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CRANIAL INJURIES.
EXt’RR [MENTAL SEARCH FOR 1.jVIDI1JNCI.
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surroundings : even this simple treatment is difficult to obtain in the ward of a general hospital to which so many patients with these injuries are. perforce consigned. Subtemporal decompressions have often "Ne quid nimis. been tried, but the results have been bad, and it is recognised that this operation is inadvisable. The EXPERIMENTAL SEARCH FOR EVIDENCE. prognosis of severe cranial injuries has therefore A PAPER by Dr. 11. E. House, of ’4’(,xas,l throws remained extremely grave. The patient remains for " light upon mysterious reports of a truth serum" a longer or shorter time in a state of acute cerebral which was apparently to take the place of the oath in irritation which is followed by stupor. If he surviveAmerican legal procedure. The serum is our old these stages, it is often found, after a prolonged confriend, scopolamine. and Dr. House was led by valescence, that he has suffered permanent impairobservations on twilight sleep to make use of its effect, ment of his mentality or intellect or of both. The importance of a paper published by Dr. Harry in combination with chloroform, in inhibiting control so that the subject truthfully answered questions and Jackson, of Chicago,can thus be readily appreciated, lost the power of telling lies. He claims to have aided for here a systematic line of treatment, which has justice in some cases. and says I could make anyone given good results, is advocated. This writer bases tell the truth on any question," but scrutiny reveals his argument on present-day knowledge of the cerebroa one-sided experience, for the truth was always in spinal circulatory system. That severe cranial injury favour of the person questioned. Yet, reading is often accompanied by laceration of the brain, and between the lines, we may presume that under the always followed by traumatic oedema of the brain, is influence of the drug there was an increased acuity common knowledge ; but the way in which this of memory such as occurs in hypnoidal or trance interferes with the normal balance in the vascular states, and the information obtained may well have and cerebro-spinal systems is less well understood. been of value. Following the analogy. we may note The resulting increase in intracranial pressure is not that even under hypnosis information that the relieved by a decompression operation because the subject is determined to withhold will be withheld, opening that is made is at once blocked by the bulging and Dr. House produces no evidence that this control of the brain against its edges, so that the relief of is lessened in the physio-psychological state induced tension is slight and transitory. Dr. Jackson has, by scopolamine. Moreover, though the recall of however, successfully treated this state of affairs by forgotten experiences under hypnosis is a common- systematic drainage of the cerebro-spinal system place, yet sometimes, though rarely, the subject through a lumbar puncture needle. There is nothing produces phantasies showing great verisimilitude. new in the performance of a lumbar puncture for only to repudiate them when waking. Apart from increased intracranial pressure, but Dr. Jackson has possible legal value, such special methods may aid in applied the needle with the maximum of science by the elucidation of the truth. We understand that attaching to it a mercurial manometer, so that a investigations under some kind of hypnosis occa- definite relief of increased pressure is the object in view. sionally showed, during the war. that punishable This is repeated at frequent intervals as often as is actions were carried out when the agent was in a found necessary while the pressure is seriously raised, pathological mental state, although it is doubtful so much fluid being withdrawn on each occasion as whether a man ever confessed under hypnosis to will produce the result desired. As Dr. Jackson points actions which he would not have confessed, to the out, the remote effects of cranial injury are probably to be attributed to the prolonged anaemia to which same operator, when in a state of full consciousness. On the other hand, Jung has described his success in the brain cells are subjected if the pressure be not detecting a thief among several suspects by the word- relieved. The treatment should therefore be applied association test, which, though appearing to be little within a few hours of injury, and the pressure should not be allowed to increase to the point of producing more than a drawing-room game. may be a really searching inquisition. This test has the advantage of obvious signs. The immediate results have been most being harmless to the innocent and can be used encouraging, probably owing to the relief of pressure without indicating what the aim of it may be, on the medulla which is obtained. A large number especially in an institution where, as in Jung’s case, of patients have been treated, about 1000 lumbar suspicion falls upon several people, but its inter- punctures having been performed without mishap. pretation needs care and experience. In an attractivee Fluid to the amount of 10-20 c.cm. is withdrawn every unfinished drama now on the London stage, Sir James 12 to 24 hours, according to the amount of increase Barrie sketches the behaviour towards an unexpected in pressure registered on the first occasion. Severe accusation of murder of a circle of dinner guests, one cases have been tapped on eight successivedays, and of whom and one only is guilty. In England the subsequently at intervals of three to four days, the prisoner or suspect is not compelled to incriminate pressure being reduced by 4 to 6 mm. Hg each time. himself. Legal custom does not tolerate the brow- It is claimed that the mortality in cases of cranial beating procedure, known as the " third degree," to injury has been reduced by this means from 50 to break the will of a suspect, nor do we follow the 25 per cent. The later results, which will be reported French method of confronting him with a recon- more fully in another communication from the same struction of the crime. The only apparent scope for writer, have also been gratifying, the symptoms known experimentation along the lines suggested by as traumatic neurosis " usually being absent. Dr. House’s paper would be in the preparation of a prisoner’s defence, and then interesting legal questions PHYSIOLOGICAL OLD AGE IN MAN. might be expected to arise. I)r. Arthur MacDonald, of Washington, D.C., in the New Yorlo Medical Times for September, 1922. CRANIAL INJURIES. deliberately regards old age from the physiological THE treatment of severe cranial injury has. up to standpoint, whilst admitting that physiological the present time, remained in an unsatisfactory changes in the old appear much greater than can be state. Where there is a clear indication for operation, explained by waste or anatomical structure. He such as a depressed fracture or a subdural haemorrhage, divides what he terms senile regression into three giving rise to localising symptoms, then operative phases : first, presenility ; second, old age proper; and, interference has often been successfully carried out. ’, third, decrepitude, and declares the view that women But in cases of linear fracture or of severe concussion do not show signs of the first stage at the age of 40 so the treatment has usually been ultra-conservative, often as men. Here Major R. J. C. Thompson and the patient being left to the care of nature, almost Major R. E. Todd, writing recently in THE LANCET. unaided except by the provision of darkness and quiet have supplied pertinent information. They have been
Annotations. "
"
"
1 The Use of Scopolamine in Criminology. Reprint from Texas State Journal of Medicine, September. 1922.
1 Jour. Amer. Med. Assoc., Sept. 22nd, 1922, lxxix., 1394. 2 THE LANCET, April 29th, 1922, p. 874.
1082
surroundings : even this simple treatment is difficult to obtain in the ward of a general hospital to which so many patients with these injuries are. perforce consigned. Subtemporal decompressions have often "Ne quid nimis. been tried, but the results have been bad, and it is recognised that this operation is inadvisable. The EXPERIMENTAL SEARCH FOR EVIDENCE. prognosis of severe cranial injuries has therefore A PAPER by Dr. 11. E. House, of ’4’(,xas,l throws remained extremely grave. The patient remains for " light upon mysterious reports of a truth serum" a longer or shorter time in a state of acute cerebral which was apparently to take the place of the oath in irritation which is followed by stupor. If he surviveAmerican legal procedure. The serum is our old these stages, it is often found, after a prolonged confriend, scopolamine. and Dr. House was led by valescence, that he has suffered permanent impairobservations on twilight sleep to make use of its effect, ment of his mentality or intellect or of both. The importance of a paper published by Dr. Harry in combination with chloroform, in inhibiting control so that the subject truthfully answered questions and Jackson, of Chicago,can thus be readily appreciated, lost the power of telling lies. He claims to have aided for here a systematic line of treatment, which has justice in some cases. and says I could make anyone given good results, is advocated. This writer bases tell the truth on any question," but scrutiny reveals his argument on present-day knowledge of the cerebroa one-sided experience, for the truth was always in spinal circulatory system. That severe cranial injury favour of the person questioned. Yet, reading is often accompanied by laceration of the brain, and between the lines, we may presume that under the always followed by traumatic oedema of the brain, is influence of the drug there was an increased acuity common knowledge ; but the way in which this of memory such as occurs in hypnoidal or trance interferes with the normal balance in the vascular states, and the information obtained may well have and cerebro-spinal systems is less well understood. been of value. Following the analogy. we may note The resulting increase in intracranial pressure is not that even under hypnosis information that the relieved by a decompression operation because the subject is determined to withhold will be withheld, opening that is made is at once blocked by the bulging and Dr. House produces no evidence that this control of the brain against its edges, so that the relief of is lessened in the physio-psychological state induced tension is slight and transitory. Dr. Jackson has, by scopolamine. Moreover, though the recall of however, successfully treated this state of affairs by forgotten experiences under hypnosis is a common- systematic drainage of the cerebro-spinal system place, yet sometimes, though rarely, the subject through a lumbar puncture needle. There is nothing produces phantasies showing great verisimilitude. new in the performance of a lumbar puncture for only to repudiate them when waking. Apart from increased intracranial pressure, but Dr. Jackson has possible legal value, such special methods may aid in applied the needle with the maximum of science by the elucidation of the truth. We understand that attaching to it a mercurial manometer, so that a investigations under some kind of hypnosis occa- definite relief of increased pressure is the object in view. sionally showed, during the war. that punishable This is repeated at frequent intervals as often as is actions were carried out when the agent was in a found necessary while the pressure is seriously raised, pathological mental state, although it is doubtful so much fluid being withdrawn on each occasion as whether a man ever confessed under hypnosis to will produce the result desired. As Dr. Jackson points actions which he would not have confessed, to the out, the remote effects of cranial injury are probably to be attributed to the prolonged anaemia to which same operator, when in a state of full consciousness. On the other hand, Jung has described his success in the brain cells are subjected if the pressure be not detecting a thief among several suspects by the word- relieved. The treatment should therefore be applied association test, which, though appearing to be little within a few hours of injury, and the pressure should not be allowed to increase to the point of producing more than a drawing-room game. may be a really searching inquisition. This test has the advantage of obvious signs. The immediate results have been most being harmless to the innocent and can be used encouraging, probably owing to the relief of pressure without indicating what the aim of it may be, on the medulla which is obtained. A large number especially in an institution where, as in Jung’s case, of patients have been treated, about 1000 lumbar suspicion falls upon several people, but its inter- punctures having been performed without mishap. pretation needs care and experience. In an attractivee Fluid to the amount of 10-20 c.cm. is withdrawn every unfinished drama now on the London stage, Sir James 12 to 24 hours, according to the amount of increase Barrie sketches the behaviour towards an unexpected in pressure registered on the first occasion. Severe accusation of murder of a circle of dinner guests, one cases have been tapped on eight successivedays, and of whom and one only is guilty. In England the subsequently at intervals of three to four days, the prisoner or suspect is not compelled to incriminate pressure being reduced by 4 to 6 mm. Hg each time. himself. Legal custom does not tolerate the brow- It is claimed that the mortality in cases of cranial beating procedure, known as the " third degree," to injury has been reduced by this means from 50 to break the will of a suspect, nor do we follow the 25 per cent. The later results, which will be reported French method of confronting him with a recon- more fully in another communication from the same struction of the crime. The only apparent scope for writer, have also been gratifying, the symptoms known experimentation along the lines suggested by as traumatic neurosis " usually being absent. Dr. House’s paper would be in the preparation of a prisoner’s defence, and then interesting legal questions PHYSIOLOGICAL OLD AGE IN MAN. might be expected to arise. I)r. Arthur MacDonald, of Washington, D.C., in the New Yorlo Medical Times for September, 1922. CRANIAL INJURIES. deliberately regards old age from the physiological THE treatment of severe cranial injury has. up to standpoint, whilst admitting that physiological the present time, remained in an unsatisfactory changes in the old appear much greater than can be state. Where there is a clear indication for operation, explained by waste or anatomical structure. He such as a depressed fracture or a subdural haemorrhage, divides what he terms senile regression into three giving rise to localising symptoms, then operative phases : first, presenility ; second, old age proper; and, interference has often been successfully carried out. ’, third, decrepitude, and declares the view that women But in cases of linear fracture or of severe concussion do not show signs of the first stage at the age of 40 so the treatment has usually been ultra-conservative, often as men. Here Major R. J. C. Thompson and the patient being left to the care of nature, almost Major R. E. Todd, writing recently in THE LANCET. unaided except by the provision of darkness and quiet have supplied pertinent information. They have been
Annotations. "
"
"
1 The Use of Scopolamine in Criminology. Reprint from Texas State Journal of Medicine, September. 1922.
1 Jour. Amer. Med. Assoc., Sept. 22nd, 1922, lxxix., 1394. 2 THE LANCET, April 29th, 1922, p. 874.