ache, pain in the back and limbs, with vertigo and delirium, in some cases with convulsions. Dr. Mary Putnam-Jacobi (The American Journal of Obstetrics, June, 1874), has analyzed one hundred and sixty-three cases, and finds that there are several modes of onset. In twelve cases the paralysis occurred suddenly without any prodromes; in some cases the paralysis appears in the morning after a quiet night, or better between morning and evening, without symptoms. In the majority of the cases there is an attack of fever lasting two or three days; in some, merely nausea and vomiting, and in still others the paralysis is preceded by convulsions. What symptoms soever precede the palsy, they subside in a day, or in two or three days, and the health seems restored, but one limb or several are found to be paralyzed; or one legs fimp and motionless, and in an hour or two the other leg is found to be in the same condition; and in the course of the next twenty-four hours the arms may also be paralyzed. From the beginning of the symptoms until the paralysis is completed rarely more than a week is required. AS TO COMPLICATIONS. The bladder may participate la the paralysis, and the urine be retained, or there may be incontinence, but the bladder is not permanently affected, and these troubles disappear in a few days or weeks. Sensibility is not affected. The paralysis is complete at once and soon begins to lessen, some restoration of power taking place in from one to three weeks, which may gradually go on until the paralyzed parts are completely restored in the course of a few months; most cases behave differently, improvements begin as in the case just narrated, but it proceeds to a certain point only; some of the members recover entirely, leaving one or more or a single group of muscles affected. The temperature of the paralyzed parts falls several degrees; they become cool at the touch and present a blue eyanosed appear ance. For further information ou this head I refer you to any standard text book. COURSE, DURATION AND TERMINATION. The course of the disease is very uniform. The mild cases, in which restoration of power begins in a few days, recover entirely in a few weeks or in a month or two. cases have been designated, "temporary paralysis." These Other cases, in which a single nember or group of muscles remains paralyzed after the efforts at restoration have ceased, may regain the lost power in from two to six months. If the restoration does not take place within this time it becomes less and less likely with the increasing duration of the case. Partial res: toration is the rule even in favorable cases. Much depends upon the treatment. So far as ultimate entire restoration is concerned, the prognosis is unfavorable Persistently and rightly conducted electrical treatment may accomplish much, even in unfavorable cases. DIAGNOSIS. The first point in diagnosis is the condition of the paralyzed muscles. If wasted, how do the muscular elements exist? this is ascertained by electrical tests. In these cases the muscles do not respond to a faradic current, but will contract on the application of a weak and slowly interrupted galvanic. Muscular contraction is the proof of the presence of the muscular elements. Some portion of the tis sue could be withdrawn and submitted to a microscopic examination. Infantile paralysis may be confounded with acute myelitis, hemorrhage into the cord, progressive muscular atrophy, paralysis from cerebral affections in childhood and paralysis from local-nerve lesions so much for diagnosis. NOW FOR TREATMENT. During the attack of fever with which the disease begins, only symptomatic treatment is proper, since a diagnosis is not possible. When paralysis has occurred the damage to the cord is complete, but as the functional disturbance is more extensive than the symptomatic expression of the real lesions, the improvement which follows from the paralysis is simply the disappearance of the merely functional troubles. Any active treatment therefore, instituted, with a view of combating an inflammation, is improperly applied. The problem is: To prevent further destruction of gray matter and restore damaged but still functionally capable tissue. The remedies best adapted to accomplish this, and which in the author's hands (Bartholow) have acted best, are quinia and belladonna (from a fourth to four grains according to age, of quinia, and from one-twentieth to one-fourth grain of belladonna extract) hot douche to the spine and tepid water packs; the application of galvanism, Inverse current, stabile, large volume and low intensity, and rest, as nearly absolute as possible until the period of restoration. When the period of improvement comes on, the muscles may be faradized, if they re-act to the faradie current, massage is suitably combined with electrical treatinent. The wasted muscles are much improved by aquapuncture; still more by intra-muscular injection of strychnia gr. 1-100 to 1-60, two or three times a week. The injection of strych For additional treatment, tincture of iodine in fractional doses for a few days at a time, tr. iodine gtt. i-iii to water oz. i or elixir lactated pepsin with a few drops of cascara. One teaspoonful every three or four hours with a drink of water. Carbolic acid in same proportion is also scientific. For pain morphine to assure physical rest. Some preparation of lime and soda, especially the chlorides thereof in small doses to follow up, should meet Bartholow's statement on treatment of this disease and would no doubt solve the problem. Some elegant preparations of tasteless codliver oil with lime and soda gtt 15 to one teaspoonful 3 or 4 times a day. Pure cod-liver oil, one teaspoonful night and morning, if weather should turn cool. When using massage along the spinal colum and affected muscles, would suggest, that the masseur dip his fingers in a tablespoonful of pure cod-liver oil and use it up, every time as an inunction once a day or less often, this method can also be extended to xillae and thighs. Good results will be obtained with light splinting, strapping or bandaging; passive exercise should also go along with medicinal treatment; which is very necessary. In conclusion, the evidence of both sides of the case is all in. Kock's and his followers' germ theory received its due place in this disease, and Virchow's philosophy of the chemical-synthetic evolution of cell-life and its social relation in the organic corporation in the human body have been harmonized with the germ theory, and it should now be an easy task for the vital chemist, acquainted with chemical work and observation at the bedside, to spot and explain the real materies morbi "the defacto infectious agents involved in this disease." We have shown that the disease springs up mainly in infants below five years of age, and sporadically in weakly adults; that it affects the anterior horns of the spinal cord, where all the voluntary actions of the will come into play; therefore always on a great strain, especially so, in early childhood and in weakly adults. We have also observed, that peculiar moist telluric conditions, followed by great heat or severe cold, which has the same effect under similar conditions, seems to be the exciting cause of this disease; and it is reasonable to accept this observation as correct, when we remember a lowered tension from within the physical organization of the infant and a raised tension from without, caused by abnormal telluric conditions and great atmospheric heat. Lately this disease has been considered contagious in the sense like influenza, coryza or a common cold, secretions either from the mouth or nostrils, etc., of man to man, or animal to man, or flies, bed-bugs, fleas, what nots? The clinician, the bedside practitioner should ever keep in mind the pathological picture so ably outlined by Bartholow, and adjust his treatment to his case in hand, viz.: absolute rest, obtained, if necessary, with morphine not with bromides, for the latter drug benumbs and depresses the nervous system, a condition, which must be avoided. A good dose of castor oil, 'to be repeated as occasion requires. A shady, cool, out-door place, if possible, or an airy artificially cooled room 70 to 78 degrees Fahrenheit, if agreeable to patient, the room should be screened, none but the nurse be allowed with the patient. The food should be plain, wholesome and nourishing, according to the stage of the disease, pure fresh milk, brown toast with a little fresh sweet butter, fresh cool water at proper intervals; at subsidence of fever start with more substantial food; but you gentlemen know this already. Serums and vaccine teatment are still subjudice and can only act, if ever successful, in a chemicalneutralizing manner, similarly as alterativereconstructive therapeutic agents do. Gentle antiseptsis of intestines with elimination, of the mouth and nostrils, etc., are indicated. Alterative, reconstructive tonies should be begun at the earliest possible moment; so as to improve the status lymphaticus, fluids and synthesis of the cells; and last but not least by patient persevering and optimistic after-treatment, electric and surgical, such as bandaging light strapping and splinting and manipulation under your personal observation, and last but not least, remember the mental factor, hope, cheerfulness and optimism, coupled with a firm desire to get well great good and better résults will be obtained and the people of the country will bless the humble bed-side practitioner, as the greatest specialist in the universe. Gentlemen, I thank you for your kind indulgence and attention. SPLENOMEGALY OF INHERITED SYPHILIS. By CHARLES A. VANCE, Lexington. The following case is one of unusual interest to me. It is rather a rare condition and I believe it is of sufficient interest to the profession to be placed on record. The patient was a girl fifteen years of age. The family history could not be obtained as both parents were dead and she knew nothing about it herself. Some friends sent her here from the mountains and they knew very little about her. There was no history of any skin eruption in her babyhood, nor of any other disease that her friends or she knew of. Her illness began two years ago, when she began to have attacks of jaundice. She had a number of these attacks and recovered from each of them in a short time. Three times she had attacks of abdominal pain like colic; these attacks lasted several days would pass away, and then she would be entirely free from pain. Her abdomen had gradually enlarged until the swelling was very marked. All this time she had constant pain and a dragging-down sensation on the left side of the abdomen and occasionally some shortness of breath. She sometimes bled from her mouth and gums. There never was any blood in the stools, nor were there any clay-colored stools. She was very poorly nourished and far behind the normal in general and sexual development. Her breasts were not developed at all and her pubic hair was very scanty. Her skin was slightly jaundiced. Her face had an old withered appearance. Her teeth were not well formed, but distinctly "Hutchinson's Teeth." Her mouth and throat were negative. No enlarged glands were felt anywhere. The heart dulness was pushed up; sounds were clear and there were no murmurs. The breath sounds were normal; there were signs of fluid in both bases posteriorly, with a good Ideal more in left base. The spleen extended below the umbilicus and to the right beyond the median line; the edge was very plainly felt. The liver percussed slightly enlarged and the edge could be felt on inspiration. There were signs of free fluid in the abdomen. There was enlargement of superficial abdominal veins. The urine was negative. Blood examination: White blood cells, 4,800 red blood cells, 3,110,000; haemoglobin, 50 per cent; the differential white count; polynuclears, 65 per cent; lymphocytes, 30 per cent; large Mono-nuclears, 5 per cent. No Wassermann test was made. The case was diagnosed by myself and every one who saw it as one of Banti's Disease. Spleenectomy was done August 10th. opened the abdomen through a right rectus incision and a good deal of clear fluid escaped when the peritoneum was incised. The upper border of the spleen was adherent to the diaphragm, but after being separated, it was easily delivered and the pedicle was ligated and cut off. The wound was closed with drainage. She had very little shock and after operation improved a good deal. The spleen weighed five pounds after being drained of blood. Blood examination August 15th, white blood cells 30,400, with 80 per cent. polynuclears; red blood cells 4,720,000; haemoglobin, 75 per cent. Her wound healed primarily, and on August 24th, she was out of bed and walking around the hospital, and seemed to be gaining strength rapidly. Blood examination August 24th showed: white blood cells, 30,000 with 260,000; haemoglobin, 80 per cent. 86 per cent. polynuclears; red blood cells, 4, About six o'clock on August 27th, seventeen days after the operation, she said she felt sick and had pain in her head. She was put to bed and died quietly in about fifteen minutes. Autopsy: There was some fluid in the abdominal cavity and a good deal of fluid in her left chest, the left lung being pushed way up in the pleural cavity; there was a small amount of fluid in the right chest; the left diaphragm was three and one-half inches thick; the liver was knobbed and hard; the ligated stump of the spleen pedicle was healed and omentum adherent; the kidneys were negative, the heart was negative. We were not allowed to open her skull. Microscopical examination of the liver and spleen by Dr. A. S. Warthin, of Ann Arbor, is as follows: "It is syphilis, most probably congenital, as the character of the liver cirrhosis is that of a diffuse interstitial type. ;The caseous areas are typical gummata. If the case was one of acquired syphilis, it must have been very early acquired." The literature on this subject is very scant and very difficult to find, but from a careful study of everything that I could find for a number of years, I have made the following deductions: Splenic enlargement is recognized by all authorities as a symptom in inherited syphilis. Moderate splenic enlargement in children from five to fifteen years of age may be about the only evidence of an inherited syphilitic taint, except the positive Wassermann, which is frequently present. Hutchinson states that in infancy the degree of enlargement is usually slight, but often met with in syphilitic infants. A more marked splenomegaly is one of the late manifestations of inherited syphilis after the second dentition and is usually associated with cirrhosis of the liver. In this latter type the spleen may be gummatous. Occasionally the teeth may be of the Hutchinson type; there may be interstitial keratitis, persistent cracks at the corners of the mouth, a history of some skin eruption in babyhood, a history of syphilis in the parents, or of inherited syphilis in the brothers and sisters. The splenomegaly of inherited syphilis is often accomplished by occasional, slight attacks of obstructive jaundice and by excess of urobilin in the urine. Hepatic cirrhosis, with or without ascites, may be associated with the splenomegaly, and at the time of death the cirrhosis is usually of the hobnail type. The cirrhosis of the liver in these cases is of specific syphilitic origin. The inherited syphilis in these cases may be associated with some degree of infantilism, a more or less retardation in general physical development, and especially in the sexual functions. In these cases great caution must be employed in regard to anti-syphilitic treatment, especially mercurial, probably on account of the general delicacy of the patients and their liability to renal and catarrhal complications. Iodide of iron seems to be very useful. In these cases there is generally very little real anaemia, even where the general appear ance is cachectic; and anaemia, if present, is often temporary. Abdominal crises, pain, etc., of uncertain explanation, may occur both in the inherited an dacquired syphilitic cases. Splenomegaly in children may be the most important sign of the presence of hepatic cirrhosis, when the former is either secondary to, or due to the same cause as the latter. A good many cases of splenomegaly in children with inherited syphilis probably ultimately present the characteristic clinical features of splenic anaemia or Banti's Disease. BIBLIOGRAPHY. F. Parkes Weber, Splenomegaly with Recurrent Jaundice Ending in Hepatic Cirrhosis and Ascites and the Splenomegaly of Inherited Syphilis in Children.-British Journal of Children's Diseases. C. V. Weller. Splenic Enlargement in infancy and Childhood.-Archives of Pediatrics. B. S. Vedder and P. C. Jeans. the Infantile Type of Hereditary Syphilis.-American Journal of Diseases of Chil dren. E. B. Krumhaar, Clinical Types of Splenomegaly Ac companied by Anaemia.-American Journal Medical Setence. L. E. LeFetra. Later Manifestations of Hereditary Syphilis.-American Journal of Obstetrics. B. Myers, Splenomegaly Improved by Antisyphilitic Treatment.-Sect. Dis. Children, Royal Society. P. L. Parrish. Some Phases of Inherited Syphilis.Long Island Medical Journal H. Thursfield, Enlargements of the Spleen in Children.Med. Press and Circ. H. W. Chaney, Splenic Enlargement.-International Clinic. SUMMER DIARRHOEA.* By F. G. CARROLL, Cave City. This condition may be divided into four classes as to etiology: 1. We have the acute dyspeptic diarrhoea usually caused by eating food unsuited for the patient, such as unripe fruits, stale, decaying fruits and food, mulberries and June apples. Symptoms: Cramping pains in the abdomen, general symptoms of distress aud stools which at first contain particles of the food which are responsible for the attack; followed by mucus. Treatment: Nature has already begun thie with the friendly diarrhoea; lend a helping and by giving a large dose of castor oil, which, in my opinion, is the best purgative for the occasion. Withhold food for a few hours or days as case may demand. Then give food of light character, with some intestinal antiseptic of your own choice, preferably small doses of calomel at from 5 to 6 our intervals have served me best. 2. Summer complaint occurs in hot summer months at the age of twelve to eighteen months, or in second summer, when child is off the breast feeding, and is being experiimented with often by the "all too wise parents, and neighbors." This trouble is produced by bacterial growths in the alimentary canal, which produce a change in the entire canal, and by the absorption of its toxines, produce our great trouble. The stools are frequent, watery, usually green, of bad odor and if acid will excoriate the buttocks. Treatment: A good oil purge will get rid of as many bacteria as possible; and then retard their growth by giving food of different character from milk, such as rice water, albumen water, barley water or orange juice. Dilute the remaining bacteria in the gut and prevent their growth, by having a different culture media. Reduce your sugars and carbohydrates, giving instead, acids, buttermilk is good. The acid bulgaris bacillus, is used to good advantage; give plenty of boiled water, keep child in cool, well ventilated roon. away from flies and filth, and above all keep the child out of the mother's lap, but instead *Read before the Barren County Medical Society. on a cot or pallet and sponge frequently to relieve temperature. At this stage you may give such intestinal antiseptics as you prefer. The best I have used is Rx. Bis. sub. nit.. Pulv. Rheubarb Pulv. Pepsin -gr x gr. x -gr. ii .gr. ii Sig: Give 4 to 6 hours apart until Saline irrigations are of much advantage. They help support by absorption of water in in the bowel, thereby increasing elimination also to keep temperature reduced and quiet the nervous system. Some prefer bicarbonate of soda for this purpose, but I think salines have given me the best results. 3. Cholera Infantum. Nearly always attacks a child that is already sick. Symptoms: Profuse watery stools, shrunken tissue and prostration. Treatment: Supportive is all you can do, saline enemas, or better, hypodermoclysis to supply fluid to the tissues, hypodermics of brandy, or better morphine and atropine, gr. 1-100 and 1-200 each, according to age. The tincture opium and starch enemas will do much to quiet the bowel and stop the tenes Pyorrhea Alveolaris in Causation of Bronchitis and Asthma.-Cases are cited by Shivdas to show that pyorrhea alveolaris is a most potent etiologic factor in the causation ofthese diseases. In the cases in which the pyorrhea alone was treated, either a marked improvement or disappearance of the lung affection was observed, with the arrest or improvement of the pyorrhea. When the lung affections alone were treated without any attention to the pyorrhea, hardly any good results were obtained, except a siight temporary relief in the symptoms in consequence of the administration of soothing and anodyne remedies. FUNCTIONAL HEART DISEASES; WHAT ARE THEY AND HOW TREATED?* By BEN B. KEYS, Murray. Our Medical experience teaches us that many people complain of really serious cardiac symptoms, who on the most careful objective examination show no trace of organic disease whatever. Strumpbell says that the number of imaginary heart diseases is decidedly greater than the number of cases of actual organic diseases of the heart. Functional heart disease then can be considered in many respects a cardiac neurosis, which may have numerous etiological factors. First, we mention the mental conditions as excitement, emotion, depression, worry, and so on. Second, from anemias, chlorosis, and such changes in the blood. Third, the acute infectious diseases as influenza, diphtheria, typhoid fever, and so on, in which the toxic material in the blood irritate the cardiac accelerating nerves. Fourth, dyspepsia, or indigestion in the alimentary tract, and those who commit dietetic errors, overeating, etc. Fifth, the use of such stimulants as tea, coffee, tobacco, and alcohol which are injurious through the effects on the nervous system. Sixth, the cardiac disturbances are found more frequently in the female sex, especially about the age of puberty and menopause and menses. Seventh, any disease of the pelvic organs, as the uterus and ovaries. There are a great many of these cases that are purely psychic, caused probably by the fear of a heart lesion and its consequences. The discussion of the disease by members of the family, the reading of medical pamphlets, advertising nostrums, etc., arouse a lively fear of becoming a victim to the dreaded disease. In exophthalmic goiter We have a very rapid heart called tachycardia which is always present in these cases, due to paralysis of the muscles of the vagus nerve. Tachycardia may be due to some organic condition of the myocardium or may be due to some reflex irritation or paralysis of some center in the brain. Marey has shown that lowering the blood pressure increases the rate of heart beat; the heart beats more quickly when its load is lessened. Hysterical and neurasthenical patients are usually troubled with rapid heart and palpitation. Dieulafay says the physiology of the nerves of the heart has been examined for an expla |