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TOTAL NECROSIS OF THE INFERIOR MAXILLA.
1791 and became greyish- for their proper physical development and to enable in the lower nasal them fully to avail themselves of the education provided. quadrant, ciliary injection increased, and a fine greyish The needs of underfed school children should not be deposit developed on the lower half of the posterior surface forgotten when Christmas donations are being conof the cornea, indicating extension of inflammation from sidered and we cordially endorse the appeal of Sir Edwin On Ojt. 24th injections of Koch’s Cornwall, the chairman of the London County Council, for the adjacent iris. T.R. and instillation of atropine were begun. The first contributions towards this object in the metropolis over injection, "hth of a milligramme, caused no perceptible whose municipal affairs he presides. The London County change. On the 26th the same do,e was given. On the 31st Council does nothing whatever to provide meals out of the 1;’ö21)ths of a milligramme were injected and 24 hours later rates or at public expense, and, as Sir Edwin Cornwall points the temperature had risen to 100’6°. The ciliary injection out, " unless sufficient voluntary assistance is forthcoming a increased and vessels stood out prominently over the largest very serious condition of things must prevail in those disnodule. In 12 hours this local reaction disappeared. On tricts where underfed children are daily to be found in the Nov. 5th ,fijooths of a milligramme were injected and this was schools." There are three central organisations for collectrepeated in the evening. 24 hours later the ciliary injection ing and distributing funds to meet the needs of underfed was again increased and the large nodule was brick-red and children-namely, the Referee Fund, honorary treasurer, remained so for several hours. After six months’ treatment Mrs. Burgwin, 147, Brixton-road, S.W.; the London Schools’ the nodules and the ciliary injection disappeared and the iris Association, 32, John-street, Bedford-row, W.C.; and its normal colour. the Destitute Children’s Dinner Society, honorary secretary, nearly regained Mr. H. Morton Carr, 52, Lavender-gardens, Lavender-hill, S.W.-and contributions can be sent to one of these TOTAL NECROSIS OF THE INFERIOR MAXILLA. organisations by those of our readers who sympathise with IN the Boston Medical and Surgical Journal of Nov. 16th their common object.
The two nodules steadily opaque and three others
enlarged appeared
Dinner
-
Dr. T. Fillebrown has published a case of a very rare condition-total necrosis of the inferior maxilla. The patient was a robust boy, aged ten years, who showed no indications of inherited syphilis. In November, 1902, the first lower right molar tooth was extracted in order to relieve an abscess but the swelling and pain only increased. Four days after tha extraction he was removed to a private hospital where necrosis was diagnosed but its extent was not determined. He came under Dr. Fillebrown’s care in May, 1903, when there was marked symmetrical swelling of the neck and lower part of the face. As far back as the rami the A part of the inferior maxilla was entirely denuded. mental region and a part of the alveolar process had been destroyed by caries. As the general condition was good and there was no indication of septic absorption it was thought best to wait for more complete separation of the sequestrum. On June 2nd an operation was performed. The skin of the face and neck was tense and oedematous. Within the mouth the entire body of the lower maxilla and a considerable portion of the rami were denuded. Anteriorly the mental portion of the bone had completely separated as far as the foramina on either side. The bone was completely separated on either side by means of periosteum dissectors, no sharp instruments being used. In this manner one-half of the right ramus with the sigmoid notch and coronoid process and neck of the condyle, leaving but a shell of the latter, was separated and removed. A similar operation was performed on the left side. The operation occupied 25 minutes and the beemorrhage was slight. The subsequent treatment consisted in irrigation with antiseptic solutions. On the second day the temperature reached 100° F. and on the fourth day it regained the normal. Recovery ensued. Whether the bone will be reproduced or the jaw will continue to grow remains to be seen. ____
UNDERFED SCHOOL CHILDREN. As Christmas
the appeals to the charitable that much judgment has to be expended in selecting the particular institutions for individual support from among so many which present the most pressing needs. But we can advocate the claims of underfed school children to the charity of all. Whatever may be the opinion as to the wisdom or unwisdom of feeding as well as educating the pupils in our elementary schools, there can be no doubt that there are very many childrenwho do not receive the amount of food necessary
become
approaches
so numerous
ADVERTISING AND CANVASSING BY REGISTERED MEDICAL PRACTITIONERS. WE desire to draw the attention of our readers to an announcement by the General Medical Council which will be found in our advertising columns. From its nature the subject is of immediate personal interest only to those practitioners whose views on matters of professional ethics are lax and who require some guidance in choosing the way that they should go. - These individuals, we are happy to think, form
relatively
a
, ’,
small
minority of
the
profession. They belong
to a class whose main object is purely selfish ; their methods, if allowed free scope, would inevitably have a detrimental effect on the reputation of the profession in general, and the less scrupulous among them would come perilously near the reproach of charlatanism. We are therefore in complete sympathy with the efforts which the General Medical Council is making to diminish this evil; our only regret is that in such cases of what might be called exaggerated commercialism the Council if it resolves to inflict a penalty cannot avoid the incongruity of describing this misdemeanour in the same terms as the most serious offences against society or
the law of the land. THE
DEADLOCK IN THE ROMAN SCHOOL.
MEDICAL
THERE is never smoke without fire, and the turbulence of the students of medicine in the Roman School, proceeding to lengths which their well-wishers will be the last to justify, has its cause in conditions for which the legislature is, it seems, in the last resort, to blame. It is surely a scandal that the press of Italy should have it in its power to bring home to the Ministers of Public Works and Public Instruction such grave dereliction of duty as that described in THE LANCET of Dec. 9th by one of our Italian correspondents and supplemented as well as confirmed by the That the future members of a noble Tribzcna of Rome. in whose hands the health and happiness of the profession community in great measure rest should, even temporarily, be deprived of much of their teaching by the chaotic state in which the chief clinical institution still remains, and that such teaching as is already available in that institution should lose much of its efficiency by the remoteness of the institution itself from the central University, involving a journey, going and coming, fraught with expense, delay, and even discomfort to the student-all this, we say, constitutes a grievance for which the sufferers are to be sympathised
The two nodules steadily opaque and three others
enlarged appeared
Dinner
-
Dr. T. Fillebrown has published a case of a very rare condition-total necrosis of the inferior maxilla. The patient was a robust boy, aged ten years, who showed no indications of inherited syphilis. In November, 1902, the first lower right molar tooth was extracted in order to relieve an abscess but the swelling and pain only increased. Four days after tha extraction he was removed to a private hospital where necrosis was diagnosed but its extent was not determined. He came under Dr. Fillebrown’s care in May, 1903, when there was marked symmetrical swelling of the neck and lower part of the face. As far back as the rami the A part of the inferior maxilla was entirely denuded. mental region and a part of the alveolar process had been destroyed by caries. As the general condition was good and there was no indication of septic absorption it was thought best to wait for more complete separation of the sequestrum. On June 2nd an operation was performed. The skin of the face and neck was tense and oedematous. Within the mouth the entire body of the lower maxilla and a considerable portion of the rami were denuded. Anteriorly the mental portion of the bone had completely separated as far as the foramina on either side. The bone was completely separated on either side by means of periosteum dissectors, no sharp instruments being used. In this manner one-half of the right ramus with the sigmoid notch and coronoid process and neck of the condyle, leaving but a shell of the latter, was separated and removed. A similar operation was performed on the left side. The operation occupied 25 minutes and the beemorrhage was slight. The subsequent treatment consisted in irrigation with antiseptic solutions. On the second day the temperature reached 100° F. and on the fourth day it regained the normal. Recovery ensued. Whether the bone will be reproduced or the jaw will continue to grow remains to be seen. ____
UNDERFED SCHOOL CHILDREN. As Christmas
the appeals to the charitable that much judgment has to be expended in selecting the particular institutions for individual support from among so many which present the most pressing needs. But we can advocate the claims of underfed school children to the charity of all. Whatever may be the opinion as to the wisdom or unwisdom of feeding as well as educating the pupils in our elementary schools, there can be no doubt that there are very many childrenwho do not receive the amount of food necessary
become
approaches
so numerous
ADVERTISING AND CANVASSING BY REGISTERED MEDICAL PRACTITIONERS. WE desire to draw the attention of our readers to an announcement by the General Medical Council which will be found in our advertising columns. From its nature the subject is of immediate personal interest only to those practitioners whose views on matters of professional ethics are lax and who require some guidance in choosing the way that they should go. - These individuals, we are happy to think, form
relatively
a
, ’,
small
minority of
the
profession. They belong
to a class whose main object is purely selfish ; their methods, if allowed free scope, would inevitably have a detrimental effect on the reputation of the profession in general, and the less scrupulous among them would come perilously near the reproach of charlatanism. We are therefore in complete sympathy with the efforts which the General Medical Council is making to diminish this evil; our only regret is that in such cases of what might be called exaggerated commercialism the Council if it resolves to inflict a penalty cannot avoid the incongruity of describing this misdemeanour in the same terms as the most serious offences against society or
the law of the land. THE
DEADLOCK IN THE ROMAN SCHOOL.
MEDICAL
THERE is never smoke without fire, and the turbulence of the students of medicine in the Roman School, proceeding to lengths which their well-wishers will be the last to justify, has its cause in conditions for which the legislature is, it seems, in the last resort, to blame. It is surely a scandal that the press of Italy should have it in its power to bring home to the Ministers of Public Works and Public Instruction such grave dereliction of duty as that described in THE LANCET of Dec. 9th by one of our Italian correspondents and supplemented as well as confirmed by the That the future members of a noble Tribzcna of Rome. in whose hands the health and happiness of the profession community in great measure rest should, even temporarily, be deprived of much of their teaching by the chaotic state in which the chief clinical institution still remains, and that such teaching as is already available in that institution should lose much of its efficiency by the remoteness of the institution itself from the central University, involving a journey, going and coming, fraught with expense, delay, and even discomfort to the student-all this, we say, constitutes a grievance for which the sufferers are to be sympathised