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Castration of Habitual Criminals.

Editor MEDICAL WORLD:-On page 352 of the August WORLD appears an article entitled " Castration of the Idiots," in which the writer favors unsexing of both male and female. At first thought this does not seem a question of much importance, but upon sober second thought it becomes apparent that the enforcement of such a measure would jeopardize the procreative organs of some men of the present century who pose as statesmen; and for this reason it is not only a matter of considerable gravity, but its consideration would cause stubborn and endless debate; for in the very beginning we are confronted with the important question: Where shall the line be drawn making one man an idiot and another a statesman?

Castration of habitual criminals is a matter of much more importance in the state.

Since the state must bear the expense of prosecuting and providing for the criminals, why not enact a law that would to some extent prevent the multiplication of the criminal class? Under a habitual criminal law, any person convicted of a crime punishable by imprisonment in a penitentiary who has already served two or more terms in a penitentiary, shall be sentenced by the court to imprisonment in the penitentiary during his natural

life.

If every person sent up under this act were to remain behind the prison walls for the time specified by law, it would require nothing more to rid society of the habitual criminal and his pernicious influence, but when we come to consider the influ. ence brought to bear upon a state pardon board, and the influence of the convict's friends and of penitentiary officials upon a pliable governor, and for other reasons, good and true, which need not be mentioned at this time, it must be apparent to all that the object for which the habitual criminal law was enacted is defeated, the professional or habitual criminal is

turned loose upon a long-suffering community, and the criminal class is given an opportunity in this way to multiply. Under such circumstances there would be wisdom in the enactment of a law, making it a part of the duty of the warden of every penitentiary to emasculate all habitual criminals. The moral restraint that would hear upon the criminal class in view of the possible enforcement of a law like this is incalculable; and, aside from this fact, the enforcement of such a law would insure society against the criminal handing down a vicious and productive posterity. Grade the criminals if you will; give them 4th of July and Thanksgiving dinners; provide them with roast turkey and cranberry sauce at Christmas time, and all at the expense of the state, as has been done time and again in the state of Ohio, and that, too, at a time. when many poor honest families in every city and hamlet within the borders of this great state had scarcely the necessaries of life, to say nothing of luxuries. In view of such stubborn facts, I say make all these provisions for the habitual criminal, and more; do what you will for him, but first of all, "cut" him. Make it impossible for him to propagate his species, for "blood will tell." "Like begets like."

There are other criminals for whom I would prescribe castration; viz: the rapist and that other despicable scoundrel, the bigamist. But whatever else we do, let us make it absolutely impossible for the habitual criminal to beget his kind.

Columbus, O. J. G. TIDBALL, M.D.

Cranial Pathology.

Editor MEDICAL WORLD:-A brother in Tennessee-August WORLD, page 339describes a case of convulsions with cranial enlargement, the perusal of which actuates some reflections on this class of disorders. The patient is a girl twentyeight months old. Why are convulsions more frequently encountered and more readily excited in children than in older persons? The most plausible explanation is found in the incomplete development of the entire nervous system during infantile life. At birth the motor centers in the spinal cord and medulla oblongata, and even those in the cerebral cortex as well as the afferent and efferent fibers of the peripheral and sympathetic nerves, are further advanced toward structural perfection than are the higher cerebral centers. The lower structures are directly

concerned in the production of muscular action. Irritation of the afferent terminal organs in the skin, mucous membranes or elsewhere is transmitted to the motor centers and stimulates them to a discharge of nervous energy, resulting in muscular action. But the higher cerebral centers, the function of which is to inhibit excessive muscular action on the part of the motor centers, are but slightly developt, and consequently violent muscular action results from a degree of irritation that in the adult would prove wholly inadequate to the production of spasm. It is likely some time after the nervous system in the child is structurally complete before its functional perfection is attained, and it is only reasonable to suppose, the parts that are latest completed structurally are the last to develop functional perfection.

Rachitis is an exceedingly influential factor in the development of the convulsions of childhood. As the disease usually exists about the period of the first dentition, most cases due to this cause were formerly ascribed to teething. The irritation of a tooth, impinging on the gum, prior to its eruption, is doubtless a potent, exciting cause; but in most instances not the most powerful one. Indigestible matter in the intestinal canal sometimes produces them, and they are occasionally the reflex manifestation of worms, for the most part lumbrici, in the alimentary system. Convulsions come on as a result of toxic conditions of the blood, not infrequently ushering in an attack of an acute disease. Exhausting discharges may be responsible for their development; a severe diarrhea, for instance, may induce cerebral anemia, or may cause absorption of the sub-arachnoid fluid, with consequent deficiency of intra-cranial pressure, and either of these conditions, or the two combined, will sometimes induce convulsions. Passive congestion of the brain excites convulsions which are in reality due to anemia, the venous blood, detained in the cerebral vessels, proving a mechanical impediment to the renewal of a sufficient supply of the arterial variety. Active congestion of the brain was formerly thought to be the common cause of infantile convulsions, but it is not believed now that they are ever due to this cause. Twenty years ago students in the medical schools were instructed to place a child suffering from spasm in a warm bath as soon as it could be prepared. This thera

peutic measure was to be resorted to in all cases regardless of the apparent cause, the bath being prepared and the patient immerst in it while the medical attendant was yet engaged in determining the other factors in the creation of the disturbance. Theoretically the revulsive action of the bath was expected to relieve the presumed congestion of the brain. I adhered to this procedure in practice for a few years; but with many patrons the bath was commonly difficult to prepare and required so much time that I began to leave it off and soon found that as a rule the little patient's muscles relaxt not less readily, nor were the spasmodic actions more prone to recur, as a result of the omission. Of course organic lesions of the brain cause convulsions in children; cerebral birth palsy and infantile hemiplegia commonly originate an epileptiform type of convulsions which are continued thruout life.

In the case under consideration, the only obtrusive symptom, other than the convulsions, appears to be cranial enlargement, the child's head measuring twentytwo inches in the largest circumference. Serous pachymeningitis, a pathological condition the etiology of which is not clear, has in rare instances caused cranial expansion. In this state, a membrane is formed on the inner surface of the duramater, which is continuous at the base of the brain with a more feeble membrane reflected over the external surface of the arachnoid, the two membranes being separated by a variable quantity of serum. This condition sometimes develops in the victims of paresis, and occasionally in quite young children. It at times causes cranial enlargement, but not in all cases. Children subject to this malady are often bright and cheerful, but some, manifesting the symptoms of cerebral compression, are somnolent, inclined to stupor and exhibit mental apathy as well as muscular weakness, contractions and convulsions. This trouble is frequently, but incorrectly, designated external hydrocephalus.

Thickening of the cranial bones, without enlargement of the cavity, has been observed in patients of all ages, causing very noticeable enlargement of the head, but it is doubtful whether these rare cases can be diagnosticated during life. other exceedingly rare morbid condition which may occasion enlargement of the head is denominated hypertrophy of the brain. In these cases the mass of brain

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tissue is greatly exaggerated, and the cranial cavity, whether enlarged or no, contains but little fluid, the vessels being comprest, and the ventricular walls flattened. The microscopic investigation of this condition is by no means complete, but from what has been ascertained, it appears that the increase occurs in the connective tissue (neuroglia), rather than in the intrinsic brain structures. This morbid condition is met with at all ages, but commonly in quite young infants and again toward the close of the first year. A frequent etiological factor, in developing enlargement of the cranium, is rickets. The enlarged head due to this cause is somewhat square-shaped and less globular than that resulting from other causes, and the fontanelle is lax and retracted, the direct reverse of what is found in the other forms of cranial enlargement. Children affected by rickets are said to be more precocious than others of the same age, but this, if true at all, can scarcely apply to those in whom the disease causes appreciable enlargement of the head.

By far the most frequent cause of cranial enlargement is hydrocephalus. The deformity makes its appearance from this cause at every period of human life. Its development, during intra-uterine existence, has rendered necessary the sacrifice of many a child's life in order to effect its delivery. At the other end of the volume may be mentioned the case of Jonathan Swift, the celebrated Dublin satyrist of a century and a half ago, who succumbed to the ailment when nearly four score years old, three years after its inception and four years subsequent to his being placed under restraint because of his excited mental condition. The disease makes its appearance in the acute and in the chronic form; as a congenital and as an acquired malady, and may be of either the external or the internal variety. It may also be of primary origin or secondary to some other disease. The distinguishing feature is a hyper-accumulation of fluid in the cranial cavity. Acute cases terminate in the course of a few weeks, or at most in a few months; but in the chronic form the disease often continues for several years. Hydrocephalus frequently develops as a consequence of some other disease. Thus it appears in considerably more than half the patients afflicted with tubercular meningitis, and from that fact tubercular meningitis was formerly referred to as acute hydrocephalus. In other cases the accu

mulation of fluid is the principal manifestation of disease (primary form). In some cases the fluid is secreted in the sub-dural space constituting external hydrocephalus; in other instances it is secreted in the cerebral ventricles-the internal form. In the former case the fluid is secreted by the pia mater, in the latter mostly by the choroid plexuses, but also in part by the velum interpositum and the ventricular lining membranes. In external hydrocephalus the secreting surface may be a circumscribed portion of the pia, and the dura may adhere to the pia at the outer edge of the secreting portion limiting the hydrocephalic fluid to a part of the subdural space. This sacculated hydrocephalus, if extensive enuf, may cause irregular enlargement of the skull. In the internal form the fluid may occupy the whole or only part of the ventricles. Compression of the veins of Galen, impeding or preventing the return of blood from the intra-ventricular veins to the straight sinus, sometimes causes the oversecretion. A more frequent and more effective cause, however, is found in occlusion of the foramina of communication between the ventricles and in occlusion of the foramina communicating between the general ventricular cavity and the subdural space.. Meningitis may close the foramen of Magendie and the foramina of Mierzejewski. The former unites the subdural space with the fourth ventricle in the median line at its lower and posterior extremity; the latter unite the same cavities, being the lateral openings, one situated behind the root of either glosso-pharyngeal nerve. Their occlusion causes an accumulation of fluid in all the ventricles. Pressure, as by a tumor in the median cerebellar lobe, may occlude the aqueduct of Sylvius when the fluid will be confined to the third and lateral ventricles. If by any means the foramen of Munro is occluded, the hydrocephalic secretion will be limited to the lateral ventricles. Internal hydrocephalus may distend the ventricles enormously. They may be so distorted as to appear as one large cavity, and the brain matter may be comprest and distended until it forms a thin layer lining the inner surface of the cranial walls.

The quantity of fluid secreted in some instances is enormous, twenty-seven pounds having been reported in a single case. If the disorder develops before the cranial bones have united, the skull yields to the pressure from the gradually

accumulated fluid within, and the symptoms of intra-cranial pressure occur later than in patients whose bones have been more completely ossified and united. If the disease comes on at a later period, the pressure may cause the skull to become thin, with final disarticulation of the sutures and separation of the bones.

Serous pachymeningitis, hypertrophy of the brain and thickening of the bones are each so rare and their manifestations during life so ambiguous that they are practically unconsidered when a diagnosis is to be made. The case under consideration would appear to be either rickets or hydrocephalus, the probabilities decidedly favoring the latter. As a general rule the differentiation of the two maladies is not particularly difficult. In rickets the enlarged head is irregular in outline, being somewhat square-shaped and the anterior fontanelle is relaxt and retracted; the general manifestations of the disease, as deformity of the long bones in the lower extremities, are usually plainly in evidence. In hydrocephalus the enlarged cranium is globular and the fontanelles (if open) are tense and distended. There is often a history of meningitis or other disease known to precede hydrocephalus. Rickets is usually amenable to treatment, and the therapeutic agent most in vogue is phosphorus in some of the numerous forms which should be administered judiciously in combination with cod liver oil.

Whatever diminishes the volume of blood relieves hydrocephalus for the time. Hydrogog cathartics have the desired effect, but the treatment is more heroic than a patient subject to the disease can tolerate. Diuretics are safer for the purpose, but less efficient. Frequent applications of tincture of iodin to the scalp have been recommended.

The administration of the so-called absorbents, mercury and iodid of potash, has been advised, but has seldom proven efficacious. Paracentesis has been resorted to, but has seldom been known to effect a cure. Withdrawing a small quantity of fluid sometimes relieves urgent symptoms of compression, but repetition of the operation or a third resort to it is likely to prove positively harmful. The outer angle of the anterior fontanelle was the seat formerly selected for the introduction of the aspirator needle, but since surgery has been so completely revolutionized by the introduction of aseptic and antiseptic methods of procedure, the skull may be

trephined and the trocar inserted at the point most accessible to the lateral ventricle. More recently puncture of the spinal membranes below the cord in the lumbar portion of the canal has been substituted for puncture of the cranium. It can do no harm, but appears to be capable of affording relief only. It can do no good, in internal hydrocephalus, if the channels of communication between the ventricular cavity and subdural space are impervious. Compression of the skull has done good in some instances, but frequently proves a damage, rendering the symptoms of cerebral compression more intense. Should the method be decided on, the modus operandi advised by Trousseau is not particularly difficult to follow: Strips of adhesive plaster one-third of an inch wide should be provided. A piece should be applied from each mastoid process to the outer angle of the opposite orbit. Next a strip should he applied following the median line from the hair at the back of the neck to the root of the nose. A sufficient number of strips should then be applied to cover the whole head, the different strips crossing each other at the vertex. encircle the head once, just above the eyebrows and mastoid processes, and below the occipital protuberance, with a strip long enuf to go around three times. The ends of all the strips now protrude below this band and should be turned up on the band, then the two remaining turns should be applied in the same direction.

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After all, sad as it may seem, neither the science of medicin nor the art of surgery is able to accomplish much for the hydrocephalic child. Most patients sooner or latter succumb to the evil effects of the malady, death occurring from marasmus or the exhaustion of coma or convulsions. In exceptional cases, however, the excessive secretion is arrested and it is said the accumulated fluid even has been absorbed. Very great danger exists. that after recovery from rickets or hydrocephalus, the convulsions may continue. constituting epilepsy. Whenever the cause of convulsions has disappeared and the convulsions themselves continue, the case must be regarded as epilepsy. In the treatment of the epileptiform type of convulsions, bromids are of the first importance. When a series of convulsions extend over several hours or a few days, the paroxysms following one another at short intervals, the patient scarcely regaining consciousness between them.

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Salix Nigra in Prostatic Troubles. Editor MEDICAL WORLD:--Enclosed find one dollar for renewal of my subscription. I read your journal carefully, and have been well suited with every prescription I have made from formulas found in its pages. I preserve my journals and frequently refer to them. My journals I consider to be my latest text-book, and by the very best authors in the land. Practical articles from every-day experience excel theories.

I have been somewhat disappointed with the curative effects of sanmetto. It has not done as well in my hands in prostatic troubles as plain salix nigra (fluid extract). I consider salix nigra (black willow) to be of great benefit in both acute and chronic prostatitis. In my experience and with my cases I have to use the fluid extract in from one half to teaspoonful doses, well dilated with water three or four times per day; it being of an astringent nature, you may have to use a mild cathartic in some cases, but in prostatic enlargement I consider it the remedy par excellence. W. A. OLIVER, M.D. Camden, Mich.

Liquid Air in Minor Surgery: Dr. W. K. Grayson, of Ratler, Texas, writes us that he cleansed the surface of a carbuncle and then applied liquid air. Its application caused some pain, on account of the extreme cold (it is 344° colder than ice), then all pain disappeared. The surface was turned white. Slight and healthy discharge of pus followed, with rapid healing. The doctor is one of the first of our profession to experiment with liquid airthe first in the South, he thinks. He will continue his experiments and report any results that may be of value.

What is a Sure Sign of Death?-Burns and Carbolic Acid.

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Editor MEDICAL WORLD:-There two or three things upon my mind which may interest your readers; they do me. First, what is a certain sign of deatha sign that death has actually taken place? I was called hurriedly to a neighbor's house where it was thought a lady member of the family had swooned while sitting reading aloud to the company present. Upon my arrival I found her dead. This was about noon. At dark I was sent for again, the messenger stating that the body was still quite warm and limp, and the relatives desired me to institute further examination with a view to ascertaining whether life was really extinct. I found, as had been represented to me, she was warm and limber. Upon opening the eye before a candle I could detect no alteration whatever in the appearance of the globe; of course the pupil did not respond to the light. I held the candle to the little finger of the woman to ascertain if vesication with serum would result. There was, after a few moments, a sharp explosion which I attributed to the effect of the burning taper on the gases of the dead body, but no blister filled with serum. I had already, I forgot to state, held a mirror before the face to ascertain if imperceptible breathing left a vapor, with negative results. I then told the parties that they might try tying a cord around a finger, and that if swelling resulted they might take it as an indication that the subject was not actually dead, but that it was perhaps a case of suspended animation. I then went home. I learned the next day that there was apparently some tumefaction of the bulb of the finger. I was perfectly satisfied from the personal | examinations I had given, that life was extinct. Can any of your family of readers give me a sure sign of death, where there is no rigor mortis?

I desire to ask Dr. Brodnax, of our state, whose name I see occasionally among your contributors, if I remember correctly when I state that I saw, some months ago, in giving in some journal a record of a day's work in his office, the application of pure, undiluted carbolic acid to an extensive burn with blister and denudation upon a child's breast and abdomen, with the effect of easing pain and procuring immediate relief and sleep? Am I correct, Dr. Brodnax? Anent this query, a little girl of three years, in my practice, climbed upon a dresser where

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