Here, as in nearly every department of medicine, neurology, physiological or pathological, continues to shed its salutary rays of light on clinical medicine.

The past year has witnessed more attention to psychiatry on the part of neurologists and more attention to pathological work, as instance in illustration the wide range of subjects treated of in the State Hospitals Bulletin, of New York, a publication which bids fair to become as famous for record of good work as the well known and unsurpassed West Riding Asylum Reports of Great Britain.

A committee of the American Neurological Association has, since our last meeting, taken up and reported to that body on the subject of the after care of the insane.

In this connection I note that Dr. Putman, of Boston, in the transactions of the Association of American Physicians and in the American Journal of the Medical Sciences, offers new views of thyroidal diseases and Graves' disease, and Dr. J. T. Eskridge, of Denver, also on some new uses of the thyroid extract. Our colleague of this city, who never rests from his labors, will soon be heard from in the American System of Practical Medicine, volume IV., now in press, and has reported in the September Medical News an interesting case of intradural spinal tumor, extending through the foramen magnum, compressing the extreme upper portion of the cord and almost completely destroying it at the third cervical segment.

Up to 1884, Drs. Goodell, Pallen and other gynecologists advised the removal of the ovaries in all cases of insanity.

That same year Dr. T. G. Thomas reported three cases of insanity following the operation, and Dr. Putzel, of the New York City Lunatic Asylum, reported one hundred post mortems on insane women dying in that institution without a trace of disease of the ovaries.

Since our protest in 1882 (vide Alienist and Neurologist, January, 1882) against the too reckless surgical disposition then in vogue to "obliterate the neuropathic constitution by excising the ovaries," and the later protests of our neurological colleagues, a sensible conservatism has supplanted reckless radicalism concerning this operation which Spencer Wells, Matthews Duncan and Martin, of Berlin, early discountenanced. And now neurology and gynecology clasp hands on common grounds respecting this operative procedure. Lately Drs. Weir Mitchell, Wharton Sinclair and F. X. Dercum have counseled and reported marked progress in the direction of a salutary escape of the pelvic viscera from the surgeon's knife in neuropathic states hitherto erroneously considered remediable only by radical operations, and the medical press since our last meeting (The Medical Council, March, 1898) thus marches with us in line of neurological progress:

"Somewhat recently two Italian physicians, Drs. Angelucci and Pieraccini, of the Provincial Asylum of Macerata, addressed letters to prominent alienists in various countries, most of them in charge of asylums and clinics, resulting in the tabulation of one hundred and fifteen cases subjected to a pretended operation, and one hundred and nine actually oper ated upon.

"Their studies forced them to the sensible conclusion that the removal of normal intra-pelvic organs for the cure of general nervous affections was wholly unjustifiable, and that hysteria in itself is actually a contra-indication for the performance of a serious gynecologic operation. They suggest, further, that in hysteric conditions, not remedial by other means, a simulated operation may be beneficial. The pathological condition of the uterus and its adnexa should be the only indication for their removal, and that all the benefit that may accrue to nervous and insane women from the removal of any part of their generative organs is merely due to suggestion, and this is equally effective in simulated procedures." The entire editorial under the caption of "Unjustifiable Pelvic Operations" is a further evidence of the invasion of neurological thought into the domain of general clinical medicine and surgery, especially during the past year, and confirms our long ago expressed conviction (vide Alienist and Neurologist, 1880) that "neurology is destined to reign paramount in medical thought and practice."

Playfair, a professor of obstetric medicine in Kings College, contributes a chapter to Allbutt's “English and American Gynecology," and Howard Kelly, our own countryman, in a late number of the American Journal of Medical Sciences, opposes needless vaginal examinations and repeated local treatments of virgins from a psychical standpoint, as any neurologist might.

The year since last we met closes with the prevalent professional conviction, no longer confined to neurologists alone, that the neuropathic diathesis is not removable by the knife.

The manner in which the neuropathic constitution is often overlooked among gynecological chirophiles is revealed in the following, taken from the "conclusions" of a writer in the Boston Medical and Surgical Journal, no further back than 1895:

"(3) The extent or form of pelvic disease is no indication of the character or degree of the resulting nervous manifestation.

"(4) The most thorough pelvic examination should be made with the aid of an anesthetic, in every obscure case of [to the ordinary practitioner and gynecologist, of course, he means] nervous disease in a woman, occurring during the age of menstrual activity."

Why not a genital examination and operation in all nervous men? "(5) Some forms of uterine disease may occasion an amount of nervous disturbance which may require the removal of the healthy Fallopian tubes and ovaries as the simplest and safest means of cure."

This is an exceedingly vicious conclusion, for there can be no justification for the belief that the uterine appendages are at fault unless they are sensibly diseased, and neurology, which has the best right to be heard on this subject, has never taught or believed in this monstrous conclusion.

Great neurological progress has taken place in the past and few preceding years in the abandoning of such conclusions by the best gynecologists.

The influence of magnetic stress on physiological action as a part of neurotherapy is worthy of note here, and on this subject our colleague, Prof. W. J. Herdman, in the Bulletin of the electro-therapeutical labora

DENVER MEDICAL TIMES.

21 tory of the University of Michigan, in his capacity of director thereof, called attention to this subject, October, 1887, showing a 10 per cent. daily increase of eliminated urea on the days when subjects were in the magnetic field, and upon animals 20 per cent. of increase of nutrition for eight weeks while in the magnetic field, with a gradual decline after the twelfth week, showing tolerance. These results correspond with d'Arsonval's.

The surgical treatment of exophthalmic goitre was the subject of discussion at the French Surgical Congress, Paris, October, 1897. M. Faure, of Paris, reported having excised the cervical sympathetic in three cases. In the first of these, the superior cervical ganglion, along with five or six centimeters of the descending cord, was excised on both sides; after four months the exophthalmos had diminished, the goitre was less in size, the tachycardia and the general health had much improved. In the second, the entire sympathetic was resected on the right side (superior and inferior ganglion included), the superior ganglion and part of the cord only on the left side (because of the onset of alarming syncope); this patient improved still more markedly than the first. The third case died on the table after the entire sympathetic cord had been removed from the right side and the dissection on the left side was about to begin.

I introduce this record of so-called progress in surgical neurotherapy only to enter my protest against M. Faure's procedure. The improvement recorded in the two first recorded cases was not greater than would have come to the victims of his knife under the enforced rest and expectancy of the operation, and the sympathetic system is not so useless in the human economy as to justify such radical destruction. This, the death on the table of the third case operated upon, confirms.

I oppose this surgical procedure also because it is not only too destructive, but because it is not necessary, since exophthalmic goitre is almost invariably curable without the knife; at least it has been so in my hands under arseniated and phosphorated bromide and blood reconstructive treatment, with adequate nerve and brain rest and changed mental environment for the patient. But one of my cases in a neurological practice of thirty years has failed of recovery, and that was taken out of my hands markedly improved for the useless gynecological operation.

I note this progress in neurology to condemn it, though M. Faure considers his operation a justifiable procedure, and thinks chloroform did the fatality in one of his cases, and the knife, and not the neural rest and changed environment, improved the others. I could have cured them under the same treatment without the use of the knife. I object to this surgical procedure also because I think the vagus quite as much in fault in Graves' disease as the sympathetic, and it would be quite as justifiable to cut that as so much of the sympathetic cord as was excised in M. Faure's fatal case. Surgeons might call this progress in treating the nervous system for its diseases; neurologists will hardly agree with them. Surgery has not up to date regarded the human anatomy quite as conservatively as neurology. The sympathetic system of the cord should not be caused to perish, that neural surgery may live.

As the thyreogenic theory of Graves' disease has not been proved, neither the thyroid extract nor the thyroidectomy treatment has received any new support during the past year, except that thyroidin, as Roumeville has shown, improves growth and reduces obesity in cretins and myxædemics, thus giving some apparent though not real color, through the benefit induced in exophthalmic goitre, to the hæmogenic over the neurotic theory.

Something has been added to the therapy of neuropathy during the past year. The suspension treatment of tabes, modified by recumbent knee-abdomen process and stretching of the sciatic nerve in sciatica, have passed from a great therapeutic expectation to their normal remedial limitations, and the much heralded massage cure for tabetics is now on the tapis to find the sphere of legitimate limitation during the coming year, as is the fate of all therapeutic fads.

Spermin (Poehl's Deutsche Medicinishe Wochenschrift, October 7, 1897) has been used with benefit by Wesbitzky, of Prof. Payoff's clinic in St. Petersburg. One of his cases, a soldier of sixty years of age, after ten injections improved markedly in gait, posture, pains and perception (tactile and electric), etc. A second case, not so typical, improved, but not so markedly.

Many new cures for epilepsy have been emblazoned on the therapeutic horizon during the past year, but none have yet eclipsed the BrownSequard formula.

Among the latest additions abroad to the therapy of this disease is an old remedy long used in this country before the advent of bromides, viz., Adonis vernalis. Tekutiew, in Neurologisches Centralblatt, February, 1898, has recorded the case of a boy, aged ten years, who had suffered from severe epilepsy for two years, fifteen to twenty fits a day, and commencing mental degeneration. An infusion of Adonis vernalis, with some codeine and sodium bromide, was given, and the dose of Adonis vernalis subsequently increased. The attacks of epilepsy gradually diminished, and then ceased altogether. The treatment of Adonis vernalis was strongly recommended by Bechterew, who combined it with bromides, and found that some cases of epilepsy seemed to be permanently cured by it.

It will be noted, as I have taken occasion to remark elsewhere in the deliberations of this and other assemblages, that none of these newly vaunted remedies for the old disease enable us to dispense with the old reliable bromide treatment as the essential adjunct and really main agent in every valuable combination. We are learning that the patient, not alone the convulsions of epilepsy, requires treatment, and while a prudent therapy of epilepsy prompts us to minimize the bromides to the anti-spasmodic needs and vaso-motor demands of the disease, the period for the passing of the bromides in epilepsy is yet far remote, if, indeed, we shall ever be able to dispense with them entirely in this formidable affection of the brain.

Thyroid therapy has been much extended in its usefulness in neurology, but my twenty minutes' limit will not permit me to dwell at length on this subject.

The Johns Hopkins Hospital Reports, the Journal of Psychology and Comparative Physiology and the Ophthalmologic Review have contributed during the past year to neurological progress.

The after care of the insane, separate provision for epileptics, sequestration in hospital colonies, the increased attention given to the subject of asexualization for incurable and propagable and criminal neuropathic disorders, mark neurological progress during the past year and gives hope of the staying of that neuropathic plague which, like a silent pestilence, has followed and damaged civilization in its march since its emergence from barbarism.

The literature of psychiatry in this country has been enriched also by a book by Dr. Kellogg on “Mental Diseases," Dr. Chapin's "Compendium of Insanity," John C. Shaw's "Compendium of the Essentials of Nervous Diseases and Insanity," and S. V. Clevenger's treatise.

The advancing popular professional interest in psychiatry is further shown by the advent of Burr's "Primer of Psychiatry for Medical Men and Students and Trained Nurses," and the frequent contributions to the psychiatrical aspects of the practice of medicine and surgery from sources of clinical experience where, until lately, these subjects were ignored.

Psychological and neurological medicine during the past year has elicited unusual interest in the general medical societies of the country. Chas. E. Beevar and H. K. Lewis, and Mills and Dana, of this country, have, since last we met, brought out new books on the diseases of the nervous system.

The normal histology and pathology of the neurolgia (so called) in relation especially to mental diseases, has been much elucidated during the past year by Dr. W. F. Robertson's report from the laboratory of the Scottish asylums, in addition to the contributions of other American and European asylums, especially the Italian. The Monatschrift für Psychiatrie und Neurologie, the Allgemeine Zeitschrift fur Psychiatrie und PsychischGerichtliche Medicin, the Bibliographischer Semesterbericht der Neurologie und Psychiatrie, the Bulletin de L'Academie de Medecine, the Iconographie de la Salpetriere, Archives de Neurolgie, Annales Medico-Psychologiques, Bulletin de la Societe de Medicine Mentale de Belgique, Archives de Physiologie, Journal de Neurologie et D'Hypnologie, the Revista Sperimentale di Freniatria e Medicina Legale Della Alienazioni Mentali, Revista Mensile di Psichiatria Forense, Antropologia Criminale e Scienze Affini, Annali de Neurologia, Il Pisani Gironale de Patologia Nervosa e Mentale, Brain and the Journal of Mental Science, West Riding Asylum Reports and our own special periodicals, the Journal of Nervous and Mental Disease, the Journal of Insanity and the Alienist and Neurologist, the remarkably interesting Russian neurological journals, the late International Medical Congress at Moscow, the great Italian Congress of Freniatria of the last year, and the French, German, English and American psychological and neurological associations of the past and passing year, this special section of the American Medical Association and the current general literature at home and abroad, have enriched and advanced psychiatry and neurology on the whole to a degree not comparable by any previous year in the history of neurological and psychological progress.