all restrictive clothing, and teach your patients the immeasureable value of thorough inflation of the lungs. Your efforts to relieve them of chronic ailments will fall still-born if you cannot make them breathe. 2. See to their diet. Not in that indefinite way so customary with physicians, by casually mentioning a few dietetic commonplaces-stereotyped phrases that have come to mean no more than the average talk about the weather-but by a careful inquiry into details, and a thorough as well as generous adjustment of rules and condi tions which will insure a regimen combining all essential food elements in due pro portion, and at the same time be attractive and appetizing to the patient. Many practitioners, otherwise careful and painstaking, fail in this particular. Every year further demonstrates the fact that hereafter the question of nutrition must occupy the foreground in every rational system of therapeutics. We do not question the assertion that without nutrition there is no life, but we fail to realize that to be but half nourished is to be but half alive. In connection with an oxygen course, the question of proper and adequate nutrition is especially important, since tissue changes are inaugurated which require that ample supplies of reconstructive material shall be promptly at hand and in the best form for assimilation. Remember, that imperfect and perverted nutrition is at the bottom of all wasting and degenerative diseases, and that it may be safely asserted that of a majority of the race only half live because they are only half nourished. 3. Having properly regulated the breathing and feeding habits of your patients, do not forget the importance of the bath. Accelerated tissue changes involve increased waste, and this should be promptly removed and washed away. For this pur pose a semi-weekly tepid, warm, or hot bath, according to individual conditions and preferences, with plenty of solvents and aromatics added - borax, ammonia, Cologne, Florida water, etc. - will add greatly to the progress of the case and the comfort of the patient. With reference to the fifth source of failure cited, it is sufficient to barely revert to the subject No rational aid is to be ignored. The day of hobbies has gone by. There are no specifics, but there are many aids. Let none of them be omitted. many cases they are all essential. In Finally, as far as possible do away with the high-minded uneasiness to which so many patients yield long before they have had time to realize any marked or permanent benefits. Show them how unreason able it is to expect the long accumulated results of bad habits or bad surroundings should be undone and overcome in a day or a week. Teach them to be content with a slow but steady progress, though necessarily slow, but all the more surely thorough and permanent processes, whereby the diseased conditions are quietly removed and long lost health regained.—Wallian, The Medical Bulletin. SANITATION IN STREET-PAYING, by George Baird, M. D., Wheeling, W. Va., in the Sanitarian.. Should Sanitarians be consulted by municipal authorities in reference to the material used for street-paving and the manner of laying it, to best protect the lives and health of the citizens? To this question there should only be an affirmative answer. The macadam road, the cobble pavement, the wood pavement in its various forms, and the granite pavement have all been found more or less objectionable from a sanitary standpoint. The macadam, with its rapidly worn surface and clouds of dust, carrying disease germs in them; the cobble pavement, with its noise and innumerable pockets, furnishing lodging places for decaying animal and vegetable matter; the wooden pavement, decaying in a few years and absorbing urine of horses and foul liquids of all kinds, which were poured on its surface, and the granite, with its noise far exceeding the cobble, its slippery surface when worn, and its open crevices between the blocks, permitting liquids of all kinds to pass down and pollute the street surface beneath, are each and all of them subject to adverse criticism. If these statements are true, the question naturally suggests itself: Is there any material known for suitable street-paving free from such objections and at the same time of such cost as to be within the reach of the great majority of cities and towns desiring to have paved streets. It is claimed by our people that there is a material which fulfills these requirements, and that Wheeling is the city to first introduce it. 15 The material is the vitrified paving | made of fire bricks of the size of an ordiblock manufactured by John Porter, of nary red brick, laid on their edges, in New Cumberland, W. Va. The block is sand, and rammed or rolled. The same an oblong truncated wedge 9 inches long, objections to this pavement as to the cob434 inches wide, 3 1-16 inches on one edge, ble and granite pavements. The crevices and 2 34 inches on the other. It is com betwen the bricks are filled with sand (no posed of fire-clay, iron-ore, and silica, fus- pitch and gravel being used), through ed to a homogenous mass. When the sur- which foul liquids are liable to pass down. face of the street is properly graded and Wherever this occurs, the bricks not hav rolled the blocks are laid in three or more ing any power of resistance to the downinches of sand, the broad and narrow edges ward pressure of loaded vehicles passing turned upward in alternate rows, and the over them, on account of their sides being joints broken, as in first-class brickwork. straight and not beveled, as the blocks are, The spaces between the blocks are brushed depressions are made in which decomposfull of finely screened gravel and paving ing substances lodge. These depressions cement poured on this until they are made also add to the noise which the unprotectcompletely water-tight. Over the surface ed street surface gives rise to. The surface of the pavement pitch is poured, and a being bare of pitch and sand allows the layer of sand one-half inch thick is spread. wear and tear of the brick to be much The roller is then passed back and forth greater than if it were covered, and reover the pavement until all the blocks are duces the life of the pavement to a few firmly settled in their places, and the entire years at most; for these reasons this appasurface forms a continuous uniform plane. rently cheap pavement will prove not only The advantages of this pavement are a dear one, but also an unhealthy onethe antiseptic properties of the pitch on its dear because it will in a few years cost as surface and between the blocks, the pro. much as it did at first for repairs and reviding a water-tight cover for the surface of laying, and unhealthful, because there is the street, preventing the passage of foul not a single sanitary precaution taken in its liquids to the street beneath, and also furn- construction. ishing the great desideratum for a good street-to wit, a dry foundation, the absence of depressions in which animal and vegetable matters can lodge and decom pose, the ease and economy in cleansing it, its not absorbing urine of horses or any foul liquids, its freedom from noise, and its not being affected by frost or heat. It also offers less resistance to the passage of heavily loaded vehicles than any other street surface except asphalt, and it has an advantage over it in its not being slippery in any weather or on any grade. The combination of pitch and sand affords a sure footing for horses at all times. The life of the pavement is without limit. A renewal of the surface coating of pitch and sand when worn off at a cost of one cent per square yard will prevent all wear of the block. The cost of this pavement is not more than cobble, much less than wood, less than one-half that of asphalt, and not onethird that of granite. A pavement called the Stubenville pavement has been extensively noticed in the newspapers in the United States, and has been a good deal sought after on account of its supposed cheapness. It is A brief statement of Wheeling's experience in brick and block pavements may show why her people have such firm faith in their good qualities. A few years ago it came to the knowl edge of our Board of Public Works that street pavements composed of hard burned red bricks, laid on a board foundation, had been in use in towns in France and in one or two places in this country for many years. Thoroughly disgusted with cobble and macadam, having no faith in wood, too poor to attempt having asphalt or granite, and satisfied that here was a style of pavement which, if successful, would prove a blessing to our people, the Board laid a few squares of a pavement of fire brick on a board foundation. Each board was soaked in boiling pitch before being laid and the bricks laid in a bed of sand, spread on the boards. The crevices between the bricks and also the surface of the pavement were not poured with pitch until a year or more after the pavement was laid and after experience in the block pavement showed the advantages of doing so. Satisfied that in a few years this board foundation would decay and become detrimental to health, the Board used the vitri fied block before mentioned. Two objects were especially desired to be accomplished by it. One was to do away with the board foundation, and the other was to have the blocks of such shape as to be self-sustaining and furnish. crevices which would securely retain the gravel and pitch and make them thoroughly water-tight. Several of our principal streets have been paved with the blocks, and although those are the streets over which the greater part of the travel and heavy hauling of a manufacturing city of thirty-five thousand people have passed for several years there has not yet been a dollar expended for repairs on them. During the past season there have been ten streets paved with the fire-brick with out the board foundation, but with the crevices brushed full of sand and hot pitch poured in them as well as on the street surface. This makes a much better and more healthful pavement than the Steubenville pavement, but at a somewhat greater cost. But this pavement lasts longer and has less liability to require repairs. It is open, however, to the objection that the bricks are not self-sustaining, but will become depressed and furnish lodging-places for offensive substances. The first cost of this brick pavement being a few cents less per square yard than the block pavement, has made it many advocates here, and it will require time to convince its friends that the block pavement will in a term of years be, by odds, the cheaper one. Be this as it may, one thing can be safely claimed for this style of pavement, and that is, there are more recommendations in its favor from a sanitary standpoint than there are for any other street pavement at present in use. A NEW ATOMIZER. vention of Dr. Henry K. Oliver, made so These atomizers are based upon the invention of Dr. Henry K. Oliver, made so long ago as 1866, and described by him in The Boston Medical and Surgical Journal for March in that year. Renewed and very general interest in this invention has been manifested of late, growing out of the recognition by Dr. George Å. Evans, and other observers, of the fact that the atomized medicine when suitably constituted by vehicle, after being broken into fine spray addition of glycerine, or other suitable by striking against a hard surface, as described by Dr. Oliver, is not readily absor bed into the atmosphere, but will continue to float for along time upon it. Dr. LIVEZEY writes: "While wintering in Florida I met with my annual patient, a young hither three or four years ago in order to pass out lady of twenty eight, from Chicago, who was sent into the "spirit land" comfortably, who now being troubled with poor appetite, a slight but distressing nausea, great debility, irregular menstruon the least ation, excessive cardiac action exertion, &c. I ordered I oz. bottle of Lactopeptine of the N. Y. Pharmacal Association's manufacture and she improved at once. Soon after, she met a lady friend, who told her she ought to take Lactopeptine, stating what wonders it had done for her, who was troubled just the same way" (of course). "Why, bless me," said my patient, "that is just what my doctor prescribed for me and I am doing nicely." By the time she finished the small vial she declared she never felt better in her life, her appetite being regular and everything O. K. 6 N. B.-She has taken since Lactopeptine, Elixir, Calisaya, Iron and Bismuth, with excellent results.-The Medical Summary. The LANCET-CLINIC and Obstetric Gazette to one address, one year for $5 Selections. MEDICINE. SOME OBSERVATIONS CONCERNING WHAT is Called NeurasTHENIA.—A paper read by W. S. Playfair, M.D., before the British Medical Association, and published in the British Medical Journal. I have ventured to take, as the title of this note, that given to a paper written by Sir Andrew Clark, which I have read with great ir terest and satisfaction, since it will certainly lead to the further study of an obscure and little understood form of disease, that it should be made the subject of a pa per by a physician of his eminence. This topic was originally almost accidentally forced upon my attention from the very frequent association of this type of disease within the gynæcological work which is my special province. General physicians are constantly preaching of this evil which, in their judgment, comes of over much local treatment in women; and it was the taking to heart of these sermons which led me to a closer study of the neurotic complications of uterine disease. Having drawn the attention of the profession to the remarkable success which followed the treatment of certain cases on the principles first systematised by Dr. Weir Mitchell, ot Philadelphia, it was only natural that numerous examples of this type should come under my observation, many of them en tirely unconnected with gynæcology. I saw many cases in which the originating local ailment, when it existed, had become entirely overshadowed by a neurotic condition engrafted upon it, which had in time become the dominant factor of the case, and, too often, I had the humiliation of observing that this neurotic state had been cultivated and fostered by injudicious medication, as surely as mushrooms are forced in a hotbed. I soon became convinced of the great importance of some of the varieties of functional neurosis to which the term "neurasthenia" has been applied; and I also learnt how completely ignorant I had myself previously been of this class of disease, and how very little it had been studied by the profession at large. If it be the case, as Sir Andrew Clark tells us, that this subject is being at last recognized in our modern systematic and clinical works, still more it it attracts the attention and is deemed worthy of being written on by a physician of his position, all is being done that can be desired. No one can wish for more than that a subject should be thoroughly threshed out,. and dismissed from every point of view, favorable and unfavorable. Magna est veritas et prevalebit, and the proper estimate of any form of disease can only be arrived at by an open discussion of this kind. I have done my best to bring this matter publicly before the profession by papers in the medical periodicals, by a discussion in the Medical Section of the British Medical Association at Worcester, and by an unsuccessful attempt to induce the Collective Investigation Committee to embrace it! in the field of their inquiries. With regard to the latter point, I must observe, en passant, that their reason for not doing so was to my mind a strange one, namely, "that the topic was not ripe for investigation." I fancied that the very raison d'étre of this Committee is to facilitate the study of little understood and "unripe" forms of disease; and I venture to think that conditions shattering the life and happiness of thousands of chronic invalids all over the country, are quite as legitimate subjects for scientific study as such topics, for example, as the "value of pure terebene." I am happy to say that the endeavors I have made have not been altogether unsuccessful, for the matter has attracted a good deal of profes sional notice, and the main fear now is that certain cases will be classed and treated as "neurasthenic," if I may be pardoned the provisional use of the word, which certainly have no right to the term. Before say. ing more on this, let me point out that the reason why this type of general neurosis has been so little studied as not to find even a casual mention in most of our systematic treatise on medicine is to a great extent, I think, because it is chiefly a disease of the cultured classes, gradually increasing as the so-called "culture," or "over-pressure, or analogous causes of nervous strain are brought into operation, and not found, or to a very partial degree, in the patients of our large hospitals, I, at least, have no ret ollection of having seen a well marked case except in private practice; and as most of our systematic writers have drawn their experience from their clinical wards, it is not surprising that it should have been only partially recognized. Another explanation is to be found in the fact that neurology— whether the term be applied to functional or organic disease is a comparatively modern study, and that many advanced cases have been wrongly diagnosed, and attributed to some obscure organic cause, instead of to a pure neurosis. As it was the perusal of Sir Andrew Clark's paper which induced me to write this note, I may venture to allude to some of the views he maintains, to which I feel bound to take exception. In the first place, he objects to the term "neurasthenia," and says that the condition to which the name has been applied has been already more or less fully described under such names as "nervous erethism," or "mimosa inquieta,' etc. It may be so, but certainly such terms have not attracted much professional attention, as neither of them is mentioned in the four medical dictionaries I have consulted, namely, Quain, Dunglison, Littre, and Robin I hold no brief to defend the word "neurasthenia." I have never used it myself preferring English expressions to Greek, and it must be admitted that it has sometimes been employed in a way that is reprehensible. Still, a disease, or assemblage of symptoms, or morbid state, must have a name of some sort. The theory involved in the term "neurasthenia" is, perhaps, as near the truth as any other that we are likely to reach for some time, and it is practically more euphonic to talk of a "neurasthenic" patient, that of one who is a "nervous erethistic," or an "inquiet mimotic." The mere nomenclature is really of little moment; the thing of importance is that the morbid state, disease, or assemblage of symptoms, should be fully realized and carefully studied. Sir Andrew next proceeds to give a graphic and very accurate description of what he properly terms "mere nervousness;" and then satisfactorily proves that anyone treating such a condition on lines other than the very common sense ones he lays down, would be committing a grievous fault. For my part, I believe that no one short of a lunatic could possibly be guilty of such an error. What Sir Andrew so well describes is, doubtless, the raw material from which "neurasthenics" are made (I find I am obliged to use the forbidden word, after all, for want of another); but such a person is no more to be described as suffering from "neurasthenia," than a person who has an inherited tendency to tuberculosis can justifiably be called "phth isical" in the absence of all lung symptoms. A "neurasthenic" is not a person with a nervous system prone to break down, but one whose nervous system, from some cause or other, shock, overwork, mental strain, and so on, actually has broken down, and who has thus become a complete invalid, and is incapable of fulfilling the ordinary duties of life. Under such circumstances, the patient is as much a fit and proper subject for treatment as one who has broken a leg, or has typhoid fever. It is by no means easy to define the symptoms of what I should understand as "neurasthenia." They are far too multiform, and the stress of the break-down may be thrown on very different organs in different cases, so that any concise definition suited to a brief paper such as this is an impossibility. One thing I am certain of is, that there exists a distinct functional neurosis, completely shattering the life of the patient, well worthy of being called a disease, quite capable cf cure in certain ways, which ways are certainly not those generally adopted, and quite distinct from what is generally known as "hysteria," although sometimes associated with it. Perhaps I may best illustrate what I mean by a very brief reference to three of my old cases, whose welfare I have chanced to have heard of within the past few weeks. 1. In May, 1883, I was asked to see a lady, 46 years of age, who had come home from one of our distant colonies in a state of complete collapse. She was a woman of very energetic temperament, and the mother of a large family. Her state of exhaustion and cachexia was so great that she could not walk across the room. She had been carried on to the ship and off it on a litter, and a consultation of the best colonial medical men had resulted in the opinion, which her wasted and cachectic condition easily accounted for, that she was the sub ject of malignant visceral disease. This state had existed for three years, and was progressively increasing. The patient came under my care not with any idea that she was suffering from a neurosis, but as one dying from cancer. Not finding any evidence of this, I treated her as suffering from neurasthenia, and in two months she was a strong heal.hy woman, up to any exertion, and she soon returned home. Some months ago, I gave some friends who were traveling round the world a letter of intro |