pain is sometimes very intense. It is not constant, but attacks are easily brought on by exertion or prolonged reading. This latter cause probably operates by reason of the weakened condition of the muscles of the eye, which share in the general poor nutrition of the body. The diagnosis of this type is rendered easy by the accompanying symptoms, which exist in varying degree, of faintness, vertigo, palpitation, breathlessness, dizzi ness on rising suddenly, and improvement of the head ache by lowering the head and elevating the feet.

There is also the congestive headache due to prolonged brain work. It is perhaps needless for me to remind you that when an organ is functionating it requires more blood than when at rest, and that after prolonged mental work there sometimes is a passive cerebral congestion. This is seen in lecturers, ministers, jury lawyers, and students cramming for examinations. It is usually accompanied with restlessness, general fatigue and insomnia. The patients complain of a feeling of pressure on top of the head. There is also dizziness, ringing in the ears, and photophobia. If the attacks are frequent there gradually develops a capillary dilation, due to the frequent active hyperemia, and then

The treatment of the anemic condition need not be described here. The treatment of the attack is often successful by giving a diffusible stimulant, as spirits ammonia arom., one drachm, to be repeated if necessary a chronic congestion may occur, and we then have a

in one-half hour. Sulphate of quinia in five or ten grain doses often is effectual in arresting the pain or at least in moderating it.

chronic headache most difficult to cure. These headaches are made worse by the worker taking stimulants as a spur to the flagging energy.

My treatment of these cases is, cessation of work where possible; first thing in the morning before rising a cup of black coffee; a spinal douche, 40 degrees, at ten or eleven o'clock

R

M.

Tinct. nucis vom.
Elix. gent,

Acid. phos. dil.,

Elix. pepsin,

3j. 3j.

3j.

The congestive headache affects the whole head. It occurs often in school children. It is rarely due to overwork-more often to gastric and intestinal causes. The pain is throbbing, increased after meals, and is usually worse in the latter part of the day. Sleep is often tardy, and when it does come it is often disturbed by bad dreams. The patients are as a rule all children of neuropathic ancestry, and are liable to suffer from other diseases, as epilepsy and chorea. As a rule they are dull at school, or else bright in some things, dull in others, irritable on the play ground and changeable in their moods. Such patients, it should be remembered, are always in danger. It is possible that these headaches, in a limited number of cases, may be forerunners of more serious mischief-tubercular meningitis. These children should be taken out of school and the entire attention be given to making good active physical beings, not intellectual prodigies of them. They should be given a system which they are to carry out most religiously. This should include mild gymnastics, cold sponging, salt water rubbing, outdoor plays, but par ticular care must be taken that the child does not believes the severity of the pain. come exhausted, and to that end I make it a rule to order that the child come in at four o'clock and rest an hour. In many cases we find such cases are best treated by the mixed bromides, five to ten grains, t. i. d., for a few days only.

Sig. A teaspoonful in water three times a day.

If the heart is flagging, give a little digitalis. At night I have them take a sponge bath with cold salt water before retiring, well rubbed, in order to stimulate the peripheral circulation, and deplete, if possible, the engorged cerebral circulation. If, after being in bed one hour they do not sleep, I give

Regulation of the diet, which should include avoidance of sweets, prevention of over eating, the giving of fruits, and attention to the bowels, should complete a

cure.

In adults, congestive headaches more frequently occur in men and are often due to frequent wining and dining. The head pain is described as being a feeling of fullness a throbbing, beating head. The treatment by blue pill and salts, with dietary restrictions, is effectual in curtailing the duration of the attack. A full dose of bromide of potash, or of one of the effervescent salts of caffein or antipyrin often relieves the pain. The English gentleman prescribes for himself on such occa sions the juice of half a lemon in a glass of apollinaris

water.

Ergot,

Pot. brom.,

mxxx. gr.xxx to lx.

In the congestive headache of old people I have had some good results from continued small doses of ergot. In some chronic cases which have yielded to no other treatment, potassium iodid in 15 to 20 grains a day re

In the headache occurring at the menstrual period in which the pain is frontal, extending from the root of the nose over the eyes to the temples, Dr. Glasgow of St. Louis, reports that in a number of cases he has given immediate relief by pricking the congested cavernous bodies, and thus causing free local blood letting. This I have never tried, as it requires some manual dexterity which I do not possess.

The syphilitic headache is marked by great violence. The pain is usually verticel and may be diffuse or localized. Its characteristic accompaniment of scalp tender. ness and nocturnal increase of pain make the diagnosis sure enough to warrant questioning the patient as to his personal history, and to treat him antisyphilitically, even though we meet with a denial of specific disease. I have not found as prompt results with small doses of mercury in these cases as I have with doses of potass. iodid of from 15 to 20 grains three times a day. This may be due to the fact thot the majority of my cases have had the headache as a late symptom.

ABSTRACTS

Treatment and Cure of Lepra Tuberosa With Europhen.-Dr. Julius Goldschmidt, Madeira, iu Therapeutische Monatshefte, April, 1893, says:

The headache due to cerebral growth, the toxic headache, arising from the ase of drugs, the headache accur ring in the course of acute febrile diseases, of which typhoid fever and la grippe are examples, the headaches which occur in rheumatic, gouty and lithemic subjects form a group, the treatment of which is a part of the treatment of the disease of which it is a symptom, and will not therefore receive special consideration here. The attempts to institute a rational treatment of The headache due to reflex causes, chief of which is leprosy by internal or external remedies have been some eye defect, are to the general practitioner of the characterized thus far by so unsatisfactory results that most baffling character. This is so because, even though most physicians practicing in countries in which leprosy the patient is asked if there is any trouble noticed in prevails have come to regard all therapeutic measures using the eyes, we often are answered: "No, my eyes under the condition hitherto existing as hopeless. On are perfectly strong. I can see perfectly." An exami the other hand we observe in the unimpeded course of nation with the test type, which is the only way we who this disease certain circumstances which should conare not oculists have of examining the eyes, often re- stantly impel us anew to a judicious effort to influence veals what we estimate as normal, or near enough to single symptoms if not the entire disease. These cirnormal vision, and then we dismiss the eye question cumstances are the arrest in the development of the cufrom the case. Or perhaps the patient may be wearing taneous thickening continuing for many months and glasses, and will mention the name of some well known even years, or the complete remission in the appearance oculist who fitted the glasses, and pronounced them cor- of new eruptions for a long period, the atrophy of the rect. The general practitioner must indeed be bold nodules, (attended of course with the pronounced dewho will persist in clinging to the idea that there is struction of large areas of tissue) the extraordinary restill an unsolved ocular problem. But my experience sistance to the disease manifested by the organism or with rather a large number of patients ef this class has some of its parts such as the scalp, the extensor surface forced me to the conclusion that oculists may differ in of the extremities; further that the observation that their mathematical calculations as surely as we will dif- this affection never appears as an acute one but that fer in our prescriptions for dissase. It is not uncom- the affected areas are only the seat of an acute inflammon to have a patient examined by two different com- mation and finally the therapeutic experience which I petent men, and receive different glasses from them. was the first to make with tuberculin (All my cases This, I believe, is not always because the measurements treated with tuberculin, see my article on "Leprosy taken differ, but because oculists differ to the advisa- and Madeira 1891 F. C. W. Vogel Leipzig, became soon bility of giving full correction or only a partial correc- worse after initiation of this treatment. In the case of tion. What may be the correct view to be taken in a child ten years old a real facies leonina had developed case of fitting glasses for correcting defective vision from the isolated patches in less than two years. This unaccompanied by nervous symptoms, is not within my is the more remarkable since prior to puberty the province to say, but in those cases in which the defec- course of leprosy is usually very chronic.) that it exerts tive eyes are accompanied by headache, I am convinced a specific influence upon the nodules but unfortunately that in the very large proportion of chronic cases the error must be fully corrected, and corrected after the use of a midriatic before we can eliminate the eyes from the case.

In reference to the cases in whom we find loss of mus cular balance, we must wait for the decision of the oculist as to the relative value of tenotomies and prisms.

In the cases due to ocular defects which have existed for a long time, the patients will as a rule require treat ment for a considerable time after the proper correction has been made.

After a cateful study of all headache cases, there still remains a considerable number in whom we can find no ascertainable cause, and where we meet with but little success in treatment. It is these cases that give the general impression that headaches cannot be cured but must be endured. It is also in these cases that we must be endured. It is also in these cases that we must avoid recourse to the hypodermic or other use of morphia, for they become habitues only too easily.

Leaving out those cases in whom we can find no defi. nite cause, I believe that by careful study of individual cases a large majority can be greatly improved, if not

cured.

only causes a temporary retrogression. All these facts urgently impel to new therapeutic experiments. In estimating the result obtained from the treatment of leprosy, we must of course be reserved, for as already mentioned a remission of long duration is frequently followed by a paroxysmal, sudden further development of the affection. During periods of many months I have measured certain nodules and patches in the most accurate manner without detecting even the slightest difference in size until suddenly without any external influences they began to grow and within three to four weeks had attained to double their previous dimensions, or in the same inexplicable manner new foci developed at a greater or less distance. This observation was confirmed by means of photography which permits an ac. curate measurement of the projected nodules. Indeed one finally reaches the conclusion that leprosy produces local foci at some orifice on the skin or a mucous mem.

brane (nose). These spread slowly along certain routes avoiding as long as possible the regions of the body where the skin is tense (such as the skull and the ex

tensor surface of the extremities.) This pronounced a pronounced effect followed then the treatment must tendency to commence as a local affection and to remain be energetic either by continuous application of the local during its entire course extending over many years Europhen both during day and night or by introand even decades is an important indication of the pos duction of the remedy into the nodule itself. In exsibility of influencing and even curing the disease by perimenting with the injections of the remedy I was local means. I have never observed an acute leprosy actuated by the thought that it might be possible to resembling an acute miliary tuberculosis or an acute effect an immediate curative result, and at the same disease produced by absorption of the metabolic pro time I tried to increase the tension within the nodules ducts of the bacilli. Every focus undergoes its own to a maximum; for as already mentioned regions where process of evolution. Death is brought about by the the skin is tightly stretched remain intact as a rule or complications and scarcely by the disease per se since at least for a long time. And one also observes an inthe vital organs are seldom attacked or only at a late volution of the tumors as soon as they have attained period. Whether the chronic pulmonary phthisis so a certain degree of development and consequently a frequently observed at least in Madeira is of leprous or certain degree of hardness. In order to convince mytuberculous character I will not attempt to decide. self of the inoccuous character of the remedy I employed at first a few subcutaneous injections of a 3 per cent solution in oil which were well borne in amounts of one centimetre (a syringeful) without producing a local or general reaction. The strength of the solution was gradually increased to 5 per cent.

In view of this position of clinical observation the idea suggested itself to extirpate the isolated nodules at the beginning of the disease and in this way to arrest the spread of the infection. The total extirpation of small nodules is unattended with difficulty; the wound cicatrizes rapidly ond no appearance of leprosy manifest CASE 1. Alexandrina Rosas, aged forty-eight years themselves at this place for a long time until finally new coming from one of the villages of the southern coast. eruptions develop around the scar in its vicinity. Long Parents are not leprous, a sister, a male and female before surgical treatment was resorted to it had been cousin had died of leprosy. Patient is married and customery to employ local means consisting in inunc had eight children two of which are still alive and not tions of various substances among which chaul moogra leprous. She had lived thirty years in Demerona oil enjoyed the best reputation. As a rule however, other British Guaya has been sick seven years and returned remedies were administered internally at the same time. to her native place three years ago. The disease has All such experiments I have made during a long series invaded almost the entire cutaneous surface and the of years without any real or permanent results. For mucous membrane of the pharynx and larynx. A five this reason I have sought to find a new remedy, a new per cent solution of Europhen in oil was injected into method of treatment. the degenerated skin of the arm at different places. No Among all the local remedies employed against the improvement was noted at the end of three weeks. The tubercle bacillus, which is so closely related to the or- leprous infiltrations opposed a considerable resistance ganism of leprosy, iodoform has probably given the to the injections which injections which for this reason could be most satisfactory results in tuberculosis of the joints practiced only slowly drop by drop at various places bones and glands. Its employment in leprosy com until the skin became tense and further introduction of mended itself for many obvious reasons. I was soon the remedy was impossible. The absorption of the oil compelled however to refrain from its use on account required at the very least three days and some time of the general disturbance it occasioned such as eleva eight and on this account a number of infiltrated patches tions of temperature which became dangerous on ac- not too far removed from each other were subjected to count of the wretched and feeble condition of the pa- this proceeding. Owing to the incredulity which the tient. Europhen (I am greatly indebted to the Farben patient manifested toward any kind of interference the fabriken Vorm. Friedr Bayer & Co. Elberfeld who treatment was suspended at the end of three weeks. The placed the remedy at my disposal. A quite extensive leprous lesions were not affected in any manner. I literature exists relative to the chemical constitution would remark here that no formation of abscesses ocand therapy of the remedy, in most of which a favora- curred in this case, or in any of other cases; of course ble opinion is expressed.) appeared to me a harmless all the injections were made under aseptic precautions. substitute rich in iodine (28 per cent) which probably is CASE 2. Pedro Peleiro (see illustration and history the sole effective element and in my further experiments in the article on "Lepra in Madeira" already referred I made use exclusively of Europhen. My observations to.) This far advanced case will only serve to emphasize were made in five cases and extended in four over a the harmless character of the treatment. After it had period of eight months and in one case (which was been kept up for seven months the proceeding disease cured) over fifteen months. The remedy was employed continued; several of the nodules had become flatter, to the exclusion of other measures while the patients but at the present time, almost a year after commencemanner of life remained unchanged. I first treated advanced cases of Lepra Tuberosa in order to form an ment of the treatment a change for the worse has maniidea of the manner of application of the remedy and its fested itself. action upon certain nodules or diffuse thickenings. If

An attempt now was made to select cases in which the

nodules were slowly circumscribed and to continue our size the intense redness subsided and the patient could experiments on these.

CASE 3. Silva, aged nineteen years coming from the northern part of the island. Had been sick eight years. Father died of leprosy. Facies Leonina present. On the extremities circumscribed nodules, chiefly iso lated varying in size up to a pigeons egg. Over each olecranon isolated tumors of the size of a cherry which seem especially adapted for the experiment. These nodules were injected as frequently as possible, usually every third day with the largest possible quantity of Europhen Oil five per cent. At the close of the small operation the originally doughy nodule felt hard and tense. After six months of treatment the nodules had decreased to one third of their original size. At the present time eight months later the nodules have not en larged although the disease has slowly advanced.

Isabel Gowsalves Serras, aged twelve years coming from the western part of the island (see 1.c. page 2q) In this case there ensued after the tuberculin treatment which at that time was not followed by visible results, whether favorable or unfavorable a subacute exacerbation such as I have observed only at the time of puberty which in the mentally and physically backward children is much delayed. At first subcutaneous injections in the vicinity of the infected areas of skin was tried for six weeks but without success. Later the nodules were treated as in case 3 the treatment being continued for five months. The nodules slowly decreased in circumference and at the close of the treatment were of about one half their original size the disease progressed rapidly so that after six months the nodules treated on the arms and legs had attained their previous size.

open her mouth more readily and widely and pucker her lips more tightly. The affected patches of skin on the extremity show signs of improvement. Without entering into the details of the slow but steady progress toward recovery I will only report the ultimate result of fifteen months treatment. The eyelids are perfectly normal so that the original site of the dis. ease can no longer be detected. The large leprous area on the upper lip and angle of the mouth and the smaller one on the chin are completely cured; the skin can be lifted up in folds is of a light brownish hue, and somewhat depressed toward the periphery; bacilli can no longer be detected in it. The point of the nose alone is still somewhat reddened and swollen; here also no bacilli are present. The leprosy of the lower extremities has been perfectly cured; at the former situation of the disease the skin is of a brownish color but has a healthy feel and contains no bacilli. The general condition of the woman is excellent, and was never disturbed during the long course of treatment.

I will nevertheless continue the treatment for an indefinite period. At any rate a sufficiently long time had elapsed to warrant me in regarding this case whose constant advance I had observed for a number of years as influenced therapeutically or even cured by the remedy. During a period of twenty-five years observation of leprosy, such a result, such a decided cure has never occurred notwithstanding all the pains and care I have taken in the treatment. Indeed I would say that a case in which a cure has been affected has never come to my knowledge.

tensive changes of the mucous membranes are present, which cannot be rendered accessible to treatment.

The treatment by means of injections is more painful than that by inunctions but has the advantage of not making as many demands upon the patient whose frequently low intelligence renders him incapable of independent action. The patients should be under medical supervision.

Accordingly this case although an isolated example, seems urgently to demand of us to use the same remedy CASE 5. Maria Julia. (illustration and history 1. c.) and the same method in other cases, the more so since The disease was characterized by the formation of the injections into the nodules also exerted a distinctly nodules on the left angle of mouth the left side of the favorable effect. I would exclude the cases of extensive upper lip, the chin, the right eyelid, the point of the degenerations of the skin in as much as the surface to nose, and on the right upper and lower extremity. To be treated is too large. Symptoms of iodoform poisonsecure as lengthy and uninterrupted treatment as possi- ing might be produced and besides this deep and exble the injections were discarded and about fifteen months I began to treat the degenerated leprous patches and their vicinity with inunctions of five per cent Europhen Oil. Thrice daily all the thickened and suspicious areas of skin were gently rubbed with oil for a period of five minutes. Any oil remaining on the skin after the inunction was not removed so that the parts were kept in contact with the remedy day and night. It was also introduced into the nose three times daily. The patient continued the treatment conscientiously for ten months interrupting it during the latter part of her pregnancy and during the four weeks following the birth of her child which was vigorous and healthy. The result of this treatment was truly astonishing although I had been previously acquainted with the action of Europhen in weakening if not destroying in leprosy by staining the cells and bacilli in corpore the entire bacilli. As early as four weeks after the application a decided improvement could be noted. The swollen upper lip, the thickened eyelid diminished in

NOTE: In the course of the above therapeutic investigation I also made experiments with pyoktanin which was injected into the leprous nodules in sulutions up to 1 per cent. In as much as the other observers have expected to obtain curative effects from the parenchyma. tous administration of the aniline dyes as for instance in cancer I thought it possible to exert a healing action

vivo. It is an easy matter to demonstrate the coloring. All that is necessary is to fill a small nodule as much as possible with pyoktanin and then extirpate it for ex