Abstracts and Extracts. A Statistical Study of Alcoholism as a Causative Factor in Insanity. By CLYDE R. MCKINNISS, M. D. Medical Record, Vol. 76, p. 906, Nov. 27, 1909. This study is based on the admissions to the Male Department of the Norristown State Hospital for the period from April 1, 1907, to April 1, 1909. The following summary is given: 1. Our study includes 520 male patients, a majority of whom were admitted from Philadelphia and the larger towns in the counties of Philadelphia, Delaware, Montgomery, Bucks, Lehigh and Northampton. 2. In 46 per cent of these, alcohol either alone or in combination was an important etiological factor. In 13.5 per cent they were classed as alcoholic psychoses. 3. In 41 per cent of the imbeciles and 34.5 per cent of the epileptics, alcohol was responsible for their commitment. W. R. D. Contribution critique et clinique à l'étude des états terminaux dans la démence précoce. Par F. MEEUS. Bulletin de l'Academie Royale de Médecine de Belgique, Tome XXII, p. 855. (Seance, du 26 decembre, 1908.) In beginning his paper the author makes the same statistical error which has been frequently made before and of which a correction was published in the JOURNAL, Vol. 62, page 511. He gives the recovery rate for dementia præcox as 21 per cent, when it should be but 7 per cent. Meeus states that he has never seen a true recovery in dementia præcox, as all cases show some residual symptoms. This is but natural, as we are dealing with a primary dementia. The cures that have been reported are probably due to incorrectly diagnosing cases of mental confusion as dementia præcox. He quotes from Aschaffenburg, who says: "Dementia præcox is an affection which develops usually in youth and which leads under all circumstances, sometimes immediately, sometimes after more or less numerous remissions, to a condition of characteristic and definite mental weakness." The mental weakness has its degrees and varieties. Individually we are not able to predict the degree which will remain after the subsidence of acute symptoms, but generally, in the milder forms, such as hebephrenics in whom the disease develops without violent symptoms of excitement or depression, the weakness will not be very profound and the patient will be like an imbecile. In catatonics with marked mental disturbance the weakness is marked, but at the same time we meet with marked remissions in these forms. The first case Two case abstracts are given followed by comment. showed marked moral defects; the second is a case of heboidophrenia, which the author believes is an important form from a medico-legal and pedagogic standpoint. W. R. D. Psychical End-Results Following Major Surgical Operations. By JAMES G. MUMFORD, M. D. Annals of Surgery, Vol. XLVII, p. 853, June, 1908. While there may be an anatomical cure following operation, the psychical result may be unsatisfactory, the patient still considering himself an invalid. This is discussed, but no satisfactory remedy is proposed. A case showing an unsatisfactory psychical result is termed a failure and the percentage of these is shown in the following table: WOMEN. Total number of operations... Total number of failures.. Total psychical failures.... Total operations on sexual organs.. Total failures in operations on sexual organs.... .... MEN. Total number of operations. Total of psychical failures... Total number of genital operations.. 91 37.4% 35.0% 68 37.0% 35.0% 23 35.0% 26.0% 39 18.0% 23 W. R. D. Surgical Aspects of Graves' Disease with Reference to the Psychic Factor. By GEORGE CRILE. Annals of Surgery, Vol. XLVII, p. 864, June, 1908. The serious barrier to surgical treatment of Graves' disease is the immediate operative risk, which is not shock or hemorrhage, but hyperthyroidism due undoubtedly to psychic excitation. This is combated very ingeniously by training the patient to become accustomed to the administration of ether, by daily dropping upon an ether mask solutions of volatile oils. As soon as the patient is trained and no physical signs are observed to follow the above procedure, she is prepared for operation by giving bromides the evening before and morphia the morning of the operation. The anesthetist then gives the so-called inhalation treatment, the patient being told that the inhalation will be stronger and that possibly a sore throat may result, but that the doctors say that this will be the last treatment required. Ether is then added drop by drop and gradually the patient passes into the second stage of anesthesia in which she is taken to the operating room and the operation is performed. Among 28 cases of Graves' disease operated upon by the old method the mortality was four. With the present method 13 cases have been operated upon without the patient's knowledge, the usual circulatory changes attending the operation not appearing. W. R. D. AMERICAN JOURNAL OF INSANITY THE NEW GOVERNMENT HOSPITAL FOR THE INSANE. BY WILLIAM A. WHITE, M. D., Superintendent, Washington, D. C. Next May the American Medico-Psychological Association will meet in Washington. The Thursday afternoon session of the meeting will be held at the Government Hospital for the Insane and many of the members will, I trust, visit the hospital, so I am taking this opportunity of "writing up" a short account of the hospital, describing its principal features, particularly the medical and scientific organization, and setting forth those points that I think may be of interest to the members of the Association. The hospital was created in 1855 by Act of Congress and since that time has been steadily growing. As might be supposed practically every type of asylum construction that has been in vogue for the past half century is represented in the several departments of the institution. While many of these features have a great deal of interest it is not the purpose of this article to dilate upon them but only to take up the more recent improvements in both construction and organization. The new hospital extension, designed by Dr. Richardson, which has in large part made possible the improvements of recent years, comprises fifteen buildings which were under construction when I took charge October 1, 1903. These fifteen buildings include an administration building, a nurses' home for women, a detached kitchen, a power, heat and lighting plant, and eleven buildings for the accommodation of one thousand patients. The cost of this extension was approximately $1,500,000. The first of these fifteen buildings was occupied in June, 1904. From that date the other cottages have been successively opened and this shifting of the patient population made it possible to remodel many of the older structures. Four buildings have been entirely remodeled; one made into a nurses' home for men, the porches of several of the old buildings have been made into sun parlors (Fig. 1) and wards for the tubercular, a dispensary and circulating library established in the old administration quarters, two buildings abandoned, many small structures torn down, two buildings moved in their entirety to different locations, and an amusement hall with seating capacity of approximately 1200 erected. At the present time the three power plants of the hospital are being consolidated and the electrical system changed from the direct to the alternating current. The eleven new cottages for patients are of two general types— small cottages for from 30 to 60 patients, and large cottages of four wards each for 120 patients. There are five cottages of this latter type, one each for the disturbed classes, male and female, one for the infirm and bed-ridden white men, and two psychopathic (receiving) buildings. These two psychopathic pavilions are located one on either side of the new administration building (Fig. 2) and have certain features of construction that are worth noting (Figs. 3, 4, 5, 6). These features are shown in the plans and are: the porches, enclosed on the second floor, large enough to accommodate the entire population of the wards-a special corridor for noisy patients which can be shut off completely from the rest of the ward and has a continuous bath at one end—a surgical department consisting of surgical amphitheater, anesthetizing room, sterilizing room, and surgeons' room-a hydrotherapeutic equipmentand a large proportion of single rooms. For administrative purposes the hospital is divided into five departments, each with a chief, as follows: Steward, Disbursing Officer, Chief Clerk, Clinical Director, and Scientific Director. The first three of these chiefs of departments have to do entirely with the administrative and business management of the institution and I will, therefore, not mention them further in this article. The medical service of the hospital is presided over by the clinical director, a position which was created something over three years ago. His duties comprise the general supervision and oversight of the medical work of the hospital, and the charge of the hydrotherapeutic department, operating room, training school for nurses, and the clinical records. In general, his function is to bring into closer organic connection the different medical services and to that end he operates as a clearing house through which all transfers of patients from one service to another must be made. |