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EPILEPSY AND OPERATION UPON THE FEMALE PELVIC ORGANS.
385 .
We
practical importance.
trust that
while milk dried over hot cylinders occupied an intermediate position. In each of the three methods of treatment there was a stage at which the reduction in the total number of bacteria was much greater than that observed in the finished article ready for sale. This increase is attributed to recontamination. The interesting observation is made that the tubercle bacilli which had survived pasteurisation in method 1 and drying by heat in method 2 were still capable of producing progressive tuberculosis in guinea-pigs inoculated subcutaneously with milk containing these bacilli, but the course of the disease produced by these organisms was very much slower than that of the disease produced in guinea-pigs inoculated with the same amount of untreated tuberculous milk. The tuberculosis produced by the heated bacilli was "latent" or "occult" for some four weeks, while young rabbits fed with milk containing these modified bacilli did not contract tuberculosis. The report forms a valuable addition to the series of food reports issued from time to time by the Local Government Board, and it appears clear that if precautions were taken to guard the condensed or dried milk products from recontamination they would, generally speaking, be safer to use than raw milk.
the whole
subject will, at some short interval, be again discussed by representative surgeons in order that this kind of practical suggestion may be widely forthcoming from different experts, while the sad circumstances in which debate available.
we
live render material for
Annotations. "Ne
quid nimis."
THE FOOD-SUPPLY OF THE GERMAN
PEOPLE.
WE publish this week a detailed review of Dr. Paul Eltzbacher’s remarkable pamphlet on the food-supply of the German people. This work is a complete and authoritative exposition of the situation which he and his collaborators foresaw might arise when the British Fleet began to exercise serious pressure upon the German resources. The ftgures are as striking as the arguments, and sufficiently show how enormous the task of the Allies has been. ____
THE
A
"
"
BACTERIOLOGY OF CONDENSED MILK AND MILK POWDERS.
concerning the effects of certain conand densing drying processes used in the preservation of milk upon its bacterial contents was issued last week by the Local Government Board. The investigation was undertaken by The three methods of Dr. Sheridan Delepine. examined were: (1) the manufacpreservation ture of sweetened condensed milk; (2) the drying of milk over heated revolving cylinders ; and (3) the drying of milk by spraying it into a current of hot air. The experiments now reported were made with the view of ascertaining whether tuberculous cows’ milk was still capable of conveying tuberculosis after being treated according to methods 1 and 2. Further experiments have been made on the general effects upon the bacterial contents of milk following the use of methods 2 and 3, but the results await further inquiries. In feeding experiments Dr. Delepine reports the superiority of dry milk over fresh milk, and points out the advantages of dry milk from the hygienic as well as from the commercial point of view. It is therefore regrettable, he adds, that the process of drying should not alwayss yield an article entirely free from pathogenic bacteria. He concludes that if clean milk obtained from healthy cows were dried in a factory where suitable precautions were taken to prevent recontamination, dry milk almost free from bacteria could be produced. No experiments appear to have been made on the question of how long in a practically dry powder the organisms remain virile. The activity of bacteria is necessarily diminished in the absence of moisture, and milk powders do not, as a rule, contain more than 3 or at the most 5 per cent. of moisture which can be expelled by heat. In summarising his work Dr. Delepine states that the total number of bacteria present in mixed cows’ milk: has been found to be considerably reduced by treatment according to each of the three methods investigated. The reduction was greatest in the case of sweetened condensed milk, least in the powder obtained by spraying milk into hot air , REPORT
,
EPILEPSY AND OPERATION UPON PELVIC ORGANS.
THE
FEMALE
IT is stated by some writers that the development and commencing activity of the female sexual organs are in some way concerned with the onset of epileptic convulsions. It has also been said that the time at which the menses cease to appear is again apt to be attended with the occurrence of epilepsy, but Nothnagel denies that this is the case. It would not be difficult to find a number of cases recorded in medical literature in which the onset of epileptic fits coincided with great accuracy with the occurrence of the menstrual period. Cases, too, are to be found in which the fits have ceased during a pregnancy, only to recommence with the return of the monthly periods. When we bear in mind the increased nervous excitability of the woman at the menstrual period, and further, when we remember the tendency to periodic recurrence of epileptic attacks and the periodicity of the monthly periods, it is not surprising to find that in a certain number of women the two conditions coincide so frequently as almost to lead to the conclusion that there is some definite relationship between them. There is, however, no certain proof of any etiological relationship between uterine and ovarian disease and epilepsy. Sir William Gowers said, "Of epilepsy due to disease of the uterus or ovaries nothing is seen except by gynaecologists," and from the point of view of a judge demanding evidence the statement stands. In spite of this opinion from so high an authority a number of cases have been recorded in which various operations have been carried out upon the pelvic,organs of the woman for the purpose of curing epileptic. fits. Dilatation of the cervix, the treatment of erosions, the amputation of the cervix, and even the removal of the healthy ovaries have been advocated, and indeed practised, from time to time with reputed benefit to the patients, That the fits have ceased and in some cases have never. returned has been adduced as proof of tha value of the particular procedure
386
adopted.
It
is, however, important
to remember may be said for many different operations, and it has been shown that any surgical procedure on any part of the body may influence favourably, for a time at any rate, the course of
that the
same
and it is not every case that can stand the journey. But a preparatory course-resisted exercises, massage, carbonated baths, or Bergonie treatment-can be given locally if necessary, and in addition to a favourable situation-near the sea-level and sheltered from the prevailing winds-and a mild winter climate, the disposition of the ground in many of our seaside places probably offers an excellent arena for carrying out the exercises for the terrain cure. With this object in view he has mapped out a course at Eastbourne, giving the various gradients on the parades and sea front, beginning with gentle exercises and ending with a more rigorous treatment by gradually bringing the patient to accomplish a stiff climb on the Downs and to Beachy Head. The principle throughout is to strengthen the heart by making it work with a lightened load, this being obtained by restriction of fluids when necessary and by the dilatation of the peripheral vessels in the big muscle groups and skin produced by exercise. Exercise is given by walking along roads of graduated steepness, commencing at level and progressing to hill-climbing, the activity and distance being increased as the case improves. The suggestion seems to us to be an admirable one, and should set other seaside authorities thinking.
as having collected in which such diverse operations as ligation of the internal carotid, circumcision, castration, tracheotomy, excision of the superior cervical ganglion, and incision of the scalp have all been practised, often with good results. The extraction of a carious tooth has not infrequently had an equally good effect, or a treatment for worms. Fagge mentions the case of an American who had been castrated and treated with nitrate of silver in the hope of curing his epilepsy. His skin looked as if it had been polished with blacklead, but the result of the combined treatment was negative so far as the disease was concerned. A recollection of these and many similar facts concerning the operative treatment of epilepsy should prevent any gynaecologist who is careful to take a broad-minded view of his patients, and who has freed himself from the old and utterly erroneous belief, " mulier tota in utero," from practising the operation of removal of the healthy ovaries for the cure of epilepsy. The old-fashioned term "spaying" has rather dropped out of use at the present day, but if the enterprising surgeon who contemplates THE FUNCTIONAL CAPACITY OF THE KIDNEY. this operation will recollect that he is in reality spayhis he think twice before THE problem of investigating the functional ing patients may carrying out such treatment. Naturally, if the pelvic organs activity of the kidney is admittedly a difficult one are diseased and require removal this should be in view of the uncertainty which still dominates done, and if the patient also suffers from epilepsy the definition of the renal function, which some she will no doubt derive benefit from the operation, consider to be under the influence of simple and may even be cured for a time or completely of physical or physico-chemical laws, while others her convulsions. This is, however, no argument contend that it is controlled by laws, mysterious for the removal of healthy ovaries, and we should and unknown in their essence, like those which are not have believed that such an operation was attributed to the so-called vital energy. Dr. L. practised at the present day had not a correspondent Pezzana1 has studied the application of the written to ask our opinion of this procedure. If phenolsulphonphthalein test to this question, and the pelvic organs are diseased in a case of epilepsy considers it markedly superior to all others for surgical treatment estimating the functional capacity of the kidney any necessary medical or should be carried out coincidently with the appro- from the point of view of its facility and of rapidity priate medical treatment for the disease. In a very of elimination. Phenolsulphonphthalein, discovered few rare cases in which the genital tract is so by the American Ira Ramsen, was first promalformed that the patient can never marry, as. posed for the study of the renal function by for example, with absence of the vagina, and where Rowntree and Geraghty, who proved its harmat the same time she suffers from epileptic attacks and exclusive elimination by the kidney. recurring at monthly intervals, oophorectomy might It is administered by subcutaneous, intramuscular, be justifiable. The removal, however, of the or intravenous injection in doses of 6 mg., and in healthy ovaries, when a normal genital tract is normal conditions is completely eliminated in from present in an otherwise healthy woman, in the two to four hours. In the urine phenolsulphonhope of curing epilepsy, is not likely to be success- phthalein is discoverable by simple alkalinisation, ful and is never, in our opinion, necessary or and the quantity also may be easily estimated by The patient is means of a suitable colorimeter. justifiable. made to drink 200 to 300 c.c. of water and then GRADUATED EXERCISES AT OUR HOME to micturate so as completely to empty the bladder, HEALTH RESORTS. prior to the injection being made, preferably into THE observation that so many of our home health the gluteal muscles. The urine passed after 6-10resorts present ample facilities for a course of 15 minutes is received into vessels containing a few .graduated exercises in functional disorders of the drops of solution of caustic soda, and the moment heart is opportune and should receive careful when elimination begins is shown by the red colour In an interesting paper which imparted to the urine as soon as it comes into - consideration. Mr. J. S. Kellett Smith has sent us he refers,contact with the alkali. For the estimation, the to the extreme suitability ofurine passed in the first hour is collected, for example, solution of per cent. Eastbourne for the treatment of favourable 10-15 c.c. of a 15 cases, and there can be little doubt that othersodic hydrate added, and diluted with water 1 a litre; a portion of this is then placed seaside health resorts present similar oppor-to tunities when their environment comes to be]in the colorimeter, which gives the actual The same is done with eliminated. I carefully studied. As Mr. Kellett Smith points out, percentage even under normal circumstances it is not every 1 Il Policlinico, vol. xxi., 1914, Medical Section, Fasc. 12, December, patient who can visit a continental health resort, 1914.
epilepsy.
a
series of
Osler
quotes White
cases
lessness
____
We
practical importance.
trust that
while milk dried over hot cylinders occupied an intermediate position. In each of the three methods of treatment there was a stage at which the reduction in the total number of bacteria was much greater than that observed in the finished article ready for sale. This increase is attributed to recontamination. The interesting observation is made that the tubercle bacilli which had survived pasteurisation in method 1 and drying by heat in method 2 were still capable of producing progressive tuberculosis in guinea-pigs inoculated subcutaneously with milk containing these bacilli, but the course of the disease produced by these organisms was very much slower than that of the disease produced in guinea-pigs inoculated with the same amount of untreated tuberculous milk. The tuberculosis produced by the heated bacilli was "latent" or "occult" for some four weeks, while young rabbits fed with milk containing these modified bacilli did not contract tuberculosis. The report forms a valuable addition to the series of food reports issued from time to time by the Local Government Board, and it appears clear that if precautions were taken to guard the condensed or dried milk products from recontamination they would, generally speaking, be safer to use than raw milk.
the whole
subject will, at some short interval, be again discussed by representative surgeons in order that this kind of practical suggestion may be widely forthcoming from different experts, while the sad circumstances in which debate available.
we
live render material for
Annotations. "Ne
quid nimis."
THE FOOD-SUPPLY OF THE GERMAN
PEOPLE.
WE publish this week a detailed review of Dr. Paul Eltzbacher’s remarkable pamphlet on the food-supply of the German people. This work is a complete and authoritative exposition of the situation which he and his collaborators foresaw might arise when the British Fleet began to exercise serious pressure upon the German resources. The ftgures are as striking as the arguments, and sufficiently show how enormous the task of the Allies has been. ____
THE
A
"
"
BACTERIOLOGY OF CONDENSED MILK AND MILK POWDERS.
concerning the effects of certain conand densing drying processes used in the preservation of milk upon its bacterial contents was issued last week by the Local Government Board. The investigation was undertaken by The three methods of Dr. Sheridan Delepine. examined were: (1) the manufacpreservation ture of sweetened condensed milk; (2) the drying of milk over heated revolving cylinders ; and (3) the drying of milk by spraying it into a current of hot air. The experiments now reported were made with the view of ascertaining whether tuberculous cows’ milk was still capable of conveying tuberculosis after being treated according to methods 1 and 2. Further experiments have been made on the general effects upon the bacterial contents of milk following the use of methods 2 and 3, but the results await further inquiries. In feeding experiments Dr. Delepine reports the superiority of dry milk over fresh milk, and points out the advantages of dry milk from the hygienic as well as from the commercial point of view. It is therefore regrettable, he adds, that the process of drying should not alwayss yield an article entirely free from pathogenic bacteria. He concludes that if clean milk obtained from healthy cows were dried in a factory where suitable precautions were taken to prevent recontamination, dry milk almost free from bacteria could be produced. No experiments appear to have been made on the question of how long in a practically dry powder the organisms remain virile. The activity of bacteria is necessarily diminished in the absence of moisture, and milk powders do not, as a rule, contain more than 3 or at the most 5 per cent. of moisture which can be expelled by heat. In summarising his work Dr. Delepine states that the total number of bacteria present in mixed cows’ milk: has been found to be considerably reduced by treatment according to each of the three methods investigated. The reduction was greatest in the case of sweetened condensed milk, least in the powder obtained by spraying milk into hot air , REPORT
,
EPILEPSY AND OPERATION UPON PELVIC ORGANS.
THE
FEMALE
IT is stated by some writers that the development and commencing activity of the female sexual organs are in some way concerned with the onset of epileptic convulsions. It has also been said that the time at which the menses cease to appear is again apt to be attended with the occurrence of epilepsy, but Nothnagel denies that this is the case. It would not be difficult to find a number of cases recorded in medical literature in which the onset of epileptic fits coincided with great accuracy with the occurrence of the menstrual period. Cases, too, are to be found in which the fits have ceased during a pregnancy, only to recommence with the return of the monthly periods. When we bear in mind the increased nervous excitability of the woman at the menstrual period, and further, when we remember the tendency to periodic recurrence of epileptic attacks and the periodicity of the monthly periods, it is not surprising to find that in a certain number of women the two conditions coincide so frequently as almost to lead to the conclusion that there is some definite relationship between them. There is, however, no certain proof of any etiological relationship between uterine and ovarian disease and epilepsy. Sir William Gowers said, "Of epilepsy due to disease of the uterus or ovaries nothing is seen except by gynaecologists," and from the point of view of a judge demanding evidence the statement stands. In spite of this opinion from so high an authority a number of cases have been recorded in which various operations have been carried out upon the pelvic,organs of the woman for the purpose of curing epileptic. fits. Dilatation of the cervix, the treatment of erosions, the amputation of the cervix, and even the removal of the healthy ovaries have been advocated, and indeed practised, from time to time with reputed benefit to the patients, That the fits have ceased and in some cases have never. returned has been adduced as proof of tha value of the particular procedure
386
adopted.
It
is, however, important
to remember may be said for many different operations, and it has been shown that any surgical procedure on any part of the body may influence favourably, for a time at any rate, the course of
that the
same
and it is not every case that can stand the journey. But a preparatory course-resisted exercises, massage, carbonated baths, or Bergonie treatment-can be given locally if necessary, and in addition to a favourable situation-near the sea-level and sheltered from the prevailing winds-and a mild winter climate, the disposition of the ground in many of our seaside places probably offers an excellent arena for carrying out the exercises for the terrain cure. With this object in view he has mapped out a course at Eastbourne, giving the various gradients on the parades and sea front, beginning with gentle exercises and ending with a more rigorous treatment by gradually bringing the patient to accomplish a stiff climb on the Downs and to Beachy Head. The principle throughout is to strengthen the heart by making it work with a lightened load, this being obtained by restriction of fluids when necessary and by the dilatation of the peripheral vessels in the big muscle groups and skin produced by exercise. Exercise is given by walking along roads of graduated steepness, commencing at level and progressing to hill-climbing, the activity and distance being increased as the case improves. The suggestion seems to us to be an admirable one, and should set other seaside authorities thinking.
as having collected in which such diverse operations as ligation of the internal carotid, circumcision, castration, tracheotomy, excision of the superior cervical ganglion, and incision of the scalp have all been practised, often with good results. The extraction of a carious tooth has not infrequently had an equally good effect, or a treatment for worms. Fagge mentions the case of an American who had been castrated and treated with nitrate of silver in the hope of curing his epilepsy. His skin looked as if it had been polished with blacklead, but the result of the combined treatment was negative so far as the disease was concerned. A recollection of these and many similar facts concerning the operative treatment of epilepsy should prevent any gynaecologist who is careful to take a broad-minded view of his patients, and who has freed himself from the old and utterly erroneous belief, " mulier tota in utero," from practising the operation of removal of the healthy ovaries for the cure of epilepsy. The old-fashioned term "spaying" has rather dropped out of use at the present day, but if the enterprising surgeon who contemplates THE FUNCTIONAL CAPACITY OF THE KIDNEY. this operation will recollect that he is in reality spayhis he think twice before THE problem of investigating the functional ing patients may carrying out such treatment. Naturally, if the pelvic organs activity of the kidney is admittedly a difficult one are diseased and require removal this should be in view of the uncertainty which still dominates done, and if the patient also suffers from epilepsy the definition of the renal function, which some she will no doubt derive benefit from the operation, consider to be under the influence of simple and may even be cured for a time or completely of physical or physico-chemical laws, while others her convulsions. This is, however, no argument contend that it is controlled by laws, mysterious for the removal of healthy ovaries, and we should and unknown in their essence, like those which are not have believed that such an operation was attributed to the so-called vital energy. Dr. L. practised at the present day had not a correspondent Pezzana1 has studied the application of the written to ask our opinion of this procedure. If phenolsulphonphthalein test to this question, and the pelvic organs are diseased in a case of epilepsy considers it markedly superior to all others for surgical treatment estimating the functional capacity of the kidney any necessary medical or should be carried out coincidently with the appro- from the point of view of its facility and of rapidity priate medical treatment for the disease. In a very of elimination. Phenolsulphonphthalein, discovered few rare cases in which the genital tract is so by the American Ira Ramsen, was first promalformed that the patient can never marry, as. posed for the study of the renal function by for example, with absence of the vagina, and where Rowntree and Geraghty, who proved its harmat the same time she suffers from epileptic attacks and exclusive elimination by the kidney. recurring at monthly intervals, oophorectomy might It is administered by subcutaneous, intramuscular, be justifiable. The removal, however, of the or intravenous injection in doses of 6 mg., and in healthy ovaries, when a normal genital tract is normal conditions is completely eliminated in from present in an otherwise healthy woman, in the two to four hours. In the urine phenolsulphonhope of curing epilepsy, is not likely to be success- phthalein is discoverable by simple alkalinisation, ful and is never, in our opinion, necessary or and the quantity also may be easily estimated by The patient is means of a suitable colorimeter. justifiable. made to drink 200 to 300 c.c. of water and then GRADUATED EXERCISES AT OUR HOME to micturate so as completely to empty the bladder, HEALTH RESORTS. prior to the injection being made, preferably into THE observation that so many of our home health the gluteal muscles. The urine passed after 6-10resorts present ample facilities for a course of 15 minutes is received into vessels containing a few .graduated exercises in functional disorders of the drops of solution of caustic soda, and the moment heart is opportune and should receive careful when elimination begins is shown by the red colour In an interesting paper which imparted to the urine as soon as it comes into - consideration. Mr. J. S. Kellett Smith has sent us he refers,contact with the alkali. For the estimation, the to the extreme suitability ofurine passed in the first hour is collected, for example, solution of per cent. Eastbourne for the treatment of favourable 10-15 c.c. of a 15 cases, and there can be little doubt that othersodic hydrate added, and diluted with water 1 a litre; a portion of this is then placed seaside health resorts present similar oppor-to tunities when their environment comes to be]in the colorimeter, which gives the actual The same is done with eliminated. I carefully studied. As Mr. Kellett Smith points out, percentage even under normal circumstances it is not every 1 Il Policlinico, vol. xxi., 1914, Medical Section, Fasc. 12, December, patient who can visit a continental health resort, 1914.
epilepsy.
a
series of
Osler
quotes White
cases
lessness
____