round stones I see on the pavement, all numbered held on his head, was a little coffin of the dead. with the chisel?" "Sepultures, Signore," he replied. "There are in all 365, exactly as many as the days of the year, 360 are here, as you see, and 5 others are in the church. At half-past six in the evening, one is opened each day, and, with that machine down there, the dead that have arrived in the day and those who are brought through the night, are buried. It is closed at half past six in the morning; but if it would please you to see how we do it, amuse yourself in the meantime, and come again towards seven, that you may be diverted." After parting from the custodian, the visitor wandered around, and among other sights he met with the following. "Two old men, with heads bare, under a scorching sun, ran through the various parts, up and down along the lines of sepultures, reciting psalms in a low voice, and every now and again making lamentation, at one time striking their breasts, and again making the sign of the cross, and next spreading out their arms, and raising their eyes to heaven. Near a stone, at a little distance from me, was a group, consisting of an adult woman, a girl and three children; the woman was certainly the mother; she was praying and weeping at intervals, in broken silence. I would willingly have asked these sorrowers some questions, but I refrained from disturbing the mournful assemblage. The mother was kneeling, with her head resting on the shoulder of her eldest daughter, who was sitting beside her; the eldest of the three children joined in the prayer, and wept; the second was sleeping, with his head between the knees of his sister, and the third was playing with a lizard which was tied by the tail. In one corner two ragged fellows were sleeping and snoring sweetly; in another a lot of rogues were clamoring and jesting, and throwing stones into the air. Whilst I was silently observing these things, a man without a shirt made his appearance at the gate, with breeches half down his legs; he was carrying something on his head, which at a distance I could not recognize. He entered singing, with one hand on his hip and the other on the object he was bringing on his head. He was as nimble and elegant as a Pompeian figure. He advanced some paces, and after looking around he called out, 'Treonce,' one of the assistants who was sleeping in a corner; he jumped up and ran to meet him, and so did I. The thing which the newly arrived Whilst the custodian was preparing the metal casket of deposit, the two assistants undid the lid of the little coffin and exposed the emaciated body of a child of about two years. It was enveloped in a few rags, but a poor garland of green twigs surrounded the slender corpse, and a May rose was seen hanging from its mouth. The thought of the hand which had placed that rose there, came over me, and I felt a choking, whilst the children, sporting down below were running about tickling each other, and smiling and cheery were skipping around. The casket of deposit was prepared in a moment, and the little cadaver was laid hold of by one assistant by a leg, and was tossed into it. The garland flew one way and the rose another. and two streaks of blood ran from the nostrils over the cheeks of the miserable creature. The ragged fellows, between them, made away with the garland and the rose, and the industrions Treonce having, in the meantime, at the sound of some footsteps, finished the breaking up of the coffin, went off with the pieces under his arm, whistling cheerily the air of Palumbella. "In like manner I saw other cases (coffins?) with the bodies of adults arrive, either on vehicles, or carried by hands, or on the roofs of carriages, and to all that I saw nearly the same treatment was given. From one corpse, that of an old woman, I saw, while it was being lifted, the only bit of cloth which covered the abdomen, fall off, and it was left stark naked under the eyes of the staring crowd; in another instance, that of an old man, who slipped from the hands of him who was raising the body by the shoulders, I saw the head slap down on the pavement, with that sinister thump which is never forgotten, and can never be mistaken for any other sound. But it is nothing at all; the satraps of Naples are at dinner; and this little sound will certainly not reach them, nor derange their placid digestion." The visitor returned on the second evening after, in order to witness the established system of Neapolitan sepulture. Here are some of the sights witnessed by him :-" There are some impressions which cannot be recounted, and we can only think, and be silent, for language is insufficient. The aged priest recited the prayer for the dead; he blessed the bodies, and withdrew, giving a signal to the men of the service, which set them quickly The pamphlet above quoted from, gives the number of the dead thrown into the 360 pits annually, as 7,000, which would give an average of nearly 20 bodies yearly to each. After a year of closure the capping-stone is again raised, and a new supply is cast in. Who will assert that crema tion here would not be both a more decent and a more affectionate disposal of the dead? ON SPASM OF THE GLOTTIS. BY THOMAS W. POOLE, M.D., LINDSAY, ONT. to work. 'To it,' cried one of them, and in an | down, as if it had fallen on her heart, and she gave instant the capping-stone of the huge charnel-house herself over into the arms of her companions. 1 was raised. An escaping volume of sickening turned round to an old man who was near, looking stench in a moment drove back the hundred faces on, and said, 'Do you know her?' 'Robba de of the curious who were standing over it, but ano- lupenare eccellenza,'* was his reply. 'Enough,' ther hundred, urged forward by stupid curiosity, said I. A deep murmur of compassion and fear fear, and horror, took their places over the fetid arose over the scene, and some of us moved out to opening. The ragged fellows who stood apart, assist the unhappy one, but we were not in time, called loudly, opening a passage for themselves for tottering, and throwing her arms convulsively through the crowd, which remained closely locked in the air, she disappeared as a phantom, under and screaming, feeling themselves suffocated; and the light of the lamp which illumined the entrance, in this time the men placed at the machine did borne onward by her companions." not cease to salute one another, calling out, 'Back there! pitch it in! forward, forward, let us finish.' It was necessary to allow a full quarter of an hour to give vent to the beastly curiosity of the crowd, and the dismal operation again proceeded. The wretched machine turned creaking on its wheels, and the metallic ca ket, suspended by its chains, was brought into horizontal position on the ground. At this time I went to the gloomy opening, and running my eyes around, I saw beneath, a formless mass of whitening bones and musty clothes. Horror drove me back. The first body taken off the bier was quickly placed in the metal casket, which, under the force of the winch and crane, was raised a little above the surface, and then let slowly down into the pit. The crowd again bent over it to see the descent, when at a certain point a spring was loosed, the bottom of the casket opened, and the first human carcase went down with a thud, to take its place in the great dungpit assigned to it for its last abode. The casket came up again, and this time it fell to the lot of a young man to present the sad spectacle. Two attendants, the one laying hold of the body by the legs, and the other by the axillæ, placed it in the casket of the machine. The aspect of the corpse, that of a young man, who was now to make the mournful descent, had impressed even the most stupid present. All were breathless, and in the general silence the crane gave out its grating sound. A smothered cry reached my ears, and I saw presenting herself, weeping and approaching the opening, into which the body was descending, a young woman who, a little before, had arrested my attention. Two friends ran after her and seized her by her dress, lest she might throw herself into the gloomy cistern, but she halted and stooped over its edge with glazed eyes, until the body struck the bottom,--she then sank It is easy to show, from the facts of recent physiology, that the opinions currently taught and received on this subject, are entirely erroneous and misleading. The opinion, in chief, to which exception is here taken, is that the spasm in question is due to an over excitation of the nerves supplying the muscles of the glottis. The aperture of the glottis is regulated by two opposing sets of muscles, one of which tends to widen, and the other to close it. Both groups of muscles derive their motor nervous supply exclusively from the inferior laryngeal, or recurrent nerve, which is a branch of the pneumogastric. When the latter, or the recurrent branches, are cut on both sides of the neck, the glottis closes, and this closure, as Dr. Burdon Sanderson shews, is due not to paralysis of the dilating muscles, but to the fact that these are overpowered by the superior force of the constricting muscles. "The combined effect" of the activity of all the muscles concerned "manifesting itself in approximation of the vocal cords," and closure of the glottis.-(Handbook for Phys. Labor, Amer Ed. pp. 308-318). what a history may not that of this mourner have been ! This is a very important fact, both theoretically stridulous) or in the onset of true membranous and practically, and is fully corroborated. Gutt- croup, which is accompanied by recurring spasms man, in his "Physical Diagnosis," mentions the of the glottal muscles, often greatly accelerating same fact in stating that "section of the recurrent the fatal issue. It also throws some light on the nerve in animals produces narrowing of the glottis." general failure of what has been known as "anti(p. 40.) Dr. Austin Flint, discussing the "danger of death from suffocation," in the "obstructed in spiration," occurring in nervous aphonia, says, "the condition is analogous to that after the physiological experiment of dividing both recurrent laryngeal nerves." (Prac. of Med. 5th Ed., p. 309.) The same author has "reported a case in which the left recurrent nerve being situated between a calcareous deposit and an aneurismal tumor, spasm of the glottis occurred so frequently and to such an extent as to prove fatal." (Ib. p. 371). Now, in such a case as this, as well as in that of section of the nerve in the physiological experiment, the active condition of the muscles (which, as we have seen, results in closure of the glottis,) must be associated with a paralytic condition of the nerve. This will hardly be questioned, from the very nature of the case; for it is impossible to see how the divided nerve could be the medium for the transmission from the nerve to the muscles of what Dr. Pereira calls "a preternatural stimulus," forcing the muscles into spasm. Besides, Dr. Burdon Sanderson, in his account of the experiment, writes, that "the glottis is partially closed, just as it is after death." (Loc. cit. p. 318). (Italics mine). Further on we read :---" In animals with divided vagi, life is prolonged by tracheotomy," showing that the closure here referred to as "partial," must in reality be so nearly complete, as at all events to produce a fatal result if not obviated by special intervention. How closely drawn is the glossal aperture" in death," will appear from the well-known difficulty of passing a probang within the larynx of the cadaver, on the feasibility of which Dr. Flint throws serious doubts. (Loc. Cit. p. 294.) If it be true, then, that section of the nerve, or the pressure on it of a tumor, results in a condition of the glottis similar to what is present in death, it is a legitimate conclusion that in one case as in the other, nerve action has ceased to be operative as regards the muscle, that in short, the condition is one of nervous paralysis. This fact is of prime importance to the general practitioner, in the treatment of spasm of the glottis, whether in the case of simple spasm (laryngismus phlogistic measures," in the latter disease, which Dr. Flint says, "have been employed sufficiently to show that they are not successful, and if they do not do good, they can hardly fail to do harm." (b. p. 299). It must be obvious that in an abnormal condition of the glottal muscles, depending essentially (so far as the spasm is concerned) on paralysis of the motor nerves supplying these muscles, agents which tend still further to lower nervous activity, can hardly be expected to prove beneficial. Here the results of physiological experiment and an enlightened experience are eminently in accord. The foregoing facts appear to me to prove as clearly as anything in physiology can be proven, that spasm of the muscles of the glottis closing that aperture results from : (a.) Section of the motor nerves supplying those musles. (b.) Pressure on those nerves arresting their functional activity. (c.) General paralysis on the death of the body. Suppose now, that a precisely similar spasm of the glottis were shewn to attend the application of a powerful agent-a purely physical force-to the motor nerves of the muscles referred to, would not the legitimate inference be, that the action of such agent was of a paralyzing character also? Would it not be regarded as an outrage on physiological propriety to class as a nervous stimulant or excitant, an agent producing effects indistinguishable from those of nerve section, paralysis and death! Such an agent is electricity; and it is here said to play the role of an excitant. "During excitation" of one recurrent nerve, "the vocal cord of the same side approaches the middle line. If both recurrents are excited, the rima is completely closed." (Hand-book, etc., p. 308). Of course it is obvious why electricity came to be called an excitant to nerve action. Appearances seemed to justify it. But appearances are eminently deceptive; and it is expected of a true physiology that it will be able to distinguish the real from the apparent. It is also authoritatively alleged, that after sec tion of the vagi, "the muscular fibres of the oeso- in the cases of puppies, kittens, rats and frogs, phagus are paralyzed,” (Ib., p. 318), and the same that the arterial system, so far from being "reis repeated in all our physiological treatises. This laxed" or "dilated," is empty and collapsed, and is not the place to enter into a refutation of this that it is the venous system which is expanded fallacy. Suffice it to say, that a muscular tube and engorged. which, as Dr. Dalton states, is able to eject its contents "by a peculiar kind of regurgitation," is by no means in a state of muscular paralysis; and that its active condition is further vouched for by the observation of Marshall Hall, who found it to display "a distinct peristaltic movement along the tube, after its nerves have been divided, causing it to discharge its contents when cut across.' (Dr. W. B. Carpenter, Phys. p. 404.) Finally, the records of physiology furnish ample evidence, though strangely overlooked, that what has been shewn above to be true of the muscles of the glottis, is equally true of involuntary muscles generally, including the muscular bands of the arterial coats, which invariably contract and empty these vessels into the corresponding veins, on section of their controlling nerves, or on destruction of the cerebro-spinal centres, as in the operation of "pithing." Indeed, Dr. Burdon Sanderson furnishes absolute proof of this himself, in the case of the splanchnics, though he strangely ignores it. The splanchnics, he tells us, contain the vaso-motor nerves which are distributed to the arteries of the abdominal viscera, and which regulate the calibre of these tubes (p. 258). After section of these nerves, these arteries are emptied, and “the portal system is filled." In his own words, "a quantity of blood is, so to speak, transferred into the portal system, and thereby as completely discharged from the systemic circulation as if a great internal hemorrhage had taken place" (p. 260). These facts are produced here to show that the muscles which control the aperture of the glottis are not alone, or exceptional, in passing into a state of contraction when deprived of nerve influence. There is distinct proof that the same is true also of the muscles of the oesophageal and arterial walls, of the muscular bands of the bronchi and alimentary tube, and indeed of muscles of the involuntary class generally, producing characteristic effects in the organs with which they are associated. As already stated, the fact is of the first importance, not only theoretically but practically, and will some day receive the attention it merits at the hands of the profession. BY J. B. MATTISON, M.D., BROOKLYN, N. Y. I am aware that this statement is in flagrant antagonism to the authoritative teaching of the day, and that Dr. Burdon Sanderson enters into the details of experiments to prove that under the conditions just mentioned, "all the arteries are (Loc. Cit. pp. 245, 296.) But the very facts he furnishes refute his thesis. For instance, when the heart of the pithed frog is laid open, "only a few drops of blood escape,-the quantity, that is to say, previously contained in the heart and in the beginning of the arterial system," while THERAPEUTICS OF OPIUM ADDICTION. in the frog whose nervous system is intact, "the bleeding is not only more abundant, but continues for several minutes after section" (p. 296). That is to say, in the pithed frog the arterial system is as empty as its physical structure will permit it to be, and “the whole mass of blood comes to rest out of reach of the influence of the heart" (p. 246), having found a lodgment in the more capacious venous system; while in the frog whose nervous system is intact, the arterial system retains its blood, and yields it up "more abundantly," and continues to do so "for several minutes," till the arteries are emptied. Besides, the operation of pithing is easily performed, and any one can satisfy himself, as I have done, by actual experiment, That the continued use of opium, in any form, from whatever cause, will, in time, beget a well marked functional disorder, is a fact which no properly informed physician can fail to accept; and that this disorder, under ordinary professional regime, is one difficult, and often impossible, to treat with success, is another fact which any one who has had experience in this direction, will, very likely, not dispute. Under special supervision, however, this difficulty disappears, and, granting cases suitable for treatment, the disease proves promptly and easily curable, as the following notes will tend to attest. For the muscular debility following withdrawal, nothing, in our experience, equals general faradization-10 to 20 minute seances daily. The sense of exhilirating comfort resulting is often very decided. Occasionally it is used twice daily, and, very exceptionally, it is not at all acceptable. रु Atropia is used in initial doses of T. gr., hypodermically ter dié-or its equivalent by the mouth and pushed until it produces systemic effects— dry throat and disturbed vision. This has never required a dose exceeding of a grain. Strychnia is given in subcutaneous doses of of a gr., thrice daily, and continued, in some form, through The therapeutics of these cases include bromide tive. The galvanic current we often employ from of sodium, hot baths, electricity-both galvanic and the outset, and, after abandonment, find it useful faradic current, atropia, strychnia, hyoscyamia, as a general restorative and remover of local pains. quinia, chloral, coca, cannabis indica, Jamaica dogwood, varied tonics, full feeding, and cheerful surroundings. To note these in detail requires some preliminary reference to the morbid condition they are intended to relieve. The symptomatology of opium abandonment, in our opinion, relates to an exalted activity of the spinal cord manifested in varied reflex irritations. To this are attributable the aches, pains, vomiting, purging, collapse and horrible discomfort, in general, which follow entire and abrupt withdrawal of a long accustomed opiate. If this be correct, it is also correct to assert that any drug able to control this over-action must prove potent for good in treat-out treatment. Hyoscyamia, in our experience, ment. Such we have in the bromides. Their power to subdue reflex irritation is known to all, and in no disorder is this more happily proven than in the one to which we refer. A special and original application of this power is what we term preliminary sedation, which consists in the giving of the bromide for a time prior to entire opiate withdrawal-meanwhile gradually reducing the accustomed narcotic-so that at the time of maximum spinal irritation we have maximum bromide sedation, and the one counteracts and controls the other. We use, exclusively, bromide of sodium. It has two leading advantages. Saving bromide of lithium, it contains the largest proportion of bromine, which is the active factor, and it is less unpleasant than any other, never, in our experience, causing gastric trouble. Minor points in its favor are, lessened tendency to digestive and muscular impairment, and cutaneous irritation. We use it in full doses-60 grains, increased to 100 or 120-citement, stated by Levenstein, but, simply, that it in eight ounces of water, twice daily, at twelve hour intervals, and continue it from five to ten days, or even longer-average time one week-the extent of its giving, both ainount and duration, depending entirely on the peculiarities of each case, before and during treatment. has proven itself the nearest approach to morphia of any alkaloid yet presented. We use Merck's amorphous, in the dose of gr. hypodermically, and have known it, repeatedly, to produce steady sleep of several hours' duration. Quinia is used for a two-fold purpose-tonic and sedative. As the former, in two grain doses, three or four times daily, throughout treatment. As a sedative, in 20 gr. doses, given a few hours in advance of the restlessness following withdrawal, and repeated at 12 or 24 hour intervals, as required. Thermometric observation proves its power to control the rise in temperature noted after opiate abandonment. Subsequently, it is sometimes given as a soporific, and its efficacy in this respect is, to us, beyond dispute. During the first three or four days after opiate discontinuance, chloral fails of its usual effect and we never employ it. We have not noted the ex does not induce sleep. Subsequently, as a hypnotic, it answers every purpose, and is given-usually combined with a bromide or hyoscyamus-as long as may be required. We use Squibb's make, in decided doses, our experience being that a single full dose is preferable to one small and frequently Hot baths, 110° to 112°, are the most efficient repeated. When unacceptable to the stomach it agent at command to relieve and remove the pecu- is often kindly received, per rectum, same dose as liar restlessness which is an invariable sequel of by mouth, in an ounce or half ounce of warm muopiate abandonment. They are given as often as cilage. Coca, though far from being what some required, ten to twenty minutes duration. Their theoretical enthusiasts have claimed, is a stimulant efficacy is sometimes enhanced by a short douche of value, and as such fills a place in treatment. We or shower. Electricity is used as a tonic and seda-use Squibb's extract, in half ounce doses, frequently |