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THE CANADA LANCET.

A Monthly Journal of Medical and Surgical Science Criticism and News.

Communications solicited on all Medical and Scientific subjects, and also Reports of Cases occurring in practice. Address, DR. J. L. DAVISON, 12 Charles St., Toronto. Advertisements inserted on the most liberal terms. All Letters and Remittances to be addressed to DR. C. SHEARD, 320 Jarvis St., Toronto.

AGENTS.-DAWSON BROS., Montreal; J. & A. MCMILLAN, St. John, N.B.; GEO. STREET & Co., 30 Cornhill, London, Eng.; M. H. MAHLER, 23 Rue Richer, Paris.

TORONTO, AUGUST, 1889.

The LANCET has the largest circulation of any Medical Journal in Canada.

THE CARE OF THE INSANE. The ponderous mechanism of the existing laws for the admission of an insane person into one of our asylums, has been dwelt upon at considerable length at various times, in both the professional and lay journals of Canada. That the present methods are not as facile as they should be, or as indeed they might be, is evident to any one who has had the painful experience of committing a patient suffering from mental alienation. But great bodies move slowly, and the amount of conservatism displayed by our legislators in this matter compares favorably with that of the oldline Tories, who would gravely discuss for hours the advisability or not of changing the number or style of buttons on the soldier's coat, or the regulation length of his hair. And this weary delay of the law exists, notwithstanding the fact that the medical profession is, and has always been well represented in our legislative halls. It would have been reasonable to suppose that some one of these legislators, who belong to our profession, would long ago have succeeded in sweeping away some at least of the old-time barriers, and making the sad road to the asylum as short and as little unpleasant as possible.

It would seem that the present methods are intended to protect the individual. But it should be remembered that the community also has rights to be considered. Insanity means danger to the community, and while the individual should be protected to the fullest extent, the community

should also be so guarded, that the terrible consequences of alienation in the individual may not endanger life or property.

The difficulty seems to lie in the magisterial supervision of those held to be insane. The question of sanity or insanity is surely a medical one, no layman, be he judge or magistrate, being considered competent to pass an opinion as to the fact. So that the medical testimony is, after all, the only one which has weight. Why then should there be so cumbrous a method of committal ? Have we not all seen the evil results of the delay in treatment in certain cases demanding prompt attention by experts? The month, or perhaps more, during which the unhappy lunatic lies in jail, may be so many days spent with the worst possible surroundings, during which the chances for his eventual recovery become greatly lessened.

There can be no doubt that the "painful and harassing procedures," now necessary for the admission of a patient to the asylum, are the cause of the retention at home of many lunatics who, both for their own, as well as their relations' sake, would be much better under the special environment and treatment of an asylum. But parents and friends hesitate to open up the case of a son or daughter who begins to show symptoms of mental derangement, or of à wife suffering from, say, puerperal mania, to the magisterial function of their neighborhood, and thus many valuable days are lost for early treatment, days which can perhaps never be recalled, and which may, by their inactivity, doom the unhappy sufferer to a life of alienation, which might, with early special treatment, have been averted. There certainly exists a strong prejudice in the minds of a majority of the community against sending a relative or friend to an asylum. This prejudice is no doubt the result of the education of generations regarding the insane, heredity, etc. It should be the duty of the profession to do battle with such prejudice, and educate the laity up to the idea that insanity is a disease requiring prompt and special treatment by experts, with proper environment, and that the so-called kindness of keeping a dement at home is, in nearly every case, an absolute injustice, not to say cruelty to the sufferer, as well as fraught with danger to all those with whom he comes into contact.

DIPHTHERITIC PARALYSIS.

The cause of this frequent sequela of diphtheria is not well understood. It is most probably a neuritis migrans, as Fagge called it. This theory would go to show that a morbid process, starting in the part most affected by the diphtheritic poison, travels along the fibres until the centres are reached. Trousseau pointed out that when the disease was cutaneous, the limbs were affected as early as the fauces. As against the theory that it is due to a general systemic poison, we have the fact that faucial paralysis is the rule, and true paralysis has been known to follow an abscess of the tonsil, as also a case of parotitis. Some authors assert that the paralysis occurs after the primary disease has ceased; but this is certainly not true, although in many cases it does not show itself till the patient is thought to be well. It not unfrequently begins, says Sanné, on the fifth or sixth, or even as early as the second day from the beginning of the diphtheria,

in this form of paralysis has not been materially changed. A few years ago, the necessity of injecting the strychnia into the tissues was urged,

but it is doubtful if the benefit derived from this

drug is much if at all increased by this method of administration. Perhaps the syr. ferri, quin. et strychniæ phosphat. is as useful a preparation as any, combining as it does the specific action of the strychnia with the useful tonic action of the other ingredients of the syrup.

Oertel objects to the use of either strychnia or nux vomica, depending upon ferruginous and other tonics; but the consensus of opinion is strongly against him. Massage of the limbs, stimulating baths as of warm salt water, and electricity are all useful in their place. The patient may have to be fed for weeks through the stomach-tube or per rectum, the most perfect nutrition possible being a sine qua non in the management of such cases.

THE VIRTUE OF THE PROFESSION.

It has been all along looked upon as having a The men of the medical profession are rarely favorable prognosis. But recent observation would credited with the virtue that their conduct entigo to prove that it is a very serious matter. The tles them to; there is no profession or occupation staff of the Great Ormond St. Hospital have con- beset with so many temptations and opportunities cluded that, in children especially, it is attended as ours. The doctor is made the repository of the by dread possibilities. The organs supplied mainly family secrets and the misdoings of the patients. by the pneumogastric and phrenic nerves, viz., With closed doors and drawn window blinds in heart, lungs and larynx, are the ones through the doctor's private office, the lady patient describes which danger comes to the sufferer. Cases of her symptoms and relates in detail any circumheart failure or paralysis; of pneumonia whether stances that may stand in a causative relation to from disturbed innervation or from the irritation a disease peculiar to her sex. During a long course of the lungs by inhaled matters, the larynx of treatment there springs up, by gradual growth, having lost the power of properly protect a simple familiarity which may ripen into an ading these organs, are frequent, and extremely miration on the part of the patient, encouraged by dangerous. The muscles of respiration are some- the kind and gentle treatment and sympathetic times attacked, giving a panting, difficult breathing manner of the benevolent physician. With this as the result. Death may come on by more or less state of facts, which are not in the least overslow degrees in this way, accumulation of mucus drawn, it is highly creditable to the profession from want of functional activity of the lungs, that so few violate their trust and take advantage cyanosis and asphyxia. When the heart is the of the weakness of the gentler sex under these cirseat of the trouble, there is, says Duchenne, a cumstances. We do not pretend to say that the sense of cardiac oppression and distress; small, physician is purer by nature than men of other slow, irregular pulse, becoming at times thready professions, but through their special education, and imperceptible. The cardiac lesion is perhaps and the sense of honor inherent in every rightthe most serious of the whole series, for though it minded man, they learn to exercise self-denial with may be cured, death is the usual result. Some- those whose physical welfare is committed to their times this organ is alone paralyzed. charge. Opportunities for blackmail are fruitful The treatment which has so long been followed under the above conditions, yet few are improved.

The clergy, we are sorry to say, suffer tenfold more scandals than physicians, notwithstanding that they are the physicians to the moral and spiritual being. They assume to build up what, sad to relate, some of them destroy by a single misdeed. When we pause and look into the retrospect, and compare the moral conduct of the medicai man towards his clients with other professions and occupations in life, we are proud to announce our profession as a physician.

CANADIAN MEDICAL ASSOCIATION.-The follow

ing are the papers promised for the meeting of C. M. A., at Banff, August 12th, so far as heard

from:

The Endemic Fern of the North-West Territories (Mountain Fern), Dr. A. Jukes, Regina, N. W. T. The climate of South Alberta, with special reference to its advantages for patients with pulmonary complaints, Dr. G. A. Kennedy, McLeod. Traumatic Inflammations of the eye and their proper treatment, Dr. John F. Fulton, St. Paul, Minn. Hæmatoma of the Vagina and Vulva, Dr. A. W. Wright, Toronto. A case of Empyema successfully treated by free incisions, Dr. James Ross, Toronto. The early recognition and treatment of Epithelioma, Dr. L. Duncan Bulkley, New York city. The relief of pain in Eye and Ear affections, Dr. R. A. Reeve, Toronto. Sulfonal, Dr. James Stewart, Montreal. Nephrolithotomy, Dr. F. J. Shepherd, Montreal. tigo, an eye and ear symptom, Dr. J. W. Stirling, Montreal. A Resumé of a few surgical cases, Dr. E. A. Praegu, Nanaimo, B. C.

Ver

SULPHONAL AS A HYPNOTIC. -The Swiss correspondent of the Br. Med. Jour. says that Drs. Paschoud and Claret read a paper on the use of sulphonal in insanity, in which they stated that the drug is of great service, especially in maniacal excitement, and in the insomnia of melancholia, as well as in every kind of sleeplessness of nervous origin. When given in a dose of 2 grammes (which, if necessary, may be safely repeated once or twice in 24 hours), sulphonal produces calm and refreshing sleep, lasting from 4 to 5 hours. The remedy caused no digestive, respiratory, or vascular disturbances, nor any unpleasant subjective sensations on awakening.

QUININE IN PREGNANCY.-The idea that full doses of quinine are liable to produce abortion seems to be no longer held. A writer to the Br. Med. Jour. says, "I have frequently, both at home and abroad, administered large doses of quinine (10 to 20 grains) to pregnant women suffering from malarial fevers, and never observed the uterus at all stimulated by it. I do not know of any drug that will cause, when taken internally, the expulsion of the contents of the pregnant uterus."

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as follows:

R.-Calomel

Digitalis

2 grains. grain.-M.

S.-Every three hours for a week.

The diuretic action of this combination is far greater than that of either drug alone and can also be tolerated longer and better than either drug when taken by itself.

PROLONGED GESTATION.--Dr. Mans (V. Y. Med. Jour.) gives a case of prolonged gestation which he thinks can be authenticated. The period of pregnancy, calculating from the time of last menstruation, was 334 days. At the end of this time the patient bore a healthy male infant weighing nine pounds. This almost breaks the record, though. Simpson mentions a case in which delivery occur

red 336 days after menstruation ceased. Playfair sociation. The doctor read a paper which will places the extreme limit at 295 days. appear in a subsequent issue of this Journal.

PRINTER'S ERROR.-In the Announcement of Trinity Medical College, just issued, the reference to Dr. Spilsbury's course of practical instruction in diseases of the throat and nose (at page 19) is marred by the accidental introduction, by the printer, of the Dr.'s name before the word "instruction." Any one can readily see that it is a printer's blunder. That the teaching will be good and practical, the students will soon discover, Dr. Spilsbury's protracted training in Europe for his. work having specially fitted him for this post.

WOMAN'S MEDICAL COLLEGE, TORONTO.-The following gentlemen have been appointed to positions upon the staff of this institution: Dr. Atherton, Lecturer on Principles of Surgery; Dr. Powell, Associate Lecturer on Practice of Surgery; Dr. B. G. McKenzie, Lecturer on Orthopaedics and Surgical Anatomy; Dr. R. S. Tyrrell, Lecturer on Jurisprudence; Dr. L. M. Sweetnam, Lecturer on Therapeutics.

FOR TONSILLITIS. - Dr. John Aulde recommends (Med. Reg.) the following as a useful medicine and gargle in this troublesome complaint:

R.-Tr. guaic. ammoniat.

Tr. cinchonæ comp.
Potas, chloral.

Mel. desp.

Pulv. acacia
Aquam.

aa fiv.

3ij. fōiv.

q. s.

q. s. ad fziv.

M. Sig. Use as a gargle, and take a teaspoonful every two hours.

ATROPINE IN HÆMORRHAGE FROM THE LUNGS.Dr. Stirling says the Therap. Gaz. relates a case in which hemorrhage from the apex of the left lung was entirely uncontrollable by ergotin, and all the other remedies usually prescribed. He administered ʊ grain of atropine, hypodermi cally, with the result that the bleeding was at · once stopped. He found that when the drug was stopped the bleeding recommenced, to be controlled by a further use of the atropine.

The name of Dr. Buller, of Montreal, was inadvertently omitted in our last number from the list of those attending the Ontario Medical As

HONORS TO RICHARD QUAIN.-The Queen has been pleased to appoint Richard Quain, M.D., LL.D., F.R.S., Fellow of the Royal College of Physicians, to be one of Her Majesty's Physicians Extraordinary.

Books and Lamphlets.

WOOD'S MEDICAL AND SURGICAL MONOGRAPHSConsisting of original treatises and complete reproductions in English, of Books and Monograph selected from the latest literature of foreign countries, with illustrations, etc. Published monthly at $10 per year. Single copies $1.00. New York: William Wood & Co., 56 & 58 Lafayette Place. Toronto: Vannevar & Co.

In our March issue we noted the January and February volumes of these Monographs. We have lately received the March, April, May, June and July numbers. We can only reiterate what we then said as to the character of these productions; their excellence is made the more manifest, as they continue to appear, while their cheapness and attractiveness are undoubted. The contents of the various numbers are as follows: MarchNeurasthenia and its Treatment; Antipyresis and Antipyretic Methods of Treatment, by Dr. H. Von Ziemssen; the Tongue, as an Indication of Disease, by Dr. W. H. Dickinson; On the Treatment of Cystic Goitre, by T. M. Hovell, F.R.C. S.; New Remedies from 1878 to 1888, by Dr. C. Cauquil. April-On Diabetes and its connection with Heart Disease, by Jacques Mayer, M.D.; Blenorrhoea of the Sexual Organs and its complications, by Dr. Ernest Finger. May-On the Preventive Treatment of Calculous Disease and the use of Solvent Remedies, by Sir Henry Thompson, F. R. C. S., M.B., London; Sprains; their consequences and treatment, by C. W. Mansell Moullin, M.A., M.D. Oxon. June-General Orthopedics, including Surgical Operations, by Dr. August Schreiber, Surgeon-in-Chief to the division of the Augsberg Hospital. 388 illustrations. July-Cancer and Cancerous Diseases, by Sir Spencer Wells, Bart., F.R.C.S.; Cardiac Dyspnoea and Cardiac Asthma, by Dr. S. Von Basch; The Influence of Menstruation and of the Pathological Condition of the Uterus on Cutaneous Diseases, by Dr. L. Grellety; Tension as met with in and Intracranial Injuries, by T. Bryant, F.R.C. Surgical Practice, Inflammation of Bone, Cranial S.; Antisepsis and its Relation to Bacteriology, by Dr. J. Neudorfer.

THE

A Monthly Journal of Medical and Surgical Sciet

Vol. XXI.
No. 9.

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BROMIDIA

FORMULA - ·

DOSE

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THE HYPNOTIC.

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PAPINE

THE ANODYNE.

Papine is the Anodyne or pain-relieving principle of Opium, the Narcotic and Convulsive elements being eliminated. It has less tendency to cause Nausea, Vomiting, Constipation, etc.

DOSE

(ONE FLUID DRACHM)— represents the Anodyne principle of one-eighth grain of Morphia.

INDICATIONS Same as Opium or Morphia.

FORMULA

IODIA

-

THE ALTERATIVE AND UTERINE TONIC.
Iodia is a combination of active Principles obtained from the Green Roots of
STILLINGIA, HKLONIAS, SAXIFRAGA, Menispermum and Aromatics. Each fluid
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One or two fluid dracums (more or less as indicated) three times a day, be-
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DOSE

INDICATIONS Syphilitic, Sorofulous and Cutaneous Diseases, Dysmenorrhea, Menorrhagia, Leucorrhea, Amenorrhea, Impaired Vitality, Habitual Abortions and General Uterine Debility.

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