NOTE ON THE TREATMENT OF INSANITY.

659

they found the test inferior to nitric acid. And justly so; no doubt that the Government will be quite reasonable in but if it had simply occurred to them to use it as they did reconsidering this proposal. As to our correspondent’s the latter-that i, after Heller’s method, without allowing second point, the insufficiency of the penal clauses, we are admixture of the two fluids, they could never have come to advised by those capable of forming an opinion that the this conclusion. But simple things require to be discovered, clauses of the Medical Bill are the best that have ever and it is a remarkable fact that this method is even of more penal value with picric acid than it is with nitric acid. Indeed, been suggested. 2. The proposal to "put down quackery looks obvious and easy. From the statesman’s point of apart from this the former is valueless. Dr. Johnson must have been quite ignorant of the exis- view it is simply impossible. What he ought to do is to tence of my paper, and it is to be presumed his son was make all false titles and representations punishable. This besides the coincidence in our manner of equally so. Yet, is done in the Bill more effectually than under the existing using the test, there is another circumstance which appears tome somewhat singular. He states that he has used the laws. Let our correspondent ask himself what is possible test for about two years,l just about the time which has in Parliament, ani he will not bs dissatisfied with this porelapsed since my paper appeared. He further informs us tion of the Bill. But the penal clauses must not be relaxed. of it came from his after some exthat the "

suggestion periments performed

son,

and published by the latter in 1874. suppose that the suggestion was made at the same time, and if so it does seem singular that Dr. Johnson did not act upon it till seven years afrerwards, and that the time of his doing so should so closely coincide with the publication of my paper on the subject. It seems, from some jubilant remarks in the British Medical Joacrn.ccl of March 17th, in its summary of the events of the week, that this method of using picric acid solution, which I cannot but regard as mine, is now to be recognised as Dr. Johnson’s test. Be it so, my principal objectin the paper alluded to was to call attention to some facts and views which I considered of greater importance to chemists and the profession than the merits of the disputed test. I have still to complainn that these have attracted as little attention as my remarks on the picric acid test have apparently done. How far this is due to want of any intrinsic merit, or bow far to the fact that it was written by an obscure practitioner like myself, instead of emanating from some high authority in London, is not for me to decide.- I am, Sir, yours truly, ROBERT KIRK, M.D. Partick, Glasgow, March 26th, 1883.

Wemust

It is but

ju-)t, when making severe laws for regulating the acquisition of medical titles, to give these titles additional security and sanctity. As tothe third point, the College of Surgeons might do worse than take much of our correspondent’s advice to heart. We should scarcely like to see the College revert to the complete ignoring of medicine and mid wifery ; but the suggestion to make the Membership of the College a distinction in surgery, instead of a mere licence, is one evidently not held by ourselves alone. Our correspondent, we may add, is a Member of the College.-ED. L. "FIBRINOUS COACULA IN THE HEART AND PULMONARY ARTERY"

To the Editor of THE LANCE T. SIR,-Press of professional work having delayed my reading of the last two or three numbers of THE LANCET, I was much interested to-day, when looking for the first time at the copy for January 6t,h, to see Sir Joseph Fayrer’s article on the above subject. I was particularly struck by it, because THE NEW MEDICAL BILL. a few days ago (in fact since the appearance of the article), it To the Editor of THE LANCET. was my lot to observe an instance of sudden death resulting SIR,-I think the views expressed by you will meet with from this condition. A female infant, aged eight months, had general acceptance by most of the profession. With your been under my care, in a neighbouring village, suffering from permission, though, I would like very briefly to direct atten- debility and a large ulcer on the arm, said to have been the result of vaccination. The ulcer had contracted very much, tion to a few points. 1. It is proposed to give leave to the new Medical Council and was healing satisfactorily, when, on Monday, January to exact an annual fee for retaining our names on the 8th, I was hurriedly called to see the child, who, I was was dying. On reaching the house I found my patient Register. Now, whatever the advantages of such a plan in told, for breath. There was ’no pulae persecuring a perfect Register, it is unjust to those already livid andatgaspmg the wrist, and on auscultation with a binaural ceptible We have five as a life paid registered. guineas registration fee. To demand an additional annual payment now would stethoscope no action of the heart was audible. Some coarse be a fraud. Our five guineas would, in fact, have been râles were to be heard in the trachea and large bronchi. The obtained from us under false pretences. Moreover, the pro- child died two or three minutes after my arrival, continuing to the moment of her death to make inspiratory efforts. posed levy might pave the way for an annual tax, as in up From the symptoms, I imagined that a thrombus must have some other countries. 2. The penalties for illegal practice are insufficient. formed in the right side of the heart, and have become imin the orifice of the pulmonary artery; but, at the Quackery should be put down. Our own corporations have pacted been deficient in this, but now we are to have a new Bill, same time, in view of the existing uncertainty of the correctness of my surmise, and the sudden and unexpected we should put strong pressure on the Government to induce them to insert more stringent clauses prohibiting practice character of the death, I suggested to the parents the advisability of an autopsy, to clear up the matter. At the by unqualified persons, and prescribing by chemists. 3. If the College of Surgeons, instead of standing in the examination, which was not made till forty-eight hours after death, I found a very firm decolourised clot, filling the right way, were to abandon the position of a licensing body, but ventricle and closely entangled in the musculi papillares, raise the standard of its M. R. C. S. examination somewhat The in surgery, whilst ceasing to examine in medicine and mid- but not extending far into the pulmonary artery. and the left ventricle contained bloodless, appeared lungs it the of and increase its prestige membership wifery, might have an honourable career before it. The M. R. C. S. could only a small and very soft red clot. With the exception of then be registrable, as a higher diploma in surgery, and its the liver, which was much enlarged and had a slight nutmeg : further was noticed at all abnormal. possessor would then be, not merely as now, one just appearance, nothing I , am, Sir, yours faithfully, licensed to practise, but one who, having passed the State ALBERT E. MAY, L R.C.P. Lond. examination, had gone a step further, and taken an addiMoreton Hampstead, Jan. 20th, 1883. tional qualification in surgery. The College would gain by the change, as many would take it as a half-way step to the Fellowship. The new M.R.C.S. would, in fact, more NOTE ON THE TREATMENT OF INSANITY. nearly resemble the M.R.C.P., and the two Colleges occupy To the Editor of THE LANCET. similar positions.-I am, Sir, yours truly, ONE OF THE CROWD. second portion of his interesting communicaApril 7th, 1883. the SIR,-In on treatment of insanity, Dr. Campbell alludes to We tion the with our in the %* agree correspondent disapproving annual fee for registration, especially in the case of those the use of tonics. His remarks recall to my recollection a who have already paid a, large fee for registration. Wehave somewhat striking case which fell under my observation about three years ago, the main facts in connexion with 1 In his first paper (THE LANCET, Nov. 4th, 1883), he states that he which I shall state as briefly as possibly. The patient in had used the solution only for some months.

I

660 came to my house on a very unsettled and was afraid he was

the night of Sunday, Dec. 7th, CRANIUM HOLDER. excited state of mind, saying that he To the Editor of THE LANCET. going mad, as he had been with a strong and almost overmastering desire to commit SIR,-In last Stturday’s LANCET, under the head of in a fit of suicidal suicide. Some years previously his New Inventions," an engraving appears of a cranium mania, had killed herself by leaping from a window ; and while sitting with his wife and children the recollection of holder, or " skull grip," which I consider bears a very her fate came suddenly upon my patient, and in a state strong resemblance to an instrument I suggested many of great mental agitation he rushed out of the house. He years ago for the same purpose, a short description of which appeared to be a man of fair intelligence, and was a rigid appeared some time since in the pages of the Medical Press abstainer. I found on questioning him that he had been aocL Circular (April 2ad, 1879). And, more recently, the annoyed while at work by his fellow workmen, and that he same instrument is depicted in Reeves’ new work, "Human in the sins was habit of exciting himself greatly over their I append a figure of the cranium holder Morphology." against temperance. He had also concerned himself about matters that were far beyond his mental range, and, in a word, he had worried his brain into such a state as to place it at the mercy of every dangerous impulse that memory or imagination might suggest. I prescribed twenty grains of chloral. The next day I found him in bed, still very unsettled, and, if anything, less coherent in his conversation. He appeared to be very feeble, and his wife informed me that he had fallen when he attempted to get out of bed in the morning. I did not continue the chloral, but prescribed arsenic and iron. Upon this he rapidly recovered his strength, and, although his mind continued, in a sense, weak and inactive for some days after, his general health had been restored; it also gradually recovered tone and strength, and when I last saw him, about two years after his attack, he seemed to be quite sane.

question 1879, in

seized

shter,

Glasgow, April,

1883.

I am, Sir, yours obediently, ROBERT MACPHERSON, M. B.

A CASE FOR GENERAL SYMPATHY. To the Editor of THE LANCET. I SIR,-May venture to direct the attention of the medical profession to the sad case of Dr. Hurford, the circumstances of which are set forth at length in the annexed statement : Cedric Herbert Hurford, M.D., B.A., Trinity College, Dublin, aged thirty-four, filled the office of House-Surgeou for five years at Dr. Stilwell’s Asylum, Hillingdon, and in 1880 he obtained an appointment in the British Guiana Medical Service and, having married, proceeded to Demerara. At the expiration of two years and a half, through the ill-enacts of the climate, he became mentally deranged, was compelled to resign his appointment, and, with his wife, to return to England. After three mon’hs’ detention at subBethlem Hospital he apparently recovered and was discharged. sequently, with the assistance of friends, he furnished a house and purchased a small practice; but soon again his mind gave way, and it became necessary to place him a second time in Bethlem Hospital and to break up the recently acquired home. The opinion of the medical men at the institution is that he will never be fit for his work again. He and his wife are entirely without means, and there are two children, one aged two years, and a baby nine months. Dr. Hurford’s father has but a small Government pension, three of his sisters earn their livelihood as governesses, while his wife has only a mother with very limited means. It is proposed to raise a fund which will, it is hoped, suffice to provide a home for the family upon whom this crushing blow has fallen.

Dr. Hurford’s case has been brought before Earl Derby, who has consented to refer it to the Governor and Council of British Guiana, with the view of ascertaining if a special grant can be made. The Colonial Otficp, however, point out that the prospects of a grant of even ;E20 being made are not good, because these appointments are conferred upon medical men on the understanding that they have no claim for pension, and in Dr. Hurford’s case much expense has already been incurred by the colonial authorities. My excuse, if excuse be needed, for directing the attention of the medical profession to Dr. Hurford’s case is its peculiar and exceptional sadness. A capable, earnest, and robust worker is suddenly cut off in the midst of his career by an attack of what is probably general paralysis of the insane, which renders him unfit for duty though in the prime of life, and which makes it impossible that he shall ever again contribute to the support of his family. Thus by an act of Providence which Dr. Hurford was powerless to anticipate or provide against, a whole family is left in distressing circumstances, and unless those who have and to spare will come forward and lend a hand the result must be sad indeed. I will only add that the Medical Benevolent Fund has given a donation of ;E20; other friends about £ 150, in sums of half a guinea and upwards, and that I shall be glad to

receive and acknowledge any contribution, however small, towards the fund which is now being raised for Mrs. Hurford and the children. I am, Sir, your obedient servant HENRY C. BURDETT. 39, Gloucester-road, Regent’s-park, N.W., April 11th, 1883.

suggested by me, and your readers will, no doubt, perceive the great similarity to the figure inserted last week as a " new invention" by Messrs. Mayer and Meltzer, of Grea.4 Portland-street, London, W. I am, Sir, yours, &c.,

LAMBERT H. ORMSBY, M.D., F.R.C.S., 3. Dublin, April 9th, 1883. Surgeon to the Meath Hospital.

BILHARZIA HÆMATOBIA. To the Editor of THE LANCET. SIR,-In THE LANCET published Nov. 18th, 1882, received by me last mail, is a report of the Transactions of the Royal Medical and Chirurgical Society, in which there are some remarks upon epidemic hæmaturia in South-eastern Africa due to the Bilharzia haematobia, speculations as to how the parasite’enters the body, and opinions as to its treatment. This subject has become of considerable importance since the occupation of Egypt by our troops. Until then it was a condition of such rarity that few physicians in England had seen a case ; in this part of the world it has always been a matter of great magnitude to the European settlers. Among the different gentlemen who gave information as to its habitat, nature, and treatment was Dr. Cobbold, than whom no one has devoted more time and consideration to the subject of human parasites, and has thus deservedly become an authority upon the subject. In pursuit of his specialty, he some time ago wrote to me asking for any particulars I could give about the Bilharzia hoematobia. He had been, he gaid, consulted by a gentleman who had lately returned from South Africa, suffering from haematuna. He had been an inmate of Grey’s Hospital in Pietermaritzburg for some time before he left the colony, and while there he bad heard that I had successfully treated persons similarly affected. I wrote to Dr. Cobbold giving some of the history common to persons suffering from this parasite. This letter was published in THE LANCET, July 15th, 1882. Anyone who takes the trouble to read it will find I have positively stated that the results of the treatment I had adopted were in every case successful. My surprise was therefore great on reading the Proceedings of the Royal Medical and Chirur. gical Society to find that Dr. Cobbold made the following statement :-" He described the three modes of dealing with the disease as the heroic,’ the do nothing,’ and the rational plans of treatment. Of the first, Dr. Allen had lately given an example advocating injection into the bladder of saturated alcoholic solution of santonin. This produced severe cystitis. And the fact quoted in sUi’ port of its eilieacy, that the patients did not return, was capable of an opposite inference from that given by I have to correct this assertion of Dr. Dr. Allen." Cobbold’s. I was convinced of the efficacy of the treat.