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LINCOLN COUNTY HOSPITAL.
652 hours after operation, the anterior flap showed signs of gangrene, but there was no trace of tension. The whole flap (about three inches long) eventually became gangrenous, and was completely separated on the nineteenth day after operation, the whole process taking place quite aseptically. The raw surface which was left was skin grafted by Thiersch’s method on May 25th, all the granulations being shaved off before the grafts were applied. The stump healed rapidly, and by July 8th was quite sound. The boy was seen in January, 1893, and the stump was quite satisfactory in every way. The length of time elapsing between amputation and skin grafting is accounted for by an attack of scarlet fever which commenced on the sixteenth day after ad-
mission.
Remarks by Mr. BEALE.-This case exhibits the following interesting points : (1) Violent traumatic delirium, caused by the large extent of skin lacerated and the great amount of comminution of bone and injury to nerves ; (2) the exceedinglyhigh temperature accompanying the delirium and lasting for thirty hours, these two factors bringing about the gangrene of the anterior flap; (3) the sloughing of the flap began and continued quite aseptically ; (4) the value of skin grafting by Thiersch’s method as applied to a stump. Had this not been resorted to, a second amputation through, or above, the knee-joint would have been necessary. I would lay great stress upon the complete removal of all granulation tissue by the knife or razor before applying the grafts, as by this means only can the subsequent, and otherwise inevitable, contraction be obviated.
LINCOLN
COUNTY
care
HOSPITAL.
of Dr. E. MAXSEL
SYMPSON.)
will prove of interest to many of our readers, although the symptoms and their mode of development are not fully given. In the first case a primary carcinomatous growth was found in the brain, and there does not appear to have been any secondary tumour in other parts of the body. ’It cannot have existed for the whole period of the illness. Dr. Seguin, in writing of cerebral tumours, published a collected list of 580 in which the nature of the disease was proved ; only twenty-four of these were carcinomatous, therefore these are rare as compared with tuberculous tumours, which numbered as many as 137. CASE 1.-A female aged sixty-six. For four years she had been suffering from increasing paresis of both legs, attended with great increase in the tendon reflexes. She had for about the same length of time been absolutely deaf in the right ear. She was partially deaf on the left side also. She had double optic neuritis, going on to optic atrophy. She suffered severely from headaches, nausea and actual vomiting, and she was often attacked with dizziness. She eventually sank into a comatose condition for some days before death. On post-mortem examination there was found to be a large tumour occupying the surface of the upper and posterior portion of the temporo-sphenoidal convolutions, from the fissure of Sylvius to the sulcus between the second and third convolutions. It was of carcinomatous nature and apparently sprang from the dura mater of the temporal bone. CASE 2.-A young man aged eighteen was first admitted under the care of the late Mr. Sympson into the Lincoln County Hospital on Nov. 2nd, 1891, and died on June 21st, 1892. History : He was in the hospital for pleurisy eight months ago,land had pain and swelling in the right hip for three months and pain in the right knee. On admission there was fulness over the right hip-joint and great pain on attempted movement ; the thigh was kept rigid and there was tenderness over the anterior part. He started at night. His leg and thigh were put up in an extension apparatus. The note on March 2nd is as follows : "Tubular breathing over the upper part of the front of the left lung and dulness at the left base behind ; caries of the fifth right rib ; abscesses over the front of the right femur, left elbow-joint and over the third right rib." On May 10th there were complete left facial palsy, diplopia on looking to the left, paralysis of the left THESE
1
the
cases
exemplifies the belief expressed by Dr. Barrs of Leeds as to frequency with which phthisis follows an apparently simple pleurisy.
This
I have
seen
several instances.
Medical Societies. MEDICAL SOCIETY OF LONDON.
TWO CASES OF TUMOUR OF THE BRAIN.
(Under the
external rectus and double optic neuritis ; the urine contained one-fourth albumen. He suffered from frequent headaches. There was anæsthesia of the cornea and of the left side of the face ; the condition of the palate was not tested. On June 19th he was unable to retain any food on the stomach whatever. He died on June 21st from exhaustion. At the post-mortem examination one feature of interest was a dried up empyema which had been detected, watched and heard to disappear during life. In the brain was a tumour about the size of a filbert, in the left side of the pons Varolii, pressing on the floor of the fourth ventricle, especially on the roots of the third, fourth, fifth, sixth and seventh nerves. On being cut into it was commencing to caseate in the centre. Remarks.-The curiously exact limitation of the tumour and the results produced by its pressure seemed worth recording. It is not often that nature permits her cerebral experiments to be so definite. For the sake of compression For no details have been given of the surgical treatment. the notes I have to thank our late house surgeon, Mr. Harper, as well as our present one, Mr. D. G. Watkins, who performed the post-mortem examination in a most careful manner.
Symptoms of bet7veen
Mental Dissolution.-Constitutional Differences and Girls and their relation to Educational
Boys
Requirements. AN ordinary meeting of this Society was held on March 20th, the President, Dr. Bristowe, in the chair. Dr. G. H. SAVAGE read a paper on the Symptoms of Mental Dissolution. He took as the basis of his paper chiefly his experience of seventeen years at Bethlem Hospital, taking out tables of all patients over sixty; these tables were only useful as general indicators of the way in which senile dissolution showed itself. Herbert Spencer had shown the uses of the study of mental dissolution as well as of mental evolution. Natural decay followed certain lines, but these differed in individuals. Premature decay occurred in certain diseases, such as general paralysis of the insane. It also followed certain toxic conditions, such as those due to alcohol. No single symptom was pathognomonic of dissolution, though loss of memory was the most common. In all stages of dissolution there was loss of mental power, which might be shown in different ways and in different degrees ; there might be loss of power or loss of control. Dissolution was shown early by reduced power of acquisition, next by reduction of power of retention of recent impressions, next by defect of coördination ; later by loss of control and of judgment. Dissolution was, on the whole, the reverse of evolution, but did not follow quite the same lines. He began by an outline study of dissolution as seen in general paralysis of the insane; next with disorders of control of a general kind such as hysteria, epilepsy, mania, melancholia and dementia. In fact, taking the groups of symptoms before the individual ones, he specially noted the danger of impulse in the maniacal and of suicide in the melancholic states. As to special or individual symptoms, sudden loss of memory of recent events, varying much in kind and degree, was most important ; loss of emotional control was next in frequency and was even more important as leading to sexual faults. There was a tendency to collect objects of all kinds, which might depend on several causes. There was frequently a disregard of cleanliness which was hard to understand. Judgment might remain for a long time after the memory was weakened and the control defective.-The PRESIDENT related two cases which illustrated a point brought out in the paper. One was that of a wellknown man, who, in the full zenith of his intellect, while stopping in a provincial town, had a standing invitation to luncheon at the house of a friend. One day he went in and lunched, and an hour later returned and asked for lunch again, being apparently unaware that he had already In another case a gentleman, who had had a meal. in the morning made all the arrangements for a conver’sazione and supper party in his house for the same evening, came home and went to bed, having forgotten all about it.. Dr. PASTEUR referred to cases of men who, between fifty and sixty years of age, suddenly developed epileptic convulsions
mission.
Remarks by Mr. BEALE.-This case exhibits the following interesting points : (1) Violent traumatic delirium, caused by the large extent of skin lacerated and the great amount of comminution of bone and injury to nerves ; (2) the exceedinglyhigh temperature accompanying the delirium and lasting for thirty hours, these two factors bringing about the gangrene of the anterior flap; (3) the sloughing of the flap began and continued quite aseptically ; (4) the value of skin grafting by Thiersch’s method as applied to a stump. Had this not been resorted to, a second amputation through, or above, the knee-joint would have been necessary. I would lay great stress upon the complete removal of all granulation tissue by the knife or razor before applying the grafts, as by this means only can the subsequent, and otherwise inevitable, contraction be obviated.
LINCOLN
COUNTY
care
HOSPITAL.
of Dr. E. MAXSEL
SYMPSON.)
will prove of interest to many of our readers, although the symptoms and their mode of development are not fully given. In the first case a primary carcinomatous growth was found in the brain, and there does not appear to have been any secondary tumour in other parts of the body. ’It cannot have existed for the whole period of the illness. Dr. Seguin, in writing of cerebral tumours, published a collected list of 580 in which the nature of the disease was proved ; only twenty-four of these were carcinomatous, therefore these are rare as compared with tuberculous tumours, which numbered as many as 137. CASE 1.-A female aged sixty-six. For four years she had been suffering from increasing paresis of both legs, attended with great increase in the tendon reflexes. She had for about the same length of time been absolutely deaf in the right ear. She was partially deaf on the left side also. She had double optic neuritis, going on to optic atrophy. She suffered severely from headaches, nausea and actual vomiting, and she was often attacked with dizziness. She eventually sank into a comatose condition for some days before death. On post-mortem examination there was found to be a large tumour occupying the surface of the upper and posterior portion of the temporo-sphenoidal convolutions, from the fissure of Sylvius to the sulcus between the second and third convolutions. It was of carcinomatous nature and apparently sprang from the dura mater of the temporal bone. CASE 2.-A young man aged eighteen was first admitted under the care of the late Mr. Sympson into the Lincoln County Hospital on Nov. 2nd, 1891, and died on June 21st, 1892. History : He was in the hospital for pleurisy eight months ago,land had pain and swelling in the right hip for three months and pain in the right knee. On admission there was fulness over the right hip-joint and great pain on attempted movement ; the thigh was kept rigid and there was tenderness over the anterior part. He started at night. His leg and thigh were put up in an extension apparatus. The note on March 2nd is as follows : "Tubular breathing over the upper part of the front of the left lung and dulness at the left base behind ; caries of the fifth right rib ; abscesses over the front of the right femur, left elbow-joint and over the third right rib." On May 10th there were complete left facial palsy, diplopia on looking to the left, paralysis of the left THESE
1
the
cases
exemplifies the belief expressed by Dr. Barrs of Leeds as to frequency with which phthisis follows an apparently simple pleurisy.
This
I have
seen
several instances.
Medical Societies. MEDICAL SOCIETY OF LONDON.
TWO CASES OF TUMOUR OF THE BRAIN.
(Under the
external rectus and double optic neuritis ; the urine contained one-fourth albumen. He suffered from frequent headaches. There was anæsthesia of the cornea and of the left side of the face ; the condition of the palate was not tested. On June 19th he was unable to retain any food on the stomach whatever. He died on June 21st from exhaustion. At the post-mortem examination one feature of interest was a dried up empyema which had been detected, watched and heard to disappear during life. In the brain was a tumour about the size of a filbert, in the left side of the pons Varolii, pressing on the floor of the fourth ventricle, especially on the roots of the third, fourth, fifth, sixth and seventh nerves. On being cut into it was commencing to caseate in the centre. Remarks.-The curiously exact limitation of the tumour and the results produced by its pressure seemed worth recording. It is not often that nature permits her cerebral experiments to be so definite. For the sake of compression For no details have been given of the surgical treatment. the notes I have to thank our late house surgeon, Mr. Harper, as well as our present one, Mr. D. G. Watkins, who performed the post-mortem examination in a most careful manner.
Symptoms of bet7veen
Mental Dissolution.-Constitutional Differences and Girls and their relation to Educational
Boys
Requirements. AN ordinary meeting of this Society was held on March 20th, the President, Dr. Bristowe, in the chair. Dr. G. H. SAVAGE read a paper on the Symptoms of Mental Dissolution. He took as the basis of his paper chiefly his experience of seventeen years at Bethlem Hospital, taking out tables of all patients over sixty; these tables were only useful as general indicators of the way in which senile dissolution showed itself. Herbert Spencer had shown the uses of the study of mental dissolution as well as of mental evolution. Natural decay followed certain lines, but these differed in individuals. Premature decay occurred in certain diseases, such as general paralysis of the insane. It also followed certain toxic conditions, such as those due to alcohol. No single symptom was pathognomonic of dissolution, though loss of memory was the most common. In all stages of dissolution there was loss of mental power, which might be shown in different ways and in different degrees ; there might be loss of power or loss of control. Dissolution was shown early by reduced power of acquisition, next by reduction of power of retention of recent impressions, next by defect of coördination ; later by loss of control and of judgment. Dissolution was, on the whole, the reverse of evolution, but did not follow quite the same lines. He began by an outline study of dissolution as seen in general paralysis of the insane; next with disorders of control of a general kind such as hysteria, epilepsy, mania, melancholia and dementia. In fact, taking the groups of symptoms before the individual ones, he specially noted the danger of impulse in the maniacal and of suicide in the melancholic states. As to special or individual symptoms, sudden loss of memory of recent events, varying much in kind and degree, was most important ; loss of emotional control was next in frequency and was even more important as leading to sexual faults. There was a tendency to collect objects of all kinds, which might depend on several causes. There was frequently a disregard of cleanliness which was hard to understand. Judgment might remain for a long time after the memory was weakened and the control defective.-The PRESIDENT related two cases which illustrated a point brought out in the paper. One was that of a wellknown man, who, in the full zenith of his intellect, while stopping in a provincial town, had a standing invitation to luncheon at the house of a friend. One day he went in and lunched, and an hour later returned and asked for lunch again, being apparently unaware that he had already In another case a gentleman, who had had a meal. in the morning made all the arrangements for a conver’sazione and supper party in his house for the same evening, came home and went to bed, having forgotten all about it.. Dr. PASTEUR referred to cases of men who, between fifty and sixty years of age, suddenly developed epileptic convulsions