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Unsuccessful cases have been reported, it is true; but it is not to be supposed that any treatment would be infallible in such a disease as rheumatic fever. And I think that satisfactory reasons

can be given why it failed in some cases in which it was tried.

And this brings us to the question of dose. Dr. Maclagan insists on the necessity of quickly saturating the system with the drug. Dr. Ringer says little or no good follows small dosage, and that thirty grains are required every two hours to make an impression on the hyperpyrexia, and that even this dose sometimes fails; and then thirty grains hourly are called for-a dose which he admits encumbers the already diseased system with a toxic state. Without doubt, it is useless to temporize with doses of three to five grains. We must either resort to massive dosage using the drug as an antipyretic-and getting its beneficial results at the cost of salicylism, or else content ourselves with such results as are obtainable with minute doses. Neither course is thoroughly satisfactory, and the medium course, as I have just said, is utterly useless. In all cases blanket your patients, and give them the benefit of warm alkaline-opiate epithems.

In acute cases the benefit is always apparent in twenty-four hours, and the more acute the case the more marked the benefit. The earlier it is given in the course of the malady, the more effectual it is, arresting sometimes the attack as promptly as quinine cures a recent ague, or ipecac a dysentery. The relief of pain is always the first evidence that it is doing good, although in acute cases the fall of temperature is almost simultaneous. In sub-acute cases the benefit is slower and less positive, while in chronic rheumatism it often fails altogether.

In acute cases, there is always danger of heart complications and any remedy which curtails the duration or mitigates the severity of the fever, necessarily diminishes, in a proportionate degree, the risks of cardiac mischief. Unfortunately salicin is not at all times. able to control the fever or prevent the onset of pericarditis. Cases are reported where immense doses have been given-eight hundred grains in five days-which went steadily on to a fatal termination.

In the treatment of gout by salicin, the results have been altogether unsatisfactory.

Cases of diabetes mellitus have been cured with salicylate of soda, after resisting various other treatments.

In endo-metritis and the vomiting of pregnancy, I have frequently prescribed it successfully in grain doses every two hours.

It is highly recommended in asthma, and the fœtid expectora tion sometimes present in phthisis. Twenty grains in four ounces of water, flavored with syrup of orange, a tablespoonful every two hours.

The tincture of the buds is a powerful anaphrodisiac, suppressing venereal desires for a long time, and is highly recommended in the treatment of spermatorrhoea.

SOME OBSERVATIONS ON THE GENERAL PARALYSIS OF THE INSANE.

BY A. FITZGERALD, B. A.,

Member of the Royal College of Surgeons of England; Fellow of the Royal College of Surgeons of Edinburgh, etc., etc.

The first notice of the malady is to be found in the work of M. Bayle, which appeared in the year 1822, entitled, "Recherches sur les maladies mentales;" but the first distinct treatise was. published by M. Delaye in the same year, and styled "Quelques considérations sur une espêce de Paralysie qui affecte particulärement les aliénés.” M. Bayle and Calmeil have since written on the subject, and Dr. Calmeil's work is justly considered one of the best of the kind published in any language.

Having had occasion to witness, at the Middlesex Lunatic Asylum, several cases of general paralysis, I was convinced, that if Dr. Calmeil's division of the disease in three distinct periods was not absolutely correct, it was certainly the most convenient arrangement. The commencement is different in different cases.

After an epileptiform attack the mind has become affected. The diffident man now boasts of his wealth and rank, and looks down contemptuously at what he previously viewed with awe and respect; he becomes haughty in his demeanor, or condescending in manner to his superiors as well as his inferiors; he makes foolish speculations, extravagant purchases, and incurs the disapproval of his friends and the contempt of the world. When, at last, the mind

is suspected of not being all right, the physician is consulted, and finds a slight and peculiar affection of the speech. It is, therefore, necessary to inquire if this peculiar impediment of the speech existed before the total change of character was observed, as it is one of the first symptoms of general paralysis, and one which never fails to be present in all the stages of the disease.

After years of recurrent mania, good and bad symptoms alternating, and sometimes after continued mania, lasting for several years, the speech has become lingering, and the legs are observed to be a little unsteady.

In the hesitation of speech to be remarked in general paralysis, the patient does not stammer or repeat his words, but there is a lingering, which is not unlike the pronunciation of a person in a state of inebriety. When asked to protrude his tongue, the patient does so hastily, with a sweep from side to side when retracted. Sometimes it is protruded by successive efforts, or rather kept so by such efforts, and in later stages protrusion cannot be accomplished; there is a slight trembling about the corners of the mouth.

Although the muscles of the face have free play in the first stage of the disease, an incipient immobility is to be seen. Good and bad symptoms alternate, but the progress of the malady is to be remarked in the increased difficulty of the pronunciation, and by the appearance of a want of vitality in the features, which gives a fatuitous and expressionless look; the upper eyelid is raised with difficulty, the look is stupid, the cheeks are pendulous, and the lips touch without the power of resting one upon the other.

Dr. Calmeil says the lower limbs are paralyzed first. M. Lallemand says the disease appears to begin in the lower limbs, because their weakening is more perceptible on account of the strength required for the exercise of their functions. He says he has met with paralyzed patients who could not walk or sit up, but who, when placed on their backs, could exercise their legs in various ways; but when a glassful of liquid was placed in their hands, they spilt a portion of it when carrying it to their mouths. My experience leads me to agree with Dr. Calmeil, and I believe what Mr. Herbert Mayo says of herniplegia when he considers it a palsy stroke, which affects the arms first from their proximity to the brain, is not applicable to the general paralysis of the insane.

The second period of the disease is ushered in by an increase in the intensity of the symptoms, and attacks of congestion frequently occur in this stage. The patient is now very much excited at times, and will bear no contradiction. If there has been any doubt in the physician's mind, it is now completely dispelled. It is no longer the fatuitous look and the hesitation of speech; the patient is often delirious and furious, the face is flushed, the eyes prominent and injected, the breathings hurried, and an attack of epilepsy will occasionally supervene.

When Dr. Conolly, accompanied by a large class of students, was going round the wards of the Hanwell Middlesex Lunatic Asylum, he called their attention to the following case of general paralysis:

W. R. was engaged in one of the fisheries of the North of Ireland by a London company. Fever prevailed among the men employed by him, and much additional anxiety and labor devolved upon him. He returned to England full of delusions, and so consequential, that his employers could not understand him or make him useful. This case having been reported to Dr. Conolly, W. R. called one day upon him, and as he was not at home, left his card as Sir W. R., preparing me, said Dr. C., for the nature of his disease.

In this case, in fact, was well exemplified the ambitious monomania which so generally accompanies general paralysis. W. R. was a baronet; his wife had left him because he had been married to Queen Victoria; she had gone away with another man, and had committed infidelity with four thousand men. At all this he was very much distressed, and would fret for days; the speech was lingering and the tongue tremulous. At other times I have seen him in the best of spirits; his voice, he would say, was superior to Jenny Lind's; he was second in command at Navarino, took thirty-five ships, only killing one man; he was a great tragedian.

Fits of animation and depression continued to alternate for a year, when severe epileptiform attacks supervened, and coma, threatening death. In a few days he was up and dressed, walking about again, but his consciousness and memory were injured. W. R. had a well formed head.

When I last saw W. R. he had been two years and a half in

sane, and although rallying from epileptiform attacks, he was obliged to keep his bed; his face was flushed, his eyes prominent, he readily raised his arm when asked to do so, but could not move his legs; consciousness, although much impaired, was not extinct. I could not ascertain if he remembered me, as to all questions the only answer was "yes," and with more of that fatal lingering of the speech, which is peculiar to the general paralysis of the insane, than I had observed on previous occasions.

The two first stages of the malady are well exemplified in W. R.'s case, viz. First stages, or period of incubation, with alteration of character; second stage, the acute maniacal period.

Several patients have been irregular in their habits. B. S., a male patient, was admitted to the Hanwell Middlesex Lunatic Asylum; he had been an attendant on the insane in another asylum, and was a tall, stout, powerful man, forty-six years of age, with the appearance of a drinker. General paralysis was here manifest; there was the unmistakable pronunciation, and not the distinctness of speech found in alcoholic paralysis. He was particularly lively, good-humored and incoherent. The ambitious monomania was not wanting; he was the Pope, his father was a king; he had twenty-five wives. The poor man died suddenly six months after his admission, having been insane one year and a half.

Intemperance, although an occasional cause, is not so general as it has been supposed to be. In the majority of cases the patients have been temperate men, with active, overwrought brains, which fell into disease from excessive labors and anxiety. The only case in which I have seen the ambitious monomaniac absent, was in the case of C., a tailor, aged thirty-three, admitted with general paralysis, caused by immoderate drinking. He had the peculiar pronunciation and other symptoms, but his ambition to be no longer a journeyman and to set up in business for himself was quite legitimate.

The third stage of the disease, or that of chronic dementia, is characterized by hopeless dementia and utter fatuity: the patient can only walk slowly, with a shuffling gait; the countenance is vacant and puffy; he gets thin, the hands tremble like a person palsied by age; there is grinding of the teeth. The appetite is

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