Reviews and Notices of Books

1916 The Lancet  
he now suffered from hallucinations of hearing, and his pupils exhibited a sluggish reaction to light. Lumbar puncture had been done, and the examination was negative. -Sir GEORGE SAVAGE reminded the section of the observation of Dr. Maudsley that there was an alternation between glycosuria and melancholia, which he (Sir George Savage) had amply confirmed. If diabetics had mental disorder, they usually lost the sugar in the urine. In one particular case at Bethlem no sugar could be found in the
more » ... uld be found in the urine as long as the patient was excited, but it reappeared in the intervals.-The PRESIDENT pointed out that the determining factor in deciding whether it was a toxic condition was the presence of aceto-acetic acid or acetone in the urine. (Dr. Phillips had said those substances were not present in this case.) With regard to the Wassermann reaction, in 97 per cent. of cases of general paralysis the cerebro-spinal fluid gave a positive result, and in the serum in 98 per cent. Clinically he did not regard either this or the first case as general paralysis. He suggested that attendants should be instructed to describe exactly the kind of fit patients had when a medical man was not near ; it would prove of great service. Dr. SERGEANT exhibited a male patient, aged 41, who was certified in consequence of a condition of acute mania, following excessive drinking and the use of drugs. He first showed abnormal suspicion, melancholia, and refusal of food. He now had ideas of persecution based on hallucinations of smell and taste. Lucid intervals, however, occurred, during which memory, perception, and orientation seemed unimpaired. While the compound fracture which he sustained by jumping off the top of an omnibus was in a bad condition the mental condition seemed clear, but since the healing of the leg condition he had been imitative and worse mentally, as if he were trying to live up to the reputation he had entered upon. Once he kept silent for 42 days, but at times he was strongly imitative and quick-witted.-Dr. PHILLIPS thought the various phases the case had passed through justified the opinion that it was maniacal depressive insanity.-Dr. BERNARD HART inclined to the diagnosis of dementia prsecox, for the patient's history as a youth, and the fact that he had never had any occupation, favoured the idea that the abnormal mentality dated back a considerable timc -Dr. T. SEYMOUR TUKE agreed with Dr. Hart, and spoke of a similar case in his own experience. His prognosis was not hopeful.-Dr. HART, in further comment, said it was a well-known fact that in many cases the dementia was much less than it appeared. He had carried out intelligence tests in a considerable series of cases, carefully graded, and the general opinion of medical observers placed the cases much lower in the scale of intelligence than the tests showed they deserved. The dementia seemed to be pronounced because the patients were shut off from their surroundings. Sometimes a case of dementia præcox would, after a number of years, wake up and show surprising intelligence, a state of things which did not occur in the organic dementias. Dr. SERGEANT also showed a female, aged 40, whose mental illness dated from pneumonia and pleurisy following influenza 21 months ago. She was very restless, slept badly, complained of headache, was sensitive, irritable, and expressed a wish for self-destruction. She had occasional auditory hallucinations, and though formerly an ideal wife, she was now quite apathetic about her family. LONDON DERMATOLOGICAL SOCIETY.-A meeting of this society was held at St. John's Hospital for Diseases of the Skin on Dec. 21st, 1915, Dr. J. L. Bunch, the President, being in the chair.-The President showed a case of Bichromate Dermatitis in a man, aged 81, who had peculiar purpuric lesions present on the left hand.-Dr. W. Knowsley Sibley showed a case of Actinomycosis in a man aged 37.-Mr. C. R. Kempster showed a man who had received a scratch on the left ear with a piece of barbed wire three years ago. Ten weeks ago he had a large fungating cauliflower growth present in this region ; a section was examined and was found to be an epithelioma. To appreciate this volume it must be recognised that though it will prove of interest and value to most surgeons, yet it is primarily intended for the dental student, many of whom do not study medicine. Accordingly it is prefaced by a general description of the principles of surgery. We find here accounts of surgical bacteriology and infections; there are chapters on syphilis and tuberculosis, on wounds, antisepsis, haemorrhage and anaesthesia; fractures and dislocations, and diseases of bones and tumours are the subjects of some of the chapters, and in our opinion this introductory material is very well put together. Then we come to that portion of the work which is more particularly concerned with the mouth. We have chapters on the infections of oral origin, the diseases of the tongue and of the tonsils, dislocation of the jaw and ankylosis of the temporo-maxillary joint, the extraction and transplantation of teeth, cysts and tumours of the jaws, trigeminal neuralgia and diseases of the salivary glands. The most important chapters, however, are those which deal with hare-lip and cleft palate, and these are indeed valuable, for while much of the book could have been written from the experiences of a surgeon with general hospital practice these chapters deal with a subject which the author has made specially his own. He has devised new methods which in his hands at least have given almost perfect results, and we rejoice to have so complete a presentment of the author's ideas. Many surgeons associate the name of Brophy only with the special operation which is called by his name, and which consists in the forcible pressing together of the two maxillæ in very young infants; but, as a matter of fact, he has made important additions also to the operations employed in older children and in adults, and his results more than justify the procedures he adopts. Professor Brophy lays down the principle that the earlier the operation for cleft palate is performed the better, provided that the health of the child is satisfactory. If the child is under 5 months of age he holds that the approximation method is the best treatment, and that the ideal time for the operation is the second week of life. If, however, the child is older than this it will be impossible to adopt the method. If a hare-lip is present as well as a cleft of the palate we are told that the palate should be closed before any operation is performed on the lip, as the cleft in the lip will give much needed room for the operation on the palate. He does not consider it necessary in the great majority of cases to make any lateral incisions in the palate for the relief of tension, but he employs leaden plates fixed with wire sutures to overcome the strain. The subject is important, and we do not attempt
doi:10.1016/s0140-6736(01)10568-4 fatcat:ewai5dco6vdkrf37ugrhmilyoe