Australian Medical Journal: (March, 1886)

THE

4usfrallan Medical Yournal

MARCH 15, 1886.

Original -Article.

NOTES OF A VISIT TO THE KEW ASYLUM.

By W. MOORE, M.D., M.S., Melb.

Dermatologist, Melbourne Hospital.

The Kew Asylum has lately been brought frequently before the public by criticisms from various quarters ; but it is to be feared that the public generally, and even the members of the medical profession, know very little of the Asylum as regards its internal arrangements, its methods of treating and caring for the insane, and the results obtained.

The Asylum stands in the midst of very extensive grounds, and, from its elevated position, commands a wide view of the surround- ing district. There are two main parts of the building, one for the male, the other for the female inmates, separated by a large hall, which is so arranged that it serves for a theatre, a dancing hall, and also for a church, a screen then shutting off the stage from the rest of the hall. On the east of the hall are the men's quarters, consisting of long (somewhat narrow) day rooms, with single dormitories built along one side, and large dormitories at the end. Off these rooms are the bathrooms, lavatories, &c. All the rooms are well ventilated, the small dormitories being Provided with a large ventilator leading into the day room, and being ventilated on the free side by a window and ventilator. A few pictures on the walls of the day rooms, the number of which might with advantage be increased, somewhat relieve the dulness which necessarily attaches itself to very large poorly-

fu

_rnished

rooms. The sameness of the dormitories is relieved by Painting the walls in lively colours. The beds are very comfortable, and, like everything all through the Asylum, scrupulously clean.

E

ach bed is provided with a straw under-mattress, a firm hair Mattress, and the requisite number of sheets and blankets, with a good thick quilt. The small dormitories are ordinary bedrooms for patients who are noisy and would disturb the others. In the do

rmitory for epileptics, the beds are raised just off the floor, in order to insure against injury from falling out of bed. The baths

• VIII. No. 3.

98 Australian Medical Journal. MatcH 15, 1886 are of wood, and, being kept well cleaned, are quite dry and smooth, and free from anything approaching greasiness. The shower-baths are of the same height as ordinary showers, and are so arranged that by pulling a string from outside, a copious shower falls from a tub placed above the bather. Unless the weather is persistently wet, the patients are kept in the open air throughout the day. Many are engaged about the farm ; and those who are unfit, or who cannot be induced to work, are allowed to wander about in the yards under the charge of a few attendants. These enclosures are rough and bare, and might, with advantage, be planted with trees and flowers much ^more than they are. The newly-admitted patients are kept by them- selves for a time, until their peculiarities are understood ; or, if likely to recover soon, until recovery has taken place. If possible, a patient is never permitted to go into the large yards, but has some work allotted to him. In the women's quarters, the internal arrangements are much the same. A great number of women find employment in the laundry, and seem quite contented and even happy at their work. Others are engaged in sewing, and a great number of the worst patients, both men and women, are occupied picking oakum ; and it is astonishing that so many, who might be expected to be noisy, are wonderfully quiet over their work.

The women's day rooms are more cheerful than those of the men, and in these rooms a few women sit quietly sewing. In the male wards, with over 490 patients, there are only about six in bed. Among the females there are more, though only a small number. For a long time there has not been a bed-sore in the institution, which shows that great care must be bestowed upon the general paralytics. The medical attendants recognise the importance of employment as a means of furthering recovery, hence all the work about the institution is done by the patients, with the assistance of the ordinary attendants. All the clothing, the absence of any attempt at uniformity of which strikes one agreeably, is made of strong material by the patients, thus furnishing tailoring as work for the men. A farm also furnishes employment for many, and provides the institution with almost all the vegetables needed, with eggs, partly with butter, and occasionally with beef. In this way 255 males out of a total of 492 are kept employed, whilst the laundry, sewing, &c., keep 245 females, out of a total of 411, in employment.

MARCH 15, 1886 Australian Medical Journal. ₉₉

In a very large institution like this, where all classes of patients are received indiscriminately, the results of treatment should not be expected to show a large percentage of recoveries _; and the only way of coming to an opinion as to whether these results are good or bad, is to compare them with the results in similar institutions. In 13 Asylums in England and Wales, each containing over 700 and under 1000 patients, the percentage of recoveries on the number of admissions varied, in 1884, from 30'6 in the Devon Asylum, to 52.1 in the Norfolk. In the Kew Asylum the percentage of recoveries on admissions has been, in the last five years, as follows :-1880, 66.46 _; 1881, 36.41 1882, 72.39 ; 1883, 50.89 ; 1884, 55.17. Thus, the results at Kew are seen to compare very favourably with those of the English Asylums. And that this is not entirely due to circumstances affecting the patients previous to their admission, (e.g.,

their surroundings, the quantity and quality of food, &c.), 18 clearly indicated by comparing the percentage of recoveries in the Victorian Asylum with those not only of England and Wales, but also of New South Wales and South Australia. The Percentage of recoveries on admissions are : Victoria, 52.01 ;

New South Wales, 36.91; South Australia, 39.71 ; England and Wales, 39.41. Here we have the percentage of recoveries in New South Wales less than that in England and Wales, whilst that of South Australia is almost the same as the latter. In the Percentage of deaths, Victoria compares favourably with England and Wales and the other colonies. Thus, the percentage of deaths

°11 the average number resident was, for 1884, in Victoria, 6.97 ; New South Wales, 7.43 ; South Australia, 9.50 ; England and Wales, 9.11. These facts in themselves are a sufficient answer to the adverse criticisms which have been so persistently circulated.

It has been said that the Barrack system is a mistake, and that lunatics should be treated in cottages. In England the Asylums, old and recent, are on the Barrack plan, as also in this colony, where the results of treatment are so good. In the Yarra Bend, in addition to a number of large wards and several yards ; there are some cottages. It must be remembered that only a limited number of cases can be treated in cottages, and these are, of course, as a rule quiet and harmless, but equally, as a rule, quite incurable. Further, a great extension of the cottage system would involve a greatly increased expenditure, as the number of

-tendants would need to be multiplied considerably. Heller , it is G

100 Australian Medical Journal. MARCH 15, 1886

evident that the cottage system is never likely to be much adopted in Lunatic Asylums which receive patients indiscriminately.

Several alterations which have already been decided on will increase the efficiency of the Kew Asylum, and will also afford more space which is urgently needed. Separate rooms for very noisy patients are now in course of erection, and it is intended shortly to build wards for the idiot patients. Then the Asylum, though far from perfect, will be well fitted for the purpose for which it was intended.

i.otittp. fittoria.

ORDINARY MONTHLY ^MEETING.

WEDNESDAY, 3RD MARCH, 1886.

(Hall of the Society, 8 p.m.)

Present : Drs. Jamieson, Allen, Moloney, Gray, Tweeddale, Workman, Springthorpe, Neild, W. Moore, J. Robertson, Peipers, Bowen, T. N. Fitzgerald, J. Jackson, Iredell, A. J. Wood, A. S.

Aitchison, C. S. Ryan, Fyffe, Alsop, Cox, J. Williams, Elsner, and Griffiths.

The President, Dr. JAMIESON, occupied the chair.

Dr. DOYLE was presented as a visitor.

The minutes of the preceding meeting were read and confirmed.

The HoN. SECRETARY reported that the Government Statist had forwarded to the Society a copy of the last issue of the Victorian Year Book, the receipt of which had been duly acknowledged.

Several, photographs of cases of elephantiasis of the scrotum, before and after operation, were laid upon the table. Copies can be obtained from Mr. Chuck.

The HON. SECRETARY also reported that one gentleman, who was nominated for election as a member of the Society at the last meeting, had unexpectedly left the colony on a visit to England, and that his name had consequently been withdrawn by his proposer and seconder.

NEW MEMBERS.

The following gentlemen were elected members of the Society ^:

—Dr. William Christian Daish, M.B. Melbourne, of Malvern, proposed by Professor Allen and seconded by Dr. Neild ^;

MEARca 15, 1886 A ustralian Medical Journal. 101

Dr. Alexander Sydney Joske, M.B. et Ch. B. Melbourne, of the Melbourne Hospital, proposed by Dr. Neild and seconded by

1)

r• J. Williams ; and Dr. William Hall Owen, L. et L.M.

of South Melbourne, proposed by Dr. Jamieson and

s

econded by Dr. Webb. Three gentlemen were nominated for election at the next monthly meeting.

EXHIBIT BY DR. C. S. RYAN.

Dr

. C. S. RYAN exhibited a patient from whom he had

r

emoved the upper jaw.

The following paper was then read :

NO

TES ON TWENTY-ONE CASES OF EPILEPSY.

By J. W. SPRINGTHORPE, M.D., M.R.C.P.

In the following abstract, the theory of Hughlings Jackson as to the origin and modus operandi of epileptic attacks is the one adopted. The main points noted are the age at first attack, the frequency and duration of the fits, the family history, the Proximate cause, the premonitory symptoms, the peripheral

ir

ritants, and the results of treatment. Before proceeding to the

a

bstract, however, it may be well to dwell somewhat upon some of

t

he more important of these points.

Without wearying you with a description of the well-known

f

eatures of an epileptic attack, in its different forms of petit mal, epilepsy proper, and Jacksonian epilepsy, it may be well to

su

mmarize the most recent view of its pathological conditions.

.1etlinagel's combination of convulsive and vaso-motor centres in ,,die medulla is now abandoned. The epileptic status is considered ,e,ae to excessive discharges of nervous energy, occurring primarily in

!Joie cortex of the brain. These depend upon a condition of nerve In stability, inherited or acquired, which instability, molecular,

Is

omeric, or whatever it may be, can be functionally originated .either during the ordinary vital reactions, or brought about by irritant messages from any part of the body. The seizures that paresult from the former are still, in the absence of a minute thology, called attacks of idiopathic epilepsy—the latter, of

S3

^:raptornatic epilepsy, with a subdivision of Jacksonian epilepsy,

t

wrtere

the

perceptible irritant is a recognisable brain lesion. By

e

help of such a theory, all the material phenomena of epilepsy

can

be satisfactorily explained. The fundamental unconsciousness i

s

due to nerve discharge in the conscious cells of the cortex, a molecular

storm in which the receptive state known as conscious-

102 Australian Medical Journal. MARCH 15, 1886 ness is disturbed to the extent of temporary oblivion. The rigidity of onset follows from tonic spasm, the necessary result of a large discharge of nervous energy down the pyramidal columns, and centrifugal nerve paths generally. The irregular clonic con- vulsions, which occur later on, are in all probability a combination of irregular cortical action, and the general asphyxia resulting therefrom; the stupor which so frequently ends the attack, and the apparent paralysis which continues for some time afterwards, point to exhaustion of the highest centres ; and the unseemly acts and insane conduct which characterise some seizures are due, similarly, to suspension of inhibitory influence from these same centres. In like manner, the aurae, or premonitory signs which immediately usher in so many attacks, are merely indications of the portion of the brain in which the epileptic storm is brewing,.

the last point at which consciousness becomes alarmed, and which it notes prior to the rush of the epileptic gale. Thus, when a.

motor aura precedes, molecular disturbance begins in the motor areas, when sensory in the sensory, and when psychical in the anterior lobes, though it must be remembered that fear, anger, and the like may be primarily if not entirely sensory hallu- cinations.

Thus constituted, it is easy to see the influence of heredity, general pathological states, and peripheral irritants upon the causation of epilepsy. Heredity hands down the damaged cerebral cortex—a molecular vulnerability. General pathological states may upset a brain insufficiently stable, or by slow degrees build up an instable nervous mechanism. And peripheral irritants may have the power of originating cerebral disturbances where the irritant message is strong and the recipient cortex weak. So important a part, indeed, do peripheral irritants play in the causation of epilepsy, that Brown Sequard locates the site of epilepsy in the nervous system generally, and though this certainly seems to ignore over much the more fundamental weakness in the cerebral cortex, still, it is clinically found that treatment which overlooks this peripheral element is very frequently of little, if any avail.

This brief resume, even if somewhat unnecessary before such a Society as this, will still be useful for the better appreciation of the histories which follow, and such comment as may arise therefrom. Appended are the histories of 21 cases, an introductory series of statistics, which I hope in time considerably to enlarge.

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Sunstroke ? - - 2 yrs. ago had syphilis. Sunstroke 3 yrs. ago Sunstroke - - Fright - • Fright during preg- nancy Fright - - - Syphilis 18 months before Anxiety. Scrofula - Worms - - Worms - - - Fall - - Heredity - - - Rheumatism. Mam- mary tumour re- moved 7 months child and big head Typhoid - - - Scarlatina, followed by hemiplegia

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104 Australian Medical Journal. MARCH 15, 1896 I have no intention of drawing any special inferences from such a small number of cases as have been given above. Still, a few general remarks may not be inappropriate. In the first place, the number of cases goes towards illustrating my conviction that epilepsy is far commoner here than in England. This I would explain on the general ground that a neurotic inheritance is more common here than at home, and in fast living, excited life, alcoholism, excessive meat diet, and sunstroke, we may find exciting causes in unusual operation. It may next be noted that out of 21 consecutive cases, 8 are males, and 13 are females. The time of commencement also is interesting. Ten of the cases began before the age of 20, four between 20 and 30, and five between 30 and 45. The earliest occurred at six months, the latest at 45 years of age.

The family history is of great importance from an heredity point of view. In only 7 cases was a neurotic taint not found, and these are well worthy of attention. They comprise cases of fright duiing pregnancy, rheumatism and climacteric changes, alcohol, syphilis, scarlatina, embolism, fright, and worms. In each of the other 13 cases a more or less clear instance of heredity may be found, and in many this exists to a marked degree.

The exciting causes are seen to comprise all those most commonly narrated. Thus we have worms figuring in 2 cases, alcohol in 3, sunstroke (possibly) in 3, fright in 3, syphilis in 2, scarlatina, rheumatism, and typhoid fever in 1 each, anxiety in another, and injury to the head in 1 also. In 3 the cause could not be ascertained, and in 2 it seemed nothing but hereditary vulnerability.

Regarding the characters of the attack, there is no need to say much. Petit mal co-existed in 5 only, as far as could be discovered. An aura was found in 10, micturition occurred in 5, and tongue-biting in 8. In other respects the seizures may be taken as those of ordinary attacks. The importance of tongue- biting and micturition of course lies in the fact that they are symptoms of the tonic spasm which accompanies the onset of the attack.

The frequency of the attacks illustrates very markedly the periodicity of epilepsy—we have as many as 25 a day, and as few as half-yearly seizures. The frequency of attacks depended upon the nature of the exciting cause, and will be found to vary simultaneously with its activity.

Ilea 15, 1886

The sequels; disclose little that is unusual ; there is headache

in

the more recent cases, with hebetude and stupor. In the more chronic cases there is amnesia often to a marked degree. Where wornas are the cause we find boulimia, obesity, and marked

ir

ritability generally. Where hysteria complicates, we have the laYsteroid convulsions and status following. Rarer sequel of

i

nterest are seen in chorea, religious hallucination, and migraine.

In the first, the sensory seizures, known as migraine, seem to have

t

aken the place of the motor phenomena characterising epilepsy.

The

influence of irritants is further well shown by these twenty- one eases. Centric irritation—as worry, excitement, anxiety; and peripheral irritation—as gastric, ovarian, intestinal—are seen to

ha

ve marked effect. This was especially noticed in the case of worms and piles

;

but it was sufficiently present in all but a few to point towards the need for special treatment.

Regarding the progress of the cases-1 ended in idiocy, another

s

eems tending that way, in 5, owing to the patients' absences,

the

^progress

is

unknown, and in all the rest more or less marked

1

,131Provement occurred. This was specially noticed in the cases

du

e to alcohol, syphilis, worms, and constitutional diseases.

As to the treatment adopted, it was directed to the special cases. Any constitutional taint that was discovered was treated, all discoverable peripheral irritants were removed where possible, or combatted as far as possible, and pot. bromide, as a specific

sedative,

was given in 30 grain doses at night as a routine dose, which required altering to suit the special case. Further, special stress

was laid upon the dangers of intestinal irritation, either in the form of dyspepsia or constipation, upon the necessity for exercise, restricted meat diet, and moderation in the use of

st

imulants of all kinds.

the JAMES ROBERTSON said that he had listened with attention to :e paper just read

;

the statistics had evidently been carefully

t

erdied, but did not seem to extend over any long period, so that i,_°

would not be safe to draw inferences from them. In his

own

Pl

'aetiee

he had met very numerous cases of epilepsy, but the a

nd

results were not satisfactory; patients improved for a time

t lic l then

were lost sight of, and nothing would be heard of them

or a year or two.

A practical paper was much wanted, indicating o; lines of a more successful treatment. No doubt treatment

'en

proved satisfactory, especially when the fits were due to

Australian Medical Journal.

105

106 Australian Medical Journal. MARCH 15, 1886 peripheric irritation. Much less benefit could be expected in idiopathic epilepsy where the brain itself was affected ; he believed that the seat of the mischief was not al ways on the surface of the brain ; the theory that the convulsions originate always, or in the great majority of cases, in a hyper-charged condition of the cells of the cortex seemed to him open to question. Much importance attached to the initial pallor of the face ; some authorities attributed this symptom, as well as the subsequent phenomena, to contraction of the blood-vessels, but this explanation was not sufficient. Epilepsy, in fact, owned the most varied causes ; for examples, he had met with several cases due to the presence of tumours in the brain, situated not only on the surface, but also in the central parts ; in these cases temporary paralysis might be noted, and the aura commenced on the opposite side of the body to the tumour, as subsequently proved by post-mortem examination.

Even such cases as these sometimes seemed for a while amenable to treatment, but death ultimately resulted. With reference to the treatment of epilepsy, there could be no doubt as to the utility of bromides, which distinctly lessen the excitability of the brain and the tendency to explosive disturbance ; but, lately, he had been compelled in one case to combine belladonna with the bromide, and had found the result very satisfactory ; this case was still under observation, and the fits, instead of coming several times a day, might not happen once a month ; but he was doubtful whether there was not some organic mischief in the brain ; the symptoms did not seem to be due, at all events entirely, to peripheral causes. In the treatment of epileptics, a correct system of classification was most important ; if the fits are due to organic disease of the brain, no treatment ultimately succeeds ; severe epilepsy occurring in early life ends in idiocy unless due to worms, when removal of the cause would produce a cure ; epilepsy in syphilitics should be treated with bromides and iodides ; and in general the causation of every case must be rigorously examined. The Society was indebted to Dr. Spring- thorpe for his statistics, which however, lost much of their value inasmuch as they covered too short a time to permit deductions being safely drawn from them.

Dr. MOLONEY agreed with Dr. Robertson that thanks were due to Dr. Springthorpe for his paper, which was introduced in modern style according to the statistical method. For himself, he was no statistician and trusted to his general memory; and he would have

14411tH _{15, 1886} Australian Medical Journal. ₁₀₇

l

iked the present paper better if the cases had been grouped in

c

lasses for more ready comprehension. He was struck with the small number credited to alcohol. In his own experience, when

e

pilepsy developed either in men or in women after majority,

th

ere Was usually a history of alcoholism or of syphilis. Psychic

co

nditions, too, were powerful agents in the causation of epilepsy.

As a matter of fact, many people owed their personal power to an epileptic tendency, as may be exemplified from the history of

N

apoleon and of several great reformers ; and, speaking generally, we owed more to our neuroses than we were disposed to allow.

The treatment of chronic cases of epilepsy was well understood,

b

ut acute cases were more difficult to deal with. He had found Feat benefit from hypodermic injections of atropine pushed to the e. ictrerne physiological limit. In cases associated with ovarian Irritation, deep pressure in the situation of the ovary, especially the left, often gave decided relief; some patients wore a truss over this region with benefit, and in chronic cases local blistering was of service. He met with one case which was formerly under the

c

are of Dr. Buzzard. The aura commenced in a branch of the radial nerve. Dr. Buzzard tried blistering over the affected nerve, and subsequently gave the patient a belt to wear over the nerve, so made that it could be tightened up and could exercise considerable local pressure ; but sometimes the fit developed before the patient

ec

alld tighten up the belt. At the speaker's suggestion the apparatus was altered so as to allow pressure to be produced .

Wit

hout any delay, and the result was most satisfactory. With the to the prevalence of epilepsy in this Colony, he noted 'Ile tendency to a highly neurotic condition, such as already manifested itself in full development in the United States. With

the

progress of this neurotic tendency, he feared that epilepsy would become more and more common. He noticed in neurotic

people, and especially in children, a tendency to over eating, he

al

i

ght

even say a necessity fol. over-eating, persons eating largely th

e

tears in their eyes ; but the habit reacted unfavourably upon

i e

health of the patients. He was surprised at not finding a case

h

Ystero-epilepsy among those cited by Dr. Springthorpe.

J. WILLIAMS, without committing himself to all the , ateroents of Dr. Moloney, agreed generally with him ; the statistics supplied by Dr. Springthorpe were valuable so far as

the

y Went. Epileptics may get well, for a time at least, under

"41Y treatment. They improve so long as the medical attendant

108 Australian Medical .Journal. _{MARCH 15, 1886} retains any enthusiasm ; but when he grows cold they try another medical man, and thus the disease appears to be more common than it really is. Rarely do epileptics remain under the care of one practitioner for many years. In treatment, distinctions must be made according to the cause and type of the disease ; thus the epilepsy of syphilitics may be relieved or temporarily cured by iodide of potassium ; in the epilepsy or epileptiform convulsions of alcoholics, when exhaustion is imminent, the subcutaneous injection of morphia, or its combination with atropine, has often a most marked eftect. This is what might be expected from the analogy of puerperal convulsions, in which, notwithstanding the ureemic trouble, morphia may be given without hesitation.

Dr. Maberly Smith, in a very interesting paper, drew attention to the value of morphia in puerperal convulsions, and subsequently many practitioners availed themselves of this mode of treatment with great success. In the epileptiform attacks of acute alcoholism, morphia is almost a specific. He did not believe that epilepsy was unusually prevalent in this Colony, but it would be difficult to obtain any reliable statistics. Dr. Springthorpe's paper, however, would form a good commencement of a study of epilepsy.

Dr. GRIFFITHS believed that epilepsy was more common in England than in Victoria, judging from the number of cases under treatment in Asylums. The disease was certainly more common in females than in males. The successful results of treatment with bromides were undoubted, but it was open to question whether the continued use of these drugs did not interfere with the physical or intellectual health of the patientS.

In his own experience this was not the case. If mental

wreck

ensued, it was due to the disease and not to the remedies.

Bromism is frequently induced, and he had noted it to be associated in some cases with a condition resembling locomotor- ataxy ; but if the drug was stopped for a time, the symptoms passed off, and did not return when its administration was re-commenced.

Professor ALLEN said that, the Society was indebted to Dr. Springthorpe for his paper, which, in its form as a collected study of a series of cases, might well be imitated by other members. In too many instances the papers read before the Society consisted of the notes of some single case, with comments thereon ; and though such isolated observations were of value, yet it would be well if investigations were conducted in a more

11411c$ 15, 1886 Australian Medical Journal.

109 c onnected and continuous manner, so as to afford the material for sound general deductions. At the same time, he felt that the Paper was open to the objection that the data were too limited to

allow

any inferences to be drawn, and he thought that there was not sufficient evidence to establish the statement that epilepsy was more common in this colony than at Home. It was impossible in a short discussion to touch upon all the questions which had been raised or might be raised concerning epilepsy, and he would only been to a few of them. In regard to the symptoms, he had

r en struck with a paper published some years ago by Dr. Moxon, la ying stress on their dual nature—on the one hand unconscious- ness, and on the other hand convulsions, the abolition of mental functions concurring with explosive action of the motor nervous c entres. The unconsciousness seemed closely related to the initial facial pallor so often noted, and he was not aware that it had been clearly ascertained how largely an element of syncope alight be involved in the outset of the insensibility. This question, however, should be capable of easy solution. The attacks of temporary faintness short of complete unconscious- Iles; and not attended with convulsions, were deserving

°,1 study in this respect. Much importance attached to a decision whether the loss of consciousness was due to defective V ascular supply or to paralysis, inhibitory or direct, of the centres consciousness themselves. The fact that unconsciousness may be associated, not with the typical tonic and clonie spasms, but Trousseau, definite regulated movements, as in the cases narrated by

"-rousseau, still further complicates the question. Clearly there 1,_s 110 constant relation between the affection of the psychic and of the motor centres, and a sharp distinction must be drawn between the Primary abolition of consciousness and the secondary effects of the convulsive outburst upon the centres which subserve ideation and emotion. Post-mortem appearances do not lend much support t0

the view that the cerebral cortex is the true and sole seat of m ischief in epileptics. After death, in chronic cases, there is usually atrophy of the convolutions, with gaping sulci, thickened there membranes, and increase of the cerebro-spinal fluid; but ere is no predominant lesion in the cortical substance, and the alterations just mentioned are common to many conditions, such

.4

,8

chronic insanity apart from epilepsy, chronic alcoholism, chronic

to p, disease, and others. After death from chronic epilepsy,

lu, dilated vessels and swollen perivascular canals are commonly

110 Australian Medical Journal. Mena 15, 1886 found in the brain, but chiefly in the great basal ganglia and not in the grey cortex. These dilated vessels may be well marked in the lower part of the corpus striatum, but usually they are specially developed in the dorsal portion of the pons varolii and medulla oblongata, and also in and around the corpora dentata of the cerebellum. Even these alterations in the vessels are in no way peculiar to epilepsy. A closer study of the mental and motor phenomena of uremia may throw considerable side-light upon the pathology of epilepsy. In the so-called epilepsy of alcoholics, which is closely related to uremia, the danger of suffocation should not be forgotten. In many cases vomiting occurs while the patient is semi-conscious, and the ejecta may be drawn into the larynx and

thus cause

death. In the treatment of chronic epilepsy, the speaker inclined to think that the value of a seton in the back of the neck is too often forgotten.

The President, Dr. JAMIESON, thought that Dr. Springthorpe had not done justice to his paper, which would have been more effective if the tabulated results had been read downwards, so as to give the ages of all the cases, then the duration, the causes, &c.

The various points would thus have been more readily grasped.

Dr. Springthorpe, too, would pardon him for saying that sufficient stress had not been laid on the distinction between epilepsy and eclampsia, insomuch that some of the cases narrated were in his own opinion not epilepsy at all. Certainly the distinction was largely one of degree, but none the less was it important. Eclampsia

was often due to a removable cause. A wound, healing badly, might keep up a condition of chronic irritation, and induce convulsive or eclampsic attacks, which, under aggravated or long continued irritation, might assume a decidedly epileptic character. The distinction is sometimes easy, some- times difficult. For example, when a man, with no hereditary tendency to epilepsy, has a severe drinking bout, and, while verging on delirium tremens, suffers from convulsions, these should be attributed to alcoholism and not to epilepsy.

On the other hand, in convulsions during chronic alcoholism, such distinctions cannot be readily made. Or again, in the middle of pregnancy, convulsive attacks may occur and be repeated, _ceasing after labour is completed. Such may well be grouped under eclampsia ; but sometimes the convulsions recur after a time, though the original exciting cause has been removed. In all cages, therefore, the element of time must not be forgotten ; and

Ivhitett 15, 1886 Australian Medial Journal. ₁₁₁ he inclined to think that Dr. Springthorpe's cases had scarcely

b

een under observation long enough to form any reliable basis for

4r

gioent or for judging what would be in several instances the ultimate issue ; when improvement had been noted, there was

l

'etuu for hope that it might be permanent, but still no certainty.

l

j'r• Moloney had raised several interesting speculations, but time would scarcely permit his dealing with them in detail. But before concluding his remarks he must express his special satisfaction

w

ith the style and aim of the present paper, for he had always attached great value to the methodical accumulation of data for

t

he purpose of arriving at some general conclusions. Isolated records, however carefully taken, could never possess the

im

portance which belongs to large collations of facts, and he frosted that many members of the Society would endeavour to VStetriatise their observations and present them to the Society in

ee

tluected form.

k.r)r. SPRINGTHORPE, in reply, thanked the members for their hearing and for their criticisms. Some of the latter, perhaps, were scarcely warranted, as his paper did not purport to

,

li.051 With questions of treatment, but was intended simply to Illustrate absolute facts relating to the ages of patients at their

fir

st attack, the influence of heredity, &c. He agreed that

s

ufficient time had not elapsed to render deductions from his cases

ve

rY safe, but still some cases had been from fifteen to eighteen inonths under treatment, and he hoped hereafter to be able to furnish

mu

ch more extended and complete observations. In connection

w

ith the remarks of Dr. Moloney, he had been chary of drawing any conclusion with respect to the influence of alcohol as a factor

til

the causation of epilepsy ; but it was noteworthy that among

h

Wenty cases 14 per cent. were due to alcohol, and surely that was gh enough. As to the grouping of the cases, doubtless such an arrangement would have been useful, and he had carried it out a summary. Concerning hystero-epilepsy, he had only remark that no typical cases had come under his notice, at all

er

its no such outrageous, almost unnatural cases as were

re

ported by Charcot. Two of the cases referred to in his paper

°

^{f the} apparently mild cases of this condition. As to the question the frequency of epilepsy, no doubt there was much difficulty

o

btaining data for an accurate judgment ; but if his memory se 8

not at fault, at the Westminster Hospital there were only en epileptics among a thousand patients, whereas among a less

112 Australian Medical Journal. MARCH 15, 1886 number of patients he himself had met with three times that number. His experience in the Lunacy Department in this colony also led him to believe that epilepsy is more common here than in England. Neuroses, in general, are certainly far more frequent here, and epilepsy as a neurosis may be expected to share in this general prevalence. Concerning the initial facial pallor, he might remark that during two years he had watched the practice of Dr. Gowers and Dr. Ferrier, and in many cases this symptom was wanting, so that any reasonings based upon it must be unsubstantial. As to the morbid appearances found in epileptics after death, Professor Allen had not found marked changes in the cortical substance of the brain

;

but

visible

changes were not to be expected ; the alterations were

probably

molecular, affecting the isomeric constitution. At all

events,

higher powers of the microscope than are yet available would

be

required to detect them. In reply to Dr. Jamieson's remarks,

he

would state that he had read the tabular part of his paper

both

ways. He maintained that the cases were truly epileptic,

because

even where some local irritation was present there was

evidence

of instability of brain in addition. Thus, two members of

one

family being infested with worms, one had fits and the

other

had not, and it was necessary to suppose that the presence

or

absence of change in the nervous centres governed the

varying

result. Since the question of treatment had been introduced,

he

might remark that he did not tie himself down to bromide

of

potassium. The routine followed by Gowers

was

to remove

all

sources of irritation and attend to morbid constitutional

states, to

give bromide of potassium in thirty-grain doses at night, decreasing these doses if they proved too large ; but sometimes very much larger doses were given, half an ounce being occasionally administered. Bromides of sodium and ammonium were more rarely employed. When bromides failed, the

chief

remedies employed were oxide of zinc, belladonna or atropine, cannabis indica, and sometimes digitalis. In petit mal reliance was placed upon citrate

of

caffein and nitro-glycerine. The

acne

following the administration of bromides was dealt with

either by

the combination

of

arsenic, or after the American plan by

the

addition of

a

diuretic. Counter-irritants had been highly

lauded

by Brown-Sequard, and he had heard Dr. Wilks

remark

that he would consider no

case

of epilepsy hopeless until a

seton

had been tried in the back of the neck.

Melton 15, ₁₈₈₆ Australian Medical Journal.

113 EXHIBIT BY DR. CLEAVER WOODS.

Professor ALLEN then exhibited a large tumour successfully removed from the abdomen of an infant by Dr. CLEAVER WOODS, of Albury. The hour being late, Dr. Woods' paper on the case could not be read that evening, but it will duly appear in this

' journal

with a description of the tumour by Professor Allen.

EXHIBITS BY PROFESSOR ALLEN.

Professor ALLEN then exhibited a number of pathological specimens, among which may be mentioned hemorrhagic sarcoma of the ilium, with secondary sarcoma of the lung ; gunshot wound o f the stomach and spinal column ; stricture of the urethra, with secondary changes in the bladder and kidneys ; and mitral st _euosis.

We publish below the notes of specimens exhibited by Professor Allen at the preceding meeting, the pressure upon our space ne cessitating their postponement from our last number.

1 • A series of specimens illustrating four of the methods in 'which articular cartilage may be destroyed :-

(a.) The head of the femur from a case of intense articular ostitis : here the nutritive relations between the articular lamella of bone and the cartilage were arrested, and the cartilage was se parating in very large flakes. in the acetabulum the cartilage had disappeared, and the bony floor of the cavity was necrosed t hroughout its entire thickness, and was breaking up into fr agments. There was extensive suppuration in and around the hi p joint, but the pus had not yet made its way into the

°hturator internus, the internal periosteum over the necrosed floor of the acetabulum not being perforated. Such a process

of

stripping of cartilage almost

_{en masse}

is, however, rarely

seen.

(b.) The medio-tarsal joints denuded of cartilage by intra- articular suppuration, which had apparently originated in ssuppura- tive periostitis of the calcaneum and cuboid. This condition

_is

better

exemplified on a larger scale by the history of synovial

suppuration within the knee joint ; the cartilage becomes swollen,

becomes and succulent, of opaque greyish colour ; then the surface

ecomes filamentous by the unequal process of softening, an

_I

grad

ually

the whole thickness of the cartilage or of portions of i it

I° . ay be removed, the changes in i

nsignificant. the subjacent bone being relatively

114 Australian Medical Journal. MARCH 15, 1886

(c.) The much slower process seen in many cases of chronic synovitis may be exemplified by specimens of protracted disease of the knee and ankle ; the synovial membrane becomes hyperaemic and swollen, densely infiltrated with leucocytes, and at last is practically composed of granulation tissue which may or may not secrete pus. The more rapid the disease and the greater the hyperaemia, the more abundant will suppuration be, but in chronic cases, with scarcely any hyperaemia and a minimum of swelling, fringes of lowly vascular granulation tissue may form without suppuration.' It is in these very chronic cases that the changes in the cartilage are best seen. For example, in the ankle now exhibited, little grey fleshy processes are slowly growing from the edge of the synovial membrane over the cartilage, which itself is as yet little altered. But with the continued growth of these highly cellular processes, the cartilage beneath becomes eroded, literally eaten away, the destructive action being patchy or general according to the distribution of the cellular ingrowths from the synovial membrane. In relatively acute cases, the process is modified by the free formation of pus, and in very acute cases there is no time for the development of the cellular ingrowths.

(d.) The fourth variety of destructive change in the cartilages may be illustrated by various joints of the tarsus from a case of chronic ostitis ; the cartilages become pale pink, either uniformlY or in patches, and are gradually replaced by granulation tissue growing slowly from the medullary substance in the Haversian canals of the subjacent bone. As the process of replacement progresses the surface of the eartilage becomes more distinctly vascular and soft, so that the finger-nail readily indents it, and the granulation tissue may even form slightly elevated ruddy patches in the midst of the pinkish less altered cartilage around.

These four varieties of destructive change in cartilage are com- paratively seldom seen in pure forms in the post-mortem room ; in cases which run to amputation or to a fatal issue, acute inflam- mations have often alternated with the more chronic processes, and synovial, periosteal and endosteal lesions have accumulated them- selves upon one another. But even in such cases, much may be learnt ; the foot now shown is an instance in point, the media- tarsal joint is utterly disorganised by suppuration, the periosteum around the os calcis is thickened and softened, readily peeling from the subjacent bone and at parts separated from it by abundant pus, the ankle shows the slow growth of cellular processes

Mum/ _{15, 1886}

Australian Medical Journal. ₁₁₅ over the cartilage, apart from suppuration, while the anterior tarsal and tarso-metatarsal joints exemplify in different degrees the development of granulation tissue from beneath the cartilages.

The processes thus described are quite distinct from the gradual erosion of cartilage which occurs apart from inflammation, e_specially

in advanced age ; and they are also distinct from the changes included under the title of chronic rheumatoid arthritis.

It must be remembered, however, that the eburnation of the articular surfaces and the growth of osteophytes, so characteristic of r

heumatoid arthritis, may be variously complicated by the various inflammatory processes described above, and, if the early stages of eburnation could be observed, it is probable that the slow dev

elopment of a granulation tissue from the subjacent bone, and its slow conversion pari passu into ivory bone would be the true Pathological change, modified by imperfect ossification of the granulation tissue on the one hand, and by intercurrent attacks of Voovitis on the other. The close anatomical relations between cartilage, synovial membrane, periosteum, and medullary osseous tissue are now well understood ; the gradual transition of articular cartilages at their edges into the connective tissue of the synovial membranes suffices to explain some of the differences which are so often seen between the lesions at the margins, and those towards the centres of articular surfaces, while the varying degree Of co-

aptation, pressure, and attrition of the articular surfaces may explain other differences.

PROFESSOR ALLEN also exhibited :—

lowe 2.r ja periosteal sarcoma growing from the inner surface of the w.

3. A heart with retroversion of the left posterior segment of the

aortic

valve ; the retroverted segment rubbing against the adjacent

N

Parts so that it became ulcerated, perforated, and dotted with small o tations, and also similarly produced a small ragged perforation through the base of the anterior segment of the aortic valve, and

"'I

an vegetations at the line of junction between the other two segments of the aortic valve.

Three specimens of loose cartilages from the 4. knee joint, removed from separate patients by operation.

5. An old fracture of the tibia and fibula at the junction of the middle and lower third, firmly united, but with a limited fusion of the two bones.

116 Australian Medical Journal. MARCH 15, 1886 6. Tuberculous ulceration of the cocum and ascending colon, with pale shallow ulcers in the vermiform appendix.

FEES TO MEDICAL PRACTITIONERS UNDER THE FACTORIES ACT.

Dr. TWEEDDALE, by permission of the meeting, drew attention to the unsatisfactory rate of remuneration which the Government proposed to allow to medical practitioners for examining factory employes, and reporting upon their physical fitness for such work.

The Central Board of Health fixed the fee for each case at seven shillings and sixpence, but the Chief Secretary had reduced it to five shillings. The Central Board objected to the change, and it was in the power of the Society to materially strengthen the objection.

A short discussion followed, in which several members took part, the President, Dr. Williams, Dr. J. Robertson, and Professor Allen urging that the Society should not express satisfaction with either fee named ^; that satisfactory work would never be obtained for a nominal fee ; that the careless issue of certificates would defeat the purposes of the Act ^; and that the simplest remedy was for medical men to refuse to accept the proposed fee.

Finally, on the motion of Dr. NEILD, seconded by Professor

ALLEN, it was resolved—" That in the opinion of the Medical Society of Victoria, the fee offered to medical practitioners for examining factory employes, and certifying concerning their physical health, is altogether inadequate."

ROLL OF MEMBERS.

The following is the roll of members up to the present date.

Asterisks are placed before the names of those who have been Presidents :

LIFE MEMBERS.

Barrett, James, M.D. Syd., M.R.C.S. Eng., L.S.A. Lond.

*Bowen, Thomas Aubrey, L.K. et Q.C.P.I., M.R.C.S. Eng.

Bird, Frederick Dougan, M.B. et Ch. B. Melb., MRCS Eng.

*Bird, Samuel Dougan, M.D. St. A. et Melb., L.R.C.P. Lond., M.R.C.S. Eng., L.S.A. Lond.

Burke, Stephen John, M.R.C.S. Eng., L.K.Q.C.P.I.

*Fetherston, Gerald Henry, M.D. Melb., L.R.C.P. Ed., L.F.P.S.G. , L.A.H.D.

*Fitzgerald, Thomas Naghten, F.R.C.S.I.

*Haig, William, M.D. Maryland (U.S.)

MAucrt 15, 1886 Australian Medical Journal. ₁₁₇

*

Hewlett, Thomas, M.R.C.S. Eng., L.S.A. Lond.

*

Moloney, Patrick, M.B. Melb.

*

Neild, James Edward, M.D. et Ch. B. Melb., L.S.A. Lond.

Webb, John Holden, M.R.C.S. Eng., L.R.C.P. Lond.

ORDINARY MEMBERS.

A'Beckett, William Goldsmid, M.R.C.S. Eng., L.S.A. Lond.

Adam, George Bothwell Wilson, M.B. et Ch. M. Ed.

Aitchison, Alexander Smith, M.B. et Ch. B. Melb.

Aitchison, Roderick, M.B. et Ch. B. 1VIelb.

Allen, Harry Brookes, M.D. et Ch. B. Melb.

Alsop, Thomas Osmond Fabian, M.B. et Ch. M. et L.M. Ed., M.R.C.S. Eng

Armand, George, M.D. et Ch. B. Melb., M.R.C.S. Eng., L. et L.M. R.C.P. et S. Ed.

Armstrong, William, M.D. et Ch. B. Melb.

Backhouse, John Burder, M.B. et Ch. B. Melb.

Bage, Charles, M.D. et Ch. B. Melb.

Balls-Headley, Walter, M.D. et Ch. M. Cant., M.D. Melb., M.R.C.P. Lond.

Barker, William, M.R.C.S. Eng.

Barrett, James William, M.B. et Ch. B. Melb., M.R.C.S. Eng.

Bennie, Peter Bruce, MA., M.B. et Ch. B. Melb.

Black, Archibald Grant, M.B. et Ch. M. Glas.

Brett, John Talbot, M.R.C.S. Eng., L.R.C.P. Lond.

Browning, John Henry, M.D. et Ch. B. Melb.

Campbell, James, M.D. et Ch. M, McGill Univ. Montreal.

Cashel, Edward Baldwin, L.R.C.S.I., L. et L.M.K.Q.C.P.I.

Cooke, John, M.R.C.S. Eng., L.S.A. Lond.

Colquhoun, Archibald, L.R.C.S. Ed., M.B. Glas.

Cox, James, M.D. Melb., M.R.C.S. Eng.

*

Cutts, William Henry, M.D. Ed. et Melb., L.S.A. Lond.

Daish, William Christian, M.B. Melb.

Dickinson, George Dixon, M.R.C.S. Eng., M.B. et Ch. M. Ed.

Dowling, Francis Joseph, M.R.C.S. Eng., L.S.A. Lond., M.B. Lond.

Duigan, Charles B., L.R.C.P. et S. Ed.

Duncan, Robert Byron, F. et L.M. F.P.S.G., L.S.A. Lond.

Dunn, Robert Henry, M.R.C.S. Eng.

buret, Charles, M.D. Paris.

Elsner, Frederick William, L.K.Q.C.P.I., L. et F.R.C.S.I.

tialing, William Henry, L.F.P.S.G., L.R.C.P. Lond

118 Australian Medical Journal. MARCH 15, 1886

•

Embling, Herbert Augustus, L. et L. Mid. R.C.P. Ed., L. et L.

Mid. F.P.S.G.

Fenwick, Henry Marshall, M.D. Durham, M.R.C.S. Eng.

Fergusson, James, M.D. Glas.

Fishbourne, John William Yorke, M.B. et Ch. M. Dub.

Fisher, Alexander, L.R.C.S. Ed.

Fleetwood, Thomas Falkner, M.A. Dub. et Melb., M.B. Dub., F.R.C.S.I.

Fletcher, Arthur Augustus, M.B. et Ch. B. Melb.

Fletcher, Edward, M.R.C.S. Eng.

Florance, James William, M.B. et Ch. B. Melb.

*Ford, Frederick Thomas West, M.R.C.S. Eng.

Foster, Thomas, M.R.C.S. Eng.

Fulton, John, M.D. Glas. et Melb., L.F.P.S.G., Ch. M. Glas.

Fyffe, Benjamin, M.R.C.S. Eng., L.R.C.P. Lond.

*Girdlestone, Tharp Mountain, F.R.C.S. Eng.

Goldie, James Joseph, L.R.C.S. Ed.

*Graham, George, M.D. Melb., M.R.C.S. Eng.

*Gray, Andrew Sexton, M.R.C.S. Eng.

Griffith, James de Burgh, M.B. et Ch. M. Dub.

Haley, Frank, M.B. et Ch. B. Melb.

Harricks, Francis Meagher, L. et L.M.K.Q.C.P.I.

Heath, Richard, L.S.A. Lond., M.R.C.S. Eng.

Heffernan, Edward Bonaventure, M.D. et Ch. B. Melb.

Henderson, Arthur Vincent, M.B. et Ch. B. Melb.

Hinchcliff, Edwin, M.D. Ed. et Melb., M.R.C.S. Eng.

Honman, Andrew, M.R.C.S, Eng., L.S.A. Lond.

Hooper, Francis Leopold, M.R.C.S. Eng., L.S.A.

Hooper, John William Dunbar, L.R.C.P. et S. Ed.

Hora, Tudor, M.R.C.S. Eng., L. et L.M. F.P.S.G., Horne, George, M.B., Ch. B. Melb.

Hudson, Robert Fawell, L.F.P.S.G., M.D. St. A. et Melb.

Hutchinson, Benjamin Clay, M.D. Edin.

Iredell, Charles Lesingham Maynard, L. et L.M.R.C.P. Ed., M.R.C.S. Eng., L.S.A.

Jackson, James, M.D. Lond. et Melb., M.R.C.S. Eng.

*James, Edwin Matthews, M.R.C.S. Eng., L.S.A. Lond.

James, Henry, M.R.C.S. Eng.

Jamieson, James, M.D. Glas. et Melb., Ch. M. Glas.

Jermyn, David, L.R.C.S.I.

Johnston, John, M.B. et Ch. M. Glas.

%Rea 15, 1886 Australian. Medical Journal. 119 Johnston, James Couper, M.B. et Ch. M. Ed.

*

Joriasson, Hermann, M.D. Wurz. et Melb.

Joske, Alexander Sydney, M.B. et Ch. B. Melb.

Lalor, Joseph, L.K.Q.C.P.I., L.R.C.S.I. et L.M., Ch. D. et. M.D.

et Mid. D. Brux.

Lawrence, Octavius Vernon, M.D. et Ch. B. Melb.

Lawton, Frederick, M.R.C.S. Eng., L.S.A. Lond.

Le Fevre, George, M.D. et Ch. M. Ed., M.D. Melb., L.S.A. Lond.

Lernpriere, Charles, M.B., C. M. Edin.

Levis, John Sampson, M.D.Q.U.I., M.R.C.S. Eng.

Lewellin, Augustus John Richard, M.B. et Ch. B. Melb., L.K.Q.C.P.I.

Lillies, Herbert, M.R.C.S. Eng., L.R.C.P. Ed.

*

MacGillivray, Paul Howard, M.A. Mar. Coll. Aberd. et Melb., M.R.C.S. Eng.

MacInerney, James, L. et L. M.K.Q.C.P.I., L.R.C.S.I., L.A.H.D.

Maclean, David Purdie, L.R.C.S. Ed., L.S.A. Lond.

McCarthy, Charles Louis, M.D. Melb.

McConnochie, James, M.D. Glas., F.R.C.S. Ed.

McCrea, William, M.B. Lond. et Melb., M.R.C.S. Eng., L.S.A.

Lond.

McCreery, James Vernon, L.R.C.S.I.

McFarlane, Colin, L.R.C.P. et S. Ed.

McLean, Hector Rath, M.B. et Ch. M. Edin.

*

McMillan, Thomas Law, M.D. St. A., L.R.C.P. et S. Ed.

McMullen, Hamilton, M.B. Dub., L. et L.M.R.C.S.I.

Malcolmson, John Finlay, L.F.P.S.G., L.A.H.D.

Meyer, Felix, M.B. et Ch. B. Melb.

Miller, Hubert Lindsay, L. et L.M.R.C.P. et S. Ed., M.D. et Oh et Mid. Brux.

Mitchell, Henry St. John, L.F.P.S.G., L.R.C.P. Ed.

Mollison, Crawford Henry, M.B. Ch. B. Melb.

Montgomery, John Park, M.B. Ch. B. Melb.

Moore, William, M.D. Ch. M., Melb.

Morrison, Alexander, L. et L.M.R.C.P. et S. Ed.

Morton, Francis William Watson, L.R.C.P. et S. Ed.,

L,M. Ed.

*

Motherwell, James Bridgeham, M.D. Glas. et Melb., L.R.C.S.I.

Nickoll, Edward Harvey Bird, L.R.C.P. et S. Ed.

Nickoll, John Sayer, M.R.C.S. Eng., L.S.A. Lond.

1

N-Oyes, Alfred William Finch, M.R.C.S. Eng.

O'Brien, John Aloysius, M.B. et Ch. M. Glas.

120 Australian Medical Journal. Mena 15, 1886- O'Sullivan, Michael Ulich, L. et L.M.R.C.P. et S. Ed.

Owen, Frederic James, M.B. et Ch. B. Melb.

Owen, Richard Jones, M.R.C.S. Eng., L.S.A. Lond.

Owen, William Hall, L et L.M., K.Q.C.P.I.

Paley, Edward, M.R.C.S. Eng., L.S.A. Lond.

Peacock, Samuel, M.B. Glas., L. et L.M.R.C.S. Ed.

Peipers, Friedrich, M.D. Berlin.

Penfold, Oliver, M.R.C.S. Eng., L.S.A. Lond.

Pettigrew, Augustus Joseph Walford, M.R.C.S. Eng., L.S.A.

Lond.

Pincott, Rupert, M.R.C.S. Eng., L.S.A. Lond.

Porter, Charles Frederic, M. R. C. S. Eng., L. K. Q. C. P. I.

Power Richard, L.R. C. P. Ed., L. R. C. S. I.

Reid, George More, M.D. Edin., M.R.C.S. Eng., L.R.C.P. Lond.

*Robertson, James, M.A. et M.D. Aber. et Melb., L.R.C.S. Ed.

Robertson, Robert, M.R.C.S. Eng.

Robinson, Leonard, M.D. et Ch. M. Roy. Univ. Ire.

Rudall, James Thomas, F.R.C.S. Eng.

Ryan, Charles Snodgrass, M.B. Ed. et Melb., Ch. M. Ed.

Ryan, James Patrick, L. K. Q. C. P. I. , L. R. C. S. I.

Ryan, Timothy Bernard, M.B. et Ch. B. Melb.

Schlesinger, Richard Emil, M.R.C.S. Eng., M.B. et Ch. M. Edin.

Shields, Andrew, M.D. Ed.

Shields, Charles James, M.B. et Ch. B. Melb.

Singleton, John, M.D. Glas. et Melb.

Smith, Charles, M.D. Lond. et Melb., L.R.C.P. Lond., M.R.C.S.

Eng.

Smith, Stephen Maberley, M.R.C.S. Eng., L. et L.M.R.C.P.

Ed.

Smith, William Beattie, F.R.C.S. Ed., L.R.C.P. Ed.

Snowball, William, M.B. et Ch. B. Melb., L.R.C.S. et L.M. Ed., L. S. A.

Sparling, William Augustus, M.R.C.S. Eng., L.R.C.P. Ed.

Sparrow, Richard Henry, M.R.C.S. Eng , L. et L.M.K.Q.C.P.I.

Springthorpe, John William, M.D. et Ch. B. Melb., M.R.C.P. Lon.

Steel, Thomas Henry, M.D. Glas., L.F.P.S.G.

Stirling, Robert Andrew, M.B. et Ch. B. Melb., L.R.C.P. et S. Ed.

Sutherland, Alexander, M.B. et Ch. B. Melb., L.R.C.P. et S.

E.

Sweetnam, William Francis, M.D. et Ch.M. Q.U.I.

Syme, George Adlington, M.B. et Ch. B. Melb.,

F.R.C.S. Eng.

Talbot, Robert, M.D., Edin. et Melb., Ch.

B.

Melb.

Thomson, Matthew

Barclay,

M.B.

et

Ch.

M. Ed.

MAReR 15, 1886 Australian Medical Journal. 121

Trernearne,

John, M.R C S Eng.

Tweeddale, John Dunbar, M.R.C.S. Eng.

Walsh, William Butler, M.D. Dub., F.R.C.S.I.

Warren, Richard Benson, F.R.C.S.I., L. et L.M.K.Q.C.P.I.

Warren, William, L. et L.M.K.Q.C.P.I., L.R.C.S.I.

1V

igg, Henry Carter, M.D. Ed., F.R.C.S. Eng.

Wight,

John Cam, M.B. Ch. B. Melb.

Williams, John, M.D. Ed. et Melb., M.R.C.S. Eng.

Willis, Rupert Henry, M.B. et Ch. B. Melb.

llmott, Julius John Eardley, M.D. et Ch.M. Aber., M.R.C.S.

Eng.

Wilson, John Smith, M.R.C.S. Eng., L.R.C.P. Ed.

Woinarski, Gustave Henry Zichy, M.B. et Ch. B. Melb.

W

oinarski, Stanislaus Emil Anthony Zichy, M.B. et Ch. B. Melb.

Wood, Arthur Jeffreys, M.B. Melb.

Wood, William Atkinson, M.B. Melb.

Woods, William Cleaver, M.B. et Ch. M. Aber.

Woolley, George Talbot, M.R.C.S. Eng.

W

orkman, Francis, M.R.C.S. Eng., L.S.A. Lond.

Wyer, Charles Erskine, L.R.C.P. et F.R.C.S. Ed.

CORRESPONDING MEMBERS.

A stles, Harvey Eustace, F.R.C.P. Ed.

Cl

utterbuck, James Bennett, M.D. Giess., L.S.A. Lond.

G

ardner, William, M.D. et Ch. M. Glas.

Itarris, Henry Louis, M.B. et Ch. B. Melb.

X

ennedy, Patrick, L.R.C.S.I., L. et L.M.K.Q.C.P.I.

Little, Joseph Henry, M.B. et Ch. M. Ed.

P

oulton, Benjamin, M.D. Melb., M.R.C.S. Eng.

Smith, Patrick, M.D. Syd.

Thomas, John Davies, M.D. Lond., F.R.C.S. Eng., L.R.C.P.

Lond., L.S.A. Lond.

T

homas, Walter, M.B. et Ch. M. Glasg.

HONORARY MEMBERS.

Archer, William Henry, formerly Registrar-General of Victoria, Robert, M.D., F.R.C.P. Lond., etc.,'Ex-Pres. Obstetrical Society of London.

//l

ack, Thomas, M.D.

)10sisto, Joseph, Ex-President Pharmaceutical Society of Victoria.

Ca

mpbell, William Henry, M.R.C.S. Eng.

vmwsnst,c,cmisii -

_ ^-

122 Australian Medical Journal. MARCH 15, 1886

Davis, John Hall, M.D., F.R.C.P. Lond., Ex-Pres. Obstetrical Society of London.

Ellery, Robert L. J., F.R.S. Government Astronomer of Victoria, President of the Royal Society of Victoria.

Ralph, Thomas Shearman, M.R.C.S. Eng., L.S.A. Lond., President of the Microscopical Society of Victoria.

Von Mueller, Baron Sir Ferdinand, F.R.S., K.C.M.G., Ph. D.

etc., etc., Government Botanist of Victoria.

Ibritisb- Marital Association.

VICTORIAN BRANCH.

ORDINARY MONTHLY MEETING.

Wednesday, 24th February, 1886.

(Hall of the Royal Society, 8 p.m.)

The President, Dr. HENRY, occupied the chair, and there was a fair attendance of members.

Dr. Cox gave the particulars of a recent fatal case of malignant disease of the larynx, of peculiar interest, promising to show the specimen at the next meeting.

Dr. SPRINGTHORPE exhibited three patients. The first was a case of right hemiplegia, with the following history :-

G. P., mt. 46, with unusually good family history, and personal history free from gout, syphilis, and alcohol ; of a bilio-sanguine disposition, and never laid up except for typhoid fever 9 years ago, a history of mild sunstroke. Three months ago an attack of minor hemiplegia, after premonitory stuttering, twitching, and cold feet. The right leg was affected more than the arm, but there was no hemi-anaesthesia. There was no unconsciousness, no deviation of head, mouth, or tongue. The affected side went through the usual changes of such attacks until at present motion has fairly returned, except in the leg which drags. Some slight degeneration, however, followed, as shown in the ankle clonus and increased knee-jerk of the right leg. The interest of the case lay in the cause. Everything pointed to an embolism of some branch of the lenticulo optic artery of the left internal capsule.

Of rheumatic history, however, there was only great exposure to wet, and pains in the knees, without any fever. On examining the heart, however, there were corroborative signs. There was considerable hypertrophy of the left ventricle, with the usual