is perhaps no doubt that the bromide exerts in time a lasting influence upon the intellectual faculties, which does not, however, justify a total discontinuance of the drug, since there is less harm done by it than by frequently repeated epileptic attacks. In the hysterical varieties the bromide does not, as a general thing, seem to effect the prognosis less than in other forms of convulsive disease.

Another important drug is belladonna and atropia, which in increasing doses, taken for a long time, and the dose lessened upon the commencement of intoxication, but not wholly abandoned, may have a beneficial effect upon the disease. The question when we should prescribe bromide of potassium, and when atropia, I would answer by saying that atropia must be reserved especially for those times and cases in which convulsions follow close one upon another with such severity that the life and intelligence of the patient are greatly endangered. Then atropia frequently renders surprising service. The opinion of Schroeder van der Kolk, that preparations of belladonna exert a bad influence upon the intelligence of the patient, I believe, after experience, during the time before the unniversal introduction of the bromide, to be correct.

A drug of which we ought to expect much as an antispasmodic-namely, curare-is in the highest degree uncertain. It is true I have reported a few cures, and one cured case I had under my observation for many years, but these cases were exceptional experiments. It does not surprise me that curare is generally unreliable, now that we know that it does not operate upon the vaso-motor nerves, and epilepsy is without doubt essentially a vaso-motor neurosis.

The zinc preparations and nitrate of silver are only exceptionally beneficial, and the effect is principally due to the fact that they operate upon a special, but obscure cause of the suffering, e. g., upon irritations of the the pneumogastric nerve. It would be supposed that secale cornutum might be very advantageously employed as anti-epileptic; at all events it should be submitted to careful experimentation.

Quinia and iron probably work favorably only in hysterical and hystero-anæmic conditions. Iodide of potassium and mercury are useful not only in syphilitic complications, but especiallly in symptomatic epilepsy. Hydropathic and thermal measures are universally prized in hysterical cases, and now and then in symptomatic cases. Iron baths are useful in the hysterical variety, but it must be borne in mind that the spasms increase very considerably during the ferruginous treatment; a good result, however, ultimately follows. Electricity is useful ir. the more violent hysterical variety, particularly galvanization along the spine. In general, I find electricity especially indicated where in the intervals there is considerable disturbance of the sympathetic, particularly of the facial branches, etc., the treatment being directed to the special symptoms, e. g., galvanization of the sympathetic and plexus in prodromal disturbances in the upper extremities. In reflex epilepsy the experiment may be made upon the peripheral nerves. Sometimes this is foliowed by decided benefit.

It is especially true of epilepsy, that the physician who studies the disease most diligently, observes most critically the prodromata and different forms of attack, and is swayed by the noble ambition to do all that can be done to help, will achieve greater success than he who heedlessly observes and treats this disease.

The pathological anatomy of epilepsy furnishes very little of practical importance. Whether in the true and reflex forms there is a lesion, and through the affection of the cerebral hemisheres the centre becomes diseased, is unknown, or whether the cornu ammonis is such a centre.

Vascular dilatation in the medulla oblongata seems to occur only secondarily, in consequence of the vascular excitement attending many attacks.—Translated from the Wiener Medizinische Presse, for the Journal of Nervous and Mental Diseases.

INSANITY.

Dr. J. S. Conrad, in the report of the sections of Psychology and Physiology, to the Medical and Chirurgical Faculty of Maryland, held April 11th, 1876, maintained:

1. That in the United States the insane population is increasing more rapidly relatively than the sane.

2. That the present system of support and treatment of the indigent insane serves to increase the number of chronic cases. 3. That the present system of hospitals is expensive beyond the ability of the States.

4. That the cottage system for chronic cases presents the best method of correcting the present system, by securing greater economy, and more liberty and comfort to the insane.

5. That the occupation of the insane can be utilized to a far greater degree with benefit to the patient and profit to the state. 6. That a greater amount of liberty may be granted the insane without detriment to themselves or to others.

The subjoined table is somewhat to the point as showing the increase of the insane :

The increase of population from 1860 to 1870 was 22 per cent. and of the insane 55 per cent. The estimate for 1876 is founded on these ratios. In 1860 there was I insane to 1,310 sane; in 1870 1 to 1031.

Dr. Wilkins, Commissioner in Lunacy for California, in his report of 1871, shows that the propotion of the insane to the sane population of England is 1 to 403; in Scotland, 1 to 336; and in Ireland 1 to 302.-Virginia Medical Monthly, May 1876.

SYNOVITIS BY ASPIRATION.

Dr. N. G. Hutchinson, Proceedings of the Medical Society of the County of Kings, Brooklyn, N. Y., reports a case of chronic synovitis of the knee joint of ten years standing. The patient was 33 years old and ansemic. The leg was considerably flexed, the petella floated on the subjacent liquid, which could be readily detected by its fluctuation. Ten ounces of serum was removed by aspiration and the knee tightly bandaged. One week later seven ounces more were removed and again bandaged. At the end of the second week a small quantity of liquid had again accumulated, but the patient would not permit it to be removed, he being very much improved. Iodine internally and mercurial ointment locally were ordered. Ptyalism was induced in five days from, supposed, excessive use of the ointment, which had to be discontinued. The patient was completely well in two months, and the doctor considers the aspiration the most important part of the treatment.

Ars, ante omnia veritas.

Editorial,

INTERNATIONAL MEDICAL CONGRESS. Philadelphia, Septem"ber 4-9, 1876.

The International Medical Congress will be formally opened at noon on Monday the fourth day of September.

The session of the Congress and of its sections will be held in the University of Pennsylvania, Locust and Thirty-fourth

streets.

I

The General Meetings will be held daily, from 10 to 1 o'clock. The Sections will meet a 2 o'clock.

Luncheon for members of the Congress will be served daily in the University building from 1 to 2 o'clock.

On Wednesday evening, September 6th, Dr. J. J. Woodward, U. S. A., will address the Congress on the scientific work of the Surgeon-General's Bureau.

The public dinner of the Congress will be given on Thursday evening, September 7th, at 7 o'clock.

The registration book will be open daily from Thursday, August 31st, to Saturday, September 2d, inclusive, from 12 to 3 P. M., in the hall of the College of Physicians, northeast corner of Thirteenth and Locust streets, and at the University of Pennsylvania on Monday, September 4th, from 9 to 12 M., and daily thereafter from 9 to 10 A. M. Credentials must in every case be

presented.

Letters addressed to the members of the Congress, to the care of the College of Physicians, northeast corner of Locust and Thirteenth streets, Philadelphia, during the week of meeting will be delivered at the University of Pennsylvania.

The Secretaries of State and Territorial Medical Societies are requested to forward without delay to the chairman of the Committee on Credentials, I. Minis Hays, M.D., 1607 Locust street, Philadelphia, lists of their duly accredited delegates to the Congress.

Delegates and visitors intending to attend the Congress are earnestly requested individully to notify immediately the same Committee.

This information is desired to facilitate registration, and to ensure proper accommodation for the Congress.

Members intending to participate in the public (subscription) dinner of the Congress will please notify the Secretary of the Committee on Entertainment, J. Ewing Mears, M.D., 1429 Walnut street, Philadelphia.

Gentlemen intending to make communications upon scientific subjects, or to participate in any of the debates, will please notify the Commission before the 15th of August.

AMERICAN DERMATOLOGICAL ASSOCIATION.

of

At an informal meeting, held in Philadelphia, at the rooms the Section of Practical Medicine, of the American Medical Association, Wednesday, June 7, 1876, after an election of a