that this is all reflex,* is possibly the warning that the system is undergoing some change preparatory to the menstrual functions-that it is in fact a true hysteria. This may or may not be the case. My own impression is that it is often due to the anæmia brought about by rapid growth and development, with faulty assimilation and deficient oxygenation. In my experience such cases present two types, the one essentially nervous, just described, the other the so-called strumous or lymphatic, in whom the want of proper assimilation is shown by a large amount of stored fat, and the anæmia by excessive pallor. In the first case, the mother will tell you at once that her child cannot take iron, that she has frequent nose bleeds, and that she feels confident that if iron could be given it would be of great service. The nervous system seems to run riot, but this very excitement in itself is an evidence of the demand on the part of nature for a blood supply which is nutritious and well oxygenated. All the exercise in the world, all the most nutritious and sustaining of foods, will have no effect, until the digestive organs are made to perform their normal functions. If you examine the tongue you will find it coated, the breath is heavy, the bowels are sluggish, the appetite is perverted, the child craves extraordinary articles of food, especially acids and sweets. disgust for her regular meals. There is flatulence, cardiac palpitations, asthma after exertion. The urine is either scanty and high colored, or very copious and of low specific gravity. If the menses have been established they are scanty, colorless, and irregular, or there is a leucorrhoea. In these cases the recommendation of popular writers for gymnastics, friction, mild diet, etc., are admirable after the digestive organs have been cleared of their accumulation of ashes, and the normal functions whipped into activity. For an infant I have the greatest confidence in small doses of calomel, with soda bicarb. and ipecac., frequently repeated; but for the cases we now speak of, I much prefer the following:

She has a

B. Acid nitro-muriat. dil. mxl. Succus. tarax. mlxxx. Vin. pepsini q. s. ad. 3j. Sig.-Teaspoonful in water after meals three times daily, with a half teaspoonful of the fluid extract cascara sagrada every night until the bowels become regular.

After taking these for a few days, if the tongue has become clean, the complexion clearer, the patient can be placed on the following instead:

:

*Sufficient attention has not been called to the disturbances caused by the pressure of the twelfth year molars. These may show themselves in either dental neuralgia, or, in fact, any form of trifacial neuralgia, gastric disorders, or mental peculiarities, amounting to melancholia or symptoms of acute meningial irritation.

B. Hydrarg. chl. corros. Liq. arsenici chlor. Tinct. ferri chlor.

3j.

3j.

Syr. limonis Aquæ q. s. ad. fzvj. Sig.-Tablespoonful after meals, and the laxative continued, if necessary, at night.

As far as the general treatment is concerned, the little patient should be sponged every morning with tepid water, she should stand in a tub, and have a pitcher of it poured down her spine from the nape of her neck, and then be thoroughly rubbed with a soft Turkish towel into a glow. The breakfast should consist of warm milk, or cocoa, a soft-boiled egg, or rare pieces of steak or chop, either oatmeal, cracked wheat, grits, or Indian meal alternating; bread and butter, with hot cakes. For dinner, soup, rare meat, fresh vegetables, very little water. supper, stewed fruits, bread and butter, warm milk or cocoa, with tea, not coffee. She should retire early, and not be permitted to read at night. The supply of oxygen should come from out-door exercise, not an over-indulgence in walks or games that fatigue; let the school hours be limited to the early part of the day, and avoid that abomination of preparing lessons in the afternoon or evening for next day's recitations.

For

In about a week's time the girl will be able to bear the iron alone, and the tincture of the chloride can be given in ten- or fifteen-drop doses for some time, or a chalybeate water can be given with arsenic. The digestive organs will now also tolerate milk in large quantities, provided it is of medium richness, is fresh, and given warm.

But this is not all. There are very many cases of a highly nervous type, which despite the most careful treatment, will not improve at home. The constant association with parents of like temperament, however solicitous they may be in carrying out instructions, is of itself a cause of nervous irritation.

It may be necessary to send such children from home, either to some relative, living possibly in the country or some distant city, or perhaps to some suburban or country boarding-school, where a thorough change of air and scene, the association with girls of a different temperament, will work wonders.

For the strumous type, the same preparatory treatment may be instituted, and for such I would not hesitate to push the iron, phosphates, and codliver oil as soon as possible. Change of air to the sea-shore is advisable. There is little trouble in the home treatment of these latter cases; there is rarely a conflict of authority in such families.

Although I have intimated that the ovaries have little to do with the production of these conditions, I feel satisfied that the weakness, consti

METZ.

BOOK REVIEWS.

How we Treat Wounds to-day. By ROBERT T. MORRIS, M.D. Second edition. New York and London: G. P. Putnam's Sons, 1886. This book is rich in bombast, but destitute of any practical value.

The Healing of Arteries after Ligature in Man and Animals. By J. COLLINS WARREN, M.D., Assistant Professor of Surgery, Harvard University, etc. New York: William Wood & Co., 1886.

This scholarly monograph contains an elaborate description of the different processes which take place in the walls of arteries from the moment of ligature until the formation of the final cicatrix occurs, and is worthy of the careful consideration of every practical surgeon.

A Manual of Diseases of the Skin. By BALMANO SQUIRE, M.B., London, Surgeon to the British Hospital for Diseases of the Skin, London, England. Chicago: A. N. Marquis & Co., 1886.

This valuable little book contains in an epitomized form the results of the author's extended experience in the treatment of diseases of the skin, and will be found to be a valuable addition to the working library of every practical physician.

A Manual of Practical Therapeutics Considered with Reference to Articles of the Materia Medica. By EDWARD JOHN WARING, C. I. E., M.D., and DUDLEY W. BUXTON, M.D., B.S. Fourth edition. Philadelphia: P. Blackiston, Son & Co., 1886.

Waring's Manual of Therapeutics has been so favorably known for the last generation, that no extended commendatory notice is necessary for it now.

Suffice it to say that the present edition has been thoroughly revised by Dr. Dudley W. Buxton, the accomplished assistant of Dr. Wm. Murrell, Professor of Medicine in University College, London, and that the additions which were made to it by him have materially increased its practical value and rendered it indispensable to every practitioner of medicine.

of Clinical Therapeutics for the Student and Practitioner. By Professor DUJARDIN-BEAUTranslated from the fourth French edition. By E. P. HURD, M.D., Newburyport, Mass. With illustrations and chromo-lithograph. New York: Wm. Wood & Co., 1886. This valuable treatise which has been issued as the August number of Wood's Medical Library, is one of the most noteworthy publications of the year. Its author is so widely known as a clinician and therapeutist, that there will be a general desire to become acquainted with the methods of treatment which have been so successful in his hands.

A Laboratory Guide in Urinalysis and Toxicology. By R. A. WITTHAUS, A.M., M.D., Professor of Chemistry and Physics in the Medical Department of the University of the City of New York, Professor of Chemistry and Toxicology in the Medical Department University of Vermont and in the University of Buffalo, etc. New York: William Wood & Co., 1886.

This admirable little book contains a complete list of the most approved tests for the morbid products found in urine as well as for the various vegetable, mineral, and volatile substances which are capable of producing poisonous effects when introduced accidentally or intentionally into the circulation.

The Physician Himself and what he should add to his Scientific Requirements in order to secure Success. By D. W. CATTELL, M.D., late Professor of Pathology in the College of Physicians and Surgeons of Baltimore. Fifth edition, thoroughly revised. Baltimore: Cushings & Bailey.

The appearance of a fifth edition of this valuable work, sufficiently attests the appreciation in which it is deservedly held by the medical profession. It is a book replete with valuable suggestions and thoughtful admonition, and one which no physician can afford to do without. Cancer of the Mouth, Tongue, and Alimentary Tract: Their Pathology, Symptoms, Diagnosis, and Treatment. By FREDERIC BOWSEMAN JESSETT, F.R.C.S., England, Surgeon to the Cancer Hospital, Brompton. With numerous illustrations. London: J. & A. Churchill, 1886. This valuable monograph is one of the most important contributions that has yet been made to the literature of carcinomatous affections. It embodies the results of the author's wide researches as well as extended experience, and clearly indicates the line upon which future inquiries into the origin and progress of this baffling class of diseases must be made in order to obtain a measurable degree of success in their treatment.

1

Some time since THE MEDICAL BULLETIN had

advice from Codman & Shurtleff that a prominent specialist on diseases of the throat had expressed his delight with their atomizers, and had This led us to inordered one of each kind. quire into the merits of these apparatuses and we find they are based upon the invention of Dr. Henry K. Oliver, made so long ago as 1866, and described by him in the Boston Medical and Surgical Journal for March of that year. Renewed and very general interest in this invention has been manifested of late, growing out of the recognition by Dr. George A. Evans and other observers, of the fact that the atomized medicine when suitably constituted by addition of glycerine, or other suitable vehicle, after being broken into fine spray by striking against a hard surface, as described by Dr. Oliver, is not readily absorbed into the atmosphere, but will continue to float for a long time upon it.

A CLINICAL LECTURE.

CHOREA;

No. 12.

BY WILLIAM B. ATKINSON, M.D., Professor of the Diseases of Children.

The boy has a sore on his lower lip which has been present for some time. For this we shall order unguentum zinci oxidi with three This is drops of carbolic acid to the ounce.

to be well rubbed in after the scab has been entirely removed.

The treatment will be continued. The

G

LEGE.

[Reported for THE BULLETIN by WM. H. MORRISON, M.D.] ENTLEMEN: This child, suffering with chorea, was before us one week ago. We are informed that the involuntary movements are much diminished. This is not a well-marked case of this affection, or, perhaps, it is a case which is improving under treatment more rapidly than we had expected. A child with a severe attack of chorea will be found to have lost almost entirely the power of cöordination. The cases are sometimes so bad that the patient totters in walking and will look as though he had some paralytic trouble. This affection may be induced by a number of causes. I have known a most terrific attack depend upon the presence of seat-worms. After the removal of the worms the whole difficulty disappeared. You must, therefore, do all that you can to find the cause, but while you are looking for the cause, you must treat symptoms. During the past week, this boy has been taking a tonic containing a preparation of iron; the formula has been :

B. Acidi phosphorici dil.
Tr. ferri chloridi

āā p.æ.

food, such as milk, soft-boiled eggs and the like, but nothing fried. One of my old professors used to say that if he had hold of the man who invented the frying-pan he would hang him.

Suppose that after this treatment has been kept up for a couple of weeks the nervous symptoms still continue, what is to be given? One of the oldest remedies for the treatment of chorea is arsenic, which has usually been given in the form of Fowler's solution, the liquor potassi arsenitis. I do not believe, however, that the effects of the drug are so well obtained from this preparation as from arsenious acid. Granules of arsenious acid containing from one-eightieth to one-fortieth of a grain can be procured. If I find it necessary, I shall order for this boy one-eightieth of a grain of arsenious acid, three times a day. The effect of this drug must be watched. I believe that in nearly all these cases the good results are only obtained when toxic effects are produced. What are the toxic symptoms for which you are to watch? These are oedema under the eyes, swelling of the hands and feet, and slight nausea. When these symptoms appear, you

should be careful how you push the drug any further. It may be that we shall be able to cure the chorea by continuing the line of treatment already adopted.

Chorea-Amenorrhea. This little girl has also had chorea. She was given some domestic remedy and the disease improved. It has reappeared and is chiefly seen in the right hand. The child is fourteen years of age and has not menstruated, and her mother is much inclined to attribute her symptoms to that fact. This function is usually established between the twelfth and sixteenth years of age, but may not appear until the eighteenth or twentieth year. The mother says that there is a tendency in her family for menstruation not to appear until about the eighteenth year. This child may have a tendency to postpone, just as some women postpone the menopause to the age of fifty-five or even sixty. I have had one case in which a woman married a second time, three years after she had ceased to menstruate, and much to her chagrin, her second marriage brought her an heir inside of a year. In another case a woman had been married to her first husband twenty years without becoming pregnant. At the age of forty-eight, six or eight months after the cessation of the menses, she again married, and in due time I delivered her of twins. If I had not known all about this patient and had her under my care, I should have had a little doubt about it.

This girl is evidently weak and ill-nourished. Her tongue is pale and flabby and slightly coated. The pulse is weak. The bowels are constipated. She needs toning up and requires something to stimulate the action of the bowels. "We shall order the following:

B. Tr. nucis vomicæ.

Ex. cimicifugæ

Syrupi aurantii

M. Sig. A teaspoonful four times a day.

We shall also give her, with the above, ten drops of the syrup of the iodide of iron four times a day. This will act as a tonic and an alterative. The child must receive good nourishing food and spend much of her time in the open air. Hygiene is of the first importance in a case like this. If the child is working hard at school she should be removed and the brain given a rest.

Potassium permanganate has been strongly recommended in just such cases as this by Professor Fordyce Banker, of New York, and

other authorities. In order to relieve the nervous symptoms and bring on the menstrual flow, the remedy has to be continued for a length of time. From one-half to one grain may be given three or four times a day. It may be given in the form of compressed or sugar-coated pills. I have not employed it to any extent in my own practice, but those of my friends who have used it speak highly of its powers. It would probably be beneficial where the failure to start the menstrual function was due to the want of a general wakening up of the system, so to speak. You cannot make the child have its menstrual discharge by the use of remedies. I may here refer to what Professor Charles D. Meigs used to say with reference to emmenagogues. He said that the use of such remedies forcibly reminded him of the Yankee who invented a machine to make hens lay. He made a nest with a little trap through which the egg dropped as soon as · it was laid. The hen, turning around to look at the egg before she began to make a fuss about it, would find that she was mistaken, and at once lay another. The first time the machine was tried the hen laid herself entirely away, and there was nothing left but a bushel of eggs and a lot of claws and feathers. Emmenagogues are not able to do the work which they are supposed to do; they can only act secondarily.

Whooping Cough Treated with Tincture of Belladonna. This little girl, two and a half years of age, is suffering with whooping cough. She was here last week and I ordered the following preparation:—

B. Tr. belladonnæ 3ss. Mist. glycyrrhizæ comp.. 3iij. M. Sig. A teaspoonful in water every four hours.

The mother states that the cough is much improved, but that the appetite is very poor. We should not expect the appetite to improve while she was taking this mixture. We learn that the child drinks considerable tea. This should be stopped; of the two, coffee is the less injurious; you burn and grind the coffee under your own supervision, and you know what you have; with tea, you do not know what you are using; it may be a mixture of leaves from our fields, or it may be the siftings from various grades of tea. In talking with a Chinese merchant in California, he told me that very little good tea reached this country. He had some which he had brought over with