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He has gone the rounds of the hospitals and various practitioners have treated him and the result has not been encouraging. When he presented himself Dr. Morell placed him in isolation and gave silver nitrate in increasing doses. After having been on this treatment for about three weeks the coprolalia had entirely left him and the tic was diminished somewhat. After two months of isolation the barking did not return until a fire occurred in the vicinity of the hospital, when the coprolalia and loud noises returned which lasted a week or so. The patient was in isolation for eight months. During that time he seemed to improve but after that when he started to go out occasionally the symptoms gradually returned. Since his return to public life the disease seems uninfluenced by the treatment given.

NYCTURIA IN CARDIO-VASCULAR AFFECTIONS.-M. Pehu holds, Revue de Med. (Med. Record), that in a large number of subacute or chronic affections characterized by temporary or permanent involvement of the heart, the normal rhythm of urinary elimination is modified, the excretion being more active at night than during the day. This symptom is found not only in diabetes and scleroses of the urinary apparatus, but also in diseases affecting the systemic or the portal circulation. It would appear to be due to insufficiency of the myocardium in eliminating fluids ingested during the day, which remain in the tissues or blood. During the repose of the night, as arterial pressure is raised, watery excretion is produced. According to this theory, nycturia is a sign of cardiac weakness and will assist in the diagnosis of insufficiency of the muscle when there is no frank asystole. The occurrence of this symptom will suggest certain methods of treatment, especially the reduction of fluids ingested.—

CEREBRAL WOUND RIVALING THE PHENEAS P. GAGE CASE.-Dr. Walker Keate, Nacozari, Sonora, Mexico, gives (Med. Rec., Oct. 17, 1903) details of an accident near his place, on May 18, 1903. A miner, age 40, was preparing to spring a hole with dynamite, in which he had

Berk

61⁄2 sticks of giant powder inserted. They accidentally exploded while his face was over the hole. When Dr. Keate reached him two hours later, pulse 30 per minute and very weak. Eyes were blown out; skin and muscles and forehead were partly off; with the anterior portion of the skull cap turned back over the parietal bones. Orbital plate of frontal bone (roof of orbit) was blown into the brain, and the brains exuded through opening into cheek. A hole was in frontal bone about size of a silver dimelocated at about center of frontal-through which brains. exuded. Brain membranes-dura and pia mater and arachnoid-as also frontal lobes of brain, were badly lacerated. End of nose was badly cut; face and lips badly burned with powder and literally filled with small rocks and dirt.

After trephining to make a larger opening and to smoothe ragged edges, the doctor removed from the brain twenty small stones and several pieces of bone besides considerable dirt. Most of the foreign bodies were located at a point corresponding to anterior fontanelle, deeply buried in the brain. A large piece of bone corresponding to roof of orbit was extracted from brain through opening in forehead.

Amount of cerebral matter which exuded, weighed an ounce, but the patient has never for one moment been unconscious. His mind has been perfectly clear. He readily recognizes his friends when they speak to him, answers questions intelligently and describes accurately the details. of the accident, He has never complained of pain, and says the anterior portion of the head feels paralyzed. Appetite is and always had been fairly good.

During the first two weeks, his temperature ranged between 100° and 103°; but during the last two weeks, it has been practically normal. Patient has been able to get up every day since the accident, and locomotion is good. Just a month after the accident the patient was sitting in a rocker on the porch in the fresh air, chewing tobacco. Both eyes are completely destroyed.-Virg. Med. Monthly.

PROGNOSIS AND CURABILITY OF EPILEPSY.-W. A. Turner (Lancet, June 13, 1903) reports the results of his

investigations of the prognosis and curability of epilepsy. His conclusions are derived from the study of 366 cases of genuine idiopathic epilepsy which had been under constant observation and treatment for 2 years. He believes that a family history of epilepsy will be found more frequently amongst those who have become confirmed epileptics, but a hereditary history of epilepsy does not necessarily militate against the prospects of arrest or improvement of the disease in any given case. The age at the onset of the disease has an especial bearing upon the prognosis. The most unsatisfactory cases are those in which the disease commences under 10 years of age; they show the smallest percentage of recoveries and the largest of confirmed cases. If the disease arises between 15 and 20 years of age an almost equal percentage of arrested and confirmed cases may be expected. The greatest percentage of confirmed cases is found amongst those in whom the disease begins between 25 and 35 years of age, from which time onward there is a steady increase in the expectations of arrest and diminution in the number which become confirmed. The duration of the malady influences the prognosis to the extent that arrest or improvement is much more likely during the first 5 than during the second 5 years. Cases, however, may be arrested even after a duration of from 20 to 30 years. The greatest percentage of confirmed and the lowest percentage of arrested cases occur in those epileptics who are subject to daily or weekly attacks, while conversely the smallest percentages of confirmed and the highest of arrested cases occur in those whose fits are as infrequent as once or twice a year. The character of the seizures influences the prognosis to the extent that the major attacks are the most tractable; then follow combined major and minor seizures; and lastly, the minor attacks occurring alone. Marriage exerts little, if any, influence upon epileptic fits. Some patients are relieved and others are made worse. In the majority of cases the disease remains unaffected. Pregnancy has little influence upon the seizures; at the best there may be only a temporary respite. On the other hand, the puerperium would seem to be especially favorable for the recurrence of fits; while lactation

also is not without an exciting influence in their production. The common incidence of epileptic fits is an irregular periodicity. There are types, however, which have been described as "increasing" or "decreasing," according as the fits increase or decrease in number in a definite period of time or in which there is a shortening or lengthening of the intervals between the fits. A case of increasing type may by treatment be converted into one of the decreasing variety. Long remissions, induced either by successful treatment or from spontaneous cessation of the fits, sometimes lasting for several years, are not unusual in epilepsy; they are of favorable prognostic value but are not synonymous with a cure of the disease. From the collected statistics a period of remission for at least 9 years has been fixed as the basis upon which a cure of epilepsy may be established. With this definition of a cure the author regards 10.2% of epileptics as curable. There are some cases of epilepsy which may be regarded as belonging to a curable type of the disease. These present little or no mental impairment, notwithstanding that fits may have existed for a long period. In the cases in which arrest took place cessation of the fits occurred within the first year of continuous treatment in over 50%. -Peterson, Pearce and Peters' Abstracts Int. Med. Mag.

AN EXTREME CASE OF BRADYCARDIA.-L. E. Norfleet, Tarboro, N. C., reports (N. Y. Med. Rec., Nov. 21, 1903) a case where the pulse rate rarely exceeded 45, and was intermittent. On one occasion it fell to 30 per minute. This, however, was not the lowest. He had a paroxysm of convulsion in the midst of which the pulse intermitted so much that the rate averaged only 8 to 9 per minute. Points of especial interest about the case in the author's opinion are (1) that any one should live and remain cool and conscious on an intermitting pulse of 8 to 9 per minute, and this for 24 hours; (2) that the drugs suggested by the text books-alcohol, strophanthus and belladonna, not only did no good, but actually did harm; (3) the strict localization of the convulsive seizures to the head and neck, and the general pallor of patient's face as well as the failure of the

cranial arteries to show any pulsation, made the author regard seizures and irregular heart action as a species of epilepsy, due to anemia of the brain centers, hence the use of morphin and nitroglycerin, which were successful.

CONCERNING PORENCEPHALY. (Ueber Porencephalie.)(Kellner. Monatsschrift fur Psychiatrie und Neurologie, Band XII, Heft 6, December, 1902.) In the institution for epileptics and feeble-minded at Hamburg, Kellner found twenty-one pupils with the characteristic symptom complex of porencephaly-namely, coincidence of epilepsy, psychic defect and hemiplegia, combined with defective development of the paralyzed limbs. Ten of these children were girls and eleven were boys. In seventeen the paralysis was left-sided, and in three of the remaining four, who had a right-sided paralysis, the mental defect was much more profound than in those of right-sided affection. In only four children was the head symmetrical. The asymmetry of the head was shown in nine of the left-sided cases as diminution in size of the right side, and in six others the left side was small (the same side as the affection of the limbs.) Of the four children with right hemiplegia, two presented asymmetrical heads, a rightsided and left-sided enlargement. Hydrocephalic heads were noted in four instances and microcephalic in five, one other presenting a dome-shaped head twelve centimeters in height. Three cases presented certain indications of pressure of the obstetric forceps as a possible cause of porencephaly, one showing a depression at the vertex and two others upon the parietal bones. In only one case was one side of the face smaller than the other, and in four there was a moderate amount of facial paralysis. The shoulder girdle was involved in eleven cases, showing a decreased circumference of an average of six centimeters. Paralysis of the trapezius was present in eight cases. In the arm affections of the extensors were much more common than those of the flexors, seventeen cases of paralysis of the musculo-spiral as against one case involving the musculo-cutaneous, the latter leading to an over

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