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CANADIAN MEDICAL DIRECTORY
440 of the protein granule in the colloidal system ; in the group was the overweight, with diminished metabolic rate and vessel permeability, altered calcium-potassium ratio with lessened calcium, increased alkalinity, and an increase in the size of the
pyorrhoea
protein granule. OSTEOCHONDRITIS DISSECANS review of the pathology and aetiology of osteochondritis dissecans (Brit. Jour. Surg., 1933, xxi., 67) Mr. H. A. T. Fairbank agrees with other authorities that while the condition is occasionally seen in the elbow, ankle, hip, and other joints, it is much more common in the knee. Though it is usually said that males are more liable to it than females, in his series of 20 cases the incidence is equally divided between them. He adduces strong arguments in favour of the traumatic theory and regards the condition as due to a subchondrial fracture. If this is accepted, there are two explanations why it so often occurs in the knee-joint. One school thinks that the fracture is produced by a force transmitted through the patella when falling on the flexed knee, a not unusual incident at an age when the subchondrial bone is said to be especially brittle. The other school thinks that the inner tubercle of the spine of the tibia may impinge on the femoral condyle in rotatory movements of the tibia. Fairbank sides with the latter. He points out that the inner tubercle is always well developed in these cases, and experimentally it can be seen that if the tibia is forcibly rotated in the flexed position it impinges on the femoral condyle at the point which is the most frequent site of the lesion. He disposes of the infarction theory by quoting the observations of Phemister, who says that when the fragment is pedunculated the bone is alive. This observation cannot be reconciled with a theory that presupposes necrosis of the fragment before its separation. Furthermore, he lays emphasis on the absence of granulation tissue in the hollow when examined at operation ; so how, he asks, can the fragment, if it is a sequestrum, be cast off without the granulation tissue which is essential for the process ? The reason why these subchondrial fractures tend not to heal is that they are painless, and the joint continues to be used. Fairbank advises exploration in all cases that give rise to symptoms, and when the articular cartilage is soft, shredded, and rough, even though unbroken, it should be excised, any underlying loose bone being removed with it. IN
a
"MORNING MISERIES "
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DR. W. B. COSENS writes : "This condition of mind, so named by the late Sir Andrew Clark, deserves When told more heed than is usually bestowed on it. by a middle-aged patient of either sex,’Ihave such a rotten feeling when I first wake up, everything seems hopeless,’ the doctor is too apt to forget to ask the few sympathetic questions which will put him wise. As a matter of fact the symptomatology varies little. The miseries are more common in men than women ; they only occur after a good night’s sleep, lasting on the average one hour, or longer if the victim remains in bed. They seldom occur after a night of dreams. They consist of a mental deluge of imaginary coming disasters, accompanied with a feeling of intense depression, arising without sufficient cause. They seem to destroy any fighting spirit, and to replace it with intense self-pity. I do not include under the term those who suffer in the early morning from real troubles and anxieties, or the after-effects of alcohol ; in these the clinical picture is quite different. I can recall three cases of early morning suicides in persons whose only complaint had been of this dreadful feeling on waking. " But morning miseries afflict the young as well as the old, although most common in the fourth to the sixth decade. Among adolescents they are due to faulty mental construction, which can often be traced to one or other parent. The late middle-aged usually give a long history of being " highly strung," and a -
shorter one of loss of mental balance over trifles. This suggests failure of brain-cells to adjust rapidly from a condition of profound sleep ; it is a case of function. delayed " The duty of the doctor is to protect the sufferer during this period of delay. To administer advice about introspection is just waste of energy. To order a bottle of medicine is worse ; it just cerves to remind the victim three times a day that he was miserable on waking. Tell him rather to follow the habit of the great Duke of Wellington, to turn out when he turns over. As soon as he is out of bed he should actively engage in some mechanical officemake a cup of tea, prepare clothes for wearing, black his boots, dust out his room, in the country go for a ride -no matter what, so long as he remains
employed." * * Sir Andrew Clark was dealing in his presidential address to the Clinical Society of London (see THE LANCET, 1883, i., 223) with "that interesting and instructive group of clinical affections which is unconnected, except causally, with sensible structural alterations of the tissues and organs," and the first illustration he gave of the group was the " morning agony of middle-aged nervous people, often the precursor of melancholia. A man awaking at early dawn is conscious of undefinable malaise and unrest; his mental and moral outlook becomes dark and gloomy ; aching pains arise in the limbs ; unable to lie still, he tosses restlessly about his bed ; the malaise deepens into distress, and he groans ; a cold sweat breaks forth over all his body ; and then in a few minutes the attack subsides, and the patient finds himself in his accustomed health and spirits."-ED. L.
SCIENTIFIC HYBRIDS H. WILLIAMSON, 1.M.S., writes : Is it not Major time to check the growth of the hideous verbal hybrids which are springing up in our scientific garden ? Perhaps the zeal of the research worker has outrun his erudition, but surely such abominations as " " hyperfunction and " antibody " could be replaced more by something worthy of our learned profession, while many other regrettable examples will occur to the educated mind. Sir Clifford Allbutt, a fine scholar, coined the very good word " hyperpiesis," which is now being slowly replaced by the hybrid " hypertension." Let us either retain his word or call the condition " supertension," even at the risk of being accused of emulating the perpetrator of " supercinema," for we can confound our accusers by replying that if they find the word necessary they should say "
hypercinema.."
CANADIAN MEDICAL DIRECTORY WE have received from the Canadian Medical Publishing Co., of Montreal, the fifteenth edition of the Canadian Medical Directory (the title page calls it the fourteenth), being a register of physicians, dentists, and druggists of the Dominion. The directory opens with a general section containing the of the Medical Council of Canada, followed by a list of colleges, councils, and medical societies throughout the provinces, and a survey of hospitals classified according to their geographical position, with their number of beds and a brief indication of their scope. The directory proper takes each province in succession, first citing the local acts regulating medical practice, then giving information about provincial, university, and medical schools, and finally a classified list of practitioners, with a street list of the larger centres. It is the object of the publishers to make the directory as accurate and reliable as possible, and subscribers are requested to cooperate by notifying any errors which come to their attention. The volume is indispensable for its purpose, but its value would, we think, be enhanced by a table of contents giving the reader his cue where to find this and that, and by further attention to the page captions. The price of the directory in paper cover is 7 dollars ; cloth bound 10 dollars.
personnel
pyorrhoea
protein granule. OSTEOCHONDRITIS DISSECANS review of the pathology and aetiology of osteochondritis dissecans (Brit. Jour. Surg., 1933, xxi., 67) Mr. H. A. T. Fairbank agrees with other authorities that while the condition is occasionally seen in the elbow, ankle, hip, and other joints, it is much more common in the knee. Though it is usually said that males are more liable to it than females, in his series of 20 cases the incidence is equally divided between them. He adduces strong arguments in favour of the traumatic theory and regards the condition as due to a subchondrial fracture. If this is accepted, there are two explanations why it so often occurs in the knee-joint. One school thinks that the fracture is produced by a force transmitted through the patella when falling on the flexed knee, a not unusual incident at an age when the subchondrial bone is said to be especially brittle. The other school thinks that the inner tubercle of the spine of the tibia may impinge on the femoral condyle in rotatory movements of the tibia. Fairbank sides with the latter. He points out that the inner tubercle is always well developed in these cases, and experimentally it can be seen that if the tibia is forcibly rotated in the flexed position it impinges on the femoral condyle at the point which is the most frequent site of the lesion. He disposes of the infarction theory by quoting the observations of Phemister, who says that when the fragment is pedunculated the bone is alive. This observation cannot be reconciled with a theory that presupposes necrosis of the fragment before its separation. Furthermore, he lays emphasis on the absence of granulation tissue in the hollow when examined at operation ; so how, he asks, can the fragment, if it is a sequestrum, be cast off without the granulation tissue which is essential for the process ? The reason why these subchondrial fractures tend not to heal is that they are painless, and the joint continues to be used. Fairbank advises exploration in all cases that give rise to symptoms, and when the articular cartilage is soft, shredded, and rough, even though unbroken, it should be excised, any underlying loose bone being removed with it. IN
a
"MORNING MISERIES "
-
DR. W. B. COSENS writes : "This condition of mind, so named by the late Sir Andrew Clark, deserves When told more heed than is usually bestowed on it. by a middle-aged patient of either sex,’Ihave such a rotten feeling when I first wake up, everything seems hopeless,’ the doctor is too apt to forget to ask the few sympathetic questions which will put him wise. As a matter of fact the symptomatology varies little. The miseries are more common in men than women ; they only occur after a good night’s sleep, lasting on the average one hour, or longer if the victim remains in bed. They seldom occur after a night of dreams. They consist of a mental deluge of imaginary coming disasters, accompanied with a feeling of intense depression, arising without sufficient cause. They seem to destroy any fighting spirit, and to replace it with intense self-pity. I do not include under the term those who suffer in the early morning from real troubles and anxieties, or the after-effects of alcohol ; in these the clinical picture is quite different. I can recall three cases of early morning suicides in persons whose only complaint had been of this dreadful feeling on waking. " But morning miseries afflict the young as well as the old, although most common in the fourth to the sixth decade. Among adolescents they are due to faulty mental construction, which can often be traced to one or other parent. The late middle-aged usually give a long history of being " highly strung," and a -
shorter one of loss of mental balance over trifles. This suggests failure of brain-cells to adjust rapidly from a condition of profound sleep ; it is a case of function. delayed " The duty of the doctor is to protect the sufferer during this period of delay. To administer advice about introspection is just waste of energy. To order a bottle of medicine is worse ; it just cerves to remind the victim three times a day that he was miserable on waking. Tell him rather to follow the habit of the great Duke of Wellington, to turn out when he turns over. As soon as he is out of bed he should actively engage in some mechanical officemake a cup of tea, prepare clothes for wearing, black his boots, dust out his room, in the country go for a ride -no matter what, so long as he remains
employed." * * Sir Andrew Clark was dealing in his presidential address to the Clinical Society of London (see THE LANCET, 1883, i., 223) with "that interesting and instructive group of clinical affections which is unconnected, except causally, with sensible structural alterations of the tissues and organs," and the first illustration he gave of the group was the " morning agony of middle-aged nervous people, often the precursor of melancholia. A man awaking at early dawn is conscious of undefinable malaise and unrest; his mental and moral outlook becomes dark and gloomy ; aching pains arise in the limbs ; unable to lie still, he tosses restlessly about his bed ; the malaise deepens into distress, and he groans ; a cold sweat breaks forth over all his body ; and then in a few minutes the attack subsides, and the patient finds himself in his accustomed health and spirits."-ED. L.
SCIENTIFIC HYBRIDS H. WILLIAMSON, 1.M.S., writes : Is it not Major time to check the growth of the hideous verbal hybrids which are springing up in our scientific garden ? Perhaps the zeal of the research worker has outrun his erudition, but surely such abominations as " " hyperfunction and " antibody " could be replaced more by something worthy of our learned profession, while many other regrettable examples will occur to the educated mind. Sir Clifford Allbutt, a fine scholar, coined the very good word " hyperpiesis," which is now being slowly replaced by the hybrid " hypertension." Let us either retain his word or call the condition " supertension," even at the risk of being accused of emulating the perpetrator of " supercinema," for we can confound our accusers by replying that if they find the word necessary they should say "
hypercinema.."
CANADIAN MEDICAL DIRECTORY WE have received from the Canadian Medical Publishing Co., of Montreal, the fifteenth edition of the Canadian Medical Directory (the title page calls it the fourteenth), being a register of physicians, dentists, and druggists of the Dominion. The directory opens with a general section containing the of the Medical Council of Canada, followed by a list of colleges, councils, and medical societies throughout the provinces, and a survey of hospitals classified according to their geographical position, with their number of beds and a brief indication of their scope. The directory proper takes each province in succession, first citing the local acts regulating medical practice, then giving information about provincial, university, and medical schools, and finally a classified list of practitioners, with a street list of the larger centres. It is the object of the publishers to make the directory as accurate and reliable as possible, and subscribers are requested to cooperate by notifying any errors which come to their attention. The volume is indispensable for its purpose, but its value would, we think, be enhanced by a table of contents giving the reader his cue where to find this and that, and by further attention to the page captions. The price of the directory in paper cover is 7 dollars ; cloth bound 10 dollars.
personnel