James Ross

On a Case of Pseudo-Hypertrophic Paralysis.

dilatatibn of the heart which -were going on very well, till some foolish effort,Verhaps a-run i not nore than twenty yards, produoed a strain of the cardiac muscle which has not been recovered from for weeks, even if the heart has ever reverted quite to its former state; if, then, angina i4 ~due to over-strain of the heart, may not its attacks also each produce.a lIting mischief ? To sum up, .then, Iwould say that the presence of increased arterial tension or blood-pressure involves the existence of obstruction at one end, and increased heart-force at the other; that it is important to distinguish between these two conditions; that the form of trace usuaUy considered indicative of high tension really only shows obstruction, which, while necessarily occurring with it, may also occur by itself; that the measure of the tension is the pressure required to stop pulsation in the artery or the circulation in the limb; and-that while we should always try to reduce abnormal obstruction, wve should but seldom interfere with the tension as such, unless it threaten danger to the heart or vessels.

On Peripheral Neuritis

work, to an equally extensive and thorough acquaintance wit*1 the great advances made during the last thirty years in the theory and practice of nervous diseases. To his ability to brifo to bear on recent discoveries all that was true and worthy survive from the past, we think he owed that far-reaching poWef of generalisation and the broad grasp of his subject which distinguish his writings. For his was one of those rare minds that

Treatment of 100 War Wounds and Burns.

For one year all went well, and it was possible to reduce the extract to 20 to 30 c.cm. a week, given intramuscularly. Then a severe crisis occurred following some days of overexertion and domestic worry. There was nausea with fiequent vomiting and fatty diarrhoeic stools, and the abdominal musculature was rigid and painfuLl to pressure. Blood pressure dropped to 70 mm. In view of the patients very thin veins and the collapsed circulation, intravenous administration of considerable amounts of fluid could not be undertaken Fluids (1,200 c.cm.) with 20 grammes of salt were given daily, mostly by mouth and to a small extent rectally. The patient received daily 80 c.cm. of adrenal extract (cortin and eschatin), and with eventual improvement the amount was reduced to 70 and later to 50 c.cm. a week, given intravenously. But the former condition of comparative ease could not be regained. The patients complexion became more yellowish, with a clay-coloured tinge, and freckle-like spots appeared on the backs of the hands and on the face; but the typical Addison pigmentation was not shown, nor was there at any time pigmentation of the mucous membrane of the mouth.

Mr. Howorth on Darwinism

MR. WALLACE, in replying to Mr. Howorths objections to the theory of Natural Selection, points out that that gentleman first misrepresents Darwinism, and that having done so he does not employ the distorted doctrine as premisses to a further conclusion. But the second part of the criticism is not quite just. Mr. Howorth, after stating the Darwinism theory, introduces us to an order of facts which is at variance with that theory as apprehended by him; and not only does he do so, but he places an interpretation upon these facts which is utterly irreconcilable with the Darwinian theory as understood by its most able expositors. It is true that Mr. Howorth does not bring his interpretation of the facts he adduces and the theory of natural selection into such juxtaposition as to show their mutual contradiction; but a little consideration will enable Mr. Wallace to supply the missing links, and to see that in any generous construction of Mr. Howorths letter, the real questions at issue are the correctness of the facts he adduces and the validity of the generalisation he makes from these facts. My object in writing is to direct Mr. Howorths attention to Mr. Herbert Spencers profound discussion of this subject, as it appears to have escaped his notice. This is the more surprising, since, on p. III, vol ii. of “The Variation of Animals and Plants under Domestication,” and to which Mr. Darwin refers him, there is the following marginal note :— “Since this MS. has been sent to press, a full discussion on the present subject has appeared in Mr. Herbert Spencers ‘Principles of Biology’ vol ii., 1867, p. 457, et seq.” He is a bold man who undertakes to enlighten the public on a subject which Mr. Spencer has fully discussed, without first ascertaining what view that profound and original thinker adopts; and most certainly a fresh writer coming into the field ought to take up the discussion where an author of such eminence has left it. If Mr. Howorth will look at Mr. Herbert Spencers “Principles of Biology,” he will find in sections 78 and 79, an explanation of the process adopted by gardeners of cutting the roots, and “ringing” the bark of fruit trees. Section 355 explains the fact that fatness is often accompanied by barrenness. In a footnote at p. 483, vol. ii., he will find Mr. Doubledays doctrine specially noticed, and the fallacies upon which it is based exposed; while in the chapters “On the Laws of Multiplication,” vol. ii., p. 391, et seq., he will find the whole subject treated with a fulness and exhaustiveness which leaves little to be desired. Mr. Howorth will notice that Mr. Spencer does not deny Mr. Doubledays facts, but that he places upon them an interpretation which brings them into harmony with the general theory of evolution, and with the special part of organic evolution which constitutes the Darwinian theory.

Sarah Gamp's Pharmacopoeia

Despite liberal fluid and colloid replacement his pulse rate remained very high. Four hours later bowel sounds could not be heard and the abdomen was explored. There was no vomiting. At operation a subserosal haematoma was found to have ruptured the peritoneum on the lateral wall of the caecum. A thin film of blood was present in the patacolic gutter. Bleeding had ceased. No other injury was found, but he had an intussusception of the jejunum situated 4 ft. (1.22 m.) distal to the duodeno-jejunal flexure. It was 3 in. (7.6 cm.) in length, reduction presented no difficulty, and there was no local predisposing factor present. The abdomen was closed and recovery was without incident.-I am, etc.,

Treatment of Burns by Silver Nitrate, Tannic Acid, and Gentian Violet.

were admitted under our care, four within eight hours of their injury and one after forty-eight hours. These burns, though not so extensive as those seen by one of us (J. A. R.) during the evacuation from Flanders, were serious enough to warrant careful attention, and are the type likely to be met with in the futwre. The treatment adopted in each case closely followed the routine advocated by Dennison (1939), and it is to emphasize the excellent results obtainable by this method that these-cases are described.

The Action of Alcohol.

inherited neurosis ; and this association is so constant that the intem. perance must be regarded, at least ultimately, as thze result, rather than the cause, of the insanity. Dipsomania has three forms-acute, periodic, and continuous. In the acuteformi, the patient, formerly temperate, takes suddenly to excessive drinking usually after some loss, shock, or disappointment, becomes utterly indifferent to all claims of family, business, or duty, and drinks himself to death as speedily as possible. The history of such a case is almost certain to reveal unstable nervous organisation ; and probably suicide in a more sudden form has been a consequence of similar moral causes in some other member of the family. The periodic or paroxysmzal form is yet more constantly associated with some hereditary neurosis. The patient is correct and abstemious in habits, irreproachable in character, and, perhaps, of superior attainments; but occasionally, from anxiety, overwork, or casual indulgence, he is seized with a fierce and uncontrollable craving for stimulants. At the same time, his whole nature seems changed, and he becomes in every respect the opposite of his former self ; he forgets and sacrifices everything in the gratification of this passionate craving, chooses the vilest associates, frequents the lowest haunts, resorts to cunning lies to conceal himself, lives chiefly on brandy, and is at length discovered, probably in some low pothouse, dirty, haggard, and exhausted, with the brandy by his side, for which he still craves even when the irritated stomach refuses to retain it. The attack is followed by utter loathing of alcohol and of himself for yielding to the temptation; but, after a varying number of months, the wretched experience is onlv too certain to be repeated. No form of brain-disorder is more definite than this ; and, as already said, it is almost invariably associated with a hereditary tendency to intemperance, or to some form of nervous disease, which may or may not have been awakened by convivial habits, but in which habits the attacks ,often seem to begin. The third form-contintuous orconstant dipsomiiania-is that where the difficulty is usually greatest in drawing the line between the vice and the disease. It is often the outcome and the result of intemperate habits, often associated with other vices, and always associated with an active form of the moral insanity, which is usually negative or merely periodic in the other types of dipsomania. It is distinguished by an amount of acute cunning, plausible hypocrisy, and fearless lying, which it is often difficult to regard as mental weakness, and difficult to describe except as blackguardism-so difficult, indeed, that one who has never seen this form of insanity may be pardoned for doubting its existence; but no such sceptics are ever found among those whose friends -or relatives have been its victims. I believe the mere habit of intemperance in the individual rarely produces this condition, but that it is usually a result and development of the baneful heritage entailed on their descendants by intemperate progenitors ; the vice of one generation becoming the weakness of the next, liable to be evoked at any time by the parental vice, and then bringing a double curse. The inherited tendency to intemperance may itself prompt to the habits which develope the disease; or these habits may be easily acquired in social life, the patient thoughtlessly tempting his fate ; or, again, the inherited weakness may be evoked by brain-disturbance from quite other causes, such as injury, sun-stroke, or moral shock. But, however excited, the existence of this predisposition to intemperance or nervous disorder seems the chief and essential fact in connexion with dipsomania. The limits of this paper allow only a word or two as to its treatment. The absolute withdrawal of alcohol, except in the very rare cases where physical prostration forbids it, and the seclusion of the patient from all temptation and opportunity to indulge his habits, is of course the first and imperative step ; the next, restoration of tone, physical and moral; and, lastly, confirmation by time of the amendment thus secured. Unfortunately, while it is easy thus to prescribe the treat-ment, properly to carry it out is a most difficult and trying task. The proverbial difficulty of reclaiming an inveterate drunkard is enormously increased when the drunkenness is not a habit, but a disease. While the repentance and good resolutions of the drunkard are sadly apt to be evanescent, they are at the time earnest and sincere. The dipsomaniac is scarcely ever sincere, although he can simulate sincerity most perfectly; and scarcely ever earnest, except in accomplishing the gratification of his passion, and hating those who prevent it. The proper treatment of dipsomania is only possible in an asylum, and seldom successful even there. At the best, it needs years of treatment; and even then a relapse is always to be feared. Unhappily, asylum treatment is often impossible, since an action for damages is an unwelcome form of gratitude, and the medical and legal definitions of insanity are strangely at variance. If the admirable endeavour to provide asylums for inebriates fortunately prove successful, they will doubtless receive dipsomaniacs as well as habitual drunkards ; but it will be almost useless to provide them without power of compulsory detention, and absurd to provide them at all without lessening the needless multitude of public-houses which so liberally supply suitable inmates. Lastly, upon us, as physicians and alienists, a special duty rests in this matter. We see more than others of the evils of intemperance, and we are bound to tell in earnest words how dire and far-reaching is the curse it brings.