Reports of Societies
BMJ (Clinical Research Edition)
tlle gyrus ulnleiniattus, when it is the seat of an irritative lesioni, cither primary or elncroacllng from adjoininhg parts. Tlle association of the two types of fit miiay he m-net witlh in the sam-le case. Thus, a warninig sensationi of flavour or of smiiell or taste miiay be followed by geiieral conivul--ions. In on-e case general epileptic fits occurring onily duiring sleep wvere stucceeded by otlhers during the day of a warninD sensation of a disagreeable taste COmlling Up froIIm the
... Up froIIm the stollach inlto tlle moutll. Jus;t as the "Broca" fit, already miienltioniedl, lhas features locating the lesion in the left inferior frontal gyrtms and ad-jacent tisstues, so the " uncinote " fit is distinguishied by outstanding cliaracters wlich it is perihaps uinnecessary to recall inl detail lhere, and locating thle lesion on the mesial aspect of thlc temoporo-splhenoidal lobe. It may be nmentiolned, lhowever, that thlc symiptomatology of the fit refers especially to thie digestive system. WValnlinlg senUsa1tions of sImell and flavouir-in somiie cases of a pleasant, in others of a disagreeable kiind-mnay be followed by a "idreamy state, in wlicil simiacking movemuents of the lips, chewing nmovemniiits, anld somlletimnes spittinlg acts, liave been observed. In thle later stages thlese attacks lymay be accomi)panied by paraestihesias of one side of the body or by convulsive movements of the limbs on the side opposite to the lesion. Tlle attacks of mlinor epilepsy described in tumours of the temuporo-splienoidal lobe, in addition to those already mentioned, are " dreamy " sensations, temporary lapses of inellmo-y, anid momentary blurrings of consciousness, in whlichi the face chianged colour and objects might be cdropped from tile hands. Smunrnary.-In the foregoing remarks I liave attempted to slhow briefly tlat tumours involving thle cortex and subcortical whlite matter of a cerebral henmisphere may give rise to seizures liavinig features characteristic of idiopathlic epilepsy. These attacks may precede the onset of the symptoms and signs of intracranial tunmour by many years anld reiider the diagnosis of the true cause of the attacks well--nigh impossible. The existence of certain signs, lhowever, favours the presence of an organic lesion; such are a well-defined local warning, the presence of some degree of post-convulsive henmiplegia, inequality of thle dlel) reflexes oni thle two sides. unilateral abolition or iillpairment of thle abdominal reflexes, and, above a11, the development of an extensor plantar response. Evenitually mnore decided evidence of a destroying lesion is slhown in hemiplegia, he.mianaestlhesia, lhemianopsia or aphiasia, according to the locality of the tumouIr. Wlhen along wvitl such -well-miarked signs, optic neuritis and the othier general symptoms of intracraniial nlew growth are present, thlere is ino longer any doubt that the seizures are symptomatic of a cerebral tumour. It is therefore uinoi]0tanit in all cases of epilepsy to examine the reflexes and the optic -discs from time to time, especially if a decided chialige occurs in the chiaracter of the fits or a new symiptomi develops. 4tem1nlranba: MEDICAL, SURGICAL, OBSTETRICAL. THE TREATMENT OF ENTERIC FEVER. AN expcrience dturing the Soutlh African war which mlucl impressed inc at the time is recalled to my mind by Major Broadbent's adxvocacy of the use of an icebag suspended near to tlle patient's abdomen. In JuLne, 1901, whlen on the high veldt, I lhad among imly patients about twenty suffering from-l enteric fever. Our camup lhad been surrounicded and attaclied tlle whole day, so that when niglht fell there was no opportuinity for repitclhing telnts, and one had to leave the men, wellwrapped in blanikets, out in the open. The niglht was intensely cold, and it was witlh forebodings of findlitg several dead that I wevnt to see tllem in the Illorning. None were dead; and to mliy astonislhw? ,nt the nmost severe cases shlowved a wvonderful impro\noent, and the wlhole picture was in striking contrast witlh that presented by tlle samue me who lhad previously been treated in army tents. Delirium and restlessness were quieted, temperatures were lower, fongues and mbuiotlh were claner acnd moister. I could| only attribute the good effects to the aintipyretic actioln of tlle cold air respiredI by the lungs. My cases being quiclily removed to a base hospital, I had no opportunity of fturtlher adopting tllis treatmtient. Hydrotlherapy hias claim-ed good results; is it niot possible that tlle persistent inhalation of cold air inigh.t provo more efficicnt alnd safer? I venture to suggest tljat tlhe improvement wbicll Major Broadbent lhas observed is dnue iore to tble coolinig effect of tlle ice upon tllc air than to the local effect upon tlle exposed portion of abdomileni. Since that wAar I lhave had little experience in tlhe treatmnenlt of eniteric fever, and I do not kniow whethfer cold dry air has been tried in the treatmenit of thlis particular disease, or for diseases sucll as malaria, spirLe, etc., which tenid to persist in lhot countries, and are generally qJuickly benefite(d by clhange to a cooler one,--I amii, etc., Lon(doni, E.C4. , all of Belfast, were elected mlembers. Dr. CALWELL slowed (1) a case of Tertiary sylphilitic afection of face, withi a slighit resenblalace to a disseminated lupus; owing to th3 shortage of nuo-salvarsan, the patient was put on large doses of iodide alnd inltramuscular injections of mercury, the result being rapid healing; tllere had been a positive Wassermanni reaction. (2) A case of Prutritus in a nci urast7ec nic. (3) Early Litpus erythen?zatosuts treatecdt witlh CO2 s1nO. (4) Psoriasis in the face in a girl. (5) Actute generaliz-,ed pritrigo in a young child. (6) Photographs of two cases of Pernicious anaenzia, wlhich showed nmarked increased anid decreased skin pigmentation in patches (muclanodermiia anld leucoderma) instead of tllh custonmary lemon tint; of a case of Fri7hling's syndromne (dystrophia, adiposo-genitalis) in a young woman; anid of a case u! sevreie 3olluscutm contaqiosumn. Dr. MCK1SACK slhowed a case of Aeromegaly ill the early stage; improvenment lh,-id takeni place under tlhyroid gland administration. Mr. A. B. MIITCHELL slhowed: (1) A case of Solid oede,)ta of the eyelids, and explained tlle treatment hie lhad successfully adopted in previous cases of artificial lymplhatic channels by mieans of sterilized thread; (2) a specimen of a Gall blatlder filledl w-ith stones wlhicll he lhad suIccessfully excised; (3) a patient with Ski* grafting of 'upIper eyelid. Mr. T. S. KIlRK sent a specimen of Ulcerative colitis treate(l by excisiont. Mr. FULLERTON showed a case of Clutb-foot treated by tarsectomy, and oxplained tle rationzale anid miiethod of the operation. Dr. THO'MAS HOUSTO?showed a numiber of cases of Acne treatecd by vaccinies. He emiplhasized the lecessity of finiding the microbes whicll caused the disease; lhe did not believe in compound vaccines, as one could niot increase eitlher independently; one might desire to increase the acne bacillus, btut tlle staphylococcus would be increased far beyond the proper dose -in doing so. Long periods of treatment were somietimes necessary. He tlhought it better to begin witlh small dloses of one nmicrobe, and increase gradually. Dr. J. C. RANKIN showed a series of cases of Liuptus vulgaris and of Rodent ulccr, slhowing Lenthlal Cheatle's distributiona, and remarked on tlle frequency of lupus of the mucous membrane of the nostril causinig stenosis of the tear duct, for which the patient not infrequently wenit to tile ophthalmic lhospital. Dr. T. KILLEN (Lamne) showedl (1) A specimen of Calcified hydrocele of the tunicia vagila-lis testis; (2) A meningocele, whliclh lhe had successfully removed from a child aged three weeks; the child was still alive a year and nine montlhs later, but was slhowing signs of idiocy. THE late Dr. Williala Thomas Fernie, of Richmon(d, Suirrely, author of several books on cooking and herbal reiie(lies, left cstate valued 'at £14,983.