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that came under his observation he was able to say that in ninety per cent there were morbid hereditary influences present.

Pathologic research has shown that in the idiot there is a paucity of imperfectly developed and irregularly arranged nerve cells and processes, but in the imbecile the cells more nearly approach the normal in both number and degree of development, the principal change being an irregularity of arrangement. He thinks there is no doubt that the degrees of pathologic change cause the variations of mental capacity which exist in the different types, and while the idiot is capable of little beyond reflex action the higher grade imbeciles are possessed of good perception, of memory, of emotion and of ideation. They are, however, deficient in the power of concentration, of continued application and of comparison. Their appreciation of their surroundings is therefore inaccurate and their iriglier faculties of deliberaton, judgment and control reman undeveloped. This absence of the higher faculties and the consequent absence of the inhibitory action over ideation and emotion seriously endangers the individual's sanity. In uncontrolled ideation the primary idea rapidly assumes such dimensions as to entirely alter the individual's mental attitude toward his surroundings, hence delusions result and may be of identity or persecution, fixed or rapidly changing, and their existence soon brings about a condition of mania or melancholia. Hallucinations often figure largely in the ideational type of insanity.

Uncontrolied emotional actions characterize another class. Emotional storms of a transient nature may be present before the actuai outbreak of the insanity, and though of short duration are closely allied to true insanity. In the course of time these outbreaks become more severe and prolonged until finally they last for weeks and present all the features of acute inania or melancholia.

All the cases of insanity in imbeciles which Doctor Tredgold has seen conform at first to one or the other of these types, and therefore appear to be the direct consequences of imperfect development of the higher mental faculties with its associated instability. It is said that the first attack in these persons usually appears between the ages of puberty and adoiescence, and some of the cases may be mistaken for adolescent insanity and so classified. This is important from the prognostic point of view. The type of insanity is chiefly mania or melancholia, mania, the most common, occurring in fifty-five per cent of all cases, and melancholia in from forty to forty-five per cent. General paralysis occurs probably to the extent of two or three per cent. Delusions can be ascertained in about two-thirds of the cases. He eliminated all cases in which epilepsy was present from those from which he deduces his conclusions. The ideational variety of insanity was found in the greater number of cases. Melancholia existed in nearly half the cases, a larger proportion than in the nonimbecile class of insane, the probable explanation being that the temperament of these patients is more apt to be gloomy owing to general poor health. Suicidal attempts occur in two-thirds of these melancholy patients and form real and definite efforts to put an end to existence. Improvement is noticed early and the acute condition may only last a week or a month and rarely continues longer than two or three months. There is, however, scarcely any class of patients in whom recurrence of insanity is so likely to take place as in these imbeciles, and the greater number discharged from asylums will be back within a few months or a year at the most. As a rule the second and subsequent attacks are of the same clinic type as the first but in fifteen per cent the subsequent attack is different from the primary but the tendency in the end is to become more and more apathetic until dementia is established. Many of the patients seem to improve under firm and judicious treatment and the diminished severity and frequency of the outbreaks would appear to indicate that their power of control is in some degree capable of development but probably not to a sufficient extent to enable them to be freed from supervision. Their future depends largely upon the patience and intelligence of their attendants.



THE THERAPEUTICS OF OXYGENATED WATER. Doctor LUCAS-CHAMPIONNIERE (Journal de Médecine et de Chirurgie Pratiques, April 10, 1903) writes of the great utility of oxygenated water for antiseptic purposes. The use to which he recommends it is a local one.

An important property of this substance is that in concentrated solutions (ten and twelve volumes) it is not irritating.

The action of oxygenated water depends on the presence of albuminoid matter. This is because such matter decomposes it and sets free oxygen, which is the substance that produces the antisepsis.

A peculiar advantage is gained by this kind of action. Pus and blood are albuminoid substances and the greater the degree in which they are present the greater the antiseptic action—a condition the reverse of that which obtains in the case of other antiseptics such as corrosive sublimate.

Experience has shown that this antiseptic is quite as efficient in destroying aerobic as anaerobic microbes.

In applying the remedy locally any strength up to ten or twelve volumes can be used. This should be applied freely and kept in contact with the affected surface for some time.

In addition to the action of the liquid itself Doctor Lucas-Championiere has found that when oxygenated water is boiled and the vapor inhaled a decided antiseptic effect is produced in the air passages. The effect here is increased by the addition of five per cent of alcohol to the water. The employment of this remedy has been found particularly valuable in laryngeal tuberculosis.


THE STATE MEDICAL SOCIETY MEETING. The thirty-eighth annual meeting of the Michigan State Medical Society at Detroit, June 11 and 12, 1903, was a splendid demonstration of the results of hard work. Heretofore the annual meetings have been generally well enough managed and profitable to those in attendance, but nothing like a representative gathering of the profession of the whole state lias been secured. And even though the six hundred in attendance at the Detroit session were only a small moiety of those who might have been expected, yet this number was so far in advance of past records that this feature alone created interest and enthusiasm. All declared without reservation that the last meeting was the best in the history of the society.

A large part of the added interest in the meeting may be attached to the reorganization of the profession--the new constitution adopted at the Port Huron meeting and the new relations of the county organizations to the state society. Much hard work has been done by the officers of these organizations and by others of strong altruistic spirit in furthering their spread. It is this energy put forth through the organizations, not the reorganization itself, that has accomplished such results. From this point of view can be easily discerned the necessity of energetic officers.

The committee of arrangements made excellent preparation for the visiting members. No better arranged and more commodious places of meeting were ever at the society's disposal. The section meetings, registration office, reception and exhibit hall, being all located in the one building, centered the spirit and activities of the whole session. The special committee on exhibits was unusually gracious in its results. At no meeting of the State society have we seen so much satisfaction on the part of both members and exhibitors as on this occasion. The reception and vaudeville on the evening of the first day was a pleasurably informal and amusing event, contributing not a little to the success of the meeting

The section meetings were on the whole very profitable. There were many excellent papers and addresses, but incidents that occurred here and there may be used to enhance the effect of future meetings. Long addresses make an impatient audience anywhere. The attempt to catechise a crowd of voluntary listeners will not contribute to the general interest even though it prolong the session. The introduction of an industrial undertaking into the scientific part of our meetings has never yet worked to advantage and never will. These were not serious matters but sufficient to be noticeable.

This meeting demonstrated beyond question the need of an ophthalmologic and otologic section. The papers presented in this special department were worthy of larger attendance, but through some unfortunate arrangement were badly mixed between the surgical and medical sections, and were of absolutely no more interest to many not engaged in that specialty than the technical use of obstetric forceps proved to be to the members of the ophthalmologic club. It is a condition and not a theory that the institution of a fourth section would improve.

a The manner of election of section officers is of the greatest importance to the society. In the past elections have for the most part gone by default. They are held at the opening of the session on the afternoon of the second day. A committee on nominations has previously been appointed, which cuts and dries the result, and a handful only of the section members who get around at the specified time, sanctify the choice. Clearly these elections should be held in such a manner and at such a time as to secure the attention of the entire society, for the life of the sections is after all the mainspring of the whole organization. Abolish the committee on nominations, nominate by ballot on the first day, when the enthusiasm is at its height and before half of the visitors have gone home or are otherwise engaged.



(BOSTON MEDICAL AND SURGICAL JOURNAL.] The discovery that diabetic coma was due to an acid intoxication of the body was a notable advance in our knowledge of diabetes. It furnished a starting point for further investigation. This was first directed to the determination of the specific acid, and almost sooner than could be expected the problem was solved by Minkowski and Külz, who isolated B-oxybutyric acid from the urine of patients dying in diabetic coma. A little later this question was more thoroughly studied by Magnus Levy. He showed that the body of such a patient contained as much B-oxybutyric acid and its derivatives per kilo body weight as Walther had found necessary to produce acid intoxication in a dog.

The symptomatic treatment of diabetic coma in consequence received a great impetus. To be sure but few cases have recovered from actual coma by the use of alkalies, but unquestionably the prophylactic use of bicarbonate of soda has prolonged life for months. Progress, however, is still being made in this condition, and, as is usually the case, along strictly scientific lines.

The source of the B-oxybutyric acid and its derivatives was the next question to be attacked. These bodies may be syntheticly produced in the system or derived in some way from the food. The latter is the far more reasonable hypothesis. Of the three classes of food stuffs, carbohydrates were the first to be excluded as a possible source. This was easy of demonstration, for it was found that the acid intoxication produced by an exclusive meat and fat diet disappeared at once when carbohydrates were eaten. Not so easily has the matter been settled with proteids. But the case is fairly represented by the statement that von Noorden in his third edition has changed his former opinion and accepted Magnus Levy's view that proteids are not the source.

Having ruled out the carbohydrates and proteids, the fats remain by exclusion the source of the acid intoxication. And there is much in favor of this explanation, but into this we cannot now enter. If this is accepted, the next question which arises is as to the nature of the fat. Is it one particular kind of fat, or is the variety indifferent? It is with this special subject that some suggestive work has recently been done. Hagenburg has reported that a diminution in the excretion of acetone followed the exclusive use of fat when taken in the form of bacon; Schwarz, on the other hand, noted an increase of acetone with a diet containing much butter. Grube has repeated their work qualitatively, and confirms their results. It is too early yet to draw far-reaching inferences from these data, but it seems probable that the higher fats, palmitin and stearin, have less to do with the production of diabetic coma than the lower fats, olein and butyric acid, which are present to such great extent in butter. If the coma of diabetes could be traced to one special variety of fat, a new and simpler problem for study would be gained. In the meantime, it may be well to urge our advanced cases of diabetes to eat less butter, but more fat of meat.


[COLUMBUS MEDICAL JOURNAL.] Not infrequently the obstetrician overlooks the various positions which would greatly facilitate labor were they employed at the proper time. On account of the laxity of all pelvic joints during the latter months of pregnancy there is possible a nutatory motion of the sacrum. In case of slightly contracted pelves, as for instance, 8.5 cm. to 10 cm., the addition of one cm. to the conjugata vera diameter which the Walcher position gives may allow a head to pass through the brim of the pelvis, which otherwise would not or at least would not engage unless prolonged time were given for moulding.

Again, what might be termed the opposite of the Walcher position is useful at the time of delivery of the head. With the mother in left lateral position, Alex the thighs, bend and separate the knees and you will thereby increase the anteroposterior diameter of the outlet. Many authors advocate the lithotomy position during the delivery of the head, but the lateral position requires one less assistant and also allows the obstetrician to protect and care for the perineum to a much better advantage. A good description of the Walcher position is given in the "Practice of Obstetrics," by American authors, as follows:

"Walcher, in 1889, called attention to the importance of utilizing the mobility of the sacroiliac joints in different labor. The sacral promontory lies in a plane above the axis of rotation and in front of it. The promontory, therefore, moves forward and backward, according to the changing inclination of the pelvis in different postures of the body, and the tip of the sacrum, of course, moves in a reverse direction. When the woman lies in the lithotomy position, the thighs being

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