The book is a valuable production and adds greatly to the reputation of its eminent author.

THE PRINCIPLES AND PRACTICE OF MEDICINE. Designed for the use of practitioners and students of medicine. By William Osler, M. D., Fellow of the Royal Society, Fellow of the Royal College of Physicians, London, Regina Professor of Medicine, Oxford University, Honorary Professor of Medicine Johns Hopkins University, Baltimore, formerly Professor of the Institute of Medicine, McGill University, Montreal; Professor of Clinical Medicine in the University of Pennsylvania, Philadelphia. Sixth edition, revised, with new plates. D. Appleton & Co., New York and London.

"Osler's Practice" needs no introduction to the profession. The present edition has been thoroughly revised and brought up to date. It is a volume of 1150 pages, bound in cloth and good type. It covers in short, concise descriptions, the entire field of medical practice. The volume is a classic in medical literature and is esteemed by members of all schools of medicine. To homeopathic physicians especially it is a valuable book, as it contains very little of drug treatment of the allopathic kind. Osler's three great remedies are food, exercise and sunshine, and to these we can all give our hearty approval. THE DIAGNOSITICS OF INTERNAL MEDICINE. A clinical treatise upon the recognized principles of medical diagnosis, prepared for the use of students and practitioners of medicine. By Glentworth Reeve Butler, Sc. D., M. D., Chief of the Second Medical Division, Methodist Episcopal Hospital; Attending Physician to the Brooklyn Hospital; Consulting Physician to the Brunswick Central Hospital, Brooklyn, N. Y. With 5 colored plates and 288 illustrations and charts in the text. Second revised edition. 1168 pages. Cloth, $6.00. D. Appleton & Co., New York.

This volume in its first edition was one of the great successes of the medical book world. It is said that more than 50,000 copies have been printed by the publishers. It is used as a text-book in the college and in many ways is an ideal book on diagnosis. This edition has over 100 more pages than the previous one and over 40 additional illustrations. Many articles have been rewritten and an entire new section upon Diseases of the Mind has been added.

THE ELEMENTS OF HOMEOPATHIC THEORY, MATERIA MEDICA, PRACTICE AND PHARMACY. Compiled and arranged from Homeopathic textbooks by Drs. F. A. Boericke and E. P. Anshutz. 196 pages. Cloth, $1.00. Postage, 5 cts. Philadelphia. Boericke & Tafel.

This little volume is a clear and concise exposition of homeopathic practice and is written especially for those physicians who have not had the advantage of a homeopathic training and yet desire to familiarize themselves with its principles. It is a good book to present to your broad-minded allopathic confrere.

The Editors cordially invite the readers of the Reporter to contribute to this Department and make it a valuable medium for communication between them. To this end we earnestly solicit the following:

Questions, Comments and Criticisms on all topics of interest to the physician in his daily work, from both the medical and business standpoint.

Reports of Society Meetings, Personal Items, Hospital Reports and all News of interest to members of our school.

ing.

Clinical Reports, giving experience in the use of the products of our advertisers.

***

NEWS NOTES.

Jessie C. Dickerson, '98, is located at Muskogee, Indian Ter. *** Wm. F. Rohland, '05, has opened offices in the Rose Build

*** C. A. Stedman, '83, formerly of this city, is located at Choctaw City, Oklahoma.

*** J. R. Gleason, '90, is located at Windham, Ohio. He reports that he is doing a flourishing business.

*** Lewis C. Crowell, '72, Syracuse, N. Y., and E. H. Morrow, '83, Altoona, Pa., were in attendance at the Sanders-Beckwith banquet.

*** Margaret Johnson, '98, was in the city for a few days during the last month. She is located at Spokane, Wash., and is doing well.

*** J. S. Lunger, '91, Prospect, Ohio, has sold his practice to Dr. Pond, who is now in charge. Dr. Lunger is taking a special course at the Eye, Ear, Nose and Throat College, Chicago.

*** The Pennsylvania State Homeopathic Medical Society will hold its 1906 meeting at Atlantic City during the meeting of the International Homeopathic Congress in September.

*** The REPORTER extends a hearty welcome to Dr. A. E. Iberschoff, formerly of Ann Arbor Mich. He has located his offices in the Rose Building and will devote his practice to eye and ear work exclusively.

*** The Southern Homeopathic Association meets at Louisville, Ky., Oct. 23-24. Special attention will be given at this meeting to the needs of the State of Kentucky for some means of caring for its tuberculous patients.

*** The REPORTER has received the announcement of the mar riage of Miss Anna Mehew Price to George Hoff Irwin, at Norwalk, Ohio, on Sept. 20th. Dr. Irwin has been located at Orrville, Ohio, since leaving the hospital and has achieved unusual success. We extend our heartiest congratulations.

Cleveland Medical and Surgical Reporter.

Contributions are solicited upon any subject connected with the practice of medicine or the allied sciences, and the only restrictions placed upon them are that they shall be free from personalities and given to the REPORTER exclusively. The Editors of the REPORTER are not responsible for any opinion expressed by contributors.

Vol. XIII.

DECEMBER, 1905.

No. 12.

Original Articles.

THE MODERN DISEASE "NEURASTHENIA."

By Garrett B. B. Larkeque, A. M., M. D., Athol, Mass.

Nervous exhaustion, like appendicitis, has been popularly looked upon as a disease of modern life, and a vague one at that; a generally wretched condition induced by sharp rivalry in the pursuit of the elusive dollar, especially in this country. It is supposed that people had nervous exhaustion long ago, only it was not frequent enough to get itself classified.

The fact is that a case of nervous exhaustion may show some of the symptoms of every distinct nervous disorder, and lead the victim to believe he has everything from heart disease to softening of the brain. This is not surprising in view of the recent discoveries, since the entire nervous system is involved.

It is now recognized as a distinct disease by the profession, under the name of neurasthenia. The French often associate it with hysteria. Just what changes take place in the nerves is not settled, but the doctors are satisfied with the explanation that there is persistent enfeeblement of neural energy or of a lack of nerve force. To any one who understands the part the nervous system plays in the body, it is plain. that a lack of energy in the nerves must make a tremendous difference in one's life. For example, it is the nerves that keep the temperature of the body the same, whether the man is at the equator or the north pole. The nerves are the regulators of everything that goes on in the body, and when they are not properly nourished-either because they do not get the right sort of food or because they are unable to appropriate it-things all go wrong. No doubt the condition of modern life, the increasing difficulty of most people of living at ease and in quiet have enlarged the proportion of sufferers from this very terrible affliction. Very many people have had it, or have it, or will have it, and its cause, course and treatment are the special study of famous

doctors. Everybody knows how common diseases of the nervous system are. Well, by far the greater number of the victims suffer from neurasthenia. This surely gives warrant enough for all the attention it receives, or is likely to.

Mere sleeplessness is bad enough. It is just as bad as sleep is good, and the most thoughtful and observing men have paid the highest tribute to sleep-which "knits up the ravelled sleeve of care." When to insomnia is added profound depression of spirits, awful forebodings, all the more dreadful because they are vague, the patient's state grows well nigh intolerable. The feeling of lassitude in nervous exhaustion is not like the languor of convalescence, for it is associated with the restlessness of the captive polar bear, without the energy or strength to pace. The sense of weakness and impatience is bitter to endure. There is nothing sweet and tender in the melancholy of this ailment. Headache, complicated and various, is the most usual of all the symptoms, and there are often pains in the back and shifting aches. Frequently there are palpitations of the heart that are very distressing and sudden flushes or extreme hot flashes that leave one dripping, but are soon succeeded by a chill. In short, all sorts of sensations naturally attend a nervous system which is not equal to its work.

Nervous exhaustion may be more frequent among Americans than most other people, but not all. In its hysterical form, it attacks more Hebrews in proportion to their numbers than Americans, who boast of their over-work as though it were a virtue.

An important and suggestive discovery is that neurasthenia is a disease of indoor life. It is a matter of course that by far the greater part of the persons who apply for general treatment at the clinics are engaged in out-door unskilled labor; yet to the sufferers from nervous exhaustion who are treated there, seventy-nine per cent have in-door occupations. Over-work in a house-atmosphere causes worry and is favorable to the development of the disease.

This, of course, suggests the first step in the treatment. Every brain worker knows the effect on the nervous system of long confinement with steady application and the almost immediate benefit, the restorative influence of a walk in the open air. There seems to be an hereditary pre-disposition to neurasthenia, fully one-half the patients in one report recalling a nervous diathesis in a parent. This is the nearest we come to a realization of the frequent prophecy that the American habit of working long under high pressure and anxiety must make nervous wrecks of the coming generations.

Neurasthenia is the most common of the diseases of the nervous system, and one of the most distressing; is grave enough to warrant

every effort to escape it. Its treatment requires a deeper insight into the understanding of mankind than almost any other bodily or mental disease. The mind of the patient calls for as much attention as the body and often more. The first thing, of course, is to remove the Then, in the fully developed cases, isolation and rest are de

manded.

The treatment depends on the individual, but there are general remedial measures that may be applied to most, though in different degrees. These include agencies of reconstruction, such as diet, hydriatics, massage, rest and exercise, changes of surroundings and of climate. Water is used in many ways and often. One scheme is to seat the patient in a bath-tub so that the water can be applied to most of the spinal column. First a quart of hot water is poured slowly on the neck and allowed to run down. It should be very hot-hot enough to bring an instant fiery redness. This is followed by a quart of nearly ice cold water. The applications are alternated until twenty quarts of each have been used, in severe cases. Then comes a thorough massage and in some instances a kneading of the abdomen. Often a careful massage will give relief to the most violent headache.

The water treatment, especially for sleeplessness, is good. Sometimes the cold water pack, the prolonged warm bath, the drip sheet and the wet compress, known as Neptune's girdle, are used to good advantage. The prolonged warm bath from twenty to forty minutes, is at a temperature of from ninety-five to one hundred degrees. The drip sheet is applied by throwing a linen sheet which has been loosely wrung out of water at sixty-five degrees around a patient who is standing in a foot-tub of comfortably hot water, and with a Turkish towel wrung out of iced water about the head. The sheet is applied to the whole body by a few quick rubbings. Then it is removed, the patient is dried and subjected to a light massage. Treatments which may benefit one person may be injurious to another and good judgment must be used in treating the patients.

It is clear that the practitioner who has not made a particular study of the diseases of the nervous system is not equal to the treatment of a fully developed case of nervous exhaustion.

It is not so much physical or mental work or over-work that produces neurasthenia as it is worry, anxiety and depression, which entail sleeplessness and disordered digestion. There are persons, too, who are born with a nervous system deficient in the capacity to produce neural energy or to supply the waste when there is an abnormal tax on the nerve energy.

Nothing could be more timely in connection with this matter than