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method of treating wounds the author recommends for such eases as those where there is some difficulty in completely stopping haemorrhage after operation, and when there is some doubt as to the complete antiseptic courte of any cose. The cases mostly coming under this category are operations upon the month, rectum, abdomen, ftc., where there exists a cavity w hich cannot be properly treated with an ordinary surface dressing. The parts, after the operation, are first thoroughly washed out with some antiseptic, such as sublimate, 1 to -2000 ; salicylic acid, 1 to 1000 ; boracic acid, 2 to 100 ; or iodoform in ether, 1 to 10. The cavity is then stuffed with strips of iodoform gauze, usually in lengths of one to two yards, the end of each strip being allowed to project from the corner of the wound. The strips are left in for about two days, but, if thought necessary, longer. The author gives numerous cases in which the treatment had been adopted, and in nearly all the results were good. Thus, in 26 cases of operation upon the rectum for cancer, not one had a bad symptom. Of 20 excisions of the tongue, only 1 died from haemorrhage, and in that case the patient was a feeble old man of 66. Of 19 total excisions of the upper jaw, 1 only did not recover—the patient, a female aged 07, dying on the 10th day from pneumonia. Several other successful results are recorded in cases of excision of the hip, compound fracture, &c.
A New Operation for the Treatment of Fixed Retroflexion
Of the Uterus. By Klotz (Berl. Klin. Wochensch., 1888, No. 4).—The abdomen is opened and any adhesions found binding the fundus to the neck of the uterus or to other parts in the cavity of the pelvis are broken through with the hand. A glass tube for drainage is inserted behind the uterus reaching to the bottom of the cul-de-sac of Douglas. This method of drainage prevents any accumulation of blood in the peritoneal cavity, offers a means of support to the readjusted uterus, and effects the formation of a mass of new connective tissue, which takes the place of the originally retroHexed fundus. Klotz has treated in this manner seventeen patients, and all with success. The displacement has been corrected, the uterus has become movable, the pains have disappeared, and in none has there been any tendency to a ventral hernia through the parietal cicatrix.—(Archives GrnUrul'H de Mexlecinc, June, 1888.)
The Immediate and Remote Effects of Vaginal Hysterectomy for Cancer of the Uterus. By F. Terrier (fievne de Chirurgie, May and June, 1888.)—In a paper, extending over two numbers of the Revue, M. Terrier—on the basis of 18 cases operated on by himself—discusses two questions—(1) The advisability or not of entire removal of the uterus in disease affecting only the neck; and (2) the value of the operation as regards curing the disease. Upon tw o grounds he argues for complete removal in all cases—one, that it is a practice consistent with what is usually performed in other parts of the body for cancer—to wit, the mamma; and second, that the disease, though apparently only involving the neck, may also implicate the lx>dy of the organ. Still further, he does not believe the extra danger involved in total extirpation out of proportion to the good which may result. As regards the value of the operation in bringing about a cure, of M. Terrier's 18 cases, four only died, and these mostly from shock and haemorrhage. Of those alive at present one was operated on three years ago, another two years, two one year, and three less than a year ago.
The Galvano-Cautery Sound and its Application, especially in Hypertrophied Prostate, with Report of Cases. By Robert Newman, M.D., of New York.—This paper was read on 8th September, 1887, before the Section of General Surgery, of the Ninth International Medical Congress, and printed in the Jyvip Em/land Afntutd Monthly. Several cases are given as illustrative of the success of the method, but a brief account of the first will be sufficient to indicate the apparent value of the method and its mode of application.
A medical man, aet. 60, suffered greatly from enlarged prostate, frequent and painful micturition, and from cystitis. He was obliged to pass urine seven or eight times during the night. He suffered by day and was deprived of rest at night, and was no longer equal to the performance of his professional duties. A digital examination per rectum disclosed a hypertrophied prostate, enlarged in its entirety, with a preponderance of pons intermedia. On 26th May, the fenestrum of the galvanocautery sound (in which is the platinum wire) was brought against the hypertrophied prostate, at inches from the meatus, then the cautery applied by two instantaneous flashes. The operation occupied but a moment and was painless. The same operation was repeated several times for the next twelve months, with the final result that the patient passed his urine voluntarily, easily, and at regular intervals. Slept without disturbance the whole night; could retain his urine for eight hours, and was able to attend to a large country practice without fatigue.
An Observation upon the Physics of the Male Urethra. By
W. W. Wagstaffe, B.A., F.R.C.S.—" I have been struck, during the passage of catheters and bougies in the out-patient room, with the fact that a natural twist is given to the instrument during its removal from the bladder and urethra of the male, a rotation very sensible to the feel, especially when light and flexible instruments are used. . . . The degrees of rotation are estimated by means of a pin fixed vertically in the stem of the bougie just outside the meatus."
The experiment was performed with a bougie a boule of medium size; the bulbous end being grasped by the part of the urethra it is in contact with, is rotated with readiness; and to prevent any check to freedom of movement of the bougie it is withdrawn by means of a piece of fine silk noosed round the stem near the top. In nearly all the cases observed rotation began at once to the patient's left for a certain distance and to a certain degree, generally making the index stand directly opposite its original position, passing, that is to say, through 180' or half a circle. This position was reached when the instrument had passed about four inches from its start, and then began a reverse rotation, usually, but not invariably, until the index stood at right angles to the start. The reason of this twist the author ascribes to the peculiar construction of the urethra. In the ordinary state the canal is represented by a fissure bounded by columns of mucous membrane which may be traced from the bladder outwards running in the direction of an elongated spiral. In the tracing out the changes upon the subject it will be found that the urethra is rifled somewhat after the manner of a gun barrel, but the spiral of the urethral tube which runs from right to left in about the upper three-fourths of its length usually becomes reversed over its distal extremity. In concluding, the author observes—"The object of the spiral grooving in the case of the gun is to secure for the projectile a rotatory motion and greater precision in the direction of aim, and we may very fairly assume that similar advantages of a physiological nature are gained for the outflow of the urine and semen by the arrangement of the urethral column."
By Dr. K. S. STEWART.
Miliary Aneurism. By Spitzka (Amer. Jouru. of Insanity, October, 1887).—This case, interesting from (1st) its resemblance to disseminated sclerosis, and (-2nd), as affording an illustration of the hereditary tendency to degeneration of one particular system, the vascular, is that of a girl in whom symptoms began to develop about the age of 16. These were mainly as follows:—Peculiar mental disturbance with incoherence of speech, occurring mainly during the night; a tendency to drop objects held in the hands; fainting seizures ; amenorrhea ; anxiety ; timidity of demeanour and taciturnity: scanning of speech; spastic paretic gait; exaggeration of the knee-jerk; marked intention tremor; progressive failure of nutrition and cardiac action; coma and deatli ; the duration being about eight years. The father died at 40, and a brother at the same age as the sister, with symptoms closely resembling those above mentioned. At the autopsy a large number of blood islands was found in the cord, chiefly in the grey substance, and in the cortex and white substance of the w hole eucephelon. These, on examination, proved to be closed sacs, and were, in reality, ectases of the normal arteries of the parts.
A Case of Etheromania- By Ritti (Annates Medico-Psychologiqnes,
January, 1888).—A woman, whose father died of apoplexy and whose mother was very nervous, began at 22 to suffer from menstrual irregularity with faintings. For these latter ether was prescribed. For four months she continued to take it in excess and then discontinued it, but at 42 it was again prescribed for the same complaint. The craving increased until in the course of a single night (the day being mainly occupied in purchasing from different chemists small quantities of the drug) she would take as much as 215 grammes (nearly seven ounces). Her disposition became entirely altered. She became irritable, suspicious, and suicidal, and resorted to all sorts of mean subterfuges, finally (having previously moved in good society) taking to begging in the streets to obtain money to satisfy the craving. After six months residence in an asylum the craving disappeared, and three months after her discharge it showed no signs of returning.
A Case of Morphinomania terminating suddenly in Death.
By Ball (Auntil. Medico-Psychol., January, 1888.)—A young woman of 25, addicted for many years to morphia injections, after repeated but unsuccessful attempts to discontinue the habit, voluntarily entered the Asylum of St. Anne. At the time of her admission she was taking one gramme of hydroehlorate of morphia per diem. The morphia was gradually diminished until, after 45 <lays, it was entirely discontinued, injections of sparteine being given to combat the cardiac failure, which was a prominent symptom. On the twelfth day of convalescence syncope suddenly supervened, terminating fatally, in spite of repeated injections of morphia.
The only noteworthy feature revealed by the autopsy was the presence of morphia in large quantity in all the viscera, and particularly in the liver, where it amounted to 46 centigrammes (A rchiv. tie y enrol., January, p. 114).
The points to which Dr. Ball specially directs attention are:—1st, That after several days of complete abstinence from morphia that drug still remains in the viscera; 2nd, that the presence of the morphia may explain the occurrence of accidents observed long after the cessation of the habit, a sort of auto-intoxication taking place; and 3rd, that cardiac tonics play an important part in the treatment and should be continued long after the discontinuance of the morphia.
Race and Insanity. By Bannister and Hektoen (American Journal of Insanity, April, 1888. )—From an analysis of the admissions into the Illinois Eastern Asylum, these writers draw the following conclusions:—In the white races the depressive types of mental disease are most frequent in the Germanic and Scandinavian peoples and least so in the Celts. The insanity of African races is especially and predominantly of the exalted or maniacal type. General paralysis is much less frequent in this State than in England, the respective proportions being 3 '75 and 9 per cent of the admissions. This type of disease, though furnished chiefly by the native born, affects all other nationalities, the only one, however, that shows a greater percentage than is attributed to it at home being the Irish. Insanity is much more common amongst the foreign born than amongst natives, a fact not to any great extent explainable by the shipment of the defective classes from Europe, but to be attributed rather to tho altered conditions of life attendant upon emigration.
A Case of Pseudo-Tabes. By Pities (Archives </<- Keurologie, May, 1888). —This is the ease of a man who presented all the symptoms of locomotor ataxia with two exceptions—viz., absence of any affection of the knee-jerk or of the pupillary reflexes. A foreman in a foundry, and previously in the enjoyment of vigorous health, at 35 he complained of lumbago and a year later be suffered from acute lancinating pain in the right hip and polyuria. At 39 girdle sensation, uncertainty of gait with a feeling as if the ground were sinking at each step, Romberg's symptom, and genital excitement succeeded by frigidity supervened, followed during the next rive years by urinary troubles, rectal tenesmus, gastric crises, and lightning pains. Death occurred at 45, from tubercular pleurisy, and careful microscopic examination failed to detect any lesion of the spinal cord or peripheral nerves, except the left recurrent laryngeal, which was composed entirely of atrophied ribbon-like fibres.
Cumberland and Westmoreland Asylum: Annual Report
for 1887.—During the past four years melancholia has been the preponderating form of insanity in the admissions, and this Dr. Campbell attributes to the depressed state of trade, prosperous times tending rather to develop the excited forms of mental disorder. This same fact tends also to affect the recovery rate, mania being more hopeful, as regards prognosis, than melancholia. As another instance of the influence of passing events on the form of insanity, it is pointed out that six of the admissions of the Jubilee year were possessed of delusions that they were members of the royal family or the recipients of crown honours.
Garlands occupies an unique position among asylums with regard to autopsies, all the deaths, with only one exception during the last 20 years, having been followed by post-mortem examination.
Dr. Campbell's report concludes with some useful remarks on Lunacy Legislation, pointing out the necessity for provision to allow of removal of Irish and Scotch patients to their place of settlement, for simplification in the admission form, directions to relieving officers with regard to the possession by patients of dangerous weapons, for the introduction of some proceeding by which the capital of lunatics, at present treated as paupers, may be appropriated for their maintenance as private patients and for the extension of the capitation grant of four shillings per week to the insane maintained in workhouses and in private families and not, as at present, only to those maintained in asylums.
Saupb/ton Hall Institution: Annual Report for 1887. By J.
Batty 1 uke, M.D.—The voluntary system appears to be taken advantage of to a considerable extent in this asylum, no fewer than 10 being admitted during the year as voluntary lIoarders. The procedure entails very little trouble and as little publicity, all that is required Deing a permission, granted, on appliea tion, by the General Hoard of Lunacy, to be received into the asylum. At the same time the patient's name is entered in a special book, and therefore does not appear in the list of legally certified lunatics. A written application is necessary for discharge, the superintendent having the power of detention, if such appears to him to be urgently necessary, for a period of not more than three days. Dr. Tuke, as the result of 20 years' experience, both in private and pauper asylums, speaks in the highest terms of the open-door system. The commissioners report very favourably of the management of the institution, while the introduction of hospital-trained nurses and the training of ranwiws, changes effected during the year, are in themselves sufficient indication that the medical spirit is fully maintained. The terms of board are from £100 to £500.
GLASGOW MEDICAL JOURNAL.
No. III. September, 1888.
CLINICAL OBSERVATIONS ON EPILEPTIC
By DAVID FINLAY, M.B. CM.,
(Thesis for the Degree of M.D. in the University of Glasgov.)
The subject of epilepsy has engaged attention from the earliest times, and yet it is one which is ever new. Much as has been written regarding it, it is generally recognised to be veiled in considerable obscurity, and this from the fact that we do not know its pathology. Notwithstanding, its clinical phenomena, so closely related to the insane neurosis, are of interest, not only to the alienist, but to the general practitioner, and as these cannot be said to have been exhaustively investigated, I have been led to make a few observations on some of the cases of epileptic insanity at my disposal. I have traversed no new ground; but have directed more special attention to points which hitherto have been less fully inquired into than some of the many interesting features of the disease—viz., the urine and the condition of the deep reflexes. The question of treatment has also received some special consideration, and in the majority of cases the comparative value of various drugs has been estimated.
The epileptic insane patient is, of all asylum patients, the most troublesome to deal with, and they who have such cases
No. 3. 0 Vol. XXX.