weeks, and after partially sobering up he kept with his low associates for several weeks longer, so that I did not see him again until February 6, 1895, when he came into my office in a truly pitiable condition. His money was all gone, he had been half-starved for several weeks, he had been exposed to cold and wet during some very cold weather, he had a severe, hacking cough, with some slight expectoration, his feet and ankles were swollen and edematous, his breath was quite short, especially after any exertion, he was thin, white and pinched. The action of his heart was quite weak and irregular, ranging from 100 to 120 at different times; the mitral murmur was much more apparent and slight murmurs were to be heard at the other valves. He was sent home and told to go to bed.

The next day he reported that he was in no way better for his rest; he had slept but little and from that had derived no benefit. It was now apparent that rheumatism could have had no part in causing his trouble, for he had been so exposed during his spree that any rheumatic tendency must have developed, but no articular trouble could be found, nor the history of any such trouble. The iron had given him no relief when persisted in for weeks.

The possibility of a syphilitic taint became a strong probability; as a test by medicine he was ordered one-twelfth of a grain of red iodide of mercury with eight grains of iodide of potash in solution three times a day. After three or four days his improvement was manifest and after one week he could sleep quite comfortably at night, had much less pain in the region of the heart and complained little of shortness of breath. The treatment was continued for three weeks without interruption, when his improvement was so great that but two doses were given each day instead of three. At the end of one month he felt very well, looked better in every way, his heart sounds also had improved; no murmur could be heard except the mitral regurgitation and that was much less apparent than before the iodide had been given. The edema had entirely disappeared. He was allowed to go to

work and did so with very little inconvenience. On March 26 I listened to his heart and had some difficulty in making out any murmur whatever. He is working now at hard labor and has no difficulty in performing his share. He was advised to continue the same medicine at least once a day for several months and to continue under observation. On April 2 I examined him again and no murmur could be detected.

Recent references to heart syphilis may be found in Flint (Practice of Medicine, pp. 324 and 349), Osler (Practice of Medicine, page 178), Loomis (Practice of Medicine, page 543), Keyes (Venereal Diseases, page 203), and in Vol. II of Morrow's System of GenitoUrinary Diseases, Syphilis and Dermatology, pages 375 and 376. This is in the article by Councilman on visceral syphilis, in which he treats of syphilis of the heart. He describes minutely the pathological changes that have been observed in the heart as a result of syphilis, especially changes in the myocardium; of endocarditis he says, "There

have been cases described in which the lesions were limited to the endocardium. It is very difficult to say how many of these should be ascribed to syphilis." He quotes Lang, who describes a syphilitic valvular endocarditis in which papillary condylomatous grayish - white nodules are distributed along the edges of the valves. He quotes a case reported by Baumgarten, of a man twenty-eight years old, who had, along with syphilis of the cerebral arteries, a soft, smooth, round excrescence on the left flap of the mitral valve. Councilman, however, does not relate any of his own cases in which syphilitic endocarditis may have occurred. Either of the lesions described above would probably cause during the life of the individual just such a murmur as existed in my case; and anti-syphilitic treatment, in all probability, if begun early enough and persisted in would have produced a rapid and complete reabsorption of the neoplasm and a consequent disappearance of the murmur. This, I think, is what happened to the man that I had to deal with.

It is a well known fact that the heart murmurs of rheumatic endocarditis frequently disappear if properly handled soon after their commencement, but this man had no rheumatism, even when exposed to very severe weather, with insufficient clothing and food while on his drunken sprees, an experience that must have involved some of his joints were he suffering from rheumatic taint. Nor could the murmur be hemic, for, although he was quite anemic in appearance and for a while very poorly fed, yet the murmur made its appearance at a time when he was otherwise in ordinarily good health, and grew no better when he was carefully nourished and treated vigorously with iron.

The course of the disease seemed gradually but surely to progress alike under good care and attention as under the grossest neglect and positive abuse. No marked improvement followed any treatment until he was put on the iodides, when he began at once to receive benefit; and this change for the better has been lasting, he has gone on steadily growing stronger, has lost his heartpain, has entirely got rid of the murmur and works every day as well as ever at very hard work. The course of improvement is so very like the recovery from some syphilitic nervous lesion that the striking analogy renders the accuracy of the diagnosis almost certain.

IS THERE any one present who has not read "Trilby ?" If so let him hold up his hand; or better, let him preserve his incognito and make good the omission at the first opportunity. What is it that gives this book its wonderful charm, so that young and old, men and women alike, yield to its fascination and devour its pages? And why have its characters become so suddenly living personalities in our daily life? It appears to me that at least one, if not an all-sufficient, reason, can be found in the fact that the story is a series of flashlight photographs of living beings and actual scenes. It throws these upon the screen in the strongest light and shade. It is absolutely true in all its detailssets down naught in malice and naught extenuates-indulges in no mawkish sentimentalism or morbid introspection, but goes straight to its point with all the directness, naïveté and freedom from affectation of an Old Testament narrative.

Among its pictures we find one of an interesting case of disease of the great nerve centers. It is boldly drawn and

with few strokes, the description being not that of a scientist, but of an acute lay observer. You all know the story. How a gifted young artist, little more than a boy, of a temperament sensitive, emotional and high-strung, receives a sudden and terrible shock, in the cruel loss of the woman whose love he has just succeeded in winning, and whom he in turn loves to distraction. An outburst of stormy and semi-maniacal rage followed the discovery. “And finally he gasped, screamed and fell down in a fit on the floor." "Little Billee's attack," says the author, "appears to have been a kind of epileptic seizure. It ended in a brain fever and other complications -a long and tedious illness. It was many weeks before he was out of danger and his convalescence was long and tedious too. His nature seemed changed. He lay languid and listless-never even mentioned Trilby, except once to ask if she had come back, and if she had been written to."

At length one day, touched by the devotion of his mother and sister, "tak

ing them both in his feeble arms, he fell aweeping quite desperately, and for a long time.

And when his weeping time was over, when he had quite wept himself out, he fell asleep. And when he awoke he was conscious that another sad thing had happened to him, and that for some mysterious cause his power of loving had not come back with his wandering wits had been left behind - and it seemed to him that it was gone forever and ever would never come back again -not even his love for his mother and sister, not even his love for Trilbywhere all that had once been was a void, a gap, a blackness.”

At the end of a few months spent in his native village, his health returns, he takes his part in the social life of the village, and awakes one morning to find himself famous, his pictures painted while he was in Paris having achieved a distinguished success. "But," still using the words of the story teller, one thing constantly preoccupied and distressed him-the numbness of his affections." "It was as though some part of his brain, where his affections were seated, had been paralyzed, while all the rest of it was as keen and active as ever. He felt like some poor live bird or beast or reptile, a part of whose cerebrum or cerebellum (or whatever it was) had been dug out by the vivisector for experimental purposes; and the strongest emotional feeling he seemed capable of was his anxiety and alarm about this curious symptom." "He felt,

rather bitterly, how happy he could be if the little spot or blot or knot or clot, which paralyzed that convolution in hist brain where he kept his affections, could but be conveyed away." All the adulation of the world of fashion, all the distractions of London society, cannot charm away "his everlasting chronic plague of heart insensibility, which no doctor could explain or cure." His own diagnosis of his case occurs in a monologue held with an amiable dog of the name of Tray: "Wait," he says, "till you get a pimple inside of your bump ofwherever you keep your fondness, Tray. For that's what's the matter with me

a pimple just a little clot of blood at the root of a nerve, and no bigger than a pin's point."

For

Thus much for the clinical picture. What shall we say as to the diagnosis? To a certain extent it is corThere is a lesion of an important nerve center. It may be, in his unscientific language, 'a spot or a knot or a blot, or a clot" we often come no nearer an accurate description of a pathological condition ourselves which is paralyzing this nerve mass. But he mistakes in locating it in either the cerebrum or the cerebellum. every human being has two brains, a thinking brain and a feeling brain; a rational brain and an emotional brain, a brain which ponders and calculates and schemes and records impressions of the outer world, and a brain which loves and hates, rejoices and grieves. The rational brain it situated in the cranium, the emotional brain in the abdomen. In common parlance we speak of their respective functions, or manifestations, or resultants, as mind and heart. anatomists we know of course that the heart, being simply an ingenious pump, has nothing to do with the case more than 'the flowers that bloom in the spring.' This expression has come into use because the heart, for wise purposes, is greatly under the control of the emotional, or as it has been well called, the "abdominal" brain, and responds quickly to its varying stages and perturbations.

As

any

The old phrase "bowels," meaning not the intestinal tube, but the abdominal viscera, comes much nearer the truth. Thus we read in the Bible of "bowels of mercies,' "bowels of compassion," and of the "yearning of the bowels." The particular viscus, from which the affections emanate and which was the seat of Littrebilli's malady, is the solar plexus, composed of the two semi-lunar ganglia, with the wonderful interlacement of nerves and lesser ganglionic enlargements which bind them together and at the same time associate them with the sympathetic and cerebrospinal nerves and ganglia. The old anatomists showed a correct appreciation

of its importance in naming it the solar plexus, for it is indeed the sun of the human system, radiating light, warmth and joy to its remotest parts, while when its rays are withdrawn, the whole nature is shrouded in gloom.

What do we know of this important organ? Little enough. Both anatomist and physiologist pass it by with the baldest kind of a reference, and in autopsies no one thinks of digging it out from its secure hiding place behind the stomach, and interrogating it for the solution of the obscure problems of emotional pathology.

It is probably safe, however, to attribute principally to its abnormal action or condition three by no means uncommon and very intractable affections, hysteria, melancholia, and hypochondria. I think it was Abernethy who recorded it as the result of his extensive observation that no one ever died happy who died of a disease below the diaphragm. This is readily understood if we consider how directly affections of the organs of that region must react upon the abdominal brain. The depressing effect of dyspepsia in all its forms, and of defective action of the liver, upon the spirits is explainable in the same way. Of acute diseases the only one which we can reasonably consider as directly affecting the solar plexus is epidemic influenza, and I know of no other way of accounting for the protean manifestations of that malady, and especially for the profound and abject despair which is so constant an accompaniment of it.

If we know little of the pathology of this organ, we know still less of its therapeutics. The agent which appears to have the greatest affinity for its cells is alcohol, and next to that nitrous oxide. It is probable that all the nervines affect it in common with the rest of the nervous system. Of these, nux vomica and its derivatives have the most potent influence. Coca, theine and caffein are also possibly of value.

Physics, rather than physic, however, must furnish our armamentarium for the treatment of disorders of this important nerve center. The imponderables-light, heat, electricity, and that

which includes, involves and evolves them all, motion, are the agents on which we must place our main dependence. We must work back through the terminal sensory nerve filaments to the centers of sensation and of emotion, and thus modify their nutrition. Light and heat are available through travel and change of climate, and the sun bath. Heat, locally, may either be added or rapidly abstracted. Hot and cold douches are favorite means of accomplishing these objects, but the hot water bag and the ice bag are more manageable and efficacious and usually more acceptable to the patient. They should be applied to the epigastrium and to the corresponding region of the back on either side of the spinal column.

Electricity may be employed both generally and locally, that is to the muscles and the cutaneous surface. Faradization generally and galvanization locally give the best results. Locally one pole should be placed over the epigastrium and the other on either side of the spine, below the tenth ribor one on the neck just below the angle of the jaw and in front of the sternocleido-mastoid muscle, and the other alternately at the epigastrium and over the points indicated on the back.

Motion is administered in the form of exercise in its ordinary sense, of Swedish movements, and of massage. For those who are strong enough to take it, the saddle is an admirable prescription, not only for its invigorating effects on the general processes of nutrition and the emotional exhilaration which it arouses, but because the vibrations which it produces act directly upon the capillaries and cells of the central nerve mass under consideration.

In cases in which the patient is unable to take ordinary exercise, the movement cure provides an admirable substitute, affording us the advantage of exercise without the expenditure of nerve force. This should always be accompanied by massage, and, indeed, in a large number of cases the latter alone can be resorted to. Its application includes the four well known divisions of kneading, stroking, friction ing, friction and percussion, which

should be varied to suit the requirements of each particular case. The form known as vibrations is of special service in these conditions. These may be applied either by the hand of the manipulator, or, much more effectively, by means of a machine constructed for the purpose. In this way, vibrations of excessive rapidity may be communicated to any part of the body for any required length of time. The abdomen,

epigastrium and dorsum are the proper points for application in the affections under consideration. This therapeutic means produces a profound impression

INFLUENZA AFTER CHILDBIRTH.-Influenza or grippe is principally a serious. malady on account of its complications. The lying-in woman is especially susceptible to infectious diseases and no conscientious physician will attend a labor case after a visit to a contagious disease. One would think that the lying-in woman would be a prey to influenza, but as Dr. R. Abrahams points in the American Journal of Obstetrics, the facts show that the character of the grippe infection differs from all other known infectious diseases at least as far as the relation of the infection to the puerperal state is concerned.

His observations on this subject lead him to state positively that the woman in her accouchment is no more susceptible to grippe than her husband, but if this disease does gain a foothold at this period it is very demoralizing in spite of the most elaborate antiseptic precautions. In conclusion he says that the following points have guided him to at correct diagnosis :

"The uterus in every case was normally contracted and of normal size; no tenderness or pain over it or its appendages, either by abdominal palpation or vaginal examination. The lochia, which in very severe cases were somewhat suppressed, yet in all were of the normal color and odor; the os was not patulous, and tympanites was absent.

"In addition to these valuable differential points, I made it a rule to examine most carefully every patient, with a view to the detection of some possible

on the nutrition and cellular activities of the nervous tissues, and should therefore, like galvanism, be used with caution and discretion.

My object in bringing this subject before the Society has been to call attention to a neglected and, as I believe, fruitful field of research, and to urge upon those who have the time, the facilities and the training, the importance of losing no opportunity of prosecuting microscopical and laboratory investigations into the pathology and the cellular affinities of the great solar plexus.

hidden source of infection, and in each case the result was negative.

"The prognosis, as far as I could judge from my experience, is good. Not one patient died, not one developed sequelae. In one instance an urticarial eruption appeared, during the course of the complication, over the abdomen, which was attended with severe itching, but I was inclined to think that that was the result of the quinine that was given for the temperature.

"No matter what type the grippe assumed, the average duration was not longer than from four to eight days. Thereafter the woman felt and looked as if she fought hard, but had the satisfaction of being the victor. My treatment is worth mentioning for its negative character. The ice bag, the curette, the intrauterine douche, were conspicuous by their absence; the main reliance was placed on good nourishment and stimulants when indicated."

* *

TRIONAL-POISONING. Hecker (University Medical Magazine) reports the following case : A woman, aged 50 years, a sufferer from mental depression for ten years, had taken forty-five grains of trional at bedtime with good results for a period of ten days. Subsequently, however, the drug induced coryza, slight fever, vertigo, weakness and profound malaise. Subsequently symptoms resembling paretic dementia developed. The discontinuance of the hypnotic was followed by complete restoration to her former condition.