Case 6.-In the first number of this journal, I published the case of a woman, 26 years of age, who had hemiplegia, preceded by convulsions, and where sleeplessness was a prominent symptom. She was most urgent in asking for something to make her sleep, not having slept at all for many nights, and being greatly exhausted by want of rest. Fifteen grains of the bromide were ordered to be taken at six in the evening, and again at nine o'clock. She slept the first night, and after taking it in this way for a few days, there was no further need of the remedy. She also recovered completely from the paralysis of the side.

These cases will suffice to show any one that may not have used the bromide in full doses to overcome sleeplessness, that it is a valuable remedy, which may be safely administered for this purpose in a variety of nervous affections.

The bromide has been used with more or less benefit in many other nervous disorders, such as mania, hypochondriasis, chorea, vertigo, headache, and local affections. I gave it lately with very good effect to a young lady who had long suffered from hysterical difficulty in swallowing. Dr. Begbie states that he has prescribed it successfully in some cases of diabetes; and Dr. J. Russell Reynolds has given it with great advantage in certain nervous affections characterised by sudden. distressing, but indefinable feelings in the epigastrium and abdomen, which he attributes to disturbances of the vaso motor system. A case, which might be embraced in this group of anomalous nervous affections, and where there was disturbance of the circulation in the head, with uneasy sensations in the abdomen, was quickly removed by bromide of potassium, after other means had been resorted to ineffectually.

Case 8.-A gentleman, about 45 years of age, came under my care, who had formerly been stout and plethoric, at which time he suffered much from bleeding piles, but had for some years become less stout and had almost ceased to be troubled by the piles. He had distressing sensations at the epigastrium, loss of appetite, and flatulence, but he was most alarmed by some head symptoms, pain, giddiness, and floating specks before his eyes. There was no heat, increased action of the vessels, or any sign of determination of blood to the head, but, on the contrary, the pulse was very weak, and the countenance paler than natural. He took steel with ammonia, but, still suffering from the same symptoms, he went to Harrogate for ten days, and took the saline sulphur aperient water, which improved the condition of the digestive organs, but did not remove the uneasy sensations at the epigastrium, or in any degree diminish the head symptoms. On his return I prescribed 12 grains of the bromide, to be taken three times a-day, in a tonic infusion, with some aromatic spirit of ammonia. This had an immediate effect, in relieving all his symptoms and improving his appetite also, and within four days he said that, whereas he had been quite unfit for any business, he felt fresh energy and was able to face anything.

I shall now advert to what has been called bromism, or the effects which may be produced by the excessive use of this salt when it is taken in full or considerable doses for long periods. The following case is a good illustra

tion.

Case 9.-A lady, about 47 years of age, whom I had previously attended occasionally, came under my care in November, 1865, on account of pain at the stomach and vomiting. There was constipation and very dark coloured motions, which seemed to be coloured by blood, as they got blacker by purging. On examination of the epigastrium, a tumour the size of a small egg, was found in the situation of the spleen. She was seen by Dr. Vose also, and we both thought it might prove of malignant nature. By blistering, however, attention to diet, and other means to relieve the dyspeptic symptoms, and finally by the use of cod liver oil, which improved the general health as it had often previously done, the tumour gradually decreased, so that towards the end of the year it could scarcely be discovered. In the spring she went to Edinburgh, and put herself under the care of one of the leading physicians there, who prescribed bromide of potassium, the dose of

which was increased to about a scruple thrice a day. She was more or less under his care all the summer and autumn, and she was so strongly impressed with the belief of the necessity of its continuance for the removal of the tumour, or what remained of it, that she clung to it with great tenacity. She lost her father in the autumn, and at that time her health was so bad that it was thought she could not long survive. In November, 1866, she returned to Liverpool, but did not place herself under my care for a fortnight after, as she did not wish to have the treatment of her Edinburgh adviser interfered with. Her friends, however, found that she was getting extremely weak and ill, and I was therefore sent for. I found her very emaciated and weak, and of a peculiar pallid colour. She was also inclined to doze, so that she often dropt off to sleep. There was remarkable slowness of speech, and difficulty in collecting the ideas and expressing them. The extremities were cold, and the pulse slow and very weak. She was fearfully depressed, and frequently shed tears. There was no tumour whatever to be felt, and therefore no indication for continuing the bromide. The symptoms were such as might have been partly due to malignant disease, but I thought they were chiefly caused by the protracted use of the bromide, and I insisted on it being relinquished. I improved the diet and gave stimulants and tonics, with cod liver oil; in fact, returned to the original treatment she had left off on going from Liverpool. The rapidity with which she recovered, getting colour, strength, flesh, and spirits, was surprising, and showed me that her condition and symptoms were entirely due to the excessive and protracted use of the bromide. She has continued perfectly well.

I was not then aware that Dr. Bazire had described a condition precisely the same, which was induced by the protracted use of the bromide of potassium. "When given," he says, "in large doses, such as thirty or forty grains, two and three times a day, it produces very striking symptoms in about ten or fifteen days. The patient at first complains of a dull headache, becomes listless and apathetic, with an expressionless face and lustreless eye. His intellect is clouded, his mind confused, and he is unable to concentrate his thoughts. There is slowness of perception, and questions have to be asked several times before their meaning is understood and an answer can be obtained, If, when these symptoms have begun to show themselves, the medicine be continued, hebetude follows, with inability to think, and a kind of stupor resembling that of the first stages of typhoid fever, together with drowsiness, somnolence, and constant dropping off to sleep. In no case have I seen delirium or hallucinations. The pupils are dilated, and contract very sluggishly under the influence of a strong light; the sensibility of the conjunctiva is so deadened that a finger may be passed with impunity over the surface of the eye-ball without producing winking. Hearing loses its usual acuteness, and it is only by speaking in a very loud voice that the patient can be roused from his stupor."

These symptoms are similar to what I witnessed in the preceding case; and Dr. Bazire has described effects of a less severe character, but with an eruption of boils, occurring when the bromide is taken for much longer periods, in ten to fifteen grain doses, twice or thrice daily.

The chief object of this paper having been to give practical illustrations of some of the uses of bromide of potassium, I shall not enlarge on its modus operandi. It would seem, however, that it produces a direct sedative effect on the whole nervous system, especially the sensory and motary nerves, and that it has a power of controlling irregular vascular action. According to MM. Damourette and Pelvet, it acts as an anesthetic on the nervous centres and cord on the one hand, and on the mucous and tegumentary surfaces on the other. It diminishes muscular irritability, and thus has an extensive effect on the muscular organs of digestion, respiration, and urinary secretion, as well as the striated musoles.-Liverpool Medical and Surgical Reports, Oct. 1868, p. 9.

17.-AMERICAN CONTRIBUTIONS TO THE STUDY OF CUTANEOUS NEUROSES.

By Dr. H. S. PURDON, Physician Belfast Dispensary for Diseases of the Skin; Assistant Physician Belfast Charitable Infirmary, &c.

Neuroses of the Skin.-In the early part of last year a distinguished American dermatologist, Dr. Howard F. Damon, published a monograph on "Neuroses of the Skin," which work has been favourably mentioned by Dr. Brown-Séquard.

In the introductory chapter our author informs us that neuroses of the skin are caused by peculiar conditions, either of the sensitive or of the vasomotor nerves. The sensibility of the former may be exalted or diminished to a variable extent. Spasm and paralysis are the peculiar forms of derangement of the vaso-motor nerves.

The first disease treated of is "Dermalgia," manifested in the form of tenderness, or increased sensibility to touch, and is generally confined to a limited portion of the skin. Sometimes, however, it involves the integument of one side of the body-usually the left-or even the whole skin. The skin is either painful to the touch only, or the pain may be spontaneous and independent of contact with any sensible object. In other instances a draught of air may be sufficient to excite this pain, or the threatened contact with any material substance. Dermalgia appears to be of two kinds as regards cause the hysteric and rheumatic. That form which is associated with hysteria is usually confined to the left side, and is often extensive; sometimes, however, only small areas of the skin are endowed with this exquisite sensibility to external impressions. These are veritable neuralgic spots. This irritation may have its origin in unhealthy conditions of the uterine organs and the sympathetic troubles to which they give rise. When this hyperesthesia to touch is more general and of a severe character, it has been regarded as one of the indications of commencing myelitis, or of inflammation of the membranes of the spinal cord. There is a rheumatic form of dermalgia which is confined to a limited portion of the skin, and which is encountered frequently in practice. It consists in an excessive tenderness to the touch, and sometimes pain. When the latter symptom is present, alteration in the nutrition of the part speedily takes place. The skin often becomes red, and there is slight engorgement of its tissues. The tender spot occasionally occupies a portion of the integument supplied by filaments of some large cutaneous nerve. The disease appears to be due-for the most part, however to a morbid condition of the sensory apparatus of the skin Dermalgia has been observed to be more frequent in those regions which are occupied by hairs or lanugo than elsewhere. The arrangement of the hairs upon the surface of the body corresponds somewhat with the general distribution of the cutaneous nerves.

The rheumatic variety of this painful affection is usually of an intermittent character-worse at night; and in course of time the nerves themselves appear to become inplicated. It is often complicated with muscular pains. In the treatment of dermalgia our author recommends the application of blisters, the linimentum ammonia and belladonna. Internally hyoscyamus, combined with valerianate of zinc, and states that the efficacy of the valerianates has been confirmed by many practitioners, amongst whom Dr. Silas Durkee, of Boston, is specially mentioned. If the patient is sleepless he administers the bromide of potassium in very large doses, such as from thirty to sixty grains, at bed-time, and which, we are informed, quiets the nervous excitement of the patient, thereby insuring sleep. If the insomnia persists the hypodermic injection of morphia is recommended. Where there is much debility present the bromide of ammonium is to be preferred to the simil .r preparation of potassium.-Dublin Quarterly Journal, Feb., 1869, p. 98.

18.-SULPHATE OF NICKEL IN NEURALGIA.

The interest of the following remarks does not lie in the employment of the sulphate of nickel in neuralgia, but in its therapeutic effects. We are told that it is a gentle tonic, acting like the preparations of iron and quinia. In this case, however, it seemed to exercise a sedative influence, more closely resembling that of the bromide of potassium.

Mrs. B. has suffered with neuralgia more than three years. During the last two months the paroxysms have been very violent and frequent-occurring every few minutes. She has taken iron, quinine, arsenic, strychnine, colchicum, aconite, morphine, chloroform, valerian, zinc, mercury, electricity, and many other remedial agents, with only temporary relief. As Prof. Simpson had used the sulphate of nickel successfully in a case of severe and obstinate periodic headache, I concluded to try it, and began February 19th by giving her half-grain doses three times a day. In less than a week the paroxysms were reduced to only one within twenty-four hours; this came on at noon. On last Sunday (March 1st) it did not commence until about 3 p.m I was present and gave one grain of the sulphate, notwithstanding she had taken her regular doses that day. Its sedative action was speedily manifested in reducing the pulse and producing sleep. All symptoms of the paroxysm disappeared, and Mrs. B. states that they did not return until 7 o'clock. In this case the sulphate of nickel has given more permanent relief than anything else; Mrs. B. tells me that it soothes her quicker than morphine, and is not followed by any unpleasant effects.-Medical Press and Circular, Dec. 30, 1868, p. 562.

19.-ON HEMICRANIA, OR SICK HEADACHE.

By Dr. SAMUEL WILKS, Physician to, and Lecturer on the Practice of Medicine at, Guy's Hospital. [Hemicrania, or sick-headache as it is generally called, is of a dull and sickening character. Its great peculiarity is the throbbing which occurs with each beat of the heart, aggravated by every movement of the body, and more especially of the head itself.]

Now, as to the cause of this misery, I have already said that whilst the body is cold the head is hot, and that whilst the radial artery is small the carotid is full; in fact, if the term determination of blood to the head is applicable to any malady it is assuredly to this. This irregularity in the circulation due to nervous influence has created much interest of late years, as I have already told you in describing various diseases. It has been clearly shown that the blood-vessels are regulated in calibre by the sympathetic nerves, and that the supply of blood is immediately under nervous control. Now in this complaint of which I am speaking, the carotid on one side with its branches is dilated, throbs inordinately, and sends too much blood to the brain and its coverings. The fact I knew when quite a boy, for when leaning my head on my hand I distinctly felt the increased size of the throbbing temporal artery on the side of the pain, which would be sometimes on the right and sometimes on left side. I remember mentioning the circumstance to more than one medical man, and they received the statement with incredulity. I knew it, however, to be a fact, nevertheless, and am sorry to say I have been too fully aware of it up to the present day. The fact is, that in this dilated throbbing carotid and its branches lies the source of the trouble. The vaso-motor nerve on one side is for the time paralysed, the vessels of the head dilate, more blood is sent to it; and thus the increased heat, throbbing, and pain which the patient has to suffer until the tone of the nerve is restored. The most important question to solve is the immediate cause of the function of the nerve being thus temporarily in abeyance. Since a stomach derangement usually accompanies the hemicrania, it is very frequently thought that the source of the trouble is always gastric, and that medicine of a particular kind will relieve. That this is partially true is no

doubt correct, but just as frequently the complaint arises from a direct influence on the nervous system. Besides, if arising from the stomach, the cause is not the same as that which operates injuriously in the mass of people from over-indulgence in eating and drinking, and which produces a more general headache in consequence, but the cause is a slighter one, and dependent upon a number of trivial circumstances which the sufferer himself could alone detail. It may be said no doubt with truth, that gastric derangement is a very common exciting cause in those who are subject to the complaint, but very frequently no cause for the attack is apparent, and certainly none attributable to the stomach. When the cause is evident, it is very often one which has acted directly on some portion of the nervous system, and to the non-susceptible would scarcely be credited with so powerful an operation. Thus all worry, excitement, or overwork will readily produce a headache; walking in the sun is a very sure method of inducing an attack; strong impressions on the olfactory nerve, as the smell of paint, and in some persons the odour of spring flowers; also impressions on the retina, as long use of the microscope, or a protracted visit to a picture gallery. An atmosphere overcharged with carbonic acid is one of the most fruitful sources of headache, as that of a crowded assembly-room, and what would affect myself at once and in the most intense degree would be the presence of unconsumed carbon from candles or lamps. Loud noises in the ear will also cause a headache; and, in fact, it would seem that a strong impression made upon any part of the nervous system is sufficient to induce an attack. Probably derangements of any organ might also bring it on, as of the stomach, which we constantly see, and in women the uterus, more especially at the catamenial periods. Some of the most violent attacks which we witness are in women at these periods. There are those who are doomed every month to an illness of a few days, with intense headache, prostration, and sickness; if there be much uterine pain, the case is styled one of dysmenorrhoea, and the cause attributed to the uterus, which may or may not be true. Those, both men and women, who are thus liable to these violent headaches are proscribed many of the pleasures of life, since irregularities of any kind are so apt to lead to their wonted complaint. Under the most favouring circumstances, however, it is my experience that they can never escape an occasional attack.

As such trivial causes are sufficient to induce an attack of this hemicrania or migraine, it might be supposed that some equally slight circumstance might be sufficient to counteract or cure it. I should think it probable that such is the case, although, after long searching for the remedy, I have not yet discovered it. Certainly the ordinary aperient doses which the medical man so commonly prescribes for a headache are useless; besides, the attack may have spontaneously subsided before there could be any expectation of a result from the medicine. The act of vomiting, however, does in some cases afford very speedy relief. This is not by getting rid of any crudities, for the stomach may be empty, and therefore the effect must have been through the nervous system. As regards stimulants, as a rule they cannot be prescribed; they often aggravate the complaint to an intense degree, although I have found that in some milder cases a little brandy-andwater or a glass of champagne has, after a short period, been apparently beneficial; sometimes a cigar. Of all remedies perhaps tea is the best, but I am not quite certain what amount of benefit is to be ascribed to the tea and what amount to the hot water. Tea, of course, is well known to have a direct and marked action on the nervous system, and thus it might appear absurd to raise a doubt as to its efficacy did I not know more than one person who obtains more relief for a headache by sipping very hot water than by any medicine which has ever been prescribed.

Those who have any knowledge of the perpetual and horrible throbbing in the brow or temple, also know that nature prompts relief by pressure on the aching part. The leaning the head against the hand or other object is in obedience to what instinct dictates. On lying down, the aching brow is always pressed against the pillow. By more direct and intentional pressure a