213 



. I. nt when the symptoms an- urgent it may b. necessary to give a te i-spo.mful 

 ever} hour tor three or tour consecutive hours. It usually produces a r.ilin and 



"!' 



Three tal>le -spoonfuls of tin- bromide of potassium mixture (Pr. 31), given every 



tw.> hours, will succeed, in a lar!_,'e number of eases, in calming the nervous agitation 



.-ind producing a i^ood sound sleep. As soon as the patient awakes the admini.-t ra- 



;ia\ In- resumed to the extent of three or four doses more. These are laru'e 



of bromide of potassium, but it is much safer to ijive them than to administer 



:. down doses of opium. liromide of potassium is especially serviceable ill 



di^pellinic delusions remaining after the- partial subdual of an attack. 



Ilelladonna, in two-drop doses of the tincture everv two liours, has been recom- 

 ;nended. Sleep and a quiet night, with marked improvement the next day, are said 

 to be the results. 



Stramonium answers well in cases characterised by violent, noisy delirium and 

 complete loss of sleep. A tea-spoonful of the tincture should be put in an cixht- 

 ounce bottle of water, and of this a tea-spoonful should be given every hour or every 

 two liours. 



It is important that the skin should act well, and benefit is often derived from 

 the use of the wet pack. It has frequently a most soothing influence. In every 

 case of delirium tremens a doctor should be called in. 



DERBYSHIRE NECK, GOITRE, OR BRONCHOCELE. 



By the terms Derbyshire neck, goitre, or bronchocele, we mean hypertrophy, 

 r enlargement of the large gland called the thyroid, which naturally exists on the 

 front of the windpipe. 



The eireumstances which favour the production of this complaint have been 

 frequently investigated, but the question is still to a great extent involved in 

 obscurity. Goitre is essentially an endemic disease that is, it prevails in certain 

 Localities, but scarcely occurs elsewhere. It has been frequently noticed that people 

 who have gone to live in these districts have become affected with the complaint ; 

 whilst, on the other hand, persons who have migrated from the locality have been 

 sometimes cured by the mere change in residence. Goitre abounds in the hollows 

 and valleys of many mountainous districts, among the Alps, for example, and in the 

 Pyrenees, and on this account it was supposed to be due to some peculiarity in the 

 atmosphere. It was at one time said that the disease was always found and occurred 

 only in deep, close, moist valleys, shut in by high mountains. On further investi- 

 gation, this statement was found to be too general, and in fact there is now abundant 

 evidence to show that the complaint occurs quite independently of atmospheric 

 conditions. 



It has been proved pretty conclusively that goitre has its origin in some impurity 

 in the water, but of what that impurity consists is not precisely known. At one 

 time probably from its frequent occurrence in Alpine regions the disease was 

 ascribed to the use of snow-water. A very little consideration will serve to show 

 (that this explanation is insufficient, for the people in almost all the valleys of 



