connective and fatty tissues that support the organs, as well as in regions further away.

These sacs, spaces and channels are primary symptoms of proctitis, and are revealed very soon after the onset of the malady, while pruritus ani, scroti, etc., are secondary symptoms. If the hollow spaces and channels are deep and pass just above the muscular tissue of the buttocks, the itching is not apt to occur (although odor and moisture may be observed), as the inflamed connective tissue along the channel does not disturb the skin; but when the spaces and channels are just under the integument, it also becomes inflamed, and itching usually results. Often, too, cicatricial tissue is formed in the integument and in the connective tissues along the course of the mucus channel. Sometimes the channels form a double subway in the buttocks-one channel running along the muscular tissue and the other just above it and near the skin, separated by newly-formed fibrous connective tissue.

If the onset of proctitis is quite active and continues so, and the sphincter muscles are in a somewhat relaxed state, the mucus channels formed under the layers of the mucous membrane and in the underlying connective tissue can easily pass under the integument about the anus and buttocks. The slight obstruction to the channels offered by the anal canal will prevent the formation of rectal sacs, ano-rectal sacs, and often muco-cutaneous sacs, commonly called internal and external piles by those having no conception of their origin or nature. Many of the channels pass from under the anal mucous membrane and integument and outside of the anal sphincters into the pelvic space around the rectum and sigmoid flexure and thence into more distant neighboring tissue, as well as in the connective tissue, both deep and shallow, of the buttocks and genitourinary organs.

So numerous are the hollow spaces and channels in some cases that the pelvic space, the buttocks and the genito-urinary region remind one of a large sponge instead of the compact healthy tissues found in normal persons. The amount of exudates absorbed into the system from the large inflamed area is great enough to cause a peculiarly intense irritation of the nervous system, with more or less local and reflex pain throughout the body. Very often sufferers from proctitis and sigmoiditis and their varied symptoms are subjected to surgical operations on the appendix, ovaries, uterus, spine, etc., with the hope of removing the intense nervous condition of the sufferer. How long must mankind suffer from the ignorance of those that should know better?

During the first two or three years of my practice I did not know any more about the cause of pruritus ani, etc., than the authors of conventional text-books on the subject of anal and rectal

diseases, who usually devoted about fifteen pages to the "probable" cause of pruritus ani. Moreover, the entire subject-matter of the books I read and studied was of the same ancient imitative character of guessing referred to in the first paragraph of this article.

Having learned that proctitis is the cause of sacs, spaces and channels, and that these primary symptoms of proctitis often cause pruritus ani, a secondary symptom, the question of treatment and cure of the extremely annoying trouble is very simple, and often prevents the development of symptoms that are far worse. than the tortures of the itching by day and night. As soon as one has obtained accurate knowledge of the pathology of the primary and secondary symptoms of proctitis, the question of where to cut through the skin to find the channels is also very simple. The anterior and posterior raphe usually show evidence of channels, whether itching is present or not. On either side of the anus are found muco-cutaneous sacs (so-called external piles), which are the outer evidence of a number of channels that pass into the tissue of the buttocks, as well as upward on the outside of the anal canal and rectum into the abundant spaces of fatty tissue that support the organs. Make an incision in the skin and connective tissue long and deep enough to expose a considerable area of channels, which should then be irrigated with antiseptic injections from a proper syringe until healed. Then another region should be opened, then another, and so on until the whole territory of channels is covered. At the same time, of course, proper attention should be given to the cause of the symptoms.

Proctitis and its severe local and general symptoms can be prevented by the examination of infants and children to see if the organs of elimination are in a healthy state. With healthy bowels. and normal intestinal elimination of waste matter there will be little or no occasion for "diet" and medicine to "overcome" gastroenteric disturbances.

43 West 45th Street, N. Y. City.

Items from the Field of Neurology.

BY THEODORE ADLERMAN, A.B., M.D.

Neuralgia of the sympathetic or of the vagus may occur in about the same manner as neuralgia of other nerves in the different parts of the body. In neuralgia of the vagus we mostly find that the pain is felt in the area of distribution of the sensory fibers of the affected nerve. The neuralgia condition may exist in either one of the gastric nerves, the vagi and in the splanchnias

The pain of intercostal neuralgia is often confused with the pain

which arises from the stomach. It is easy to diagnose if you remember that in intercostal neuralgia there are tender points in the corresponding intercostal spaces, about 11⁄2 inches from the spine.

Do you know that ears, in many cases, produce head pains? The principal causes acting upon the ears to produce head pains are anaemia and mastoid disease.

The eyes will often produce the so-called ocular headaches. In these headaches the pain is as a rule very severe on using the eyes. Ocular headaches are found over the middle of the eyebrow and the pain seems to radiate into the back of the eyes.

If you examine the blood pressure in lead colic, you will find it increased from one-half to twice the normal pressure. This increased pressure seems to irritate the terminal nerve filaments and will often cause considerable pain by reducing the circulation in the intestine.

The periodic psychose as a rule offer fewer signs of grave disturbances of the lower functions of the nervous system than the majority of mental derangements, even in the very severe forms. The condition of the arteries is, however, of practical interest in these cases. In the melancholia stage of the circular form, for example, there is a vascular spasm with a weak, unsteady pulse. In the maniacal phase, the condition is reversed, the pulse is full and throbbing, the pressure great and the face flushed.

The Hebrews are very much predisposed to neurasthenia and neurasthenic psychoses. This may be explained perhaps by the intermarriage between consanguineous strains, by the urban, close, clannish life, which they have led for so many centuries. The Teutons are less affected, and the Russians still less. In this country the consegration of the population in towns, the existing mode, the rush of life, the continual struggle for existence, the peculiar vices, have all combined to produce the type of the nervous Americanand the national disease of America-neurasthenia.

I forgot who it was that wrote the following verses:
"There is a pleasure in being mad

Which none but madmen know."

And this could be applied to many cases suffering from primary mania. They seem to overflow with a certain recklessness of conduct and the sense of well being and an overflow of spirit, which is so distinctly peculiar of these cases.

Tuberculous affections of the lungs are very rarely accompanied by actual psychoses, but still there are many instances in which, during the course of the disease, there developed a distinct hypochondriacal, melancholic and even an apathic disposion, or in some other cases undue exaltation and elation-but not enough to come to the degree of even a light mania.

Delirium is not an infrequent symptom in the last stages of chronic nephritis. It may be quiet or an active delirium, and is more of the sort which we know as the "low muttering delirium." The forms of actual psychoses which depend upon uremia vary with the nature of the renal trouble, and with the individual susceptibility of the case to the non-excreted toxins.

I have seen some cases of "mania transitoria," a delirious excitement, which may come on during the second or third day after childbirth, which arises suddenly and passes off as quickly. These cases should not be mistaken for the ordinary cases of puerperal mania which lasts for weeks and even months.

In some cases of paresis symptoms of exudative syphilis introduce the disease. The patient has at first palsies of the eyes, or attacks of hemiplegia with severe pains in head, followed by convulsions. The specific exudate is found to be pressing against the convexity or against the base.

I consider the "trifacial" one of the most important nerves from a neurological point of view, since diseases of this particular nerve produce more suffering and occur more frequently in neurotic individuals than in any other nerve. For the neurologist-the trifacial is a "good thing."

I heard so much about the great results obtained by some neurologists with quinine, in some cases of vertigo, that I fell to it. I tried it in a few cases, tried it in small doses, increasing till cinchonism resulted and had the pleasure of seeing it fail in each and every case. Hydrobromic acid in the form of a syrup, given in 30drop doses, with salicylate of soda in 5-grain doses gave me some better results. I read a report somewhere, in which Hirt gave hypodermics of 10 drops of a two per cent. solution of pilocarpine with good results.

Hypochondriacal delusions relate to imaginary disease from which the patient thinks he suffers. He may be afraid to move less his bones will break. He may try not to laugh, less his face shall become paralyzed, etc., etc. As long as these beliefs do not interfere, well and good, but when they dominate the actions of the patient, they should be considered as evidence of insanity.

910 St. Johns Place, Brooklyn.

Materia Medica and Therapeutics

EDITED BY

JOHN WILLIAM FYFE, M. D.

Short Articles giving definite indications for remedies are solicited, and may be sent to DR. J. W. FYFE, Saugatuck, Conn.

Explosive.

The chlorate of potassium being a favorite remedy of many physicians of the Eclectic school it is of vital importance that we keep constantly in mind the fact that it must never be associated with any organic substance, as it is decomposed easily by a slight elevation of temperature, giving off its oxygen to the organic matter, and producing a dangerous explosion.

The above precaution is equally applicable to the permanganate of potassium.

Symposium on Treatment of Pneumonia.

Under the above caption several interesting articles on the treatment of pneumonia, written by practitioners of long experience, were published in the December issue of the Medical World. The articles were written by special request of the editor, and as they fairly well represent the three regular schools of medicine, no doubt the following abstracts from them will prove of interest to the readers of the REVIEW:

"I have found veratrin, or veratrum viride, not only effective in the initial stage, but also later on, when there have been signs of toxemia, with more or less delirium. In such instances the drug acts to favor greater elimination, with consequent riddance of the toxins. Other writers tell us that digitalis or digitalin should not be administered until the heart wavers, but it has been my observation that, administered with aconitin or veratrin, it overcomes the tendency to cardiac weakness. The use of strychnin is also decried by many, they insisting that no stimulation is required until there is a break in the