(e) Lichen pilaris (Bazin). (f) Ulerythema ophryogenes (Taenzer)? Closely allied if not synonymous: (a) Follicular xeroderma (Liveing). (b) Icythyose ansérine des scrofuleux (Lemoine). (d) Ichthyosis follicularis (Lesser). (f) Xérodermie pilaire (Thibierge). (g) Xérodermie pilaire érythémateuse (Besnier). (6) Lichen pilaris seu spinulosus (Devergie). Synonyms (a) Acne cornée (Leloir, Vidal). (d) Folliculitis setosa (Wilson). (e) Keratosis follicularis spinulosa (Unna). (f) Kératose folliculaire (Type de Brooke) (Barbe). (7) Psorospermosis follicularis vegetans (Darier). (a) Ichthyosis sebacea cornea (Wilson). (b) Ichthyose noire cornee (Beretta model No. 4)? PSYCHIATRY. ALBERT MOORE BARRETT, A. B., M. D. J. F. B. PROFESSOR OF PSYCHIATRY IN THE UNIVERSITY OF MICHIGAN AND DIRECTOR OF THE CHARLES WELLMAN HITCHCOCK, A. M., M. D. ADJUNCT PROFESSOR OF NERVOUS DISEASES AND CLINICAL PROFESSOR OF NEUROLOGY IN PEDAGOGIC THERAPEUTICS OF NERVOUS AND DOCTOR EDWARD HESS, Centralblatt fur Nervenheilkunde und Psychiatrie, January, 1909. In the improvement of our views regarding the differences in individual mental equipment of children, and a recognition of the fact that peculiar personalities often spring from pathologic mental organization, there arises before us the total lack of provision for the systematic and intelligent correction of these conditions. The problem of their treatment is essentially a medical one, and the importance of these nervous and mental abnormalities in their relation to the later development of a serious form of insanity or the production of a wrecked life cannot be overestimated. The writer of this article speaks with the experience of one who is the head physician of perhaps the foremost private institution in Germany and one which has for a long time specially concerned itself with therapeutic problems. The field of pedagogic therapeutics includes a complete education on a psychiatric basis. Such an education can only be carried on in a psychiatric institution. The fundamental part of a child's education is that which is received from the parents in home relations. All school training is but a supporting part of this education and chiefly concerns the intellectual side. When the home training of a child, who is nervously or mentally diseased, fails, then a medical problem arises, which is one for the pshyciatrist who then takes the place of the parent. Any child or young adult up to the age of twenty to twenty-three, who may be nervously or mentally diseased, is suitable for psychiatric pedagogic treatment unless contraindications exist. These latter include idiots in whom exists abnormal structural conditions of the brain, and the states of backward mental development which are serious enough to be classed as imbecility. For thereapeutic purposes, and in no way diagnostic, these conditions may be differentiated into three classes. (1) Neuroses, neurasthenia, hysteria. The conditions of the first group, where they occur in mild degree, may be treated in the home. But it should be remembered that the best results often occur when the patient is taken out of the family. Where the conditions do not improve they should be treated in a medical "pedagogium." No ordinary hospital for the insane is suitable for this class of patients. The second group of conditions includes the psychoses developing during youth. Often these patients need care and treatment in a hospital for the insane, during the acute phase of the disease, for example, during excitement, stupor, or delusional states. After a certain period a condition of quietude occurs in these patients and at this time the patients need to be cared for in a special psychiatric "pedagogium." Conditions of moral defectiveness, of the third group, are an important feature of imbecility, psychopathic personalities, and the questionable “moral insanity" and are an early symptom of that special type of insanity in youth, the "heboidphrenie." Here these exists an ethical defect without disturbance of the intelligence. If treated in their beginning such cases offer hopes for recovery. These conditions need long treatment in a "pedagogium." An institution of this type can reach its greatest usefulness as a part of a hospital for the insane. As a part of such an institution there are facilities for transferring from ward to ward when necessary, and the conditions under which the patients are admitted should allow of his being held against leaving of his own accord. Apart from the routine ward care, under nurses, there should be specially trained teachers. To be of any value. all training should be individual. The details of this training the author does not go into, further than to state that the ultimate end of the training is to direct the patient towards a practical mode of livelihood. In educating the ethical side of the patient the only successful procedure is to develop the idea of a utilitarian value of correct moral conduct. By practice the patients must learn to suppress or modify those inclinations and impulses which are in conflict with the moral standards of ordinary social life. Except by conforming to the moral laws and customs which prevail in social communities, life outside for him is not practical. By making it impossible for the continuance of immoral inclinations and useless activities they are gradually forgotten. Outbreaks against order and customs are to be firmly met by such methods as reproofs, withdrawal of amusements or privileges; threats and corporal punishments have no place in the discipline. A patient who is inaccessible to discipline is unsuited for treatment in this class of an institution. The period of treatment must necessarily be a long one, and even after the patient leaves the institution for family life a supervision may be continued by the physician. The explanation for the apparent great increase in abnormal mental conditions in youthful individuals the author finds in the recognition by the general public that children who formerly were regarded as bad or mentally backward or abnormal, are mentally diseased, a fact which has long been recognized by the more thoughtful but has only recently become more generally understood. A. M. B. NEUROLOGY. DAVID INGLIS, M. D. PROFESSOR OF MENTAL AND NERVOUS DISEASES IN THE DETROIT CARL DUDLEY CAMP, M. D. COLLEGE OF MEDICINE. CLINICAL PROFESSOR OF NEUROLOGY IN THE UNIVERSITY OF MICHIGAN. ON THE EXCRETION OF HEXAMETHYLENAMIN (UROTROPIN) IN THE CEREBROSPINAL FLUID AND ITS THERAPEUTIC VALUE IN MENINGITIS. CROWE (Johns Hopkins Hospital Bulletin, for April, 1909) gives the results of various tests as to the excretion of hexamethylenamin into the cerebrospinal fluid. Ten-grain doses were administered and the drug appeared in the fluid in maximum concentration, from thirty minutes to one hour later. It is not clear whether it appears as formaldehyde or urotropin. The test which was used was as follows: To the clear cerebrospinal fluid a drop of milk or very small amount of casein was added, and this mixture was stratified with an equal volume of the reagent, which was composed of one hundred cubic centimeters of ninety-nine per cent sulphuric acid and one drop of three per cent ferric chloride solution. The sulphuric acid decomposed the urotropin into formaldehyde and ammonia and a deep amethyst color developed at the junction of the layers. Urotropin was administered in purulent meningitis and also as a prophylactic measure in cases of brain injury where meningitis might be expected to develop, with good results. It was also given before lumbar puncture. Experiments with animals inoculated with virulent streptococcus into the meninges showed that the administration of urotropin by mouth would inhibit the clinical symptoms of meningitis. The dose which was necessary was from sixty to eighty grains a day. ASCENDING NEURITIS. C. D. C. DEJERINE and ANDRE-THOMAS (Revue Neurologique, Volume XVII, Number VIII, page 496) report a case of ascending neuritis which was followed by autopsy and study of the pathologic anatomy. The patient pricked the anterior surface of the thumb with a pin. It was not more painful than ordinary pinprick and, was not followed by any inflammation or lymphangitis. The pain persisted and was followed by other symptoms of a neuritis, extending up the arm-excessive pain, wasting of the muscles, tenderness on pressure, loss of reflexes, et cetera. The necropsy showed a marked neuritis. The affection is very rare. This is the first case with autopsy, and the pathogenesis is unexplained. DIAGNOSTICS. FRANK SMITHIES, M. D. C. D. C. THE EARLY DIAGNOSIS OF TABES DORSALIS. THE diagnosis of locomotor ataxia in its initial stage is often no easy matter, the detection of the signs and symptoms of the disease requiring careful search, an acute eye, and an alert mind. It is in this stage, however, that the diagnosis is of especial importance, particularly in deciding the question of whether or not a man should marry.. Much unnecessary hardship has been caused by physicians in overlooking early cases of tabes dorsalis, and permitting sufferers to marry when in a physical condition which would make matrimony little better than a crime. Every care should be taken in examining a prospective bridegroom, especially if there is the faintest suspicion of a previous specific taint, in order to detect the first suggestion of this insidious disease. In this relation an article by Kann, of Bad Oeynhausen on the diagnosis of initial tabes, which appears in the Berliner klinische Wochenschrift for June 21 is of interest, for, while it teaches nothing new, it emphasizes some points which seem worthy of note. The pain in early tabes is often not of the typical lightning character, but may be a dull ache in the joints resembling chronic rheumatism or persistent boring pains in various parts of the body. The well-known paresthesias may be absent from the hands and feet, but present in the perineal region. Digestive symptoms, loss of appetite, or constipation may be early symptoms, while bladder symptoms of all kinds must be investigated with care. The Argyle Robertson sign may be only partial or unilateral. Inequality of the pupils, loss of the reflex pupil reaction, and double vision from muscular paresis may occur early. The loss of the knee jerk appears comparatively late in the disease, and is of but little value in early diagnosis. The tendoAchillis reflex, however, disappears much earlier. Owing to their frequent absence in health, the state of the arm reflexes is of little value, though that of the triceps is of some significance, especially if it is weaker on one side than the other. The hypotonicity of the musculature shown by the abnormal motility of the joints is of especial value. Pronounced ataxia occurs late, but the symptom may manifest itself early by slight uncertainty in the dark or by tremor of the leg when held in the air. When the Romberg symptom appears to be negative, it may be elicited by standing with one foot before the other, or with one off the ground; while in the absence of gross swaying, an abnormally active play of the leg and buttock muscles may put the examiner on his guard. The important point is not the presence of abnormal movements, but their increase on closing the eyes. All abnormalities of sensation should be studied, especially those in the neighborhood of the breasts and perineum. The deep joint sensation is demonstrated by moving the great toe, and its loss is of significance. More recent discoveries of value are the lymphocytosis in the spinal fluid and increase in globulin as shown by Noguchi's test. The Wassermann test, too, may give information of value. A careful and systematic search for these minor and more obscure symptoms of tabes in every suspect of past syphilis or candidate for matrimony may establish a diagnosis in a case which otherwise would be overlooked, may save the physician some later chagrin and a prospective bride a life of slavery and unhappiness, and by enabling the institution of early treatment will give the patient himself the greatest possible chance for checking the course of the disease. A METHOD FOR HEMOLYSIS AND AGGLUTINATION TESTS. EPSTEIN and OTTENBERG (Archives of Internal Medicine, Volume III, Number IV, 1909) comment upon the fact that in the development of the methods for estimating hemolysins and agglutinins, animals have been used and the factor of getting large quantities of blood for the tests and their controls has not had to be considered. The application of such tests to humans has been fraught with the difficulty of getting the proper quantity |
