919

the professions that would benefit by a more direct, more"personal" contact, so to speak, between teacher andstudent than is possible in the overcrowded class-rooms ofthe Scottish Universities, none has more to gain from suchan improved system than the medical, in which theoreticalexposition is every day yielding ground to practical demon-stration, and in which, as all history and experience of thepractitioner’s art teaches, the more the disciple is broughtface to face with the master, the more likely is he to perfecthimself in that special relation he is one day to assume tohis suffering fellow-man. -

CONTRACTION OF THE TONGUE IN HYSTERIA.

DR. CARL LAUFENAUER mentions in a Hungarianmedical journal the case of a patient with hysterical torti-collis complicated with a peculiar ataxy of the tongue, theintensity of which increased and decreased with the neuro-muscular excitability of the throat, a proof of the peri-pheral origin of the ataxy. Another patient, who hadhystero. epilepsy, immediately on protruding her tonguecontracted it to such a degree as to be unable to put itback, suffering severe dyspnoea until the contraction wasspontaneously relieved. Occasionally this patient’s tongueremained motionless in her mouth for from three to five

days. He mentions also two cases in which hypnotismwas employed. A servant girl suffering from hystero-epilepsy presented under hypnosis as well as in the wakingstate the following symptoms : A Konig’s tuning-fork I I sol "held before the right ear caused the protruded tongue to I

deviate to the right, to remain contracted from fifty-five to eighty seconds, to become swollen and hard, and toappear cyanotic. Both eyes were turned in the samedirection. Similar results were obtained on the left side.When the tuning-fork was held under the chin a broadeningof the tongue took place, the tip pointing downwards.When the fork was held over the top of the head, thetongue was drawn back into the mouth, with the tipagainst the hard palate. It was not only possible to pro-duce this reflex action of the glosso-pharyngeus, but themuscle could also be excited directly by means of a smallprobe. In this case, however, the eyes would not act withthe tongue. Another servant girl, suffering from hystero-epilepsy, presented the same symptoms, with the addition,however, of uniform contraction of all the muscles of thethroat and head, the latter, of course, moving correspond-ingly. When the tuning-fork was made to revolve roundits own axis the tongue not only followed in the same

direction, but remained contracted in this position, a con-dition which could not possibly be imitated by a healthyperson.

-

SPECIALISM IN NURSING.

SoME perhaps have imagined that the education of nursesis by this time too well understood to admit of much furtherdevelopment or modification. That there still is room,however, at least for differences of opinion on the subjectis apparent from the animated discussion which followed apaper on "Division of Labour in Nursing," read by Mr.Warrington Haward before the British Nurses’ Associationon the 18th inst. The author is to be congratulated on hisreluctance to multiply distinctions in this field of work.Medicine has suffered much from the schisms wrought in itby excessive specialism, but this applies to practice ratherthan training. "All round" is now, as formerly, thefundamental maxim of professional instruction. First the

general, then, if desired, the special. The position ofnurses is in this respect very similar. To train them

according to any exclusive rule would simply mar theirusefulness even in what would then be their meagre totalof proficiency. Special needs exist, no doubt-as, for I

example, in the nursing of certain major operation cases ;and special aptitude must be acquired by any nurse whomay be called upon to deal with them. Any suchapdtude, however, can only be intelligent if it isfounded on a correct understanding of general prin-ciples. It is most important also that this necessarybasis, no less than any particular after-development,should be firmly established by practical experience. At

this point we may profitably discuss the question of out-visiting by hospital nurses. A speaker at the meeting abovementioned objected strongly to this course, unless the nurseemployed had been already thoroughly trained. The

objection is perfectly intelligible, though it must beremembered also that out-nursing is really a most usefulsupplement to the experience already gained in a hospitalward. Its educational value is one of its chief advantages,since it is amid the emergencies and inconveniences of

private practice that a nurse will acquire much neededhabits of readiness and decision. There is no reason, indeed,why a senior probationer under due supervision (as in thecase of advanced medical students) should not learn andaccomplish much if allowed a reasonable degree of libertyin this department of her calling.

THE FASTING MAN.

THERE is a degree of scientific interest abrmt enrh ex-periments as the fast which is now approaching its close atthe Aquarium. It is no doubt instructive to note thedecline or the disturbance of physical processes whichmarks the steady ebb of a starved life. Interest, however,and that of a kind allied to curiosity, is almost, if not

quite, the only gain. There is little or no practical utilityin such observations, since the results attainable by them,unless we except that of merely registering the limit ofhuman endurance, are and have been arrived at by investi-gations carried out on the lower animals. We candidlyconfess, therefore, that such exhibitions as this appearto us, even on physiological grounds, to be needless andunadvisable. The risk of a fatal issue, or of permanentinjury to health, is too serious to be lightly undertaken.When we find it, as in the present case, wilfully encounteredfor the entertainment of a general assemblage of sightseers,and for the mere sake of gain, we hardly know which is themore blameworthy, the wanton sufferer or the callous on-lookers who countenance his folly. It is time that we sawthe last of this dangerous pastime, which will soon, we hope,have found its true place among the discarded eccentricitiesof a depraved public taste.

A CASE OF SPORADIC CRETINISM.

I A CASE of this interesting disease is described under thename of " idiotic myxoedeniateuse" " in the current numberof the Archives de Neurologie by :1B1. Bourneville. The

patient, who is now twenty-five years of age, is the youngestof five. None of the others are cretins, but several havedied of tuberculosis. The parents were not related and themother was quite healthy, but the father died of phthisis.Until three years of age the patient is said to have talked,walked, and played just like other children ; but at thistime he stopped growing and became fat and puffy. On hisadmission to the Bicetre his height was only thirty-fiveinches and a half, and his weight fifty-four pounds. Hishead was bossy, with projecting occipital region, and hisanterior fontanelle was not quite closed. His forehead waslow, narrow, and compressed laterally. There was the usualthickeningof the eyelids, so that they could scarcely beraisedat all. The teeth were irregular in position, and the tempo-rary canines and premolars had not been shed either in the

! upper or lower jaw. There were the usual masses of fat seenon each side of the neck, and no thyroid gland could be