Recent Literature Medical and Surgical Reports of the Boston City Hospital . Third series
Boston Medical and Surgical Journal
in general paralysis, suggests the importance of great care in feeding all patients who may be in a semiconscious condition." In the appendix we find the post-mortem appearance in six cases of general paralysis described. Want of space prevents giving an account of the remaining eight cases. In five of the six cases of general paralysis marked interstitial changes in the first layer of the cortex were found. Iu the sixth case, which was the only female case, no such changes were observed.
... r were these changes found in the eight cases not here recorded. In four of the six cases epeudymitis of the ventricles existed. In the remaining eight cases it was found only in a case of epilepsy. Atrophy of the brain existed in five of the six cases. In the remaining eight cases in five. Chronic internal pachymeningitis was found in two of the six cases, aud in oue case only of the eight. Chronic leptomeningitis existed in three of the six cases, and in two of the remaining eight. No attempt is made to draw any conelusions from these few cases. liable expressions of the best pathological opinion on this subject that is anywhere to be fouud. It possesses, in fact, so nearly the requirements of a practical manual that it would repay enlargement and amplification from that point of view. It would also have been especially interesting to learn the author's experience concerning the pseudo-pathological changes produced iu the cord by post-mortem processes and under the various methods of hardening, since these are rocks not always laid down in the charts of even pretty experienced discoverers, and a cause of very frequent mishaps to tyros. We miss also some statement as to how far the pathological changes described are compatible with apparent health. The toue of confidence and authority which pervades the paper gives proof of long and conscientious labor on the writer's part. The pathological division of the different forms of myelitis into acute and chronic, parenchymatous and interstitial, is no doubt the best that pure histology can now furnish, but it sounds a little barren when we think of the varied aetiology of diseases of the spinal cord, such as exposure, fright, over-exertion, the many poisons, the obstruction, of lymph or blood-vessels. We are certainly destined to learn something more from topographical anatomy guided by embryology and physiology. The latest advance in this direction is that made by Dr. Ross, of Manchester, England, in pointing out the probable difference in pathological 1 Vide JouiiNAL for July 18th and 25th. relationship between the tissues of earlier and those of later development or differentiation. If these opinions are verified, a new incentive will be given to the study of the histology of special localities. The value of Dr. Webber's paper is increased by a number of good plates, made from preparations of his own. J. J. P. OPTICO-CILIARY NEUROTOMY. FIFTEEN CASES BY OLIVER F. WADSWORTII, M. D. The question whether optico-ciliary neurotomy shall be established as an ordinary substitute for enucleation, or whether it shall be placed iu the category of unusual and extraordinary operations, is a pressing one among ophthalmologists of the present day. Dr. Wadsworth's paper in the City Hospital Reports coutain s an account of fifteen cases of this operation, and a candid review of them as far as their bearing upon the question of the substitution of neurotomy for enucleation is concerned. The clinical deductions contained in the review are of great practical value, and impress one as the Work of a cultured and honest observer. The anatomical facts, stated as bearing upon the question of the danger of reunion of ciliary nerves, are given iu a manner that contrasts quite strongly with the painstaking thoroughness with which the clinical questions involved are handled. After noticing Friedrich Arnold's description of the ciliary nerves, it is stated that " later writers on the anatomy of the ciliary nerves in man, however, so far as I am aware, with a single exception, describe these nerves as all entering the sciera around the optic nerve, and not very far distant from it." Redard is mentioned as the " single exception." Now the fact is that Heule's classical description of the ciliary nerves is almost a literal restatement of Arnold's observations, aud we think Henle's views are the same upon this point as those of most leading anatomists. The conclusions of Mooren,2 that " the extraordinary number of means of communication favoring the development of sympathetic troubles explains that only the perfect separation of these means of communication by enucleation furnishes the possibility of bringing the destructive process to a stop, " provided, of course, that the operation is undertaken in proper season ; all other methods, such as section of the ciliary nerves, the neurotomy of the optic and ciliary nerves, caunot furnish the same guarantee of the result without regard to the fact that the formation of the cicatrix following the section may of itself favor the conveyance of sympathetic trouble," seems to us more iu accord with our present knowledge of anatomy and pathology. Instead, then, of regarding opticociliary neurotomy with Dr. Wadsworth, as "advisable in many cases," we should favor its restriction to the small series in which a fair cosmetic result may reward the patient for the extra dangers and the loss of time incident to the operation. D. H. -The works of Galen, supposed to have been lost, are said to have been discovered in Salónica, by M. Papageorges. They are in manuscript, and originally formed two hundred and forty-eight sheets, of which one hundred and forty-four are in good condition, twenty-four are mutilated, and eighty are missing. 2 Fünf Lustren Opbthalmologischeu Wirksamkeit Wiesbaden, 1882.