300

all to 130 cubic centimetres. Membrane re-formed on theeleventh day, but disappeared under an injection of 10 cubiccentimetres. Another indication for increasing the quantityof antitoxin is diphtheritic bronchitis; the dose should bedouble or treble the ordinary one. Hence the importance ofearly diagnosis of this complication by careful examination ofthe chest and of matters expectorated or discharged by thetracheotomy tube. Finally, the persistence of toxic symptomsis an indication to give more antitoxin. Thus a child showedtoxic symptoms-prostration and acceleration and feeblenessof pulse. The injection was repeated four times and on eachoccasion there was marked improvement, the prostrationdiminished, and the pulse became slower and stronger.

THE FOURTEENTH INTERNATIONAL CONGRESSOF MEDICINE, MADRID, 1903.

THE Fourteenth International Congress of Medicine willbe held at Madrid from April 23rd to the 30th, 1903, underthe patronage of King Alphonso XIII. and the QueenRegent. The subscription is 30 pesetas (equivalent to 24s.).Ladies accompanying members will be entitled to the

privileges of the members in the reduction of fares on theSpanish railways, &c., on payment of 12 pesetas apiece (or108.). The National Committee for Great Britain andIreland remains the same as at the Paris Congress, SirWilliam MacCormac, Bart., K.C.B., K.C.V.O., being thePresident. The honorary secretaries are Dr. PercivalHorton-Smith of 15, Upper Brook-street, Grosvenor-square,London, W., and Mr. D’Arcy Power, of 10A, Chandos-street,Cavendish-square, London, W. ,

EPHEMERAL MENTAL DISORDER AND ITSMEDICO-LEGAL ASPECTS.

DR. CHARLES ALDRICH, neurologist to the Cleveland CityHospital, in the May number of the Philadelphia MedicalJournal deals with the important subject of ephemeralmental disorder (mania transitoria) and refers to its medico-legal aspects. The occurrence of such a condition having aduration of a few hours or a few days-15 to 48 hours

according to Kellog-is usually followed by many hours ofdeep sleep, and owing to its brief duration only symptomatictreatment is possible. The disease usually occurs in youngpersons and has close affinities with certain forms of

psychical epilepsy. Dr. Aldrich records the following twocases. Case 1.—A young woman aged 18 years, with a goodfamily history and free from epileptic attacks or mental

aberration, was employed as a domestic servant. She was of

steady and religious habits and never addicted to alcohol ornarcotics. One morning about 4 o’clock her mistress was

aroused by someone beating at her door and loudly callingto her to come out. She opened the door and saw theservant standing in her night-clothes with a Bible under herarm urging her mistress to come with her. She was sayingthat "the world was about to end and Christ had sent her to

save her mistress." " The mistress realised that the girl wasin a delirium, soothed her, and told her to dress. The

girl retired and reappeared dressed, ate a hearty break-fast, meanwhile talking incoherently on religion and thethreatened destruction of the world. She then went

with a friend to see a procession, keeping her Bible underher arm and maintaining perfect silence for over an hour.Then she said that she felt tired, and on returning homeimmediately undressed herself and went to bed, sleepingsoundly for five hours, after which she awoke "with a dimrecollection of the street pageant." She was free from som-nambulistic traits and has since the above occurrence nevermanifested any other symptom of mental aberration,Case 2.-A man aged 40 years, married and in goodhealth, was employed as a workman. He had been

always free from mental aberration. "One day while

_. -7 _.___._._.., _..,.,.. , s.,.,u.,N ", ""a.

at work ...... he went to his foreman and com-

plained that two of his fellow-workmen were plotting tokill him, and that one of them had a knife concealed inhis clothing."

" The man seemed so sincere and had alwaysbeen such a sober, industrious, and peaceful workman thatthe foreman called the other two men to account, who beinginnocent were perfectly astounded. The patient, however,insisted vehemently on their guilt, and said he had heard theirplotting and seen the knife. Of this there was no proof andhe was taken home and thence to the Cleveland City Hospitaland remained in bed a few days and was discharged. Beforehis discharge he realised he had been the victim of a delusionand seemed surprised and could assign no cause for it. Hehad not, says Dr. Aldrich, had a recurrence of any mentalsymptoms since then or any disturbance of the nature ofinsanity or of epilepsy. Kellog states that such cases ofephemeral mental disorder are of great judicial interest," since responsibility cannot exist where consciousness is inabeyance." The treatment was devoted to relief of symptomsand included the administration of hyoscine and morphia ascerebral sedatives, and careful supervision to prevent criminalor suicidal acts during the period of impaired and abnormalconsciousness.

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UNIVERSITY OF LONDON.

A MEETING of the Faculty of Medicine was held at theUniversity on Friday, July 20th, at 5 p.M. Although thebusiness was specially important less than 30 memberswere present. An interim report from the ConcentrationCommittee was first presented, but its consideration was

postponed until a final report is laid before the members ofthe faculty early next winter session. Reports were alsoreceived from the Boards of Preliminary and IntermediateMedical Studies. The consideration of the reports was alsodeferred until October, as there was much division of opinionas to whether there should be separate examinations at thePreliminary M. B. Examination in botany and zoology, or

whether these subjects should be taken collectively underthe general term of biology. The Senate has decided to

publish a gazette as a record of matters connected withthe University.

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THE DIETETIC TREATMENT OF EPILEPSY.

THE dietetic treatment of epilepsy, one of the most

hopeful and effective of the more recent therapeutic methodsintroduced, is dealt with in a recent issue of the BerlinerKlinisohe Wochensohrift (June 10th, 1901), by Dr. RudolfBálint who contributes an important article based uponobservations made by himself at the Clinic of Professor

Koranyi in Budapest. The work was undertaken in con-

sequence of the theory advocated by Richet and Toulousethat ’’ salt-starvation " and the administration of alkalinebromides constituted the most effective form of treatment.Dr. Balint treated 28 epileptic patients who were the subjectsof idiopathic epilepsy (petit mal and haut mal) with a dietfrom which all chlorides were as far as possible removed,after which a small amount of bromides was added. Anumber of preliminary trials were made and eventuallythe following daily diet table was adopted as one

satisfying the necessary conditions-viz., from one to oneand a half litres of milk, from 40 to 50 grammes of butter,three eggs, and from 300 to 400 grammes of bread and fruit.The bread was specially prepared without common saltand with the addition of three grammes of sodium bromideper loaf. Living on the above diet a patient would con-sume altogether only about two grammes of sodium chlorideper diem, a quantity very much below the average consump-tion of the salt in every-day diet, while at the same time hewould be unconsciously taking about three grammes ofsodium bromide daily in his food. The results obtained