrown up the 9-eetttiiz. Symptoms of paralysis of the face. Evil efect of mental excitement and rising from bed. Causes of the unequal streaking of the tong1.te. A tremulous tongue denotes drinking habits. Cessation of the escape of cerebro-spinal fluid from the ear sometimes a very 'itnfav01wable symptom. Accession of delirium; twitching of facial muscles; subsultus tendinum death. The cause of subsultus tendinit7n. Review of the sYlnpt011!S, cerebral lesions, which may be supposed to have given rise to them. Probable tearing of the arachazoid tube containing the pm'tio dura and portio mollis. Post-mortem examination. Fissure of the temporal bone; injury to the middle meningeal artery. Arachazitis and non-plastic effusion. Tube of amchnoid membrane into theforamen auditorium internum, tOI'n. Course of the fracture. The latter intersected the tube of arachnoid before mentioned. Paralysis of the face or deafness depending on the more or less amount of laceration io7tich the portio dura and the j)0)'<M moMM SM?'. Escape of cerebra-spinal fluid from the ear a sign of fracture of the base of the skull, the line running through the petl'01tS portion of the temporal bone. Arachnitis the cause of death. Danger of moving about after fracture of the base of the skull. Quotation of examples, showing the evil effects of free movements after this accident. Another case of fracture of the base of the skull, and escape of cerebra-spinal fluid; recovery. OO1!ndsive tavitchings in the face soon after the accident and during the insensibility, following upon the latter. Alternatioazs between iitsei-tsibility and the recovery of consciousness; involun-I tary escape of urine and faeces-What state of system induces this ' symptom? GJ'eat abundance of cerebro-spinal flzcid escaping fi'om I , the ew'; it is found similar in nature to the fluid collected in ' other cases. Rapid improvement and cessation of the Row from the ecM'. Complete recovery. Conclusion. GENTLEMEN,—I intend to-day to continue the important sub-I ject of fracture of the base of the skull. The cases which I mentioned in the last lecture and the remarks I made have doubtless suggested to your minds that some erroneous notions are prevalent touching the curability of this injury ; and I would now add my firm belief that it is a condition which occurs from accident much more frequently than is generally supposed, and that it is far from being necessarily attended by fatal results. Just recollect the patient I showed you here last time we met, and who, after presenting all the symptoms of fractured base, recovered with paralysis of one side of the face. The principal features of the case are thus noted :-" Fracture of the base of the skull; blood from the auditory canal, nostrils, and araoutla; loss of hearing ; reC01.'ery. Thomas H-, aged forty-seven, was admitted August 15, 1850, under the care of Mr. Hilton. The patient is a greengrocer ; his habits are irregular, he is much given to drinking, yet his general health has been remarkably good up to the time of his admission. whilst riding home on the top of a cab the patient slipped from his seat and fell upon the road, and struck the left side of his head. When admitted he was in a state of stupor; the breathing was stertorous, short, and rapid; pulse thready and very weak, at 120. Blood was flowing from the left ear, nostrils, and mouth; there was considerable pain in the same ear and some deafness. The left eye was discoloured from effusion of blood, and all the muscles of the left side of the face were paralyzed; the tongue was thrust over to the opposite side, and the patient manifested much difficulty in swallowing; his articulation was slow, and his enunciation very imperfect. (See Fig. 1.) ' " The man perfectly understood any remark addressed to him, and complained of pain extending down the neck of the affected side as low as the clavicle. It was noticed that sensation of the left side of the face was unsatisfactory, but there was no anaesthesia or paralysis of the trunk or extremities. The bladder and rectum performed their functions, and the pupils were dilated, but influenced by strong light. Both smell and taste very impaired. The haemorrhage from the ear was followed by a sero-sanguineous discharge, which only lasted for a few hours. " Mr. Hilton ordered, after a purge of calomel and rhubarb, mercury with chalk and Dover's powder, five grains each to be taken three times a day ; and two days atferwards eight ounces of blood were taken from the nape of the neck by cupping. " The subsequent features of the treatment were the continuation of mercury in diminished doses, blisters to the back of the neck, followed by alkalies and bitters. " About four months after admission the patient had so far progressed that electricity was used daily to the affected side of the face; but this was found too frequent, and therefore only employed three times a week. The patient left the hospital, went to the workhouse, and has continued for several months to come to the electrifying-room, after which time he almost recovered the full use of his facial muscles on the left side. But it should be noticed that for a long time after the man was sufficiently well to get up, walking or stepping suddenly forward caused pain in the head, confusion, singing in the ears, unsteadiness, &c." This man is now much improved, and will eventually regain, according to all probability, the full use of his facial muscles. I would just direct your attention for a moment to the treatment employed in this case. (See Fig. 2 .) At the outset an efficient purgative of calomel and rhubarb was administered. This is a plan I constantly adopt as a first step in the medical treatment of all accidents, except there be evident collapse, or any suspicion of some intestinal injury in the patient. A brisk purgative, which clears the primse vise thoroughly, relieves congestion in the glandular organs in the abdomen, and so anticipates the state of repletion to which they would otherwise be exposed from want of exercise in a person confined to his bed, and prepares the intestinal canal for the rapid absorption of whatever medicinal agents or nourishment you may wish to prescribe. Always begin by opening medicine in cases of injury to the skull or brain, provided there be no distinct counter-indications. The patient was after these preliminary steps put under a course of mercury, and had a blister applied to the nape of the neck, after having been cupped in the same region. These measures were soon followed by marked improvement, and this great and rapid amelioration might certainly have excited doubts as to the nature of the injury—viz., whether there had been bond fide fracture of the base of the skull. The patient himself could not understand why we kept him in bed ; still feverish attacks would now and then occur, and it was only after four months' treatment that I allowed him to get up cautiously. Electricity was then used, in order to solicit the action of the nerves of the face by a stimulus looked upon as being analogous to neurose force. The electricity disturbed his head a good deal, and induced a general restless and uneasy state of mind, and he had different febrile attacks, from which he always recovered by the employment of the usual means of rest and purgatives. As this patient is gone from this hospital to the workhouse it is not probable that the complete recovery will be disturbed by overstimulation. Being on the subject of paralysis of the face, I may perhaps show you two drawings (See Figs. 3 & 4) representing the appearance of a patient some time ago under my care, for whom I performed a surgical operationwith aview of remedying a permanent distortion of the face resulting from paralysis. I excised, on the paralysed side, a large triangular piece of the upper lip and adjoining portion of the cheek; then by bringing the margins of the wound together, as in the hare-lip operation, the angle of the mouth became raised and advanced; the oral aperture reduced in size, and the deformity, as you may see, very much diminished. Many people who are affected with paralysis of the face have the corner u