728 good, in a very large proportion of cases, is the nitrate of silver, given in doses of one-tenth to a half grain, two or three times a day. Professor Wunderlich, of Leipzig, was the first who employed silver in seven cases of this disease, in none of which, it is true, he obtained an actual cure, but in most of them considerable improvement. In 1862, Messrs. Charcot and Vulpian, in France, took up Wunderlich's idea, and used the nitrate in five other cases, and in each of them there was

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... amendment. Since then this remedy has been employed in most cases of ataxy, and with somewhat variable success. In some it has so disagreed with the patients that it was necessary to discontinue its use ; in others it had little or no effect ; while in the majority of cases the remedy has proved, if not curative, at least very useful, and it is the one upon which most reliance can be placed in the treatment of this disease. I am in the habit of giving the silver combined with the hypophosphite of soda, and it seems to do far more in this combination than either of these remedies singly. I have, indeed, now a case of ataxy under my care in which the improvement has, for the last six months, been so considerable under this medication that I am hopeful of a cure. Certain precautions should, however, be taken in administering the nitrate. I generally employ it for four or six weeks consecutively, and then discontinue it for a fortnight or three weeks, giving in the meantime a slightly aperient mineral water. After this the use of the remedy may be safely recommenced, and continued for a month or so. The gums must be inspected from time to time, as the peculiar coloration which silver produces in the long run first appears in the mucous membrane, and only afterwards in the skin. With the precautions mentioned, however, no disfigurement of the patient need be feared. I have never gone beyond the dose of half a grain, and perhaps this is another reason why in my cases the remedy has been borne without any inconvenience. I should, however, not recommend all cases of ataxy to be treated alike ; in this affection we must, as in every other, study each individual case by itself, and advise for it what seems, under the special circumstances, most likely to do good. Thus hysterical or hypochondriacal patients in whom ataxy may supervene, will require a different treatment from plethoric persons, or sach as have long suffered from rheumatism, or have been subject to privations and anxiety. Much is, therefore, left to the tact and discrimination which, together with knowledge, should, in all cases brought before him, guide the doings of the physician. SOME few months since I gave an account in THE LANCET of the success attending the administration of bromide of potassium in certain forms of epilepsy. In doing this I made frequent reference to an able article from the pen of Dr. M'Donnell, which appeared in the llublio (ua7Le7-L Journal for February, 1864; and I hoped ere this Dr. --1'1)onnell would have made good his promise, and given to the profession his further observations on the use of the above-named drug. I much regret that my suggestion was not carried out by the medical staff of any metropolitan hospital. It was, that for a period of three months fair trial should be given to the bromide of potassium in cases of epilepsy characterized by histories similar to those I related. I carefully avoided lauding the remedy as applicable to all and every form of epileptic convulsion ; but from what I had seen of its action, I thought it well adapted to cases where uterine derangement might be looked upon as the prime cause of the cerebro-spinal irritation. This I understand to have been the view originally taken by Sir Charles Locock, whose paper I quoted. Further experience of the effects of the bromide has strengthened my idea of its efficacy, and in addition I can record my mite of testimony to its non-hindrance of the genital functions. The portions of THE LANCET devoted to correspondence teemed with anxious inquiries on this head. One would have thought that a valuable remedial agent was about to be tabooed lest the next British census should lack its column of increased population. Neither when administered to epileptic males or females as a curative agent, nor to either sex in largish doses merely by way of trial, have very careful inquiries elicited accounts of diminished sexual power. I further ventured to affirm that where the system had been debilitated by the nauseous practice of masturbation, and epilepsy was of frequent occurrence, the good effects of the drug were manifested in a high degree. On this point also I am increasingly confident; but, of course, unless moral agencies can be brought to bear on the patient, all treatment is useless. I have now under my care a young man who formerly had weekly, and not unfrequently daily, epileptic seizures. He is now in the fifcy-fourth week of complete exemption from the attacks, and I shall continue to give him the bromide for some months longer. He has gained flesh, and is able to do a long day's work, and his general appearance is much improved. This leads me to remark, that in numerous cases I have watched the effects of the drug upon the external tegumentary structures, and have found that the complexion loses its sallowness, or, where naturally inclined to be ruddy, the florid tint is heightened. The eyes become brighter, and the skin generally assumes a more healthy hue." In prolonged small doses I think I have seen benefit to children affected with chorea, but further experience is required on this head. One very commonly hears it said, "Oh ! as to bromide of potassium, don't. trouble to get that for your patient; the iodide will do just as. well." " Now 1 do not think so, nor do I believe that the same vigour is sustained when a lengthened course of the latter medicine is prescribed. I remember making a note of a remark in this journal which I cannot now lay my hand upen. It was to the effect that the Kreatznach waters were unjustlv accused of exercising a lowering influence; and the writer called this a mere random assertion, from a supposed analogy between bromine and iodine. In two epileptic patients (one of them the case above named who have been taking the bromide, in doses of a drachm daily, with great benefit, the intermission of the medicine caused headache and nausea, and a feeling of fulness in the fauces, the tongue also " feeling too large for the mouth." How far these may have been mere nervous sensations, arising from the idea that a fit must occur because they had no medicine, I cannot say. Probably mental influences had much to do with the matter. It is curious, however, that the same uneasy feelings should be spoken to by both patients, and that in both the resumption of the medicine has caused them to disappear. The black oxide of manganese is used at the West London Hospital in some forms of dyspepsia, in accordance with the suggestions of Dr. Leared; but not to such an extent as I could wish. Not very long ago, by permission of Dr. Leared, I gave in the pages of THE LANCET some illustrations of its beneficial action. The chief hindrance to its larger administration is the reluctance of the patients themselves to take it. However carefully suspended by tragacanth mucilage, it has an unpleasant grittiness. The wafer-paper might be used perhaps to envelop it when prescribed for private patients. If' the palate can tolerate the mixture, and it is regularly taken before a meal, the pain following the subsequent ingestion of food is very much allayed-more so than by bismuth. After the meal the sulphite of soda in small doses greatly adds to. the comfort of the dyspeptic person, either of itself allaying the tendency to eructation, and diminishing a sense of fulnessso often complained of, or directly aiding the oxide in keeping up a placid condition of the lining membrane during the action of the gastric fluid. A case illustrative of one of the Protean manifestations of pneumonia occurred lately in a man who had always enjoyed good health previously. He was lifting a ladder the evening before his admission, when, to use his own words, he "found something give way at the pit of the stomach." He went home to bed and got some sleep, but soon woke up screaming with pain across the chest. He was brought to the hospital breathing with difficulty, with a flushed face and frequent pulse, and "doubled up" with pain over the inferior cardiac region. Warm fomentations were applied and opiates given, but the pain lost none of its intensity. Auscultation and percussion failed to detect anything wrong, and so we were left in doubt as to the nature of the case for some hours. It seemed likely to prove diaphragmatic pleurisy, but in the evening, when the pain had lessened, very careful examination detected a small extent of fine crepitation just under the spine of the left scapula. Antimony was given, with salines and ammonia, and a blister placed over the back of the lung. The extent of crepitation never increased, and the dulness on percussion was limited to the one infrascapular spot. It was not until the fourth day that any rust-coloured sputa made their appearance. Had this man been treated simply on his own state-* Dr. Gibb has noticed much the same effects from bromide of ammonium.