neurasthenics produces a cerebral vasodilation; that venous stasis augments the volume of the brain, which within the rigid confines of the cranium produces slight compression, whence arises the headache. He also maintains that clinically all measures which decongest the brain either dispel the headache or reduce its intensity, while opposite means add to it. Further, he says that cranial thermometry proves directly that the brain in neurasthenia is in a congested state, the temperature being somewhat more elevated than in healthy individuals, and the maximum of the headache corresponds to the point where the temperature is the highest. Moreover, the temperature diminishes with the recession of the headache. He has found an addition of 2 degrees in the local temperature between conditions in which headache was present or

not.

Romeiser and Collins contribute an article on the condition of the blood in neurasthenia-a subject that has received considerable attention abroad. They do not find, however, that there is anything peculiar in the blood of neurasthenics, but state that in general the condition of the blood corresponds to what might be expected in such a bodily condition as attends neurasthenia. Great variation was often observed in individual cases, and no two cases were exactly alike, as regards symptomatology, severity of the disease, or blood state. They found that the blood changes corresponded rather to the objective than to the subjective clinical picture.

Karl Petrén 2 inquires as to the social state of neurasthenia and confirms the statement that the disease is as common among hand workers and laborers as it is among those more fortunately situated. It also appears to be slightly more common among men than among

women.

Andre 3 calls prominent attention to the dyspnea of neurasthenics. He refers particularly to the feeling the patients express of being unable to get sufficient air into the lungs, often making statements that the air "does not seem to get down into the lungs or reach the right spot." He also notes the significant fact that if their attention be strongly diverted, or they are in any way distracted from the subject in hand, the difficulty of breathing subsides. Moreover, it is not attended by any objective inconvenience or respiratory difficulty; cyanosis, rapid breathing, and other similar defects do not accompany it; neither is the pulse accelerated unless the patient's anxiety reaches a point where the cardiac action is modified by the emotional state.

Hysteria.-F. Walter claims to have found a valuable remedy for hysteria by the exhibition of derivatives of the colon bacillus taken from a noninfectious source. He limits the value of the treatment, however, to the active convulsive type, and claims that the symptoms disappear in from 24 to 48 hours, the patient being restored to health, so far as the hysteria is concerned, but the same result does not follow in what he calls latent hysteric phenomena. He would class this

1 Medicine, Nov., 1900.

Rev. Neurol., Aug., 1900.

2 Deut. Zeit. f. Nervenh., Aug., 1900.

4 N. Y. Med. Jour., July 21, 1900.

remedy as a specific. The culture is prepared upon the surface of agaragar in Petri dishes, and when well developed may be scraped off, suspended in water, or mixed with some indifferent substance and administered in capsules. The products of one dish make from 3 to 6 doses. [This treatment has found no supporters so far as known.]

Krafft-Ebing 1 presents a very instructive case of hysteria mimicking paralysis agitans lasting for years, with the characteristic tremor and the highly distinctive handwriting, a sample of which is published with the report. After careful study and examination it was finally classified as a hysteric condition secondary to mental shock, with a tremor identical to that presented by paralysis agitans. The disease had lasted 23 years without any particular modification. The principal hysteric stigmata in the case were slight hyperesthesia to cold, associated with left-sided hemihyperalgesia, and the mental shock was furnished by the sudden death of an only daughter.

J. Abadie 2 presents an interesting study of polyuria and frequent urination in hysterics, and reaches the conclusion that they are susceptible of cure by both direct and indirect suggestion.

G. Comar, struck by the fact that hysterics often present sensory stigmata in the region of the organs that are disturbed, investigated the sensibility of the head in the neighborhood of the cortical centers related to body segments and limbs, affected by the neurosis, and believes that in many such instances hyperesthesia or anesthesia and headaches of corresponding location can be detected.

P. Sollier expresses the belief, and presents cases to substantiate the thesis, that areas of the cortex and of the corresponding scalp and skull show disturbance in the way of hyperesthesia, subjective pains, and general or localized headaches related to the body and limbs affected by hysteric disturbances. The internal organs also present their spots of tenderness on the head. The stomach he considers to be represented on both sides of the skull, but more particularly on the left side, about 5 cm. behind the biauricular line-that is to say, over the superior parietal lobule. For the heart he has only observed a median point a little in front of that for the stomach, while the centers for the bladder and intestine are situated near the median line and 5 cm. or 6 cm. behind that for the stomach. The center for the larynx corresponds nearly to the foot of the third frontal convolution, and that of the respiratory apparatus above it is in the neighborhood of the second frontal, while those for the genitals seem to be situated at the foot of the first frontal.

Brissaud 5 sustains the thesis that polyuria is a hysteric manifestation. In other words, that simple polyuria is not related to diabetes, but is always significant of the hysteric state.

1 Deut. Zeit. f. Nervenh., 1900.

3 Rev. Neurol., June, 1900.

5

2 Arch. de neurol., Mar. 19, 1900.
4 Rev. Neurol., Feb. 15, 1900.

Leçons sur la Maladie Nerveuse, 1899.

Chronic hereditary tropho-edema at 17 and 21 years of age (Meige, in Nouv. Icon. de la Salpêtrière,

TROPHONEUROSES.

Chronic Hereditary Tropho-edema.-Henry Meige1 describes a family in which edema affected 8 members, both men and women, distributed through 4 generations. Four of these cases were observed, and presented the same singular affection: namely, a chronic white, firm, and painless edema, appearing at the age of puberty and affecting especially the feet and legs and sometimes the entire lower members, generally on both sides. He also refers to a remarkable family reported by Milroy in 1893 in the "New York Medical Record," in which in 6 generations there were 22 cases.

Acromegaly.-Sainton and State 2 attempt to differentiate a form of acromegaly which is particularly marked by pains. From a study of 140 reported observations, pains are mentioned 70 times, sometimes situated in the extremities, sometimes in the spine, sometimes in the viscera; but pains in the members are the most common, and are generally symmetric, usually involving all 4 extremities. They would divide pains into osteo-articular, neuralgic, muscular, and tabetic, and pains of the extremities. [While it does not seem necessary to make a distinction, as the authors would do, the importance of pain in acromegaly is emphasized by their contribution, and becomes a symptom of some diagnostic value.] They report a case in which they note certain changes in the spinal cord, which they epitomize as follows: (1) The presence of osseous infiltration of the dura mater, with the production of calcareous seeds on its internal surface; (2) cord lesion of the nature of degeneration, principally in the columns of Goll. They would conclude that these osseous lesions and changes in the cord are associated with the pains that mark so many cases of acromegaly.

Woods Hutchinson 3 contributes an able article to the study of acromegaly and giantism and the function of the pituitary gland. He concludes: (1) That the pituitary body is still functional. (2) That disturbances of its metabolism are the principal factors in both acromegaly and giantism, the difference between results being simply due to the stage of individual development at which the disturbance of the function begins. (3) That the nature of the overgrowth in both these diseases is primarily on the order of a pure functional hypertrophy; later, however, losing something of the definiteness of its impulse, and either producing immature tissue of a mixed type, or resulting in hemorrhagic exudation, with either cyst formation or complete breaking down of the tissue mass. (4) That it seems probable, although upon this head the evidence is still uncertain, that some part is played by this body in "dwarfism," rickets, and the dwarf forms of cretinism. (5) That a reflex disturbance of its function may possibly underlie the dystrophy accompanying pharyngeal adenoids. (6) That it would appear to be a sort of "growth center" or proportion regulator of the entire appendicular skeleton.

1 Nouv. Icon. de la Salpêt., Dec., 1899.

2 Rev. Neurol., April 15, 1900.

3 N. Y. Med. Jour., July, 1900.