MEDICAL DEFENCE MATTERS. (To the Editor of the Australasian Medical Gazette.) SIR,-Although there may be a considerable difference of opinion as to the advisability of establishing an Australasian Medical Association yet, I believe, those who are interested in medical politics will readily agree that the federation of all the various State Medical Defence Associations is desirable, and that the sooner it can be accomplished the better. For any great good to result from such a federation it would be necessary, however, to alter the constitution of at least one of the Medical Defence Unions, and that the oldest, viz., the New South Wales. Comparing this union with the younger association of Victoria, we find that the latter is becoming much more vigorous and increasing each year, while the former is doing little else than accumulating funds, though, of course, one must admit that the mere establishment of such a union is enough in many cases to deter people from entering on legal action. If we ask for the reason why the younger society is outrunning the older, we shall find it in the fact that the Victorian society combines with its medical defence work the consideration of any matter affecting the welfare of profession in general. Hence it is able and does deal with such matters as lodge abuses, insufficient remuneration of medical men at inquests, notification of infectious diseases, etc., whereas the New South Wales Medical Union is by its constitution confined to the legal defence of its members only, and is thus purely provincial since nothing it does can have any effect upon men outside New South Wales. The entrance fee, £1 1s. and annual subscription £1 1s. is also double that of the Victorian Association and seeing that it has now a balance of £1,560 to its credit there is surely no need to keep its subscription at the higher figure. A striking illustration of the difference in the working of the two associations is afforded by a recent instance. It will be within the recollection of your readers that last year certain Friendly Societies in Broken Hill combined and advertised for a doctor. The only man in New South Wales who accepted the position was a member of the New South Wales Medical Union, and still is a member. Such a thing would never have occurred in the Victorian Medical Defence Association, as it would have at once notified, not only its members, but the whole of the profession in Victoria, of the condition of matters, and any member so applying would have been summarily dealt with. Fortunately the Broken Hill men by standing together have been able to prevent the continuance of the institute, but the New South Wales Medical Union did little to help it. This instance as well as the fact that medicoes of one of the largest New South Wales towns were not aware till lately that the Australian Natives' Association had been declared a society prejudicial to the best interests of the profession, afford proof enough that there is need in New South Wales of an organisation working on the Victorian lines. Is it too much to hope that the members of the New South Wales Medical Union will so alter its constitution as to become a more active body, and worthily representative of the unity with which the Sydney men have held together, as shown by their opposition to the Australian Natives' Association, the Clerk and Warehousemen's Association, etc. The South Australian Medical Defence Association is to be congratulated upon passing a resolution disapproving of its members giving their services to racing clubs in an honorary capacity, and it is to be hoped that the Victorian societies will do the same, for there is nothing whatever to justify the continuation of the practice. In this connection, however, one is sorry to see in the report of the recently formed Queensland Medical Defence Association that an honorary solicitor had been appointed and had drafted out the rules and constitution of the association. May one, in a kindly spirit, suggest to the Queenslanders that their action is somewhat inconsistent with the South Australian resolution, and that they should pay their lawyer and not accept his services gratuitously. We all hope our Queensland brethren will be able to successfully boycott the Brisbane Medical Institute. In this connection, may one draw attention to the recent decision of the General Medical Council of Great Britain, as reported in the British Medical Journal of December 7th, 1901, in the case of Dr. Randell. The action of the Council is surely the most hopeful sign that the general practitioner has been able to see amidst the gloom cast round him by lodge work, and should encourage all medical reformers not to be faint-hearted. There is no doubt whatever that Friendly Societies canvass, but it is done so indirectly that it is difficult to prove. If newly qualified medicoes can be kept from accepting these lodge appointments. only half the applications would be received. Years ago I suggested the method advocated in your leading article, viz., special lectures on medical politics to fifth-year students, to bring matters prominently under the notice of recent Melbourne graduates. I, at the request of one of the Melbourne Hospital staff, wrote an article dealing with the subject for the Melbourne medical students' journal, The Speculum. Cannot more of our men do likewise? Yours, etc., ABOU BEN ADHEM. (To the Editor of the Australasian Medical Gazette.) practitioner in New South Wales after two years' SIR, Contemplating the position of the contract absence from the State, and having carefully read the correspondence, notes, etc., in your issues during that interval. I beg to draw your readers' attention to page 53 of the report of the Brisbane Intercolonial Medical Conference, held in September, 1899. It will be seen that on September 20th, 1899, I suggested that the members of our profession "should form an association to supervise all contracts between medical men and friendly societies, and to improve the conditions under which such practitioners laboured. He moved that they should recommend the formation of such a Society, because he believed its disciplinary powers would be of benefit, and its advisory powers equally great." I believe that in formulating that motion I used the word "contract" very markedly, as I wished to bring insurance companies and hospitals into the scope of the resolution. A later speaker made a demur at this word, and I, with permission, altered my proposal, naming an "Australian Medical Practitioners Asssociation for the purpose of supervising and controlling the practice with regard to benefit societies and similar institutions." Dr. Worrall moved as an amendment that the defence associations should take up the matter, and proposed the names of six gentlemen "to press forward the desire of the Congress in this important matter." I withdrew my motion, an seconded Dr. Worrall's. His motion was unanimously carried. meeting is "The proceedings then terminated." Can The last entry in the report of the you inform me if, at the Hobart Conference or elsewhere, a report has been made by the six gentlemen referred to ? now I can see so slight a difference in our position after two and a half years lapse of time that I again venture to suggest the formation of a new and special organi. zation. The chief difficulty under which we labour is lack of mutual aid. If Dr. A. resigns a Lodge to-day, to-morrow Dr. B. offers himself. If Drs. A. and B. will join such an association, A's articles would prevent Dr. B.'s action when opportunity arose from Dr. A.'s action. The essence of mutuality in such cases is some common bond other than that which is now regarded as nominal-a professional kinship. I am more than ever convinced that not only union, but the discipline of volunteers, is required. A rule that none should offer their services except with the consent of the Council, or to bodies already approved of by the Council, would make such a society real. Items of detail I am prepared to add, but not to this letter, which is already too long. As Dr. Syme said at the meeting to which I referred above, the other Societies have their special work. Therefore I think something new is required. The British Medical Association has its scientific work, Defence Unions their special work, and so on, Some practices have made an improvement-but only a small number-after many years. Let our profession try to get all into line that individuals will have the advice and support of a centre. By such means only will, I believe, we all be freed in this connexion from and away from distrust of the profession or any individual member thereof. I am, etc., GERALD S. SAMUELSON. Armidale, March 19th, 1902. THE TREATMENT OF MIDDLE EAR SUPPURATION. (To the Editor of the Australasian Medical Gazette.) SIR,-I desire to offer a few remarks on Dr. Arthur's paper on "The Treatment of Middle Ear Suppuration," which appears in your issue of March 20th. With most of his conclusions I agree, but some I think, cannot be allowed to pass without criticism. Where he makes Macewen, of Glasgow, say that "he would rather have a charge of dynamite in his ear than a drop of pus," I would point out that Professor Macewen, whom I may venture to call my friend, having been so kindly received by him when I, six years ago, had the privi lege of attending his Clinic in Glasgow, does not express any personal preference of this sort. Macewen, in his classic work, "Pyogenic Diseases of the Brain, etc.," says: " Where the tympanic cavity has become the seat of chronic suppuration, with ulceration of the mucous membrane extending into the antrum and mastoid cells, it becomes a standing menace to the safety of the patient. A person might as well have a charge of dynamite in the mastoid antrum and cells, as one cannot know the moment when accidental circumstances may arise, which may cause the infectious matter to become widely disseminated all over the cerebro-spinal system." The italics in the passage quoted are mine. They emphasise the cases in which surgical treatment of the mastoid, according to Macewen, becomes necessary. "The indications for opening the mastoid antrum" are clearly stated later on in his work. Regarding the radical operation, Dr. Arthur says before he would allow it to be performed on himself he would like to know 1. The dangers of the operation and the anaesthetic. 2. The danger to my facial nerve and what hearing power I had left. 3. The chances of the discharge continuing even after the operation. I would say to No. 1. The dangers of the operation, when skilfully performed, are small; of the anesthetic, not more than in other operations-less probably than that for tooth extraction. To No. 2. In sixteen years experience of mastoid operations in private and hospital practice, during six of which I have, when necessary, done the radical operation, I have not had one case of permanent paralysis of the facial nerve. The hearing power is more likely to be improved than injured when a middle ear, filled with granulations and pus, is converted into a clean cavity. To No. 3 I would say that I have many cases of complete success by the radical operation, which could be attained by no other means. I agree with Dr. Arthur that operative measures are only exceptionally required, but not with his pessimistic statement that "a chronic otitis will exhaust all our remedies and patience.' I find that cases which have existed for years will generally yield to local treatment-particularly when diseased granulation and polypoid tissues are removed. The exceptional cases may include some which require radical operative treatment. In fact, I regard the treatment of middle ear suppuration-acute and chronic-as the most brilliant field of the aural surgeon, if we except the fine results which follow the removal of a piug of impacted cerumen. I do not hold with the view that operations on the mastoid should be postponed till dangerous symptoms supervene. This means that a mastoid suppuration may have extended to a sinus thrombosis, a cerebral, or cerebellar abscess. Like Dr. Arthur, I do not operate because there is pus in the middle ear, which it may be impossible to stop by local treatment, that is, so long as the condition is quiescent. I operate when I believe the patient's life is endangered by delay, but I go further, and comply with the wish of many, and endeavour to cure a condition, which makes life a misery, by operative measures, when other treatment, after sufficient trial, has failed. Against the method mentioned by Dr. Arthur of some American surgeons of filling the auditory canal with carbolic acid, I would warn the profession. I have no experience of it, nor am I likely to have. The result would be a probable necrosis of the epidermis of the auditory canal, and of what remained of the memb. tympani. If I have thought it necessary to make these remarks on the able and thoughtful paper of my colleague, Dr. Arthur, it does not follow that I do not agree in the main with most of his conclusions. I am, Sir, Yours obediently, A. J. BRADY. Hon. Surgeon, Department for Diseases of the Ear, Nose, and Throat, Sydney Hospital. 3 Lyons' Terrace, Sydney, March 24th, 1902. According to a recent consular report, Dr. Ekenberg, of Gothenberg, has worked out a method of reducing milk to the form of powder, which will be of far-reaching importance to the business of dairy farming. It is said that the product possesses all the qualities of milk in concentrated form, except that moisture is absent, and that it will not get sour or ferment. The milk flour is completely soluble in water, and can easily be transported in tins, barrels, or bags. George W. Kaan (Annals of Gynaecology and Pediatrics, December, 1901) advocates the pessary in cases in which the displacement is capable of replacement or can be made so by treatment, and in which the pessary is capable of holding it in place and can be Curetting Patients attending the Out-patient worn with comfort. The case must be watched with Department. Bookoemskavo (Vratch, 1901, No. 39) says that in the year 1901, 5,593 patients attended his out-patient room, and curetting was performed 154 times. In 116 cases it was for fungous endometritis, and endometritis following upon abortion; in 35 for recent abortion; and in 3 for diagnostic purposes. The endometritis was completely cured in 116 cases; in 14 cases some metrorrhagia remained, which was cured by the injection of a solution of iodine (grammatiki solution). The presence of salpingo-oophoritis when the tubes were not thicker than a finger and ovaries not larger than a pigeon's egg, was not accepted as a contraindication against curetting. In 2 cases, after curetting for abortion, the hæmorrhage recurred, but a second curetting put everything right. The abortions were operated upon immediately, but the cases of endometritis were prepared for the next day, a piece of iodoform gauze being introduced for twenty-four hours. In half the cases Hegar's dilators, up to sizes 9 and 10, were introduced to enable the curette to be used. Every possible antiseptic precaution was taken. The iodoform gauze was not passed into the uterus, except in inflammatory cases for purposes of drainage. The patients, after curetting, were kept on a couch for three to four hours, and a bladder of ice placed upon the abdomen. They were driven home, and went to bed for four days, when they returned to the clinic. The results were so good that the author has continued his practice, and has done several dozens already this year., Gonorrhoea. T. W. Eden (Clinical Journal, September 18th, 1901) uses a 1 in 1,000 solution of bi-chloride or biniodide of mercury thoroughly applied to the vaginal mucous membrane. This solution must be applied un er an anæsthetic and by means of a stiff brush. This treatment must be carried out early, that is, before the Bartholinian glands are involved. When the disease involves the urethra, this must be dilated and the canal swabbed out with a 1 in 2000 perchloride solution. When the above treatment is refused, the best method of treatment is by pessaries of cocoa butter containing twenty grains of iodoform and ten grains of oil of eucalyptus. A pessary is passed into the vagina when the patient goes to bed; it melts, and the solution flows over the vaginal walls and into the folds and depressions. Douches are used in addition to the above. A douche should always be given with the patient in the dorsal position Hæmaturia due to Uterine Fibroids. H. Hartmann (Annale de Gynecologie et d'Obstetric, September, 1901) calls attention to the possibility of a fibroid of the uterus simulating a tumour of the bladder. His patient had had persistent hæmaturia for six weeks, and examination of the bladder showed a tumour projecting from its posterior wall. Supra-pubic section proved that the tumour was a fibroid projecting from the supra-vaginal portion of the cervix, and merely pushing in the posterior wall of the bladder, which was red and granular at that point. Recovery followed curettage and cauterisation of the granulations. particular care and the pessary removed with the onset of the slightest pain. The ability to do without the pessary within a year or so occurs in about 25 or 30 per cent. of the cases. Ordinarily the error is made of Kaan makes a plea choosing too large a pessary. for the more careful treatment of displacements by suitable applications and by pessaries before resorting to operative measures, which are by no means uniformly successful in their results. Uterine Displacements. Henry C. Coe (New York Medical Journal, November 9th, 1901) offers the following deductions :Muscular atony is an important factor in the causation of uterine displacements, either alone or associated with the usual factors, overweight of the uterus and weakening of its ligaments and the pelvic floor. Mere restoration of the organ to its normal position with regard to the axes of the pelvis is not sufficient to cause permanent relief of symptoms, provided additional support is not afforded by firm pelvic and abdominal muscles. The prognosis as to the cure of malpositions by operations is influenced by the general muscular tone of the individual. Hence it should be the aim of the physician to endeavour to restore such a healthy condition of the muscles, either before or after operation, by appropriate treatment-baths, massage, electricity, gymnastic movements, out-of-door exercise, tonics, and such regulation of the patient's dress and mode of life as seems best fitted to the individual case. In short, the work of the physician often begins where that of the surgeon ends, if the result is to be complete and permanent. Retention of the Menses. Christopher Martin (British Gynæcological Journal, November, 1901), contributes a paper on this subject, and reports twelve cases. In two cases the atresia was at the hymen, in four in the vagina, and in six in the cervix. In one case there was a bicornate uterus, in two cases the uterus was double, and in two cases both the uterus and vagina were double. In three cases the retention cyst consisted of the vagina alone, in three of the uterus alone. The uterus and tubes were distended in six. The retained fluid was blood in seven cases, pus in three, and blood in the uterus with pus in the tubes in two cases. In discussing treatment he says: The cases vary so much that no one line of treatment can be laid down as applicable to all cases; but there are certain general principles which should guide us. (a) Whenever it is possible, the collection should be opened and drained per vaginam. The vulva and vaginal cul-de-sac must be rendered aseptic, and a free horizontal incision made in the roof of the cul-desac, and carefully deepened by dissecting up between the bladder and the rectum (if they be in contact). When the wall of the retention cyst is reached a free transverse incision should be made into it, and the viscid treacly fluid washed away by prolonged irrigation. If it be possible the mucous membrane of the sac should be drawn down and sutured to that of the vaginal cul-de-sac, and the cavity packed with iodoform gauze. (b) Should the Fallopian tubes be felt distended on either side of the uterus, an abdominal section should at once be performed, and the tubes emptied of their contents by free incision. Should they contain pus they ought to be removed. (c) In those cases where it is impossible or dangerous to reach the retention cyst from the vagina, the abdomen must be opened and the uterus and tubes extirpated. (d) Where there is a septate condition of the uterus or a double vagina, the septum should be divided as far as possible and the two cavities thrown into one. (e) In many cases where an artificial opening is made, especially in the cervix, there is a marked tendency for it to reclose by cicatricial contraction. This must be prevented by the regular passage of bougies, or by the wearing for months or years of a flanged rubber or vulcanite tube. (1) In all these operations there is a great danger of septic infection, and therefore the most scrupulous antiseptic precautions, not only in the operation, but during the after treatment, are of vital importance. OBSTETRICS. Unusual Perineal Rupture in a Primipara. Erwin Kehrer, of Bonn (Cent. für Gynäk., No. 36, 1901) describes the case of a primipara (age not stated) who was delivered in the obstetric ward of the hospital. The presentation was L.O.A. The vagina was very narrow and rigid; it presented numerous wart-like elevations and a muco-purulent discharge, but no gonococci were found. Twenty-two hours after the pains began the anus was observed to be widely di lated, but retained its round contour, and presenting through it was seen the nose and upper lip of the fœtus, and later the mouth and hair on the forehead, whilst the occiput presented at the vulva. The perineum was thinner in the middle, and a typical central rupture was expected, but it tore at its two extremities, in spite of all efforts to keep the head back. When all hope of saving the perineal floor was lost, it was cut through centrally with scissors. The lower third of the posterior vaginal wall was torn, the rectovaginal septum was torn, and the rectum only in its posterolateral walls remained attached to the sphincter. split anterior rectal wall was drawn up to a great dis. tance from the sphincter, which, until the perineum ruptured, was intact. The vaginal wall was sewn up with catgut, the perineum with silkworm sutures, and the last two stitches passed through the sphincter ani and then through the retracted rectal wall on the one side, and again through the rectal wall and sphincter on the other side of the tear. This closed the sphincter, and at the same time brought down the retracted bowel by a kind of purse-string suture. A rubber tube, wrapped in gauze, was inserted through the repaired sphincter. The healing of the wound was complete; there was no rise of temperature. The bowels were opened on the tenth day, sutures removed on the eleventh day, and an enema given. The patient was discharged from the hospital on the twenty-first day, and the sphincter action, both for fæces and flatus, was completely restored. Hæmaturia of Pregnancy. The Chiaventone (Ann. de Ggn, et d'Obstet., September, 1901) defines this complication as "a hæmaturia without hereditary or individual pathological antecedents, which supervenes during pregnancy, and passes off with its termination, which is marked by the absence of ordinary lesions, and is entirely and exclusively brought about by pregnancy." Albarran had collected twelve cases of hæmaturia during pregnancy, but in five of these, as Chiaventone shows, the hæmorrhage was due to pathological conditions other than pregnancy, viz., hæmophilia, nephritis, cystic tuberculous kidney, and chyluria, followed by hæmaturia of probably parasitic origin. These five cases are instances of hæmaturia during pregnancy. The remaining seven are admitted by the author as genuine cases of hæmaturia of pregnancy, and he adds a note of a personal case, making eight cases recorded in all. As a working hypothesis of the cause of this condition the author suggests that it may be due to a gravid toxæmia, brought about by hepatico-renal insufficiency. Prognosis is not unfavourable. Treatment is expectant, for ordinary styptics appear to be of little value. If the loss of blood is grave, the membranes should be punctured or labour induced. An excellent resumé of published cases is appended to the paper. Congenital Diaphragmatic Hernia. Porak and G. Duranti (Comptes-Reud. de la Soc. d'Obst. de Paris, May, 1901) describe a case in which the child did not breathe and rapidly became cyanotic. The presence of the apex beat in the right mammary line suggested transposition of the viscera, but intestinal tympany over the whole left half of the thorax showed the presence of a diaphragmatic hernia. Autopsy demonstrated the situation in the left pleural cavity of the left lobe of the liver, the stomach, duodenum, ascending and descending colon, spleen, pancreas and the entire small intestine. The Influence of Pregnancy and Childbed on Phthisis. Bernheim (Annals of Gyn, and Paed., June, 1901), in an article on the above subject, comes to the following conclusions : In those predisposed to such infection pregnancy does not necessarily lead to phthisis, but is the more likely to do so the younger the subject may be. Latent or ancient tuberculosis is not necessarily aroused by a single pregnancy. Where ultimate infection is to be feared marriage should be delayed; in case of past tuberculosis, prognosis as to the results of maternity must be reserved. The more extensive the tubercular lesions the greater the danger of pregnancy; in miliary tuberculosis it is almost certainly fatal. A single pregnancy may not aggravate dormant tuberculosis; repeated pregnancies are almost always dis strous, even in the curable forms of phthisis. Childbed and convalescence are particularly trying to the phthisical; lactation should be prohibited. If existing tuberculosis be aggravated from the first weeks of pregnancy, induced abortion, with due pre cautions, is justifiable. The influence of paternal tuberculosis on pregnancy is nil. Young Primiparæ. H. Paunetier (Paris, Thesis.) has collected 281 cases of labour in women below the age of 17, at the Tarnier Clinic. His statistics go to prove that labour is not usually reached term. unusually hazardous for very young women. Pregnancy There were no abnormal presentations. The average duration of labour was only fourteen hours and nine minutes. Forceps were employed in 16 cases. At the meeting of the executive committee of the Queen Victoria Home for Consumptives on April 9th, Dr. Purser, hon. secretary, stated that he had advertised for a resident medical officer for the new sanatorium at Wentworth Falls in the various medical journals in Australia and throughout the United Kingdom. The salary for the position was £300 per annum, with board and residence. the 24 applications received, none were from Australia. They were as follows:-Great Britain 15, Germany 4, United States of America 4, and Fiji 1. Of NEUROLOGY. The Supra-Orbital Reflex. Prof. V. Bechterew (Neurologisches Centralblatt, No. 20) has investigated the reflexes to be elicited in the region of the face. Beside the conjunctival and the pharyngeal, he mentions four others which are present with greater or less frequency. The "Eye Reflex" is demonstrated by striking with a percussion hammer on any part of the fronto-temporal portion of the skull or on the malar bone. The result produced is a slight contraction of the orbicularis ocuti. He finds the reflex present in the majority of the cases investigated. Since the reflex arc consists of the trigeminus, its sensory nucleus, and the upper branch of the facial, the reflex should be of interest in lesions of the brainstem, and the parts of the brain lying above it. Q. McCarthy (Neurologisches Centralblatt, No. 17) considered that this reflex, which he named the "SupraOrbital," was only elicited by direct percussion over the position of the supro-orbital nerve. Bechterew now points out that the area of excitability is much larger. Another writer (Carl Hudovering) holds that it is not a true reflex at all, since he found it intact after removal of the gasserian ganglion, in a case in which complete hemi-anesthesia and hemianolgesia of the face resulted from the operation. Tabes Dorsalis and General Paralysis. A very interesting discussion on the unity of the pathological process in these two diseases took place at the Pathological Society of London (Transactions vol. 51). Mott expressed his well-known opinion that both diseases were due to a primary degeneration of the neurone due to a poison, most probably that of syphilis; in the case of tabes it is the enogenous spinal neurones which are affected, while in general paralysis the stress falls on the association system of neurones of the cerebral hemispheres, especially on those of the frontal and central convolutions. He said, "A striking instance of the selective action of the syphilitic poison is shown in the fact that only in persons affected with acquired or inherited syphilis is the symptom known as the Argyll-Robertson pupil found, indeed it is sometimes the only symptom. Seeing that this is the most common objective phenomenon in the two diseases mentioned, it strengthens the presumption, based on experience, that the syphilitic poison is the cause of the disease in the majority of instances." Among his reasons for considering the diseases identical were the following facts: (1) a certain number of cases of tabes present mental symptoms; (2) a certain number of cases of general paralysis present tabetic symptoms, and after death atrophy and sclerosis of the posterior columus are frequently found in these cases; (3) a certain number of cases of tabes develop subsequently mental symptoms, and die of general paralysis. It had been contended, he said, that the degeneration of the posterior columus in general paralysis was endogenous and not enogenous; his own observations led to quite the contrary conclusion. He had further observed that characteristic tabetic symptoms such as grey atrophy of the discs were not uncommon in general paralysis, and he had even met with symmetrical perforating ulcers and Charchob's disease of the joints. The meeting was almost unanimous in considering syphilis as the chief if not the only cause of both diseases. Alex. Bruce combatted the idea of a primary neurone degeneration, but Mott was supported by such men as Gowens, Ferrier, Buzzard, Head, etc. Physiology and Pathology of Muscular Tone, of Reflexes, and of Contractures. At the recent Congress of French Alienists and Neurologists (Archives de Neurologie, No. 70), M. Crocq read an interesting paper on the above subject, which he treated by the methods of comparative neurology. He gives the condition of muscular tone, the reflexes, etc., as found in the rabbit, the dog, the monkey, and man, under various normal and pathological conditions. As regards muscle tone in man, he finds that a complete transverse lesion of the cord in the cervical or upper dorsal region produces total and permanent abolition of the tone of voluntary muscles and exaggeration of tone in the sphincters. From this he concludes that in man the long conducting paths are alone charged with transmitting the impulses regulating the tone of the voluntary muscles, and that the centre for this tone is exclusively cortical. The tone of the sphincters is regulated by means of the short paths, but cortical influence is more marked in man than in the other animals. In the new-born the pyramidal tracks are not functionally present, and in them, as in the lower animals, voluntary muscular tone is regulated by the short paths. Concerning the reflexes, he points out that section of the posterior roots produces the abolition of all reflexes; that in man complete section of the cord in the cervical or upper dorsal region produces permanent and entire abolition of tendon and cutaneous reflexes; that destructive lesions of the corten cerebri cause in all animals an exaggeration, more or less marked, of tendon reflexes, and in some animals a diminution of cutaneous reflexes; that destructive lesions of the cerebellum produce an exaggeration of tendon reflexes. His conclusions are that in man the centres for tendon reflexes are basilar, and are subject cerebellum, and that the centres for cutaneous reflexes to the inhibitory action of the cerebrum and of the are cortical. In this connection, he pointed out how common it is to find clinically a disagreement between the tendon and cutaneous reflexes, and further showed that, if his suppositions were correct, such disagreement would be of high diagnostic value. Contracture, he pointed out, was indissolubly bound up with muscle tone, it being the expression of hypertonicity; irritative lesions of the corten cause in man and the monkey (as opposed to other animals in which muscular tone is maintained irrespective of the corten) marked contractures, since with them the tonus mechanism involves the cerebral corten. True muscular contraction is produced on the one hand by alterations in the central motor neurones, and on the other by the laws of muscular antagonism. Intra-spinal Injection of Cocaine. Pitres and Abodie, of Bordeaux (Archives de Neurologie, No. 70) write on the physiological effects of intra-spinal injection of cocaine. The most important of these effects is analgesia of the lower limbs, and we have thus an elegant method of producing surgical anææsthesia, and of relieving painful crises, such as those of tabes. Their conclusions are drawn from observations on about fifty cases. In each case they injected 5 to 2 c. c. of a per cent. sol. cocaine. They consider the effects are due, not to a direct action on the cord, as maintained by other writers, but to an alteration in the conductibility of the posterior roots. The analgesia comes on gradually and in patches. These patches spread, and become continuous. The analgesia is preceded naturally by a condition of hypoalgesia. Sensibility to pain disappears first, next that for temperature, and, lastly, that for pressure is lost. |