Again, a female is said to have taken cold when she has enjoyed an unusual degree of health; her menstrua fail to appear, or they may have become arrested in the midst of her flux; she becomes excited and wrought up to a high state of nervous tension, perhaps, hysterical and delirious. To say the menstrua are retained, and that this supposed excrementitious matter must be eliminated, does not satisfy a scientific inquiry. But if we may be allowed to suppose that the cold first produced a shock to the vegetative centers, locally diminishing nutrition, or that such force may be evolved at other localities in the gray nerve-substance and that the shock paralyzed special centers of ovulation, or that the force about to be directed toward the menstrual operation should be deflected to other channels, and expended on the mucous membranes of the nose, mouth or lungs, then we can comprehend why an exudation or transudation takes place.

The force necessary to establish and operate an exudation from the mucous membranes of the uterus, if deflected, will establish an exudation from mucous membranes (most likely mucous membranes) of any portion of the body. Then it may not be retrained menstrua, but deflected nerve-force, that causes vicarious menstruation. Commonly, a deflection of nerve-force is accompanied by, and the real cause of, great bodily disturbance and mental derangement, though not, by any means, always.

To thoroughly elucidate the theories we have so long held would lead us beyond the province of a journal paper, and, in passing, can but call attention to a few facts that may lead to a better understanding of Nature's elaborations.

CASE.-Mrs. D., aged 30, often passes a period of three months without experiencing her menstrual nisus, during which time she becomes dropsical in her feet and limbs. So soon as her flux appears the effusion disappears; thus do we see the aqueous elements transude by the vicarious expenditure of nerve-force.

CASE.-Mrs. S., aged 28, has often been afflicted by tardy menstruation (from one to two weeks late). At such times

she is rheumatic; sometimes her joints are swelled and tender to the touch. When her flux becomes established her rheumatism, as it were, vanishes in a day.

These conditions must suggest the nature and cause to be vicarious expenditures of nerve-force, in many cases in everyday practice, and should often change the methods of our treatment to the relieving of some encumbered nerve-centers, and diminished activity of others also should explain the modus operandi of so-called emmenagogues when such agents afford relief.

Emmenagogues are so uncertain, and when success has followed their use, their action is so uncertain as to modus operandi, that the next case, apparently similar, meets with the same experimental management.

Again, anti-rheumatics will not reduce the swelling of joints caused by this abnormal expenditure of nerve-force. Hydragogues will carry off the water effused from such cause but the tissues will immediately fill again.

The nerve-centers that preside over the contractility of muscular fibers of capillaries must be looked after, or such effusions may prove troublesome, and such tumefaction of joints. may cause serious local structural changes. These are from relaxations of capillary parietes-reflex vaso-motor paralyses of capillaries.

Sleeplessness is a common phenomenon of vicarious expenditure of nerve-force. A female is often said to "take cold" by undue exposure to cold, sudden atmospheric vicissitudes, or from damp feet; the menstrua do not appear; she is sleepless; her face is flushed and she suffers from the usual symptoms of suppression. The absence of the flux is not by any means the lesion. A shock to the nerve-centers that preside over ovulation has occurred and the force is deflected to the capillaries of the brain. At first, excitation of the vaso-motor centers is produced by centric irritation, lastly, reflex vaso-motor paralyses of the cerebral capillaries in portions. The brain first suffers, providing the predisposition of the patient is favorable to such localization. Then, firstly, comes the period of excitement, which is not generally noticed except in the

brain, spinal spel z trgs: hastly, the period of stasis or reflex vaso-motor paralysis of capilares.

For the purpose of erectatic may not be beyond my province to mention that satural sleep only occurs during a moderate state of anemia of the cerebrum, and it is by such a condition we may contradistinguish natural sleep from true coma, which is a condition beriod excitement-stasis of the capillary eirenlation—and in adulas is very rare. During the active stage the appearance is sleeplessness, and during the passive, coma, which is profound in proportion to the extent of passive turgescence of the nervous structures.

In regard to the expenditure of nerve-force in other than natural channels, as in reflex vaso-motor paralyses, which are often, if not always, examples of vicarious expenditure, it may be suggested that, in such conditions, there appears to be a lack of nerve-force; but, when carefully considered, we can but notice, first, the freedom from these reflex paralyses when all nerve-force is equally expended in the natural manner throughout the economy; second, that all reflex vasomotor centers are excited before they are depressed; finally, that relaxation of vascular parietes is only produced by hyperstimulation when the causes are of the reflex variety.

The excitation is invariably centric, and the phenomena are usually, but not always, peripheral, as head and cord symptoms are not very uncommon.

The proper administration of drugs may lead these cases to a satisfactory termination, but as conditions elucidated in the the above will most likely suggest the proper medicinal agents, I have deemed it more advisable to confine this paper in closing to the management of the rather subacute consequences, or the condition commonly entailed by these not well-understood maladies.

The majority of these cases recover without aid, or if attempted aid be offered, it is commonly so contrary to the real nature of the conditions that nature, in addition to establishing an equilibrium of nerve-force, has to combat with antagonistic drug action, viz., catharsis, diuresis, diaphoresis, and the numerous gogue-agents of old-fashioned physic.

Then, after the exciting period is over, the effect of electrization is a luxury compared to the old management, and medicine is seldom required to overcome the subacute and chronic centric lesions. When there has been no period of excitement the electrization should be begun at once.

An inexperienced physician in the effects of electrization, might inquire if electricity is useful in such apparent hemorrhages of the nose, mouth and lung?

Patients and even physicians denominate every machine constructed for generating electricity a "galvanic battery." Not long since I heard a physician call a Franklinic apparatus a galvanic battery.

Physicians in this, the period of reason, should be capable of an ordinary degree of intelligence in regard to these things, even if they do not desire to expend the time and money necessary to qualify them to make use of electricity in general practice.

General Faradisation should be applied by placing a metallic plate (zinc), which is padded with sponge, wetted when in use with warm water, under the feet, connecting it with the cathode, generally, and the operator should stroke the spinal column from the cervix to the sacrum with one hand, holding in his other hand the anode. A feeble current may be passed through the top of the head and forehead by wetting the hair to facilitate conductivity. The term "feeble," needs some qualifications, as generally used it is very indefinite, but should be considered such a strength of current as will not produce shock or painful contraction of the muscles. It always has in view the impressibility of the patient, which varies with different individuals and with the same individual at different times and under different circumstances.

Increasing currents are advisable, commencing with only a perceptible current and gradually increasing until the patient is mildly influenced.

For general Faradisation, large electrodes (sponge) are preferable, as condensation and pain are avoided. By large

electrodes, the patient may receive a much greater quantity and not suffer pain.

Condensed currents are only necessary when it is desirable to produce a local impression and perhaps some excitement or local sedation.

[XLIV.]

CHOLERA INFANTUM.

BY I. G. M. GOSS, M. D.

Cholera infantum has been epidemic in this locality this past spring and summer, and it is still prevailing. It has generally commenced with diarrhoea, but frequently the vomiting marked the onset of the disease. This epidemic has been characterized by unusual putrescency of the discharges, together with very rapid emaciation and anæmia, and in many cases hydrocephaloid symptoms. Children teething have been generally obnoxious to the disease, from the rapid growth of the brain during that critical period, which requires an abundance of fresh air for its development. The above fact accounts for the prevalence of the disease in densely crowded cities.

I can illustrate the treatment that I have found successful by giving a case that I have carried through safely. I was called to an infant some fifteen months old, which I found with constant vomiting and excessive purging; stools thin, greenish, and very offensive. I commenced the treatment. with tincture of ipecac, 6 drops to 23 of water; dose, a teaspoonful every hour. This moderated the vomiting, but did not check it. I then gave Merrell's specific tincture of euphorbia cor., 6 drops to 23 of water, every hour, which checked the vomiting, but the diarrhoea continued. I now gave tincture of rhei. 1 drop every hour, but the discharges continued. As the discharges were very offensive, owing to the very marked septic condition, I now gave creosote, 5 drops in 43 of water; dose, a teaspoonful every two hours. This readily checked the discharges. I now thought that I had my little patient safe, and dismissed it; but in some twelve hours, the father called me in again. On examination,