- Email: [email protected]
INJECTION OF THE GASSERIAN GANGLION FOR TIC DOULOUREUX.
1135 was found to be It may be remembered that THE LANCET that the British we reported in Fire Prevention Committee recommended the use of a mixture of bicarbonate of soda and sawdust for the extinction of small petrol fires. In this case, however, the use of sawdust appeared to be effective because it floats on the top of the petrol so to an extent excluding the air and smothering the fire. The bicarbonate of soda, it was added in the report, had certain advantages, but its use was not regarded as essential.
further ½to 3/4c.c., whereupon analgesia
the dry powder extinguishers
inject
bicarbonate of soda.
appears throughout the distribution of the nerve. It is advisable to shield the corresponding eye during the first 24 hours following the injection, or even to Dr. Wilfred suture the lids together. Harris, however, has shown that corneal ulceration may be avoided by stopping short of total anaasthesia ; the good effects are just as lasting from the point of view of relief from the pain.
a
THE METROPOLITAN WATER-SUPPLY.
THE
INJECTION OF THE
GASSERIAN GANGLION TIC DOULOUREUX.
FOR
IN the Medical CLinics of Chicago for January Dr. Ralph C. Hamill, of the Cook County Hospital, has published the record of a case of trigeminal neuralgia successfully treated by the injection of the Gasserian ganglion with alcohol. The patient was an Italian labourer, aged 37, whose illness had been of some ten years’ duration. Paroxysms of pain occurred at very frequent intervals, running from the inner canthus of the left eye down into the left upper bicuspids. This pain was described as consisting of lightning-like jabs of tearing, wrenching, stabbing pain, coming on with full intensity, and lasting from a few moments to three
minutes. Swallowing, talking, chewing, shaving, &c., would all precipitate a paroxysm. On objective examination no signs of organic disease could be detected, and there was no evidence of arteriosclerosis. Tic douloureux is a well-known clinical condition for which no adequate pathology has ever been demonstrated, and its etiology is obscure. Where some definite local condition causes the pain there is usually a more or less constant dull ache apart from the paroxysms, whereas in so-called idiopathic trigeminal neuralgia between the paroxysms the patient is often entirely free from pain. The administration of various sedatives having proved unsatisfactory, Dr. Hamill injected the Gasserian ganglion with 20 minims of the following solution : alcohol 3t drachms, cocaine 1 grain, water to half The point selected for the injection was an ounce. 2 cm. below the zygoma and 2t cm. anterior to the external auditory meatus. When the puncture is made at this point it is necessary to have the patient open his mouth as widely as possible, in order that the needle may clear the coronoid process of the inferior maxilla. The needle is pointed upwards at an angle of about 60° to the plane of the face and slightly backward. At about 4 cm. in from the surface bone is encountered, the pterygoid plate; by slightly withdrawing the point of the needle, changing its direction rather more backward, and elevating it the operator gradually feels his way somewhat, with the needle-point past the edge of the pterygoid
plate to the base of the skull, just lateral to the foramen ovale.
If the point is then inclined downwards and advanced, sudden pain should be felt in the distribution of the inferior division of the trigeminal-viz., in the lower jaw, cheek, lip, or tongue. If the needle is now advanced another ½cm. pain will be felt in the other branches of the fifth. The syringe is then connected to the needle and a few minims of the alcohol mixture is injected. Immediately the patient complains of a sensation " as if thousands of little darts or needles had shot through the corresponding side of the face." Assured by this sign, the physician can then
slightly
report on the condition of the metropolitan water-supply during the month of January by the Water Examiner appointed under the Metropolis Water Act was issued last week. It is the briefest document so far issued by this authority; its size perhaps reflects the shortage of paper, which is now seriously inconveniencing public bodies. The usual information on the chemical and bacteriological examinations, for which Dr. A. C. Houston, the Director of Water Examination, is responsible, is summarised by Mr. C. Perrin, and does not, The tables conas hitherto, appear separately. the chemical and taining bacteriological results All the samples of are, however, appended. water collected at the different works were clear, bright, and free from suspended matter. The results of chemical examination showed that the raw waters of the New River, the Lee, and the Thames improved in quality as judged by the albuminoid nitrogen, permanganate, turbidity, and colour tests. The filtered waters, however, deteriorated as judged by the albuminoid nitrogen (New River excepted) and colour tests (with the exception of New River, East London, Sunbury, and Chelsea). Compared with the 1915 averages, the raw waters yielded results worse than their respective averages as judged by the usual tests. The filtered waters yielded similarly worse results. All three raw waters contained more bacteria than their respective averages, while the filtered waters gave, generally speaking, not unsatisfactory results. Whereas 95’0, 100’0, and 65’0 per cent. of the samples of raw Thames, Lee, and New River water respectively contained typical B. coli in one cubic centimetre (or less) of water, 83’4, 90’0. and 69’0 per cent. of the filtered samples derived from the Thames, Lee, and New River respectively contained no typical B. coli even in 100 times as much water examined-viz., 100 cubic centimetres. The rainfall was below the average mean for the month taken for the previous 33 years. ____
ITALY’S chief balneary resort, Montecatini, sustained (writes our Rome correspondent) a severe loss last winter in the deaths, within a few weeks of each other, of its consulting head, Dr. Guido Baccelli, and of its medical administrator, Dr. Pietro Grocco. Their vacant posts have just been satisfactorily filled by the appointment in succession to Baccelli of Dr. Augusto Murri, the veteran professor of clinical medicine in the University of Bologna, known also, since Baccelli’s death, as " Dean of the Medical Faculty throughout Italy ; and by the appointment, as Grocco’s successor, of Dr. Giovanni Battista Queirolo, who has long held the clinical chair in the Pisan School with conspicuous acceptance. One of the many sequelae expected to supervene on the close of the present war will be, so far as Italy is concerned, a greatly increased development of her resources in balneary health resorts, with a view to "
further ½to 3/4c.c., whereupon analgesia
the dry powder extinguishers
inject
bicarbonate of soda.
appears throughout the distribution of the nerve. It is advisable to shield the corresponding eye during the first 24 hours following the injection, or even to Dr. Wilfred suture the lids together. Harris, however, has shown that corneal ulceration may be avoided by stopping short of total anaasthesia ; the good effects are just as lasting from the point of view of relief from the pain.
a
THE METROPOLITAN WATER-SUPPLY.
THE
INJECTION OF THE
GASSERIAN GANGLION TIC DOULOUREUX.
FOR
IN the Medical CLinics of Chicago for January Dr. Ralph C. Hamill, of the Cook County Hospital, has published the record of a case of trigeminal neuralgia successfully treated by the injection of the Gasserian ganglion with alcohol. The patient was an Italian labourer, aged 37, whose illness had been of some ten years’ duration. Paroxysms of pain occurred at very frequent intervals, running from the inner canthus of the left eye down into the left upper bicuspids. This pain was described as consisting of lightning-like jabs of tearing, wrenching, stabbing pain, coming on with full intensity, and lasting from a few moments to three
minutes. Swallowing, talking, chewing, shaving, &c., would all precipitate a paroxysm. On objective examination no signs of organic disease could be detected, and there was no evidence of arteriosclerosis. Tic douloureux is a well-known clinical condition for which no adequate pathology has ever been demonstrated, and its etiology is obscure. Where some definite local condition causes the pain there is usually a more or less constant dull ache apart from the paroxysms, whereas in so-called idiopathic trigeminal neuralgia between the paroxysms the patient is often entirely free from pain. The administration of various sedatives having proved unsatisfactory, Dr. Hamill injected the Gasserian ganglion with 20 minims of the following solution : alcohol 3t drachms, cocaine 1 grain, water to half The point selected for the injection was an ounce. 2 cm. below the zygoma and 2t cm. anterior to the external auditory meatus. When the puncture is made at this point it is necessary to have the patient open his mouth as widely as possible, in order that the needle may clear the coronoid process of the inferior maxilla. The needle is pointed upwards at an angle of about 60° to the plane of the face and slightly backward. At about 4 cm. in from the surface bone is encountered, the pterygoid plate; by slightly withdrawing the point of the needle, changing its direction rather more backward, and elevating it the operator gradually feels his way somewhat, with the needle-point past the edge of the pterygoid
plate to the base of the skull, just lateral to the foramen ovale.
If the point is then inclined downwards and advanced, sudden pain should be felt in the distribution of the inferior division of the trigeminal-viz., in the lower jaw, cheek, lip, or tongue. If the needle is now advanced another ½cm. pain will be felt in the other branches of the fifth. The syringe is then connected to the needle and a few minims of the alcohol mixture is injected. Immediately the patient complains of a sensation " as if thousands of little darts or needles had shot through the corresponding side of the face." Assured by this sign, the physician can then
slightly
report on the condition of the metropolitan water-supply during the month of January by the Water Examiner appointed under the Metropolis Water Act was issued last week. It is the briefest document so far issued by this authority; its size perhaps reflects the shortage of paper, which is now seriously inconveniencing public bodies. The usual information on the chemical and bacteriological examinations, for which Dr. A. C. Houston, the Director of Water Examination, is responsible, is summarised by Mr. C. Perrin, and does not, The tables conas hitherto, appear separately. the chemical and taining bacteriological results All the samples of are, however, appended. water collected at the different works were clear, bright, and free from suspended matter. The results of chemical examination showed that the raw waters of the New River, the Lee, and the Thames improved in quality as judged by the albuminoid nitrogen, permanganate, turbidity, and colour tests. The filtered waters, however, deteriorated as judged by the albuminoid nitrogen (New River excepted) and colour tests (with the exception of New River, East London, Sunbury, and Chelsea). Compared with the 1915 averages, the raw waters yielded results worse than their respective averages as judged by the usual tests. The filtered waters yielded similarly worse results. All three raw waters contained more bacteria than their respective averages, while the filtered waters gave, generally speaking, not unsatisfactory results. Whereas 95’0, 100’0, and 65’0 per cent. of the samples of raw Thames, Lee, and New River water respectively contained typical B. coli in one cubic centimetre (or less) of water, 83’4, 90’0. and 69’0 per cent. of the filtered samples derived from the Thames, Lee, and New River respectively contained no typical B. coli even in 100 times as much water examined-viz., 100 cubic centimetres. The rainfall was below the average mean for the month taken for the previous 33 years. ____
ITALY’S chief balneary resort, Montecatini, sustained (writes our Rome correspondent) a severe loss last winter in the deaths, within a few weeks of each other, of its consulting head, Dr. Guido Baccelli, and of its medical administrator, Dr. Pietro Grocco. Their vacant posts have just been satisfactorily filled by the appointment in succession to Baccelli of Dr. Augusto Murri, the veteran professor of clinical medicine in the University of Bologna, known also, since Baccelli’s death, as " Dean of the Medical Faculty throughout Italy ; and by the appointment, as Grocco’s successor, of Dr. Giovanni Battista Queirolo, who has long held the clinical chair in the Pisan School with conspicuous acceptance. One of the many sequelae expected to supervene on the close of the present war will be, so far as Italy is concerned, a greatly increased development of her resources in balneary health resorts, with a view to "