when patients were not generally asleep, in four cases sleep came on within half an hour, which lasted from five to eight hours; the two other cases showed no effect from the drug. It is their habit to get at least gr. of morphine sulph. to put them asleep every night, as they are sufferers from intractable malignant growth. pended, as he had had good natural sleep at night and seemed quite restored. Alcohol was positively prohibited, the only substitute allowed being Elixir of Cocoa and Camellia (P. D. & Co.), in tablespoonful doses, in which it is true there was a small amount of alcohol, which was quite infinitesimal when compared with what he had been using, "In no case was there any noticeable Somnal, therefore, acts well as a hypafter-effect. "I have not formed any opinion upon the length of time that the drug could be used daily upon the same patient. "To this I might add that no depression of the normal temperature was noticed in any case in my hands, and thus far I have not used it in pyrexia." Therapeutic Application. The effects of somnal in producing natural sleep suggested its use in insomnia. The first case in which I used it was in a patient suffering with acute alcoholism, who had been under treatment for a fortnight in an institution where he had a free supply of liquor, and he came out rather worse than he went in. He was 39 years of age, very tremulous, and could not sleep, or if he dozed off would immediately waken up. I gave him, at about 3 P. M., thirty minims of somnal (or rather a drachm of a mixture of equal parts of somnal and whiskey), well diluted, and went into an adjoining room to speak to an attendant. Upon my return I was surprised to find him fast asleep, although I had not been away from him more than fifteen minHe slept for four hours, and then was able to take something to eat. At ten o'clock he had another dose and he slept until seven the next morning, having waken up once only during the night and insisted upon having another dose, and immediately after taking it he fell asleep again. The next night he was given a double dose at 10 P. M., and he slept all night without wakening. No bad effects were observed. somnal was given for four nights, when he was so nearly well that it was sus utes. The notic in acute alcoholism as a tranquillizer and hypnotic. In a case of neuralgia of the bowels (visceral neurosis of Allbutt), where the patient had a sleepless night, a dose of twenty minims relieved nausea and pain, and the patient fell asleep. In syphilitic headache and insomnia, somnal in moderate doses failed to produce sleep, which was afterwards secured by potassium bromide and iodide and antipyrine. In cases of insomnia, fretfulness, and restlessness in young children, somnal with mint water and syrup, offers better results than opiates, and is much safer. The same remark probably applies to the use of somnal in acute pneumonia, but I have not been able to confirm this yet by actual trial. Without furthur going into detail it may be stated in conclusion that somnal acts as a hypnotic, but instead of depressing the system as chloral does, it slightly stimulates the gastric mucous membrane, relieves nausea and pain, improves the appetite, increases secretion (probably), does not cause constipation. The circulation, respiration, and temperature are not notably depressed after its administration. No disagreeable after-effects have been observed. As it is rapidly eliminated from the body it may be administered each night for a number of days without any obvious ill-effects. It acts very much like chloral, but is more pleasant to take and not so depressing in its effects upon the nervous system and the circulation. CASE OF NERVOUS DISEASE OF STUMP. BY WILLIAM F. HUTCHINSON, M. D., N PROVIDENCE, R. I. ERVOUS disease of stumps accompanied by illusions are of sufficient rarity among medical records to warrant publication of every case, especially when the details are as complete and well authenticated as in this. Weir Mitchell says: "these maladies have been almost entirely neglected," and in my own experience and searching I have been unable to find anything of value upon the subject outside of that author's book. The curious phenomena attendant upon and following amputations of large limbs have thus far received such small attention, and opportunities for their study are so infrequent, that I have followed them in this case with close care and great interest, increased by the chance for minute study of nerves involved that was afforded me. August 2nd, 1889, I was summoned to a consultation at Osterville, Mass., by Dr. T. R. Clement, of that place, in the case of Mrs. C., of the same village. Arriving, the following history was recounted by the doctor. On the 15th of October, 1888, Mrs. C., accompanied by her husband and two friends, started for a drive about three o'clock p.m., and shortly after four had occasion to cross a railway line. by one of those inexplicable oversights that occur now and then, no look-out was kept, and the carriage was struck by an approaching locomotive, with the result of death upon the spot to the husband and one friend, more or less serious injury to the other two and the following hurts to Mrs. C. Her right arm was crushed off just above the elbow, back and hips severely bruised, and she received severe general shock from being dragged some distance by the engine before it could be stopped. She was immediately carried to the Massachusetts General Hospital at Boston, some seventy-five miles distant where the arm was amputated the same evening. She rallied well, and returned to her home in two weeks with the stump completely healed. She soon got about again and began going out of the house, calling on friends, going to church, etc., notwithstanding that at times the stump gave her much pain of a neuralgic nature. She then began to grow worse, and this condition increasing, it was thought best to resect the median nerve, which operation was performed by Dr. Richardson, of Boston, on the 24th of May, 1889. The section gave but little relief and that for a short time only, pain soon returning as severely as before. The wound healed kindly in less than twenty one days, at which date stump neuralgia was about as bad as before. I was summoned in consultation by Dr. Clement, found the condition of things as stated, and believing that much good would result from the systematic use of galvanism, I recommended that a fifty volt battery be placed in her house and a current averaging twenty-five m. a. be passed through the stump in line with the nerves for half an hour twice daily. Relief followed, but it was by no means permanent, and pain soon returned so severely that morphine had to be used. Sept. 6th, 1889, Dr. Clement resected four inches of the ulnar nerve, the operation completely relieving pain for two weeks, when it gradually returned, and she was then placed under my care in Providence, R. I. While here, systematic faradisation was employed twice daily, one pole upon the cervical plexus, the other moved up and down the stump and across its end. Pain in the hand and forearm was quite controlled by the induced current, and to use her own expression, when the circuit was closed she could feel the fingers straighten out, the wrist unbend and the forearm extend. She grew strong enough to go on the streets and enjoy herself, and returned home after a week, hopeful and in a fair condition. But this improvement did not persist. As soon as she was in the quiet of the country, she became rapidly worse, but by dint of strenuous effort kept about for some time, made calls and superintended the making of several articles of clothing. At Christmas she took to her bed and has never left it since. Saturday, the 17th of May, 1890, I was again summoned to Osterville, and the ulnar nerve was resected the second time, close to the plexus. The nerve measured half an inch in diameter, two inches long, of the consistence of tendon, and had assumed the shape of the spinal cord, with four pillars and two dividing grooves. During the operation, the astonishing fact was revealed that not a trace was left of either the brachial artery, the median nerve, the cutaneous nerve, any blood vessel except capillaries, or any muscular tissue whatever. The stump was composed entirely of adipose, apparently nourished by vessels from the skin. I regret to say that only temporary relief was afforded by this operation, a result that was certain when it was discovered that the sclerosis and enlargement extended into the plexus beyond reach. For a few days, the pain was modified, but not sufficiently so at any time to allow the patient to get up. Her present condition is that of a person so prostrated by sheer pain as to be incapable of exercising sufficient will power to rise from bed, although there is no other disease than that of the injured nerve. In the course of study of the case, the following observations were made which seem to me to be of value as contributions to the literature of the subject. Sense of touch has never been impaired in the stump. It is to-day and has been always hypersensitive, and this undue sensitiveness does not vary with meteorological changes, winter cold and summer heat being alike impotent to relieve or make it worse. The only motor phenomena noticed in the stump have been spasmodic or convulsive twitching, occasionally annoying or even painful. These movements are readily induced by handling the stump, no matter how slight the touch may be. The patient is sensible of the existence of the entire limb, complaining now and then of pain in elbow and forearm. The hand itself is sensitive over its whole surface. It does not assume any position permanently. Sometimes it is, as she expresses it, twisted backwards, at others the fingers are clinched into the palm, and again the forearm is sharply flexed upon the stump. At this writing, they are extended at right angles with the stump, palmar side of the hand downward, thumb and index finger spread out, and the other fingers clinched into the palm so as to cause acute pain. There is distinct sensation of the hand being attached to the wrist, not to the stump, as was the case with one or two of Dr. Mitchell's cases. There is no difference from normal insensitiveness to heat and cold, tests of ice and hot water having been applied with negative results. July 5th, I visited Mrs. C. again, and found some improvement. There is distinctly less pain when she comes out from narcotism, and her general health is good in spite of the morphia, of which she is taking about three grains daily. The chief danger at present seems to be from opium habit, so firmly established that there will probably be much difficulty in subduing it, especially as it is developing a hysterical state, wherein stubborness is a prime factor. I The result is still very doubtful, but am not hopeless, although I have never known of a similar case cured. Sclerosis of the ulner nerve having extended into the plexus, further surgical interference is probably useless, and it seems as if any future gain can only be accomplished by nature. R. I., for the sections from which I made the drawings accompanying it. I have made a careful microscopic study of both median and ulnar nerves, and have not found a single nerve cell in either, both being transformed into fibrous cords, with numerous fat globules, so dense that they felt like specimens that had undergone hardening for section. It is probable that lack of nerve supply was the cause of the transformation of normal structures into adipose, alluded to before. I wish to express my obligations to my friend Dr. Clement for many of the notes used in the preparation of this ticle, and to Dr. Swarts, of Providence, REPORT ON THE CAUSE OF THE RECENT OUTBREAK OF TYPHOID FEVER IN WATERBURY. Made to the Connecticut State Board of Health, ON BY HERBERT E. SMITH, M.D. N the twenty-fifth of June, 1890, Dr. Lindsley, the Secretary of the State Board of Health, received a communication from Dr. Frost, Health Officer of Waterbury, informing him of an outbreak of typhoid fever in that city, and requesting the assistance of the State Board in ascertaining the cause. Dr. Lindsley requested me to undertake an investigation, and on the following day I accompanied him and Dr. Goodwin, another member of the State Board, to Waterbury to begin the inquiry. We were informed that of the cases then known, a considerable number had occurred in houses supplied with milk from one dealer, who drew a considerable part of his supply from a dairy farm on which there had been three cases of typhoid fever. Immediately on learning this, on June 23d, the Health Officer had stopped the sale of the milk of this dealer, and had been not a little criticized for so doing. Because of the suddenness of this outbreak, and its apparent connection with a special milk supply, it was decided to make a thorough investigation. Waterbury is a city of about 33,000 inhabitants, situated in the Naugatuck Valley, at the junction of the Naugatuck and a small stream, Mad River. The city is mostly on the east side of the Naugatuck, but extends also somewhat to the west of it, and to the south of Mad River. The soil of Waterbury is sand, gravel and light loam, which is generally deep, but in some places the underlying granite and schistose rocks come nearly or quite to the surface. The surface rises rapidly from the river to the hills on the east and west. A portion of the city about the public green was formerly swampy, and has been filled in, but generally there is good surface drainage and a deep and dry subsoil. SEWAGE DISPOSAL. The rapid growth of the ciity has led to the erection of many houses in unsewered districts; and although sewer construction has been pushed rapidly during the last few years, and the sewer system is now quite complete, except in outlying districts, there are many houses without sewer connections. Mr. Whitlock, the acting engineer, to whom I am indebted for many courtesies, estimates plemented by visits to the infected houses. Because of the nature of this disease, exact dates cannot be assigned to the time of invasion in each case; in some cases the date given is the time when the physician was first called, in others it is the time when the patient was first confined to bed. According to the death records on the Town Registrar, there were five deaths from typhoid fever during the first fivemonths of the year; during June there were six; and also six during July up to the 25th. The total number of cases during these months I have no means of ascertaining; but as there was a sudden outbreak of cases during June, I confined my attention to them. There were reported as occurring during June fifty new cases in thirty-five houses, the first case on the 8th and the last on the 30th. that abont one-half the inhabitants use River between Bank Street and Mad WATER SUPPLY. Water is supplied from the city water works, chiefly from two collecting and one distributing reservoir situated about three miles to the southeast of the city. But in the northern part of the town is another, the Cooke Street reservoir, fed in part by springs and from a small collecting area, but chiefly from the East Mountain reservoirs. The Cooke street reservoir supplies the houses on the hill near it, but is held chiefly as a reserve supply. Wells are to be found in considerable numbers, and are still used. THE FEVER CASES. The data concerning the cases of tpphoid fever were mainly obtained from the physicians of the city, to whom my thanks are due for their uniform courtesy. Whenever it seemed desirable, the data thus obtained were sup Date in June, 8-10, 11-15, 16-20, 21-25, 26-30. 11 10 6 There were a few cases, perhaps six, that came to my notice as occurring during July. They were not investigated, and there were probably very few more than these. There was, therefore, a sudden outbreak of cases in the last two-thirds of June, the majority, or twenty-eight cases in nineteen houses, being in the middle third. Of the ten houses in which there were more than one case, the dates assigned were as follows: house (a), cases ill on June 16th and 22d; (b), 15th, 20th and 22d; (c), 12th and 15th; (d), 19th and 20th; (e), 8th, 11th and 14th; (ƒ), 10th and 12th; (g), 12th, 15th and 28th; (h), 11th and 15th; (), 22d, 28th and 29th; (), 25th and 29th. These dates cannot be accepted as exact, as already stated; but they surely indicate that few of these cases are to be regarded as secondary, receiving the contagium from a first case in the same house, since in but one case is the interval as great as the usually accepted period of incubation, ten to fourteen days. In that case the time from the |