became affected with inflammatory rheumatism which, I think, proves beyond all reasonable doubt that it was, from the first, one of simple rheumatic fever attacking the nerve centers first.

All authors in discussing the pathology of the nervous disturbances that occur in cerebral rheumatism have made mistakes, it seems to me, from not particularly discriminating between the different forms regarding the symptoms, no matter how different, as being due to the same cause, and in saying that meningitis, which is of rare occurrence, has for its cause some accidental, and simple complication, and is not due to the agency of rheumatic products.

TREATMENT. In regard to treatment I have not much to offer. I think it may be divided into two methods. First, when symptoms of nervous disturbances are manifested, and when unmistakable evidences of cerebral rheumatism have made their appearance. When a patient, suffering from articular rheumatism, is excited and despairing of his condition, I think cerebral complaint may be looked for, and in conjunction with the rheumatic treatment Bromide of Potassium, with choral hydrate may be given to good advantage. It allays the excitement and at the same time exercises some control over the

vessels of the nervous system. But if the symptoms are those of cerebral insanity, then the damage is done, and the treatment then is one of repair, and not prophylactic. In the case that I had which was one of cerebral insanity, I succeded in effecting a cureor I think I did as the patient got well-by the use of Iodide Potassium with the anti-rheumatic remedies. I give the Iodide with the view of absorbing the fibrinous exudate.

ARTICLE X.

REPORT OF COMMITTEE ON NERVOUS SYSTEM.

BY J. H. M'BRIDE, M. D.,

Superintendent Milwaukee Sanitarium for Nervous Diseases.

In the matter of therapeutics of Nervous Disorders, several new hypnotics have been introduced during the past year, of which one, Urethran, promises to be of some value.

In

In my own experience I have found Urethran to be a satisfactory hypnotic, in many cases in doses of from ten to twenty grains. Occasionally it fails, and in some cases it is inferior to chloral. certain cases where chloral is not admissable, Urethran may be used successfully. It seems to produce natural sleep, leaving no unpleasant effects, and does not oppress the heart. Dr. J. S. Jewell gives his conclusions in regard to Urethran as follows:

1st. It is an efficient hypnotic, though not so certain to produce sleep as chloral hydrate. If it does not produce full sleep, it is more apt than chloral to produce unpleasant dreams.

2d. It has but little influence in lowering card ac tension; in this it happily differs from chloral.

3d. It is seldom efficient in less doses than from ten to twenty grains; its action is not quite so prolonged as that of chloral hydrate.

4th. As might be expected, it diminishes reflex excitability to a rather marked extent. It is hence valuable in convulsive disorders of children and in allaying nervousness. For these purposes it

should be given in doses not to exceed three to fifteen grains, every two to six hours.

5th. From the best we have been able to learn, it is to be preferred in most cases to either chloral hydrate, croton chloral, or hypnone, on account of the slightness of its effect in depressing or exhausting nervo-vascular apparatus. Dr. J. B. Andrews reports that he has

used Urethran as a hypnotic with satisfactory results. In experiments upon himself, he found that the sleep produced seemed to be of a strictly physiological character. Its approach was normal and on awakening, there was no headache, nor any other feeling, than that of having been aroused from natural sleep: there was no subsequent disturbance of the stomach of any kind, and in fact, nothing to distinguish it from a pleasant period of repose. In cases of insanity he reports that its results have been quite favorable. The effects of the drug, are felt within an hour from the administration and last six hours, and there are no unpleasant effects whatever.

PARALDEHYDE.

In the Therapeutic Gazette for December, 1885, Dr. Dujardin Beaumetz, gives his expreience with Paraldehyde, as a hypnotic. He says that its advantages over Chloral are, that it is less irritating to the stomach, that it does not depress the heart, that it is especially useful in insomnia of drunkards.

My own experience with Paraldehyde, is that it is a safe and efficient hypnotic. Contrary to the experience of some, I have found that in large doses, it may depress the heart's action and for this reason, caution is necessary in administering it the first time or two to a patient. Its action is very similar to Chloral, though it acts more quickly, and its effects are hardly so prolonged. It sometimes irritates the stomach, though less frequently in my experience, than Chloral. I usually give twenty drops at first, and repeat it if necessary. I have given two drams at one dose without unpleasant effects.

HYPNONE.

Hypnone is another hypnotic, which has been introduced during the past year. It has some hypnotic power, but so far experience has not demonstrated that it is of any special value.

HYDROBROMATE OF HYOSCINE.

This is another remedy that has been introduced during the past year, and promises to take a permanent place as a hypnotic. Drs. Francis E. and John R. Haynes have published the results of their experience with this remedy. They divided their cases into three classes: Ist, those cases in which it produced sleep, which were fifteen in number; 2d, those cases in which it produced delirium, sixteen in number; 3d, those in which it produced no marked effect,

which were twenty-nine in number. As a result of their experience, they conclude that it is unreliable and consider that it should not be used except where other remedies have failed. Dr. Weatherill claims that his experience has demonstrated that it is the best remedy we possess for calming the excitement of acute or chronic mania In this class of cases he gives from one 50th to one 100th of a grain. My own experience with Hyoscine is, that it is variable in its action, though in some cases it is a valuable remedy. The result that can be obtained by one 200th of a grain in one case, can only be obtained in another by one grain. The proper method is, to always begin with a dose not larger than one 200th of a grain, and this can be repeated every hour if necessary. I believe its chief use will be found in cases of insanity in which the patients refuse to take medicine. It is entirely tasteless, and can thereby be administered without the patient's knowledge.

STROPHANTHUS.

Dr. Fraser read an article before the British Medical Association in 1886, upon the uses of Digitalis and its substitutes, with special reference to Strophanthus, a drug which belongs to the Digitalis group. It is a muscle poison, in large doses, and increases the contractile power of all striped muscles. It acts on the heart more powerfully than Digitalis, and it does not contract the blood-vessels.

The chief interest of Strophanthus for the Neurologist is in the fact that it controls functional irregularity of the heart. Dr. F. has used it in this class of disorders, with decided benefit and it is apparently destined to become of value in this direction.

OPERATIONS FOR EPILEPSY AND OTHER DISEASES OF THE BRAIN.

During the past year substantial and valuable progress has been made in the cure of certain diseases of the brain by operation and though the procedures to be now related are surgical, they yet pertain to Neurological science, and appear to belong in the report of this committee. I know of nothing of greater value in the recent progress in the specialty of nervous diseases than in the operative surgery of the brain. Dr. Victor Horsley, has published an interesting article on this subject, in which he gives the histories of a number of cases of Epilepsy in which he operated successfully.

The first case was that of a man who had Epilepsy, following an accident at 7 years of age, which caused a depressed, comminuted

fracture of the skull, causing a loss of brain substance at a point corresponding to the upper third of the ascending frontal convolution. The fits, which were very frequent, began in the right lower limb, and attacked successively the right upper limb, face and neck. They were always followed by right hemiplegia. An operation was performed by trephining and removing an old scar, the result of the orignal injury to the brain. The operation was followed by paralysis of the fingers of the right hand, by incomplete loss of the sense of touch below the wrist, and by loss of muscular sense. Within the next two months, the motor and sensory paralysis, had entirely disappeared. Up to the time of the report, six months after the date of the operation, the patient had remained entirely free from fits. The next case was one of Epilepsy, in which the convulsions began by spasmodic opposition of the left thumb and fore-finger, then the wrist and elbows, and shoulders were involved, then the face twitched and the patient became unconscious. Paralysis of the left leg fre quently followed a fit.

An operation was performed and a tumor was found situated at the junction of the lower and middle third of the ascending frontal and parietal convolutious, which was excised. Before closing the wound, the center of the thumb area was removed by an incision. This was done to prevent a recurrence of the fits. The operation was followed by a cure of the epilepsy but by paralysis of the left arm and shoulder and left side of the face, which, however, shortly disappeared and the recovery was complete.

The next case was one of epilepsy due to injury of the skull, involving the posterior third of the superior frontal convulsion. Scar tissue was found in the brain and was removed and the patient entirely recovered. Dr. C. F. McDonald has reported two additional cases of epilepsy cured by trephining. The first case was due to fracture of the skull on the right side. The patient was violently insane and was confined in the insane asylum at Auburn, N. Y. The skull was trephined, the patient completely recovered, and was soon discharged from the institution. The next case was due to fracture of the skull. The patient was insane. The skull was trephined, the depressed bone removed, and up to ten months following the opera. tion there had been no return of the fits. During the past year Dr. J. B. Roberts of Philadelphia has collected ninety-two American operations for epilepsy, of which sixty-three were cured, thirteen improved, two unimproved, fourteen died. He also cites one hundred