The distribution especially is peculiar; namely, to the muscles of the trunk and proximal portions of the limbs, and only occasionally those of the neck and face.

The spasm is a characteristic one; not a sudden, single irregular muscular contraction, like that of chorea, but bilateral, involving several muscles of a physiological group at once, thus resulting in a series of movements, any one of which can be voluntarily made. The clonic contractions continue, when once set up, for a time varying from a half minute to ten minutes, and are succeeded by an interval of complete freedom from spasm that lasts from half an hour to about a week. Sometimes the movements are very violent, at other times the amount of contraction in the muscles is not enough to move the extremity.

The characteristics of the disease make it possible to differentiate it from chorea, epilepsy or hysteria, with which affections it would be more likely to be confused. These characteristics may be summed up as follows: Paramyoclonus multiplex is a spasmodic affection of the muscular system, occurring bilaterally in symmetrically situated muscles attached at one or both ends at the trunk, and in muscles whose function is associated with these, consisting of a series of violent clonic spasms of considerable rapidity and severity, occuring only at intervals; and associated with fascicular tremors of the affected muscles, persisting during the interval between the spasm. It occurs after some mental or physical strain, and is not accompanied by any disturbance of sensory or motor functions, excepting by an increase of the superficial and deep reflexes. It can be excited by irritation of the skin and tendons.-The Jour. of Ment. and Nervous Dis.

The Cerebral Circulation During Sleep.-DURHAM many years ago by observing the vascularity of the brain through a trephine aperture, demonstrated that in sleep it is relatively in an anemic condition. These conclusions have been many times confirmed by later observers who have used his methods.

SPEHL has resorted to a new and altogether different method of studying this point. He suddenly arrests the circulation between. head and trunk by an écraseur, placed close to the head; the latter being finally removed without any loss of blood. The relative amount of blood in the head and the remainder of the body is then determined. These figures then form a basis for estimating the relative

amounts of blood in the heads of sleeping and wakeful animals. His conclusions are as follows:

1. During the sleep produced by chloral the brain, taken en masse, is anemic.

2. Chloral hypnotism very closely resembles natural sleep, (Labbée, Gubler, Rabuteau, Claude Bernard, Liebreich, Bouchut,) and it is probable that during the latter the brain is equally anemic.

3. During sleep, natural or otherwise, certain parts of the brain are in activity, while others are in repose.

4. The active portions probably are congested; the parts in repose are physiologically anemic.-Brain,-July 1887.

Nerves in the Liver.-A. B. MACULLAM says: Observations made with the chloride of gold method showed that there is an intimate relation between nerve fibrils and liver cells. Nerve filaments enter the cells, and terminate in bead-like enlargements near the nucleus-Quart. Jour. Micros. Science, March 1887.

Crushed Nerves. The behavior of the axis cylinder of nerves that have been ligatured shows that it is not fluid, but has a considerable power of resistance, and possibly elasticity, as well. FRANZ TAUGL in Arch. Micros. Anat. pl. XXVII.

MEDICINE.

Treatment of Cholera.-PROF. V. ZIEMSSEN says that in his experience calomel is the most valuable drug in the treatment of cholera in the prodromal stage. He would commence with two or three doses of .5 gram (gr. viiss) and then give small doses .05 gram (gr. 4) every two hours. The antimycotic action of the calomel is believed to be due to the transformation of an indefinite but certainly minute portion of the drug into the corrosive chloride in the intestine.

The professor disapproves the use of opium, but says, "that the ethereal oils combined with opium and known as Russian "cholera drops," are said to have a favorable effect, though as usually given in peppermint tea the taste is atrocious and increases nausea.

Mulled wine is preferable on account of the ethereal oil which it contains, as well as the amount of tannin which it contains.

He emphasizes the importance of close attention to diet and whatever is connected with it. In cholera time every case of diarrhea must be at once put to bed, and warm applications made to the abdomen and a cup of hot tea administered. If there is any indigestion he recommends a hydrochloric acid mixture (3 to 150 water and 25 syrup) and for food and drink only oat and barley water. And this, he says, exhausts the most essential part of the treatment of cholera diarrhea. In all cases in which diarrhea is profuse and resists other treatment for twenty-four hours, he would commence at once with the calomel treatment as indicated above.

In cholerine, the specific infectious vomiting and diarrhea, the same line of treatment is indicated. For the vomiting, and to allay thirst small pieces of ice may be swallowed and morphine given subcutaneously in doses of .01-02 (gr.1/−1/3)·

When called to a case of cholera fully developed, he would at once commence the calomel treatment, and also would make use of Cantani's treatment by enteroclysis, or injection into the intestines of large quantities of a tannin solution. Cantani speaks as follows: "The warm mass of water certainly acts mechanically and by its heat in a way to vivify and stimulate the intestine and the whole organism, but the principal point is the stimulation of absorption, in consequence of which, thickening of the blood and anuria are prevented, or actually antagonized if already set in. He thinks further, that the tannin sterilizes the contents of the intestine and possibly forms insoluble compounds with the alkaloids of degeneration, thus rendering them harmless, and limits transudation from the mucous membrane by its astringent action on the blood vessels. He admits that other agents, as hydrochloric acid 5 per cent, as also corrosive sublimate, salicylic acid, boracic acid, thymol and some other agents have a more efficient action in sterilizing than the tannic acid, but he has been so well satisfied with the tannic acid that he has no inclination to experiment with other agents.

Another measure advocated by Cantani, and to which Ziemssen gives approval,is what he calls, hypodermoclysis, for the purpose of antagonizing the effect of the rapid loss of water and alkalies from the blood and tissues. One to one and a half litres (two to three

pints) of a solution of sodium chloride 4 grams, sodium carbonate 3 grams to 1000 cc. of water at a temperature between 37° and 40°C., according to the temperature of the patient, are injected into the subcutaneous tissues of the body. This is to be repeated about every four hours until the favorable effects, which may appear after one injection, are manifested. These effects are re-animation of the organism, warming of the extremities, improvement in the pulse and respiration, and disappearance of anuria and cyanosis. Keppler, of Venice, injects into the neck or infra-clavicular region 50 cc. every minute until pulse returns, then every five minutes and later every half hour, until in all from 8 to 12 litres (8 to 12 quarts) have been injected of a solution of 1 gram of salt 1000 cc. of distilled water and 10 grams of absolute alcohol He emphasizes the value of alcohol for sustaining the heart, and v. Ziemssen approves his claim.

In

beginning paralysis and cyanosis v. Ziemssen recommends camphor in the form of ol. camphorat. fort. (1: 5) hypodermically, and says that when three to five syringefuls are injected one after another at the right time the action on the heart is favorable.

Rubbing the bellies of the muscles with a large piece of ice bas proved the most effective remedy for the muscular cramps of the legs and other parts.

Continuance and repetition of the diarrhea with colic and tenesmus are best treated locally with warm infusions of tannin with some opium or, if large injections are no longer borne, by small clysters of warm, thin starch and opium several times. In the later stages of the disease opium is a very valuable remedy.

Regimen of Cholera Convalescents.-PROF. V. ZIEMSSEN in the lecture above referred to, calls attention in closing, to the importance of diet and regimen generally of patients convalescent from cholera as follows: The severe and partly necrotic lesions of the intestinal mucous membrane, the extensive epithelial loss, the tendency of the vessels to new hyperemia, the faulty state of the assimilative functions, all demand the greatest precaution, and we cannot too strongly oppose the impatience of the patient and his friends to quickly return to solid food and to leave the bed. Restoration takes place more rapidly and more completely in bed and on a fluid and semi-fluid diet. You will not go wrong if you regulate the diet for three or four weeks, as after a severe attack of typhoid fever.-Jour. Am. Med. Asso. July, 23.

Salol in Diarrhea, Dysentery and Intestinal Inflammation.-DR. A. H. GOELET writes that he finds salol a most valuable remedy in the treatment of diarrhea, dysentery, and inflammation of the intestines.

The first case in which he tried it was that of an adult, who had had a bad diarrhea for three days, and had been treated for half that time with bismuth, extractum pancreatis and bicarbonate of soda with a milk diet and had received no benefit. Dr. G. ordered salol in ten grain doses every two hours. The movements ceased after the second dose, as also the pain and cramps. The med. icine was continued, one dose an hour before meals for a couple of days. Movements were natural and occurred once a day, showing no constipating effects from the medicine, a condition which is of ten so annoying after opium treatment.

The next case was one of acute indigestion with diarrhea and vomiting in a child fifteen months old. He ordered one grain to be placed dry on the tongue and a teaspoonful of water to be given afterwards, the dose to be repeated every two hours. The vomiting ceased immediately, and in six hours the diarrhea had ceased. The powders were then given every four hours. The next day the stools were natural and the medicine was discontinued.

Dr. Goelet says that this "is the only purely satisfactory remedy thet he has ever used in these cases.'

While the adult dose is ten grains, the dose is much larger in proportion for children, and varies very considerably with the age. For a child six months old or under the dose is half a grain every two hours. From seven to ten months old the dose may be from one half to one grain, according to the severity of the symptoms and the strength of the child, a child one year old may be given from one grain to one and a half grain according to the severity of the symptoms. A child fifteen to eighteen months old may take one and a half to two grains. For a child of two years the dose would be two grains. At three years two to two and half grains; at four years two and a half to three grains; and at five or six, three to three and a half grains. From this age it is seldom nec essary to give more than five grains. It is always given to commence with every two hours and, as the symptoms are relieved the interval is lengthened to three or four hours. Sometimes it is well to continue it three or four times a day for one or two days after the symptoms have abated.