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lately employed this means successfully in three very bad E

cases induces me to put on record the following brief notes son the subject as likely to be of some interest. CASE 1.-A man about fifty-five years of age, suffering

from melancholia with homicidal tendencies. Prolapsus ! arecti occurred in March, 1892, and recurred frequently till the following July. Galvanism was applied soon after thebowel was replaced on the first occasion, and about once a 1

week thereafter. After four months’ treatment the bowelceased to protrude, and between July, 1892, and May 13th,1893, at which latter date the patient was sent to Ireland, norelapse occurred. He thus remained well for a period of atleast ten months, and the tone of the sphincter seemedquite restored at the date of his leaving the asylum.CASE 2 -A female chronic maniac fifty years of age.

Prolapsus recti occurred in December, 1889. She concealedher condition at first, and when it was detected the protrudedportion of gut was as large as a cricket ball and intenselycongested and bleeding. The hernia could not be reducedtill the patient was put thoroughly under chloroform. Afterthe bowel was replaced the sphincter was so relaxed that fivefingers could be easily inserted into it nearly as far as theproximal ends of the third phalanges. Galvanism was soonapplied, but the bowel came down again frequently-in fact,almost every time that micturition was performed andevery time that the bowels were evacuated. The curewas doubtless delayed by the obstinate conduct of the patientin concealing her condition every time a prolapse occurred ;but after six months of galvanic treatment the bowel ceasedto protrude, and the patient has now remained quite freefrom any return of the disorder for over three years and ahalf.CASE 3.-A man thirty-two years of age. This patient was

suffering from general paralysis of the insane and great im-pairment of the motor and coördinating powers of the lowerlimbs. Obstinate constipation was a feature of the case.

Prolapsus recti first occurred in December, 1892. Galvanismwas applied frequently for six months without much apparentbenefit ; but after eight months’ treatment the bowel seemedto have lost its tendency to come down, and now for fourmonths the patient has been quite well in this respect. Thestate of the spinal cord constituted a very unfavourableelement in the prognosis in this case.Remarks.-Galvanism seems to have been successfully

employed over thirty years ago in three cases of prolapsusani, 1 this is the only reference to the subject that I canfind. In my cases an ordinary Smee’s battery was employed.One pole was applied to the sphincter ani, the other pole tothe spinous processes of the sacral and lumbar vertebrae,and the current made to pass for five minutes. This was

repeated once or twice a week, whenever the bowel had to bereplaced. The strength of the current was slight at firstand gradually increased to nearly full strength. One dis-

advantage of this method of treatment is the long timerequired to effect a cure, but it must be admitted that morefrequent applications might have been followed by morerapidly successful results. The classes of cases most suit-able to treat in the way above noted are probably childrenand other restless patients, especially lunatics, who generallycannot be trusted to leave alone the wounds following anoperation about the anus, and who are generally with thegreatest difficulty prevented from tearing off dressings andbandages, or any retentive apparatus.Rosslyn Castle, N.B.

CIRCUMSCRIBED ATROPHY OF THE HAIRAND SKIN OF THE SCALP.

BY TOM ROBINSON, M.D. ST. AND.

IT is not within the range of these few remarks to alludeto the common form of bald patches which are met within the hairy parts of the body. These are undoubtedly dueto the invasion of the skin by a micro-organism, and theyare known by the generic name of alopecia areata. ButI am desirous to call attention to a group of cases which,so far as I know, have not hitherto been described, andwhich are distinguished by the following attributes :-1. Theatrophic areas are confined to the scalp. 2. The arese are

1 Medical and Chirurgical Review, vol. i., p. 106, 1859.

absolutely bald. 3. The aræe are depressed like ordinaryscars. 4. The hair never returns. The following case is anexample of the condition.A woman thirty-nine years of age, who has always had

a fair share of health and who is the mother of six children.came to me in 1893 because "her hair was coming out."There was nothing unusual in her skin or epidermic struc-tures, but on examination she had a cluster of bald patcheson her scalp, which were practically confined to the

parietal regions. They varied in size from a split pea to ashilling ; some had joined at their circumference. I couldnot obtain a history of any inherited tendency towards thecondition, and it may be taken as a fact that shehad not been syphilised. Neither had she at any timebeen the subject of severe headaches or had any injuryThe scars (for such they literally were) resembled those onesees when lupus erythematosus attacks the scalp or whena scald or a burn has been inflicted. I have looked care-fully through my notes taken during the last ten years, and,although I find that thirteen such cases have consulted me,in every instance the patient has been a woman. I havenaturally asked myself the question, "Why do these patchesoccur?" and I confess to an inability to find a satisfactoryreply. The medical man might shelter himself behind a.

theory of local anaemia,, which in the first degree would pro-duce a diminished growth of hair, and if continued would leadto atrophy or even to local death, but no one would acceptsuch a hypothesis. Cases of loss of hair which have beeneither a sequel or a symptom connected with profounddisturbance of the nervous system are on record. CooperTodd described the case of a man who fell from awaggon and sustained injuries which caused hemiplegia andloss of consciousness, and who one day on going to shave himself could not find any beard. Fischer, who had great

. experience in military surgery, noticed after gunshot woundsthat the limb corresponding to the wound received (if that

L wound had interfered with the nervous integrity of the part)became bald. Virchow describes a circumscribed atrophyL which has been observed in one-half of the face, butrat times in other parts of the body. On careful examina-,} tion of the whole cutaneous area of an old man evidence; of cutaneous wasting will usually be found occurring

locally and generaliy, the skin being wanting in lustre,and in scme old and thin men I have seen the epidermis

of the face and shins stretched over the bones like a piecei of hog’s bladder. Wilson called the condition derma-toxerasia. Celsus, in his chapter de areis, describes a formof baldness which probably refers to the case now under, discussion. It is what he calls the worst form-namely,s that which destroys the fat and renders the surface totallye smooth-but he confuses it obviously with alopecia areata.t One may without any unfair straining of theory easily under-- stand that the injurious and positively cruel way in whiche women produce the cuiling of the hair will account for ane injury to the scalp. Curling pins, curling irons, and curlinge papers form an essential part of the toilet armoury of almost- every woman, and this torturing of the hair drags on the11 roots, and by so doing starts the inflammation which mayy be the forerunner of this atrophy. The scalp being so dull ofn sensation will enable the victim to bear a good deal ofe tension without much suffering. Again, the number of hair-d pins used in dressing the head may damage the scalp.

Prince’s-street, Cavendish-square, W.

RECOVERY FROM OVARIOTOMY: FIVEWEEKS SUBSEQUENTLY DEATH FROM

CANCER OF THE PANCREAS ANDDUODENUM.

BY JOHN D. MALCOLM, M.B, C.M., F.R.C.S. EDIN.,SURGEON TO THE SAMARITAN FREE HOSPITAL.

A CONGENITAL deaf-mute, single, forty-nine years of age,consulted me on Feb. 23rd, 1892. on account of an enlarge-ment of the abdomen, which had been increasing for aboutfive years, and yellowness of the skin, which had existed forthree months. Emaciation had taken place, but not to

any great extent until the last four or five months, duringwhich time it had been very rapid, and the abdominal

, swelling had also increased more quickly. There had been,

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no pain unless the bowels were more than usually constipated,when there was a complaint of soreness in the back. Theonly facts in the family history bearing on the case were thata brother and a sister of the patient were deaf-mutes andher father’s sister had died of cancer. The patient wasof a bright yellow colour all over, was extremely thin,and obviously very weak. There was no difficulty in

diagnosing a large ovarian cyst pushing a small healthyuterus forwards and extending above the costal margins. ’,The respiratory, circulatory, renal, and alimentary systemsshowed no evidence of disease except that there was

mach constipation, with absence of bile from the stoolsand its presence in the tissues and in the urine. Therewas occasional vomiting, but this was not an urgentsymptom, and did not occur at all between the date ofmy first seeing the patient and the date of operation.Daring that time the temperature was taken night and morn-ing. It varied from 99° to 100-4° F. in the axilla. The pulsewas fairly steady, about ninety to the minute. Menstruationhad ceased at the age of forty-one, and had never given anytrouble. The presence of the ovarian tumour made anyexamination by palpition in the region of the gall-bladderquite impossible. The uncertainty of the nature of theobstruction which existed in the gall-ducts seemed, there-fore, an additional argument in favour of removing the cyst,although the condition of the patient was by no means suchas to promise success, especially if a tedious operation shouldbe necessary. The absence of any history of pain wasagainst the view that the obstruction was due to gall-stones,but with the possibility that this explanation might be correctthere was no alternative to treatment by operation. OnMarch lst I removed, without any difficulty, a simple cystomaof the left ovary, weighing 5-2L oz. and containing fourteen pints,of fluid. In spite of the frequent administration of purgativesand enemata for a week before the operation the colon con-tained a large amount of hard fseoes. The gall-bladder was,greatly distended, and in the position of the head of thepancreas-or, I thought, a little lower down-there was asomewhat oval retro-peritoneal tumour about three and a halfinches in diameter and much flattened from before back-wards. It was impossible to remove this, and I therefore-closed the abdominal incision in the usual way. Six hoursafter the operation the temperature had risen to 103° F., thehighest point recorded. It gradually came down, and afterabout a week it was very much the same as before the opera-tion. The record was a little higher, but the temperatures weretaken in the vagina, and previously they had been taken inthe axilla. The pulse did not go above 96 to the minute atany time. There was no sign of difficulty in the action of thekidneys, and the bowels gave little trouble. I began to clearthe colon by enema the day after the operation. The bowelswere thus moved twice that day, and afterwards daily, oroftener. A little milk and water was given on the third day,the quantity being gradually increased. Beef-tea was

added to the diet later, nutritive enemata being givenwhenever the rectum was sufficiently empty, until the

patient was able to take food freely by the mouth in thecourse of the second week. She vomited on the after-noon of the sixth day, and again several times on thetwelfth day. These were the only vomitings, acd con-

valescence from the operation was otherwise as satisfactoryas possible in a patient so feeble. She was bright and happy,would talk incessantly to anyone who could use the dumb.alphabet, and expressed herself as much more comfortablewithout the tumour. Hard fseoes in the colon were felt

through the abdominal wall for nearly three weeks after theop3ration. As they were gradually removed the distendedgall-bladder became very prominent, but I could not definethe neoplasm behind. Of course I did not make any serious

attempt to do so, as manipulation could do no good andmight do harm. In the third week the patient was

encoaraged to get out of bed on to a sofa, but she wasstronger the first day she was up than on any other, and itquickly became obvious that it was not safe to permit thisexertion. She remained cheerful and comfortable as long asslie lay still, and there was no further trouble except therapidly increasing weakness. On the thirty-fourth day afterthe operation the patient died, while quite quiet in bed,somewhat suddenly.Tne following post-mortem report is by Dr. Allchin:-" The

body was much emaciated and of a uniform bright yellow(icteric) colour. There was scarcely any subcutaneous fat.The scar of the incision, about two inches long, belowumbilicus in the middle line, was quite healed. There was

complete absence of fat from the mesentery and omentum ;the latter was adherent to the abdominal wall alongthe line of the operation incision. No recer.t peri-tonitis was observed. There were about three ounces ofbile-stained serum in the peritoneal cavity. Examinationshowed the head of the pancreas to be the seat of malignantgrowth, which had involved the entire descending (middle)portion of the duodenum, scarcely a point remaining, thenew growth forming a villous fungating tube replacing thispart of the duodenum and maintaining the continuity of thecanal between the first and third portions. The commonbile-duct was involved in the growth, and was occluded,causing an enormous distension of the gall-bladder (to thecapacity of about a third of a pint), which was full of verydark viscid bile, and the walls of which were much thickened.No gall-stones were found. The entire mass of new growthwas about four inches across and an inch and a half thickand at one spot was extremely thin, and would certainly veryshortly have burst into the peritoneal cavity, between whichand the gut communication would have been established.The body and tail of the pancreas were hard, but there wasno naked-eye appearance of new growth. No secondarygrowth was detected in other organs, and these were for themost part healthy. The uterus and the right ovary andtube (two ounces and a half) were quite normal. Thestump of the left tube with ligatures appeared to be healinghealthily. There was no peritonitis about it, and it lay freein the pelvis without adhesions."That this patient was not adversely affected, but was

rendered more comfortable and underwent a fairly normalconvalescence after the removal of an ovarian tumour withinfive weeks of her death from cancer of the pancreas andduodenum, seems sufficiently remarkable to be put on record.The administration of purgative enemata twice on the dayfollowing the operation and very frequently afterwads wasalso unusual. The treatment is not to be recommended inmany cases ; but it seemed to me safer, in this particularinstance, than to leave the colon packed full of fasces forseveral days. Such a condition could hardly have failed tocause abdominal distension, which would have seriouslyaffected a patient so weak. The association of extensivedisease of the duodenum with complete absence of vomitingdue to chloroform, and with the almost complete absence ofthis symptom and of any sign of difficulty in digestion duringthe whole time the patient was under observation, is also

worthy of note.Portman-street, W.

COLOURED MILK.

BY P. RHYS GRIFFITHS, M.B., B.S. LOND.,MEDICAL OFFICER TO OUT-PATIENTS, THE IMFIRMARY, CARDIFF.

IN the late summer of 1891 a woman thirty-nine years ofage presented herself in the out-patient department of theInfirmary, Cardiff. She stated that during the hay harvestin June, when she was five months pregnant, she noticedsome irritation and itching of the breasts. On examiningthem and squeezing the nipples a greenish fluid exuded.

When seen on July 25Gh I was able to squeeze out from thebreast about a drachm of this fluid, which to the naked eyewas in all respects except colour like normal milk. A speci-men examined under the microscope revealed only the generalcharacters of milk. My first impression was that the colourwas probably due to the presence of bile pigment, but onsubmitting the secretion to the usual tests for bile I wasunable to obtain any evidence in support. There was nothingin the condition or the appearance of the patient, moreover,to suggest this ; no jaundice and no change in colour ofurine or fasces. I sent to my friend, Professor Halliburton,F.R.S., some of the milk which had been allowed to

evaporate to dryness, and he agreed with me that the greencolour was not due to the presence of bile pigments. Hefurther submitted the specimen to careful chemical examina-tion. His report was as follows :- .

"1. The lumps are insoluble in water, alcohol, chloroform,and ether. 2. With nitric acid the pieces are changed toyellow, deepened to orange by ammonia. This, I take it, isthe xanthoproteic reaction due to admixture with casein andother albuminous matter. There is no play of colours likethat obtained from bile pigment. 3. Haemin test negative.