electrical reactions of the extensors, especially those of the right arm, were markedly impaired. The patient has been under observation for the past two years, and had been known to me for several years before. Arsenic (but no lead) was found in the urine three or four times at intervals of many months, at first in relatively large amounts, afterwards in traces, until finally it disappeared. The health gradually improved after removal from exposure, except that a moderately severe facial spasm has been present ever since. The general health has once or twice given way to some extent under hard work, but the special symptoms have never returned. I omitted to say that at one time the sensibility of the right finger tips was found slightly less than that of the left. The dynamometer finally registered 35. R L I consider this case of special value for the reason that while evidently an instance of neuritis, the morbid conditions would certainly have been overlooked but for careful examination. Careful electrical examinations in doubtful cases would very likely reveal slight changes of great diagnostic importance, since we know, both from experimentation with animals, and from clinical observation, with both lead and arsenic, that there is a period when neuritis is latent as regards paralysis, and yet is discoverable by electrical tests and by the microscope. Far more numerous than these characteristic cases of arsenical neuritis, are of course the lesser and obscurer symptoms, and they are also really of far greater importance just because they are obscure. I shall not occupy space by discussing them, because physicians at large are not yet in the mood to consider them without prejudice, and my present object is solely to allay that prejudice. I will only remark that we have good reason to believe, not only from the history of domestic poisoning, but from medicinal, and accidental, and homicidal cases, that in chronic arsenical poisoning, or in the chronic remains of acute poisoning, two tendencies are occasionally manifest; one to relatively isolated impairment of special organs or functions (tachycardia, sexual impotence, loss of voice, irritation of the kidney, localized neuralgia, herpes zoster and other affection of the skin, etc.,); the other to anæmia, or the impairment of the general nutrition, without marked local symptoms. This latter tendency has seemed to me especially important as occurring among infants. I have, however, also seen, in consultation, in a child of two years, a generalized neuritis, with impairment of the electrical reactions, apparently due to arsenical poisoning. What is the source of the arsenic in the cases of domestic poisoning; and in what form does it act? These questions are still unanswered, but no candid person can doubt that papers (mainly those of older date) and fabrics are mainly responsible. Probably it comes little by little from many sources and acts after accumulation. In the case of a lady, under my own care, a severe eruption, of inflammatory vesicular character, broke out all over the face and neck. She was seen by an experienced dermatologist who pronounced the eruption not eczematous, and found traces of arsenic in the scales removed from the skin, I found traces of arsenic in the urine and a large quantity in the covering of a reclining chair in which she habitually sat. The patient was subject to universal eczema, and had proved susceptible to arsenic given internally. Perhaps for these reasons the skin was unusually sensitive. The theory that the arsenic sometimes occurs in a gaseous form cannot yet be set aside; and the mode of introduction (i. e., by the lungs) may perhaps increase its immediate violence, just as Alexander (1.c.) found that when injected under the skin of the shoulder in animals it had more constitutional effect than when injected into the peritoneal cavity. At any rate, the urine analyses prove that it comes from somewhere and accumulates in quite a quantity; and the clinical analyses prove that it may cause serious and characteristic symptoms, and a great many more slight but very troublesome and often chronic and obscure effects. Especially Profs. E. S. Wood, C. Harrington, W. B. Hills, C. R. Sanger, (now of Annapolis Naval Academy), H. B. Hill, C. P. Worcester, A. M. Corney. 2 Boston Medical and Surgical Journal, March 7, 1889. 3 It has been abundantly shown by the history of acute arsenical poisoning that symptoms once inaugurated may continue and increase, though no more arsenic is taken. The paralysis, for example, often fails to appear for days or weeks, and even months. 4 Boston Medical and Surgical Journal, March 7, 1889. 5 Inaugural Diss. on Arsenical Paralysis. 1889. 6 For details see the published report. Boston Medical and Surgical Journal, March 7, 1889. THE THERAPEUTIC ACTION OF TONICA WATER. WITH THE HISTORY OF TWENTY-SIX CASES WHERE IT HAS BEEN USED, BY J. W. SMALL, M.D., OF NEW YORK. Water, as an agent in the treatment of disease, is a remedy which should not be too lightly estimated, as it is more or less concerned in all those changes which take place in inorganic matter, and is essential to the life and growth of all living organisms, whether animal or vegetable. When taken into the stomach it acts by its temperature, its bulk, its absorption, and as a solvent for mineral and vegetable matters which otherwise could produce no beneficial action in the animal economy. When natural spring waters are so far impregnated with foreign substances as to have a decided taste and a peculiar therapeutic action, they are classed in the Pharmacopœia as mineral waters, and are divided into five classes: the carbonated, alkaline, sulphuretted, saline (including magnesian, chalybeate and chlorinated), and silicious. The name of each of these classes |