annoying people or circumstances, plenty of sleep, fresh air and exercise and agreeable occupation; mental and physical diversion also must be afforded. The most careful attention to detail in all the various methods pursued; the dietary must be changed, allowing the sufferer plenty of vegetables and such, but very little meats, and the less pastries and sweets used the better, always giving a light meal at night. Thorough elimination must be secured, and intestinal antiseptics and digestants given as required; the skin must be kept clean, and its glands in the best condition, hydrotherapy being invaluable for this end.

Concerning drugs, some must be given, and experience has proved the bromides to be superior to all other forms of medication, and it matters very little which one is chosen, as sooner or later all will produce similar disagreeable results, which, however, can be greatly ameliorated by careful management. The most acceptable method of administering the bromides is to give them in combination with sodium, glycerophosphate. Some prefer bromipin, which is a solution of bromine in oil of benne.

As has formerly been emphasized, changing and combining the various salts is productive of advantage, and the administration of such agents as atropia, chloral, adonis, vernalis, horse nettle, etc., in combination with the bromides, will permit of a considerable reduction in the size of the dosage. Similar results are claimed for the use of sodium bromide in place of sodium chloride as a seasoning for the food. To prevent or remove the disagreeable effects of bromism, the use of sulphur, hot baths, alkaline diuretics, arsenic, calcium sulphite, and, in severe cases, some substitute drug temporarily in place of the halogen salts are of benefit.

The treatment should be suspended one or two days a week, and must be kept up for at least two years.

Cerebral Arterio Sclerosis.-Those changes, senile or pre-senile, of the arterial supply of the cerebrum classed under the term arterio sclerosis, in which, owing to the changes in the vessel walls the "second heart action" of their muscular layer is lost, and because of which and the lesions found in the intima, there is a loss of elasticity which renders these vessels so liable to rupture under any strain, or in older subjects with weakened heart action allows a stasis, even a clotting of the contained blood stream, producing a variety of symptoms of an untoward nature. Fortunately, nature rings an alarm bell as these changes proceed, and if the warning is properly interpreted, and means for their relief speedily instituted, the graver results can be postponed. So it behooves the physician to give a thorough examination to these subjects, and to hold himself in readiness to combat the onward march of this progressive disorder. In the management of these cases nothing can be done to replace the loss of vital rubber, so our only hope is to check, if possible, the opera

tion of the underlying cause, so as to make amends for the damage already done. In making an effort in this direction the subject must be removed in so far as practicable from strains, shocks, and any form of excitement. There must be no dissipation, no undue exertion, no exposure to inclement weather; in a word, the utmost care must be practiced. No overfeeding, no over-consumption of even the blandest of fluids, plenty of sleep, moderate exercise, warm clothing, and personal and domiciliary cleanliness secured.

As to treatment, keep the skin active by judicious bathing (caution must be observed in recommending hot baths to these cases). The kidneys must be put in good condition, and careful attention to the bowels advised; the best purgative agents are salines with an occasional mercurial, discountenancing the use of "liver pills," as their use is not followed by the same benefit as the agents named.

The remedies which give the best results are nitroglycerin, ammonia and potassium iodide, given separately or in combination, probably the most satisfactory method being to give: R Ammon. chlor., gr. ij ss; kalii iodid., gr. v; F. E. taraxici qs., 3j, at a dose, to be given after meals. Then give nitroglycerin in gr. 1 three times daily. If there

is any indication for general tonic medication the Elix. Nitroglycerin Comp. 3j doses may be given instead.

If there be any evidence of syphilis, lead, alcohol, or rheumatism, suitable remedies can be given to control these causes, as so long as they continue to operate other treatment will not avail much.

Localization.-Cerebral-It was formerly taught that the motor area of the cerebral cortex was located in the Rolandic area, comprising both the ascending frontal and the ascending parietal convolutions. In 1901 Grunbaum and Sherrington reported a series of investigations in higher apes, which they claimed showed the motor area to be limited to the parts anterior to the Rolandic fissure. In 1905 Mills and Frazier report results of 138 observations of faradic stimulation in the Rolandic area, and as a result practically confirmed the statements of Grunbaum and Sherrington. This area, as mapped out by these gentlemen, comprises. the ascending frontal convolution (precentral gyrus), with an anterior extension into the middle and inferior frontal convolutions bordering the inferior frontal fissure.

Cord. There is a failure of evidence to prove the exact path in the cord for the conduction of pain and temperature sensations, and whilst it is probable that such an office is subserved by Gower's antero-lateral ascending tracts, still the assumption is by no means a certainty.

Spiller reports a clinical case presenting lesions of these tracts which gave rise to analgesia and thermoanesthesia in the parts below.

Similar sensory phenomena are present in the condition denominated "syringo-myelia," where the lesion is in the central area of gray matter

of the cord, in which region the anatomists have demonstrated are found the parent cells of the fibers composing these tracts.

THERAPEUTICS.

Chloretone.-Chloretone is rapidly gaining the recognition it deserves. Its value as an antiseptic, as a local anesthetic and especially as a hypnotic has been conclusively demonstrated. Chloretone resembles chloral in some respects, but possesses certain advantages, chief of which are a lesser liability to irritate the stomach and the absence of a tendency to depress the circulation. Its chief action is that of a sedative to the central nervous system. Very large doses have been swallowed without producing any untoward symptoms, so the claim can be made with confidence that the drug in medicinal doses is non-toxic. In addition, its non-irritant properties, together with the fact that it exerts little effect upon the heart, certainly commends its use as a hypnotic in preference to chloral. rule the hypnotic effect is obtained by the use of smaller doses than are necessary in the case of chloral. It is a remedy of great service in cases of nausea, gastric irritation and vomiting, conditions it relieves by paralyzing the terminations of the sensory nerves in the mucous membrane of the stomach. It is, in fact, the very best remedy to counteract the distressing nausea of sea-sickness; five grains administered at intervals of four hours during the first day or possibly the first two days of the voyage will tide the "mal de mer" victim over and have the effect of rendering the latter days of the voyage comfortable, even in heavy seas. Chloretone is likewise serviceable in allaying the unpleasant nauseasymptoms following chloroform or ether anæsthesia; here the dose should be fifteen grains administered two hours after the operation. Owing to the fact that chloretone paralyzes the terminations of the sensory nerves when it is applied locally, frequent use is now being made of it as a local anesthetic. Together with menthol and the various antiseptic oils, all in solution in liquid petrolatum, it affords relief in irritable conditions of the nasal, pharyngeal and bronchial mucous membranes. In addition to its local anesthetic properties chloretone has some power as an antiseptic, which of course enhances its value as an ingredient in the above mentioned solution intended for application to inflamed mucous membranes. In concentrated aqueous solution its action is that of an efficient local anæsthetic on wounded surfaces and mixed in the dry state with an equal quantity of powdered boric acid it forms an excellent dusting powder for wounds, bed-sores, ulcers, etc.

The principal use of chloretone is to produce rest and sleep in cases of insomnia and in practically every form of nervous excitement; in delirium, even in mania and convulsions. Its action is especially good in delirium from fever.

Chloretone occurs in white crystals with camphor-like odor and taste. It is only sparingly soluble in water; warm water will take up about one

per cent. but on cooling a portion crystallizes out leaving a saturated solution of about 0.8 per cent. strength. It is soluble in alcohol and in glycerine, but the best way to administer the drug is in powder, or if the taste is objectionable, in capsules or wafers. The dose as a hypnotic is from five to twenty grains.

Camphoric Acid.-Camphoric acid is now an official drug duly recognized by the new pharmacopoeia. The revisers acted wisely in accepting this drug as one of the additions for official recognition. Its place in therapeutics is firmly established. It has many uses in medicine, but it is especially prominent as a remedial agent in combating the night-sweats of consumptives. The claim can safely be made that the use of no other remedy is followed by results so beneficial as follows the administration of camphoric acid in controlling the profuse night-sweats of pulmonary tuberculosis. The controlling influence is also exerted in sweating from other causes. Locally, its action is that of a mild antiseptic. In one per cent. solution it is useful in the treatment of pharyngitis and laryngitis ; in the same strength solution it has been used with benefit as a bladder irrigation in the treatment of chronic cystitis. Internally administered, camphoric acid gives good results as an intestinal disinfectant, proving beneficial in the treatment of diarrhoea resulting from intestinal fermentation. The dose for internal administration is from 10 to 30 grains, usually in powder or wafer. In combating profuse sweats it is well to give full doses. When employed in the treatment of night sweats camporic acid should be given about two hours before the time the sweat usually occurs. If the sweats occur in the morning the drug must be administered late at night, as it is quickly eliminated in the urine.

Picric Acid.-Picric acid is of little value in medicine for internal administration, but applied locally, in saturated aqueous solution, to burns, its value can scarcely be estimated. Could this solution be applied immediately or within a few minutes after the accident in cases of burns the percentage of fatalities would be materially lessened. It allays the pain at once, is antiseptic, and moreover, excludes the air through its chemical action, which might be likened to a tanning effect. The solution should be applied freely, keeping the burned surface wet through the medium of cotton or gauze compresses soaked with the liquid. An outer covering of rubber tissue or oiled silk will tend to keep the dress. ing moist and occasion the use of a smaller quantity of the fluid.

Picric acid, in aqueous solution, locally applied by means of compresses, is also employed successfully in the treatment of eczematous and copiously weeping affections of the skin. It should not be applied in the form of powder, as its action is that of an irritant in the concentrated state.

Euquinine.-Euquinine is meeting with increased favor, particularly in the East. It is used quite extensively in New York, where it is

probably best known. Euquinine is said to possess the virtues of quinine without its bitter taste and without inducing ringing in the ears and other objectionable secondary symptoms. It also has a considerable advantage over quinine in the treatment of children in that it is tasteless. It must, however, be administered in substance; solutions of euquinine are decidedly bitter. Its therapeutic value is highly praised by various writers as a remedy in the treatment of malaria, influenza, neuralgia, migrain, fever occurring in tuberculosis, pertussis and many other conditions. In whooping cough it is recommended that the treatment should be instituted as promptly and energetically as possible, in which case, the claim is made, the affection may often be suppressed within a week. The treatment consists in giving two doses of the drug daily, ranging from 3 to 10 grains, according to the age of the child.

In the ordinary therapeutical uses to which quinine is put, it not infrequently occurs that a patient is met having some idiosyncrasy for the drug. In such cases euquinine appears to be the ideal substitute.

Theocine. (Synthetic Theophylline.)-Natural theophylline is an alkaloid possessing strong diuretic properties and found in tea leaves. The natural alkaloid is, however, found only in small amount and the small yield has precluded its use in medicine, but its synthetic production, under the name of theocine, has made its employment as a valuable diuretic possible. It is now manufactured on a large scale in Germany and enjoys the distinction of being the first instance of the successful production of an alkaloid on a commercial scale by strictly synthetic methods. Theocine is regarded as one of the best diuretics and acting quickly. At times it is not borne well by the stomach; this contingency may be obviated by avoiding its administration on an empty stomach, and by restricting the dose to two or three grains. The average dose is five grains, and the maximum dose should not exceed eight grains. Theocine should not be prescribed as a powder on account of the stomach affect, but rather in the form of a solution. Other than an occasional gastric disturbance, theocine seems to be quite free from secondary effects.

Guaiacol.-Guaiacol is one of the chief constituents of creosote and familiar as a substitute for creosote in the treatment of pulmonary tuberculosis. That it has any specific action on the tubercle bacillus is questioned, but as it is eliminated by the bronchial mucous membrane it frequently does good by diminishing the cough. Given internally in medicinal doses, its action is that of an expectorant and intestinal antiseptic. Guaiacol is an excellent remedy, diluted with three or four parts of glycerine, locally applied by means of painting it over the scrotum, for the relief of orchitis. Pain is promptly allayed, and the swelling gradually subsides. The frequency of application depends much on the sensitiveness of the skin; the applications are usually borne well if made every other day.