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the centre for strong closure of the eyelids is physiologically distinct from that for their gentle closure. If the orbicularis is paralysed the associated inhibition of the levator still occurs on an attempt to close the lids. But, if the inferior rectus is paralysed, a fruitless attempt to rotate the eyeball down is not attended with inhibition of the levator. This phenomenon (of which photographs were shown) is difficult to explain. Possibly this relaxation of the levator is not the result of a central mechanism, but is reflex from the commencing tension on the fibres, and so does not occur if the globe does not move. If so, the fact is of much interest in relation to the mechanism of other movements in the body. Lastly, it is pointed out that the eyelids commonly participate in the movements of the eyeballs in vertical nystagmus.
Ophthalmoscopic appearances in Tubercular Meningitis. The following is an abstract of a paper on the “Ophthalmoscopic Appearances in the Tubercular Meningitis of Children,” by GEORGE GARLICK, M.D. :—The ophthalmoscope discloses changes in the optic discs of about 80 per cent. of the children who die of tubercular meningitis. These changes fall under one of two headsviz., optic neuritis or distension of the retinal veins alone. As the discs vary physiologically in different individuals and even in the same person, the two are often not alike; progressive change is better evidence than can be obtained from a single examination. In a small proportion of cases the optic changes occur very early in the course of the disease, and enable a diagnosis to be made when the symptoms are equivocal ; this is the case when the meningitis is seated chiefly about the optic commissure. But the ophthalmoscopic changes are an important factor in the diagnosis in a much larger number of
The two forms of disc change—viz., optic neuritis and distension of the veins—appear related respectively to meningeal inflammation and pressure. The intracranial pressure may result from excess of ventricular or of subarachnoid fluid, and gives evidence of its presence in the anæmia of the cranial
contents. The palsy of the limbs is mostly found on the side opposite to that hemisphere of the brain which presents that greatest meningeal affection. No such definite relation exists with regard to the optic discs. In many cases of tubercular meningitis which run an indefinite course, especially those which are secondary to some other advanced disease, the optic changes share the indistinctness of the other symptoms. The ophthalmoscope countenances the idea that some cases of tubercular meningitis recover, and, even in fatal cases, a temporary improvement may occur in the discs. Tubercles of the choroid appear to be an uncommon complication.---The Lancet.
Gas in Peritoneal Cavity in Typhoid Fever relieved by Puncture.--Mr. GEORGE Brown read a paper before the Clinical Society of London on a case as above. The patient, a young man aged twenty-one, was under Mr. Brown's care for typhoid fever in October last. The temperature was high throughout, ranging from 1029 to 105.2° during the height of the fever. The case was complicated with double pneumonia. In the third week of the fever tympanites developed, which was at first localized to the parts of the abdomen occupied by the intestines, but a few days later the physical signs indicated that gas had escaped from the intestines into the peritoneal cavity, or was being generated in the cavity itself, The distension of the abdominal wall gradually became more and more extreme, the tympanitic note entirely masking the hepatic and splenic dulness, and could be elicited over the sternum as high as the articulations of the fourth costal cartilages. Through the upward pressure on the diaphragm there was urgent dyspnea, the respirations reaching as high as 50 per minute, and the heart was displaced upwards and outwards, so that the apex-beat was half an inch outside the nipple and in a line with it. Mr. Brown pierced the abdominal wall with a small aspirator trocar an inch below the umbilicus, and on withdrawing the cannula a rush of gas took place which continued for several seconds. The gas was odourless. The relief was immediate, the heart regained its normal situation, and in a few minutes the
respirations fell from 50 to 36 per minute. No ill effect followed the operation, The patient succumbed, however, from the lung complications thirty-six hours after. As to the source of the gas, Mr. Brown dismissed the idea of perforation of the intestine on the following grounds, viz. :-1. The gradual development of the gas in the peritoneal cavity. 2. Absence of symptoms of collapse which might have been expected had perforation taken place. 3. The fact that the tympanitic condition of the colon and small intestines was unrelieved by the operation. Ilad perforation existed, gas would probably have continued to escape into the peritoneal cavity after the operation, but of this there was no evidence, although the patient lived thirty-six hours afterwards. 4. The fact that the gas was odourless. Mr. Brown advanced two theories as probable sources of the gas : first, the gas might have passed by diffusion through the intestinal wall; or second, the gas might have been derived directly from the blood by exosmosis through the delicate wall of the peritoneal capillaries—and this was the more probable, from the fact that several days previous to the distension taking place the blood was highly charged with carbonic acid gas in consequence of imperfect aëration in the lungs. Mr. Brown said he was unable to decide this point, and preferred to merely record the case in the hope that other observers would be able to throw more light upon the subject should similar cases occur in their practices.—Medical Times.
Amussat's Operation in a case of Imperforate Rectum. - Mr. MORRANT BAKER read notes of a case of imperforate rectum, for which Amussat's operation was performed, in a female infant, who, when nineteen days old, came under the care of Mr. Morrant Baker at St. Bartholomew's Hospital. When first seen, the abdomen was enormously distended; there was frequent vomiting, and the child was much exhausted. Chloroform having been administered, an attempt was made to find the lower end of the bowel, through the short cul-de-sac which represented the anus. The bowel, however, could not be found, uotwithstanding very free incisions, and in spite of the great distension of the abdomen, no bulging of the parts could be detected, even during the action of the abdominal muscles. It was decided, therefore, after a consultation, to desist from furthar operative procedures in the neighbourhood of the anus, and to perform colotomy by Amussat's operation in the left loin. This operation was accordingly performed. Meconium freely escaped, and within a few hours the infant was greatly relieved. An elastic tracheotomy-tube was inserted into the bowel through the wound in the loin, and had been worn continuously ever since. In this way all troubles which might have arisen from contraction on the one hand, or prolapse on the other, were avoided. A year after the operation it was noted that the child was well and wore the elastic tube ; fæces passing only once or twice in the week. The abdomen was, however, not distended. Two years after the operation the note was the same, and the child, now nearly three years old, was shown to the Society, perfectly well in health, and still wearing the elastic tube in the loin. Instances of recovery, it was remarked, after the performance of colotomy for the relief of imperforate rectum were curiously rare, and probably the case shown to the Society was the only one now in this country. The question as to the best operation to be performed in cases of imperforate rectum, in which the bowel could not be found at the outlet of the pelvis, was discussed, and Mr. Baker thought that, on the whole, a preference should be given to Amussat's rather than to Littré's method of colotomy.—Medical Times.
WARNER'S PILLS OF QUININE. We have received from Messrs. Warner & Co., a sample of their pills, containing gr. ii. of Quinine in each pill. These are thoroughly reliable preparations, and are beautifully put up, being coated over with sugar. The use of sugar as a coating for pills has been objected to, but there is nothing that in verity can be advanced against this method of coating these preparations. It is stated that in sugar-coated pills the drugs become dry and hard and soon loose their efficiency-not more so we should suppose than in drugs prepared in the ordinary way. But everything in nature is perishable, and will in time deteriorate. These pills, like others of Messrs. Warner & Co's. preparations, are made for use and not to be retained for any length of time in stock. We commend them as being reliable, and in being the most palatable form of taking medicine.
Medical and Surgical Journal.
MONTREAL, JUNE, 1879.
REGISTRATION OF COLONIAL DEGREES.
There is a considerable amount of egotism in the sayings of some of our exchange journals of British heritage concerning this subject of the recognition of Colonial degrees. The Editor of The Medical Times and Gazette, in an article on “ Colonial Medical Registration," informs us that he has been trying to establish reciprocity of Registration between the colonies and the mother country, and then quotes the Letter of Dr. Baldwin, a Registered Practitioner of the United Kingdom, to which we have already referred on a former occasion,
In the number of our Journal for December, 1878, we endeavoured to aid the understanding of our English contemporary touching our Canadian institutions, but it would appear that we were not sufficiently explicit. We fail to see in what particular The Medical Times has in any way advocated reciprocity of Registration between Canada and the mother country, and on referring to an article which was published by that periodical on the 16th November, 1878, the directly opposite inference must be drawn therefrom. But probably the Editor of The Medical Times and Gazette did not take the trouble to read our article, and he again falls into error as regards Canada and our Registration system. He states that “the Privy Council of Canada has omitted to notice that when the British Medical Act of 1858 passed, the Ontario College did not exist, and that for anything that appears, there may not have been at that date any Licensing Body in the British North American Provinces.” Now the facts of the case are these : Medical legislation in this colony dates back to the 28th year of the reign of His late