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Correspondence.

To the Editor of the CANADA MEDICAL AND SURGICAL JOURNAL :

EDINBURGH, January 14, 1879.

SIR, A few notes from this, the greatest seat, perhaps, in all the United Kingdom of medical teaching, will prove interesting, I have no doubt, to many of your numerous readers. During the last five or six years the changes in the teaching staff of the medical faculty of this university have been very numerous. After the loss of such men as Bennett, Christison, Lister, Laycock, &c., many false prophets arose, who would fain have placarded the walls of their Alma Mater with "Ichabod! Ichabod!" Happily, however, the state of matters has turned out quite differently, and it is universally acknowledged that the teaching was never so thorough and efficient as it is this winter. The late returns of the matriculation rolls show an attendance of 1293 medical students. Of this number 565 are from Scotland, 445 from England, 22 from Ireland, 75 from India, 149 from different British colonies, and 34 from foreign countries. The majority of the colonial students are from the Cape and Australia. There are also about 150 students who attend exclusively the extra-mural lectures. Owing to the small size of some of the class rooms, a few of the lecturers have been compelled to divide their classes and lecture twice daily. This difficulty will, however, be overcome when the buildings at present under construction for the medical department of the university will be completed. They are situated in close proximity to the new infirmary buildings, and already $1,000,000 has been subscribed (including the government grant of £80,000) towards the building fund.

Prof. Fraser has instituted, this winter, a practical class in Materia Medica. It is very ably conducted, bnt, owing to the restrictions of the late act, experiments on animals are not carried out. That some misguided people are still clamoring for more repressive measures against experiments on animals, the following advertisement, which is copied from to-day's Scotsman, shows:

"Anti-vivisection Prayer Meeting this Day, 1:30 o'clock, 5 St. Andrew's Square."

The following case of a rather rare disease of the spinal cord is worthy of mention, principally on account of the benefit to be derived from judicious treatment, and from the light it throws on allied spinal affections, which are, as yet, but little understood:

The case, one of acute palio-myelitis, or the so-called “infantile "paralysis of adults, was made the subject of a clinical lecture by Prof. Grainger Stewart, the distinguished occupant of the chair of Practice of Medicine. The patient, who is 18 years of age, and a gardener, has been under observation since August. His social and family history are good. He never had any previous illness, nor did he ever meet with any accident. His illness began suddenly during the last week of July. The symptoms during the first week resembled those of an acute gastric catarrh. On the fifth day of his illness he noticed that all his extremities were weak; on the seventh day his right arm and leg were completely paralyzed, the left arm and leg partially so. The following was his condition during

the first week of November :-
:-

Nervous System.-Sensibility to touch; pain and heat normal. Muscular sense is unimpaired. Sight, hearing, taste and smell normal. The organic motor functions of swallowing, micturition and defecation are not interfered with. The bowels. are slightly costive, but this is owing to a loss of power in the abdominal muscles. The respiratory acts, although quickened, are normal in rhythm. There is scarcely any lateral expansion of the chest during inspiration; when he was admitted there was none whatever. Forced expiration is a very difficult task. Both the skin and tendon reflex functions are entirely abolished. The arms have recovered power to a great extent, but there is only the slightest improvement in the motion of the lower extremities. The arms respond to the faradic current, but there is no response to this form of current in the lower extremities. There is no exaggerated reaction to the continuous current, showing that the "reaction of degeneration is not present."

There has been a great and rapid wasting of the muscles in this case-more than could be accounted for by disease. There

was a considerable elevation of temperature at first. Shortly after his admission into the infirmary, he nearly succumbed to an attack of acute bronchitis-he was unable to expel the profuse secretion which collected in his tubes, owing to paralysis of his intercostals. At present (January 6th) this patient is steadily improving; the upper extremities have wholly regained their power, and the improvement in the feet and legs is very considerable, but as yet he is not able to walk unassisted.

The distinguishing features of this disease are:- The rapid occurrence of paresis, passing into palsy of either whole, or groups of muscles, and quickly followed by the rapid wasting of the muscles involved. There is loss of reflex action and faradic excitability, but no loss of sensation.

Its pathology is the same as infantile paralysis. It consists in a degeneration of the cells of the anterior horns of grey matter. It is not a settled point whether the change consists in a primary degeneration of the cells, or whether they are injured and pressed upon by the inflammatory products arising from an affection of the interstitial tissues of the anterior horns of grey matter. The latter is, however, the view that is generally adopted.

This disease throws light on the following diseases of the cord : I. Paralysis of infants. II. Spinal paralysis of adults. III. Lauder's acute ascending paralysis. IV. Amyotrophic lateral spinal sclerosis.

The treatment pursued in this case was, in the early stages, large doses of ergot, followed by iodide of potassium and the continuous current.

Prof. Grainger Stewart has had lately under his care, in the infirmary, a case of what Trousseau designated as epileptiform neuralgia. The patient, a man 70 years of age, has been troubled with it for 18 years, and during that time he tried a great number of different remedies, but nothing, except very large hypodermic injections of morphia, had the least effect in mitigating the severity of the attacks, latterly even the morphia failed to relieve him. The pain, which came on in paroxysms, lasting from half a minute to one and a-half or two minutes, and

was of the most agonizing character, started in the region of distribution of the labial branches of the superior maxillary nerve. The act of chewing invariably brought on a paroxysm; on this account he was compelled to feed himself through a tube. The slightest friction over the area supplied by the superior maxillary nerve excited an attack. As soon as the pain started, the muscles of the right side of the face began to twitch. As a rule, he had several attacks daily; the longest interval during the 18 years that he was free from them was six months. After his admission into hospital various remedies were tried, but not the slightest benefit was noticeable from any or all of them.

The nerve, as it emerges from the infra-orbital foramen, was cut down upon and stretched. This procedure was attended, after 12 hours, by almost complete relief; but the pain recurring shortly afterwards, the operation was attempted to be repeated, but owing to the nerve being up in the newly-formed cicatricial tissue, it could not be stretched, but was cut through. This only gave partial relief for a short time. The labial branch of the nerve was stretched, and since this has been done (seven weeks ago) he has been completely free from pain. He is able now to chew his food, and bear his face to be roughly rubbed.

Although the relief which has followed this last method of treatment is complete, it remains to be seen whether it will be permanent or not.

The following case, although it presents nothing unusual in its pathology or treatment, is of very great interest from its frequency, and is a good example of how a patient with irretrievably damaged organs can be made to enjoy a comparatively comfortable existence, and have his life greatly prolonged. The patient, a man 60 years of age, was admitted into the hospital a year ago under Prof. McLagan's care. Last May he was transferred to Prof. Stewart's wards, and his condition then was as follows::

He was suffering from great dyspnoea, oedema of the lower extremities, scrotum, and integument of the lower part of the back and abdomen. He had bronchitis with oedema of the

lungs, and double hydrothorax. His heart was dilated and feeble, his mitral valve was incompetent, and the orifice of his aorta was obstructed. He had a degree of cirrhosis of the kidneys, and his urinary tubules were the seat of acute catarrh. He was drowsy from uræmic poisoning. The pulse was hard and tense. Sixty ounces of serum were withdrawn from the right pleural cavity, although the dullness did not reach up to the inferior angle of the scapula. Up to the present he has been tapped on ten different occasions-eight times from the right and twice from the left pleural cavity; 700 ounces in all having been withdrawn.

He was given a pill containing digitalis, squills and carbonate of ammonia.

At present the patient enjoys a fair degree of comfort, the dropsy of the lower extremities having almost completely disappeared. Prof. Stewart says he has learnt the three following lessons from this case:-I. A bolder use of the aspirator in cardiac dropsy. The fluid should be allowed, however, to drain away very slowly, and the cavity should not be completely emptied. II. A very large quantity of fluid may be present in the pleural cavity without giving rise to extensive dullness. This is explained by the constant and long-continued pressure of the fluid, causing exhaustion of the diaphragm. III. A more thorough appreciation of the great value of digitalis as a cardiac tonic, and of digitalis with squills as diuretics.

The anæmia, which is an important factor in the causation of the dropsy, in those cases is more certainly relieved by the use of the muriated tinct. than any of the other iron preparations, but often it disagrees. Dr. G. Stewart says that he has found that if the chloride of ammonium is combined with the iron tinct., the result is better, and the former prevents the irritant action of the iron.

Can acute lobar pneumonia be aborted? This question, which is generally answered in the negative, is one of great moment, and is one which Dr. Geo. Balfour considers can be answered affirmatively. For some years he has given chloroform in cases of pneumonia, and from a close observation of its

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