difficult to administer it in sufficient quantity to young children. This observation will apply likewise to all the other bitter tonics, such as colombo, quassia, gentian, etc., whose good effects are in a great measure lost or counterbalanced by the extreme reluctance and disgust with which they are taken. The metallic tonics are free from objection. Zinc, iron, and arsenic, are used; the latter is particularly convenient, as being tasteless and inodorous, and thus very easily administered to the most unmanageable patient. It is the subject of very strong eulogy from Dr. Ferriar, who declares his belief, that "the only remedy which promises to shorten the disorder effectually, after the proper preliminary steps have been taken, is the solution of arsenic."

The general management of the patient should be carefully regulated. His diet should be light, nutritious, and unstimulating. He should be warmly clad, and protected from vicissitudes. There is a popular prejudice in favor of exposure to the open air in hooping. cough, which does injury, if yielded to, while there remain any of the complications with bronchitis and pneumonia, so common. These require confinement, not only within doors, but to the equable warmth. of a well-ventilated chamber, or even, for the time, to bed.

In serious and protracted cases it may be found necessary to advise change of air, or, at any rate, a temporary removal from an accustomed residence. A contrasted locality should be sought. The lowlander may be sent to the mountains, and the native of the interior country brought for a time to the sea shore.

SECTION IV.

DISEASES OF THE SENSORIAL
SYSTEM.

THE organs of this important system are the brain, the spinal cord, and the nerves; the diseases of which must be considered in succession. Their functions are varied and numerous, and essential both to organic and animal life. Intellection, including sensation, volition, and all forms of mental action and passion; motivity, in both the voluntary and involuntary muscular fibres; secretion, nutrition, circulation, and, indeed, all the specific actions of all the viscera and tissues, are absolutely dependent upon, or inevitably modified by their condition.

Some portions of the intracranial mass, the "hemispherical ganglia, are exclusively devoted to intellection; the offices of "the true spinal cord" are purely physical; the nerves seem mere conductors of sensations, volitions, and impulses direct and reflex, between the nervous centres and their extremities. These centres are supposed to be sources of nervous power, which is generated, probably too, by the organic or nutritive action of all the tissues. The gray vesicular, and the white tubular matter, exist together in the brain, spinal cord, and ganglia; the nerves consist of the white only.

Nervous matter is composed of albumen in combination with phosphorus and certain fatty substances.

The disorders of the various departments of the sensorial system must of course express themselves by prominent impairment of the special function of the portion affected; this is not always clearly known, however, and the connection between them all is so close, that for the most part the lines of demarcation cannot be drawn with absolute certainty or precision. Nay, we must confess that in many instances they are so thoroughly intermingled that our efforts at nice separation result in nothing more than a selection on doubtful grounds of mere preference, theoretically. Following, with this preliminary remark, the familiar distinctions, we recognize the various affections of this great system, as prominently seated in some special portion of it, and treat of them under the separate heads of Cerebral, Spinal, and Nervous:-and first of those of the BRAIN and its membranes.

CEPHALALGIA (Hyperesthesia of the Brain, of Romberg-Headache) is one of the most frequent and painful of human maladies. It attends most febrile ailments, depending on the irritation, congestion, and inflammation, which belong to the history of these affections; and is sympathetic of, or caused by, many gastric derangements.

When idiopathic, it seems to consist of a peculiar erethism of the brain, which may be extensive, spreading over the head, or limited to one side (hemicrania), or confined to a single narrow spot. Most persons habitually subject to it have it usually at some particular point.

Its causes are direct and indirect; prolonged and intense impressions of light and sound; strong thought, violent emotion or passion; solar heat, or the warmth of a crowded apartment, are among the first-so is the motion of a ship or a swing-so, too, want of sleep-the effect of tobacco, opium, wine, and other stimulants and narcotics. The indirect are found in the disturbances of the digestive system; chiefly acidity of stomach and constipation. The idiosyncrasies of the subject, and the contingencies with which it is connected, modify it somewhat, and give it a qualifying title-as nervous, sick headache, hysteric headache.

It becomes, by repetition, almost habitual in many, and returns upon the application of the slightest causes.

Pathology.-Hemicrania is ascribed by Turenne to compression of the facial nerve, especially the ophthalmic branch, by congestion in the sinuses at the base of the cranium. The attendant nausea is caused, he thinks, by the compression of the eighth pair at the foramen lacerum posterius. Each pulsation of the carotid increases the pain; epistaxis relieves it. Inspiration, during which the venous blood tends towards the heart, diminishes it. The left side is most affected. These views correspond closely with my own observation and experience. The history of the causes which produce the attack, and the general means of relief, both favor his conclusions. Sieveking finds cephalalgia connected with anemic as well as congestive states of the brain.

Treatment. Its natural cure or termination is in profound sleep, yet the employment of narcotics is productive of less benefit than would hence be expected.

Much palliation is effected by enjoining perfect stillness and quiet. A cold wet cloth applied to the head gives relief.

Holding the arms elevated above the head, as advised in epistaxis, by favoring the flow of blood from the seat of congestion is often found useful; so is the repetition of full inspirations, long protracted, alternating with deep expirations. Parry recommends the compres sion of the carotid of the affected side with the finger, so as to impede the force of the current of blood driven upwards; and I have certainly found it of some benefit.

Trousseau and Bonnet treat cephalalgia, both pyrectic and apyrectic, successfully, as they affirm, with the cyanuret of potassium. They use the solution externally-six or eight grains in an ounce of water, alcohol, or ether-the first in preference; this amount will ordinarily suffice for a day, but it may be necessary to double the strength or the quantity used. It may be applied to the sound or the blistered skin. Compresses wet with it, or a wad of cotton laid on the part, must be renewed as often as they become dry. If used on the denuded skin, it must be guarded with cerate, on account of its causticity. When ap

plied, the solution produces a decided sense of cold; in half an hour a prickling is perceived, and a kind of itching, not disagreeable. The skin becomes red, especially if the alcoholic solution is used. If too strong, or kept on for more than twenty-four or forty-eight hours, eczema follows.

Great care should be taken to avoid all obvious exciting causes, or apparent sources. When this cannot be done, the system should be gradually accustomed to them, guarding against any unfavorable circumstances of predisposing character, such as indigestion, costiveness, and the like. Camphor and belladonna have been supposed to exert some specific good effects in the relief of constitutional headaches, and may be employed in small doses. The best remedy is found in the annealing or hardening influence of long and frequent journeys, in which discomfort to moderate extent is incurred.

I have seen many experiments made with very powerful agents of sedation and counter-irritation, for the relief of this tormenting malady. The inhalation of chloroform has been in some very useful, inducing sleep, from which the patient wakes relieved. In others, I have seen it do much harm, prolonging and increasing the headache. Aconitine is equally irregular and uncertain in its effect, and attended with some serious risks besides.

PHRENITIS.

Phrenitis-Meningitis-Encephalitis-Inflammation of the brain and its investing membranes. I treat of these together on account of the universally acknowledged difficulty of distinguishing between inflammation as it affects the cerebral substance on the one hand, and on the other, of the membranes which invest it. In the acute stage the symp toms are nearly, if not absolutely the same; the result is chiefly the same, implying a degree of pressure upon the various portions of the intra-cranial mass, which goes to confuse very much by its progressive influence, all nice diagnosis.

Acute phrenitis is not often met with as occurring idiopathically or independently, but many of its phenomena arise sympathetically, in the course of other diseases; and in the class of fevers this is so generally the fact, that Clutterbuck and others have maintained cerebral inflammation to be the primary location and essential condition of fever, properly so called.

Acute inflammation of any portion of the brain and its membranes, commences with pain in the head, with a sense of fulness, heat, and throbbing; the eyes are red and suffused, and intolerant of light; the face is flushed and turgid; there is pain in the back of the neck and down the spine; the scalp is occasionally tender to the touch; the stomach is in some cases oppressed with retching and vomiting; the pulse is full, hard, and bounding; there is great anxiety or mental dejection, or, even from the first, wild delirium, which at any rate seldom fails to supervene early in the progress of the attack; the hearing is

acute, and ordinary sounds occasion distress; there is pervigilium; the tongue is whitish, and slightly furred; and the skin hot and dry. If the disease advance unchecked, the patient sinks into a soporose state; the eyes grow less and less sensible to light; there is perhaps strabismus, or a fixed state of the pupil, at first contracted slowly, and afterwards widely dilated; the hearing is impaired; there is sighing, grinding of the teeth, tremulous debility; respiration and deglutition become difficult, and coma or convulsions precede death.

The predisposition is said to be sometimes hereditarily transmitted. It is found to exist in men of violent and irritable temper, and morbid susceptibility to mental emotion; in persons of sanguineous temperament; those accustomed to free and luxurious living; and in the profound student and ardent cultivator of literature.

The exciting causes are insolation, blows on the head, gusts of vehement or prolonged passion, and intemperance or excess.

Autopsy. The appearances after death vary with the duration of the case. The vessels of the brain and its membranes are turgid; lymph is found adhering to the surfaces of the latter, and connecting them by adhesions; serum is often effused over the surfaces and in the ventricles, and pus not unfrequently found mingled with it in considerable quantity. The seat of meningitis is the loose, areolar, subarachnoid tissue, rich in blood vessels. The exudation here is usually puruloid, consisting of pus-corpuscles chiefly mingled with loose granules and molecules, and some serum. The serous effusions, I agree with Bennett, belong to the class of dropsies rather than inflammations. Acute cerebritis will be distinguished pathologically by the exudation of liquor sanguinis into the substance of the brain, whence abscess in the more rapid cases and softening in the slower. Softening is of several kinds; besides this inflammatory softening, we have the hemorrhagic, occurring round a clot, and a species probably independent of inflammation, a vice of nutrition, or lesion from diminished nutrition in a part of the brain from obstruction by a clot of blood, the emboli or embolismus of Virchow. Induration attends rather upon chronic than acute cerebral disorders.

The prognosis is generally unfavorable. We draw the most gloomy inferences from the supervention of great debility, while the local excitement is unabated, and from the tokens of effusion and mechanical pressure, as paralysis, strabismus, deafness, stupor, coma, convulsions.

Treatment.-Bloodletting is, in the early stage, indispensable. Some open the temporal artery, some the jugular vein. That vessel is to be selected from which we can obtain the fullest and freest flow of blood. The head should be elevated, and persevering affusions of cold water thrown on it from some height. The scalp should be shaved; cups or leeches may be applied to the skull and behind the ears; but our best reliance is on the lancet and cold affusion, which I prefer to pounded ice or any continuous application. The most active purgative doses should be given-a combination of the resinous and saline, I think, should be preferred, and used freely, as long as the strength will bear. A more permanent reduction of the force of vascular