MEDICAL SOCIETIES Quasi-Insanity in Children.-At the last meet ing of the Medical society of Pensylvania Dr. Charles K. Mills, of Philadelphia, presented a paper on Some Forms of Insanity and Quasi insanity in Children. (N. Y. Med. Jour.). Hurd reports one from an account written by the patient herself. When about twelve years old she began to have strange fancies, as fearing that the blood flowing from a cut finger would harm those who came near her. Later, dressing, walking out of doors, eating, were all greatly interfered with through the same morbid ideas. She feared contagious disease because she might communicate it to others. The insistent idea changed from time to time, but seemed to spring always from the In a philosophical sense sanity and insanity are rela- emotion of fear. She eventually recovered. Hammond tive terms whether applied to children or adults. Cer- cites from King, of Sedalia, Missouri, an interesting tainly not a few may be properly regarded as on the case of pyrophobia in a boy of ten years old. Day and borderland between mental health and disease, and night he was infested with fear of this kind. On one these are perhaps best classed as examples of partial or occasion when the morning was cool he succeeded after quasi-insanity, forms of mental disease which in a cer- a contest with his mother in opening the stove door and tain manner and degree have the attributes of insanity. pouring a bucket of water over the fire. He is said to Quasi-insanity better expresses the idea than such terms have been cured by quinine, the bromides, and the use as partial or pseudo insanity, or borderland cases, for of evaporating applications to the head. the prefix 'quasi,' as used in English, indicates that the thing spoken of resembles or has the attributes of something without being the latter in the full sense. Some of the best examples of quasi-insanity are to be seen in those suffering from those affections which are shown by morbid doubts and morbid fears, and have been de scribed under many names, as folie du doute, introspective insanity; or as phobias in endless train-claustrophobia, agorophobia, pathophobia, pantophobia, etc. Some knowledge of these phobias and of what they import might be of value to many of my brethren not neu rologists to gynecologists and surgeons particularly. They are psychoses, which lead sometimes to oophorectomies and laparotomies, to uncalled for operations and treatments of various sorts on all parts of the body. They are abortive or imperfectly developed mental dis. orders. Sometimes they are as transient in duration as they are limited in phenomena; but in other instances a few elementary deficiencies or disturbances may persist without much change or increase through life Many of these cases, like certain morbid impulses, belong under the general head of paranoia. They have been described not only as morbid fears or phobias, and as morbid doubts or abulias, but also as emotional monomanias, and even as forms of neurasthenia. They are fundamentally dependent upon the domination of the mind by morbid concepts and insistent ideas. They are sometimes observed among young children, although more common after than before the period of puberty. Their most striking illustrations occur in those who have not been subjected to any physical or mental strain sufficient to break down a healthy organization. Persistent fear of the monomaniacal type occurring in children is rarely due to overwork at school, as is frequently supposed. The cause is generally in the child's progenitor or progenitors. A boy, eleven years old, developed what was practi cally a pantophobia, although his disorder exhibited itself chiefly aa a pathophobia, or fear of disease. He was kept almost constantly in the hands of physicians. Sometimes his morbid ideas revolved around real affec tions of slight importance; sometimes his fears and suffering were due purely to morbid conceptions and insistent ideas. Now his eyes were the source of morbid dread, and soon his limbs were the seat of rheumatic pain; he narrowly escaped, after solemn consultation, a laparotomy for 'typhlitis,' a case of strange metastasis, as the typhlitis was probably in his head. To a moderate degree he suffered from mysophobia, spending unusual time at his ablutions, teeth cleaning, dressing, and in the care and arrangement of his clothes. Anything in the nature of a symptom or a disease mentioned in his presence was likely to take possession of him. His morbid notions and apprehensions were fed and en couraged by the unceasing attention of members of his family. He was the only son of a widow, and was under the tutelage of a mother, a maiden aunt, and a grandmother, probably the worst board of management for a pathophobic boy that could have been chosen by per verse fate. He was practically cured by taking him from his home surroundings, disregarding his complaints, forcing him to do things on time and after the manner of others, at the same time carefully but not obtrusively looking after the general health. Another boy, at the age of ten, began to develop the scrupulous and mysophobic type of monomania; in fact, he was, as so many of these cases are, an illustration of an admixture of several of the so called classes of morbid fears. He was constantly worrying about many things that he said and did in his intercourse with others. If left alone, he would spend hours in bathing and washing himself; and often imagined that he had Not infrequently several of the so-called varieties are been polluted or would contaminate others. The symppresent at the same time, in the same case, and some toms were in many respects like those of the lady decases belong to a class which has been well described as scribed by Hammond, and to whose case he first applied pantophobia, or fear of everything. the term mysophobia-who could touch nothing without As to cases observed in comparatively young children being irresistibly impelled to wash her hands, and who in many other ways was tormented by the fear of contamination. This boy improved greatly under mental discipline, outdoor exercise, and careful tonic medication. It may be necessary sometimes to separate a form of juvenile dementia the result of inherited syphilis from idiocy and imbecility, whether of syphilitic or other origin, which may commonly be done by the fact that the dementia usually comes on after the child is four or five years old, and therefore when the mental condition has been determined not to have been that of idiocy. In rare cases, it happens that a juvenile or infantile de mentia occurs when the child is two or three years old -so young that its true mental status has not been fully determined. With this word of caution as to the possibility of inherited syphilis showing itself in a child otherwise healthy in the first year or two of its life, most of the cases of this form of dementia will be comparatively easy of recognition. A family history of syphilis will often but not always be obtained. Often the upper incisors will be pegged and notched, and cicatrices at the angles of the mouth, and the characteris tic physiognomy be present; the child will have attacks of keratitis, chorioiditis, or iritis, or a history of snuffles, or of a rash; and sometimes epilepsy will have developed. The Evolution of Surgical Principles was the subject of Dr. G H. Hume's address in surgery, delivered on August 3rd before the British Medical Asso ciation. In the course of his address, (Brit. Med. Jour.) Dr. Hume said: justly described as a man of theory. And yet theories which become the motive or suggestion of surgical action are surgical principles, and these may be sound or unsound according to the character of the views upon which they are based. In so far as surgery is applied science, the data from which surgical procedures spring are in the strictest sense scientific principles; and we find that surgery advances by precisely the same methods as all other practical sciences. We have our inventions, our appliances, our practical details upon which an ever increasing ingenuity and industry are expended. We have also sometimes our discoveries in medical or collateral science, which become the inspiration or rallying point of great practical advances. But the phrase covers more even than scientific data. The definite ends or objects of surgical action which are proper under given circumstances belong to the princi. ples of surgery. So also do rules of procedure which the gathered experience of the past and present prescribes or sanctions. The mode of formation of surgical principles is therefore a double one. They may arise like a superstructure upon a foundation of scientific knowledge, or they grow down out of experience to be themselves part of the foundation. They are the mainsprings of action; and so far from being alien to practical efficiency, they are at once its inspiration and guide. One of the not least important surgical principles dictates. scrupulous attention to the minutest practical detail; and he who, knowing that a life may hang on the integrity of a stitch, concerns himself anxiously about the method or material of a suture is only acting in faithful obedience to surgical principle. The mode of growth of scientific principles can find It is our frequent boast that surgery has become, and is becoming, more scientific, and by an appeal to our results we justify the claim. But the science of surgery-no better illustration than in our modern doctrines of and by the phrase we mean the principles of surgery-is nearly altogether the growth of the century that has fol lowed Hunter's death, and its growth has been by no means one of continuous or steady progress-rather, as Inflammation-which, though pondered and labored surgical repair. The beginnings of these doctrines may be traced far back in the history of surgery. But it was by Hunter's work and in the pages of that Treatise on is usually the case in the development of scientific truth, through many previous years, as was Hunter's way, was it has been by fits and starts. The greater part of the not published till the year of his death-that the real work has been done in our own generation. And now, beginning was made. Hunter's statement that primary with regard to much of the art of surgery, it rests on healing takes place without inflammation contains the principles so worked out and firmly established that the germ of what we believe and act upon now. It did not, claim to scientific position can be made good. But with of course, go far enough. It defined the relationship regard to much also we are still only struggling toward between what was then, as it is now, ideal healing and scientific truth. In speaking, therefore, of the develop. inflammation, in the sense that no relationship can or ment of surgical principles I shall endeavor to illustrate both classes-both those principles which, being in a sense perfected, have issued in enhanced success; and those also toward which we are still groping, and by which we have not yet been guided out of difficulty and uncertainty. The principles of surgery is one of those elastic phrases which carry to our minds a fairly exact meaning, but to which we find it hard to give a concise definition. We certainly do not use it as the equivalent of theory. The surgeon who, thinking himself well versed in surgical principles, and therefore prepared to act in the best manner for the best reasons, would not consider himself does exist between them all. But there is no such definite expression to be found in Hunter's writing with regard to the modes of secondary healing. Hunter, I think, believed, as did most of his successors down to the last few years, that a certain degree of inflammation was necessary for these delayed forms of healing. Indeed, from Hunter's time there was a falling away from the faith, and we find the most philosophical surgical opinion as represented by Travers holding that a 'subdued state of inflammation favors healing,' and that to supersede it would effectually retard or preclude' the process of repair. I am sure, sir, that to many in this audience it may seem to demand an apology that I should even mention tion I have briefly sketched is the antiseptic system. in their hearing the name of inflammation. I may ap pear to be abusing my opportunities in carrying them. Mississippi Valley Medical Association. back to their earlier days when inflammation was the -The nineteenth annual meeting of Mississippi Valley bugbear of their surgical studies, a true surgical pons Medical Association will take place at Indianapolis, asinorum. But I plead in excuse that down to a recent Ind., October 4, 5 and 6, 1891. President, R. Stansbury period the ideas of healing and the ideas of inflamma- Sutton, M.D., Pittsburgh; Vice Presidents, W. N. Wishtion seemed in the very nature of things to be insepa- ard, M.D., Indianapolis, W. S. Christopher, M.D., Chirably interwoven. It turns out that they were only cago; Secretary, Frederick C. Woodburn, M.D., Inneedlessly entangled, and ideas which in the time of dianapolis; Committee of arrangements, H. M. Lash, their confusion belonged mainly to the region of theory M D., O. G. Pfaff, M.D., Theo. Potter, M.D., Geo. W. have since proved to be matters of the most eminent Vernon, M.D. practical importance. The process of disentangling The General Sessions will be held in Plymouth The Surgical Section will meet in Plymouth Church. The Medical Section will meet in Meridian Street Church, southwest corner Meridian and New York streets. The Section Obstetrics, Gynecology and Abdominal Surgery, will meet in Plymouth Church. The sections will meet daily at 10:30 A. M., with the exception of the first morning, when there will be no meeting of the sections. The Registration Hall will be in the Denison Hotel, southeast corner Pennsylvania and Ohio streets, which has been selected as the general headquarters. began in and proceeded with the elucidation of the true Church, southeast corner Meridian and New York nature of inflammation and its consequent suppuration. streets, at 10 o'clock on the opening morning, and at There was a time when the four classical symptoms of 9 o'clock on the two succeeding mornings. pain, heat, redness, and swelling summed up nearly all that was known of the process of inflammation. Then followed the anatomical era, the time most fruitful of bewilderment to the student, in which, thanks to rapid improvement in the methods of microscopical investi gation, attention was concentrated in the blood stasis, the changes in the tissues and in the vessel walls, and on the out-wandering of the white corpuscles. An intermediate stage followed this in which, clinically and experimentally, the suppurative processes were recognized to be infective in their nature. And this culminated on the period in which we now find ourselves when the whole process is demonstrated to be due to the agency of micro organisms. One point, however, remains to be cleared up. Is the febrile access which follows an asep tic operation, sometimes sharp in degree though short in duration, to be looked on as the result of inflammation? There is no ground for supposing it to be an infective process the same in kind and different only in degree from that which always tends to suppuration. If different in nature it should also be distinguished in name, and there is much to justify the proposal to restrict the word inflammation to those changes which result from the action of septic organisms, while the other and simpler process under some such title as traumatic reaction demands further examination for the clearing up of its intimate character. Such a defined use of the term would end the confusion which has hitherto attended the conception of inflammation as a disease, and would rest the idea to which the word corresponds on the sure ground of etiology. The Committee Rooms will be in the Denison Hotel. The Exhibit Hall will be in the spacious building on the southwest corner Pennsylvania and Ohio streets, directly opposite the Denison Hotel. ENTERTAINMENT.-Wednesday evening, October 4, the profession of Indianapolis will give a reception and collation in honor of the visiting physicians and ladies at the Denison Hotel. Thursday evening, October 5, Col. Eli F. Lilly will give a reception. HOTELS.-Hotel Rates will be from $1.50 to $3.00 a day. The Secretary, Dr. F. C. Woodburn, of Indiana. polis, will take pleasure in securing accommodations for any who may desire them secured in advance. RAILROADS.-Reduced railroad rates may be obtained on the following conditions: Each person must purchase a first-class ticket to Indianapolis, for which he will pay full fare, at the same time requesting the ticket agent to furnish him with a certificate of such purchase. This certificate will be signed by the secretary of the meeting and viseed by the agent of the Central Traffic Association, which will entitle the holder to a return ticket at one third the regular rate of fare. Tickets should not be purchased earlier than three days before the meeting. Tickets are good three days after the adjournment of the meeting. Naturally with the true knowledge of inflammation and suppuration have come clearer and more accurate views with regard to the process of repair. Not alone in primary adhesion but in all forms of healing it is seen that inflammation is never a help, and can only be a hindrance, and that if it occurs repair must take place in spite of it, or be delayed until it has passed away. We have gone back upon Hunter's dictum, only we have given it a more extended, or rather an unrestricted, application. The surgeon's part, therefore, is now not to treat but to prevent inflammation and sup- President's Address-Fibroid Tumors of the Uterus, puration, and the practical side of the scientific evolu- | R. Stansbury Sutton, M.D., Pittsburg. Be sure to ask the ticket agent to furnish you with a certificate, as no refund of fare will be made because of failure to obtain one. Address on Medicine. Jas. F. Hibbard, M.D., Rich. mond, Ind. Address on Surgery-The Anatomy and Surgical Treatment of Inguinal Hernia in the Male. Henry O. Marcy, M.D., Boston. A great many papers have been announced and judg ing from their titles the meeting promises to be very interesting. The Indian Territory Medical Association.-At the next regular semi-annual meeting of this association at Muskogee, Ind. Ter., Thursday and Friday, December 14 and 15, 1893, the following programme will be presented: Cerebro Spinal Meningitis, J. C. Robinson, McAlester, I. T.; Discussion opened by J. S. Fulton, Atoka, I. T. Enteritis, G. R. Rucker, Eufaula, I. T.; Discussion opened by Oliver Bagby, Vinita, I. T. NOTES: AND ITEMS A Gift from Professor Czerny.-Dr. Czerny has sent a contribution of twenty dollars to the Gross Monument Committee, as a mark of his "admiration for the man and the surgical work which he has done." Dr. W. H. Galt, for years City Health Officer of Louisville and a member of the Faculty of the Louisville Medical College, died September 14, in that city, of erysipelas. He was 65 years of age. Dr. Galt was prominent as a health official, and was known in all the larger cities. The Johns Hopkins Medical School.-Johns Hopkins University will open its new medical depart Miner's Fever, L. C. Tennant, McAlester, I. T.; Dis- ment next October. The regular course in this school cussion opened by M C. Marrs, Claremore, I. T. Laceration of Cervix Uteri, D. H. Burke, Webber's Falls, I. T.; Discussion opened by C. P. Linn, Clare more, I. T. Uterine Displacements, M. F. Williams, Muskogee, I. T.; Discussion opened by L. A. Hamilton, Pryor Creek, I. T. is to be four years, and women are to be admitted on the same footing as men, and on the same conditions; a collegiate degree or evidence of an equivalent education. Dr. Henry B. Millard, the eminent medical authority and one of the foremost physicians of New York, died in Paris, France, September 14, of typhoid fever. He was on his regular annual trip abroad and Dr. Millard's most lasting was about to return home. production was "A Treatise on Bright's Disease," pubDis-lished in 1884. He was a specialist in that disease. Osmotic reatment of Uterine Inflammation, R. I. Bond, Hartshorn, I. T.; Discussion opened by R. L. Fite, Tahlequah, I. T. Symphysiotomy, B. F. Fortner, Vinita, I. T.; cussion opened by M. P. Haynes, Vinita, I. T. Vesical Calculus, W. H. Harrison, Webber's Fall, I T.; Discussion opened by J. R. Blakemore, Muskogee, I. T. Ocular Headaches, H. Moulton, (Specialist) Ft. Smith, Cataract, F. B. Tiffany, Kansas City, Mo. F. B. Fite, President, Muskogee, I. T.; Oliver Bagby, Distinguished Visitors.-The profession will be surprised to learn that Drs. H. Knapp and Helmholtz, the inventors of the ophthalmoscope, recently made a meteoric visit to this city. On the morning of Tuesday, the 12th inst, the arrived from Denver, Col., in company, and having spent the day in St. Louis, they, in the evening continued their journey to New York. Their presence was, so far as we have learned, revealed only to Dr. James P. Parker. We regret their tarry was so short, for the profession would in some suitable manner have honored these luminaries in ophthalmology of two countries, had opportunity been afforded by prior information of their proposed advent and the tarry of even a few days in the city. D. A Case of Supernumerary Spleen.-Surgeon G. Harry Younge reports the following case in the British Medical Journal (Med. Rec.): Private M. D— was admitted into the Station Hospital, Malapuram, March 28, 1893, suffering from enteric fever. From the Death of a Medical House-Officer.-Another first the range of temperature was very high, and the sad case of death during hospital duty is reported from symptoms very severe. He died April 4, from hyperLondon. Mr. Arthur Durham, a brilliant graduate of pyrexia, his temperature at the time of death being Christ's College, Cambridge, and of Guy's Hospital, 108° F. The post-mortem examination showed unusudied August 11, while on duty as medical house officer ally deep and extensive ulceration of Peyer's patches at the London Fever Hospital, after an illness of only and the solitary glands, several of the ulcers varying four days, from virulent diphtheria contracted from a from one to one and a half inch in diameter. There patient. was hypostatic pneumonia of both lungs. The left lung ! was firmly adherent to the parietes and diaphragm over other children that were vaccinated at the same time its entire surface. A mass of calcified tubercle as large presented no abnormal manifestations. as a hazel-nut was found in its apex. The spleen weighed fifteen ounces, and was congested and friable The Administration of Anesthetics.-The Lying almost in contact with its lower border was a following deductions (Lancet, No. 3642, p. 1498) have supernumerary spleen. The latter was one and a quar been arrived at by the Commission appointed by the ter inches in diameter, was perfectly circular in shape Lancet to investigate from a clinical standpoint the without any attempt at a hilum, was attached to the subject of the administration of chloroform and other spleen by a distinct fold of peritoneum, and was sup; anesthetics: The death-rate under anesthetics has plied by a special branch from the splenic artery. On heretofore been unduly high, and may be lowered by being cut into it presented the usual appearance of a improved methods and greater care. Ether is the safest spleen which was congested and friable. Charity-Organization.-All who are interested in charity organization, the proper distribution and use of alms, the sanitary improvement of the poor, the proper relations of the hospitals to the community, etc., should procure a copy of the Fifteenth Annual Report of the Charity Organization Society, of Buffalo, N. Y., a pamphlet that shows what noble efforts are being made and what splendid success is being achieved in the special fields chosen. Every city should have such a society, and physicians should be leaders in the move. ment. Congenital Absence of Nails.-Dr. Herman Eichhorst reports in the Centralblatt f. Klinische Medi cin of April 8, 1893, the case of a man, twenty-six years of age, who had no nails on either fingers or toes. The nail-bed and fold were well formed, and the former presented a shiny surface, giving the appearance of a very thin nail. Close examination, showed, however, that there was not the slightest trace of a nail. the skin of this part being softer and more delicate even than the surrounding integument. Sensation was also as acute here as on the palmar surface of the fingers. The man's hair and teeth were perfectly normal. Acute Nephritis after Vaccination.-Perl (Berliner klin. Wochenscr., No. 28, 1893, p. 674) has reported the case of a child, two and three-quarter years old, which was vaccinated for the first time. The child had been rachitic, slow in learning to walk, and had suffered a great deal with eczema, but at the time of the operation it was in perfect health and well nourish ed. Four days later the little one became restless,com plaining of pains in the abdomen and back and appearing feverish. On the following day vesicles were visi ble at the site of vaccination. It was also noticed that the urine was scanty, turbid, brownish, and deposited a heavy sediment. On examination, its specific gravity was found to be 1016, and albumin in the proportion of 1-2 per cent was detected, together with blood coloring matter. Microscopic examination disclosed the presence of red and colorless blood-corpuscles and numer ous hyaline, epithelial, and blood tube-casts. With rest in bed and a milk diet these manifestations disappeared in the course of a week, and the child recovered per fectly. The vaccination pursued its usual course. Three anesthetic in temperate climes for general surgery, when properly given from an inhaler permitting graduation of the strength of the vapor. Nitrous oxide gas should be employed for minor surgery. Chloroform is a com. paratively safe body when given by a carefully trained person, but is not in any case wholly devoid of risk. No age or nation is free from danger under anesthetics. The perils of anesthesia, however slight, demand that the undivided attention of a duly qualified and trained medical man should be given to the administration of the anesthetic. Suggested Cremation of the Remains of Consumptives.-At the recent International Congress on Tuberculosis, one of the questions discussed was the necessity for the obligatory cremation of the remains of consumptives (Med. Times and Hosp. Gaz.). Earthworms, it was urged, bring to the surface the ba cilli which infest the dead body, and in dry weather they may be inhalee in the form of dust. This, it is suggested, is the reason why the health resorts of the South of Europe are centres of tubercular contagion. Doctors Lortet and Depugnes, of Lyons, related cases of such infection, and described experiments they made which led them to demand obligatory cremation. They mixed the sputa of consumptives in earth, which they placed in pots. A month later the earthworms in them were tnbercnlar, and the earth they passed through communicated the disease to animals. Other experi ments were made by placing earthworms on graves where bodies of those who had died from consumption had long laid, and it is said the results were confirma. tory of the possibility of contagion being conveyed in this manner. Migraine with Recurrent Palsy of the Third Nerve.-At a recent meeting of the Ophthal· mological Society of the United Kingdom, Snell (Brit. Med. Jour., No. 1698, p. 118) reported two cases in which attacks of migraine were attended with paralysis of the third nerve. One case was in a man, twentyseven years old, who had had attacks of migraine from the age of ten years, during the last seven of which the eye had been closed in the attacks. These occurred at first at intervals of about eight weeks, but subsequently every two or three weeks, and lasted three or four days. The palsy of the third nerve was practically complete, there being ptosis and paralysis of the ocular muscles, |