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: 37.0% Total failures in operations on sexual organs. Total psychical failures in operations on sexual organs 35.0% Total operations on non-sexual organs. Total psychical failures on non-sexual organs. 23 35.0% 26.0% MEN. Total number of operations.. Total of psychical failures.... Total number of genital operations. 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. |