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“ LITERARY CAUSERIE."

By WILLIAM STIRLING, M.D., D.Sc., LL.D., Professor of

Physiology, of the Victoria University of Manchester; and
Dean of the Medical Faculty.

I.

A GREAT deal of attention is being paid at present in the lay press to the advantages of ambidexterity, or the interchangeable use of both hands. Some of a cynical turn of mind call it ambidextrous clumsiness, and gravely discuss the question of why one should attempt to make humanity, equally awkward with both hands.

Landseer was a noted example of a painter who could use both hands nearly equally in the practice of his art. Schools exist on the Continent both in France and Germany where children are trained with a view to making them equally skilful with the right and left hand. In the Philadelphia art schools in the United States similar systems exist. We do not call attention to the problem either from the physiological or practical point of view, but rather to direct attention to a remarkable essay by Benjamin Franklin, who wrote a powerful plea for the left hand. The modern American is attempting to bring into use a practice advocated by “poor Richard " in the last quarter of the eighteenth century. We venture to quote in full

“ A PETITION OF THE LEFT HAND."

To those who have the Superintendency of Education. I address myself to all the friends of youth, and conjure them to direct their compassionate regards to my unhappy fate in order to remove the prejudices of which I am a victim. There are twin sisters of us; and the two eyes of man do not more resemble, nor are more capable of being upon better terms with each other, than my sister and myself, were it not for the partiality of our parents, who make the most injurious distinctions between us. infancy I have been led to consider my sister as a being of a more elevated rank. I was suffered to grow up without the least

From my

instruction, while nothing was spared in her education. She had masters to teach her writing, drawing, music, and other accomplishments; but if by chance I touched a pencil, a pen, or a needle, I was bitterly rebuked; and more than once I have been beaten for being awkward, and wanting a graceful manner. It is true, my sister associated me with her upon some occasions; but she always made a point of taking the lead, calling upon me only from necessity, or to figure by her side.

But conceive not, Sirs, that my complaints are instigated merely by vanity. No; my uneasiness is occasioned by an object much more serious. It is the practice in our family, that the whole business of providing for its subsistence falls upon my sister and myself. If any indisposition should attack my sister—and I

mention it in confidence upon this occasion, that she is subject to the gout, the rheumatism, and cramp, without making mention of other accidents—what would be the fate of our poor family! Must not the regret of our parents be excessive at having placed 80 great a difference between sisters who are so perfectly equal? Alas! we must perish from distress; for it would not be in my power even to scrawl a suppliant petition for relief, having been obliged to employ the hand of another in transcribing the request which I have now the honour to prefer to you. Condescend, Sirs, to make my parents sensible of the injustice of an exclusive tenderness, and of the necessity of distributing their care and affection among all their children equally.

I am, with a profound respect,

Sirs,
Your obedient Servant,

THE LEFT HAND.

CHRONICLE.

Medicine.

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ALLEMAN (L. W.). Symptoms of Vascular Degeneration. American

Medicine, Feb. 20, 1904. This paper is the result of an inquiry into the physical condition of patients presenting vascular spasm of the retina and other slight departures from the normal which were found in association with sufficient frequency to form a reasonably distinct clinical picture. Such cases are divided into four groups which pass insensibly one into the other:

I. No organic retinal lesion, but a tortuosity of the smaller retinal arteries and their twigs; usually also a slight retinal haze.

II. A similar condition to I., but, in addition, more or less bending of the vessels where one crosses another. In many of these cases diminutions of the calibre of the vessels are noticeable, due to localised spasm, which may be transient or permanent. Sometimes while examining the fundus the observer is given the impression of a flash caused by a momentary decrease in the force of the retinal circulation. The writer has also noted a rhythmic rise and fall in the force of the circulation not corresponding to the pulse-beat. During the period of low pressure a multitude of glistening dots in the retina have been observed.

III. The curve at the crossings more pronounced, and the underlying vessel is somewhat obscured by the upper one. Spasmodic changes in calibre are not the rule; but in well-marked cases minute hæmorrhages are observable.

IV. In all cases presenting advanced vascular disease. Many lesions are found in this group, but there are three principal types (a) hæmorrhagic, (6) degenerative, (c) active, showing neuro-retinitis or intense papillitis and occasionally thrombosis.

The physical condition which gives rise to the first evidence of disturbed nutrition, visible in the fundus, is a high peripheral tension dependent upon, or associated with, improper elimination. The general symptoms of group I. may be absent or consist of lassitude, headaches, vague nervous symptoms and constipation. There is some disturbance of metabolism, which in the vast majority of cases is evidenced by a diminution in the elimination of urea. It is, however, possible that an abnormality of some of the less well-known elements in the urine will prove the more reliable indication, and that the diminution of the urea is a coincidence. The urine analysis should be repeated at intervals.

In group II, there is usually some ill-health, headache, mental hebetude and intestinal indigestion and its results. As a rule, no organic lesions are found.

In III. there is usually some discoverable evidence of vascular degeneration, the radial arteries are rather resistant, and frequently there is some cardiac hypertrophy. The urine shows low urea, low sp. gr., occasional presence of albumen, hyaline and even granular casts.

In IV. organic lesions are always found.

Another group includes patients who most unexpectedly develop advanced Bright's disease from no known cause, often in early life. They show degenerate retinal vessels with marks of previous inflammation, but no indications of active processes. Such cases are the result of a nephritis following exanthemata in childhood. Brief notes on a series of forty cases are appended.

J. GRAY CLEGG.

LEPINE and BOULUD. On the Absence of Hyperglycæmia in

Glycosuria Produced by Uranium Salts. Revue de Méd., 1904. The authors made a number of experiments with dogs in order to discover whether the glycosuria which is caused by toxic doses of uranium salts is, or is not, due to an increased amount of sugar in the blood. They found that uranium acetate acts in the same manner as phloridzin, only more feebly ; that is to say, that it does not cause hyperglycæmia, and, further, that it does not diminish the glycolytic power of the blood, but rather tends to increase it.

МАХІмо. On Alimentary Glycosuria in Enterica. Wratsch., 1904. The author tried the sugar-assimilation limit of a number of patients with enterica during and after the febrile periods, by giving 150 grammes of grape sugar to each patient and then examining the urine every two hours for the amount of sugar it contained. The urine of 18 patients was examined 27 times during the febrile stage, and 36 times during the non-febrile stage; the first group yielded 3, and the second group 9, in which the results were negative, so that alimentary glycosuria occurred in a large majority of cases. observed that complications in which the lungs were implicated favoured the occurrence of alimentary glycosuria.

It was

HOKE (E.). Uramic Symptoms with Peculiar Casts in the Urine.

Prager med. Wochenschr., 1904. A WOMAN, aged 23, was received into hospital with pains in the joints and a dull mitral murmur; the temperature was normal. In the course of a few days the temperature went up to 103°F., and the joint-pains

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increased considerably. The urine was normal. A fortnight after, the patient became unconscious, with violent convulsions and vomiting; a rough mitral murmur was now audible. The urine contained blood, kidney epithelium, epithelial casts and sugar; the albumin amounted to 0:08 per cent. The surface was pale, the lips were slightly cyanotic; there was no ædema. The heart was dilated, the apex-beat was in the seventh inter-costal space, outside the nipple-line. In the deposit from the urine a number of long, narrow, transparent casts were seen, thickly grouped together; some long, narrow, granular casts were also seen. The diagnosis arrived at by von Jaksch was mitral insufficiency and stenosis ; hypertrophy of both sides of the heart; kidney infarct due to embolism; uræmia and renal glycosuria. The patient rapidly improved, and in a little over a fortnight left the hospital with the indications of cardiac compensation, the urine being free from albumin and sugar.

von Jaksch considers that the rapid onset of uræmia in a patient with chronic endocarditis, together with the presence in the urine of the above described peculiar varieties of casts are characteristic of transitory disturbance of the circulation in the kidneys.

LE GOFF (J.). On the Organic Gases of Respiration in Diabetes

Mellitus. Compt. Rend., 1904. The quantity of acetone exhaled from the lungs in a severe case of diabetes was about half that excreted in the urine during the twentyfour hours. The author considers it probable that other organic gases than acetone, which also respond to Lieben's acetone-test, were present in the expired air.

LION (A.). On the Simultaneous Occurrence of Levulose and

Dextrose in Urine. Münch. med. Wochenschr., 1904. A case in which all the tests for sugar gave positive results, the urine being optically inactive, was found to be due to the presence of both grape and fruit sugars. Alimentary levulosuria was more pronounced than alimentary glycosuria. According to Ferrannini's view alimentary levulosuria is indicative of disease of the liver; this case afforded no support to that view. The author points out that the exclusive use of the polarimeter in the quantitative estimation of urinary glucose cannot be depended on unless the patient is known to be free from levulosuria.

J. Dixon MANN.

COOK (PHILIP H.). A Case of Epilepsy and Nephritis Simulating

Puerperal Eclampsia. Boston Med. and Surg. Journ., 1903.

p. 568. Vol. xlix. Good clinical notes are given of a patient who had an epileptic fit that suggested puerperal eclampsia. She was admitted to hospital in the first stage of labour with ædema of the legs and albuminuria. Labour

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