A WORD ON CATALEPSY.

1766 for various medicines, that 460 more were granted by the end to a condition of semi-paralysis by adverse economic conof October, 1908, and that there are valid "trade marks’’ ditions, and who have no power to take the first step covering 319 different" drugs and chemicals," and 5974 towards elevating themselves. We think that all who know covering various medicinal compounds." It seems that the poor, and especially the members of our own profession, the composition of a" patent " medicine must be declared at who know them well, will agree that the recommendations of the patent office, but that of a" proprietarymedicine, the Washington Committee are characterised at once by protected only by a trade mark, was allowed to remain secret wisdom and by philanthropy. until the enactment of the Pure Food and Drugs Law of 1906, which requires the presence and amount of alcohol,

Annotations.

morphia, opium, cocaine, heroin, alpha or beta eucaine, chloroform, cannabis indica, chloral hydrate, acetanilid, or any derivative or preparation of such substances, to be disclosed

on

the label.

If this enactment be enforced it

deprive the users of quack medicine of the of excuse ignorance. A general survey of the social condition and circumstances of the poorer population of the District is based upon a careful investigation of the circumstances of 1251 families, occupying 1054 houses, comprising 5157 persons, and, in the great majority of cases, having a family income below$1000 per annum. The investigation concerned both white and coloured people, and embraced an exhaustive survey of the general conditions of living, of income and expenditure, of occupations, of hours of labour, of unemployment, of sickness, and generally of all the circumstances favourable or adverse to the people who were interviewed. Perhaps the most will at least

remarkable result is the disclosure of the extent to which the classes concerned, including among them a large number of

subordinate Government officials, are fleeced by money-lenders; and’ a very important recommendation of the report is that this form of business should be controlled by enactment, and placed under such regulations as to terminate the crying abuses which now prevail. It seems to be recognised that loans to people situated as described are a necessity, and that the only way to get rid of the shark is to meet him on his own ground. Various attempts to do this have been made in different States and are described in the report ; and a Bill for the same purpose has been drafted by the Commissioners for the District of Columbia, and, if enacted, will legalise the business, will lay down rules subject to which it must be conducted, and will thus, it is hoped, induce respectable people to supply the necessary capital. But the main or key note of the report is in the conviction which it expresses that the first duty of the State is to strive for the elevation of the slum-dwellers. To this end it is recommended that all unsightly and insanitary property should be condemned and purchased by the Government, and that inexpensive and healthful habitations should be erected for the poor, who should be assisted to rent such clerks and other

"Ne

quid nimis."

A WORD ON CATALEPSY. FROM time immemorial the "living statue"has been regarded with superstitious awe and wonder, and in other days and lands he has been hailed as specially favoured, and made the object of reverence and even of worship. If we of the twentieth century are less inclined to wonder, the word trance" still conjures up to the lay mind something of the romantic and the mysterious: it forms a prominent feature of many fairy tales familiar to our childhood. While the inevitable result of increase in the sum of human knowledge is a tendency to scepticism where old tales are concerned, our scientific wonder is none the less excited by authenticated instances of the phenomena of catalepsy. With an involuntary immobility that far surpasses the range of voluntary immobility, the cataleptic or catatoniac will remain for hours oi days in the same position, indifferent to his surroundings and oblivious of the passing of time. We publish this week the interesting narrative of a case of catalepsy occurring in a boy of 15 years, under the observation of Dr. Donald E. Core. For a period of over 16 weeks the patient did not make a single voluntary movement, apart from electrical stimulation, but lay on his back staring at the ceiling. His condition was one of passive negativism; active negativism is a state in which any suggestion im-

arouses the corresponding opposite suggestion. that The view many of the wondrous stories of the Middle Ages are to be explained as manifestations of epidemic hysteria is one which is steadily gaining ground. Readers of Dr. Paul Richer’s treatise on hystero-epilepsy will find ample evidence there to support this hypothesis. Among these manifestations catalepsy occupies a foremost place, and many writers regard it as essentially and peculiarly hysterical. In the light of recent advances in our knowledge of the functions of the cerebrum, however, this contention is inadequate. Catalepsy may be, and often is, indicative of grave organic disease. A distinction is drawn by some between catalepsy and catatonia, the former being a state in which there is blind unconditioned obedience to suggestion from without, the latter to abnormal stimuli from within. Dr. Core’s patient exemplified both of these. In response to stimuli of extraneous origin his limbs could be moulded into any unusual position and kept there-the condition known as flexibilitas cerea; while he lay immobile for weeks at the bidding of stimuli of intrinsic origin homes or to purchase them by instalments bearing low (or perhaps in the entire absence of such stimuli), a interest. Many families now pay for "shacks"at a condition of typical catatonia. Any one who has been forced rate which returns to the owners anything between 9 and to maintain the same position for any length of time knows 35 per cent., and the inhabitants of such places have no how difficult and fatiguing active inhibition is; passive possibility of raising themselves in the scale of humanity. inhibition must be a phenomenon of quite a different nature. In general paralysis of the insane, cerebral arterio-sclerosis, The report contends that if the Government can build post-epileptic confusional states, above all in dementia prisons for criminals, almshouses for the poor, asylums for prsecox, catatonic phenomena are to be encountered. They the afflicted, and analogous institutions on which millions may occur in varying degrees of intensity and duration. As have been spent, there can be no condemnation for an a result of the persistence of the idea of a movement, what. application of the same solicitude to those who are reduced ever be the source of this idea, the innervation of the

mediately

1767

corresponding muscles is continued until fatigue renders the medical profession or of those involved in the contention. maintenance of the position impossible. In Pick’s Studies The Report for the year 1908, which has just reached us, in Motor Apragia"will be found a photograph of a patient publishes the names of the reconstituted staff, which are as with his face in a jug of milk, a position which he preserved follows :-Consulting Physician-Sir Samuel Wilks. Confor some time consequent on his entire inability to inhibit sulting Surgeon-Mr. Edmund Owen. Acting Staff-Phy-

persistent innervation. In the severe catatonia of dementia prxcox there would appear to be a dissociation between the

a

afferent and efferent aspects of cerebral function. Ideas of afferent or central derivation, which normally awaken innervation and so movement, are wanting, or at least fail Whether catatonia in its varying to produce any effect. forms will prove a symptom of localising value remains to be seen. ____

THE HAMPSTEAD GENERAL HOSPITAL.

sicians to In-patients : Dr. G. A. Sutherland and Sir John F. H. Broadbent. Physicians to Out-patients : Dr. C. 0. Hawthorne, Dr. Frederick W. Price, and Dr. A. Manuel. Gynaecologist: Mr. Frank T. Taylor. Physician for Diseases of the Skin: Dr. S. Ernest Dore. Surgeons to In-patients: Mr. J. Jackson Clarke and Mr. W. H. ClaytonGreene. Surgeons to Out-patients : Mr. J. W. Thomson Walker, Mr. W. Fedde Fedden, and Mr. George E. Waugh. Ophthalmic Surgeon to In-patients: Sir William J. Collins. Ophthalmic Surgeon to Out-patients : Mr. Malcolm L. Hepburn. Surgeon for Diseases of the Throat, Nose, and Ear: Mr. Harold Barwell. Dental Surgeon: Mr. Charles H. J. Acret. Anaesthetists: Dr. G. A. H. Barton and Mr. Hedley C. Visick. Pathologist: Dr. J. A. Torrens. Medical t Officer in Charge of Roentgen Ray and Electrical DepartMr. S. Gilbert Scott.

IN an annotation last week we expressed our belief that the troubles in connexion with this hospital were at an end, though we did not go so far as to say, as certain of our correspondents seem to have believed, that the resulting situation was quite satisfactory to everybody. We were perhaps a little previous in the definite statement that all controversy is a thing of the past, but we had good reason DIVULSION OF THE PUBIC SYMPHYSIS WITH for considering that such was the case, or will be in a RUPTURE OF THE BLADDER. short time. Our statement has very slightly anticipated IN the Intercolonial Medical Journal of Aust’J’alasia Mr. events, but we hear that three good friends of the A. F. Maclure has reported the following remarkable case General as a have been chosen Hampstead Hospital small embassy to meet the British Medical Association, of injury of the bladder under the care of Mr. R. Hamilton which Association has delegated three important members of Russell at the Alfred Hospital, Melbourne. A man, aged its body to meet them and finally suggest a position which 50 years, was taken to the hospital in an ambulance. While shall leave no grounds for further recrimination. Six riding a bucking horse he was thrown several times upwards, familiar from level-headed men, experienced, beginning to coming down on the pommel of the saddle, which struck end with all the details of a most difficult and unfortunate him in the pubic arch. At the second impact he said that contention, having absolutely nothing personally to gain in " he felt the bones give way," causing intense pain, which the matter, but being anxious only for the interests of the was aggravated by each succeeding blow. The agony was institution and the honour of the medical profession, should great, and when at length the horse was controlled certainly be able to bury the quarrel, even though it may be and he was lifted off he was unable to stand. impossible to please everybody. They have to deal, it must He was carried home, where a practitioner who saw him be remembered, with accomplished facts and the results of soon after the accident passed a catheter. Only a On admission eight hours those facts, not with the situation as it originally arose ; it little bloody fluid came away. is out of their power-out of anyone’s power-to obliterate after the accident he complained of severe pain in the past. A vigorous communication has reached us this week the pubic and right iliac regions, which came on in spasms. wherein some pointed remarks are made upon the financial Examination showed marked fulness and rigidity of the position of the hospital, but our correspondent speaks of the whole lower abdomen, which was dull on percussion. Over "lingering hope that some mod1M vit’endi may be arrived this region there was general ecchymosis. The scrotum was at whereby the general practitioners of Hampstead may be distended and dark purple. The discolouration extended as readmitted to the free wards of an institution founded far back as Colles’s fascia. The penis was swollen and disand developed by them." In echoing that hope we are coloured. Pressing the pubic bones together did not cause glad to think that it has much more justification probably pain or crepitus, but on palpation these bones were felt to than the words suggest. We think it quite probable that be separated by a considerable interval. A rubber catheter beds will be set apart in the Hampstead General Hospital was passed, but only a little bloody fluid was obtained. for the use of the Hampstead general practitioners. Of There were no bleeding from the urethra and no desire to course, in such an arrangement all the practitioners of the micturate. There seemed no doubt that the impact of the neighbourhood would have equal facilities extended to them, pommel of the saddle had torn the pubic bones asunder and, if only for reasons of administration, the wards would and involved the bladder and perhaps the urethra. An be separate from those occupied by the beds of the con- operation was performed nine hours after the injury. sultant staff. We sincerely trust that in this way the A median incision four inches long in the hypohospital will enter upon a peaceful and prosperous gastric region showed the following conditions. The career. The quarrel has been a strenuous one, and pre-vesical space was distended with bloody fluid (blood on both sides the arguments employed have been open to and urine) which had stripped up the peritoneum, which was for was no there obvious and untorn, from the pelvis and iliac fossa for some distance. legitimate criticism, right in the several difficult situations which wrong presented The pubic bones were separated for a distance of nearly an themselves. All that those involved could do was to act inch, and on being pressed together sprang apart again when upon their convictions and in accordance with what they the pressure was removed. A large piece of the right believed to be the best thing for the medical profession and rectus muscle was torn from its insertion into the os pubis. the best thing for the public. When the episode is finally The bladder and surrounding structures were separated from closed we suggest that a full and clear statement should be the bones and the tissues generally were much infiltrated. made of all the circumstances, and we are glad to believe that A large tear was found in the front of the bladder on the in spite of a good deal of hard language it will be then found i left side near the neck. It would not have been possible to that has occurred derogatory to the honour of the suture the bladder, nor was this considered desirable. A

ment :

nothing