effective tendency toward mental weakness, irritability, dementia, and inevitably toward exhaustion. In nearly all cases the hereditary tendency may be traced.

Lisle reports two cases of epilepsy in which barium chloride C. P., one-eighth to one-half grain doses, was used with good results. He remarks that barium has an action similar to digitalis and ergot and on this, bases his therapeutic use of the drug, while Halle entertains us. with the information that he has discovered the bacillus of epilepsy! Kelley has relieved a woman, aged 64, suffering from convulsions, by simply compressing the carotid with his thumb. (An expedient often tried before without success.)

Casciani has used quinine in severe cases of hysteroepilepsy with uniform success, in doses from twelve to fifteen grains, and according to the report the attacks "are cut short at once and definitely (?)." The bisulphate is preferred.

Engel describes a new form of nervous disease, under the title of "Dementia Epileptica," a disease of childhood, in which the patient is healthy until its ninth to fourteenth year and is then simultaneously affected with epileptic convulsions and mental impairment. The attacks are of unusual severity, duration and frequency. The patients thus affected are well developed physically (differing in this respect from idiots) while mentally ill-developed. They can talk correctly but are sulky and vicious. The mind retrogresses while the passions, vices and immoral ideas become more and more licentious. They are prone to maniacal attacks, and under the bromides the fits lessen, but the maniacal attacks increase. The cause of the disease is an abnormal formation of bone structure. The bone loses its outer and inner laminæ and its deplo resembles chalky matter, and in consequence the fontanelles and sutures close prematurely. The cranium is abnormal in shape, its dimensions are narrower and it presents depressions and flattenings where it should be vaulted. The treatment is linear

craniotomy, and the author, speaking of its results, says:

Diagnosis having been established, improvement, rapid and often miraculous, following linear craniotomy may be guaranteed. The operation should be done at the localized seat of the trouble which will generally be found within an area whose center is the junction of the coronary and sagittal sutures. The line between the trephined openings is sawed. Strict asepsis is a sine qua non.

Constantine Paul claims excellent results in the treatment of neurasthenia by injecting an extract of the grey substance of the brain, while Hammond has likewise by a special process obtained an extract for a similar purpose.

Seguin discusses the relation between eye-strain and cerebral hyperæmia, under the title of "Cephalic Paræsthesia." He discredits "Cerebral Hyperæmia" (Hammond), "Congestion of the Base of the Brain" and such "fanciful vasomotor pathology," and states that he believes "such cases have never been cured by these means alone."

His etiology is (1), "Eye-Strain" (the largest credit is given this); (2), Dyscrasic Conditions, as Oxaluria, Lithæmia, and latent Gout or Conditions of Suboxidation;" (3), "Anæmia;" (4), "Origin of Organic Disease," and (5), "Extra Cerebral Lesions, as as Spinal Irritations." The symptoms are those commonly associated with neurasthenia. Eye-strain may produce unquestionably paræsthesiæ, and the resulting symptoms remain unrelieved by glasses, as the reviewer has seen on more than one occasion. A common-sense therapy is hygiene, tonics and correction of ocular defects.

John Ferguson, in an article of unusual merit, calls the attention of the profession to the subject of tendon reflexes, remarking that it is well known that muscle tone is due to a normal and healthy nerve connection with its spinal center; that this is stimulated by the cerebellum and controlled by the cerebrum. Loss of cerebellar influence by disease causes loss of reflexes, and the loss of cerebral control causes increase of

reflexes. He shows in an interesting manner that exaggerated reflexes are not always always due to descending degenerations. In diphtheria the loss of the knee-jerk in the early stage is, in his opinion, a valuable differential diagnostic point. In a later article he locates the center for the knee-jerk in the fourth lumbar segment.

In the following table I have summed up his experience with the knee-jerk:

Diphtheria.

Supervenosity.

LOST.

Total transverse lesion.
Cerebellar damage (by tumor).
Coal gas poisoning (2d stage).
Cyanosis (from cough).
Status epilepticus (after fit).
Sleep (deep).

INCREASED.

Spastic paraplegia.
Ataxic paraplegia.

Multiple sclerosis.
Concussion.

Alcoholism.

Bromism (impending).

After shock.

Cerebral injury.

Coal gas poisoning (1st stage).
Jacksonian epilepsy.

Sleep (light).

Church discusses the question of vertigo due to arteriosclerosis. The symptoms are these: a man in the prime of life without previous serious illness becomes suddenly faint, has swimming in the head, giddiness or distinct gyration, darkness, and a feeling of impending death. He seeks advice of a physician, who upon examination discovers a tortuous frontal artery, an arcus senilis, a strong clanging second sound of the heart and a sphygmographic tracing of increased arterial tension, with pulse slow, urine scant, and may be a trace of albumen. There is usually fullness in the head, heat in the scalp and blurs before the eyes, predisposing to hypochondria. As a cause, specific disease, gout, rheumatism and lead infections are mentioned. Iodide of potash, in thirty. grain doses, is of value, while the nervous symptoms are to be treated rationally.

Tomson calls attention to the fact that patients suffering from vasomotor neuroses are usually found in highly cultured communities, and are not dull and stupid but

keenly intellectual. Parents, the subjects of epilepsy, hysteria, morbid blushing and drink craving, may produce in the child faulty nerve habit, which an exciting cause may turn into disease, be it mental, emotional, fear, fright, or shock. He quotes cases of polyuria, diarrhea, blushing, cardiac palpitation, enlargment of the thyroid, œdema, facial blushing, and tremor. He attributes this to vasomotor disease, agreeing with Hughlings-Jackson that "all parts of the body are represented in the highest cerebral centers."

His

Mackenzie has treated myxedema with success. description of the disease is admirable and worthy of a reproduction had I the space. The treatment consists of feeding with thyroid glands, which in a short time produces a complete change and eventually a cure.

Wallace gives us his personal and professional experience of those nerve storms to which the name of migraine is given. The symptoms are a dull, heavy aching, desire for the avoidance of mental and physical exertion, coated tongue, nausea, irritability, constantly increasing pain, light-colored urine, acid vomiting, sleep and finally relief. He believes it to be due to defective or insufficient excretion of the liver and partly of the kidney. Overwork, exposure to cold, lack of skin action, tobacco, alcohol, malt liquors, saccharine food, poor mastication, etc., are causative factors. To prevent the attack, fresh food, fruit and vegetables, milk, fresh butter, meat, well masticated, without pickles, pastry, or jams, should be partaken of. Be a sparing rather than a repletive eater, with regular hours for mental and phys'ical work. Drink large quantities of water. The bowels should be kept open. To abort an attack the food should be mostly fluid, and alkaline drinks with small doses of iodide of potash should be drunk in the morning. (In my experience this is better than many of the coal tar derivatives, as it does not cause subsequent depression. A sweat in a sweat-box, at 150 degrees, for ten minutes, followed by a rain-bath at eighty degrees, twenty pounds

pressure, for one or two minutes, is even more efficacious. I rarely use antipyrine, but prefer the dietary and water treatment). During the attack no solid food should be eaten, but alkaline drinks, such as soda-water, vichy, seltzer, or geisshubler should be drank freely and the bowels kept open thoroughly. Between times, flush the kidneys by copious draughts of plain alkaline or slightly laxative waters.

Ferguson reviews the work of others and adds his own experience upon the "Insanity of Exhaustion after Acute Diseases, etc." He states that it usually takes the form of confusion of thought and dementia, but that such names as "Typhomania, Confusional Insanity," etc., are objectionable, because it may be a mania, melancholia, or dementia. They may be caused by exhaustion of nerve centers, specific materies morbi of germ origin, non-specific poisons (as uræmia), hyperæmia, and overactive brain centers, especially the emotional. As to prognosis I quote the writer :

In cases not the result of organic disease, it is among the most amenable to treatment of the many morbid conditions with which we meet. This should be recognized by the general practitioner in its early stages and if proper treatment were pursued we would have less chronic and incurable victims in our asylums.

Home treatment is advisable if possible. Go in to win, and be "ever careful, kind, firm, persevering, and patient in your attentions, and if possible never cause distrust." Sleep should always be secured. Equable temperature and forced feeding are necessities.

He closes with the words that every practitioner of medicine should remember and follow:

Pray do not substitute the insanity of drugs for the insanity of disease, and I beg of all to use great care not to establish the habit of taking hypnotics among your patients.

Corning announces to the profession a new device for the cure of localized and diffuse internal head pains. A warm solution is used to cleanse the nose, remove the mucus and dilate the capillaries. Alkaloid solutions of