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the sphere of the massed movements. Possibly thecaecum has a separate mechanism for mixing thecontents and feeding them into the ascending colonpreparatory to the occurrence of the mass move-ment. The significance of incompetence of the ileo-csecal valve, a condition which Dr. Barclay confirmsin his own observations in relation to chronic

constipation, is not touched upon here. Notall cases of constipation are due to those motordisturbances of the large intestine thus described.Whilst stagnation of faeces in these cases is metwith in the caacum, the larger class of cases of

constipation are due to stagnation in the rectum, acondition termed by Hertz " dyschezia." This is,however, a fault of defaecation rather than a trueconstipation. Dealing with the X ray findings incases of neoplasm of the large intestine, the opaqueenema is recommended in preference to oraladministration. By the latter method it is onlywhen the growth is very far advanced that definitebanking up of the shadow behind the growthappears; generally, too, the head of the shadowseldom reaches the obstruction itself, suggestinghypertonicity of the colon above the site.

THE INEBRIATES ACT IN 1918.

IN submitting his report for 1913, with regard toinstitutions certified or licensed under the InebriatesActs, 1879 to 1900, Dr. R. Welsh Branthwaiteexplains that owing to the pressure of other workboth before and after the war he has been unableto incorporate observations on the medical aspectsof inebriety in continuation of remarks madein a previous report. The report is thereforeconfined to the usual statistics relating to inmatesof inebriate reformatories and retreats. As thetotal number of persons treated in these institu-tions has not been large many of the tablesdo not refer only to 1913, the year specially dealtwith, but contain corresponding figures for each yearsince 1899, when the Act of 1898 came into force.Many of these are of interest, but attention may bespecially called to one of them, because at the

present time two topics upon which it has a moreor less direct bearing are arresting public attention.It will be found that during the period included inthe report, 1899 to 1913, there were in all 586

persons committed to certified inebriate reforma-tories for offences dealt with under Section 1 ofthe Act of 1898-that is to say from assizes andsessions. The nature of these offences is specified ’,in the report, and it will be found that com-

paratively few involved conduct of the kind

commonly regarded as seriously criminal in char-acter. Only 47 persons in all were convicted oflarceny, stealing and receiving, and 44 of attemptedsuicide, 13 of assault, and 7 of malicious wound-ing. In this connexion it is necessary, perhaps, tosuggest that a very large number of serious offencesdue to inebriety are not so looked upon in thecouts, but are punished in the usual way by im-prisonment, without attempt at reformatory treat-ment. The one offence, however, which appears tobe specially selected to be dealt with under thesection mentioned is that of unlawfully neglectingchildren in a manner likely to cause them un-necessary suffering. Out of the 586 committalsto inebriate reformatories referred to 459 werefor offences of this kind, and as only 57 were menit will be seen that drunken mothers who neglecttheir children constitute a very large proportion ofthe persons sought to be reformed under Section 1.

The " drink question " has been made prominentrecently by delay alleged to be caused by intem-perance in the production of munitions of war, andthe figures cited above show a particular aspect ofthe effect likely to be produced by inebriety uponthe rearing of a healthy generation of children, tocompensate for the ghastly destruction of humanlife which the war is causing, and for the diminishedbirth-rate which may be expected in future years.

INJURIES OF THE PERIPHERAL NERVES.

INJURIES to the peripheral nerves are extremelycommon in warfare, and at the same time they forma class of case in which early and expert treatmentis essential if the best results are to be obtained.At its meeting of March 4th the Société de Neuro-logie of Paris passed a resolution, which was for-warded to the French Minister of War, pointing outthe extreme desirability of avoiding delay in trans-porting those with nerve injuries, and injuries ofthe nervous system generally, to the special neuro-logical hospitals of Paris and elsewhere, sincesuccessful treatment depends on the care andminuteness with which the preliminary neurologicalinvestigation of such cases is prosecuted. The

society points out how frequently the special hos-pitals are asked to take cases of traumatic neuritisin which, as the result of delay, fibro-tendinousretractions, sub-ankyloses, and other complicationshave supervened, which often prove rebellious totreatment. From a later number of the Presse Midi-cale we learn that improvement has taken place andthat special neurological services have been estab-lished in connexion with various of the army hos-

pitals. Similar utilisation of the expert neurologicalopinion of this country should be organised to itsfullest extent, to obviate unsatisfactory results incases treated originally, owing to stress of timeand other circumstances, in an incomplete fashion.The French medical journals have contained anumber of useful contributions to the studyand treatment of traumatic lesions of the

peripheral nerves. Among these may be men-

tioned a paper by M. Temoin, read before theSociete de Chirurgie, emphasising the neces-

sity of a complete motor, sensory, and electricalexamination in all cases of peripheral nerve

injury, to facilitate early and successful surgicalintervention. M. Claude has given to the Académiede Medecine the results of 100 cases of peripheralnerve lesions operated on, and in the PresseMédicale of March 4th, with M. Vigouroux andM. Dumas, he records the results in a further seriesof 100 cases. All of these were examined byneurologists clinically and electrically before opera-tion, and after operation they were given suitablesecondary treatment. In a series of 56 cases

there were 7 of complete section of a nerve trunkwith separation of the ends, in 12 the nerve wascut across but the ends were together, in a fibrousdevelopment, in 21 the section was incomplete,3 showed induration without section, and in 13 the

I nerve was compressed by perineural sclerosis.i Apart from the complete sections, where improve-; ment is a question of time mainly, in no fewer than. 87 per cent. the result of surgical interference was! amelioration of symptoms. In another series of 46 cases, improvement was obtained in 74 percent. The paper contains useful hints for theb surgeon. Another communication of interestE appears in the PressE Médicale of March 18th.from the service of Professor Pierre Marie at

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the Salpetriere. Professor Marie gives a full

description of an unusual variety of traumaticlesion of the median nerve, in which the sym-ptoms are mainly sensory, the motor symptomsbeing slight. Instead of holding his hand inthe characteristic position of median palsy,the patient keeps his fingers extended, some-

times the terminal phalanges are hyperextended,the thumb is in slight opposition. There is a finetremor of the three radial fingers, and markedtrophic and vaso-motor changes in the mediandistribution are always observable. The hand iswarmer than its fellow, but, above all, it is "<xoc6-ment douloureuse." The maximum pain is in thepulp of the affected fingers and their nails; what-ever be the site of the lesion in the nerve trunk this Iis the distribution of the pain. Dry heat alwaysaggravates the condition, hence the patients covertheir hand in cold, wet dressings, and keep renew-ing them themselves. So insignificant a stimulusas a cough increases the pain at once, andin three cases it was noted that grasping, withthe sound hand, a warm object induced an

exacerbation of the pain on the affected side.A yawn, a sneeze, even simple emotions suchas seeing a fellow patient slip on a polishedfloor, a sudden noise, music, looking at a touchingor an amusing picture, are all mentioned by Pro-fessor Marie as aggravating the neuralgia. Objectivesensory changes are confined mainly to the tactileform. There is also a slight wasting of the musclesconcerned, but, as already observed, never a pro-nounced paralysis. The pathological condition isprobably one of traumatic ascending neuritis of thenerve, and operative treatment has not, in ProfessorMarie’s experience, been very satisfactory. Hemakes the interesting observation that the musculo-spiral, ulnar, and median seem to vary somewhatin their reaction to injury; in the case of themusculo-spiral, the chief symptoms are paralysis,and there is little sensory change; in the case ofthe ulnar, with a traumatic main-en-griffe, thereare few, if any, trophic and vaso-motor changes;while with the median the motor defects are

secondary and, in some cases at least, pain andvaso-motor phenomena are extremely pronounced.

RUPTURE OF THE EXTENSOR LONGUS

POLLICIS.

Dr. J. Ramsay Hunt has recorded in a recentissue of the Journal of the American MedicalAssociation a case of a very rare injury-rupture ofthe tendon of the extensor longus pollicis. Thepatient was a tailor, aged 31 years, who worked from10 to 12 hours daily, much of the time sewing witha coarse, heavy needle. He also used an iron for

pressing clothes. On Oct. 25th, 1914, after a day’swork, he inserted his right hand into his trouserspocket in search of some object, twisting the handabout as one does in trying to explore angles andrecesses. He was seized with severe pain over theposterior surface of the wrist on the radial sideand over the back of the first metacarpal bone.On removing his hand he could not extend thedistal phalanx of the thumb, though he could

easily flex it. For several days there was greatpain over the dorsal surface of the wrist and firstmetacarpal bone, and for a fortnight this regionwas tender and showed some swelling. On examina.tion on Dec. lst there was paralysis of the extensoilongus pollicis. The patient could strongly flex thE

distal phalanx of the thumb, but had not the leastpower of extension. In contrast there was fairpower to extend the proximal phalanx and firstmetacarpal bone. When the tendons of the thumbwere rendered prominent by strong extension thenormal prominence of the extensor longus polliciswas absent. When the finger was drawn alongthe course of the long extensor there couldbe felt just below the posterior annular ligamenta small movable rounded slightly tender swelling.This corresponded to the distal end of the rupturedtendon. The proximal end was not palpable.Electrical examination failed to elicit any responsein the extensor longus pollicis, while all the othermuscles reacted normally. The sensibility of thehand was normal. Suture of the tendon was recom-mended but declined. Normal tendons are so strongthat rupture is almost impossible. In the case ofsevere strains either the muscle tears or theperiosteal insertion of the tendon gives way, oftencarrying a fragment of bone. For a tendon to

rupture it must have been previously weakened bydisease. While rupture of the extensor longuspollicis is very rare in medical literature gener-ally it has been well known to German militarysurgeons for a long time. In the medical reportsof the Prussian army from 1870 to 1904 vonWurthenau collected 62 cases, all in drummers.The condition is the result of chronic teno-synovitis induced by a peculiar method of holdingand using the left t drumstick, which causes

mechanical irritation of the tendon as it emergesfrom its compartment in the posterior annular

ligament of the wrist. In time changes take

place in the tendon and its sheath and eventu-ally rupture occurs, either during a paroxysmof drumming or more rarely spontaneously.It is said that the affection occurs usuallyin beginners and exclusively on the left side.Microscopic examination of the severed tendonshas shown hyaline swelling and necrosis andseparation of the tendon fibres. Dr. Huntthinks that in the case of the tailor there musthave been similar changes in the tendon. Itis curious that no warning pain seems tohave been observed in any of the cases.

But though rupture may occur painlessly, morefrequently a piercing pain is felt over theback of the wrist, often shooting up the fore-arm. The tendon may be swollen and tenderand the distal portion is often felt below theannular ligament as a tender movable nodule.Isolated instances of the lesion have been recordedin a compositor, a wood-carver, a farmer, and inwaiters. As to treatment, if there is no evidence ofunion after a brief period of fixation, suture shouldbe performed.

THE Croonian lectures will be delivered at theRoyal College of Physicians of London on June 17th,22nd, 24th, and 29th, at 5 P.M., by Surgeon-General SirDavid Bruce, C.B., F.R.S., A.M.S. The subject willbe Trypanosomes causing Disease in Man andDomestic Animals in Central Africa.

i THE Progress of Public Health in Egypt is the; subject which Dr. F. M. Sandwith has chosen forl his course of four Gresham lectures to be delivered. at the Gresham College, Basinghall-street, E.C., on. May 18th, 19th, 20th, and 21st, at 6 P.M. The; lectures will have a topical bearing.