cases,

It never occurred to me to do otherwise ; and I cannot with correction of the least ametropic eye, or of that recollect any one of my teachers so slipshod in his which has the best vision, or we may particularly work as to have suggested it.

correct the most ametropic, and fully correct the least One can, of course, confirm the observations of Dr. ametropic.” All the other authorities say practically the Duane regarding the often great difference in the same thing. Surely these men are “ worthy of the refraction of the two eyes, the frequent obtaining of name of ophthalmic surgeons," and “take their great relief and of binocular vision after careful refraction work seriously,” and do not teach in a correction for constant wear, and the recognised fact slipshod” way. With Dr. Gibson's practice in these that small differences between the two eyes often give cases the writer, in general, agrees, and has followed rise to more suffering than great differences. Parallel it himself for some years with good results in many to this last is the fact that small errors of refraction

He was gratified to find Duane and Dr. Kentare answerable for more headaches than large ones. Dr. Hughes endorsing it, and is also pleased to find Dr. Duane himself, does not appear to me to claim in his Gibson also believes in it. When, however, Dr. Gibson excellent paper the originality attributed to him by says that this is the usual course in all cases of avisoyour periscopist.

metropia, he cannot follow him, when Duane himself, Yours faithfully, all the available text books, and his own ophthalmic

J, LOCKHART GIBSON. acquaintances, say it is not.-PERISCOPIST.] Brisbane, 25th February, 1902.

MEDICO-LEGAL. [The above caustic criticism from so well-known, and able an ophthalmic surgeon, and so fair-minded a Employers' Liability for Contracting Ininan as Dr. Gibson, is puzzling. The writer is quite fectious Diseases.-On January 29th, at Sydney, in content to adhere to his statements and opinion, for he Chambers, Mr. Justice Stephen considered an applicais in good company. Were it not manifestly otherwise, tion on behalf of William A. Kennedy for leave to he would like to think that the explanation of Dr. proceed against the Australian Drug Co., Ltd., under Gibson's letter might lie in his misapprehension of the

the provisions of the Employers' Liability Act. He sense in which the word anisometropia was, and is

was a glass-blower, and his work required him to blow generally, used. Of course, slight differences in each through a glass tube, which was handed from workman eye (up to about 1.5 D.), are always separately corrected.

to workman. He contracted a certain disease, wbich But the paragraph in the Gazette referred to cases up to manifested itself in the form of a sore near the mouth. 11D. Moreover, Dr. Gibson has read the original It was alleged that three or four cases of the same sort article, in which Duane clearly states that he has had occurred in the works, and his legal advisers " for the most part, included only such cases as showed

claimed that the plant of the company was defective in & difference of at least 20." The term, aniso

that the glass tube had not been kept in a sanitary metropia, is not generally applied to slight differences, condition, and this negligence had caused the injury. or nearly all cases of ametropia would be included under The judge decided that the application could not be that head. The whole point of Duane's paper is that granted, as the notice of intention to proceed should he gives each eye its own correction in inequality of high | have been given within six months after the injury had degree. Dr. Gibson says that in 17 years he has never been sustained. The second case, heard on February done anything else than correct each eye in aniso

5th, was brought by Robert G. Kennedy, an apprentice. metropia (he must include a large number of cases of

For the defendants it was urged that scc.

of the high degree), and in most emphatic and unmistakable Employers' Liability Act did not apply to apprentices. language, he says that this is the only recognised The judge held that this contention was sound, and practice. Well, Donders, Landolt, Fuchs, Swanzy, application was refused, with costs. Norris and Oliver, Meyer, Fick, Roosa. Nettleship, Brudenell Carter, and, in fact, every accessible authority say it is not, and funnily enough, so does Dr. Duane

Sydney Metropolitan Medical Association. himself in the paper referred to. Dr. Gibson can

At a meeting of this Association held on March 17th, a surely not have read very carefully this paper, of

resolution was passed that this Association should which he so highly approves, for the opening paragraph nominate one medical practitioner engaged in Lodge begins : “ There is still such considerable difference of practice as their representative on the Council of the opinion with regard to the management of cases of

New South Wales Branch of the British Medical Assoanisometropia that there seems little reason to apologise ciation, and that the Western Suburbs Medical Associfor offering my personal experience in the matter. I

ation be asked to nominate one representative instead am the rather led to offer mine, because it seems to

of two, as heretofore. A ballot was taken, and resulted differ more or less from that of others who have

in the selection of Dr. E. H. Binney as the nominee. written upon the subject, and particularly because it An Unfortunate Experience.—A corresponruns counter to the statements contained in many of dent writes informing us he has had an unpleasant and the text books.” So it appears that Dr. Duane does unprofitable experience through taking charge of a claim that his practice is not the usual

country hospital in New South Wales, and he would (" Originality” was not attributed to him). It is caution his confrères against entering into a similar unnecessary to quote all the above-mentioned author-, contract. He signed an agreement for twelve months, ilies. Two will suffice. Fuchs rays (Text Book of and found there was litile or no private practice to be Ophthalmology) : “ The obvious course to pursue would : obtained in the neighbourhood, and consequently the seem to be to correct the anisometropia by ordering salary paid by the hospital authorities was insufficient. different glasses for the two eyes. Nevertheless, this He complains also that "encouragement” was given measure, in most cases, proves impracticable.

We to two unqualified men, one of whom was elected to therefore prefer, in anisonietropia, either to give the the committee. Such an experience, unfortunately, is same glasses for both eyes, or to correct one eye, and not uncommon, and we can but ad vise medical men to place a plane glass before the other." Swanszy says : inquire carefully into the circumstances and surround- When the difference is considerable it is often imposs-, ings of any such an appointment before binding ible to correct both eyes. . .. We must then be content i themselves by signing an agreement.

one.

:

:

:

REVIEW OF CURRENT MEDICAL convulsions, affecting chiefly the left side of the body. LITERATURE,

Six days previously he fell whilst carrying a sack of potatoes down a flight of stone steps, and was found unconscious at the bottom of the steps, bleeding

slightly from a scalp wound on the left side of the SURGERY.

head. He was slightly under the influence of drink.

He was got to bed, and remained unconscious till the A Case of Pneumococcal Suppurating Peri- next morning, when he woke up and walked to see a carditis, treated by Incision and Drainage : shaken by the fall. He remained away from his work

He complained of headache and of being Right Lobar Pneumonia : Right Empyema : for five days, but apparently without any definite Death.

symptoms until 10 o'clock the night before admission, John Fawcett, M.D., and F. J. Steward, M.S., record

when he had a fit, and continued to have_ rapidly the above (Clinical Society's Transactions, Vol. xxxiv., repeated, fits until he was admitted to the Hospital. 1901). The patient, a boy of eight, was admitted to

On admission he was bathed in perspiration, temGuy's Hospital with signs of lobar pneumonia at the perature 102° F., pulse 100. Each fit lasted from two right base, six days after commencement of illness. to four minutes, with an interval of from one to five The following day there was slight increase of ræcor

minutes, and the mode of onset was either the turning dial dulness, and this gradually increased, till, at the of the eyes to the left, or twitching of the left side of

the face. end of ten days, it reached the first intercostal space

The clonic spasms rapidly involved the above, one inch to the right of border of sternum, and

whole of the left side of the body and the right leg. on the left, two inches outside nipple line. There was

During the fits the patient sweated profusely, and was at first a soft " to and fro” bruit at the apex, and the deeply cyanosed. In the intervals he could usually sounds became more muffled. The temperature ranged

answer questions. Pupils equal, of medium size, and from 98° to 101° F. The signs at the base were dis- reacted normally. The left arm was distinctly weaker appearing. The upper portion of the epigastrium and more flaccid than the right. The arm-jerks were became more prominent and was very tender on pres present on the left side but not on the right. On the sure. The cough again became frequent and severe,

left side there was exaggeration of the knee-jerk with and the pulse and respiration rate had increased. As

ankle clonus, and the extensor response was obtained the boy was becoming visibly thinner, and was eating as the plantar reflex. Chloroform was administered and sleeping badly, it was decided to explore the

for half-an-hour on two occasions, and checked the fits pericardium. A needle was inserted in the fouth left

each time, but they returned as soon as it was stopped, space, about one inch from the margin of the sternum,

A full dose of chloral and bromide was adminis. and thick yellow pus was withdrawn. A few hours tered per rectum. In arriving at a diagnosis uræmia later the pericardium

was opened under A.C.E. was quickly excluded. Epilepsy, however, caused through an incision over the fifth costal cartilage. The more serious consideration, as the father and brother perichondrium was stripped off, and about one inch of

had both suffered from it ; but as many of the fits the cartilage removed. "No pleura came into view, but began by twitching of the left side of the face, and the pericardium was easily seen and incised. About others by movements of the left hand, this mode of eight ounces of thick pus were evacuated ; a short onset, coupled with the state of the reflexes, and the thick drainage-tube was inserted and dressings applied. paresis of the left arm before mentioned, was regarded The operation only occupied a few minutes. A large

as indicating the existence of a definite irritation of quantity of pus drained away during the first twenty- the right cerebral hemisphere. The evidence did not four hours, but gradually lessened, so that after the justify the diagnosis of a focal lesion, as the fits did fifth day very little came away. An attempt was made not constantly begin in the same region. The late to keep the boy on bis face, to assist drainage, but had

onset of the fits also seemed to negative the presence to be abandoned. The child's general condition

of a clot of blood, so that the recorders were forced to improved very much during the first ten days, his the conclusion that the lesion was probably inflammacough became less troublesome, his pulse stronger, and tory in nature. It was decided to expose the right he ate and slept much better. A localised empyema hemisphere over the middle of the Rolandic area.

On was found on the right side, which was opened and removing a disc of bone with an inch trephine, the drained fourteen days after the first operation. The

dura mater was found to bulge slightly, and to present child again improved for a while, but died five days a bluish tint. On incising the dura a small quantity later, or nineteen days after the pericardium was

of thick dark blood escaped. The opening in the skull opened. The authors state that the post-mortem ex. was enlarged upwards and downwards with bone amination clearly demonstrated that the proper triat

forceps, and the opening in the dura opened in a ment was adopted, as the pericardial sac, which must crucial manner to the full extent of the bone opening. have held about ten ounces of pus at first, had become In all, between two and three drachms of blood practically obliterated. A reference is given to a escaped. The surface of the brain presented a perpaper by C. B. Porter (Annals of Surgery, December, fectly normal appearance. The divided dura was 1900) giving 51 cases, or with the present 52, of which turned into position, and the scalp incision sutured. 20 recovered and 32 died.

No bone was replaced. No fits occurred after the

operation. Considerable weakness of the left side, Traumatic Subdural Hæmorrhage, Occasion- especially of the arm, followed, and it was nearly a ing Convulsions on the Sixth Day after Injury, month before the arm had fully recovered its strength. and Successfully Treated by Operation.

The extensor response on the left side was present for

four days after the operation, and the right pupil was Raymond Johnson, B.F., and J. Risien Russell, larger than the left for six days. The temperature M.D. (Clinical Society's Transactions, Vol. xxxiv., rose to 105° four hours after the operation, and for 1901) record the above case. The patient, a porter four days varied between 101:4° and 104°, and after at. 33, was admitted to University College Hospital the sixth day was normal. The patient left the hosOctober 23rd, 1901, suffering from frequently recurring pital on the 34th day in perfect health.

Ano-Rectal Transplantation.

suturing was used throughout. The abdomen was then RUSH MORE, of Brooklyn (Annals of Surgery, December, closed. The course of the case was satisfactory; there

was little or no shock, and the patient only vomited 1901), briefly relates a case of the above, where very

once. By the ninth day he was able to take solid food. satisfactory results were obtainerl. The patient, a male Twenty-tive days after the gastro-enterostomy the abaged 39, had five months before, while bending over his

domen was again opened in the middle line by an in. work, been gored in the rectum by a bullock, which caused a lacerated wound through the sphincter, and exposed, an opening was made in the lesser omentum

cision five inches long. When the stomach region was both backward and forward into the perineum. The in order to explore the posterior aspect of the tumour. loss of blood was sufficient to weaken him. Sereral

A Doyen's clamp was placed across the duodenum, operations had been performed in New York,

which was cut across, and the end at once sewn up by a Boston and Chicago, but witbout any material relief.

double row of silk sutures. The stomach was then cut He had no control over the sphincter, and was con

across between clamps placed well beyond the apparent sequently always in a filthy state, and unable to work. The sphincter manifested no contractile power what: double row of silk sutures.

limits of the growth, and the opening closed up by a ever on inserting the finger into the rectum, nor could

There was very little loss of blood during the operation. the patient by any voluntary effort cause it to contract

which lasted one and three-quarters of an hour. The in the slightest degree. Inguinal colotomy and ano. rectal transplantation were the only two methods of rowing of the pylorus by a growth which proved to be

excised portion of stomach showed a considerable nar. treatment likely to do good. As it was desired to

a columnar celled cancer. The patient's condition for restore the man to a condition fit for active work, the

some days after the operation was a precarious one. latter operation was decided upon, after explaining to

His temperature went to 102° F. and his pulse to 160 on him its experimental character. With the patient on his side, under ether, an incision was made extending bilious fluid occurred from the bottom of the first in

one occasion. On the fourth day a free discharge of from about a quarter of an inch outside the anus

cision ; but the general condition of the patient imfollowing the natal cleft to the sacro-coccygeal articu

proved At the end of the first week a considerable lation. The coccyx was removed and the rectum,

increase in the nourishhment was risked, and it was including its middle and lower third, freed from the

found that he could take four pints of peptonised milk surrounding soft parts posteriorly and laterally, and

in the day without any discomfort. Steady improvethe hæmorrhage checked by torsion. The patient was

ment took place, and the patient gained 12 lb. in weight then put in the lithotomy position, and with an assist

in four months. ant holding a sound in the urethra, the anterior portion

The author in his remarks discusses the question " Is of the rectum was separated by means of scissors well

pylorect.my under any circumstance legitimate ? " and up to Douglas' cul-de-sac. The anal end of the rectum

comes to the conclusion that it is, provided the operation was then anchored in the upper angle of the wound,

can be performed early. He briefly summarises as ust below the sacrum, by means of black silk sutures. follows :The wound below the upturned rectum was theu irrigated and stitched. The result of the operation was a

1. The present position of pylorectomy is unsatis

factory, but there is no cause for despair. rectal pouch, the bottom of which was about three

2. That an advance may be made, it is, in the first inches below the transplanted anus, and toe posterior

instance, necessary to reduce the immediate wall of the rectum was folded back on itself and formed

mortality. This is to be done by (a) a more a thick valve just inside the anus. The operation was

careful selection of cases, and (b) by performing followed by a good deal of pain for a few days, and

the operation in two stages. In the second place some suppuration, but the ultimate result was very good,

it is necessary to obtain better ultimate results. the patient gaining strength and weight, and was able

The way to this end lies in (c) wider resections, to resume work,

and (d) in this case also in better selection of Pylorectomy performed in two stages.

3. Let these things be accomplished and we may GORDON ( Medical Press and Circular, January, 1902)

then, with more justice than at present, call reports a successful case of pylorectomy performed in

upon physicians to resort more frequently to two stages. The patient, a man aged 43, had suffered

exploratory operation. from vague gastric symptoms for about 20 months. The pain was never severe, nor was vomiting constant. He had lost 21 lb. in weight during the last four months,

THERAPEUTICS. A tumour was to be felt in the abdomen, just above

The Treatment of Cardiac Dilatation and the umbilicus ; it measured about three inches in trans

Asthenia. verse diameter, was hard and irregular, and could be felt to move readily with respiration. It could be Burney Yeo (Practitioner, January, 1902), points moved freely in all directions. There was no liver en. out that there are three manifest causes which have largement ; and this, together with the remarkable been at work in recent years in giving rise to the mobility of the tumour led to the hope that there was prevailing tendency to cardiac asthenia and dilatation, an absence of adhesions and of secondary cancer de (1) the influenza epidemic; (2) abuse of muscular posits. An incision was made slightly to the left of exercises ; (3) excessive use of tobacco. The two last the middle line. A hasty examination of the tumour differ from the first in being entirely preventible. The justified the hope that had been entertained. The incidence of influenza is, of coursc, to a great extent transverse colon was turned upward and posterior unavoidable, but in dealing with the period of congastro-enterostomy performed. The opening in the valescence after this disease, sufficient stress has not stomach was made as far to the left as possible, after the been laid on the necessity of a prolonged period of method of Roux. The jejunum was divided some dis- physical rest; for, while it may be altogether advantance from the duodenal flexure, the lower end was tagcous for the patient to be much in the fresh air, fixed to the stomach opening, and the upper end was active physical exercise should certainly be forbidden. made to anastomose with the jejunum again some four Physical exercise has its place and season in the inches or morc from the stomach junction. Simple' treatment of cardiac debility, but it is often applied

cases.

or

out of place and season. Physical rest in bed has ever heart's action much improved. In both of these cases been, and ever will be, the surest of all cardiac tonics the extract had only been given as a last resource, the in serious cases of cardiac dilatation and asthenia, and usual cardiac tonics having failed to effect any im. this is the most essential remedy in the early periods provement. These results are somewhat remarkable, of commencing dilatation, When exercise becomes in view of the known action of this remedy in raising desirable and necessary, gentle carriage exercise is of arterial blood pressure, since with a weakened myoreal value, and also horse exercise for those who are cardium and degenerate vessels one would rather have accustomed to it. The author has found the use of expected unfavourable results--either a rupture of the saline batàs containing carbonic acid at temperatures blood-vessels, or fatal syncope from over-strain of the from 88° to 93° F, beneficial in cases of chronic cardiac cardiac musculature. asthenia and dilatation following upon acute disease, and also in nervous persons with dilatation from strain and over-exertion, mental and physical.

Creosotal in Pneumonia. With regard to general considerations as to the appropriate treatment of cases of cardiac dilatation, in

Leonard Weber (New York Medical Record, Novemthe first place the patient must be withdrawn from the

ber 2nd, 1901), relates his experience with this remedy influence of all those conditions which have caused it. in the treatment of nine cases of pneumonia, both If it has been due to over-exertion, then there must be lobar and lobular. The ages of the patients ranged avoidance of all kinds of muscular effort and only

from twenty to forty-seven years. The oldest patient gentle exercise allowed. If it has been induced by died from cardiac degeneration, but all the others over-excitement, either mental emotional, or

recovered. The course of the disease so treated shows addiction to evil habits, these causes must be sought

that this drug exercises a remarkably beneficial and ont and corrected. An open-air life in the country, or

uniform influence. There were no symptoms of at the sea-side, gentle exercise, a nourishing but light depression or disturbance of the gastro-intestinal tract. and digestible diet, regular action of the bowels, and As soon as the patient came under the full influence of early retirement to bed are all very obvious but

the drug the temperature fell, and the same improvenecessary remedial measures. Some form of cardiac ment ensued as usually supervenes at the onset of the tonic is generally indispensable in these cases, specially crisis. It is doubtful if the drug exercises any direct in those which follow attacks of acute febrile and

curative effect on the disease. The author adminisseptic diseases, and also in anæmic conditions. If tered the remedy in capsules containing ten minims there be much dyspnoea and troublesome palpitation, six times a day, in some cases for eight days. small doses of digitalis with iron may be given, but the author prefers to employ strophanthus, or strychnine, with coca, in combination with iron, quinine, or

The Clinical Uses of Citrophen. arsenic, as may seem desirable. In purely anæmic cases, iron and nux vomica with some aperient will be

Syers (Treatment, January, 1902), relates his exmost appropriate. In cases of acute dilatation,

perience of the use of citropben in various conditions, however induced, the hypodermic injection of strych

He has found it of great service in the treatment of nine in doses of th to bth of a grain will often be

the headache of anæmic girls. In most cases one tenattended with remarkably good results. Free action of grain dose has been followed by a relief of the pain, the

bowels is very advantageous in nearly all cases of and, as a rule, two or three doses of the same amount cardiac dilatation and feebleness, but aperients must

have cured the headache for the time being. No be so given as to clear away only the residue of unpleasant symptoms have ensued. In migraine, it digestion. For this purpose the best method is to give

has seldom failed to give relief and frequently has cut an aloetic pill after dinner or at bedtime, and a saline

short the attack. In neuralgia, generally the relief bas dose early in the morning, about an hour before

been only temporary, and no permanent cure of this breakfast.

condition has been observed by the author. But he

has obtained excellent results in the relief of the Suprarenal Extract in Cardiac Conditions. various aches and pains so frequently met with in

neurasthenics. In lumbago and sciatica 15-grain doses Deeks (Montreal Medical Journal. November, 1901), 1 given every three hours up to three doses have nearly gives the history of two cases in which he used the always proved beneficial in removing the pain, at any suprarenal extract with good results. The first case rate, for the time being. In chronic articular rheuwas a female patient, eighty-two years of age, suffer. matism a dose of ten grains given night and morning ing from the symptoms of dilatation of the heart. has relieved the pain when other remedies have all The cardiac action was weak and irregular, the legs failed. The author also has found it useful in the much swollen, the ædema persisting in spite of rest in severe head pains at night in patients suffering from bed. The diagnosis was myocarditis, mitral incom- syphilis. In febrile diseases citrophen is certainly petence and arterio-sclerosis. All the usual remedies useful ; in some cases of pleurisy in which the pain had been tried with no benefit. Vomiting set in, and was very severe it was greatly relieved or entirely the patient's condition became extremely serious. removed by a few 10-grain doses. On the other hand, Suprarenal extract in three-grain doses was ordered, the author has not found it to be of much service in and from the first day a marvellous improvement was reducing temperature-neither in acute rheumatism observed. The vomiting ceased, the swelling dis- nor in pulmonary inflammations, acute or chronic -has appeared, and the patient was soon able to walk. The the author's experience proved it to be superior to heart's action became regular, and the patient was other remedies. Nevertheless, the very marked power better than she had been at any time during the of relieving pain in many and various morbid conpreceding three years. She took from nine to eighteen ditions which citrophen undoubtedly possesses renders grains of the extract each day. The second case was a it a valuable addition to the list of drugs in ordinary man seventy-six years of age, with oedema of the legs, daily use. It is pleasant to take, and can be adminisheart regular but rapid, with weakness of the first tered in effervescent waters. It has no depressing or sound. Under the use of suprarenal extract, the deleterious effect, and the author has never observed Pdema entirely disappeared in six weeks, and the the slightest ill effect as the result of its use.